Understanding Mental Illnesses, and Ourselves

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.