dr al siebert non diagnostic listening

Dr. Al Siebert: Non-Diagnostic Listening

Summary

When I was a staff psychologist at a neuropsychiatric institute in

1965, I conducted an experimental interview with an 18-year-old woman

diagnosed as "acute paranoid schizophrenic." I'd been influenced by

the writings of Carl Jung, Thomas Szasz, and Ayn Rand, and was puzzled

about methods for training psychiatric residents that are unreported

in the literature. I prepared for the interview by asking myself

questions. I wondered what would happen if I listened to the woman as

a friend, avoided letting my mind diagnose her, and questioned her to

see if there was a link between events in her life and her feelings of

self-esteem.

This account raises important questions about:

the powerful influence of the interviewer's mind set and way of

relating to patients perceived as "schizophrenic,"

aspects of psychiatric training and practices that have never been

researched,

why psychiatrists misrepresent what is scientifically known about

"schizophrenia," and

why the psychiatric literature is silent about the personality

characteristics of people who fully recover from their so-called

"schizophrenia" and the processes by which they recover.

My duties as a staff psychologist at the Neuropsychiatric Institute at

the University of Michigan Hospital in 1965 included attending morning

"rounds." The staff gathered in a small conference room at 7:30 a.m.

to hear various announcements and reports about patient admissions and

discharges.

One morning the head nurse of the locked ward reported the admission

of an 18-year-old woman. The psychiatric resident who admitted her the

previous evening said "Molly's parents brought her in. They told us

Molly claims God talked to her. My provisional diagnosis is that she

is a paranoid schizophrenic. She is very withdrawn. She won't talk to

me or the nurses."

For several weeks the morning reports about Molly were the same. She

would not participate in any ward activities. She would not talk to

the nurses, her case worker, or her doctor. The nurses couldn't get

her to comb her hair or put on make-up.

Because of her withdrawal and lack of response to staff efforts, the

supervising psychiatrist, David Bostian, told the resident in charge

of Molly to begin plans to commit her to Ypsilanti State Hospital.

Bostian said the university hospital was a teaching facility, not one

that could hold patients who need long-term treatment. The staff

consensus was that she was so severely paranoid schizophrenic she

would probably spend the rest of her life in the back ward.

I decided that since she was headed for the "snake pit," this was an

opportunity to interview a psychiatric patient in a way very different

from how I'd been trained in my clinical psychology program. I asked

Molly's doctor, a third-year resident, for permission to administer

some psychological tests and interview her before she was transferred

to the state hospital. The resident said I could try, although she

expected nothing to come of my efforts.

I contacted the head nurse and arranged to meet with Molly the next

morning in the ward dining room. At home that evening I prepared

myself for the interview with Molly by reflecting on a cluster of the

following four issues and concerns:

After reading The Myth of Mental Illness by Thomas Szasz, I began to

notice that the only time I saw "mental illness" in anyone was when I

was at the hospital wearing my long white coat, working as a

psychologist. When I was outside the hospital I never thought of

anything people said as "sick," no matter how outrageous their words

or actions. I found it interesting that my perception of "mental

illness" in people was so situationally influenced.

I'd been puzzled about an unresearched, unreported aspect of the way

psychiatric residents talked to newly admitted mental patients. At our

institute the psychiatric residents were required to convince each of

their patients that they were "mentally ill." I was present in the

office of a resident, for example, during a shouting match with a

patient, Tony, who refused to believe he was "mentally ill." Tony was

a 20-year-old unemployed factory worker. He was in our facility for a

court-ordered examination because he had beat up his father in a fist

fight. Also present in the room were his wife, a social worker, and a

large male aide.

The psychiatric resident said "Tony, your behavior is sick. We can

treat you here as an out-patient, but you must understand you are

mentally ill before we can make any progress."

Tony shouted "No, I'm not! You doctors are crazy if you think I'm

mentally ill!"

Resident: (voice raised) "We've argued about this before. You must

believe you are mentally ill or we can't help you!"

Tony's face got red. His nostrils flared. His breathing quickened.

He yelled, "I'm not mentally ill!"

Tony's wife reached over and put her hand on his arm.

The resident yelled "Yes you are!"

Tony: "No I'm not!"

Resident: "Yes you are!"

And so it went.

Finally the resident shook his head and said to the aide "take him

back."

Such arguments between psychiatric residents and patients were common.

I searched through the psychiatric literature, but could not find any

research about why it is essential in the early stages of psychiatric

treatment to convince patients they must believe they are mentally

ill. How to Live with Schizophrenia, by psychiatrists Abram Hoffer and

Humphry Osmond, contains a written statement typical of what patients

were commonly told:

As a patient, you have a grave responsibility to yourself and to your

family to get well. You will have no problem if you are convinced that

you are ill. But no matter what you think, you must do all you can to

accept the statement of your doctor that you are ill... (p. 153).

The psychiatric literature contains a few articles and discussions

about "lack of insight" in patients, but there is no research

exploring the validity or therapeutic rationale of efforts to convince

people they are ill.

Such efforts, routine at our institute, created some weird situations.

For example, we heard at staff rounds about a man admitted to our

service with a diagnosis of "acute paranoid state." His main complaint

was that people were trying to force thoughts into his mind. I was

curious about his experience from his point of view. I obtained

permission from his psychiatric resident to interview him. An aide

brought the man, whom I will call Ron, to my office. He was 25 years

old, about six feet tall, clean-shaven, in good physical shape, and

nicely dressed in slacks and a clean shirt. He shook hands with me and

moved with confidence.

After he sat down I asked him "Why are you here in the hospital?"

Ron: "My wife and family say I don't think right (clenches jaw).

They say I talk crazy. They pressured me into this place."

"You're a voluntary admission, aren't you?"

Ron: "Yes. It won't do any good though; they're the ones who need a

psychiatrist."

"Why do you say that?"

Ron: "I work in sales in a big company. Everyone there is out for

themselves. I don't like it. I don't like to pressure people or

trick them into buying to put bucks in my pocket. The others seem

to go for it...selfish, clawing to get ahead. I tried to talk to my

boss, but he says I have the wrong attitude. He rides me all the

time."

"So what is the problem with your family?"

Ron: "I've talked about quitting and going to veterinarian school.

I like animals. I'd like that work. My wife says I'm not thinking

right. She wants me to stay with the company and work up into

management. She went to my parents and got them on her side."

We talked for a while about how his wife and parents wanted him to

live up to their dreams for him. I said "I still don't see the

reason for your being here."

Ron: "They're upset because I started yelling at them how selfish

they are. My wife wants a husband who earns big money, owns a fancy

home, and drives an expensive car. She doesn't want to be the wife

of a veterinarian. They can't see how selfish they are in trying to

make me fit into a slot so they can be happy. Everyone is telling

me what I should think and what should make me happy."

"So you told them how selfish they are?"

Ron: "Yes. They couldn't take it because they believe they are only

interested in my welfare. " He sagged in his chair and held his

face in his hands.

"Did you tell the admitting physician about them trying to make you

think right?"

Ron: "Yes. Everyone is trying to brainwash me. My wife, my parents,

the sales manager. Everyone is trying to push their thinking into

my head."

"How do you feel about all this?"

Ron: "I feel angry. They say they have done this to help me, but

they don't care about me. They're all selfish. Afraid I'll upset

their tight little worlds. I shouldn't be here."

I saw that Ron's doctor was obediently acting as trained when he

diagnosed Ron as paranoid. The consequence, however, was a

"crazy-making" double-bind for Ron. His doctor was saying to him, in

essence, "Because you believe that people are trying to force thoughts

into your mind, you must accept into your mind the thought that you

are mentally ill." Two days later Ron signed out. It was rumored that

he took off for California.

These incidents helped me see how hard psychiatrists try to force

their words and thoughts into patients' minds without insight into

what they are doing. When a patient disagrees, this is diagnosed as

"resistance," "lack of insight," and viewed as another sign of "mental

illness."

During admissions meetings I'd observed that when a patient was

reported as talking in bizarre ways, the staff would reflexively

declare the person "schizophrenic". Diagnosis seemed more important

than understanding. No one seemed influenced by Carl Jung, who said in

his autobiography, "Through my work with the patients I realized that

paranoid ideas and hallucinations contain a germ of meaning....The

fault is ours if we do not understand them....It was always astounding

to me that psychiatry should have taken so long to look into the

content of the psychoses" (p. 127).

I'd just finished Ayn Rand's book Atlas Shrugged. I was impressed

with her portrayal of how the need for self-esteem influences what

people do, say, think, and feel. I'd been noticing, for example, that

when someone made a statement of extremely high self-esteem, most

people reacted negatively and tried to tear the person down. I

wondered what was wrong with thinking highly of oneself.

My Questions

As I prepared myself for my interview with Molly the next day, I

developed four questions for myself:

What would happen if I just listen to her and don't allow my mind to

put any psychiatric labels on her?

What would happen if I talk to her believing that she could turn out

to be my best friend?

What would happen if I accept everything she reports about herself

as being the truth?

What would happen if I question her to find out if there's a link

between her self-esteem, the workings of her mind, and the way that

others have been treating her?

Read more...

Source: How Non-Diagnostic Listening Lead to a Rapid "Recovery" From

Paranoid Schizophrenia

See also: Unethical Psychiatrists Misrepresent What Is Known About

Schizophrenia

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