For therapy to work, both parties must have faith, sometimes against all reason, that their expedition will succeed.
I heartily recommend Gary Greenberg’s article America’s War on Unhappiness in Harper’s Magazine/September 2010. It is an often tongue-in-cheek look at the post-Freudian state of therapy today. Unfortunately, the article is only available to Harper’s subcribers. I have written about it previously here.
Greenberg writes about the “Dodo Bird Effect” as it applies to therapy. The Dodo Bird Effect is a term borrowed from Alice in Wonderland and coined in 1936 by psychologist Saul Rosenzweig. Rosenzweig discovered that it doesn’t really matter what therapy you choose to pursue, because they all work. “Everyone has won and all must have prizes” is the way the dodo bird put it. The Dodo Bird Effect is similar to the better known placebo effect. But what numerous studies have shown since the Rosenzweig study is that the single factor that makes a difference is FAITH, the patient’s faith that the therapy will work and the therapist believing in what he does.
Step back from this insight and marvel. It doesn’t matter what your chosen course of action is re supposedly “treatment resistant” schizophrenia, as long as you believe in its ability to produce the outcome you want. You don’t even have to buy any of the therapies that Chris and I have tested – just find your own version of the truth and run with it. (I recommend not putting all your dodo eggs* in one basket. Spread your therapeutic interventions around and very importantly, find a therapist who believes in what he or she is doing.)
The key here is that if a therapy is to work, not only the patient but the therapist must believe in what he does. Since my son’s initial two year course of day program and drug therapy was what I would call a failure, I came to the conclusion early on that the therapists actually didn’t believe in the approach either. Imagine going to work every day and not believing in what you are doing.
It’s especially critical for therapists to believe in happy endings. The doctors in the day program had a “professed” belief in the medication, where they seemed to put most of their emphasis, but it became obvious to me as it should have been obvious to them, that if the patient isn’t getting better you’d better find approach you actually do believe in or take down your shingle. I could tell that the doctors also didn’t believe that schizophrenia was “curable” and that my son would get through this. One way of measuring their belief is by the words they used and the tone of voice. To them, schizophrenia was a sad, sad business. This doesn’t inspire belief by others, because belief must be positive in order to heal. They couldn’t sell me on a healing outcome because the elaboration of the Dodo Bird Effect says they didn’t believe in one.
We have been lucky. Once I figured out that the program wasn’t going to help Chris, I looked around for doctors who could. I found two excellent psychiatrists. The first one introduced us to the world of holistic healing and energy medicine. Dr. “O” totally believed in what she was doing and her belief was contagious. Dr. Stern passes my litmus test for belief through her commitment to what she does as a Family Constellation therapist amongst other interventions.
Poetic license, the dodo bird has been extinct since the late 1600s.
The last leg of our vacation was attending a wedding anniversary celebration for Ian’s father and his father’s wife (no blood relation to Ian). I was particularly curious to get reacquainted with “Joan’s” eldest daughter, who I had not seen for almost twenty-five years. “Linda” was a nurse married to an ambitious, up-and-coming young man until it all fell apart after the birth of her second child. Linda was diagnosed paranoid schizophrenic. Her husband ditched her, took the children, and quickly remarried. She seemed like a lost soul for many, many years. From time to time I would hear from Joan that Linda was living out of her car, or living in church basements. Joan’s family doctor had told her after several years of trying to intervene, just to “let her go, there is nothing you can do.”
So, I went to the anniversary celebration half expecting to see Linda on the fringes of the room muttering incoherently to herself and looking dishevelled. (Dr. Abram Hoffer referred to untreated people with schizophrenia as “deteriorated schizophrenics.”) I am guessing that Linda was not now and had not been on medication based on the information I had picked up over the years. I used to worry that her not being on medication was affecting her brain and would make it harder for her to make a come-back. I had bought, without feeling really good about it, the “protect the brain” hype that the pharmaceutical companies were using to sell their products. Dr. Hoffer’s point was that megadose vitamins were better than medications, yet I doubt Linda had been taking vitamins.
At the gathering I looked all over the place for Linda and about half way through the party I spotted her. She was healthy and happy, and better yet, she was socially outgoing. She greeted me warmly and enthusiastically. I was dying to ask all kinds of inappropriate questions to find out how she had managed to be so well, but of course, I didn’t. I doubt if she has gone back to nursing, I even doubt if she is working at the moment, but I remain open to being surprised. I was told that her sister took a real interest in her welfare and has helped her tremendously in regaining her confidence.
Linda’s twenty something daughter is struggling, however. She has dealt with the aftermath of a premature birth all her young life. A few years ago she “came out” as a homosexual, married and divorced a woman, and was subsequently diagnosed with schizophrenia. (Makes me wonder more than ever about the validity of these labels when you consider all the suffering.) The daughter is young and can work it through for herself in her own way, in her own time. Empathy is a great healer, too.
Michel Montignac died last Sunday in Annemasse, France. His name is frequently referred to in reverential tones in our household, usually at dinner time. He perfected a low-glycemic diet (despite no scientific training, harrumph his critics) that was the inspiration for the South Beach Diet and the Susanne Somers Diet amongst others.
“All traditional methods of dieting have amounted to a myth as big as Communism, and like Communism, they are destined to collapse,” Mr. Montignac told The New York Times in 1993.
Despite the fact that his diet isn’t actually a diet but a sensible way of life, he still has his critics. “The diet is basically a delightful, joyous swindle,” Dr. Marian Afpfelbaum, a nutrition professor at the Bichat medical school in Paris, said in 1993.
When I hear a nutritionist weigh in with an opinion, I usually tune out. Nutritionists have been telling us for years rubbish such as what my mother heard from one on CBC Radio back in the 1950s. Kool-Aid is a nutritious drink for children, the nutritionist said soothingly. Yes, she actually said that! Nutritionists then went on to contradict themselves for several decades by saying that sugar causes hyperactivity, then recently nutritionists have begun telling us that sugar doesn’t cause hyperactivity. Nutritionists also tell us nonsense that we can get all the nutrients we need just by eating a balanced meal, completely ignoring the fact that food loses much of its nutritive value by being shipped long distances (so do people, BTW), frozen and defrosted, and more importantly, some people need lots more of certain vitamins than the recommended daily amount. Recommended daily amounts are for sissies. You gotta be bold when it comes to your own health.
I put nutritionists in the same category as most psychiatrists – they both are faddists. Since we are all unique in mind and body, we owe it to ourselves to think for ourselves about what works and what doesn’t for us.
Just this week, in fact, I was daydreaming about opening up a chain of restaurants in North America based on the Montignac low-glycemic index and food combining. Patrons at my restaurants and fast food outlets would be refused any food combination that provokes weight gain and diabetes. “You want potatoes or pasta with your meat? Forget it. And don’t even think of ordering fruit after dinner. It’s just not going to happen here.”
R.I.P. Michel Montignac. I haven’t had that bloated feeling since I embarked on your diet.
There is a fascinating article in the July 12 & 19 New Yorker magazine about the art world and forgeries, but it just as much could apply to the world of psychiatry, which is still trying (badly) to gain respectability as a science. The comparison between psychiatry and art dealers is not an exact fit, but it’s close. Psychiatry and pharma are trying to justify the existence of the “schizophrenia gene” and to utilize brain scans that will put us endlessly in their thrall, just as this article explains that fingerprints are the holy grail in authenticating works of art. Many people will take advantage of the public’s wanting to believe in certainty.
In the early twentieth century, as J. P. Morgan, Henry Clay Frick, and other wealthy Americans bid up prices of Old Masters, the search for a foolproof system of connoisseurship intensified. At the same time, the flood of money into the art market led to widespread corruption, with dealers often paying off connoisseurs to validate paintings. In 1928, the art dealer René Gimpel complained, “The American collector is prey to the greatest swindle the world has ever seen: the certified swindle.”
The public has long been suspicious of connoisseurship. As John Brewer recounts in his recent book “The American Leonardo,” about a Kansas City couple’s battle, in the nineteen-twenties, to authenticate a potential Leonardo, this distrust had to do with more than the system’s reliability; it also had to do with doubts about the authenticity of the art world itself, with its cult of prized artists, its exorbitant trafficking in aesthetic pleasure, and an élite that seemed even more rarefied than most. In 1920, the Kansas couple, Harry and Andrée Hahn, sued the powerful art dealer Joseph Duveen for half a million dollars after he told a reporter that a portrait they owned could not possibly be a Leonardo. The Hahns argued that connoisseurs offered only “air-spun abstractions and nebulous mumbo-jumbos,” and that “smart and tricky art dealers” ran a “racket.” Even the judge in the case warned jurors to be wary of experts who relied on means “too introspective and subjective.” (Though none of the leading connoisseurs considered the painting a Leonardo, and later technical evaluations confirmed their judgment, the trial ended in a hung jury, and Duveen paid the Hahns sixty thousand dollars to settle the case.)
The desire to “scientificize” connoisseurship was therefore as much about the desire to democratize it, to wrest it out of the hands of art experts. Before the Hahn trial, rumors surfaced that there was a thumbprint in the paint. One newspaper asked, “WILL THUMBPRINT MADE 400 YEARS AGO PROVE PAINTING IS LEONARDO DA VINCI’S ORIGINAL?” But identifying the author of a painting through fingerprints still seemed far beyond the reach of science, and the process of authentication remained largely unchanged until Biro came up with his radical idea.
And so it goes, too, for psychoanalysis. In Gary Greenberg’s excellent article in September’s Harper’s Magazine The war on unhappiness: Goodbye Freud, hello positive thinking, the seeds for our current brain disease model of mental illness were being planted in the wake of Freud’s appearance at Clark University in September 1909:
In 1926, less than two decades after Freud’s visit, the doctors of the New York Psychoanalytic Society declared their independence from their European forebears by decreeing that only physicians could practice psychoanalysis. Back in Vienna, Freud was livid. Medical education was exactly the wrong preparation for a psychoanalyst, he wrote, as it abandoned study of “the history of civilization and sociology” for anatomy and biology, culture for science. A psychoanalyst trained this way was bound to have the wrong idea about psychic suffering: that it was an illness to be isolated and cured by the doctor. This was a form of piety that Freud could not tolerate. “As long as I live,” he wrote, “I shall balk at having psychoanalysis swallowed by medicine.”
Over Freud’s dead body, this is exactly what has happened, to the financial benefit of virtually everyone at the Anaheim conference. The New York Psychoanalytic Society’s marriage of therapy to medicine secured us a place at the health-care trough.
Those of us in the trenches of the mental health industry that has resulted, think psychiatry looks pretty ridiculous at the altar of Mammon and it should have taken Freud’s original advice. Marian Goldstein sums up the up situation in her recent comment on Ron Unger’s blog: A friend of mine once told me about a psychopharmacologist (married to a shrink, btw, the perfect couple… ), who’d said, he would love to cure Jesus with Haldol. He meant it. Seriously.
Or more like a tired whimper. Got back home this morning having not slept at all in economy class and unable to sleep much since. My holiday in the United States and Canada is now a mental collection of snapshots, impressions, and articles clipped from newspapers and magazines that caught my interest, always on my narrowly focused pet topic.
Here’s one impression that I call the “irony and the ecstasy.”
Sign at the entrance to Herdon, Virginia:
Herdon, Virginia – Committed to being drug free.
They’re serious about this, apparently. Yet if Herdonites are like everybody else these days they are loading up on the legally sanctioned drugs while sanctimoniously hounding their teenagers about the evils of the illegal stuff.
An interesting NY Times piece today about the descendants of Thomas Carnegie, brother to Andrew.
The Times interview with “rational anti-psychiatrist” Richard Bentall
In Bentall’s view, we need nothing less than a wholesale culture-change in our approach to mental illness. He says that psychiatric diagnoses are less reliable than star signs (“at least with star signs you can agree on who has which sign.
Anti-psychotics, says Bentall, may lead not only to lethargy and weight gain but to diabetes, cardiovascular disease and early death (“these are drugs that don’t get sold on street corners. They are very unpleasant to take”).
But, he says, psychiatry has long suffered from a crisis of identity, to which it responds by trying to present itself as a “proper” branch of medicine, or, as he puts it, “establishing credibility in the eyes of anaesthetists and neurosurgeons when perhaps they should have been thinking more about what their patients thought of them”. He dreams of a system in which psychiatrists “celebrate the fact that they are not like other doctors”.
Drug companies are bribing American child psychiatrists with huge research grants to advocate this kind of treatment, and it’s beginning to happen in the UK. I don’t know how else to put it but that people are being bribed to poison children — and accepting the bribe.”
With great regret, but also some relief, I am posting my Gone Fishing sign for the month of August. Ian and I will be in the States, sans young men, except for Taylor, our youngest, who will be meeting us for a few days while we tour some battlefields and monuments.
What a difference time makes. A few years ago Ian and I couldn’t leave Chris alone because he deteriorated in our absence. We were confined to our sofa, night after night, watching endless reruns of Friends and downing bottles of red wine to maintain our equilibrium. We continue to down bottles of red wine for our equilibrium, but now we are “self-medicating” for all the right reasons!
Chris isn’t actually alone. He’s with Alex our middle son. It’s almost like being alone because Alex, when he’s not at work, generally stays in his room watching YouTube. (Check out Hamlet!) He parties on week-ends. Chris and Alex get along well, thank goodness.
Despite being on vacation, I will be ever on the look-out for blog ideas. What worked before is that when I got inspired by something I saw or heard, I jotted it down in a notebook or in my new post file if I had access to a computer. When I got back home I could then post something daily without having to think too hard.
So, have a great rest of the summer and see you in September, or periodically in August if I can’t keep my hands off a computer. I will still approve messages from time to time.