Psychiatry at the Center of Our Cultural Crisis

Healing the Soul in the Age of the Brain: Why Medication Isn't Enough NOT Becoming Conscious In An Unconscious World
by Elio Frattaroli, M.D.

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The Case of Tony Soprano

This choice is the underlying theme of the recent television smash hit The Sopranos, which-judging from its immense popularity and the extravagant critical acclaim it has inspired-seems to have struck a deeply resonant chord in our cultural consciousness. The hero, Mafia boss Tony Soprano, is a modern American Everyman, suffering from a modern American problem. He needs Prozac! The plot revolves around Tony's symptoms of anxiety and depression, and the fact that he has to see a psychiatrist. Every episode poses implicit questions about Tony's predicament that are at the same time larger questions to us about our cultural predicament: What do Tony's anxiety and depression mean? What does he want from the psychiatrist? What should the psychiatrist be doing for him? Does he suffer from a chemical imbalance for which the psychiatrist should give him Prozac so that he can function more effectively as a mafioso? Or are anxiety and depression exactly what he should be feeling as symptoms of his inability to be at peace with being a mafioso. Tony's psychiatrist can't seem to decide. On the one hand, she treats his symptoms with Prozac. On the other hand, she tells him that his symptoms reflect his feeling trapped by a sense of loyalty to parents (and the "Family"), whom he has always secretly feared and viewed as destructive.

Ultimately, the point of the series-and the reason for its popularity-is that Tony's dilemma is our dilemma. He is torn between his deeper spiritual values-his desire to be a good person-and the values of power, wealth, sex, fine living, and family loyalty that define modern American society as much as they do Tony's Mafia. Significantly, religion doesn't help Tony resolve this conflict. The Catholic priest who claims he wants to help is a self-described "schnorrer" who eats Tony's food and lusts after his wife but never actually talks to Tony at all. The only person who even comes close to speaking for moral or spiritual values in the story-and helping Tony recognize his own values-is the psychiatrist.

The Cultural Crisis As Reflected in the Practice of Medicine

Historically, physicians have often spoken for spiritual values. In the traditions of both Western and Eastern medicine, as in the shamanic traditions of indigenous cultures, physicians have served a dual role as healers and priests. In his book The Way of the Physician, Jacob Needleman reminds us of this age-old relationship between medicine and religion, and warns of the danger inherent in our modern tendency to dissociate the two. He points out that the familiar symbol of the medical doctor, the caduceus, originated as an ancient religious symbol of transformation. The two serpents represent two intertwined but opposing movements of the soul-the movement outward of the ego (its emotional attachments to power and success, winning and losing) and the movement inward toward the authentic self. Needleman argues that the true physician is one who integrates within himself these opposing movements of the soul through the healing power of conscious attention-represented in the caduceus by the wings hovering above the opposed serpent heads-and in so doing provides a model for leading a fully human life:

Only through the appearance in ourselves of an attention that can care for both sides of our nature can we develop into the transformed being that is the real meaning of the symbol of the ... "priest-physician."

I agree with Needleman that our society suffers greatly from the loss of this vital role model that our physicians once gave us. The practice of medicine has now become an industry in which doctors are, in effect, employees of insurance companies, paid to put the needs of big business before the needs of their patients. The physician-patient relationship has been reduced from a sacred personal trust, as described in the Hippocratic oath, to a commodity-the delivery of a "product" by a "provider" to a "consumer" via a corporately managed "network of health care options." This rampant commercialization of the practice of medicine-degrading it from a calling to a commodity-epitomizes everything that is wrong with our addictive, quick-fix society. It has left us with a gaping hole in the fabric of our culture that used to be filled by its physicians.

Speechifying

My intention here is not simply to add another voice to the chorus bemoaning the crisis of modern culture. Rather, it is to say that the Psychotherapeutic Model of psychiatry offers a uniquely valuable approach to understanding and healing this crisis. But perhaps I am being a bit preachy. What I have attempted to do above is to summarize the larger message of the book as implied by the title, Healing the Soul in the Age of the Brain: Becoming Conscious in an Unconscious World. Reading over my words, however, I recognize that it is an unbalanced summary. In my polemical enthusiasm, I have put too much energy into proclaiming what's wrong with our unconscious, materialistic world and not enough into explaining how we can heal our individual souls (and hopefully improve the world) by becoming conscious. That's really the point of the book, after all. That's why Part One was about "the importance of being conscious." That's why, throughout the book, I have gone into so much detail describing how people actually do become conscious through the psychotherapeutic process. But I realize that you may still be left with questions. You may be wondering how all those stories about my experiences with patients apply to you personally. How can you become more conscious in your own life, you might ask, whether or not the future of our culture depends on it?

You could begin by reviewing the steps of the psychotherapeutic process as I described them in Chapter 3. Recall that the process starts with the awareness of anxiety. If you are currently at a loss for something to be anxious about, try thinking about your relation to our addictive, quick-fix society. What is your own favorite addictive pursuit and what are you using it to distract yourself from? What kind of choices are you making each day between the swimming pool and the quest? Your choice could be watching TV instead of writing a letter to the editor. It could be writing a letter to the editor instead of playing a game with your children. It could be playing games with your children instead of working on your novel. It could be working on your novel instead of watching TV with your children. It could be having a beer with the guys instead of a conversation. It could be working late, or playing solitaire on the computer, instead of having a beer with the guys. It differs for different people, but we all spend more time than we like to admit following our own path of least resistance while avoiding or procrastinating doing what we consider more valuable. If you reflect on it carefully, I believe you will recognize that most of the time you aren't really choosing at all but are simply reacting to situations, unconsciously and automatically, according to the habitual tendencies of your personality-your repetition compulsion. In doing so you are instinctively following the swimming-pool values of the quick fix.

This is a crucial point. What I am really saying is that the addictive tendency in human nature-the inner pressure that impels us toward the quick fix and has become the major problem in society today-is none other than our old friend and nemesis the repetition compulsion. The addictive sequence of discomfort -> quick fix -> relief is unconsciously organized by an emotionally charged personal scenario whose plot is something like victimization -> revenge -> triumph, or accusation -> justification -> vindication, or oppression -> rescue -> liberation. If your quick fix is TV, for instance, you may unconsciously experience it as a liberation from oppression by your job or your family. If your quick fix is playing games, you may unconsciously experience winning as a revenge for painful losses or humiliations in your life. If your quick fix is some form of living through your children, you may be unconsciously needing them to succeed as a way of vindicating yourself to a world that undervalues you. We all have such a scenario and we all have a powerful need to produce, direct, and star in it again and again, day after day, throughout the course of our lives.

The way I began this chapter is a good example. Although I am confident that what I said is important, I said it in a way that was more polemical than it perhaps needed to be. There was a touch of the same self-righteous outrage that fueled my adolescent diatribes against Catholicism and American imperialism (as I described in Chapter 9). Instead of communicating with you at a personal emotional level-as I try to do when I am writing at my best-I was distracted by the addictive drama of my repetition compulsion into doing what Martin Buber calls speechifying:

By far the greater part of what is today called conversation among men would be more properly and precisely described as speechifying. In general, people do not really speak to one another, but each, although turned to the other, really speaks to a fictitious court of appeal whose life consists of nothing but listening to him.

© 2001 Viking Press, a division of Penguin Putnam, used by permission.

About the Author

Elio Frattaroli, M.D., is a psychiatrist and psychoanalyst in full time private practice. He is on the faculty of the Psychoanalytic Center of Philadelphia and is also an assistant clinical professor of psychiatry at the University of Pennsylvania. He studied Shakespeare at Harvard and trained with Bruno Bettelheim at the University of Chicago before turning to medicine. He has written and lectured on Shakespeare as well as on psychiatry and psychoanalysis. This is his first book.