Hazel McHaffie

psychiatry

From the Edge of the Couch

When I was a student I made a conscious decision not to do a stint in psychiatry. Why? I was acutely conscious of the fine dividing line between what’s ‘normal’ and what’s ‘abnormal’, and had a sneaking suspicion I was too close to the edge for comfort myself at times. Decades on, I’m more sanguine about my own mental resilience, and more sympathetic to others’ strengths and weaknesses, and I guess, more curious about how the mind works.

Why am I re-living this decision now? Let me explain.

I was at a bit of a loss as to what book to take for eight hours sitting on a train with weighty matters on my mind. I needed something that I could dip in and out of, but something sufficiently absorbing to hold my interest. Ahah! Time maybe to tackle From the Edge of the Couch: Bizarre psychiatric cases and what they teach us about ourselves. The author: Dr Raj Persaud, a consultant psychiatrist, writer and TV personality.

It’s disturbing (as expected) and raises all sorts of questions about the way the mind functions, the variety of delusions and distorted beliefs that can lurk in its hinterland, and the cracks and flaws that can derail the psyche. More than that, it shows how delusions are far more common than we might imagine, and probing them can reveal much more understanding of how the ‘normal’ mind works.

From werewolves and vampires, to phantom lovers and stalkers, to Munchausens and gender issues, to various distorted perceptions relating to parts of the body, Dr Persaud unravels the problems, the possible causes, and the treatments, through the lives of real people amassed from reported cases over many countries, many years, and from many clinicians. It’s detailed, it’s research based, and it corroborates my remembered feeling that the line between the healthy and the disordered can indeed be thin.

Which of us doesn’t feel unworthy at times?
But most of us don’t resort to eating animal faeces as penitence, or slicing off a hand with a chain saw.

Which of us has not at times disliked a part of our appearance, or experienced anxiety about something untoward happening to cause us acute embarrassment or public humiliation?
But most of us don’t shut ourselves away from society altogether, or deliberately inflict injuries to ourselves and then infect them in order to get a limb amputated.

Which of us has not at some stage tried to alter their body image by something like dieting or exercise?
But most of us don’t eat industrial quantities of toilet paper or our own hair.

Which of us does not have some an experience in our childhood that was fairly traumatic?
But most of us don’t deliberately mutilate our face, amputate limbs, castrate ourselves or enucleate our eyes.

Which of us has not worried about body odour of some kind?
But most of us don’t opt our of work/school to obsessively wash our clothes, and avoid all social and domestic excursions out of the house.

Which of us has not known someone who had a stroke?
But most of us don’t react by becoming pathologically obsessed with eating fine haute cuisine food ourselves.

The list goes on and on. Puts our normal little anxieties into perspective, doesn’t it?

Dr Persaud takes delusions very seriously – sometimes indeed more seriously that the disturbed patient! Furthermore, for him, anything we can learn from them is valuable, as he points out in the postscript:
… dialogue with the delusional has much to offer us. It will not only assist in the specialized scientific enterprise of understanding the brain and mind, but such people’s experience should inform our personal understanding of what it is to be human … If we can grope towards some understanding of the most bizarre and incomprehensible ideas of all, then surely there is more hope for us to understand what each other thinks.
Many have said the most complex entity in the known universe is the human brain, but in fact there is something much more intricate and elaborate: human society – or groups of brains interacting. What is produced when minds try to understand and manipulate each other is where the real mystery and excitement of the human sciences lie.

From the Edge of the Couch is a lengthy tome, and holds a wealth of information – 59 pages of footnotes alone! All made viable by the bringing together of cases from so many sources, enabling deductions to be generated which would not be possible from the occasional single example that comes the way of any specific clinician. It’s perhaps small comfort that, as Dr Persaud admits, psychiatry is far from being an exact science, and relies heavily on objective interpretation of symptoms. That’s part of my worry!

Yep, I’ve no regrets at bypassing psychiatry! But after finishing this book, I’ve got the gratitude-for-what-life-has-dealt-me T-shirt and the mug.

 

 

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Man’s Search for Meaning

HEALTH WARNING: This week’s post may not be easy or desirable reading for those who are finding life tough right now.

In a week where the headlines revolve around the financial implications of a global pandemic, bitter in-fighting in the Scottish government, and the revelations of a woman who found the burden of royal life too much after a couple of years, coming at a time when a proud 99-year-old prince who gave up a successful career and the next 70-odd years of his personal ambitions, to always walk two steps behind his wife, lies ill in hospital … well, I, for one, was looking for perspective.

And I found it in the depths of the Holocaust.

During WWII, psychiatrist Viktor E. Frankl, spent three years in Auschwitz, Dachau and other concentration camps – as an inmate, not as a doctor. But he survived and went on to be professor of neurology and psychiatry at the University of Vienna Medical School until his death in 1997, the author of thirty books. So when he speaks about the importance of finding meaning in life, we ought, at the very least, to sit up and listen.

I certainly did.  Man’s Search for Meaning: The Classic Tribute to Hope from the Holocaust – written in 1945 – has been described as ‘profoundly honest’ … ‘inspiring’ … ‘deeply sensitive’ … ‘influential and eloquent’ …’wise, kind, and comforting’. It’s all of those things. And it’s eminently readable to boot.

The bulk of this slim volume is not so much a fascinating account of his own three years of appalling treatment in one concentration camp after another, but his analysis of what suffering of this depth and magnitude reveals about mankind, and what he learned about himself through the experiences. Here he was, ‘stripped to naked existence‘, quite literally. With the exception of his sister, his entire family – father, mother, brother, wife – perished in the camps.
How could he – every possession lost, every value destroyed, suffering from hunger, cold and brutality, hourly expecting extermination – how could he find life worth preserving?
He dug deep to discover why.

He unpicked, with a kind of detached professional interest, the gradual dulling of emotion, which inured prisoners to horrific sights, sounds, smells and tastes, as well as a brutality and sadism normally unknown to them. He watched the apathy and blunted sensitivities helping his fellow inmates acquire a protective shell – a mechanism of self-defence which eventually detached them from the frequent beatings. He observed the detail of human behaviour in these appalling circumstances, translated it into psychopathological terms, and explained the ‘Why?’- why they followed like sheep; why they sought the centre of the group during marches; why they ripped clothes and food from still warm corpses; why they secreted their meagre ration of bread in their pocket, taking a crumb at a time throughout the day. Throughout his incarceration, he retained this sense of medical curiosity, pitting received wisdom against lived reality in these uniquely horrific conditions, and sometimes he found both medical texts and his own reservoir of knowledge wanting.

And gradually, over time, he discovered first hand ‘the meaning of the greatest secret that human poetry and human thought and belief have to impart: The salvation of man is through love and in love.’ And that ‘love goes very far beyond the physical person of the beloved. It finds its deepest meaning in his spiritual being, his inner self.’ Even though he had no means of knowing whether she was alive or dead, nothing could touch the strength of his love for his young wife (she had in fact died aged just 23).

But good does not always prevail, and he saw his fair share of evil, before concluding that everyone has a choice as to how they deal with adversity. ‘The way in which a man accepts his fate and all the suffering it entails, the way in which he takes up his cross, gives him ample opportunity – even under the most difficult circumstances – to add a deeper meaning to his life. It may remain brave, dignified and unselfish. Or, in a bitter fight for self-preservation he may forget his human dignity and become no more than an animal. Here lies the chance for a man either to make use of or to forgo the opportunities of attaining the moral values that a difficult situation may afford him. And this decides whether he is worthy of his sufferings or not.‘ Dr Frankl himself found the courage and resources to make a victory of the experiences, to turn this humiliating life into an inner triumph.

One of the tactics he adopted to gain this inner strength and mastery over his present adversity, was to imagine himself giving a lecture on the psychology of the concentration camp! By this method he somehow rose above the present situation and observed the sufferings as if they were already in the past. Nevertheless, he remained humble and understanding and forgiving of others’ less robust approach. When he saw them steal, or act meanly or brutally, he refused to condemn: ‘No man should judge unless he asks himself in absolute honesty whether in a similar situation he might not have done the same.’ Nor would he judge any group as a whole, not even those who routinely harmed him. None were made up of all angels or all devils; indeed, in his thinking, there are only two races of men in this world – the ‘decent‘ and the ‘indecent‘.

But of course, he saw utter despair and hopelessness elsewhere in Auschwitz and Dachau. And it was through the inmates who were at rock bottom, contemplating suicide, that the psychiatrist in him recognised a fundamental truth. ‘When the impossibility of replacing a person is realized‘ – it could be a father to his child; or an author to his unfinished creative or scientific work – ‘it allows the responsibility which a man has for his existence and its continuance to appear in all its magnitude … He knows the “why” of his existence, and will be able to bear almost any “how”.‘ An understanding shared with Nietzsche.

And it was by this route, that Dr Frankl honed his own version of existential analysis – ‘logotherapy‘. Essentially logotherapy involves searching for the thing that stops a person committing suicide, the one thing that anchors him to life, and using this as the guide-line for psychotherapy, to help him find meaning in life. One is moved to ask, Who better to steer others away from the torments that are devouring them, than this exceptional man?

Part 2 of this little book is a brief capsule version of Viktor Frankl’s therapeutic doctrine: Logotherapy in a Nutshell. As he says himself, it’s a pretty hopeless task to try to collapse twenty volumes in German into thirty small pages in English! Not much hope I can do it in a couple of sentences, then. In essence though, logotherapy focuses on the meaning to be fulfilled by the patient in the future. Man inherently needs ‘something’ for the sake of which to live, and he desires a life that is as meaningful as possible. Using logotherapy, a patient is assisted to identify what this ‘something’ is, and is then reorientated towards the meaning of his life. Dr Frankl himself felt a deep desire to write the manuscript he had started before he was taken to the camps. That helped him survive.

Not your average Holocaust book; but a remarkable tribute to the triumph of hope and endurance against insuperable odds, and a potential doorway towards finding meaning and purpose in our own lives.

 

 

 

 

 

 

 

 

 

 

 

 

 

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