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Hope, and Brain Science
of speech by Lars Martensson at seminar
"Road to Recovery", San Diego, April 2nd, 2004:
Love, Hope and
Brain Science. What does Love and Hope have to do with Brain Science? Simply,
that a human mind, a human consciousness, cannot arise and cannot exist without
Love and Hope. Therefore a science of the human brain, a science that seeks to
understand and explain the characteristic human functions of the brain, the
functions that distinguish us from other species, the human mind, human
consciousness, – in such a brain science Love and Hope must have a central
Consider a baby with its mother. The baby kicks and screams like mad, oblivious
of everything, oblivious of the caring mother above. But suddenly the baby
quiets down, the eyes of the two meet, the baby laughs and coos. Now the baby
sees the mother and, most importantly, it sees itself through the eyes of the
mother. The two are together in a common world. This is how we are born, how we
are mentally born, this is the birth of our human consciousness. We are born
through Love with an Other.
At that moment the highest functions of the human brain centered in the Frontal
Lobe are activated. The baby takes a Leap to a View outside itself. We go on to
develop this function and learn to take all kinds of viewpoints. D.R. Hofstadter
said: "The Self comes into being the moment it has the power to reflect itself".
Thanks to this outside perspective we are able to develop an inner world
separate from the outside world, where we can do our thought experiments, a
world where we ourselves are the Creator.
Archimedes said: "Give me a fixed point outside and I will move the world!"
Similarly we get a new power to move our own world, our inner world, when we
make the leap to a point outside ourselves.
The highest function of the human brain, the self-reflective function centered
in the frontal lobe which gives us an inner world, an inner light, and power
over ourselves – is thus activated in interaction with another human being.
of Consciousness: Psychosis
Now, let us move 15, 20, 25 years forward. The baby has become a teenager or a
young adult. In the meantime his consciousness, his frontal brain functions, has
developed tremendously in richness. At the same time unresolved stresses,
strains, inconsistencies may have accumulated in his inner world. Perhaps he or
she is very idealistic and finds the world and people simply too corrupt and
ugly, and for this reason, or for some other reason, he withdraws more and more.
Unwittingly he deprives himself of the empathic interactions that maintain and
strengthen his consciousness. Life becomes more and more lonely and hopeless.
Anxiety and despair rises. He feels he has an impossible life to live. He breaks
down. Becomes psychotic.
This breakdown means that the separate inner world that was created by a view
from the outside through empathy with another, breaks down.
The inner world merges more or less with the outer world. When inner and outer
are no longer distinct, fiction and fact, thought and perception are confused.
In short, delusions and hallucinations and other psychotic symptoms are due to
the breakdown of the frontal brain function that maintains a separate inner
world and that depends on empathic interactions with other people.
Now we see, not a baby, but a young adult person that kicks and screams, maybe
not literally, but
figuratively speaking, kicks and screams like mad. When the superordinate
control of mind and behavior by the frontal brain is lost in a person with all
the physical and mental powers of a young adult the ensuing chaos is, of course,
much more threatening and problematic than that of a kicking and screaming
little baby. But, the point is that this young adult, despite appearances, is
helpless in essentially the same way that a baby is helpless and as much in need
of Love and Hope in order to emerge from the psychotic chaos.
Responses to Crazy People
When we see or hear a baby cry we, as human adults, are programmed to want to
comfort, to feel tenderness and love. Our instincts help us to respond
appropriately. Our genetic programming makes us try to give the baby what it
But how do our instincts make us respond when we are faced with an adult person
who is unreasonable and out of control because of a breakdown in frontal
brain functions. We are apt to respond with anger. Our impulse is not, what it
would be with a crying baby or child, to approach, to hold, to comfort, to
cherish. We get out of the way, if we can. Everybody withdraws.
Normally young people have a rich and intense social life, but when a young
person breaks down and becomes psychotic, he or she very soon finds himself in a
If you cannot withdraw, for example, because you are in the same family, you may
quite naturally respond with overt or covert anger, and thus worsen the
loneliness, hopelessness, and lovelessness that caused the psychosis. Thus, this
young person may be trapped in a vicious circle.
Now, remember the baby kicking and screaming like mad. We saw the transformation
when the eyes of baby and mother met in love. The baby turned happy and quiet,
just cooing and laughing.
There is another way we can quiet babies. We can give them a tranquilizer, a so
called antipsychotic drug, a neuroleptic drug. Give such drugs to children.
Surely crying and other troublesome behaviors will be reduced. Maintenance
neuroleptic treatment is also effective in preventing relapse into troublesome
Yet we are all convinced that with drug free care after a few years the children
will be in better shape than if they are given drugs. Similarly, people in
psychosis will be in better shape if they are given love and understanding
rather than drugs.
The main effect of these drugs is to inhibit the reward system, the pleasure
system, of the brain by blocking dopamine receptors. The drugs deprive a person
of the emotional energy that drives crazy behavior. By the same token, however,
the drugs deprive a person of the emotional energy that drives any creative
activity. For example, we saw how the crazy little baby turned happy and quiet,
just cooing and laughing with mother. That transformation could not have
occurred if the baby had been given a neuroleptic, an antipsychotic drug.
In other words, the drugs prevent activation of the frontal brain. In short, the drugs suppress troublesome
behaviors, but at a high price. They suppress trouble at the price of blocking
But is recovery possible? Isn’t schizophrenia a chronic, lifelong disease? Yes,
in general, at least with the drugs. Almost everybody who gets the diagnosis is
stuck both with the diagnosis and the drugs for life. But is recovery possible
without the drugs?
I will return to that question. But first we will make a trip to the Swedish
city of Falun and talk with Goran Andre, a psychiatrist. In the early and mid
1990s he was head of psychiatry in Falun, and responsible for psychiatric
services for a population of about 60,000 people.
During a four year period 1992 to 1996 all first time psychotic people in this
area were taken care of in a novel way that is also practiced, more or less, at
some other psychiatric centers in Scandinavia.
Goran describes the four cornerstones of the Falun method a follows:
1. Psychosis is seen as a crisis. A crisis to be overcome.
2. A session with the whole family is arranged within 24 hours.
3. Neuroleptic drugs are avoided. In fact, hardly ever used.
4. Hospitalization is avoided. In fact, hardly ever necessary.
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." In short, the psychiatry in Falun is an upside down, a contrarian
psychiatry, a REVERSE PSYCHIATRY.
What happens in Falun is that the people around the patient, the ”family,” are
gathered as soon as possible for a session with the team. The team consists of
the psychiatrist, Goran Andre, a psychologist, and two other people. They meet
in a living-room type setting. By family is meant whoever is significant in the
life of the patient. The experience of the team is that people will come, even
if they have to travel from far away.
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. If needed, one of the team members may come
along home and stay the night with the family.
Outcome with Reverse Psychiatry
Now the remarkable outcome. During these four years the Falun team took care of
37 first time psychotic patients. Normally about half of first time
psychotic persons get stuck in their psychosis, become chronically psychotic,
and get the diagnosis schizophrenia.You do not get that diagnosis right away;
you get it after some time when you seem stuck in psychosis. The remarkable
outcome is that during these years there was not a single new case of
schizophrenia in the Falun area.
In a population of 60,000 people in four years you expect about 30 new cases of
psychosis out of which about 15 graduate to schizophrenia. In Falun there were
ZERO, instead of 15 cases of schizophrenia. This fact indicates that most, if
not all people, who become schizophrenic with normal psychiatry, would overcome
the psychosis with the Falun REVERSE PSYCHIATRY. In other words, with the right
help at an early stage the development from psychosis to schizophrenia may be
Since in normal psychiatry most patients would receive neuroleptic drugs, I
asked Göran how many of the 37 patients got the drugs. He estimates that perhaps
1/4 of the 37 patients have received a neuroleptic drug some time or times,
when, he said “we have thought the drug might be of help."
By 1998 one or two of the 37 patients were taking the drugs. In normal
psychiatry, typically about 20 of the 37 patients would be getting neuroleptic
drugs at that point in time. In other words, all or almost all of the Falun
patients had escaped the usual fate of psychotic patients, the fate of being
stuck in the neuroleptic drug trap.
Because GA was chief of psychiatry these years in Falun he was able to ensure
that ALL first time psychotic patients were directed to the psychosis team.
Thus, there was no selection of patients. Therefore we can be sure that all
those 10 or 20 young people in Falun who were destined to become chronic
schizophrenics if they had been treated by normal psychiatric methods, were
saved from this terrible fate – we can be sure they were among the 37 patients seen by the team.
You would think these results should have been written up in a proper research
Of course. Goran and his team are dedicated professionals, but they are not
academic people writing research reports. Obviously, if the academic psychiatric
establishment had been truly interested, the continued work of the team would
have been protected and the data would have been evaluated and published in the
psychiatric literature. I am sorry to say, that did not happen.
The Falun results vindicated views I had presented a decade earlier, in the
mid80s, when I argued, among other things, for a legal right to drug free care.
Let me quote Loren Mosher, whom you will hear later today. He said “In
psychiatry, the powerful, established gate-keepers - a group composed almost
entirely of academic - conservative - psychiatric - research mafiosi - can be
relied upon to reject unfashionable research.” What is true in America is true,
also in Sweden.
A senior psychiatrist, my friend, who also knew what made his colleagues tick,
said to me in the mid80s: “Lars, you have to realize, if you are right, all they
have done all their life is wrong.” When did you hear the people in power admit:
“We were all wrong!”
with Psychiatry and Psychiatrists
What was happening in Falun? Why was there no schizophrenia? Even the
members of the team are wondering. Goran told me that "What we are NOT doing may
be more important than what we are doing." Ulf Wamming, the psychologist
explained: "Never leave a first time psychotic patient alone in a room with a
Why? What is it about a psychiatrist that is destructive? What does a
Let us think for a moment about what typically goes on between a doctor, the
expert, and a patient, the non-expert. The doctor tries to understand what the
patient's words suggest about the disease. The doctor has ideas and thoughts
that he does not share with the patient. With a psychiatrist, while the patient
is talking the doctor is really looking for psychotic symptoms. He has ulterior
thoughts. This professional attitude may be OK when the concern is a disease of
the body. But it is very problematic with a psychotic person.
Let us compare the relation between doctor and patient with the relation between
the mother and the baby at the moment the baby is mentally born by the leap to
an outside viewpoint. That leap, we understand, is only possible because of the
empathy, dedication, openness, total presence of the mother. There are no
ulterior thoughts, no manipulation. This is love. Human consciousness is born in
The task with a psychotic person is, as we noted, similar to the task with a
baby. The task is to activate the frontal brain function that underlies human
consciousness. When the psychotic person makes the leap to an outside viewpoint
through a fully empathic mutual relation with another, at that moment the
psychosis is overcome. The person is whole again.
We noted that human beings are programmed to respond appropriately with care and
love to a crying baby. But with a crazy adult our spontaneous reaction is not
care and love, rather it is withdrawal or anger. The professional attitude is
not the answer. The professional attitude is also a kind of withdrawal, a kind
of anger management.
If we understand the task that the psychotic person faces in order to become
whole again, and if we want to make it possible for him or her to get the faith
to dare that vital leap, the recipe is: Be there, but not aloof and observing,
and not intrusive, but fully present with a pure and open mind.
So, what the patient needs is more or less the opposite of what a psychiatrist
is trained to give.
Some 20 years ago when I had been giving a speech in Denmark a psychiatrist in
the back of the room asked: It is nighttime. I am on duty in the emergency room
and I have this very strong, big, violent, psychotic man. Do you say I should
not give him a neuroleptic drug?
The answer that came out of my mouth was: “Let us start with the problem, not
with the system.” Within the existing system, of course, the psychiatrist may
have no alternative.
In our society we expect to do our jobs with a professional attitude and between
9 and 5. Maybe there will be some overtime etc., but still, our involvement is
limited. We can do a lot of things this comfortable way. But there are essential
tasks that demand more. For example, in wartime we may be expected to risk our
lives. If a person is drowning in the river, the only way to save that person
may be to jump in and share the danger. If it is my child, or someone else I
love, I probably will jump in.
There are tasks for which our system, our way of doing things is inadequate.
Doing psychiatry the way we do other kinds of medicine is totally inadequate.
It is an unbearable horrible tragedy when a young person, often a gifted,
sensitive, creative young person is drowning in psychosis. Today I have focused
on the experience in Falun, but time permitting I could have marshaled much
other evidence that most, if not all, these young people can be saved, saved
from the psychosis, and saved from the drugs – saved to live the lives they were
born to live.
They can be saved. Therefore they must be saved. If we understand and face up to
the actual problem we will have no patience with the existing system of
Love opens the road to recovery: Love instills the Faith to dare the vital leap.
Love gives the Hope that the impossible life IS possible, after all.
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