Introduction and interview by John Soderlund
Elio Frattaroli is no Karl Marx in his demeanour. But his first book, entitled Healing the Soul in the Age of the Brain: Becoming Conscious in an Unconsious World, reads like an incisive Das Kapital of the psychiatry industry. The friends he'll make from its publication won't be many. But they'll be of a revolutionary persuasion. And Frattaroli's revolution may turn out to be corrosive enough to make the most cognitively simple elements of the psychiatry world think very seriously about an over-reliance on medication in the absence of an examination of what troubles the soul. New Therapist spoke to Frattaroli about his new book, the revolution it promises to ignite in our understanding of the mental health complex, and who features among his new friends and enemies.
NT: You talk in your book "Healing the Soul in the Age of the Brain" of depression as "the muffled voice of the soul". You lambaste medically oriented psychiatrists as too heavily reliant on psychopharmacological approaches to human unhappiness and you raise perplexing and fundamental doubts about the apparently research-based rationale for the ubiquity of antidepressant medication. Your book is a frontal attack on many of the assumptions the psychiatric profession has successfully sold to modern, western society for decades. I would imagine many psychiatrists and large sectors of modern, western society would be unhappy with your objections to what they have learned to take for granted. Given that, what groups of people did you have in mind as readers when you embarked on the writing of this book?
EF: Certainly this is a countercultural book and, as you suggest, it probably goes counter to every culture and subculture it inhabits. It is to be expected that vast numbers of people won't want to hear what I have to say and will dismiss it without giving it serious consideration. Several reviews I have received confirm that this is indeed happening. But I have also been heartened by many enthusiastic responses from people (like you) in all the relevant subcultures who have felt that the book speaks deeply to them.
In writing the book I had the following groups of people in mind:
a) young psychiatrists who have not yet been brainwashed and still have someaspiration to be healers and some awareness that listening is important,
b) psychotherapists of many persuasions who are looking for a deeper understanding of what they are doing and want to improve their skills,
c) current and prospective patients who want to know what they can expect from psychotherapy,
d) educated laypeople and, hopefully, academics, interested in understanding the emptiness of modern culture, the quasi-religious role of science in modern society, the nature of the mind and consciousness and the mind-body problem, the nature of mental illness and the uses of medication, and the philosophical assumptions that underlie current thinking about all these issues.
e) psychoanalysts and psychoanalytically oriented therapists who have been intimidated by many mindless Freud-bashing attackson psychoanalysis by brain scientists, psychiatric researchers, positivist philosophers, medication docs and managed care reviewers, and so have lost confidence in the validity of the psychoanalytic enterprise and need a jolt of clear thinking,
f) psychoanalysts who are looking for a new way of understanding Freud and a reframing of psychoanalytic theory in a way that retains the traditional centrality of the intrapsychic perspective and of intrapsychic conflict and integrates this with a more modern appreciation of the role of transference, countertransference and enactment in the psychoanalytic process without having to succumb to the anything-goes vagaries of the current "relational" fad.
NT: To what extent do you believe that 1) modern, western society and 2) mental health professionals, might be receptive to your anti-medical ideas at this time, and how might this have changed in the past 10 years?
EF: I have to start by correcting a potential misinterpretation of your question. I do not think of my ideas as anti-medical. I am proud to be a physician and I believe that my medical training has made me a better psychotherapist. But I believe that what is nowadays called the medical model of psychiatry is simply bad medicine. It dehumanizes patients, treating their hypothetical chemical imbalances and ignoring their palpable emotional conflicts, treating symptoms as if they were diseases and ignoring perhaps the oldest principle in Western medicine, that the symptom is part of the healing process (which would imply that it is likely to be a genetic adaptation rather than a genetic defect).
Having said that, I think that a significant minority of non-medical mental health professionals will be receptive to my message. Those whose living depends on insurance that pays only for quick-fix approaches will naturally find ways to rationalize whatever quick-fix approach they are using, but the still small voice of common sense will remain. Common sense says that it should be quite impossible to change dysfunctional patterns of emotional interaction (and secondarily of cognition) that have been deeply ingrained in the neural networks of the brain over the course of a lifetime and that define a person's view of him-or-herself and the world, in a therapy limited to an hour per week for ten weeks or for twenty weeks or even for twenty months.
Other non-medical mental health professionals-those who are not stuck in a protocol-driven short-term-therapy mindset-are likely to be much more receptive to my message now than 10 years ago because they are less likely to believe in the miraculous curative powers of psychotropics. Such belief-epitomized and spurred by the evangelism of Listening to Prozac-peaked about ten years ago, and we have now had a decade for disillusioning reality to make itself felt.
As for psychiatrists, I think that there continues to be a small minority who go into psychiatry oriented toward emotional healing rather than chemical fixing and that they will hear the ring of truth in my book. But in general I think psychiatry will die out as a medical subspecialty. If the only thing psychiatrists do is make diagnoses according to a diagnostic manual and prescribe pills to take away symptoms, then they can easily be (and in fact are already being) replaced by symptom checklists and computer programs (for diagnosis) and by primary care physicians and nurse practitioners (for writing prescriptions).
As to how receptive I expect modern western society to be to my message, the answer is "not very." Modern western society is so caught up in superficial materialistic needs and values-the pursuit of material goods, physical appearances, creature comforts and addictive pleasures, all used as quick fixes to distract us from having to feel any anxiety-that it would take a large-scale cultural disaster for people to wake up and notice that they have been ignoring their inner lives and that the one who dies with the most toys doesn't win anything. On the other hand, I do think that society is more receptive now than it was ten years ago because the moral and economic bankruptcy of our addictive materialism is more obvious now. The current stock market disaster (courtesy of Enron, Worldcom, et al) and the even more ominous trend of global warming are two very palpable indicators of the culture's emptiness of values and absence of vision. Hopefully we will, as a culture, be able to do what alcoholics do as individuals: hit bottom, wake up and acknowledge that we have a big problem that we need to take responsibility for. That's what I'm trying to foster in the book.
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