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& BRAIN SCIENCE
Cornerstones of a New Psychiatry
Lars Martensson, M.D.
Based on a public lecture at the University of Oslo,
Norway, September 16th, 1997.
What is a human being? We associate the concept of a human being with our highest values: Freedom, Love, Creativity, Insight, and Understanding. When we are free, when we love, when we create, when we have insight and understanding, we feel alive and our life has meaning. Only then are we really human.
Let us look at the human brain (Fig 1). The cortex of the brain is divided into four lobes. In front, behind our forehead, is the frontal lobe. The frontal lobe of the cortex together with its associated deep nuclei is referred to as the frontal brain.
In the posterior part of the frontal brain the movements of our body are organized; in the anterior part, higher order behaviors and mental life are organized. In the course of evolution the anterior frontal brain, referred to as the prefrontal brain, developed out of the posterior frontal brain. Therefore its 'neural machinery' is similar. We find the same transmittor substances and similar nerve circuits in both parts.
While activity in the posterior frontal brain represents body movements, activity in the prefrontal brain may be quite unrelated to physical activity. Our thoughts and feelings organized by the prefrontal brain are, of course, often not displayed in movements of the body. Thoughts and feelings are movements of the mind, inner movements, inner behavior, actions in our inner world. As we evolved to become human the prefrontal brain grew more than any other part of our brain.
Figure 1. The Human Brain. The cortex of the brain is divided into four lobes. In front, behind our forehead, is the frontal lobe. The frontal lobe of the cortex, together with its associated deep nuclei, is referred to as the frontal brain. In the posterior part of the frontal brain (shaded) the movements of our body are organized; in the anterior part, referred to as the prefrontal brain, higher order behaviors and mental life are organized.
Lobotomy and Neuroleptics
Today the standard treatment for madness, i.e., for schizophrenia and other psychoses, is neuroleptic drugs (also called antipsychotic drugs or major tranquilizers). Before the "antipsychotic drugs" were introduced in the 1950s, schizophrenia was often treated with "antipsychotic surgery," lobotomy. Lobotomy involves more or less destroying the functions of the prefrontal brain by cutting connections between the prefrontal cortex and its deep nuclei.
Due to the fact that the "neural machinery" of the posterior frontal brain organizing body movements is similar to that of the prefrontal brain organizing mind movements, neuroleptic drugs, unlike lobotomy, have effects not only on mind movements but also on body movements. The medical terms for the body movement disorders induced by neuroleptic drugs are: akinesia (immobility), Parkinsonism (rigidity and trembling), akathisia (disquiet, inability to be still), dystonia (contortions of face and body), and dyskinesia (disturbed movements). These are the so called side effects of neuroleptic drugs. Since mind and body movements are similarly inhibited and disturbed by neuroleptic drugs, the outer person gives us an image of the state of the inner person. As the outer person is impoverished and uglified by neuroleptic drugs so is the inner person.
Psychotic symptoms-hallucinations, delusions, aggressiveness, etc. - may be reduced by neuroleptic drugs as well as by lobotomy. This is, of course, why neuroleptics are commonly called "antipsychotic drugs." However, the term "antipsychotic" is quite misleading, since it is not psychotic symptoms specifically, but mental or psychic life in general that is being reduced. Neuroleptics are not anti-psychotic, but rather anti-psychic drugs.
We shall continue the comparison of the effect of lobotomy with the effect of neuroleptics. But first, let us take a further look at the higher human brain functions that are organized by the prefrontal brain.
Animals, particularly monkeys and apes, also have a prefrontal brain, although it is smaller and less developed than in humans. If this part of the brain in a monkey is destroyed, the animal may still appear quite normal. But it has lost the ability to solve certain types of tasks. When the prefrontal brain has been destroyed the monkey fails at tasks that require the maintenance of an inner image or map of a situation. The monkey has lost its ability to create inner images and conceptions.
As the prefrontal brain grew while we became human, our ability to create and use inner images, conceptions, maps of situations and problems developed. We can not only, like the monkey, maintain a simple image of a situation. We have a highly evolved power to create and manipulate images and to take different points of view.
And, the decisive step ! We take a leap out of ourselves, a leap to a point of view outside ourselves. We can see ourselves from the outside. We can see ourselves and the world with the eyes of others. Because we can see ourselves from the outside we are able to distinguish between our inner world and outside reality. "The Self comes into being the moment it has the power to reflect itself," wrote D. R. Hofstadter.
We humans have an inner world where we ourselves are the Creator and where we can perform experiments of thought. Archimedes (speaking of the use of levers in the physical world) said: "Give me a fixed point outside and I will move the world!" Similarly we get the power to move our own world, our inner world, when we make the leap to a point outside ourselves.
Love makes this leap possible, and is made possible by it. Suddenly the child sees itself through the eyes of the mother and knows that it exists. Thus we become human. Through another human being. Thus the possibility is opened for the individual to identitify with something that is higher and larger than himself. By this leap we become human beings who can grow in Freedom, Love, Creativity, Insight, and Understanding. By this leap we gain power over ourselves and over our inner world.
The highest function of the human brain, the selfreflective
function centered in the prefrontal brain which gives us an inner world, an
inner light, and power over ourselves - is thus activated in interaction with
another human being. So, Love and Hope must have a central place in a human
Psychosis means chaos in the inner world. The picture Hallucinations (Fig 2), made in 1978 by a woman on her way into psychosis, shows the beginning disintegration of her inner world. Her own shape is starting to dissolve and new shapes are being formed, shapes that harass her with their voices.
For a larger, clearer version of the drawing CLICK HERE. (you may then also press F11).
It was only because she was protected from any disturbance from the outside that her pen could go on recording what was happening. This happened in the middle of the night. A couple of hours later another picture, Apocalypse (Fig 3), emerged on her pad. In that drawing her own shape is entirely effaced. The world, what we call reality, has dissolved. Something else is appearing.
Her experience is the same as that described by the mystics. All is fire, Holocaust. The ego is effaced. Even the gestalts of the Voices are effaced. Face to face with God. In the picture we see the letters of the Swedish word for chaos, kaos: O,S,K,A. "Chaos is the neighbor of God," wrote the 18th century Swedish poet Stagnelius. This God spoke and gave the woman her name: Hebriana. In the picture we see the word "Hebriana" followed by an apparently meaningless, but perhaps esoteric series of letters NAGA CTORNC and the word 'hjärnlarm' (brain din or noise in Swedish). Chaos no longer allows distinguishable Voices to crystallize.
For a larger, clearer version of the drawing CLICK HERE. (you may then also press F11).
This happened a night twenty years ago. She has kept the name, Hebriana, that she was given in her psychosis. The three photos of Hebriana (Fig 4-6) were taken in 1981, three years after she made these drawings.
In psychosis, what we call reality falls apart. Something
else is unveiled, something that is normally hidden behind our social,
consensual reality. That night, Hebriana was sitting lost in a puzzle. The
puzzle was her world shattered into pieces.
What was required for her to recreate a whole from the pieces? The least disturbance, the least intrusion into her sphere would have destroyed her ability to draw. Her drawing was an utterly fragile activity, because she no longer had a social, "reality-oriented" persona to protect herself. The least intrusion - which a psychotic person is, of course, rarely spared - would have triggered panic and chaos in her behavior. Would have triggered madness.
I knew I had to be there with a deep but completely quiet interest in her puzzle and in her predicament, knowing that only she herself could recreate her world. I had to be there, but not aloof and observing, and not intrusive, but fully present with a pure and open mind.
Only then could she come out again. In her own time. Out to me and to all others. Only then could she again make the leap to points of view outside herself. Make the leap required to recreate her inner world, and to share a world in mutual empathy with others. Only then could she again become the warm, intelligent, curious, sensitive, and very present person that you see in the pictures taken three years later (Fig 4-6).
If she had been taken into psychiatric care when in this state, she would have been exposed to the very opposite of what she needed. Her behavior would have broken down in madness. Archimedes, when enemy soldiers storming into Syracuse trampled into his study, cried: "Don't move my circles!"
In a psychiatric setting, Hebriana, as a matter of course, would have been given a neuroleptic drug. The drug would have devastated her inner world, would have destroyed her puzzle and her visions. Poverty. Ugliness. A wasteland.
A person is given a neuroleptic drug. He who loves her sees that her Life has been taken. But the psychiatrist does not see. The psychiatrist records "reduction of symptoms," "improvement," "therapeutic effect," etc. Psychiatrists are blinded by their language.
Neuroleptics, or a lobotomy, would not have helped her, but would, on the contrary, have made her task impossible: the task of recreating a whole from the shattered pieces. Neuroleptics would, like enemy soldiers, have destroyed her circles, would have trampled and scattered the pieces of her puzzle. They would have made it impossible for her to become what she wanted to be - what she was meant to be.
The Neuroleptic Trap
"Wait," I hear someone say, "many people who have experienced psychosis say they need neuroleptics!" My answer: Psychosis may be terrifying! A person who never gets the kind of protection and help that Hebriana got, but instead ends up in psychiatric "care" and is given neuroleptic drugs, may think, perhaps mistakenly, that the drug is the only way to get out of the unbearable anxiety and the end of the world experience of psychosis. Rather emptiness than chaos!
Furthermore, the drug alters the brain so that psychotic pressure increases when the drug is withdrawn. It gets more and more difficult to create order in the inner world. Thus a person gets stuck in the neuroleptic trap. When the drug is withdrawn and the person becomes confused, it is concluded that she "needs" the neuroleptic. Medication meant to be temporary becomes permanent, life-long. Therefore, chemical lobotomy by neuroleptic drugs, often ends up being as irreversible as a surgical lobotomy.
Neuroleptic drugs, a trap? Life-long lobotomy? Is it that bad?
Statistics from Sweden show that 95% of people who have once received the diagnosis of schizophrenia are on neuroleptic drugs today. In Sweden that means about 30'000 people. In the US with a 30 times greater population, the number of schizophrenic persons permanently drugged with neuroleptics is probably about one million.
Hebriana was diagnosed by leading psychiatrists as having a particularly severe form of schizophrenia requiring high doses of neuroleptics. Nevertheless, as a rare exception, she escaped psychiatry and the neuroleptic fate. Today she is a healthy, creative woman with an equally radiant 14 year old daughter. She did not become a psychiatric slave, a neuroleptic zombie.
Besides all the people with schizophrenia, according to Swedish statistics about five times as many people with other diagnoses receive neuroleptics. Since neuroleptic drugging appears to be even more prevalent in the US, at least 5 million Americans may be neuroleptic drugged at any time. Many receive the drugs permanently. So, millions of Americans are stuck in the neuroleptic trap - are living out their lives lobotomized.
What an enormous unrecognized genocidal horror!
"I Need Neuroleptics"
But surely neuroleptic drugs are needed in the acute stage, aren't they? - Maybe. Maybe sometimes. Maybe neuroleptics can be of help. But millions of people permanently chemically lobotomized! In the enormous misuse of neuroleptics it is not possible to distinguish limited usage that may be justified.
It's my belief that if doctors who prescribe neuroleptics would take responsibility for making sure that the drug is discontinued - take responsibility for making sure that the patient does not get caught in the neuroleptic trap - then I think doctors would learn that it is almost always best to abstain from the drug in the first place. That was our choice, Hebriana's and mine: Resist the neuroleptic temptation.
In the immensely trying situation that a psychosis may entail, neuroleptic drugs may be a great temptation, indeed, not only for people of good will around the patient, but also for the patient herself. On a couple of occasions Hebriana was committed and heavily drugged with neuroleptics against her will before it was possible to rescue her from the psychiatric system. In the paper Should neuroleptic drugs be banned? she describes her experience of neuroleptic drugs.
Once or twice Hebriana asked me: "Shouldn't we accept the treatment program that the authorities are offering?" Her doubt was the real threat! The great danger was that she would choose to surrender herself to the psychiatric system. If so, she would not have become the rich, beautiful, free person that she now is (See collage of photos of Hebriana and her daughter, August 1987). She would have become a neuroleptic slave, an impoverished, sorry wreck of a person.
Her life wasted, she would have had two choices: Killing her body also, as so many people caught in the neuroleptic trap do. Or accepting her fate, accepting the identity imposed on her by psychiatry. I believe Hebriana is one of those who would have chosen suicide. (Read Interview with Hebriana 1998, in which she looks back on her experiences of psychiatry.)
If, after all, she had tried to accept her neuroleptic fate and if I would have approached her today with the question whether a far better life might have been possible without neuroleptics, I would have been a threat. I would have been a threat she must defend against. "I need neuroleptics!" she would have maintained indignantly.
If so, her name today would not have been Hebriana. In the care of psychiatry she would not have been able to realize her Hebriana identity. Hebriana is Life fulfilled.
In 1985 I wrote a series of articles in the leading Swedish newspaper, the Dagens Nyheter, about neuroleptic drugs. In the debate that followed in the pages of the paper a woman by the name of Eva Leonhardt told her story in a moving article My way out of schizophrenia (Nov 3, 1985).
Eva Leonhardt, like Hebriana, was diagnosed with severe schizophrenia and condemned to a neuroleptic drugged life, until a medical student rescued her from psychiatry. She writes that although she herself had escaped, "I understood fellow patients who said they needed the drug. When they tried to stop taking the neuroleptic the prognosis of the doctors usually came true. I have gone through it, too. I got confused and mad. In addition, I had guilt feelings because of my disobedience. I have begged for mercy: Please, take care of me. I am ill. I will never again doubt you." Today Eva says: "I was a child of psychiatry."
Abandonment - Burned Out Schizophrenia
Hebriana is a member of a north Swedish family well known in the psychiatric literature because of a high frequency of severe schizophrenia. The family is often described in psychiatric textbooks as an illustration of the inheritance of schizophrenia. Such descriptions have created the false impression that schizophrenia is an inexorable fate.
So, what happened to Hebriana's relatives in the early decades of this century? What happened to people with schizophrenia before the surgical lobotomies and before the neuroleptics?
Earlier in our century, both in Sweden and in America, a young person who became mad, confused, and psychotic would be taken to a mental hospital, often far from home. He or she would be surrounded by a complete lack of understanding. Medical authority would pronounce the sentence: schizophrenia, incurable mental illness. Complete forlornness. Terror.
The years in the mental hospital would pass. Early on symptoms would often be dramatic and violent. With time, more calm. In the records it would be noted that the schizophrenia had "burned out." The positive schizophrenia with strong passions, hallucinations etc., had progressed to negative schizophrenia: apathy, compliancy, a living death. This development was seen as improvement and sometimes the patient would be released and sent home. But often the patient had no home out there any more and was too helpless. He or she remained to exist until death in the hospital.
Shortcuts to Negative Schizophrenia
Then, in the 1940s "anti-psychotic surgery," lobotomy, was introduced. The lobotomy knife more or less destroyed the functions of the prefrontal brain. In 1947 the "post lobotomy syndrome" was described as follows by a Scandinavian psychiatrist: "A reduction of the faculty of conscience, an impoverishment of interests, a loss of the ability to dream, to have distant goals, to fantasize, to plan, etc." Thus medical science had discovered a shortcut from positive to negative schizophrenia. Instead of waiting for the schizophrenic "disease process" - due to human abandonment, forlornness, loneliness, and hopelessness - to devastate the prefrontal brain, it was immediately destroyed by means of the lobotomy knife.
In the 1950s "antipsychotic medicine" replaced "antipsychotic surgery"; neuroleptics replaced lobotomy. The psychiatrists of that time noted that the same result was achieved with the new drugs as with lobotomy. With neuroleptics, as with lobotomy, the prefrontal brain is more or less inactivated. In other words, neuroleptics, like lobotomy, are a shortcut to negative schizophrenia, to a living death.
When a person calms down after the schizophrenia has "burned out," or because of "antipsychotic surgery," or "antipsychotic medicine," the calm is the calm of forgetfulness. You have forgotten what you cared about. It is the calm of darkness, when the inner light, the light of human life has dimmed.
Roads to Prefrontal Brain Devastatation
We have seen three roads to devastation of the inner world. Three roads to a living death for people like Hebriana and Eva Leonhardt. Three roads to the darkness that Hebriana and Eva escaped only because they were saved from the psychiatric system.
These are the three dark epochs in the history of psychiatry during our century. Three terrible delusions in the name of science. Three disasters. Lobotomy by three different methods: Psychological, surgical, and medical:
1. Abandonment. 2. Lobotomy. 3. Neuroleptics.
As we approach a new century, we may be on the threshold of a new era, an era when people like Hebriana and Eva will no longer be condemned to a living death. When we no longer destroy the brain functions that make us human. A time when we no longer destroy the pieces of the puzzle and the ability to put them together, the ability to create wholeness. A time when we have learned not to destroy, but to help and enable.
We should look ahead. But in order to mobilize the resolution we need to decisively work our way out of the neuroleptic epoch in which we are still mired, we must clearly see it as the delusion it is.
Let's Face It: Our Delusion Is the Worst Yet!
The number of people permanently drugged with neuroleptics today is many times greater than the number of people that were ever victims of the lobotomy knives. For almost everybody with a diagnosis of schizophrenia, and for many others as well, neuroleptics mean as permanent a destruction of the frontal brain as a surgical lobotomy.
The number of people permanently drugged with neuroleptics today is also many times greater than the number of people that were ever locked up in mental hospitals and asylums in earlier times. And do we really believe that there is more meaning and value to life as a neuroleptic zombie than to life in a mental hospital of the past? Let's face it: Our delusion is the worst yet.
Today drug companies and psychiatrists advertise new neuroleptics as "antipsychotic drugs without side effects." They mean neuroleptics that do not cause movement disorders, such as akathisia, Parkinsonism, and dyskinesia (see above). In other words, neuroleptics that do not target the posterior frontal brain which is directly involved in body movements, but only the prefrontal brain which organizes the mind. In other words, neuroleptics with a pure lobotomy effect. Neuroleptics that "only" devastate the prefrontal brain, the mind.
Why not reintroduce surgical lobotomy, "antipsychotic surgery," instead?
Neuroleptic Drugs Questioned
Around 1980 when I moved into this field and when I worked with Hebriana nobody was questioning neuroleptic drugs. Neuroleptics were simply wonder drugs, "anti-psychotic" drugs, that had meant a revolution of psychiatry. They were the pride of psychiatry.
Non-professionals did not even know the term neuroleptic drugs and had no idea of the essential difference between, on the one hand, tranquilizing drugs like valium, and on the other hand, neuroleptic drugs with a lobotomy effect.
In the early 1980s I developed a critique of the use of neuroleptic drugs. The paper Should neuroleptic drugs be banned? was presented in 1984 and, as mentioned above, the arguments were summarized in the Dagens Nyheter 1985. About the same time the American psychiatrist Peter Breggin published his book Psychiatric Drugs: Hazards to the Brain, describing the harm done by neuroleptics and other drugs.
Since then neuroleptic drugs have become problematic to psychiatrists, at least in Scandinavia. While the consumption of neuroleptic drugs in Sweden had been steadily increasing until 1985 the curve then turned down. Consumption fell 20-25% 1985 to 1995.
When Is a Human Being to Be Given Up?
But, on the whole, neuroleptics are still used as before. Even today only a tiny percentage of people like Hebriana and Eva are allowed to escape the neuroleptic fate.
More important than the relatively modest decline in neuroleptic consumption may be that the proponents of neuroleptics have become more humble, not to say demoralized and confused. Today, a small, but increasing number of psychiatrists, at least in Scandinavia, are becoming more and more skeptical of neuroleptics and still are allowed to work. Ten years ago they would have lost their positions for not giving "anti-psychotic drugs when indicated."
One important change is that treatment guidelines issued by psychiatric bodies today often recommend that patients who are psychotic for the first time in their life should not be given neuroleptic drugs during the first week of psychosis. During this week some patients manage to overcome their psychosis. Thus, some who previously would have been caught, escape the neuroleptic trap.
But why give up a human being after a week? Hebriana needed 3-5 years before she definitively overcame her psychosis. Can you ever give neuroleptics to a person you love?
A few years ago at a psychiatric clinic in Turku, Finland, it was decided to compare the outcome for first time psychotic patients if they got neuroleptics, with the outcome if they did not get the drugs. But first all the patients were granted three drug-free weeks.
The plan was to have about ten patients in each of the two groups. However, the study could not be carried out. After the three weeks without neuroleptics virtually all the patients had overcome the psychosis, and the drug no longer appeared justified.
The reason almost all the patients emerged from the psychosis was most likely not only that they were given three weeks without the drugs. It was certainly also important that these patients were surrounded by personnel who did not believe in neuroleptics, who regarded a psychosis as a human crisis, people with an attitude more or less like my attitude with Hebriana in her psychosis 20 years ago.
In the city of Falun in Sweden there is a psychiatric team that works according to similar principles in the care of first time psychotic patients
1. Psychosis is seen as a crisis (to be overcome).
2. Session with the whole family within 24 hours.
3. Avoid neuroleptic drugs.
4. Avoid hospitalization.
Each one of these principles is contrary to the usual routine in psychiatry. In normal psychiatry a psychotic patient is hospitalized, separated from the family, and finally, after some time, released with maintenance neuroleptic drugs. The family is "educated" to help make sure the patient takes the drugs she "needs." The psychiatry in Falun is, in short, a REVERSE PSYCHIATRY
What happens in Falun is that the people around the patient, the "family," is gathered as soon as possible for a session with the team. In this situation, everybody, not only the patient, is filled with anxiety and despair. Together with the team the family gets an increased capacity to contain and solve problems. It is often found that the patient emerges from psychosis during this first family session. The patient is almost always able to return home with the family the same day.
Prevention of Schizophrenia
A person who becomes psychotic for the first time is most often young. In normal psychiatry about half of first time psychotic persons get stuck in their psychosis, become chronically psychotic, and get the diagnosis schizophrenia.
With reverse psychiatry, on the other hand, it appears that most persons who would become schizophrenic with normal psychiatry, are able to overcome the psychosis. In other words, with the right help at an early stage the development from psychosis to schizophrenia may be prevented.
During the years 1992-96 the team in Falun took care of all first time psychotic patients in an area with a population of about 60'000. In addition, some patients were referred from outside. Altogether the team received 37 first time psychotic patients.
25 of the 37 patients are still in the Falun area. None of the 25 (and probably none of the other 12) have received the diagnosis schizophrenia. After the initial period of family sessions with the team, the responsibility for most of the patients has been taken over by other psychiatrists or general practitioners who have been trained to use neuroleptics in the usual way. Nevertheless, few, if any, of these patients do receive neuroleptics today.
In other areas of Sweden with a population of about 60'000, on the average at least about 15 people get the diagnosis schizophrenia during a four year period. All of these, plus a large proportion of the patients with other psychoses, usually receive neuroleptic drugs.
Does the 0 mean that with REVERSE PSYCHIATRY nobody becomes schizophrenic? The 0 may be due to chance. But these data do suggest that many, if not most, people who get stuck in psychosis and get the diagnosis schizophrenia could have been saved with REVERSE PSYCHIATRY
Does the 2? mean that neuroleptics are hardly used at all today in the Falun area? No! The consumption of neuroleptics in that area is about as high as elsewhere. In Falun, as in any other community of 60,000 people in Sweden or in the US, there are some 1-2,000 people who receive neuroleptics: people stuck in the neuroleptic trap who receive the drugs year after year until the end of life. It is not the chronic neuroleptic drugging, but the recruitment of more chronically drugged people that has almost ceased!
Göran Andre, the psychiatrist in the team, estimates that perhaps 1/4 of the 37 patients have received a neuroleptic drug some time or times, "when we have thought the drug might be of help." The significance of the low figure 2? is that none, or almost none, of the patients have become stuck in the neuroleptic trap.
Should Neuroleptic Drugs Be Banned?
In 1984 I wrote under the above heading: "The drugs have promoted a false definition of schizophrenia as a medical problem with a medical solution. They have prevented us from taking our responsibility. As a consequence, people with schizophrenia have been abandoned. That is the real cause of their tragedy. If they had not been abandoned, most of these young and often gifted people would have been able, like the rest of us, to fulfill many of the promises and possibilities of their lives."
The data and arguments I advanced then fully supported my view. For example, I described the Soteria project in California 1971-1983. In Soteria schizophrenic persons were provided human care without neuroleptics. Under the heading Avoiding New Knowledge, Loren R Mosher, who was the research director of Soteria, recently gave an analysis of why the Soteria data have been suppressed. He said: "In psychiatry, the powerful, established gate-keepers of research journals - a group composed almost entirely of academic -conservative - psychiatric - research mafiosi - can be relied upon to reject unfashionable research... Soteria ... is a study as if never conducted."
I know the results from Falun very well from discussions with members of the team, the psychiatrist Goran Andre and the psychologist Ulf Wamming. They are conscientious and dedicated professionals, but they are not academic people writing research reports. Obviously, if the academic psychiatric establishment had been sincerely interested, the continued work of the team would have been protected and the data would have been evaluated and published in the psychiatric literature.
Why No Schizophrenia in Falun?
What was happening in Falun? Even the members of the team are wondering. "More important than what we are doing may be what we are not doing," said Goran Andre, the psychiatrist, and added Ulf Wamming, the psychologist: "Never leave a first time psychotic patient alone in a room with a psychiatrist!"
Why? What is it about a psychiatrist that is so destructive? What does a psychiatrist do?
When a physician talks with a patient he or she tries to understand what the patient's words may be suggesting about the functioning of the possibly diseased organ. The physician has ideas and thoughts that he does not share with the patient. He has ulterior thoughts. That may not be much of a problem when the concern is functions of the body. But it may be problematic when the concern is the mind, the highest functions of the brain, and particularly problematic in the meeting with a psychotic person.
Ulterior thoughts may spell disaster for a person in a state such as that of Hebriana when she made the pictures Hallucinations and Apocalypse. The patient confides, opens herself. No! She does not confide, she does not open herself. Her boundaries are dissolved. She has no choice! She can not close, nor open herself. She is open. She is at the mercy of the Other. She can only possibly take the presence of an Other who is free of ulterior thoughts.
I may give you my confidence. If you do not reciprocate I may feel betrayed and misused. But my life is not at stake, as it is for a psychotic person.
When we made the Leap, the decisive leap, the leap to the Other (see Becoming Human), it was made in Love. We were a little child, as open as Hebriana in psychosis. We could take the leap because there was a You. A true and open Other. A human being without ulterior thoughts.
As we saw, it is through this leap that the highest integrating function of our brain is activated. Through this leap we become human beings who can grow in Freedom, Love, Creativity, Insight, and Understanding. By this leap we achieve the point of view that gives us power over ourselves and our own inner world.
The question is: How do we save a human being who is drowning in herself, in chaos, in psychosis. How do we make it possible for her to take the Leap again. How do we make it possible for her to reactivate the self-reflective function of the brain, to reactivate the superordinate function of the prefrontal brain, so that wholeness may be recreated.
Psychiatry means healing (making whole) the psyche. It is a horrible fact that psychiatrists are trained into a professional attitude that spells disaster for the most important group of psychiatric patients: an attitude that destroys the patient's power to recreate her wholeness, to overcome the psychosis. In order to make the patient reveal herself the psychiatrist pretends an interest he does not feel. The patient confides, and tumbles down into a black hole. Hope becomes hopelessness.
Above (under Overcoming Psychosis) we considered what was required for Hebriana to be able to recreate a wholeness from her shattered world : "I had to be there with a deep but completely quiet interest in her puzzle and in her predicament, knowing that only she herself could recreate her world. I had to be there, but not aloof and observing, and not intrusive, but fully present with a pure and open mind."
Her interest had to be mine. No ulterior thoughts. A pure and open mind. That's what I learned. That was my school.
The school of psychiatry teaches the opposite. The psychiatrist learns a secret, deceitful agenda. While the patient is speaking the psychiatrist is really looking for psychotic symptoms. He lets the patient go on talking until he is through with his diagnostic checklist. After that he leaves and prescribes a neuroleptic drug. Or, if he follows the more recent treatment recommendations: He leaves and returns after a week in order to start neuroleptics then, if the psychotic symptoms persist.
Says a member of the Falun team, Ulf Wamming: "We consider someone a first time psychotic patient if this is the first time he comes to psychiatry in a psychotic state, i.e., even if he may have been psychotic before. Such a patient comes with the hope to be helped."
"We think our way of working means that the patients do not lose this hope. That's why they are able to overcome their psychosis. That's why they do not become chronically psychotic. That's why they do not become schizophrenic."
Ethics and science are due to join in the recognition that Love and Hope are essential to the highest functions of the human brain.
© 1998: Lars Martensson. All rights to reprint and use this paper are reserved by the author.