Adam Blatner

Words and Images from the Mind of Adam Blatner

Challenging Psychiatry

Originally posted on April 25, 2014

I have been re-thinking my profession in preparation for giving a talk on the changes it has gone through over the last fifty to a hundred years. The title is “We Don’t Do That Anymore,” but alas, we do, at least some things that maybe we shouldn’t. I’ll post it on my website when I’ve thought it through some more.

The point today is that one of the biggest money-makers and status-builders in the mid-20th century was psychoanalysis, or dynamic psychotherapy, and lots of celebrities all had their “shrinks.” It was a bit of a fashion. More, many people in psychotherapy were would-be psychotherapists. The point was that psychoanalysis had been coopted by the profession of medicine, in the guise of psychiatry. It had come to dominate psychiatry, as a matter of fact.

Even before it became a guild-driven rationalization, the theory evolved that neuroses were just milder forms of psychoses. They both were essentially distortions of the ego. More contemporary research strongly suggests that the major psychoses partake of a distortion of brain function that is by no means fully understood. There’s a lot of research on the different forms of major mental illness. But for sure, major mental illnesses are not just more severe “problems in living.” They are a different type of dysfunction!

Imagining that all types of neurosis were variations of more severe mental illnesses, though, is what offered the bread and butter for legions of psychiatrists. Then, in greater numbers starting in the 1960s, many other forms of psychotherapists and counselors began to offer dynamic and other types of therapy or counseling. (What was counseling and what was therapy became increasingly blurred after the mid-1970s.) For the most part these latter groups and to some extent psychiatrists too treated many people with problems in living. I use this term rather than “neurosis.”

There are other permutations, complications, mixtures, and I won’t go into that here and now. Later. For now, the point is that the problems in living in today’s world are many and subtle, but there’s not a lot of evidence that suggest that a medical degree adds much to the job of learning to help most people cope. Indeed, it is questionable whether some of the milder cases even need training in psychotherapy.

On the other hand, what if a small percentage of people with seeming problems in coping are suffering from actual physical diseases such as  hypothyroidism or epilepsy! I fear that many people who offer “coaching” would not be able to be helpful and might even hurt or at least delay treatment. (These are some of my thoughts on reading through the May 2014 article on coaching in the Harper’s Magazine.) Not that I’m saying that one must be a medical doctor in case there’s a the small chance that there’s a medical basis for some psychiatric symptom. Rather, I’m just suggesting that this possibility should be raised repeatedly during coaching training along with some strong suggestion that such conditions be watched for.

But the question stands as potential turf war: Coaches are increasing in number, having obtained training according to no particular standards. Some programs are more rigorous than others, some programs far less rigorous than most. How can a client beware? It’s open season so far.

Some therapists are extending their practice to include coaching, extending their services to include milder, non-diagnosable “problems in living.” Will some coaches extend their services to include milder, slightly-diagnosable problems that have some components of depression or anxiety or other conditions? It’s a predicament. Just noting it.

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