Book Reviews, Mind Management

Psychiatry in Disorder

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, Relationships

Imaginary Friends

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

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

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.

Book Reviews

Behavior and Adaptation

Life is change. For most of history, change was transmitted only through birth. Looking at the natural world, then, Darwin and his followers upheld the survival of our genes as the compulsion that drives our every behavior. In the mental health world, Freud also flirted with that view (everything is about sex).

But humanity has subdued the natural world with our ideas. Corn, cows and cars wouldn’t exist if ideas weren’t transmissible from person to person after birth. That exchange of ideas is also an adaptive process, but it’s not Darwinian. It’s closer to the evolution proposed by Lamarck, which is thousands of times faster than Darwin’s evolution through gene transmission.

As human beings, then, we are a combination of Darwinian (sexual) impulses and Lamarckian (intellectual) impulses. Sadly, just as our relationship with the natural world is out-of-balance, the tension between genes and ideas also drives us out of balance in our relationship with the self. Our mind changes far faster than our body. Worse, improving the mind occurs through experiences that often limit the body (and visce-versa). To keep this competition under control, the mind divides into two: the conscious mind that learns and adapts to a changing world, and the subconscious mind that manages our well-being and “automatic” behaviors.

Hypnotherapy is helpful in maintaining or restoring balance between the conscious and subconscious parts of our mind. Often that means negotiating alternatives to genetically inherited behaviors – most commonly the “fight or flight” response, but also lowered mood (sadness or depression) or pain. It’s important to understand those foundations of the personality as the basis for our work.

It was this need that stimulated my interest in Randolph Nesse’s new work “Good Reasons for Bad Feelings.” Nesse is an advocate of Evolutionary Psychiatry – a discipline that holds that we can understand the cause of mental disease as imbalances or extreme cases of behaviors that ensure that our genes are passed on. Explicit in the Nesse’s framing of the issue is that those genes cause defects in our brains that predispose us to the disease.

The book considers, chapter by chapter, our major mental health problems. In each case, Nesse proposes explanations for why more primitive species would have benefited from the behavior. The fear response triggers fight or flight, which in the right balance ensures that we mate as frequently as possible. Depression pushes us to abandon unattainable goals. Altruistic behaviors imply loyalty to sexual partners that depend upon that loyalty to ensure the survival of children over the decade preceding self-sufficiency. These are all plausible explanations for why genes that code for those traits would continue to be passed on, despite making us susceptible (respectively) to irrational phobias, suicide, and sexual manipulation.

As documented in detail by Nesse (I have to admire his integrity), the defect in this proposition is that no study has been able to identify consistent genetic differences between those that suffer from mental illness and those that don’t. The doubt generated by this observation is reinforced by clinical studies that demonstrate the importance of individual life experience in determining who suffers from mental illness. Unfortunately, the administration of determinative assessments takes hours – far more than is possible in a busy clinical setting.

Of course, life experience is not predictable. As with medicine, the preventative utility of genomic markers is seductive, perhaps leading Nesse to flog a proposition that appears to have a limited future.

In specific sections of the book, the blurry boundary between genomics and culture is evident. Child rearing doesn’t require a commitment from the male – in fact some feminist authors assert that agriculture was invented by women in part because they stayed in camp to share those duties while the men went out to hunt. So Nesse’s explanation for cooperation is arguably cultural. A more direct descent from genomics might be grooming to remove pests, which is manifested even among fish.

Nesse sets his observations against the backdrop of his clinical and professional development. All are set as heroic outcomes – illustrations of clinical innovations, or transformative insights that puncture professional myopia. As a hypnotherapist, however, some of the clinical innovations seem barbaric – exposure therapy for those suffering severe phobias is one illustration. And the primacy of evolutionary psychiatry seems overblown when outcomes depend upon life experience.

Both matters are dealt with more elegantly in practices (such as hypnotherapy) that recognize the division of the mind between conscious and subconscious realms. I was surprised when I encountered psychologists that disputed that division, and Nesse is defensive in the sections in which he recognizes its importance. His hesitancy indicates that the dispute is more widely entrenched than I knew.

This is an omission that I find indefensible. The tension between biological and social imperatives explains so much regarding our behavior – and mental vulnerabilities.  Even more, those insights inform powerful therapeutic strategies that are known to be gentler and more efficacious than the alternatives described by Nesse.

To conclude, “Good Reasons for Bad Feelings” is an excellent survey of mental health issues, and in relating those pathologies to behavioral benefits, Nesse reduces the stigma that burdens sufferers. I am concerned, however, that his focus on genetics will delay recognition that the genome specifies an architecture for the brain that is vulnerable to cultural pathologies. In both the formation of synapses and the allocation of blood flow, the brain is wonderfully plastic. That faculty facilitates the spread of ideas, but also the insinuation of contradictions that manifest as pathological behavior. Evolutionary psychiatry only sets the table – it doesn’t determine the contents of life’s meal.