Is there an Alternative Fact to the Medical Model?
The Western world’s interpretation and understanding of human kind is based on a rational-materialistic stance of what constitutes science and psychology. Grof (1985) expounds on how the biomedical model for psychiatry was instituted:
The Cartesian-Newtonian world view that had a powerful impact on the development of various fields has played a crucial role in the evolution of neuropsychiatry and psychology. The renaissance of scientific interest in mental disorders culminated in a series of revolutionary discoveries in the nineteenth century that firmly defined psychiatry as a medical discipline. (extracted from Chapter 5 of Beyond the Brain: Birth, Death and Transcendence in Psychotherapy)
This paradigm is useful for diseases such as tertiary syphilis of the brain, traumatic brain injury, brain tumors and diseases, malnutrition, and other organic or infectious ailments which contribute to the creation of mental disorders. Bio-chemical-medical model establishes that all mental/emotional disorders like schizophrenia, ADHD, major depressive disorder, and even, addictions are biological brain diseases (Deacon, 2013, Whitaker, 2002). This reductionist point of view bypasses the psychosocial, adaptive behaviors, and the spiritual components of the human condition. For some, viewing human kind as a carnal and tangible being with a “postnatal history”, is not enough to understand the human as a whole (Razmgar, 2009).
For many clinicians, seeking to break away from the established discourse may prove to be a professional and personal challenge. As much as insinuating and fabricating a paradoxical paradigm to understand the human condition, it is recommended and encouraged by many schools of thought to be achieved by the clinician’s own experiential phenomenon of delving into the dark cave of her own psyche. As important it is to reach into the far recesses of that subconscious or unconscious cave, many fear stigmatization , embarrassment, and rebuttal from the establishment. Yet, it is a necessary component of transcendance into the state of presence, once one delves into the darkness to embrace the shadow self.
Delving into the Dark Recesses of the Cave: Procuring and Integrating with the Shadow Self
My path is light. ‘Yet I indignantly answered, ‘Do you call light what we men call the worst darkness?” CG Jung, The Red Book, pg. 240
Jung is revered for innovative ideas on the personal and collective unconscious, the anima and the animus (which is latin for the soul), the study of human spiritual experience, and the archetypes. Interestingly, the body of his work was a result of a treacherous time he endured and weathered during his early forties. From around World War I until 1928, Jung compiled a series of notes, experiences, and bizarre rantings of his emotional, mental, and spiritual state, thoughts, voices, and visions (Lucas, 2011). At the time, he shared his work with no one. At that time, Jung was going through, what many in the field would diagnose, a psychotic break, but, as he, Grof (1989), Bragdon (1990) and Perry (1974) define as a spiritual emergency, or as in St. John of the Cross’ poem the Dark Night of the Soul. It is during this time, that his controversial “Red Book” was conceived, only to be shared with others fifty years after his passing. During this time, Jung experienced voices and visions, feelings of terror as the tension between of what was rational and irrational grew thinner, and especially, fearing the scrutiny of his peers. It was during this time of internal chaos, that he became acquainted with his shadow self, and discovered the collective unconscious. His terrifying fears, his internal and external entropy lasted until he consciously chose to surrender to the process of his madness. Upon mindful surrendering he was able to experience a spiritual, emotional, and cognitive awakening of his consciousness, creativity, and ability to be present (Lucas, 2011).
During this ego shift, Jung continued seeing his private patients and it is said the he was fully present. Jung integrated his shadow self with his persona in a conscious effort to be objectively mindful of the shadow, ego, and persona’s integrative manifestation. It was a natural form of what Roberto Assagioli coins as, psychosynthesis , an integration into a cohesive unified self. A cohesive and unified self does not come without strife. Just as manifested by CG Jung, Eckhart Tolle, Vincent Van Gogh, St. John of the Cross, Eleanor Longden, Yayoi Kusama, and many other mystics, creators, artists, visionaries, and healers had to endure what Joseph Campbell (1988) describes as the Hero’s Journey. The Hero is compelled to embark on his or her journey in order to evolve out of the emotional/psychological immaturity and achieve confidence and self-responsibility. To achieve this, Campbell explains:
..requires a death and a resurrection…leaving one condition and finding the source of life to bring you forth into a richer or mature condition ( pp. 124).
The death and resurrection of the Hero involves nonordinary states of mind. Auditory and visual hallucinations, fear of going insane and of dying, internal and external chaos, isolation and loneliness, withdrawal and an inability to function in society. These are just a few of the symptoms or manifestations the individual undergoes whilst having a spiritual emergency and delves into the far recesses of the psychic cave. Under the biomedical model and Judeo-Christian tradition, this symptomatology is not understood as a journey, but, as of mental illness or lunacy. Labeled psychotic, schizophrenic, and a hopeless soul, his only salvation is through medical interventions to make him whole (Grof, 1989). Along this thinking, Klerman (1977) states:
As Foucault and other historians have demonstrated, the consideration of mental illness as a medical concern was an “invention” of the Enlightenment. Western society has long recognized the existence of and made provisions for dealing with lunacy and insanity, but most often in prisons and poorhouses or through religious institutions (pp. 222).
Concordantly, Szasz (1960) declares in his essay “The Myth of Mental Illness”,
the proposition that mental illness is a myth, whose function it is to disguise and thus render more palatable the bitter pill of moral conflicts in human relations.
Just as Jung had his spiritual emergency, so did Laing experience altered states of consciousness with LSD . Having first hand experience with altered states of consciousness or any other human suffering allows some clinicians to empathize with the pained other. Laing (1967) reflects that diagnoses are not mental illness at all, but, a way of living and coping with the unlivable. He calls this state of being: radical privation. Yet, the medical model’s view of non ordinary states of consciousness is one of psychopathology and illness caused by faulty biology, genes and sick/deviant parents. The “apple doesn’t fall far from the tree” mentality does not give the pained other much room for growth, nor does it give any form of agency, other than medication compliance, marginalization, scrutiny, and a self-fulfilling prophesy of being mentally ill and sick.
The dichotomous paradigms of illness and spiritual emergency create further perplexity to the complexity of what constitutes wellness and pathology. Is the understanding of the pained other one of a transitory crisis? Or moral illness? Or as Jung states, a projection of the conformist’s unresolved shadow self onto a nonconformist? Is the deviant pained other society’s scapegoat? With this in mind, the great question is how does the ethical clinician understand and treat the pained other?
Before deciding on a treatment paradigm, Kass (2016) reflects on the root word of psychotherapy. Accordingly, the word therapy derives from an ancient Egyptian cult called: Therapeutae. The Therapeutaes were, at the time, attendants to the divine. As modern-day attendants to the divine patient (etymology: mid-14c., “enduring without complaint,” from Old French pacient and directly from Latin patientem “bearing, supporting, suffering, enduring, permitting) we need to be clear minded. As we are clear minded, we need to be reminded, that the pained other is not any more different from ourselves (Laing, 1967). As we are clear minded we are empathic to the pain of the other. As we are empathic we are aware of our shadow self. As we are self-reflective and aware of our shadow self, we are volitionally healing and integrating the shadow self with our present self. As we are healing and integrating our shadow self, we are self-compassionate, self-loving, self-healing, thus, reinforcing our empathy for the other. As we are empathic we are still. As our minds are still, we are present with the pained other. As we are present we find our selves attendant to our stillness and the connection we have with the pained other, not as sick, deviant, or nonconformist, but as united divine beings co-creators of our present reality through mutuality and respect. This is the art of presence, which, can also be used along with the medical model. With the clinician’s presence the medical model is a valuable tool, not the basis of understanding the human mind.
Assagioli, R.- http://www.sunypress.edu/pdf/60641.pdf
Bragdon, E. (1990). The Call of spiritual emergency: from personal crisis to personal transformation. San Francisco: Harper & Row.
Deacon, B. (2013, April). The biomedical model of mental disorder: A critical … Retrieved February 16, 2017, from https://www.bing.com/cr?IG=AC559907BED64BAC81EF0493B0233F03&CID=2275DCF2CBAC6E6F313ED6DECA9D6FEF&rd=1&h=DpNB2pmA9o6eIEVXSGnCikXR3FoYgfs2u2-XYlAaXfg&v=1&r=https%3a%2f%2fwww.researchgate.net%2fpublication%2f236690483_The_biomedical_model_of_mental_disorder_A_critical_analysis_of_its_validity_utility_and_effects_on_psychotherapy_research&p=DevEx,5084.1
Grof, S. (1985). Beyond the brain: birth, death, and transcendence in psychotherapy. New York, NY: State University of New York Press.
Grof, S., & Grof, C. (1989). Spiritual Emergency When Personal Transformation Becomes a Crisis. New York, NY: Jeremy P. Tarcher/Putnam a member of Penguin Putnam Inc.
Jung, C. (2009) The red book: liber novus, Sonu Shamdasani (ed.) WW Norten & Co.
Kass, S. -Posted on October 21, 2013 by Sarah Kass – New Existentialists Posts, S. (2016, February 16). R. D. Laing and Anti-Psychopathology: The Myth of Mental Illness Redux. Retrieved March 16, 2017, from http://www.saybrook.edu/newexistentialists/posts/10-21-13/
Klerman, G. L. (1977). Mental Illness, the Medical Model, and Psychiatry. Journal of Medicine and Philosophy, 2(3), 220-243. doi:10.1093/jmp/2.3.220
Laing, R.D (1967) the politics of experience and the bird of paradise. Penguin, England. 1967
Lucas, C. G. (2011). In case of spiritual emergency: moving successfully through your awakening. Forres, Scotland: Findhorn Press.
Moral illness– http://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1452&context=jeffjpsychiatry
Perry, J. W. (1974). The far side of madness. Englewood Cliffs, NJ: Prentice-Hall, Inc.
Radical privation – http://www.laingsociety.org/biblio/critique/solotaroff.htm
Razmgar, D. (2009, Spring). Spiritual madness and its many definitions, – Stanislav Grof. Retrieved February 16, 2017, from http://www.bing.com/cr?IG=9BA16AE3999D41AD8E2BF4BCE5D2523E&CID=37826703B9666C1607166D2FB8576DE7&rd=1&h=nc-TDI9epN6pGqWzBjEZVTNszfx75uJ605YknBP6WVY&v=1&r=http%3a%2f%2fwww.stanislavgrof.com%2fwp-content%2fuploads%2f2015%2f02%2fSpiritual-madness-Hafiz-Grof-Psychology.pdf&p=DevEx,5050.1
Self fulfilling prophesy–https://www.thoughtco.com/self-fulfilling-prophecy-3026577
Szasz, T. S. (1960). The myth of mental illness. American Psychologist, 15(2), 113-118. doi:10.1037/h0046535
St. John of the Cross– http://www.poetseers.org/spiritual-and-devotional-poets/christian/the-works-of-st-john-of-the-cross/dark-night-of-the-soul/
Therapeutae – http://www.newworldencyclopedia.org/entry/Therapeutae
Whitaker, R. (2002). Mad in America bad science, bad medicine, and the enduring mistreatment of the mentally ill. New York: Basic Books
3 comments on “Being Present: Integrating the Shadow Self and Being an Ethical Clinician within the Medical Model”
[…] Being Present: Integrating the Shadow Self and Being an Ethical Clinician within the Medical Model […]
I wonder if we can circumvent the constriction of our medical modeled systems to allow for attunement with a pained other.
The only way the system can be attuned to the pained other is by utilizing the available resources and understanding the pained person as a whole not just by the overt symptomatology and history. Compassion and empathy are necessary to understand the whole person.
However, by understanding the pained person as the overt and fluid diagnosis, the clinician may feel sympathy to the pained person’s plight which prevents him or her to empower. Other times, the diagnosis and some related acting out behaviors deters any feeling from the clinician other then dismay and/or focus on the pained person’s (perceived) deficiencies.
For example, a patient diagnosed with autism is deterred by the family to go to college due to acting out behaviors, isolation, and parental fear that he will not succeed. When the parents met with the patient’s treatment coordinator she concurred with the parents that the patient should stay home, go to a psychiatric facility, and take his medication as prescribed to deter any overt acting out behaviors. When the treatment coordinator was on vacation another social worker covered the case. She believed the patient’s narratives on home life, believed in the patient’s resiliency, listened to his hopes and wishes, and was compassionately present when the patient related to her and to his peers. Upon having a family meeting both parents opposed the patient’s wish to go to college, yet, the social worker advocated and assisted the patient to fulfill his wish. Both social worker and patient worked together for his dream to materialize. The patient is now a sophomore in a nearby college and all he needed was a clinician who thought outside the bio-medical box, validated, and believed in him to attain a simple wish.