Monthly Archives: October 2019

On the Abandonment of Psychotherapy, An Introduction -I-

In a response to Prof. Laura Dilley’s “thread on some of the problems with the diagnostic approach to mental conditions posed in the DSM (Diagnostic and Statistical Manual of Mental Disorders)” I commented that “the problem was created with the abandonment of individualised psychotherapy and the dawn of chemical psychiatry and behavioural psychology. Psychotherapy has become entrenched in Freudian/Jungian philosophy, while people needed immediate help. Shortcuts were arbitrarily created.”

I am acutely aware about the limitations of “twitter science”, however, I have found twitter to be, probably the best practice ground for channelling one’s Asperger’s/Dyslexia short-time memory nightmares into the holy grail of Orwell’s third of his “Six rules for writing”:

Orwell 6 rules

Continuing my line of thought, I wrote: “given its exponentially growing negative effects on the subsequent abandonment of individualism for the ephemeral short-term results of mass therapies, this has become my interest area. Foulkes (Fuchs) was concerned that the drive for results is causing a drift to shallowness” also that “I’ve been involved shortly with group analysis, and experientially understood probably the precise period, motives and failures of this abandonment.”

I’ll leave my readers the choice of being curious about the multiple aspect born necessities which led to the development by Foulkes and others of a group approach to psychoanalysis, mentioning nevertheless his genuine, time and history proven ‘concern’.

In the 2nd edition of his and Anthony’s “Group Psychotherapy – The Psychoanalytic Approach” (S. H. Foulkes and E. J. Anthony, Penguin Books, 1957/…/1973) he wrote:

“The present writers stand firmly on the ground of classical psychoanalysis whilst many other workers appeared to have been trained within the schools which, for short, one might call neo-Freudian. All these neo-analytic schools are not so much distinguished by what they have added to or developed from Freud’s work, but by what they have left out or distorted.”

It becomes worth noticing that the timing of these thoughts coincides with what I consider to be a major drift from the fundamental depths of psychoanalysis onto the one sidedness of behaviourism.

Unfortunately, the psychoanalytical school isn’t without fault as for the causes of this drift; the intrinsic danger of every ground-breaking idea is its enticing sea-siren song, luring the inquisitive mind into its never-ending intricacies. The truth is however, that besides what Foulkes mentioned in his rather bitter observation about neo-Freudianism as omissive distortions, I see as an equally pernicious development stagnation in the purely theoretical results of such endless philosophical dissections.

I firmly believe that one of the main influences of this abandonment of the individual for the group, and of psychoanalytical psychotherapy for behaviourism has been and still is, the mercantile, cost driven approach to healthcare.

The main difference between psychoanalytical psychotherapy and the behaviourist cognitive approach is the paradigm shift from intellectual individualism to mental collectivism, where an individual’s value is irrelevant if the social expectations of the almighty profit dictate otherwise.

Returning to my initial point about the quick results driven therapeutic shortcuts, I have found a rather disturbing effort to justify in a rather politically correct, nonconfrontational way the professional life-support dependent existence, of apparently well evidence-based reasons to reconsider and restore psychodynamic psychotherapy back to its history proven fertile-root role, and further into the mainstream of better available psychiatric and mental health care provisions.

While working in 2015 on one of my forensic mental health degree assignments, I have discovered a document by Jessica Yakeley, Director of the Portman Clinic and Director of Medical Education, Vice Chair of the Royal College of Psychiatrists Psychotherapy Faculty, Research Lead for the British Psychoanalytic Council, and Peter Hobson, Emeritus Professor of Developmental Psychopathology, University of London. To my surprise, the document which at the time was last updated in 2013, stated the following:

“In discussions over the evidence base, it is important to be positioned appropriately.   One of the reasons CBT evidence has had such political sway, is that research on this approach has been applied to diagnostic groups that correspond with those considered by NICE. Psychodynamic psychotherapists question the validity of these nosological categories […]”

In 2018 however, for reasons I do not wish to critically guess at the moment, Yakeley updated the document, amongst others with a “disclaimer”, stating that:

“We also advise caution in discussions comparing, or claiming superiority for, psychodynamic psychotherapy with other psychotherapies, especially CBT. Not only does CBT have a much larger evidence base than psychodynamic psychotherapy in terms of the sheer number of studies, but there is little evidence that any one therapeutic modality is superior to any other.”

She finishes however the same paragraph with the following, emphatic “key message” which clarifies a maybe different view, which again I do not wish to critically analyse:

The key message, therefore, is that the available evidence demonstrates that the efficacy of psychodynamic psychotherapy is not inferior to, but is, on the contrary, as good as, that of other psychological treatments, including CBT, and moreover the benefits of psychodynamic psychotherapy may be long lasting and extend beyond symptom remission.”

A conclusion to this introductory critique to the causes and effects of what has been incipiently identified as an “abandonment”, must take into account -as previously mentioned- that “I’ve been involved shortly with group analysis, and experientially understood probably the precise period, motives and failures of this abandonment.” Having briefly touched some of the “periods and motives” part, brings back traumatic memories of my short-lived involvement in group analysis, which I have painfully experienced due to an utter failure to have relevantly included from its inception, consideration of individuals on the autism spectrum, for whom a different neurological development is an intrinsic barrier to participating in any “group” designed therapies. However, for the sakes of academic and scientific integrity, it must be mentioned that the 1950s period when group analysis was developing, coincides with the period when autism understanding, and research barely made it through the horrors of WW2, with ripples sadly alive to this they, especially in regard of Hans Asperger and his unclear involvement in Nazi war crimes.

What I believe to have understood, is that the emerging necessity of therapeutic skills and methods which could be applied in a shorter span of time to larger social groups, has overshadowed the concept of the individual as key component of any group. Even worse, it has caused an unwarranted departure of autism research, from individual uniqueness to socially interconnectible, representative groups. Unfortunately, this has damaged the very core of individual functionality, by stripping it from its biological and psychological autonomy, forced ultimately to become a simple asset of a hive-minded social construct.

If therefore, autism and mental health research have any chances of reaching out, they must return to where everything begins, to the individual as the undividable core of human existence.

[Rev.] Romulus Campan LTh (Hons), FDScMH (Forensic), CertEd, QTS,
PgCert Religion, Spirituality & Mental Health,
PgCert Special Psychopedagogy,
PgCert Autism & Asperger’s
Chair, Disability & Neurodivergence Staff Network – BSMHFT

 

 

Is an “autism community” a dangerous mirage, or a valid social construct?

LEGO puzzle piece (3)

I have recently been asked on Twitter the following:

“I’m going to ask a question but you don’t have to answer. So, I just started wanting to understand autism better since my son was dx, and I know the best knowledge comes from those actually in the community. Anyway, I imagine as you get (o)lder* it’s important to have an understanding community you can relate with; so why is this community so divided? I’ve seen many very respectful, but I also saw some downright cruel to one another. And guess my question is what happened, why [Are]* there some people in this community that [are]* so viscous and vile? I just can’t understand why a few are determined to tear others down?”

The question which I read at 06:26 this morning, grabbed both my mind and heart with its absolute, wise candour, prompting my following answer thread:

“A real “autism community” is a mirage, generated from noble intentions, an illusion however, because Autism is the epitome of individualism, defying any true group cohesion. 1->”

“Further, since Autism is characterised by polarised thinking patterns, it inevitably generates extremes, which will inevitably clash. This unfortunately, will tear down any attempts to create a monolithic unity, leading to “factionism”, dominated by belligerence and loudness. 2->”

“The ONLY way of mending this self-generated gap, is rationally accepting the legitimacy of situational truths, where valid, evidence-based fragments of an endless reality, are allowed to be mutually/reciprocally used as building bricks of a developing understanding of Autism. 3->”

“The Puzzle Piece was a valid beginning. However, the time of the LEGO brick has come. LEGO bricks are the best descriptors for infinity, better than the closed-circuit Mobius symbol, because they can’t be practically “complete”. Anything meaningful in LEGO must be agreed. 4->”

“And real-life agreements are reached only through the mutual acceptance of any remaining disagreements. Autistic nirvana is real. It is the simple acceptance of a perfectly autistic dichotomy of open ends, where for every aspect there will be an anti-aspect. 5->”

“Once un understanding has been reached about the fact that the very existence of “disagreement” as a concept, is guaranteed by the pre-existence of a concept called “agreement”, mutual acceptance becomes possible*. Life itself is built upon acceptance-rejection, yes-no. 6->”

“What makes us human nevertheless, is an understanding of this dichotomy, a rational acceptance of the axiomatic right of every disagreement to live in the protective shadow of an* agreement. The only other alternative is war, ultimately mutual annihilation. I’ve chosen therefore, the * LEGO way*.”

As you may see, I have intentionally left everything twitter-formatted; because it best covers the core essentialism of my thought, summarised in the last tweet:

“The only other alternative is war, ultimately mutual annihilation.”

I’ve seen and experienced cruelty and meaningless trolling on twitter, which has left me scarred for a lifetime. Lives on the brink of emotional ruin, behaviours which in a real-life scenario could seriously extend someone’s psychiatric hospitalisation, all for the almighty sake of winning oftentimes questionable arguments.

Much of the time I have spent on this platform hijacked by extremism and abuse, it was time robbed away from the duty I have due the talents I’ve been bestowed upon, a waste of energy and resources, with one apparent reason, an unwarranted albeit necessary dive in the rabbit hole of my own darkness and fears.

I’ve seen and experienced enough, time has come to move on.

I will start by unblocking all those (quite few unfortunately), of whom I believe to have seen a side different than the one I may have encountered while incidentally intersecting with their own, rabbit hole dives.

I will carry on building my side of what I believe to be valuable in a dialogue, at the moment between the moderate pro-ND and ND-critical sides, awaiting any reasonable proposals to interconnect with similarly minded individuals from the “other” side. The fact that individuals find themselves on either side of Neurodiversity, may show an interest, an eagerness to maybe find valuable aspects and details for a much necessary common ground. Exception from this willingness concern those determined at this time to trivialise the Medical/Clinical Model of Disability, together with those seeking to do the same about the Social Model of Disability in regard of their relation to neurodivergent conditions.

I am to this end, openly and respectfully calling Judy Singer @singer_judy to a constructive dialogue, away as much as possible from twitter, of reconsidering Neuro-Diversity from the perspective of nearly three decades since the concept saw the “light of day”.

It is a rather desperate call, rooted in my unwillingness to passively witness the annihilation of a genuine possibility for progress and development, long due in the lives of autistics, individuals with autism, their dedicated families and carers. We are already witnessing the disastrous results of a derailed neurodiversity militantism, in the lives of families having had drastic, valuable government funding reductions, following biased and unwarranted lobbying by groups unwilling to see beyond subjectivism in regard of effective behavioural interventions.

This is also an invitation to all those who are willing and capable for as much as possible to lay down or bury the hatchet of past grievances and participate in such a dialogue. I am aware that many such grievances have gone too far into the realm of personal offensiveness, having maybe left irreversible emotional trauma and scars. And while forgiveness is always on option, it doesn’t come for granted. It is up to every one of us, to seek, give or receive it as individually considered, because I do not see the Stockholm Syndrome an option for cooperation.

In my title, I ask, “Is an ‘autism community’ a dangerous mirage, or a valid social construct?”

I believe that if it becomes bound to a hive-mind, with enforced, rigid language policing and taboo subjects, it is no better than an aggressively militant mob, a mockery and indeed a dangerous mirage of a dystopian “community”.

A genuine community allows for growth, change and constructive debate, where all members have equitable rights and responsibilities, aware that behind all objectivity, hide real lives of individuals with subjective ideas, behaviours and needs.

[Rev.] Romulus Campan LTh (Hons), FDScMH (Forensic), CertEd, QTS,
PgCert Religion, Spirituality & Mental Health,
PgCert Special Psychopedagogy,
PgCert Autism & Asperger’s
Chair, Disability & Neurodivergence Staff Network – BSMHFT

*later addition

-original image: https://www.pinterest.es/pin/403635185323282537/