Dave: I have mentioned one of my fundamental assumptions more than once: Everything we consider psychopathology is grounded in interpersonal experience, until proven otherwise. In my work as a Family Systems Psychiatrist this is the mindset I start with in all clinical situations.
When I say this to an audience, whether professionals or a community group, inevitably, within 2 minutes, someone will ask, “What about schizophrenia?” I assume it to be true about schizophrenia. I assume it to be true of bipolar disorder, ADHD, depression. I am not stating this as an absolute, I am saying it to stimulate reflection in the listeners (and in myself). I am telling you this as a counterbalance to the current cultural myth that psychopathology is the manifestation of some yet to be measured “chemical imbalance”. This is where I begin when I am working clinically. Why? Because, if the psychopathology is grounded in interpersonal experience, then I can treat it by “figuring out” and working on the patient’s interpersonal experiences. Amy Begel did this with her depressed woman. I gave an illustration of this process in my thoughts about ADHD and medications.
Where does this assumption come from? It came from doing a lot of clinical work with schizophrenics and with children, with suicidal patients and with serious, disabling psychosomatic troubles. It also comes from endless conversation with my now-deceased colleague, Carl Whitaker, M.D.
I entered Psychiatry in 1971. I can’t remember if that was Psychiatry’s Golden Age, or was it the Dark Ages. One of the professors in my residency program was Carl Whitaker, MD, a psychiatrist known for his work with schizophrenic patients. At the time he had evolved into working with families; regardless of the presenting problem of any patient of any age. He became a mentor, a cotherapist, a coauthor and ultimately I had the good fortune to count him among my closest friends.
As a way to attune you to what we are attempting to do with our Relationship Rhythms blog, I am going to share a long excerpt from Dr. Whitaker’s book, Midnight Musings of a Family Therapist ((1989), New York: W.W. Norton & Company).”
This is Dr. Whitaker’s voice. “I have become convinced that my orientation, which has emerged out of many years of treating schizophrenics, has evolved a peculiar definition of health. I have become convinced that the socially adapted citizen—the culturally adjusted individual—is essentially duplicitous. He lives the socially dishonest game, making believe that his vision of the world and the vision of the world held by other people is identical, that altruism is a valid concept, and that the people who practice dishonest politics are really unusual. My conviction is that we are all as dishonest as the standard politician; we are all talking out of both sides of our mouths, making believe that we are not the center of our own worlds. We carefully conceal our personal lives and maintain an artificially constructed social facade that is essentially dishonest.
Concomitant with this viewpoint is my conviction that psychopathology is proof of psychological health. The individual who is distorted in this thinking is essentially carrying on an open war with himself rather than capitulating to social slavery. His delusional system and his hallucinations are a direct result of this war with his lifetime situation—the stresses of his living and his efforts to defeat those stresses rather than become a non-person and a social robot. Schizophrenics are individuals who are pathologically determined to live up to their own worldview. They have a disease of abnormal integrity they are trained to be scapegoats; whether heroes or villains, they dedicate themselves to trying to change the world and trying to massively disturb the system that so duplicitously surrounds them.
I believe that the depression we view as individual pathology is actually a response to a real perception of the pathology in others. It is an effort which is recognized as a failure to do something about the pain in the world…”
This is an alternative, unconventional way of thinking about complex experiences. I hope you find it interesting. Feel free to read it more than once.