Adam Blatner

A recent NY Times Magazine article dated Sunday, June 28, 2015 by Casey Schwartz was titled  “Tell it about your mother: Can brain scanning save psychoanalysis”.  Schwartz interviewed Otto Kernberg, now 86, known for his contributions to using psychoanalysis with borderline person-ality and work on personality disorders. “Psychoanalysis is several things,” he said.  “It’s a theory of personality, a method of treatment, a method of investigation of unconscious phenomena.

But it has been limited sharply in the past for ignoring neurobiological basis.” Kernberg worries that the method by which psychoanalysis in the United States is transmitted from one generation to the next –training in cloistered institutes–has contributed to the problem. “Psychoanalytic education is characterized by a neglect of research,” he said.  “The fact that it has developed outside the university, in private institutions, has hampered its integration with other sciences.  Psychoanalysis is in a dangerous situation, because of its scientific isolation, because of a lack of sufficient research.  And therefore its theory and techniques have been kind of limping behind what is happening in other fields.”  The field’s “future as a profession and a science, “ he told me, will depend on its ability to integrate itself back into a broader intellectual community.

A colleagues in psychodrama sent me this and I agree with her in thinking this is a problem for psychodrama, as well, perhaps even more than for psycho-analysis, since psychodrama has been less well known. I added: The problems are similar in part because both approaches in fact encompass phenomena that go far beyond the sick role or treatment. The idea that either of these fields are treatment is itself problematic, as is the idea that there is any consensus as to what treatment should consist of!

The DSM is a crude instrument, and the idea that mild neuroses are more than part of the human condition, healthy or sick, is itself faulty. My wife and I have been impressed with the degrees of learning continuing even whilst in the midst of vibrant health, learning that decreases our tendencies to be captured by neurosis. There is no clear boundary between tendencies to be caught by and then being caught and then whether or not being caught compounds itself into any actual diagnosable entity, the last speaking to the ambiguities of when mild quirks become severe enough.. And whether of course neurosis transforms into anything akin to a physical disease. It does, I will affirm, but the boundaries are blurry.

Both psychoanalysis and psychodrama work chiefly on the “software” or “programming” or ideas and processes entertained by the mind. Increasingly psychiatric illness is being noted as being influenced by the wet-ware, the degree to which impressions exert an impact, some of which is more biological or neurophysiologic than experiential re-learning. There is a blurred in-between, though!

The mind can quiet a tumultuous brain to a point, but there are points beyond that it becomes arguable that no degree of psychotherapy can help. Medicines are needed. I am dubious about the amount of actual good psychodrama did in the 1940s through the 1970s. For one thing, most patients were given medicine, and how much did the medicine have an effect? In other words, I have no doubt that psychodramatic methods help, but how much, and in what way? If the patient improves, does that validate all elements of the rationale of the talk therapy? How much may be attributed to things not claimed as part of the treatment, like time away from the actual irritating sources, asylum, group of shared sufferers, tone of mutual comfort (if present) among the patients, etc?

Moreno, it should be noted, did attend to this last theme, at least a bit, and in theory. Nor should we assume that the degrees of support patients on a ward give each other is of the same quality as support given by relatively healthy and intelligent workers in a group workshop. I’m just saying that there are so very many variables at play that it seriously escalates the problem of explaining why any therapy works. A second issue is that psychodrama involves many different sub-procedures, many of which are used by other approaches too—such as group psychotherapy. And there are different kinds of groups in tone, sense of group cohesion, etc.

Different Orders of Complexity

Reality is organized not as equal elements competing and interacting, but, like the human body, in different levels of complexity. Ken Wilber called these “holons.” The liver is composed of many tissues that are themselves composed of different types of cells that do different things. Whole books have been written about the liver. Yet it is a part of a larger system—several, in fact—from the gastro-intestinal to the blood and clotting system to the heart and kidney system, and so forth. It has smaller systems, cellular, that are composed of yet-smaller systems, and so forth. People operate in families, in sub-cultures (several), and those operate in larger cultures and nations and language systems, and so forth.

Experience happens on all these levels: It’s not just within the brain of the individual, as if that brain were apart from levels higher and lower. Psychotherapy must calibrate itself to individual differences and the influences of all these levels. Many people are not at all psychologically- minded, and do not respond to the primarily verbal maneuvers in conventional talk therapy. For them sometimes music or art or poetry or dance-movement makes more headway. Drama is sort of a mixture, but the point is that many modalities need to be applied intelligently according to the needs and abilities of each person.

Thus, there cannot, there should not be imagined to be a single therapy for all persons any more than there should be a single building design for all purposes. Therapy is not like a single chemical medicine, but more a category, akin to the whole field of pharmacology, and it may mix and match many different elements. Therapy neither does or does not work, but must be crafted according to the needs. Nor is therapy always the only treatment for some patients—often they need several types of intervention: rest, diet, exercise, sleep, activities, medicines, etc.

Dissecting Psychodrama

Psychodrama is a complex of many types of intervention, and each of these components may be useful in some contexts, irrelevant in others, and occasionally even contra-indicated—a big word that says that under certain circumstances, do NOT use this!

There’s a group context, and the group needs to be developed so that it’s collaborative. Many groupings become competitive. Group itself is by no means intrinsically humane. So there’s an art to working a group and sometimes it doesn’t work. The group is composed of people who are too inimical to each other’s interests. There’s an art to finding this out, too.

There’s fostering a sense of sufficient support for risk-taking that it outweighs the fear of being shut down, and this must be of greater degree if people are to risk enacting their improvisation.

There’s a range of imaginative enhancements that can be introduced to the exploratory process that makes it safer and easier. But these techniques—many derived from psychodrama, but also from related approaches—must be introduced and applied wisely. If they’re done wrong, the whole enterprise might not work, if not collapse in psycho-social chaos.

I’ve dissected psychodrama and the aforementioned are key component operations. They may or may not take the form of classical psychodrama as Moreno and others envisioned it, but I’ve been trying to isolate the functions apart from the traditional names given them.