10/9/13.
My review of Dr. Ghaemi's new book.
Ghaemi, Nassir. “On Depression. Drugs, Diagnosis, and Despair in the Modern World.” Baltimore: The Johns Hopkins University Press. 2013.
Book Review.
To some intelligent consumers, mental health
clinicians come in two varieties:
muddleheaded or simpleminded. In the mind of too many, either you go for
help with your mental troubles for years in psychotherapy, or you get a pill after
a fifteen minute conversation listing your symptoms.
Of course these stereotypes are silly --- but may
illustrate the stigma and fear still associated with mental illness.
The recent slew of critical articles in the national
press covering the roll-out of the fifth-edition of the “Psychiatric Bible” no
doubt adds to this confusion and misunderstanding of mental maladies in the
general public. The DSM-V runs amok with
poorly understood psychiatric diagnoses, consisting of a list of ingredients
for many psychological disorders with no recipes for the causes or etiology of
any of the increasing number of mental maladies. To ask what mental illness is,
is to often get a story along the lines of some theory.
An expert in mood disorders, steeped in philosophy,
existential biology (his term), statistics, rigorous research, psychiatric
diagnoses, and psychotherapy --- Dr. Nassir Ghaemi brings his knowledge of
science and the humanities in his new book to look at the complexity of
depression. He has written books on concepts in psychiatry, statistics, and the
psychology of leadership and mental illness.
Dr. Ghaemi asks what it means to experience despair or
happiness in a post-modern world he defines as “the notion that the ‘modernist’
goal of discovering the truth, through reason and science has failed; our
claims to the truth and knowledge, whether through science or democracy or
other ideologies, are merely culturally relative opinions, with economic and
political sources…” (1).
He says many people now live as if God is dead because
hope has died, meaning has been sucked out of the world, and the ideals of the
Enlightenment have perished in the nightmare of the gas chambers. Even if we
don’t know it, he says, we are drenched in a culture where nothing is true or
false so that a rational response to the world is cynicism and despair. We spend endless time and money getting the
world to bend to the desires of the self.
Dr. Ghaemi discusses the big lies of
postmodern thinking and steers a course of adherence to scientific principles
and existential understanding of the human condition – focusing on depression.
He takes a dim view of the mental health clinicians he calls “pretenders” who only
see the pharmaceutical companies as evil profiteers, selling snake oil for
nonexistent conditions. Other “pretenders”, he says, embrace all views as true,
producing an eclecticism which leaves patients on their own. Ghaemi says that
critics of psychiatric drugs often ignore evidence of their benefits. His
approach is to advocate a biological existentialism, which means that science
and humanism are not in conflict.
He describes depression as many things---not all
requiring medication, and not all consisting of twisted thoughts tied to twisted
neurons. Sometimes depression is a disease such as manic-depression, where
episodes of despair and flights into disorganized exuberance come and go, and
in severe episodes require the right medications to stop the horrors of a shattered
soul, and block the nightmare of suicide. Sometimes depression reflects
personality traits, such as a tendency to be anxious or sad all the time, with
brief periods of more severe symptoms. Sometimes depression is a reflection of
life, death, and existential despair --- that Freud characterized as, “The
terrors of nature,…the cruelty of Fate, particularly as it is shown in
death,…the sufferings and privations which a civilized life…has imposed,…the perplexity
and helplessness of the human race,…the suffering which men inflict on one
another.” (2).
Dr. Ghaemi devotes chapters describing
the work of some existentially oriented psychologists and psychiatrists who
have deeply influenced his clinical work
and world view.
The following are some of these clinical
guides along with their chapter headings and quotes:
Viktor Frankl, M.D., Ph.D. (1905 –
1997): Learning to Suffer
He
was an Austrian neurologist and psychiatrist as well as a Holocaust survivor.
He founded Logotherapy, a form of existential therapy.
·
“The most
horrible psychiatric outcome isn’t suffering – it’s apathy.”
·
“We shouldn’t
fear suffering; we should fear not caring about whether or not we suffer.”
·
“The goal of
existential psychotherapy is to try to help us learn to suffer.”
Rollo May, Ph.D. (1909 – 1994) and Elvin
Semrad, M.D. (1909 - 1976): I Am, We Are
Rollo May was an American existential psychologist. He sought
to analyze the structure of human existence with the aim of understanding the
reality underlying all situations of humans in crises.
·
“I don’t think
I’m either pessimistic or optimistic; I’m realistic. I don’t disparage your
joy, but I think true joy only arises from acknowledging our despair.”
Elvin Semrad was an American psychiatrist who was an influential
teacher of psychotherapy at Harvard’s Massachusetts Mental Health Center. His approach was difficult to classify but he
had an uncanny ability to empathically focus on the patient’s experiences. He
would say that no one is psychotic in his presence.
·
“I’ve always
thought that some of the things people suffer most from are the things they
tell themselves that are not true.”
·
“The psychiatrist’s
job is to acknowledge, bear, and put into perspective suffering.”
Leston Havens, M.D. (1924 – 2011): Holding Opposed Ideas at Once
An
American psychiatrist known for his work on biological psychiatry, and his
existential approach to psychotherapy.
·
“I teach the
philosophy that we don’t know.”
·
“Experience is a
comb you get when you’re bald.”
·
“Creativity meant
holding two apparently irreconcilable positions at once.”
·
“The goal of
psychotherapy: personal liberation.”
·
“The goal of
empathy is enough safety to begin to find out the painful truth.”
·
“Psychic health
requires the ability to connect and disconnect, to connect with others and to
leave and protect oneself from others.”
Paul Roazen, Ph.D. (1936 – 2005): Being Honest about the Past
Dr.
Roazen was a political scientist who became a historian of psychoanalysis.
Roazen was the first non-psychoanalyst whom Anna Freud allowed access to the
archives of the British Psychoanalytical Institute. He interviewed surviving
friends, relatives, colleagues and patients of Sigmund Freud.
·
“Freud used to
quote the line from Schiller or somebody, to the effect that a person who does
not lose his mind under certain circumstances has no mind to lose. Put that in
your DSM pipe and smoke it – I do not think anything that DSM does or does not
say is of any intellectual relevance…DSM is a question of what insurance needs
require – period. In my view nothing to do with ‘science,’ certainly not the
life of the mind.”
·
Dr. Ghaemi: “What
can we learn about psychiatry today from Paul Roazen? Psychoanalysis as a dogma
should be rejected. Freud as a thinker can be embraced. Biology as a dogma
should be rejected. Medications, carefully used, can be accepted. Not all
symptoms are diagnoses; not all diagnoses are very symptomatic. The concept of
neurosis should be resuscitated: it
tells us much about the many people who have psychological symptoms but no
psychiatric diseases.”
Alfred North Whitehead, a famous mathematician and
philosopher, urged us to remember that knowledge keeps no better than fish. Therefore,
throughout our lives, we are all in the
learning game, not the authorities’ game.
Dr. Ghaemi offers much fresh knowledge in his elegant new
book.
I think Dr. Ghaemi would agree with Anna Freud who when she was eighty-five offered the
following succinct statement of her credo to a depressed young man who sent her
a lament about the chaotic state of the world:
“I agree with you
wholeheartedly that things are not as well as you would like them to be.
However, my feeling is that there is only one way to deal with it, namely to
try and be all right with oneself, and to create around one at least a small
circle where matters are arranged as one wants them to be.” (3)
References:
(1) Ghaemi, Nassir. On
Depression. Drugs, Diagnosis, and Despair in the Modern World. Baltimore,
The Johns Hopkins University Press, 2013.
(2) Schur, M. Freud:
Living and Dying. New York:
International Universities Press, 1972.
(3) Young-Bruehl, Elizabeth. “Anna Freud: A Biography.
Second Edition.” Ann Arbor: Sheridan
Books, 2008.
