By Dr. Aakash Dharmaraj September 2001 Recent developments in the field of psychotherapy offer a humane insight into the world of mentally disabled Feelings of shame and inadequacy are the first response to a suggestion that professional help may be required in order to deal with personal problems or wounds inflicted by traumatic life situations. Add to that the social stigma attached to visiting a psychiatrist or psychotherapist, and most people prefer to live with their problems. They stay mired in distress, in an endless cycle of denial, fear, blaming self, others or fate. This resistance appears to be a hangover from times when the irrational behavior of the ‘insane’ was evidence of being possessed by evil spirits or demons. They were treated as social outcasts, objects of morbid curiosity, fear and contempt. They were locked away in prisons, in conditions of intolerable misery, subjected to taunts, physical abuse and open ridicule. ‘Treatment’ usually took the form of exorcism, beating, torture and bartering with the evil spirits. ‘At a famous hospital in London, Bethlehem (pronounced Bedlam), which was built to house lunatics, it became a public amusement (for a fee) to taunt and watch the weird behavior of the inmates! The word bedlam remains in the English language to describe chaotic confusion,’ according to Sheldon Korchini who has authored serious works on psychiatry. A HUMANE PERCEPTION Changes began sometime in the middle of the eighteenth century, mainly in Europe, later spreading to North America as part of the renaissance of rationalism and humanism. In France, Phillipe Pinel (1745-1826), a scholarly and humane man, proposed for the first time that the insane were sick people whose sorry state deserved the same consideration as suffering humanity. He strongly believed that medical attention along with dignity and freedom could help restore sanity. Gradually, the shackles and chains were removed and hospitals became places of treatment and care rather than imprisonment. Asylums for the insane became places of refuge, rest and recovery. The emphasis was on a combination of physical care, spiritual guidance and study. Unfortunately, these places soon regressed to the same dehumanizing conditions from which they had arisen! Bedlam lives on and behind the overt public attitude to view the insane as physically sick, the belief persists of the mentally disturbed as subhuman or possessed or both. On the positive side, the concept of the insane as sick became the medical model of mental illness and led to extensive research, methods for investigation, drugs, shock treatment and other therapeutic methods of treatment. Psychiatry came into its own only in the early twentieth century with the work of Emil Kraepelin (1855-1926). The medical approach banished concepts of demons and evil spirits and helped reduce some of the terror and dread that surrounded mental disturbance. Unfortunately, it did not take into account social and psychological factors. FROM PATIENT TO CLIENT Attention also turned to non-hospitalized ‘patients’ whose state seemed to reflect, not a sickness, or a disease of the brain, but ‘psycho-biological reactions to life stress’. This triggered a search for psychological causes of ‘neurotic’ behavior and non-medical cures and interventions. Sigmund Freud’s (1856-1939) introduction of psychoanalysis transcended the medical mould, to create a thoroughly psychological theory of human motivation, bridging so-called normal and abnormal behavior. He established that psychological problems were often created by unconscious fault lines deeply etched in the psyche, by traumatic experiences and childhood conditioning. Treatment required the uncovering of buried traumas, which were being expressed through revealed symptoms. Psychotherapy was ushered in and the ‘demons of the unconscious’—guilt, fear, shame, rage and bitterness became the focus of medical interest. Purely psychological techniques like hypnosis, free association and dream analysis gained wider acceptance. Treatment moved from hospitals to the consulting room couch and patients now became clients. UNDERSTANDING THE MIND In the 1950s and 60s began a humanistic and existential stream of thought. These systems viewed human beings as having a purpose, options, rights and the capacity for self-determination, rather than as hapless victims of the unconscious or the environment. The biomedical model represented a big step forward from the demonological concept, and continues to be most appropriate for work with deeply disturbed, hospitalized and psychotic people who are unable to function in a social environment. The psychological model is most appropriate for use with persons who are able to function in a social environment, but may be experiencing emotional difficulties, confusion, worry, anxiety and depression, who would not consider themselves or be considered crazy. The humanistic, existential models are most appropriate for people who don’t have major problems, but want to know themselves, take responsibility for themselves, and seek greater meaning and fulfillment in their lives, using psychological insights as tools for growth and change in a group setting. Overall, in the West, as new techniques continue to evolve, there has been a steady increase in the range of human problems that come within the ken of psychotherapy. From the visibly disturbed ‘lunatic’, at one end, to people with personality difficulties, addictions, relationship issues, family traumas, anxiety, psychosomatic health problems, uncontrollable emotional outbursts, depression, marital conflict, an inability to cope with everyday issues-to a desire for enhanced self-awareness, at the other. INDIA LAGS BEHIND In India, there has not been much visible change. Evil spirits are still believed to inhabit the bodies and minds of the mentally disturbed and they are still chained and tortured instead of being given medical attention and care. Mental asylums remain largely custodial, where the unwanted languish for years. Among the educated, there is a leaning towards the medical model and psychiatry, but not much awareness of the benefits of psychotherapy and a stigma attached to both! Family and religion are still expected to provide relief from all problems. Our rich spiritual heritage has not been channeled into healing practices that are accessible to people living ordinary lives. Osho (1931-1990), in his lifetime, in an incredible stretch of effort and imagination, put together a blend of modern western psycho-technologies and meditation, which are effective and also gaining in popularity. Awareness about these is limited, often overshadowed by fears and myths about the methods and the cult. Some awareness has started to filter in—’New Age’ movements are gaining momentum, heady cocktails of energy healing techniques have surfaced, offering cures for everything. Pop psychology and self-help books are stacked in every bookshop, spreading information on all subjects-causing much confusion! Despite this, psychotherapy still remains suspect, and there are very few trained practitioners. So, there continue to be people who may be suffering—who are painfully shy or irrational; feel depleted or worthless; drink too much or are confused about their sexuality; are stuck in abusive relationships or stressful lifestyles; unable to recover from the shock of losing a loved one—or in a thousand other ways, live joyless lives, a burden to themselves and others, unwilling to get help because they may be considered ‘crazy’! You don’t have to be crazy to seek therapy. It is as right to seek professional help for mental and emotional problems, as it is to go to a doctor when you have a sore throat.
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