Leon Eisenberg, a pioneer in psychopharmacology at Harvard, observed that “in the first half of the 20th century, American psychiatry was virtually ‘brainless.’ . . . In the second half of the 20th century, psychiatry became virtually ‘mindless.’ ” The brainless period, in his view, was the when psychiatry centered on psychoanalysis; the mindless period, is our current state of affairs, where pills are offered more often than therapy.
Unhinged: the Trouble With Psychiatry by Daniel Carlat M.D. is the partial confessional of a pill-pusher. With admirable candor, Carlat, a psychopharmacologist who is now a professor at Tufts University School of Medicine, describes many years in which a typical client session consisted of deciding - through rapid-fire questioning over 15 minutes - which of the labels from DSM-IV, the manual of American psychiatry, best applied to a patient, and then writing a prescription for the drugs recommended for that condition. "Psychiatry, for me and many of my colleagues, had become a process of corralling patients’ symptoms into labels and finding a drug to match."
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While drugs relieved the symptoms of depression in 40 percent of patients, he notes that placebos lift depression in nearly as many - 30 percent. Carlat came to realize that he knew almost nothing about most of his patients. He was shocked into starting to look at his patients as moe than DSM tags when one of them asked him whether it was possible that her childhood experiences had something to do with her current mental and emotional suffering. Carlat's recommendations are modest: let's have some talk, as well as the pills. Let's try to put the patient's symptoms in a context and offer some emotional support and help with problem-solving.
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Carlat brings out something we need to know, in the thick of the current debate over health insurance options. "Insurance companies typically encourage short medication visits by paying nearly as much for a 20-minute medication visit as for 50 minutes of therapy." For both the insurance companies and uninformed patients, quick-fix meds may seem preferable to a series of therapy sessions. But as Carlat came to appreciate, "the majority of patients need more."
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Medication may be essential to contain a crisis situation, threatening suicide or a psychotic outbreak. But the reflexive move to suppress the symptoms of dis-ease by medication misses a vital avenue of healing. Through the creative imagination, we can work with any image - even the most terrifying - towards wholeness and integration. When we reach for a bottle of pills to drive a troubled person's images (be they fantasies, dreams or nightmares) out of their conscious minds, we may be smothering their own source of authentic healing. Through the practice of Active Dreaming, we learn to go into the forests of the mind and confront and resolve whatever terrors wait for us there. We discover that very often the deepest healing comes through the wound. Therapists can learn to use these techniques to guide others to safe clearings. But that will require more than 15 minutes and a prescription pad.
26 comments:
I have first hand experience -as I'm sure many others also do- of the quick DSM tags. I went through a major depression -indeed soul loss even- when I was in my teens after placing my daughter into an open adoption. I have a close relationship with her, but it was a trying time for my family and I. Self medicating with street drugs wasn't working and neither were the therapists. Within the first ten minutes of a visit with one therapist, I was classified as possibly schizophrenic -because of a history of schizophrenia in my family (both war veterans by-the-way) and the fact that I admitted to hearing voices and seeing colors (don't all dreamers?). Luckily my Father was with me for this visit, and with good common sense, shared my distaste for this therapist.
I never did any long term therapy at that time. But eventually after starting to keep a dream journal, I had a series of dreams involving sewer openings and one involvig the sewer and the angel Gabriel. I eventually, with chills and rushes of insight, came to the realize that I had left a piece of myself in the underworld. Through dream rentry though it was able to be recovered.
Pills may also smother purpose and other deeper connections. But, maybe one has to be 'called'to take the longer, harder, lonelier road. Most people wouldn't consciously dream of choosing it and are very uncomfortable with those of us who do because we don't get 'well' fast enough.
I wonder if in that manual they have a condition called "The-need-to-categorize-everything-as-an-illness-syndrome."
Carlat also notes that scientific studies of the impact of placebos on the brain can be measured, as can the impact of medicine. Further studies show that therapy leads to measureable changes in the brain. If the situation is right, why not use therapy, dream exploration, images without the potential side-effects of medicine.
I have the incredible privilege of walking and dreaming with people who are on healing paths. There are times when medication, in conjuction with counseling has been helpful to people. I have also seen situations where years of medicine did not help.
I think of a woman I once met who was in full-blown panic, shaking, mind and heart racing, years of medicine that didn't work, memories of abuse as a child and adult. She thought so little of herself that she was convinced I would not want to see her again. The light of the candle in my counseling room was for her an image she grabbed onto and wanted to carry. A light that led to images of warmth, loving Spirit, light for her dark paths. We talked and devised a plan, using many resources. She left walking calmly and with hope and a healing image. Oh, she isn't cured of panic and grief. But neither is she in the dark. She has a glimpse of inner light for her healing journey. And her resources are in process of expanding.
‘There is nothing that I can do about what is wrong with you, what I can do however is address what is right in you. You cannot fight darkness you must turn on the light. You cannot fight disease, you must turn on life.’ Jean Belaval, DC
I read this quote this morning and thought it appropriate. Also, thanks to Justin Patrick Moore, the description of his dream involving Gabriel and the sewer helped make clear a portion of a vision I had recently.
Michael Soucy
Sadly, I think that the phrase "psychiatry, for me and many of my colleagues, had become a process of corralling patients’ symptoms into labels and finding a drug to match" could be applied not only to psychiatry, but to the entire Western medicine, which sees the body segmentally, and can't deal with the whole organism. When I began to have higher levels of cholesterol, my doctor immediately prescribed me pills. I read about it on the web and learnt that those pills somehow block one's liver for to prevent producing extra cholesterol. If somebody tells me that THIS is the way to go, instead of cleansing one's liver and having a different life style, then I'll eat my hat. :-) Also, surgeons just love cutting off organs left and right. Something seems to be wrong with the world. But as I suspect, the good news is - it always works in both directions. In shadowy times there are always the opposite processes, some new or old forgotten possibilities which help to survive and grow, which we might not recognize right away.
Dreaming is a wonderful thing. It's the closest one to one's very core, where the things can be seen from a close distance. For me sometimes - even now - it is the only place to escape and then to ponder, when something goes wrong. And, probably, it gives not weaker altered experiences than those with drugs.
I heard and read about metapsychology, which gives a better chances of recovery of one's soul than official psychology. It involves a metaphysical approach. Sometimes people don't remember dreams per decades while desperately needing help. Active dreaming is still not recognized as a powerful cure. The medical analists interpret it in a completely different way, taking all the control and telling fairy-tale-like stories about what it's supposed to mean.
Over the years there have been quite a few changes in psychotherapy. Years ago Freud was the authority. I recall in the 1960’s that Reality Therapy, was regarded as the best. Then they came out with Transactional Analysis, which replaced it. And there were other approaches. Presently Cognative Behaviorism is regarded as the best. I think the science of psychology is still groping for answers. That science has a ways to go.
I like the conclusion of this post: "From brainless to mindless." Dreams have been very healing for me. An example—
I was an Army medic during the Korean War. Afterwards I had memories of death and destruction, including the deaths and horrible injuries of many, many purely innocent people, men women and children, from blanket bombing. Blanket bombing is utterly criminal, in my opinion. And there was more. After my discharge I had dreams of pure horror at times. One night, shortly after my wife and I were married, I started screaming in my sleep. After I woke up, (and after my wife came down from the ceiling), I told her that there were some things that I needed to explain to her. I certainly did! I had only one screaming dream after that, and it wasn’t as bad.
It might not seem like it, but those horrible dreams were very healing. I was able to face what had happened and was able to deal with it. I still have those memories, of course. I do not intend to forget them. I regard them as learning experiences. I neither sought nor received any psychological help. I was able to get on with a successful and happy life.
Recently I began trying to help care for a man who was an Army medic in the Vietnam War. He has the post traumatic stress syndrome. He has had it since he left Vietnam years ago. The VA does give him some counseling. But mostly he gets antidepressant medications. I try to help him by telling him how much my dreams have helped me. But he fears his dreams. I wish I could recommend a therapist who understands the value of dreaming, and who delves deeply enough to treat someone like him. Pills are not working a cure for him. They only alleviate immediate pain.
I see dreaming of all kinds as being very valuable in dealing with troubles. Your post reached one of my "hot buttons."
Thank you
Last night I sat next to a young nurse who had been asked to join the board of a breast cancer advocacy organization. She and I talked about the over-medication of patients and the immediate leap to surgery as a response in treatment. She described her role as healer and nurturer. She said her first professor told her the most distressing result of a physician's education in the modern university is that he or she has studied a specific disease and is so focused on the role that disease plays in the patient [and the pills/surgery that treat it] that - until and unless the physician has a good nurse - or a great patient - to help him unlearn that primary role - he or she cannot move beyond years of learned procedures in order to treat the whole person. She was trained to understand that a substantial part of her healing role was to advocate between the patient and the doctor and to remind the doctor that the mind/body/spirit work together toward healing.
Interesting post and discussion, thank you Robert! This all feels like part of a gentle revolution... Of course in the best of all possible worlds Leon Eisenberg will be at one of your future play shops soon - or at least get on with reading your books...
Another good book on this subject is Healing the Soul in the Age of the Brain (Penguin, 2002) by Elio Frattaroli, a good, conscientious psychiatrist and psychotherapist. He writes, "Psychiatrists today are far less tolerant of the unknown (and our fear of it) than we were when we had fewer pills in our therapeutic 'arsenal'."
Indeed, medical education in this country eradicates curiosity, humility before the unknown and self-doubt. As Tim, one of the three wise Heads of Zmey Gorynych, said, "In the army, they break you down and they build you up. In medical school, they break you down and they make you god."
I'm enjoying the rich and lively discussion this post has generated. Let's keep it going!
Justin, I would love to hear a full account of your dream of Gabriel and the sewer. I once dreamed the Sipowitz (the somewhat seedy detective played by Dennis Frantz in the old NYPD Blue TV series) was my guide to the Underworld. Sometimes angels travel in disguise!
Alla and Wanda - You are both quite correct that the treatment of patients as labelled symptoms or organs ("the kidney in Ward X") is endemic in medicine as well as psychiatry. Here, as a matter of humanity and of basic survival, we are required to help each other to define ourselves as whole persons and life projects - well enough for doctors and shrinks to hear us.
Don - I am moved, yet again, by the depth of your life experience and your compassion. Thank you for not discarding those "post-traumatic" dreams. In my limited work with vets (mostly from the Vietnam era) I have found it possible to accompany some of them along the roads of initially terrifying dreams to places of resolution, healing and self-integration.
Carol - Thanks for the important insight that the stories and thoughts we entertain, and convey to others, can send directions to the pharmaceuticals factory inside each of our bodies, sending the right cytokines to the right places.
Awllnes - I like that quote from the French chiropractor: "You cannot fight disease, you must turn on life." Those of us who shared in an extraordinary gathering on Gore Mountain last weekend were privileged to see this enacted, in a wonderful dance of life in the midst of an evening fire ceremony.
Louisa - Thanks for recommending Elio Frattaroli. That book is already on its way to me. Of the making of books (and in my case, the acquiring of them) there is, indeed, no end.
Robert, indeed angels do travel in disguise, though in this case it was a thin one. In my dream I was in a vaulted room within the sewer system. I was accompanied by a friend from my freshman year in high school, Gabe Moses. I didn't realize it was Gabriel the angel until later that day after I had woken up and the insight came with a rush of heat rising up my spine. Gabriel was obviously my friends full name, and the Angel was of the people of Moses: Jew, Chistian, and Islam alike. I'll have to dig into my diaries to send you a full report.
I've been reading these inspiring posts and wholeheartedly join with the wholistic approach. When I started training as a family system's therapist many years ago, the movement was away from the DSM. With time and more managed "care," many times one person had to have a diagnosis to get paid by insurance even at the lowest rates. At this time, one of the most popular rising stars in Minneapolis is a pyschiatrist, Henry Emmons, ( The Chemistry of Joy and The Chemistry of Calm ). His institute talks about exercise, meditation, diet, relationships. He states that medicine and psychotherapy is not enough. I don't hear him address dreams. Maybe I need to give him a call? I have found personally, addressing my dreams and being in a community of dreamers has brought me further along in healing. I loved Don's comment that he didn't need a therapist but DID need to talk out the dreams and have the support of his wife. All the tools of Henry Emmons are good, but there is still more that can help breathe more live into out lives. This is getting long but I do think there is a piece about readiness and for each client or client group with whom I converse, one has to start with where that client is and move and expand from there.
Robert, Dennis Frantz also played a (willingly) fallen angel in that movie with Nic Cage and Meg Ryan.
The chiropractic quote is meat and potatoes for vitalistic chiro's. What is not widely know is that the founder of chiropractic was a serious Theosophist and said that he learned the basics of chiropractic from a spirit. Mysticism plays a huge role in early chiropractic, (and with some of its modern practitioners as well.)
Wow! This discussion, and the account which triggered it, opens areas of understanding much bigger than the evolution of mental health concepts and treatment. I attended medical school during a time when the transition to the current DSM/pharmacologic paradigm was really blasting off. I remember how relieved some of my fellow students were, when they came to "understand" how depression could be seen and treated on the same level as a case of bronchitis, or maybe diabetes. How neat and clean! It sounds a it like what has happened with our political and economic systems. Could there be a connection?
I am grateful that I have been able to evolve from the fear and shame-based medical training I had in the 70's to the Integrative Holistic model that I now practice. One thing that I have noticed is how many people with major dysfunctions of all types and levels claim not to dream at all. Some have been taught to regard the breakthrough of dreams to be evidence of pathology-- need to take more meds. I have also seen that facilitating the return of dreaming is usually associated with improved functioning, even healing-- and not just on the obvious mental-emotional levels. Current psychiatric practices often regard dreams as a form of"noise", to be suppressed if too extreme or disturbing, or at best to be ignored. On the contrary, I say we put a new code into the DSM: "666.0 Absence of taking one's dreams seriously". Healing may actually be hidden in plain sight!
Hey Carol - Sounds like Henry Emmons (and many others) would benefit greatly from some coaching from you on the applications of our Active Dreaming techniques and our basic dream sharing process.
Michael - Thanks for yoyr reminded gthat Dennis Frantz was indeed cast as a (happily fallen) angle in "City of Angels", a movie inspired by Wim Wender's "Wings of Desire". I dreamed of Sipowitz as a guide to the Underworld years before "City of Angels" was made; maybe both the dream and the movie were drawing on something out there in the ethers :-)
Speaking of ethers, you are also correct in reminding us that the founder of chiropractice, D.D. Palmer, was a spiritist who said that he received his core method through direct communication (which he called "inspiration") from a deceased physician, Dr Jim Atkinson. A story I neglected to include in my "Dreamer's Book of the Dead".
Bob - I love your suggestion of a ndew code for the DSM: "666.0 Absence of taking one's dreams seriously." Thank you for all you are doing, as physician, healer and teacher, to restore dreaming to medicine.
In 1988 I had just come back from a 4 month bike trip through Australia. I was in the best shape ever and was ready to figure out "what to do with the rest of my life". I put a call out to the Universe asking "Please let me be of service!" and 2 days later - BAM! Out of nowhere sunk into the deepest, blackest state of depression and panic which no doctor in the small little town of Davis, CA knew what to do with. They offered pills and thank God I said "No thanks!" because it led to me finding a therapist who practiced Psychosynthesis, a form of depth psychology, which emphasizes the use of guided imagery to effect deep healing. Inside of two months I was on the mend and was so impressed with the results of the therapy that I later went on to become a therapist myself and did training in this method as well as others that recognize that the body knows how to heal itself if you speak to it in the language it understands – using dreams, imagery and other somatic approaches. Drugs can alter body chemistry, but they can’t help us make meaning of our experience. And no folks, we weren’t born Prozac deficient!
And another thing....I don’t know how we got so far afield from the true definition of psychiatry -soul healing ( from the Greek “psyche” meaning “soul, mind” and “iatreia” meaning “healing, care” ) but I do know we are finally recognizing that a strictly materialistic approach in the end actually costs more, not less, for the insurance companies in the form of increased stress –related disorders and major medical problems resulting there from. I am heartened by the recognition that the methods I employ in my practice such as guided imagery, EFT (Emotional Freedom Technique) and mindfulness training are gaining more credibility in the medical community now that we have ways to scientifically validate their efficacy ( alas, as if tons of clinical proof wasn’t enough!)
However I still subscribe to Ames Williams view that “There is no psychiatrist in the world like a puppy licking your face!”
Hey Karolyn - Thanks for reminding us that psychiatry means "care of the soul" and that this should be its practice. I also agree that there is no therapy better than a friendly dog who loves you no matter what and whose slobber beats almost any Rx.
To add a little different spin, I have utilized many therapies including acupuncture, chiropractic, years of psychotherapy, nutrition, and nothing has been more life-saving and life-changing than my medications. They have been absolutely necessary in my healing, and with dream work I continue to explore deeper the intricacies of my severe depressive illness. My psychiatrists have been caring, sensitive doctors, and I often feel that people are quick to jump on the "medicine bad" wagon. I would surely not still be walking here in this world if not for it, nor would I be able to mother my children. Mental illness IS shown in modern neuroscience to be an illness of the brain, let us not forget that -- though I agree that medicine is prescribed too frequently and too quickly, for many of us it is a Godsend which helps us to lift our eyes from a darkness that is ever hovering and horrifying.
Heidi
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