Many years ago, I met a mid-level military officer who was injured in a car accident. The officer sustained a bad concussion and the impact of the head trauma affected the area of the brain that not only controls memory but also impulse control. The officer in question was 40 years old and yet memory could not be retrieved beyond late teen years. Furthermore, the officer’s sexual activity reverted to that of a later teenager much to the consternation of the officer’s partner.
I remember talking to this officer and was informed that he was seeing a therapist. The prescription for the officer was to wear the military uniform around the base and salute everyone and with that the memory would return.
I have to admit I thought that this was a rather “kooky “ intervention. Traumatic Brain Injury can be a complex phenomenon and somehow the idea of a person wearing their uniform and saluting everyone on a military base, in order to get their memory back, seems to be very far- fetched and laughable.
The rise in mass gun shootings has brought not only attention regarding gun policy but also with regard to mental health policy and accessibility to services. Anything we can do, as a country, to extend mental health services to those who need them, especially those who are poor and marginalized regarding race, income and ethnicity, gender and gender orientation is a good thing.
However, when we talk about mental health, making it accessible to community mental health services, I think we need to consider what do we mean by treatment and what type of treatment are people likely to receive?
You can have a person who wants to stop biting their finger nails and thus a short-term cognitive-behavioral intervention may work very nicely in a few weeks to extinguish the unwanted behavior.
However, if someone wants to recover from witnessing their father kill their mother and a beloved uncle, and try to make sense regarding what it means to live now, then “treatment” is going to take more than just a few sessions.
On March 9, 2018, Clarity Child Guidance Center in San Antonio, TX sponsored a panel discussion “Are We Living In The Same World ? Psychoanalysis and Community Mental Health”. Several distinguished speakers addressed the dilemma of trying to provide care for patients where there is time actually devoted to getting to know the patient as a person. Dr. Joshua Essery Psy. D, ABPP, Director of Psychological Services at Clarity Child Guidance Center observed:
“ We all have a social , cultural matrix which we carry determining what makes one well. Increasingly, managed care treatment conveys a lack of recognition with regard to the embodiment of what it means to be a person. Psychoanalytic work allows a response to a lot of human suffering, to attachment and to attachment consensus.”
These comments are powerful because they speak to the reality that a lot of therapist’s experience, where there is limited time, the pressure to come up with a diagnosis quickly and also to quickly come up with a treatment plan that will cure the problem ASAP !
The image here could be of therapists working on a conveyor belt offering boxes of treatment interventions to patients like hawking boxes of cereal. There is no gourmet food here ! No chance to listen and to learn what the patient really wants for their life and what is important to them. No, instead, we are offering and consuming bad fast food.
Another speaker Dr. Steven Spitz Ph.D. reminded conference attendees about the Psychologist Harry Stack Sullivan who defined Dissociation as “disconnecting from something as a way to deal with the anxiety “. Again, this is an apt description regarding the process of rushing assessment and quote treatment for patients. If you follow the instructions of the manual and “you paint by numbers “, Presto ! Your problems are solved. Instead, I would argue this speaks to the greater anxiety that the patient and therapist hold together in the same room awkwardly trying to address a problem, but having little time to consider it and a dealing with a lot of institutional pressure to solve it.
Dr Spitz also remarked that Harry Stack Sullivan was fond of saying:
“ I treat problems in living. “
Here the goal and the focus becomes that the therapist really works on getting to know the patient as a person and that whatever treatment plan emerges will fit that person.
This is vastly different from a “ kooky “ prescription to a person who is really hurting and in need of help. The more that you can get under the symptoms and address depth and insight, the better and more rewarding the outcome can be, not only for the patient but for the therapist as well.
May it be so.