Saturday, December 26, 2009

To Medicate or not to Medicate, that is the Question 1

We have all read of the Anti-Psychiatric Movement with its glaringly obvious condemnation of the over-prescription of anti-psychotic and other pharmaco-psychological drugs. This is an issue that touches us all intimately. After viewing the recent statistics available at a reputable site who could disagree that this topic is extremely relevant. The prevalence of depression in the USA is estimated as "5.3% adults (USSG); 17 million people; approximately 4% of adolescents get seriously depressed (NIMH); annually 12% of women ; 7% of men; lifetime risk of an episode for women 20%. 3-4 million men USA." (Quoted from this link here STATS and accessed on December 26, 2009, 23:21 GMT)

Anti-psychiatry is now quite a dated term used to refer to a configuration of groups and theoretical constructs that emerged in the 1960s and were considerably hostile to most of the fundamental assumptions and practices then and still current in psychiatry. Its igniting influences were Michel Foucault (1926-1984), R. D. Laing (1927-1989), Thomas Szasz (1920- ) and, in Italy, Franco Basaglia (1924-1980). The term was first used by the English psychiatrist David Cooper (1931-1986) in 1967. Some now prefer the term critical psychiatry to avoid connotations that may appear oppositional merely, though the two concepts are distinct.

These critics and today their contemporary colleagues-in-arms argue that (i) the specific definitions and criteria for various psychiatric complaints (as promulgated in the DSM) are extremely vague and even arbitrary, thereby leaving great elbow room for clinicians to diagnose what they consider more likely, rather than basing their conclusions on the rigours of more scientific criteria. They also argue that (ii) psychiatric interventions are often more harmful than helpful to patients. Other key arguments have been the fact that the psychiatric profession has (i) overused and over prescribed anti-psychotics and anti-depressants and other drugs, (ii) have ruled out or are exceedingly sceptical of alternative or complementary approaches, (iii) the abuse of authority and power with respect to patients and their families and (iv) the compromising of medical ethics by alignment with certain pharmaceutical companies and insurance groups.

From my relatively narrow study of psychotherapy over the past number of years, it would seem that Dr. William Glasser, the founder of Reality Therapy belongs firmly to the anti-psychiatric group. Reality Therapy is an approach to psychotherapy and counselling which was developed by the psychiatrist Dr. William Glasser in 1965. It is based on choice theory (originally called control theory). It has become well-established in the US and internationally and it has also been widely applied in education. It also has a strong foothold in Ireland. Its anti-drugs stance in psychiatric complaints is quite delimiting in my opinion, and I speak from personal experience.

What's needed in psychiatry is a holistic approach, a "both/and" approach, not an "either/or" one. I suffer from clinical depression of the unipolar variety. I went through several extremely disturbing bots of depression before I was properly diagnosed. Since then, some twelve years ago, I have devoured as many books as I could on the subject. The one which most appealed to me was was called Malignant Sadness by the atheistic biologist, a wonderful scholar, Lewis Wolpert. I cannot remember if I reviewed that book in these pages as I read it some ten or more years ago. It is full of science and explains the whole psychiatry thing in a biochemical fashion. I loved it, because Lewis Wolpert wrote with scientific knowledge and a passion and a certainty I did not find in other books. He also described my own peculiar symptoms, which I shared with him, in precise detail. I also learned that many patients spend years trying to get a proper diagnosis because, while there are many common early symptoms, there are also ones peculiar to the personal chemistry of this or that individual. Anyway, psychopharmacological intervention helped me and continues to do so. It's at my peril that I discontinue my medication...

It's a long story, which I cannot summarise in full in this wee post, but which I want briefly to allude to. The central distinction for me is the distinction between Reactive Depression and Endogenous or Clinical Depression. After being hospitalised for some seven weeks after a particularly frightening breakdown, my consultant psychiatrist had diagnosed "reactive depression." Even though, I was adamant that I was not suffering from depression of the reactive variety, I bowed to the superior knowledge of the wonderful consultant who was responsible for my getting better. Why did I not believe that I suffered from reactive depression? Well reactive depression results from a negative reaction to one's work environment. However, I knew well that, while I certainly suffered from the normal stressors that go with teaching - belligerent or defiant students now and then - I certainly never hated teaching. In fact, I loved it and enjoyed the verbal jousting and even boisterous interaction of every class, good, bad and indifferent. Therefore, while I was well, I still doubted the diagnosis. In line with his diagnosis, the doctor withdrew the anti-depressants gradually over the following year while recommending counselling and psychotherapy which I did attend. However, lo and behold, when I was off the drugs for a number of weeks the depression returned. This time, I found that I did not go quite as deep into the pit of desolation as I had the first time, but rather on this occasion I went down a certain depth, but disconcertingly remained down there for a longer period. This time, while the experience was not as violently agitating, it was more disturbing insofar as it was impossible to see any light at the end of the tunnel.

To make a long story short, after twelve weeks of experimenting with this and that drug an appropriate one was found. For the last twelve years I have been well and medicated, and have only missed two days from school in that long period. For me, this is the success of pharmaco-psychology. However, I readily admit that I also look after myself and do attend courses on self-development, have gone to therapists and counsellors, and general keep myself mentally and physically healthy as best as I can.

Let me talk about a few other cases I know. A friend of mine, who is 55 years old is also on the same medication as I. However, he has reactive depression. He goes on and off this medication after attending his G.P. when he feels depressed or under pressure. I have told him often that this is the wrong way to go. What he needs is psychotherapy or counselling to deal with the obvious environmental and psychical stressor namely post-traumatic stress after a rather violent attack on himself by an armed robber at his business premises. This brave, if silly, man went back to work that afternoon as if nothing had happened to him. From that instant he could trace his bouts of depression. Fine, for this gentleman, the drug therapy is necessary to calm him down or decrease his depression or anxiety. However, he needs concurrent and post medication counselling. Such on-going counselling will eventually allow him to never (or only very seldom) have to use those antidepressants in the future.

Another worrying case is that of a special needs student in my school who is extremely weak and has Asperger's Syndrome coupled with a recent diagnosis of crippling OCD. He is extremely anxious at all times and is heavily medicated. Well the psychiatrists and psychologists say that they cannot do any CBT with this young boy until the meds have kicked in. His case is complex. However, as a teacher who has studied psychotherapy for some years and as a medicated and "cured" sufferer of endogenous depression, I feel that his problems are more deeply rooted in the human condition. My preference for Rogerian Psychotherapy or Person-Centred and the more existential approaches of the likes of my current guru Irvin D. Yalom suggest to me that this boy is suffering from an angst or anxiety of high intensity - sheer existentialism to the nth degree. My diagnostics in numeracy, communication and language and in literacy show him to be operating at a second or third class primary level. My contention and that of his Special Needs Assistant is that his anxiety comes from the fact that every day that he walks into class he feels inferior or worse, he feels that he is an uncomprehending nobody, an insignificant little thing who can understand nothing of what's going on. No person should have to feel thus, much less a young adult. His mother has rung me in a distraught condition about her son's anxiety which shows itself in considerable anxiety and agitation at home. He can shout and roar and protest. The poor lady videoed the poor lad on her mobile phone to show us and his psychiatrist and psychologist his sheer distress. The SNA was disturbed and so was I to a lesser extent. (Remember I have spent 7 weeks in a psychiatric hospital and have also counselled some people in my time as well as helping calm agitated souls.) The SNA and I feel his troubles are of the reactive existentialist variety rather than of the endogenous variety. So putting him into class may not be a good idea if that's what's causing him to stress out. The quandary is that now this poor boy is highly medicated for anxiety and stress. Are we treating symptoms rather than the underlying problem? Therein lies the crux of the matter.

To be continued.

Above a tree "lives" in Death Valley, California.

Life and Death and Life in Death and all that Jazz

If the Christmas season achieves anything at all, it achieves a period of rest for most of us, and if we are lucky, a period of reflection, - sustained reflection if we're exceptionally lucky - on where our individual lives are taking us. In that sense it achieves the purpose of what going on retreat is all about: stepping back from the constant involvement in Doing and just being able to be open to Being. It would seem, to this writer at least, that we need these twin realities in our lives if these latter are to be fulfilling at all. We need both TO DO and TO BE. Too much doing can weary the soul too much. Too much being can lead to all types of self-delusion, egotism, boredom, megalomania or just plain silliness. Each needs to be leavened by the balance of the other. Likewise Life needs to be balanced by Death and Death needs to be balanced by Life. My experiences of life, my studies in psychotherapy, my being both counsellor and counselled, have all taught me that both these realities literally do go together "like a horse and carriage." Or better still like light and dark which we cannot really understand or even have one without the other.

In these reflections, I have been helped by my continued reading of Dr. Irvin D. Yalom's deep, if painful and inspiring by turns, book, Staring at the Sun: Overcoming the Terror of Death,the meditative books of the Dalai Lama and many other books on popular psychology, philosophy and psychotherapy that I have at my disposal. Yalom writes a wonderful chapter in this just mentioned book on his own personal experiences of death and how they have made him the person he is, how they, in fact, have transformed his living into a deeper sense of awareness and appreciation of life.

Above, Life and Death by REDJUICE. This is also an optical illusion!

Circular, not Linear!

One of the myths that we so-called moderns have all rather too readily bought into is that of what I call linearity - let me write it large for emphasis: THE MYTH OF LINEARITY. Yes, that's a powerful myth indeed, traceable all the way back to the Industrial Revolution, I believe. The thinkers of the Enlightenment gave great support to this myth with their own parallel one of indefinite progress. Let me write that myth large here for you: THE MYTH OF PROGRESS. However, more often than not, the wisdom, garnered over long years of living, of the ancient religions, seems definitely to contain a little more of the truth - certainly much more existential truth, that is truth as it is involved in the daily experience of living. They proposed a circular myth. Let me write that large, too: THE CIRCULAR MYTH. One could write this myth in other words, too, like: THE MYTH OF CYCLES. Linearity is a pretty one-dimensional one (also bi-directional, given that a line points in two opposite directions) whereas the circular/cyclic one is more dynamic and this can spiral outwards and inwards and on and on and on.

Anyway, the Christmas Season is, indeed, quintessentially a mythic one. Christmas itself is a profound MYTH. Santa Claus and Christ belong to the same mythic dimensions, and we poor human animals need to be inspired by our more profound myths. Let me return to the cyclic myth here. I contend that the cyclic myth is a healthier one for a number of reasons: (i) it is in harmony with the seasons and with planetary movement (I refer to astronomical principles here, not to the pseudo-science of astrology), (ii) it is more in harmony with the nature of the human animal, who as a creature participates in the cycles of conception, growth, decay and death and so on and on and on and on and (iii) it also appears to me that it is more psychically true - that is, we grow not in a linear fashion, but in a cyclic one. For instance, take my regrets as I grow older, for hurting X or Y or Z; for not doing A, B or C; for not saying "sorry", for not telling X or Y that I loved them before they "shuffled off this mortal coil" etc. Sometimes, I quite fancy that I have dealt with these "hurts" and "hurtings", to have quite dealt with them, "sloughed them off", only to have them return, as if within the circle of regret, no sooner have I erased an outer circle, a further inner concentric circle raises its ugly circumference. It were as if as soon as I had peeled back a layer of the onion of regret I had only exposed a deeper-seated eye-watering layer beneath.

Back to Dickens:
The work of all great novelists is replete with wisdom and none more truly than that of the great story teller Charles Dickens. One of my favourite books by Dickens is his wonderful Tale of Two Cities, with those opening lines, worthy of a medieval divine in their import: "It was the best of times. It was the worst of times." How we all might wish we had the wit to pen them. Yet, I still would like to quote some other lines from this famous book, coutesy of my current favourite contemporary analyst, Dr. Irvin D. Yalom:
For, as I draw closer and closer to the end, I travel in a circle nearer and nearer to the beginning. It seems to be one of the kind of smoothings and preparings of the way. My heart is touched now by many rememberances that had long fallen alseep. (Charles Dickens, A Tale of Two Cities, quoted in Yalom's Staring at the Sun, 149.)
I am reminded by the lines from one of my favourite modernist poets, T.S. Eliot which run thus: "In my beginning is my end. ..In my end is my beginning."--from Four Quartets, "East Coker."

Enough. Walk lightly on Mother Earth, my friends, and open yourself to the cyclic experience of living.

Friday, December 25, 2009

Christmas and all that excess...

Being only half-awake (or half-asleep) this morning I seem to recall some minister of religion on the radio saying how he had quite frankly grown tired and bored about people trotting out the more than obvious observation that Christmas had grown very commercialised. Indeed, the reverent gentleman was and is very correct. This particular phrase has become cheapened and trite by its constant repetition, and is now little more than a cliché.

Whatever about the growth of commercialism around the Christmas season, I wish here to allude to excess. There is, in lexical terms, quite obviously, a distinct difference between commercialism or commercialisation and excess. Commerce and indeed commercialisation can and do bring about improvement in someone's lot at least - more than likely that of the shopkeeper or business person. It is often our naive hope that their wealth will trickle down to the less well off. Whether that contention is true or not is beyond the scope of this post.

And now to excess. Excess is simply waste, and waste in a world where so many dwell in want is nothing short of obscene. And yet, we post-Celtic-Tiger Irish have been partying and buying as much as ever. I don't base this conclusion on any statistics or indeed newspaper articles or books read, but rather on my own experiences and observations. I, like many of my colleagues, am doing the round of parties, am giving and receiving presents, am eating and drinking and doing all the seasonal things like visiting relations and friends. I don't believe that I'm doing any of these things to excess, and yet, the question remains as to how exact my judgement of my own motivations really is.

As I drove down early this afternoon on my way to my brother's house for Christmas dinner , I heard the following lovely song on the car radio. It is worth printing the lyrics here in full. They run as follows:
I did my best to notice when the call came down the line
up to the platform of surrender
I was brought but I was kind
and sometimes I get nervous
when I see an open door

close your eyes, clear your heart
cut the cord
are we human or are we dancer
my sign is vital, my hands are cold
and I’m on my knees looking for the answer
are we human or are we dancer

pay my respects to grace and virtue
send my condolences to good
give my regards to soul and romance
they always did the best they could
and so long to devotion, you taught me everything I know
wave good bye, wish me well

you gotta let me go
are we human or are we dancer
my sign is vital, my hands are cold
and I’m on my knees looking for the answer
are we human or
are we dancer

will your system be alright
when you dream of home tonight
there is no message we're receiving
let me know is your heart's still beating

are we human or are we dancer
my sign is vital, my hands are cold
and I’m on my knees looking for the answer

you’ve gotta let me know
are we human or are we dancer
my sign is vital, my hands are cold
and I’m on my knees looking for the answer
are we human or are we dancer

are we human or are we dancer
are we human or are we dancer
The above song is, in fact, about excess as far as I can determine. The name of the song is, of course, Human by The Animals. I really love both the lyrics and the melody of this song. The mystery of the meaning of this song rests in the cryptic nature of the chorus: "are we human or are we dancer", which is quite ambiguous and also contains a glaring grammatical mistake or at least a grammatical oddity in that the second substantive disagrees with the first in number. It also blithely leaves out the question mark, but, as it is sung, who, quite frankly, gives a damn? (Interestingly, I've put one in for the previous sentence, and I do give a damn, quite obviously). However, maybe that poor grammar is just because of the eccentricity of the song writer or even, perhaps, for musical reasons (I'm glaringly ignorant of the principles of music, obviously also).

This beautiful, if mysterious, song is, in fact, based on a quote by Hunter S. Thompson that runs similarly to the song: "We are raising a generation of dancers." In keeping with his rather late beatnik philosophy he implies that we are losing basic humanity and becoming mere dancers living on the whim of the moment. This might be unfair to committed dancers, but I think Thompson was referring to those of us caught up in the "excessive" and rather "superficial" and "trivial" nature of indulging our senses. Therefore, the writer of the song considers that we, the acquisitive, selfish and gluttonous people of today, in the words of the song actually do "Pay my (our) respects to grace and virtue//Send my (our) condolences to good//Give my (our) regards to soul and romance //They always did the best they could". People today, according to the song-writer concentrate more on what dance club we'll be at over the weekend.

Now back to the writer, who declared that the U.S.were 'raising a generation of dancers'. In this he was commenting on the "softness" of America's youth. Hunter Stockton Thompson (1937 – 2005) was an American journalist and author, most famous for his novel Fear and Loathing in Las Vegas. He is credited as the creator of Gonzo journalism, a style of reporting where reporters involve themselves in the action to such a degree that they become central figures of their stories. He is also known for his use of psychedelics (that is, drugs, rather akin to the way Timothy Leary)used them, and also for his over-use of alcohol, firearms, and his iconoclastic contempt for authoritarianism. This obviously endeared him to the Hippie generation.

Above a Christmas scene in O'Connell Street, Dublin. I took this picture in December, 2006.

Sunday, December 20, 2009

Literature and its Allure

My romance with literature is a complex one, like any other romance indeed. On the one hand, I find literature - and by that term I mean all written works whether fictional, prose, poetry or in any of the sciences, popular or professional - a marvellous escape from the work-a-day world and paradoxically, on the other, a deep and reflective involvement in that same world.

As I write these lines, I am trying to recall where and when that romance with books first began. I suppose it goes back to the dark and dismal 1960s when we were quite a poor working class family. I was a sensitive kid who knew that education provided one escape from the drab and miserable world about me. Then, I had good teachers, especially Mr. Murray in fourth class in primary school, who was a wonderful teacher and an absolutely fine gentleman who encouraged the young pupils he taught. While, like all the teachers of his era, he did use corporal punishment, I can never remember his abusing it, or even over-using it. He had a deep respect for his charges and, indeed, for learning. I learned a lot from that wonderful teacher, and I think he was the primary reason why I became a teacher myself. Under his stewardship I became an inveterate reader. I remember getting prizes of books for my academic achievements, the first one being Robinson Crusoe by Daniel Defoe when I was ten years of age. It was one of the first great books that I read. Needless to say, in the sixties and early seventies I read numerous books by Enid Blighton and all those wonderful Biggles books by Captain W.E. Johns. I also loved the poems and the stories recounted in the school textbooks, which pale into insignificance with respect to layout and illustrations beside the modern ones that our young people have at their disposal today. Nevertheless, they were wonderful to the extent of their literary content. We were challenged, not alone with the wonderful world of words, but with the magic and wonder and allure of marvellous literature. What those books lacked in illustration, they made up for in their literary breadth and depth.

Another formative book I remember reading was the wonderful Twenty Years A-Growing by Muiris Ó Súilleabháin, which I read later in the original. This book touched me greatly in both languages, and it led to my deep interest in the Irish language. Interestingly, it was Muiris's actor son, Eoin Ó Súilleabháin, who was one of the presenters of Buntús Cainte who caught my interest with his wonderful natural pronunciation of the Gaelic.

Anyway, there I was yesterday like a child in a candy shop while I looked through all the remaindered books in Hodges Figgis bookshop here in Dublin. Also I am addicted to the Amazon Book site where I buy all too many books. Be that as it may, I suppose book buying is a relatively harmless habit to have. I always tell myself that I should be spending far more if I were a smoker or a heavy drinker. Anyway, here are some books to wonder at, peruse or perhaps buy. These are the ones I bought in the last week:

1. Man's Search For Himself - Rollo May.

2. The Recovery of Being - Rollo May.

3. When Nietzsche Wept - Irvin D. Yalom.

4. The Schopenhauer Cure -Irvin D. Yalom.

5. The Yalom Reader -Irvin D. Yalom.

6. Cosmos - Carl Sagan.

7. The Oxford Book of Modern Science Writing - Richard Dawkins.

8. 50 Mathematical Ideas - Tony Crilly.

9. 50 Philosophical Ideas - Ben Dupré.

10. Advice on Dying - The Dalai Lama.

11. The Form of Things - A.C. Grayling.

12. Origins of The Modern Mind - Merlin Donald.

13. The Voyage of the Beagle - Charles Darwin.

14. Our Universe - An Introduction - Patrick Moore.

15. Going Inside - John McCrone.

16. The Human Story - James C. Davis.

17. Freud's Wizard - Brenda Maddox.

18. Symposium and The Death of Socrates - Plato.

19. Empire Falls - Richard Russo.

Above a picture I took of the above pile of books.