The Insanity in the Treatment of Insanity

I read something in a respected scientific journal that set my hair on fire. I wonder how long it will be until shrinks catch on to science; to neurology and evolution. An understanding of these would prevent a lot of the current nonsense in psychotherapy. A case in point: the article, “At Risk for Psychosis” (in the sept/oct issue of Scientific American Mind (http://www.scientificamerican.com/article.cfm?id=at-risk-for-psychosis). The reason my hair is burning is not because they are incorrect and unscientific but because so many will go on suffering due to this lack of understanding. It isn’t just some shrink missing the point; it is that this kind of therapy is a waste of time and misleading.

So what is it? It is this: “In one type of therapy practitioners encourage patients to look for evidence supporting their delusions.” If it is a delusion and is false, why would we force the patient to look for supporting evidence? Unless of course we think it is all in the mind, this psychosis, and therefore we can convince her otherwise. It is, they reason, just a matter of illogic logic. We straighten out their ideas and voila, all is well.

So first let us look at psychosis. We know now that many kinds of psychosis derive from imprints very early in our lives; for example, a smoking pregnant mother can lead to later psychosis in her child. But there are many studies indicating that how the mother feels and the drugs she takes while carrying can have serious adverse effects on the offspring. An anguished mother can lead to sexual dysfunction and mental disorders years later. That is, those early memory/imprints are the most powerful because they impact the developing brain and its effects on the organ systems, and because they are often a matter of life and death. When a mother is heavily anesthetized while giving birth, that drug overpowers the neonate and leaves a lasting impression. It weakens the child and makes her vulnerable to disease later on. When there is later trauma, psychosis could be on result. But mental psychosis is only one of many options in reacting to trauma. We can go crazy in our body, as well.

First let us look at this brain of ours. We know through my writings, that there are three distinct levels of brain function: the brainstem, limbic system and cortical-thing/believing one. They all have the capacity of reacting to early pain in very different ways. When there is early pain engraved while we are being carried, the pain is first registered and then moves upwards in an attempt to connect to its cortical/comprehending counterpart. Unfortunately, repression blocks its travel and keeps it hidden. There are many more neural pathways leading upward than downward. The route for the neural circuits, therefore, is one way, not a two way street. More information flows upward toward conscious connection than downward. In brief, contrary to cognitive therapy and its offshoot sisters, ideas do not change feelings; rather, feelings move upward and change ideas. This is what it is meant to be in terms of evolution. The lower brain levels predate later ones by millions of years. The earlier ones are survival systems, don’t forget. They are meant to be strong and invulnerable. If they could change easily or were weak, our survival would be threatened. In most primates this abundance of neural cells leading from the amygdala to the cortex is evident. And those higher level connections are found almost throughout the whole neocortex. There is a range of brainstem connections to higher cortical centers, as well. This includes the locus coeruleus which in some respects is the terror center of the brain (at least one of them). Here again we begin to understand how a lower site, the locus coeruleus, connects higher up and drives obsessions and paranoid ideas. It is what keeps awake at night ruminating about hurts or imagined hurts. It is these projections to higher areas that can account for delusions when the lower level is triggered by current events; a rejection or an insult. When a patient relives what I call first-line, brainstem imprints, he can stop his ruminations and delusions. It is how we know, among many other ways, how lower level imprints drive higher level thoughts.

The work of Dr. Jaak Panksepp (author of Affective Neuroscience) is most relevant here. He demonstrates how the brain circuits are more plentiful and move upward and forward rather than downward. This is especially true of the feeling structures such as the amygdala which has its circuits reaching upwards toward the neocortex. There are other scientists (Luiz Pessoa), who demonstrate how certain structures are suppressed; they are recruited by feelings and thereby diminish cognitive/insight/understanding. In short, feelings reign over thoughts. If we want to understand psychology we must first understand how the brain works and how evolution is built into our human brain development.

Contrarily there is evidence now to show how cortical/insight/thoughts can suppress feelings. There are structures alongside the temple of the brain that have to do with integration of feelings; that is the orbitofrontal area.

From this structure there are relatively few networks leading down to feeling centers. Let’s not drown the fish. Feelings drive thoughts much more than thoughts drive feelings. This should undermine the cognitivists, but it doesn’t. We will see in a moment why this is so important in alleviating suffering.

Feelings are genetically coded to unravel and appear on a timetable to help us survive. That is why they are so strong. They boost alertness and vigilance and keep us aware. And they work in see-saw fashion with awareness. The hyperawareness we see can ultimately suppress feelings for a time. Too much arousal can shut down feelings and put us over the feeling/primal zone.

OK, let’s get down to the business at hand. In this piece on psychosis in the Scientific American Mind, they want to have the patient gather evidence to support his delusions. They think that if they crack their intellectual defense it can lead the patient to logic so that he can see his craziness. “So you see, there is no reason to think that way.” But there is and it is not faulty logic; it is created to push down the powerful feelings. A way to bind that energy and keep it logical. That is the point, isn’t it? The paranoia is trying to use his inherent logic to make sense out of his feelings.

Let’s share the framework: feelings/sensations with great power are engraved into the brain and physical system. Their powerful force moves toward connection.
They can go all the way to the top in our therapy or they can be blocked at certain levels. When blocking occurs against this massive force, the body and its cells can go crazy. In other words, there are many ways to go crazy and cancer is one of them; where the integrity of the cell implodes and overspills its boundaries. Or some of that power reaches higher up and stimulates the production of ideas—of paranoid ideation. It is the same impressed pain extending to different areas. Here feelings move toward the higher levels and gather up ideas to deal with them. Thus early trauma and lack of love move around in the brain and force sometimes elaborate thoughts—they are coming to get me and want to kill me. I have seen enough of this to lead me to know that some devastating feelings are behind those thoughts. “I am dying in the womb” may be the real feeling, and the delusions is “they want to kill me”. In any case, despite the rhetoric, death is the end result.
The delusion about “they” is just the ginger bread covering the feeling. The important part is dying. And is why if want to get to causes we need to explore the deep-lying terror. It is never a matter of logic and illogic. Illogic is often forced by imprints.

The delusion is an outgrowth of a terrible feeling; it is designed as part of a defense. To spend time changing the defense is a useless enterprise.  The problem is feelings, not ideas the patient has concocted. Why does he have those feelings and what are they; not why does he think like that? Where do those thoughts come from? If that question is not considered, the patient will go on suffering. It should be very clear how strange ideas arrive when we give delusional patients strong medication that works on lower brain areas and it stops their delusions. We don’t really touch ideational areas of the brain yet they change radically. Clearly it is the lower centers that send messages higher up to distort thinking and create paranoid ideas.

What the current researchers want to do is create another diagnosis in the diagnostic manual called, attenuated psychosis syndrome. How that helps is beyond me, except that it gives the inventor some cachet? It is psychosis but not really. It is all couched in behavioral terms such as (and I am not kidding) hallucinations or delusions once a week; you or a loved one is bothered by your symptoms, symptoms have appeared or worsened in the past year; and above all, no other disorder can explain the problem.

They want to ape medical diagnosis where if you get headaches more than once a week you have the migraine syndrome. And how is it that my diagnosis depends on whether someone else is bothered by it?

There is nothing, nothing about the patient and her history; just behavior. But of course what else could we expect from cognitive/behaviorists? Now as to why patients are required to gather evidence for their delusions, I am at a loss. But if you assume ideas are the problem and not the history behind them, then you might agree with all this. And allow the patient to spend his time in the futile search for supporting evidence. It is all about suppressing symptoms, suppressing behavior. It is assumed by them that the ideas are what’s wrong instead of seeing what caused those ideas; but if you believe in cognition alone, then of course there is no higher place to go than ideas. If you believe that ideas emanate from nowhere, as you must if you believe in the cognitive approach, then you may focus only on ideas. No deeper force exists for them. It is all part of the “mindfulness” approach; it is all in your head and it is that head we must deal with. Only those bereft of feelings and unattached to their history could think that way. They personally skim the surface and so does their therapy.