March 29, 2011

Mark Foster, DO
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Dear Bob–

Since you posted about my termination last week, I’ve received a lot of words of support and encouragement, and I wanted to say thank you. Mental health reform is a cause I have come to deeply believe in, and I am happy to be a part of it, to have borne a wound of sorts in the battle. For those of your readers who are wondering, my family and I are doing well. My wife has been extremely supportive, and the kids have been glad to have daddy around more. There are still feelings of hurt, embarrassment, and betrayal–a lot of my frustration centers on my inability to communicate with my patients. But out of the mess of my termination, there have arisen a number of great clinical, writing, and speaking opportunities, and I think that good things eventually will come of this situation. I am hoping to reestablish my practice in the Denver area, and we are currently evaluating our other options, deciding how to best focus our energies.

Two great opportunities have arisen that center on my friendship with a remarkable woman, Amy Smith. Amy is former consumer and mental health reform advocate from Colorado, and she has an amazing personal story, which she has asked me to write, and which is so emblematic of the inefficiencies and ironies of our mental health system. She had been labeled as schizophrenic and was on a ridiculous amount of medications, twelve psychotropics drugs plus a muscle relaxer. She was muttering to herself, wandering the streets, violent, suffering from severe physical ailments, and basically given up for lost. Then one day she developed a toothache, became unable to swallow her pills for four days, and on day five, she says she awoke as if from a twenty-five year coma, newly in possession of her mind and body. That was the beginning of her remarkable transformation into the warm, bright, funny, and passionate person that she is today. I certainly don’t advocate that anyone stop their psychotropics cold turkey, much less twelve at once. Yet Amy did, and that was the start of her remarkable recovery, hopefully to be told in detail as a book.

Amy’s great passion now is mental health reform, and she is one of the leading community organizers and reform advocates in Colorado. She and I connected initially through your website, and our friendship has developed into a collaboration on a very important project in Colorado, what we are currently calling Shift: A Psychiatric Medicine Withdrawal Facility. Discussions are ongoing, and we’ve had a very positive response from those with whom we’ve shared this idea. It will be exciting to see how the project develops. I will periodically post updates on this site.

Since I have not been working the last two weeks, I have had some more time to read, think, and write. I just finished Man’s Search For Meaning by Viktor Frankl. How in the world I made it to my age and position without having read it, I don’t know. It should be required reading for every doctor, every human. He describes first his horrifying, dehumanizing survival experience in Auschwitz and other concentration camps, and then details his philosophy and methods for coping with the vicissitudes of life by finding meaning in our experiences and even our suffering. Written over fifty years ago, the book is remarkably prescient in forecasting the cynical, mechanistic state of our current drug-intensive mental health system, and sums up perfectly my evolving observations as to the costs of turning to drug therapies at the first blush of mental distress, the cost not only in money and side effects, but also the opportunity cost to patients’ humanity, to their ability to learn something valuable and essential from their distress that could enhance their sense of meaning in life. I wanted to share a few particularly pertinent quotes from the book. Some of the vocabulary seems a bit dated, but the ideas are more timely than ever.

“Not every conflict is necessarily neurotic; some amount of conflict is normal and healthy. In a similar sense suffering is not always a pathological phenomenon; rather than being a symptom of neurosis, suffering may well be a human achievement, especially if the suffering grows out of existential frustration. I would strictly deny that one’s search for a meaning to his existence, or even his doubt of it, in every case is derived from, or results in, any disease. Existential frustration is in itself neither pathological nor pathogenic. A man’s concern, even his despair, over the worthwhileness of life is an existential distress but by no means a mental disease. It may well be that interpreting the first in terms of the latter motivates a doctor to bury his patient’s existential despair under a heap of tranquilizing drugs. It is his task, rather, to pilot the patient through his existential crises of growth and development . . .” (Try comparing these sentiments with those of a modern day psychiatrist)

“To be sure, man’s search for meaning may arouse inner tension rather than inner equilibrium. However, precisely such tension is an indispensable prerequisite of mental health. There is nothing in the world, I venture to say, that would so effectively help one to survive even the worst conditions as the knowledge that there is a meaning in one’s life. There is much wisdom in the words of Nietzsche: ‘He who has a why to live for can bear almost any how.’ In the Nazi concentration camps, one could have witnessed that those who knew that there was a task waiting for them to fulfill were most apt to survive.

“Thus is can be seen that mental health is based on a certain degree of tension, the tension between what one has already achieved and what one still ought to accomplish, or the gap between what one is and what one should become. Such tension is inherent in the human being and therefore is indispensable to mental well-being. We should not, then, be hesitant about challenging man with a potential meaning for him to fulfill. It is only thus that we evoke his will to meaning from its state of latency. I consider it a dangerous misconception of mental hygiene to assume that what man needs in the first place is equilibrium or, as it is called in biology, ‘homeostasis, i.e., a tensionless state. What man actually needs is not a tensionless state but rather the striving and struggling for a worthwhile goal, a freely chosen task. What he needs is not the discharge of tension at any cost but the call of a potential meaning waiting to be fulfilled by him.” (2006 revised edition, pg 102-105)

(And finally, Frankl concludes this masterpiece with these words that would ring disturbingly true if read at any psychiatric convention today.)

“Psychiatry Rehumanized:

“For too long a time–half a century, in fact–psychiatry tried to interpret the human mind merely as a mechanism and consequently the therapy of mental disease merely in terms of a technique. I believe this dream has been dreamt out. What now begins to loom on the horizon are not the sketches of a psychologized medicine but rather those of a humanized psychiatry.

“A doctor, however, who would still interpret his own role mainly as that of a technician would confess that he sees in his patient nothing more than a machine, instead of seeing the human being behind the disease!

“A human being is not one thing among others; things determine each other, but man is ultimately self-determining. What he becomes–within the limits of his endowment and environment–he has made out of himself. In the concentration camps, for example, in this living laboratory and on this testing ground, we watched and witnessed some of our comrades behave like swine while others behaved like saints. Man has both potentialities within himself; which one is actualized depends on decisions but not on conditions.

“Our generation is realistic, for we have come to know man as he really is. After all, man is that being who invented the gas chambers of Auschwitz; however, he is also that being who entered those gas chambers upright, with the Lord’s Prayer or the Shema Yisrael on this lips.” (pg 133-134)

Amen, Viktor.

Mark