In Dr Symonds’s experience, many people with a diagnosis of depression, anxiety, panic attacks, etc., are really suffering from ‘problems of living’ rather than mental illnesses – which is how they tend to be viewed by psychiatrists!
These symptoms do not usually arise in a vacuum. On the contrary, a person’s current difficulties may be related to repressed trauma or unconscious conflicts often dating from childhood. By being brought to light (but see below) and the patient expressing his or her feelings about them to a supportive, non-judgmental therapist, the process of healing or at least acceptance can be assisted.
Although Dr Symonds can, and does, prescribe antidepressants and anxiety-reducing drugs, drug-free treatment is generally preferred. In fact a large part of his practice consists in helping patients come off drugs prescribed elsewhere which are no longer helpful and which may be difficult to stop.
Mental problems are not brain diseases
It is often claimed and believed that mental problems are due to chemical imbalances in the brain, but this is no more than a theory. It is impossible to measure the levels of neurotransmitter chemicals (dopamine, serotonin, etc.) in the living human brain and such imbalances, if they exist, may be a result, rather than the cause, of the symptoms. Further, drugs which affect the mind can only work, if they work at all, by themselves producing a drugged state, that is, a disturbance of the brain’s chemistry – something in principle it is better to avoid. This is because all drugs can have side-effects and may produce withdrawal symptoms when people try to stop them. They may have a place as a short-term expedient to help patients through a difficult patch, but they are not a cure. (Some mental illnesses do appear to benefit from long-term treatment.)
What happens in psychotherapy?
From counselling websites one may get the impression that what is being offered are techniques with scientific-sounding, if slightly scary, names such as cognitive behavioural therapy, psychodynamic psychotherapy, cognitive analytic therapy, etc. Following on from this, there have been attempts to classify and subject to scientific assessment these various types of ‘intervention’ to see if there is evidence that supports their use for particular disorders. And this means patients first need to be assigned to diagnostic categories, such as depression, generalized anxiety disorder, panic disorder, bi-polar disorder, or attention deficit hyperactivity disorder. So many disorders!
Further, a potential patient – I prefer the word patient to client or mental health service-user – might get the impression he or she will have to undergo a process or submit to a kind of psychological excavation to delve into the past and dig up disturbing events from childhood. Some people may find this prospect off-putting and be deterred from seeking help.
With the approach I have found works best, there is no process, much less a syllabus (!), that is followed to delve into this or that from patients’ past lives. Patients, when given the undivided attention of a supportive, caring and non-judgemental therapist, usually have plenty to say. Certainly, the direction of the session, as well as the pace and nature of the material revealed are entirely in the hands of the patient and no attempt is made to induce people to talk about things they would prefer not to mention. It has to be said, however, that not everyone is suitable for this kind of therapy and in such cases the above-mentioned techniques may be useful.
The role of the therapist, above all, is to listen. This of itself can have a healing effect. Also, observations and interpretations may be offered and the therapist can act as a kind of sounding-board. As mentioned above, the object is always to help patients find their own solutions to their problems or at least to come to accept the reality of their situation.
What does ‘cognitive’ mean?
This word appears a lot in connection with psychotherapy and counselling. The dictionary defines cognition as ‘the action or faculty of knowing, specifically including perceiving, conceiving, etc., as opposed to emotion and volition; the acquisition and possession of empirical factual knowledge’. So now you know! Techniques such as cognitive behavioural therapy (defined as ‘a type of psychotherapy in which negative patterns of thought about the self and the world are challenged in order to alter behaviour or mood) do seem to be helpful for some people and, as they are usually time-limited, can be applied in a health service setting.
Teaching these ways of coping with distressing symptoms, useful as they may be, does not, however, get to the root of the problem. As mentioned above, the kind of therapy I have found most effective for this is based on Jung’s analytical psychology (if we are to put a name to it).
What is the difference between a psychiatrist and a psychotherapist?
A psychiatrist is a medical doctor who specializes in the treatment of mental illness. A psychotherapist may be a doctor or lay person who treats patients (clients) suffering from unhappiness, anxiety and other distressing psychological symptoms who are not mentally ill in the conventional sense.
It should be remembered that in disorders affecting the mind, all diagnoses are necessarily subjective. There are no blood tests or scans which are of the slightest help. Further, it is all too easy for someone to be labelled with a diagnosis such as major depressive disorder or generalized anxiety disorder. Labels tend to stick! And the treatment that conventionally follows may include mind-altering drugs, for example, lithium in bi-polar disorder. Lithium can be helpful to control symptoms in this condition and I have prescribed it myself for such patients. However, both doctor and patient should have no illusions that it is an empirical treatment, not a cure. Its use has been characterized – not entirely tongue-in-cheek – as the treatment of bi-polar disorder by lithium poisoning.
What is mental illness anyway? There is no simple answer but I think a working definition is the state of being out of touch with reality. For a patient in this situation it can be a very frightening experience where he or she does not know the difference between normal external life and the often chaotic inner events. We all have a conversation with ourselves going on in our head all the time. This is normal because we know what is reality and what is not, but sometimes the distinction may not be clear.
What are the qualifications you should look for in a therapist? Letters after their names – MD, PhD, etc.? Membership of learned societies? Yes, of course these can give an indication that someone is potentially suitable for your needs. But the most important qualifications, it seems to me, are a broad experience of life and long experience in actually treating patients.
Further, what really matters if you seek the ‘talking cure’ is to see someone whom you get on with and have confidence in. One or two sessions are usually sufficient to establish whether you and the therapist are right for each other.