Quiet revolutionary contd ...
NT: Please outline some of your prognostications about the future of psychotherapy, whether you believe it will enjoy increasing favour in the coming decade or two and how you believe the struggle with the medical approach to mental health will play itself out.
EF: I think that the severe limitations of a predominantly pharmacologic approach will become more and more obvious to more and more people. Increasingly, people will realize that they have a right to be offended by doctors and nurses who have no interest in listening to their story or understanding what they're unhappy about, who spend 3 minutes with them (in general medical offices) or 15 minutes (in psychiatric offices) and then give them a prescription for an antidepressant and a return appointment in a month. The rapidly revolving door that is already obvious to people who work in hospitals will become more widely publicized. There will be an increasing awareness of how often medication doesn't work and how often it stops working. And there will probably turn out to be serious long-term consequences of medicating a generation of school children and even pre-school children with psychotropics (these consequences will probably take more than two decades to reveal themselves, however).
Unfortunately, none of this will necessarily change the fundamentally quick-fix mentality of modern culture so, even if it gives psychotherapy a boost, there will still be an emphasis on short-term protocol-driven therapies that can be studied scientistically. For dynamic psychotherapy to be revitalized there would need to be a more widespread re-examining of more fundamental premises of our culture. The kind of thing many people hoped would happen in the 1960s. I would like to think that it is in fact happening in various subcultures now and that when the larger culture hits bottom-however that happens-the seeds of a new cultural consciousness will be there ready to open and grow.
NT: You talk of symptoms and "mental disorders" as markers of an unwellness beneath the surface, and note that these symptoms are often regarded by medical practitioners as the things to obliterate. In a metaphorical sense, ideas like your own-expounded by several writers and objectors in addition to yourself-might be viewed as something of a symptom in the mental health fraternity, an uncomfortable sore on the dominant, homogeneous medical approach. Is this analogy fair and, if so, are you comfortable being a symptom?
Although I secretly aspire to be the observing ego-the Freudian Über-Ich or I that stands above-for the mental health fraternity, I welcome the role of symptom as a step in the right direction (and a needed check on my grandiosity!). Like any good psychiatric symptom, I am trying to call attention to a disharmony within the organism, an inner conflict that needs to be resolved. And like any good symptom I need to be annoying enough to be noticed and recidivistic enough not to be easily obliterated. So the fact that you see me as being annoying enough to inspire a desire to obliterate me seems to me a very good sign (though it may be wishful thinking on both our parts).
NT: Have you experienced ostracism or rejection in your professional life because of the ideas raised in your book?
EF: Usually the people who reject my ideas are very comfortable in their belief that their beliefs aren't beliefs at all, but rather scientific facts that all rational people can't help but acknowledge. So they don't consider me important enough to ostracize. They simply ignore me or dismiss what I have to say as unscientific or (surprisingly often) they dismiss it simply because I use the word "soul." On the other hand I think I have also gained a lot of respect from people-both patients and professionals-who have felt as I do but didn't feel they had a voice to say so. So on balance, I actually feel much more accepted now than I did before I wrote the book. Best of all, I've received a small but steady stream of responses from people who feel inspired and empowered by my message. Whether the positive responses will lead to enough word-of-mouth, enough lecture invitations and enough interviews like this one to give my book staying power remains to be seen. But I'm confident that the message will survive even if the book doesn't.
NT: This choice of a polemical subject for your book makes compelling reading, not least because of the unashamed manner in which you raise your concerns with modern psychiatry. But you allude to the idea that your preferred leaning for decades has been towards the polemical. Do you think your polemical stance is more effective in convincing people of your ideas than might be a more mainstream and polite approach?
EF: As I discuss in the last chapter, the process of editing and revising the book for seven years (after I wrote the first draft in one year) was largely a process of radically toning down my polemical tendency because it was hostile, disrespectful, and alienating of the very people I wanted to convince. I had to have a panic attack at the podium and several extra years of psychoanalysis to appreciate this. I would like to think that the book as it stands now is respectfully polemical in that it acknowledges the utility of medication and of brain science but objects strenuously to the dehumanizing idea that people don't need anything more than that-that we don't need a kind of treatment and a kind of science that deal with the personal, emotional dimension, the actual experience of mental illness and the actual experience of consciousness.
Still, I think that if I weren't polemical at all, nobody would know I was saying anything. The vast majority of people who ignore me now would still ignore me, simply because my ideas don't fit their world view. And the people who agree with me but don't feel they have a voice still wouldn't feel they have a voice. If you present non-mainstream ideas in a polite mainstream way, people won't recognize what's new and different about the ideas, they will only recognize what's familiar. That's why, to this day, Robert Waelder's revolutionary reframing of Freudian theory isn't recognized for what it is even by the hundreds of psychoanalytic teachers who assign Waelder's papers to their students. Waelder was too polite. He went out of his way not to step on anyone's toes, and the result was that his powerful and original ideas were taken for commonplace truisms and never really understood.
As for the people who don't agree with me but are potentially convincible, I am counting on the fact that they are already vaguely uneasy about what they are doing and need a wake-up call to amplify that little voice in the back of their heads so they can actually hear it. But all of that may be rationalization. The truth is, I am a dialectical thinker and my impulse to write is in large part an impulse to argue against received ideas that I perceive to be unfounded. (Unconsciously of course this impulse is loaded with Oedipal meaning, which, again, I discuss in the last chapter). For better or worse, if I had to be completely mainstream and completely polite, I probably would never have the motivation to write anything at all.
NT: I found myself quietly cheering at some of your eloquent criticisms of the pharmacological approach to unhappiness. But my sharing of this satisfaction with others, even with practitioners of psychotherapy, has frequently met with a measure of indifference. This makes me wonder about the readiness of our own profession for an approach which doesn't assume a medical view of psychological problems. To what extent do you think psychotherapists themselves have thought through the ideas you present?
EF: Almost not at all. I think that most psychotherapists, and even most fully trained psychoanalysts, are intimidated by science, so they tend to be fairly uncritical in believing what scientists report about the effectiveness of medication and the relative ineffectiveness of psychotherapy. (I know, there are many studies showing the effectiveness of psychotherapy and even of placebo but it is still pretty much universally accepted that the gold standard of psychiatric research studies is the response to medication). Therapists are also uncritical about accepting as fact the scientific belief that mental illness is caused by a genetic defect that leads to a chemical imbalance. Relatively few understand that medical symptoms generally are genetic adaptations and that psychiatric symptoms specifically are unconscious attempts to resolve inner conflict. Nor do they appreciate the corollary that the goal of pharmacologic treatment-to get rid of the symptom because it is viewed as a defect-is fundamentally different from the goal of dynamic psychotherapy, which is to resolve inner conflict and facilitate growth, goals that are already inherent in the function of the symptom.
NT: Do you have any plans for another book and, if so, what do you have in mind? Or, if no further books, do you intend promoting your ideas in any other way?
EF: I'm sure I will write another book, something shorter and simpler that will highlight only one of the interwoven themes of Healing the Soul in the Age of the Brain. But right now I don't have a clear focus in mind so I am taking suggestions and will keep trying to promote HSAB until something clicks and I feel a distinct need to move on. I have a number of lectures and media interviews planned and I hope to do many more during the next few years. You can check out my schedule at www.healingthesoul.net. Hopefully I will be writing a few short articles too, in professional journals and maybe popular magazines. I very much appreciate the opportunity to do this interview for New Therapist, and I wish you continued success in pursuing our shared mission.
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