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Who is in need of True-Self Psychotherapy? |
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Of course the answer is: who has not attained the power of Ethical Freedom. Those in need are people who have not accepted the ethic of the freedom of conscience and who are caught in the faulty ethic of Hedonism. Thus Medical Humanities, a philosophical discipline, is linked with people's ethical views, applied to their psychiatric suffering. When you eliminate the most important spiritual dimension of the human being, you are bound to suffer terrible consequences, a Social Spiritual Malaise. In my book Medicine for the Whole Person I have related Mental Illness to a person's ethical orientation.
The British Journal of Psychiatry provides information about the seriousness of this malaise, the extent of neurotic illness. The diagnostic label is ‘mixed anxiety and depressive disorder’ or ‘generalized anxiety disorder’.
The astonishing thing is that the particular complaints are not usually considered to be psychiatric illnesses. They are in the following order of frequency: fatigue 27%, sleep problems 25%, irritability 22% and worry 20%. England, Scotland and Wales have a 14% neurotic health problem. (16)
The trouble is that medical science has no remedy for these millions. A tranquillizer has a temporary effect, but patients become dependent on the drug; therefore doctors are told not to give such prescriptions for more than a week. This is no use, as the symptoms continue.
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Counselling |
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Many GPs ask a Counsellor to see such patients. What type of treatment provide the Counsellors? They are trained in a great number of schools. The underlying theory may be psychosynthesis, person-centred psychotherapy, psychodynamics. The Middlesex University offers accredited diplomas, MSc, BA in Counselling , the British Association for Psychoanalytic and Psychodynamic offers Supervision Graduate Research, The Minster Centre offers courses in Integrative Psychotherapy, leading to a Diploma or an MA., the Lincoln Clinic and Centre trains counsellors in Psychoanalytic Psychotherapy. The training involves personal counselling to make sure that the counsellor must be able to offer unconditional positive regard for the clients. The emotional stresses are heavy for the candidates. They are ‘notorious for de-stabilising marriages’ (17).
This summary draws the following conclusion for Medical Humanities: Counselling accepts the deterministic principle of science, university teaching leading to various degrees has nothing to do with Ethical Freedom. Clients are not asked to consider their ethical convictions. My cancer patient was encouraged to find strength in religious faith and in the influence she and others can exert on those who share faith in an ethical conscience. Such faith cannot be provided or mobilized by any of the academic courses, offered to prospective counsellors, there are no examinations which test grades of Ethical Freedom. We are left with our need to make a commitment to the ethic of conscience.
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Infringement of Ethical Freedom by Genetic Determinism
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Counsellors and scientifically minded psychotherapists are not alone in infringing Ethical Freedom. The science of genetics which is based on the Darwinian Theory of Evolution is a major factor which opposes Medical Humanities including even criminal responsibility.
Robert Wright considers that the legal system that finds criminals guilty is ‘outmoded’, as behaviour is not the person's responsibility but is ‘reducible to evolutionary impulse’. (18) These followers of Evolutionary Psychology ‘explain international violence in terms of evolutionary pressures on males.’ Warfare, they claim, can be understood as an adaptive strategy for acquiring the resources to mate and produce offspring that will carry on genetic endowment
Evolutionary explanations combine the credibility of science with the certainty of religion. They are convenient at a time when governments, faced with cost constrain, are seeking to dismantle the welfare state. Why support job training, welfare of children or childcare programmes when those targeted are biologically incapable of benefiting from the effort? Evolutionary principles imply genetic destiny.
Evolution, defined as an eternal principle 'writ large’, becomes a way to justify existing social categories and to deflect critical examination of powers underlying social policy. Why couldn't God have used the mechanism of evolution to create differently? (19)
This use would not only destroy the essence of Medical Humanities which rely on personal responsibility, but would also destroy the essence of religion, denying the possibility of sin.
Another example of denying a justification of Humanistic Ethic is the following: ‘This book is written in the conviction that our existence once presented the greatest of all mysteries, but that is a mystery no longer because it is solved. Darwin and Wallace solved it.’ The ‘solution’ only covers accounts of ‘biological complexity’, (20) but human existence is not just a biological phenomenon.
Biological complexity in no way solves the mystery of our existence. We cannot understand nor explain nature’s creativity and human creativity in particular which is fundamental for Medical Humanities.
Do changes in material-social circumstances explain changes in our values such as a woman's attitude regarding the importance of wealth of a prospective husband or the number of children born in a certain family? Have such people just ‘escaped’ Evolutionary Psychology, as Steven Rose argues? (21)
We can agree that economical conditions play a part. If a particular society experiences greater prosperity than was the case in the past, people may adopt different attitudes. But women ’decide’ to marry certain men and the couple ’decide’ that they want more children than they had wanted before.
It is crucial for Medical Humanities to affirm that such vital decisions are manifestations of Ethical Freedom. This does not mean that purely logical concerns are not involved. The question may be "can we afford to have so many children, can we feed them?" A woman may ask herself. "Should I marry a particular man who not only has not much money now, but is not likely ever to earn enough to keep a family?” Marital love can break if there is not enough money to provide for the needs of the family.
Such denials of the monopoly of the validity of social and genetic determinism are vital for Medical Humanities.
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A Refutation of Darwinian Psychiatry
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How relevant are refutations of Darwinian genetic determinism for medical practice? An answer to this question can be found in an issue of The British Journal of Psychiatry which is the organ of the Royal College of Psychiatry. The title of the Editorial is: ‘Psychiatry and Darwinism’, to which author Rhiad T. Abed adds a subtitle, ‘Time to reconsider?’ He remarks that at present psychiatry has no single theory but ‘a number of competing (and occasionally incompatible) paradigms have coexisted within the field'. A ‘striking weakness’ results for psychiatry if there is an ‘absence of the most rudimentary rules about the functions of the human mind. In such an environment any theory, however irrational, can demand equal attention. Unscientific and erroneous claims that cannot be directly tested empirically can flourish.'
Medical Humanities which are not scientific but personal-ethical and which affirm the dimension of Ethical Freedom and responsibility have been proposed in this paper as a rational basis for all medicine including psychiatry. The author of the Editorial has a different solution: Integrating Psychology and Psychiatry into Biology …That is of course the Darwinian solution, providing ‘the ideal overall framework within which a new and reformed scientific psychiatry can be formulated.’ We are left with, as the only valid principle for consideration with the human brain, its biological structure. It is supposed to enable us ‘to form hypotheses about depression, obsessional-compulsive disorder and the anti-social personality disorder.’ (21)
The question raised by Medical Humanities, is: how can such structure provide answers to these disorders which are by no means biological, but which are related to questions about the meaning of life, about the difficulties of coping with these experiences?
Darwinian psychiatry fails to allow for the challenges that occur in human lives, including those of all types of illness.
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An irrelevant outcome of an important research subject |
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Darwinian psychiatry has chosen marital infidelity as a research subject. The aim was to predict differences between men and women in their responses to marital infidelity. These were supposed to reveal consequences for reproductive fitness in men and women in different cultures. The males were expected to be primarily distressed by the sexual infidelity of their partners because of paternal uncertainty. Only secondarily would they be jealous of their rivals. The women, on the other hand, were expected to feel the reverse: first, jealousy of their successful rivals, secondarily concern about paternity uncertainty. This prediction has been upheld in a number of studies across different cultures.
The author sees in this project a contribution to evolutionary paradigms. The right question is supposed to have yielded ‘novel hypotheses, leading to significant advances in understanding.’ (22)
The result of this research is supposed to be in the region of gender psychology. As procreation of children is involved in this study, we are supposed to have obtained knowledge of psychology, linked with biology.
The objection from the point of view of Medical Humanities to this project is that it entirely misses the significance of its subject, marital infidelity. The study has left out the fundamental importance of love which cannot be divorced from sex. ‘Reproductive fitness’ is not the fundamental issue for the medical humanist. Marital infidelity constitutes a serious crisis in a marriage. The unfaithful partner is guilty of having broken the marital trust. The question of paternal certainty can be solved through DNA testing. But this does not solve the problem how this baby can be integrated into the husband's family if the child's father is the lover. Can this marriage endure? The answer depends on the commitment which the partners have to each other. If marital infidelity is just a matter of jealousy and paternal certainty, the chances are that the couple will split up and seek ‘reproductive fitness’ with new partners.
The current rate of divorces in this country is nearly sixty per cent. The main victims are the children. Compared with children brought up by their natural parents, those whose parents divorced are more likely to leave school with low educational qualifications, experience early sexual activity with unmarried teenage pregnancy, display behaviour aggression, substance abuse, delinquency, depression, unemployment or earning low pay as adults. The author of the article from which these terrible effects of divorce are quoted provides a psychological explanation which is of very fundamental importance and has not the irrelevance of the author of Darwinian psychiatry.
People expect marriage to be self-fulfilling, but this expectation is not possible if some see marriages as a ‘business opportunity’. (23)
Business involves only some material success. If this is not forthcoming, the business is changed for one that appears to be more lucrative. In business there is no question of regard for the competing other business. We are left to guess how many marriage partners belong to this business category. Many share with the business attitude one of selfish expectations in their marriage and when these do not materialise, a divorce ensues. This selfish attitude is contrary to the idea of marriage when each partner expects mutual unselfishness, so that each receives as well as gives. Medical Humanities is deeply concerned with the serious results of divorce.
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A Case invalidating genetic deterministic monopoly |
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One of my patients whom I shall call Jane is an identical twin. She and her sister Joan have the same genes. They were brought up by their parents together and no important changes in their environment occurred which affected one differently from the other. They are physically very similar, but are totally different spiritually. All her life has my patient suffered from her sister's malicious sadistic desire to diminish her, to prove her own superiority and power.
She prevented Jane from entering a medical school, making a great success of her own medical career. When they meet, Jane is always in fear, expecting another attack.
This case proves that we are not entirely determined by our genes. The ethical personal freedom which is basic for Medical Humanities has been saved.
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Conclusion |
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I am a Medical Humanist. In this paper I have formulated the basis, the foundation, for the treatment of the human beings who ask for my medical help. The Ethic of Conscience is for me this foundation, a manifestation of Freedom which rises above scientific knowledge which I fully accept in its own right. It is based on the presupposition of necessity or determinism. I had to reject its incursion into the dimension of Ethical Freedom by scientific psychotherapies, by counselling and by genetics, applied to biological and psychological evolution, to psychiatry and to personal heredity
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References |
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(1) Jaspers, Karl The Perennial Scope of Philosophy, Philosophical Library, New York 1949 pp 65, 69, 74.
(2) Freud, S. Group Psychology and the Analysis of the Ego, The Hogarth Press and the Institute of Psycho-Analysis, London, vol. 19, 1955, p. 90.
(3) Freud, S, Civilization and its Discontents, 3. edition, Hogarth Press and the Institute of Psycho-analysis 1946 p. 102.
(4) Ibid. p. 83.
(5) Andrew, Gavin ‘The Essential Psychotherapies’ in The British Journal of Psychiatry, 1993, no 162, pp. 447-51.
(6) Jacobi, Jolan The Psychology of C.G.Jung, An Introduction with Illustrations, Kegan Paul, Trench, Trubner & Co, Ltd, London 1942, p.143.
(7) Fordham, Frieda, An Introduction to Jung's Psychology, Penguin Books Ltd, 1953, p 66.
(8) Ibid. p. 27.
(9) Ibid. p. 25.
(10) Ibid. p. 25.
(11) Jung, C. G, Memoirs, Dreams, Reflections, recorded and edited by Aniela Jaffe, Routledge & Kegan Paul, London 1953, p. 17.
(12) Jung C. G The Integration of the Personality, Kegan Paul, Trench, Trubner & Co, London 1940, p. 80.
(13) Fordham Frieda, op. cit. p. 51.
(14) Ledermann, E.K. Medicine for the Whole Person; A Critique of Scientific Medicine, Element Books 1997, chapter 4.
(15) Cassirer, Ernst An Essay on Man, An Introduction of a Philosophy of Human Culture, Yale University, U.S.A.1944, p161.
(16) Mason, P and Wilkinson, G ‘The Prevalence of psychiatric morbidity in Great Britain’ in The British Journal of Psychiatry, January 1996, vol. 168, pp 1-3.
(17) Williams, Mary, letter in Counselling, The Journal of the British Association for Counselling, November l998, Vol. 9 No 4, p. 262.
(18) Nelkin, Dorothy ‘Less Selfish than Sacred? Genes and the Religious Impulse in Evolutionary Psychology ’ in Alas, Poor Darwin; Arguments Against Evolutionary Psychology Edited by Hilary Rose and Steven Rose, Jonathan Cape, London 2000
p.20.
(19) Ibid. pp 21-23.
(20) Dawkins, Richard The Blind Watchmaker, Longman, Scientific & Technical, Longman Group UK Limited, p. 19.
(21) Riadh T.Abed, ‘Psychiatry and Darwinism: Time to consider?’ in The British Journal of Psychiatry, July 2000, vol. 177, p. 1-2.
(22) Ibid. p. 2.
(23) Waterhouse, Rosie ‘Divorce Inc. Nearly half of all marriages end in divorce. It's so common, some see it not as a stigma but as a business opportunity’ in The Sunday Times 10 2000 p. 14.
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