From Dr. Peter Breggin’s Center for the Study of Empathic Therapy, Education & Living Newsletter
The Case of the One Word Cure
and How Psychiatry Falsifies the Record to Promote the Myth of Incurability
by Richard F. Gottlieb, MSW
When I was a first-year graduate student in social work I had a placement in a general hospital’s psychiatric outpatient unit. A psychiatrist was brought in from California to provide inservice training to students and full-time staff. He had a reputation as an excellent diagnostician. I had already worked in the field before grad school, had been well-trained, and I looked forward to seeing the diagnostic “chops” of this psychiatrist.
He had us watch him through a one-way mirror as he interviewed a new patient. After the patient left we gathered to discuss the interview and hear his diagnosis.
This patient was a 62 year old man who had been nationally recognized for his professional accomplishments as a high school educator until, at age 55, he suffered a complete mental breakdown. He then lost his job, stopped working on a book about his work, became estranged from his wife, moved into an apartment alone, and saw his adult son hospitalized in a state mental hospital with a diagnosis of schizophrenia. The patient had seen a psychiatrist for the past 7 years, was prescribed neuroleptics, and was now displaying the following symptoms; flat affect, drooling, unclear verbal articulation, bent-over posture, poor hygiene, delusions, unregulated emotional states ranging from nearly-catatonic to agitated and frenetic, chronic and severe constipation, no eye contact, an empty gaze, and an inability to relate to others.
After describing the dynamics of the interview and the data gathered, the psychiatrist stated that this man was “manic-depressive, psychotic.” He went on to say “. . . of course this disorder is incurable . . .” and that he will require life-long medication with little hope of any improvement, only maintenance. I, being a lot younger and possibly brasher than I am now, raised my hand and asked the psychiatrist how he could possibly reach the conclusion of incurability based on one interview of 45 minutes. His response was that his experience and the literature both supported his position.
I had worked with autistic children, also called incurable, and knew that the ability to cure resided within the patient and required only a relationship with a person who was committed to and focused on that patient in order to engage their health. I suggested to him that he was making a statement based not on data gleaned from the patient but taken instead from the opinions of other professionals in the field.
At that point he turned to the group and informed them that he would be returning in six months for a follow-up inservice training and that this patient would be assigned to me to treat, and I could report on it when the psychiatrist returned. I accepted what was meant to be a challenge as simply a referral and thanked him. I was introduced to the patient as his new therapist, and we set up our next meeting, our first full appointment, the following Tuesday morning at 10:00.
I met the patient in the waiting room and invited him into my office. After sitting down, the gentleman asked me, with slow and slurred speech and a great deal of drooling, if he could phone me in the interval between our sessions. I asked him to tell me what made this request so important that he wanted to begin our first full session with it. He told me that his psychiatrist of seven years always allowed these calls.
I suggested to him that if his current condition was the result of treatment which included these calls, then the answer seemed to present itself within the context of his question. I answered “No” because it seemed to me the urgency of his request suggested that this was a very important issue, and that we would need to further explore its meanings and implications before any decision to bridge the time between appointments could be made.
That one word, “No,” seemed to change everything. The patient’s head snapped up, he locked eyes with mine as I finished speaking and said “What?” in a rather louder and clearer voice than before. I explained that there were two reasons for my answer: first, that the option of calling between sessions didn’t seem to have had a beneficial effect on him over the previous seven years and, second, that our work together could best be accomplished within the context of the face-to-face meetings between him and me. (To be continued)
