Kedron: Where Residential Psychotherapy Meets Psychiatry

by Aidan Duggan

Kedron Counselling and Therapy Centre provides residential and non-residential psychotherapy/counselling for children, adolescents, adults and families who have been emotionally wounded or are experiencing life as too difficult.  Kedron is a project of The Dublin Counselling and Therapy Centre Ltd., a Registered Charity (No. 10020).We are a fifteen-bed facility providing psychotherapy programmes for people suffering with anxiety, depression, hopelessness, despair, schizophrenia, suicidal feelings and the inability to connect and form relationships with others.

At Kedron we create a caring and gentle environment in which a person can engage with deep hurts, wounds and the potentialities of his/her life. A special emphasis is placed on our willingness and ability to accompany a person into and through their deepest valleys of fear, pain, rejection and sense of annihilation. We do not buy into the ideas of mental illness or mental distress as somehow a genetic or biochemical given. We see people in pain as lying on a continuum from healthy to very distressed.  Many of our residents are moderately distressed and would be representative of clients seen in general psychotherapy practice. Some of our residents fall into that area that society and others can be defined as mentally ill.

For us at Kedron mental illness is experienced by those who have been wounded beyond the point of bearing into a place where the only defence against the inner world and other world is mental illness. When the inner/outer world becomes too intolerable the person can take flight into ‘grandiosity’ (mania) to defend against the devastating fear of failure. Some take flight into intricate fantasy (schizophrenia) to defend against the fear of annihilation while others simply shut down (depression) because life’s pain and affliction is too much.

Residential Treatment in Ireland

Residential treatment for people in distress (other than addiction) is, with the exception of Kedron, exclusively in a psychiatric hospital or psychiatric ward in a general hospital. Psychiatric treatment in Ireland is predominantly from a biopsychiatric perspective. It is interested in focusing exclusively on the possible biochemical and genetic factors in the cause of mental illness and personal distress.  Furthermore it emphasises the role of medication in ameliorating symptoms.  Currently in terms of our ‘scientific’ knowledge there is little or no support for the role of genes and biochemicals in the aetiology of mental illness. There is scant evidence for the efficacy of medication except in the very short term (i.e. 1-14 days approximately).

The effect of the power of psychiatry is that it defines the nature of mental illness and its treatment modalities. This has devastating effects on the individual sufferer as it walls off certain areas of healing (e.g. psychotherapy) as of no value and illegitimate. It further condemns an individual sufferer to a lifetime of illness. Furthermore with the collusion of psychology, psychotherapy and others, psychiatry is being allowed to broaden the area of human experience that is being labelled as abnormal and as a genetic or biochemical aberration. Given that the medical model constructs the mentally ill person as diseased, volatile, incapable of personal responsibility, the correct setting for treatment is determined by others (i.e. the medical profession), and is of necessity custodial.

The effects of hospitalisation have been very clearly outlined by Goffman as “a series of abasements, degradations, humiliations and profanations of the self” (Goffman,1968:24).  Further methods through which self meaning was achieved and the self presented, are fundamentally altered by the total institution.  Private territories of the self are also violated due to forced access to the person’s thoughts and the interpretation of the person’s actions within the terms of illness.

Residential Psychotherapeutic Centres

At Kedron we avoid the negative effects of hospitalisation by the respectful and accepting environment which looks at the person as a physical, mental, emotional and psychospiritual being and acknowledges the person’s symptoms as meaningful within the context of his/her life. Symptoms are acknowledged as an escape from human woundedness and paradoxically as one path that may move us to a larger and fuller sense of who we are or may become as people.

A person who becomes distressed or mentally ill is rarely left in any doubt that his/her life is in chaos. A breakdown may be the first time a person realises and acknowledges a history of poor relationships with others and his/her world. The breakdown is often the first sign of the Breakthrough. However in our society the guidance and accompaniment needed by the distressed person is rarely if ever available. In residential psychotherapeutic centres we can work with clients who lie along all the spectrum of human suffering, not simply those who are moderately distressed and fit into our definition of what a psychotherapy client ‘should’ be.

Severe distress, mental illness and psychotherapy

Many psychotherapists shy away from clients who present symptoms and are mentally ill.  I use the words mental illness quite deliberately because by using other language like mental distress or something similar we create the opportunity for some people to be labelled as mentally ill and others as mentally distressed. Therefore we allow psychiatry to colonise an area called mental illness which can be portrayed as having nothing to do with psychotherapy and as an area somehow immune to be worked with in a psychotherapeutic way. As psychotherapists I would like to see us redefining mental illness as a challenge to us to become more alive and present and to heal our past histories. Therefore I use the word mental illness, although it is clearly not an illness as traditionally defined.

In general psychotherapists seem intimidated by symptoms and often feel out of their ‘depth’. At Kedron we realise that the same principles of acceptance, empathy, genuineness, respect, confrontation and integrity are what is needed with the very disturbed person. The person comes as he or she is; upset, distressed, up, down, anywhere in between or simply just a little crazy.  It is the presence, the ability to be with the disturbed person that the therapist brings to the therapeutic relationship that is important. Furthermore a deep listening to the person and a thorough understanding of the territory of human development is necessary. This is especially the case with psychotic symptoms when we need to be intimately familiar with primal areas of development.

When the disturbed or mentally ill person is listened to in a deep way, which appreciates the background context of expressed symptoms, he/she communicates the process and context of his/her trauma. Symptoms are often a symbolic manifestation of underlying woundedness. Traditionally psychotherapists have shied away from the challenges of mental illness but it is an area that needs to be ‘recolonised’ as a territory of human development.

Summary

Mental illness is not a separate, distinct psychiatric label that is exclusive of psychotherapeutic understanding or consideration. Health and illness is a continuum although the majority of our clients in general psychotherapy practice lie in the mid to sick range. Beyond this range are the disturbed that are not included in our epistemology. We are similar to psychiatry as we say to those who are severely distressed or mentally ill ‘you are outside our territory of human development and are therefore illegitimate’. In residential settings, as psychotherapists, we have the chance to work with our clients irrespective of where they are on the continuum of health and illness.

Aidan Duggan is Senior Psychologist and Head of Dept. at Kedron Counselling and Therapy Centre, St. Mary’s Rd., Edenderry, Co. Offaly. Tel: 046-9733311.  email: kedron@eircom.net.

References

Breggin, P. (1993). Toxic Psychiatry. London: Fontana.

Goffman, E. (1968). Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. Harmondsworth, England:Penguin Books.

Lynch, T. (2001). Beyond Prozac: Healing Mental Suffering Without Drugs. Dublin:Marino Books.

Corry, M., & Tubridy, A. (2001). Going Mad? Understanding Mental Illness. Dublin:Newleaf.