Psychiatry and Psychotherapy

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.