Lecture 4 Part 2: In which we continue to address some age old questions– What does a psychologist do? What does a psychiatrist do? Why should I choose one over the other? What about a social worker? How do they differ from a (mental health, drug and alcohol, pastoral, sex, school or other) counselor?

But what does work?  If you have a headache, you take an aspirin.  If it’s a particularly sharp headache, you see a doctor.  If you are suspected of having a brain tumor, your primary care physician will refer you to a neurologist.  And if a brain scan reveals that there is nothing visibly wrong with your brain, you will be sent to a psychiatrist.  If you get frustrated because the pills the psychiatrist gives you don’t do anything but make you sleep all the time, you just might break down and decide you might want to talk to somebody about your headache.  But, who?

Before I endeavor to answer this question, I would like to review what we just covered from a slightly different view in order to clarify some important issues.  You may notice that, when our hypothetical patient first gets the notion that he has a headache, he goes to a medical doctor, a physician, to relieve the pain in his head.  That doctor refers the patient to another medical doctor, a neurologist, who determines that there is nothing wrong with the brain.  That doctor refers our proposed patient to a psychiatrist (whose training incidentally is very similar to that of the neurologist who made the referral).  The psychiatrist then proceeds to assess symptoms and prescribe pills.  The first doctor, a general practitioner, looks at the headache from the point of view of the body as a whole.  The second doctor, a neurologist, focuses specifically on the brain and nervous system (when you see the word neurologist, read “nerves”) and the third doctor closely related to the second doctor by training works on readjusting the brain chemistry with medication.

Although most people take it for granted, the world of mental health treatment did not always work like this.  Before there were drugs, brain scans, and brain surgery, before there were psychologists and mental health professionals, there was one focus of study, the mind, with two different points of approach, philosophy and medicine.  The study of the mind goes back to the Ancient Greeks, probably before that, and was mostly philosophical.  It continued as a mostly philosophical pursuit until a Viennese physician and psychiatrist, Sigmund Freud, got hold of it and made it a focus of his investigations.  Due to his efforts, psychiatry became closely aligned with psychoanalysis, the first formal psychotherapy and, as such, it was more philosophical, although the outcomes of Freud’s therapy were described as medical breakthroughs.  This differs from Pavlov, a Russian physician whose medical research was the beginning of Classical Conditioning, which led eventually to the Behavior Modification practiced by parents, teachers, and mental health professionals and is, therefore, now the domain of psychological thought.  All of this was turned topsy-turvy around 1950 when the first psychotropic medication was developed to treat schizophrenia and, as Wikipedia tells us, was used to cure everything down to hiccups.  (Further complicating this picture is the fact that most of the researchers who develop medications are PhD’s not MD’s, which may lead one to think that psychologists develop drugs because they have PhD’s too.  In this case, the majority of researchers doing the developing have a doctor of philosophy [PhD] in biochemistry, whereas psychologists often have a doctor of philosophy in psychology.  The PhD refers to the method of academic training, not the subject being studied, which is the focus of their training.)

This mostly describes the Psychiatric/Psychological times in the 1950s because it was accompanied by the belief that medication could be used to cure EVERYTHING (or almost everything), a belief that can still be found by many in the medical profession and among patients today.  With this belief, most psychiatrists abandoned doing psychotherapy and went off with their colleagues in the medical profession to prescribe drugs to cure mental ills, leaving only a small handful of psychiatrists to continue to do talking therapy of whatever sort.  The gap in treatment that was created by psychiatrists moving away from therapy and toward drugs left an opening for those psychologists and homespun philosophers, studiers of the mind, to provide their form of treatment.  And it is from here that we get the inclusion of social workers and the panoply of counselors who continued to fill similar gaps, as they encountered people with a variety of psychological problems who needed some type of personal support.  This event was partly driven by necessity, partly by economics.  (Psychologists have become rather expensive, after all, especially for the insurance companies and other third party payers.  Besides, if you reduce the amount of training required to provide mental health services, you increase the number of people providing the service, thereby increasing competition and lowering cost.)

So where does all of this leave us today?  Well, if, as a patient, you think that your body is a machine made of muscle, bone, nerves, and chemicals, you will follow the yellow brick road of physicians for treating your brain because it is just another part of your body.  If you just want some advice, you can get it from anyone, your mother, father, neighbor, doctor or nurse, pastor or priest, counselor, social worker, or psychologist or you can just stuff it, which is what most people do.

More to follow…

 

Lecture 4: In which we answer some age old questions– What does a psychologist do? What does a psychiatrist do? Why should I choose one over the other? What about a social worker? How do they differ from a (mental health, drug and alcohol, pastoral, sex, school or other) counselor?

Readers with Internet should go to the following address from the American Psychological Association and use the chart that they find there as Figure 1:

http://www.apa.org/about/division.html

To understand the diversity of interest in the field of Psychology, one need only look to the left on the chart at the 55 Divisions within the APA. (Division 11 is now defunct, for some reason.)  To the right, the reader will see a list of some 85 Topics in which the 55 Divisions are interested and numerical reference made to which Topics are of interest to each Division.  (For those without Internet, imagine if you will, most of the Divisions have more than one Topic of interest, therefore the need for numerical references to link them.  The Division with the most Topics of interest, Social Policy Issues, has 10 Topics that concern them.)  With each Division having more than one interest, one can see that there is some complicated circuitry involved in making sure that people’s psychological needs are met. 

The list linking Divisions with Topics can be seen as a kind of flow chart.  It was my intention to present the chart with all the lines connected as a way to illustrate the complexity of the field of Psychology.  However, the material is copyrighted first of all. Secondly, upon further inspection, I realized that by showing the relationship between the Divisions and the Topics, by entering the lines connecting them, most readers would become confused.  Then, I realized I would become confused and finally it seemed likely that the screen would become so cluttered, even if my computer would allow me to enter the lines, that the presentation would look like a giant mass of lines more complicated than the Los Angeles freeway system.  It would probably look more like your brain (on or off drugs). 

Herein lies part of the problem, the world inside our brains is complicated.  Like the outside world, it can be inhabited by aliens of all kinds– native, foreign, and space.  If you want an imprecise way of looking at the mind, look at the APA Division chart and see how they regard our mental needs.  Some of these Divisions clearly have nothing to do with the majority of folks, but have to do more with the APA machinery.  Others seem like they may have some application to people’s needs, although the connection may not be obvious.  This confusion is not necessarily a bad thing, especially if the system works, that is, if it accurately portrays the various Divisions of the APA in a way that the people who use it understand. 

There is little doubt that the APA would be quick to respond that this chart is to be used by its members and not the general public.  However, if one were to have a particular, indefinable, intangible, but sharp ache in one’s heart– let’s say you were suicidal– and were to enter a building where psychologists congregate, such as in the APA building in Washington, DC, were to grab toward your heart or your head, and were to scream, “I NEED TO SEE A PSYCHOLOGIST… NOW!!!” looking at the above list, what sort of psychologist do you think you would get?  You might get someone from Division 17, Society of Counseling Psychology, who might be able to help you, unless of course that person’s specialty is men and masculinity and you are a woman or you are a man and the psychologist specializes in women.  Heck, they might not even like you because of your gender assignment (read “sex”).  And if you get a Population and Environmental Psychologist from Division 34 (Hey, what is a Population and Environmental Psychologist anyway?), you might not get the therapy that you need in your particular crisis.  What if you were suicidal because you were just informed that your spouse was cheating on you or that you had cancer and only 24 hours to live?  If you get a psychologist from the wrong Division and a specialist in the wrong topic, you could have problems.  However, if you were suicidal because you were in the middle of a remodel on your house, you might get better therapy at the Carpenters or Plumbers Union.  In the proposed theory, Survival Psych, you will find that the guiding principle is utility, that is, whatever works.

To be continued…

Lecture 3: What does Psychology have to do with Survival and why should I care?-Part 2

So, what do psychologists do?  Take Dr. Phil for example.  Most people consult him not because they want to solve their own problems, but because they want to solve other people’s problems so that they won’t bug them so much.  This has nothing to do with either surviving or thriving, but how they can keep from wanting to kill somebody close to them.  Mars and Venus bug you?  See if you can learn some way to arrive at compromise without infidelity (a threat to Survival), to rekindle interest when life is too stressful or dull to allow for real intimacy. 

But, do most of us living in the real world find that any of this works for us personally or do we really pay attention to these experts to titillate ourselves by listening to other people’s problems?  Undoubtedly, there are those who have learned from following these experts that all a psychologist does is listen, peek into the most intimate details of people’s lives, find the pimple and either squeeze it or cover it up with ointment.  Just as with a pimple, we are left in no better position watching the experts apply their psychological nostrums to other people’s emotional wounds because, where wounds and blemishes are concerned, the mental equivalents are almost always unique and cannot apply equally well to everyone…certainly not to us!

The same limitations are seen in the teachings of our Psychiatric/Psychological forebears, the Gods of mental health theory and practice, the Freuds, Jungs, Pavlovs, Skinners, Rogers, and Ellises of the world.  You may not have heard of some of these people, perhaps not any of them– There are many more that are not named here and some that I have not heard of myself– but a mental health therapist of almost any level of licensure certainly has heard these names and have had to learn something of their theories.  More than that, almost all psychological training demands that students take a position, declaring, in essence, which theory best conforms to their own personal ideas about how people work and which they intend to follow in their practice.  Even in the academic world, certain theories go in and out of fashion.  You can tell this by the sentiments of professors, colleagues, classmates, and by the way questions are framed on Psych Department comprehensive examinations and on State Licensing Exams.

Freud is one excellent example of this.  During my master’s training, he was considered taboo mostly because of his theory of penis envy.  Penis envy was his proposition that women unconsciously envied men their penises, in one interpretation for their ability to unzip their pants and urinate over great distances while women could not similarly project themselves into the world.  (It may be helpful to note that, in certain cultures and even in our own past, it was not considered offensive for a man to relieve himself on the street [number one, not number two], while a woman was not permitted the same freedom because they would have to unfrock to relieve themselves.  Although almost forgotten, even in my earliest memories in Brooklyn, I recall the competitions we would have pissing into the street.)

Because of his hypothesis, whenever Freud was mentioned in the University classroom, there would be a tension and everyone would get uncomfortable, including the instructor.  On the other hand, we had a compulsory class in sex therapy in which we were given homework to take a sensual bath at home, to light candles and incense, put on soothing music, massage ourselves and masturbate.

However strange any of this sounds, the point, the important psychological point, does not have to do with the idiosyncrasies of mental health training.  It has to do with practicability, the use of mental health training in the real world.  In this day and age, with our current level of sophistication, it seems reasonably certain that Freud was envying his own penis and that otherwise some women may envy men in other cultures because they are given more freedoms, such as dress and walking unaccompanied in public, but that public urination, even over a distance, is of lesser importance.

Stranger still, the one theory that was likely the most useful was also regarded squeamishly by my professors, that is, eclecticism.  The problem with eclecticism was that it was not a theory at all, at least not a formal one.  (Indeed, one may comment appropriately that of the above theorists’ contributions, Albert Ellis’s Reality Therapy is more a technique than a theory.  Having attended one of his lectures, I observed that, after a failed demonstration to help a woman solve her problem by changing her thoughts and attitudes, he simply continued his discussion, in effect shrugging his shoulders when his technique didn’t work and the woman was left to fend for herself.)  What eclecticism means is that the practitioner will do whatever works.  The therapist is not tied down to a theory, but will draw from any theory or technique to assist the client or patient.  The problem, from an academic point of view, is that you cannot test for knowledge of eclecticism very well because it is undefined.  Further, because eclecticism is undefined, a student cannot be called on to defend it, allowing the student the opportunity to demonstrate knowledge of eclecticism as a theory and simultaneously to strengthen the basis of the theory by showing its logic and its sense.

Once again comparing Psychology to other areas of expertise, one may see that, if you are looking to put up a building, it may be helpful to have someone who understands theories of construction, but you will be far better served by finding someone who has previously put up a building that might meet your specific needs, a building that works and that has lasted.  To fix or install plumbing, you want someone who knows pipe and how to put it together, not someone who knows how to lie in a bathtub and play with himself.  (“I was just trying it out,” the plumber said.  “Was it as good for you as it was for me?” the therapist responded.) 

It follows logically then that, if you want to adapt more successfully in an adversarial environment where your spouse or the in-laws scream at you or even batter you, you better figure out how to insure your Survival first before you think about how to eliminate their flaws.  This is the basis of Survival Psych, a theory based on what I have learned from personal experience and in my clinical practice, what I have learned from observing and working with people, ways of understanding problems that are both understandable and that can be used to meet people’s needs.

Before anyone is too quick to judge what follows, I would encourage you to consider how you might help someone solve basic Survival issues or quiet a screaming father- or mother-in-law by applying Freud’s psychoanalytic theory of ego-id-superego, Jung’s theory of dreams and the unconscious, Pavlov’s classical conditioning taken from training his dog to increase the production of digestive juices when a bell rings, Skinner’s operant conditioning which is still used today in behavior modification, Roger’s unconditional positive regard that leaves us to solve our own problems, or Ellis’s Reality Therapy in which negative thoughts are either reframed, denied, or obliterated.  If you cannot solve this conundrum, don’t be put off or give up, neither can your psychologist.  This is the reason that Psychology is so poor at selling itself in the first place, despite the fact that one important and lucrative application of Psychology is in advertising.  The problem appears to be that Psychology doesn’t know what it is until it is first applied to something else.  Given this starting point, I will be applying what I know about this chameleon of a discipline to the most basic of questions, that of Survival, in an effort to cast light on human thought and behavior as a whole.  I will be using mostly simple logic and concrete examples drawn from common experience.

 

If by some chance you want to see how Survival Psych works in application without reading these lectures, I encourage you to have a look at the primary level text, THE MEANING OF LIFE: A Child’s Book of Existential Psychology, which may be purchased through this website.  Dedicated students who have paid their tuition may earn credit (of some kind) by passing a final exam (which may or may not be given at the end of the term, a term which lasts for at least a lifetime.  Cheating on the final exam is not only acceptable, but is openly encouraged.  Do look to see what your neighbor is doing, but For God’s Sake learn from it!  Cheating is actively discouraged when applying this course material in life and, in certain instances, it may also be illegal.)