Treating the Patient With Respect

Why can’t any therapy help patients with their feelings? One good reason is that they are talking to the wrong brain—the brain that thinks rather than the one that feels. Unfortunately the correct brain, the right brain and lower brain, doesn’t talk much, doesn’t understand English and, as a matter of fact, doesn’t understand words. It doesn’t understand in the way we think of understanding. The correct brain is one that contains our history, our pain and our feelings; the brain that processes our deep feelings that can finally liberate us. It does understand feelings; we need to speak that language—one without words. We have to convince the brain that spouts words and ideas that it is necessary to go back to early life and a world devoid of intellectuality (kids are not intellectual as yet), and relive feelings—that lack of love—that were too much to feel at the time. We have to convince that thinking brain to let go, let the lower brain systems emerge and breathe the air of freedom. It can be done; cure can be accomplished. But only by stealth, not by deliberation. Feelings have to creep up on us, not be sought out. It has to be a therapy of nuance, of subtleties, of flexibilities and lack of domination; that is, it cannot be a therapy of experts because the only expert is the patient. The doctor has to let go of any notion of superiority. Even keeping the patient waiting for a session is a sign of superiority, which I do not tolerate in our therapy: it says “I am more important than you and my time is more valuable”. And while you are trying to get back some self-esteem, the doctor lowers it by keeping you waiting. It is subtle but there. And above all, we need to get rid of any time constraints that force a crying patient in the midst of her feelings to leave and wait until the next session.

We do not touch the patient when she needs to feel unloved; we touch her when the pain is so excruciating that we need to lower its force so it can be experienced and integrated. It is one means of keeping the patient in the primal/feeling zone. If the therapist cannot feel he cannot distinguish the difference and will touch at the wrong time or in the wrong way. Patients can sense when they are being touched out of the needs of the therapist and not their own needs.

When a therapist cannot tolerate the patient's suffering she may touch to ease the pain, and thereby ruin the session because it kept the patient from feeling all of his pain. The therapist may be acting out her own need for touch and caress in her own early life. Watching the patient writhing may bring up great pain in herself, setting off her own feelings, forcing her to stop the patient from feeling.

So the therapy can go wrong when the therapist has not resolved a good piece of her own pain. And none of that can be taught: when trainees take notes all of the time it usually means that they cannot feel what is right and need intellectual signs of what to do. This is a therapy that cannot be done by the numbers. It is a matter of sensing, intuition, and instinct…plus a soupcon of training…a lot of training.


ON PAINKILLERS AND PREGNANCY

The more painkillers a woman takes during labor the more likely her child will be to abuse drugs or alcohol later on. Karin Nyberg of the University of Gothenburg, Sweden, looked at medication given to the mothers of 69 adult drug users and 33 of their siblings who did not take drugs (Nyberg, et al., 2000). Twenty-three percent of the drug abusers were exposed to multiple doses of barbiturates or opiates in the hours just before birth. Only three percent of their siblings were exposed to the same levels of drugs in utero. If the mother received three or more doses of drugs, her child was five times more likely to abuse drugs later on in life. Enough animal studies have been done to confirm the finding—exposure to drugs in the womb changes the individual's propensity for drugs later on.

There is some evidence that a mother taking downers during pregnancy will have an offspring who later will be addicted to amphetamines, known as “uppers” (speed) (Jacobson, et al., 1988); while a mother taking uppers during pregnancy—coffee, cocaine, caffeinated colas, may produce an offspring later addicted to downers—Quaaludes, for example. And the reason that the person can take inordinate doses, such as drinking two cups of coffee before bedtime and still be able to sleep easily, is that there exists a major deficiency of stimulating hormones—the catecholamines. In short, the original set points for activation or repression have been altered during womb-life and persist for a lifetime.

I have treated patients who have taken enormous doses of speed and yet have shown very little mania as a result. While other patients of mine have taken lethal doses of painkillers in previous suicide attempts, enough to kill anyone else, and yet still lie awake hours later, only feeling slightly drugged. The severe brain activation by imprinted pain resists any attempts to quell the system.


Jacobson, B., Nyberg, K., Eklund, G., Bygdeman, M., Rydberg, U. (1988) Obstetric pain medication and eventual adult amphetamine addiction in offspring. Acta Obstet Gynecol Scand 67:677-682.

Nyberg, K., Buka, S.L., and Lipsitt, L. (2000). Perinatal Medication as a Potential Risk Factor for Adult Drug Abuse in a North American Cohort. Epidemiology 11(6):715-716.