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The Devolution and Regression of By Maurie D. Pressman, M.D. A dose of diagnosis, instead of a dose of understanding Devolution is the regression and the opposite of evolution, a downward slide instead of ascension and elevation. What is psychiatry? It is that branch of medicine that deals with the mind. Conventionally, it presupposes that the mind arises from the brain. For the moment, we will let it go at that. Early on, at the turn of the century, meaningful psychiatry arrived on the scene in the form of the teaching and discoveries of Sigmund Freud. These discoveries revealed the deeper layers of the mind, a mind which had previously been thought of as the realm of the five senses. This was an enormously important discovery, a giant step in human understanding of humanity. From this breakthrough, from the rapid spread of its power and influence in America, came the ascendancy of a group of pioneering spirits, dedicated to intimate union with their patients. This meant that time was taken to understand, and to understand deeply, while at the same time giving the reins of self-understanding over to the patient. This produced many things, and was really the progenitor of the various psychotherapies that are presently with us, and even expanding. However, in the past few decades there has been a discovery of and a shift toward biological psychiatry. The gift of biological psychiatry has been the knowledge of the chemistry of the brain. From this gift has emerged pharmacological agents which are very helpful. But in the rush of our society to pack more things into a minute, to get there faster and faster and faster, we have created “speedy psychiatry,” with the substitution of a pill in place of understanding and self-empowerment. This is devolution, anti-evolution. This is regression into materialism and dependency, accompanied by an enslavement to those who profit from the chemical “cure.” It is also enslavement to those who manage “managed care.” Managed care has entered mightily into this transition downward, emphasizing more and more the placing of ever greater numbers of patients into as small a dollar amount as possible. This means that psychiatrists (who are expensive) are relegated to the ten to fifteen minute segment of time required to write a prescription to satisfy the needs of the patient. And the deeper understanding and possible self-empowerment for the patient of therapy, then, has been relegated to the ranks of those doctors who are less and less trained, and therefore less and less expensive. Sadly, psychiatry and psychiatrists have colluded in this downward turn. They have willingly accepted the dollars while sparing themselves the trouble to take the time to ponder over the problems of the patient, to take the time to intimately know and join with the patient, to take the time to struggle within themselves with the obfuscation the patient unknowingly spreads around himself/herself, in order to maintain an unconsciousness of the source of their problems. And from this has evolved an ever growing number of children (and adults) assigned to the category of Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder. So many of them are gifted individuals with an abundance of energy that may be hard to handle for parents who are busily engaged otherwise, mothers and fathers who are struggling to make a living in this fast moving, material minded society. This means that patients are given a dose of diagnosis, instead of a dose of understanding. I saw a young woman in consultation who, truly enough, loses her grip on reality for brief periods of time, but who recovers quickly. She has been assigned various diagnoses throughout her young life: Bipolar Disorder at one time, Schizo-affective Disorder at another, and in childhood, Attention Deficit Disorder. This is the same person, just assigned different diagnoses. But a true understanding of the person lets one realize that she also has a goodly portion of solid personality, of ego strength, or recovery capacity. None of these diagnoses seemed to recognize that from that basis of strength comes the ability to help her to solidify, to pay attention to being practical, to taking her fantasies and spiritual emergence to a level of practicality, rather than to have them wash over her, and wash her away. Another patient, a man of 41 who had married for the first time two years before, was sent in to therapy by his very accomplished wife because he seemed so scattered. Indeed he was, in his speech and in the way he arranged his life. He was seen by another psychiatrist who prescribed Adderall, a drug addressed to Attention Deficit Disorder, a symptom of which is scattered thinking. The medication did no good. A little investigation of his life and background revealed that he had been kidnapped by his father at the age of two and taken to a distant country. At the age of three, he was snatched again, this time by his mother. At no time subsequently did he have the chance to be mentored by anyone. Nevertheless, he was able to take care of himself and to earn a living on a small scale, and continued on while adjusted to a quite limited life. He was a rather handsome man and openly charming. He met his wife at a bar and was swept away into marriage. He has been puzzled and mildly depressed since. His wife, who is self-made and very successful, wants to push him into success, and he is puzzled. The picture he projects is that of a little boy, in over his head, and puzzled about how to keep up. Needless to say, the Adderall did nothing to help with the problem. The answer will be through meaningful understanding, both of him and his life situation. This will call for finding a good mentor to help him in his floundering in his business, and to arrange for joint visits with him and his wife to further explore his situation, and the possibilities for mutual understanding and mutual support. How different this would be from placing him in a diagnostic category, only to be prescribed the almighty chemical alone. We need to return to a deeper understanding, to taking time to be with, to less emphasis on fast psychiatry and fast psychotherapy, and more emphasis on the altruistic, aesthetic and empathic approach. It is this method which will be an antidote to the ever-accelerating pace of our society, and to the ever-accelerating separation we feel with each other, by becoming speedier and speedier and more and more affiliated with material and separatistic wants. Let us join to celebrate and to pursue those attributes we call elevation of the personality, in which we look toward our common bonds of love, union and service to each other. This is the desired approach to patients, and yes, to each other as fellow human beings. Contact Dr. Pressman by writing to: Maurie D. Pressman, M.D., 200 Locust Street, Philadelphia, PA 19106, or call 215-922-0204, email: mauriedavid@earthlink.net, or visit his website, www.mauriepressman.com.
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