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Psychotically Frightened to Death
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17957 |
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Section : |
BOOK WORLD
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| Issue
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5 / 1990 |
3,283 Words |
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Ann-Louise Silver, M.D.
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"We shall not cease from exploration
And the end of all our exploring
Will be to arrive where we
started
And know the place for the first
time."
T.S. Eliot
Four Quartets: "Little Gidding"
"There's one good thing
about this place, though.
My doctor is good.
I think I can talk to
him easily now…"
Rickie
Rickie, Dr. Frederic Flach's daughter, fell ill at age fourteen: "Daddy, I'm scared because…I want to die." Over the next decade, she stayed in many hospitals undergoing various treatments. In Rickie, her psychiatrist father shares his perspective with us. He is both an insider, used to treating patients, and an outsider, watching others treat his daughter. As a therapist at a psychodynamic hospital, I wish I could examine Rickie's case more fully, for much of Rickie's drama of illness and treatment takes place behind a drawn curtain.
Interspersed throughout the book are Rickie's contributions - recollections, letters, and poetry. They sparkle with intense self-scrutiny. Like Joanne Greenberg, powerhouse author of I Never Promised You a Rose Garden, she teaches the lesson often resisted by the healthy. Psychosis is not simply a chemical phenomenon but a metal one as well; the process of recovery brings wisdom and strength. Her observations how her enlightened hopefulness evolved could influence the treatment of many patients.
A psychodynamic approach
As the turn-of-the century psychiatrist William Alanson White taught: "The difference between the so-called insane person or the criminal on the one hand and the so-called sane or normal person on the other is only a difference in quantity…of the various tendencies and stimuli with which he has to deal." Just as we all have the capacity for nay of the insanities, all mentally ill people have the capacity to recover.
Quoting T.S. Eliot, "Humankind cannot stand too much reality." The knowledge that we each will die is universal to humans. At times, this knowledge can disorganize us to the point that we are diagnosed psychotic.
This disorganization takes place in the brain in ways demonstrated by neuroscience with increasing elegance. Gene markers, changes in neuronal activity, neurotransmitters, and even brain blood-flow and brain size all document that thought as are the product of brain activity. Psychodynamic psychiatrists appreciate these advances. A huge and effective armament of pharmaceutical agents may quiet turmoil and aid reorganization. New medications such as clozapine can facilitate remarkable improvement in those already benefiting from the phenothiazines.
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