Opening the Can of Worms

In its response to human problems in living, psychiatry is both confusing and contradictory.  On the one hand, it proposes that individuals who are depressed, delusional, obsessive-compulsive, hallucinatory are suffering from ‘mental illnesses’ which are caused by biochemical imbalances or dysfunctional genes.  On the other hand, psychiatry has long advocated ‘not to open the can of worms.’  This latter admonition does not make sense in the face of their ‘theory’ that a psychiatric condition has a biological origin.  I deliberately say ‘theory’ because there is no research or clinical substance to their theory.  Nonetheless, the notion of ‘a can of worms’ seriously weakens their medical model of human misery.  I assume what they mean by the ‘can of worms’ is the unresolved sad and often massively abusive history of their clients.  During my time working in psychiatric hospitals in Ireland and England, I came across the bulky hospital files of the distressed individuals which graphically related the most appalling abandonment experiences.  What absolutely amazed me was that in the treatment of these individuals, no consideration or response to their stories of gross neglect was part of helping them.  No hope was provided; they were told they had ‘incurable’ conditions and either would have to be medicated or hospitalised for the rest of their lives.  This model of ‘mental illness’ still prevails.  At least with regard to the childhood conditions of ADD, ADHD and other such childhood syndromes, the inventor, Dr. Robert Spitzer, admitted that ‘I got it wrong’; that ‘I failed to look at the contexts of the labelled children’s lives.’  The contexts are the life stories of children – the ‘can of worms’ of which psychiatry appears to be afraid to open.  Surely, if psychiatry got it so wrong about children in turmoil, is it not probable that they have got it wrong about adult problems in living as well?  At some level of consciousness, adult psychiatry seemed to have recognised this possibility, because if the profession was absolutely convinced about its biological model they would not believe that there is any such thing as a can of worms!

In my own work with individuals who are deeply and disturbingly distressed, biographical history is central to helping the person.  In the story, the creative reasons and the intentions of anxiety, depression, delusions, aggression, obsessiveness and hallucinations emerge.  What also emerges is an overwhelming tide of fear, darkness, anger, rage and a catalogue of unmet needs.  What is critical is the relationship with the person and the sitting with and holding of the pain of the individual.

The notion of ‘mental illness’ may represent a society that has been too frightened to own its contribution to the stories of abuse and neglect.  Whatever the reasons why psychiatry has been reinforced in it practices, the writing has been on the wall for sometime now for a radical shift in perspective.  Indeed, according to a recent report by the Institute of Psychiatry at King’s College, London, psycho-social factors have an influence on what have been known as psychotic illnesses and the researchers state that psychotic illnesses should not just be regarded as brain diseases.

The researchers found that children whose parents split up before their sixteenth year and the subsequent separation from one or both parents are four and a half times more likely to experience psychosis in adulthood.  The researchers also found disproportionate schizophrenia rates in African-Carribean and black African people.  The researchers concluded that their ‘findings provide evidence that early social adversity may increase the risk of later psychosis.’  The recent revelations on the uselessness of anti-depressants have also rocked psychiatry.  Clinical psychologists, psychotherapists and psychoanalysts well know the psycho-social origins of psychological disturbance; the shelves are filled with their clinical and research findings.

It is not just Psychiatry that needs to wake up; it is Irish society as a whole that needs to wake up to the reality that adults’ insecurities, vulnerabilities, passivity, aggression, addictions to work, to success and to substances deeply influence the wellbeing of children in homes, classrooms and communities.  Irish society and the medical profession need to reframe psychological turmoil as psychosocial in origin.  Such an approach makes prevention and more meaningful interventions possible.  The focus on the wellbeing of parents themselves and on the couple relationship are important starting points as is the preparation of teachers for their psychosocial work in classrooms.  Effective parenting courses are critical to enabling parents to equip their children with personal, emotional and interpersonal skills, responsibility for themselves and creative ways of living their precious lives.  For those young people and adults who are in serious turmoil, the psychosocial approach paves the way for personal and group psychotherapy, crisis intervention centres, family and community therapy services and other psychosocial support and intervention services.

Dr. Tony Humphreys practices clinical psychology and is author of several books on practical psychology, including The Power of ‘Negative’ Thinking.