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Posts Tagged ‘Psychiatry’

The previous post looked at the Grof’s account of Karen’s experience of a spiritual emergency and how it was dealt with. Now we need to look at some of the implications as well as other aspects of their approach.

The Context

I want to open this section with that part of Bahá’u’lláh’s Seven Valleys that has formed the focus of my morning meditations for the last few weeks. I have persisted so long in the hope that I will eventually understand it more fully. I believe that Shoghi Effendi, the great-grandson of Bahá’u’lláh and the one whom ‘Abdu’l-Bahá appointed as His successor, was of the opinion that one needed to read at least ten books by writers who were not Bahá’ís in order to have any hope of understanding a Bahá’í text fully. I may have conveniently chosen to believe that factoid in order to justify my own bookaholic tendencies.

Setting that aside for now, what matters at the moment are the resonances between the words of Bahá’u’lláh and the topic I am exploring more deeply here.

I have touched on how materialistic assumptions about reality will dismiss as rubbish or even pathologise phenomena their paradigm excludes from possibility.

Bahá’u’lláh directly addresses this point (page 33):

God, the Exalted, hath placed these signs in men, to the end that philosophers may not deny the mysteries of the life beyond nor belittle that which hath been promised them. For some hold to reason and deny whatever the reason comprehendeth not, and yet weak minds can never grasp the matters which we have related, but only the Supreme, Divine Intelligence can comprehend them:

How can feeble reason encompass the Qur’án,
Or the spider snare a phoenix in his web?

Our deification of reason has stripped the world we believe in of God and made it difficult, even impossible, in some cases for some people, to entertain the possibility that God in some form does exist, though that would not be as some white-bearded chariot-riding figure in the sky.

This is the Grofs take on this issue (page 247):

A system of thinking that deliberately discards everything that cannot be weighed and measured does not leave any opening for the recognition of creative cosmic intelligence, spiritual realities, or such entities as transpersonal experiences or the collective unconscious. . . . . . While they are clearly incompatible with traditional Newtonian-Cartesian thinking, they are actually in basic resonance with the revolutionary developments in various disciplines of modern science that are often referred to as the new paradigm.

This world-view seriously demeans us (page 248):

Human beings are described as material objects with Newtonian properties, more specifically as highly developed animals and thinking biological machines. . .

We have taken this model or simulation as the truth (ibid.):

In addition, the above description of the nature of reality and of human beings has in the past been generally seen not for what it is – a useful model organising the observations and knowledge available at a certain time in the history of science – but as a definitive and accurate description of reality itself. From a logical point of view, this would be considered a serious confusion of the ‘map’ with the ‘territory.’

This reductionist dogmatism has serious implications for psychosis (page 249):

Since the concept of objective reality and accurate reality testing are the key factors in determining whether the individual is mentally healthy, the scientific understanding of the nature of reality is absolutely critical in this regard. Therefore, any fundamental change in the scientific world-view has to have far-reaching consequences for the definition of psychosis.

A Holographic Approach

They contend that the paradigm is shifting (ibid.:)

. . . The physical universe has come to be viewed as a unified web of paradoxical, statistically determined events in which consciousness and creative intelligence play a critical role. . . This approach has become known as holographic because some of its remarkable features can be demonstrated with use of optical holograms as conceptual tools.

Their explanation of the holographic model is clear and straightforward (page 250):

The information in holographic systems is distributed in such a way that all of it is contained and available in each of its parts. . . .

It’s implications are profound:

If the individual and the brain are not isolated entities but integral parts of a universe with holographic properties – if they are in some way microcosms of a much larger system – then it is conceivable that they can have direct and immediate access to information outside themselves.

This resonates with what Bahá’u’lláh writes in the same section of the Seven Valleys:

Likewise, reflect upon the perfection of man’s creation, and that all these planes and states are folded up and hidden away within him.

Dost thou reckon thyself only a puny form
When within thee the universe is folded?

Then we must labor to destroy the animal condition, till the meaning of humanity shall come to light.

It is crucial for us all as well as for those labelled psychotic that we cease to reduce the mind to a machine. The Grofs spell out the implications for psychosis when we refuse to take the more transcendent perspective (page 252):

The discoveries of the last few decades strongly suggest that the psyche is not limited to postnatal biography and to the Freudian individual unconscious and confirm the perennial truth, found in many mystical traditions, that human beings might be commensurate with all there is. Transpersonal experiences and their extraordinary potential certainly attest to this fact.

. . . In traditional psychiatry, all holotropic experiences have been interpreted as pathological phenomena, in spite of the fact that the alleged disease process has never been identified; this reflects the fact that the old paradigm did not have an adequate explanation for these experiences and was not able to account for them in any other way.

Assuming that we do accept that possibility of a spiritual reality, what follows? They spell it out:

. . . . two important and frequently asked questions are how one can diagnose spiritual emergency and how it is possible to differentiate transformational crises from spiritual emergence and from mental illness.

This is only possible up to a point (page 253):

The psychological symptoms of… organic psychoses are clearly distinguishable from functional psychoses by means of psychiatric examination and psychological tests.

. . . . When the appropriate examinations and tests have excluded the possibility that the problem we are dealing with is organic in nature, the next task is to find out whether the client fits into the category of spiritual emergency – in other words, differentiate this state from functional psychoses. There is no way of establishing absolutely clear criteria for differentiation between spiritual emergency and psychosis or mental disease, since such terms themselves lack objective scientific validity. One should not confuse categories of this kind with such precisely defined disease entities as diabetes mellitus or pernicious anaemia. Functional psychoses are not diseases in a strictly medical sense and cannot be identified with the degree of accuracy that is required in medicine when establishing a differential diagnosis.

What they say next blends nicely with the points made in my recent posts about where the dubious basis of diagnosis takes us (page 256):

Since traditional psychiatry makes no distinction between psychotic reactions and mystical states, not the only crises of spiritual opening but also uncomplicated transpersonal experiences often receive a pathological label.

This has paved the way to dealing with their approach to intervention and their criteria for distinguishing spiritual emergencies that can be helped from other states.

Holotropic Breathwork

Before we look briefly at their attempt to create criteria by which we might distinguish spiritual from purely functional phenomena I want to look at their recommended method for helping people work through inner crises. This method applies what the non-organic origin. This technique they call Holotropic Breathwork.

First they define what they mean by holotropic (page 258):

We use the term holotropic in two different ways – the therapeutic technique we have developed and for the mode of consciousness it induces. The use of the word holotropic in relation to therapy suggests that the goal is to overcome inner fragmentation as well as the sense of separation between the individual and the environment. The relationship between wholeness and healing is reflected in the English language, since both words have the same root.

They then look at its components and their effects (page 259):

The reaction to [a] combination of accelerated reading, music, and introspective focus of attention varies from person to person. After a period of about fifteen minutes to half an hour, most of the participants show strong active response. Some experience a buildup of intense emotions, such as sadness, joy, anger, fear, or sexual arousal.

They feel that this approach unlocks blocks between our awareness and the contents of the unconscious:

. . . .  It seems that the nonordinary state of consciousness induced by holotropic breathing is associated with biochemical changes in the brain that make it possible for the contents of the unconscious to surface, to be consciously experienced, and – if necessary – to be physically expressed. In our bodies and in our psyches we carry imprints of various traumatic events that we have not fully digested and assimilated psychologically. Holographic breathing makes them available, so that we can fully experience them and release the emotions that are associated with them.

As Fontana makes clear in his book Is there an Afterlife?, experience is the most compelling way to confirm the validity of a paradigm of reality, so my experience of continuous conscious breathing in the 70s and 80s gives me a strong sense that what the Grofs are saying about Holotropic Breathwork had validity. My experience in the mid-70s confirms the dramatic power of some of the possible effects: my experience in the mid-80s confirms their sense that the body stores memories to which breathwork can give access. I will not repeat these accounts in full as I have explored them elsewhere. I’ve consigned brief accounts to the footnotes.[1]

They go on to explain the possible advantages of Holotropic Breathwork over alternative therapies (pages 261-263):

The technique of Holotropic Breathwork is extremely simple in comparison with traditional forms of verbal psychotherapy, which emphasise the therapist’s understanding of the process, correct and properly timed interpretations, and work with transference . . . . It has a much less technical emphasis than many of the new experiential methods, such as Gestalt therapy, Rolfing, and bioenergetics. . . . . .

In the holotropic model, the client is seen as the real source of healing and is encouraged to realise that and to develop a sense of mastery and independence.

. . . . . In a certain sense, he or she is ultimately the only real expert because of his or her immediate access to the experiential process that provides all the clues.

Distinguishing Criteria

Below is the table they devised to differentiate between the two categories of spiritual emergence and what they term psychiatric disorder. They explain the purpose of the criteria (page 253):

The task of deciding whether we are dealing with a spiritual emergency in a particular case means in practical terms that we must assess whether the client could benefit from the strategies described in this book or should be treated in traditional ways. This is their table of criteria.

They are certainly not claiming that they have an unerring way of distinguishing between these states, nor that some of those who are placed in the ‘psychiatric’ have no aspects of spiritual emergency in the phenomena they are experiencing. Readers will also know by now that I am a strong advocate of more enlightened ways of managing any such problems than those which are implied in the term ‘traditional.’

Coda

This last post turned out to  be much longer than I planned. I hope it conveys my sense of the value of their approach and of the validity of their concept of a spiritual emergency.

My feeling that their approach is a good one derives largely from my own dramatic experience of what was an almost identical method involving breathwork. In a previous sequence I have dealt with the way the breakthrough I experienced in the 70s had lasting beneficial effects on my my life, first of all in terms of opening my mind so I was able to take advantage of other therapeutic interventions. Perhaps most importantly though in the first instance was the way that the first breakthrough loosened the grip of my previous pattern of anaesthetising myself against earlier grief and pain mostly by cigarettes, gambling and heavy social drinking, so that I could realise that I needed to undertake more mindwork.

I also find it reinforcing of my trust in the basic validity of their perspective that it has led them to draw much the same conclusions as I have about the dangers of materialism and its negative impact upon the way we deal with mental health problems

It doesn’t end my quest though for more evidence to support my sense that psychosis can and often does have a spiritual dimension. Hopefully you will be hearing more on this.

Footnote:

[1] Rebirthing provided the experience that gave me my last major break-through in self-understanding by means of some form of psychotherapy. I heard first about it from a talk I attended on the subject at an alternative therapies fair in Malvern in early 1985. I then bought a book on the subject. The key was breathing:

Jim Leonard saw what the key elements were and refined them into the five elements theory.

The five elements are (1) breathing mechanics, (2) awareness in detail, (3) intentional relaxation, (4) embracing whatever arises, and (5) trusting intuition.  These elements have been defined a little differently in several versions, but are similar in meaning.  Jim Leonard found that if a person persists in the breathing mechanics, then he or she eventually integrates the suppressed emotion.

It was as though what is known as body scanning were linked to a continuous conscious breathing form of meditation. All the subsequent steps (2-5) took place in the context of the breathing.

After three hours I was trembling all over. I was resisting letting go and ‘embracing’ the experience. When I eventually did the quaking literally dissolved in an instant into a dazzling warmth that pervaded my whole body. I knew that I was in the hospital as a child of four, my parents nowhere to be seen, being held down by several adults and chloroformed for the second time in my short life, unable to prevent it – terrified and furious at the same time. I had always known that something like it happened. What was new was that I had vividly re-experienced the critical moment itself, the few seconds before I went unconscious. I remembered also what I had never got close to before, my feelings at the time, and even more than that I knew exactly what I had thought at the time as well.

I knew instantly that I had lost my faith in Christ, and therefore God – where was He right then? Nowhere. And they’d told me He would always look after me. I lost my faith in my family, especially my parents. Where were they? Nowhere to be seen. I obviously couldn’t rely on them. Then like a blaze of light from behind a cloud came the idea: ‘You’ve only yourself to rely on.’

The earlier experience had been more confusing, with no specific experience to explain it by.

Saturday was the day I dynamited my way into my basement. Suddenly, without any warning that I can remember, I was catapulted from my cushioned platform of bored breathing into the underground river of my tears – tears that I had never known existed.

It was an Emily Dickinson moment:

And then a Plank in Reason, broke,
And I dropped down, and down –
And hit a World, at every plunge, . . .

I’m just not as capable of conveying my experience in words as vividly as she did hers.

Drowning is probably the best word to describe how it felt. Yes, of course I could breath, but every breath plunged me deeper into the pain. Somehow I felt safe enough in that room full of unorthodox fellow travellers, pillow pounders and stretched out deep breathers alike, to continue exploring this bizarre dam-breaking flood of feeling, searching for what it meant.

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A passion to cage the invisible by visible methods continues to motivate the science of psychology, even though that science has given up the century-long search for the soul in various body parts and systems.

(James Hillman – The Soul’s Code: in search of character & calling – page 92)

In the last post I looked at some of the ways in which the arrogance of our convictions creates problems for us all, a theme triggered by excellent books on the afterlife by Fontana and Kean, who both emphasise the way our culture dismisses compelling evidence that supports the idea of the transcendent.

Basically, human beings are prone to asserting their unexamined convictions in the face of contradictory evidence.

One important reason for this has been labelled confirmation biasShahram Heshmat, in a Psychology Today article, explains:

[This] occurs from the direct influence of desire on beliefs. When people would like a certain idea/concept to be true, they end up believing it to be true. They are motivated by wishful thinking. This error leads the individual to stop gathering information when the evidence gathered so far confirms the views (prejudices) one would like to be true.

Once we have formed a view, we embrace information that confirms that view while ignoring, or rejecting, information that casts doubt on it. Confirmation bias suggests that we don’t perceive circumstances objectively. We pick out those bits of data that make us feel good because they confirm our prejudices. Thus, we may become prisoners of our assumptions.

This tendency is not much of a problem when the belief in question does no harm. When beliefs do damage, this tendency is fundamentally unacceptable, especially if the beliefs spread, as they often do, and when our sense of self is deeply invested in them.

What do I mean by that exactly?

To answer that question, at least in part, let’s come back to the issue of the afterlife.

Fontana writes (page 94):

Just as once the multitudes were persuaded by the priesthood they had no right to approach the divine except through the intermediation of the church, so the multitudes are now persuaded by the materialistic creed of our times that they have no right to approach mental life except through the intermediation of those who put their faith in prescription drugs and brain scans.

Those who have invested their credulity in scientism plainly do not see that they are operating just like a Holocaust denier. Denial and arrogant ignorance is toxic enough when applied to the facts of history, and could potentially create the conditions for a repetition of the same abusive genocide. Denial of our spiritual dimension allied to a denigration of our more extraordinary experiences is not just potentially destructive, it is actually damaging huge numbers of people already, as previous posts on this blog have explored.

One short quote from James Davies’s book Cracked in support of this contention will have to suffice here. He is addressing the issue of our exportation of our psychiatric model to the rest of the world. In the chapter dealing with the export issue he first summarises his case up to that point (page 258 – square brackets pull in additional points he has made elsewhere):

Western psychiatry has just too many fissures in the system to warrant its wholesale exportation, not just because psychiatric diagnostic manuals are more products of culture than science (chapter 2) [and have labelled as disorders many normal responses to experience], or because the efficacy of our drugs is far from encouraging (Chapter 4), or because behind Western psychiatry lie a variety of cultural assumptions about human nature and the role of suffering of often questionable validity and utility (Chapter 9), or because pharmaceutical marketing can’t be relied on to report the facts unadulterated and unadorned [and its influence has helped consolidate the stranglehold of diagnosis and a simplistic psychiatric approach] (Chapter 10), or finally because our exported practices may undermine successful local ways of managing distress. If there is any conclusion to which the chapters of this book should point, it is that we must think twice before confidently imparting to unsuspecting people around the globe our particular brand of biological psychiatry, our wholly negative views of suffering, our medicalisation of everyday life, and our fearfulness of any emotion that may bring us down.

Not an entirely healthy approach to human experience then. Hillman defines the problem neatly (page 184):

If a culture’s philosophy does not allow enough place for the other, give credit to the invisible, then the other must squeeze itself into our psychic system in distorted form. This suggests that some psychic dysfunctions would be better located in the dysfunctional world view by which they are judged.

So, the widespread self-serving disparagement of the evidence in favour of an afterlife is just one troubling symptom of a prevalent materialistic disease.

It does not have to be so. There is a remedy and it is a matter of urgency that enough of us come to recognise that.

For a start, an important principle of my faith asserts that religion and science are in harmony, something I have  explored at length on this blog in the work of Alvin Plantinga and am republishing currently.

The third principle or teaching of Bahá’u’lláh is the oneness of religion and science. Any religious belief which is not conformable with scientific proof and investigation is superstition, for true science is reason and reality, and religion is essentially reality and pure reason; therefore, the two must correspond. Religious teaching which is at variance with science and reason is human invention and imagination unworthy of acceptance, for the antithesis and opposite of knowledge is superstition born of the ignorance of man. If we say religion is opposed to science, we lack knowledge of either true science or true religion, for both are founded upon the premises and conclusions of reason, and both must bear its test

(Promulgation of Universal Peace – page 106)

Moreover, in the Bahá’í view the existence of the spiritual dimension is supported by evidence, though such a proposition is not one that is widely accepted.

If you should ask a thousand persons, ‘What are the proofs of the reality of Divinity?’ perhaps not one would be able to answer. If you should ask further, ‘What proofs have you regarding the essence of God?’ ‘How do you explain inspiration and revelation?’ ‘What are the evidences of conscious intelligence beyond the material universe?’ ‘Can you suggest a plan and method for the betterment of human moralities?’ ‘Can you clearly define and differentiate the world of nature and the world of Divinity?’ — you would receive very little real knowledge and enlightenment upon these questions….

The intellectual proofs of Divinity are based upon observation and evidence which constitute decisive argument, logically proving the reality of Divinity, the effulgence of mercy, the certainty of inspiration and immortality of the spirit. This is, in reality, the science of Divinity

(Promulgation of Universal Peace – page 326)

Stewart in his home studio: for source of image see link.

The two books under consideration here provide a plethora of hard evidence for the reality of some kind of transcendent dimension. Kean’s account of her direct experience of  Stewart Alexander’s mediumship is just one of many such pieces of evidence (pages 321-344). It contains much that would trigger the incredulity of a convinced and dogmatic sceptic, including physical manifestations: however the conditions under which these phenomena occurred make it hard, perhaps virtually impossible to dismiss them out of hand.

She quotes Fontana in their defence (page 326):

Despite his distaste for travel, Stewart has held séances in Scotland and Wales, as well as Sweden, Switzerland, Germany, and Spain. He has sat for sceptics, researchers, and parapsychological organisations. For these public sittings, he was often bodily searched, and his chair and every aspect of the various rooms were thoroughly searched. ‘Apart from the very few and unconvincing accusations made against him by ill-informed individuals,’ David Fontana wrote in 2010, ‘Stewart’s long career has been free from attempts to cast doubt on the genuine nature of the phenomena associated with his mediumship.’

In fact, the evidence in favour of this transcendent reality has often been more rigorously generated and seems more convincing, in my view, than that which recommends our ingestion of chemicals with a multitude of unpleasant effects in addition to their dubious benefits.

Kean’s words towards the end of her book seem a good place to stop (page 360):

No matter where the force that produces these extraordinary phenomena comes from, any intellectually honest person who studies the literature and engages directly with authentic, skilled mediums cannot deny that psi is real. . . . . I’m not a scientist, but I would think that if consciousness is nonlocal and there are nonphysical realms, these would naturally exist outside the confines of the material world and would therefore not be subject to the laws of physics. My only request of those who deny any of this is possible is to simply look at the evidence with an open mind.

Where the afterlife is concerned, there would be no better place to start such an investigation than these two books. There are of course other issues to explore. For the deficiencies of psychiatry James Davies and Richard Bentall are to be highly recommended: in terms of our econocracy Earle et al’s book is a good one.

Whatever area we want to explore we need to ‘look [and look hard] at the evidence with an open mind’ if we are not simply to be dupes of our prevailing materialistic, consumer oriented, economic-growth-is-good mythology.

Oh, and I’ll be looking at mythology again in the next post or two.

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To seek coherence between the spiritual and the material does not imply that the material goals of development are to be trivialised. It does require, however, the rejection of approaches to development which define it as the transfer to all societies of the ideological convictions, the social structures, the economic practices, the models of governance—in the final analysis, the very patterns of life—prevalent in certain highly industrialized regions of the world. When the material and spiritual dimensions of the life of a community are kept in mind and due attention is given to both scientific and spiritual knowledge, the tendency to reduce development to the mere consumption of goods and services and the naive use of technological packages is avoided.

(Bahá’í Office of Social and Economic Development statement on Social Action page 5)

There is no justification for continuing to perpetuate structures, rules, and systems that manifestly fail to serve the interests of all peoples. The teachings of the Faith leave no room for doubt: there is an inherent moral dimension to the generation, distribution, and utilization of wealth and resources.

(Message from the Universal House of Justice – 1 March 2017)

I may be biased. My suspicions about psychiatry and capitalism go back a long way. I know you’ll want to know what on earth those two systems of thought have to do with each other but I’ll come back to that in a moment.

For now I want to declare up front that my recent reading may have simply been confirming my long-standing biases. My flirtation with Marxism in my late twenties and my involvement with People Not Psychiatry (PNP) in the early 70s testify to the biases.

My iconoclasm was tempered by experience, and I came to realise that neither of my bêtes noires was all bad. However, I remained convinced that they were not all they were cracked up to be either.

Which brings me to the first book I wish to speak about: Cracked by James Davies. I did a short review of it recently so I won’t be rehashing any of that. I just want to focus now on one small part of his argument.

Davies, towards the end of his book, addresses his concerns about the training of future psychiatrists (pages 282-285):

At present in the UK, psychiatric training provides only cursory lip service to academic critiques of the bio-psychiatric world-view. Serious anthropological, sociological or philosophical critiques of the medical model are seen at best as interesting sidelines to what psychiatrists actually do.

He quotes one of his interviewees:

As Pat Bracken said frankly: ‘What I hear from the trainees working with me is that the exams are very much heavily skewed towards learning facts, diagnostic categories, causal models all framed in the medical model, as though you can teach psychiatry in the same way as you will teach respiratory medicine or endocrinology.’

Psychiatrists who are sceptical of this approach nonetheless teach it uncritically. He quotes someone in that position: ‘What troubled this psychiatrist most was not just that he was acting against his convictions, but that by the time these trainees had passed their professional tests their critical sensitivities had been eroded.’ The reported experience of trainees supports this view. And young psychiatrists are afraid of seeming critical in case they are written off as ‘anti-psychiatry’ to the detriment of their careers.

Which paves the way to finding out why I have lumped two apparently dissimilar disciplines together.

In their book, The Econocracy, Earle, Moran and Ward-Perkins write (page 37):

Economic students learn one particular type of economics; and… they are taught to accept this type of economics in an uncritical manner.

Why would that matter?

Well, firstly, we all know by now that neoclassical economic models failed to predict the 2008 crash and still fail to explain it fully now.

The authors go further and make it clear that:

We are failing to equip the next generation of economic experts with the knowledge and skills to build healthy, resilient societies… Critical and independent thinking is discouraged and there is little or no history, ethics or politics in economics courses.

They are troubled by two characteristics in particular of neoclassical economics (page 38-39):

Firstly, it is based on a mechanical view of the world. . . . . Secondly, neoclassical economics paints a picture of the economy as a stand-alone, abstract system that emerges naturally from the actions of individual agents.

It does not ask ‘why agents behave as they do’ or ‘whether the economic goals embedded in its models are desirable.’

They go on to explain (page 40):

In practice the type of mathematics used by economists means that there is a focus on material sources of well-being such as income and consumption over less tangible issues such as human rights, job security and mental health.

There is an almost complete absence of critical and independent thinking (page 47). There is also a total lack of focus on ethics (page 51). The authors regard this as indoctrination, not even training and certainly not education (page 54).

The book as whole is a rigorous and detailed examination of the evidence for econocracy’s failings, both as a system for training competent economists and as the means of ridding our society of its potentially disastrous flaws in the political and economic sphere.

The authors argue in the end that (page 151) ‘we need a new relationship between experts and society,’ and suggest various ways in which this could over time be accomplished. They do not claim it would be easy, not least because many economists in the US, for example, like too many psychiatrists everywhere, are supping with the devil without a sufficiently long spoon (page 158): in 2010 ‘During 96 testimonies to Congress by 82 academic economists – under oath – one third failed to disclose that they were being paid for consulting by companies that would be regulated under [the proposed legislation under discussion].’

They conclude (page 169):

We know it is tempting to leave economics to the experts, particularly as this is part of the dominant political culture of the twentieth century, but in this case we cannot afford to. We are being sold short because the very knowledge and skills we need to address the great challenges humanity faces in the twentieth century have been systematically left out of the education of those who go on to run our economy.

I find it disturbing that two key areas of education in our culture, the one affecting our general well-being and the other affecting our mental health, should have been so deeply infected by both a mechanistic way of thinking, whose limitations McGilchrist has convincingly exposed, and a prioritising of profit, that many thinkers other than Karl Marx have long been questioning.

I won’t go over that ground in detail again here as it is covered extensively elsewhere on this blog. Just one quote, from McGilchrist’s The Master & his Emissary to illustrate what a the nightmare world he feels will be created by the untrammelled operation of the utilitarian left-hemisphere,will have to sufficeTowards the end of his book, McGilchrist spells out simply and clearly some of the characteristics of that world (page 430):

Skills . . . would be reduced to algorithmic procedures . . . which could be regulated by administrators. . . . Increasingly the living world would be modelled on the mechanical. . . . When we deal with a machine, there are three things that we want to know: how much it can do, how fast it can do it, and with what degree of precision. . . . In human affairs, increasing the amount or extent of something, or the speed with which something happens, or the inflexible precision with which it is conceived or applied, can actually destroy. But since the left hemisphere is the hemisphere of What, quantity would be the only criterion that it would understand. The right hemisphere’s appreciation of How (quality) would be lost.

And another from Ehrenfeld in the book Flourishing, describing vividly where the mindless and unbridled consumption free market capitalism encourages will take us (pages 82-83):

Executives of the firms that are pushing sustainability… are unaware or purposely ignoring that the global economy is already consuming more than the Earth can provide. No matter what happens in the United States and Europe, the burden will increase as the rapidly growing economies of China, India, and elsewhere strive to attain the same levels that we “enjoy.”

But do we “enjoy” our consumer lifestyle? Data on drug abuse, crime, social alienation, and disintegrating communities might suggest otherwise. And yet, we continue to seek satisfaction in having and consuming more stuff.

As more of us consume more as more countries get wealthier, time may be running out.

And now, I will end by simply emphasising that both these books, The Econocracy and Cracked, are well worth a careful read.

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12iht-educside12A-articleLarge

Given the subject matter of my last post, this one from 2013 seems an appropriate one to re-publish.

A friend gave me the heads up on this interesting exchange of views. It needs to be taken into account in the light of the very different system of diagnosis in the French system (see link). Still it’s a valuable discussion in its own right. Below is an extract – for the full post see link.

“The analytic philosophers brought a real clarity to our discussions,” Dr. Harland said. “We were looking at various models to help us understand what we were doing as psychiatrists.

“There is lots of applied science now in psychiatry: neuroimaging, genetics, epidemiology. But they don’t have much to say about sitting with a patient and trying to understand that person’s experiences.”

Tania L. Gergel, a philosopher whose work stretches from Ancient Greek ideas about ethics to dilemmas in contemporary medicine, was drawn to the Maudsley seminar out of intellectual curiosity. She also relished the chance to “come into contact with people who have actual clinical experience.”

“You can only learn so much from reading journal articles,” Ms. Gergel said. “The problem is that, as you move towards abstraction, it’s easy to lose sight of the fact that people are dealing with real suffering and real dysfunctions. We need to remember that those dysfunctions — whether of the brain or of the mind — are linked to a real individual who is going through a devastating crisis.”

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Suffering is life.

(Thomas Szasz quoted by James Davies in Cracked – page 276)

I was walking back from town one day when my phone pinged. It was a message telling me my book was ready for collection from Waterstones. I was puzzled to begin with then the penny dropped. Just before my birthday someone spotted that I had scribbled, in my list of books to buy, the title of Cracked by James Davies.

I turned round and headed back to town again. When I picked up the book, for some reason I wasn’t impressed by its cover. Maybe the words ‘Mail on Sunday’ put me off, though Wilf Self’s comment helped to redress the balance.

Anyhow, for whatever reason, I didn’t get round to reading it until after I’d finished Rovelli’s Reality is not What it Seems. I’ll be doing a short review of that later, possibly.

Once I started Davies’s book I was hooked.

I’ve already shared on this blog a review of Bentall’s book Doctoring the Mind, which brilliantly, for me at least, brings the more grandiose pretentions of psychiatry back to the earth with a bump. I quoted Salley Vickers’ verdict:

Bentall’s thesis is that, for all the apparent advances in understanding psychiatric disorders, psychiatric treatment has done little to improve human welfare, because the scientific research which has led to the favouring of mind-altering drugs is, as he puts it, “fatally flawed”. He cites some startling evidence from the World Health Organisation that suggests patients suffering psychotic episodes in developing countries recover “better” than those from the industrialised world and the aim of the book is broadly to suggest why this might be so. . . .

I summarised my own view by praising ‘its rigorous analysis of the misleading inadequacy of psychiatry’s diagnostic system, its powerful and carefully argued exposure of the myths surrounding psychotropic medications and their supposed efficacy, and its moving description of the critical importance of positive relationships to recovery.’

The Davies book also covers much of this same ground and is equally compelling. What needs to be acknowledged is that he also takes the argument to another level towards the end of his book. He is concerned that we are exporting our Western model with all its flaws to country after country and goes on to explore other implications as well.

In the chapter dealing with the export issue he first summarises his case up to that point (page 258 – square brackets pull in additional points he has made elsewhere):

Western psychiatry has just too many fissures in the system to warrant its wholesale exportation, not just because psychiatric diagnostic manuals are more products of culture than science (chapter 2) [and have labelled as disorders many normal responses to experience], or because the efficacy of our drugs is far from encouraging (Chapter 4), or because behind Western psychiatry lie a variety of cultural assumptions about human nature and the role of suffering of often questionable validity and utility (Chapter 9), or because pharmaceutical marketing can’t be relied on to report the facts unadulterated and unadorned [and its influence has helped consolidate the stranglehold of diagnosis and a simplistic psychiatric approach] (Chapter 10), or finally because our exported practices may undermine successful local ways of managing distress. If there is any conclusion to which the chapters of this book should point, it is that we must think twice before confidently imparting to unsuspecting people around the globe our particular brand of biological psychiatry, our wholly negative views of suffering, our medicalisation of everyday life, and our fearfulness of any emotion that may bring us down.

I can’t emphasise too strongly the value of reading through the details of his treatment of all these other aspects. I am of course aware that physical medicine, even though there are biological markers for diseases in this sphere unlike in mental health, has not been exempt from the disingenuous manipulation of data and unscrupulous marketing methods practiced by the pharmaceutical industry, as Malcolm Kendrick’s book Doctoring Data eloquently testifies, but the scale of that abuse is dwarfed in the arena of mental health – and I mean arena in the fullest sense of that word: the battle here is damaging more ‘patients’ and costing even more lives.

Davies’s examination of exactly how this exportation of the psychiatric perspective is coming about is also disturbing and compelling reading. He adduces for example how skilfully drug companies have learned to read the reality of cultures into which they want to make inroads with their products, how effectively they target key figures in the prescribing hierarchy of professionals, and how astutely they now reach out to the public themselves so they will go to their doctors and request what the drug company is selling – all this to detriment of the many ways the social cohesion of the receiving culture has often (though not always, of course) been supporting those who are suffering from some form of emotional distress.

Where he takes his case next, in Chapter 10, I found both compelling and resonant. He is in tune with Bentall in seeing the importance of supportive relationships but, I think, explores that aspect somewhat more deeply.

He repeats basic points, to begin with (page 266):

What the evidence shows… is that what matters most in mental health care is not diagnosing problems and prescribing medication, but developing meaningful relationships with sufferers with the aim of cultivating insight into their problems, so the right interventions can be individually tailored to their needs. Sometimes this means giving meds, but more often it does not.

He then quotes research done by a psychiatrist he interviewed (page 267). Using two existing MH teams, Dr Sami Timimi set up a study comparing the results from two groups, one diagnostic, the usual approach, and the other non-diagnostic, where medication was given only sparingly, diagnosis was hardly used at all, and individual treatment plans were tailored to the person’s unique needs.’

In the non-diagnostic group the psychiatrist spent far more time exploring with his clients the context of their problems.

The results were clear (page 269):

Only 9 per cent of patients treated by the non-diagnostic approach continued needing treatment after two years, compared with 34 per cent of patients who were being treated via the medical model. Furthermore, only one person from the non-diagnostic group ended up having to be hospitalised, whereas over 15 people in the medical-model team were referred for inpatient hospital treatment. Finally, the non-diagnostic approach led to more people being discharged more quickly, and to the lowest patient ‘no-show’ rate out of all the mental health teams in the county.

Davies also interviewed Dr Peter Breggin, a US psychiatrist who is critical of the medical model. Breggin explained his viewpoint (page 279):

Most problems are created by the contexts in which people live and therefore require contextual not chemical solutions. ‘People who are breaking down are often like canaries in a mineshafts,’ explained Breggin. ‘They are a signal of a severe family issue.’ .  . . . For Breggin, because the medical model fails to take context seriously – whether the family or the wider social context – it overlooks the importance of understanding and managing context to help the person in distress.

Davies quotes Dr Pat Bracken as singing from the same hymn sheet (page 273):

We should start turning the paradigm round, start seeing the non-medical approach as the real work of psychiatry, rather than as incidental to the main thrust of the job, which is about diagnosing people and then getting them on the right drugs.

It’s where he goes next that I found most unexpected but most welcome to my heart. He leads into it with an interview with Thomas Sasz just before his death at the age of 92 (page 276). He asks Szasz, ‘why do we believe as a culture that suffering must be removed chemically rather than understood in many cases as a natural human phenomenon, and possibly something from which we can learn and grow if worked through productively?’

Szasz’s response is fascinating:

Our age has replaced a religious point of view with a pseudo-scientific point of view. . .   Now everything is explained in terms of molecules and atoms and brain scans. It is a reduction of the human being to a biological machine. We don’t have existential or religious or mental suffering any more. Instead we have brain disorders.

Davies summarises Szasz’s position on psychiatry (page 277): ‘It had become deluded in its belief that its physical technologies, its ECT machines and laboratory-manufactured molecules, could solve the deeper dilemmas of the soul, society and self.

Bracken’s view on this brings in capitalism (page 278):

What complicates things more is that we also live in a capitalist society, where there is always going to be someone trying to sell you something… In fact, some people would argue that capitalism can only continue by constantly making us dissatisfied with our lives.… You know, if everybody said I am very happy with my television, my car and everything else I’ve got, and I’m perfectly content with my lifestyle, the whole economy would come shattering down around our ears.

He continues (page 279):

What we customarily call mental illness is not always illness in the medical sense. It’s often a natural outcome of struggling to make our way in a world where the traditional guides, props and understandings are rapidly disappearing… Not all mental strife is therefore due to an internal malfunction but often to the outcome of living in a malfunctioning world. The solution is not yet more medicalisation, but an overhaul of our cultural beliefs, a reinfusing of life with spiritual, religious or humanistic meaning with emphasis on the essential involvement of community, and with whatever helps bring us greater direction, understanding, courage and purpose.

Unfortunately psychiatry, as with economics according to the writers of Econocracy, is failing to train psychiatrists in the adoption of a critical perspective on their own practice. So, he concludes, the pressure to change perspective has to come from outside the psychiatric system. He quotes Timimi again (page 285):

The things that get powerful institutions to change don’t usually come from inside those institutions. They usually come from outside. So anything that can put pressure on psychiatry as an institution to critique its concepts and reform its ways must surely be a good thing.

So, it’s down to us then. For me, promoting this book is a start. We all need to think, though, what else could be done, whether as a patient, a volunteer, a friend, a family member, an MP, a clinician or simply a citizen.

Currently, help is often tied to diagnosis. One psychiatrist quoted in this book is concerned that if categories of mental disorder are not confirmed as diseases, services will never be funded at the required level, the level, say, at which cancer services are funded. Surely, though, if opinion shifts to a tipping point not only the greater humanity of non-diagnostic treatments but also their relative cost effectiveness must carry the day in the end. But opinion will only shift sufficiently if we all play our part.

I know! I’ve got it.

You all could start by reading these two books. How about that?

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doctoring-the-mindEven during the last few hectic weeks, I have managed to find time to read Richard Bentall’s brilliant demolition of standard psychiatric treatments. I realise it’s a bit late in the day to flag up my enthusiasm for this book which was first published in 2009, just after I retired. However, as it’s message is so important and resonates so strongly with my current preoccupations I feel obliged to sing its praises.

In subsequent posts, I intend to draw on its rigorous analysis of the misleading inadequacy of psychiatry’s diagnostic system, its powerful and carefully argued exposure of the myths surrounding psychotropic medications and their supposed efficacy, and its moving description of the critical importance of positive relationships to recovery. In the meantime for those who want a more detailed sense of this book’s perspective, the Guardian review of 2009 is a good place to start. Below is a short extract. For the full post see link.

Salley Vickers applauds a brave work that argues that mind-altering drugs do more harm than good to the mentally ill.

Richard Bentall, a clinical psychologist, is a controversial figure in the field of mental health. An example of the hostility that his conclusions provoke among those practising conventional (that is, drug-based) psychiatry is given in the preface to this book, which raises serious questions about the treatment of mental illness. Bentall describes an encounter with an amiable-seeming psychiatrist who responds to a talk he has given as follows: “Professor Bentall has told us he is a scientist. But he is not! Nothing that Professor Bentall has said – not one single word – is true.”

The unlikelihood of a professor of psychology delivering, in the sober environment of an NHS conference, a talk in which every word is fictitious and every opinion fallacious gives a flavour of the threat that Bentall’s theories pose. The response, as reported, sounds deranged and it is interesting to observe how debate among professionals over the causes of mental illness appears to induce its own version of madness, as if the topic itself were contagious. One sign of sanity, both in the individual and society, is the ability to deal with dissent.

In an earlier book, Madness Explained, Bentall was at pains to distinguish his approach from other anti-psychiatrists – for example, RD Laing, whose radical views were discredited because of his flamboyant lack of rigour and attendant inability to accept criticism. Bentall, as this book attests, is a different kettle of fish. With patient persistence and without recourse to rancorous diatribes, he has appraised the scientific evidence for the success of contemporary psychiatric treatments and come up with a dismal report. It is probably the very balance of his approach that drives his opponents crazy.

Doctoring the Mind is an attempt to clarify the dense array of evidence offered in Bentall’s earlier work. The result is a much easier read. It is also, for that reason, more disturbing. Other recent books (Lisa Appignanesi’s Mad, Bad and Sad, for example) have also traced the dark strains of misperception, mismanagement and downright cruelty in psychiatry’s chequered history, but Bentall’s achievement is to focus on contemporary psychiatric practices, especially those dedicated to treating serious psychoses (his own area of expertise).

Bentall’s thesis is that, for all the apparent advances in understanding psychiatric disorders, psychiatric treatment has done little to improve human welfare, because the scientific research which has led to the favouring of mind-altering drugs is, as he puts it, “fatally flawed”. He cites some startling evidence from the World Health Organisation that suggests patients suffering psychotic episodes in developing countries recover “better” than those from the industrialised world and the aim of the book is broadly to suggest why this might be so. . . .

As Bentall starkly says: “Without hope, the struggle for survival seems pointless.” At a time when dialogue in the presence of other human beings is becoming less and less available, this brave book gives a sense of why this could be disastrous.

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A friend gave me the heads up on this interesting exchange of views. It needs to be taken into account in the light of the very different system of diagnosis in the French system (see link). Still it’s a valuable discussion in its own right. Below is an extract – for the full post see link.

“The analytic philosophers brought a real clarity to our discussions,” Dr. Harland said. “We were looking at various models to help us understand what we were doing as psychiatrists.

“There is lots of applied science now in psychiatry: neuroimaging, genetics, epidemiology. But they don’t have much to say about sitting with a patient and trying to understand that person’s experiences.”

Tania L. Gergel, a philosopher whose work stretches from Ancient Greek ideas about ethics to dilemmas in contemporary medicine, was drawn to the Maudsley seminar out of intellectual curiosity. She also relished the chance to “come into contact with people who have actual clinical experience.”

“You can only learn so much from reading journal articles,” Ms. Gergel said. “The problem is that, as you move towards abstraction, it’s easy to lose sight of the fact that people are dealing with real suffering and real dysfunctions. We need to remember that those dysfunctions — whether of the brain or of the mind — are linked to a real individual who is going through a devastating crisis.”

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