Facts and Pessimism #2
Monday September 24, 2007
Dear Ms. Miller and Ms. Rogers,
Thank you for your detailed and thoughtful replies. What I said was my own judgment on the issue of mental illness and brain dysfunction, after studying the matter from medical textbooks and journals during my medical training. However, I am not an expert on these matters and it is entirely possible that I am wrong. I will take a closer look at the links you gave me in the following days, but there are several points I want to clarify right away.
R.D. Laing, who has recently been mentioned on this list, would surely agree with Ms. Miller when she writes: "Where are the people with normally functioning brains?". Yes, scientific research suffers from lack of reliable control groups, as Ms. Miller points out, because "normal" people can be no point of reference. "Normal man have killed perhaps 100,000,000 of their fellow men in the last fifty years... Given these and other conditions of contemporary civilization, how can one claim that the 'normal' man is sane?" ( R.D. Laing, "The Politics of Experience", 1967).
The problem with scientific, quantitative research is that at best it makes us realize there is a CORRELATION between two things. It can show (and you say that it in fact shows) that child abuse and brain dysfunction are connected. Okay, let's suppose this is true. How do we know the MEANING of this correlation? Science cannot tell us that.
One explanation may indeed be that the brain lesions we discovered are the cause of our patient's mental problems. But it is also possible that the patient's mental problem is causing his brain to change, just as the denial of abuse can cause inflammatory bowel disease ( e.g. the story of Isabelle in "The Truth will Set You Free", part 1, ch. 1), a skin rash or heart disease.
Likewise, it may well be that the brain damage of victims will be found to be generally "irreversible". Is this the reason why most people are never prepared to admit their parents were wrong? Or is it the other way around? Can it be that stubborn, irresponsible denial of one's own past results in brain dysfunctions that never seem to improve? It is hard to imagine a set of experiments that can answer such questions.
Is it not best to base further research based on what we already know FOR CERTAIN? The predictable experience of the abused child, the resulting emotional blindness and suffering, the process of awakening from this blindness (as described in part II of "Banished Knowledge") - here we have a splendid description of an inner logic that every human being can test on himself and realize its truth first-hand. There is no confusion here.
As I see it, it is strange that a human being should use unbelievably complicated and expensive technical technologies just so he can prove to himself the truth he could find in his own heart. Everything that we need to know about our patients can be found in their personal histories. In my view, EEGs and MRIs will add very little to this knowledge.
Suppose we have a patient who was severely abused in childhood and we find a brain lesion in his MRI. What are we to do with this information? Will we operate on this lesion? Radiate it? Perform a lobotomy? Change it with psychiatric drugs? Of course not. It is already clear that these methods only cause damage. Will we be more prepared to believe the patient's claims that he cannot change? Maybe so. But what if the lesions happen to have nothing to do with our patient's running away from responsibility?
Again, how can we answer such questions? Why do they always cause confusion instead of clarity? We cannot draw any practical recommendation from the results of such experiments on patients, so there is little medical logic in performing them. And yet scientists keep on doing them. Why?
Information can be used for good purpose or for bad ones. I wrote the previous message because I wanted to warn the readers of the abuse of victims by the psychiatric establishment, abuse that claims to derive its legitimacy from precisely such research. Information is repeatedly presented to victims by their doctors and psychiatrists, about biological explanation to their feelings of rage and panic, instead of exposing the historical roots of these feelings. The doctors then use this biological information to convince the patients to take an antidepressant or another "biological" treatment.
The information is used with seemingly simple logic: biological problem - biological therapy. Most patients are not critical enough to realize it's false logic. The message the average patient gets from this kind of information is that he can do nothing to change his situation, and it often leads him to be pessimistic and skeptical toward psychotherapy in general. The result is also that the patient becomes dependent on his psychiatrist and drugs.
The fact that the information these psychiatrists cite is at best controversial, as I have tried to point out, only magnifies the scandal. But it would still be a scandal if the information were not controversial.
The main issue, as I see it, is not whether or not our patients have brain pathology. The issue is that asking such questions is itself a mistake, because the information we will get as answers will only confuse us and will never help us understand our individual patient. Furthermore, scientific debate in this field distracts our attention from the most burning questions, and here lies its greatest danger.
It is easier to ask questions about blood flows than to ask meaningful questions, such as "What and how much is done today to stop child abuse in my country?" Or "What do therapists contribute toward this goal and what do governments and policy-makers contribute in terms of education and legislation?" Question like "Do we unwittingly use prisons and psychiatric research and hospitals to silence the outcry if the abused and mystify it with technical language?"; Is the research our governments and industry sponsor the RIGHT kind of research we need to answer the questions that interest us?
As a physician I would first perform a neurological examination to my "mental" patients to detect any signs of nervous system injury. In most cases, no such signs will be found, and there will be no medical logic in further pressing the issue and exposing the patient to expensive and harmful brain studies, imaging or EEGs.
I will act on the assumption that my patient's problem is PSYCHOLOGICAL. I will tell him that this is my proposed diagnosis (diagnoses in medicine are seldom 100% certain), and that there are ways to heal these psychological effects of abuse, even if not perfectly or in every case.
There are case studies that demonstrate how patients who suffered unbelievably sadistic and violent abuse, that have had multiple personalities, schizophrenia and autism, managed to heal remarkably with the help of unusually brave and creative therapists. If I personally fail at treating a mental patient I will refer him to several other psychotherapists before I will resort to biological terms to explain the therapeutic failure, even if he was very badly abused.
When my patients will ask me about brain abnormalities I will tell them that this is possible and maybe even likely that they exist, but that nobody at present really knows, because we still know very little about the functioning even of the normal brain. I will recommend for them to stay away from brain research articles, because reading them will only dishearten and confuse them.
I will recommend that they focus on their personal stories, and learn from them to care for themselves in deeper and deeper ways. This is the only approach I believe can really help most patients break the vicious circle of violence and abuse, and to relieve their mental distress and physical symptoms. Today, even though most medical doctors meet so many victims of abuse every day in their clinic, it seems that very few physicians routinely focus on their patients' histories of abuse, or on their patients' inner world in general.
To serve the development of this kind of approach to patients, a small research into victims' inner worlds, memories and physical findings, as repeatedly reflected in readers' stories on this list, right here on Ms. Miller's site, can be far more helpful and informative than a thousand MRI and brain scans. And it will be informative in a much more MEANINGFUL and USEFUL way, too.
Why, then, are those millions of dollars invested in MRIs and not spent on more projects like this website, for example, or to finance large-scale educational campaigns for parents? Why are dangerous and outdated approaches, like psychoanalytic therapy, criminal prisons and psychiatric electroshock are continuously being supported and practiced? How much research is being done to establish alternatives to these approaches? What kind of information can help us and are we using the right methods to obtain it?
I personally believe that brain research has never given us meaningful answers and will never do, because it asks the wrong kind of questions. This is my personal impression, and it is entirely possible that in the future we will benefit from this kind of research and put it to good use - if it happens I will be the first to admit I was wrong.
AM: We seem to agree about the issue of therapy: that working on the own history is a way to healing the effects of child abuse and its denial. But there is still another question that bothers us and seems not to bother you, namely: Why is this knowledge (for us so easy to understand) globally denied, ignored, feared, and avoided? What causes this ignorance and blindness of abusers, cruel parents, doctors, lawyers, and why don't they understand the most simple connections? In our opinion they are hindered to understand by the lesions in their mind, caused by the fear of a tormented baby and toddler. Why can only very few people realize that spanking children produces a violent and sick society?
What do you answer to this question? Please, answer ONLY this one.