Accepted for publication March 12, 1973. -From the Department of Neurology and Psychiatry, University of Texas Medical Branch, Galveston, Tex. Reprint requests to Department of Psychiatry, University of Texas Medical Branch, Galveston, TX 77550 (Dr. Vanderpool).

THE QUEST FOR INSTANT MENTAL HEALTH

This paper demonstrates through historical and current examples that there has been and is a persistent tendency to try to solve serious mental problems quickly and simply. An analysis of some of the factors that have contributed to this wishful quest is given, followed by a review of several specific past and present efforts: the Age of Miracles, mesmerism and hypnosis, galvanism, cocaine, orgone ther- apy, infected teeth (Cotton), dianetics, The Primal Scream, the New Left. It is hoped that, because of this review, the tendency toward finding instant solutions to complex emotional problems will be lessened

The history of psychiatry indicates an interesting and important pattern-a repetitious search by various individuals for what could appropriately be termed "instant mental health." As will be shown, numerous attempts using a wide variety of methods have been made in the past to quickly correct complex emotional problems. (No attempt will be made in this paper to defend what is meant by "complex emotional problems," assuming that this includes such varying clinical entities as paralysis of a limb without apparent physical injury and hearing accusatory voices when no one else is around. Although past efforts either have fallen into disrepute or, more commonly, have ultimately been seen as more limited in their curative effect than originally proclaimed,- new efforts arise to perpetuate the process.

This paper concerns itself with two aspects of this pattern. First, a brief theoretical analysis of some of the underlying factors that give rise to the quest are presented. Then, a chronological review of some of the significant historical events that demonstrate the process are given.

In my opinion, this tendency to believe that one can, quickly and simplistically snatch other humans from the throes of mental anguish arises out of the number of interrelated factors which stem from individual, familial and societal systems, but the expression of these factors is most clearly seen in the form of certain individuals who begin to espouse particular theories or methods as curative. Complex in nature, these underlying factors undoubtedly include the following diverse points: the familial and/or societal push to "conquer the unknown," to somehow solve the riddles that baffle mankind, the personal wish shared by, most humans that all people can, somehow be "normal" and "happy," the often unconscious; fear that one may become insane oneself and the resultant counter-thought that "things must not be that serious with others (and me).. . I can come up with a simple solution and prove how easy it is to help others," the wish for the power and charisma to effect an immediate cure of one's own or another's illness, and the human tendency to deny the seriousness of our dilemmas and to attribute them to other things or people.

Certainly other factors are involved in contributing to the quest, and each factor interrelates in some way with the others and impinges on each individual in particular ways. Because of the complexity of these factors and my limitations, only two human tendencies that are involved: here will be further discussed-hopefulness and wishfulness.Surely there is no clear-cut line of demarcation between these seemingly innate feeling-states. Nevertheless, hopefulness can be seen as an emotion more closely connected with reality. It has been and is an essential ingredient, that underlies the ongoing quest to find new data and develop new approaches that contribute to the ultimate solution of the problems that face us. It has contributed to the drive to find the cause of emotional illness and to develop, more effective treatment modalities. It has been recognized as an essential aspect in effective psychotherapy.

As White, has written: The hope-faith effect is an important aspect of all psychiatric treatment. Karl Menninger has emphasized (1959) that a sense of hope is crucial to our work.

Indeed, hope is essential for life itself as Richter (1957) and Cannon (1957) have shown, without hope people and experimental animals die.

More recently, Yalom discusses the importance of hope in group psychotherapy. He lists it as one of the "curative factors" that are operative in every type of group therapy and discusses how it is especially emphasized in such groups as Recovery, Inc., and Alcoholics Anonymous.' Along with White, he considers the maintenance and instillation of hope crucial in all of the psychotherapies, particularly as patients proceed along the "coping-collapse" continuum.

Hope, then, is a needed- feeling-state that keeps people and their projects going. It is usually based on data that supports its presence. For example, in group therapy, hope is engendered when a patient sees that others have improved, and in research, hopefulness is increased in the researcher when the data begins point toward the possibility of finding answers and 'making sense out of the existing data.

In contrast, wishfulness is a diffuse feeling-state that arises from within the wishful individual's internal set of experiences. It is hardly ever based on hard data. As a result, it tends to overlook existing facts and, in the process, denies the basic complexities of problems in general and emotional conditions in particular.

Denial is one of the most apparent characteristics of the wishful person, but coupled with it is the pressing desire to focus on those wished-for beliefs. Personified by the mystic who contemplates heaven while letting the world go by, the wishful person tends to think globally in his own set direction, often designing in his mind some simplistic and optimistic system that he feels can be applied to everyone. The' effect on others varies from enticing, them to devote their lives to the wish (particularly if the wishful person is highly charismatic) to inducing in others increased skepticism. Perhaps the usual effect is not unlike that of growing up-the affected person becomes wishful for a spell, increasingly realizes the unrealistic aspect of 'the wishful dream, and temporarily becomes somewhat disillusioned, eventually coming to realize that "There was an element of truth in it, but it's not the final answer, I will now have to explore it on my own." In view of his contributing to maturity, the wishful person should not be indicted as being no more than a scourge to mankind, in spite of the fact that, like the Pied-Piper, he may lead children astray. It is, however, helpful to "call his bluff" so that we can get on with the task to realistically evaluating the problems that face us.It is in this vein that a summary of some of the past and present historical events that demonstrate the wishful quests will now be given, with the hope that by examining such events the tendency toward wishfulness will be lessened. No attempt will be made to be exhaustive, and many readers will, no doubt, think of other examples from past reading and experience that demonstrate the process.

The Age of Miracles

From the beginning of time, instances of healing mental illness by miraculous means have been recorded. An outstanding example of this appears in the New Testament when Jesus reportedly healed "the wild man of the Gerasenes" (Luke 8:2G-89). Certainly, in this case, the treatment was said to be instantaneous and dramatic and the exciting news spread rapidly to surrounding territories.

In his book, The Discovery of the Unconscious, Ellenberger discusses the facets of this kind of healing. His description of the exorcist Gassner is particularly illuminating and demonstrates the importance of faith on the part of both the healer and the healed. Such a faith is based on the wishful belief that a complete cure can be rendered in a minimal amount of time with minimal effort and understanding on the part of the healer and the healed but with a great amount of effort on the part of supernatural forces.

Mesmerism and Hypnosis Ellenberger goes on to show that Anton Mesmer skillfully took over Gassner's dramatic healing role, but, instead of being attributed to godly supernatural forces, this time. the sudden cures were attributed to "animal magnetism." This unseen substance was said to reside in more-than-adequate amounts in the great magnetists such as Mesmer, Puysegur, and Kerner. It was their "task to dispense it around to those less fortunate and ill individuals. It was their wish that diseases of all kinds could quickly be conquered, thus, "bringing medicine to its highest point of perfection."' Of course, this did not occur, and following the negative report of the Royal Commission of Paris, animal magnetism eventually fell into disrepute. A somewhat similar, though less dramatic, story could be told regarding hypnotism

Electricity and Galvanism About this same-time, another source of hope appeared on the scene-electricity. Beginning in the 1750s with Benjamin Franklin's discovery, electricity began to be envisioned as of possible benefit for all kinds of psychiatric problems. Altschule states that physicians like Debois de Rochefort felt that galvanism (electric currents, sparks) would be helpful in treating a number of psychiatric problems including the psychoses. Neurologists used galvanism extensively to treat hysteria, but as is well known, a number of physicians began to suspect that the "cure" was due to suggestion not to electricity. As this became increasingly more clear, galvanism ceased to be used in the treatment of nervous disorders.

Cocaine

In 1884, in one of his early attempts to make a name for himself, Freud began to experiment with cocaine, "a therapeutic project and a hope."' Initially somewhat cautious, he later became more and more enthusiastic regarding the use of cocaine, which he called the "magical drug." He felt it was useful in abolishing vomiting, indigestion, depression, and pain. He not only gave it to his fiancee, his sisters, and his friends, but he also took it himself to handle his anxious and depressive moods.

One of his quotes goes, "I took coca again and a small dose lifted me to the heights in a wonderful fashion. I am just now busily collecting the literature for a song of praise to this magical subtance."

The euphoria did not last long. Several years later Freud was condemned for his indiscriminate usage and advocacy of the drug, and some of his critics reproached him for introducing the "third scourge of humanity." (The other two were alcohol and morphine.) Freud himself carried the guilt of having hopelessly addicted a close friend, Ernest von Fleischl-Marxow, contributing to his early death. So, once again, a wished-for magical cure failed to materialize.

Orgone Therapy

Regarding the development of psychoanalysis, Freud was not so wishful. Even initially, he seemed quite aware of many of the complexities of the problems he was attempting to treat. For example, in one of his early papers,the Psychical Mechanisms of Hysterical Phenomena (1892), he discusses the variations that occur with different patients, the effort and time needed to spend with each patient, and the need for clearly recalling traumatic events with appropriate and full affect and in great detail.

Some of his followers were tempted to be less realistic. A case in point was Wilhelm Reich and his development of the "orgone box." Ilse Ollendorff Reich, in her biography of her husband, which she confesses is subjective, described Reich's progression from an early and promising member of the Viennese Psychoanalytic Society and his development of character analysis to his later preoccupation with attempting to objectively find and capture life energy (or "orgone energy" as Reich called it). As is well known, Reich began to feel that this energy could be concentrated in orgone boxes by "orgone energy accumulators" and would be beneficial for all kinds of diseases, including cancer. A significant quote from Mrs. Reich's book demonstrates Reich's progressive desire to get away from the painstaking work with patients and their problems to the more dramatic aspect of his wish, He started to daydream of possibilities for working with Einstein at the Institute of Advanced Studies where he would find a give and take on his own level. He had wanted for a long time to be done with the world of the neurotic, to devote himself solely to the biophysical aspects of his discovery. But unless he could work within a framework that would support his research, he was obliged, for financial reasons, to continue with the psychotherapeutic training in character-analysis therapy. He spoke that night of such possibilities, and hung onto this daydream for the next few weeks.

The tragic end of Reich's career will not be repeated here. Clearly, however, Reich's quest for orgone energy and his feelings and thoughts about it illustrate again the premise of this paper.

Infected Teeth

In 1922, Henry A. Cotton reported the recovery of 80% of state hospital patients following surgical removal of foci of infection, particularly infection of the teeth-but also of the lower abdominal track, the seminal vesicles in males, and the cervix in females." Cotton felt that the brains of patients who had the "so-called functional psychosis; "had been rendered toxic by these infections." Regarding his 20% failure rate, he said: "The brain has become permanently damaged and no amount of detoxifi cation has any effect in restoring the mental condition."Cotton's enthusiasm affected others and a number of psychiatrists began to search for his reported foci which were to demonstrate, wishfully, that severe mental conditions had a relatively simple organic cause. The actual treatment itself (ie, removing infections) has not, of course, proved to be of any benefit to patients with emotional problems, but as noted earlier, the hopeful attitude of the healer did, as shown by Greenacre in an independent evaluation of Cotton's successes.

Dianetics

In his book entitled Dianetics: ' The Modern Science Mental Health, L. Ron Hubbard proposed his. "new discovery" which was to revolutionize the treatment of emotional problems. Written in 1950, the book asserts that, the hidden source of all "psychic" diseases has been discovered and that such diseases will be cured (italics mine). Hubbard does little to qualify his statements. He said that with the use of this "exact science," a person can achieve "release" (from all psychic difficulties) in less than - hours of work. Considered far "superior" to psychoanalysis, the troubled mind could be "cleared" by the dianetic therapist ("auditor") by simply telling the individual to return to an earlier period of his life which the individual supposedly found easy to do. Immediately, in the process "engrams" (troublesome memories of the "subconscious mind") would be erased, and the individual would be fully conscious of the entire earlier experience. This would give him complete control of his mind and result in a rapid development of the "I" (center of awareness).'This process was not only felt to rapidly cure emotional problems but to dramatically increase intelligence. It was considered simple to do and was said to involve only "minor discomforts."

It is certainly no secret that dianetics made little, if any, impact on the problems of psychiatric illness. Naive and simplistic assertions are classic illustrationsthe wishfulness involved in the quest for instant mental health. In this case, however, the magical cure is housed a "psychological" approach as compared with Cottons "medical" approach, demonstrating the fact that wishfulness can affect any approach that proposes to correct severe emotional problems.

The Present Scene

Based on the above discussion and the proposition that there are no easy solutions to complex problems, it is the author's belief that any approach-whether old or new organic" or "psychological"-that claims to quickly,easily, or simplistically correct emotional problems should be viewed with skepticism. Currently, there are a number of "new" treatment modalities which claim to have such answers. Several of these will be mentioned here as examples, but the reader will undoubtedly think of others that make similar claims, thus, carrying on the ancient patternof continued wishful thinking as it affects the treatment of emotional illness.

The Primal Scream.

Arthur Janov begins his book The Primal Scream by describing a group therapy session in which a young man called Danny, after being exhorted to call out "Mommy! Daddy?, utters an eerie scream while writhing and convulsing on the floor. Several other patients, again at Janov's suggestion to call out "Mommy!, Daddy!" went through the. same experience and reportedly achieved at least a sense of relief afterward and, at most, a sense of being completely cured, in a dramatically short period of time.

Based on several such cases, Janov develops a theoretical, system and a treatment approach which he flatly says is the cure for neurosis. Built on the assumption that neurotics do not feel the original painful insults of their parents (They have been victimized by their parents, according to Janov.), Janov goes on to describe primal therapy as " getting patients in touch with "the universal pains that reside in all neurotics."" This-is accomplished by using various sensory deprivation techniques and usually culminates, as in the case of Danny, with the patients' writhing on the floor uttering eerie screams (going through primals). Though it is not clearly stated in the book, a number of patients continue to go - through "primals" even after a year of primal therapy, thus, making the originally described brief process a much more lengthy one. Janov confesses early in his book that, "What we have lacked is some kind of unified structure that would offer concrete guidance on how to proceed with patients during each and every hour of therapy." He says further, "I was staggered by the complexity of the problems presented by a suffering patient." And further, "All neuroses stem from the same specific cause and respond to the same specific treatment."

Out of sensed complexity, then, Janov develops a simplistic theoretical system that he applies to all "neurotics." He never clearly defines what he means by neurosis. He does not deal with the complexities of pathological family interactions-how children and adults contribute to their " own problems, how constitutional factors enter into the picture, how parental indulgence (not just neglect) may produce emotional discomfort. Much more could be said about his omissions-"such as his avoidance of giving specific data regarding the types or numbers of patients treated, a lack of clear statistical data on follow-up progress based on objective psychometric scales, and the lack of clearly-stated time factors.

Enough has been said to illustrate some of the hallmarks of the kind of thinking that continues the ancient trend toward finding quick and simple cures for complex emotional problems.

The New Left,

In the last meeting of the American Psychiatric Association (Dallas, 1972), Dr. Arnold Mandell discussed the coming (albeit present) challenge of the 'New Left," or as some call it, "Radical Psychiatry." New trainees are, as he said, questioning the reason for the existence of psychiatry as a discipline and specialty. Their stance is basically one that says "the location of and the responsibility for the 'disease' in the patient is the major vehicle by which attention is taken away from a guilty society."" The work of Goflman, Szasz, and Laing are considered conservative in a now more radical stance that maintains that patients have been victimized by American society as it exists today. As Dr. Mandell declared, their position is: "The society is the locus of the disease, the patient' is the victim, many psychiatric settings are jails, and one's professional identity becomes that of a tool of an oppressive society.""

Implicit in this movement is the wishful idea that "If society were what it ought to be, mental illness would go away." Certainly, some of the issues raised by this "new challenge" are of crucial importance-a fact not overlooked in recent publications,"- but the tenor of the rhetoric and the gross generalizations that deny the complexities that have been mentioned previously give clear indication of an old process-the quest for instant mental health by wishful, diffuse, simplistic thinking. Spurred an by the inflammatory language of charismatic leaders like Szasz, ("It is customary to define psychiatry as a medical specialty concerned with the study, diagnosis, and treatment of mental illnesses. This is a worthless and misleading definition. Mental illness is a myth.")," the New Left fails to carefully consider even obvious facts. (In the words of Don Quixote: "Facts are the enemy of truth!") So, again, in our time, another expression of wishful-thinking demonstrates the now ancient process to find quick, easy solutions to the complex, difficult problems of emotional illness.

References

1."White RB: Recent development in psychoanalytic research. Dis Nerv Syst 22a]-12, ]961.

2 Yalom ID: The Theory and Practice of Group Psychotherapy. New York, Basic Books Inc, 1970.

3. Ellenber ger HF: The Discovery of the Unconscious. New York, Basic Basic Books Inc, 1970.

4. Altachule MD: Roots o/' Modern Psychiatry: Essays in the History of Psychiatry, ed 2. New York, Grune & Stratton Inc,

5. Jones E: The Life and Work of Sigmund Freud. Trilling L, Marcus S (eds) Garden City, NY, Doubleday & Co Inc, 1963.

6. Freud S: Early Psychoanalytic Writings. New York, Crowell-Collier Press, 1963.

7. Reich 10: Wilhelm Reich. New York, St. Martins Press Inc, 1969.

8. Cotton HA: The etiology and treatment of the so-called functional psychoses: Summary of results based on experience of four years. Am J Psychiatry 28:157-194, 1922

9. Greenacre P, Oberndorf CP, Kubie L: Symposium on the evaluation of therapeutic results. Int J Psychoanal 29:7-33, 1948.

10. Hubbard LR: Dianetics: The Modern Science of Mental Health. New York, Hermitage House, 7950. "

11 Janov A: The Primal Scream. New York Delta Books 1970.

12 Challenge of new left said most critical to field. Psychiatry Ness 7:19, 1972

13. Hughes HS: Emotional disturbances and American social change. Am J Psychiatry 126:21-28, 1969.

14. The psychiatrist: Activist or onlooker. Ment Hyg 54:191-204, 1970.

15. Shapiro DL: The psychiatrist and the problem of social control. Am J Psychiatry 127:1098-1099, 1971.

16 Szasz TS: The Myth of Mental Illness. New York, Paul B Hoeber Inc, 1961.

Go Back