PSYCHOTHERAPY :: Perspective

More: What exactly is Psychotherapy


Psychotherapy? You want me to see a shrink ? No way !! I'm not crazy!

This is, almost always, the first response to a suggestion that professional help may be required, in order to deal with personal problems, or heal the wounds inflicted by traumatic life situations. Feelings of shame & inadequacy arise instantly, because the persons in distress have to admit to an inability to solve the problem on their own…

Add to that, the social stigma attached to visiting a psychiatrist or psychotherapist, and most people prefer to live with their problems, & stay mired in distress, in an endless cycle of denial, fear, blaming self, or blaming others, rather than seek professional help…often seeking it when it is too late.

This resistance appears to be a hang over from the days when the bizarre and irrational behavior of the "insane" was taken as evidence that they were possessed of evil spirits & demons. They were treated as social outcasts…objects of morbid curiosity, fear & contempt…mindless beasts who could be controlled only by chains. They were locked away in prisons, where they often lived in conditions of intolerable misery, subjected to taunts, physical abuse & ridicule.

"At a famous hospital in London, Bethlehem, [pronounced Bedlam] which was built to house lunatics, it became a public amusement [for a fee] to taunt & watch the weird behavior of the inmates ! The word bedlam remains in the English language to describe chaotic confusion…"]

"Treatment" took the form of exorcism, beating, torture, & bartering with the evil spirits.

Somewhere along the way, changes began …mostly in Europe, & spread to America as part of the renaissance of rationalism & humanism. In France came Phillipe Pinel [1745-1826] a scholarly & humane man, who believed that the insane were "sick" people, whose sorry state deserved all the consideration due to suffering humanity! He strongly believed that medical attention, along with dignity and freedom could help restore sanity. Gradually, shackles and chains were removed, & hospitals became places of treatment & care rather than imprisonment.

"Asylums for the insane" were set up as places of refuge, rest & recovery. Here, there was an emphasis on a combination of benevolent care, spiritual guidance & study. Unfortunately, these soon regressed to the same de humanizing conditions from which they had arisen! Bedlam lives on, & beneath the public attitude that views the insane as physically sick, there seems to persist the view of the mentally disturbed as subhuman or possessed, or both.

In any case, the concept of the insane as sick, became the Medical Model of mental illness & led to extensive research, investigatory methods, drugs, shock treatment, & other medical therapeutic methods of treatment. Psychiatry came into its own, in the early 1900's, with the work of Emil Kraepelin [1855-1926]. In his classic text book on psychiatry, with extraordinary patience, he classified the many manifest symptoms of mental dysfunction, according to patterns of occurrence, & thus identified & labeled types of mental diseases, or "Psychoses". This made possible the development of specific drugs, & treatment strategies.

The medical approach brought freedom from evil spirits !! And helped to reduce some of the terror & dread that surrounded mental disturbance. It did not, however, take into account, social & psychological factors.

Attention turned to non-hospitalized "patients" who state seemed to reflect, not a sickness, not a disease of the brain, but a "psycho-biological reaction to life stress". This triggered a search for psychosocial causes of "neurotic" behavior, & non -medical cures and interventions.

Sigmund Freud's [1856-1939] Psychoanalysis, transcended the medical mould, to create a thoroughly psychological theory of human motivation, bridging normal and abnormal behavior. He established that psychological problems were often created by unconscious fault lines etched deeply into the in the psyche, by traumatic experiences, and conditioning in childhood. Treatment required the uncovering of the buried trauma, [which was being expressed through the symptoms].

Psychotherapy was ushered in…& the "demons of the unconscious"-guilt, fear, shame, rage, bitterness… became the focus of interest. Purely psychological techniques like hypnosis, free association, & dream analysis gained wider acceptance. The work moved from hospitals to the consulting room 'couch' &' patients' became 'clients'.

This was a time of discovery, research, & scientific methodology.
Wilhelm Reich explored & mapped body armor, & Alexander developed "movement therapies" to explore body-mind connections.

Gurdjieff [1877-1949] masterfully blended all these, together with Sufi practices, in a pioneering effort at combining the strengths of Western & Eastern medicine, psychology, & spirituality.

Simultaneously, there began, a 'Behavioral engineering' orientation, with the famous experiments on conditioning, conducted by Pavlov, & the work of B.F. Skinner. Therapies based on association, & de-conditioning developed from this, widely used in the treatment of phobias, & obsessions, sexual problems, & social inhibitions.

A little later, in the fifties and sixties, began a 'Humanistic' & 'Existential' stream of thought, in which the work of Abraham Maslow, [Hieirarchy of needs] & Carl Rogers,[Non-directive therapy] is significant, as well as that of Frederick Perls, [ Gestalt Therapy], & Eric Berne, [ Transactional Analysis.] These systems viewed human beings as having a purpose, options, rights, & the capacity for self determination, rather than as just hapless victims of the unconscious, or the environment.
All these positions coexist today, with considerable overlap. Although they appeared sequentially, one did not supersede the other, and a judicious mix in the hands of a competent practitioner, is often highly successful.

The bio-medical model represented a big step forward from the demonological concept, and continues to be most appropriate for work with deeply disturbed, hospitalized, psychotic, people who are unable to function in a social environment.

The psychological model is most appropriate for use with persons, who are able to function in a social environment, but may be experiencing emotional difficulties…confusion, worry, anxiety, depression…who would hardly consider themselves, or be considered, crazy !!

The humanistic, existential models are most appropriate for people who don't have major problems, but want to know themselves, take responsibility for themselves, and seek greater meaning & fulfillment in their lives, using psychological insights as tools for growth & change, in a group setting.

Overall, in the West, as new techniques continue to evolve, there has been a steady increase in the range of human problems that come within the ken of psychotherapy. From the visibly disturbed "lunatic", at one end… to people with personality difficulties, addictions, relationship issues, family traumas, anxiety, psychosomatic health problems, uncontrollable emotional outbursts, depression, marital conflict, an inability to cope with everyday issues…… to a desire for enhanced self awareness, at the other.

In India, there has not been much visible change. Evil spirits are still believed to inhabit the bodies & minds of the mentally disturbed, & they are still chained & tortured, instead of being given medical attention & care.

Mental Asylums remain largely custodial, where the unwanted languish for years.

Among the educated, there is a leaning towards the medical model & psychiatry, but not much awareness of the benefits of psychotherapy…& a stigma attached to both!

Family & religion are still expected to provide relief from all problems.

Our rich spiritual heritage has not been channeled into healing practices that are accessible to people living ordinary lives.

Osho, [1931-1990] in his lifetime, in an incredible stretch of effort and imagination, put together a blend of modern western psycho-technologies, & meditation, which are effective, & are gaining in popularity. Awareness about these is limited, often overshadowed by fears & myths about the methods, & the 'cult'.
Some awareness has started to filter in… "New Age" movements are gaining momentum…heady cocktails of energy healing techniques have surfaced, in a sort of quasi psycho-spiritual format, offering cures for every thing !! Pop psychology & self - help, 'how to' books are stacked in every bookshop, spreading information on all subjects…causing much confusion!

Despite all this, psychotherapy still remains suspect, & there are very few trained practitioners. So, there continue to be people who may be suffering…who are painfully shy, fearful, or irrational, feel depleted, or worthless, or drink too much, or are confused about their sexuality, or are stuck in abusive relationships, or stressful life styles, or unable to recover from the shock of losing a loved one… or in a thousand other ways, live joyless lives, a burden to themselves & others…unwilling to get help because they may be considered 'crazy' !!

You don't have to be crazy to seek therapy. It is as ok to seek professional help for mental & emotional problems, as it is to go to a doctor when you have a sore throat!