Talk Therapy & Mental Illness

By Dr David Laing Dawson

In the years between 1965 and 1975 I would loved to have discovered that psychotherapy (talk therapy) worked for severe mental illness. I had read Freud (Sigmund and Anna), Jung, Adler, Sullivan and many others. I read all the detailed case studies available. I read all the theories.

We unlocked the door of the first mental hospital ward I worked on in 1968 and started group therapy and community meetings. I learned how to talk with people who are psychotic. I spent many hours trying to penetrate the mask of catatonia, the wall of stuporous depression, to calm the ravage of mania, and the erosion of anxiety. I saw the pain of what we then called agitated depression.

And I found that humanizing the environment and finding ways of relating to very ill people are good things, but they do not cure, treat, or ameliorate the actual illness. Talking alone does not work, though, as I have said before, it is always good to have someone in your corner.

I studied the history of Asylums and the treatment of the mentally ill pre-asylum, and before the application of, dare I say it, the disease model. I read all the analysts’ and other therapists’ case studies and discovered that though the writers developed an elegant understanding of each patient, their actual patients did not get better. Much like some of the data mining studies referred to recently in this blog, the results belied the conclusions.

So I am sometimes puzzled and sometimes angered by the periodic waves of anti-medication opinion that surface in all forms of media. Actually I am not very puzzled because one can usually detect the underlying ideology or motive. The motive is usually the preservation of status and/or ascendancy of the non-prescribing counseling professions. The ideology can be traced to some kind of belief in the perfection of the human mind, spirit, and soul, and a quite reasonable fear of us humans tampering with this.

I am not against psychotherapy and counseling at all. For mental illness the best results are always realized with a combination of medication and good counsel. And I say “good counsel” rather than naming a specific brand of psychotherapy, for despite the continuing attempts to rarefy (also own, patent, and make money from) one form over another, it is the common elements of good counsel that are ultimately helpful: a professional relationship that offers acceptance, empathy, dependability, understanding, support without moral judgment, and, sometimes, wise advice.

We also know people need decent housing, adequate diet, a meaningful activity, membership in some group providing a sense of identity, at least one good relationship, and a bit of exercise.

So why can’t we just get on with it and spend our time and money developing good services for the mentally ill which provide all of the above, rather than argue over the relative merits of each?

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3 thoughts on “Talk Therapy & Mental Illness

  1. Amen! I started a little later than you, but in a PhD clinical psychology program housed in the Department of Psychiatry, University of Texas Southwestern Medical School, Dallas. The psychiatrists taught schizophrenia was caused by dysfunctional double-bind parenting. Psychologists said it was all learned behavior. When I actually worked with people suffering from serious mental illness, I learned there are no simplistic answers and there are those who are what we called clearly “organic.” Those needed medicine and there were few options at that time. Then I started working in prisons and learned that we just needed to all work together to do whatever worked best. In prison you quickly learned if what you were doing worked. We didn’t have the luxury of guild warfare or rigid ideologies.
    We’ve got to stop believing in the latest fad and miracle worker. We need rational research and multidisciplinary collaboration.

    Liked by 1 person

    1. Good column . Many of us were taken in by the analysts. I got wise when i developed a very extreme case of Hyperemesis Gravidarum. This happened with each of my lovely babies.

      And that was my coming to terms with the money grubbing Freud and his nonsense. I suspect that 15 weeks of violent vomiting might have made him refute his own theories.

      I do like the bit in Dawson’s column about having someone in my corner. Quite a bit of cruelty has been wielded by dogmatic psychiatrists who have dabbled in the black arts.

      Like

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