A Conversation with Dr. Dorman
What was your inspiration to become a doctor? And how did you choose the field of psychiatry?
I had a strong interest in chemistry and biology back in high school. Once in college, I could see that medicine was my calling. In my first year of medical school, psychiatry was my favorite course. I was fascinated by the mind. After my internship, I thought I wanted an academic career, so I took a postdoctoral fellowship in neurophysiology-studying and doing research on the brain. That's when I discovered I missed a clinical setting-listening to people talk about their problems and how their minds worked. I put myself through medical school by working and obtaining loans, so I practiced family medicine for six years to pay off my debts, and then I started my residency training in psychiatry at UCLA.
I had read books by psychiatrists who really had an interest in the mind of the psychotic person. Back then, in the 60's, there was plenty to read: Frieda Fromm-Reichmann, the treating psychiatrist in I Never Promised You A Rose Garden, Harry Stack Sullivan, Harold Searles, and many others. These people were actually listening to the psychotic person-not just managing or controlling some of his distress with drugs or electric shock treatments. I was convinced that the person suffering from schizophrenia struggled with the same problems as anyone else, but for degree. I thought that if I could understand Catherine's inner world, find out why she was trapped in madness, I might help her find a way out. At least I thought that it was worth a try.
The National Institute of Mental Health (NIMH) web site is misleading. One in five people do not recover completely, as the web site states. NIMH and most doctors define recovery as a reduction or elimination of so-called "psychotic symptoms," defined as hallucinations, delusions, alleged distorted perceptions and profound withdrawal. Those few symptoms hardly describe the magnitude of the difficulties faced by a person with schizophrenia. Not included in the definition are serious problems with relationships, work, motivation, energy, purpose, self-esteem, self-care, hopefulness, creativity, and ability to love-in short, everything most of us live for. Most so-called recovered schizophrenics are living in halfway houses or in sheltered environments. If they work at all, it is usually at menial jobs. They usually do not form meaningful relationships. They do not develop and grow in a substantial way, and they walk around mentally dulled by the medications they take. True recovery, Catherine's recovery, is so rare that it is not even mentioned in the psychiatric literature. In fact, young psychiatrists are taught that if a schizophrenic person ends up living a normal life, then he couldn't have had schizophrenia!
Catherine did fully recover. She lives a rich and full life. She has a responsible job. She is a member of several county commissions. She lectures. She has had long-term relationships. She has many interests. She even is a semi-professional flamenco dancer. She has never been on medication. I saw Catherine six days a week in psychotherapy for three years while she was in the hospital. For the next three years I saw her five days a week, and then three days a week during her last year of therapy. Therapy as I see it is an attempt to hear the other person, her soul and her struggles. As Catherine told me about herself, she and I both learned about her self, who she was. I added my self-my strength and my perspective — to help her understand herself and her fears. The result was that she slowly developed a more realistic self over time. In other words, she grew and developed. She left her schizophrenia behind. Most patients with schizophrenia see their doctors a few minutes a month for medication checks. What the schizophrenic person says is not taken seriously by his doctor. He is regarded as crazy. His struggles are never known. How can a person work his way out of his fears without knowing something about himself? He can't.
Drug therapy is not treatment-it's management. And not very good management, since most schizophrenics end up living very limited lives. In fact, there is good evidence that a lifetime of taking drugs, the standard treatment in the United States, may do harm. Telling a schizophrenic, or even a depressed or anxious person, that he has a brain disease and that he must be on drugs, is telling him that he is a hopeless case. It is telling him that the best he can do is to live a limited life. Just administering drugs leave the problem at the core untouched. Most psychiatrists do not believe that there is a problem at the core that can be understood and treated. The psychiatrist is writing a prescription for himself, since he doesn't know what else to do for his patient. I saw Catherine as being just as human as anyone else-with problems, struggles, hopes and dreams. I intended to help her identify and resolve her problems, and to grow and develop. It was a lot of work, all those years. But it was worth it. She's a normal, healthy person.
Yes, I am going against the grain. The psychiatrist-drug company cabal would have us believe that mental suffering means we have diseases of the brain-broken brains. They tell us that chemical imbalances in the brain cause depression, anxiety and madness. Nothing could be further from the truth. One can find brain correlates of any mental state. But what causes the mental state? It is hopelessly simplistic and reductive to say that a singular measurement of cellular activity causes something as complex as a mental state. The measurement is much more likely to be the result of a mental state. Trying to understand mental life using a medical model-seeing mental life as nothing more than brain activity — is too limiting. Measurement is the catechism of science. There are some things you cannot measure, such as the experience of being human. How do you measure my tears when I stand in front of a painting by Vermeer? You might get a few measurements within my brain, but that would tell you very little. One cannot reduce mental life down to cellular activity anyway. It is like saying that an opera is nothing but notes. Mental illnesses are not illnesses at all. Mental struggles are states of mind, responsive to the human spirit. The official word, however, is that Catherine suffered from a broken brain. It says right on the NIMH web site that schizophrenia is a brain disease. If Catherine had had a broken brain, how is it that she recovered? There was nothing broken about Catherine's brain.
She is cured. She has grown and developed. She has left her madness behind. If she had received the standard medication treatment, her schizophrenia would still be there, barely covered over by drugging her brain. In fact, if schizophrenics stop their medication, there is a 70-80% chance of recurrence.
First of all, don't buy the broken brain-chemical imbalance theory. If you or your loved one is caught in the vicious cycle of taking medications to control feelings, consider finding a therapist who will help you understand the origin of the problem. If a family member suffers from schizophrenia, you might obtain a referral from the U.S. branch of the International Society for the Psychotherapy of Schizophrenia and Other Psychoses at ISPS-US.org
Psychiatrists are trained to view mental states as diseases of the mind. If you see a psychiatrist, he will likely hand you a prescription. There are many exceptions, however. Some psychiatrists specialize in psychotherapy. Choose one of those. The aim of psychotherapy is to understand your problem. The idea is that if you know what's wrong, you can fix it. Psychotherapists also can be psychologists, social workers, or marriage and family counselors. The problem is that many psychotherapists are also trained to use the medical model. By medical model I mean the system devised by psychiatrists to diagnose your mental state as a mental illness as defined by the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. Try to find a therapist who will see your problem as part of ordinary human struggle, as opposed to seeing you as a diagnosis. Psychoanalysis is a specialized form of psychotherapy. Psychoanalysts are interested in how the life history of the individual affects him in the present day. I advise most people to choose a therapist based on an interview. Choose someone who feels natural and understands you, right off the bat.
The answer is both. The catatonic person has shut down. He needed to shut down to protect himself from being overwhelmed by his inner experiences. Thus, he chose to shut down. But he is unable to respond because if he allows himself to feel, he will feel overwhelmed.
Oh, yes. After her recovery, it was she who suggested that I write about how that occurred. We met on a weekly basis, and I recorded her impressions of why she became insane, her experience of madness, and how our relationship led to her sanity. In DANTE'S CURE she articulately describes what it was like to suffer within her catatonic state.
That quote is one of the things I said at the beginning of her treatment. During this time she was almost totally unresponsive. I mused aloud about what I thought might be going on in her head. Perhaps the reason it stuck with her was that I was attempting to understand why she was so silent, rather than diagnosing her, therefore making a judgement about her. I must have been on the mark-being silent was her way of being safe.
Apparent worsening is common in all psychotherapy. That is particularly so in people suffering from schizophrenia. The reason is that people who suffer from mental problems try and protect themselves by various means-one can become hyperactive, practice all sorts of diversions, or even shut down, as Catherine did. The therapist wants to get down to the truth of the person's pain. I helped break up Catherine's defenses, thus exposing what she was trying to hide from. Underneath, she was still suffering and felt overwhelmed. She, then, increased her efforts to hide. Finally, her true nature-the fact that she was insane and terrified, could no longer be denied. My colleagues accused me of making her worse by treating her with psychotherapy. But, in fact, looking worse meant that progress was being made. We can't subdue our demons unless we can see them, or better yet, experience them.
I've been in practice now for over thirty years. Other patients, who have suffered from schizophrenia, and from other psychoses, have fully recovered. But I cannot treat everyone. I never know, when I begin, who will have the stamina or will to do battle with their demons, or whether they will succeed. Schizophrenics are just as human as anyone else, and treating them is no different.
In order to descend into hell, and make it out, Dante needed a guide. He chose Virgil, the Latin poet. Catherine, my patient, was trapped in hell, and could not have found her way out without a guide.
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