When I started to specialize in psychiatry in Finland in the early 80’s, the psych-scene looked quite different from today. The dominant rhetoric was psychoanalysis, and we all, including psychologists, social workers and psych nurses, were expected to learn to speak ‘psychoanaleeze’ and see patients one-on-one once a week — sometimes twice a week — for years. Those were the days.
I soon became a disbeliever. Psychodynamic therapy took years and only a minority of people seemed to benefit from it. Lots of patients complained that their therapists were sitting on their chairs silently throughout the sessions. Many became so dependent on their therapists that they needed hospitalization when their therapist was on summer vacation. Others cut their relationship to their parents because they learned from their therapists that all their problems were caused by their parents. Most people who entered individual therapy because of marital dissatisfaction ended up divorcing their spouses. Some could give long and boring lectures about why they had their problems but didn’t have a clue about how to make their life better. Also, children were forced to go to long-term therapy and when their parents complained about lack of progress, or even worsening of the situation, the parents were criticized for sabotaging their child’s therapy and told to obtain individual therapy to work through their own issues.
To me, psychoanalysis appeared like a pseudoscientific cult that had somehow succeeded in infiltrating the medical establishment. It baffled me how they had succeeded in doing so. Representatives of the movement had conquered a position in society where they were not only indoctrinating mental health professionals into Freudian beliefs, but also other medical doctors, educators and even kindergarten teachers. They were adamant in getting the whole world to swallow their unfounded beliefs about the origins of mental health problems.
I didn’t like psychoanalysis. I suggested to my professor, who wanted me to do a doctorate, that I study the adverse effects of psychotherapy. He was a psychoanalyst — not unlike all the other professors of psychiatry and child psychiatry at the time — and of course he immediately rejected the idea. At that time, it was taboo to even suggest that psychotherapy could cause adverse effects. Everyone was supposed to believe that psychodynamic therapy was superior to any other form of therapy. If the symptoms of a patient became worse during the course of therapy, it was not because there was something wrong with the therapy but because the therapy had revealed that the patient was, in fact, more seriously disturbed than was evident at the outset. I abhorred the twisted and self-serving logic of my psychodynamic colleagues.
I was a dissident. I had become interested in family therapy in general, and solution-focused brief therapy in particular. These were promising approaches to helping patients and their families, where the focus was not on the past but on the future. The therapist was not a passive listener but an active participant whose task was not to help patients discover the presumed underlying roots of their suffering, but to support them in finding solutions, in figuring out what they could do to improve their life. Brief therapy made much more sense to me than psychodynamic therapy and instead of keeping the patient in therapy for years, in this kind of therapy the number of sessions was kept to a minimum and patients were not led to believe that all their problems stemmed from their bad childhood.
I tried to question the psychoanalytic belief system, but it was not possible to argue with believers. Their argumentation didn’t follow any logic known to me. One colleague said that psychoanalysis must be a valid system because it had been there for so many years. Another said that my criticism of psychoanalysis must be caused by some mental health issue of my own. He said that I probably had some issues with attachment that made it difficult for me to commit to the kind of long-term relationships that are required for long-term therapy. A third one said that I was not in any position to criticize psychoanalysis because I was not sufficiently analyzed myself. Two colleagues, both psychoanalytic child psychiatrists, filed a complaint about me to the ethical committee of the Finnish Medical Association, accusing me of non-collegial behavior as I had publicly criticized child psychiatric treatment methods without being a child psychiatrist myself. According to the complaint — which was turned down by the ethical committee — adult psychiatrists like me were not entitled to present criticism toward child psychiatry. Criticism toward the field of child psychiatry, according to them, could only be presented by child psychiatrists, not adult psychiatrists.
It was a frustrating struggle. I don’t think I succeeded in bringing about any change. I only managed to piss off my analytically minded colleagues. I think I even became a persona non grata for several years within my profession. But fortunately, I didn’t care too much. I had already set my foot on a different path. I was thrilled about brief therapy and in those days many other people in the field of mental health shared my enthusiasm with these innovative methods.
I focused on spreading information about brief therapy to like-minded professionals and even the public through hosting a mental health-related talk show on national TV that ran for more than 200 episodes. Today, solution-focused therapy (also known as collaborative or resource-oriented therapy) is in my country an officially recognized therapy method that patients can be reimbursed for by national health insurance.
While I was busy spreading the good news about solution-focused therapy and shying away from criticizing psychiatric conventions, psychiatry was going through big changes. The psychoanalytic belief system was thrown out and replaced with the DSM and the biomedical doctrine: everyone should have a diagnosis, and everyone should have medication. All the conditions that had previously been treated with therapy were now treated with medication, which had become the treatment of choice for almost all mental health conditions regardless of whether the patient was an adult, teenager or child. A patient without medication became a rarity. The data system of mental health services required clinicians to diagnose anyone who sought help. For years I had hoped that psychiatry would free itself from the psychoanalytic doctrine, and when my wish finally came true, my profession went from the frying pan to the fire.
But I am struggling on. I am a member of the international critical psychiatry network. Over the years I have written several letters to the editor that have been published in our main newspaper, I am active on the closed Facebook site of the Finnish Psychiatric Association, and sometimes speak directly to policy makers such as the head of our National Health Insurance Institute.
My main goal, currently, is to convince professionals as well as the public that most child psychiatric problems can be handled effectively without medication. Together with my colleagues we developed in the 90’s a method that we have called Kids’ Skills. It is a simple method that anyone can learn which is based on the idea that children’s problems do not need to be thought of as psychiatric disturbances but as a lack of some psychosocial skills that children haven’t learned yet.
Kids’ Skills provides a protocol for figuring out what skill the child needs to learn, and a means of engaging the child’s parents and friends in helping the child develop the missing skill in a fun and rewarding manner. Books and other materials about this method have appeared in more than 20 languages and there are trained Kids’ Skills coaches in many countries around the world. I have even created an app about the method that has been translated by a volunteer translator into several languages including Russian, Spanish and Chinese. I like to think that people will realize that we have come to the end of the rope. It doesn’t make sense to medicalize the entire population. Let’s start making the world a better place by helping our children to overcome their problems not with drugs but with support and help from their peers and parents.