I still remember my first training sessions as a budding psychotherapist. It was 1965 and I had just dropped out of medical school at U.C. San Francisco and transferred to U.C. Berkeley. I had wanted to help people ever since my father was committed to a mental hospital when I was five years old. I wondered what happened to my father and whether it would happen to me. I thought if I were well-trained I could avoid “mental illness” and the fate that my father faced when he had his emotional breakdown.
My first student placement was at Napa State Hospital and social work and psychology students had an opportunity to observe a well-respected psychiatrist work with patients. We attended sessions every week for a year and watched this expert through a one-way mirror as he worked with various patients. After the session we could join the psychiatrist and ask questions.
Right from the beginning there were a number of things about this expert’s way of doing therapy that I questioned. First, he never touched the patient. When the patient reached out to shake his hand in thanks at the end of the session, he didn’t extend his hand. When questioned he asserted that it would interfere with the transference where-in the patient would project the issues he had in his life on the “blank screen” of the therapist and then the therapist would interpret his feelings. I told him, I thought that human contact was important. He explained that I would learn the value of therapeutic distance as I became better trained.
Second, he would never advocate for the patient if there was a problem on the ward. On numerous occasions he patient couldn’t come to a session because of a mistake getting him released. The doctor said, that the therapy session had to be insulated from the rest of the patient’s life if it were to be most effective. I disagreed.
Third, it seemed that there was no relationship between the diagnosis that a patient was given and what went on in the therapy sessions. One patient may be diagnosed as being manic-depressive, another with an anxiety disorder, and a third as having a character disorder. But he interacted in the same way. When I asked he said diagnosis was very important, but it seemed a far cry from diagnosing someone with pneumonia, diabetes, or some physical illness.
I learned what I could and developed my own approach to working with a wide variety of people. I’ve now been helping people deal with the challenges of life for nearly fifty years. There are 7 principles that form the cornerstone of my practice.
1. Engaging everyone with sensitivity, warmth, and caring, is healing.
I believe that we are all human beings dealing with similar challenges in life. Being a therapist doesn’t exempt us from having problems. People may express their wounds differently than I do, but tuning into their needs and responding as a fellow human being helps most everyone.
2. Finding a proper diagnosis is less important that focusing on what is wrong and how to help.
In another learning encounter in my training, another expert offered a very similar diagnosis to a number of patients. “I’d say this man has PPP,” he intoned with authority. “I’ve never heard of that diagnosis,” I said. “What is PPP?”
“Piss Poor Protoplasm,” he said. He went on to explain that most of the patients were just born that way and trying to find a diagnosis was a waste of time. “Our job is just to do what we can to make their lives a little better.”
3. Most of the patterns and behaviors we call “mental illness” are primarily due to what happens to a person after birth.
Our lives are certainly a mixture of genetics and environment, but the idea that most people with severe problems are just born that way (i.e. PPP) leaves out too much family, environmental, and social stresses. The more I talked to people and listened to their live stories, the more I came to understand the importance of things like childhood trauma, poverty, violence, absent fathers, alcoholism in the family and other forms of environmental assault on the lives of the people I was treating.
4. Quick fix, pharmacological, medications may be harmful in the long run.
We live at a time when “medications” are seen as the answer to people who have a “brain disease.” The current theories about “mental illness” suggest that the problem is biochemical in nature and the solution is a biochemical. Remember seeing those ads on T.V. for anti-depressants? We watch a video of a nerve communicating with another nerve and little dots going across the synapse between nerves. We are told that an anti-depressant like Prozac or Zoloft keeps the little dots of serotonin from being reabsorbed and thus relieves depression.
However, recent research indicates that medications may actually be harmful in the long-run.
5. Social support and community is more important than medications.
In another study, around 85 percent of patients within specialized mental healthcare settings experience another major depressive episode within 15 years, but only 35 percent of people with major depressive disorder in the community have a relapse in the same time frame. There seems to be great healing potential in community that isn’t available when we isolate “crazy” people and treat them as “mentally ill.”
New apps for problems like depression can offer support for people in a world-wide community. If isolation is part of the problem, re-connecting people to community can be a solution.
6. Talk therapy can be helpful, but the medical model separates people.
I talk to people as part of the help that I do. But I’ve learned that calling them “mentally ill” causes more harm than good. Rather, I use my own experiences in life to help people figure out how to live more effectively and connect more deeply with other people. I don’t set myself up as an “expert” with some magical therapeutic knowledge. I present myself as a fellow human with a lot of experience. I see the people who come to see me as partners on this healing journey. We can work together to make their lives more loving and more joyful.
7. Embracing the Mental Health Revolution.
I’ve known Eric Maisel since I read his book The Van Gogh Blues: The Creative Person’s Path Through Depression. He struck a chord in my understanding of creativity and depression. He says, “Virtually 100 percent of creative people will suffer from episodes of depression.” The reason is that creative people come into the world “ready to interrogate life and determine for themselves what life would mean, could mean, and should men.” The creative process of making meaning in life, when stymied can lead to depression or what we’ve mistakenly called “mental illness.”
Maisel was a psychotherapist for many years until he realized that the current paradigm for treatment was inadequate. In his recent book, The Future of Mental Health: Deconstructing the Mental Disorder Paradigm. For professionals, he offers a movement “away from the current misguided practice of ‘diagnosing and treating mental disorders.’ I’ll show a way toward a wiser, truer, more human, and more effective practice that focuses on a sufferer’s complaints and problems, formed personality, life experiences, current circumstances, and existential realities rather than on ‘symptom pictures’ and the mechanical, illegitimate application of mental disorder labels.”
As the “crazy” Zorba the Greek tells his straight-laced English boss, “You have everything but one thing: Madness. A man needs a little madness or else – he never dares cut the rope and be free.” May we all hold on to our creative madness and let go of the current paradigm of mental illness.
Are you ready to join the revolution? Your comments are appreciated.
Originally posted on Men Alive.
Photo Credit: Getty Images