"Schmoozing" with Ron Pies, M.D.

As many of you know, through this blog I've developed a friendship with Boston's Tufts University clinical professor of psychiatry Dr. Ron Pies. He's also a psychiatry professor and lecturer on bioethics and humanities at the S.U.N.Y. Upstate Medical University in Syracuse. Plus he's editor-in-chief of Psychiatric Times. 

Dr. Pies is a polymath.

He's written a novella based on the life of medieval physician-philosopher Maimonides who believed that "the physician does not cure the disease, he cures the diseased person."

As well, Dr. Pies has had several psychiatric textbooks published along with a volume of poetry, Creeping Thyme, a collection of short stories, Zimmerman's Tefilin, and Everything Has Two Handles – The Stoic's Guide to the Art of Living. 

This charming slim volume of essays weaves together the ancient wisdom of the Greek Stoics and many great Eastern and Western philosophical thinkers with his own insights drawn from years of psychiatric practice – case histories of real people. He demonstrates how Cognitive Behavioural Therapy – a psychotherapeutic approach based on rational thought and understanding the present – offers helpful tools in coming to terms with emotional difficulties. I've found his book to be endlessly re-readable and a great tonic for sleeplessness.

(NOTE: It's unavailable through Amazon.ca or Amazon.com. However, you can buy it online at Barnes and Noble.com and it sure beats medication.)

My psychiatrist Dr. Bob and Dr. Pies come from similar schools. Dr. Bob blends this rational approach and a psychoanalytical bent in his therapy with me. It works wonders.

Last night, I read the short chapter on "Morality and Self-Respect" and, to quote Marcus Aurelius – "I do my duty. Other things, trouble me not." 

Dr. Pies often illustrates the Stoics ideas with practical contemporary examples, in this case a woman who couldn't do enough to satisfy her mother – a problem I've had. 

Do I want to lose my soul in trying? No way. So, after reading Dr. Pies and the ancients, I fell asleep peacefully with the words of Epictetus ringing in my ears: "If you fulfill your duties, you have what belongs to you." Or as Dr. Pies suggests, "the only real possession to which we may lay claim is our own moral integrity. Everything else in life either belongs to someone else or is beyond our control."

How did Dr. Pies and I meet? Well, to be honest, we've never met. And until last night at 7:30 p.m., we had never even spoken on the telephone. I had never heard his voice, though I feel very close to this man. 

Our friendship began when I misinterpreted him in a September 26, 2008 post I wrote about an article of his in The New York Times on depression and grieving.

He commented, correcting me in a very gentlemanly way – very gently and thoughtfully. And I wrote back. Thus began our correspondence. 

On two occasions, I've written lengthy posts about Dr. Pies and his wit and wisdom. From time to time, he often enters into my posts with a thought, a nugget of wisdom or in many instances, the support he is so generous in giving. His words speak volumes because he is so wise, well-read, and open-minded. He also willingly acknowledges that modern, contemporary psychiatry may be losing sight of its roots – a belief to which I subscribe. Where other practitioners in his profession are blinded by their current intoxication with the neurosciences, Pies is not. He's endlessly curious and willing to learn and keep on learning – a real signal of wisdom.

Our correspondence has lasted for almost a year, during which he has opened my eyes to many truths about his world of psychiatry and psychopharmacology. I've learned so much from him. And I suspect that I, too, have given him some interesting perspectives to ponder. We don't always agree, but we can easily agree to disagree. With respect.

His post The "McDonaldization" of Psychiatry: Psychiatric Knowledge is Not the Equivalent of "Fast Food" in the Psychiatric Times blog The Couch in Crisis is a perfect example of this thoughtful self-analysis. It's a studied critique of today's psychiatric paradigm.I urge you to read it if you haven't already.

What better metaphor for the current "norm" in psychiatry than fast food and its "McDonaldization" – 20 minute diagnoses, 15 minute-appointments featuring a prescription pad more than a willingness to listen and engage in any form of talking therapy or psychotherapy. 

What I have never understood is why psychic healing is supposed to happen fast. We didn't become emotionally disturbed fast. Often, it takes years, especially if trauma is involved. I'm in no rush. My healing is going to take a lifetime. I'm always learning and healing – becoming more and more whole.

Also, and I love this in Dr. Pies. Like me, he is fascinated by etymology – the study of words. He pointed something out to me last night, during our pre-arranged telephone conversation. I've often said that there's a world of difference between "doctoring" and "healing." The words are interesting. Doctor means teacher. Healer derives from the  Old English or Germanic origin "heilen" which means "whole."

Have you ever considered the word "physician," he asked? 

No. I had not. He explained that "physician" means "a person qualified to practice medicine." I looked it up myself and found as well that it also means, "a healer, as in physicians of the soul." The origin of that word is from Old French – "fiscien," based on the Latin "physica" which means – "things relating to nature" or as he put it, "assisting nature."

I wonder if all these medications, these drug cocktails too many psychiatrists prescribe these days – the main tool in the modern psychiatrist's toolbox on this continent – are assisting nature or impeding it. 

What do these drugs do for the soul?

As I've often said, you'll find no insight in a pill bottle. I am not angry at psychiatry nor I do not believe in throwing the baby out with the bath-water. All knowledge is useful, depending on how you choose to use it and what you choose to use. Psychiatrist Sigmund Freud had enormous contributions to make, as did R. D. Laing and Philip Thomas who subscribes to "Critical Psychiatry."

I use one medication everyday. In 1988, it stopped, cold, my severe annual manic episodes. I take one 200 mg tablet of the anticonvulsant Tegretol morning and night. It stabilizes my manic mind. I can live without it, but I'm better with it. And it's perfectly innocent for me. I have no side effects whatsoever. It suits me. (Unlike Lithium, which for me, was toxic and destroyed my kidney function because my psychiatrist at that time neglected to monitor it. Be sure yours is monitoring you!)

But Tegretol hasn't given me insight or healed my soul. Dr. Bob has helped me to do that. And my loving husband, the first person on the planet who has ever loved me unconditionally.

I find other ways to peace of mind, too. Like reading Dr. Pies. Our easy and relaxed conversation will continue in the future. I'll keep you posted. 

Do whatever you have to do to wake up in the morning feeling happy to greet the new day.

All the best. Happy Canada Day!

Comments

[Sonia]

Dr. Pies, Dr. Bob, Sandy & readers,

I applaud you in your courage to stand "outside" the mainstream psycho-pharma-copia ... as Sandy has so eloquently stated, some drugs work for some people some of the time.

When I was referred to a psychiatrist in the mid 1980s, he took one look at me, took out his pad, scratched something on it and told me to "get this, and see me next month" ... I looked at his piece of paper and made up my mind. The damage done had taken years, not drugs. The healing would also take years, not drugs. I never saw him again.

I have since found that some vitamin supplements help to stabilise mood swings, appetite swings, among others.

Here's my question: I have "worked" in English on many of the difficulties that have come up over the years. That has helped alot. However, this year, I discovered that this "English" work has not touched those events that took place in "not English" environments. I have searched for studies or other papers published (in non-medical terms) on the topic of language-specific talking / healing therapy with very little success. Can you - three great sources of knowledge - recommend some "light" reading (pun intended).

Thank you,

Sonia

[Sandy Naiman]

Hi Sonia,

That's a great question. I really can't answer it myself, but I've forwarded it to both psychiatrists and will await their thoughts. Dr. Pies is in transit right now, so it may take some time.

I hope you will be patient. I know he'll come through.

Take care.
sln

[Ron Pies MD]

Hi, Sandy and Sonia--First of all, thanks so much for the kind comments, Sandy. And, I fully agree that "healing" as part of good medical/psychiatric care requires addressing the whole person--and this can't be done simply via medication, even though sometimes, medication is helpful or even necessary.

Re: Sonia's bi-lingual experience in therapy: this appears to be a subtype of what is sometimes called "state-dependent memory" or "context-dependent learning." One person who has written about this is Jeanette Altarriba at
University at Albany. I am quoting from her chapter, below:

Language, Culture, and Emotion

Researchers have noted that emotions are often shaped by the social or cultural context in which they are experienced rather than being the result solely of biological determinants (see e.g., Campos, Campos, & Barrett, 1989; Lutz, 1988). Kitayama and Markus (1994) noted that cultural processes work to organize and structure emotional experiences and that descriptions of emotions may vary greatly cross-culturally. In fact, anthropologists have specified a category of emotion called indigenous emotions-those that are non-Western and have no clear counterparts in the West (Doi, 1986, 1990). In a therapeutic setting, for example, emotions are most commonly expressed using language and language labels. Therefore, emotion and culture are closely intertwined and can likely best be examined through the use of the language in which they are expressed. The following sections review the literature on how emotion is coded and used in therapeutic sessions, how descriptions of emotions are tied to the language in which they were experienced, and the implications of switching between languages when discussing emotionally- charged experiences.

http://www.ac.wwu.edu/~culture/altarriba.htm

You can read much more about this phenomenon by going to the full article, Sonia. I think it will help explain your experience with English and non-English therapeutic contexts. --Best regards, Ron Pies MD

[Sonia]

Dr. Pies & Sandy,

Tank you for the source ... validation is a healing experience in this context.

[Sandy Naiman]

Hi Dr. Pies,

I want to thank you for answering Sonia's question so thoughtfully and quickly. I've bookmarked that article and plan to read it, too, as part of my education. I know you're travelling and will be teaching this summer, so I really appreciate the time you took to comment and I'm sure there are others in our community who may find the Altaribba research useful and helpful on their healing journeys.

Have a wonderful summer. I continue to find enormous emotional sustenance in your book. Life can throw you unexpected challenges. This bedside companion is a great philosophical and practical tonic for my peace of mind.

Take care and be well.

Cheers,
sln

[Dr. Jeanette Altarriba]

Hello everyone!

I'm pleased that our work has had an impact on many of you.

I have worked in the bilingual realm for many years and have been working more closely with mental health professionals developing the notions of "bilingual therapy," writing and speaking about those notions, and lending my expertise to individuals in a variety of settings.

I have several related articles in PDF format that I'm happy to share:

ja087@albany.edu (third character is a zero).

I'll be presenting some of this work at a forthcoming conference in Madrid on clinical linguistics and can pass along that paper, as well.

Email me! Fascinating topic!

Thank you for honing in on our contribution.

Dr.Jeanette Altarriba

[Sandy Naiman]

Dear Dr. Altarriba,

Thank you, belatedly, for contributing to this dialogue and so generously offering to share your research with us. This, as you say, is a fascinating topic and I know your articles on "bilingual therapy" research will help many people who read this blog. We live in a bilingual country, after all, and Toronto is a highly multicultural city.

I'm thrilled that you've joined this community and I know we would be most interested in hearing about your upcoming conference in Madrid and the paper you're presenting there.

Take care and safe journey.

Cheers,
sln