Yesterday, I blew it. Though I think you'll understand.
I mistakenly gave Tufts University School of Medicine professor and psychiatrist Dr. Ronald Pies credit for the charming Random Wit and Wisdom quoter.
In an email on Thursday afternoon, he was quick to correct me, claiming that he wasn't responsible for this little device that turned up on a website where he used to answer questions as the resident expert. The column is no longer active, though you can still view his 2001-2004 archive of questions and answers at Ask The Expert/Mental Health and, of course, the Random Wit and Wisdom is there and a great little pick me up.
Example, apropos of today's economy: "To know you have enough is to be rich."
I'm happy Dr. Pies corrected my mistake and I respect him even more for his honesty.
Yesterday, he wrote: "I always joked to my wife that the column should have been called, 'Ask the So-called Expert', since none of us (as we discussed) has all the answers. The human mind and soul are far more complex than we know, as you have pointed out. In any case, I thank you for your appreciative comments and look forward to Part Two."
Well, Dr. Pies, here goes! Part Two.
What I appreciate so much about you and your approach is that you're a thoughtful and insightful psychiatrist willing to accept that psychiatry doesn't know everything and have all the answers.
What we know as mental illnesses or "the big 3" as he calls them – schizophrenia, bipolar disorder and major depression – is that their causes "are a very complex set of variables: genetic, intrauterine, biochemical, environmental, social, cultural, and certainly, 'psychological' (you will see presently why I put this in quotes)," wrote Dr. Pies.
This is such a rarity in this profession, from my perspective. I have interviewed dozens, perhaps hundreds of psychiatrists in my career and most tend to be arrogant and very certain about what they promote as "the answers." This certainty has always made me uncomfortable. How can there be certainty about "the mind"? About human behaviour? About the uncountable variables that influence how people perceive their reality.
We all perceive the world and our own world uniquely. It's not seeing is believing, but believing is seeing. What we know changes the way we see the world and ourselves in it. How can there be certainty about that?
Dr. Pies wrote, "It is unlikely that any one of these factors alone (genetic, intrauterine, biochemical, environmental, social, culture, 'psychological') could account for most cases of these illnesses. Just to cite one concrete example: we know that in identical twins – even when raised in separate households – the 'concordance rate' of bipolar disorder (the chances that if one twin has the condition, the other will, too) is upwards of 50%."
My question is, and his too, is that why isn't it 100%? What about the other 50%? That's a major unknown.
Dr. Pies rightly insists that, "We must be missing something! No doubt the other factors (besides genetic ones) are operating in some mysterious way.
That mystery is, I think, that we are all unique and unclassifiable. That labelling us is more damaging than what we're labelled with. We internalize those labels. They haven't help rid the world of fear and ignorance of "mental illnesses" or prejudice and discrimination against those of us with those labels or diagnoses.
The solution has created another ill. Is it possible that the labelling, the diagnostics outlined in any psychiatric classification system like the Diagnostic and Statistical Manual of Mental Disorders cause a more serious problem than the disorders those labels or diagnoses describe?
And there are so many. One for every kind of behaviour. Normal? What's normal anymore? How can medications solve these mysteries, even if they are, as Dr. Pies describes below, "bridges" to feeling better?
He writes, "As for the role of medication, no competent psychiatrist would assert that these are somehow curative for any major mental illness; alas, we really have no "cures--at least, not yet.
"I agree with you that medication is no "panacea." I agree that they are but one "tool" in the therapeutic "tool box" to extend your metaphor. In fact, I nearly say the same thing – using a different metaphor – in another essay I wrote on the PsychCentral blog site, which may also be of interest. I write:
"Psychotropic medications, as I tell my patients, are neither a crutch nor a magic wand; they are a bridge between feeling bad and feeling better. The patient must still walk — sometimes painfully — across that bridge. This means doing the hard work of changing thoughts, feelings, and behaviors. Medications can often aid that process, and are sometimes needed to get the patient’s work in therapy moving."
The problem is that too many people are only given medication and no other therapy. Pills they think will "cure" their problems. Are there "cures" or simply ways of meaningfully living well with one's condition. Managing it. Pills don't give you those skills and we are a pill-popping society. We want the quick fix and aren't interested in the years it takes to work through all those other "factors" that may have made us the unique individuals we are.
The media doesn't help. For the most part, the media instantly and thoughtlessly trumpets inaccurate messages about how violence and mental illnesses go hand in hand. This is wrong.
But, it's another quick and easy assumption. Blame people who have no voice and cannot speak for themselves. The status quo!
Recently, Liz Spikol, executive editor of the Philadelphia Weekly in her award winning bipolar blog, The Trouble with Spikol asked her readers to weigh in on which of the following words were most offensive when used in a "punny" headlines in a newspaper?
"Madness. Insanity. Crazy. Lunacy. Madhouse. Bedlam."
Context is everything. None of these words bother me in and of themselves.
However, if they are used to describe someone who has been arrested for some alleged act of violence, I say, they are more than offensive in a newspaper headline or story. To use any of these words is not only misleading, it is morally and ethically wrong. A serious crime that can have irreparable consequences to the person it may be describing.
Instead of educating the public, the media insists on perpetuating potentially dangerous misinformation.
What right does a headline writer have to diagnose another human being? Or a police spokesperson?
Psychiatric diagnostics are far from objective. At best, it takes years of training and no headline writer, anywhere, has that training.
Dr. Pies continues...
"'Wellness' – in the full, humanistic sense of the word – requires, as you suggest, more than just medication – though sometimes medication may be the "bridge" to wellness.
"And, yes, certainly: peer support is important, and I believe the "recovery movement" has some very positive features (though some advocates seem to have a strong anti-psychiatry stance, and believe that psychiatry has little to offer them – which I believe is an unfortunate, even if understandable, position)."
Recovery, I would add here, involves much more than peer support.
Dr. Pie writes, "My personal view is that 'mind' and 'brain' are not two different things; rather, what we call 'mind' is essentially the faculties and functions of brain (a view that actually goes back as far as Aristotle, and is also found in Spinoza). But in our everyday work with those who suffer with mental illness, it is important to address many 'non-biological' aspects of the patient's experience, including creative and spiritual strivings – certainly, there is much more to understand than merely the function of the patient's neurons!
If you want a fascinating discussion on this, have a look at Dr. Pies paper The anatomy of sorrow: a spiritual, phenomenological, and neurological perspective in the journal Philosophy, Humanities and Ethics in Medicine or PHEM.
"Moreover," notes Dr. Pies, "I believe that spiritual and philosophical approaches can sometimes do more than psychiatry alone can do, as I try to illustrate in my book, Everything Has Two Handles: The Stoic's Guide to the Art of Living (Hamilton Books).
"I hope this long-winded response at least explains my position to some degree, and why I believe that psychiatry is, in its heart and soul, a humane and broad-based discipline. That serious error and even mistreatment have occurred in its name, I do not deny. But I believe that these failings have Occurred despite, not because of, the ideals and paradigms of the profession."
I cannot agree more, Dr. Pies, which is why I continue to see my psychiatrist, and we continue to work on my "creative and spiritual" and I would add "emotional" strivings or, as Dr. Bob calls them, "the old records," that continue to play and perplex me.
That's it for now, Dr. Pies. Here's to our continuing the dialogue.