Once More with Feeling

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.

(Page 3 of 4)

To restore the balance, let me give you the more personal side of what I have just been speechifying about. Perhaps the most important lesson about healing the soul that I hope you will take from this book is that the symptoms and painful emotions we instinctively want to get rid of are in fact integral to the process of becoming who we truly are. Symptoms are part of the healing process. Anxiety is consciousness trying to happen. Falling down is a way of growing up. In the Age of the Brain these are surprising, even radical, ideas. And yet they belong to a teaching that is as old as Western civilization. I learned them as people have always learned them-as you can, too-not from books or scientific experiments but from a disciplined practice of listening to the soul.

This book is the product of that practice. It reflects my ongoing personal quest to become conscious, to experience my anxiety, to feel and accept responsibility for the good-and-evil emotions of my own dark side. That's what I was referring to in Chapter 17 when I described how the passions of my repetition compulsion had put me into a state of inner conflict that produced writer's block. I was tempted-in fact, driven-to present myself as a white knight rescuing society from the evils of a dehumanizing Medical Model. But this made me anxious, because it involved an impulse to attack Peter Kramer as the villain in the story, which would have been unfair to him and would have made me guilty of the very evil I was objecting to: dehumanizing (demonizing) Peter Kramer, using him as a straw man to beat up on.

But that discussion in Chapter 17 was only the happy ending of the story, in which I became fully conscious of the problematic passion of my repetition compulsion and could then integrate it into what I hope is a responsible, balanced critique of Listening to Prozac. I didn't tell you the whole story of what my repetition compulsion and I had to go through-including a full-blown chemically imbalanced mental illness-to get to that point of integration. I'd like to fill in the rest of this story now, because I think it captures what healing the soul is all about. It illustrates how the impassioned need of my repetition compulsion to fight the evil dragons of materialism impelled me on an inward journey where I had to confront and accept the good-and-evil dragon within myself. The path of that journey was long and difficult, and it led directly through the writing of this book.

Ego Trip

My first attempt to challenge the cultural forces of materialism was an article I submitted in 1985 to a national essay contest run by the Psychiatric Times on the topic "The Most Important Problem Facing American Psychiatry." My essay was a polemic against "the philosophical myopia of [psychiatry's] materialistic bias." I argued that an exaggerated emphasis on the brain at the expense of the mind and soul served to "vitiate ideals ... of moral [and] legal responsibility" and "encourage the unrealistic popular drug-culture expectation of quick, painless solutions to problems." I took exception to the misuse of scientific research to justify a theory of mental illness-as a chemical imbalance-that was both dehumanizing and irrational. I cited the systematic misinterpretation of treatment-outcome research (as discussed in Chapter 4) that denied the obvious significance of the placebo effect:

The essence of the current psychiatric world view is captured by a description I heard recently of a psychotic episode as a "hurricane in the brain." This perspective is limited by its inability to account for a brain hurricane being stopped by a placebo, a phenomenon equivalent to a real hurricane being stopped by a fervently believed weather prediction.

I then went on a more personal rant against researchers Robert McCarley and Allan Hobson, whose neurological theory of dreams had gained considerable notoriety in those days because it claimed to discredit the classic Freudian theory of dreams. From experiments performed on the brains of sleeping cats, McCarley and Hobson had drawn a rather momentous conclusion about human dreams: that they consist of a series of random neurologically generated images inherently devoid of meaning. The reasoning they had used to reach this conclusion was specious, I thought, and I was less than polite in saying so. After taking them to task for their self-refuting neurological nihilism, I concluded that their theory was "far inferior to Freud's because it is, in the literal sense, Mindless."

When Allan Hobson quickly responded to the essay by challenging me to a formal debate at a national meeting of the American Psychiatric Association, I was thrilled. Hobson's debate partner was philosopher of science Adolf Grünbaum, another well-known critic of Freudian theory, whose argument against Freud was different from Hobson's but seemed to me just as irrational. When the debate was over, I felt great, confident that, with the help of my partner, dream researcher Ernest Hartmann, I had thoroughly demolished the pretenses of those arrogant Freud-bashers. From what I could tell, the audience thought so, too.

But had I really accomplished anything other than indulging my own arrogant pretenses and gratifying my own ego? That's the question I should have asked myself, but I didn't. I was on a roll. The arrogant combativeness of my repetition compulsion was like bananas in my ears. I felt entitled to be outraged because I was fighting the good fight. My friends were applauding me. The only people who complained were the designated bad guys in my scenario and I couldn't hear what they were trying to tell me from outside the box of that scenario. For example, when psychiatrist Ronald Pies published an editorial accusing me of "splitting the discipline of psychiatry" with my "self-congratulatory polemic against the medical model," I felt insulted and immediately fired off a caustic counterattack. In retrospect, however, I can see the truth in Pies's accusation. The colleagues who appreciated my self-righteous speechifying were those who already agreed with me anyway. The people I really needed to convince-people like Pies himself, who I thought overemphasized drugs but was also interested in psychotherapy-were the ones I was demonizing, arrogantly dismissing their strongly held beliefs and then expecting them to listen respectfully to what I had to say.

Meanwhile, I continued to devote most of my professional energy to treating individual patients with an attitude of empathic understanding, knowing that in order to help them, I had to be able to respect and accept them-including their illnesses-which often meant having to confront my own prejudices and expand my awareness so that I could see and feel things from their point of view. So where was this enlightened empathic awareness in my writing and lecturing? Again, that's a question I should have been asking myself. I might have been more concerned about the danger of splitting the discipline of psychiatry had I been more conscious of the dramatic split within myself. On the one hand, I was aspiring to treat my patients, family, and friends with an I-Thou attitude of love and respect. On the other, I was thoughtlessly railing against my Medical Model colleagues with a disrespectful I-It attitude of contempt.

© 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.