Dr. Michael Corry, (MB.Dch.DObs.MRCPsych.MMed.Sci.) of the institute of Psychosocial Medicine, 2, Eden Park, Summerhill, Sandycove, Co. Dublin, tel. 01 800084, talked about the future of psychiatry and psychotherapy to Mary Montaut.
The Shoehorn of Psychiatry
Although psychiatry started in analytical psychology, it has moved towards a much more medical interpretation and is inclined to see mental distress as an illness and treat it by various medical means, ranging from psychoactive medication through hospitalization to more invasive forms of therapy like ECT and, in England and America, psychosurgery. I think that psychiatry will go through its own form of perestroika and move towards less absolute ways of interpreting what is going on psychologically in people’s lives. But to be fair, I think psychiatry is caught in a difficult role where it services society as its psychic policeman. How can we as doctors, as psychiatrists, work when there is fear on one side of the relationship and power on the other? People are genuinely afraid to come near a psychiatrist because they know something may happen to them beyond their control. I think psychiatrists have to make up their minds about whom they are serving – are they serving society? Or their clients? Or indeed are they serving themselves? Can they truly be at one with themselves doing this job which sometimes involves taking away the personal liberty of an individual through involuntary detention, and doing so outside of a court of law? This makes psychiatry the most powerful body in the land – no other profession can detain people outside the law and against their will.
Furthermore, I wonder if we are dealing with illness at all in the first place? The reason why a person can be detained under the mental treatment Act is to receive treatment on the basis of illness, but we know that years and years of hospital treatment may not change the phenomenon. Either we are working with an illness like pneumonia or diabetes, with a similar timespan and phenomenology; or else we are dealing with something we may call an illness but which is in fact an existential problem and a statement about the angst of human beings interfacing with the difficulties which surround them. You can’t have it both ways. To reframe those difficulties as illness is, to me, a real travesty. It reduces people, it minimises people and in fact it is holding back social change and social reform. As psychiatrists, it is as if we are on the sidelines of a game: we treat the injured as they come off the field but we are not allowed to have any say in the rules. I believe that doctors and psychiatrists have to make up their minds whether they want to be casualty officers to a society which is breaking down, or whether they see their role more in terms of the body politics.
The Need for a Contemporary Morality
In medicine we seem to have forgotten the context in which the human organism is living and we are always treating it without looking at the environment which may be causing the stress. I would hope that there will be a movement in medicine towards the community, lifestyle, stress management and that it will become much more holistic and ecological. I should like to see psychiatry move back to a more psychotherapeutic approach, where a human being can only be understood in the context of a milieu. All of us are the products of the interfacements we have had in our lives. We have actually had very little choice. No-one consulted us as to what sex, nationality or colour we wanted to be. We pay lip service to a lot of values but in fact human beings do not have much choice. I think that freedom begins when they finally realise that. We are truly conditioned if we don’t realise how conditioned we are. Most of us work the world from beliefs and value systems that have nothing to do with our own existences. We need a contemporary morality based on individual existentialism. We need to say, “Well, if I have had very little choice and most of the important decisions have been out of my control, paradoxically I am perfect. The way I am at this moment is the only way I could be. I can evolve from that starting point”.
Undoubtedly a human being is divided between a part that observes and a part that performs. In a sense, a human being is an actor born onto the stage with no say as to where or when, handed a script and told he’s on. It is very sad that the observer part of us, the witness, who really should be in the front row applauding us, has been called to the back of the hall, got at by various institutions as to how we should act, then goes back to his place and starts abusing us. Most of what I see in my work is people who do not like themselves, who hate themselves, who do not love themselves. We are the only form of life that can look at itself. It is tragic that, in using this gift of evolution, we are actually undermining ourselves, undermining the millions of years of knowledge – because of ideas. Ideas are only there to complement the witness, to complement creation. It is very sad to meet people who are oppressed by ideas because they never had a chance in their lives to evolve ideas which are commensurate with their feelings or to gain a sense of the direction in which they particularly wanted to go. Rather than the notion of Descartes, Cogito ergo sum (I think therefore I am), I think it is much more appropriate to say I feel therefore I am.
It is the feeling of “what it is like to be me” that gives us individuality, the sense of personhood. Like a nation, we have our own boundary, the right to import and export, to fly our own flag. On the surface that may be labelled as selfishness, but in fact the moment you develop a self that loves itself and negotiates across its boundary with the world, you are likelier to treat others with the same respect. It is auto-poesis - self-making – in the context of others. So to me, psychotherapy is about personal liberation and growth.
The Wisdom of Evolution
I suppose that psychology has to be seen in the context of what is called unconscious knowledge or innate knowledge: the wisdom of evolution. Metaphorically we could see self-consciousness as a stream of consciousness full of thousands of thoughts, values and beliefs, flowing past a window of perception. The fact that those thoughts, values and beliefs are in the stream does not mean that they are ours. Most of them have been put there by various agencies. It is like a river with a lot of pollution in it – which we may decide to throw out. We are inclined to spend time on negative thoughts as if somehow they are ours, but you can’t make a negative positive. It would be as if the river said it could turn a beer can into a lotus flower. Ultimately we have to let go of those thoughts and to choose the direction we want to go. The road back to wholeness is through loving ourselves. The whole of society seems to be against that; if we loved ourselves, we would not consume at the rate we do consume things, we would discriminate, we would be selective. The oneness between the witness side of us and the actor side is quickly undone from the beginning. There is a whole language dealing with a child who loves himself – we say “W ho does he think he is? He is too big for his boots, cut him down to size, children should be seen and not heard.” In therapy if we could develop a language and style whereby we can help people to give themselves permission to be the way they are, we can help them to love themselves and to manage the boundary around that love. I believe that oneness in spiritual terms is the coming together of the observer with the actor. The person needs to have a boundary to give them the confidence not to be anxious and watchful, and which can let things in and out. Somehow we have got to have a mission which is about being auto-poetic – looking after oneself. When I was in Africa I could see that our nearest relatives really do this – most of the time they eat well, they sleep well, they groom each other. They really do love each other and look after each other. Obviously within man too there is the information to be co- operative, to be gentle and to accept each other. We must personally learn to get in touch with the life-force, with our own inner voice, and learn, how to dovetail our thinking with a personal vision/mission that develops oneness with self, others and the environment.