Psychobattery: A Chronicle of Psychotherapeutic Abuse

251 Pages·1981·11.13 MB·English

by  Therese Spitzer (auth.)

Psychobattery
A Chronicle of Psychotherapeutic Abuse
I will use treatment to help the
sick according to my ability
and judgment, but I will never
use it to injure or wrong them.
-Hippocrates
PSYCHOBATTERY
A Chronicle of Psychotherapeutic Abuse
by Therese Spitzer
With medical discussion by
Ralph Spitzer, PhD, MD
Foreword by Joseph Needham
Humana Press. Inc. • Clifton, New Jersey
Dedication
To those humane and scientific
doctors and nurses who believe
that sound medical treatment and
compassionate care are the sine
qua non of treating the mentally ill
Library of Congress Cataloging in Publication Data
Main entry under title
Spitzer, Therese.
Psycho battery, a chronicle of psychotherapeutic abuse.
Includes bibliographical references.
I. Mental illness-Physiological aspects-Case
studies. 2. Psychotherapy-Complications and sequelae
Case studies. 3. Diagnostic errors-Case studies.
I. Spitzer, Ralph. II. Title. [DNLM: 1. Psycho
therapy-Case studies. WM420.3 S769p]
RC455.4.B5S64 616.89 79-92083
ISBN-13: 978-1-4612-5999-2 e-ISBN-13: 978-1-4612-5997-8
DOl: 10.1007/978-1-4612-5997-8
© 1980 The HUMANA Press Inc.
Softcover reprint of the hardcover 1st edition 1980
Crescent Manor
P. O. Box 2148
Clifton, NJ 07015
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted, in
any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher.
Table of Contents
Foreword, by Dr. Joseph Needham .................. VB
Medical Author's Note to the Reader,
by Dr. Ralph Spitzer ............................. xv
What Psychobattery is About ......................... 1
Savage Encounter ................................... 8
Primal Scream ..................................... 21
The Mystery of Lithium ............................. 39
The Biology of M ental Illness ........................ 54
Facing Reality ..................................... 78
Treatment by Assault ............................... 90
The Identity Crisis in Psychiatry ...................... 99
Psychotherapy is Forever ........................... 112
Treatment by Incarceration ......................... 126
The Family is the Patient ........................... 138
The Identified Patient .............................. lSI
Anorexia N ervosa ................................. 162
Suicide ........................................... 174
Warning: May be Harmful or Fatal if Swallowed ...... 194
Erewhon Revisited, A Psychoparable ................. 212
Bibliography ...................................... 227
v
foreword
It is an honour for me to be asked to contribute a foreword
to the book of my friends Therese and Ralph Spitzer. I got to
know them during an assignment as Visiting Professor at the
University of British Columbia at Vancouver, and I have
shared to the full the distress that comes to all those who have
to watch people that they love affected by mental illness in one
form or another.
I have been an orientalist for only half my life; for the first
half I was a biochemist, embryologist, and experimental
morphologist. "When I, a young man, was called to the bar" (as
Gilbert & Sullivan have it), in other words, when in the early
twenties I was starting life as a research biochemist, I was
greatly attracted to the biochemistry of mental disease. I
followed the lectures for the Diploma in Psychological
Medicine, and worked at the Fulbourn Mental Hospital near
Cambridge on the creatinine metabolism in catatonic patients
suffering from what we used to call in those days dementia
praecox. I published one paper (with T. J. McCarthy), but my
hopes soon faded, and when I read an excellent review on the
subject which covered much literature, and ended by saying
that biochemists had grown tired of "fishing in distilled water
for the causes of mental disease," I realised that I had better
find something more worthwhile. Eggs and embryos were the
answer, and very worthwhile they were.
But the decades passed, knowledge increased, and the
time came once again when I felt that any young man would be
vii
viti foreword
very well advised to go in for neurological and psychological
biochemistry. Contemporaries of my own, like Derek Richter
and J. H. Quastel, had made pioneer discoveries, and vast new
fields were opened up. I followed from a distance the new
developments in neuro-anatomy and -physiology, the plotting
of previously unimagined neuron connections, often by such
delicate methods as fluorescence, and the revelation of pain
and pleasure centers in the midbrain, or clumps of neurons
concerned with analgesia or hyperalgesia. Gating theories
threw light on the perception of pain and its inhibition, and the
peripheral connections of the cerebral cortex were mapped
out.
Even more revolutionary were the advances in
neurochemistry. Many enzymes characteristic of the brain and
neural axis were discovered, and, equally important, many of
those small molecules that we now call neurotransmitters
serotonin, 'Y-aminobutyric acid, dopamine, and the like. When
I was a medical student, and used to make models of the spinal
cord in plasticine, we thought entirely in terms of wire and
cable connections, a Post Office telecommunications view, but
not we know that the whole nervous system is a mass of minute
chemical factories, with the dendrons producing puffs of many
different substances acting on the next neuron across the
synapse down the line. Otto von Loewy was the father and
mother of all this, with his discovery of the effects of
acetylcholine on the heart muscle; and now for decades the
distinction between cholinergic and adrenergic nerve endings
has been a commonplace. Only in the last few years, however,
has come the exciting discovery of the endogenously produced
opioid peptides, the enkephalins and endorphins, with all their
functions, not only in control of pain but probably in many
other forms of control and drive also. Yet another chapter has
been the unfolding of knowledge about the psychotropic
drugs, the hallucinogens, the mood changers (tricyclic and
other antidepressants), the tranquilisers, the narcotics and
Foreword Ix
quasi-narcotics-a whole laboratory shelf of powerful agents
ranging from the violently dangerous to the enormously
beneficient. And some there are too, such as the lithium salts,
so valuable in the manic-depressive states, for which as yet no
clear theory of action exists, unlike those others which act quite
simply as monoamine oxidase inhibitors and so conserve the
needed neurotransmitter molecules. And all this is to say
nothing of the clearly visualised but yet little known effects on
the brain, and hence the mind, of the many hormones of the
body, including the newly discovered but powerful
prostaglandins.
In parallel with all this there developed the psychological
approach, also since the twenties. I always believe that I was
fortunate in being a student when A. G. Tansley was
expounding the ideas of Sigmund Freud to English readers.
The New Introductory Lectures I devoured on the long
transatlantic sea-voyages of those days. At the B.A. 's table at
Caius we talked exclusively of Oedipus complexes, anxiety
neuroses, penis envy, and Jungian archetypes, and I believe
that this familiarisation was profoundly beneficial to me;
otherwise I could have been very alarmed by psychological
phenomena that I experienced as I grew older. The Psycho
Pathology of Everyday Life was assuredly a great help for
many people. I believe that Freud, Adler, and Jung were men
of the deepest insight, as revolutionary and liberating in their
way as Darwin, Marx, and Huxley had been before them, and I
believe too that the cathartic method has been in some cases
veritably therapeutic. Subsequent generations, however,
developed methods of much more dubious value, greatly in the
public eye, and also in psychiatric practice, at the present day. I
refer to that sociological psychiatry which sees everything in
personal and familial terms, or the group therapies and
encounter groups of so many kinds. We may certainly grant
that society is far from ideal anywhere, indeed itself deeply
sick, especially in the Western world and parts of the Third, but
x foreword
it is not something that the individual citizen, however
mentally ill he or she may be, can totally contract out of.
Looking back, I do not think that the purely psychological
line of development has anything like the achievements in
assured knowledge to its credit which the neurophysiological
and neurochemical has, elementary though our understanding
is, and for long to come will be. And yet there is a certain
dogmatism that insists the troubles of the mind can only be
dispelled mentally. This is a denial of the psychophysical
interrelation, the organic character of human beings. I suspect
also that this prejudice has its roots in a Christianity too much
infected by Manichaeism and Gnosticism. "People think of the
soul" wrote Middleton Murry, "as if it was a superior little
gentleman living on the top floor of a disreputable block of
apartments." The philosophia perennis of China, always
unwilling to separate spirit from matter, never fell into this
damaging trap.
What the mind really is, I do not pretend to know. I
accept, however, as the only reasonable working hypothesis
that all mental events are accompanied by concomitant
physicochemical events, even though it will probably take
mankind centuries yet to achieve an approximate comprehen
sion of this. At the same time it seems to me that the
disturbances inducing mental illness may arise either from the
socio-mentallevel or from the physicochemical level. After all,
the same could be said of corporeal illness, for gastric or
duodenal ulcer may well follow excessive societal strain,
though that could probably not put the interstitial cells of the
pancreas out of action. Psychosomatic medicine has certainly
come to stay in the West, though the medical systems of Asia
have always recognised it. As William Blake wrote nearly two
centuries ago:
Man has no Body distinct from his Soul; for that called
Body is a portion of Soul discerned by the five Senses, the
chief inlets of Soul in this age.
foreword xl
The idea of the psychophysical organism was never better
expressed. And if mental illness may originate either from
"above" or from "below," as it were, I am prepared to believe
that it may be cured either from above or from below, either by
judicious psychoanalytic procedures or by neuropharma
cology. Some sort of place must also obviously be left for the
phenomena of "faith-healing," difficult though they are to
document or to reproduce.
The ocean of troubles described in this book of the
Spitzers arises largely from the crass stupidity and gross
dogmatism of those who insist that one explanation, one
therapy alone, is right. And it must be admitted that most of
these doctrinal bigots are on the pharmacophobic side, not the
pharmacophilic; in other words they believe they can handle
the mind while despising the atoms and molecules with which it
is indissolubly associated. As Cheng Ming-Tao said in the 11 th
century:
Those who strive to understand the high without studying
the low: how can their understanding of the high be right?
It has been my own fate to see individuals whom I loved
dominated by the evil power of mental illness. Dora (as I shall
name her) I knew first as a student at Girton. Then eventually
she married a young man in a government ministry and at first
seemed very happy. Some years later I remember sitting with
her on a bench in the Green Park in London and sensing that
something was profoundly wrong-only a few months later
she killed both her children and had to be certified insane. No
on was more surprised than her psychiatrist, who had
supposed she was suffering from mild neurotic symptoms.
Often have I wondered whether neuropharmacology could not
have prevented that tragedy. Many years later there was
Sophie, a learned and even eminent French scholar, who fell
into a deep depression with complete loss oflibido and suicidal
ruminations. Like so many humanists, and indeed ordinary
people today, she was a true pharmacophobe, and would