Foundations of Psychotherapy

Foundations of Psychotherapy

Say what you like about Freud but at least he had a general theory of the nature, origins, and development of human personality. It centered on psychosexual dynamics, and repression figured prominently. It covered the emotions, neurosis, unhappiness, the family, dreams, jokes, art, morality, and other things. But we need not follow Freud into the intricacies of psychoanalysis; we can attempt our own theory of the human condition with similar ambitions in mind. We can adumbrate a general conception of personality that may be used in therapeutic contexts. We already have a wealth of information about this domain, because we have each lived human lives and been subjected to the travails thereof. We just need to assemble this information into a general framework of understanding and then recommend the appropriate course of treatment for what ails us. I actually don’t think this is difficult; the truth lies close to the surface. It is not, however, easily converted into ameliorative protocols; and my proposal may well seem drastic and potentially dangerous, certainly not reassuring.

We are not born miserable, damaged, neurotic, unstable, or a complete mess—though there are no doubt genetic predispositions at work. It is the world—experience–that does these things to us. We don’t need psychotherapy in the womb. We are born a blank slate psychopathology-wise; we should therefore be empiricists about psychological disease, unease, imbalance (whatever we want to call it—and that matters). This is an oft-told tale: the hapless neonate is hit immediately with hunger, discomfort, frustration, disappointment, isolation, its own incompetence, and (of course) maternal displacement or deprivation (she’s always going away). It’s a rough old world, a world of inconvenience and hostility, hurt and misfortune. And it is like this for everybody, before we even get to serious cases of neglect, abuse, danger, and injury. The infant’s psyche is assaulted on every side. Nor does it get much better: as time goes by there is rejection, bullying, parental failure, injustice, feelings of inferiority, self-doubt, fear, and all the rest. The years are marked by damaging stimuli, periods of misery, general ennui, and worse (betrayal, heartbreak, illness). None of it is easy to cope with. And on top of all that the human psyche, especially in early years, is stubbornly retentive: we remember all this bad stuff, not just in explicit memory but in the deeper recesses of the psyche. There is thus a cumulative build-up of wounds, traumas, and stresses, as well as trivial slights and disappointments (also some good things!). Other people become sources of pain, agents of harm. The suffering psyche must carry this burden. Thankfully, memory is not perfect: memories fade, leaving only a trace of their former sting (or stab). Time heals, as they say, but only partially; the scars remain. There is one balm for all this accumulated damage: sleep. Each day we awake to a new dawn with the residue of the previous day somewhat attenuated. If memory were perfect and sleep non-existent, we would surely be a lot more (what shall I say?) fucked up—done over, beaten down. But again, this provides only partial relief to the struggling psyche. That’s why psychotherapists exist, to take up the slack, to supplement forgetting and sleeping (feeble, really, against the slings and arrows of outrageous etc.). Bad experiences and retentive memory, with little relief, are the human lot in life. We all know this is true, though we may be reluctant to admit it.

What is the solution? What can put a stop to this inescapable build-up of trauma, large and small? What can reverse it? An obvious idea is to zap the memory banks: just erase all that bad stuff from the psyche, so that we can go back to those blissful days before the world had its way with us. Maybe a drug, maybe hypnosis, maybe electroconvulsive therapy—anything would do. But this is clearly impractical: such methods will wipe out too much, or not enough, or leave us like newborn babies mentally. Reincarnation looks like it might be a way out, but there is no such thing, and anyway the same shit will happen again. Here is where I reach for my drastic and possibly dangerous therapeutic proposal: Controlled Rebirth. First, we simulate death; then, we simulate birth. We thus distance ourselves from the life we have lived up to now; we put it in the past, bracket it, deactivate it. It is as if our past life is someone else’s, no longer at the core of what we are. Concretely, you lie down, therapist by your side, and you pretend to die, possibly thinking of the person or animal you hope to meet on the other side. You have to do this with full conviction. Next you lie still for a while, whatever length of time seems right; you then signal to the therapist that it is time for you to wake up. She proceeds to act as psychological midwife, coaxing you back to life, as if this is your first experience of reality—you act the part of newborn baby. You don’t talk. Your helper may then take you on a soothing walk in your new world, as if experiencing it for the first time. You gradually adjust to your new reality. This protocol may be gone through once or several times, depending on felt efficacy; and it is best undertaken after a period of preparation in which your wounds and scars are patiently excavated and curated, lovingly examined. It demands complete trust in the therapist, and she must treat the process with the utmost seriousness. The purpose of the treatment must be fully understood by the patient (and assented to, of course). It won’t cure you of all your psychic ills, obviously, but it may help to mitigate them, reduce their hold on you. The spirit of the procedure is to recognize the causation of the presenting symptoms and provide a form of treatment that directly attacks the basic problem. This is a medical approach in its general form. Instead of the release of repression as in Freud’s practice, this approach advocates rebirth of the psyche in simulated form. It is to be judged by its efficacy (as most medical procedures are—it is often not known how they work). I call this Simulated Rebirth Therapy, or just Rebirth Therapy. I venture to suggest that it is probably no worse than all the others, and more theoretically well-founded. It acknowledges the indisputable facts of human life, which can be more or less severe, and it attacks them in a literal and methodical manner. The only way out of human life is renewed human life.[1]

[1] The element of drama and ritual should not be underestimated: rebirth therapy is a dramatic enactment of the basic fact of birth, ritualistically realized. It exploits the power of the theatrical—the ability to make things so by acting as if they are so. It is like a performative utterance gone existential. Or again, it draws upon the power of fantasy (a theme of Freud’s). Coming-of-age rituals are similar, though virtual rebirth is a step beyond, a harder climb. In it we choose to be reborn.

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12 replies
  1. Giulio Katis
    Giulio Katis says:

    Maybe. I can see the potential in it, but I suspect such a Rebirth would only be effective if the subject recognised the way in which they had been broken. Though some instances of trauma are far worse and more debilitating than others, as you imply, it is pervasive, in fact the norm. (Perhaps the reason for this lies not just in the circumstances of the outer world. Maybe our brains and minds are such that in a paradisiacal environment trauma would also occur, though to a much less extent.) Winnicott I believe wrote that for therapy to be successful (to the extent it can be) the patient must acknowledge the breakdown that has already occurred (and the fear of breakdown is an inhibitor to therapy). I suspect there is a lot of truth to this.

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    • Colin McGinn
      Colin McGinn says:

      Not only must the patient acknowledge breakdown (note how limited our vocabulary is here), he or she would need to accept the suggested remedy, or else it would be unlikely to work. The patient would be the main engine of success, with the therapist acting as mere assistant.

      Reply
  2. Mark L
    Mark L says:

    I’ve probably told this before, but Psychiatrist Dr Ewan Cameron used to erase patients memories and feed them positive messages via cassette. I believe he was the inspiration for the Ipcress File, Though he was relatively successful at wiping memory – the reprogramming was useless. I saw an interview with a patient who basically said she had no memory of her past traumas, but still felt depressed/traumatised . I suspect this is because the neural pathways of misery have been reinforced, perhaps this implies some difference in the way memory is stored vs the impact of the memory (if he was able to erase one, but not the other). So more positive pathways need to be encouraged.

    I think your idea is a good one, but it needs to be a very big deal indeed – building in some type of humanist ceremony to this rebirth may help it along. One of the few things that we can all probably agree vis near death experiences is that there is a lot of anecdotal evidence of experiencers outlook being changed for the better. There is also some evidence of mental health improvement from controlled use of hallucinogenic drugs. I think these things Tap into our sense of spirituality which, could be put to good use in this case.

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    • Colin McGinn
      Colin McGinn says:

      These are all good points, especially apropos the near-death experience. We need to harness the power of suggestion, so that the transformation can take hold. General acceptance of the procedure would help with this.

      Reply
  3. Giulio Katis
    Giulio Katis says:

    I recently read the World of Yesterday by Stefan Zweig. I was reflecting on this post in the context of Zweig and this autobiography, his last book. That the day, and ourselves, will be reborn with the resurrection of the sun is one of the oldest and most important pieces of conscious knowledge we have as individuals and as a species, be that with regard to an actual or metaphorical night. Rebirth and resurrection seem fundamentally tied together in this way (reflecting perhaps a deeper biological dependence on cycles, that doesn’t seem to appear in physics). Unfortunately for Zweig, he felt that he no longer knew it to be true.

    Reply
    • Colin McGinn
      Colin McGinn says:

      I think the idea of resurrection resonates deeply with people, and with it the idea of rebirth or starting anew. This is why my idea of rebirth therapy has intuitive appeal–the psyche wants to be reborn.

      Reply

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