Introduction

The sad fact is that psychiatrists have very limited training in depth-psychotherapy,which requires a symbolic or metaphoric  “listening”, and a paradigm shift away from the medical model approach. Psychiatrists are medically trained and have medical knowledge for investigating and treating the patient. They are not trained to read psychological subtexts or meta-narratives.  Similarly, psychologists, if only trained in the humanities and not grounded in clinical experience , may hear the deep pain of the patient’s “soul,” but lose sight of the fact that medication may indeed be essential for relief of overwhelming symptoms.

I see very few patients, ranging from severe schizophrenics to high functioning “neurotics”, (like us), with everyday life problems, who don’t need and appreciate proper time, to really be heard.  We all need a few hours at least, in a safe, non-judgmental, confidential space, with someone practiced in emotional attunement and developed in their own interiority, for us to speak and risk  revealing ourselves. This will release “eros” (the connecting principle) and engender the possibility of developing a conscious reflecting relationship with psyche.

Biography

I studied medicine in Johannesburg, at Wits University, from 1972 to 1977 and then did my Housemanship and Senior Housemanship at Baragwanath Hospital. In 1980 I worked at Guys Hospital, London,in the United Kingdom as a medical officer, as well as on the British protectorate Islands of Tristan da Cunha and St Helena in the mid-Atlantic Ocean. My registrar years of training to become a specialist psychiatrist commenced in 1981 at Groote Schuur Hospital in Cape Town, and I qualified as a psychiatrist in 1985. After working as a consultant in the department of psychiatry, University of Cape Town Medical School for two years, I commenced private practice in 1987. I have been a Jungian Analyst and founding member of SAAJA since 1994 and am registered with the IAAP in Zurich as such. I am married to a professional artist and have three grown up sons and work as a general psychiatrist and psycho-analyst, in the City Bowl of Cape Town.

Early years:

During my school years I had displayed sufficient interest in the visual arts to be sent to the Johannesburg School of Art for drawing classes on Saturday mornings. Drawing and painting was the natural direction to which I reverted, when the years at medical school became tiresome and ‘soul-less’ for me. I joined Bill Ainslie’s private art school in Johannesburg as a part time art student in 1977. This was a non-racial school, and for the first time in my young years, I was exposed to intellectuals and artists of all races and to the big questions concerning what constituted “relevant” art during the struggle years. In those years under apartheid, figurative art was mainly political in nature, but Bill Ainslie, himself a political activist, belonged to the New York School of Abstract Expressionism. I joined poetry and literature classes too, and my own reading broadened from this exposure, beyond the curriculum and training of the narrow corridors of medical school.

Jungian training:

I became specifically interested in C.G. Jung’s work again, his writing appealing to my own experiences during the sixties and seventies. Those years seemed a unique period during which people in the West had begun to challenge and explore the reality and relativity of “consciousness” as experienced in various counter-culture and “mystical” movements. Although I considered a career in the arts, financial realities and practical pressures made me continue after attaining my medical degree, into the clinical years, necessary for full registration to practice as a medical doctor. I continued studying Jung however, and later considered emigration in order to find a Jungian training overseas. Synchronicity made such a training fall into my lap at home, where unbeknown to me, many others in Jungian circles, both internationally and in Cape Town, had been working with the IAAP in Zurich, to establish a formal Jungian training in South Africa governed and monitored by the Zurich school. I got involved with the local study groups and supervision activities within the Jungian circles, towards the end of my psychiatry training, and when the training programme was finally established in Cape Town, my formal application to be a full-time candidate was accepted. I commenced with the training programme in 1989. Five years later I was a founding member of the South African Association of Jungian Analysts (SAAJA).

Saaja (Southern African Association of Jungian Analysts):

The early years of SAAJA where “golden” ones indeed, full of fresh ideas about Jung in Africa and our group was soon granted training status by the international body. The decade of the nineties saw me involved in many positions of office in the organisation including its presidency, and I continued to teach and examine candidates in training for several years. Over the past few years however, my involvement with the Jung School has diminished, and as an ordinary SAAJA member, I now just attend the occasional professional meetings. As the membership of SAAJA grew, it became more institutional as an educational and academic centre, and my own self development felt thwarted by organisational duties and teaching responsibilities. I currently work alone, writing and reading;, some of my friends are Jungian colleagues, also doing their “own  thing’. I anticipate a return to sculpture and drawing as adjunctive activities to explore creativity through working with my hands.

Consciousness and early beginnings:

The emphasis is on personality,  “the complete realisation of our whole being, which is an unattainable ideal; but unattainability is no argument against the ideal, for ideals are only signposts, never the goal.” (C.G.Jung). My work is about this process in my life and in the lives of my patients. It  is a formidable task, noble yet forever challenging.

I first became involved in the notion of human “consciousness” in childhood.  I grew up in the fifties and sixties, and although my parents were not “academic intellectuals” or activists, they created a home of psychological and emotional openness which quickly appropriated the counter-culture movement of those two decades.

I was always encouraged to express my feelings and ideas and to try on different identities. The idea that psychology is a reality that underpins and informs human behaviour was endorsed by a unique psychological openness in the family. It came as no surprise to me when my mother sought psychotherapy to help her deal with the sudden death of her two parents and her brother in 1963, and at gatherings with friends we all spoke of the merits of behaviourism vs in-depth psychotherapy. The value of psycho-pharmacology was also discussed, as was the acceptance that “neurosis” was part of the struggle and challenge of life, rather than an “illness” of which to be ashamed or a mere self-centredness. The expression of feelings was considered healthy and not self-indulgent, and their repression was seen to be more damaging to self and others.

Literature on the emerging science of psychology; different theologies; philosophy and mythology was abundant in the home, as were works on the creative arts in the form of novels, plays, cinema, dance and  music. My mother was a classical music teacher and my father a businessman whose passion was flying and training pupil pilots in his position as a glider instructor.

psychotherapy:

Although I considered my formative years as relatively undamaging, it was not until I engaged in depth psychotherapy as a “patient” myself, that I was able to gain some objectivity regarding my personality development, my defence mechanisms, my idiosyncrasies and shadow material. The  training to become a professional registered analyst, consisted of an academic curriculum in Jungian theory; weekly hourly supervision sessions with a senior qualified Jungian psycho-analyst and two hours a week of personal psychotherapy with a different professional Jungian analyst, who was also senior and internationally qualified.

The personal analysis was considered to be the main place of learning about psyche The therapy frame created the setting where your life and personal history was revealed to an “other” in its naked truth and reality. Life’s fictions were  re-imaged through their re- telling; and fears were revealed to be reflections of  personal complexes and shadow projections. Dreams were recorded and discussed with  poetic sensitivity. I am very grateful to have found a language in Jungian and post-Jungian psychology that to this day continues to assist me with the ongoing dialectic between the conscious and  unconscious processes within and in my relationship with significant others.

Psychiatry and Psychotherapy

Photo of pencil portrait of C.G. Jung (1875-1961)

Jung laments that psychiatrists, who concern themselves exclusively with cellular biology in their research into mental symptoms and mental activities, see “psyche” as an epiphenomenon, like steam coming off  hot spaghetti.

Psyche” is a Greek term referring to the totality of all psychological processes, both conscious and unconscious. Jung uses the Greek word to accentuate the reality of its mysterious and autonomous nature. The English word, mind, from the Latin, “mens”, has been adulterated to mean mental activities that can be harnessed under one’s control and rendered rational and understandable. Psyche implies that there are vast areas of  “unconscious” processes that will never be integrated into consciousness, but are necessary to reflect on in inner dialogue. When Jung was asked then how he saw the relationship between psyche and matter, he replied that they had a reciprocal relationship.

This attitude is what specifically defines Jungian depth-psychology. Jung implies that the psyche has a unique ability to create images, that are not merely perceptual fragments or remnants from the sense organs, as the brain reboots itself after the day’s experience, but are loaded with symbolic meaning. They  are produced autonomously and are meaningful archetypal images and themes, working purposely or teleologically towards the individual’s wholeness. Dreams for example, are highly sophisticated products of the psyche, resulting from the individuals conscious and unconscious interaction with the world. An intelligent “casting” agent selects people either known or unknown to the individual, to represent bits of emotion and fragments of experience, that are then anthropomorphised into  specific  “sub-personalities” or “complexes” of the dreamer. These fragments of personal psyche (carrying primordial archetypal value), are objectified and projected onto the sleeping ego consciousness, in symbolic patterns. Their potential is to broaden the narrow conscious attitude of the dreamer, offering it a chance of re-connecting to the transpersonal background hidden behind the subjective literal  and personal world. All symbols, fully felt, confer meaning and purpose to the mundane  and concrete events of one’s life. Animals too serve this purpose, being theriomorphic intra-psychic symbols in compensation to the conditioned human world, that has lost touch with its primordial roots.

So when talking about the reciprocal relationship between psyche and matter, we are saying that brain activity affects psyche i.e. neurotransmitter and receptor interactions, have psychological sequelae; but that also the psyche, activated by internal or external transformative challenges, alter brain neurotransmitters, perhaps through the resultant emotions. This would mean in the first situation, that an episode of “clinical” depression, presenting with somatic symptoms and likely to be a  manifestation of an inherited predilection, will change the way we experience the world psychologically due to the neuro-transmitter imbalances. At the other end of the spectrum, extreme worry and stress, from purely psychological challenges and conflicts, can cause the brain’s chemistry to alter. If chronic and extreme, a threshold may be crossed, which will result in physiological shifts. This then may require medication to restore the ensuing neuro-transmitter imbalances.

Listening to a patient carefully therefore requires an ear turned both towards the psychiatric and psychological aspects of the narrative, so that a clinical decision can be made as to whether the patient needs psychotherapy alone or together with medication.

Jung’s reference to the reciprocity of psyche and matter confers separate life and autonomy to both, and emphasises that they are linked to each other in a significant way. The behaviour of molecules at the sub-cellular level is as mysterious and autonomous as that of the images of the psyche.

The sad fact is that psychiatrists have very limited training in depth-psychotherapy,which requires a symbolic or metaphoric  “listening”, and a paradigm shift away from the medical model approach. Psychiatrists are medically trained and have medical knowledge for investigating and treating the patient. They are not trained to read psychological subtexts or meta-narratives.  Similarly, psychologists, if only trained in the humanities and not grounded in clinical experience , may hear the deep pain of the patient’s “soul,” but lose sight of the fact that medication may indeed be essential for relief of overwhelming symptoms.

I see very few patients, ranging from severe schizophrenics to high functioning “neurotics” as well as “normal neurotics” with life problems, who don’t need and appreciate “proper” time, to really be “heard.”  We all need a few hours at least, in a safe, non-judgmental, confidential space, with someone practiced in emotional attunement, to speak and perhaps risk  revealing ourselves. This will release “eros” (the connecting principle) and engender the possibility of developing a conscious reflecting relationship with psyche.

Relationships are established between depth- therapist and patient, that although  defined by professional boundaries, are human and interactive, and not locked in formal and stultifying doctor-patient dynamics. The latter is limited by an inherent hierarchical assumption that the doctor has the authority, and always knows what treatment is best for the patient. The former is more authentic, interactive and dialectic, and allows for transformation and growth in both.