Dear Young Therapist: Are You Ready to Jump?

Hieronymus Bosch / The Stone Cutting / Prado

The anti-psychiatry movement has garnered increasing popularity within the last few years. Criticisms have been lodged against the medicalization of the human experience. In particular, many observers have noted the increasing movement toward pathologizing human suffering and categorizing that pain as a psychiatric disorder requiring medical intervention.

This phenomena isn't particularly new. As long as we've had emotions, we've sought ways to control experiences that are viewed as unpleasant, unwanted, or otherwise out of the norm. Starting in at least neolithic times, we attempted to drive out unwanted behavior through trepanning--drilling burr holes into the heads of those suffering. In fact, it is still occurring, assuming this website isn't some sort of strange parody. In our quest to help alleviate suffering we've also tried hydrotherapy, cold wet sheet packs, continuous baths, hot boxes, metrazol therapy, insulin induced shock, electroconvulsive shock, magnets, and lobotomies. 

Ouch.

I've worked with clients who have undergone all of these treatments with the exception of trepanning. I'm not that old. The video below offers glimpses of many of the various treatments. 

And then there is psychotherapy. So many kinds of psychotherapy.

The director of training of my postdoctoral fellowship, Joseph Shay, once handed us a list of every type of therapeutic intervention for mental illness that he could find. It ranged from some of the ones mentioned in this YouTube clip, to primal scream therapy, to dialectal behavioral therapy. We laughed at some and mostly we felt superior because we were being trained in the modern best practices.

As I've written before, Joe reminded us that in 10, 20, or 30 years we'd look back on our careers as psychologists and be horrified at what we thought constituted good therapy. Times change. We move forward. Joe taught us to remember that we have always tried our best to help, we can only help in the ways we know, and we can only know what we know when we know it.

We get better.

Back to the Future: Thorazine for Sanity

healing or control?

I sat around in a circle with my cohort of post-doctoral fellows appropriately snickering. Our training director, Joe Shay, had distributed a list of hundreds of different types of psychotherapy. Many of them were laughable, sad, or just outrageous. How could anyone have practiced these therapies with a straight face? Didn't they know they were quacks?

With our recently minted doctorates in hand, we all looked smug and self assured. We were training to practice dialectal behavioral therapy--the state of the art treatment for people diagnosed with borderline personality disorder. Our mentors were elite luminaries in the field.  Our offices were in the heart of Harvard Square in Cambridge Massachusetts. I felt I arrived in the liberal elite intellectual promised land.

With a deft few words, our training director swept away my smug look of superiority and taught me an enduring lesson. This post today is what I came to know in thinking about Joe's lecture that day.

People have come for treatment for hundreds--if not thousands--of years for phenomena that we currently call borderline personality disorder. People have turned to shamans, priests, friends, psychiatrists, psychologists, and others to receive treatment. Many have gotten better. Some have not.

I walked into that training room as a post-doc thinking I was learning a superior treatment. I couldn't imagine that the treatment I was providing--DBT--could ever be viewed as ridiculous, barbaric, old fashioned, or just plain weird. I could never be seen like those people we were learning about in Joe's lecture. We were better. I was better. These are modern treatments.

As many do, I failed to look forward. I failed to account for the fact that society is evolving. What one considers humane now, will be inhumane tomorrow. What are considered unquestionable facts today will be seen as antiquated examples of magical thinking tomorrow.

I will become a dinosaur one day. The way I practiced psychology will be looked at by some (if I am even remembered) as laughable--or worse.

I had this in mind yesterday morning while I was looking at vintage advertisements for Thorazine.

Blowing Smoke Up There: Smoke Enemas

I'm sure you've said it before. I'm also sure you are guilty of doing it, too.

Have you ever wondered where the phrase "you're just blowing smoke up my ass" came from? During a recent adventure though the internet I've uncovered some images of medical devices used for smoke enemas. This apparently was a thing.

Who knew?

Appropriated from the native peoples of North America, this medical technique was used to treat a panoply of conditions such as drowning, gut pain, and hernias. My sources suggest that smoke and liquid tobacco enemas started a long slow decline in popularity beginning in the early 1800s. The treatment, however, persisted well into the early 20th century. 

Photos, of course.