What's Wrong With Psychiatry?

 Believe it or not there is a statement from the director of the National Institute of Mental Health (Thomas Insel) (see for ex: http://www.nimh.nih.gov/about/director/index.shtml) who seems to think that everything is wrong with psychiatry. He thinks there is no science of psychotherapy and little validity to the new DSM, diagnostic manual which he says, is not a bible of psychiatry but a dictionary; listing symptoms and not getting below them. He’s right. I wrote him a letter about our work and its validity but I doubt if I will get an answer. At least I wrote to the previous directors and never had the courtesy of a reply. So we’ll see. He is right about what’s wrong but I am not sure he knows what to do about it. I think he wants to get into brain function and genetics; and those will never get him there. As I said in my last article, the brain cannot feel pain but the mind does. If we go on reducing it all to brain function we will never succeed. If we delve into the works of the mind and its relationship to the brain, then we will succeed. The mind has to relate to how the brain functions so we don’t erect theories that fly in the face of brain science.

 It cannot be either or; when it is you get theories of therapy by brain scientists, and I could mention several well known neurologists, who miss the mark completely.They have never done a day of psychotherapy and they extrapolate from the brain about how therapy should be practiced. I have written to them with no answer and that includes Antonio Damasio. They are too busy lecturing to see how therapy can work. You know what an expert is? Someone from out of town. I would change that to someone out in space because they are not grounded and do not see daily, anxious and depressed patients. It is not that something is wrong with their brains; they grew up neglected, abandoned and unloved. We won’t find that in the brain………ever. We will find it in their history. Neurons contain history but we cannot see it, and they won’t give up their secrets freely. I have an idea. How about talking to the patient? How about not drugging him but delving into his or her past? How about listening? That is hard to do when you take 8 patients a day. We don’t.

Insel admits that there is no science here and no proper theory to guide therapy for addiction, for example. Rates of mental illness are mounting rapidly. Let us hope they hear but why am I so pessimistic? Because I have sent at least 50 letters to the powers that be without response. It seems that many scientists are putting their hopes into president Obama’s new initiative, pouring millions into mapping the brain. Yes that is wonderful but it won’t solve the problem of mental illness; unless we think it really lies in brain dysfunction or in genetics. And now there is so much focus on the brain that we have missed out on the mind which speaks for the brain.

Let me tell you a story. When I was young and naïve I asked the NIMH to come investigate and see our work. Three men in ties came and watched a session. The patient, a woman, was screaming in agony; her ass was in the air. One of the men turned to me and without commenting on her pain said,” Why is her ass in the air? Is she being provocative?” Right then I knew the jig was up. There was no chance. Here was a horny guy who saw no pain. He had no empathic reaction. My heart sank.

I Feel Good: A Letter From a Patient

Last night, sitting at my desk like I always do, a surprising and unfamiliar sense of relief suddenly washed over me. It wasn’t like a thunderbolt, but like the slow lifting of a veil. This pall of pain that hangs over me like a cloud all the time was vanishing into thin air. I felt an exhilarating sense of release, of relaxation. A calm invaded my body and I wasn’t quite sure why. It was so different from the chronic aches and pains I live with much of the time. In contrast to the routine, relentless misery, this welcome calm felt like euphoria.
The moment reminded me of that night 40 years ago when I was just as suddenly plunged into a crater of panic and anxiety, without knowing why. One moment, I’m sitting in my Berkeley apartment calmly reading a book, a sophomore without a care in the world. The next, a pit opens in my stomach and I’m being engulfed by a fear and dread that came out of nowhere. I got up, went to the bathroom, splashed water on my face. I went to the kitchen and manically did the dishes. But it wouldn’t stop. I thought if I went to sleep it would finally go away, so I clutched the pillow and shut my eyes tight, praying for this inner monster to disappear, but when I woke up it was still there. I’ve been trying to find the cause and the cure ever since. Only Primal Therapy ever gave me any answers and any respite.
But Primal Therapy only works if you stay with it. I’ve had big breakthroughs over the years. Clouds part, angels sing and you really feel reborn. But the pain comes back and you have to keep muddling through. My problem is that I’m a big avoider. If my terror is kept under wraps and my pain at an endurable, dull constant, that’s good enough. I focused on my work, my family, my whatever. So literally years would go by without therapy, without feeling. Eventually, it caught up with me, slowly dragged me into a mental and physical morass. I could no longer brush it off saying I’m fine for now. I was feeling horrible.
There were times when my whole being felt anguished. I’d be just sitting in my house and feel this pain in every pore. Like a wretch, I wanted to be put out of my misery. How could I be feeling so miserable when my life was going relatively well?
My body carries all my pain. The tension grabs my stomach like a vice, penetrates to my bones. There are times when I’m just one big aching organism. I even feel at times like there's acid in my veins. Maybe that’s why I was so transfixed by the images of Christ on the cross as a kid. I was not aware then that I was hurting, but I was mesmerized by the symbols of suffering, of pure agony, of despair in the face of so much pain. I now see that was me.
For a year, I’ve been getting regular sessions again at the Primal Center in Santa Monica. It’s the fourth time I’ve been back for therapy since I started in 1974. Every two weeks, chipping away at the things that hurt me, in the present and the past. Luckily, I cry easily. And almost from the first deep Primal, I started feeling that little bit of relief, enough to keep me going.
But then came last night. This was a feeling of total well-being that swelled up in me. Oh my God, there was no aching muscles, no throbbing forehead, no clenched abdomen. I didn’t feel any of those symptoms of suffering I’ve learned to live with.
Instead, I felt…I felt… good!
There was almost a pleasant buzz in the pit of my stomach where that old panic used to be. That acid in my veins turned into a rush of warmth flowing through me. I didn’t just feel relieved. I felt free. Hallelujah. There is an end to this misery at last.
The sliding door to my office was open. Outside, a warm Santa Ana wind was rustling the tall palm tree overhead. It felt like a caress from nature, like a good wind blowing down the canyon. I was at the computer and I had to stop what I was doing, the chore of paying monthly bills. As it happens, I was on the phone with my bank, trying to resolve a problem with their website. The agent had put me on hold and I had put down the phone with the loudspeaker on, and they had classical music playing during the wait. That piano sounded so soothing, so completely attuned to my mood at the moment. It reminded me of the music my Mom played at night as she fell asleep, the radio always on her nightstand. And I just closed my eyes and listened and floated away on that reverie. The breeze, the piano, the inner peace. I felt serene, liberated. For that moment, I was just there.
What is strange is that the payoff came today. I had gone for a session earlier that morning, but nothing big had happened. The feelings were not so strong, not so deep. It was more like wrapping up lose ends from two weeks ago, when I had plunged into big feelings about being molested by a relative at age 10, the age my son is now. The uncle who did this had been very nice to me, showing all the interest, praise and affection that I had never received from my dad. He let me put shaving cream on his face and I still remember his stubble bristling on my hand because I had never touched a man’s beard before. He let me sit at the head of the table and asked me all about myself and what I wanted for dinner and made me feel special, like no other man ever had. He held me in his arms as we fell asleep, and I was in heaven because I had never been held by a man like that before. So when he twisted our closeness into something bad, something so selfish, I felt crushed. Not back then, mind you. Back then, it was never discussed. It was a secret that I buried down deep. I always knew it was there. What I didn’t know was how deeply it hurt. That pain was buried too. But now, in reliving it, I understood the meaning of that abuse for me. It meant the little love I had found was a fraud. It meant I would never find pure love. I would never be loved just for me.
So in that follow-up session, I cried more about that. About how sad it was to come to the end of my emotionally empty and lonesome childhood to have my hopes raised, then betrayed. I cried thinking about my dad, seeing him at his usual place at the kitchen table, wanting to go to him with my secret but not actually having to tell him. I just wanted him to understand, to see my need and my hurt. I wanted to ask him to hold me, like a son. Just put his arm around me and protect me. If I didn’t need him so much, maybe this would not have happened.
I left feeling almost as sad as I came in. So eight hours later, when that veil of pain lifted, it was like a delayed pay-off. I see it as the cumulative benefit of consistently dipping into my personal “hurt locker.” I was just so backed up and overloaded, I needed to drain it down.
The next morning I had to get up early to take my son to chorus practice at 7:30. I didn’t sleep much, but I didn’t feel as lousy as I usually do in the morning, especially when I’m sleep-deprived. In fact, I was cheerful, laughing with my son over some jokes on the TV and moving more quickly without coffee. After dropping him off, I went for a walk, salsa music playing on my earphones. I felt so different, physically, than I usually do. Before, every step was a burden. My muscles hurt by just stepping up on a curb. I felt like I was loaded down, heavy, always pushing against some force. But this day, my step was light. I walked briskly for three miles and didn't feel all that inner sludge weighing me down. I actually skipped up onto curbs.
When I mentioned this milestone of progress in an email to Art Janov, he suggested I write something for the blog. Patients get discouraged, he said, and this could help them stay motivated. That’s the key. Primal Therapy requires stick-to-it-iveness, but it’s easy to get bogged down and give up. That was even part of my feeling: “This won't stop. Nothing works to make it better. Art is wrong. His critics are right. Primal is dangerous. I need a doctor to give me painkillers and get it over with. It’s all too much, too scary.”
When the relief finally came, Dr. Janov looked like a genius.
Coincidentally, when I got home and checked Facebook, the following quote from the philosopher Rainer Maria Rilke came across my newsfeed. Wow, I hadn’t thought of him for a long, long while. But when I was in college, at the depths of my breakdown and the peak of my insanity, I somehow found comfort reading him. Back then, it was just his lyrical prose, his uplifting spirituality that lulled my freaked-out nerves, plus a kindness and wisdom I perceived in him.
Now that Primal has released my potential for enjoying life, his words have a real meaning.

 “I confess that I consider life to be a thing of the most untouchable deliciousness, and that even the confluence of so many disasters and deprivations, the exposure of countless fates, everything that insurmountably increased for us over the past few years to become a still rising terror, cannot distract me from the fullness and goodness of existence that is inclined toward us.”

― Rainer Maria Rilke, Letters on Life: New Prose Translations