On the Diagnostic Manual in Psychiatry (Part 2/3)

Each of us  in  psychiatry has a right  to our own opinion, but no one of us has a right to our own science.  Facts are public and are in the domain of science. They cannot be argued against; we need to test them in a specific way.  That is why there can no longer be many different psychiatric approaches  with all those disparate  schools of psychiatry.   They all have concocted beliefs and theories that are not based in strict science and so of course they differ. No different from differences in politics.  It is just a matter of who has the best argument.  Is childhood sex a fact as the  Freudians believe or used to believe?   Or can you think your way to health?   This is the true underlying principle of all insight and cognitive therapists.  You cannot do that therapy if you don’t believe in that idea whether  explicit or not.  If you believe in insight as curative you are a  cognitivist, no matter how you deny it. It is again thinking your way to health.

 There can be no paradigm shift in psychiatry until we are bereft of the cognitive bias implied in all of this. And it is underlined by psychiatrist Michael First, who was an editor of this Manual some time ago. What he states, grosso modo, is that none of this can be helpful.  What it will help,  and this is acknowledged  by many of my colleagues, is billing insurance companies.  Why is there  such a debate among my confreres about all this?  Because each has a different idea of what constitutes  an affliction.  If you are a psychoanalyst you have one idea, and if you are a Jungian quite another. And  since it all is  part of intellectual fabrication everyone or no one is  right.  None of this is based solidly on neurobiology.  It is as if the brain and the body are two distinct entities that have nothing to do with each other.  These psychiatric disagreements occur because of the theories they adhere to; and those theories reflect the doctor’s  personality, and little else.  A feeling woman is never going to be a cognitivist; she knows feelings and the unconscious, and cannot adhere to the idea that we can make profound change because of a change in our ideas.  

     I have treated hundreds of anxiety states (as explained in my Life Before Birth book), but the origin is nearly always remote and deep in the brain.  How can anyone diagnose it so it can be treated in a few sessions?   It has its beginning often in the first months of life, not life on earth but in the womb.  So those specialists take what the anxiety behavior looks like, try to change it, and when the apparent symptoms go away they imagine there has been success. The problem is that the generating source is still there raging below; that promises early disease and a premature death.  That is what we get for ignoring history, especially the critical nine months of gestation.  We will ultimately be struck down by a reality that is denied or ignored.  We are creatures of need and history; there is no escape from ourselves.

 There seems to be no motivating source in what they do.  Yet the unconscious is merciless and relentless.   The imprints lying there do not go away, not with pleas, exhortation, shock therapy or mechanical  manipulation.  It will only go away when it is addressed, relived and integrated.  Only then.  It needs to be experienced because it never was,  and has remained an alien force inside our bodies.   A small part of the original experience may have been felt but the charge value, the valence or force had to be instantly repressed and put on hold.  It is still there waiting for full connection.  We must eventually address and integrate it into the system.   It is that motivating source that is the origin of so much neurosis and psychosis.   The emperor is naked!

     On any given day there are about five million individuals getting mental health help.   And what they get now is mechanics and count-downs;  cut down mania to 3 days and they believe we have really helped the patient.  I don’t see much science in all this except they say that when the patient is fearful  he  has greater neuronal activity in the amygdala.  OK. Agreed. Now what?  Of  course  the feeling centers will be activated when feelings are.  These are accompaniments, not separate diagnoses.  And the cortisol levels will go up  too, as  they should when we are on  alert. But what to do about it?    We will never find a cure in the minute examination of the neurons; we may find a way to help; i.e., drugs and shock therapy.  But in all this there is no talk  of curing anything.   Where does the illness come from?   Why is it there?  How did it start and why? These are the critical questions that should be asked.    Ask a superficial question and you get a superficial answer. That is   the dilemma those doctors are in; they don’t know how to ask the critical questions.   And why don’t they? Because  their theory and therapy doesn’t allow it. And why not?  Because  their personality and repression won’t allow them to adopt a feeling approach.   Because to speak of cure you need to speak of generating sources.  So they are Behaviorists out of conviction and that conviction emanates out of  repression . How do you beat that?  Moreover, Behaviorism gets paid, and feeling therapies do not.  You see, as I have said before, that if I knock you in the head every time you start to smoke, sooner or later you will stop. Now if my criteria for progress is stopping smoking and I have the research to prove it, then of course I will get backing because no one seems to criticize the criteria I use for progress.   In the same way if I tell a therapist that every time he treats a patient I will give him money (but only if it is cognitive or behavioral), then he will treat in the manner I want.   Or to put it differently, if every time the patient stops smoking I  will  give him one hundred dollars, chances are he  will stop. So isn't that what the insurance companies are doing?

   We adopt the theory and therapy that suits our personality; that easily merges one with the other (therapeutic mode is therefore an outgrowth of one’s personality).  If we have never had a feeling and are not  close  to our pain, we will never adopt a therapy that will penetrate defenses and aim at feelings.  Theory, in so many cases, is part of the defense system—beliefs are one aspect of our defenses.   They emerge from the prefrontal cortex and help suppress rising feelings from the right limbic area.  Or to put it better,  beliefs are generated as a result from a surge of powerful feelings from the limbic area which galvanizes the cortex to rush into action to form beliefs which ultimately will hold back those feelings.  They dilute, vitiate and absorb the force or energy of the feeling through a myriad of ideas.  It makes the shrinks comfortable.  The rational we propose “works” and we feel better for a brief time; which is why we need to go back many, many times.

    Who would  adopt something that makes them uncomfortable.  We adopt beliefs, now called  theory, that helps keeps  feelings away.  Yes, we can call it theory but it is still a belief.  That is why real science plays so little a part in all this.  Those manuals of diagnoses never change how we do therapy.  We can still be Cognitive or Analytic therapists even with or despite this manual.   The frame of reference, the theory they adopt seems to have nothing to do with diagnosis.  So how come it never questions how we do therapy?  Why is it a given?  Because we need to go on doing what we are doing without having to change anything, particularly how we do therapy.  Our whole training militates against any change.    So on one side we have diagnoses, and the other side we have treatment.   I know from my training at the Freudian clinic of the West, that they never have anything to do with each other.