mhobserv

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Some Observations and Thoughts
on the "Treatment" of "Mental Illness"

by Frank Gordon

   "Mental Illness" is not defined in "Black's Law Dictionary" (West, 1979) as such, but is somewhat synonymous with "Insanity."

   Insanity. The term is a social and legal term rather than a medical one, and indicates a condition which renders the affected person unfit to enjoy liberty of action because of the unreliability of his behaviour with concommitent danger to himself and others. The term is more or less synonymous with mental illness or psychosis.

   Thus, precisely, these terms are social, community, or group concepts. A mild "mental illness" in this social sense could be an irresponsible ignorance about the common rules or statutes which define our mutual rights and correlative duties. (The right of one always implies a correlative duty from another not to infringe that right).

   A social "crime" is a breach of duty. For a breach of duty to occur there must be an implied contract defining this duty, and the valuable rights obtained by accepting this duty. Also, the duties need to be known and after information about them is obtained, there should be an inner and actual consent as to the goodness of these duties, arrived at without undue influence; and for the purpose of obtaining those valuable considerations which are the correlative rights.

   Where a "crime" may be seen as a lack of fair play, or taking undue advantage with a vague notion of what the socially enforced penalties are for a breach of one of these duties; "mental illness" is more like a social confusion, with an accompanying ignorance or misunderstanding of the social rules of action.

   These common rules of action are not taught in the school system, along with an explanation of the reasons for, and the workability and advantages of these rules.

   Additionally, there are no varied apprentice systems, including apprentice law students. This barriers the interested practical involvement of the young, who are further restricted by a largely verbal and initiative dulling educational system; which fosters such passive solutions as street drugs, medical neuroleptics, TV watching, blanking-out with radio noise, and random uncaring conduct.

   Most laws are stated as the limits of tolerated conduct, where "If one does x, the punishment is y." Within this band is an area of abrasive but tolerated conduct (C), and the area (B) of ordinary accepted conduct. Totally lacking is a rationale for each rule of prohibited action which states why the action is harmful to the group; and how this limit implies a standard of excellent conduct (A) which is admirable, desirable, and worthy of achievement.

    The Greek New Testament term "amartia", usually translated "sin" is better translated as "without a criterion or standard of excellence." Fear of punishment as a negative deterrent may actually increase "crime" and "mental illness," through either a response of defiance to threats, or succumbing in confusion to them. The cultivation of pride in excellence, and patience and practice in its attainment in a calm and safe environment certainly must be seen to be far superior.

   The social aspects of "mental illness" may be seen in several lines of investigation:

   1. "The Importance of the Personality of the Helping-Person":

   Whitehorn and others (1) correlate successful improvement of "schizophrenics" with the personality and style of the treating physician. He summarizes:

   ... improvement in the schizophrenic patient is most likely to occur:

   (1) when the physician indicates in his personal diagnostic formulation some grasp of the meaning and motivation of the patient's behaviour, going beyond mere clinical description and narrative biography;

   (2) when the physician selects personality oriented goals rather than psychopathology oriented goals, i.e., aims at assisting the patient in definite modifications of personal adjustment patterns and toward more constructive use of assets rather than mere decrease of symptoms or vague "better socialization;"

   (3) when the physician makes use of "active personal participation" rather than the patterns "passive permissive," "interpretation and instruction," or "practical care." (1,p.331)

   (4) ... There is a similarly high association between improved condition at the time of a patient's discharge and the development by the patient, while in treatment, of a trusting, confidential relationship to the physician.

   A summary of the general approaches of Type A (good success rates) and Type B psychiatrists (poor success rates) are given in Table 1.

Table 1. Psychiatrists with

Good results with schizophrenics               Poor results

            Type A                                  Type B

personality oriented goals. Finds     psychopathology oriented
 a basis for understanding            goals
personal meanings
formulates a positive personal goal   antipathological goals
active personal participation
manifested inititive in sympathetic   passive permissive
inquiry. Expressed honest
disagreement at times
sometimes challenged patient's        interpretation & instruction
self-deprecatory attitudes
realistic limits                      practical care
attitude of respectful &              emphasis on decreased
sympathetic independence              symptoms
expectation that patient can show
respectful independent action
diagnostic grasp of personal mean-
ing and motivation of behaviour
resembles lawyers and accountants     resembles printers &
with problem solving approach         math-science teachers
                                      purely regulative or
                                      coercive measures
                                      wayward mind correction
collaborative exploration of          model of authoritative
possibilities                         instruction

Table 1 was abstracted from Whitehorn and Betz (2,3).

   2. "The Importance of the Therapist Admitting his Feelings":

   The writings of Harold F. Searles (4) are remarkable in that he admits to his own difficulties and emotional reactions while working with long-term schizophrenics:

   "When it comes to psychotherapeutic technique, .. always I find the therapist's openness to various feelings, of whatever sort, to be the key to the situation." (p.26)

   This includes his own feelings, and their expression; and he includes descriptions of these in his book. This is very unusual for this type of scientific writing.

   Most psychiatric writings focus upon the patient as if he stood alone, without any relation to, or evoking human reactions in, the therapist. This gives a kind of "schizophrenic flavor" to the report of the investigator. Searles has reported successes with his approach to patients, which correlates with his realization that every stick has two ends. The therapist and the patient influence one another actively.

   The highly theoretical "schizophrenic prose" type can be seen in the work of Gregory Bateson et als (5). This paper postulates a double-bind situation, that occurs when:

   1. ..the individual is involved in an intense relationship .. in which he feels it is important that he discriminate accurately what sort of message is being communicated so that he may respond appropriately.

   2. And, the individual is caught in a situation in which the other in the relationship is expressing two orders of message and one of these denies the other.

   3. And, the individual is unable to comment on the messages being expressed to correct his discrimination of what order of message to respond to, i.e., he cannot make a metacommunicative statement.

   This paper, though excellent in many ways, does not report success with therapies derived from this theory. The key, to my mind, is that the feelings of frustration and confusion induced in the investigators by a "schizophrenic communication style" has been denied.

   By removing their own personal reactions from the report, they have ended up with a "scientific prose reflection of the dehumanized schizophrenic." (Note 1991: It is also very likely that these double-binds were part of a highly abusive and threatening situation. The underlying terror and physical injuries could pin the confusion in place.)

   Bach (6), in his popularized paperback based on this research and directed to adults in neurotic relationships, comes a little closer, as he brings out the frustrations and concealed aggressions on both ends of the communication line.

   3. Family Therapy:

   This approach is exemplified by Jay Haley (7), who considers the dilemmas of late adolescents on the verge of independent living. There may be "mental breakdowns" associated with this; and he has had some success by observing that these "breakdowns" don't occur in a vacuum, but as part of a total family picture.

   This view contradicts the old and ineffective approach, still used at the Institute, that the patient is not an importnt social member of any group, and that his "illness" can be described just in terms of himself. That is, that he must introvert and find out what is "wrong with me."

   This is unreal, and disregards current cultural taboos and deficits which have nurtured his "illness;" and neglects his need for better relationships.

   Haley's view has had some success, probably because it is closer to what really happens than the old "illness" theory. When reading both Haley and Searles, I could sense that these approaches fit people and situations I have experienced at the Institute.

   4. Psychosocial Interaction:

   A treatment approach very similar to the family therapy above has been investigated by Carpenter, McGlashan et als. (8) They obtain results showing that psychosocial treatment without neuroleptics is superior, especially over the long-term. This paper does not even consider the extreme discomfort frequently caused when neuroleptics are used to suppress symptoms that "something is wrong." This hurtful aspect is still another reason for avoiding them.

   McGlashan (9) also has a perceptive article which points up the difference between "Let's handle this problem," and "Let's forget it and sweep it under the rug." (with drugs).

   5. An Intriguing Clue:

   Perry (10) notes that under the conditions of living in Diabasis House, a full-blown schizophrenic may settle out so rapidly that he needs to be encouraged to remain in contact with his symptoms. This is really odd, and in stark contrast to the results of most mental health systems. It could provide a starting point for a sociological investigation of what may well be an unrcognized and widespread "social disease."

   6. Independent Researchers:

   There have been a number of interesting books proposing solutions to "mental illness." I'll briefly mention three of interest to me, perhaps because they don't advocate the use of drugs:

   DIANETICS:"The Modern science of Mental Health", L. Ron Hubbard (11), pb, Bridge Pubs, 1982

   This approaches trauma by re-experiencing it (without interpretation) enough times to reduce any command value it might have. Iconoclastic and rambunctious.

   CHARACTER ANALYSIS, Wilhelm Reich (12), Touchstone Books, pb, 1974

   Branching off from psychoanalyis into muscular de-armoring. Based on observable tensions and their release. His belief that adolescent sexual repression formed the basis of authoritarianism gave him some social opposition.

   THE PRIMAL SCREAM, Arthur Janov (13), Dell, pb, 1970

   Releasing the needs of the inner child. "Mommy, Daddy!" Based on the unanswered cries for help and understanding of the inner child.

   6. The Case Against Neuroleptics:

   This section has been replaced and expanded by the following article on my personal experiences with the neuroleptics.

   7. The Issue: In Black's Law Dictionary (5th Ed.), an Issue, in pleading and practice, is defined as:

   A single, certain, and material point, deduced by the allegations and pleadings of the parties, which is affirmed on the one side and denied on the other.

   What I affirm is the right to integrate my own life and myself into the social group, and thus become well. And also to learn to defend and nurture this wellness.

   I consider the statement from the Declaration of Independence about "a goverment (or any authority) whose just powers are derived from the consent of the governed (without undue influence)" to express an important principle. And that there should be a Code of Sanity analogous to the Bill of Rights in order to prevent undue influences (chemical or physical) which lead to the improper subversion of the individual will.

   Is the answer to any personal or social problem to be achieved by "integration" or by "covering up?"

   This is the central issue.

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