Tuesday, December 29, 2009

Visiting the Underworld - Preparing for our Death.

I have never doubted for a moment the universal importance of symbols and of myth. Myth-making like religion-making, like poem-making, like novel-making and indeed like science-making is quintessentially about making meaning. What separates the human animal from his brothers and sisters among other animals is this very thrust to meaning. We are meaning-making animals, and we weave our myths in the sciences as well as in the arts. I shall return to what I mean by this very loaded and controversial sentence when I get some time in a future post to explicate the nature of myth. Here, I wish to expatiate on the image or symbol or myth of the underworld. In this respect I am continuing my engagement with existential psychotherapy and with some little reference to the great contemporary psychoanalyst and psychiatrist, Dr Irvin D. Yalom.

The Underworld:
Here, I do not wish to discuss its meaning with reference to any notion of an afterlife at all. Rather, in the tradition of Freud and Jung and others I wish to discuss its reality, perhaps even its genesis, in mythology or in dreams or in both, whichever came first - or perhaps, indeed, they emerged simultaneously. For me it is the world of shadows where life is not life as we know it as Dr Bones McCoy used have it in the first great inimitable Star Trek. The underworld presents us with beings who live a very mysterious or shadowy life indeed. On-line encyclopedias put too much emphasis on the reference of this underworld to the afterlife, which to my mind is a sort of "Christian reading-back-into" the pagan myths. I could be wrong in this contention, but there it is nevertheless. If anything this shadowy world was more of a hellish place than a heavenly one to my mind. To that extent, it could certainly be a very dystopic reality, that is the direct opposite to a utopic reality. There conditions of life would be miserable and characterized by poverty, oppression, war, violence and/or terror, resulting in widespread unhappiness, suffering, and other kinds of pain, whereas the latter, Utopia, represented an ideal society, where justice and peace and equality ruled the day.

Sometimes the underworld is identified as "Hell" because Hell/Hades is thought to be under the Earth. Hence we read in many myths and in much of the literature of the world about the descent into the underworld. Such an image as this which occurs again and again is called a mytheme in the study of mythology, that is one of the most basic units in any study of myths. Here is what the WIKI says on this interesting topic:
The descent to the underworld is a mytheme of comparative mythology found in the religions of the Ancient Near East up to and including Christianity. The myth involves the death of a youthful god (or goddess: Persephone, Inanna, for instance) who is a life-death-rebirth deity, mourned and then recovered from the underworld by his or her consort, lover or mother. (See here: Underworld)
The most famous story about the descent into the underworld is that of Orpheus and his wife Eurydice. While fleeing from Aristaeus (son of Apollo), Eurydice ran into a nest of snakes which bit her fatally on her heel. Distraught, Orpheus played such sad songs and sang so mournfully that all the nymphs and gods wept. On their advice, Orpheus travelled to the underworld and by his music softened the hearts of Hades and Persephone, who agreed to allow Eurydice to return with him to earth on one condition: he should walk in front of her and not look back until they both had reached the upper world. He set off with Eurydice following and in his anxiety as soon as he reached the upper world he turned to look at her, forgetting that both needed to be in the upper world, and she vanished for the second time, but now forever.

Thoughts on an Image:
The image of descent, then, or "going down" is very significant. As I write I think of the many resonances in my mind of what "going down" means: sexual, carceral, spiritual and philosophic. It is interesting to muse (I suppose that's the way one amuses oneself!) upon that famous Irish film "I went Down" (1997 - nearly 13 years ago - Good God, how time flies!) has the same resonances, too. That's the famous film that was directed by Paddy Breathnach and written by Conor McPherson that starred Brendan Gleeson, Peter MacDonald, Peter Caffrey and Tony Doyle. If you haven't seen it, get your hands on it and feast your eyes - the photography is done by Cian de Buitléir - Éamonn's son. Anyway, it's no surprise that McPherson should use such a connotative title as after all he is an M.A. from U.C.D. no less. I seem to recall from my distant philosophical studies that a few of the Platonic classics begin with the words "I went down" or, at least, certainly contain that motif. "Going down" is all about purification, all about renewing one's spirit, all about dying, or at least learning from experience to come to terms with what dying and death is all about.

Okay. Let me talk about illness now for a while. I have recalled my own illness when I was forty already many times in these pages, so I shan't bother the reader with it here again. However, I will remind you that anyone who has ever been seriously sick, and who has recovered that they face the world anew. They begin to see things from a different perspective, from a different optic, from a different viewpoint. They begin to live each day as if it were their last, or perhaps better, as if it were their first (just a change in perspective again!) You only get one chance at life, and if it's nearly taken away from you, you begin to value it more dearly. And so our sicknesses and our illnesses bring us down, and we should not struggle too much against them, but go with them, and then when it is time, we then begin to fight back and recover. You see, our illnesses teach us many lessons. It is said that the great Romantic poets like Coleridge, Wordsworth, and most certainly poor young John Keats could have written volumes on the subject. The Illnesses of The Romantic Poets would make a great title for a book. I wonder has it been written yet?

And then, our dreams come into play here. I suppose, to some extent, we dream with greater intensity when we are sick. Ask anyone who has been in hospital, or who has gone under a serious operation. Most of them dream very clearly indeed. In other words, dreaming is all part of the "going down" into the unconscious. I have written many posts about Freud in this blog prior to thus and you can hit the link for him on the right side of this blog to read more about this great man, one of the major founders of modern civilization with the great theoretical physicist Albert Einstein, who refused to let the great doctor psychoanalyse him, as like Joyce with Jung, he was afraid his gift of genius might abandon him. Our dreams tell us much about our fears and when we write them down, dialogue with their images and their meaning we become stronger and stronger. We begin to be able to face our fears head on, begin to be able to face and indeed fight our demons - again this is the really deep meaning of the myth of St George's slaying the dragon. We all have to become our very own St George and slay our very own dragon. Or, once again, let me use another image or metaphor - we all have to become our own David and slay our very own Goliath. Indeed, this last image came to me in a wonderful dream after I had stood my ground against a bully six years back. When I awoke and wrote the dream, and dialogued with the meaning of the image, I confirmed myself in my actions. I grew stronger. A few nights ago I dreamt that someone who is close to me had died, but I knew that he had not physically died. What had died was what he represented in my dreams. In like manner, I have already dreamt about the deaths of my mother and father, long before either of them had or have died. (My father dies in 1993, RIP, and my mother is still alive at 93, though she is completely happily demented, and smiles all the time because every minute of the day is new to her as her memory is wiped totally clean!)

And so "going down" to the underworld is not that bad at all. It's like jumping in at the deep end of the swimming pool without knowing how to swim - the wrestling with the water is frightening, but if we think rationally and let go our fear, we become calmer and can manage a few stokes to eventually bring us to safety.

In short, ascent or descent in dreams, often express direction in life. Ascent represents aspiration and achievement; descent may represent decline or failure, or it may refer to the transition into unconsciousness. Stairs can stand for deliberate, step-by-step advances, escalators for steady progress, lifts for instant transitions. If dream ascents or descents are interrupted or reversed, this can imply a need for the dreamer to reflect upon his or her life, or to try to change the direction in which he or she is moving.

Sunday, December 27, 2009

To Medicate or not to Medicate, that is the Question 2

In short, my argument in general is that both medication and psychotherapy work hand-in-hand and are complementary. Both/and, not either/or as I have argued above. Okay, there are some cases where psychotherapy alone will work, but for more complex cases and deeper suffering a combination of drug and talk therapy is needed. There probably are extreme cases also where no talk therapy could ever be used as the patient is too disturbed. But that is surely the exception.

What has brought all of the above to my mind? Well, I have been listening to an old broadcast, a podcast of an interview by one of my favourite broadcasters, Andy O'Mahony with Dr Daniel Burston, Associate Professor of Psychology at Duquesne University, Pittsburg, USA. The tenor of their discussions centred around the influence of these three great psychoanalysts: Erich Fromm, Erik Erikson and the famous Scot R.D. Laing on psychiatry in general and psychotherapy in particular. Erik Erikson (1902–1994) was a Danish-German-American developmental psychologist and psychoanalyst known for his theory on social development of human beings. Erich Seligmann Fromm (1900–1980) was an internationally renowned social psychologist, psychoanalyst, humanistic philosopher, and democratic socialist. Of R.D. Laing the WIKI has this to say:
Ronald David Laing (7 October 1927 – 23 August 1989), was a Scottish psychiatrist who wrote extensively on mental illness – in particular, the experience of psychosis. Laing's views on the causes and treatment of serious mental dysfunction, greatly influenced by existential philosophy, ran counter to the psychiatric orthodoxy of the day by taking the expressed feelings of the individual patient or client as valid descriptions of lived experience rather than simply as symptoms of some separate or underlying disorder. Often associated with the anti-psychiatry movement, he himself rejected the label as such, as did certain others critical of conventional psychiatry at the time. (see this link: Laing )
However, these three "greats" could be seen as viewing the client from a very wide model of therapy, not from a narrow pharmacopsychological one. O'Mahony and his guest began their discussions with the present reality or nature of teaching at third level, with both lamenting a certain deterioration of standards that have resulted in too high a level of grades being given out. Sadly, both also felt that there was a consumerist approach to education today, just as there is a consumerist approach to health in all its incarnations whether mental or physical. They then discussed Erich Fromm's marvellous division of the nature of authority into three types, viz., (i) Rational, (ii) Irrational and (iii) Anonymous.

The first of these three types, Rational Authority, teaches by example. It's an accountable authority which is transparent, never secretive or mystifying or confusing. In short it is a freeing and empowering authority that is not based on coersion. The second of these types, Irrational Authority thrives on secrecy and deception, and eventually perpetuates or continues conditions of inequality. Here, the lecturer or master is remote and superior and always remains so. I only experienced a little of this type of leccturing with a few individuals in UCd in the early 1980s. Thankfully, they were a rarity, though where they did occur, they left us students mystified and confused. Rational Authority, on the other hand, brings student and teacher onto an equal footing. (It's interesting that Fromm was talking with the Nazi or German Fascist Movement in mind.) The last of the three types, namely Anonymous Authority depends on the vagaries of the market. Here people are conformist in attitudes, opinions and actions. Also one gets such reactions as the fear of rejection, of not belonging in this type of authority as, in short, it is based on the principle of the herd mentality. Quite obviously, counselling or psychoanalysis would use a rational approach to authority, if it were to use any.

Erik Erickson was against the over-medicalisation of psychiatry. In this regard, Daniel Burston, laments a similar type of over-medicalisation in what he calls Polypharmacy. This is where a psychiatrist writes multiple prescriptions for a child. If the first drug they use does not work, these psychiatrists add another without withdrawing the first. They, then, Burston argues, keep going in this manner until the child is stable. Such use of "polypharmacy" is patently wrong. Now, the long term effect of these drugs on children is sketchy to say the least. Burston also feels that psychiatrists rush to diagnosis far too quickly with children. He believes that many psychiatric problems in children are more social or psycho-social, that is they result from bad parenting, break-ups of relationships and so on. A quick chemical fix is often the easy way out for everyone. That's why I expressed my fear in relation to one of my SEN pupils in the previous post. Perhaps in his case, the medical fix is the easy way out. However, I'm not 100% convinced either way, though I will remain open to the ideas and suggestions of other experts, both educational and medical.

Then they discussed the views of Dr. Joseph Biederman, who is Chief of the Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD at the Massachusetts General Hospital, and Professor of Psychiatry at the Harvard Medical School. Dr. Biederman is Board Certified in General and Child Psychiatry. Burston referred to the New York Times' declaration that Dr Biederman was/is in collusion with certain drug companies and that he had recommended the use or over-use of drugs for child/pediatric bipolar disorder (PBD). The discussion then ranged as far as a worrying modern tendency to tranquillize children "in utero." One gets the scent of the sulphur of some Huxleyan Brave New World here, does one not? See this link here: PharmaGossip . Then I read the following at Boston.com:

Home / News / Local / Mass. Senator broadens inquiry into psychiatrist Suggests MGH doctor was biased in research By Liz Kowalczyk Globe Staff / March 21, 2009 Email Print Single Page Yahoo! Buzz ShareThisText size – + Senator Chuck Grassley of Iowa has widened his investigation into well-known Harvard child psychiatrist Dr. Joseph Biederman, questioning whether Biederman promised pharmaceutical giant Johnson & Johnson that his research into the company's drugs would yield positive results before beginning the studies. Dr. Joseph Biederman last year was also accused of failing to make timely disclosures of drug company payments. Embattled psychiatrist The expanded inquiry is based in part on slide presentations that summarize projects at the Johnson & Johnson Center for Pediatric Psychopathology Research, a center at Massachusetts General Hospital that was funded by Johnson & Johnson and headed by Biederman from 2002 to 2005. (See this link here:Boston.com )

So it seems O'Mahony's guest, Dr. Burston, is not too far from the truth. One can only heartily declare with O'Mahony and guest that psychopharmacological interventions are very important indeed, but they must be ethically as well as scientifically controlled. We need to always direct our efforts, medical and psychotherapeutic, to getting at the root causes always, and that while medical interventions may control the symptoms, we do indeed need to dig deeper. Burston and O'Mahony are at one that the neglect of the ideas of the likes of the three great psychoanalysts alluded to in this and the previous post has indeed led to the phenomenon of OVERMEDICALISATION of our mental health problems in modern society.

I am also at one with both Burston and O'Mahony in their contention that R.D Laing was fundamentally correct , when in the tradition of Dr. Harry Stack and others, that if we are to help heal the psychoses of others, the healers themselves must be in touch with their own "psychotic side," not that they themselves should be going through a psychotic episode at the time obviously!

During this learned and deep interview there were also lovely throw-away remarks like: "We are all a little bit madder than we think, and also a little bit saner." Lovely! I also loved Laing's comment on schizophrenia: "There but for the grace of God go I," that is, we all share to some little or perhaps some greater extent in a common ground with our clients and patients, be they psychotic or neurotic. That's what I loved about R.D. Laing: he did sincerely believe in and sincerely did achieve in practice what he preached, namely that the psychiatrist, psychotherapist or psychoanalyst can communicate in a human manner with their patient. He really believed thoroughly in what Rogers called the healing or therapeutic relationship between doctor and patient or therapist and client.

I also loved Burston's insight into what so-called "normality" really is. He describes it in this interview as "just an assumption merely", "a cultural congruence" and a "statistical average" and that we must never forget that. We can then ask as to whether such "normality" is really set in stone for all time. Surely it can change also. And then, does normality change from society to society? And will it change with whims or fashions? The questions are legion, but highly important annd necessary. Such appeals to "normality", Burston contends, do not of themselves, "confer the benefits of robust mental health." With both O'Mahony and Burston, I, too, lament the demise of psychoanalytic psychiatry as practised in the 1950s and 60s. I, too, lament the fact that psycholanalysis has lost its place in the Social Sciences and that it has now migrated into the Humanities where it has become most eclectic indeed. However, I also share their interest in the work of the modern psychoanalysts like Jacques Lacan and Michel Foucault who both belong to the antipsychiatric pantheon.

In short, there is much wisdom to be gained and many insights to be had by listening to Andy O'Mahony's wonderful radio programme called Dialogue.