By Dr David Laing Dawson
For every advance in the medical specialty of psychiatry, and every attempt to define, categorize, and improve the treatment of “mental illnesses”, there have been naysayers, pundits ready to proclaim that these aberrations of mental processes and behaviour are not illnesses or diseases at all.
Thomas Szasz would say “mental illness” is a myth, that such behaviours are really understandable reactions to an over-controlling society, even that we’d make more progress thinking schizophrenics are liars. Alan Watts, in a lecture I attended, likened mental illness to being something akin to a bird on a different flight path from the rest of the (overly conforming) flock. R.D. Laing worked overtime finding meaning in psychosis, and linking such behaviours to crazy-making parental behaviour. Then we had the frozen (unloving) mother syndrome, and the double-bind theory, again each of these ideas trying to make the symptoms of psychosis (and autism) look like rational responses to an irrational world, or, at least, to irrational parents.
And then we have L. Ron Hubbard, Scientology, Robert Wittaker, Eckhart Tolle, and then Gabor Mate with his focus on childhood trauma (with a bit of Taoism thrown in) causing everything and anything.
With his scarf draped stylishly around his neck, his voice trance-inducing, Gabor informs us that infants have no capacity for self-regulation (who would have thought?), and then he goes on about the child’s “authentic self”, and not being able to express this authentic self can be, well, traumatic. Eckhart, with his soothingly hesitant voice and kind eyes, tells a woman who suffers from manic depressive illness, rapid cycling bipolar disorder, and who has finally, after six years of chaos and delusion, started taking medication that has brought her peace – he tells her that with meditation she might be able to stop her medication, and perhaps transcendental meditation would be right for her.
Had all these men kept their contrarian views and ideas within academia and professional discourse, they might have simply provided a much needed balance to medical and pharmaceutical overreach.
But the one common theme for all of these gurus has been, of course, fame, fortune, and salesmanship. And so their ideas reached the general public, families, sufferers, and perhaps worse, politicians and policy makers, and they have done great harm.
And each of their ideas is very human, for it is very human to blame. Blaming takes away mystery, confusion, uncertainty. It also gives us false hope, hope that these illnesses can be completely vanquished by:
a change in our behaviour,
by better parenting,
more love,
creating a much less toxic and
more tolerant society.
meditation and the right attitude
And make no mistake: All of these ideas are based in blame: blaming, in turn,
Western Medicine itself,
mothers,
abrogation of personal responsibility,
loss of “family values”,
parenting practices,
capitalism,
toxic cultures,
our schools,
conformity,
big pharma,
Western Civilization,
materialism,
urban living….
And each of their ideas is the equivalent of a placebo: If swallowed whole, accompanied by belief and hope, they can make you feel better for a little while.
For politicians and policy makers they also provide a means of saving money. For certainly, if mental illness is a myth, why spend any money on it? And if childhood “trauma” is the root cause of everything, then lets just set up a three digit help line for abused kids. And instead of costly professional care lets just provide emotional support.
Experimenting with Alternatives
When I entered Riverview Hospital as a first year Resident in 1968 I was no fan of mental hospitals, insane asylums. It was the sixties after all, and we all suspected that our institutions needed an overhaul, that they were part of the problem.
The University Department of Psychiatry took over a ward in Crease Clinic and we unlocked the door and started a “Therapeutic Community”. This really meant that each day would start with all patients and all staff sitting in a very large circle in the day room, discussing whatever the patients wanted to discuss, and sometimes making decisions collectively. It was a humane if often chaotic approach to health care. It gave our patients a greater sense of autonomy and control. For myself it was a wonderful laboratory to observe human behaviour: A paranoid man would stand and shout and dominate and accuse. A manic woman would get up from her chair, dance over to the man and sweep him away in circles and sit him back in his chair. A patient would ask for a weekend leave. Another would say, “Don’t let Albert home. He was talking about killing himself just yesterday.” And another, annoyed by the word salad spewing from someone’s mouth, would say, “Joan, for God’s sake, go back on your meds. You’re talking crazy.”
A tolerance for chaos was required of staff, for uncertainty, and sometimes for threat and danger, but it did seem a humane step forward, though certainly not a treatment for what became increasingly obvious, are illnesses, aberrations, diseases of the mind/brain. Medication was the treatment. Talking in a group, being allowed more agency, counseling, walking on the grounds, exercise, safety, quiet time, music, working on crafts – these were means of fostering well-being and recovery, of taking back one’s life.
During those years we attended that lecture by Watts, talked through Irving Goffman’s ideas about spoiled identity, read R. D. Laing, Hannah Green, Foucault and Thomas Szasz, along with Freud, Yung, Frankl, Erikson, Piaget, discussed in group the double-bind theory, attended a workshop by Fritz Perls, tried out a little gestalt therapy, drama therapy, marathon encounter group therapy, even a little hypnosis.
And in those latter experiments I certainly learned how fragile our perceptions are, and how one person, a leader, a guru, can accrue so much power over his students’/followers’/patients’ thoughts and lives. And how tantalizing that power can be.
On Being a Doctor
I gave up the intense and dramatic group therapies when I realized I was no longer sure if my motive was helping my patients or gratifying my own ego. I went back to being just a doctor.
Yes, there’s more to human beings than the illnesses from which we suffer. And achieving a state of wellness, of stability, of bonhomie and equanimity, requires more than treating illness with pharmacology.
But listen to those gurus carefully. Ignore the soothing tones, the mystical ambience, and parse their phrases carefully. You will find mostly empty nonsense or grandmothers’ platitudes. Gabor Mates “authentic self” is a bit of both. A nice enough platitude, but think about it. Do you really want to attend a party, Thanksgiving dinner, a board meeting, a crowded shopping mall where everybody is “expressing their authentic selves”? Please leave most of that authentic self with the cartoons and comedians.
“Doctor, I would like a second opinion.”
“Okay. You have a sprained ankle and you are a bit of an asshole.”
That bird on a different flight path from the flock? Really? You know it’s going to miss the breeding grounds and perish in the coming storm.
It was clear to all of us right from the beginning that Gregory Bateson’s “double-bind” was a ubiquitous form of family communication and not the cause of severe illness. It too should be left to the cartoons:
Standing at the foot of the stairs, and knowing there was no safe answer to his wife’s question, “Do these slacks make me look fat?”, George froze and entered a catatonic state.
It was 1969 when a mother and father brought their teenage son into my office. The boy was withdrawn, anxious, and when he did talk he demonstrated some thought disorder, perhaps delusional thinking. In that first visit to my office the mother sat in a chair to my right, the boy in a chair straight ahead, and the father remained standing by the door, always with an angry demeanour. In fact, he refused to sit. And I quickly learned that neither the mother nor the father were willing to talk directly to one another. Instead, in my office as well as at home, each would turn to their son and say, “Tell your father…” or “Tell your mother….”. And the boy, of course, became increasingly agitated, sometimes going mute and staring at the floor.
I admitted the boy to hospital and then, well, experimented. For surely, if it were possible for parents to drive a child into a schizophrenic illness, simply through their communication patterns, this would be the one. So I would see the boy alone for a half hour or so, then bring in the parents, then alone again, and then with the parents. Without the parents in the room the boy was no longer as agitated. He would talk to me, make eye contact, engage. But he still exhibited the symptoms of schizophrenia. When his parents were in the room his agitation increased, as did his moments of refusal and muteness.
I treated the boy’s schizophrenia with one of the anti-psychotic medications we had at the time, and I counseled the parents. I did my best, but I’m afraid I do not have a long term follow up.
As later observational research did show, young people developing a psychotic illness do not do well within a household of high expressed emotion and conflict. Their recovery is poor and they relapse more often. But it doesn’t cause schizophrenia.
Harry Stack Sullivan said, “Schizophrenics are not schizophrenic with me.” And yes, a patient, empathic, sensitive, calm, thoughtful doctor or mental health worker, can develop a level of rapport and trust and have a calm conversation with someone who is paranoid and delusional. And at the end of that conversation this person may be more willing to take the medication the doctor is offering. Or not. And that half or full hour in which the doctor found a way of avoiding conflict or confrontation, found a way of helping his or her patient communicate and share his anxieties and fears without lapsing into an angry diatribe of evidence supporting his delusion – that hour was sweet and satisfying, but it did not change the course of the illness.
Many of the observations by these gurus are accurate descriptions or interpretations of human behaviour and the human condition, though not the cause of the illness.
Freud posited that repressed homosexuality was the cause of paranoia. And it was true in the sixties and seventies (and probably Freud’s time as well) that when teen age boys developed schizophrenia with ideas of reference and hallucinations, they often heard their classmates say (and think), “He’s queer, what a fagot”. But then, in my experience, that stopped happening sometime in the 90’s. The ideas of reference (they are looking at me and thinking or talking this about me) and hallucinations (accusative voices) were more along the line of, “You’re a loser.” And it became pretty clear to me that the experience of someone developing schizophrenia was really of imagining and hallucinating that others are thinking and saying the worst possible things about me. Pre-1985 or so, the worst (for a teen boy) would be “queer” or “fagot”. Times changed. Being gay was now not so bad. Now the worst you could be was “pervert” and “loser”.
And yes, medicine tends to overreach, and science is always finessing its conclusions when new data comes to light. And money does drive the pharmaceutical industry. But then, we are all human, and it turns out that money, i.e. capitalism, is the only system that spurs innovation and invention. So we do need capitalism, with much oversight and scientific study.
But it needn’t be dichotomous or conspiratorial. It is very reasonable and enlightened to look at any human misery and ask the question, “If we apply the modern concept of disease to this problem, will it help? Will scientifically applying the disease concept and methodologies to this particular human misery help us understand it, help us find and scientifically prove the efficacy of remedies, maybe even help us understand the causes and be able to formulate a means of prevention?”
There are many human miseries greatly alleviated by applying the disease model, even eradicating some of them. There is also no question that applying the disease model to severe mental illnesses, to psychotic illnesses, and the resulting pharmaceutical treatments for these, has helped, has alleviated suffering, has allowed millions of people to live full lives.