Trauma Blocks the Frontal Lobes – “Verbal Physiotherapy” Can Unblock Them

Bob Johnson, MD
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Medically speaking, the DSM is unfinished business. That’s the polite version — there’s worse. “The DSM authorises slipshod or substandard medical practice” is a more realistic verdict, which medical editors cannot stomach. The way the DSM is set up, medically, means it cannot staunch the two running sores in today’s psychiatry, namely: (1) Why does trauma continue to inflict damage, decades later? And (2) Why does trauma make the frontal lobes and the speech centre go off-line?

I’ve just sent off five papers to established medical journals in as many months, covering the above points — all perfectly feasible, well-referenced and cogently argued. All five have been rejected with fatuous or unprofessional comments — medical tunnel vision, in spades. In 2003, I reviewed Robert Whitaker’s book Mad In America for New Scientist, having been awed by it. Since then, I’ve watched in growing dismay as my favourite medical specialty continues to shoot itself in the foot.

You think I exaggerate? Can it really be that bad? Check out the latest news. On Monday, 23 July 2018, The Guardian reported, under the heading “Sexual assaults — Link to mental illness”:

“Four out of five teenage girls who have been sexually assaulted are suffering from crippling mental health problems months after their attack, research has found. . . . Experts said the findings had confirmed that becoming a victim of abuse in childhood could lead to mental health issues, which could last a lifetime.” [emphasis added]

“Hello, Teenage Girl, I’m sorry to hear you’ve been sexually harmed. I am such a skilled expert in psychiatry that I can assure you, you will be damaged by this single event for the rest of your life.” If that doesn’t make your blood boil, just a little, something’s amiss.

This is running sore number #1 from above. It would seem to any normal doctor, and to everyone else, that any mental symptom afflicting these teenage girls comes as an obvious “reaction” to sexual harm. Not so, if you’re a DSM-doctor — this simple connection is explicitly not permitted under DSM rules. On page xvii in the DSM-IV, we find: “DSM-II was similar to DSM-I but eliminated the term reaction.” This runs directly counter to clinical reality — the whole of non-psychiatric medicine relies precisely on finding just what the present symptoms are a reaction against. Incidentally, DSM-II, for those who bother to check, is replete with “reactions.”

An Aetiological Vacuum

Which leads on to aetiology, medical-speak for “causative factors.” How can you possibly hope to do any good, medically, if you declare a blank non-interest in what brought this illness on? “You’ve a pain in your leg? My psychiatrist’s bible instructs me not to ask if you recently fell over.” Again, you might think I exaggerate, but check out page xvii, in DSM-IV: “DSM-III introduced a number of important methodological innovations, including . . . a descriptive approach that attempted to be neutral with respect to theories of etiology.” Thereby wantonly sabotaging millennia of medical practice, since before Hippocrates. This approach couldn’t last microseconds in all other branches of medical practice, where ameliorating causative factors is the be-all and end-all of what doctors seek to do. Ask any non-DSM doctor.

I was a family doctor for 20 years, and the chief delight there is puzzling out, in the best Sherlock Holmes manner, which of the preceding events mattered most in bringing on any given medical problem. Digging that bit deeper, asking the unexpected, uncovering unacknowledged causes, all these add grist to an ever-growing medical skill, but not if you slavishly follow the DSM dogma — a dogma which “neutralises” aetiology. Is this substandard medical practice or what?

How can you expect to link sexual harm to psychiatric pathology, if you are debarred, by the DSM, from exploring aetiology? It sounds ridiculous even to suggest such a thing, and non-DSM doctors would find it hard if not impossible to believe — but there is it in black and white, and confirmed by the painful fact that running sore number #1 (Why does trauma continue to inflict damage?) continues unabated.

One of the five medical papers I’ve recently had rejected (April 2018) was based on a tight textual analysis of the differences between the ICD-10 and DSM-IV. A high court case turned, legally, on these differences, which meant I needed to rehearse them well enough to be able to explain them to a non-medical jury. This is why the page references here are to DSM-IV. DSM-III and DSM-5 are much the same.

Ordinary Physiotherapy & Patient Agency

The third gross medical flaw in the DSM was a bit of a challenge to convey in terms a jury could readily pick up. This is because it is quite impossible to define scientifically. It goes by the medical term “Patient Agency” — it’s what the patient does, believes, chooses, thinks. It can get all tangled up with philosophical arguments over free will and such. But again, it is 100% indispensable in any medical practice. If the doctor doesn’t chime in with what that particular individual opines, then medical progress is likely to be slow.

DSM-IV doesn’t even bother to debate the issue, but buries it behind a wodge of shallow sophistry on page xxi, where dust is thrown in the reader’s eye by way of such obfuscations as “body-mind dualism” and “problems raised by the term ‘mental’.” So let’s move promptly into something entirely uncontroversial — physiotherapy. Drop in on any physiotherapy clinic anywhere in the world, and you’ll find sturdy physiotherapists actively, and enthusiastically, engaging with Patient Agency.

Try imagining physiotherapy without it. Instead of “Try that bit harder, you can move your arm a little bit further” you’d be talking to yourself. And the patients in your care would stultify. You cannot have physiotherapy without Patient Agency. Nor can you, in my 60 years medical experience, have any other clinical practice without it either. How the DSM thinks it can get away with trying to do so, beats me.

So what would you think if, instead of the current wide gamut of psychiatric “treatments,” you had something which only worked if the sufferer knew what you were trying to do, and then engaged their “will power,” or Patient Agency, or whatever else you like to call it, to do it? It stands to reason, if you want the person in front of you to think differently about their problem, then you have to engage with what they think, and thereafter, what they’ll do, i.e. in their Patient Agency. A point even more vital in mental healthcare than anywhere.

Which leads us to Dr. Bessel van der Kolk. Way back in 1996, in his book Traumatic Stress (page 193), following groundbreaking work with traumatised people, he coined the telling phrase “speechless terror.” Look at that term. Here terror stops you from speaking. Is that significant? Does it apply more widely?

In a recent video Bessel calls this having a stroke. I call it a trauma-stroke. He gives us the wonderful notion that trauma makes the frontal lobes and the speech centre go “off-line.” So look closely at what he did. He played an audio tape of music, say, to someone whose brain he was scanning, and all was well. He then played a tape of the gunshot, the car crash, whatever that traumatic event had been, and to his surprise, and my delight, the frontals and Broca’s area of the brain (which is linked to speech production) no longer worked — they shut down.

I put this evidence centre stage. This is the one and only brain scan evidence that applies universally in psychiatry. The mind is difficult to read at the best of times, and impossible to read with a machine, so here we have something scientific, something objective, something available to anyone with the right equipment: trauma stops you from thinking straight. What could be more obvious? Stops you from talking straight — is that a serious issue for clinical personnel? I should say so.

Running Sore Number 2

Of the two running sores which currently afflict today’s psychiatry, the most injurious is the observable fact that all past events fade from memory, in the ordinary way, except the worst aspects of trauma. Why does the gunshot still ring in the head, the car keep crashing, the rape keep recurring — all in the head, no longer in reality — even decades later? Why? What can possibly account for such pathological remembering?

Just pause for a moment and consider how ordinary medical consultations proceed. The patient tells the doctor what’s been going wrong, and the doctor works out what’s best to do about it. See that verb, “tells.” What if the speech centre is “off-line”? What if the words simply don’t come out, just as happens too often with ordinary “strokes,” or cerebro-vascular-accidents (CVAs). What then? Trouble, that’s what.

So this is the number one reason why talking about abuse is so difficult: the words are blocked. Being a family doctor for so long, I was able to study childhoods, untrammeled. Thus in 1986, I asked a woman I’ll call Grace to address an empty chair on which we’d agreed to place an image, a memory of an abusive parent. “Hello parent, I’m an adult.” I knew enough by then to invite her to say that. Guess what? She couldn’t. I was astonished. She then turns to me, and repeats these words verbatim — no problem there. On turning back to the empty chair, her mind went blank — no words would come out. Frontals off, frontals on, within seconds. You can be sure this was a wowee moment. (Don’t try this at home — a prisoner threatened to garrote me, because I went too fast. Beware!)

This is where Bessel’s frontal blockages show themselves in practice. He proved they exist by obvious, objective, mechanical brain scans. Grace, and so many others, confirm their impact, clinically, by their selective speechlessness. Talking about trauma runs up against speechless terror — the terror from long ago stops speech today. Not an easy point to pick up. But Bessel’s brain scan work is irrefutable. Anyone can repeat it, any time — something you can rarely say about any other psychiatric evidence.

So if you reclassify trauma effects as trauma-strokes, and you adapt physiotherapy to take this irrefutable clinical evidence into account, then you come up with Verbal Physiotherapy — at least I do.

Now, I’m not going to tell you I’ve solved running sore number #2 — why the frontals go off-line — except to say that the abused child adopts a psychological defence: “This isn’t happening to me.” Whereupon in later life, it is hard to reverse that and say, unequivocally, “This has stopped happening to me.” The circumstances pertaining to such a reversal have to be utterly different from those prevailing at the time of the trauma, something which is often surprisingly difficult to achieve.

In fact, what is so astonishing about running sore number #1 is that the pain remains to such an extent that it blots out many earlier pleasures. Here we have both clinical and brain scan evidence (running sore number #2) as to why — the memory of the trauma is so deeply imprinted, it blocks thinking and speaking about it. Which is why it persists. However, if you are prepared to engage Patient Agency, and can gain wholehearted consent to broach quasi-lethal memories, then you can re-engage both frontals and speech centre — provided all the circumstances are propitious enough (a vitally important proviso).

How “Verbal Physiotherapy” Works

Where better to trial-run this than in a maximum security prison? In 1991, I found myself as a consultant psychiatrist in a Special Unit for violent, unstable, ill-disciplined lifers in Parkhurst Prison on the Isle of Wight. If it worked there, it’d work anywhere.

Start with Exhibit One: I asked the prisoners, “Why did you murder?” The verbal “answer” from the 60 murderers I got to know well was a blank — their frontals and speech centres were “off-line.” “S/he had it coming,” “a red mist came down,” “I just lost it.” As far from the world of Agatha Christie as you can imagine. There certainly were potent motives for homicide (there always are), but ask the perpetrators what their motive was, and you’ll draw a blank — just as you often will for other victims of Adverse Childhood Experiences. Something happened, something dreadful, but talking about it is uphill work, believe me.

So I put into practice in that prison what I had learned in family medicine: Sit your abuser down in that empty chair, and tell them they can’t hurt you anymore, because you are now an adult. Guess what? It took months, even in some cases years for many of the prisoners to be able to do it. “My mother has always been taller than me — and always will be,” one prisoner insisted. “I can’t say the words ‘hello parent, I’m an adult’.”

Verbal physiotherapy works in the same way as ordinary physiotherapy — start with the remaining healthy bits, and grow them, encourage them, empower that Patient Agency to fill out the parts that have been damaged. So as with Grace above, I gently encouraged these damaged prisoners to repeat, “Hello dad/mum, I’m an adult.” Some just couldn’t say the words, others got so angry with me that they threatened to kill me — and threats to kill from convicted murderers who have shown they know how to do it need to be taken seriously. As above, DO NOT TRY THIS AT HOME. There are powerful emotional reasons why those frontals have gone off-line — it takes a lot to convert homo sapiens into homo non-frontalis.

But gradually over the months, with gentle verbal exercises, persistent consensual explorations, and limitless optimistic enthusiasm coupled with unimpeachable emotional support, those speech centres began clicking over again. Not every time, not with everyone — some were still protesting that at 5 foot 6 inches, they were still “smaller” than their 4 foot 6 inch mums. Some frontals are more difficult to kick-start than others. But after about 18 months, say by late 1992, the number of alarm bells at the prison fell to zero — no violence, no assaults. Verbal arguments, yes, but non-thought-through physical assaults, no. Previously there had been 20 alarm bells a year, and one serious assault every six weeks. By the end, in 1996, there had been none for three years — quite a record for any maximum security wing.

And the Future?

Skepticism is entirely appropriate. All this is bound to sound far simpler in words than it is in practice, as is invariably the case with everything else in clinical work. But it has to be simple, else I can’t understand it — and if you don’t know what you’re doing in medicine, watch out. There are bucket loads of pre-conditions which must be met in full if “verbal physiotherapy” is even going to begin, let alone work. But the same pre-conditions apply to ordinary physiotherapy. Lack of Patient Agency has already been mentioned as a deal-breaker — there are several others which need just as much emphasis, if not more.

And of course, if you swear by the DSM, the “psychiatrist’s bible,” then you are not even going to start. One point really sticks in my craw — it’s such arrant medical nonsense it beggars belief, while leaving “aetiological neutrality” in tatters. Check this out: “The term ‘organic mental disorder’ is no longer used in DSM-IV because it incorrectly implies that the other mental disorders in the manual do not have a biological basis.” (DSM-IV page 10) The standard motif in today’s psychiatry is “brain insufficiency,” thereby cleaving to this supposed “biological” basis for psychiatric ills. Permit me to stand this on its head and say: yes, brain changes do occur, and do underlie all irrational symptomatology — but they are traumatic in origin, they resemble CVAs (strokes), and as such remit under physiotherapy (suitably adapted).

Well, I favour the notion of trauma-strokes — it saved my life in Parkhurst Prison. It ties in so neatly with the well-known inability to verbalise what really happened. It answers running sore #1 pretty much 100% — of course you cannot expect dangerous events not to persist if the sufferer is “blocked” from ever thinking they’re “finished.” Further, the astonishing success that ordinary physiotherapy can routinely achieve with CVAs augurs well for mental recovery, even cure. Once those frontals start working again, as they should, and as they did before the trauma, then mental health blossoms — and is a delight to see.

However problematic “verbal physiotherapy” may appear, there’s no way it can begin to see the light of day until DSM-dogma relents. Until then, expect those two running sores to continue — while all the time, a more basic, well-documented approach is “blocked” from publication. Surely we all deserve better mental health care all round — wouldn’t you agree?

15 COMMENTS

  1. Interesting thoughts Bob. It’s refreshing to hear a professional discredit the DSM and yes the DSMII was different.
    I am not sure about the stroke analogy and um the reference to the mums. My guess is paternal or paternal like actors play a role in abuse. Easier to get angry at a female- and why is that?
    Also racism et al is also is trauma inducing in and of themselves. Inter generational personal, family, culture, gender is another damn layer.
    And economics! Macro and micro!
    And the environment!
    But thanks for your thinking! And I would really like to hear your own story.
    We are all trauma victims but ah so important to go beyond into better things.
    Did the folks in the system agree to see you? That would be helpful to know. Also were any released? Because any type of incarceration is trauma.
    The best thing you were able to elucidate for me was trauma’s impact.
    There is enough trauma is life when other types of trauma are either allowed and or made to occur that in and of itself is a divine human tragedy.

  2. I wanted to take time to thank Dr. Johnson for articulating one of the cruelest aspects of traumatic stress, for me. The working memory and communicative impairments associated with trauma/traumatic stress are things I tried desperately to `explain’ by using labels like `trauma babble’ as to why I needed help to access the MD and attorney that were the routes to the safety I so desperately needed. The fact is that despite having in other regards very good communication skills and having for years made my living as a public speaker, when it comes to attempting to respond to interrogation about a trauma I need help to escape- (usually the mental health workers who are sabotaging my access to medical care, as they are in gatekeeping roles and tend to profit by so doing) especially when as presumptive as MD’s and attorney’s can be, I am presumed to be lying and/or incompetent. The ONLY condition that eases this (is `perseveration’ as useful way to describe this?) is regaining safety, in fact. That is not possible when any lay social or mental health workers are mocking whatever is traumatizing me as being about my presumed high ACES score (formerly the pop-psych stereotype of `co-dependeny’ was the stick used to batter me, now my bad toilet training is causing me to be deluded according to those who are most certainly *not* `trauma informed’. You need to be able to communicate clearly to get safe, but can’t until after you are. And, no one believes you. That makes the traumatic stress just escalate in layer after layer. And, it’s entirely preventable.

  3. Your book sounds interesting, Bob. I share your disrespect for the DSM and it’s lack of concern for etiology, since of course any sane person knows that addressing the cause of one’s distress is of utmost relevance to overcoming that distress. I agree, from personal experience, more with the huge societal problems that result from the number one “sore in today’s psychiatry,” than the number two issue. But that would be due likely to my limited experience with the second issue, to some extent.

    The fact that covering up child abuse is the number one actual function of today’s psychiatric community I see as highly problematic, from a societal perspective. Today over 80% of those labeled as “depressed,” “anxious,” “bipolar,” or “schizophrenic” are misdiagnosed child abuse survivors. Over 90% of those labeled as “borderline” are misdiagnosed child abuse survivors.

    https://www.madinamerica.com/2016/04/heal-for-life/

    The “mental health” industry should be highly ashamed of these huge percentages of misdiagnosed child abuse survivors. Such massive in scope misdiagnoses of our “society’s weakest members” are appalling, especially since covering up child abuse is illegal for all people, including the “mental health professionals.”

    You neglected to point out that the reason that covering up child abuse, by misdiagnosing child abuse survivors with the billable DSM disorders, is the number one actual function of today’s “mental health professionals,” is due to the reality that the DSM classifies child abuse as a “V Code,” and the “V Codes” are NOT insurance billable DSM disorders. Thus to get paid, all “mental health professionals” must misdiagnose all child abuse survivors, prior to trying to help them. I’d love to see people in your field try to change such an obvious error in the DSM.

    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

    In as much as I don’t doubt your findings that trauma survivors have trouble discussing their abuse, I do have a problem with the psychiatric field as a collective, proclaiming no one can ever heal from child abuse. Or as they describe it, “Four out of five teenage girls who have been sexually assaulted are suffering from crippling mental health problems months after their attack, research has found. . . . Experts said the findings had confirmed that becoming a victim of abuse in childhood could lead to mental health issues, which could last a lifetime.”

    These “crippling mental health problems” likely resulted from psychiatric misdiagnoses, then inappropriate psychiatric druggings. Especially given the reality that the ADHD drugs and antidepressants can create the bipolar symptoms, as Whitaker’s work so nicely documents.

    And the antipsychotics can create both the negative and positive symptoms of schizophrenia, as my medical research has found. The negative symptoms can be created via neuroleptic induced deficit syndrome and the positive symptoms can be created via antipsychotic induced anticholinergic toxidrome.

    https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome
    https://en.wikipedia.org/wiki/Toxidrome

    So much for the scientific validity of even “the sacred symbol of psychiatry.” I agree with you, “If that doesn’t make your blood boil, just a little, something’s amiss.” Largely because I am the mother of a child who was briefly sexually assaulted, who was gotten quickly away from the abusers, and my child did seemingly heal.

    At least according to all the psychologists, who gushed about how psychologically brilliant and well adjusted my child was, when they gave my child a psychology award upon his graduation from college. My child actually went from remedial reading in first grade, after the abuse, to graduating college with a Phi Beta Kappa, which is a “highest honors,” award as well. In other words, child abuse survivors can heal, with love, mutual respect, and keeping one’s child away from the stigmatizing and drugging “mental health professionals.”

    But I do agree, child abuse survivors do not like to discuss, or have difficultly discussing, such appalling abuse. And, especially when the abuse occurred under the age of 5, an age at which most of us remember very little, even remembering what happened is difficult. Only the medical records that were eventually handed over, document the deplorable crime.

    But being handed over those medical records did help me understand the etiology of my distress, and walk away from the insane and criminal child abuse covering up and profiteering “mental health professionals,” who’d misdiagnosed and poisoned me. A toxidrome is, by definition, a form of poisoning.

    And our society does need to move from having our DSM deluded, scientific fraud based, “mental health professionals” profiteering in the tune of billions off of being, primarily child abuse cover uppers. To our law enforcement professionals starting to actually arrest and convict the child rapists instead.

    But I will say the paternalistic “dirty little secret of the two original educated professions,” child abuse profiteering “mental health” system, does die hard. Especially since it’s a multibillion dollar, fraud based industry, today.

  4. Thank you so very much for your article here. It is so validating for me. I’m a 63 year old survivor who suffered repeated traumatic events of every kind as a child, events that were never discussed with me in my alcoholic family. Naturally I became an addict and alcoholic myself in my teen years and continued drinking and drugging till I was 32 when I sobered up in AA. Though I recalled the family violence all my life I failed to recall being raped at age five and other molestations until I was six years sober at age 38. Luckily I read Courage to Heal as well as Judith Herman’s book Trauma and Recovery twice and I was able to access my earlier buried traumas. I began talking about them in AA which helped me immeasurably.

    The thing was, though, I had gone to see “therapists” numerous times before and after sobering up and over the years since but I constantly ran into walls with them because of the DSM and my “diagnoses” and the therapists’ unwillingness to even listen to me speak about my traumas. The final straw for me came when I was enrolled in a university study on Dialectical Behavioral Therapy and Prolonged Exposure Therapy. I am a very educated woman who reads and studies everything so I read loads about DBT and PET outside of the study so I was very informed. The therapist who was assigned to me in the study systematically refused to allow me to tell her anything about the traumatic events I survived. When I questioned her about why she refused she said that DBT and PET don’t work that way, that they only work “in the moment” so I was not allowed to discuss what happened to me in the past. Say what?! I asked her several times on several different occasions how anyone is supposed to grow and heal if they’re not allowed to discuss what happened to them in the past?! Again she said that DBT and PET don’t “work like that.” I had been diagnosed by the study as having BPD, C-PTSD, Major Depressive Disorder, Panic Anxiety Disorder, Avoidant Personality Disorder, and OCD. I was age 56 when they diagnosed me.

    For several years I bought into their diagnosis but then found this website Mad In America when I was looking for articles to read about getting off my antidepressant. I had tried to quit taking it many times so I needed more information about why it was so hard to quit. I learned a lot in my reading, especially about how addicting they really are. I was finally successful in weaning off them 3 1/2 years ago. Though I still have the C-PTSD and depression I now believe the late adult diagnosis of BPD was incorrect and was made so I was more easily “billable.” Funny thing, all my so-called BPD and other DSM diagnosed disorder “criteria” dropped off once I was off the SSRI…

    • The absurdity of forcing someone through a “program” that doesn’t allow discussion of historical trauma, even when the client specifically states a need to do so herself, is beyond comprehension. Sometimes these manualized programs are almost as bad as the drugs, because they still adopt the idea that you “have something” that needs to be “treated” and that everyone who “has” the same “diagnosis” is treated in the same way. It’s beyond disrespectful!

      I’m so glad you found MIA and have been able to reclaim your narrative to a large extent, by all appearances. I am not surprised that some of your “diagnoses” melted away when you got off the drugs. Many people here have shared similar experiences.

      Thanks for sharing your story! The more we talk about these experiences, the sooner the truth will float to the surface of our blind and deaf society.

  5. Dr. Johnson,

    Dr. Deepak Chopra pointed out that

    “Suffering is when you are attached to your pain. But pain needs to be witnessed (embraced). When you lock up your pain, it becomes anger; anger is nothing but remembered pain. What is anxiety and fear? It is anticipated pain. What is guilt? It is redirected pain (towards oneself). What is depression? It is the depletion of energy when you don’t know these things. These are the sorrows of our society, when we do not embrace our pain”

    Would it be true to say that when you refer to trauma, you are referring to remembered pain? If so, would you say that it is adequately dramatized in the film, Good Will Hunting where Will is being told repeatedly, “it’s not your fault” to the point where he breaks down in abdominal sobbing?

    https://www.youtube.com/watch?v=UYa6gbDcx18

    Would the film, “Prince of Tides” be another dramatization of remembered pain where Tom is gently confronted with the trauma he experienced when he was 13? In both cases, we see how they try to avoid feeling what had actually happened to them in the past. It is as if the body remembers what the mind tries to forget.

    https://www.youtube.com/watch?v=5jE2DdTOyiM

    I’d appreciate your thoughts on this. Thank you

  6. Bob Johnson wrote: “Thus in 1986, I asked a woman I’ll call Grace to address an empty chair on which we’d agreed to place an image, a memory of an abusive parent. “Hello parent, I’m an adult.” I knew enough by then to invite her to say that. Guess what? She couldn’t. I was astonished. She then turns to me, and repeats these words verbatim — no problem there. On turning back to the empty chair, her mind went blank — no words would come out.”

    I would also, in 2018, refuse to address an empty chair with the phrase, “Hello parent, I’m an adult.” This would not be because of a shut-down Broca’s area or non-functioning frontal lobes. It would be because I’d find it very odd for a psychiatrist to be asking me to do this. I would suspect it was a trick request. A mind game.

    This experiment would have yielded better results if the context was changed. For instance, in a drama group. Imagine Grace was in a psychodynamic drama group and was asked to imagine that an abusive parent was sitting in a vacant chair and that she should say, “Hello parent, I’m an adult.” I’d lay my bet on her complying with the request, no problem at all.

    Recently I attended a very brief (about 15 minutes) psychiatric examination to get some kind of confirmation of my diagnosis. At the end he conceded that he could not affirm any diagnosis as the interview was too short and he’d have to see me more often, for longer periods of time, to make his mind up.

    Very reasonable, I thought. Very reasonable indeed.

    Not long after I was called in by my GP to discuss a letter from the psychiatrist. In it the psychiatrist says he could not find any pathology whatsoever. And that I should be completely discharged from psychiatric services.

    Work that one out.