Hearing Voices and Psychotherapeutic Position (or How Socrates Was Right)
Not long ago I participated in a seminar about hearing voices and other unusual human experiences. In an atmosphere of openness and acceptance we together -relatives, supporters, volunteers and professionals –were listening to different stories by voice hearers, who painted a completely different landscape from the one we are used to in our lives. With mouth and eyes wide open, I tried to understand their narratives of voices they hear every day, of telepathic thoughts, extra-physical experiences, of the world filled with Jungian archetypes and higher planes of existence…and each moment I was closer to my inglorious conclusion: if the width and variety of my experiences were weighed up against theirs, mine wouldn’t be “worth a hill of beans” as my friend Mina would call this particular feeling.
For quite some time psychotherapists have been trying to push our way into health-care system to work side by side next to clinical psychologists. That would make psychotherapy free of charge for our clients, plus there would be, at last, some prospect of continuous employment for psychotherapists. However, working outside the system has also advantages, since we do not have to accept concepts and standpoints (which are sometimes “a bit non-sense” standpoints) of the system. One of their “a bit-non-sense” standpoints is this: A professional, a psychiatrist or psychologist is “The One who Knows”, the one who is in position of knowledge against his patient or client respectively. Undoubtedly, a psychiatrist has a vast knowledge of mental disorders, diagnosis and medicaments; a psychologist and psychotherapist, on the other hand, know a lot about emotional, behavioural and mental patterns, traumas, non-functional beliefs and different styles of attachment.
However, in spite of all the knowledge, we have no right to think that we know more than a client himself. For example, if someone is diagnosed for personality disorder, and if we know that he has ambivalent attachment style, we are quite ignorant against the client. It is the client himself, who has a true knowledge of himself, of the phenomenology of his own experience. Only he himself knows and feels how it is to dwell inside himself. All experts, however wise and experienced, can just watch from outside and try to feel and understand.
Lacan, a French psychoanalyst, has already talked about this topic: “It is absolutely clear we are lost, if we start with an idea, that a psychoanalyst is the one who knows more than any other.” (Seminar XV). If we want to help somebody when we are in a position of power, which is also a position of superiority (predominance) we will stay on THE OHER SIDE forever.
The psychotherapist’s task is neither to give labels, nor to make a diagnosis, nor to treat with medicaments, nor to analyse, but to create a space where client will feel safe and accepted enough to tell his own story. Therefore, we must not allow ourselves to be trapped by a belief that we truly understand a person if we get to know his psychiatric diagnosis.
Each individual is different, everyone has his own unique experience of himself and the world, therefore each psychotherapy should be a new creation, built together by the client and the therapist. Therapist contributes his knowledge and experience, which represents a tool needed in their mutual exploration; he deepens the relationship with his presence and empathy; and makes a promise that he will ALWAYS be the client’s ALLY. At his work he must again and anew take a radical and humble Socratic stand: I KNOW THAT I KNOW NOTHING, although the “throne of superior knowledge” is sometimes so comfortable.
“Liberty means responsibility. That is why most men dread it.” George Bernard Shaw
I believe there are only a few, who haven’t watched the epic war film Braveheart (1995) and whose arms didn’t break out in gooseflesh at William Wallace’s (Mel Gibson) cheer: “They can take our lives, but they will never take our freedom!” The film, which is based on a true story (probably not exact to the letter) about a Scottish knight who leads his rebels against the English dominance in Scotland, has left no one undisturbed. Show me the one who hasn’t shivered with fear for William’s fate, or the one who hasn’t shed a tear during the film. William Wallace is no doubt a hero, easy to identify with: proud and brave, with a tremendous charisma which inspired the men to fight for a true cause. Freedom is of such importance to him that he is ready to sacrifice his life.
In the history, individuals, groups or nations had many an ordeal when their freedom was limited, broken or taken – they fought for freedom in wars and rose in resistance in revolutions. But modern western society has the ordeal of a different kind – to face the opposite: the abundance of freedom.
Capitalism and freedom
In the book Fear of Freedom (Escape from Freedom) Erich Fromm, a German psychoanalyst, explores how man’s attitude to freedom has been changing through history.
In the past socioeconomic systems the individual’s freedom has been limited by different authorities such as the Church, the class society system, monarchs and tradition. Capitalism is the first system to place freedom to its final position, for there are no tyrants in power anymore. And furthermore, traditional values have been marginalized and the Church has lost its predominant political influence. The individual is no longer supervised by a vindictive god or merciless absolutist, and his status is no longer defined by tradition. Every man has become the architect of his own fortune. Human freedom has therefore expanded: not only the negative one – “freedom from”, but also the positive one – “freedom of”.
One of the fundamental premises of capitalist economy is active citizenship individualism: the individual is expected to exercise critical thinking and to be a responsible and active member of society. Unlike Medieval feudalism, where the individual’s position was clearly defined in an orderly and transparent social system, the capitalist economy forces the individual to stand on his own feet. He is responsible for everything, therefore his success or his failure is nobody else’s business but his own. (Fear of Freedom p.94). Together with growing individualism (freedom from) another phenomenon has occurred – loosening of human bonding, which consequently makes the “capitalist” individual feel isolated and lonesome.
In his anxiety and helplessness, resulting from the loss of authorities, the individual can either escape to other forms of submission (religious sects, the far-right political movements) or he takes responsibility for his freedom and fulfils his own authenticity and creativity.
(Super)abundance of freedom
Since 1941, when Fromm’s book was published, western society and its attitude to freedom haven’t changed much. All spheres of life are tightly connected with freedom: we have freedom of thought, freedom of speech, freedom of conscience and religion, artistic freedom, political freedom. We are free to choose our job, our career, our life partner, where to live, to have a family or not. We are free to believe in god or not. We are free to choose our own clothes, what diet to take, what free time activities we will join and who our friends will be.
And as consumers we assert our positive freedom every day.
A member of modern society must be free (even if he doesn’t want to be): he is not free to not be free. Positive freedom – the freedom of choice has become a kind of imperative and every man’s life is irrevocably entangled with it. Psychologist Barry Schwarz in his TED speech Paradox of Choice analyses the contradictoriness of choice that we are faced with in the capitalist world. He establishes that more choice does not bring more pleasure. In the speech (See video below) he states an example from his own life showing how the formal premise that “more choice – more freedom – more benefit” brings us to a false conclusion.
This is how the story goes: For many years Barry wore the same pair of jeans. He had bought them a long time ago, when there had only been one brand of jeans in shops (similarly as in the time of socialism in ex-Yugoslavia). Those jeans suited nobody, they were uncomfortable, plain, but if you wore them long enough, you started to feel comfortable in them. After all these years Barry decided to buy a new pair of jeans. The salesman asked him what type of jeans he wanted. Barry answered that he wanted the ones they used to be the only type in the past. Of course, the salesman had no idea what the customer wanted, so he began to enumerate all sorts and styles of jeans available in modern stores: slim-fit, bootcut, bottom-bells, tight, straight, ankle-length, low-rise, mid-rise, high-rise, flare jeans, wide-leg jeans, with a zip, with buttons, light-washed, monochromatic, ripped… After the first shock and dismay at all the choice, Barry finally managed to find a pair that became him much more than any other before. But as he was leaving the store, he felt worse than before. The abundance of choice made him raise his criterion to meet his expectations of what a good pair of jeans should be like. Now he was haunted by a feeling that the jeans he had chosen were quite alright, but not as perfect as they could have been.
But the paradox of choice does not lie only in the fact that our expectations become higher but also in the fact that we have to choose one item from a vast number of alternatives. When we have picked out one pair of jeans, it means that we have refused 136 other pairs. It also means, that we have missed and rejected all other options.
This wouldn’t be a problem in itself if it weren’t for our brain’s ability (frontal lobe) to simulate possible realities. This ability allows us to imagine how it would feel to have a pair of jeans we haven’t chosen. And since our reality simulator is prone to exaggeration the best jeans are those we have left in the store, and if we had that very pair, we would be truly happy. Therefore, we can’t find contentment in owning the new pair of jeans, but we feel uncomfortable for having missed so many better options due to our choice.
The problem of choice does not end up with consumers’ freedom, but it often causes “paralysis”, stresses and anxieties of decisions, which are important for our future, success and happiness. We all know that the sun will not extinguish because we have chosen cheese with nuts instead cheese with green peppers, or that there will be no Great Flood if we haven’t explored all the options and have bought a telephone with only 289 functions. However, decisions about which study to take, what job to choose, what career to pursue, which partner to pick out to be the best choice for us, or whether to have kids or not – may have consequences of apocalyptic proportions. After all, everything depends on truly important life decisions of the individual: his life course, his happiness and the worth of his life itself.
Freedom and responsibility
Freedom of choice, nonetheless free, is, one way or the other, conditioned. Our decisions are always conditioned by our personality (which is again conditioned by genes, by the environment we were brought up in, and the zeitgeist we live in), by expectations of important other individuals, by public opinion (at one time it was ‘in’ to have a family and children and at another time it is ‘out’), by personal endowment and limitations (most likely you will not become a professional sportsperson if your favourite activity is watching TV and eating fried onion rings).
Although the individual’s choice is never entirely free, the choice itself as well as its consequences are entirely the individual’s responsibility. When facing an important life decision, our head is swarming with different doubts and second thoughts, which make our decision even more painful than it is in itself: Have I made the right choice? How will my choice affect my life? What if the choice I have made will make me miserable? What better options will I miss because of my choice? What will other people think of my choice? What if I’m not capable enough? What if I don’t succeed?
In such a situation we wish we didn’t have to choose at all, or that, like in Greek tragedies, a handy deus ex machina (or at least a semi-god) would come down on a rope and lift us out of trouble. Our burdens of freedom and responsibility cannot be laid on god, neither our destiny, nor parents, but we must carry them by ourselves.
Free choice and choice of freedom
Fromm suggests that anxiety over freedom cannot be solved by escaping, but we have to plunge into freedom even deeper. Our ‘freedom from’ can be solved by freeing from psychological patterns that disable our authenticity. And our ‘freedom of’ can be accomplished by creativity and presence.
We can decide to follow somebody else and go their way, a guru, for example or a priest, a personality advisor, a coach. We can also find help in recipes-for-life books with shining covers, such as “Be What You Are”, or “Ten Steps to Success”, or “Twelve Pieces of Advice on How to Reach the Happiness and Inner Peace.”
But we can choose our own way, the one that was chosen by Zarathustra: “This – is now my way: where is yours?’ Thus I answered those who asked me ‘the way’. For THE way – does not exist!” (Friedrich Nietzsche, Thus Spoke Zarathustra)
For the way of freedom is for each and every one of us – once again and anew- one’s own choice.
Winnie-the-Pooh is being diagnosed: about usefulness or uselessness of psychiatric diagnosis
Winnie-the-Pooh, by A.A. Milne, was one of my favourite books in the childhood. My heart would fill with warmth when I entered the magical world of the Hundred Acre Wood, where lived Pooh, a good-natured, honey-loving bear; Owl, omniscient bird; the meddlesome Rabbit; Eeyore, the gloomy donkey; Tigger, a frisky tiger; Piglet, a timid and worried pig; Kanga, an energetic kangaroo and her son Roo.
These nice and kind Milne’s characters also intrigued a group of Canadian neurodevelopmental paediatricians who published an article with the title Pathology in the Hundred Acre Wood: neurodevelopmental perspective on A.A. Milne. (See link below). So, Winnie-the-Pooh is diagnosed with obsessive compulsive disorder regarding his obsession with honey and repeated counting of honey pots, attention deficiency disorder and even Tourette syndrome. Piglet suffers from generalised anxiety disorder. Eeyore, the grey donkey, suffers from depression, of course. Owl has dyslexia, and Rabbit is full of self-importance. Roo is growing in an environment, which is detrimental to him since his closest beings are his possessive mother Kanga and hyperactive and impulsive Tigger. The paediatricians are also concerned about Cristopher Robin, a parentless child who spends all his free time together with animals.
This article is not meant to mock at people with a diagnosis, but it is a kind of parody of the authors’ scientific perspective of the world and their need to analyse, diagnose and to define every being although it is a fairy-tale character.
In their article something unpleasant can also be observed, something regarding mental disorder diagnosis. What once used to be a person with all their attributes, behaviour, way of thinking and acting, has now become a mere bunch of symptoms.
Pooh, who used to be the good old bear with a big heart, after the analysis, becomes a multitude of pathologies. The diagnosis for the Hundred Acre Wood residents is futile since they will never learn about their diseases and disorders, and therefore they will live “happily ever after”. But what is the purpose of diagnosis for us, real people?
HOW CAN A PSYCHIATRIC DIAGNOSIS BE USEFUL?
A diagnosis of mental disorder can be at least as frightening (if not even more) as a diagnosis of a severe physical disease. However, some people find it helpful, since their mental pains, thoughts, emotions and behaviours, which have caused chaos and terror, now get only one name, one label. If you know what’s happening to you, you can do something about it. Awareness of it can bring a feeling of self-control and some safety, if nothing else.
If you know what’s troubling you, you can get informed about the illness and learn about its treatment. A psychiatrist usually suggests drug treatment, yet most people try to find other sources of help and support as well (psychotherapy, hypnosis, autogenic training, supportive groups…). Nowadays people know a lot about their diseases, they would know that their causes lie partly in genetics and partly in the environment, and that they are not the ones to be blamed for their hardships. A diagnosis can help the individual to become more self-emphatic, and his relatives to be more understanding and tolerant of the individual’s altered state. If we are cognisant of the diagnosis, we know that our relative is not a lazy, incompetent fellow, but a person feeling depressed; we know that his excessive concern, which can be quite tiresome for others, is part of general anxiety disorder, or that his emotional coldness, remoteness and apathy are caused by schizoid personality disorder.
HOW CAN A PSYCHIATRIC DIAGNOSIS BE A LIMITING FACTOR?
On the one hand, getting a diagnosis is quite useful to many, but on the other hand it can be an arduous burden and limitation. Besides unpleasant side effects of psychiatric medication that an individual has to endure (fuzzy mind, apathy, increased appetite, attention problems or even epilepsy), it is stigmatisation that hurts the most.
“Unwelcome, weird and undesirable” is how people with severe mental diagnosis feel. Because of their decreased professional competence, they are left out and pushed to the edge of society.
Obstinate social ignorance of mental disorders is hindering efforts to reduce stigma towards persons with mental illness. I can often hear people say, “Have you heard that Mr X’ nerves are shot. Awful! Yeah! He allegedly committed … but fortunately, he was put to an asylum.”
Obviously, it is much easier to grow prejudice and fright and make every effort to label and frown, than to get informed.
The problem of labelling does not originate solely from society but also from an individual himself. A diagnosis is above all a label, a tag that one can live up to and identify with. Once the diagnosis has been established, for example general anxiety disorder, one starst paying more attention to symptoms indicating this disorder.
On the one hand the awareness of data that supports a certain belief is being raised, but on the other hand all the data contrary to this belief are discarded by our brain as irrelevant. So, one more often than not perceives concern, anxiety and thought disorder, but one does not pay enough attention to moments of ease and contentment. If a person keeps doing things in this manner, one can stop being a person with a unique interlacement of features, wishes, volition and plans, who at the same time has anxiety disorder. Instead of that, one identifies with the disorder itself which becomes the final denominator, and oneself becomes a person with anxious personality (This can easily be perceived with expressions used for identifying with some other diseases – “depressives”, “schizophrenics”, “anorexics”, “bipolars”,…)
A diagnosis can become one’s own predominant story, while other stories fade away in the background. It is difficult to escape this trap because of the thoughts, which attach every mood, every emotion and every event to one’s disorder. The alteration of the perspective can be made even more difficult by the psychiatrist who focuses solely to symptoms, or sometimes because of one’s family members and friends, who, concerned about person’s safety and welfare, pay too much attention to the disease, and not to the person as unique human being.
With diagnosis one has to take into the account the effect of placebo and its negative “twin brother” nocebo respectively. The power of thoughts and their effect on one’s body and psyche is tremendous, so a strong belief that one will never get better, is anything but helpful. With a diagnosis such as depression, with its recurrent nature or schizophrenia, which is supposed to be incurable (which, of course, is not true, since there are many cases of complete recovery), this data can bereave the patient of his hope and courage, and through nocebo it has a negative effect on the course of the disease.
A DIFFERENT VIEW AND REDEFINING A DIAGNOSIS
When a person gets a diagnosis, he cannot possibly forget about it or brush it aside and live happily ever after like Winnie-the-Pooh. What one can do is to not take his diagnosis word for word (in Diagnostic and Statistical Manual of Mental Disorders), but to regard it as one of the bits of information about his present state. We can get more information about what a diagnosis really is if we look up for its etymological meaning. The word diagnosis originates from a Greek word diagignoskein, which literally means to examine thoroughly, find out, learn. That is to say that we try to get to know, understand and explore what is going on inside us and discover the causes.
Each and every one of us is different, therefore our experience of ourselves and the world around us differs too. Likewise, mental state differs from person to person, although a diagnosis labels it with the same name. For every person who is treated for depression, this state has a different meaning and different contents. Therefore, it can be of great help if a diagnosis is given a new name – a name that will have a special to a person who is struggling with it. As such it will promote the improvement of the mental condition and help to understand and break taboos against mental diseases, i.e. help the client to prevent diagnosis and its labelling force from taking hold of his inner power for change.
One of my clients was diagnosed as having GAD (General Anxiety Disorder). During the therapeutic research he quickly found out that diagnosis represents an omnipresent and permeating anxiety for his well-being – a paralysing threat of danger that is awaiting for him everywhere. This fear was fuelled by his thoughts, which continuously got trapped in a loop that we called “What if…” In the therapeutic process we then followed these thoughts and discovered that they do not originate from “Here and now” but from circumstances of his childhood.
Omnipresent anxiety and fear for his safety gradually (and not by themselves but because of great efforts, will-power and work) turned into a bundle of thoughts, feelings and behaviours, which he called a State of High Mental Alertness. Such state of mind is much easier to control, since the client can check whether it is appropriate (whether there is a real reason for alertness), the state appears only in certain situations (therefore it is not omnipresent anymore), and the client can help himself how to step out from such a state using simple solutions he has learnt during the therapeutic process.
In the example above, we can see how the contents defined by a diagnosis can be altered in one person alone. Just imagine what a variety of contents there are from one person to another! Diagnostic system does not pay any attention to these differences which are often of crucial importance for the improvement of one’s mental condition, but it keeps classifying, labelling, sorting out, and sweeping them into the dustbin without distinction. But the truth is that each of us has “his own dustbin”, and that’s why it is so important to define our own inner world with a name that will stand for what is meaningful to Us and what is essential for Us.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80580/