The Courage to Create

In a break from marking essays I have just finished reading The Courage to Create, a short and delightful book by the existential psychotherapist Rollo May. I was motivated to read more of Rollo May by the video I watched and reviewed here. This deeply humane and thoughtful book was a nice antidote to the last book I finished, by the much more combative Thomas Szasz.

Rollo May's book is about the creative process. A painter himself, he draws many of his illustrations from the visual arts as well as science and psychotherapy. The title comes from May's belief that creativity is a courageous act: the discovery of 'new forms, new symbols, new patterns' challenges conformity within society, and the creative genius is often punished for it.

May writes a lovely chapter on creativity and the unconscious, exploring the experience we have all had in which we apply ourselves to a problem for days only to have the answer come out of our unconscious when we finally put our pen down, have a rest or go for a walk. My old teacher used to say 'leave it to the night shift' and he meant just this, let your unconscious mind work on the problem and it will come up with the answer. May argues that the mind needs the 'relaxation of inner controls for the unaccustomed idea to emerge' (63).

My favourite chapter though is May's meditation on 'creativity and the encounter' in Chapter Four. He argues that great art comes out of the encounter between subject and object, between, for example, the painter and the landscape. He argues that the intensity of that encounter, the passion or commitment involved, determines how great that art will be. It also brings with it anxiety (92).I love this idea of the encounter and I immediately applied it to my work as a psychotherapist. Out of the encounter between therapist and client - or out of the client's encounter with self - out of the intensity of that - come new perceptions, realisations, insights and profound change. And yes, it certainly requires courage!

Book Review: Psychiatry The Science of Lies

Reading this short book by Thomas Szasz is a real challenge. Each chapter contains half-a-dozen spring-loaded boxing gloves, which punch you on the nose as you read. That's what it felt like to have my assumptions and settled ideas about psychiatry and mental health challenged by Szasz. I had expected the attack on psychiatry, but was unprepared for his attack on patients as malingerers or the neo-liberalism that drives his approach to social reform.

The Szasz argument goes something like this: psychiatry is fake and has nothing to do with medicine. Mental illness does not exist, it is conjured into existence when a psychiatrist makes a diagnosis. So in psychiatry disease is the same thing as diagnosis. He suggests there is an unholy alliance between the state and psychiatry. The state has delegated to psychiatry the power to incarcerate individuals guilty of no crime. 

Here is Szasz in his introductory chapter, a passage that sums up his argument:

Because there are no objective methods for detecting the presence or establishing the absence of mental diseases, and because psychiatric diagnoses are stigmatizing labels with the potential for causing far-reaching personal injury to the stigmatized person, the "mental patient's' inability to prove his 'psychiatric innocence' makes psychiatry one of the dangers to liberty and responsibility in the modern world (3).

Later Szasz makes clear why psychiatric diagnoses are so damaging: 'Attributing a medical diagnosis to a healthy person does not transform him into a bodily-medically ill person, whereas attributing a psychiatric diagnosis to him does indeed transform him into a mentally-psychiatrically ill person' (15). 

If mental illness does not exist then Szasz must find a reason why so many individuals claim to be mentally ill. Szasz argues that individuals who claim to be mentally ill are in fact malingering. Szasz winds the clock back and shows us the Victorian consulting room. He says the patient arrives believing he or she is ill. The doctor must conclude that the patient is malingering or that he, the doctor, can find no disease. In the face of this unpalatable dilemma a third option emerges: the patient is mentally ill or, in the language of the time, suffering from hysteria: 'Thus arose the modern idea of mental illness, the product of the conflation of having a disease and occupying the sick role (voluntary or involuntary)' (23).

Szasz doesn't explore the 'role' of the patient much more than this. His book tends to get lost in the history of psychiatry and the wickedness of Sigmund Freud. It wages war on a number of unlikely subjects: Kay Redfield Jamison's bi-polar disorder is described as 'an alleged illness'; whilst the author, Lauren Slater, belongs on a 'list of "mad persons" using their madness to build successful careers as celebrity experts on madness' (100). Particular ire is reserved for the psychologist David Rosenhan who tricked the psychiatry establishment into admitting him and his colleagues into a dozen psychiatric hospitals despite having no symptoms of psychosis apart from a pretend 'auditory hallucination' - they told doctors that they repeatedly heard the word 'thud'. Szasz condemns Rosenhan's use of the word pseudo-patient arguing that Rosenhan was actually a real patient with a pseudo mental illness. Szazs thinks that Rosenhan had unwittingly supported the coercive system of mental health care rather than exposing it as prone to error..

If mental illness is a myth then I'm left wondering how Szasz understands the real fear and distress that people experience. There's no indication in this particular book. I see the feelings of distress that individuals experience as an understandable and legitimate reaction to stressful events.I don't see people experiencing psychosis as malingering, but as coping best they can with the circumstances of their lives. I imagine Szasz would say, 'fine' but let's not call it mental illness, and if an individual requires help let it be a be a private arrangement between the client and their chosen mental health professional, which has nothing to do with the state and it's coercive power.

This New American article, Critics Blast Big Psychiatry for Invented and Redefined Mental Illnesses, deploys the Szasz arguments against modern psychiatry and its revision of DSM-V. So Szasz is current and worth reading for his radical and alternative viewpoint, but I'm going to turn to his classic works rather than rely on this collection of essays.

DVD Review: Rollo May and Existential Psychotherapy

This is a busy time of year for me. The courses I'm teaching come to an end, the assignments flood in and the marking begins. It's great to be able to give feedback and reward my students' hard work, learning and development with medals and missions; but marking is a time consuming business and results in numerous late nights and early mornings ... well, late nights mainly.

The last book I finished was Yalom's latest, but that was several weeks ago and I haven't started another yet. When I've a lot of work on I can't concentrate sufficiently to read and enjoy a book. Instead I tend to spend a lot of time flitting round the Internet: from Twitter to Facebook, to email and back to Twitter again. I learnt yesterday, from an article published by Science Daily, that this is indicative of depression. I'm not depressed, just suffering from a little bit of stress. In fact the research described in the Science Daily article makes a bit of a leap when it says flitting around the Web indicates an inability to concentrate and that indicates depression - I go with the first conclusion but hesitate at the second. 

So, unable or unwilling to dedicate time to reading I have hit upon a clever alternative. Several months ago I noticed that Psychotherapy.net DVDs were available for purchase on Amazon. I've bought them before, from the USA, and been slugged with a £28 import tax, so seeing them on Amazon and available in the UK was a pleasant discovery and flicked the 'buy me' switch in my mind - at this point imagine a railway line, a clanging bell and a locomotive carrying hard-earned cash towards Amazon INC's company HQ.

Despite the expense, watching DVDs of expert therapists working with actor/clients is great learning and very satisfying. I've recently watched Gestalt Therapy with a difficult to engage client and brief psychodynamic therapy with an elderly depressed client. My latest is an interview about existential psychotherapy with Yalom's own therapist, the existential psychotherapist and author, Rollo May. 

The sound and picture quality on the Rollo May DVD is pretty poor. It was made in the '80s on VHS - or possibly a machine that has a revolving foil drum. There is one camera, which pans around the participants when it might have more fruitfully remained exclusively on Rollo May. The participants are dressed for the1980s, early 1980s, when the moustache enjoyed a final blaze of popularity before its final death rattle and demise everywhere but Northern Ireland. 

The video has the flavour of the '80s for other reasons too. May constantly repeats his opinion that other therapies are 'gimmicks' - gimmicks in comparison to the therapy he practices, the therapy of Freud and Jung. Indeed he doesn't recognise short-term problem-focused therapy as psychotherapy at all. 

Remember that this is the time when managed care became popular and funding shifted from long-term psychoanalysis to short-term interventions and in particular Cognitive Behaviour Therapy (CBT). On reflection Rollo May seems rather zealous and intolerant of other therapies. We have come to accept the existence of a multitude of brief, outcome orientated or problem focused approaches.  For May they are quick fixes (gimmicks) whilst true therapy is a philosophical and mythological endeavour, an exploration of how to live the good life. I can sympathise with this, it treats seriously our existential concerns, but I see nothing wrong with helping clients to solve problems or reduce the symptoms of trauma and distress. May believes, with some justification, that these remedies are short-term and that symptoms return. Indeed symptoms tell us that all is not well, that we need to attend to the existential roots of our distress. 

There is no way to settle this dispute except to say that watching the DVD crystallised the problem for me at a time when I wasn't able to concentrate on reading any of the Rollo May books I have just bought for Summer reading ... from Amazon INC.

Existential Psychotherapy - Irvin Yalom

I've started dropping the name of Irvin Yalom when talking to my students. So far it's been pretty successful, with a couple of them reading his work and expressing pleasure in what he's written. So I wanted to put something about Yalom on this blog with a list of references and a few links to resources.

In my opinion Irvin Yalom is one of the world's great therapists. I've formed this view after many years reading his books and watching his DVDs. His writing includes intellectual work on existential psychotherapy and therapeutic groups; several novels, Lying on the Couch, When Nietszche Wept and The Schopenhauer Cure; works about the process of therapy; two collections of case studies, the finest of which is a wonderful bedtime read and called, Loves Executioner; recent works include a book about death anxiety called, Staring at the Sun. A novel about the philosopher Spinoza is published in March 2012.

Yalom's DVDs include an amazing set of recordings on the practice of inpatient and outpatient group therapy. It seems to me that Yalom is an amazingly humane, empathic and sensitive man in those films. The work is pretty challenging but the overall impression is of Yalom accepting and working with whatever his patients bring. Carl Rogers talked about 'prizing' his clients and I think this is what Yalom achieves. Another DVD sees a much older Yalom (he's 80 now) providing case consultation for a number of psychotherapists; again the same themes re-occur: existentialism, working in the here-and-now, therapy in groups, the therapeutic relationship and the importance of dreams. In his supervision session Yalom listens out for these themes as they emerge in the course of the consultation, it's nice to watch.

So here are some Irvin Yalom links.

Psychotherapy.net is a Yalom company. Their YouTube site includes clips from Yalom's DVDs here

Yalom's personal website is here and his Facebook Page is here

Most of his books (and now his DVDs too) are available on Amazon here

Annotated Bibliography

Novels

1992 When Nietzsche Wept

What if the existential philosopher, Friedrich Nietzsche, had asked Freud for help with his neurosis and benefited from the talking cure?

1996 Lying on the Couch

Twists and turns as a client out for revenge entraps her therapist

2005 The Schopenhauer Cure

A philosophy teacher with a love for the pessimistic philosopher Arnold Schopenhauer joins a therapy group.

2012 The Spinoza Problem

Soon to be published - mine is on order!

Non-Fiction

1970 The Theory and Practice of Group Psychotherapy

Yalom's huge contribution to the practice of group therapy

1974 Every Day Gets a Little Closer

Yalom and his patient write an account of their therapy together. Thus he can charge her reduced fees and help with her writing block. I read this and thought Yalom was way off with some of his interventions - an honest account of therapy in all it's movement and stuckness.

1980 Existential Psychotherapy

Yalom's magisterial account of existential psychotherapy, in which existential concerns (freedom, isolation, meaning and death) are presented as the unwavering facts of our existence, to be addressed in therapy, the cause of great and often displaced anxiety.

1983 Inpatient Group Psychotherapy

More insights into group work where distressed individuals are able to work on their own issues by working with each other.

1989 Love's Executioner and Other Tales of Psychotherapy

Wonderful set of case studies - Yalom called them his teaching tales. Each is full of wisdom, thoughts about practice and Yalom's core concerns.

1998 The Yalom Reader

A selection of Yalom's writing from his novels and text books

1999 Momma and the Meaning of Life

More case studies or teaching tales with a focus on existential issues and in particular our mortality and what that means

2001 The Gift of Therapy

Beautifully written short chapters covering numerous FAQs about the practice of good therapy.

2008 Staring at the Sun: Overcoming the Terror of Death

As Yalom has got older the subject of death has become more compelling. This is a book length treatment of death anxiety and how it might be overcome, containing Yalom's idea of 'the ripple effect'.