THE LIMITS OF PSYCHIATRY

...There is no point in glorifying her, or her child...

...Will computers or neurophysiologists help us out with that problem...

...Perhaps more than anything else we in psychiatry are devoted to our medical terms, to the imagery they provide...

...One can regret the ignorance that still bedevils medicine and psychiatry...

...Finally, there is the old cry that "psychoanalysis is primarily a tool of research, or a method of study"—or so it is said by those who spend whole days "applying" their research and study to the same upper-middle-class patients...

...Nor will ten million psychiatrists, even when they know more than they do now, take away the billions of dollars from those who have so that the poor will no longer go hungry...

...We have limited manpower," I hear from clinicians whose hours go readily to those who can command them with dollar bills, and who seem to notice "limitations" only when the problems of the indigent are mentioned...

...He emphasized quite rightly how little we in the profession know—and how we have turned increasingly to biochemistry and neurophysiology, a direction that Freud predicted...

...The million nuances of man's psychological life are easily placed under categories like "human behavior," but any further effort to understand and deal with that behavior requires what Freud rightly called a "mythological theory...

...So that's why they didn't get sick, because there was work they had to do...

...We need to do more research...

...Have you seen your psychoanalyzed friends rush to Mississippi or Appalachia, or even to nearby ghettos...

...It took her to let me know what in fact I was thinking...

...Nothing, I repeat nothing, that anyone engaged in psychiatric research might find will make us as human beings invulnerable to repetitions, in future centuries, of such sins...

...What further "frontiers" do we really have to conquer, when it comes to such subjects as despair, brutality, envy...

...It's like she didn't get sick before, but she got hurt, even if we didn't see it, and inside her somewhere there's a bug, and it's eating away at her, and she'll have to get sick someday, for all she went through...

...Nor do I expect my colleagues to correct (not through "insight" anyway) the hunger of the poor, or the exhausted, enfeebled state in which they find themselves...

...I think that rather the opposite condition faces us...

...There is no point in discrediting a field for not doing what no one in his right mind wants it to do—"cure" man of his human capacity to suffer not "illness" but feelings...

...As a result he saw not only what ailed others, but what happened between himself and them, between one person and another...

...The issue, then, may well not be one of further psychiatric "discovery," but a reappraisal by psychiatrists of what, in fact, their job is...

...Now, precisely what improvements can help us care more for one another...

...I do not know about the fate of various theories among nuclear physicists, but I can easily point out the devotional quality that substantially informs psychiatric discussion...

...the Limits of Psychiatry by ROBERT COLES T wish to make it clear that I have no essential disagreement with Selig Greenberg's "Frontiers Beyond Freud" which appeared in the February issue of The Progressive...

...The poor are hard to reach," I hear from those who never have lifted one finger in any direction but a paying customer's...

...That is all well and good, provided everyone concerned—psychiatrists and particularly the American public who adores them—understands what is happening, which is that imagery is being used...

...The life of the mind needs a context, and one that is not called a mere "background...

...Likewise, terms like "ego" or "id" describe certain kinds of activity, of mental life...

...I know the popular answer to all those questions...

...When I went to study harassed Southern Negro children who were going through mobs to attend desegregated schools, I was looking for "psychopathology," for the "strains" that follow "stresses" —all neatly concrete and mechanistic...

...He is a contributing editor to The New Republic, and his articles have also appeared in Harper's, The Atlantic, The Reporter, and Saturday Review...

...It may sound presumptuous of me, but I honestly believe that there is not much left for us to discover about man's fantasies, dreams, wishes, and doubts...

...That is, he became "subjective" rather than "objective," much to his own shame for a long while...

...They have always known trouble, and when a chance came to put an end to at least some of their trouble—ironically by going through trou-ble—they accepted the challenge and survived, or as Faulkner would put it, endured, perhaps eventually to prevail...

...For several decades now the best psychoanalysts have explored that treacherous, undramatic, highly elusive, un-measurable terrain—the land where two people meet and exchange words and feelings...

...Psycho-pathology is then, by definition, a social problem involving the family, the nursery, the neighborhood, the nation and its economic or political condition...

...that one "has" schizophrenia...

...Or is it that from birth to death we live in a world whose premises teach us suspicion and greed, a world that has to be changed, by action rather than research...

...What he did was systematically pull together what Shakespeare or Dostoyevsky sensed into a coherent theory...

...What he also did was look inward...

...One can expect a variety of metabolic disorders and their psychiatric manifestations to disappear as ROBERT COLES is a research psychiatrist at the Harvard University Health Services...

...We "treat" people, and try to "cure" them of their "diseases," which we are trying to study, so that we can unlock their secrets...

...His book on his experiences in the South, "Children of Crisis," will be pu.blished this month by Little, Brown...

...The danger to all this, to theoretical thinking, comes when a model devised to make things clear becomes itself a sacred object...

...It took that occasion for me to tell her and myself that the past was the past, and the present quite another time...

...There is "mental health," and its opposite, "mental illness...

...In this case, the language we use becomes misleading...

...I myself have certainly thought in those terms...

...Yet, I do not believe psychoanalytic psychiatry is anywhere near bankruptcy...

...As for what can legitimately be called psychiatric disorders, I am not at all convinced that anything "new" will be discovered to "cure" them...

...I'm like you," she said...

...I will call them heroes, but not in the romantic sense of the word...

...Psychiatrists deal with people who are having a hard time with themselves or with other people, more likely with both...

...As we learn more and more about the influence that money and power exert upon people, upon their minds, perhaps we will have gone as far as we can, as psychiatrists...

...It is as if, somehow, a vaccine will be found, a bit of chemistry found relevant, and yet another "disease" will succumb to "science...

...The poor cannot communicate in our language," I hear from psychiatrists who talk in such confused and jargon-filled phrases that one can only wonder what goes on between middle-class patients (who do "communicate") and their willing psychiatric listeners...

...The girl had gone through a hard time of it, mobs and violence, to enter a white school in Louisiana, and again, like others, had done very well psychologically...

...This person "has" a depression...

...It is fascinating how many assumptions we all share in this world, regardless of class and caste...

...We know so little...

...One can regret the widespread mistrust we all have for one another, race against race, nation against nation, class against class, region against region...

...Instead I had to explain the good health of these children, maintained against terrible harassment...

...Physics has it—atoms and molecules that no one has ever seen, but which exist as "phenomena," or as words that signify phenomena...

...I believe it is still what Freud saw it to be—to look relentlessly and scrupulously at what goes on between people...

...I suppose the mother knew what was on my mind, though no more explicitly than I myself when I am with her, when I forget my "research" and simply listen to other human beings talk...

...Our thoughts, unlike the diseases that viruses and bacteria cause, simply cannot be considered as going on only inside the body...

...I am getting at the great paradox that plagues more than the profession of psychiatry—the difference between understanding and action...

...He was trying to show how inadequate psychiatric facilities are, even for the job they purport to do, let alone the work some indiscriminate partisans of psychiatry would thrust upon it—such as "treating" the social and economic "ills" of the nation...

...I am not about to suggest that a more decent and fair society will provide an end to "mental illness," or even everyday tension...

...Put differently, the entire medical imagery that psychiatrists and the public apply to the social processes at work in what we call "mental illness" may well need revision...

...A good part of the psychiatrist's time is spent confronting, with another person, one or more aspects of "the human condition," rather than what is called "illness...

...I keep thinking there'll be some trouble some day for her to pay, because of what she went through...

...Meanwhile the mother had achieved a degree of wisdom, and could share it with someone like me...

...Here is how the mother of one of them explained it all for me—and her words virtually summarize the argument I am making here: "Well, I think they just went ahead and did it, because it was there for them to do...

...I see on television periodic advertisements asking that we "fight mental illness," and wonder exactly what the beleaguered public can possibly do with that particular military summons...

...In that sense, it is impossible to call the psychoanalytic method outdated...

...Figurative language enables us to comprehend what may otherwise be an impossibly clouded issue...

...But like Gertrude Stein, we will have to ask what question we are trying to answer...

...I had treated middle-class children— who had all the psychiatric help they could want—and I expected the poor, Negro children of the South to be like them because all children seem susceptible to "pressures," and then become "ill," or so I would have it...

...At least I hope what I have just declared will hold because psychoanalysis seeks (or should seek) above all else the kind of truth Nietzsche proclaimed: "It takes two to make a truth...

...What will psychiatry ever know that it does not know now about the damage done by thoughtless, cruel parents to vulnerable children...

...When I failed to find symptoms in these Negro children I was puzzled, really because my imagery had failed...

...I eventually realized that my way of thinking had really prevented me from looking at the lives of those children...

...He also points out how isolated many of us psychiatrists are, not only because we lack knowledge about so many things, which is, after all, forgivable, but because we are narrow-minded, or preoccupied with social advancement and money...

...Consequently, we have to be cautious in the use we make of words like "treating" psychopathology—yes, even doing "research" to discover what brings "it" about...

...scientists catch up with errant genes and flawed glands...

...An "illiterate" woman from a sharecropper farm— culturally "deprived" and all that—she nevertheless thought exactly as I did, and psychiatrists do, and Freud did...

...In this regard it is instructive to hear the elaborate network of rationalizations used by psychiatrists to justify the restricted clientele they see...

...The dynamics are all on the table, and in a way were there before Freud ever came along, as he acknowledged more than once...

...quite the contrary, it has much to offer a huge, industrialized nation whose machines, computers, gadgets— "technology" is the word—threaten to take over everything from here to Mars, including what is most preciously human in all of us, face-to-face encounter...

...In Kierkegaard's words, "fear and trembling" are roused, because nothing can be more decisive than the presence of another person who cares, or whom one wants to care...

...Because psychiatrists are doctors, and quite properly aim to be scientists, they use medical terms to describe their territory and try to be as exact as possible in defining its limits...

...In sum, psychiatric knowledge, however refined it becomes, will never liberate man from himself—that is, unless George Orwell was right when he pictured the brainwashed men of 1984, controlled by a breed of psychologically sophisticated politicians whose prototypes may be alive and rehearsing right now...

...What we do not know is what to do...

...I am not even sure we ought to call them "disorders" or "diseases...

...I have kept on coming back though, mindful of the time that my theories tell me mental illness sometimes needs before it "appears...

...If it is the question of human relatedness and its vicissitudes, I fear that even now we know—as human beings, let alone psychiatrists—much more than presidents and kings, executives and leaders care to consider...

...The eyes move, the ears are called into play, and the past comes alivej filled with hope, adoration, timidity, and disenchantment...

...The public may then tell us to go back to our "laboratories," and find some neurochemical "answer" to this or that...

...To tell the truth we never thought they would get sick, no matter what...

...Somehow, though, the possibilities or potentialities for violence and hatred that live inside us all become activated and institutionalized so that murder, war, racism, concentration camps, and genocide are what science has conspicuously failed to prevent in this century...

...I recently heard the mother of one child I have known for six years tell me how well her child continues to be...

...There may be a lot to what the more biological of psychiatrists say, but the worth of Freud's ideas, in my opinion, will never be made less by biochemistry, no matter what he himself—wedded to Nineteenth Century mechanistic science—may have said...

...We know all there is to know...

...And their spirits, they held up because they knew they was doing something good, and it made a lot of sense to them...

...Is there really anything more we have to learn about hate and love...

...But what pills will ever dissolve the anxiety and fear that go with life itself...

...Certainly I do not want psychiatrists "treating" the legitimate despair that people feel in Harlem or at the spectacle of Auschwitz...

...Here were boys and girls from the worst homes—"culturally disadvantaged" or "deprived"—and they did not develop the "syndromes" or "diseases" that a child psychiatrist like me expected...

...Will more scientific research teach us compassion or instruct us in the "pathology" of envy...