April 07, 2016

Shrinks

Why do we think so negatively about psychiatrists that we still insult them by calling them shrinks? Some medics might be quacks, but we don’t generally refer to them as witches!

Shrinks; The untold story of Psychiatry, by Dr. Jeffrey Lieberman, is a sobering account of how psychiatry has swung from a marginal, unscientific mixture of weird theories into one of the most common and pervasive forms of treatment of what are commonly called “disorders of the mind”. Is it science or fantasy, medical or quackery?

We have discovered prehistoric attempts to bore into skulls that we assume were attempts to correct mental disorders. But at the same time we have continued to argue about what we mean by “the mind” and how we categorize or explain what are mental disorders.

We used to abuse what we called the village idiot, shackling him to the wall, dousing him with cold water, or exhibiting him to the public like a wild animal. Then we “progressed” to removing organs, cutting out parts of the brain, and passing electric currents through him. The cruelties we have done in the name of medicine is as inhuman as the experiments that the unspeakably evil apology for a man Josef Mengele inflicted on Jewish children in Auschwitz.

Sigmund Freud who introduced the “talking cure". Josef Breuer had initiated Freud into the idea, and then Freud took it much further. If one was showing signs of neurosis, dysfunction of the mind, it was because from our birth we have found ourselves wanting or fearing sexual issues. If we were unable to achieve or escape these urges, they would be deflected and turned in on ourselves, thus hampering “normal” development. Dreams were ways to discover what was going on in the inner recesses of a person’s mind. The value of a patient talking about his past was that this way he would come to recognize and accept what these urges were and how dreams and other “tells” revealed them. Thus the patient could understand and purge his mind of the the guilt that was causing these problem inside.

Like most great innovators, Freud had his weaknesses. Everyone had to agree with his system of thought. So that when Carl Jung, the great Swiss doctor, disagreed with the primacy of sex in Freud’s system and wanted to take a more spiritual approach, Freud threw his intended successor out of the Psychoanalytic Society, which he had founded to create a new profession. Freud had criticized religion for being preoccupied with petty little differences. He was guilty of precisely that, with his new anti-religion, and initiated a witch hunt against anyone who disagreed with him. After his death, the system he tried to control split into rival camps. Charlatans and crackpots began to give the whole system the air of lunacy. Yet there is no doubt he radically changed the way we think about mental issues.

In the USA, the American Psychiatric Association grew out of an organization set up in 1844 to deal with the insane. Then the dominant approach to mental problems was that insanity was simply a disease. The field was so ill-defined and open to abuse that there was a need to try to document what were regarded as problems. Hence the DSM, Diagnostic and Statistical Manual of Mental Disorders, became the profession’s bible. But it too has always been controversial and patently wrong in so many areas. Lieberman’s book goes through the history of the titanic struggles (often more personal than scientific) to accommodate new theories, modify old ones, and adapt to chemical solutions.

Psychoanalysis made inroads into American medicine as the refugees from Vienna arrived before and during the Second World War. Even so, it was regarded askance. To see a psychiatrist was a sort of blot on one’s sanity, and some people often hid their visits from friends and colleagues for fear it would affect their careers and marriage prospects. The term “shrink” became fashionable. They were regarded as primitive medicine men, like witch doctors with their shrunken human heads strung around their necks.

Psychiatry has gone through many phases and internal conflicts. The latest is the excessive prescription of medication. Simpler and less time consuming. Yet psychiatry and psychology have played a part in almost every area of activity, from business to military torture, from public health to personal insecurity. It controls the ways we buy and think. And yet there still remains something of a stigma.

Despite it all, talking to someone remains very popular, whether one goes to a trained psychoanalyst or psychiatrist, a life coach, a clergyman, or any good listener. Some find cures, others find comfort, and many become dependent. And yes, snake oil salesmen, charlatans, and frauds continue to proliferate.

Whereas in medicine it is possible to see whether one is being effective or not, in the talking cure it is not so straightforward. As a headmaster and rabbi, I used to encourage people to see professional psychiatrists if they were troubled beyond my expertise. Yet I do not recall any cases where I thought there were any tangible improvements or benefits. Too often it became an excuse and a prop to avoid confronting reality.

One can argue about brain and mind and what the difference is or is not, but clearly humans are complex beings. All the more so as we hear more and more about how we can alter our brains biologically. It is very important to ensure that the non-rational, non-medical, spiritual side of person’s being should be attended to. Jung wins over Freud on this one!

I value doctors of the body (though I do not worship them), so why shouldn’t there be doctors of the soul (as Maimonides called them)? The fact that pastoral work is still very much in demand only suggests that, at the very least, the need for people to talk to those who will listen is a significant part of human wholeness.

Religion used to, and still can, play its part. A caring pastor needs some training in understanding how human beings work. We ought not to disregard it, any more than we should scientific medicine. But as with conventional medicine, one must not think there is only one infallible way. Natural cures are not pointless. There is room for other forms of therapy and help when people suffer from whatever the ailment. Some practitioners still are shrinks, manipulators, and more interested in money than people, but others are doctors of the mind—both physical and spiritual. As in any sphere, one has to do due diligence and sort out the good from the bad.

1 Comments:

At 2:17 AM , Anonymous Leila said...

The expertise surely comes from diagnosis. It is doubtful whether a psychoanalyst would be good at treating someone with a severe chemical disorder by just listening and talking. Medication has its place and a good psychiatrist should be able to prescribe accordingly. As in most things, a little kindness goes a long way, too.

 

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