For mental distress to be alleviated, it is often very important to understand how individuals construct meaning. For some this sense of meaning comes from spirituality. Modern psychiatric practice has become medicalized to the point where it has significantly ignored the human experience and sought to understand human experience only in terms of chemical accidents.
If we examine the term ‘psychotherapy’ we will see that it literally means the ‘healing of the soul’. Much of emotional distress is actually a spiritual problem, where an individual has lost meaning and hope. In today’s society, we have lost sight of spiritual values and many have in turn decided to turn to the religion of bio-psychiatry.
Psychotherapy, on the other hand, focuses on the subjective changes in patient’s feelings and on actual changes in lifestyle or conduct of life (Fisher & Greenberg, 1989). Based on the viewpoints of biopsychiatry, persons who are medicated and placed in mental hospitals are labeled as improved when they conform to hospital demands or receive discharge.
However, what is not examined is, how do the patients themselves actually feel? An estimated 180,000 to 300,000 young people a year are placed in private psychiatric facilities in the US. These children and adolescents often feel powerless in these placements. But as mentioned above, it is the need for feelings of empowerment and hope that will lead to a genuine recovery from distress.
Psychologist D.L. Rosenhan led a study where ‘pseudopatients’ had themselves admitted to psychiatric hospitals to experience them first hand and report on this experience. Rosenhan reported in an article appearing in the January 19, 1973 issue of Science, “Powerlessness was evident everywhere…He is shorn of credibility by virtue of his psychiatric label. His freedom of movement is restricted. He cannot initiate contact with staff, but may only respond to overtures as they make. Personal privacy is minimal…” With children and adolescents it is easier to rationalize away their rights and control becomes more arbitrary and complete (Breggin, 1994).
Anti-psychotic medications are reported to cause lack of energy, painful emotions, motor impairment, cognitive dysfunction and tend to blunt; the personality of the treated patients as well as having a risk for the development of tardive dyskinesia, a permanent and debilitating neurological problem (Gualteri and Barnhill, 1988). These drugs subdue the person into conformity by blunting the brain, but never do they teach the person how to develop meaning, how to cope, nor do they allow the person to express his or her pain and emotional distress that is within. The person is merely sedated to make his behaviors more manageable to adults. The person learns nothing. The persons who are suffering from severe emotional distress are in conflict. They have internalized feelings of guilt, shame, anger, anxiety, and numbing. These persons need instead of coercive and intrusive ‘treatments’, the ability to find a safe place where coercive power is replaced by reason, love, and mutual attempts to satisfy their basic needs. These persons because of their distress have broken away from the accepted realities, they have sought to recreate their existence.
The feelings of anxiety the person may experience are linked to a fear of being and belonging. Depression, mania, and anxiety are all linked together and are indicative of trauma. The person being a shattered person seeks an escape by altered perception. We must begin to realize that all behaviors and experiences have meaning, even those things that may appear the most ‘odd’ to us. The symptoms labeled to be schizophrenic exhibited by certain persons in distress ‘may be understood as manifestations of chronic terror or defense against the terror (Karon, 1996).
This is often expressed as anger, loneliness, and humiliation. The therapist and others must convey to the person that he wants to understand, that the client is helpable, but it will take hard work (Karon, 1996). The therapist must forge an alliance with the person, aiding them to understand the real dangers and to be able to develop appropriate coping mechanisms. These persons are often viewed as dangerous themselves but the majority are not. They need to be heard, and forging this alliance will give them the needed voice leading to their recovery.
Hallucinations that are experienced by the seriously distressed person are actually repressed thoughts and feelings coming outward, the unconscious into the conscious. Delusions are the adolescent transferring experiences from their past without having the awareness that it is past (Karon, 1996, pg. 36). The therapist can guide in interpreting the meaning of these hallucinations and delusions and once the person is gently approached with their underlying meaning, these events can dissipate.
Delusions are also connected with an attempt to find a systematic explanation of our world, to find meaning. A person who has experienced severe distress has lost this meaning and thus develops unusual ways of seeking to make sense of their experiences and the world around them (Karon, 1996, pg. 38). The therapist can gently call the person’s attention to inconsistencies but at the same time respect their vision. The results of a psychosocial approach to those with severe emotional distress has been proven
to be more effective than the current biopsychiatric methods as evidenced by a study by Mosher where he took schizophrenic adults who were on either very low doses or no medication, and offered them a ‘safe place’ with non professional staff residing with them and sharing in their daily experiences. A 2 year follow up of these patients noted higher levels of success and progress than their counterparts who were subjected to neuroleptics and psychiatric hospitalization (Mosher, 1996, pg. 53). The model known as the Soteria project was based on principles of growth, development, and learning. All facets of the distressed person’s experience were treated by the staff as ‘real’ (Mosher, 1996, pg. 49). Limits were set and mutual agreements made with the patients if they presented as a danger to themselves or others. Such a model could be adapted to use with adolescents, offering them the need for compassion, empathy, and finding that ‘safe’ place, restoring within themselves a feeling of worth and dignity that will lead to their ability to address the issues of their distress and traverse towards recovery. It should be understood that recovery means being able to overcome distress, not being a lifelong consumer of toxic drugs.
What can we do to recreate a mental health system which is humane? First, we must stop looking through the eyes of a medical model, where we see people as broken and disordered and attempts are made to attributing their behaviors and emotions solely to a malfunctioning brain. There is no evidence supporting the psychopathology of a number of disorders. The linkage between the pharmaceutical companies and psychiatry needs to be evaluated as well as the information that is disseminated via the research and materials provided by pharmaceutical company money. The goal should be to examine the underlying factors of a person’s behavior, looking at the person with dignity and respect, and seeing the person as one in conflict rather than a person who is disordered. Such stigmatization remains indefinitely, and labels can often become a self fulfilling prophecy and will follow for years to come and shape the way that one views themselves and also the way others view them.
We cannot look to solely the most cost effective solution when people’s lives are at stake. Indeed, providing a prescription may control aspects of behavior and be thought to have a ‘therapeutic effect’ but never gets to the root cause. Second, the realm of psychotherapy must return to its original roots. The word psychotherapy literally means the healing of the soul. We must return the soul to therapy, encouraging therapists to instill within themselves the principles of compassion and empathy that are crucial for any therapeutic relationship to blossom forth.
Therapists need to be compassionate and creative, and willing to give additional time and effort to see that a person’s needs are met and to also provide community linkages and ongoing support within their environment and to encourage the least restrictive setting. The coercion into forced ‘treatments’ needs to be eliminated. Third, our society must change in its attitudes. We are a society where we try to find our answers to ailments within a simple pill. We are a society that has unfortunately lost sight of the welfare of those vulnerable and in need. We are a society where we are prosperous, yet greed often blinds us. Somewhere along the line we have failed our fellow human beings.
We need to rely less on psychiatry and its devices to solve our problems and more on what we can do within ourselves- to take a holistic approach, to understand the person as a whole person- physical, emotional, and spiritual, and to examine in each of these areas where there may be difficulties that can be alleviated. We need to rely less on others dictating the course of our own lives and develop workable plans within our own family structure. Nothing will ever be perfect, but even in the most serious disturbances, love and compassion can heal much.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.