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Book Reviews, Mind Management

Psychiatry in Disorder

Brian Balke

Any accredited professional college must educate students on the legal requirements for their practice. In the case of hypnotherapy, in most states the law makes psychology a dominant field. I have been forced to turn away clients because their concerns might be due in part to an actual illness of the mind – something that I was unqualified to diagnose or treat. Sometimes that’s made easier because the client is actually under the care of a psychologist – I’ve learned to expect that I just need to turn them away, because I’ve never found a psychologist that was willing to work in tandem with me. They don’t even answer my e-mails.

In the gray zone are clients that have read the pop psychology press and tell me, for example, that they have “PTSD.” Given what I know about the diagnostic definition, I ask a few questions and determine that they probably have post-traumatic stress, or PTS. Now I can work with PTS, but not PTSD. Here’s the rub: I can’t tell them that they have PTS, because that would be a diagnosis that I am not qualified to offer. You can imagine how difficult this becomes with more common psychiatric designations: depression and general anxiety disorder, for example.

Against the backdrop of this frustration I now report on the message of Anne Harrington’s “Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness.” Obviously I would like to be assured that there’s a valid scientific basis for the designations and treatments offered by psychologist – something more than just the power of suggestion. Because if that basis is weak, then the legal pressure I am under is hurting not just me, but my potential clients.

I regret, then, that Harrington mounts a devastating critique of psychology. It is not just that psychology has no sound scientific basis – the dynamics of its development have systematically brought suffering to those it characterizes as patients.

In considering the history surveyed by Harrington, I think that it would be generous to say that, desperate for some therapeutic method, psychiatrists have systematically seized upon symptoms as causes. Each generation of psychiatrists took up tools that addressed the purported cause of the era, only to discover that the treatment tended to increase the aggregate suffering of their patients.

This generalization applies to both of the broad classes of therapeutic approaches. The first assumes that mental illness reflects a biologic imbalance in the brain that can be treated with surgery or drugs. The second sees the imbalance as a learned response to a toxic environment that can only be corrected with therapy that builds new behaviors in a supportive environment. These two approaches are known popularly as “nature or nurture.”

Harrington’s history develops as a pendulum swinging between these two approaches, driven by shifting political winds. Reflecting the stark contrasts, psychiatry’s torch-bearers tend to be absolutists.

On the medical or nature side, anatomists first treated asylum patients as laboratory specimens, extended in their second era with legislative policies of sterilization and euthanization. This was followed by the practices of electroconvulsive therapy and prefrontal lobotomy. As biochemistry advanced, drugs were sought to target the specific pathways. Manipulation of metabolism (for depression and mania) was pursued using addictive drugs, followed in the modern era with drugs that target neurotransmitter balance. Unfortunately, Harrington reveals that early drug trials did not assess serious long-term side effects of metabolic drugs, and that more rigorous tests of neurotransmitter drugs show that they are only marginally better than sugar pills. Having hidden those results while marketing directly to consumers, Big Pharma is abandoning mental health under pressure from European advertising regulations that require that any new drug must be demonstrably better than existing remedies.

On the nurture front, Freud first blamed sexual repression for all mental illness. Mental institutes abandoned treatment to function largely as warehouses of sufferers deemed to be incurable. In the aftermath of World War II those concerned with valor blamed mothers for mental illness. Seeking early intervention, psychologists formulated categories of “deviance” that were seized upon by parents and schools as justifications for anesthetizing unruly youth. Finally legal decisions forced the disbanding of mental institutions, eventually leaving the prison system to step in as de facto provider of care for those that that cannot align their behavior with our civil codes. Of course prison society is not an incubator for civil behavior, and certain practices (solitary confinement foremost among them) are known to trigger psychotic breaks. While Harrington does not reference a statement of policy that blames the mentally ill for their condition, today American society does choose to punish them.

In grappling with these outcomes, psychiatry has recognized that therapies cannot be evaluated effectively until mental illness can be diagnosed accurately. Thus was born the institution of the Diagnostic and Statistical Manual. At this time it recognizes over two hundred conditions. Perhaps because of this complexity, Harrington reports that two clinical evaluations are likely to disagree roughly 70% of the time – and thus that treatment will follow different paths. Harrington does not report any studies that elucidate the discrepancies, but I am familiar with reports that suggest that overlap of criteria means that the diagnosis is often biased by clinical predisposition. If a psychiatrist has had success treating schizophrenia, they may look for schizoid symptoms and thus bias towards that diagnosis.

Harrington concludes her survey with the admission that the scientific foundations of psychiatry are vague, and calls for clinicians to return to basics. Should they fail, she foresees that they will surrender therapeutic initiative to those that lack prescribing authority: counselors, therapists and social workers.

I have deeper concerns. Hypnotherapists understand that the brain is not the mind. Through personal experience, in fact, I believe that the human brain is best understood as a multi-channel radio receiver, and that most of our thinking is done in the soul. If true, this largely undermines biological investigation of the causes of mental illness. There may be correlations between diseases of the soul and brain biology, but attempts to change only the biology will be ineffective in treating the disease.

As a hypnotherapist, my response to Harrington’s indictment of her discipline was angry. Given that “science” was the justification for preferential licensing, it now appears that in fact the regulators were snookered by a profession seeking simply to engage in restraint of trade. I plan on promoting Harrington’s revelations, and will be far more aggressive in seeking to help clients that have been disempowered by the industry.

For that is where the real answers are to be found. After more than a century, the evidence is in, and the human mind is beyond biological understanding. Psychology should recognize that it is largely a philosophical discipline – which in the best sense serves to provide citizens with understanding to manage their minds and relationships. The obfuscating complexity of psychiatric terminology must be removed from public dialog, and replaced with something with greater utility. Perhaps the Kappasinian Theory of Mind?

Book Reviews, Specializations

A Geriatrician Advocates for the Elderly

Brian Balke

When I reached 50, friends began advising me to color my hair. I laughed – given what I’d been through in my 40s, I was proud of the evidence that I’d made it that far.

In “Elderhood,” Louise Aronson reflects on a career in gerontology (the medical specialty that focuses on the elderly) to expose the cultural disease of opportunism that infects our experience of aging – both within medicine and the larger culture.

The challenge of caring for the elderly is that normal aging changes body chemistry, making invalid many of the strategies pursued when caring for adults. Since all medications and medical procedures are proven for adults, gerontologists must understand the entire body when planning care. The liver and kidneys no longer may be able to eliminate drugs before harmful side-effects occur. As conditions accumulate, physical therapy requirements may overwhelm the patient’s decreased stamina. And procedures designed to restore full functioning in younger patients may instead cut short the life of a less resilient senior.

Paradoxically, the complexity of caring for a senior created the opportunity for Aronson to operate for most of her career as a dying breed: the home-calling general practitioner. Financial limits meant that radical treatments were often out of reach to her patients, and so common-sense behavioral and environmental adaptations were acceptable options. Perhaps not surprisingly, many seniors report greater satisfaction with their care when offered options that preserve their social setting, whereas hospitalization would have left them isolated for long periods – if not permanently.

Unfortunately, Aronson’s written contribution to this public debate was triggered by burn-out. Systemic factors – medical specialization, rigorous reimbursement policies, and profit-conscious administrators – generated resistance to providing the kinds of care that were best for her patients. To illuminate those factors, Aronson’s writing develops two themes in parallel: how medical care should evolve as a patient ages, and then the professional history that finally drove her to collapse in frustration when praised for her outstanding performance. While laudable in intent, the mixing of these two stories dilutes the focus of the book. In the end, only the most careful reader can form an independent judgment about Aronson’s views.

To a degree, Aronson seems to have accepted this outcome. Her afterward opens with a quote in which another author describes his work as a polemic – as intended to stimulate emotions that would drive political change. Taking this as Aronson’s goal, “Elderhood” builds a strong case: 50% of doctors “burn out” as Aronson did, and leave medical practice. More desperately, young and heavily indebted doctors choose suicide at rates far higher than the general public. It is only the narrowly qualified specialists that thrive, and they are precisely those unable to deal with the complexity of aging. Aronson takes the point further, believing that myopia extends even to treatment of “normal” adults – precisely because there is no “normal” adult. The inability of the specialist to anticipate the side-effects of their treatments eventually traps patients in the medical system as the treatment of side-effects creates further side-effects until the patient runs out of financial resources.

From the perspective of hypnotherapy, however, it is the first thread (the evolution of care with age) that is most important – and specifically to those of us seeking to serve the senior population. Aronson draws upon her clinical experience to illustrate the shifting goals of aging patients. To distinguish them, she proposes that we consider the stages of senior, old, elderly, and aged. These are wrapped in life’s third act – elderhood (the first two acts being childhood and adulthood). Aronson’s purpose is to hone our sensitivity to the opportunities and challenges of growing old.

Most of society relates to growing old as the loss of youth. Those visible changes – wrinkled skin, gray hair, and decreased vitality – appear long before we lose our creative potential. Seniors, therefore, are those still seeking opportunities after leaving their adult career. Their unique gifts are discernment, patience, and a surrender of financial ambition that allows them to prioritize options that benefit their community.

Medically the principle concern for the senior is decreased recuperative capacity. Senior illness and injury can trigger a debilitating cascade that speeds decline. This is therefore the stage to begin defining preferences for managing the inevitable decline. Aronson sets the two poles of the spectrum as “breathing at all costs” and non-intervention. Aronson’s illustrations tend to support “comfortable longevity” as the best compromise.

As aging continues activity begins to match the expectations generated by appearance. We become “old.” In planning gatherings and outings, compromises are made for reduced stamina. This transfers to medication – “adult” prescriptions should be screened for new or enhanced side-effects. With conditions that require surgery, discomfort may best be managed with lifestyle changes.

“Old” is also the stage where social changes begin to cascade. This follows naturally as life-long friends relocate and die. While still fairly active, this may be the best time to move to a dedicated retirement community, simplifying lifestyle while developing new friendships. Aronson emphasizes, however, the benefits of multi-generational households – once a necessity but now an overlooked option that enriches the lives of both youngest and eldest family members.

“Elderly” follows when management of medical complaints begins to dominate our days. Aronson dwells on the challenges posed by America’s utilitarian ethic. Cab drivers speed away from elderly fares, and private and public spaces become inhospitable – both physically and socially. Aronson warns that our failure to accommodate the elderly condemns us to suffering in our elderly years and denies us the opportunity to reap the insights gained from their lived experience.

In treating the elderly, Aronson condemns our modern “disease management” system. Essential practical needs are not recognized as medical expenses, creating “penny-wise and pound-foolish” practices that allow minor inconveniences (such as nutritional deficits and hearing loss) to evolve into serious conditions before services are provided. Worse, when those conditions arise, the influence of medical specialists means that the course of treatment often depends on which doctor is available first.

Ultimately, of course, the principle concern is managing the decline of the “aged” to death. Even here, Aronson offers inspirational tales – a bed-ridden grandfather who became tutor to the neighborhood’s school children. She argues for advanced planning and hospice over the isolating and desperate institution of the nursing home.

While I only outline the changes that define the transitions between the stages of elderhood. Aronson’s monumental work draws upon her experience in geriatric practice to illuminate the psychological needs that evolve from reinvention (seniors), to isolation (old) to wellness (elderly), and finally into mortality (aged). While somewhat diluted by her indictment of the medical establishment, Elderhood is rich with insight for those seeking to support each of these distinct communities.

Book Reviews, Relationships

Imaginary Friends

Brian Balke

Natural selection (Darwin’s evolution) drives animals toward faster, stronger, and more lethal. Greater specimens act freely, while lesser creatures scrabble in the shadow of death. Imagination changes that picture: lesser creatures still submit, but may observe and plan to turn the tables on their oppressors.

In society, the immediate merits of action and planning are obscured by ritual, rules and rights. The Greek philosophers admired the tyrant – a man capable of driving an entire city toward a common goal. To temper his excesses, the Fathers of the Catholic Church invented the feudal hierarchy: ownership was ceded to the tyrant, but the Church agreed to manage property (including vassals and serfs) only if the tyrant defended the commandments (foremost being “thou shalt not murder”). History tells us that to escape these constraints, the kings established secular universities. It was then left to their vassals to organize parliamentary procedures to reign in the tyrant.

In “Quiet”, Susan Cain dissects the status in America society of the balance between action and planning. As offered by Jung, the preferences carry the labels “extroverted” (for those that prefer action) and “introverted” (for those that plan).

The struggle is intensified by the tendency of individuals to prefer one or the other as a competitive strategy. From the title, you might expect that Cain is partial to introversion, and indeed she uses personal illustrations as she catalogs the costs of America’s deference to extroversion. The projection of ego has been designed into education, work, and social interactions. This allows the aggressive extrovert to monitor and disrupt planning. Cain implies that this is undermining the creativity that is the foundation of vibrant economies. Yet while Cain is sympathetic to the plight of introverts in this culture, she draws a balanced picture of the two types, concluding that they form natural partnerships.

Our personal preference is fundamental to the personality, evident in infancy and persisting through adulthood. The origin of the preference is obscure; Cain spends several chapters surveying the studies that explored the relative impacts of nature (genetics) and nurture (life experience). I concluded that there seems to be a missing factor – perhaps the biochemical milieu during gestation and infancy?

But the studies do illuminate the behaviors that distinguish the extrovert from the introvert. Planning requires information, and thus introverts are “sensitive.” The introvert in unfamiliar surroundings is hypervigilant to the point of exhaustion. This makes them shy of the public performances dominated by extroverts. Conversely, extroverts commit prematurely to goals, a tendency that can drive them to expensive mistakes (Cain references disastrous corporate mergers).

Cain prescribes two paths for strengthening the introvert’s hand. The first is the power of purpose in projecting introverts into public dialog. Cain uses her personal history as one illustration. As a legal advisor, she was terrified of public speaking. While still anxious before presentations, she is stimulated by the worthiness of her mission (coaching introverts to greater influence). Her first recommendation, then, is that introverts seek work that they value.

Using Franklin and Eleanor Roosevelt as examples, Cain’s second path illuminates the power of collaboration. The illustrations in this last section of the book become a little testy, particular in vignettes of group work in school that tend to bullying by the extrovert. But she concludes with vignettes that emphasize the value of allowing each party to lead in their domain of excellence.

Cain’s study is a valuable read for the hypnotherapist, but also sends up a warning flag for the Kappasinian practitioner. Kappas elaborated the categories as “Emotional” and “Physical” types of suggestibility and sexuality. Those distinctions are a powerful aid in therapy, but Cain’s exploration of introversion and extroversion is proof that psychologists are working toward those same insights. While Kappas’ theory is more pervasive – covering learning, communication, intimacy, and child rearing – it’s only a matter of time before those aspects are integrated under Jung’s terminology.

Book Reviews, Mind Management

Myelin and Mind

Brian Balke

To play a musical instrument, it’s not enough to put your fingers in the right place. They have to arrive there at the right time. Getting to the right place is controlled by the wiring of the neurons. Right timing is controlled by myelin.

Myelin is a fatty sheathe around the axon – the part of the neuron that carries signals out from the cell body. Just as neurons form new connections as we learn, so the brain adds myelin to axons. Special cells called oligodendrocytes wrap myelin around the axons that carry the heaviest traffic. Each wrap causes the signal to move faster.

This improved speed helps us to think faster. This applies to all forms of thinking – logical deduction as well as muscle movement. That isn’t always a good thing – we’ve all heard the term “motor mouth,” somebody who talks faster than we can follow. To correct for such problems, myelin gradually decays, slowing the speed along the affected pathways. To maintain optimum performance, then, myelin must be constantly restored.

Building optimum performance is the subject of The Talent Code by Daniel Coyle. The book sings the praises of myelin and the processes that refine its placement. The most heartening insight is that talent – broadly understood to be the capacity to respond rapidly and precisely – can be cultivated through proper training.

Both internal attitudes and external feedback (coaching) figure in the development, refinement, and maintenance of myelin networks. Attitudes include commitment, caring, challenge and consequences. Commitment is recognized as the belief that a life will be built around execution of our skill. Caring manifests as an emotional response to competence: irritation at failure and joy in achievement. Challenge is the restless seeking beyond current skill – to always be in pursuit of greater aptitudes. Lastly a demonstrable connection between skill and social recognition is the honey of consequence that draws others into challenge with us, giving us the stimulus to continue to improve.

Coyle sees these factors at play in many settings: sports, music and academics are highlighted. While explicitly considered only in the afterward, every example highlights the value of tension between creativity and discipline. Creativity is the goal, but can be cultivated only when the student believes that what she does makes a difference. In the proper setting, then, negative feedback becomes a positive when self-awareness (shame or guilt) is followed immediately with repetition that is rewarded with approval when competence is achieved.

From this, it is clear that mentors are critical to the development of mastery. It’s not a one-size-fits all proposition. In the early stages of talent development (what Coyle calls “ignition”), the mentor must build an emotional connection between the student and their skill. As mastery is approached, the mentor creates conditions of constant challenge. Performance is driven by practice with others of high skill, and the mentor intervenes mostly to help the competitors leap-frog past each other.

In this pursuit, myelination alone is insufficient. In a competitive setting, mastery is not repeatable, because competitors will adapt to its demonstration. This requires endless variation that can be achieved only by composing smaller elements as sequences. Part of coaching is to break skills down into chunks that can be creatively sequenced. Coyle illustrates this with a detailed breakdown of how a master coach teaches a quarterback the drop-back. The most telling proof of the principle, however, is in the failure of chess masters to recall random board configurations, where they can instantly recall actual game configurations. The chess master sees actual game configurations in “chunks” of related pieces.

While hypnotherapists are not life coaches, the insights of The Talent Code are critical to our discipline. Emotional attachment is the foundation of excellence. Hypnotic rehearsal builds myelin networks in the brain, but must be tied immediately to myelination in the rest of the body. Habits are best maintained under variations that instill challenge, and best undermined by substituting alternatives to feed higher behaviors. Recovery from loss may be facilitated by seeking actively to tie high-level networks to new contexts for expression (“chunking-down” instead of “chunking-up”).

Perhaps most importantly, however, is in managing client expectations. Learning is not life-long – it must be actively maintained, and constantly evolves as others adapt to our capabilities. In fact, that tension is critical to skill. The subconscious may resist change, but great accomplishments derive from the struggle to overcome that resistance. In some sense, the properties of the myelin system are how the brain comes to understand what is really important to us.

Basics

The Kappasinian Difference

Brian Balke

The public considers hypnotherapy to be “woo-woo” principally because most demonstrations celebrate the dominance of the “operator.” The “subject” appears to relinquish control – something that only the frivolous or desperate would tolerate.

Graduates from the HMI College of Hypnotherapy are trained in methods that ensure clients understand and participate fully in their behavioral development. The founder, Dr. John Kappas, actually proposed California’s legal scope for hypnotherapy: “vocational and avocational self-improvement.”

For people able to set and pursue goals (i.e. – those without clinical psychological disorders), Kappasinian hypnotherapy has deep and diverse methods for addressing the entire gamut of problematic and self-limiting behaviors. Even more, clients will receive a basic, common-sense understanding of personal behavior and development. Given in non-technical language, it is an understanding that they can carry forward into the rest of their lives.

If you have been considering hypnotherapy, look for an HMI graduate in your area, or contact one of us (myself included) well-versed in phone and web sessions. You’ll not just find your behavior corrected, you’ll find yourself empowered to step confidently into a more fulfilling future.