Paradigms Lost

As a quiet, withdrawn child, I knew in my bones that 186 Balmoral Avenue — the gothic, stucco-brick, three-storey house in mid-town Toronto where I lived until age seven — was inhospitable to children. Sometimes, when I wandered alone through the dark rooms, I felt sure that some daunting, suppressed secret was about to burst out of the cast-iron radiators, flooding the hardwood floors. I was born an archaeologist of silence.

I had no way of knowing that the house was built in 1914 by my grandfather, John Gerald “Gerry” FitzGerald, a driven, red-headed doctor of international stature who died under mysterious circumstances ten years before I was born. During my childhood, my father, Jack, a pioneering immunologist who inherited the place after his marriage, never spoke of his father. While my sister, brother and I grew up “having it all” – sports car, swimming pool, private schools, European vacations — our material prosperity was infected by a profound emotional poverty, a chronic “affluenza” embodied in the American presidential family homily we so slavishly emulated: “Kennedys don’t cry.” Even though our father Jack worshipped his namesake JFK at the altar of the TV set, he never made much of the coincidence that he shared the same birthday – May 29, 1917 — with the doomed Irish-blooded president. But I did.

The political turbulence of 1960s coincided with my own adolescence and the unraveling of our family. Following the Kennedy assassination in 1963, my father sank into a protracted mid-life crisis, culminating in reckless drug abuse and, in 1970, two attempts at suicide by jabbing morphine into his arm. As I watched a chain of emotionally-illiterate, electro-shock and pill-pushing psychiatrists botch my father’s treatment – in fact, driving him into a psychotic state — I wondered why everyone was ignoring the elephant in the room: the haunting influence of my extraordinary grandfather Gerry on my father’s life. And, of course, my own.

After studying arts at university, I drifted lethargically through a string of under-achieving jobs in journalism and book publishing, suffering a kind of success-phobia. The iatrogenic fiasco of my father’s “treatment” led me to embrace the countercultural rhetoric of the Laingian anti-psychiatry movement, but for a long time I remained suspicious of even the most humanized forms of help.

Then, in my late twenties, I befriended several members of “Therafields”, a grass-roots, lay therapeutic community born in mid-Toronto in the early 1960s. Their eclectic philosophy drew on an experimental mix of Freud, Jung, Klein, Winnicott, Reich, Laing, Sullivan, Bowlby, Kohut, Fairbairn, Bion, et al; the approach was psycho-dynamic, bio-energetic, inter-active, humanistic and non-medical, respecting the power of dreams, transference and resistance. In addition to house groups in the city, marathon group therapy weekends unfolded on an organic farm in the rolling countryside north of the city.

Many of the therapists were brilliant apostate Catholic priests and nuns busy breaking their vows of celibacy while wedding liberation theology to depth psychology. At its zenith in the 1970s, the community attracted nearly 1,000 people, especially artists and writers, and this fact alone earned my attention. But after several visits to the farm, I felt Therafields, while not a bona fide cult, emanated cultish “us-versus-them” vibrations, and I backed off. Only with the dissolution of the community in the early 1980s, and the establishment of a formal academy (the now highly respected Centre For Training In Psychotherapy), did I take the plunge, hastened by a failed romance. My stoic Irish forebearers were destined to look forward and forget; I was destined to look back and remember.

I was lucky where my father wasn’t; I met the right man at the right time and I hit the ground running. In our first session, Peter latched onto my Irish surname, suggesting that the legacy of my ethnicity was something I should take seriously. Soon I sensed my salvation depended on my laying bare the secrets of my paternal bloodlines. In my sixth session, I brought in a seminal dream that would prove prescient of my future searchings: wielding a scalpel, a doctor in a white lab coat made a deep, vertical incision down the middle of my face, releasing a violent, Niagara-like torrent of water. Dreams, I was learning, do not yield to a single interpretation, but I sensed that the image symbolized the accumulated generations of untapped grief of which I was the contemporary carrier. And the image hinted at my psychic split, the precise, ultra-rational, surgical hand of schizoid Western civilization that cut my head in half in the bloody moment of my birth: an agreeable, polite, deferential, Canadian persona masking my wild animal nature, my exiled Irish madman. In my family, the implicit male mantra was: “Go big or go home.” To me, it felt more like: “Go big, and go crazy.”

In concert with my ongoing individual and group therapy, I burrowed through the stone wall of my father’s denial by delving into archives, letters and photo albums. Year by year, I obsessively retraced my grandfather’s nomadic footprints through the cities of Europe and North America and questioned aging former colleagues. I was amazed to learn that Gerry had been a medical trailblazer of international influence. My family story was inextricably bound up in an epic drama, one that had been entirely withheld from my siblings and me. Why? What was my father trying to protect us from?

In the generation between the world wars, I discovered, Gerry boldly conceived and built the modern institutional infrastructure of Canada’s public health system. His Connaught Laboratories and the allied University of Toronto School of Hygiene, funded by the Rockefeller Foundation, became a paragon to the world and led to the effective control or eradication of a litany of deadly diseases, including syphilis, diphtheria, rabies, tetanus, meningitis, typhoid, scarlet fever, tuberculosis, smallpox, influenza, diabetes and polio. The Nobel Prize-winning discovery of insulin by Fred Banting and Charles Best in 1921-22 was merely one feather in the cap of his fledgling institutions. (Acknowledging the pivotal role of my grandfather, Best declared: “There would be no insulin without FitzGerald.”) By the late 1930s, The New York Times was praising the visionary Canadian public health model, with its unique blend of training, research and production and distribution of free preventive medicines as a public service, as the finest in the world.

Naturally the question burned inside me: why had the memory of this extraordinary man been virtually erased from family — and national – consciousness?

Early in my research, I was intrigued to discover that in 1907-08 Gerry worked as the first neuropathologist of the Toronto Asylum for the Insane, cutting open the brains of Irish paupers — the Irish dominated the populations of North American asylums — in a fruitless search for the germ of madness. Here Gerry met Dr. Ernest Jones, the Welsh colleague and future biographer of Sigmund Freud. “Living in sin” in Toronto with his sister and his morphine-addicted Jewish mistress – in fact, in the very neighbourhood where the Therafields community would emerge two generations later — Jones provoked widespread alarm in the city’s puritanical, anti-Semitic WASP medical establishment, not only for his unsavoury lifestyle but for challenging the medical model of the mind and embracing issues of psycho-sexuality. Gerry admired Jones’ intellectual dynamism and they exchanged letters and papers; Jones even gave Gerry the complete works of Freud as a wedding present.

Eventually Jones, the tactless Freudian proselytizer, was virtually run out of town in the wake of an alleged sexual harrassment scandal. My grandfather gradually lost contact with Jones and while deepening his connection with Dr. C.B. Farrar, whom he had first befriended during a stint at Johns Hopkins in Baltimore. Farrar was an orthodox, organic-minded psychiatrist of Irish Protestant blood who became a long-time editor of the American Journal of Psychiatry and founding director of the Toronto Psychiatric Hospital; he once condemned Communism, Catholicism, unionism and psychoanalysis as “the Four Horsemen of the Apocalypse.” With the departure of the radical Jones, the new psychoanalytical ideas about dreams, sex and repression did not take root in Toronto for another 40 years — such was the city’s aversion to the subversive power of Freudian and post-Freudian thought.

In 1908, my young grandfather quit neurology and psychiatry in favour of a career in the related but separate fields of public health and preventive medicine. The recent death of his invalid mother at age 50 had precipitated a nervous breakdown in his father, a village pharmacist whose drugs had failed to save her; it was at this time that Gerry began an intense period of international travel, education and training –- perhaps, paradoxically, escaping his troubled father in order to save him. Did such an intense family dynamic form the seedbed of a grandiose saviour complex? Was my grandfather being driven to give something back, not only to his family, but the global masses, reaching all the way back to the dim corners of frail Father Ireland?

###

Following a 1991 pilgrimage to Ireland, I visited my aging, reclusive father who in 1975 had retreated into a shabby, one bedroom rented apartment in a mid-Toronto highrise. Since his suicide attempts, the loss of his once-thriving medical practice, and separation from my mother, my 74 year old father has regressed into a cracked-leather Lazy-boy armchair and stared at television in a zombie-like, lithium stupour. His health stripped by years of drug abuse, he had long refused to receive old friends; he could tolerate my own presence for an hour at most – mirroring the length of my infinitely more rewarding leather-chair sessions with Peter.

As I reported details of the mythic rise and fall of the FitzGeralds over centuries of Irish history, he retained the familiar deadpan silence that had formed me so indelibly. To the end, my father the immunologist remained immune to my overtures, as if he had withdrawn inside the dungeon of a crumbling Norman castle, pulled up the drawbridge, and condemned himself to a netherworld of solitary confinement. When he died in 1992, his secrets died with him.

But the power of the uncanny never deserted me. In 1995, I visited the psychiatric archive at the former asylum where my grandfather had worked as the young neuropathologist probing the brains of Irish “lunatics.” Here, miraculously, I made the discovery of my dreams: 60 intense, confessional letters written by Gerry in 1939-40, the last year of his life. He was languishing in a private sanitarium in Hartford, Connecticut, being treated for depression in the wake of a failed suicide attempt. The letters were addressed to his close friend, Dr. Clarence B. Farrar, the thin, cerebral director of the Toronto Psychiatric Hospital where, ironically, a generation later, my father was drugged and shocked into submission. Astonishingly, the letters, sitting untouched in a drawer for 45 years, had been donated the very week I walked into the archives. In yet another irony a novelist would hesitate to invent, my grandfather, a father of insulin, suffered 57 insulin shock treatments, an experimental, barbaric, coma-inducing practice, eventually discredited, that killed roughly 5% of its victims. Even its inventor, Manfred Sakel, admitted that insulin shock was akin to medieval torture.

Electrified by my grandfather’s inner world, I devoured his anguished outpourings in one sitting. Here, at last, I found a compelling yet cryptic clue to the repressed secret of his unspeakable end. Throughout the letters, Gerry eerily repeated the haunting sentence: “I have committed the unpardonable sin — and the penalty is death.” Though not a religious man, he pleaded to see a Catholic priest, but he was refused; the psychiatrists despised Catholics as much as Freud. Talk, confessional or cathartic, was verboten.

Serendipity led me to an aging doctor in a Vancouver nursing home who turned out to be the last person alive who knew the truth. His shocking revelation confirmed my own decades-old intuitions, spawned by my childhood nightmares in my grandfather’s house on Balmoral Avenue. Over years of time-traveling, a train of epiphanies, large and small, had popped like flashbulbs, melting the generational sheets of body ice, leading me inexorably to the buried psychogenic family secret. My arduous exhumations — in the “real world” and in my dreams — paid off in Hollywood-like fashion, echoing the sled burning in the furnace in the final scene of Citizen Kane. At last I understood — and could ultimately forgive — my father’s silence. From terror was born liberation – and a book.

###

Since the 2010 publication of “What Disturbs Our Blood” (a line from Yeats), the paradoxes and ironies that abound in my book continue to play out in my daily life. I have lectured several psychiatric audiences, including the very institutions that blindly shocked and drugged my father. In my talks, I drive home the fact that it was a long-term psychodynamic talk therapy, coupled with the parallel act of dream-fed writing, that diverted me from the fateful paths of my father and grandfather. I challenge the entrenched idea, backed by the mass media, that only an M.D. is qualified to help people in emotional distress; I quote the taboo statistic that psychiatrists suffer suicide and addiction rates twice the national average; I suggest that without being required to undergo a rigorous emotional self-scrutiny of their own, well-intentioned yet head-centred (and memory-killing) doctors risk committing more harm than good (and they are able to bury their mistakes).

While grateful to be heard, if not heeded, I am dispirited by the inescapable fact that the fundamental stance of bio-medical psychiatry remains unchanged since my grandfather’s time – “mentally ill” people managed like stock portfolios, reduced to diseased brains and bundles of genes and biochemicals that can be quantified, manipulated and cured “scientifically” by bio-tech and surgical interventions. Magic bullets as magical thinking.

After one of my talks, a psychiatrist rose to declare: “James, biomedical psychiatry will answer all of these questions one day.”

I was so disarmed I did not respond as I might have wished: “The day we have answered all questions is the day we have entered a fascist – or psychotic – state of mind.”

As ruthlessly as my grandfather and his colleagues eradicated diphtheria, medical psychiatry has eradicated the sine qua non of true healing: our primal human need for sustained human relationship. To remember, to speak, to be heard, to feel, to make meanings in the presence of a trusted and reliable other in a safe, confidential and ideally non-medical setting, free of stigmatizing labels that can last a lifetime. In the words of Flaubert: “You can’t find the soul with a scalpel.” Whenever I tell audiences something so basic, obvious and self–evident, it is often received as a radical new insight, as if they had never allowed themselves to consider that perhaps, just perhaps, it is possible that a person can driven mad by his or her school and/or family. Whether consciously or unconsciously, it’s people who drive us crazy — and it’s people who can heal us.

In a stunning, public “mea culpa”, Dr. Allen Francis, the outgoing editor of DSM IV, recently confessed that the psychiatric diagnostic machinery has swollen into a Frankenstein monster, driven by the vested interests of drug and insurance companies, a force the psychiatrists themselves are impotent to redress; we are all left in the wake of the depressing fact that GPs now prescribe 80% of anti-depressants. It’s a scandal of epic scope: the Sorcerers no longer control their apprentices.

For all the talk of “de-stigmatizing” mental illness, the doctors fail to recognize that they are the first and worst offenders, labeling a troubled person as “bipolar” or “schizo-affective” in order to match specific “symptoms” to a specific coded diagnosis and a specific drug. People are made to believe their condition – in the vast majority of cases, induced by intolerable life stresses — is a medical and disease that can be targeted like a tumour; the emotional, social and environmental determinants of their health are deemed secondary, even irrelevant. The strength of the hospital setting — settling down people in extreme crisis – leads to its fundamental weakness: institutions may save you from drowning, but fail to teach you how to swim. (Or refer you to the right person who can teach you how to swim). Within the psychiatric model, no single, dedicated human being sticks it out with you, face-to-face, week by week, staying emotionally open and available, for however long it takes; he or she has drugs to prescribe, papers to write, studies to publish, ladders to climb, a career to manage. In the words of the Laurie Anderson song: “Only an expert can deal with the problem.”

The University of Toronto Department of Psychiatry is now over 800 strong, the largest in the world. Over-compensation remains deeply rooted in the Canadian psyche, still agonizing over its historical colonial status, outshone by our British and American cousins. We have much to prove, as if still driving over the top at Vimy Ridge. Dreaming of Nobel Prizes, we promote grossly invasive procedures such as Deep Brain Stimulation, surgically implanting electrodes into “Area 25” of “treatment-resistant” brains: drill, baby, drill. The media report such “breakthroughs” uncritically, as we did in the days of lobotomy; bioethicists go AWOL and desperate patients submit their “informed consent” and their bodies to the unimpeachable authority of science. What looks like short term “success” – a remission of outer symptoms that have in fact, under the hammer, simply retreated underground — justifies wider application, and the inevitable backlash. When patients relapse, as they inevitably do, the solution becomes: more of the same. Doing something, anything, is always regarded as better than inaction. For them, sitting and talking and listening and feeling and remembering and relating in a therapist’s office looks like “doing nothing.”

As long as psychiatry categorically denies the existence of the universal phenomenon of unconscious resistance — that people paradoxically undermine the very help they seek – they collude in a Sisyphean enterprise. Until the resistance is respectfully engaged and understood, no real change is possible; indeed, iatrogenic fiasco lurks round the bend. And when the worst happens and a patient kills herself, the response is typically reduced to an impotent question: “Why didn’t she take her meds like I told her to?”

###

As of October 2014, my home province of Ontario has, at long last, regulated the profession of psychotherapy. We can only hope that the two solitudes of medical and non-medical models of therapy will finally break their long history of mutual antagonism and forge systems of referral (complementary if not complimentary), rendering unto Caesar what is Caesar’s and steering the rest – the less disturbed people desirous and capable of forming a face-to-face therapeutic alliance — into the safe harbour of the humanities. Once we start to view most forms of madness as radical adaptations to intolerable stress and cumulative personal traumas, large and small, not an organic disease you spontaneously catch like pneumonia, then everything changes. We are formed, and informed, by our relationships, our histories, our experiences, our memories. We must hear ourselves telling our own stores, or else our stories will tell us.

Much of the qualitative power of talk therapy stems from its inherent subversion of the quantifiers of the status quo. The ever-evolving art of psychotherapy – from the Greek, meaning “soul healing” — is still in its infancy; perhaps its very survival and success depends on a perpetual guerrilla action — hit-and-run beserker Celts confronting the armoured rows of Roman legions and their bio-tech, amnesiac war machine arrayed against the threat of strong human feelings.

My grandfather’s generation of public health doctors did not do what they did for money, fame or professional status. Neither did the brilliant, compassionate and intuitively gifted lay therapist with whom I worked; the struggle was its own reward, an enterprise more closely allied with the arts and spirituality, the polar opposite of white-coated pseudo-science.

For all of its own demands for “proof”, science has proved nothing in its misguided quest to correlate biological markers with complex and mercurial human behaviors, for it assumes the existence of something that does not and cannot exist — “normality” – a subjective social value impossible to define objectively in a teeming, quirk-infested universe. And yet the credentialed psychiatric taxonomers of the DSM, driven by their own obsessive-compulsive disorders, continue to dissect and parse the human organism into ever-thinning slivers, losing sight of the proverbial forest for the trees.

Do we dare to dream of an impending golden age of humanistic psychotherapy? Of magic words disarming magic bullets? As R.D. Laing once observed, a breakdown can be a breakthrough. The “talking cure”, paradoxically, shows us what we can’t be cured of; that we are ultimately living in a human condition not a medical condition; that talking is useless another person is listening. Better, perhaps, to call it the listening cure.

For genuine change, growth and healing to take root, a certain degree of suffering is not only unavoidable but must be felt and experienced in small increments in a safe, confidential setting, face-to-face with a well-trained, empathic human being. If that human being happens to be an M.D. psychiatrist, so much the better for the redemption of a profession that has much to answer for. The journey is a noble one, the deepest kind of self-education, a seamless part of the life journey itself, full of revelation and personal meaning, where shame and stigma find no place. And if a truth sets us free, we know it’s largely because we allow ourselves, at some point, to be disturbed by it.