The following interview is part of a “future of mental health” interview series that will be running for 100+ days. This series presents different points of view about what helps a person in distress. I’ve aimed to be ecumenical and included many points of view different from my own. I hope you enjoy it. As with every service and resource in the mental health field, please do your due diligence. If you’d like to learn more about these philosophies, services, and organizations mentioned, follow the links provided.
Interview with Robert Berezin
EM: You argue that drugs are not the right sorts of treatment for human suffering. What do you see as the right or real “treatment” for human suffering?
RB: ‘Drug psychiatry’ is the current incarnation of somatic psychiatry—insulin shock therapy, lobotomy, and electroconvulsive therapy—which views the cause of human suffering to be the brain itself, rather than the person. Its treatments have been to act directly on the brain—physically, electrically, or chemically.
The current form of this doctrine is that problems come from genetic or developmental neurobiological disorders of the brain. And the prescribed treatments for its phantom brain diseases are psychoactive drugs. The cure for human struggle has been reduced to a pill, as if pharmaceuticals address the agency of human suffering. The very idea that drugs can cure what ails is an insult to the human condition.
The false belief is that we can now cure biological depression with antidepressants; biological anxiety with benzodiazepines; and the fictitious ADHD with, of all things, amphetamines. Likewise the belief is that schizophrenia and manic-depression should be treated with drugs. There may be a place for drugs in schizophrenia and manic depression to attend to states of terror and rampaging feelings. However, drugs are not the treatment. Schizophrenia and manic-depression are a human story. The real treatment for human suffering is psychotherapy, which deals with the human narrative. The relational and mourning aspects of psychotherapy heals human pain in precisely the way that it arose in the first place.
EM: You write about the “psychotherapy of character.” What do you have in mind there?
RB: A patient comes to a psychiatrist for relief from his suffering. The word patient itself comes from patiens, “enduring pain and suffering.” Human suffering takes many forms. People may feel unhappy, lonely, angry, or sad. They may have symptoms—obsessive, compulsive, anxiety, so-called depression, panics, phobias, paranoia, delusions. People have character behaviors that get them into trouble—drinking, drugs, gambling, eating (anorexia, bulimia, overeating, bingeing), sexual perversions, impulsivity, rages, emotional isolation, narcissism, echoism, sadism, masochism, low self-esteem, and psychotic and manic states. They may have crises in their lives—divorce, death, loss, illness, rejections, failures, disappointments, traumas of all kinds, and post-traumas.
Suffering does not exist in a vacuum. It flows from our damaged plays of consciousness. Since there are built-in fault lines to every problematic play, the way we break down follows along those fault lines. Suffering is the manifestation of something having gone wrong in one’s characterological play.
To attend to a patient’s suffering, we must explore his inner play. This exploration is the journey of psychotherapy. It proceeds through a responsive conversation between therapist and patient. What transpires is far more than the cognitive content of the words. It is the exploration of a patient’s invisible, unique inner drama—his cast of characters, the feeling relatedness between them, and how they developed by virtue of his formative environment of deprivation and abuse. In psychotherapy one mourns the consequence of trauma.
EM: What are your thoughts on child rearing? What makes for “healthy” or “effective” child rearing practices?
RB: To put it simply, child rearing is about boundaries and love. It is all about roots and wings. We begin with the most important provision of all: maternal love. By providing the requisite emotional holding the child has the security to stretch his wings to take on the world and learn. Children will inevitably go too far in their experimentations. They need secure boundaries to bump up against, to learn the limits of life. This constitutes responsiveness in child rearing. This allows the child to write a constructive play in his consciousness that fosters authenticity and the wherewithal to love. The consequences of emotional deprivation and abuse generate darker plays that are filled with sadomasochism. This in combination with traumas all the way through life create plays that will generate psychiatric symptoms.
EM: You argue that trauma outpaces our ability to adapt. Can you share your thoughts on that?
RB: Our consciousness is organized as a play in the theater of the brain. The “play” is a representational world that consists of a cast of characters who relate together by feeling. It is organized into scenarios, plots, set designs, and landscape. The way our formative play is written reflects the actualities of responsiveness, deprivation and abuse.
Trauma is the presence of abuse or loss that is too overwhelming, and we cannot adapt to it. Hence the traumas of physical abuse, sexual abuse, bullying, loss, death, and war trauma, override our original play and writes a new one. This then becomes a newly operative invisible scenario, through which we experience the world. By mourning our traumatic experience in psychotherapy we can return to our original plays of safety, reliability, trust and love.
With a death, the mourning operates in an opposite way. We have to accept that the old play of life with our loved one is over. Denial, bargaining, anger, sadness and acceptance (Elizabeth Kubler Ross), describes the mourning process that allows us to accept a new play where the loved one is no more.
EM: If you had a loved one in emotional or mental distress, what would you suggest that he or she do or try?
RB: I would suggest a loved one in distress should turn to a good psychotherapist. And by all means one should not be influenced to turn to drugs. It’s not always easy to find a good psychotherapist. Especially, in today’s world, there are not a lot of good therapists around. Although my own roots are in psychoanalytic psychotherapy, I moved on to develop the psychotherapy of character. I am well aware that old-fashioned psychoanalytic therapy and its derivatives, have been beset by considerable problems throughout the years. Its practice suffered from dogmatic theories and miscast beliefs, which worked to the detriment of responsiveness to our patients.
Psychotherapy is an unchartered journey to trust and caring that encompasses the full depth and reach of one’s character. The patient explores and mourns the pain of his deeply held characterological world through his genuine engagement with the therapist. The very human process of therapy proceeds on the basis of boundaries, respect, and caring to ameliorate his suffering, and fosters the recovery of his authenticity and his capacity to love. It is a specialized form of human engagement that repairs the damage to one’s character by acting on the play of consciousness in the very way that it formed in the brain and consciousness in the first place. The psychotherapy of character is an art and a science that bridges the old divide between psychotherapy and the brain.
Dr. Berezin has practiced the long term Intensive psychotherapy of character for the past forty-five years. He taught at the Department of Psychiatry at The Cambridge Hospital, Harvard Medical School for thirty years. He is the author of is “Psychotherapy of Character, the Play of Consciousness in the Theater of the Brain.” He has done extensive blogging on his web site, Psychology Today, and Mad in America on a wide array of topics.
Eric Maisel, Ph.D., is the author of 40+ books, among them The Future of Mental Health, Rethinking Depression, Mastering Creative Anxiety, Life Purpose Boot Camp and The Van Gogh Blues. Write Dr. Maisel at firstname.lastname@example.org, visit him and learn more about the future of mental health movement
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