Modern Psychoanalysis

Modern Psychoanalysis is a treatment for relieving mental and emotional distress. Its simple technique heals through the talking interaction between patient and therapist. Join us to learn more or post your own thoughts.

Tuesday, June 12, 2007

Curing Schizophrenia

Curing Schizophrenia

Views of Schizophrenia

A simple internet search for the word reveals a profusion of definitions with similar typecasting; e.g., Schizophrenia is “a chronic, severe, and disabling brain disorder...” (NIMHa, 2007), or “a severe, lifelong brain disorder,” (Medline, 2007), or a “disease.”

The reader may perceive something approaching a unanimity of opinion on the idea; i.e., that since this “disease” involves the brain and these authorities have deemed it to be “lifelong,” it must ipso facto be something strictly biological. A host of inferences follow: “it’s all in the genes,” “you’re born with it,” “there’s something wrong with their brains,” “the poor parents,” “medicine can cure them, if only we can find the right medicine,” “there’s no hope,” etc..., etc...

This writer thinks most of these views are about as useful as earlier ideas that people with schizophrenic symptoms were guilty of witchcraft. At least the same National Institute of Mental Health Report listed above candidly admitted:

“…schizophrenia is believed to result from a combination of environmental and genetic factors. All the tools of modern science are being used to search for the causes of this disorder.”
NIMHb, 2007.Nature or Nurture?In fact, medical science has been looking for a biological cause for schizophrenia for close to a century and has yet to find one. Over that time, many announcements of such “findings” have been made – always accompanied by the greatest publicity, but none were proved to be verifiable.

Another curious fact of this “disease” is that people who have it sometimes spontaneously recover. How then is it a disease? Or a brain disorder? Or lifelong? It is a rare disease indeed where people spontaneously recover and where there is no known physical etiology.

What about the “environmental” factors mentioned; i.e., the family backgrounds of the people who develop schizophrenic symptoms?

Peter Breggin, M.D. (p. 103, et seq.; see generally, 1994) speaks of one of the seminal reports on schizophrenia in the history of psychiatry, the study of the Genain Quadruplets (all of whom had schizophrenic symptoms). He notes that the report of the study recites the potential “biological” evidence for schizophrenia in that case in almost inexhaustible detail – but somehow neglects to consider it noteworthy that the family life of the quadruplets included such horrors as having acid poured on their genitals.

John Modrow, did not suffer the same horrors as the Genain Quadruplets; but did endure a significant amount of craziness from his parents, which he describes throughout his outstanding book “How to Become a Schizophrenic.”

Modrow notes that:

“The claim that most schizophrenics come from perfectly normal families deserves careful consideration… (regarding a case study he presented earlier)… Although the parents in this family appeared to be very ordinary and sensible people, they were later found to be playing with their daughter’s mind, subjecting her to strange ‘telepathy experiments’… it took over a year of investigation to discover those parents’ bizarre behavior.”
1995, pp. 205-206, emphasis original.

In spite of the extreme craziness of his own parents, Modrow still thinks of them as “basically decent and relatively normal” (1995, pp. 206); but also says:

“Had a psychiatrist examined my parents… he would have found… nothing strange or odd… Moreover, had that psychiatrist known my parents intimately for several years he probably would have retained his favorable opinion of them… However… there is no doubt in my mind that their behavior towards me was the major cause of my schizophrenic breakdown.”
Modern Psychoanalysis of the Schizophrenic Patient
It is no accident that the decisive text in modern psychoanalysis is entitled “Modern Psychoanalysis of the Schizophrenic Patient.” (Spotnitz, 1985). Though the theory and techniques in that book are equally applicable to all sorts of mental difficulties, Dr. Spotnitz arrived at those results through his groundbreaking work with schizophrenic patients.

Spotnitz (1985, p. 17) proceeded from the premise that “Regardless of etiology… there is no evidence that the condition is not completely reversible.”

“The operational concept follows: Schizophrenia is an organized mental situation, an intricately structured but psychologically unsuccessful defense against destructive behavior. Both aggressive and libidinal impulses figure in this organized situation… Obliteration of the object field of the mind and fragmentation of the ego are among the secondary consequences of the defense.”
Spotnitz, 1985, p. 57, emphasis original.

As to the “environmental” variables, Spotnitz says:

“It is unnecessary to postulate that a particular type of relationship produced the infantile pattern. It may be in part innate and in part learned. Even in cases where it was taught by the mother, her attitude may not have been pathological; there may simply have been a disequilibrium between her emotional training and the infant’s impulsivity. The dynamics of the mother-child relationship are not uniform in these cases. More significant than whether the parent actually loved, hated, or was indifferent to her infant is the fact that the totality of his environment failed to meet his specific maturational needs…”
1985, p. 68, emphasis original.

In this writer’s opinion, the techniques set forth in “Modern Psychoanalysis of the Schizophrenic Patient” work equally well with other mental difficulties because mental conditions have much in common – they are all part of the human condition.

One could even say that mental difficulties are normal; part of being human - the only question being whether we still function well in spite of our difficulties, or whether those difficulties have reached intolerable proportions, such as with the schizophrenic condition.
The Talking CureMany people will use Herculean efforts to appear normal, to distinguish themselves from those with problems, to split themselves off from the idea that they themselves might have any mental difficulties at all.

In spite of the efforts and protestations of these ordinary people, however, skilled observers have little difficulty seeing the underlying troubles in most of us. And, if the troubles reach a stage where they seriously interfere with the individual’s ability to love, work, or play it may be time to seek help.

When we speak of the physical illnesses we tend to think of cure as involving the complete eradication of anything relating to the condition. Not so with mental conditions – in those cases, the cure consists of placing the individual in a position where he or she can love, work and play without serious hindrance – where they can be productive and enjoy life.

The particular weakness of the individual is not likely to be completely eradicated. If a person tends to display in a phobic, or an obsessive-compulsive, or a schizophrenic, or any other way, they could have some resort to their characteristic mechanisms even after being cured. After all, we do not cure people from being human; nor do we seek to.

But, the person who has been competently treated by a modern psychoanalyst will be able to enjoy the whole range of human feelings and action available to the best of us.
References
Breggin, P. (1994). Toxic Psychiatry, New York, St. Martin's Press.

Medline. (May 24, 2007). Service of the U.S. National Library of Medicine and the National Institutes of Health, online at http://www.nlm.nih.gov/medlineplus/schizophrenia.html

Modrow, J. (1995). How to Become a Schizophrenic, Everett, Wash., Apollyon Press.

NIMHa. (March 1, 2007). “Schizophrenia,” National Institute of Mental Health, online at http://www.nimh.nih.gov/healthinformation/schizophreniamenu.cfm

NIMHb. (Jan. 24, 2007). “What Causes Schizophrenia?” National Institute of Mental Health, online at http://www.nimh.nih.gov/publicat/schizoph.cfm#symptoms

Spotnitz, H. (1985). Modern Psychoanalysis of the Schizophrenic Patient: Theory of the Technique, Second Edition, New York, Human Sciences Press.

© 2007, James G. Fennessy, M.A., J.D.
Matawan, New Jersey 07747
E-mail:
njanalyst@hotmail.com
http://modernpsychoanalysis.org/

42 comments:

Burbot said...

Anyone who knows anything about modern psychiatry knows that psychoanalysis has long been considered a pseudoscience. Sometime around 1978 psychoanalysis finally lost its credibility. Those who continue to pursue this form of quackery are obviously living in the bottom of a bucket.

Jim said...

I've been thinking that it might be useful to provide a future article on this topic, and I'd be curious to hear more about your point of view on the question.

The Encarta Dictionary (http://encarta.msn.com/dictionary_/science.html) defines science in the folowing ways:

"1. study of physical world: the study of the physical and natural world and phenomena, especially by using systematic observation and experiment (often used before a noun)

2. branch of science: a particular area of study or knowledge of the physical world the life sciences

3. systematic body of knowledge: a systematically organized body of knowledge about a particular subject the behavioral sciences

4. something studied or performed methodically: an activity that is the object of careful study or that is carried out according to a developed method the science of dressing for success

5. knowledge gained from science: the knowledge gained by the study of the physical world

[14th century. Via French < Latin scientia < scient-, present participle of scire "know, discern" < Indo-European, "cut"]>"

It is your idea that modern psychoanalysis does not fit one of these definitions?

Hugo said...

anyone who knows anything about the politics of psychiatry knows how exactly psychoanalysis fell in disgrace and understands why residents are kept away from learning psychotherapy (not just psychoanalysis); anyone who is in touch with the powers of Big Pharma (not the Hip Hop band) knows how much it has influenced the idea of a "true pseudoscience" in current medical practices, not just in psychiatry.

Jim said...

Though Dr. Spotnitz is a medical doctor, I would say that most modern psychoanalysts are not psychiatrists. In fact, a fair number of modern psychoanalysts started out as patients.

Copper Kettle said...

There is a wealth of data on changes in the brain linked to schizophrenia - decreased Reelin protein and GAD67 enzyme along with deregulation of epigenetic mechanisms (see articles by Erminio Costa); ghanges in GABAergic chandelier cells (David Lewis), glutamate receptor changes (Bita Moghaddam), in some cases - increased volume of ventricles, and more..

Jim said...

Thanks for the listing of these reputable neuroscientists and their work. The related articles should be of interest to most.

What's your idea on the significance of this wealth of data?

Anonymous said...

I can't believe that anyone is this day and age would deny that schizophrenia is a biological disorder. Please tell me what legitimate clinician thinks psychoanalysis is a legit enterprise anymore. Didn't psychoanalysis do enough harm in the past when schizophrenia was blamed upon the mother?

Jim said...

Re: your first question, there are over 1,200 legitimate clinicians listed at the National Association for the Advancement of Psychoanalysis (www.naap.org); I assume most of those think psychoanalysis is a legit enterprise.

I am curious about the answer to your second question, but not certain I know enough about it; what types of harm were done in the past?

Mark said...

" Anonymous said...

I can't believe that anyone is this day and age would deny that schizophrenia is a biological disorder."

I deny it easily, 99.9999% of diagnosis of schizophrenia is done through observation/interview with a psychiatrist.NOT a biological laboratory test.
If no laboratory tests exist, how can you in this day and age continue to believe in biological psychiatry?

There is proof psychology may work to reduce mental illness.
http://www.apa.org/monitor/feb00/schizophrenia.html
or
http://tinyurl.com/3dyw2n

"At the most optimistic of times, the traditional treatment paradigm conceded that perhaps 10 percent to 20 percent of those with schizophrenia might achieve recovery. But proponents of the recovery movement point to data that shows as high as 68 percent rate of recovery and significant improvement."

Anamaria Ivan said...

Hello,

I noticed that some people that deny psychoanalysis bring the "no-science" argument all the time... but, in my humble oppinion, this argument is at least fallacious. What if we assume that psychoanalysis is indeed a non-scientific domain? What then? Should we reject something that has souch an enormous therapeutical impact only because it does not comply to the constraints of an exact science such as physisc or mathematics? And of so... what should we do with the arts, the literature or... let's say phylosophy? Why should the word science be the supreme truth-guarantee?
And... another quetion for the "science" lovers and "non-science" haters: have you heard of the "Godel-Turing" scientific prooved statement? Just tell me what do you think about that, and then, let't have a nice chat about being human.

Best regards!

Mel Avila Alarilla said...

Hi Dr. James,
I'm new at your blog. I hope you don't mind if I give my own comment on your post.

Marvelous. Simply fantastic. I should have known and read your blog earlier. That was a very authoritative, informative and thorough medical post. I have always been fascinated with medical journals that are presented for laymen's consumption. They help eradicate misconceptions of various illnesses.

Thanks for the very wonderful post. I enjoyed it to the max. May I invite you to visit my own blog as I link your blog with mine so that I can always have an update of your informative posts on psychoanalysis.

God bless you with all the wisdom and wit in the world.

Anonymous said...

Hi Salty Davis from Belfast, I have been in three secure units and had schizophrenia for 10 years I always rubbish the idea that talking therapy could help, but I found that off loading all your bad experiences onto a stranger ie a therapist is a liberating experience and helps towards recovery I don't know about psycho analysts but I recommend anyone with schizophrenia to get some talking therapy

geo said...

Hi, I just found this blog today.

I really enjoyed this post.

Personally I think that this whole "it is proven that schizophrenia is a biological illness", "all one can do it take neuroleptics and maybe have some supportive therapy" is one of the biggest lies that exist at the moment.

I am not saying the opposit, that "schizophrenia is just a psychological problem", but when I go through articles or books that seem to be reliable, they say something like: "We do not know". And just because there are some changes in people`s brains who have schizophrenia doesn`t decide the question: "Have the thoughts changed the brain or have the brain changes affected the thoughts".

So to me it looks like the most honest way to talk about it, is to say that "we don`t know".

But as long as we don`t know it seems worthwhile to take all our strenghts to find out whether maybe there is a "talking cure" to schizophrenia. It might not be psychoanalysis, but maybe CBT, or a future mixture of both or something that isn`t invented, yet. But I think we should try.

FM said...

FM In Ireland
New to your blog as a commenter but have been reading it for a while. Iam doing a MA in Psychoanalysis and find these discussions interesting and partly frustrating! It would be easy to postulate that people with such a strong denial of psychoanalysis appear to be exhibiting a ignorant fear of some sort. Most reasonable people will at least hear both sides of an argument, state them and interrogate the points they have problems with. Not just come out with pseudoscience jargon. I can understand how PA can appear unsavory to some people, especially if they have not read up that much on it. There seems to be alot of misconceptions in particular to do with the language used and its context. I would encourage anyone to read it with an open mind and in the context it is implied, bearing in mind Freuds era of 18th C Austria. Freud gets a lot of stick. I have never come across a 'creator or inventor' of any other discipline who is attacked so frequently. The first try at things wont always be right, and (by definition of a science) the point is to move forward and alter your hypothesis accordingly.
With regards to Schizophrenia. It has not been proven either direction yet to be a biological illness or environmental reaction strictly but it appears to be a combination of the 2. This appears so far to be the most reasonable answer. Medications do work for most people but not all and not for all symptoms. I dont see why the lay persons opinion is for PA and Psychiatry always to be at odds. The most valuable way to cure anyone with any disease or condition is to value and treat them as a WHOLE person. Body mind and soul. If medication eases some of the more positive symptoms and someone feels relieved then great. Equally if exploring their feelings and thought encourages progress and relieve then equally as great. Both can and do work together well. Schizophrenia is a very unique disease and so the ideal for an individual has to be tailored to them. who is to say that some cases may be purely biological and others may be more environmental but present similarly??

Additionally, if anyone has any interesting ideas that would be worthy of an MA thesis im open to suggestions and inspiration.

Bloggerhead said...

Modrow doesn't want to take responsibility for himself and his own peculiar mind traits. "However… there is no doubt in my mind that their behavior towards me was the major cause of my schizophrenic breakdown.” What hardly anybody talks about in schizophrenic treatment is personal choice. How you choose to react is based on your own internal mindset to which others (even parents) have no access. Yet, we are supposed to endlessly coddle the patient and unquestioningly accept his or her verdict of parental failure. If a person with a more garden variety mental health concern went to a therapist with his complaints, would not the therapist try to get that person to stop assigning blame? Paranoid schizophrenics also believe they are being watched. Everybody rubbishes that one, yet when they say the parents are to blame that is accepted as truth.

Anonymous said...

There's a reason that "Biopsychosocial" formulations of mental disorders exist, and to say that Schizophrenias or Psychosis is the same as, say, Parkinson's or Alzheimer's Disease just doesn't fit with my understanding of these things.

I'd suggest everyone who is solidly convinced that Schizophrenias/Psychoses are diseases or disorders OF the brain read George Graham's "The Disordered Mind." Philosophy has a good middle grounded perspective that can provide a lot to this discussion.

Also, for those who poo-poo psychoanalysis (of any variety), ask someone whose had it how effective it is before you write it off. Anecdotal evidence is just as scientific (if not more so than) as any randomized clinical trial. Read "Cultures of Healing" about that idea.

Anonymous said...

In response to Burbot, in the United States the preferred training of modern psychiatrists who wish to become therapists is still psychoanalysis. The preferred method of psychotherapy for the enemies of psychoanalysis is Dr. Phil, or Dear Abby.

Anonymous said...

Copper Kettle said...
"There is a wealth of data on changes in the brain linked to schizophrenia - decreased Reelin protein and GAD67 enzyme along with deregulation of epigenetic mechanisms (see articles by Erminio Costa); ghanges in GABAergic chandelier cells (David Lewis), glutamate receptor changes (Bita Moghaddam), in some cases - increased volume of ventricles, and more.. "

-----
Whose to say the peculiar physiology was not preceded by psychosis? Simple sexual arousal triggers all sorts chemical and physical changes in the entire body. To assume that internal conflict would have no effect of brain physiology requires a total absence of imagination.

Anonymous said...

Schizophrenia is likely to be a combination of many factors, biological and cognitive.

It could even perhaps rely on a conditional gene which becomes active depending on the conditions.
Though you may have taken some select definitions from a select website, a key feature of science is falsifiable theories, you can not prove psychoanalysis right any more than you can wrong, this discredits it as a science.

"I deny it easily, 99.9999% of diagnosis of schizophrenia is done through observation/interview with a psychiatrist.NOT a biological laboratory test." Someone once told me that this same number of statistics was made up... There have been studies which show that schizophrenia is linked with a dopamine imbalance, and the medication that rectifies this helps with the symptoms, apparently there is no biological element?

Also, how do you explain the conordance rate in families? Even separately adopted twins have a heightened concordance rate, so this points towards genetic as well as environmental.

You see, what this article has done is called a straw man fallacy, the author has taken select points of evidence against psychoanalysis and put them out of context so they can be considered to be weak, and easily broken down, making no point to deal with other evidence, or even the evidence as a whole.

nezza said...

what's wrong with having it. Words and voices are just that, don't need to do what they say or pay them any mind. Perhaps they are making us think...as long as others are not ignorant towards mental illness then it will have a positive effect upon society since accepting different view points makes us grow

Anonymous said...

To all those who doubt the validity of this form of therapy/treatment: it seems to me that all that you have managed to do is to bring progress in psychology to a screeching halt. You essentially are saying to anyone with schizophrenia, take this medicine your entire life and supplement it with DBT treatment, a therapy that is over fifty years old, and what you end up with is the best you can hope for. Is nobody interested in striving to further the understanding of psychology anymore? By this model of treatment, we might well have just abandoned any attempt to further medical/psychological treatment while we were still using leeches and voodoo sticks to treat people--why not, why bother to try something new? I'll tell you exactly why that shouldn't happen: because say you have a person with hallucinations and delusions and they're prescribed the current best medicines and they go through a year of treatment and they still have little to no progress? Are we supposed to write that person off in our society? Because that is exactly the position that my daughter, and my family, is in... Maybe we can do a little better for our children...

Jim said...

Thanks for writing your opinion Anon. Just to clarify - I'm not recommending that anyone "take this medicine your entire life and supplement it with DBT treatment" - I'm recommending Modern Psychoanalysis.

Anonymous said...

Sorry about my post, Dr. Fennessy. I wrote it while I was in "a state," so to speak, and I didn't write it very clearly. My rant was directed at some of the other people who posted to your site and were very critical of the psycho-analysis therapy, and who also felt that the "modern" treatment of medicating and DBT therapy was the "go-to" treatment for schizophrenia spectrum conditions. I was seeing red by the time I'd finished these people's posts and wanted to point out that these methods are sometimes ineffective and that I felt they should consider other methods of treating these conditions. I fully realized that you in no way suggested that people should just take medication for a life-time, in fact, you very much seem to suggest quite the opposite and offer an alternative to the standard treatment model, psychoanalysis, which is why I found your site to begin with. I feel that psychoanalysis offers as much hope, perhaps more so, than the current treatments that are used, and have been ineffective for my daughter. I apologize for any confusion on that point.

Jim said...

Thanks for clarifying Anon. In this regard, Dr. Jonathan Shedler has a ground-breaking article on the effectiveness of Psychodynamic Psychotherapy online at the following link:

“The Efficacy of Psychodynamic Psychotherapy.”

Anonymous said...

Thank you for the article link! I'll look into that right away!
I'm sorry to impose on you, but I would like to gain some insight on the situation I'm facing concerning my daughter. In the interest of brevity, I'm going to explain this in a more linear manner than it actually occurred, as sometimes we'd discover something and then find out more about it later.
In Feb. 2015, after a several months of increasingly paranoid and obsessive behavior, my 15 year old daughter told us that she was hearing a voice she knew was God and the voice told her to kill her older sister. We took her to the ER and she was hospitalized for nearly a month, was prescribed medication, started therapy (DBT) and had some testing. They diagnosed her as having Major Depression with psychotic features. She came home and she was still very unstable. After about three weeks, she said that she felt that God still wanted her to kill her sister and she regretted not having done so the first time. She was hospitalized again, during which they increased her medication, did more therapy, etc. after which she came home, still unstable and in out-patient therapy (DBT).
She was hospitalized four times in 2015, attended months of out-patient program therapy, has been on various medications, been diagnosed with four different disorders, (the latest conclusion is Delusional Disorder, and we suspect that her age, 16 at this point, prevented her from being diagnosed as schizophrenic), and has been receiving months of therapy. After all this, she isn't psychotic, but she suffers from delusional thinking such as believing God wants certain things from her (she doesn't hear God, or feel that God is communicating with her, per se) like wanting her to be a nun. She also has thoughts about supernatural entities or the devil being in her room. She feels that her friends are mad or annoyed with her for no particular reason. She continues to have violent and deviant sexual thoughts about vulnerable people, and a variety of other mildly paranoid thoughts. She has never acted on any of these thoughts, but we fear that one day she might.
In the interest of providing necessary background, our daughter was fifteen years old when this started. She has no history of drug or alcohol abuse. She does have a history of self-harm, scratching herself when she is feeling anxious, frustrated or hurt. She has always been a bright child and does well with academics, but struggles with social issues, has few friends, none of which are close, and has always been close to her sister. She was abandoned by her biological mother at age two, and has had no contact with her in eight years.
Considering your experience, we're hoping that you can offer us some insight as to what all this means and how to proceed moving forward with treatment. The treatment she's been receiving, though well-meaning and supportive, doesn't seem to be reaping as much in results as we had hoped. The professionals seem to feel that it is an open question whether she'll be able to pursue college, work, and live independently considering her delusional thinking, horrible thoughts and her perpetual anxiousness. They seem to feel that she needs to take her medicine, perhaps for a life-time, and to continue on with therapy (DBT and exposure), and that's about the best we're going to be able to do. If that is the case, we are able to accept that, but we wonder if there is more that can be done to understand what she's suffering from and other treatments that might offer better results. Any insight or suggestion that you can offer would be most helpful and truly appreciated.
Thank you in advance!

Jim said...

Thank you for writing again Anon. I'm wondering what parts of this you're looking for insights or suggestions on, and how insights or suggestions might help your daughter. I'm also curious as to what your daughter's ideas are about all of this.

Anonymous said...

Sorry that I'm so long in replying. A number of things have made it difficult to do so before now. What I'd like to get insight into regarding my daughter is why she is having these horrendous thoughts? What purpose would they serve under the thinking of psychoanalysis? Is there an underlying “something” that they hint at? She's been having them for over a year and though they have abated a bit—for instance—she had none today, since she wasn't exposed to her triggers that sometimes, but not always, cause them and she's never acted on any of them, as far as we know, but how do we know that she won't act on them in the future? The therapists say that they feel that she won't, though they don't guarantee that, but we're skeptical about that.
The second thing that we'd love some insight into is how to help our daughter gain insight into the psychosis. Dr. Bertram Karon of University of Michigan says in several of his papers that psychosis are the waking dreams that tell us about the fears and traumas of a person that they are trying to deal with. Doctors Ira Steinman and David Garfield say similar things and that by examining the delusions/hallucinations one gains clues about what they are truly having trouble dealing with. Having limited resources, we can't afford to get our daughter psychoanalysis, but if there are areas that the therapists that we do have access to could focus on, that would be helpful to know. In other words, why a hallucination that God needed our daughter to kill her sister as a test of faith? Why hallucinate that instead of being stalked by aliens or any number of other things—many of which would have been easier to deal with on our side of things. What does it mean that God is so demanding and unforgiving of her—in her view, anyways. We asked her about her understanding of God once, and she said that she understood that God was loving and giving and forgiving, but that she didn't feel that God would forgive her because she wasn't one hundred percent certain that he existed, that she believed. I'm rambling at this point and not making sense at all. We're looking for a magic bullet, I suppose, to help end this situation, or rather to get it heading in the right direction toward recovery, but I suppose that the whole thing is so complicated that that might not be possible. It seems that most people in the field want to just say that it's all a brain chemistry imbalance and call it a day, but I think that your view of these situations makes more sense. If anything that I've written makes any sense and makes you think of anything that might be helpful to tell us and in turn to talk to the therapist about, please let us know. We'd be very grateful for any help you offer.

Anonymous said...

Dear Dr. Fennessey,
Perhaps I should wait for your next comment before adding another of my own, but I've just now finished reading the article you posted above, the Efficacy of Psychodynamic Psychotherapy, and felt compelled to tell you that I found it very interesting. (Sorry about the delay in finishing the article--reading time is at a premium in our household.) It's striking that the psychoanalytic therapy offers so much more than the therapies that are currently in widespread use, and yet one hears so little about it. Obviously, the author addressed that issue to a point, but I can't imagine why we aren't seeing psychotherapy making advances as, at least, an alternative therapy, if not the ideal therapy for the myriad mental health issues that people are struggling with today. How can that situation be remedied for the future? At any rate, thank you for the article link--it was fascinating and there was a link within it to another article that promises to be just as good.

Anonymous said...

Dear Dr. Fennessey,
While checking for a reply to my previous posts, I realized that I didn't answer one of your questions: what my daughter thought of all this? In answer to that, she feels that she's gotten better, which is true to an extent, and that all the unusual thoughts described in previous posts and the somewhat paranoid thinking and obsessing is just something that she has to live with or disavows altogether. She lives in fear of becoming psychotic again and actively avoids certain things that make her think about religion, and also avoids discussing her sister because she was the focus of the psychotic episode. She also tries to avoid children and special needs people, though she sometimes does run into them and feels she needs to make those moments as short as possible. She doesn't seem to understand, or is affected by, the idea that these moments of anxiety and the thoughts often mar the enjoyable activities that she's engaged in, which I feel is so sad. I can't imagine trying to enjoy an activity and having horrible thoughts and anxiety. I'm concerned for her quality of life and want her to be able to enjoy it without having to deal with a constant "something" running through her mind, if that makes sense to you. She seems very accepting of it, or perhaps resigned is a better word. So that is the answer to your question that I overlooked. And thank you for listening to all this. I can't tell you how much I appreciate it.

Jim said...

Thank you for your many excellent and thoughtful questions, Anon. I've posted a new brief article on this blog, entitled "Mechanisms of Cure," which may answer some of your questions regarding the modern analytic view of insight in a clinical setting.

There are a number of different theories regarding the etiology of psychoses, though I've mainly chosen to focus in this article on our approaches to clinical treatment of the content, for reasons set forth therein.

I agree with you that people are quite complicated, which is why I think the extensive training of modern analysts is so important. I strongly feel that modern clinical techniques cannot, or should not, be casually applied where therapist is not well-trained.

I am curious about your idea that modern psychoanalysis may not be affordable to you since in some areas of the country there are modern psychoanalytic clinics, such as that at the Philadelphia School of Psychoanalysis, where patients may be seen at low cost.

Jim said...

Thank you for writing more about your daughter's thoughts anon. I'm also wondering what your daughter thinks of the questions we're discussing about therapy.

Jim said...

Thank you also for your comments on the advances in psychoanalytic therapy, and the interesting questions of why one hears so little about it, and how that situation might be remedied for the future. I'm curious about your own thoughts on these questions.

Anonymous said...

Dear Dr. Fennessey,

Thank you for your post! I read your article, Mechanisms of Cure, and found it very interesting, though I'd still be interested in finding out more about the theories of etiology of psychoses, and I suspect others would be, as well.
I can only theorize as to why people are not made aware of the possibility of psychoanalysis as a viable treatment. I think that Dr. Shedler touched on a great number of them in his articles, “Efficacy of Psychodynamic Psychotherapy” and “That Was Then, This Is Now,” but I fear that there is more to it than that. People have changed in many ways over the past thirty or so years, and that might be a piece of the problem, as well. I remember that people used to view it as more of a viable treatment, so much so that it worked it's way into television programs like MASH and it was compelling. (Remember those dramatic scenes of Hawkeye being treated by Dr. Sidney—one where Hawkeye was having a reoccurring nightmare and couldn't sleep, and the final episode where Hawkeye was in a mental hospital and again needed treatment—that scene about the chicken!) If people could not fully understand the principles of psychoanalysis and how it could work, they at least considered it a beneficial method of dealing with mental illness. Somewhere along the line, they started feeling that it was more a punchline in the world of psychology, something to be scuffed at. You mention psychoanalysis and they respond, “Like Sigmond Freud?” I guess, if one also sums up astronomy by saying, “Like Galileo?” One the one hand, they recognize that we've come a long way from the pioneer of a science; on the other hand, they equate the pioneer with the science and fail to recognize that the science has progressed. You'd probably have better luck suggesting that they be treated by a voodoo witch-doctor.
(continued--sorry for the long post!)

Anonymous said...

(continued from last post...)
Not that any of this gets to the heart of the matter. I do know that I had thought that psychoanalysis was no longer practiced until a few months ago, just a month prior to contacting you. I can't say I remember where I got that impression, though it might be partly because no one mentioned it as a treatment option for my daughter, and I erroneously felt that any viable treatments would be discussed with us—all the professionals said that CBT and DBT were the standard and most reliable treatments. Are they misinformed, at least in regards to the later? I do know that the impression I had of psychoanalysis from years ago is that it was effective, but expensive, long-term, and not covered by insurance. Many people probably feel, as Dr. Shedler points out in his article, that the therapy is focused on one's parents and sexuality, and they seem to scuff at that. It hasn't helped that there have been numerous comedy movies and TV programs that poke fun at therapist and their patients, and sometimes, sadly, people equate that with reality.
I wonder if the biggest factor is that people want easy solutions to complicated problems. We're told by the pharmaceutical companies that medicine is the “fix” for virtually everything, and many doctors now say that mental illness is completely a matter of imbalance of brain chemistry, that's a simple enough concept for anyone to wrap their head around, even if it isn't the correct one. If this is the rationale of a majority of folks, then what psychoanalysts suggest probably sounds like a scam akin to selling snake-oil—“these doctors SAY they can treat mental conditions when everyone knows that it's about brain chemistry and that you can't fix that without medicine.”
This is a lot of thinking out loud, but these are some of the thoughts I have about the subject. Maybe there will be a way to reassert the value of psychoanalysis, so that the majority of doctors won't be able to easily dismiss it? Maybe challenge the idea of mental illness being a matter of brain chemistry imbalance? Make psychoanalysis more accessible for patients who will then go forth and spread the word about it's benefits?
What are your thoughts about why people don't embrace psychoanalysis and how to move it into the fore of people's thinking?
Have to run, but I haven't forgotten your other questions!

Jim said...

Thank you for writing again with a number of excellent questions, Anon. I agree that theories of development are interesting, and many modern psychoanalytic institutes have intensive curricula on studies of human development and maturation. Dr. Spotnitz reviews the theories regarding development of schizophrenia in Modern Psychoanalysis of the Schizophrenic Patient, Theory of the Technique, Second Edition (1985); and Spotnitz then says “Three other factors are primary: aggression, object protection, and sacrifice of the self. These are the elements that combine to produce the schizophrenic nucleus of the personality. The operational concept follows: Schizophrenia is an organized mental situation, an intricately structured but psychologically unsuccessful defense against destructive behavior.” (1985, p. 57, emphasis original).
Sadly, as you noted, there isn’t much real knowledge out there about modern psychoanalysis, either among members of the general public, or among clinicians. Additionally, while most mental health clinicians practice as soon as they received their requisite university degrees, it takes quite a number of additional years of post-graduate training in a psychoanalytic institute to become a competently skilled modern psychoanalyst. I wonder if societal views towards mental or emotional distress contribute towards the “quick fix” attitudes that seem to predominate in medical settings, among insurers, among government officials, and among many other people? I’m curious as to what ideas you think might help fix a society that presents with a mechanistic view of human beings.

Anonymous said...

Dear Dr. Fennessey,

Sorry for the delay of writing further. It seems that there is always much to be done, and I'm sure that you are much busier, so I imagine that you'll understand. Also sorry that this is so long and will end up being several posts.

As for what my daughter feels about her thoughts and about our discussion regarding them, she feels very much that this is something that just “is,” as that's what she's been told since the beginning of her troubles. The therapists—there have been a number of them—feel that having these thoughts are just part and parcel of the condition she has, and suggest that they may continue indefinitely. We feel that it seems unusual to have these type of thoughts. We obviously understand that people have thoughts that they would rather not have and would be reluctant to speak of, but it seems unusual to our minds that someone would be having ongoing violent and deviant sexual thoughts, what are considered intrusive thoughts and that they can be extreme in nature at times, but if that's the case, what about the delusional thoughts? How do those fit in? Perhaps there are two conditions at work? One that is delusional in nature regarding religious topics and often other vague persecution type paranoid topics, and the other that sparks the intrusive thoughts?
Our daughter simply accepts those thoughts most of the time. Occasionally she will be troubled by them, particularly if they are violent in conjunction with God, meaning that she feels that God wants her to hurt or kill someone, and she seems embarrassed about the thoughts that God wants her to be a nun because once she promised God she would, but now she doesn't but feels that God is holding her to that promise. She is chagrined to talk about these thoughts, sometimes embarrassed and sometimes ashamed. She doesn't recognize that some of her thinking is askew, such as times when she feels that people are mad or irritated at her for no reason. She asked one friend a number of times if she was being irritating, getting “no” as the answer, and after a few more times, the friend replied, “You're starting to be.” In the end, they worked it out, but it shows that she sometimes doesn't understand that things are alright between her and her friends and needs constant reassurance that they are, not believing when they do reassure her. So some of these thoughts do, albeit in minor ways, impact her enjoyment of life.
Some thoughts she just ignores or distracts herself from thinking about further. She knows that dwelling on them causes anxiety and that will prompt more thoughts. She sometimes gets anxious when she sees one of her “triggers,” fearing that she's going to have thoughts, and then she typically does.

Anonymous said...

(continued from last post)
On the whole, she feels that the thoughts are just something that she has to live with and she can't understand why they are concerning to anyone and why she isn't able to do more things because of them. For instance, she went to prom and she wanted to go to “after-prom,” a school outing to help keep kids from getting into trouble after prom ends. After-prom was a trip to the city to then board a cruise vessel that would cruise the city shoreline. We agreed to prom, but the idea of her going into the city and then on a boat was too much, since if she had an issue, we'd have to travel twenty miles into Chicago to get her at some time between 11:00 pm and 2:00 am. She was upset about it but somewhat understanding about it, as well. She truly struggles between wondering why she can't do the things her friends do and being very ill at ease in various situations that prompt her anxiety and a larger number of thoughts.
Getting back to the idea of two disorders at work... It seems that the “general” violent and sexual thoughts are more unprompted, wherever they come from, and that she has little control over them.
The delusional thoughts—like ideas of God wanting her to do things or people being mad at her—seem to be more active thinking. She has the thought or feeling, and then she considers it, obsesses about it, tries to counter it with reason, though without success. It seems (from hearing her describe these things for over a year) that it's more of an active process, but not one where she can disprove the thought and dispel it. At prom, she had a thought that God wanted her to hurt/kill her prom date, which was upsetting to her, of course, and she was able to calm herself and go on with the evening. She wasn't able to just declare the thought invalid and it also scared her because she fears that she'll become psychotic again, having such thoughts. She—and the various therapists—distinguish between these being just delusional thoughts and psychosis by noting that she no longer feels that she's being communicated with by God, as she did when she first began this condition. She says that she doesn't feel the idea coming from outside herself, only the thought of it. Still, the idea of it is disconcerting, though the therapists are fairly certain that she won't act on these thoughts because she has insight that they are thoughts, but that is cold comfort when the stakes are so high. And she's had these thoughts about God wanting her to hurt/kill her boyfriend, the same fellow who took her to prom, a number of times since, which has presented a challenge for them being able to see each other, with much still in the works to facilitate that.
The point is that one wouldn't think that God would want them to hurt/kill someone, and if that thought did strike them, they would be able to dismiss it as a “where did that come from?” moment. With all her effort, my daughter can't free herself of these delusional thoughts by any means that the therapists have suggested, and despite being on medication, which I'm now feeling is more of a hinderance to treatment than a help, considering some of the literature I've been reading. She's often either unconcerned about it or completely over-wrought with anxiety and shame about it. I've started looking into finding psychoanalysts in our area who might offer an alternative treatment that might reap better results. I also found an alternative treatment called “Eye Movement Desensitization and Reprocessing Therapy” that I've come across—don't know much about it yet, though you may, of course.
So that's where things are at the moment, and what my daughter thinks about her thoughts and delusions. Do you have any thoughts about all this?

Anonymous said...

Dear Dr. Fennessey,

The material that you wrote about Dr. Spotnitz work was very interesting. I'm going to try to get a copy of his book at some point, though that may prove challenging. Nonetheless, I'll continue to research his work as best I can for the moment. One question occurred to me though, as I read your last posting: Does Dr. Spotnitz suggest that all three of the primary factors are present with the development of schizophrenia? Or can it be only one or two? It would be interesting to know that.

As for your other question, in my opinion—not being particularly well educated and usually operating on simple reason and common sense, which can be limiting—I think that we've been heading in this direction for a few decades, primarily since the generally acceptance of computers. In the beginning of the computer age, around the 80s, of course, people were generally suspicious, if not frightened, by computers, which was reflected in a number of pop culture items: most notably, movies like“2001” and “Paper Man”; television programs such as “Battlestar Galactica,” that featured mechanical, computerized antagonists; songs like Styx's “Mr. Roboto”. Computerized machines was a concept most people rejected as being too much smarter than us and without feeling. It was particularly troubling to manufacturing workers, who feared being put out of work by automated machines made possible because of computers and run by them. Kurt Vonnegut Jr. wrote “Player Piano,” one of his less known and best novels, addressing this fear. I remember people talking about problems that people suffered from computerized billings, where someone would get a $10,000 telephone bill. I'm a believer that various art forms reflect the fears and aspirations of the particular time period in which the material was produced.

Anonymous said...

In time, computers became acceptable and even revered for the benefits that they produced in various fields, such as health care. Steve Jobs made the computer more charming and friendly-looking, a useful appliance, instead of a cold, destructive, sharp-cornered machine that people sometimes likened to Pandora's box. And somewhere in this time we shifted the focus of thought away from fluid and philosophical to rigid and pure logical—machine-like thought. Instead of considering the consequences of an action in terms of ethics and values, right and wrong, we looked at them in terms of can I or can't I, getting caught or not getting caught, risk vs reward, risk vs punishment. This might have been the time when we started down the “slippery slope.” We raised and schooled children to think this mechanical way and focused more on the sciences, and stripped away the parts of education that dealt with the arts, such as fine arts, music, poetry, etc., that instilled them with an appreciation of abstract concepts like beauty, ethics and wonder. I sometimes wonder if the problems we have today are partly the result of an education system that facilitates children's academic learning outpacing their emotional development. In any case, we're now at a point where people seem to have embraced a mechanistic view and expectation of the world, and the “quick-fix” expectation is part of that thinking—figure out how “it” works, how “it” is broken, and then fix it, pop in a new part, correct the programming. Except that we're not merely organic machines—at least, I'm very uncomfortable with that idea. The evolution of organized thought has gone through this phase before, of course; it's beautifully capsulized in a gem of a book called, “Sophie's World,” that gives the history of philosophy in a neat little package. We are in those times again, it seems, and the question is: how do we get ourselves out? If we did work our way out of this mire, I suspect that we'd see more interest and appreciation for psychoanalysis and a great many useful things that people have dismissed. Maybe they'd rebel against the brilliant PR of the pharmaceutical and insurance industries, that makes it seem as if there are simple solutions to complex problems?

What are your thoughts about all this?

Anonymous said...

Dear Dr. Fennessey,

I have reread some of your posts and some of Dr. Spotnitz's ideas about schizophrenia, and I have a few questions that would help me to understand these concepts better. (Please forgive me if they are rather dense!) Dr. Spotnitz, as you noted in your last post, cited three primary factors in schizophrenic development: aggression, protect of object and sacrifice of self.

My first question is: what is the object? Obviously I know what an object is, but what does that mean in this context? The focus of the aggression? The construct that a person has created to deal with the suppressed aggression? I'm fuzzy on this point.

My second question is: how does the sacrifice of self work? How is one doing so? Or is it very arbitrary and dependent on the person? Is this akin to a lack of identity or weak identity?

I'd really like to be able to understand these two points, as they seem of great importance to the development of schizophrenia. Thanks in advance for your help, and for all your help and questions over the past posts!

Sincerely,
Anon (for lack of a better “handle”)

Jim said...

Dear Anon, Thank you for writing again in such interesting detail. Experiences, similar to your daughter’s experiences regarding her thoughts, have been extensively written about in the wonderful book by Elyn R. Saks, entitled “The Center Cannot Hold, My Journey Through Madness,” (2015, Hachette Books, New York). I wonder what your daughter thinks about the idea of therapy. As to your question of whether “two conditions” may be at work, I guess the answer would depend on one’s definition of the “condition.” As most therapists, I have occasion to use DSM-5 for various purposes. However, I have rarely, if ever, found it’s classification of conditions to be helpful in treating patients. The DSM-5 is loosely based on a “medical” approach, which considers the patient’s symptomatology to be instructive of the person’s underlying emotional difficulty. My thinking to the contrary is that in such cases the symptoms are of minimal value to successful treatment. I am not even slightly surprised that as you’ve reported “…any means that the therapists have suggested” haven’t worked, (and I believe would have a similar reaction to EMDR). It may be that there are few modern psychoanalysts in your area of the country, however you may wish to try the “N.A.A.P. "Analyst Finder" - Directory of Analysts” link that I’ve provided in the links section of this blog.

Jim said...

Dear Anon, Thank you again for your excellent questions. Your first question regarding use of the term “object” by Dr. Spotnitz is especially thought-provoking since modern analysts use the word in a variety of ways, some of which may seem excessively complicated at first. For example, we talk of “objects” as being the first objects, or parts of objects, recognized by a very young child, such as the mother’s breast. In fact, there is any entire school of psychoanalytic study built around these concepts, called “object relations.” In this sense, Spotnitz says “(t)hus, the term ‘object field’ encompasses the earliest self-representations.” (1985, p. 58). In other words, at times Spotnitz is speaking of the representations in the patient’s mind, and he says “(t)he damage incurred by the structures of the mind often confronts the clinical observer with a scrambled picture… the primary forces that scramble the personality in schizophrenia are impulses to destroy the object.” (1985, p. 58, emphasis original). My understanding is that the “sacrifice of self” first takes place within the patient’s mind, by disruption of the patient’s normal mental functioning, and that the patient’s external relationships in the world are likewise impaired. Another way of expressing this might be, as you suggest, that the patient’s ego boundaries are weakened. The patient’s impulses towards destruction may be turned inwards towards the patient, or outwards towards other objects or people. Dr. Spotnitz says “… I am reminded of a woman who used to spring up from the couch to bang at the office door. After indulging in such behavior repeatedly, she said, ‘You ought to be grateful that I bang at the door instead of at you.’” (1985, p. 152). Regarding your last question, I believe Dr. Spotnitz is saying that all three of the primary factors earlier cited are normally present with the development of schizophrenia.

Spotnitz, H., 1985, Modern Psychoanalysis of the Schizophrenic Patient, Theory of the Technique, Second Edition, Human Sciences Press, New York.