The Criteria of What Works and for Whom Part II
by Sue Poole
Current modes of care, including incarceration, forced drugging, the use of restraints and forced electroshock, are dehumanizing and stigmatizing, cutting off psychiatrically labeled person from community support by alleging they are dangerous and in need of control, rendering them quasi-criminals.
In truth, most mental patients are shy, easily intimidated and impressionable. Research suggests the majority come from family situations with dynamics that promoted scapegoating of weaker, less aggressive members. Early childhood abuse, whether physical or insidiously emotional, may contribute to their vulnerabilities...difficulties in trusting an external world that has manifested to them from their earliest interactions with it as hostile, repressive, confusing and largely devoid of continuity and stability. If such circumstances influence the developing and plastic brain to engineer circuits of escape via fantasy replete with poignant metaphor, who with any imagination or empathy would wonder at it?
In "The Dinosaur Man:Tales of Madness and Enchantment from the Back Ward," psychologist Susan Baur discovers a touching humanity in imprisoned old men confined to the obscurity of locked wards at the institution where she is employed. She befriends one of them who shows her his visions of dinosaur families browsing the green grass of a valley, inventing himself as the child of a brontosaurus mother and a member of a gentle brontosaurus society.
Baur discovers a common thread of abuse, overcontrol and emotional abandonment in the early histories of these men labeled chronically psychotic and relegated to the status of society's castaways, unheeded and unknown. Baur believes delusions and hallucinatory thinking become defenses against processing the pain of early childhood emotional and physical abuse. The hospital setting, with its infantilizing rituals and restrictions on liberty, can only recreate the hostile early experiences and prevent breakthroughs. Baur quotes Emily Dickinson, who described the emotional defenses against abuse this way: "There is a pain so utter, it swallows distance up/Then covers abyss with a trance so memory can step/Around...across...upon it, as one within a swoon/Goes safely where an open eye/Would drop him bone by bone."
Baur's approach is the practice of presence and active listening to find "useable past memories" and gently guide the fragmented psyche toward full identity by linking positive past experience with "present useable memories." She also advocates the therapists as assistant presence, not as imposer of reality or enforcer of conformity. Finding present useable memories in the confined chaos and mindless regimens of a loony bin, she suggests, is problematic. The aim is not to squash imagination or capacity for fantasy but to aid people in recognizing their metaphors, like belonging to dinosaur families, as personal symbols of their unmet needs or most repressed wishes.
While these metaphors may seem alarming to those unable or unwilling to communicate symbolically, they have their own raison d'etre in the minds of people whose personalities were early crushed and mangled by damaging family dynamics. Baur considered herself privileged when an obscure old man on a locked ward confided to her his deepest wishes to belong to a family and a society of peaceful, if alien, creatures with simple needs and desires. Only when therapists believe admission to the private worlds of people in their care is a privilege, not a right, will psychiatry get it right at last. Only when therapists believe the imagination is a phenomenon to respect, nurture and MUTUALLY explore, an undiscovered country, a rich territory of personal meanings integral to the identity of their patients and not a disease symptom to be eliminated and controlled, will psychiatry get it right at last. Only when the therapist and client share experiences and insights in the context of trust, mutual respect and an attitude of openness to learning from each other can psychiatry begin to offer true help by recognizing the value and humanity of every human being, no matter how odd his/her surface appearances may seem.
Hannah Green's autobiographical novel "I Never Promised You a Rose Garden" details the success of psychiatrist Frieda Fromm-Reichmann, who worked Green's fantasy world and its characters into the therapy, affirming the fantasies as a product of Green's own barely articulated pain and rich creativity, as well. Fromm-Reichmann empowered her client by validating an awesomely rational, structured inner world of demons and angels, giving Green the freedom and choice to shape the contents of her own imagination, freeing her from subservience to her own imagination by taking seriously the voices, visions and events Green shared. Ultimately, by sharing her inner world with a trusted friend who also happened to be a therapist, Green was able to begin correlating her powerful fantasies with her actual experiences, learning to distinguish between the fantasy and the reality.
Fromm-Reichmann exerted no force, pushed no drugs, felt no fear, imposed no alien identity on Green. She gave credence, acceptance and listening presence, giving Green opportunities to separate the mythic defenses of her own mind from the life events and conditions her fantasies actually paralleled. "We may take the rationalistic psychiatrist's behavior as an allegory of our modern age," says May. "When we in the 20th century are so concerned about proving that our technical reason is right and we wipe away in one fell swoop the 'silliness' of myths, we also rob our own souls and we threaten to destroy our society as part of the same deterioration."
Sir Peter Madawar, quoted in Hans Eysenck's "Decline and Fall of the Freudian Empire", mourns the failure of psychoanalysis alone to shore up the ruins of a fragmented, impoverished and disintegrating culture, which is creating more fragmented, impoverished and disintegrating people...aided and abetted by the medical model of so-called mental illness. "No better theory can be erected on its ruins, which will remain forever one of the saddest and strangest of all landmarks in the history of 20th century thought," Medawar declares. Medawar is both right and wrong. While no better theory can be manufactured, a paradigm of praxis by recognition of common humanity and the value of individuals and their inner lives contains the seeds of hope, regeneration and reconstruction. Compassionate and respectful care in the context of mutual trust is both the baby and the bathwater.
Going beyond the medical model means acknowledging there is no magic pill. To subdue imagination with heavy neuroleptics and apply coercion to force conformity can only exacerbate the brokenness and suffering of people who need the support of community acceptance, heedful presence, affirmation, wise guidance, compassionate response and open-ended choices to recover - or recognize for the first time -their innate worth as members of the human species. Medicine may be an adjunct to that process, and the therapist's first choice, in the interests of our common humanity, should be the mildest one possible. Harsh forced treatment with dreadful effects can abort or impede the task of building or discovering an integrated identity.
Coercive tactics can only erode the trust and mutual communication necessary for rebuilding both shattered lives and viable communities. Locked wards, restraints, punitive measures, threats, isolation rooms, ignorance of the patient as a personality with hopes and abilities, negation of the inner life...these can only cause misery, failure, frustration, fear and indignity. The therapist's task is not to doom individuals to lifetimes of failure and dysfunction but to nurture and guide the dawning light of consciousness, to help create a useable present that can be linked to a useable past. Loony bins can never accomplish the task. The therapist's task is not to snuff the imagination with harsh drugs but to validate its creative potentials and guide its efforts toward cogency. Restraints and electroshock cannot accomplish the task.
The therapist's task is assisting the distressed individual to grow and develop, not to adjust, obey, comply and conform. Force and seclusion cannot accomplish the task. The therapist's task is helping the individual to build emotional bridges spanning the gap between imagination and society's demands, not to punish or condemn brokenness. Ghettoization and absolute judgments cannot accomplish the task. The therapist's task is to be ancillary mind, not demigod. Coercion is destructive to human growth and development, which is an ongoing and lifelong process needing the support and encouragement of community, which psychiatry eliminates through fraud, force and brainwashing strategies.
Common humanity and basic decency cry out for alternatives to the oppression, destruction, broad social control and force currently masquerading as somatic and psychotherapies. When hurt, confused people reaching for full identity are locked up, overdrugged, criminalized and stigmatized, the system is compounding emotional stress by undermining their very personhood. The human personality is dynamic, not static. Mainstream psychiatry with its labels, coercions and absolute judgments denies personal strength and abilities, devastates hopes for the future by systemically paralyzing and further fragmenting its alleged beneficiaries. To pretend that such barbarity is help is criminal fraud.
When the focus of treatment is entrenchment of a self-serving status quo rather than the care, nurture and guidance and development of broken people, the time for a new paradigm is long overdue. Mainstream psychiatry, by its backwards fight to preserve economic investment in perpetual fragmentation, is aborting human growth and development. There is a black evil inherent in declaring harmlessly eccentric individuals diseased, irreparably damaged and unfit for social inclusion, dooming them to indigence and separation from life's mainstream, pronouncing them unfit to participate in the vital processes of life itself. The disease model divorced from human considerations of life situations and personality dynamics sustains the implication that individuals in treatment are inferior and ensures society's perceptions of them as inferior. "The cogs grind on, the wheels turn and the mental health machine races toward the abyss as if to its own salvation," Farber says. "We are not dealing with an ontological entity but with an interpretation of behavior...that serves the interest of the psychiatric establishment and reassures those who worship at the altar of modern medicine that we can trust the doctors to save us from the problems engendered by a social order that is disintegrating."
Primitive societies valued the "psychotic" experience and revered those who sought it as spiritually enlightened leaders whose experience contributed to the entire tribal ethos, passed down into the social fabric as legends and myths that shaped the moral sense and made bearable the unfathomable mystery contained in consciousness and existence itself. Anthropologists have demonstrated that the consciousness crisis of the future shaman, or wise person, is phenomenological and behaviorally indistinguishable from what psychiatry calls psychosis, as are the practices of glossolalia and agitated trance states of Pentecostals and other religious denominations. In a condemnatory, materialistic, Puritan-Calvinist culture without referential guides for comprehending and shaping such experience, the inevitable result is intensification and prolongation of suffering. The disease model, divorced from acknowledgment of common humanity and crisis as a growth opportunity, denies the individual's quest for meaning, community-building and unfolding personal identity. If this model prevails, the human species is indeed decreeing its own extinction by extinguishing the life force itself. "It (the medical model) interprets the suffering of individuals who seek psychiatric help as a manifestation of their alleged worthlessness and inferiority," Farber says.
In "The Politics of Experience," dissident psychiatrist R.D. Laing says madness need not be confined to existential death and breakdown but may be a signal of liberation, breakthrough and renewal. Certainly madness in our day is a wake-up call for the destructiveness, bigotry, institutional persecutions and oppressions, mass xeonphobias and cultural insularities of a society undergoing its own biogenetic crisis. "Our society may itself have become biologically dysfunctional," Laing suggests, and psychosis may an expression of awareness, "of alienation from an impossible world." "In a society as destructive as our own, going mad may be an adaptive response. It may be that those who do not go mad are less aware," Laing says, echoing Hannah Green and others who are calling for recognition of the both the mythic dimensions of imagination and for a sane respect for differences among human beings.
Who benefits from the institutional imposition of conformity on society? Who benefits from the extraordinary power to lock away persons who have committed no crimes and have no histories of violence? Who benefits from the pathologization of behavior? Who benefits by appropriating power to define what is and is not normal behavior? Who benefits by assigning psychiatric labels to millions of people and then shuffling them into the welfare system that pays billions of insurance tax dollars to psychiatric clinics? What is working for psychiatry, the systemic persecution and devaluation of sensitive people, may not be, after all, in the best interests of its subjects or of society at large.