Understanding Mental Illnesses, and Ourselves

Although I trained in psychiatry, I usually found far more success in talking with my patients than in drugging them.

Ed Childe
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In the 1950s, I saw psychiatry switch from trying to help patients to understand themselves better to trying to find a drug that would relieve their symptoms. This was based on the assumption that mental illnesses were caused by brain or genetic defects and therefore required physical treatment rather than psychological treatment.

In over half a century they have failed to find proof that this is true, and the prevalence of mental illnesses has escalated into a pandemic.

I think it is time to reconsider developing psychotherapeutic approaches again, especially since I found that it was possible to rescue even psychotic patients from many years of drugs, shocks and hospitalizations with humane, insight-oriented therapy.

A Scientific Revelation

In university, I became fascinated with the amazing discoveries in the physical sciences over the past five hundred years, and with the people who had done this. But when I studied postgraduate courses in physics and math, I found them to be rather dehumanizing. I applied to medical school at McGill with the hope of finding a more humane use for the scientific method that I admired so greatly.

When I got there, I was delighted to find a scientific endeavour that was exactly what I was looking for: First-year psychiatric lectures, two hours every Wednesday morning, changed my life.

They were given by a European gentleman, Dr. Heinz Lehmann. He delivered an empathic view of people experiencing virtually every psychiatric disorder. I felt like I was learning more about myself than I’d ever learned before.

He also described Freud’s efforts to understand these conditions scientifically. Freud’s concept of trying to help people talk openly in a safe setting where the aim was understanding, and not censorship or punishment, seemed a scientific revelation. It transformed my life, and led to a 50-year career in which I tried to help people, including myself, understand themselves.

Ironically, Lehmann to this day is described by Wikipedia as “the father of modern psychopharmacology.” I can understand why: In his final lecture he tried to tell us about schizophrenia, the disorder that filled his and other mental hospitals around the world, and still fills our streets, prisons and morgues with its victims. He could describe the signs and symptoms of its victims, but could only recount the failures to help them. Even Freud thought them to be untreatable.

Lehmann was an empathic man who felt the agony of the poor souls trapped in this disorder. So, in 1953, when samples of chlorpromazine were left at his office, he tried the drug on staff and patients and discovered that it could not only calm some of them, but almost be like “a chemical lobotomy” (at that time, this was considered a success).

His papers describing this helped to begin the drug revolution which seemed to aim at trying to separate patients from their emotions.

Of course, this was the opposite of what I was hoping to do. Medical school after the first year was almost entirely devoted to physical disorders, so instead, I found myself reading Dostoevsky, Tolstoy, and Ernest Jones, joining the Players drama club, and organizing the class basketball team in order to help my own psyche.

After my third year, I worked at a huge state psychiatric hospital in Poughkeepsie, NY, where I did mental status exams on hundreds of incarcerated “schizophrenics.” To my mind back then, they all had impenetrable thought disorders, and it never occurred to me that in the last 20 years of my career I would enjoy being able to break through this barrier.

In my first-year psychiatric residency at McGill in 1957, I was delighted to be able to talk with my non-psychotic patients and get to know them. Together, we found the damaged or broken relationships in their lives that were causing their symptoms, and it seemed that getting someone’s support in recognizing this and talking about it relieved their symptoms.

On days when I wasn’t feeling too well and was less talkative than usual, I noticed that patients tended to do better, so I learned that they needed time to talk.

I was greatly impressed by the success of chlorpromazine in calming a couple of patients whom I’d seen admitted in acutely psychotic states. Within a few days they were talking rationally. I assumed that this was the first step of treatment—that next they would be talking with their therapists in order to try to understand what had happened.

I thought of it as three-day schizophrenia, but unfortunately, psychiatry, which was run by physicians, interpreted it as proof that emotional disorders were caused by physical brain defects and therefore required physical corrections.

My psychotherapeutic efforts went well until second-year residency, when a supervisor told me to drug a recovering depressed patient. I found I couldn’t do it, because the patient was recovering, and because as a scientist I’d learned not to change two variables in an experiment, or you’d confuse the result. My supervisor attempted to have me thrown out of residency, but fortunately he failed.

Unfortunately, though, Canada and America had begun the inexorable slide toward biomedical treatments, especially drugs and electric shocks. I decided to flee to Britain for psychoanalysis, for my life and sanity.

A Psychoanalyst in London

Fortunately, I was able to find an analyst, a parental figure to whom I could talk. After a year of tears, I was accepted as a trainee in psychoanalysis. I was able to get psychiatric jobs, but mostly had to hide my interest in psychotherapy because psychiatrists seemed to be antagonistic to this.

In one of my psychiatric jobs, there was a young male patient who was a student from Africa. I found him very interesting: He was hospitalized due to hearing extremely persecutory voices. I tried to see him when I could, but wasn’t aware of attempting therapy with him; I just talked and listened.

He was greatly puzzled by these terrible voices and couldn’t understand where they were coming from, until he figured out that a witch doctor that hated his family back home was causing them. This relieved his mind so much that he was able to leave the hospital and resume his studies. I was amazed at his apparent escape from psychosis, and that his spiritual beliefs were so powerful that they seemed capable of saving him from psychosis. I couldn’t imagine a young Canadian or British man being able to escape psychosis like this.

Perhaps this helped me to realize that even psychosis was a spiritual disorder.

Eventually I was able to get a job at a psychiatric hospital run by analysts, the Cassel hospital. One of my patients was a young woman who had been in a mental hospital. In sessions with me she was completely unable to talk, so I invited her to lie on the couch, which she did in the fetal position for ages.

Eventually she began to talk, sat up, and let her hair down. She thanked me for waiting until she was ready to talk. But, unfortunately, I’d decided to leave the hospital because a busy full-time job, plus psychoanalytic training in another part of London, was too exhausting for me. When she heard this, she threw a shoe at me and fled.

Fortunately, a perceptive nurse had anticipated something like this and saved her from the edge of a nearby canal. That nurse and I have now been married for 55 years, and she has helped with the recovery of some of my most damaged patients. I learned that coming out of the egg didn’t mean recovery, and I tried to not abandon anyone again like that.

My first psychoanalytic supervised case wasn’t very successful, but I discovered my second supervisor on BBC radio. Donald Winnicott was introduced as a senior analyst and former paediatrician. He was talking on the radio with several mothers about babies and young children. What blew my mind was not only the subject that they were addressing, but that this expert talked with them and not to them. It was an interchange between knowledgeable people, and I raved so much to my analyst about this experience that sometime later he managed to persuade Dr. Winnicott to supervise me.

On our first interview, Dr. W told me that he wasn’t good at supervision and wouldn’t be able to tell me what to do. My first patient was a young professional man who’d been vetted as suitable for a trainee, but after a short while he suddenly felt afraid of falling out of a building, and he rapidly developed an incomprehensible thought disorder. After my experience in Poughkeepsie I felt doomed about being able to help this patient, and he felt doomed at not being able to get any help from me. My “interpretations” were as meaningless to him as his words were to me.

When I told Dr. W about this, he actually had a suggestion: Try listening instead of talking, as I’d been doing. Having no other option, I did so; the patient kept coming and kept talking, until one day I felt that I may have understood something and was able to make a positive noise. Later a positive word, and gradually we began to be able to communicate.

It turned out that even patients that I had found incomprehensible could eventually communicate—if I listened well enough.

The Revolving Door Begins

In the age of drugs, it was difficult for me to make a living for my growing family. We had to leave Britain because the NHS didn’t pay me for psychotherapy, and my patients weren’t wealthy enough to support me.

I worked in Dr. Paul Polak’s excellent Crisis Intervention unit at Denver’s mental hospital for several years. Our unit had one week to attempt family and individual therapy to see if hospital admission could be prevented. Surprisingly—to drug-focused psychiatrists—this procedure often succeeded.

Psychiatry kept closing our hospital units because they thought that drugs would be faster and cheaper than talk therapy. We saw the revolving door begin: drugged patients could leave hospital more quickly, but often had to be readmitted.

I also ran an adolescent unit in Denver on a therapeutic community basis, where staff and patients were taught how to help each other, and we developed ways of helping patients and families to be more open and honest with each other, which led to recovery. Crisis intervention seemed extremely valuable to me, and I see some signs of it returning now.

Where Are We Now?

I’m profoundly grateful to have had such an interesting and rewarding career, but I’m also profoundly sorry to still see so much dehumanization in the treatment of people with emotional disorders. The suffering is immense and the financial costs are huge. I would like to express my gratitude to my patients whose courageous efforts enabled this research, and whose successes kept my spirits up after so much professional rejection.

My family was extremely supportive as I rowed upstream against the current. I know we were all hurt. I’m sure that my profound admiration for the many scientists in the past few hundred years who have helped us to understand the physical world helped to inspire me to search more deeply into patients’ lives to find answers, and I would like to encourage investigation into the human psyche.

But, perhaps because of our tremendous scientific success in understanding the objective physical world, it seems that we have forgotten that we are creatures with individual, subjective lives, and that we are filled with the spirits of people we’ve known and of our culture.

Religion reached into people’s souls, but it often demanded such obedience and loyalty that it was often abusive. Science, with its search for objectivity, seems to have abandoned our subjective souls, our true selves, and caused great emotional damage.

Darwin had to remind us that we aren’t just spiritual, but are also animals who have evolved. Sometimes I wonder if we now forget that we are mammals, and that the mother of all relationships is the relationship with the mother. This relationship begins before we develop language and its nonverbal effects colour our lives. If so much damage can be done in infancy, perhaps the corollary is that a healthy infancy can help toward a good life.

Freud was a neurologist who discovered that exploring patients’ lives was usually far more useful for helping them with psychological problems than looking for brain defects. His exploration of “the unconscious” changed the world for a while, but medicine, which is more comfortable with physical issues, overturned his efforts.

He was a pioneer, but he didn’t have a Winnicott to help him.

It’s wonderful that research by Eliott Valenstein, Robert Whitaker, Peter Breggin, and Alice Miller has helped with this. Scientifically, I realize that a small number of patients doesn’t prove the case, but hopefully it can open the door to progress in tackling this pandemic.

***

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.

24 COMMENTS

  1. Nice philosophical ruminations. But has MIA returned to no longer requiring the use of quotation marks or any disclaimer whatever when using the “mental illness” word? (Where’s Paula Caplan when we need her?) 🙁

    For extra credit — who sees the innate contradiction in the phrase “understanding mental illness”?

  2. “This was based on the assumption that mental illnesses were caused by brain or genetic defects and therefore required physical treatment rather than psychological treatment. In over half a century they have failed to find proof that this is true, and the prevalence of mental illnesses has escalated into a pandemic.”

    Assuming is never good. And what a shame psychiatry didn’t learn from the crimes of the eugenics deluded Nazi psychiatrists, like the rest of society, and merely changed the word ‘eugenics’ to the word ‘genetics.’ But thank you for pointing out that psychiatry’s modern day psychiatric holocaust is, indeed, a pandemic. For goodness sake, they’re killing “8 million” people every year.

    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2015/mortality-and-mental-disorders.shtml

    “I felt like I was learning more about myself than I’d ever learned before.” I think this is where the psych professions get most of their initiates. But I do agree, I was very taken with the two psych classes I took in college, I read all those text books … very interesting. However, since psych was the major filled with people who couldn’t get into the architecture, engineering, business, and other colleges, and I had no personal issues which needed to addressed, I decided to stay in my business program.

    “In [Lehmann’s] final lecture he tried to tell us about schizophrenia.” I never got to that “final lecture.” But since I was forced to research into psychiatry and psychopharmacology later in life, now I can tell you a lot about “schizophrenia.” The negative symptoms can be created via neuroleptic induced deficit syndrome. And the positive symptoms can be created via antipsychotic / neuroleptic, and /or antidepressant induced, anticholinergic toxidrome.

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

    But I do agree, “even psychosis was a spiritual disorder.” And, most certainly, it was Jesus who saved me from an iatrogenic induced “psychosis,” created by the insane “chemical imbalance” believing, drug pushing, systemic child abuse covering up, psychological and psychiatric system.

    And my drug withdrawal induced ‘super sensitivity manic psychosis,’ which was not bothersome to me at all, did remind me that “we are filled with the spirits of people we’ve known and of our culture.” It was actually a tale of how we are all ‘one,’ thus mutual respect of all is of paramount importance.

    I’m sorry you had to deal with “so much professional rejection,” Ed. As that is quite the opposite of mutual respect of all. But staggering, and ungodly disrespect, is also what I found typical of the psychiatric and psychological practitioners.

    “Religion reached into people’s souls, but it often demanded such obedience and loyalty that it was often abusive.” Yes, my dealings with the psychiatric and psychological industries was all about their covering up the abuse of my child, for my childhood religion; scientific fraud based industries which unfortunately have partnered with that religion. And, of course, this was ungodly abusive, as even pointed out in this righteous indignation filled ELCA insider’s book, just read the Preface.

    https://books.google.com/books?id=xI01AlxH1uAC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false

    “Sometimes I wonder if we now forget that we are mammals, and that the mother of all relationships is the relationship with the mother.” Which is a good reason why the psychologists and psychiatrists should get out of the business of attacking young mothers, and attempting to attack their children, to systemically cover up child abuse, for profit. Which is the number one actual societal function of the psychological and psychiatric, historically, and today.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
    https://www.madinamerica.com/2016/04/heal-for-life/

    In other words, a little reminder, don’t glamorize Freud too much. Personally, I believe a little more in the possible truth behind the theologies of Jung and Laing, not that I’m an expert in their theologies.

    But thank you for sharing your story, Ed. I’m glad to hear from the “mental health” workers who are not evil, child abuse cover uppers, like all the “mental health” workers, with whom I had the misfortune of dealing. And, again, thank you for calling out psychiatry’s modern day holocaust as the “pandemic,” that it shamefully is.

  3. I think it’s clear in the history of psychiatry that this sort of Freudian type stuff was an offshoot and is not in anyway what psychiatry ever was, is, does, or is doing. These were people that made up their own philosophies and “treatment” to sell to the upper class, which then wound up in literature and comics and movies. But it’s not psychiatry. If you want to help people with talk therapies, psychosocial, logical dilemmas, etc, then it’s called something else. It’s counseling. And the people who do it are called counselors. It’s not psychiatry. If not for that Frasier nonsense that kept in the media for generations, I would like to think society would have had a different attitude about psychiatry, especially when they started integrating into the school system and drugging children.

    • You’ve been here all along, it’s just the photo that’s new, right? 🙂

      Anyway all good observations. Psychiatry preceded psychoanalysis, was influenced by it for a while, and has now buckled down into strictly chemical control. Psychiatry cannot be defeated without understanding it as a system of social control, not a branch of medicine. Without this basic understanding we will be endlessly trying to “improve” it rather than end it.

    • JeffreyC, I enjoyed your article.

      In general, I agree with you, but I’d like to point out that Carl Jung was considered a psychotherapist/psychologist AND psychiatrist. And ‘counseling’ takes away a certain sophistication out of those other approaches. Jung was a ‘psychological’ psychiatrist. He worked in a psych hospital as an ‘assistant psychiatric physician’. He had a private therapy practice, but he still maintained a role of diagnostician and had a medical degree in psychiatry, I believe. But those were the days when boundaries and specialties were different. For many decades, psychiatry is as you state. Jung and Humphrey Osmond met and spoke, and Jung suggested a role for physiotherapies as well as one of the first to hypothesize a ‘metabolic toxin X’ in schizophrenia, which Osmond was so concerned with. Osmond dealt with nutrients, as well as psychedelics before made illegal, and he also used pharmaceuticals more conservatively. He also wrote a lot on hospital design and ‘models’ of health care. I take from him certain things and leave others.

      • Freud’s main contributions were that he believed that listening to people’s stories was a path to healing, and that early life trauma unconsciously affected decisions and emotions on an ongoing basis. He was the first to recognize that sexual abuse of children (especially girls) was rampant, and at first he believed these stories and attributed women’s “hysterical” symptoms to the abuse they had experienced. This outraged the Viennese society of the time (one has to wonder how many of his psychiatric colleagues were suddenly worried they’d get busted!) and he came under tremendous pressure to recant. Unfortunately, he did so, and devised all the weird “drive theories” like the Oedipus complex and penis envy and whatnot and the secret of childhood sexual abuse went back under wraps for another hundred years. Most of what he is remembered for is the crap he came up with to explain away his original observations. He may have saved his career by doing so, but his betrayal of his integrity condemned another four generations of children to unrecognized sexual abuse.

        • Steve, yes, although Carl Jung took up some of the ideas of early childhood experiences/traumas, repressed memories, and the formation of complexes, and their impact on later life. Partly through Jung, this influence DID carry on for generations. Freud’s ‘unconscious’ in a way became Jung’s ‘personal unconscious’. He also carried on things like dream analysis, transference, and abreaction from Freud’s psychoanalysis. Jung was radically different than Freud as well, for example his ‘collective unconscious’ and importance on the religious instinct, which Freud reduced to other instincts and considered all religion as illusion. Jung, unlike Freud, almost never used hypnosis.

          We also shouldn’t forget that Freud heavily focused on neurology early on in school, practice, and library, had important roles in its development, and also in psychosomatic and what he called nervous disorders. He often used cocaine for physical and mental problems, his own and clients. And tobacco for that matter.

          • But I don’t recall Jung reviving the observation that children (especially girls) were frequently sexually molested and abused by adults in society and that many of their “mental illness” manifestations resulted from these abuses. Maybe he did and I’m just not aware of it.

        • I wouldn’t necessarily invalidate his theories as CYA attempts, I think both can be recognized simultaneously — though his willingness to “reclassify” and dismiss accounts of abuse as “hysterical” fantasies was probably the low point of his career, and has a discrediting effect. He likely described and analyzed the sexuality of his era with considerable insight, but was culture bound in ways and tended to view the peculiarities of his historical era as universal human behavior.

          That said, it’s still worth a read. That Freud listened to people and tried to explore sexuality and aggression objectively was pretty enlightened for the time, and some of his insights are brilliant.

          However, psychiatry preceded psychoanalysis, it did not grow out of it. This is important to keep in mind, as psychiatry cannot be deconstructed by “exposing” Freud.

          • Yeah, Freud was a huge improvement over anything else that preceded him, because he at least started from the idea that the what the client says is the most important thing to consider. That postulate alone would invalidate the entire edifice of the DSM and all that passed for “psychiatry” throughout history. It is just a shame that he backed down from his accurate observations. But as we all are, he was a product of his time, and his revelations were just not tolerable in the society he lived in, however accurate they may have been.

        • I wouldn’t necessarily invalidate his theories as CYA attempts, though his willingness to dismiss accounts of such abuse as “hysterical” fantasies was probably the low point of his career, and has a discrediting effect. He likely described and analyzed the sexuality of his era with considerable acumen, but was culture-bound in ways and tended to view the peculiarities of his historical era as universal human behavior. That said, it’s still worth a read. That Freud listened to people and tried to explore sexuality and aggression objectively was pretty enlightened for the time.

          However, psychiatry preceded psychoanalysis, it did not grow out of it; this is important to keep in mind, because psychiatry cannot be deconstructed by “exposing” Freud.

          • Interesting points about the Complexes and the history. I didn’t find it too abstract, but an intellectual effort unsure of some of the finer details. I found ‘cookie-cutter, pea-in-the-pod mirror images’ rather poetic.

            It may be that Jung just suggested the word ‘Electra’ rather than the idea itself. That’s probably the case.

            I personally don’t see these things as just the heights or abstractions of metaphysics, philosophy, or archetypes, but psychological, which has its own substance/nature. This does deal with medicine in its broadest definition and certainly therapy. I’m not sure why you put therapy in quotations, other than showing how the psychological concepts don’t have value for health, or that therapy is a ‘so-called’. Some of these things were integral to these historical figures’ effort at healing. I know medicine has usually meant physical illness/treatment. Even Jung sometimes used it in that way despite having a medical degree and describing himself as a doctor. The term ‘medicalization’ certainly refers to medicine in its broadest definition, and I like the term in medical philosophy/sociology.

            But as you say, hopefully your abstracting will not be required or fertilized until next year at the earliest. And by all means, don’t let me try to call it forth.

        • Steve & oldhead: I think you may be right, Steve. I guess I was thinking about adverse experiences and traumas generally. Off the top of my head, I can’t think of an account or ‘case study’ of molestation, but only of various shades of the incestual ideas between mother/son or father/daughter (which aren’t always so stark as physical abuse), but which in his own way, Jung dealt with. I think it was Jung who suggested the ‘Electra Complex’ to match Freud’s Oedipal. He was always very sensitive to childhood experience and the proper education of parents. I don’t know about the history of sexual abuse, but I would like to.

          I’ve read 1.5 books of Freud’s but mostly know him through Jung. Freud’s writing is less appealing to me than Jung, more 19th century literary and sober, very dense but in a relentless way. I feel that Jung took the ‘best’ of Freud to the next level, but was keen on constructive criticism of him. The Netflix series ‘Freud’ is worth the watch, but of course it fluffs it up with drama and fiction.

          • It’s important to have these sorts of conversations with the understanding that they are essentially philosophical, metaphysical &/or archetypical in nature, and have nothing to do with medicine or “therapy.”

            With that disclaimer, I think the Oedipal Complex can be seen in terms of patterns of sexuality and power in Western society, and specifically those centered in Vienna in the 1930’s, where Freud lived for some time. But he was also able to transcend at least some of that to describe internal sex and power dynamics in a way that transcends that small corner of history and can still be seen throughout Western culture.

            I always thought the Electra Complex was also Freud’s concept, but maybe I was wrong. In any case I’d say it would not necessarily make sense to try to “match” it to the Oedipal Complex, since the latter describes a psychic dilemma engendered by patriarchy and the nuclear family; women, on the receiving end of patriarchy, are continually oppressed by the same dynamic that seems to suit men fine once they accommodate themselves to an ethic of power and conquest. So I’m just saying that Electra and Oedipus aren’t necessarily cookie-cutter, pea-in-the-pod mirror images of one another.

            To articulate this in detail is beyond my current pay grade. With luck this is the most abstract I’ll get for the rest of the year at least. But I think there’s a grain of truth in there somewhere.

  4. We have the wretched ability to notice and wonder. Assigning the diversity of the species something so imbecile as “mental illness” was a feeble attempt at using the brain. It really is an embarrassment that humanity is still so stupid and can’t see that we are not so amazing. Thank god we all die. It would be awful if we could all continue our judgmental gazes, and keep up the pretense that those who are looked upon are the problem.

  5. There should be another term instead of mental illness, something like mental reaction. Just a product of minds put into a state that provokes a warning to us that we are not secure. Maybe mental warning would be something. I got a mental warning yesterday that I was not safe. I have a constant mental reaction to the environment where I am not accepted. Things like that.

  6. thank you for the contribution.

    having said that, i do wonder…why bother with psychiatry, as a career? family medicine/general practice, maybe? dermatology? pain management, even? options…lots of them…

    nothing against this retired psychiatrist, btw. i can see being young and thinking that this is somehow a way to improve lives, maybe even help society, especially in the 50s and 60s (you know, back when society was a “thing,” before it became just individuals, all at each others’ throats…).

    i’ve seen how even the same clinic, the same talking person, the same psychiatrist…can put on a song and dance when one has leverage, good insurance, ‘good family…’

    and then when the insurance is out, the family is estranged, no leverage…the mask comes off.

    and then when the mask goes back on…some social theater, just suspend your disbelief…forget what came before…

    at a larger level, the many guises of psychiatry…tea and sympathy for the troubled; compassion for the suffering; confinement for the ‘dangerous and ill,’ etc…

    cover up the 2 core functions: social control and slavery. 🙂

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