In an effort to resume the habit of writing regularly:
I finished Reynolds’s excellent Constructive Living earlier this month and am nearly through Morita’s Morita Therapy and the True Nature of Anxiety-Based Disorders. Several thoughts related to this:
1. People may believe that psychiatrists approach patient care from generally the same theory.
This is untrue.
I am not well versed in Freudian ideas or related “psychodynamic” hypotheses of mind. This is due to my inability to understand psychodynamic writings. Example from Heinz Kohut’s The Restoration of the Self (page 15):
In the analysis of those narcissistic personality disorders where working through had on the whole concerned a primary defect in the structure of the patient’s self, resulting in a gradual healing of the defect via the acquisition of new structures through transmuting internalization, the terminal phase can be seen to parallel that of the usual transference neuroses.
That single sentence has 58 words.[1. Courtesy the Word Count Tool.] I had to read the sentence three times before I understood Kohut’s idea. (“The treatment in narcissistic personality disorder focuses on a primary problem of the patient’s character. The patient integrates new ideas about himself and other people to correct this problem. When treatment is ending, patients will demonstrate similar reactions to the therapist as they did earlier in treatment.”) Because I find it difficult to read and understand this kind of writing, I am less inclined to read it.
Furthermore, I do not agree with some (many?) of the psychodynamic hypotheses of mind. I do not believe the Oedipus complex metaphor (and sometimes I’m not sure if it is meant to be a metaphor). I do not believe in the “good breast” and “bad breast” (see object relations theory).
I readily agree that I may lack the sophistication to grasp these concepts.
(That being said, I do believe that dynamics exist amongst people: There are reasons why some people are compelled to assert their superiority in a group. There are reasons why some people have difficulties leaving abusive partners. I do not believe, however, that these reasons are due to penis envy or castration anxiety.)
As a result, I read literature that I can understand: Cognitive Behavioral Treatment of Borderline Personality Disorder. Cognitive Behavioral Therapy for Severe Mental Illness. Japanese books about anxiety disorders.
2. These two texts highlight the importance of accepting emotions, versus changing them. As a result, the focus is more on behaviors. (Or, it is not possible to will ourselves to feel different emotions. What we can will, however, are behaviors.)
Some Western formulations of psychology also highlight the acceptance of emotions (mindfulness based cognitive therapy and acceptance and commitment therapy). It is not surprising that many of these formulations are based on Eastern philosophies. I have been impressed, however, with Morita’s repeated emphasis on the importance of accepting emotions. He argues that patients often experience anxiety symptoms because they are unwilling to accept what is actually there (or what is not there). All of us, to some degree, do not accept certain aspects of reality. That lack of acceptance can result in suffering.
In some ways, these Eastern philosophies directly contradict Western, psychodynamic ideas of mind. If indulging the extremes of psychodynamic hypotheses, nothing is ever what it seems. You dreamed about a dog eating flowers (“manifest content”), but what that actually means is you hope your father will die (“latent content”). Morita might argue that you might be paying too much attention to your dreams.
Two further reading recommendations:
David Healy’s blog. I had noted earlier that all psychiatrists (and patients taking antidepressants) would benefit from reading his book, The Antidepressant Era. He’s bringing related information online.
Mad in America. The posts are stimulating counterpoints to information from mainstream psychiatry.
Maria Yang, MD 