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No Miracle Cures
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17956 |
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BOOK WORLD
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5 / 1990 |
1,109 Words |
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David Shore, M.D.
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The cover of Rickie describes it as "the riveting true story of a girl's descent into the world of madness and the extraordinary relationship with her father that helped bring her back to health." The inside cover notes that at age fourteen, "Rickie was diagnosed a schizophrenic, removed from her caring family, and condemned to long, heart-breaking years in mental institutions." Nevertheless, this story has a happy ending. Written by Rickie's father, Dr. Frederic Flach, a prominent psychiatrist, author, and researcher, its goal is apparently to diminish the stigma of mental illness and provide hope for patients and families. Hope based on rehabilitation and new research developments is fine, of course, but beware of false hope based on unproven "therapies."
Several issues emerge while reading Rickie. One question that arose was: where was the evidence that Rickie was ever really schizophrenic? We are presented with her coherent and often insightful letters and poems, and with her descriptions of the hospital setting and her treatment, but are told very little about the kind of symptoms (such as delusions, hallucinations, or incoherent speech) that would lead us to believe that she really had the diagnosis repeated throughout the book. In fact, the evidence given in her parent's recollections and her own writings suggests that (given our current understanding and diagnostic criteria) Rickie would not be considered to have been schizophrenic.
Early on, there is the suggestion that Rickie has religious delusions or even believes that she is a horse. And yet the rest of the book does not explain any of this, and the reader is left wondering what to make of leads that point in a very different direction. There are repeated references to Rickie's needing attention, pretending to be ill, and a number of symptoms or behavior that might at various times have been described as "manipulative," "hysterical," or "borderline." Why doesn't Dr. Flach focus more on his daughter's perspective, since Rickie herself describes her dramatic and attention-seeking behavior, idealizations, and extremes of emotion? Improvement when given new hope, alternating with severe deterioration when faced with a separation or a challenge in which she feels she cannot succeed (here often involving academics), seems to be a pattern. It appears that Rickie's psychiatric treatment focused so narrowly on psychodynamics or family dynamic aspects that it failed to take account of her actual symptoms and to consider possible alternative explanations and implications.
One helpful insight from the book is the often painful effect of therapists' failure to involve families and refusal to inform them about the treatment of their children. Sometimes this pushing away of families is done in the name of confidentiality, but it can be an excuse for arrogance or a conscious (or unconscious) blaming of relatives for having produced the disease. Research of the past thirty years has shown clearly that families do not cause any of the major mental disorders; schizophrenia, bipolar (manic-depressive) disorder, severe depression, and so on. It is indeed sad that so few people, even among the supposedly well educated, realize this today.
This book intrigues because it shows how outmoded many of the procedures and practices used in Rickie's treatment seem today. Maybe reading it is useful as a reminder of how wrongheaded many of our ideas and approaches were fifteen or twenty years ago. But twenty or thirty years hence, we will probably look back at much what
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