The past year brought a confluence of events that culminated and reinforced my ideas about the essence of the human being.  While each person’s journey will lead one to his or her own doubts and conclusions, this question has fascinated me ever since I was a little boy.  (For those who want to indulge in my narcissism, I would be happy to share what I wrote about the subject in the second grade.)  Suffice to say, this question and curiosity have led me to the field of psychology and psychotherapy.  I came to the conclusion that psychology, both clinically and academically, is the study of the invisible factors that makes us who we are.

To me, psychology and psychotherapy have always been about making “the invisible, visible.”  Helping people become more aware has always seemed like a noble goal.  But what helps people experience emotional stability?  Knowing why you suffer does little to alleviate it. Why is it that human beings sabotage every intention that they might have to be happy, healthy and content?  What are the invisible forces that reinforce negative thoughts, feelings, anxieties, panic, compulsions, addictions and even psychosis?   The prevailing thought among many psychiatrists and mental health specialists (with unimaginable financial support by the pharmaceutical companies) is that we are passive victims to “bad” brain chemistry or a “chemical imbalance.”  The best we can hope for is to find the right medication to “correct” the brain chemistry in order to relieve the patients of their suffering.

This is not an indictment against medications.  Medications, especially those used to treat serious mood disorders, such as depression, anxiety and bipolar illnesses, have undoubtedly saved lives and enhanced functioning. However, environmental events, trauma, child neglect and abuse strongly affect brain development and chemistry.  This last statement often escapes the thinking of many who work with the mentally ill with profound consequences.

My contention is rooted in evidence that human beings are “hard wired” social animals needing to be seen, accepted and “loved” for who we are.  While evolutionary factors have given birth to an adrenal system that pumps out adrenaline with remarkable speed to fight mightily against perceived enemies, we have also evolved in a remarkable way to produce oxytocin, which establishes and maintains meaningful “love” relationship.  Deny the human being a connection with another human being and you will inevitably create severe mental illness.  Deny an infant touch and love, you will ultimately have a baby whose brain will be severely compromised and very likely to die in a condition called “failure to thrive.”  These are the more exaggerated proofs that relationships affect our brain functioning.

Research has also shown unequivocally that physical (environmental) therapies improve brain mass in different parts of the adult brain and those who suffer from brain injury.  The advent of learning about neurostem cells and our ability to grow new brain cells indefinitely will likely usher in new treatments for brain injured patients.  The UW is researching how mild electrical currents stimulate new brain growth with very encouraging results.  But I contend that it is the human being’s ability to be understood and accepted (unconditional love?) that is the major contributor to better brain functioning and mental health. This treatment approach, which has been outlined in a previous blog, has demonstrated remarkable long-term improvement of the many adolescents who “graduated” from NorthStar Adolescent Treatment.

Parallel to these new developments in brain research is my work this year with a 27 year old man who was diagnosed with schizophrenia and steadfastly refused to take medications to the chagrin of his psychiatrists, psychiatric hospitals and those who are in charge of making sure that “mentally ill” people do not cause harm to themselves or others.  While I never was able to determine what exactly he did to have professionals argue that he met this criterion, he was conditionally released from a long-term involuntary admission from the state hospital.   His story will be part of a documentary filmed by Lise Zumwalt.  The following is a trailer for the movie:  http://www.witnessdocfilms.com/trailer/

Eric brought to my attention the serious issues of those who are neither suicidal nor homicidal, but have their rights taken away because they experience hallucinations and delusions.   His experiences brought me in touch with researchers whose studies suggest the lethality of anti-psychotic medicines that are taken over a long period of time.  Most importantly, while I have no doubt that psychosis is a real phenomenon, I began to question the validity of the high number of patients who are diagnosed with schizophrenia. Approximately, 1-2% of the adult population suffer from this debilitating disease.  However, in the 39 years of working with children and adolescents who demonstrated psychotic behaviors, thoughts and delusions, I did not know one who was later diagnosed as schizophrenic.  My colleagues, who share a similar treatment philosophy, report the same curious observations.

I was more absorbed in my work with children and adolescents to question this.  However, the implications are enormous.  When confronted with teens who were psychotic, we first ruled out trauma, bipolar, severe depression and dissociative disorder which are all treatable and/or curable disorders.  After pursuing these diagnoses, none were later diagnosed with this incurable and chronic mental illness, schizophrenia.  Until I began working with Eric, I never asked why.   Like so many of the adolescents we treated, perhaps Eric’s “psychosis” was the expression of inner turmoil that never found expression in a more “functional” way.

We all recognize the importance of “debriefing” when one experiences trauma.  Why?  The answer is self-evident; the human being needs other human beings to understand and accept our pain and rage.  It is not the trauma that makes us “crazy” but our inability to give voice to the pain.  This became evident with Eric, but other factors complicate his recovery.

I am now left with the reasonable conclusion that not only does the “chemically imbalanced” brain causes emotional, behavioral problems including psychosis, but that unprocessed traumatic events can create a “chemically imbalanced” brain.  As stated before, medications have been undeniably helpful, but I believe that they have also contributed to the muting and denial of a person’s pain and trauma which leads to a disquieting suffering that can severely effect emotional, psychological and physical well-being.  Some psychotherapeutic approaches, which only focuses on symptoms and cognition, may inadvertently ignore the systemic factors which creates this emotional and “chemical” imbalance.  Are we treating the “automobile” while denying the “driver.”   With the advent of more sensitive measurements of the brain, we are beginning to understand that the “hard-wiring” need for relevant and meaningful relationships grows brain cells, changes brain chemistry and enhances neural connections.

My return trip to Nicaragua at the invitation of CBR to explore their budding mental health delivery system will attempt to explore these issues through this prism.  The NorthStar treatment philosophy is anchored in the belief that we are continuously giving expression of who we are by our behaviors and that the offering of empathy, compassion and authenticity by trained mental health professionals yields long-lasting improvement in mental health functioning.  How helpful will this approach be to a community which as so few resources?