When it comes to the talking cure, antidepressants and anti-anxiety medications can allow you to feel more anxious or depressed. And guess what? That’s a good thing.
When I was doing my clinical training back in the 1970’s and early 80’s, our instructors and supervisors—most of them M.D.’s—frowned upon medications for our psychoanalytic patients. Psychotropic drugs were seen as a cop out or a mere palliative—a quick fix that didn’t last. Indeed, we were told that dulling a patient’s distress by relieving the anxiety and depression that brought them to treatment could take away their motivation for the hard work therapy entails, precipitating a “flight into (fake) health” and away from our offices. Feeling better, they wouldn’t feel that they needed us any longer.
At the same time, so-called biological psychiatrists were beginning to dismiss all that “talk about childhood” as a waste of time that got people nowhere, and even then or “there” much too slowly. Clients needed scientific medicine, they declared, and not “ideology.”
Both sides had a point, and both were wrong. Like “love and marriage,” more often than not according to the current outcome research:
“You can’t have one without the other!”
In those days, with a few exceptions, basically two sets of medications were available to treat the walking wounded—functional people like you and me who have the wherewithal to find their way into a psychotherapist’s office in the hope of fixing their bad moods and jittery nerves. There were the benzodiapines, introduced in the late 1950’s. These so-called tranquilizers, mostly valium in those days, calmed these nerves while undeniably dulling the senses. And they posed the potential problems of dependency, worst still addiction and sometimes life threatening physical dangers.
And there were the tricyclics, which helped with both major and low-grade depression and which were approved for use in the early 1960’s. To some degree, these antipressants also modulated obsessive-compulsive symptoms. Yet they failed to address the undertone of “angst” and occasional panic attacks that most often were mixed in with sadness, irritability and psychological self-flagellation typical of depression.
And then, in 1987, along came Prozac! Prozac, that is, and all the subsequent selective reuptake serotonin inhibitors (SSSRI”S) that followed in its wake beginning in the 1990’s. Indeed these drugs came of age at just about the same time that neuro-cognitive scientists began looking at the brain light up when people talked about childhood traumas and their aftershocks in ways I described in an earlier posting.
The new class of medications, it turns out, addressed at one and the same time both anxiety and depression, emotions which, according to neuro-psychologist Jak Panksepp, are a mammal’s (and a person’s) twin responses to separation from essential caretakers, beginning of course with mothers. They immediately lowered levels of cortisol and the stress this causes. And thus they eased the pain of a real or felt loss or rejection by a significant other to whom we remain deeply attached but of whom we now are feel bereft.
And you know what, maybe Freud was too hard on himself when in the 1930’s he remonstrated that he lacked a knowledge of the chemical agents with which to replace the talking cure. Psychoanalysis was a poor substitute, he lamented, for something more concrete, efficient and scientific with which to heal patients even if it was the only method at his disposal at the time.
In fact, as I suggested earlier, both the talking cure and carefully targeted medications such as SSRI’s accomplish much the same thing when it comes to: staunching the flow of cortisol; de-flooding the hippocampus so that it can wake up, function, thrive and grow again; and putting the kibosh on the flight-fight reflexes of that indiscriminate amygdala.
The thing is, sometimes it’s very hard to get there—to that old and outdated but persistent unhappiness. Sometimes people are so defended and uptight that they can’t begin to feel their feelings much less articulate them and then put them in perspective. In this case, SSSR’s have the paradoxical effect that in lowering a person’s baseline but still unconscious distress, they act to ease the resistances to experiencing it. This is particularly the case when difficulties from times people can remember—after four or so when hippocampus is consolidated— resonate with earlier traumas occurring before the advent of more complex verbal communication and, with this, declarative and episodic memory. In these instances, such chemical interventions may be essential to get the ball rolling.
So why not stop there? Why spend all those endless hours recalling and yakking about past injustices? “Get the ball rolling”—that’s the point. Medications alone are a first step and don’t work in the long run.
If people are deprived of the chance to remember and verbalize what they have felt forced to forget, whatever their relief in the moment from medications, the changes won’t last. It’s like a lot of orthopedic surgery: you can have your elbow or knee operated upon to fix a torn rotator cuff or acls, but if you don’t then rehab it with physical therapy, the joint will remain weak and vulnerable, you will likely either re-injure it. In a similar vein, it’s psychotherapy that serves to reinforce and strengthen permanently the underlying neurological functions and structures that separate the past and the present when comes to our bad moods.
Not forever maybe, but for a very long time—or at least until the next big stressor comes along.
And this will bring us to my next posting. Is it ever over—life’s problems, psychotherapy and what Erik Erikson once called “the growth and crises of the healthy personality?”