Summer 2003 Edition

 

 

Editorial: A Dialogue Begins

In the Spring 2003 ICSPP Newsletter I wrote? I am soliciting articles for a special edition of the newsletter that define various member?s professional activities in language completely free of the following words: patient, mental illness or disorder, therapy, diagnosis, trauma, healing and any and all terms related to medicine. I seek papers that accept Thomas Szasz?s challenge to separate our descriptive and explanatory concepts from our moral terminology. Finally, I should like to see justifications for charging fees to ?those with whom we work? if we are not literally doing psychotherapy of one type or another. It is time for what Thomas Kuhn refers to as a ?paradigm shift;? one that will free our field, our work and the help we offer others from the desultory, never ending battles with the medical model and especially, biopsychiatry.?

I was aware when I issued this challenge that it was impossible for anyone to restructure the theory and practice of psychiatry and clinical psychology given the space limitations of a newsletter. However, I still want to advance a process begun by Szasz that I believe necessary if we are to extricate ourselves from the intellectual muddle and moral quagmire that is our field. A recent article from the Los Angeles Times described the successful treatment of ?compulsive shopping disorder? with an SSRI. Our colleague, Keith Hoeller wisely remarked via an e-mail that our field was now beyond parody. I agree and have begun a forth book that will continue my efforts in three earlier volumes to create a language and a scientific and moral justification to fully reject every aspect of psychiatry while seeking to help people having problems in living.

I am delighted to print the responses I received to the challenge issued. I hope that this issue will stimulate many more thoughtful essays and even, perhaps, act as a catalyst for others to create their own versions of a Kuhnian paradigm. I believe it necessary to replace every aspect of the medical language that traps us into arguing that helping others to develop the intellectual, moral, social, and affective skills to live in a manner that they experience as better, more successful and creative is merely an alternative to drugs. As long as we continue to argue that our methods better reduce mental disorders or even improve mental health we will neither separate ourselves from ideas we find odious, nor, more importantly, end the madness that is psychiatry.

 

For those interested in reading more of my own attempts at renewal they can begin with an article that will appear in the forthcoming issue of Ethical Human Sciences and Services or turn to Psycho?therapy:? Theory, Practice, Modern and Postmodern Influences? and Psychology, Psychotherapy, Psychoanalysis and the Politics of Human Relationships both published by Praeger/Greenfield Books.  

 

 

 

Hello Dr. Simon,

I'm Mira de Vries, chairperson of the Association for Medical and

Therapeutic Self-determination in the Netherlands, and also a member of

ICSPP.

         I could not help but pick up the ball you threw to readers in the most recent newsletter. It's perhaps not exactly what you're looking for, but does reflect my views in a nutshell. I enclose it herewith for you to publish or not publish as you wish.

Thanks for being on our side.

Mira

         The most overlooked aspect of therapy is that it is for the therapist a source of income. The therapist must claim to have special knowledge or skills to justify receiving payment for his/her services. This affects the therapist?s assessment of the value of his/her services, regardless of whether s/he engages in biopsychiatry or a different form of therapy.

         Research on the efficacy of various treatments based on clients? evaluations is rarely done. Even when it is, accurate criteria are non-existent and the researcher?s vested interest in the results raise suspicions of bias.

         My own investigations into client satisfaction, which I honestly claim to be unscientific, reveal that clients? responses always fall into three categories, in descending order of frequency:

1.   No, the client derived no benefit from the therapy.

2.   Yes, the client was prescribed a pill which gave some relief.

3.   Yes, the therapist was nice, and listened.

         The first requires no elaboration.

         The second sits uncomfortably with the views of those of us who oppose biopsychiatry. The fact of the matter is that some people like feeling numbed by drugs. If that were not so, there would be no drug addicts.

Let?s approach drugs from the position of the client, who is not bound by the oath: ?First, do no harm.? Offering a drug can be legitimate when the provider of the drug meets the same requirements that the provider of any other product, say, a lawn mower, must meet: the product must be accompanied by instructions for proper use. In addition, the client should be fully informed of the effects of the drugs, i.e. addiction and various forms of brain damage. Furthermore, the client should be warned that once having begun use, s/he may never again be fit to engage in activities requiring maximum consciousness, such as raising children or driving an automobile. Needless to say, drugs should not be available, let alone offered, to children or adults who are incapable of making an informed decision.

         The question arises, if the manufacturer provides full information, instructions, and warnings regarding the product, what is the role of the doctor? Truth be told, none. The physician is an intermediary established by the government to limit the freedom of the individual citizen to access drugs. As such s/he has also slipped into the role of propagandist for the drug companies. Without the authority granted to the physician by the government for the purpose of curtailing citizens? liberty ?for their own good,? physicians would have less earning power. They would be needed less by both those who take the drugs as those who manufacture them.

         What about the most infrequent answer? What is the role of the therapist who is liked because s/he is nice and listens to the client? ?Listening? implies not talking, so not giving advice. Indeed, these clients will claim that they received no benefit beyond having had someone listen to them.

         If listening is all that is required to satisfy the client, perhaps s/he would be just as satisfied by telling his/her problems to the wall, a recording machine, or the family dog? In fact, that third suggestion does sometimes suffice. An advantage the therapist has over the wall is that s/he occasionally nods and seems to ?understand.? Clients often report that the therapist who is liked had experienced similar problems to the client?s in his/her private life.

         Thus the true benefit that the client has derived from this therapist is not previously unavailable knowledge or insight, but a feeling of emotional satisfaction. This benefit is characteristic of friendship. But a therapist who offers friendship is by definition behaving unprofessionally. The client, too, would no doubt acknowledge that true friendship cannot be bought. The relationship between this therapist and his/her client could therefore be characterized as pseudo-friendship. The therapist resembles the prostitute who offers the pretense of love in return for financial reward. A difference is that the prostitute?s client usually does not ? and the prostitute never ? deceives him/herself about the nature and purpose of the relationship.

         Another characteristic of the ?listening? therapist is that his/her service is completely useless to the vast majority of clients who seek help for themselves or family members. Those who oppose biopsychiatry prefer to ignore or deny that many people do have neurological aberrations which cause difficulty to them or the people around them. Even if they didn?t have them before being exposed to biopsychiatric treatments, they have them after. What do such people need?

         They need, in fact, the same as people with no neurological aberrations: friendship. The more severe the problem, the less well pseudo-friendship can relieve it. Only someone truly devoted to the person will be able to provide the understanding, acceptance, and practical assistance that such a person needs. Such devotion can usually not be bought. An exception might be the wealthy family who can afford to support a devoted companion, such as Ann Sullivan famously was to Helen Keller. The vast majority of people in need of such companionship are dependent on family, friends, and volunteers.

         The existence of a vast body of paid and licensed professionals who are believed to have knowledge and skills which in reality they do not have, discourages lay people from providing the assistance they very well can. ?Leave it up to the professionals who are trained for it? is common but bad advice.

It is probably unavoidable that people present themselves as experts and offer their services in return for money. Quacks have been with us since time immemorial and no doubt will be as long as money is. A step in the right direction might be that the state would stop sanctioning some of them with licenses, or worse, employing them. To achieve this, however, we must convince the public at large of the painful truth that much of the professionalism in which they invest their faith is a fraud.

There is no sign of the tide taking such a turn. To date, the public at large demands more and more state funds for professionals.

 

       Subject: Re: Spring ICSPP Newsletter "Challenge"

 

       JACQUELINE ROIG wrote:

           A challenge is presented: via the ICSPP newsletter, can I provide some ideas about how to describe my work in the field of ?mental health? without the use of popularized jargon. I rise to this challenge with clarity of thought and a metaphorical pep to my step, as there does not often seem to be interest in or reception to exploring ideas on this basic yet always provocative subject.

As a clinical psychologist, I provide people the opportunity to avail themselves of my services. These services are born of conversation, involving both speaking and listening. They surround peoples? troubles as they have determined troublesome. They involve the behavior, thoughts, and feelings of these people, whether public or secret. There is implicated a payment for my services, so there remains the transactional element of free enterprise. I do my best to listen on a level devoid of moral and political agendas of my own. I do try to express clearly that any person who avails themselves voluntarily of my services recognize that I will not coerce their cooperation, will respect their moral agency, and will expect that this respect will allow the  process to unfold as deemed beneficial by them rather than by me. I do not ?treat? people for their outlook, choices or actions. I do discuss their presented complaints, those that seem obvious and those that prove elusive to them.        

No jargon, and not difficult to write, as this process as described here is easier for me than the unwieldiness I associate with trying to run other peoples? lives based on my professional expertise and consequent inherent power. Along with the good Thomas Szasz and others who disdain taking control of others? lives ?in their best interests?, I honor the scientific method but do not tout it as evident in the art of conversation.        

I find that the attempted medicalization of talk therapy is a phony attempt to legitimatize a non-scientific event. When describing someone?s preferences, for whichever reason they might prefer something, as an illness, and subsequently providing a cure, we wield phony power in phony situations. We have pretend sick people, pretend gratefully cured people, pretend magic pills, pretend witch  doctors who talk about the need to tweak brain chemical levels, discovered to be red or yellow or green on a scan and therefore hugely significant and, while colorful, cannot discount moral agency.

         Disease, as opposed to dis-ease (i.e. discomfort), inappropriately then becomes the focus of the psychology experts. I do think about dis-ease, because I recognize the huge gamut of difficulties we humans encounter. We may experience circumstances differently from one another, based on numerous factors that get incorporated into our fabrics. We react differently across situations, too. Sometimes things that seemed impossible to manage a year ago have become a dusty and miniscule issue, and other things replaced them to challenge us today, and vice versa. The addiction propaganda, for example, that taunts humans with our inability to overcome the sheer inevitability of it all ultimately flies in the face of decisions made and ?addictions? thereby overcome.

         Today, I listened to a radio program that held a discussion on the benefits versus potential harm of growth hormones for ?short-statured? children. The questions surrounded whether such intervention was for medical need or for social, emotional or athletic reasons. I heard yet another pseudo-medicalization of a minor problem that inconvenienced children, more often vis-?-vis their parents? disappointment in sub-standard physical specimens, a.k.a. their child        

This falls into the same category as ?diagnosing? inconvenient (to the          parents/teachers) activity as a failure of the arousal system or some brain anomaly that results in drugging our children with  psycho-stimulants in order to calm them (the parents/teachers perhaps?!).Prescribing a lifetime of anti-depressants because there was an attractive advertisement promoting the relief of life?s ups and downs, an emotional botox treatment to flatten one?s responses to difficulties, also fits into this mode of falsifying the potential of  psychological ?intervention? in the most arrogant and grandiose manner.

         As a clinical psychologist, I am faced daily with people who want me to tell them how to live, how to eliminate discomfort, how to stop doubting their choices and perceptions, how to think and feel and be. I encounter overt disappointment that is usually eventually overcome by relief, the ultimate empowerment that the person experiences despite the trepidations often expressed due to the perpetuation of difficulties being certified by our field as diseases.

         I am grateful for this opportunity to share my views with the members of ICSPP, especially as the focus here may likely resonate with their own views. The challenge remains to reduce the perception of the psychology field and the consumers in general that moral agency is something beyond oneself and in the hands of pseudo-authority   figures.

Respectfully submitted by,

Jacqueline Roig, PsyD

      

Thanks Jaqueline,

       However, Clinical? clinical? clinical? Whatever does that mean? In what  way are "services born of conversation" clinical? See how hard this is? And if "mental health" and"dis-ease" and "treatment" are metaphors, then what do they stand for? It took me several years of hard work to replace these metaphorical terms with non-medical metaphors.       

Why did you mail this to me personally and not to the whole listserve?

Can I put this in the newsletter and write my response to it? You're close but not yet there. I'd love to keep up the dialogue with you and the few others who seem to want to play what to me is an exciting, dangerous intellectual game. It'll take me a few days but I'll fashion a longer response to your message but would like to do it publicly.

       Again, thanks, thanks, thanks.

       My best,

       Larry Simon

 

 Chicago IL

Hello Larry,

 

  Thanks for such a quick and comprehensive response! "Clinical" is my title, and I agree, it utilizes that medical pseudo-legitimization to ostensibly lend credibility. And, even more than metaphors, I think that the terms involving "health" "illness" "disease? etc. are flat-out misleading because they are viewed with a wink of an eye at best and taken quite seriously more typically. People turn to "professionals" to help cure them of perceived diseases, I think because they want relief but also to exonerate themselves of stigma, responsibility, what have you. When we comply, we join the "madness" and we all join to continue the pretense that things are beyond us. It's possession, not by a devil but by external forces, e.g. AA runs in the spectrum between the beastly devil that possesses and the cure coming from God, don't they?

  A higher power on either end, never a chosen, preferred behavior. 

As for writing directly to you, I had no idea how to respond - just read your challenge today when I received the newsletter and wrote. I didn't know if the letter was what you had in mind, but I'd be honored to have it printed and to continue this dialogue. I think I've "been there" for a long time, and am fortunate for having had many conversations with Tom Szasz. I love him because his points are so well-articulated and make so much sense! And he is a renegade because he poses a threat!

 

  I look forward to continuing along these lines with you, as I don't think this topic can get discussed enough.

  Best to you,

  Jacqueline

 

I have two items.

Al Siebert

 

1. I am initiating The Minds of Psychiatrists Research Project

 

Project Description:

Something is seriously wrong with mainstream psychiatry. Almost everyone knows it except psychiatrists. It is time for the research lens of scientific inquiry to shift away from endless studies of people with so-called "psychopathology" and focus, instead, on the cognitive processes, personality traits, beliefs, training experiences, and motives of psychiatrists and clinical psychologist who see themselves surrounded by people infected with invisible mental diseases.

The first phase of the project will be to interview psychiatrists and clinical psychologists who derive income from engaging in "medical model" activities that include diagnosing and treating people with so-called mental illnesses. Please contact me to obtain an interview protocol:  Al Siebert <asiebert@resiliencycenter.com>

 

2.  I'm running the following classified ad in the June APA Monitor and the Fall issue of APA's psychGRAD magazine to find grad student volunteers to review my new book manuscript. I will send a copy of the ms. to any CSPP list members who wish to see it. Contact me directly with a mailing address.  Al Siebert <asiebert@resiliencycenter.com>

Here is the ad:

Graduate students in clinical and counseling psychology are sought to read through and provide critical feedback to the forthcoming manuscript with the working title A Schizophrenia Breakthrough: Progress Toward Freeing Our Minds from Our Minds. The manuscript is ready for Beta level reviewing. The book will be a supplemental textbook for clinical and counseling graduate courses with a positive psychology focus. Each chapter includes "Issues for critical thinking and research." To obtain a review copy contact: Kristin Pintarich, Developmental Editor, Practical Psychology Press, P.O. Box 535,

Portland, OR 97207, or e-mail press@thrivenet.com.

 

********

 

Larry, thanks for doing this!

--

*******

...give hugs, relax, take naps, and have a happy heart!

 

Al Siebert, Ph.D., author of The Survivor Personality

Director of The Resiliency Center

website: http://www.resiliencycenter.com

 

_____________________________________________________________________________

 

ONLY CONNECT: NOTES ON THE FIRST INTERVIEW  

DOMINICK J. RICCIO, PH.D.

 

 

It seems that one of the essential elements in a successful psychotherapy is that an early connection be made between client and therapist--- that the therapist allow himself or herself to become impregnated with the essence of the patient by creating a receptive or empathic emotional environment which enables the embryonic patient to adhere to the wall of the therapist?s psychic uterus. Once the patient is connected to the therapist in some deep narcissistic fashion, then the patient can feel free to regress into a narcissistic transference[1] and begin the process of psychic redevelopment.

         Clinical experience has frequently reaffirmed the fact the first interview is a crucial one for a number of good reasons, not least of which is the reality that if the patient doesn?t have a ?good enough? experience at some level here, he probably won?t be back for a second session. The essential ingredient, I believe, to hold a patient in treatment and have a good prognosis, is that the therapist be capable of contacting the patient at a very deep narcissistic[2] level in the first session; that he be authentically empathic. This can best be accomplished by the therapist communicating, verbally or non-verbally that he understands and almost identifies with the plight of the patient; that he profoundly appreciates the experience of the human being, who has just walked into his office. At first reading, this may seem like a tremendous demand on the therapist, and is, but it?s one that can be met with proper supervision and self-analysis. Receptive attention to this aspect of the first interchange with a patient will often reveal many points of contact. Indeed, at times, it is much easier to accomplish this task than to set fees and form a contract, or to identify defenses and make diagnoses. Many times, this narcissistic contact forms a symbiosis which enables the treatment to weather even the stormiest course, especially with extremely angry or terrified patients. If there isn?t a positive narcissistic contact made by the analyst at some point in the first session, then it is often much more difficult to maintain a treatment relationship. It can be an indication that the therapist is in a negative narcissistic counter transference[3], which will not give the patient the feeling of being safe and welcome in the treatment. As just one possible result may be the development of a more unforgiving attitude toward the inevitable errors in technique and interpretation, and other untoward events of the treatment, and this may result in an early termination.

         Alternatively, if a therapist is focused primarily on the task of symptom identification, diagnosis and treatment strategies such as medication protocols and management issues, clients frequently feel objectified, and defensive.

         One very effective way that a therapist can create a receptive environment, is to find his own level of narcissism which approximates that of his patient. Having identified some problem or feeling or experience of his own which was similar to the patient?s, the analyst is helped to communicate an understanding of the patient?s feelings and plight (human condition). For example, because of certain aspects of my own history, I find it especially easy to make a narcissistic connection to clients who feel or have felt abandoned in early life, given up for adoption, sent away or rejected by a parent in some traumatic way. In fact, curing such a patient, in some ways becomes a special aim, because in some symbolic manner, by curing this patient, I will be curing myself. By listening to the patient and feeling along with him, I am reviewing my own experience and gaining new insights that may eventually be useful to the patient. This is a spontaneous, genuine experience of being ?in tune? or in symbiosis with a patient, borne out of syntonicity and true empathy rather than good technique. Of course it scarcely needs saying that this is extremely fertile ground for countertransference resistance[4], if the analyst retains significant unresolved conflicts in these areas; but even this need not be a major problem. With good supervision and personal analysis of his own, the analyst will be encouraged, through his interaction with the patient, to work through those aspects of his personality which remain unresolved; much in the same way that a parent is prompted to mature by meeting the demands of a growing child.

         When, on the other hand, the early experience of the patient is completely alien or unacceptable to the analyst, the frequent result is an early negative narcissistic countertransference resistance which bodes poorly for the treatment. At best, one can hope for a neutral ?professional? stance, but often this is not sufficient to cure; the analyst usually needs at some stage to develop what Hyman Spotnitz terms the ?right feelings? in order to cure the patient. A well known historical example of empathy or the ?right feelings? going a long way towards curing the patient (despite poor technique) is Breuer?s attitude towards Anna O. Even a cursory reading of the case material, reveals that the operative feelings on the part of the analyst which were ?curative?, were his very positive, receptive, almost maternal feelings for Anna. Breuer?s intense empathy for Anna is abundantly evident in his writings, for example, in his expressed admiration for her intelligence: ?She was markedly intelligent, with an astonishing quick grasp of things and penetrating intuition. ....She had great poetic and imaginative gifts....? (Breuer, J. and Freud, S. 1957. p.21). Furthermore, he communicated his feelings of concern by his frequent attendance in sessions and by his over-involvement with her to the possible detriment of his marriage. In a word, Breuer cared about Anna O. He cared about her in a way that the case history suggests her parents did not. His primary connection to Anna was as a parent to an infant He was receptive to her strange communications and he struggled to understand her symptoms. Although it is apparent that Breuer was somewhat confused and frightened by his intense empathic feelings for Anna, it is also clear that Breuer?s ability to accept Anna O and ?take her in? emotionally is probably what enabled him to work with her in an emotionally creative manner that seemed to elude Charcot and the other renowned experts in hysteria and mental illness.

         This observation may be especially cogent to psychoanalytic supervisors who receive chronic complaints from certain supervisees who continually lose patients and are unable to build a practice or meet control requirements . One supervisory approach to this problem may be to analyze the supervisee?s reistance to becoming a receptive parent in the very first session with a new patient. Is the therapist willing to become impregnated with the unconscious and conscious personality of the new patient? One who is willing to enter into the narcissistic transference relationship with a patient, must be willing to form a connection which requires behavior similar to that of an expectant mother. The therapist must be willing to tolerate the frustrations and feelings that the patient will inevitably induce just as the pregnant mother must tolerate the physical and emotional changes inherent in pregnancy. The therapist may have to modify his own impulses, behavior and emotional communications for the benefit of the patient just as the prospective mother may have to modify her needs, impulses and behavior for the sake of the developing and vulnerable fetus. As development progresses there must be a passive receptive attitude and empathic understanding which allows the infant to be who it is and to feel totally accepted by the parent. For example, a mother can?t effectively control the sleeping and eating habits of the infant since these are idiosyncratic and are related to both constitution as well as experience. She can only shape these habits over a period of time. However, in order to enable a child to grow up with a feeling of self-worth, a sense of power and an appreciation of reality, i.e. a strong ego, the mother must be willing to serve as a shield or defense against the emotional and physical stress in its environment. Later on, as a child begins to individuate and develop adequate defenses of its own, a proper parent must be willing to tolerate the ?different? behavior of the child and the attendant separation anxiety, in order for the child to develop an experience of himself as an independent individual who is worthwhile. This is often a very difficult and frequently painful process for a parent to undergo, for it requires a great deal of frustration tolerance and a strong sense of love to neutralize the strong aggressive impulses that are aroused in the process. Therapists have the ?wonderful? task of going through this process with each patient. Is it any wonder that patients often mobilize strong impulses in the therapist to abort them in the early, as well as the middle and late phases of treatment? The task of the supervisor is to help the supervisee talk about these feelings rather than act them out, especially in the very early phases of treatment when both patient and therapist are most vulnerable. Incidentally, it is critical that the supervisor recreate the same safe receptive environment for the supervisee in order to model the appropriate and empathic analytic stance to the supervisee.

         The difficulty with this paradigm is that most humans including therapists have had troubled or defective early experiences and were not adequately nurtured or tolerated during their own development. Consequently, it seems essential that the therapist undergo a thorough analysis himself in order to resolve his own conflicts around these developmental issues and work towards personal maturation.

 

CASE ILLUSTRATION: A female patient who was also a therapist, frequently complained during the middle phase of treatment that she could not hold patients in treatment and could not easily get new referrals. When this therapist first came into treatment, she staunchly declared that she would never have children and wasn?t interested in the subject whatsoever; she was only interested in working out a relationship with a man. After several years of treatment, I offered her the interpretation that her difficulty with building a practice might be related to her feelings about becoming a mother. Analysis of her resistance to having children recalled the memory that she sadistically abused her younger sister whom she was forced to babysit, in spite of the fact that, she herself, was a sometimes abused and neglected child. She was particularly sensitive to feelings of physical and emotional intrusion, and further analysis enabled her to verbalize feelings of resentment that an infant might intrude on her professional and personal life, much in the same way that her sister intruded on her play and social life. She also harbored the fear that she might physically abuse her child. Shortly after these discussions, the patient began to experience a yearning to have a child. This yearning, in turn helped her to actively work on the extremely tenuous and tumultuous relationship that she had with her boyfriend. She helped him to overcome his physical impotence and he promptly impregnated her. During pregnancy, not only did she get married, but she also began to experience an increase in her practice and growth in her self-esteem and sense of success as a therapist. Since the birth of her child, she has proven to be an excellent and sensitive mother and has actively worked on all of her positive and negative feelings associated with raising a child.

 

CASE ILLUSTRATION 2: As one might expect, this phenomenon of the infant being experienced as a toxic object is not confined to women. A male supervisee as well as other male patients have verbalized similar feelings about the prospect of having a child with their wives. In the case of the male supervisee, exploration of this resistance revealed the facts that, he too, was physically and emotionally abused by his family of origin. In addition, he felt very different from the rest of the family. Before the birth of his child, he was very conflicted about becoming a therapist and was involved with several nonproductive business activities in spite of the fact that he held a doctorate in the helping professions. After resolving his resistance to becoming a father (he was fearful that he might be sadistically abusive like his father), he has become more motivated and committed to succeed financially and professionally as a therapist in private practice.

         It should be noted that although, some patients need to be taken in by the therapist at the in-utero level, others may have to be received into the bosom of the therapist or perhaps not received at all. It depends upon the developmental needs of the patient at that given moment. The success or failure of the analyst to hold a patient may be directly related to his ability to be receptive to the particular emotional state presented in the first session and, of course, subsequent sessions.

         There are a number of ways to communicate acceptance and effect an empathic narcissistic connection. For example, consider the case of a regressed patient, who, in the first interview, barely acknowledges the existence of the analyst and talks in a most disconnected manner. One of the main ways the analyst can communicate understanding is simply by quietly listening, in effect accepting everything the patient produces. If the analyst talks during this period without being contacted, he transmits a lack of appreciation of this patent?s needs and perhaps negatively affects a narcissistic connection by being intrusive. With a patient who is withdrawn and talks little, it might be better to listen and respond to the few communications he does make (avoiding uncomfortable silences) and to show an active interest, perhaps through a brief but delicate investigation of early history in an object-oriented fashion. The patient thereby is led to feel that the therapist?s whole concern is the patient and the patient?s experience of the world. Oftentimes, even introverted patients enjoy talking about themselves when they recount the facts of their personal history. A narcissistic connection can also be made near the end of the first session by making a very general genetic and ego-syntonic interpretation which sums up the revealed experiences of the patient. By doing so, the analyst gives the person the feeling that he truly understands and has something to offer him in terms of reconstruction and empathy for his viewpoint. Emotional joining techniques* are sometimes appropos in the first session, if they lend the impression that the analyst is sympathetic to the patient?s experience of a tortuous internal and/or external world and is willing to empathically ally with the patient and help him to negotiate a seemingly hopeless situation.

         On the other hand, rigid adherence to some of the rather frustrating, intrusive but nonetheless scientific methods of interviewing recommended by authors from the various disciplines associated with psychoanalysis, may not foster the formation of an emotional connection between patient and therapist. Indeed, it may have the opposite effect and give the patient the feeling that the analyst doesn?t talk, doesn?t understand the patient and is only interested in prior history of mental illness and how much the patient would like to pay. Needless to say, there are a number of fine papers written about what to say and do in the first interview; however, I dare say that these techniques and cookbook approaches are only as good as the emotional connection made and may, in fact be obviated by this all important human connection usually called empathy.

        

* Joining Techniques are emotional communications developed by Hyman Spotnitz, M.D. and are described in his book, The Modern Psychoanalysis of the Schizophrenic Patient. New York: Grune and Stratton, 1969.        

____________________________________________________________________________________

 

 

THE HUBRIS OF TECHNOLOGY

(Biopsychiatry included)

By Al Galves

 

The lure of technology is powerful, seductive, enthralling - and dangerous.  Our brain - that wonderfully versatile and plastic organ - has the ability to conjure up images, fantasies and dreams.  In the case of technology, that ability, along with our species? desire for certainty and power over troubling randomness and chance have combined to plunge us into an unwarranted dependence on technology and, in some cases, an addiction to it.  And, as we have exaggerated the value of technology, we have excessively and prematurely discounted older technologies and our own senses, motor abilities, perceptions and emotions.

The television advertisers are perhaps more aware of this dynamic than anyone.  Their message is that, through the new technologies of computers, the Internet, and cellular phones we can really know everything that is going on in the world, we can establish contact with loved ones in a way that we never have been able to before, we can beat our competitors and, most alluring, we can keep the forces of fate at bay.  My impression is that we are relatively helpless before this onslaught of overselling, that our defenses against it are weak, that we are, in two words, dangerously gullible.

In what ways is this technological hubris dangerous?  First, it will lead us to make mistakes.  Here is the best example I know of.

The 100-meter dash final in the 1996 Olympics was a sad affair.  Lynford Christie, the British sprinter who was the defending Olympic champion, had amazingly made it to the final.  Amazingly because he was in his thirties, much older than his competitors and had not had a very successful season prior to the Olympics.  This was probably the last big race of his career.  The stage was set for a fascinating race between Christie, American Michael Johnson and Canadian Donovan Bailey, the eventual winner.

The battle was never joined.  Christie was disqualified after two false starts.  He hung around in stunned disbelief as the race was run, refusing to leave the track.  That he was not allowed to run the last great race of his life was tragic.  The way in which he was disqualified was darkly foreboding.

Christie was disqualified for two false starts.  On the first one, it was plain to see that he had left the starting blocks before the pistol had sounded.  But on the second one, his early leaving was not visible to the naked eye.  Nobody saw him leave the blocks early.  Rather he was disqualified by a device - a product of technology - which measures the time between the sound of the pistol and the lifting of pressure on the starting block.  The rules say that, if that time is less than 0.1 seconds, the runner is charged with a false start.  Presumably, even though not detected by the human eye, the runner is assumed to have anticipated the sound of the pistol and left the starting blocks too soon.

Never having heard of this device before, I was surprised at the dramatic disqualification.  But even more surprising, telling, and scary was the almost complete lack of outcry, questioning, or controversy after the incident.  There was no expression of surprise by the television commentators, no interviews with Olympic officials, no bitter protests from British Olympic officials, not even an outcry from the British press, which is not known for forbearance in such cases.

I was amazed and somewhat disheartened by the lack of protest.  It meant that we were accepting the disqualification of the defending Olympic 100-meter champion on the basis of an assumption that no human being could react to a sound faster than 0.1 seconds.   But what about Roger Bannister and the 4 minute mile; Bob Beamon?s long jump of 29-plus feet when the existing world record was less than 28 feet; routine pole vaults of 19-plus feet when the world record was barely 16 feet 20 years ago.  Were we really going to accept the fact that a world class sprinter about to run the last big race of his life, having surprised the world by qualifying for the finals, ready to defend his Olympic gold medal, could not possibly, not by any stretch of the imagination, react to a sound in less than 0.1 seconds?  Were we going to let a technological device override the wisdom of the human eye, the ability of the human eye to detect motion, even the slightest motion, even in view of the fact that, since light travels faster than sound, there is a margin of error in letting the human eye determine if the sprinter has left the blocks before the pistol has gone off?     And what if he had anticipated by a millisecond the firing of the gun?  Do we want to banish that kind of risk-taking and gamesmanship from the sport?

Again, what struck me most forcefully was, not that it happened, but that there was hardly any questioning of it.  And my chagrin was based not so much on our willingness to let a technological device substitute for the human eye as it was on our willingness to let the device override our belief in the ability of human beings to break barriers, overcome limitations, push the envelope.

I have since learned that the 0.1 seconds which is used as the threshold for false starts is based on scientific evidence of the limitations of human reaction time.  But that evidence is based on samples of human behavior and samples can give us insight into normal behavior.  But what about human variability?  What about the far ends of the Bell curve?  Olympic track and field is nothing if it isn?t a celebration of human variability and the far end of the Bell curve.

 

So this is the second danger of the hubris of technology: that it will cause us to discount and ignore the full range of human capacity, that we will fail to appreciate and use the marvelous power, complexity and variability of human beings.

Biopsychiatry is a technology that is doing this.  To believe that certain human experiences and behaviors are caused by random biological dynamics and should be treated by medication, electroshock and psychosurgery is to lose sight of the ability of the human organism to respond to situations, problems, opportunities, threats in a wide variety of functional ways.  It relegates humans to being much less aware, self-regulating and creative than they are.   Such belief and mode of intervention fails to harness the ability of humans to use their feelings as fine-tuned signals that tell them what is important, what is not right, what needs to be addressed.

Patients come in with symptoms of panic disorder.  Most of them want medication.  I tell them my experience is that these symptoms are a sign that there is a very difficult dilemma facing them,  perhaps  a dilemma so difficult they don?t want to know about it.  I tell them about the two times in my life when I suffered from panic attacks and how I didn?t know then what was causing them but I do now.

I?m 19 years old sitting in a college classroom.  There is a beautiful classmate in the room to whom I am attracted.  I have a panic attack.  What?s going on?  I didn?t know then but I do now.  I was facing an apparently irresolvable dilemma.  I wanted more than anything to learn how to be with women.  I didn?t know how to do that.  I needed help but there was no way I was going to seek it.

I?m 34 years old, married with two children.  I have a job which I love and which suits me well in many ways.  I notice that, whenever I am driving to a meeting, I have panic attacks.  What?s going on?  I didn?t know then but I do now.  In order to keep that job, I had to do things that I didn?t think were right, that I thought were fundamentally wrong.

Several weeks before the attack on Iraq, a woman was in the clinic complaining of panic symptoms.  I sat with her and asked her what might be going on.  ?I can?t think of anything at all,? she replied.  We continued to talk about her family and her life.  It turned out that her son was in the Army reserves and would very likely be in a war shortly.  As soon as she said that, she began to cry and we spent the next 30 minutes exploring the fear and anxiety that was plaguing her and how she might use it to relate more effectively with herself, her son and her family.

Biopsychiatry is causing us to lose faith in our bodyminds.  We see ourselves as less than we are.  We let ourselves down.  We fail to learn.  We are way too heroic.  We have become dense and out of touch with our mindfulness.

The third danger of the hubris created by the thrall of technology is that we will lose the value of older, time-tested technologies.

Case in point: I was standing at the copy counter looking at my old-fashioned paper and pencil planner as I waited for the copies.  The young man behind the counter said: ?You know, you can do that much better with a computer.? 

?You mean you think a computer can do better than me opening this book to the appropriate page and writing an entry at the appropriate place on the page,? I replied.  ?You?ve got to be kidding.  What could be more convenient than me carrying around this book and using paper, pencil and eraser to organize my life?  With a computer - even a portable one - I have to turn it on, punch a bunch of buttons, wait for the proper screen to come up and then type in the entry.  This way I just use this little pencil and, if I want to change an entry, I just use this handy eraser which is at the end of the pencil, erase it and put in a new entry.  How can you beat that??

?But with the computer you can do all kinds of other things.  You can use it as a tickler which reminds you of things you want to be reminded of.  You can create other schedules.?

?But I don?t need all those other schedules.  And this paper-pencil-erasure technology works just fine for a tickler system.?

The onslaught of biopsychiatry is wiping out the use of time-honored psychotherapy that has been proven effective without the damaging side effects of medication and electroshock.  After all, Freud didn?t discover psychoanalysis sitting at his desk.  He discovered it through treating paralyzed patients suffering from what he called hysteria and what we now call conversion disorder.  When they began to talk about their lives, fears and trauma and express the associated emotions, they got better; their symptoms lifted.

Studies of non-medical psychotherapy have found it to be effective for 80 percent of patients.  It is associated with a much lower rate of relapse, has proven to be just as effective as psychotropic medication and involves much less risk of structural brain damage, violence and suicide.  Yet, it is a threatened enterprise at risk of premature death.

So what do we do about this?  I?m writing on a remarkable piece of technology that enables me to compose and edit like nothing else ever has.  As skeptical as I am, I?m aware of its value.  I don?t want to go back to the typewriter, carbon paper and mimeograph machines.  I think we look for the middle ground, careful to preserve what is valuable, to discriminate, cull and protect.   We honor technological advance and we honor the tried and the true.  We keep on talking and writing and sounding the alarm.  We cast a jaundiced eye at the easy answer and the simple solution. We remember the truth of cycles and take heart in the fact that neighborhood dives are coming back into vogue, TV quiz shows have had a revival (albeit short-lived),  investors? love of chain restaurants is plateauing and they?re still using wooden bats in the majors.

OVER THREE DECADES OF ICSPP ACCOMPLISHMENTS:

Stopping the worldwide resurgence of lobotomy and psychosurgery on adults and children, and all psychosurgery in federal and state institutions.

?       The creation of a federal Psychosurgery Commission by Congress (1970's)

?       Alerting professionals to the dangers of tardive dyskinesia in children (1983). Tardive dyskinesia is a potentially devastating neurological disorder caused by neuroleptic or antipsychotic drugs.

?       Alerting professionals to the dangers of dementia produced by long-term neuroleptic drug use (1983).

?       Motivating the FDA to force the drug companies to put a new class warning of tardive dyskinesia on their labels for neuroleptic drugs (1985).

?       The withdrawal of a large multi-agency federal program to perform dangerous invasive experiments in inner-city kids in search of supposed genetic and biochemical causes of violence (the violence initiative) (early 1990's).

?       The initial cancellation and later modification of a potentially racist federally sponsored conference on the genetics of violence (early 1990's).

?       Alerting the profession to danger of down-regulation and dangerous withdrawal reactions from the new SSRI antidepressants such as Prozac, Zoloft, and Paxil (1992-4).

?       Monitoring, and at times modifying or stopping unethical, hazardous experimental research on children (1973-present).

?       Encouraging that NIH Consensus Development Conference on Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder to raise serious concerns about "ADHD" and stimulants for children.

While each of these critiques and reform projects was initially considered highly controversial, and while each was frequently opposed by organized psychiatry, most are now widely accepted as rational, ethical, and scientific. For example,

Psychosurgery is no longer widely practiced and not at all in state or federal institutions or on children in the United States; the multi-agency federal program aimed at using invasive biological procedures on inner-city children has been disbanded; the conference on the genetics of violence was delayed and then vastly modified; all experts now recognize the dangers of tardive dyskinesia in children; many researchers have confirmed that the neuroleptic drugs produce dementia, and experienced doctors now recognize the potential for dangerous withdrawal effects from the SSRIs.

     Become a member by mailing a $25 check or money order (U.S. funds) ($35 U.S. dollars if mailing address is international). Check or money order should be made out to ICSPP. An additional tax-deductible donation can be added, and would be deeply appreciated.

 

 

 

 

 

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         Become a general member by mailing a $50 dollar check or money order (U.S. funds) ($60 U.S. dollars if address is international). Check or money order should be made out to ICSPP.

 

 

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Southern Cross University

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FMH Psychiatry and Psychotherapy

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