Saturday, March 17th | 1 Nisan 5778


Be in the know!

Get our exclusive daily news briefing.

April 11, 2016 6:50 am

Psychiatry and the Spirit

avatar by Jeremy Rosen

Email a copy of "Psychiatry and the Spirit" to a friend
A 'fainting couch,' a symbol of the history of psychiatry. Photo: Wikipedia.

A ‘fainting couch,’ a symbol of the history of psychiatry. Photo: Wikipedia.

Why do we think so negatively about psychiatrists that we still insult them by calling them shrinks? Some medics might be quacks, but we don’t generally refer to them as witches!

Shrinks; The Untold Story of Psychiatry, by Dr. Jeffrey Lieberman, is a sobering account of how psychiatry has swung from a marginal, unscientific mixture of weird theories into one of the most common and pervasive forms of treatment of what are commonly called “disorders of the mind.” Is it science or fantasy, medicine or quackery?

We have discovered prehistoric attempts to bore into skulls that we assume were attempts to correct mental disorders. But at the same time we have continued to argue about what we mean by “the mind” and how we categorize or explain what are mental disorders.

We used to abuse what we called the village idiot, shackling him to the wall, dousing him with cold water, or exhibiting him to the public like a wild animal. Then we “progressed” to removing organs, cutting out parts of the brain, and passing electric currents through him. The cruelties we have done in the name of medicine is as inhuman as the experiments that the unspeakably evil apology for a man Josef Mengele inflicted on Jewish children in Auschwitz.

Sigmund Freud is the man who widely introduced the “talking cure.” Josef Breuer had initiated Freud into the idea, and then Freud took it much further. If one was showing signs of neurosis, dysfunction of the mind, it was because from our birth we have found ourselves wanting or fearing sexual issues. If we were unable to achieve or escape these urges, they would be deflected and turned in on ourselves, thus hampering “normal” development. Dreams were ways to discover what was going on in the inner recesses of a person’s mind. The value of a patient talking about his past was that this way he would come to recognize and accept what these urges were and how dreams and other “tells” revealed them. Thus the patient could understand and purge his mind of the the guilt that was causing these problem inside.

Like most great innovators, Freud had his weaknesses. Everyone had to agree with his system of thought. When Carl Jung, the great Swiss doctor, disagreed with the primacy of sex in Freud’s system and wanted to take a more spiritual approach, Freud threw his intended successor out of the Psychoanalytic Society, which he had founded to create a new profession. Freud had criticized religion for being preoccupied with petty little differences. Yet was guilty of precisely that, with his new anti-religion, and initiated a witch hunt against anyone who disagreed with him. After his death, the system he tried to control split into rival camps. Charlatans and crackpots began to give the whole system the air of lunacy. Yet there is no doubt that he radically changed the way we think about mental issues.

In the US, the American Psychiatric Association grew out of an organization set up in 1844 to deal with the insane. Then the dominant approach to mental problems was that insanity was simply a disease. The field was so ill-defined and open to abuse that there was a need to try to document what were regarded as problems. Hence the DSM, the Diagnostic and Statistical Manual of Mental Disorders, became the profession’s bible. But it too has always been controversial and patently wrong in so many areas. Lieberman’s book goes through the history of the titanic struggles (often more personal than scientific) to accommodate new theories, modify old ones, and adapt to chemical solutions.

Psychoanalysis made inroads into American medicine as the refugees from Vienna arrived before and during the Second World War. Even so, it was viewed askance. To see a psychiatrist was a sort of blot on one’s sanity, and some people often hid their visits from friends and colleagues for fear that it would affect their careers and marriage prospects. The term “shrink” became fashionable. They were regarded as primitive medicine men, like witch doctors with their shrunken human heads strung around their necks.

Psychiatry has gone through many phases and internal conflicts. The latest is the excessive prescription of medication. Simpler and less time consuming. Yet psychiatry and psychology have played a part in almost every area of activity, from business to military torture, from public health to personal insecurity. It controls the ways we buy and think. And yet there still remains something of a stigma.

Despite it all, talking to someone remains very popular, whether one goes to a trained psychoanalyst or psychiatrist, a life coach, a clergyman, or any good listener. Some find cures, others find comfort, and many become dependent. And yes, snake oil salesmen, charlatans, and frauds continue to proliferate.

Whereas in medicine it is possible to see whether one is being effective or not, in the talking cure it is not so straightforward. As a headmaster and rabbi, I used to encourage people to see professional psychiatrists if they were troubled beyond my expertise. Yet I do not recall any cases where I thought there were any tangible improvements or benefits. Too often it became an excuse and a prop to avoid confronting reality.

One can argue about brain and mind and what the difference is or is not, but clearly humans are complex beings. All the more so as we hear more and more about how we can alter our brains biologically. It is very important to ensure that the non-rational, non-medical, spiritual side of person’s being should be attended to. Jung wins over Freud on this one!

I value doctors of the body (though I do not worship them), so why shouldn’t there be doctors of the soul (as Maimonides called them)? The fact that pastoral work is still very much in demand only suggests that, at the very least, the need for people to talk to those who will listen is a significant part of human wholeness.

Religion used to, and still can, play its part. A caring pastor needs some training in understanding how human beings work. We ought not to disregard it, any more than we should scientific medicine. But as with conventional medicine, one must not think there is only one infallible way. Natural cures are not pointless. There is room for other forms of therapy and help when people suffer from whatever the ailment. Some practitioners still are shrinks, manipulators, and more interested in money than people, but others are doctors of the mind — both physical and spiritual. As in any sphere, one has to do due diligence and sort out the good from the bad.

Share this Story: Share On Facebook Share On Twitter Email This Article

Let your voice be heard!

Join the Algemeiner
  • Alan Stone

    Babble doctors, or dope pushing zombie doctors, they are 99% quacks.

  • Stein

    Mental health is the same as human happiness.

    It is hard to imagine something more important.

  • Reform School

    As life dims, watch what you wish for: You may get it!

  • Explain the basic emotions and thereby learn that this “soft” science is really “hard’ science, or remain forever quacks!


  • FlaGuy954

    Question: What’s the difference between God and a doctor?

    Answer: God knows He’s not a doctor.

  • FlaGuy954

    As a retired mental health practitioner, I never found the term “shrink” to be pejorative or derogatory in any way. It’s almost used as a term of endearment by some patients towards their therapists.

  • Jay Lavine

    It would be much preferable to refer to psychiatric illness as brain dysfunction rather than as mental illness.

    Scientific medicine should not be referred to as conventional medicine. The latter term implies that there is a set way of doing things. The very nature of scientific medicine is being open to all modalities of treatment, so long as there is at least some evidence for their efficacy and safety. Perhaps this is what the writer intended, but I just wanted to make that clear.

    One final thought. If exhibiting a person like a wild animal constitutes abuse, then we shouldn’t be treating wild animals in that manner either.

  • Ros Share

    With the greatest of respect, Rabbi Rosen, to equate psychoanalysis with a life coach, a clergyman or a good listener, not only does a disservice to psychoanalysis, but trivialises a long period of training in mental health.

    If you are interested in the efficacy of psychoanalysis instead of the universal panacea of CBT, there is a evidence, especially long term evidence. That is, that psychoanalysis continues to work even after the termination of the treatment.

    Jonathan Shedler, from America is one clinician who has written about the efficacy of psychoanalysis. For example,

    In the UK there is a current study from the Tavistock Clinic, London that also shows the efficacy of psychoanalysis. For example,; and here

    For those who do not know, the Tavistock Clinic (and its sister the Portman Clinic, dealing with forensic psychoanalytic psychotherapy) has an international reputation for clinical excellence. It is in Hampstead, alongside a statue of Freud as opposite is where Freud lived at 20 Maresfield Gardens in London.

    For those of us who spent many years training and practicing, it is enormously frustrating to continue to read articles that seem to suggest that psychoanalysis is nothing more than quackery; or that all it takes is a good listener.

    When you state that you did not find any tangible improvements or benefits, I might respond by asking whether you have any capacity to be able to tell? Unless you are an expert in a psychoanalytic assessment, on what basis can you make any judgment about the mind and the internal world of the Other person?

    Drawing on psychoanalysis, the work of Professor Peter Fonagy and Mary Target at University College, London have attempted to present a version of effective psychotherapy entitled, “Mentalization.” Professor Alessandra Lemma, has set out, drawing again on psychoanalysis, a therapy called Dynamic Interpersonal Therapy (DIT):

    Both Mentalization and DIT are based on psychoanalysis, but they are “manualized” so that non-psychoanalytic clinicians are able to carry out a brief form of therapy in the NHS. This is because the issue is economic, which was why “CBT” has been lauded again and again. However, long term evidence now suggests that CBT is not the panacea it has been claimed to be. Even master CBT clinicians acknowledge the ubiquity of transference and countertransference which affects patient and therapist alike. Indeed, we are all affected by transference and countertransference in our every day interactions with one another.

    In any profession there are those who are not very good, not very ethical. However, when you next decide to refer to psychoanalysis, there are many excellent clinicians who will be able demonstrate what it is that makes psychoanalysis a rational choice for those with a wide range of psychiatric disturbances. I have spent many years working in psychiatric units in the NHS and in mental health charities.

    Freud died a long time ago and it is as if, psychoanalysis has not evolved since the time of Freud, which is not the case. Along with neuropsychoanalysis, we are learning more about “the Mind”, not merely how it works as a body organ, but philosophically, what does it mean to have a mind? What happens between two people who meet for therapy? You may not understand to what I am referring and it may even sound like rubbish, but I assure you that when I am with a patient, something extraordinary can happen – as Wilfred Bion observed, “When two minds meet it creates a storm” and that “those two people will never be the same again.” In other words, where there is a human interaction, something happens, something gets created (or destroyed) and as a result, both of us will have been affected and thus we are different from when we met. Psychoanalysis includes insight into oneself. Knowing oneself better can be helpful in understanding why a relationship is breaking down.

    It was John Bowlby who encouraged (despite opposition and shunning) understanding the meaning of Attachment, Separation and Loss and how they affect children and child development. Adults can suffer, without realising, what had occurred as a child. Abandonment is not something that can be dismissed, although many of us try to disclaim the effects which happened many years earlier. Donald Winnicott, a radio favourite, used to talk to “ordinary mothers”, telling them they did not need to be “perfect” but “good-enough’. No one is “perfect” and trying to be “perfect” creates enormous difficulties for the individual. Learning to “be kind to oneself” is not easy for some people as they literally work themselves to death.

    Learning how we can beat ourselves up through being overly critical are aspects that are common to all of us. This is the work of psychoanalysis or turning misery into “ordinary unhappiness.” Psychoanalysis does not promise that all our anxieties and feelings will disappear. Rather, we learn the meaning these feelings have for us, where they originate and how we can be sufficiently “held” (Winnicott) or “contained” (Bion) by our therapists and gradually be able to contain our feelings in a good-enough way so we can as Freud said, be able “to work and to love.” The maternal dyad is the prototype of important relationships.

    This can still appear to be psycho-babble but this can be a sign of resistance – resistance to the idea that someone, whom one does not know, the therapist, having access to one’s thoughts and mind – is scary. Free association means literally saying whatever comes to mind, no matter how trivial or idiotic it may feel. Uncensored thoughts – and dreams are, as Freud observed, “the royal road to the unconscious” and what is in the unconscious, what we cannot access directly, is the source of what goes on in our minds.

    Psychoanalysis can offer insight into the minds of the terrorist; or why groups such as BDS operate in the way they do. Group analysis includes psychoanalysis. What about shame, humiliation and guilt, which are all involved in the Arab-Israeli conflict? Yes, psychoanalysis can offer insight there as well.

    Psychoanalysis is rooted in Judaism and Jewish “thinking.” Another wonderful book by Joseph Berke is “The Hidden Freud: His Hassidic Roots.”

    Wishing you Pesach Sameach.

    • Jennifer

      I was hoping there would a be a comment that highlighted the author’s sentiment of not observing any improvements of benefits. As a budding psychiatrist it came across as mildly insulting. I’m certain that was not the author’s intention, but you did a very thorough job of presenting the profession in a positive and I hope he reads it. Thanks.

    • EJ

      Thank you for the impressive and informative synopsis.

      To say “Psychoanalysis is rooted in Judaism and Jewish thinking” is undoubtedly correct, and even more impressive when one considers its implications in the context of an academic elite that reviles any deviation from atheistic Darwinism.

      Nevertheless, I found your insights to fit well with the example of God’s unconditional love, the family as a model of relationship, with forgiveness and redemption as the ultimate therapeutic answer to the human dilemma.

      Fortunately, there are many approaches which prove be helpful in diminishing the pain of a damaged and tormented soul, especially if we are willing to put our faith in the process and invest in change.

      Nevertheless, my feeling is that until psychiatry accepts the concept of a created human being, endowed with body, soul and spirit, it will never achieve more than the patchwork solutions which it is currently able to achieve. However, those solutions are clearly helpful and welcome when they work.