Oedipus Wrecks

Portrait of Sigmund Freud – by Salvador Dali

At the risk of waking up to find a horse’s head strapped to a red leather couch amongst my Christmas presents I’m going to let you into a few trade secrets.

By training I’m a psychologist.

No, that’s not a secret – although perhaps it ought to be – it just means that for my considerable and multitudinous sins my time at university was spent learning to fathom out the intricacies of the human mind. I don’t actually practice as a psychologist, never have, not because I couldn’t do the job just as well as anyone else with my background and training but because nothing I did learn left me feeling confident in taking on the responsibility for what goes on inside the head of anyone other than myself.

Let me illustrate what I mean.

Like most degree courses, psychology follows a pretty standard format. You spend the first six months covering a few introductory basics to get everyone on the course up to the same starting level (as with any number of other subjects, psychology attracts a sizable number of students for whom the degree course is their first serious entrée to the subject – A level courses in Psychology are not that widely available and, in any case, what you learn to cram at A level and what you’re expected to understand for a degree are two very different things). After that, and the mandatory lecture on professional ethics, you get to study the subject proper, spending the next year and a half covering foundation topics before finally getting to specialise in your final year.

One of the first, if not the first, foundation topic you cover is ‘theories of personality’ – note the plural, it’s important – a series of around twelve to thirteen lectures on the nature of personality and the various theories that try to explain what it is an how it works, which takes you through many of the ‘big name’ in the profession – Freud, Jung, Pavlov, Skinner, Kelly, Rogers, Maslow et al – all with the own distinct ideas of what personality is, what it does and how, as a psychologist, you might eventually learn to influence it’s development.

If that part of the course teaches you anything it’s that’s while psychology is by no means short of ideas, theories and conjectures on the subject of personality, no one really know what it is or how it works – if a psychologist says to you that they’re a ‘Freudian’ or a ‘Jungian’ or a ‘Behaviourist’ or whatever all they’re really saying is that when they sat down to consider what personality is, they simply liked a particular theory best and found it a bit more interesting than the others so that’s what they decided to go with. You could just as easily pick one at random for that it provides any semblance of a definitive view of personality.

(Personally, I always found that Kelly, Maslow and the other existentialists and iconoclasts like R D Laing suited me best, but that’s just my own view of things)

I mention all this in response to yet another brilliant commentary from Dr Crippen on the subject ADHD (Attention Deficit Hyperactivity Disorder) in which he expresses, in my opinion, what are well-founded and well-judged concerns about the growing practice of medicating children for no better reasons than their parents (and often schools) find them a bit ‘difficult’. It’s an issue in which, I must confess, I have a considerable personal interest as my own five (soon to be six) year-old daughter is one such child who falls into this category – although never once have I asked for or wanted her to be medicated because of it.

I’ll get back to my daughter and our experiences of ‘the system’ in a while, but first there are few more observations on the nature of the ‘profession’ I should make first.

I suppose I should try and give some sort of overview of what psychologists – and psychiatrists for that matter – actually know about the workings of the human mind.

Not much.

Don’t get me wrong, we know quite a bit about how the brain works.

We know what chemicals the brain produces (neurotransmitters) and have a fair idea of what happens in situations where it produces a bit too much or too little of a particular chemical and also what happens if you introduce the brain to all manner of other chemicals from the outside world – nicotine, alcohol and whole bucket load of prescription and non-prescription drug, legal and illegal.

We know all about the electrical activity that take place in the brain. We can map it to show that different patterns occur in different places when we do different things. We even know that we can make certain things happen if we go poking around in particular locations in the cranial cavity with electrodes – prod here and a finger twitches, prod there and you get the taste of strawberries.

We even know, roughly speaking, which bits of the brain control which functions; mostly as a result of studying various types of brain injury. Damage this bit a speech goes out of the window, here and you can’t remember anything for more than a few seconds, here and all aggression goes and you guarantee docility – that last one was once a big favourite, back in the days when it was thought reasonable to try to ‘cure’ criminality by liberal use of pre-frontal lobotomies.

We also know that despite it being long thought that the brain was incapable of making new brain cells and replacing damaged cells (neurons) its actually does make some new cells all the time – in the hippocampus – all of which appears linked to how the brain stores memories and, if injured, it does try to repair itself. I was actually at University and taking the module in neuropsychology at around the time this was discovered. Back then it was called simply ‘sprouting’ – cells around the area of injury respond by growing new connections to other undamaged cells in an effort to reconnect across the damaged area, often resulting in the partial recovery of functions otherwise lost to injury.

None of this, however, tells us anything in particular about the process of thought and thinking, which is what psychologist and psychiatrists, in the main, are concerned with – its what’s called the ‘mind-body’ problem, something that has occupied the thoughts of psychologists since the profession came into being in the 19th Century and philosophers certainly since the enlightenment and, perhaps, before. We can study and uncover the physiology of the brain and its pathological functioning fairly well, we just have no real idea how that all relates back to the way we think – not that that’s ever stopped people trying to link the two together, from which we’ve derived both pseudoscientific drivel (phrenology, the ‘science’ of reading ‘bumps’ on the head) through assorted forms of medical barbarity (lobotomy, electro-convulsive therapy) to today’s mood-altering drugs (lithium, Prozac, etc.).

It’s this that sets the use of drug treatments in psychiatry apart from most other fields of medicine. If we take a commonly used drug, say an analgesic like paracetamol, then we know with a considerable degree of accuracy what the drug does, the effect it has, how it does it and why it does it. In the case of Ritalin, which is increasingly prescribed to treat ADHD in children, we may still know all these things in terms of their physical effects on the body but nowhere near as much about how and especially why they affect the mind in a particular way – we can observe and record the effects, just not explain the why of them.

I need to digress here a touch, just to explain the difference between psychologists and psychiatrists.

Psychologists aren’t doctors (they don’t have a medical degree although some, working in the field of neuropsychology do go that route in order to qualify as surgeons), they don’t generally wear white lab coats (apart from some the experimental lot and the odd one or two who do it as an affectation) and they don’t – in fact they can’t – prescribe drugs.

Psychiatrist, on the other hand, are doctors, frequently wear white lab coats (it’s mandatory) and can prescribe drugs.

There is, as a result, quite a degree of professional rivalry akin to that you’ll often find between doctors and dentists (and from some strange reason at Manchester University, in particular, doctors and engineers – no I did get it either) much of which relates to this whole business of having access to the medicines cabinet. Psychologists are firmly of the belief that psychiatrists are far too inclined to reach for the pad of prescriptions rather than tackle problems properly – they’re also firmly of the belief that the majority of psychiatrists don’t enter the profession burning with a desire to cure the ills of human mind, but because they’re too crap at doctoring to become surgeons and too lazy and anti-social for General Practice. As far as psychologists are concerned, psychiatry is to doctors what philosophy and theology are to prospective university students – a means of getting on if your grades or too poor to qualify you do anything more useful.

That being said, I’m sure psychiatrists take a similar dim view of psychologists, although I’ve never encountered one with the courage to speak up and say so – I fully expect what they think of us is near enough what they think of complementary therapists, homeopathy and other assorted unproven therapies.

I point all this out really to make the point that psychology/psychiatry is a hell of a long way from being the kind of empirical discipline that the public are often les to believe it is – most of it is educated guesswork and bit of common sense and experience (hopefully) wrapped up in a whole load of made up words with enough syllable to sound impressive and the make the speaker appear to know what they’re talking about.

It’s frequently impossible to tell whether visiting a psychologist with your problems has any real effect or whether its all just one massive placebo for the mind – talking over your problems doesn’t actually solve them it just makes you feel a bit better for having talked them over with someone.

One of my all-time favourite stories about RD Laing illustrates this point perfectly.

Laing, while practicing as psychologist, was visited for a regular consultation by a patient with depression.

On this particular occasion, the patient seemed particularly down, so rather than do the whole ‘get on the couch and tell me your problems’ routine, Laing just decided to chat to them in general, talk about mundane things like the weather, the football results over the weekend. Just the normal kinds of things that people talk about socially.

About an hour later, Laing notices that the time allotted to the session is over. At no point have he and his patient talked about the patients problems or done anything which might be considered therapeutic – they’ve just talked. By now, however, the patient’s mood has picked up considerably and he and Laing have been swapping jokes and just generally enjoying a social chat.

So, Laing breaks into the conversation to point out that the sessions over, only for the patient to reply by pointing out that they hadn’t actually talked over any of his problems.

The bit of this story I particularly like is what comes next.

Laing’s reply to this was simply to point out to the patient how much he’d obviously cheered up since he’d arrived and that, because of that, he saw no real point in talking about the patient’s problems as it would only get the guy down.

How wonderful is that? You’re happy now so why spoil it?

I’m not going to say outright that psychology is complete con but I will happily argue, as someone trained in it, that its nowhere near what the public are led to think it is.

Take schizophrenia for example – what exactly is it?

Well, this is how it’s described by Wikipedia, which is as good a description as any you’ll find in textbook:

“Schizophrenia is a severe mental illness characterized by persistent defects in the perception or expression of reality. A person experiencing untreated schizophrenia typically demonstrates grossly disorganized thinking, and may also experience delusions or auditory hallucinations. Although the illness primarily affects cognition, it can also contribute to chronic problems with behaviour or emotions. Due to the many possible combinations of symptoms, it is difficult to say whether it is in fact a single psychiatric disorder; and Eugen Bleuler deliberately called the disease “the schizophrenias,” (plural) when he coined the present name.

3 thoughts on “Oedipus Wrecks

  1. I’ve had to wait a day or two and re-read all the above several times; you experiences with your daughter who, whatever the label (if any) may be, is clearly bright. It seems to me sort of straight forward; she needs a good child psychiatrist and a good child psychologist to do a detailed asessment – and that takes several appointments and some time – and then they need to sit down with you and work out a strategy. And if they can find a label that helps them design that strategy, then fine, and if they can’t, well, they still need the strategy even if it is more difficult to formulate.

    But what I find so desperately anger making, sad, frustrating, and it makes me prickle even though it is my daughter is the way that you, as a very educated consumer of this kind of specialised medical care, is being bounced around the system like a pin-ball.

    If you cannot cut through all the crap, how does a patient who does not have the knowledge manage?

    We get few perks in our business, but one of those few perks is that the path to care should be made a little easier.

    Although I am a family doc I am particularly interested in psychiatry and I despair at the psychiatric services currently available, particularly in child psychiatry. There is no area of medicine that has dumbed down more than child psychiatry even though it is such an important area, and an area that needs real expertese. It’s a bit like teaching assistants. It seems now that anyone who is kind, and fancies “having a go” at child psychiatry/psychology can do so. So we have specialised nurses, mental health workers (I mean, what are they?) and so on.

    We are in a jungle of (well meaning) amateurs. It is deeply depressing.

    I wish you luck.

  2. Hi – thanks for enlightening us all with your description of the realities of psychology. I am not a aprofessional and have a thought from left of field. Maybe it could be helpful in some way. I was a successful professional/management consultant/ author. Five years ago I ended up with frontal lobe etc deficits which is likely as a result of medical misadventure/ dangerous and contraindicated medication for an undiagnosed unusual form of migraine giving me a hypoxic (lack of oxygen) stroke. one side effect of these executive jdugement deficits is that i found i have a much deeper understanding of children. You will have to weigh these things up, but as I read what you said I could not help wondering if she could have had something similar occur. I know hypoxic stroke can occur as a result of prematurity. it does not show up on an mri.
    I find with my EJ deficits that i am compensating with my memory all the time; in the midst of complexity (such as an ordinary complex household) I have to have a fixed routine or I can become very agitated. yet I can be quite bright in the topics I can talk about as long as they drill down into a long step by step examination of the one topic and there are no sudden changed of topic, or people interrupting my task. I have rigidity, distractability. I can get quite a fright if people come or speak loudly close to my left side. I can be very noise sensitive. it fluctuates and varies ie good days and bad days. the bad days may be due to too much stimulation the day before. what works is establishing my fatigue tolerance, and sticking with that. others ‘getting it.’ Understanding i can only do things one step at a time, what seems simple to others isnt for me. I need to see or be triggered to do things by another repeatedly before I can learn. once I do learn its great. But I still have difficulties with attention. Big letters on things helps, and colour coding.
    perhaps there is something in here that will help.
    I have been through the ‘health’ mill as you have. I am not in the UK> Lots of effort by my insurance co to prove I have a ‘bad attitude.’ i was sent to a neuro-psychiatrist who admitted my problems were beyond my control and I was motivated, but as my doctor said really really tried to find something wrong and failed! As a former journalist I was horrified by the approach which seemd to be to elicit information and only write down what seemed ‘bad.’ eg I was single at the time which was listed as singificant, though a stable set of close friends was not. On a newspaper it would have been regarded as hack journalism!!
    I was sent to a psychologist to “fix my negative cognitions’ who said i had no sign of any such negative cognitions so they should send me to a neuro-psychologist for scaffolding under my deficits.
    the neuro-psychologists thank God at least as you say know about brain function, if this isnt working it is that area that is affected and so on. after being tested by them i can feel they have some knowledge and udnerstanding of what I can tell i am epxseriencing. I mean you do knowif you are unable to reach a conclusion and so on when you had a high elvel of functioning in this area before. well I am able to anyway.
    Ive been sent to neurologists and with one recent one who failed to read any of the reports sent to him in advance, he diagnosed (within the first five minutes of talking to me I noticed) that I probably had a ‘passive attitude,’ and should ‘take control’ as I had in earlier years.
    (I wonder perhaps whether my seeming ‘passive attitude’ could have any relation to the fact that I am completely unable to initiate a multi-step task without an outside trigger!!!)

    I saw that this startling conclusion had come about because he heard me say I didnt think the ‘help’ I was getting was very good. He didnt ask me to elaborate. Scientific method in action!!

    even when he did finally read the reports he could not bring himself to acknoewledge that his five minute pop psych conclusion could have been wrong. This was where I discovered what you have written about so well – the professional rivalry syndrome. Too bad about looking for the truth of the matter and the welfare of the patient!!

    Theres a lot of crap out there., in my case I have a msising part of my brain, but with some help from neuro-psychologists at finding the right words, I have at least abstract insight into the situation. I certainly know by now what does not work. So I sit and watch what they all say, and rather like members of the general public they all have their own story.
    I wondered about the fact that some of my emotions dont work properly. I came across a discussion on thjis by accident. I read the theories, it was of some assistance. words. But realised in the end that there was something I knew that they didnt. I also knew that because of my status as the dreaded brain damage, it was unlikely that anything I said would have any credence whatsoever! quite funny really.
    GOOD LUCK WITH YOUR DAUGHTER and best wishes to your wife. I believe, as you do I think,that your daughter is down a well – I hope you find the line.
    maybe psychologists are not the answer. It was my neurologically weird migraine that was one of the reasons i got sent to the shrinks. but the gene has now been found, and it looks as if, for that part of my difficulties anyway, i may be able to get tremendous help from folate and B vitamins!!!
    i havent been on this site before but I hope if you find some answers you post again.

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