28 September 2007

Alternative Psychotherapeutic Realities

Filed under: Psychology — ktismatics @ 9:18 am

Our daughter has a friend who spent her early childhood in America before her family moved to France when she was eight. Early last school year this girl began getting physically ill whenever she went to school. It got to the point where just anticipating the possibility of having another attack would brings one on. Desperate, her parents took her to a French psychiatrist. After an initial two-hour assessment, the psychiatrist offered his preliminary diagnosis: the girl is “mourning America;” her recurrent bouts of illness are a subconscious attempt to maneuver her parents into taking her back to the States. The therapist began gathering biographical information about the child from the mother, going all the way back to the beginning. Apparently the mother experienced a significant bleeding episode during the pregnancy, leading her gynecologist to speculate that perhaps there had been twin embryos and one of them had become unviable. Now the psychiatrist begins to suspect that the problem is more deeply rooted than he thought: it’s not about school, or about America; it’s about the vanished twin. The surviving twin mourns the loss of her empathic double; she feels guilt at possibly having caused the other’s death. Perhaps the girl could benefit from regression therapy, in which she returns emotionally to the womb and reconciles herself with the lost twin.

This French psychiatrist believes in depth psychology, where symptoms manifest an underlying pathology of mind rooted in the unexamined past. If my daughter’s friend had gone to an American therapist, in all likelihood she would simply have been told that she has panic disorder, cause indeterminate. Or perhaps she wouldn’t have been given any diagnosis at all. There’s no real point in assigning a name to the problem and trying to get to the root of it in hopes of understanding what the symptoms “mean” to the patient, because there’s no way to be sure you’ve uncovered the real cause. Besides, it’s not clear that finding the cause helps make the problem go away. Just solve the problem and get the kid back in school, says the hypothetical American therapist. It’s quicker and cheaper.

But of course even the American therapist works inside a “deep” therapeutic model. The true cause of any pathology may lie so deep that the therapist cannot realistically hope to bring it to the surface. Attaining insight into what caused a problem doesn’t necessarily make the problem disappear. From the client’s standpoint the symptoms are the problem, so therapy should focus on alleviating the symptoms. Rational-emotive therapy and systematic desensitization might be the treatments of choice: there are theoretical justifications for why these treatments might be effective in getting this kid back to school; both treatments are supported by statistical analysis of empirical data which demonstrate good outcomes.

The French therapist and the hypothetical American therapist occupy alternate realities: different ways of making sense of the same phenomena. And we haven’t even mentioned coaching or acupuncture or American Indian healing rituals.



  1. I guess the pragmatic approach is to find a medication+counseling regimen that ameliorates the symptoms while trying to not totally incapacitate the patient. The logic seems to be that if one can remain functional and not have to worry about the worst of the symptoms, ones mind is likely to slowly recover on its own – or perhaps we just gets used to it and keep going.

    Attaining insight into what caused a problem doesn’t necessarily make the problem disappear I guess the big questions are what would one consider a genuine ‘insight’ and why that doesn’t seem to be helpful?


    Comment by samlcarr — 28 September 2007 @ 12:18 pm

  2. “what would one consider a genuine ‘insight’ and why that doesn’t seem to be helpful?”

    An analogy: knowing what caused the car to start rolling down the hill isn’t going to stop it. In medicine, alleviating the cause (e.g., counteracting the infectious germs) often effects a cure. But not always: the orthopedist can replace your knee and the cardiologist can clear your arteries without being much concerned with what caused these problems. You might fear snakes because of a genetically-adaptive aversion to potentially poisonous creatures or because you were bitten by one as a small child or because its phallic resemblance triggers unconscious homoerotic desires, but none of these insights, even if true, will necessarily alleviate your fear. The cause has triggered an unconscious aversion that isn’t necessarily fixed through conscious understanding.


    Comment by ktismatics — 28 September 2007 @ 1:23 pm

  3. I think the fact that the girl is eight years old and taken out of the only setting she has known as home and put into a brand new school is probably what is making the girl sick. I would imagine that would be a terribly stressful situation for a child to go through and if it kept bothering her it would affect her physically.I know when things start to bug me my stomach starts to hurt if I dwell on it.


    Comment by Erica — 28 September 2007 @ 1:26 pm

  4. Sorry, Erica, but I see I left out an important piece of information: the girl moved to France and started attending French schools when she was eight, but she didn’t start getting sick until she was thirteen. But I tend to agree with you: something probably changed in her life at around that time — maybe the onset of teen-aged self-consciousness. The lost-twin hypothesis seems far-fetched to me, and it doesn’t account for the timing. Ignoring cause altogether and just trying to get her over the aversion to school seems short-sighted. On the other hand, you could also imagine her getting sick once because of school-related anxiety and then obsessing on its recurrence to the point that she’d make herself sick even without the school anxiety. Maybe you just try to get her over the hump and back to normal school attendance, then try to work through the other adjustment problems. Otherwise the kid potentially misses a lot of school, falls behind, and gets that new anxiety to deal with.


    Comment by ktismatics — 28 September 2007 @ 1:46 pm

  5. Another alternate therapeutic reality would regard the stomach trouble not as a psychosomatic illness to be cured or a practical problem to be solved, but rather as a way for the unconscious to express itself. Maybe the girl has a sense that school is trying to lock her in to a particular way of experiencing the world: rational, factual, authoritative conventional, graded, repressive. When she speaks at school she must say things in conformance with this academic tyranny. Maybe her unconscious is disgusted by this enforced repression by the Big Other of academia, and it expresses its disgust by throwing up. Now the therapist’s job is to help the girl’s repressed unconscious find some other channels by which it can express itself more freely. This is roughly a Lacanian reality.


    Comment by ktismatics — 28 September 2007 @ 2:46 pm

  6. You have posted that story in the past, under another context….but I searched the blog and could not find the previous post.

    Am I going crazy?


    Comment by Erdman — 30 September 2007 @ 6:26 pm

  7. Really? Dude, that’s freaky. No, I’ll tell you where it came from — for awhile I put up the chapter on realities from my Gen. 1 book as a page, and this story is used as an illustration in that chapter. So very good memory for you, along with evidence that you actually read at least part of that entry — which perhaps is an indicator of craziness.


    Comment by ktismatics — 30 September 2007 @ 7:41 pm

  8. Good…I knew I had come across that before.


    Comment by Erdman — 1 October 2007 @ 8:30 am

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