Conversation opened. 1 read message. Skip to content Using Gmail with screen readers wood neurosis 4 of 25 Wood neurosis 51 kac attac Wed, Apr 3, 10:36 AM to Stefan I An Introduction to Moral Therapy The conspiracy In this book I have sought to expose the conspiracy to ex- tend indefinitely the boundaries of mental illness. For far too long people have been led to believe that the person suffering from an excess of life's problems needs "expert" medical and psychotherapeutic intervention, thus allowing the 66 patient" to qualify for "illness, » to the ultimate detriment of his men- tal equilibrium and often at considerable financial cost. Such a view is dangerous nonsense. If we are not ill then we are well, although we may be unhappy. In order that we should know where we, and those dear to us, stand with regard to psychological illness, I have explained the ways in which psychiatrists make their diagnoses. It is far easier than one might think. The chapter entitled "'Are You Mentally Ill?» and Appendix I, "A Layman's Guide to Psy- chiatric Diagnosis, 99 demonstrate clearly the differences be- tween real psychiatric disease such as schizophrenia and manic-depressive illness and those normal but unpleasant mental states which are an inescapable and often valuable part of everyday living. Demystifying the diagnostic process, and showing how to recognize disease and the lack of it, will 2 / The Myth of Neurosis help prevent the layman from employing the potentially damaging illness excuse in situations in which psychopathol- ogy does not exist, and encourage him to seek help from psy- chiatrists when it does. In the redefinition of the proper boundaries of psychologi- cal illness I argue for a tougher, more rigorous and uncom- promising attitude towards what does and what does not constitute disease. In particular I disavow and disallow the concept of neurosis. It is neither a useful diagnostic category nor even an adequate descriptive term. Its bogus status as a psychological condition has led to the wrongful inclusion within the illness category of millions of people whose chief deficiency is their inadequate approach to problems and their unrealistic expectations of what life should give them. A huge industry of therapists has created itself to minister to, and profit from, the plight of these "'neurotics, » thus institutional- izing their "condition" while bolstering the prestige and self- esteem of these disciples of psychodynamism. So, too, it serves no purpose to regard aggressive psy- chopaths or sociopaths as being psychologically diseased. We already have a perfectly good concept to explain and de- scribe their moral bankruptcy. It is the notion of evil. Ex- treme wickedness is no surer indicator of mental illness than is extreme goodness, and we would do well not to confuse evil with disease. In calling for a contraction of the whole field of psychiatry, for greater accuracy in the diagnosis of genuine disease, I am in conflict with those who would extend its boundaries indefi- nitely, thereby creating for themselves lucrative and presti- gious new kingdoms at the ultimate expense of those they seek to treat. These misguided myth-makers have encouraged us to believe that the infinite mysteries of the mind are as ame- nable to their professed expertise as plumbing or an auto- mobile engine. This is rubbish. In fact these talk therapists, An Introduction to Moral Therapy 3 practitioners of cosmetic psychiatry, have no relevant train- ing or skills in the art of living life. It is remarkable that they have fooled us for so long. From the pages of magazines, books and newspapers, from the screens of our TV sets, we are bombarded with "clever ." intellectual explanations of the reasons why we do things, why we think things. Cowed by their status as men of science, deferring to their academic titles, bewitched by the initials after their names, we, the gullible, lap up their pretentious nonsense as if it were the gospel truth. We must learn to recognize them for what they are possessors of no special knowledge of the human psy- che, who have, nonetheless, chosen to earn their living from the dissemination of the myth that they do indeed know how the mind works, are thoroughly conversant with the "'rules" that govern human behavior. Talk therapy and mind candy It has therefore been necessary to mount a two-pronged attack on the apparently opposing groups of practitioners who would force on the individual the role of patient in the absence of hard evidence of illness. On the one hand are Freud, his psychodynamic fellow travelers and the peddlers of the talking cures, who, despite the widest differences in philosophies, must be considered his natural children. To take money for mere talk is, I would argue, in many cases both negligent and, despite the purest of motives, irresponsible. Freudian theories, and their offspring, are irrelevant where they are not actually dangerous. They harm the individual in his pursuit of mental health, and by encouraging dependency and sterile introversion, lower self-respect. Above all, they delay interminably that brave confrontation of life's prob- lems in which alone salvation lies. Such an approach relies for its popularity on the indubitable fact that talking about ourselves is strongly pleasurable, that we all like to be the 4 The Myth of Neurosis center of attention in situations devoid of threat, to perform before a captive and benevolent audience. In pandering to this mildly unworthy desire, these people do us more than a disservice. For, to the extent that such talk therapy is pleas- ant, and its withdrawal difficult and traumatic, I would argue that, like Valium and cocaine, it is psychologically addictive. In the short term it may make us feel better--a quick fix of confidence- -but over the years we will pay a considerable price in terms of dependency and lowered self-esteem. Apparently ranged against the Freudians and their talk- therapist progeny, but in fact sharing their expert/patient approach to the individual suffering a surfeit of life's prob- lems, are the medicobiologists. Instead of intellectual insights and exotic theories, their stock-in-trade is chemical panaceas which they dish out like candy to individuals who are not ill. In both cases the end result is the same-_-a passive 66 patient" prostrate at the feet of the "healer, suffering the psychologi- cal pain of guilt as he learns to like himself less. So talk therapy and the prescribing of Valium offer no so- lutions in the absence of illness. They must be replaced by something of value. I offer Moral Therapy, a philosophy based not on fantasies and pseudo-intellectual gymnastics, nor on a naive reliance on chemistry to provide the soma for a brave new world, but on common sense, on what we know in our hearts. Nobody gets paid for practicing Moral Ther- apy. Nobody profits from solving the problems of others ex- cept in feeling that natural satisfaction we all experience when we have been of service. There are no experts, no training institutes, no degrees or examinations, no gurus. There is nothing but us, our experience of life, our warmth and empathy, the voice of our conscience. In the absence of psychological illness, we can practice the principles of Moral Therapy on ourselves and on others. Contentedness can exist only if self-respect is high. Only if we An Introduction to Moral Therapy / 5 like ourselves can we be happy. At all times and in all situa- tions we must obey our own moral codes. Only by doing what we ourselves consider to be right and good can we travel the royal road to self-respect. Insofar as we disregard our moral imperatives we must sufter the psychological pain of guilt. If we use the guilt mechanism properly and recoil from those actions which cause it to operate, it will serve us well. In the absence of disease, then, guilt is good for us. Life is tough It is vital that we avoid misconceptions about the nature of life, and expose as fallacy the idea that to the extent that we are unhappy and ineffective we need "expert" intervention. Life is tough and frequently unpleasant. Our prayer, there- fore, should not be for ease but for the courage to face diffi- culty. The Myth of Neurosis is not a book about psychiatry. I de- fine psychiatric illness so that it can be excluded. What re- mains is individuals who are responsible for their predicament, slaves to neither their environment nor their brain biochemistry, and who are therefore free, with support, to change themselves for the better. With the right help from friends and loved ones, we can all friends, we can become the practitioners of a new Moral Therapy. Into the vacuum created by the disappearance of the paid "expert" will step family, friends, priests, neighbors, husbands, wives and children. For too long their rightful role has been wrongfully usurped by impostors. The time has come for them to reclaim it. In particular we should realize and encourage others to re- alize that self-respect is increased by searching out and achieving more difficult rather than easier objectives. By seeking difficulty and avoiding the easy way in pursuit of 6 The Myth of Neurosis what we consider to be worthy ambitions, we will like our- selves more. In summary, the ideas contained in this book represent a break with the immediate past and serve as a blueprint for a more optimistic era, heralding a return to that self-suffi- ciency and asceticism which forms the basis of the most widely and deeply held ethical systems. I advocate the avoid- ance of crutches, whether pills or psychiatrists. We must learn to do without unworthy, unprofitable and transitory pleasures such as those afforded by irresponsible sex and drugs, choosing instead the tough and difficult way in order that we may experience true contentedness, which flows alone from the contemplation of a hard task well done. 2 Guilt, Morals and Self-Respect Rediscovering the conscience Many of us choose to think of life's problems as unpleasant but apparently inevitable phenomena which threaten our natural state of contentedness. We feel that we have a right to be happy and that it is only the problems of life that pre- vent our being so. This is a mistaken and inaccurate judg. ment. Man has no natural right to happiness. It is obtained only through great hardship and effort, and instrumental to its attainment are the very problems of life which most of us regard with such disdain. For in overcoming difficulties and problems we increase our self-respect, and it is the central thesis of this book that self-respect and contentedness are synonymous. We cannot be happy and effective unless we like ourselves. Only if we are satisfied with our thoughts and actions can we be contented. There is only one way to increase self-respect, and that is by confronting directly the difficulties that we face. For in most situations we have a shrewd awareness of what we ought to do and ought not to do and are more or less aware of the difficulties involved in the various courses of action open to us. If we listen to our own individual moral imperatives, to 7 8 The Myth of Neurosis the voice of conscience, and attempt courageously to obey them, our self-respect must increase. The increase in self. respect will be directly proportional to the degree of diff- culty and the amount of vigor and determination that we apply to the task. If we try hard, ultimate success is not nec- essary for the gain in self-respect. It is the journey and the struggle that are important, never the destination. It is ap- parently paradoxical that relative contentedness is achieved not by escaping our self-accepted responsibilities but by em- bracing them; not by indulging in what we acknowledge to be our baser desires but by resisting them; not by taking the easy way but by seeking the most difficult. The value of guilt Each individual has his own unique moral code, fashioned and learned from the sum of his experiences. He departs from it only at the risk of compromising his self-respect. In avoid- ing such a disastrous course he has an invaluable ally in the much maligned but vital psychological mechanism of guilt. In the same way that pain acts as a warning that the body is endangered, so guilt warns us that psychological equilibrium is compromised. We must listen to our guilt feelings and cease the actions that have given rise to them rather than continuing those actions while attempting to do away with the feelings of guilt. Thus guilt should be regarded as a valu- able ally, because it will inevitably tell us when our behavior falls short of our ideals and when self-respect is likely to be diminished. In short, in the absence of psychological illness of which it may be a symptom, guilt can be good for us if we use it correctly. It has been the fashion in our permissive age, however, to emphasize the harmful nature of guilt feelings and to present them as unworthy, uncomfortable and unnecessarily self- limiting emotions tending to hamper self-development. The Guilt, Morals and Self-Respect 9 attack on guilt has come from two separate factions who on the surface would appear to have little in common. They are, however, united in their desire to alleviate the psychological pain of guilt. This is achieved by the promulgation of specu- lative theories whose effect is to absolve the individual from blame by denying him a large degree of responsibility for his actions. On the one hand the psychodynamic theorists, typified by Freud, suggest that our personalities are formed at an early age in response to environmental, and particularly family, in- fluences. In later life, Freudians maintain, our dispositional tendencies to act and think in certain ways are to a very large extent determined by these early factors and can be modified only with great difficulty in the investigative process of psy- choanalysis. We cannot be blamed for our current attitudes and actions since they follow inevitably from events and situ- ations in the distant past as the result of a causal process over which we have little, if any, control. From this it must follow that it is not our fault that we are the way we are, that we do the things we do, that we think the things we think. There is no point in the psychological pain of guilt since we cannot benefit from its warning and change our attitudes and behav- ior. We are blameless, but we are also impotent. We are not at fault but we are unable to help ourselves. Instead we must enlist the support of the psychoanalyst. Thus we pay a terri- ble price for our absolution, for how can we have self-respect if we are not responsible for what we are? Ranged against the Freudians and neo-Freudians are those of a more biological bent, who stress the speculative nature of psychoanalytic theories and point to the lack of evidence for the truth of their assertions. They prefer what they con- sider to be a more scientific approach. Such people tend to regard a situation in which an individual appears unhappy and sad, seems unable to cope with life's problems, is guilty and has low self-respect, in terms of an "illness" model. The 10 The Myth of Neurosis person is, or is well on the way to being, a "patient" who "has" a "neurosis" or a "personality disorder" in much the same way that he has bronchitis or a broken leg. In support of this view they might produce evidence that both mental and physical behavior are closely related to brain pathology and brain biochemistry. Depressive illness seems to respond to electroconvulsive therapy as well as to tricyclic drugs. Schizophrenic symptoms are alleviated by phenothiazines. General paralysis of the insane (GPI) was shown in 1911 to be related to infection with the organism which causes syphilis. Thus, while admitting that physical treatment for "neurosis 27 and "personality disorder" are not presently available, adherents of the strictly biological ap- proach might be expected to look to the area of pharmacol- ogy for an eventual cure. In the meantime the person who might, for example, have been diagnosed as having a "mild neurotic depressive illness" will be reassured and supported, possibly tranquilized if anx- ious, sedated at night if suffering from insomnia, and above all encouraged to talk freely about his problems. The doctor might advise a holiday or a few days off work. He might at- tempt to explain away the patient's condition by saying, "'It's just one of those things that happen. Nobody knows what causes it. Don't worry, it will go away in time. ." All the doc- tor's remarks will have the same purpose, namely to attempt to alleviate the immediate suffering of the patient, who will be encouraged not to blame himself; not to feel guilty; not to accept responsibility for his predicament. Above all, his con- dition will be presented as one he had little power to avoid and has less power to cure. Time, tablets, rest, support and reassurance will do the job for him. So it can be seen that both the Freudians and their oppo- nents, who adhere to a medicobiological approach, have very similar attitudes to the "'patient. " Both agree that he is a vic- Guilt, Morals and Self-Respect / 11 tim of circumstance, that his low self-respect and his guilt feelings are not his fault and that he should not be blamed for them because he is to a large extent not responsible for them. As caring people, both sets of practitioners see themselves as experts whose task it is to "cure ¿" the patient. The means are different but the end is the same. The patient is relatively without power and must accept a passive role in relation to the healer. This approach, springing as it does from the very best of motives, is a profoundly pessimistic one. By having the sense of responsibility for his actions removed, and passivity and reliance on the healer encouraged, the individual is denied the one real chance that he has to escape his unpleasant psy- chological feelings. For unless he can increase his self-respect by striving courageously to overcome the difficulties he faces, there is no real solution to his problem. It is essential that he must feel that he alone is responsible for his success. Only then can he reap the reward of learning to like himself. This he cannot do if he in any measure feels that he has adopted a passive role- -that any change in his circumstances is due either to the pharmacological skills of the physician or the psychotherapeutic ones of the analyst. The hard way All that Moral Therapy can offer is a life of struggle and brave confrontation of life's problems. It is not an easy way, but a hard way. Essential to the philosophy is that difficult tasks should actually be sought rather than shunned and should always be preferred to easy ones. When confronted with alternative courses of action in a certain situation, the individual must choose the more difficult for its own sake in order to maximize self-respect, for if the easy way is taken, self-respect is unlikely to be increased and may be dimin- ished. 12 The Myth of Neurosis It may seem paradoxical that one should eschew the easy and seek the most difficult when a consideration of human nature seems to indicate that we tend to do exactly the op- posite in practice. Certainly it seems to be the commonsense view that when faced with two or more possible actions we should try to choose that which offers the least problems. It is our normal view that life is about the avoidance of problems and difficulties, which we use our considerable ingenuity to minimize. However, it is my contention that we are seldom accurate judges of our own long-term self-interests and we pay a price for taking the easy way in terms of lessened self-respect and its constant partner the emotion of guilt. Few of us realize the source of these feelings, so accepted is it that we owe ourselves "a good time." What we fail to understand is that our notion of a good time is based on a misconception. For any momentary enjoyment of the easy way and the avoidance of difficulty is paid for eventually by feelings of guilt. An analogy might be made with the taking of heroin. In the spe- cious present, few who try it do not enjoy the experience. In the long term, after addiction has set in, the ghastly pain of withdrawal renders any short-term enjoyment inadequate and irrelevant; while the physiological mechanism of toler- ance ensures that larger and larger doses are required to pro- duce the same effect. So, too, seeking the easy way rather than the most difficult carries in it the negation of its own purpose. We must pay by suftering the psychological withdrawal symptom of guilt. For it is as useless to continue to act against our own individual moral imperatives and then attempt not to feel guilty as it is to continue to take heroin and then to attempt to deal with the withdrawal symptoms when they arise. However, in this permissive age some such course is widely advocated and guilt is considered to be something that we have the right to avoid. When we do experience it we are encouraged to per- Guilt, Morals and Self-Respect 13 form some sort of psychological surgery on ourselves to re- move it. But in the real world, guilt can be removed in one way and one way alone, and that is by modifying or changing our attitudes and actions to those that increase our liking for ourselves. 3 The Value of Moral Therapy In this book I shall offer a new way of understanding peo- ple and their problems. Further, I shall show how, in a new therapeutic process, people can learn to help themselves and to help others. I have called this system Moral Therapy. It is essential to demonstrate clearly the situations in which Moral Therapy is applicable. First, it is no part of my intention to suggest that this therapeutic method be used in situations where actual psy- chiatric illness exists. People, for instance, who are suffering from schizophrenia or clinical endogenous depression, in which pathological feelings of guilt, self-blame and worth- lessness are common symptoms, will not be helped and may be harmed by the therapeutic approach adopted here. To apply Moral Therapy to such people would not only be cruel and misguided but, bearing in mind the high risk of suicide in severe depressive illness, might easily be fatal. Rather it is ap- pliable to people who are not actually psychiatrically ill, but may be in danger of becoming so. Moral Therapy there- fore stands in the same relation to psychiatry as preventive medicine does to clinical medicine. It cannot be overempha- 14 The Value of Moral Therapy / 15 sized that any factors indicative of mental illness must be rec- ognized before one uses the Moral Therapeutic approach either on oneself or on others. Later in the book it will be ex- plained how psychiatrists do this. The people for whom Moral Therapy is appropriate are the many individuals who perceive life's problems as so daunting that their ability to lead a contented life is severely diminished. They are people who find it difficult to make de- cisions. They find it difficult to act and when they do act their actions are often not in their best long-term interests, al- though they may appear to themselves superficially to be so. Such people are seldom happy. Rarely do they enjoy them- selves, and they feel that life is tinged with a grayness and drabness that they suspect others do not experience. Mildly anxious and mildly depressed, they stumble through life liv- ing ineffectually and dreaming of improbable and fantastical victories which will transform them magically, through no effort of their own, into the sorts of individual they feel they have a right to be. They are not actually ill and may never seek advice concerning their problems. They may hold down a job, retain a marriage and appear to an observer to be functioning relatively well. But the quality of their life is low and later they may suffer an illness of the depressive type. If only. Common to all of these people is a lack of self-respect. They do not like themselves and feel angry and impotent at their failure to enjoy life. From this central lack of self- respect all else stems. They resort to subterfuges and cunning schemes in an attempt to hide from themselves and from others their felt worthlessness. They blame others for their failures. Or, encouraged by psychoanalytic-type philoso- phies, they blame their families, their friends, their circum- stances. These individuals are characterized by the "'if only 16 The Myth of Neurosis syndrome ("if only things had been different» "if only my parents had not got divorced" "if only I had been born more intelligent, with more money, taller, more attractive, etc., etc.). Constantly they shrink from challenges that they feel may put at risk their fragile self-respect. Distance is put between themselves and their objectives, as they find excuses for not tackling the tasks that they themselves acknowledge they ought to accomplish. They become static, hardly daring to move and to act, so great is their fear and expectation of failure. Obstacles are found that will either prevent them from doing what they know to be their duty or provide a rea- sonable excuse should they fail. In all cases the object is to preserve their precarious self-respect. But in attempting to insure against failure by erecting obstacles to success, they make failure more likely and paradoxically the effect is to re- duce self-respect rather than to preserve it. Their object is to reduce self-blame by blaming others, but whatever happens, the guilt mechanism is not deceived and is never effectively suppressed, causing constant psychological pain. Attached to misery It is unfortunate that many people whose need to change their attitudes and behavior is greatest often feel that they have a strong vested interest in continuing to think and act in the way they do. This is because in the short term such be- havior seems to prevent any serious decline in self-respect al- though ultimately it has the unwanted effect of preventing any increase in self-esteem. Hence they settle for second best, living vaguely unpleasant and discontented lives, while man- aging to retain some vestiges of self-respect. They do not par- ticipate fully in life because they can then, to some extent, excuse their lack of accomplishment. "'If I don't try I cannot be said to have failed" might be considered their motto. But not trying is itself a form of failure and their guilt mechanism The Value of Moral Therapy 17 will not be taken in by this subterfuge. The point is that these people are very attached to their behavior, however stultifying it may be, and they may iden- tify any attempt to dismantle their defense mechanisms as a hostile act and view it with considerable alarm. They know that their lives are not happy, but paradoxically they may re- sist all attempts to help them to improve their lot. Traditional approaches in psychotherapy may unwittingly bolster this paradox and it has been said that prolonged psy- chotherapy of the investigative, insight type includes a tacit mutual agreement to postpone indefinitely the solution to the problem. By encouraging intellectualization and introversion and the uncovering of postulated cause and effect mecha- nisms of great complexity, the individual may begin to feel that his thoughts and actions are largely psychologically de- termined and that he is not totally free to be other than what he is. This is an attractive concept to a person seeking to maintain a fragile self-respect. By emphasizing the "illness" model, the medicobiological approach also tends to help the individual to find an ex- cuse-that is, the illness- -for behaving the way he does. Such a person may feel that it is dangerous for him to get well. So low is his opinion of himself, he feels that even if he is well he is bound to fail. He therefore feels that he is better off being ill, for at least then he has the illness to help explain away his failure. The person who will benefit from Moral Therapy is then the person for whom life has lost its charm; for whom diffi- culties loom so large that he recoils from confronting them; who experiences life's problems not as a stimulating chal- lenge but as a formidable barrier preventing action and im- peding development. At certain times in our lives all of us will fall into this cate- gory. At those times we are weak and indecisive. We become 18 The Myth of Neurosis difficult to live with and blame others for our predicament. Feeling unloved we become unlovable, and a vicipus circle is set up as we interpret the understandable reactions of others to our inappropriate moods and behavior as unprovoked hos- tility. We become acutely aware of the breakdown of our at- tempts to gain satisfaction in our lives and, resenting our lack of success, our self-respect declines. We feel guilty that we are making a mess of things and bitter that the contentedness that we are encouraged to believe is our birthright seems somehow beyond our grasp. Endlessly we cast around for ex- planations and excuses that will relieve us of responsibility for our actions and alleviate our guilt. We hope not so much to understand our situation as to be able to explain it away, and we search out those who will collude with us in this ster- ile pursuit. All of us experience periods such as this, and at these times we need the help of others in order that we may be able to help ourselves. We rely during these periods on our partners, on our friends and colleagues, and on our families. If they are wise and have our best interests at heart, they will not en- courage us to dwell on our predicament but will rather at- tempt to take us out of ourselves, encouraging us to follow the path of extroversion rather than of introversion, of action rather than contemplation, of exercise and physical activity rather than sedentary intellectual ruminations. It is normal to feel like this in the same way that it is normal occasionally to be ill, and the resilience and determination that we show in extricating ourselves from our position will increase our self- respect. For some people, though, the periods of time spent in these troughs of psychological despair are prolonged. They are not ill but they are so often unhappy that moments of sat- isfaction appear to them as small islands dotted on a gray sea of semipermanent discontent. Try as they may, such people appear to be unable to deal with the problems of life. They The Value of Moral Therapy / 19 seem hemmed in, surrounded by the high walls of their diffi- culties. Hitting about them in their efforts to revenge the hurt that they feel, they may have strained the normal contracts of friendship and marriage to the breaking point. Moral Ther- apy would argue that more than any others they need the in- tervention of a concerned adviser who is prepared to travel with them on the difficult path ahead, the friend who will not demand love and affection in return for his involvement. Armed with the principles set out in this book, we will all be in a position to help such a person and to help ourselves when we experience such problems. No longer will it be thought necessary for him to search out a "mind expert" to rescue him from his predicament. The concerned and forceful friend must recapture the role that "'science " has usurped. Real self-help Moral Therapy does not attempt to solve people's prob- lems, but rather is interested in helping them solve their own. It is thus applicable to all of us, but more to some than to others. For failure to deal effectively with the problems of life clearly admits of degree. Some fail seldom, others fre- quently, while for some again failure may have become a way of life. Many of us experience extended phases when things seem to go badly, followed by periods of comparative suc- cess. The continuum then spans the gap between, at one end, the person whose self-respect is high, through the middle ground, to the frankly unsuccessful person who views the world as an oppressive and dangerous place and may be on the verge of a mental illness. As with physical illness, the se- verity of the situation will influence the prognosis. Those whose general ability to cope with problems is only margin- ally and temporarily diminished can expect to achieve the 20 The Myth of Neurosis highest levels of self-respect and mental health from Moral Therapy. At the other end of the scale are those individuals who are determined to preserve their "illness 27 status, refusing to admit that they are capable of helping themselves in situa- tions that they would prefer to believe are outside their con- trol. For such a person the efficacy of the Moral Therapeutic approach may be more limited, though its benefits will be none the less real. Starting from a low baseline, the percent- age improvement in self-respect may be large despite the fact that the end result may fall short of total success. However, such a person can at least begin to learn what it means to like himself more as he listens to his individual moral imperatives and attempts to act in accordance with his own uniquely fashioned ethical code. Nevertheless, a significant degree of motivation is always necessary if there is to be any worthwhile improvement, and if people do not possess it they will be unlikely to benefit from the ideas contained in this book. The person must truly want to feel better and have a genuine desire to escape his predicament. We should not connive with an individual in the maintenance of an unsatisfactory status quo while paying lip service to the need to change it. This may seem obvious, but it is a fact that some people prefer to remain in their de- pressed and guilty states rather than face the privations and hardships that are necessary for their proper development. That they are visiting a doctor allows them to pretend to both themselves and others that they are ill, and that factors which they have no power to resist are impeding their progress and holding them captive in their present situations. Most therapies, including drug therapy and even supportive psychotherapy, help foster this unhelpful illusion. Such people will recoil from the responsibilities that Moral Therapy insists they accept, while the realization that they alone are respon- sible for who and what they are may be profoundly disturb- The Value of Moral Therapy / 21 ing to them, removing as it does their excuses and alibis. When such individuals become aware that they are going to be asked to do things which, inevitably, they will find diff- cult-to undertake hard work, to give up many unprofitable pleasures, and to lead a strict moral life as dictated by their own consciences- -they may shrink from the situation and re- turn to more comforting but less helpful philosophies. Nor should they be dissuaded from this course. In this "caring so- ciety 99 it may seem hard that help can be given only to those who show a genuine willingness to help themselves, but in the real world it has always been thus. To pretend that there are NO "hopeless" cases is mere bravado and contradicts the commonsense view. If we are not motivated to improve our own lot, then there is little hope of our doing so, for motiva- tion itself is an exceedingly difficult seed to implant. The fundamental aim of Moral Therapy is to bring about a situation in which people can look at their lives with satisfac- tion and admiration and to give them a sense that they are worthwhile or that they have elements in them that are worthwhile. Moral Therapy cannot miraculously turn the dissatisfied into the satisfied, but its purpose is to give them some sense of achievement. It seeks also to dispel some of the more widespread misconceptions as to the nature of life and to help individuals to more realistic expectations. It is to be hoped that they will come to believe that life is about prob- lems and the solving of them; about struggle and the sur- mounting of difficulty; that it is essentially hard rather than easy. This view is of course totally opposed to the general wis- dom. Many of us feel that those conspicuously successful people whose self-respect is high have been dealt a superior hand, singled out for preferential treatment. Not for them the problems, insecurities and lack of opportunities which be- devil us. They, we feel, are able to bask in the calm waters of 22 / The Myth of Neurosis a life relatively free from difficulty and struggle. We, how- ever, feel dispirited and unfairly treated in life's lottery, that in some way the good things have passed us by and fallen quite fortuitously elsewhere. If only the cake had been di- vided differently, then we would at a stroke be free of our un- pleasant predicament. We daydream of how things could be made easy for us. If only we could win some money, get pro- moted, write that first novel, obtain a job, find someone to love us. If any or all of these things could be granted, how contented we would be. Then at last we, too, could live the dream, and what splendid people we would feel ourselves to be. Constantly we hope for an effortless transfer to the easier side of life as we wait for something to turn up; for our luck to change; for something to happen to us. We feel vaguely resentful at the unfairness of our position and insofar as we have objectives we desire more relaxation, leisure and luxury. When analyzing the apparent success of others we attempt to explain it away in terms of unfair distribution of assets and situations. We tend to suggest that the successful person, whose self-esteem is high, has not suffered from our prob lems, has had it easier than we in terms of material benefits and environmental factors, of hereditary biological gifts such as intelligence, good looks, or a "'strong 29 and attractive per- sonality. In the allocation of qualities we feel that such a per- son was given tremendous advantages and as a result has found it easy to like himself. In his fortunate position we would do the same. All this is a fundamental misconception. In reality people who like themselves and have high self-respect are people who have had many and varied problems which they have struggled extremely hard to overcome. If they had our prob- lems they would tend to be stimulated by them, treating them as springboards for action, as fences to be jumped, rather than impassable obstacles impeding progress. Their The Value of Moral Therapy / 23 high self-esteem springs from the Herculean nature of the tasks they have accomplished rather than from idle contem- plation of advantages thrust upon them in the lottery of life. Moral Therapy and the moral life Moral Therapy, then, will seek to show the individual how he can dispel the symptoms of nonclinical anxiety and de- pression. At some time or another most of us have had these feelings to a greater or lesser degree. We lack confidence and are fearful and unassertive in the presence of others. We shrink from social contact, feel unable to express ourselves and are unwilling to enter crowded rooms. Our mouth be- comes dry when we have to speak and we are conscious of our heart pumping. Familiar butterflies are felt in the stom- ach and we may begin to sweat. Words just don't seem to come in the way that they usually do, and the whole process of rational thought seems to be an effort. We find it difficult to concentrate on any one thing and find ourselves having to read something several times before we take in its meaning. Our mood is flat and sad, and everything around seems dull and boring. Above all, we lack energy. There is an emptiness and deadness within us and there seems to be little point in anything. The outside world appears gray and drab and all our senses seem blunted, so that our environment is experi- enced as less real and vital. Our ambition lies dormant and we feel incapable of achieving anything worthwhile. We avoid people, even close friends, as we cannot get interested in their dreams, schemes and enthusiasms. Relating to people becomes a major problem and we feel increasingly insecure and vulnerable as worries abound. A profound pessimism set- tles over us and all the things that we contemplate seem hedged around with dangers and difficulties. We feel strongly that it anything can go wrong it will, and we feel there is little, in our debilitated state, that we can do about it. Deci- 24 The Myth of Neurosis sion-making becomes more than usually difficult and we vac- illate and postpone all decisive action. We shrink from our responsibilities. Things that we usually enjoy cease to be en- joyable and we wonder what is wrong with us that even our most reliable pleasures cease to please. We feel semiperman- ently anxious about our condition, and fear, spread out thin, seems to permeate all our thoughts and activities. Sexual desire is diminished and we begin to shelve our plans for a future that looks increasingly bleak. We may eat more for comfort and increase our drinking in a futile attempt to bol- ster our sagging confidence. It becomes difficult to get out of bed in the morning and we tend to spend more time in bed to escape from a life that seems mysteriously to have lost its charm. As all activity becomes an effort we take less exercise and, becoming flabby, we put on weight. So our deteriorating physical condition begins to contribute to our misery and we become subject to hypochondriacal preoccupations, tending to worry about our hearts, digestive systems and even our mental health as we seek explanations for our unsatisfactory predicament. We are not clinically ill, are able to carry on, and others may not know of our feelings. We do not have the symptoms of severe endogenous depressive illness with sleep disturbance, early morning waking, anorexia, weight loss, thoughts of suicide and diurnal mood variation. Nor is our sit- uation easily attributable to a set of environmental circum- stances to which it might be an understandable reaction. Our anxiety, too, lacks the phobias, gross disturbances of the au- tonomic nervous system and panic attacks that tend to char- acterize clinical anxiety states. It is just that life does not feel so good anymore. Once physical and psychological illness have been ex- cluded by a competent doctor, Moral Therapy can help. The individual will be shown that the central problem is a lack of self-respect caused by his failure to attempt to live up to his own standards, with consequent feelings of guilt manitesting The Value of Moral Therapy / 25 themselves in a depressed and anxious mood. Once this is realized and accepted, the way forward is clear. Rather than be encouraged to abandon his standards, the individual will be helped to become more the person he knows he should be, and, as he learns to like himself, immerses himself in activity and hard work and abandons his futile search for excuses and scapegoats in the form of "illness" or psychological "determi- nants 99 in the environment, he will regain a new sense of pur- pose. The future once again will begin to make sense and he will know where he is going, enjoying the journey and not merely longing for the destination. His energy and ability to concentrate will return and he will regain his zest for lite. Relationships will improve as, liking himself, he becomes more likable and is able once more to relate to people as equals. In such a way will fear and anxiety diminish as con- fidence and self-respect grow and as difficulties are bravely confronted. Always the self-analytic approach will be avoided and in- tellectual soul-searching discouraged in favor of action, com- mitment and involvement. No longer will the "if only approach be employed, as the individual begins to realize that the world is plastic and can be made to bend to his will. Introversion will be replaced by healthy extroversion as he seeks out the difficult rather than the easy way. Decision- making will be embraced rather than avoided and there will be an end to excuses. Sound in mind, he will become sound in body too, taking regular exercise and avoiding excesses of food, drink, sleep and sex. He will lead a moral life, in tune with his own standards, in harmony with his own conscience, contented, fulfilled, brave and true, steadfast in keeping to his commitments and promises. Expecting less, he will re- ceive more as he adopts a more realistic approach to life and no longer expects something for nothing. Believing himself to be a creature of infinite possibilities, he will attempt more and more in his pursuit of excellence, and as his achievements 26 The Myth of Neurosis multiply and his self-respect increases, so guilt, depression and anxiety will melt away. It should be realized that there are many who will not benefit from Moral Therapy. Certainly those who are physi- cally or psychologically ill should be referred immediately to a specialist in these fields. Another significant group to whom Moral Therapy can offer nothing are those people who do not have a moral code in the accepted sense and for whom the notions of right and wrong are meaningless. In psychiatric terminology such people are often referred to as aggressive psychopaths and sociopaths. They are characterized by their seeming lack of any conscience, by their extreme emotional immaturity, low frustration tolerance and lability of mood. In many ways they are emotionally childlike although their in- telligence may be high. Such people are often in conflict with society and can expect to be treated accordingly. Their lack of stability, explosive tempers and disregard for generally ac- cepted laws make them frequent inmates of both hospitals and prisons. Moral Therapy has nothing to offer such people, for if an individual has no personal morality he is a rudderless ship adrift on the sea of life. Guilt as a compass is meaningless for him, and as he has no idea of where he is going or of what he is trying to achieve, he has no yardstick against which he can assess his performance. Thus he can never respect him- self and can only enjoy transient pleasures snatched from others and invariably at their expense, for which they will in- sist on retribution. The possession of a moral code is, then, a necessary prerequisite if the individual is to benefit from the principles of Moral Therapy. If no such code exists it cannot be created de novo and forced on an individual who would be, by definition, both unwilling and ill-equipped to receive it. In general the person who can benefit from therapy will al- ready be functioning in the outside world. His problem will The Value of Moral Therapy / 27 be that he is not functioning particularly well and is not gaining satisfaction from his life. He is sane but discontented; he is in touch with reality but finds no comfort in it; he is "well" but he does not feel good. To benefit he need not pos- sess the high intelligence and verbal ability considered so de- sirable in those undergoing psychoanalysis or therapies of the investigative, insight type, for in Moral Therapy the em- phasis will be on action rather than on talk and on doing rather than on thinking. He should be motivated, and be gen- uinely prepared to try to change. These, then, are the people who are ripe for Moral Therapy. 4 Are You Mentally Ill? At some time or another most of us have wondered if we might not be a little mad. At times, too, we wonder if our friends or loved ones might actually be 4;1123 in the psychiat- ric sense. Despite widespread public knowledge of subjects medical and surgical, little is known about psychiatry and, more specifically, about the art of psychiatric diagnosis. No- body really seems to know what psychiatrists do when they attempt to decide whether or not the person who confronts them is mentally unwell. Certainly it would be generally agreed that it is a difficult and mysterious process, requiring long training, high intelligence and perhaps almost supernat- ural powers of insight and intuition. Popularly it is believed that psychiatrists have the ability to "see into our minds, 93 to understand the workings of the psyche, and possibly even to predict our future behavior. In reality, of course, they possess no such skills. Illness us. unhappiness In this chapter I shall explain how psychiatrists recognize the symptoms and signs of mental illness, the sorts of things 28 Are You Mentally Ill? 29 they look for, the methods they use in making their diagnosis. I shall also define those areas of thought, emotion and behav- for which are rightly the province of psychiatry and, perhaps more important, those that are not. The purpose of this is to correct misapprehensions about the nature of psychological illness, to prevent the misguided application of Moral Ther- apy to the mentally ill and to alert people to the warning signs of psychological disease, so that they can ask for profes- sional help in the early stages of the process, when interven- tion may be more effective. Another important aim of this section is to undermine the illness excuse. If we are not ill, then we are well--and responsible for our predicament. And if, despite the absence of illness, we are unhappy, depressed and anxious, then we can use the principles of Moral Therapy to improve our condition. Psychiatry is not a difficult subject. On the whole it is rather an easy one. The workings of the minds of others being largely inaccessible to us, and most knowledge of them being derived via analogy with our own mental processes, psychi- atry contents itself with the recognition and treatment of various syndromes usually on the empirical basis of what "works. 99 Lithium "'works 29 in cases of manic-depressive ill- ness, electroconvulsive therapy (ECT) in cases of severe re- tarded depression of delusional intensity, and phenothiazine tranquilizers undoubtedly help to relieve schizophrenic symptoms. Why these treatments work is the subject of much speculation and research, but as yet hard causal mechanisms have not been found. In truth there are very few illnesses in psychiatry, and even fewer successful treatments, although certain treatments which do exist are often startlingly successful. In the large ma- jority of cases the recognition of psychiatric disease is not at all complicated, and in nine out of ten cases psychiatrists will agree on the diagnosis. Certainly there are small areas in psy- chiatry where difficult decisons do have to be made and in 30 The Myth of Neurosis which experienced doctors are often in disagreement. The difficulty, for example, in differentiating between an emo- tion-laden schizophrenia and manic-depressive illness, or between a genuine psychosis and a severe "hysterical person- ality disorder, is genuine, and such cases take up a dispro- portionate amount of time, and give rise to much stimulating argument at psychiatric case conferences and ward rounds. Intelligent minds have a tendency to stretch themselves by concentrating on difficult matters. It is right that they should do so-it is a potent source of increased self-respect--but an unfortunate by-product has been that in concentrating on the small print of the subject, in the pinpointing of esoteric diag- nostic categories, in the postulating of hypothetical psycho- logical and biochemical causative processes, psychiatrists have tended to lay a smokescreen over the indubitable fact that in the real world it is not hard either to recognize or to treat the large majority of psychiatric illnesses. It would take the intelligent layman a long weekend to learn how to do it. There are parallels with general medicine here, although medicine is a vastly more complicated subject. The GP deals mainly with coughs and colds, aches and pains, worries and depressions, pregnancies and their complications. Perhaps 80 percent of his medical training is of little use to him. He gets "qualified," but he learns the job as he goes along. So in psy- chiatry the time has come to avoid the death by a thousand qualifications, and to get to the heart of the matter. Let ped- ants and perfectionists carp and purists dissent; the fact is that we can all learn to recognize psychiatric illness, and come to know about the most effective and appropriate treatments. In those cases where doubt exists, the true professional may not be of much help as often other experts will be found to disagree. Certainly in the field of forensic psychiatry, when psychiatrists are asked to determine whether or not a Are You Mentally Ill? / 31 person committing a crime was genuinely responsible for his actions- -because of illness did not know the difference be- tween right and wrong at the time of his offense the war- ring experts in the courtroom often achieve little except to show clearly that the gray areas of psychiatric diagnosis are a no-man's land in which victory is usually awarded to the best orator, to the most charismatic personality or to the man with the most initials after his name. Putting for one moment these disputed hinterlands aside, we are left with well-trod- den territory, its signposts in place and well marked. The diagnostic action is in the psychiatric outpatients depart- ments of the hospitals and in the accident and emergency de- partments, where the sheep, metaphorically speaking, are sorted from the goats; where the decision is made whether or not genuine psychological illness exists. Recognizing real illness It will be the purpose of this chapter to allow the person who worries and wonders about his or another's mental health or psychiatric status to do the sort of thing that psy- chiatrists do, to look at the world through their eyes so that he can reach the kind of conclusions which they reach, "know " the type of things that they "know. » Basically what psychiatrists do is something called the Mental Status Exam (MISE). They do it again and again. It is the fundamental tool of their trade, the equivalent of the surgeon's physical exami- nation. Initially it is a diagnostic aid. Later it becomes the in- strument by which progress or the lack of it in response to treatment is measured. The MSE is relatively easy to perform and takes about twenty minutes. At the end of the MSE, the psychiatrist is reasonably sure whether or not he is dealing with somebody who has a psychiatric illness and what that illness is. He makes his diagnosis on the basis of the MSE and that diagnosis has im- 32 The Myth of Neurosis plications for treatment and prognosis. I am not saying that he always knows, is always correct, but rather that the index of probability is high that he is correct. In Appendix I. "A Layman's Guide to Psychiatric Diagnosis, »the form and content of the MSE, remarkably similar throughout the hos- pitals and clinics of Britain and North America, will be out- lined. The idea is that by the end of the chapter the reader will be well prepared for the recognition of psychological ill- ness in others, although lack of insight, itself a symptom of many forms of disease, may mean that he is less equipped for self-diagnosis. However, with regard to the extremely com- mon disturbances of the emotions, he will get a reasonably good idea of whether or not a psychiatrist might allocate him to the illness category. In addition to the MSE, the psychiatrist does four other things, which enable him to "flesh out" his findings, to con- firm, refute or refine his diagnosis, to illuminate possibilities for treatment and to provide a framework for the assessment of likely outcome. First, and before he performs the MSE, he takes a Psychiatric History (PH), which includes the reason for referral, an account of the patient's complaints, the his- tory of his present condition, and comprehensive details of his personal and family history, including past medical and psychiatric history, use of drugs or medicines and present life situation. During the PH the psychiatrist will attempt to as- sess the patient's personality, and the extent to which it has changed since the onset of symptoms and signs. Second, if at all possible, he obtains corroborating evidence or otherwise from an informant, somebody who knows the patient well and has seen the problems complained of develop. Third, he performs a physical examination to exclude physical illness as a cause of psychiatric symptoms. Fourth, he performs various pathological and other investigations to exclude certain phys- ical conditions which may not have revealed themselves at the physical examination. Are You Mentally Ill? / 33 Before embarking on a description of the psychiatrist's diagnostic armature, we should know what we are looking for. What are the illnesses in psychiatry? What are the treat- ments? I maintain that they can be adequately explained and enumerated in a chapter (see Appendix I). Intellectuals might recoil in horror at the enormity of such a project, theo- reticians throw up their hands at the heresies involved, at the injustice done to the complexity of the subject in the name of simplicity. Books have been written on the subject of psychi- atric diagnosis, careers dedicated to the elaboration of tech- niques, and panels of learned men involved for years in the standardization of diagnostic procedures, dreaming up along the way such exotic "illnesses" as "Tobacco Use Disorder, 27 "Social Phobia, 29 "'Academic Underachievement Disorder" and "Specific Academic or Work Inhibition. 22 Antipsychia- trists criticize the whole concept of "mental illness, 29 talk therapists pour scorn on those who look to biology for their classification of disease, scientists ridicule the metapsycholo- gists. Is psychiatric diagnosis political? Is psychiatry merely an authoritarian branch of the establishment? Does psychiat- ric diagnosis do little more than hand down tautological edicts in which the labels "mad" or 99 "crazy merely mirror the view of society on what constitutes 66 mad" Or "crazy 99 be- havior? Or is it an exact science, and if so, why is there so much disagreement over what it describes, about the useful- ness of its descriptions? All such speculations are very stimulating, pleasant to in- dulge in, possibly even "'useful. » although their ability to pro- duce workable conclusions is suspect. However, they do not help people to answer the question "Do I have a psychologi- cal illness?" and that is a question to which people would like an answer, whether or not it is an appropriate theoretical question. The fact remains that there is a rough and ready consensus, broad agreement within the psychiatric pro- fession, on what constitutes illness, despite the fact that we 34 I The Myth of Neurosis recognize that all classifications are to some extent inventions, ways of looking at the world, which make effective interven- tion possible. The classification that I have outlined below and the methods of applying that classification in diagnosis are widely used in psychiatry, although individuals might take exception to parts of them. In general, however, this is the method that psychiatrists use, the one that the consumer consumes. Nevertheless, although any psychiatrist would readily agree that the diseases mentioned below undoubtedly represent psychological illness, most would maintain that there are startling, indeed glaring, omissions. The fact that whole categories of what are generally regarded as bona fide psychological conditions have been removed from the classi- fication of illness is no oversight. I argue that the time has come to reduce the province of psychiatry drastically, to re- define its borders, to redistribute its territory. Here then is my classification: GROUP ONE The following are genuine psychiatric illnesses. Psychiatric Illness Treatment Effectiveness of Treatment 1. Schizophrenia Antipsychotic medication: e.g., chlorpromazine Effective in relieving symptoms; may need anti-Parkinsonian drugs for side eftects 2. Disorders of mood and emotion a. Manic- depressive illness (bipolar) Long-term lithium treatment for preven- tion of repeated attacks; major tranquilizer for control of acute manic phase; as below for depressive phase Lithium is very effective, but potentially toxic; requires careful monitoring Psychiatric Illmess b. Depressive illness incl. unipolar, endogenous, involutional and reactive) c. Clinical anxiety (incl. phobic anxiety states and panic disorders) 3. Obsessive- compulsive states 4. Eating disorders: e.g., anorexia nervosa Treatment Antidepressant medication: e.g., amitriptyline, imipramine Are You Mentally Ill? 1 Effectiveness of Treatment Not very effective, but significantly superior to placebo; dangerous in overdose 35 Electroconvulsive therapy Minor tranquilizers: e.g., diazepam Extremely effective in severe retarded or psy- chotic depression; in- significant side effects Mild symptomatic relief, but addictive Antidepressant medication it, as often, there is concurrent depression Behavior therapy Beta blockers: e.g., propranolol Behavior therapy Antidepressant medication if, as often, there is concurrent depression Strict refeeding regime with bed rest in hospital for anorexia nervosa See above Not very effective; of some use for phobias Very limited symptomatic relief Not very effective See above In anorexia nervosa 30-35 percent recover fully with treatment; 5 percent die. 36 / The Myth of Neurosis GROUP TwO The following are conditions treated as well, if not better, by physicians as by psychiatrists. Illness 1. Dementia 2. Delirium Treatment Investigate thoroughly to exclude treatable cause Investigate thoroughly to discover organic cause 3. Subnormality and severe subnormality Care rather than treatment Effectiveness of Treatment In large majority of cases no effective treatment Depends on response to treatment of underlying cause of delirious mental state No effective treatment GROUP THREE The following are conditions considered today within the rightful province of psychiatry. I argue that they do not repre- sent true psychological illness. 1. Abnormal personality or personality disorder 2. Abnormal personality reactions 3. Psychopathy/Sociopathy 4. Hysteria and hysterical reactions 5. Drug abuse and alcoholism 6. Sexual dysfunction and sexual deviation Some psychiatrists may approve of this drastic reduction of their territory- if not, perhaps, on a theoretical basis, then at least because it would remove from their terrain the great majority of cases for which they feel the least sympathy, with which they have the least inclination to deal. They know, too, that they possess no relevant treatment skills which are Are You Mentally IUP/ 37 applicable to such people. In short, their psychiatric training gives them no clue as to how they should react and so they have to improvise, to make it up as they go along, using their common sense or drawing from the mothy collection of psy- chodynamic theories to which most psychiatric textbooks halfheartedly refer. At the back of their minds they might recognize that their intrinsic distaste for the personality dis- orders, the sociopaths and the drug abusers is based on the sneaking suspicion that their unsatisfactory behavior and lives are in reality nothing but self-inflicted wounds, not ill- nesses at all, and therefore not worthy of the considerable time and effort they demand, energy which could be far bet- ter spent on more deserving causes. That psychiatry has become the dustbin for society's misfits is not to the taste of all psychiatrists. However, no group of people, protes- sional or otherwise, is keen to lose control over areas which have previously been widely considered their sovereign territory. That is human nature. There is the implication that their usefulness may be somewhat reduced in the proc- ess, indispensability compromised, and at the end of the day, job security threatened. And so those who emotion- ally might have little objection to a more rigorous, a tougher and more uncompromising attitude towards psychi- atric diagnosis may find themselves disinclined to turn away from their "care" those with the most tenuous claim to "illness. 99 The illness excuse These attitudes are, of course, the product of the liberal times in which we find ourselves. If somebody presents him- self for help, throws himself on our mercy, then we feel we should bend over backwards to provide it. It makes us feel better if we do, worse if we don't. Psychiatry after all prides itself that, of the various medical disciplines, it is the most 38 / The Myth of Neurosis "caring, » Thus the sufferers from the problems of life, served up to the psychiatrists by the impotent GP's, are often taken on in the outpatients department for periodic sessions of reas- surance and support, given trial courses of various pills or, very occasionally, if considered especially interesting and verbal, recommended for psychotherapy. In this way does the unsuccessful individual latch onto the illness excuse, win the illness treatment, when in fact he is not ill, merely a fail- ure at life. Gratefully he embraces it with all its implied promise of a quick fix for his troubles, often at heavy long- term cost to himself. The psychiatrist unwittingly colludes with him in the expert-layman relationship because that is what he knows how to do, although he has little idea, per- haps, of what should be done in terms of treatment, if indeed treatment is thought to be required. In fact what is needed is that such people learn how to treat themselves, and they are hindered from doing so by being told, at least by implication, that they are ill. Once ill- ness is excluded they should be turned away, referred per- haps, in the case of drug abusers, to specialized units with a heavy emphasis on discipline, or in the case of alcoholics, to the very excellent Alcoholics Anonymous, with its emphasis on moral commitment. To turn someone away from treat- ment is perhaps the hardest and most responsible decision that a psychiatrist makes, with all its attendant risks and im- plications. It is so much easier to "take the patient on 99 as an insurance policy against disaster, for inevitably there will be tragic events which could, in theory and with the benefit of hindsight, have been avoided. Such is often the case with the threat of suicide. Many people threaten psychiatrists with such action, often in a demonstrably manipulative way, especially when the courageous psychiatrist refuses their demands for treatment, which he feels is not needed. But in the absence of illness, we are responsible for our own lives, and that includes the taking of them. You are not of necessity mentally ill-al- Are You Mentally IU?/ 39 though frequently it is a symptom of psychological illness- you attempt to take your own life. -if In "A Layman's Guide to Psychiatric Diagnosis, 27 which should be read in conjunction with this chapter, we will con- sider the first two groups of my classification. Group One contains the genuine psychiatric illnesses. Group Two con- sists of those conditions which produce primarily psychiatric symptoms and signs, but are the result of clear-cut organic impairment. These, I suggest, are perhaps best treated by physicians, geriatricians and neurologists. A classification provides no new knowledge; rather it is an arrangement of existing knowledge. In drawing the lines be- tween categories, one does little justice to the gray areas. That classifications are not perfect does not diminish their usefulness, or does so only marginally. Certainly the classifica- tion that I have made has implications for life and the living of it. If it was generally accepted, it would make a big differ- ence and would free many from the seductive protective cloak of invalidism, subjecting them once again to the brac- ing winds of life with all the potential for increased self- respect that this implies. Some may not survive the rigors of the mountainside, but without the opportunity to demonstrate bravery and courage there is little else. Without trying we can only fail. Some may develop a psychological illness, in which case psychiatry can help; others will cling to their in- adequate, depressing and anxiety-producing attitudes and be- havior, failing miserably but in effect choosing to do so, having discovered some perverted masochistic satisfaction in their choice. We cannot, must not, regard them as being de- termined in their behavior, enslaved, not free to change, at the mercy of "'neurosis. » Instead we must emphasize the pos- sibilities for change, the methods by which it can be brought about, through which at least some improvement can be made. In the practice of a Moral Therapy--their own Moral 40 / The Myth of Neurosis Therapy- such people hold the key to an escape from their predicament. They must be shown that they possess it. The first two groups in my classification, containing the genuine illnesses, are discussed in Appendix I. I will now dis- cuss the conditions which are widely considered to be within the province of psychiatry, but which I argue are not really illnesses at all. Psychopathy/sociopathy: evil posing as illness Psychiatrists describe sociopaths (a name preferred by many to the term psychopath") as those people whose disre- gard for society, inability to learn from experience, and low frustration tolerance tend to bring them into conflict with others. They may end up in prison, and are frequently to be found in mental hospitals. Often they are shuttled between the two. They are occasionally aggressive, sometimes merely inadequate. The aggressive psychopath starts early and is often sexually precocious and promiscuous, showing explosive behavior and a characteristic callous disregard for the rights and well- being of others. He gets into fights, steals, plays truant from school and abuses his teachers. At work he is incapable of taking criticism and tends to get the sack. In his social rela- tionships he is manipulative, often a pathological liar and in- capable of forming deep and steady relationships. He seeks out those of a personality similar to his own who share his ir- responsibility and disregard for society's rules. When he gets married he is unfaithful, and soon he is divorced. Despite his wanton immorality he is not necessarily unintelligent, and can be charming even though his charm may be used to profit from others. Above all he is deeply and single- mindedly selfish. Alcoholism and drug abuse are commonly associated with sociopathy, as are so-called conversion symptoms (unex- Are You Mentally Ill? / 41 plained neurological symptoms). A disturbed family environ- ment seems to predispose people towards this type of person- ality and there is some suggestion from studies of twins that there might be a genetic predisposition as well. Most realistic psychiatrists would agree that there is no cure for sociopathy, although such people do best in a rather strictly controlled environment where they receive the discipline which they are unable or unwilling to provide for themselves. The view is taken here that such people are bad rather than mad, and should be treated as such, being far better off in prison than in a hospital if they have broken the law. It is not enough to say that they are ill merely because they be- have badly, and wrong to maintain that bad behavior, even of the most extreme sort, is an infallible pointer to illness. For if we are to define mental illness in terms of what society finds acceptable or unacceptable behavior, then we will have to change our definitions of illness as society's attitudes change. The deficiency in sociopathy is a moral deficiency. The in- dividual exhibits no conscience, cannot hear, or chooses to ignore, its dictates. He chooses to be bad in exactly the same way as others choose consistently to be good. He represents the inferior end of the good-bad continuum. It is no more logical to include such a person in the illness category than it is the unusual and abnormal paragon of virtue whose person- ality is the exact mirror image of the psychopath's. In the absence of genuine psychological illness, then, we should leave the sociopath to those whose task it is to pre- serve society from unacceptable behavior. Psychopathic/so- ciopathic personality disorder is not a psychiatric illness. It is, in my view, a description of badness and should be con- sidered no adequate defense against conviction for crime against society, or reason why the perpetrator of offenses against others should escape the consequences of his actions. It has become the fashion of late to consider that the devel- opment of an unsatisfactory personality should carry with it 42 / The Myth of Neurosis no implications of blame, should not occasion feelings of guilt. Further, it is considered that if the personality is suff- ciently unacceptable, then there may well be grounds for insinuating that responsibility for action is in some way di- minished. Those who hold such attitudes stress the impor- tance of environmental and constitutional factors in the development of personality, preferring to see us as victims of such phenomena, with little ability to rise above them, to overcome them. The pressures are so great, they might argue, that our personalities, our way of looking at the world, are conditioned and determined, and that in some fundamental way we are not free to be otherwise -that we are slaves to our genes and our environments. These attitudes are more easily acquired in regard to per- sonalities which manifest themselves at the lower end of the good-bad continuum. Certainly it is not often argued that those who are abnormal and remarkable for the balance and equilibrium of their characters are similarly shaped by forces outside their control. This, of course, is part and parcel of the great movement of liberal paternalism which has for so long controlled the intellectual high ground of the "caring 29 SO- ciety. Thus the bad are "'sick, „" the inadequate and unpleasant are "deprived, the habitual and violent criminal is <4;1123 rather than evil. Hospital rather than prison, it is argued, is the rightful destination of this latter category, the couch and the prescription pad the best method of dealing with the for- mer. But if our personalities are not our own creative act, the most fundamental reflection of our essence, of our hopes and ambitions, what are we but machines? If it is true that belief in the freedom of the spirit is misconceived, then we would be far wiser to pretend that it were not so. For if we are not allowed to blame the psychopath for his actions, then we are not free to praise and admire his antithesis, are divested of the hope that through our own efforts we can rise above dis- Are You Mentally Ill.? 43 advantageous circumstances and inherited weakness, are precluded from aspiring to goodness and greatness, are not to be praised for our failure to succumb to temptation, wicked- ness and evil. This is the depressing legacy of such outwardly loving and caring attitudes. Schizoid, cyclothymic, paranoid, obsessional, vulnerable, and hysterical personality disorders In their quest for a more complete understanding of their patients, psychiatrists are fond of classifying the various per- sonality disorders. Yet most realize this is an inexact and unrewarding art. Methods of objective measurement are gen- rally unsatisfactory, and attempts at categorization tend to obscure the reality that there is endless overlap between per- sonality types and that at different times, with different peo- ple and in different situations, we show widely varying personality reactions. Our propensities to think and act are in the end as many and varied as the complexities of each indi- vidual, and attempts at classification are crude, while efforts to draw meaningful conclusions from the labeling process are often misleading. However, the illusion still exists that if you can put a word to something then you have to some extent explained it, and so most psychiatric textbooks include a chapter explaining the different types of disordered personal. ities. There is a certain usefulness in identifying some personal- ity traits in that it may help in the diagnosis and prognosis of particular conditions. The schizoid personality-shy, aloof, withdrawn, dreamy, suspicious, introverted, bizarre, preoc- cupied with mystical thoughts seems particularly liable to schizophrenia of the bad prognosis type. Similarly, the cy- clothymic personality, prone to cyclical mood swings both above and below the normal, has a tendency to develop manic-depressive illness. 44 The Myth of Neurosis The hysterical personality- shallow, histrionic, manipula- tive, prone to exaggeration, attention-seeking, role-playing, untruthful, unreliable, outwardly seductive and yet funda- mentally uninterested in sex, incapable of deep relation- ships-is a widely described "personality disorder, as is the paranoid personality--mistrusting, suspicious, oversensitive and prickly. Other personalities are described as vulnerable or inadequate, meaning that these people have a history of failing to cope, of "breaking down To "have 29 any of these personalities, or a combination of them, is not to be ill. However, it is not surprising that when genuine psychiatric illness manifests itself, the previous per- sonality will be reflected in the symptoms. Thus the paranoid personality might be expected to experience paranoid delu- sions in psychosis, while the rigid, obsessional, neat and per- fectionistic person might fall prey to cleaning and tidying rituals in obsessive-compulsive illness. But the fact remains that although specific personalities might be susceptible to illness in the same way that smoking may predispose people to lung cancer or relatively high alcohol intake to cirrhosis, there is no need for medical intervention in the absence of hard psychopathology. Our personalities may well be the cause of much unhappiness, both to ourselves and to others, and act as a barrier to our enjoyment of life, but they do not need "treatment" from "'experts. » If we feel that they do us a disservice, then we can strive to modify them. Nothing pre- vents us but our own disinclination to change. No mysterious force stands in our way. It is up to us. That is both the good and the bad news. Sexual problems In general the so-called anomalies and perversions such as homosexuality, sadism/masochism, fetishism, transvestism, transsexualism, and even bestiality are not evidence of mental Are You Mentally Ill? / 45 illness, although, of course, mental illness can and does coex- ist often with these phenomena. Thus an unwanted tendency towards homosexuality might be a potent source of stress tending to precipitate an illness of the affective type. How- ever, even the most outlandish sexual behavior is in the end merely an expression of preference, which, although possibly abnormal and illegal, is not of necessity and in isolation a symptom of psychological illness. Where sexual behavior leads to offenses against the law, and in the absence of other psychopathology, the offender should be denied the illness excuse for his behavior and dealt with by society, rather than "treated" by psychiatrists. Whether or not particular sexual behavior is deviant is then a matter for social and legal rather than medical judgment. It may be that an individual, unhappy with his own sexual preferences, goes to a doctor for help. Certainly there are methods, most of them of strictly limited efficacy, by which he can be encouraged to change the direction of his sexual urges or at least curtail his unwanted sexual behavior. The same is true of cigarette smoking. However, in no way does this intervention imply the existence of an illness. Much the same can be said for the sexual dysfunctions, such as impotence, failure of ejaculation, premature ejacula- tion, frigidity and vaginismus. Of course these may, in a mi- nority of cases, be caused by genuine physical illness, and this should always be suspected in cases where sexual desire is maintained and where previous sexual function has been un- impaired. Causes can vary from diabetes, heart disease, drugs such as alcohol, tricyclic antidepressants and methyldopa, to various neurological and vascular disorders. These should be excluded by a physician, not necessarily a psychiatrist. One is then left, in the large majority of cases, with what is in effect a problem of living analogous to having difficulty in meeting the mortgage payments or finding a job. The prob- lem is that sex is no longer satisfying, or the sexual partner is 46 / The Myth of Neurosis complaining of no longer finding it satisfying. The question, as with all life's problems, is "What can be done about it?" For those of a rather clinical and cold-blooded frame of mind there are the behavioral techniques of Masters and John- son- available from any bookshop and widely regarded as being eftective. There is another solution, from which the opinion-makers of the liberal era will recoil in speechless horror. If sex is no longer satisfying, a potent source of pleasure, why not merely give it up? Is it so vitally important, and if so, why? Or is it rather that we have all been brainwashed into believing that we have a divine right to this, the ultimate pleasure, and in- sofar as we do not experience its joys we are inferior, inade- quate perhaps even ill, stunted human beings, leading sad, attenuated lives, victims of the most formidable disability? The truth of the matter is that many of us do not subscribe to the mores of the permissive age in which sexual expression has become an overvalued activity as a result of the prepos- terous theories of the psychoanalysts, which have swept away common sense. It is difficult to swim against the tide of "'sci- entific" opinion, to ignore the wisdom of the "experts, 29 to re- alize that the emperor is naked, but that is what we must do if we are to restore a sense of proportion in our attitudes to- wards sexual problems. Alcoholism and drug dependence In general alcoholism is a social and medical problem rather than a psychiatric one, unless it is complicated, as is frequently the case, by coexistent psychological illness. After the initial withdrawal from alcohol, which should be super- vised by doctors but not necessarily psychiatrists, organiza- tions such as Alcoholics Anonymous, which apply a strict, no-nonsense, commonsense approach, are probably the best people to deal with the problem. Are You Mentally Ill? 47 Traditionally it has been considered the job of psychiatrists to discover why a person has turned to drink, as if such be- havior must of necessity be indicative of some malfunction, the sign perhaps of a "disordered personality. » In truth, peo- ple drink because alcohol is available, because drinking is pleasurable and socially condoned, because in certain jobs there is pressure to drink, because it provides short-term re- lief from stress, and because alcohol possesses the property of causing both psychological and physiological dependence. Hysterical disorder There is little agreement in psychiatry on the classification of hysterical disorders, but it is maintained here that they do not and should not constitute an illness category of their own. In England the salient features of hysterical conditions are thought to be the presence of some degree of dissociation, with or without conversion symptoms (some unexplained neu- rological physical deficit in the absence of any demonstrable pathology-e.g., amnesia, paralysis, mutism), and the exis- tence of some real, imagined and usually unrecognized gain for the individual in the demonstration of these symptoms. The gain may be the attention and interest that the inexplica- ble symptoms arouse, and the usually female perpetrator of the behavior may be totally unaware of, have successfully dissociated herself from, the purpose of her actions. In real- ity, of course, such behavior has no advantage for the indi- vidual, as the price paid in pain or disability is out of all pro- portion to the significance of any reward. In America psy- chiatrists tend to prefer a narrower definition known as Briquet's syndrome. In this a woman demonstrates from early life a bewildering array of physical symptoms often involving many body systems, especially the gastrointestinal, the cen- tral nervous and the reproductive systems. Characteristically these are described in a dramatic and histrionic way and lead 48 / The Myth of Neurosis to many hospitalizations, operations, investigations and treatments. The disorder is chronic. Not all sufferers from hysterical symptoms demonstrate the hysterical personality described in the section on personality disorders, but there appears to be a definite link with socio- pathic/psychopathic mechanisms. The fact that hysterical symptoms tend to be confined to women while sociopathic ones are more typically male has led some to speculate that these men and women have the same underlying approach to life, which may merely be manifesting itself in a different way, determined perhaps by sexual and cultural factors. Certainly the phenomenon of gain in hysterical symptoms seems to indicate that semipurposive motivation is at work in a way, for instance, that it is not in the genuine illnesses such as schizophrenia. The sufferer in effect chooses to ignore what she is doing, refuses to recognize the processes at work as she dissociates herself from responsibility for, and the con- sequences of, her actions. As the practiced hysteric becomes more accomplished in the perpetration of her dissociative techniques, the mechanism begins to take on a life of its own and there is a sense in which she is actually unaware of what she is doing. But it is a weak sense of "unawareness 29 " akin perhaps to the "unawareness" of the drunkard who kills peo- ple in his automobile. He cannot remember the disaster and was totally incapable at the time, but his behavior was a self- inflicted wound, and when he started out on his evening, his drinking perhaps had a functional gain for him in the provi- sion of relaxation and the avoidance of stress. At the other end of the scale hysterical symptoms may shade by degree into frank malingering, the individual either elaborating a genuine physical symptom for gain, or perhaps harming her- self by inflicting cuts or scratches in order to manipulate her- self into some position of fancied advantage. Long-term follow-up of those suffering from hysterical symptoms reveals that very frequently they develop either Are You Mentally IUP / 49 physical or psychological illness of a genuine kind. In most cases the diagnosis has to be revised to that of schizophrenia, affective illness, epilepsy or other organic disease, while in other cases the hysterical symptoms are seen with the benefit of hindsight to be explicable in terms of histrionic, out, 99 acting manipulative behavior. Having read this chapter in conjunction with' Guide to Psychiatric Diagnosis, 79 "A Layman's we will be in a position to know whether or not we or our friends are ill. If we are ill, we should immediately consult a doctor and tell him of our sus- picions. If our friend is ill, we should persuade him to do the same, or in the absence of his having insight, we should alert the medical profession to his predicament. If on the other hand we are not ill and yet our lives are miserable, then we must learn to practice the principles of Moral Therapy, to escape from our failures through our own efforts -guided by guilt, listening to the voice of conscience. In admitting that we are fundamentally well and in aban- doning the illness excuse, we shed a mighty burden in our journey towards self-respect. The role of the doctor Where illness exists there is no place for Moral Therapy. In its absence, however, the doctor may have no role to play in helping us to deal with the problems of life. Apart from his vital function of excluding psychological illness, and the psy- chological manifestations of physical illness, in other respects a medical training may not necessarily be the best grounding for the successful practice of Moral Therapy. This is partly due to a tendency in medical education to emphasize the scientific method, which results in many doc- tors being ill at ease with, and therefore inclined to disre- gard, that which cannot easily be measured or inferred from 50 The Myth of Neurosis measurement. More important, the selection procedure for those embarking on a career in medicine discriminates in favor of a certain personality type, whose past history and present attitude denote them as being the sort of people who will be good at passing medical exams and can be relied upon to behave in a way deemed appropriate for members of the medical profession. Well grounded in science rather than arts subjects, they will have worked hard at school and tended to relate well to those in authority. In general they are conser- vative, conformist people who tend to believe in scientific solutions to the problems of the people who approach them. The medicobiological attitude is second nature to them, and because they may have little firsthand experience, in their own well-ordered lives, of the type of life problem that is fre- quently brought to them, they may have much sympathy for it, but little understanding of it. Doctors, too, are not well placed for the easy functioning of the therapeutic friendship so necessary in the practice of Moral Therapy. Professional ethics seem to demand that they stand well back from their "patients" while dispensing knowledge and expertise in an attempt to cure them. They are encouraged to feel for them but not with them; to care for them in a dispassionate rather than a passionate way; to have sympathy rather than empathy. Above all, most sub- scribe to the desirability of a hierarchical relationship in which, at least in the consultative situation, the doctor as- sumes a superior position and the patient an inferior one. The patient invests his trust and faith in the other's greater knowl- edge and skill. The effective prostration and passivity of the patient is felt to be positively therapeutic, as it is thought to ensure that his frame of mind is more receptive to the doc- tor's reassurance. It increases the patient's suggestibility and allows the doctor to do things to and for him, rather than with him. This satisfies the doctor's need for action and re- duces his feelings of impotence in situations with which he Are You Mentally IMP 51 may feel ill equipped to deal. However, this is an approach that is unlikely to have as its end effect a lasting increase in the individual's self-respect. Doctors have much to lose by showing their human face and tend to hide behind their professionalism for reasons that are not always concerned with the benefit of their patients. They may feel that if they give up their position of authority they will have little to offer the patient on a human level. Others may favor a braver and more helpful approach. As concerned and forceful friends we may find that we are bet- ter equipped to perform Moral Therapy than any man of sci- ence. In the field of helping others to help themselves there is no substitute for firm but caring involvement on a personal level, and no room at all for intellectual posturing and the af- fecting of a spurious expertise. The doctor's role then is largely a screening one. It is up to him to exclude both psychological and also, importantly, physical illness. For it must never be forgotten that in many cases actual physical illness can have symptoms and signs that manifest themselves chiefly in disturbances of mood, thought, intelligence and behavior. Inserted wood neurosis. Gmail kac attac Wood Neurosis 120 kac attac Thu, Apr 4, 2024 at 6:21 PM To: Stefan Kac 5 The Myth of Neurosis and the Validity of Blame Self-determination Deep and important misconceptions regarding our moral imperatives are rare although our desire to pretend, and skill in pretending, confusion and ignorance as to what we ought to do is usually highly developed. Deep in our hearts we in- variably know the right way forward, but we recoil from its difficulty, from the hardships that it will entail, from the dis- appointments that we feel will follow from failure in what we tell ourselves is an overambitious project. So it may be that we prefer to hide from our friends the true nature of our real ambitions. If taken in by our subterfuges, our friends may urge courses of action on us that are actually inimical to our best interests. They may also make the mistake of attempting to impose their own value systems upon us, advising behavior that while in tune with their own moral attitudes is not nec- essarily in harmony with ours. Or again they might make the mistake of urging us to obey laws and rules of society which contravene the dictates of our own conscience. But there can be no blueprint for the building of self-respect unless it is our blueprint. A plan cannot successfully or usefully be imposed upon. us unless we ourselves will it and recognize that it is ap 52 The Myth of Neurosis and the Validity of Blame / 53 propriate for us. It is our own decision to act on our own in- ternal commands that is of value to our mental health. Any- thing that tends or conspires to remove our right and ability to self-determination, however well-meaning, is doomed to failure and is liable to harm us psychologically by limiting our potential to increase our self-respect by our own efforts. Our discipline must be self-discipline, our respect must be self-respect, our restraint must be self-restraint. The individual must take the central role. It is up to him faithfully to acknowledge and to report his innermost feel- ings, desires and ambitions so that he can be encouraged to actualize them. Where they are obscure, which will be rare, they may be clarified in discussions with friends -but where they are deficient or of inferior quality, then new and supe- rior values must not be, and indeed cannot be, externally im- posed. It is not our job to question the value systems of others once we are satisfied as to their nature. That they exist is enough. Our task will be to help ensure that in all cases an in- dividual's behavior obeys his own conscience whatever that conscience may be. We may disapprove of and dislike a per- son's ethics and abhor the behavior that results from a faith- ful observance of the commands of that moral system, but we cannot deny that such a person is mentally healthy. For if a man is at peace with himself, it matters not to him that he is at war with others. In attempting to help another person, therefore, we should not set ourselves up as judges of what is good or bad, right or wrong. Instead we should be interested alone in what the in- dividual feels is good or bad, right or wrong, and in how he can be helped to act in accordance with these deeply held be- liets. Moral Therapy is not about knowing what is good for other people but is about the drawing out and examination of their own self-knowledge, of their own self-interest, and en- couraging them to behave in a way congruous with their own 54 The Myth of Neurosis ethical systems. In the deepest sense, then, the wise friend and practitioner of Moral Therapy will eschew the directive approach in that he will not choose the directions but rather will encourage us to follow our own directions. The forceful, concerned and enlightened friend who truly has our best in- terests at heart should, however, be prepared to take on the responsibility of applying pressure on us to behave in the way that we know in our hearts is right for us. Such a person has no special power over, or expert knowledge of, our lives. But his common sense tells him we are in trouble and that he can provide that initial thrust which will eventually enable us to escape our predicament. He will show us how to make the best use of our resources; urge us on when we falter; prop us up when we are in danger of falling; encourage us when our spirits are low and our will is weak; help us to become doers rather than thinkers; discourage passivity, inactivity and in- trospection; have faith in us when we have none in ourselves. He should always remain optimistic, secure in the knowledge that all of us have a potential for liking ourselves and that this ultimate objective is beyond the reach of none. He will not be afraid to inject his energy into us, to get us going_-but it is we who must decide where we are going. He may force us to act but we will choose the actions. He may suggest the methods but the credit for the awakening of our self-esteem will be ours alone. So we should encourage the troubled individual to describe the sort of person that in a "perfect world" he feels he would like to be, to talk of what he knows he ought to do and what he should leave undone. The truth and the relevance of these assertions must be discussed freely. "'Is that what you really want from life, or are you merely paying lip service to what you feel is a socially acceptable or fashionable ambition?» "Do you really crave only to be liked and respected by others, or is your deeper and more fundamental desire to The Myth of Neurosis and the Validity of Blame 55 know that you are worthy of that liking and respect?" "Do you want, above all, to escape loneliness, or would you prefer to be the sort of person whose self-sufficiency and self-esteem were so high that loneliness would become toler- able, even pleasant?" Always the desires must be separated from the basic needs, as the two are seldom synonymous. The individual may know in his heart what sort of things he should do but may fall a victim to the St. Augustine syndrome- "O Lord, make me good, but not yet!' He knows that he should do something or cease to do it, but his desires are at war with his moral im- peratives. "I know that I ought to do X, but I don't want to" is so often an expression of "X is hard and I tend to avoid hardship." How Moral Therapy works Moral Therapy insists that we always need to do what we feel we ought to do, even though often we don't want to do it. It is the purpose of Moral Therapy to teach the individual to want what he needs by demonstrating to him the psycho- logical benefits that must surely follow from a strict obser- vance of the dictates of his own conscience. Together with friends, the aims, objectives and destina- tions will be planned, the milestones along the way mapped, the oases charted. Such a discussion will not be a particularly normal one because in this age it is not fashionable to encour- age people to talk freely of their morals, their guilt, their self-respect. This is the sort of thing that we tend to associate with ear- lier eras, in which, some hold, they lacked the expertise at living that we now possess. In today's climate discussions would be more likely to center on childhood experiences, or a factual analysis of the individual's past or present environ- ment and relationships, than on his hopes and dreams for the 56 The Myth of Neurosis future. Unfortunately the object today is to explain and quantify the effects of such phenomena on the molding and shaping of the patient, who is then presented as a pawn on the chessboard of life manipulated by a mysterious, unknown and all-powerful player, with little or no influence of his own in the shaping of his destiny. But if by implication we dis- avow the individual's ability to control his present and his fu- ture, what hope can he be offered for ever improving his lot? So Moral Therapy will be rather uninterested in the past. It is unchangeable; the damage done. Its effect on the present and the future is as difficult to analyze as it is to predict. The future is the place; "What are we going to do about it?" is the question; to strive for the agreed objectives is the task. To concentrate on the "here and now 99 is not superficial, as the psychodynamists might suggest, or counterproductive, to be played down in the medicobiologists' act of reassurance. In Moral Therapy present attitudes are used and analyzed not for intellectual satisfaction in the elucidation of postulated causes, nor because the act of analysis itself has any beneficial curative qualities, but because the information provided can be used as a prelude to action. Analysis of the moral code, the guilt, the self-respect is useful because it points a way forward. It tells us what to do and how to do it. Obviously strenuous attempts are made to get it right and in this the tendency of individuals with a shared culture freely to choose codes of a fundamental similarity may be helpful. Thus in the absence of psychopathy we might regard with some suspicion the protestations of someone who pro- fessed to seeing no value in keeping promises, being kind to others, being loyal, not stealing, etc. However, although it is useful to be correct in the analysis of the underlying moral code, it is not absolutely essential. Indeed, the practitioner of Moral Therapy is not so in- terested in "'objective truth, 99 at best an uncertain concept when one is dealing with such an obscure and plastic entity 58 / The Myth of Neurosis sis do not have the importance or emphasis that they are given in both the psychodynamic and medicobiological ap- poaches because the person who follows its principles is more interested in results than in being right; in common sense than in obscure intellectualizing; in optimism than in pessimism; in motion than in inertia. The validity of blame At this stage it is important to emphasize a basic attitude of Moral Therapy that is directly at variance with the views of the psychodynamists, the medicobiologists and much of popular wisdom. Perhaps the most important tenet of the doctrine of Moral Therapy is that only by doing what we be- lieve to be right can we be contented. It follows from this that if we behave in a way that we ourselves acknowledge to be bad, then discontent must inevitably follow. The Moral Therapist will investigate discontent in terms of individual ethical codes contravened, of personal moral commands dis- obeyed. In taking this position Moral Therapy lends support to a theory that has wide acceptance among those laymen and others who do not follow views of a liberal and permis- sive type, but instead subscribe to a more robust and conser- vative philosophy. Certainly both the psychodynamists and the medicobiologists would strive to discredit the inescapable conclusion of Moral Therapy that it must follow that if our discontent has its foundations in our wrongdoing we are cor- rect to blame ourselves for our shortcomings. Furthermore, because in most cases our moral codes will be similar to those of our national, racial and socioeconomic peers, with whom we share a common environment and educational process, they may be right to blame us too. Thus it may be more cor- rect and even valuable that our failures should be regarded with rather less pity and understanding and with rather more hostility or uninterest. Few would maintain that it is good to The Myth of Neurosis and the Validity of Blame 59 fail, but many would have us believe that we are blameless when we do so. Moral Therapy seeks to redress the balance of a pendulum that has swung too far towards a state of affairs in which all "neurosis" is excused, all guilt discouraged, all blame avoided and all responsibility removed. In taking this stance Moral Therapy signals a return to more traditional at- titudes which the psychodynamists and psychoactive-drug advocates have done so much and with so little reason to un- dermine. By their insistence that we are largely controlled by respectively our past environments and our brain biochemis- try, they have rendered us at once blameless yet irresponsi- ble; innocent but helpless; in theory, without guilt but emasculated. It may seem odd that the accumulated wisdom of genera- tions could be pushed aside so easily when no irrefutable concrete evidence has been produced to discredit it. Cer- tainly there is no conclusive proof that the metapsychological posturings of the psychodynamists have any relevance to the understanding of how we live our lives or have contributed towards increasing their quality. Similarly the biochemists have produced no substances that add in any worthwhile way to the psychological well-being of those who are not suffering from actual psychiatric illness. And yet these two groups from their separate vantage points have contributed to the malaise and sense of impotence which we tend to experience when our problems get on top of us. Moral Therapy seeks to rectify this and encourages people to accept blame so that they may act to divert it; to embrace guilt so that by modi- fying their behavior they can diminish it; to take responsibil- ity for their actions so that they can experience the fruits of success. Thus paradoxically it is the acceptance of blame that is the optimistic attitude and its denial the pessimistic one, and what appears the harder line is the more kind, the softer the more cruel. 60 / The Myth of Neurosis Against those who would say that Moral Therapy is at- tempting to put back the clock it can be argued with force that there existed no reason to put it "forward" in the first place. Freud and his followers must always be credited with the fact that they made mental illness itself respectable in the sense that the misguided treatments of the nineteenth cen- tury such as the straitjackets and incarceration became unfa- shionable and irrelevant once it was realized that the mind was as amenable to disease as the body. This change of pre- vailing climate was in no small measure due to the exertions of Freud and his colleagues. The myth of neurosis On the debit side of the balance sheet, Freud and the psy- chodynamists were responsible, in opening the door to new and more enlightened attitudes towards psychopathology, for the creation of a whole new 29 "'science, one of the achieve- ments of which was to produce a whole new illness cate- gory-namely, that of neurosis. Moral Therapy argues that for many thousands of years the human race has done with- out this concept of neurosis and must and will learn to do so again. That we have a word for it does not explain what it is, if it exists, or what, if it truly exists, is the best thing to do about it. The concept of " "neurosis" has not helped the plight of "'neurotics. For in truth, neurosis is the word we use in an attempt to explain the condition of those who have chosen to make a mess of their lives, to live unsuccessfully and to expe- rience semipermanent psychological pain. In dignifying the failure to lead a satisfactory life with the descriptive term "'neurosis, 99 a new disease category is created with its own natural history, signs, symptoms and prognosis. This old philosophical mistake of the hypostasiza- tion of an abstraction, in which the existence of a word is mistakenly taken to imply the existence of a real entity which The Myth of Neurosis and the Validity of Blame / 61 that word describes, leads to the idea that there exist neuro- ses in the same way that there exist broken legs and heart murmurs. As soon as an illness has been promulgated, then practitioners must be found to administer cures and alleviate symptoms of a condition which it is believed descends upon patients like rheumatism or the flu. Such people maintain that if the patient has a "'neurosis" it is no fault of his own. Insofar as blame is relevant at all in disease, they might single out the family unit or the environment for the accusing fin- ger, in the same way as cigarettes are implicated (in this case correctly) in the pathogenesis of lung cancer, or air pollution in bronchitis. In reality, of course, to behave in a "'neurotic" way is not a disease but a misguided decision and such behavior is a func- tion of our basic freedom to choose, of our self-determina- tion, of our responsibility for our own lives. Perhaps in some perfect world of the psychodynamists, in which all were ex- posed to their teachings and methods, such freedoms would be superfluous and there would remain only well-adjusted people, their psyches working smoothly in close accordance with the blueprint for some mental machine dreamed up by metaphysical conceptualists who were longer on theory than they were on common sense. It is an old religious concept that if we are free to do well we must conversely be free to do badly. If there is good that can be freely chosen, then there must of necessity exist the possibility of choosing evil. In religious terminology blame accrues to the person who chooses wrongly, praise to he who makes the correct choice. Forgiveness is always available to the sinner if, in recanting, he is sincere. It is not part of the doctrine of Moral Therapy to espouse the cause of any partic- ular religion, although the individual who freely chooses and truly believes in the tenets of one of the great religious faiths with their comprehensive and all-embracing ethical codes 62 The Myth of Neurosis has a tremendous advantage in the struggle for self-respect over those whose decision it is to hold no such institutional- ized beliefs. The religious analogy is made because it can be extended into the area of mental health. Moral Therapy maintains that it is inefficient, irresponsible and even bad to live our lives unsuccessfully, experiencing constant psycho- logical pain, and that the individual should be encouraged to accept responsibility for this, and even blame. Here again it cannot be emphasized strongly enough that this only holds where actual psychological illness of the affective type has been categorically excluded. The unsuccessful person with his low self-esteem can, like the sinner, return at any time to the correct path and can be helped to do so. But he will not be helped by a denial of his problem or by reassurances that he does not really have one, or again that if he does have a problem it is through no fault of his own. All these attitudes merely serve to reinforce a sta- tus quo that, if the individual is to benefit, must be changed forthwith. Traditional wisdom since Freud maintains that it is harsh, unkind and insensitive to confront the unsuccessful person with his responsibility for his own shortcomings, and further that it is ineffective and cruel because he is not to blame for his situation. Instead, it is argued, we should try to understand him, to unravel the causal processes that deter- mined his unhappy position, hoping piously that this investi- gation will in some magical way "make him better. » Others will argue that the thing to do is to obliterate his unpleasant feelings, along with most others as well, with blunderbuss tranquilizing drug therapy. Above all we should avoid any censorious tone, any intimation that we do not approve of his behavior and should rely on psychological "knowledge and expertise" to solve his problems for him. Luckily in everyday life friends and loved ones seldom fall into the trap into which the so-called experts have so readily fallen. We do not tend to overindulge those of our friends The Myth of Neurosis and the Validity of Blame / 63 who make a career out of being in a psychological mess. In- stead we employ a more rough-and-ready, a more stimulating and in the end more successful approach. We are not mani- pulated as are so many of the talk therapists into entering that impenetrable jungle of psychological cause and effect in which introversion and intellectualizing are at a premium while activity, extroversion and common sense are dis- counted. We are not afraid to employ a carrot-and-stick ap- proach because we realize that ultimately the person who makes a lifetime's career out of being in trouble has chosen that path because of the "benefits" that it brings him. That those benefits are a sham, false, not really benefits at all, is something that we recognize, and we suspect that he does too. So we may threaten withdrawal of our friendship or other more minor sanctions if he continues with his tiresome behavior while rewarding his return to more reasonable activities and attitudes with increased interest, greater con- tact, etc. We are not afraid to tell him what he is up to and blame him for it. The more liberal approach using, as it prefers to do, the illness model of the "neurosis 29 Or "personality disorder" profoundly unhelpful and soon the patient has a "neurosis, 22 and an analyst to prove it. He becomes at a stroke a card-car- rying fully paid up member of the psychological walking wounded. He has a role to play and fellow actors with which to play it, in that he can keep in touch with the activities and emotions of those who share his "diagnosis" by a diligent reading of psychodynamic texts, a careful digestion of cock- tail party psychobabble, a studied observation of psychodra- matic plays and films, a casual perusal of glossy magazines and women's journals. In truth, we can do without the concept of neurosis. For there is no actual illness that exists as a tangible entity to which the term refers and the diagnosis has no valuable im- plications for prognosis or treatment. The "'neurotic is the 64 / The Myth of Neurosis person who has taken the wrong path, to the detriment of himself and others. He has freely chosen to do so and is therefore responsible for his choice. He could have behaved differently, and in similar circumstances others have done so. He has decided to be his own worst enemy and to view others as hostile and aggressive. He lives in the real world but real- ism fails to characterize his hopes and aspirations. He has made his own bed and now he must sleep in it. He has no- body but himself to blame and we must not shrink from tell- ing him so. This approach is not a matter of chastisement, of punishment. Its purpose is purely therapeutic-_to return to the individual that sense of control over his destiny, that re- sponsibility for his own actions, which the psychodynamists and the medicobiologists are so keen to deny him. Thus the decks are cleared for the positive action that alone will do him good. Tough love That there is a risk in this approach cannot be denied, but life is risky. Risks must always be taken when the circum- stances demand them. It is as risky, although superficially it may appear not to be, to create a passive, dependent "'pa- tient," with an institutionalized "neurosis, psychologically addicted to talk therapy, as it is to produce a tranquilized au- tomaton dependent on pills for the avoidance of psychologi- cal pain. Moral Therapy suggests that both these alternatives are more dangerous for the patient than firmly confronting him with his own responsibility for his own actions. How- ever, although more dangerous for the patient, in the current climate of professional attitudes, pills and talk therapy are far less dangerous for the doctor. For these are the panaceas that the patient expects and wants, although they are seldom what he needs. The ostensibly more brutal, but ultimately more kind, ap- The Myth of Newrosis and the Validity of Blame 65 proach in which the individual is held to be responsible and therefore blameworthy lays the doctor open to complaints of callousness and hard-heartedness. Further, the sufferer may attempt to punish the doctor who has refused to collude with him in maintaining his "'illness" status by harming himself or threatening so to do. "You said it was all my fault so I might as well kill myself,» could be a response. Moral Therapy admits that there is some risk to the indi- vidual here but maintains that it is an acceptable risk, a cal- culated gamble whose potential benefits far outweigh the possible harm that might ensue. Surely the more cowardly approach is to conspire with the patient to preserve his status of "'neurotic, 79 paying lip service to his psychological disability. Thus the doctor may talk around the problem in a knowing way, as if a few fine adjust- ments are all that are required before the machine is again working efficiently. Reassurance and a tranquilizer will do the rest as the hard-worked doctor moves towards his objec- tive of getting the patient out of his office with a marginally and temporarily improved mood, so that he cannot be held responsible for any increase in his patient's psychological pain and can gain a spurious, "'ersatz" ' gratification from the visible but transient effects of his efforts. So it can be seen that reassurance, pills and sympathy are the low-risk approach--that is to say, low for the doctor but ultimately high for the patient. Moral Therapy seeks to be more heroic. Like the surgeon who is unafraid of amputating the gangrenous leg of the elderly patient with cardiovascular disease despite the risks of major surgery, the practitioner of Moral Therapy will be prepared to tell the individual the truth with regard to his failings and be prepared to load onto him the responsibility for them. For until he comes to terms with his potential for choosing a more efficient way of lead- ing his life, he will be condemned indefinitely to live in the twilight world of psychological discomfort, blaming others 66 / The Myth of Neurosis for a predicament that is, in reality, of his own making. And so as the surgeon risks the death of his patient in order to re- move the diseased and life-threatening leg, we should not be afraid, in the absence of psychopathology, to agree with the individual that his behavior is indeed unsatisfactory. For Moral Therapy recognizes that, in many significant ways, the individual who presents himself for help is indeed inferior. With regard to the fact that he is unhappy, guilty, behaving in a way of which he himself does not approve, he is less good than many people at the successful practice of the art of life. He is not intrinsically inferior, in that he has the power and capability to be better than average at living with a greater than normal self-respect if he chooses to make the effort so to be. His failure is not constitutional. It is a failure of choice, showing a weakness of will, a lack of determination and perseverance, and above all a failure of direction and ap proach. As such it can be rectified, but only after a complete recognition that his failure is his own fault; that at this point in time he is inferior; that he made himself unhappy and so can now make himself less so; that nobody is to blame for his predicament but himself. Some people pay lip service to their own responsibility for their unsatisfactory condition but argue at the same time that they cannot get themselves out of it. These people use their own inadequacies as a stick to beat themselves with. "Look at me, »they might say. "I made this mess. I destroyed myself and now I hate myself for having done so!" "What a terrible person I must be to be so self-destructive!" "Surely there can be no hope, 29 they argue, "for somebody who has so freely chosen such an unhelpful path!' Thus do they attempt to disarm the person who would return to them the responsibil- ity for their own actions. In their desperation to hang on to their "illness" they are even prepared to tolerate guilt and the pain of low self-respect. Admitting their responsibility, The Myth of Neurosis and the Validity of Blame / 67 they then advance such wanton and apparently capricious self-destruction as evidence for the fact that they are clearly sick. "What possible advantage, " they ask, "can I be gaining from this misery?" That they choose so badly, so disastrously, is for them evidence of a disability so great that they consider themselves diseased, and they tend to find little difficulty in persuading doctors to agree with their self-diagnosis. They admit that they chose their actions and behavior but at the same time maintain that their unfortunate choice was deter- mined by their "'neurosis" or their "disordered personality. 29 Such people effectively maintain two contradictory posi- tions. On the one hand they admit that they are free to choose their unsatisfactory attitudes and behavior in that they were not externally coerced or environmentally in- fluenced to behave in that way--that in theory they could have chosen differently. At the same time they use their un- satisfactory life history as evidence that in some sense their actions are determined. They have such a strong dispositional tendency to act and think in this unhelpful way that in point of fact they have always done so and presumably will con- tinue so to do. They feel that although in theory they could have acted differently and therefore are prepared to accept the guilt and blame for their situation, in fact they have sel- do or never acted positively and therefore some mysterious evil force must be responsible for their continuing to choose disastrous actions and negative thoughts. Their energy and that of their "expert" advisers is then spent in the identifica- tion and explanation of this force in the hope that in the act of being identified it will in some way disappear or become more amenable to being made to do so. Once the treasure hunt for this shadowy entity has been embarked upon, all hope is lost, for by this stage both doctor and patient will have effectively denied the individual's ultimate and mean- ingful responsibility for his attitudes and actions. Thus do psychodynamists of the traditional school employ 68 / The Myth of Neurosis methods which tend to sap the self-esteem of those they would try to help. For their patients the regular visit, fre- quently over a long time span, is analogous to the Valium tablet of the medicobiologist. The weekly or, in psychoanaly- sis, daily visit builds dependence on the psychiatrist as the patient's confidence declines. "I don't know what I would do without my analyst" is a statement that is all too often heard. In this case, too, the individual is sheltered from facing up to his responsibility for his own failure, for now he can point proudly to his "'neurosis, " the existence of which is implied by the "'necessity 29 for his frequent visits to his analyst. As long as he has an analyst he has a neurosis. As long as he has a Valium prescription he has an illness. If he has neither and is turned away from both analyst and doctor, he has no excuses and only himself to blame. Then at last he will be free to set about confronting the problems that only he can solve. 6 Freudian Fantasies: Inventing the Illness Excuse Let us for a few pages shine the light of common sense upon the theories of Freud. They can be divided into two parts. First, there is the philosophy, the metapsychology of psychoanalysis, revealed apparently to Freud from a consid- eration of his patients. Second, there is the use of psychoanal- sis as a therapeutic tool, a process that is in some way supposed to benefit the person on whom it is used. So lacking is the evidence for any specific beneficial effect of psycho- analysis as a therapy that many of its practitioners have ceased to claim too much for it in this respect, although, of course, continuing to earn their living from its practice. As a metapsychology, as a religion perhaps, they remain publicly convinced of its truth. What exactly are we asked to believe? Certainly it is a fantastical story. Freudian mythology All of us remain fundamentally unaware, unless steeped in psychoanalytic dogma, that two basic instincts provide the force, the underlying energy, for all our thoughts and actions. These two instincts are, unfortunately, in direct opposition to 69 70 / The Myth of Neurosis one another. Eros, the life instinct, consists of the instinct for self-preservation. One need not be an Einstein, or even a Freud, to see that such an instinct is primary and vital in all of us. Common sense tells us that it is so. However, if we are to believe Freud there is an instinct towards self-destruction too- described by him as Thanatos, the death instinct. But if we strive for life is it intrinsically likely that we should all at the same time be struggling towards its opposite? Do we really want to die, have the basic urge to return to that disor- ganized state from which we were originally constituted? Certainly entropy, the universal tendency towards disinte- gration, is a useful physical principle and nothing is more certain than that we will die, but surely there is no sense in which we want to cease to exist. Freud came to his belief in the death instinct through his consideration of such phenomena as aggression, masochism, suicide and such apparently self-destructive behavior as alco- holism and drug addiction. From such things he deduced the existence of the death instinct. But they can be explained quite satisfactorily in other and more plausible ways, in terms of the desire for momentary gratification, of shortsightedness, of feeling threatened, of being threatened, of inability to withstand pain and misery, etc. One might think it a mighty leap in the dark from an observance of aggression and suicide to the absolute certainty of the existence in all of us, whether or not we exhibit aggression or suicidal ideas, of an instinct for self-destruction. Indeed the theory of the death instinct provides a marvelous example of how Freud, professing him- self a scientist practicing the scientific method, actually plucked his theories from thin air and then set about using his considerable intelligence and powers of persuasion to in- crease their plausibility and make them acceptable to his dis- ciples. The death instinct's existence is proved beyond doubt from a consideration of the "'evidence, 99 we are told. It is a scientific "fact." The argument runs something like this: Freudian Fantasies: Inventing the Illness Excuse 71 Human behavior provides examples which do not seem to fit a theory in which Eros alone provides the sole instinctual drive. People are often gratuitously aggressive and occasion- ally seek to harm themselves. Some seem to gain pleasure from pain inflicted on them by others. It would seem that we need another concept which will make such behavior "eX- plicable" in terms of Freudian theory. A death instinct would to some extent make sense of it. Therefore there is a death instinct. O.E.D. In such a way are the Freudian myths built. But is there not an intrinsic ridiculousness in assuming the universal exis- tence of a death instinct, and if common sense and the scien- tific method both tell us that the method by which it is «known 29 is to say the least suspect, might we not retain a healthy suspicion with regard to the more plausible tenets of Freudian philosophy? Before the discovery, dare we say invention, of the death instinct, Freud's theory of the instincts tended to concentrate on Eros. Contained within the instinct for self-preservation, or coexisting with it, is that typically Freudian fantasy animal the libido. This is the instinct towards physical gratification of the senses, which, in its purest and most unadulterated form, is manifested as the desire for sexual pleasure. The libidinal energy- _bubbling, primeval-provides a powerful force to our instinctual drive towards physical satisfaction- the pleasure principle that governs so much of conscious thought. Now Eros, with its component instincts for self-pres- ervation and the pursuit of pleasure, together with Thanatos, the death instinct, inhabit an ancient, shadowy and mystical realm known to Freudians as the "id." The id, in which the instincts repose, makes us do things, think things, want things and need things. We want to stay alive and extract pleasure from ourselves and our environment. At the same time we are apparently thrusting ourselves towards death. Of course, before Freud we were in blissful ignorance of the fact that we 72 The Myth of Neurosis all possessed an id because we none of us had ever experi enced this ghostly province. This is understandable because, according to Freud, the id remains of necessity permanently inaccessible, unconscious, literally not experienced in con sciousness, unknown directly. How, one might ask, did Freud get to know of its existence, if by definition it cannot be experienced? His answer would have to be that the existence of this psychical apparatus is in- ferred from a study of the development of human beings, in- tuited from an observance of the behavior and reported thoughts of others, or from a consideration of his own intro- spected, conscious thought processes. But the id, like so much else in psychoanalysis, requires the eye of the believer before it can be "seen." Others in their consideration of human thought and action, and despite having been alerted by Freud to its supposed existence, have found no signs or indi- cators of the mythical entity. In truth, the concept of the id is something we can do without, have done without before, and will do without again. Certainly, in view of the fact that the id is one of the most vital foundation stones on which the whole shaky edifice of psychoanalytic philosophy is built, one would have hoped that its existence and nature could have been more clearly demonstrated. One might even be forgiven for thinking that firm and unshakable belief in an undemon- strable and quintessentially unconscious entity might have the logical status of a religious belief rather than of a "scien- tific discovery, " and it may indeed be no coincidence that it was the Roman Catholic Church which Freud regarded as the most substantial enemy of psychoanalysis. Happily, however, if throughout history we have believed in gods, it is only in the last few decades that we have been asked to be- lieve in the id, and one cannot help but wonder how it is that such an important entity, literally the fount of all moti- vation and desire, should for so long have remained unrec- ognized and unknown. Could it just be that what was re- Freudian Fantasies: Inventing the Illness Excuse / 73 quired was not somebody to recognize but rather to invent it and, having done so, to flog it as a concept for the consump- tion of the gullible? Lest it be thought that one is unfair to Freud in suggesting that he thought of the id as an actual entity, rather than as merely a figurative term for describing something with no real existence over and above the idea that encapsulates it, one can refer to his view that in the fullness of time, as sci- ence advanced in its understanding of the human brain, it would be possible to define the exact location and borders of the physical provinces or agencies such as the ego and the id in terms of anatomical neuronal areas, or, perhaps, of facili- tated neuronal pathways. Further, he believed that the deter- mination of thoughts and actions, which he used the blunt instrument of psychoanalysis to predict and to explain cau- sally, would eventually be predictable and explicable in terms of physicochemical or other physical causal laws. The fact remains that if the id was an analogy, then the physical counterpart to which it supposedly refers was not demon- strated by him, and has not been demonstrated by science since. The form and content of the id have remained specula- tive metaphysics to all but the psychoanalytic faithful. In the intellectual climate of today it is difficult to see how the concept of the id and of the drive towards sensual plea- sure once seemed so plausible. Certainly if tomorrow the the- ory were to make its debut de novo it might be regarded with very considerable skepticism, not to say ridicule. It is not as if the theory itself is intrinsically plausible, even believable, al- though one can see how Freud, steeped in the atmosphere of turn-of-the-century scientific principles and influenced by the great strides that were being made in physics, chemistry and biology, might have been attracted to the idea of a fun- damental and dynamic energy force providing the stimulus to thought and action. It is also likely that as a good philoso- pher, and an even better popularizer of his philosophy, 74 The Myth of Neurosis he would realize the advantage of keeping such dynamic forces to as manageably a small number as would "'fit'" the "facts. » That the idea caught on was the result of the happy coincidence that it fell on the receptive ears of a society ripe for its message, ready for a sexual permissiveness which its tenets have indubitably done much to advance, willing the reaction against the severity of the puritan ethic which in those times held sway. A society which tended to discourage overt sexual expression and its discussion was bound to take notice of a theory which suggested that the pursuit of physi- cal gratification was one of our most fundamental instincts. Let us continue with the survey of Freudian theory. If left to its own devices, we are asked to believe, the untram- meled, uncontrolled libidinous instincts and other drives of the id would bring us into conflict with our fellow men in the "real" world. Therefore, Freud maintains, one part of the id undergoes a special development for the purpose of medi- ating between the potentially antisocial id and the external world. This psychical entity is concerned with self-preserva- tion and the principle of reality. It is called the ego. The id remains wholly unconscious, while the ego rules within the narrower confines of consciousness. The superego is the name given to a portion of the ego which has become detached and consists of the learned morality, the sum total of the moral imperatives gleaned from the environment and especially from the parents. It exercises its powers throughout the arena of the conscious mind and also within the realms of the pre- conscious, the latter being defined as that reservoir of poten- tially voluntarily recallable material that is not actually conscious but at any moment could easily be so. The ego acts as a kind of ringmaster attempting to reconcile the often con- flicting demands of the id's instinctual drives, the superego's various strictures, and the demands of reality which spring from the real world. The ego strives hard to minimize the Freudian Fantasies: Inventing the Illness Excuse - 75 tensions that continually arise from these ceaseless conflicts of interest, and in so doing employs a wide variety of defense mechanisms in its endless quest for harmony between the warring elements of the personality. Such defensive weap- onry includes the well-known phenomena of repression and sublimation, regression, projection and displacement. The ego works hard as it acts to channel the drives and thrusts of the instincts in a way that will not result in disaster for the individual, and its general purpose is to keep tension and ex- citation to a bare minimum. It strives to keep the energy level within the system at a constant and acceptably low level. This it does by forcing out of consciousness those ideas which would, if the individual became aware of them, tend to increase excitation to an unacceptable height. Thus does the ego control the personality by expending its own energy to neutralize the tensions of dangerous impulses and ideas. Insofar as the ego, without the expenditure of too much of its own energy in the process, tends towards success in estab- lishing a tenuous equilibrium, we veer toward mental health. To the extent that it fails to maintain the balance, or is forced to mount too costly a defense against the threatening uncon- scious impulses, we tend towards " neurosis, " even psychosis. No ego is ever one hundred percent successful and therefore, the theory maintains, we can all do with a bit of psychoanaly- sis. What's more, the "beneficial effects" of a few years of psychoanalysis are limited and so, in an ideal world, the ana- lytic process should be constantly repeated. This is of course a useful philosophy if your income, status and prestige de- pend on your practice of this particular "'profession. 99 Such is the "'meat' of Freudian theory-namely, the ac- count of the psychical apparatus and the theory of instincts. Now the true purpose of our lives is revealed to us. We live, apparently, to satisfy our fundamental needs--to survive, to destroy and to be destroyed, to experience physical gratifica- tion, which in its purest form is to be found in sexual activity. 76 / The Myth of Neurosis We know, too, as a result of Freud's careful study of his Viennese patients, that our mental apparatus is divided into ego, id and superego, into conscious, unconscious and pre- conscious. Is this really how we see ourselves? Is the evidence at all convincing? Is the theory plausible, or is it a lot of non- sense -meaningless verbiage, unverifiable rubbish, merely a magical way of thinking about things with no application to the real world, nothing more than fantasy and therefore ulti- mately of no value at all? Freud's meaning of life Let us take a quotation from Freud and look at it closely- "The power of the id expresses the true purpose of the indi- vidual organism's life. 29 Certainly the structure of the sen- tence is grammatically correct, and it would appear to be expressing a meaningful proposition, one which might be either true or false. The concept expressed is a theoretical one. Like quarks, quasars and black holes, ids do not appear directly to the senses but must be inferred from sense data which we do experience. So if remarks about ids are to be of more use and importance than remarks about abracadabras, we need to be aware of the sort of facts that would point un- equivocally to the existence, and illuminate the nature and attributes, of ids, and of nothing else. Thus if a set of evidence demands the existence of ids, their presence in all of us, that they contain the instincts, that their content is unconscious of necessity, that "they express the true purpose of the individ- ual's lite, 29 etc. then the evidence must not be capable of a difterent interpretation, used for example to define another concept altogether. Also the evidence must be capable of being validated or invalidated and we must be clear about the sort of things that would prove or disprove the existence and nature of the id even if those things are not immediately to hand. Freudian Fantasies: Inventing the Illness Excuse 77 If psychoanalytic theory was advanced merely as a meta- psychology, such questions would be academic, of little im- mediate use except to the philosophers who would earn their living by discussing them. But psychoanalysis is a billion-dol- lar industry, a therapeutic method which presumes to treat those with genuine psychological illness as well as "neurot- ics, 99 a theory apparently based on a consideration of evi- dence and on nothing else. If it is philosophically unsound we ought to know about it. How, then, does Freud's remark about the id stand up in the light of the above criteria? Not very well. For in truth there is nothing in human thought or behavior which points specifically and indubitably to the existence and nature of ids, to the fact that they express the true purpose of an indi- vidual's life, or anything else for that matter. Further, one can conceive of no set of experiences which would be gen- rally agreed to either validate or invalidate Freud's proposi- tion. Negative findings don't invalidate it nor positive ones prove its truth. The concept of the id is just too vague, intan- gible, mysterious, woolly, to be proved or disproved by any- thing at all. For the Freudian all behavior and thought lead inescapably to the "fact" of the id, but the nonbeliever, con- sidering the same phenomena, does not find it. It would ap- pear to be a question of belief, an article of faith, akin to the religious way of knowing. Freud, it seems, dreamed up what was for him a plausible entity, and then set about finding mental phenomena which for him, but not for others, tended to support it. This mistake runs throughout the whole of psychoanalytic theory. In fact psychoanalysis is not only scientifically invalid; it is, in my view, implausible too. It fails to do justice to our notions of the true meaning life, the finer elements of humanity. Instead it reduces us to the level of psychically determined machines, all thought and action being held to follow of necessity from 78 The Myth of Neurosis anterior events in a way fundamentally beyond our control and for which we must ultimately be irresponsible, beyond blame, beyond praise. Freud's grubby robot man, controlled by mean urges, groping for sexual gratification, drifting through a desired life towards a desired death, gripped by varying degrees of "neurosis, 27 is indeed an unappetizing phe- nomenon. Luckily it is one we can easily do without- there being no reason to believe that his ids, his death wishes, his libidos and his ego-defense mechanisms are anything but the product of an active, fertile but wholly misdirected mind. Even if, by some remarkable conceptual "hit, » Freud had by chance arrived at an ultimate truth, provable and testable at a future date to the satisfaction of all, then in the interim we would be wise to ignore it, to act as if it wasn't so, prefer- ring to believe in a more uplifting and efficacious philosophy in which our motives and instincts are not necessarily base and selfish, in which thought and action are not determined but instead represent our own creative response to lite. Freudian dreams Having arrived at an "understanding" of the very nature of the mind itself from a consideration of the superficial utter- ances and reported behavior of his patients, hardly a group representative of humanity at the time and less so now, and having constructed his ambitious and exotic metapsychology, Freud moves from the general to the more particular. How do we get to know what is going on in the mysterious world of the unexperienced unconscious, the place where the action is? As a substitute for the reading of the entrails we are offered a world of dreams, whose interpretation, according to Freud, provides the royal road to knowledge of the unconscious mind. Dreams, of course, like hands and handwriting, had been "read" before. For Freud they are, rather than fodder for the fairground booth or an open sesame to Joseph's politi- Freudian Fantasies: Inventing the Illness Excuse 79 cal career, "the securest foundation of psychoanalysis. " They are, together with Galton's discovery, free association, and an analysis of "Freudian slips, " the means by which he not only discovered the secrets of the mind but sought to "'explain" human behavior, render "'understandable" the processes of human thought. In many ways this desire to explain and understand human thought and behavior is the root problem of psychoanalysis and the other psychodynamic doctrines. For why should it be explicable? Is the mind really accessible to mere minds? Can the mind know itself, comprehend and make sense of its own essence? Is it not a fundamentally different thing to use the mind to study the external world, including our own bodies, and to attempt to employ it ontologically? Undaunted, de- termined to succeed in the formidable task of explaining the inexplicable, the psychoanalysts in the end persuade few of their ability besides themselves, and, hopefully for them, their patients. Despite their protestations to the contrary, psychoanalysts do not explain behavior and thought in terms of its suffi- cient and necessary causality, do not elucidate actual causal mechanisms which exist in the real world. Instead what they do is offer an explanation of events in terms of their own the- ory. In that way they "make sense" of actions and thoughts from the standpoint of their own prejudices. When a psycho- analyst listens to an account of behavior he interprets it psy- choanalytically. A Jungian or an Adlerian would interpret the same behavior according to his philosophy. The behavior, the facts, are the same. Only the interpretation is different. And when the understanding differs according to the philo- sophical viewpoint of the observer, can there be any true ex- planation at all? Surely we are then in the realm of opinion and beliefs rather than in an area of scientific fact. Nor would one find much uniformity of explanation, universality of un- derstanding, within the psychoanalytic profession itself. The 80 / The Myth of Neurosis same dream is interpreted differently by different analysts, and careful recourse to the undisputed "facts" of the dream's content and form do not appear to reduce the confusion. Thus do the schisms which periodically rend the profession arise, casting doubts on the scientific nature of its procedures. For it is not enough to "make sense 27 of human behavior by making it fit a particular conceptual framework. The sense that is made must have some relationship to reality, and be generally recognized to do so. Let us look briefly at Freud's theories with regard to dream interpretation. The argument goes like this. Everything that happens in a dream has a meaning, although that meaning is often obscure. Not only does it have a meaning, it has a pur- pose too, the purpose of wish fulfillment in which the desires of the unconscious mind are satisfied. Frequently these wishes cause excess excitation. Now it will be remembered that one of the functions of the ego is to dampen excitement and tension, keeping its level within what is in effect a self- regulating control system relatively constant. These poten- tally threatening and anxiety-producing unconscious wishes must be heavily disguised in the dreams if they are not to wreak havoc with the delicate arrangement of controls and balances which characterize the Freudian personality struc- ture. So for Freud the manifest content of the dream is not all that it seems and it is for the hidden meaning, the latent content, that he searches, ferreting out and identifying the various mechanisms, such as condensation and displacement, dramatization, symbolism and secondary elaboration, which the ego uses in the dream as it works to prevent the raw and unacceptable wishes of the unconscious presenting them- selves in their damaging and unadulterated form to con- sciousness. Prominent amongst such unwelcome mental phenomena are the sinister wishes for sexual gratification powered by the libidinous urges. Penises and vaginas and the appalling juxtaposition of the twain are particularly to Freudian Fantasies: Inventing the Illness Excuse 81 be guarded against in view of their potentially disastrous effect on the precarious id/ego/superego relationships of the worthy burghers of Vienna who frequented Freud's consulting rooms. So unacceptable to the psyche is, appar- ently, the contemplation of such anatomical appendages and receptacles that they must be disguised by symbols whenever they occur. Thus things long and pointed such as cigarettes and church towers and things that go off like guns or eject like hose pipes represent in symbolic fashion the dreaded phallus. Tunnels, holes, caves, anything hollow, rep- resent the consciously unacceptable vagina. Motorbikes, cars and trains, especially when they drive through tunnels, sym- bolize sexual intercourse. It is not difficult to improvise on the theme. Several thoughts occur immediately. Is conscious contem- plation of sexual activity, of penises and vaginas, really so threatening that we can't dream of them directly-_and if so, then why do we so frequently have overtly sexual dreams, and in glorious technicolor? Were dreams of sexual inter- course so rare in the Vienna of Freudian times? Possibly it was just "not done" " to talk about them, not even to the creator of psychoanalysis, perhaps especially not to him. The result might have been that Freud, who maintained steadfastly that all his theories were constructed and modified on the basis of what he learned from his patients, may have been misled by their socially conditioned unwillingness to discuss dream ma- terial which was all the time perfectly amenable to being ex- perienced by consciousness and without untoward effects. Determined to discover latent sexuality to satisfy his theory of the instincts, he was forced to "find" " it when it didn't exist. In this way do innocent dreams come to bubble with subter- ranean hidden meanings of a sexual nature. And so now, at least for the psychoanalytic faithful, surrogate penises and vaginas are condemned forever to stalk the sidewalks and thoroughfares of our nocturnal thought processes. At the last 82 / The Myth of Neurosis count there were well over two hundred such symbols. Why, one might ask, are so many necessary? There are few aspects of Freudian theory which appear so fundamentally ridiculous as his insistence that our dreams are riddled with disguised sexuality. For if our dreams are preg- nant with latent meanings usually of a sexual nature, what becomes of the innocent dreams of childhood? A child learns to ride a bicycle. That night, tired but happy, he dreams of riding it beneath the railway bridge past the field of cows a few hundred yards from his home. Symbolic of the wish for intercourse, possibly with his mother, says the psychoanalyst. "Rubbish, 79 I suspect we would wish to chorus in reply. This example is typical of the psychoanalytic "'scientific" method. Once you have made the leap of faith, have swallowed the Freudian myth, then everything can be interpreted in the light of the theory. If you remain a disbeliever, then you sit back amazed, and possibly appalled at the distortions of real- ity in which the Freudians indulge. When the Freudian sees vaginas and the wish for sex we see bicycles and bridges, and sleepy but contented children. It is a question of choice. One can't help feeling that if Freud were alive today, basking in the tradition of permissive liberalism which his work has done so much to foster, he might well have wanted to modify his theory of the interpretation of dreams and pos- sibly much else besides. For he was, as we all are, a creature of the times, living in an age when matters sexual were scarcely discussed, seldom referred to openly, hardly the ap- proved topic for dinner party conversations, TV chat shows, the endless preoccupation of newspapers and magazines. Certainly there are taboo topics today. death and class, for example-_but sex is certainly no longer one of them. So for Freud sex was a clandestine activity, prevalent and central, but hidden and disguised, to be rooted out and exposed ver- bally on his consulting room couch. Today the seeker after Freudian Fantasies: Inventing the Illness Excuse / 83 sexual soul-searching need go no further than the corner newsstand and the agony columns of the glossy magazines, which are, in many ways, Freud's legacy. The well-heeled, verbal, middle-class "neurotics" of early-twentieth-century Vienna tended to keep their sexual cards closer to their chests than the psychological breast-beaters of the 1980s, and Freud's approach both reflected and profited from that situa- tion. The myth of Oedipus It is perhaps in a consideration of Freud's theories of dream interpretation that one is confronted most vividly by his preoccupation with things sexual, but it is in his notorious theory of child development that the importance of sex to psychoanalysis is most clearly demonstrated. According to Freud, sexuality starts soon after birth and the sexual plea- sure flows in turn from different pleasure areas, the so-called erogenous zones of mouth, anus and genitals. Later on, the sexual desire of the little boy for his mother gives rise to jeal- ousy of the father and the repressed fear that the father, learning of his erotic wishes, will castrate him. Women pro- vide an ever-present example of what it might be like to have no penis. At the same developmental stage the little girl comes to the realization that she has no penis, a sorry state of affairs for which she blames her mother. Her father, however, is equipped with this strangely important piece of equipment and she begins to envy his possession of it. So she begins to identify and relate to the father, considering herself in com- petition with her mother for his interest. After the turmoils of this seminal Oedipal period the child enters, from the age of about five, into a period of sexual in- ertia known as the latency period, before exploding once again during the stage of adolescence into a second phase of active sexual interest. 84 The Myth of Neurosis The idea that sexual life begins at the very earliest age and that the search for sexual gratification characterizes all of us from just after birth to the age of about five is one of Freud's most controversial. The theory is central to the explanations of later "'neurotic 99 behavior and it is maintained that the vast majority of emotional and behavioral maladaptations in later life can be traced to unresolved problems during early devel- opment and especially at the Oedipal stage. Many of us have much experience of the bringing up of children, and in general our observation of their behavior is keen and acute. Do our own findings point irrevocably to the truth of Freud's theories? After all, it was from a considera- tion of the "evidence" that the theories were apparently constructed. The truth seems to be that the theories go far beyond anything that can actually be observed. Freud lets his imagination run free with the "facts" and then constructs his theory as if it was a logical deduction, as if the "facts" had given rise to it. From then on the "facts" are always inter- preted in the light of the theory and thus tend always to ap- pear to "confirm" it. Take for example the indubitable fact that the baby ap- pears to gain satisfaction from sucking the breast. That in it- self is not very remarkable. It is the only way that he can get food, can survive. He is born with a suck reflex and is geneti- cally programmed to gain satisfaction from feeding at the breast. From such small beginnings can mighty theories grow. Firstly the pleasure derived from this activity is de- scribed as sexual, with all the implications of the word. But to do so only makes sense if one has decided to believe that all pleasure is in a sense sexual, an assumption that tends to be made in psychoanalysis but which is by no means a common assumption. Next we are told that the child becomes "angry 29 with the mother when she delays for one reason or another in satisfying his oral "sexual" pleasures. His attitude towards the mother becomes "ambivalent" " and his "aggression 29 is ex- Freudian Fantasies: Inventing the Illness Excuse 85 pressed in a tendency to bite at her breast. This biting behav- or has the double purpose of "introjecting" a part of the mother into himself, of consuming a part of her so that she cannot leave him. At a primitive level he experiences "fears" of the consequences of his "'ambivalence, 29 etc., etc. It is all very imaginative, but is it likely? Is this really what happens, or are words being used in a specialized and un- usual way? What can it mean to say that one so young is am- bivalent about his mother, that he fears the consequences of his ambivalence? What possible evidence can point to the truth of this remarkable assertion, this wild shot in the dark. Are we really to believe that a five-year-old "fears castra- tion, 99 whether the fear is "repressed" or not? Does he have an innate concept of what it might be like to lose his penis? Does he really want to make love to his mother? The ship of Freudian theory founders on the mighty rocks of common sense when these questions are seriously considered, but un- shakable in their faith, the Freudians refuse to admit that the ship is no longer afloat. They point to the "evidence" of the case histories, to that of Little Hans, for example. Let us look at this nasty little example of dialogue in which the father, a disciple of Freud's and a firm believer in psycho- analytic dogma, questions his five-year-old son. Little Hans's supposedly spontaneous answers are thought by the cogno- scenti to be perhaps the clearest objective evidence in the Freudian literature of the existence of the Oedipus complex. Freud, incidentally, saw Little Hans on one occasion alone. Father: It seems to me that, all the same, you do wish Mummy would have a baby. Hans: But I don't want it to happen. Father: But you do wish for it? Hans: Oh, yes, wish. Father: Do you know why you wish for it? It's because you'd like to be Daddy. 86 / The Myth of Neurosis Hans: Yes. How does it work? Father: You'd like to be Daddy and married to Mummy; you'd like to be as big as me and have a mustache; and you'd like Mummy to have a baby. Hans: And, Daddy, when I'm married I'll have only one if I want to, when I'm married to Mummy, and if I don't want a baby, God won't want it either when I'm married. Father: Would you like to be married to Mummy? Hans: Oh, yes. If this took place in a court of law, you can imagine counsel for the defense leaping forward constantly with the shout, "Objection, counsel is leading the witness, 97 and hear the judge's weary reply, "Objection sustained. » Under this sort of inquisition from a persistent and authoritarian figure of whom he was naturally fond and whom he wanted to please, poor Little Hans might have admitted to very nearly any- thing. It is just as well that the father at least seems to have had a clear idea of the Oedipus complex, otherwise he would have almost certainly failed to extract any part of it from his unfortunate son. Even so, many would argue that despite his determination to do so he did not in fact succeed. So here we have the psychoanalytic method, a small but revealing example of the "evidence" from the couch that supposedly meant so much to Freud. Of what does it consist? Merely, I would argue, of the determination of prejudiced, bigoted men, exposed for too long to a ridiculous creed rich in mumbo-jumbo, to see what they want to see, and hear what they want to hear, whether or not it bears any relation to reality. Their approach and methodology are selective and self- confirming, narrow and inflexible, rigid and unyielding in their refusal to admit anything that is not explicable in terms of the philosophy they dare not question. Peering at the Freudian Fantasies: Inventing the Illness Excuse 87 world through their distorting spectacles, they not surpris- ingly have a distorted vision. Uncritical generally of their master's voice, they reserve their bile for those who fail to share their dogma, interpreting antipathy as the signs and symptoms of personality deficiency or disequilibrium for which a course of psychoanalysis might, with benefit, be pre- scribed. Thus can critics' brains be washed clear of heresy, and their arguments neutralized by the ascription of psycho- pathology, by the suggestion that some ego defense mecha- nism is at work in the attempt to dissipate anxiety to which some aspect of psychoanalytic theory has given rise. If one attacks psychoanalysis, it is not one's ideas that are scorned, but oneself. One's arguments are not contradicted but de- valued by being described as evidence of "'neurosis. " So much for the scientific method of Freud, the strict disciplinarian who would brook no criticism. For Freud upheld that no unanalyzed person could be ex- pected fully to understand the truth of psychoanalytic doc- trine; thus he disarmed his critics in advance. Only when you are one of us, the argument runs, only when you have been subjected to the full indoctrination process, will we take seriously your criticisms. Even then, if you do not fully ac- cept the theories, we will wonder about the success of your analysis rather than take note of what you say. But if indeed the undergoing of a classical analysis is so essential to a proper understanding of the philosophy, might one not won- der why it was that Freud himself never underwent this pro- cess, while insisting that all his followers were analyzed. Does this mean that Freud was cynical or wrong in maintaining that to experience the truth of psychoanalysis one had to be analyzed by another? It is surely true that he never experi- enced the "truth" of it himself. The great man would trust none of his acolytes with his psyche. Was he worried what they might find, scurrying beneath the upturned stone in the unaccustomed light? Whatever the reason, he preferred self- analysis in the investigation of his own personality, of the 88 The Myth of Neurosis mental processes from which the whole extraordinary theory sprung, and this despite his statement that "Self-analysis is really impossible." Of course, Freud cannot be judged by the same rules by which both he and his disciples would want to judge the lat- ter category. There must be droit du seigneur, privileges of the inventor. But in fact there was a difference in interest be- tween the founder of psychoanalysis and its practitioners. What Freud did, and what he was primarily interested in doing, was to construct a psychological theory that would ex- plain thought and action. The tool which he maintains he used to do this was the "scientific" method of psychoanalysis. This is to say that psychoanalysis was primarily an instru- ment of discovery through which great and important truths could be arrived at. For Freud, that was perhaps the most important function of psychoanalysis, to unravel the causal mechanisms, to gain insight and self-knowledge, to allow one most truly to be oneself. The disciples emphasized a somewhat different aspect of psychoanalysis. The fundamental "discoveries" had already been made and extensively described by the master. It was an article of faith if they were to ply their trade as psychoana- lysts that they accept the thrust, the hard core of Freud's teachings. For them psychoanalysis is of incidental interest as an experimental method, as an illuminator of the mysterious mechanisms of the psychic substance. Instead they are pri- marily interested in the therapeutic possibilities of psycho- analysis as a talking cure by which 66 "neurotic mechanisms are recognized, accepted into consciousness, and, in that ac- ceptance, to some extent attenuated if not abolished. Does psychoanalysis work! Does it work, moreover, in the way that it purports to work? There is another and possibly graver question, seldom Freudian Fantasies: Inventing the Illness Excuse 89 asked or even hinted at: Is psychoanalysis harmful, or poten- tally harmful in a way that transcends the acceptable risk/reward ratio implied in any therapeutic process? I argue that there is no proof that psychoanalysis benefits humanity and furthermore that in many cases and many situations it is both dangerous and destructive. (See Appendix Il, "The Evi- dence Against Psychoanalysis and Psychotherapy. When asking whether or not psychoanalysis works, one should be clear about what it sets out to do and what is in- volved in the process. First, it is expensive, time-consuming and labor-intensive. Going rates in New York City for private classical analysis are approximately $90 for the traditional fifty-minute hour, four to five times a week with a holiday in August, for a period of six to eight years. This involves an outlay per patient of over $100,000 not allowing for inflation. Clearly on this basis each analyst does not see very many pa- tients, although many patients do not complete the analysis usually because they have moved away, can no longer afford it, or can no longer stand it. During the fifty-minute session the patient lies on the couch with the analyst sitting unseen behind his head, and says whatever occurs to him, holding nothing back. The ana- lyst is supposed to listen, to reveal nothing of himself and his personality, but instead to act as a sounding board, a mirror, bouncing back the thoughts and utterances of the patient, who apparently gains in the process insight into the causal mechanisms within his psyche which enslave and control him. As he free associates, recounts his dreams and tells of his apparently faulty or haphazard actions (the Freudian slips, or parapraxes, apparently chance but in fact unconsciously pre- determined), the analyst listens with the knowing ear, allow- ing himself the occasional interpretation as he coaxes the interred and threatening unconscious thoughts into the pa- tient's awareness. The analogy which Freud himself liked is with surgery, as the analyst carves away at the layers of su- 90 The Myth of Neurosis perficial tissues until he has exposed the cancerous growth to the sharp knife of psychoanalytic technique. Pain is unavoid- able, even desirable, as the patient is led, slowly and inexora- bly, to a recognition of the infantile urges that govern his behavior and cause his symptoms. Gradually he comes to re- alize that all his problems, his angst, stem from those distant events, dimly and inadequately remembered, which took place between the ages of three and six, when Oedipal con- siderations ruled his life. During the often stormy and as often grotesquely dull rela- tionship, both patient and analyst will have to handle the transference as the patient invests in the analyst the strong feelings that he has felt for important and authoritarian fig- ures in the past. Thus hate and more classically love are often demonstrated by the patient for the analyst, these feelings occasionally being returned amplified in the countertrans- ference, in which the poorly analyzed analyst indulges in the same emotions vis-à-vis his patients. Everything that happens in the psychoanalytic situation is regarded as being important, especially the transference. All is important for the giving and receiving of insight. At no time is the aim to make the patient feel better or to "cure" him. Instead the task is to help him to an awareness of his "real" self, the realization that infantile urges and primitive desires are at work in the shaping of his personality. Let us suppose we believed that we are little more than butterflies pinned to the board of life by the sharp needle of the Oedipus complex, which reaches out from our childhoods into adult life to impale us. How can it possibly benefit us to recognize this fact, and how, in the recognition, can we es- cape our predicament? The psychoanalyst would say that in the expression of our true desires and impulses, by talking about them and recognizing them, we are less likely to act them out and translate them into movement. But is this really the case? Supposing I come to the realization that my anxiety Freudian Fantasies: Inventing the Illness Excuse 191 and inability to function with and relate to authoritarian fig- ures are the result of a poorly resolved Oedipal complex, in which my fear and hatred of my father and my frustration at being prevented from satisfying my sexual urges for my mother have spilled over into adult life to incapacitate me. I am no better off in knowing that my self-acknowledged unsa- tisfactory behavior is the determined result of this depressing little causal mechanism. Certainly the next time I am con- fronted by authority and the juices begin to flow I may parade my "insight" and behave in a more reasonable way, refusing to act on the conjured-up emotions. But the insight is not necessary for me to modify my behavior if I decide truly that my attitude towards authority is unworthy, self-limiting and productive of guilt feelings. I can decide not to act on emotions which are at variance with how I feel I should be- have and which tend to reduce self-respect. My reasons for doing so are straightforward and uncomplicated, and I am unburdened by theoretical beliefs that my behavior is con- strained by the past. Why I had those emotions in the first place is both speculative and irrelevant, the process of dis- covery expensive and time-consuming. For Freud, the pio- neering "'scientist" interested only in the "truth," there was doubtless something intrinsically pleasing in the very process of the search for knowledge and understanding. It was thought to be good in itself. It was enough for Freud to "transform hysterical misery into common unhappiness, 99 in the interests of greater clarity, but is it enough for psychoana- lytic patients? Most psychoanalysts assume (and have a vested interest in doing so) that one benefits from psychoanal- ysis, but if "common unhappiness" is the destination, has the $100,000 been well spent? They admit, however, that failures are legion, dramatic improvements few and far between, that progress is slow and difficult to measure. Yet despite their less than extravagant claims about the efficacy of psychoanalysis, they, like the "neurotics" they treat, seem doomed endlessly 92 The Myth of Neurosis to repeat their esoteric behavior, priests of a secular religion, locked in procedural rituals, questioning not, but obedient to the dictates of their mentor, whose words live on in the text of the Standard Edition of Freud's works, bible to the true believers, prayerbook to the faithful. To prove beyond doubt that psychoanalysis either does or does not have any beneficial effect on its recipients is no easy task. The human mind and the totality of human behavior defy accurate measurement, and we should be thankful for this. So, especially in the category of "healthy neurotics, 29 with whom psychoanalysis prefers to deal, it is often impossi- ble to isolate and measure "'improvement" in the same way that it can be evaluated by noting the reduction in the symp- toms of psychosis after a course of chlorpromazine. It is diffi- cult, too, to judge the specificity of the effect of the psychoanalytic intervention, as no one psychoanalysis resem- bles another. If there is improvement, is it due to the tech- nique of analysis, the individual analyst's personal interpretation of the technique, the personality and charisma of the analyst, the chemistry between his personality and that of the patient, the patient's suggestibility, the placebo effect, etc.? If it is difficult to isolate cause and effect within a par- ticular analysis, it is even more difficult to compare one anal- ysis with another, or large groups of analyzed patients with those who have had no treatment at all or some other type of therapeutic intervention. The unique complexity of individu- als and the extraordinarily intangible global experience of psychoanalysis render all such investigations suspect. Nonetheless, studies have been attempted. Those which tend to demonstrate the efficacy of psychoanalysis suffer from the fact that in most cases improvement is defined by either analyst, patient or both. This is an obvious deficiency, in view of the time and money invested by each in the process. All such studies suffer from considerable methodological diff- culties. The selection of patients, the construction and treat- Freudian Fantasies: Inventing the Illness Excuse 93 ment of comparable control groups, the assessment of out- come and the pinpointing of phenomena bearing a causal re- enormous problems. Some studies, too, have indicated that "neurosis, 29 whatever it is, is a self-limiting condition, and that time rather than analysis is the great healer. What appears certain is that if psychoanalysis does have any specific beneficial effect on people, then it has never been clearly and conclusively demonstrated, nor indeed ade- quately defined. But psychoanalysis is not harmless. It may be rubbish, but it is dangerous and demeaning rubbish, tending to rob us of our natural belief that we are in control of our mental and physical behavior, fostering the illusion of our lack of respon- sibility, of our passivity. This is the fundamental crime of psychodynamism, of which Freudian psychoanalysis is the cornerstone. As the tentacles of this pernicious doctrine reach out to embrace the arts, politics and education, nothing remains untouched by the poison of its determinism as it de- grades creativity, debases ambition and reduces the value of human aspiration. Human nature can be understood, re- duced, explained away by Freudian theories in terms of the pathetic supposed lusts of our no longer innocent childhoods, the mystery gone, the splendor eclipsed. All around us and within us we are encouraged to look and to find evidence of conditioned psychological malaise, the legacy of our child- hood, from which, according to Freud, none of us emerges unscathed. We are asked to dwell on the "psychopathology of everyday lite, finding illness to excuse us wherever we turn. Believing ourselves puppets dancing on the string of our libidinal urges, we lose our self-respect, our admiration for ourselves, our pride in our achievements, our satisfaction in the surmounting of difficulty, gravitating instead towards that anxious dependency, that vulnerable passivity, which 94 The Myth of Neurosis provide the cannon fodder and the income for those who peddle a talking cure. Of course, psychoanalysis today, except in the hierarchies of the psychiatric profession, where the psychodynamic way of thinking has tended to live on, is a movement in disre- pute-_its self-confidence lost, leaderless, fragmented and like the church itself rent asunder by schisms, distressed by here- sies. Psychoanalysis is discredited as a method of scientific in- vestigation, doubted as a psychology, scorned for its lack of effect as a therapy. The climate of opinion has turned against the once fashionable but pessimistic vision of human nature, against its rigidity and its doctrinaire approach, its trade- union-type closed shop, and above all against the time it takes to do whatever it is supposed to do. Instant cures and panaceas are what today's consumer of therapies desires. Perhaps even more vitally, he desires methods that are easy, are pleasurable, and involve the minimum expenditure of ef- fort and energy. Psychoanalysis-hard, unyielding, uncom- promising in its practice of painful surgery by a distant, unempathic analyst, promising little and costing much--has made only struggling efforts to catch up. Such has been the brainwashing power of the psychoanalytic experience that the majority of psychoanalytic revolutionaries are little more than fellow travelers, bending Freud a little here and there and incidentally incurring the wrath of the founder and his high priests, but hanging on to the basic principles, such as the seminal importance of the emotional life of early child- hood and the revealing nature of dreams. In particular they believe in "'neurosis" and the efficacy of their particular therapies to alleviate its symptoms. Psychoanalytic roulette So in Adler' Individual Psychology, the dynamic principle of life is seen as the individual's attempts to compensate for Freudian Fantasies: Inventing the Illness Excuse / 95 the natural feelings of inferiority felt as a helpless child, which are manifested in the life-style. Modifying this theme marginally, Karen Horney considered the anxious child's search for security as paramount and saw it as her task to un- derstand the individual's adjustment to this anxiety in the process of character analysis. For Fromm the prime consider- ation was the study of the personality's relationship with the culture of the society in which it found itself. Sullivan, like Horney, saw the need for security in a social context as fun- damental and, influenced by Meyer, saw the personality of man as a synthesis of his biological inheritance and the effect of the environment on that heredity. Jung's Analytical Psy- chology, with its mystical theories of the collective uncon- scious and his perceptive descriptions of personality types, represents a rather more exotic chip off the Freudian block. More recently the emphasis has been on changes of style in the therapeutic relationship, especially since the work of the Chicago school. Nowadays analysts are less distant, more friendly, more flexible, more prepared to "relate" and per- haps even to compromise on the once sacred principle of time, in, for example, the short-term therapies of Sifneos, Malan, Bellak and Balint. These, in brief, are a sample of the psychodynamic psy- chotherapies, cerebral, intellectual, long on words and expla- nations, on philosophy and interpretations based on that philosophy. In general the variations that they represent when compared with classical psychoanalysis amount to at- tempts to humanize the process, to dilute the austerity of the Freudian approach. They all, however, represent systems in which "'experts 79 cure "patients" -in which specific "'skills" are used to disseminate "knowledge, 22 in which founding fathers (or mothers) have arrived at "'new" insights into human na- ture, in which disciples follow masters, and in which money changes hands with respect to services whose efficacy re- mains suspect. In all this their effect is to popularize and in- 96 The Myth of Neurosis stitutionalize a wider category of illness, that of "'neurosis, whose existence is mistakenly implied by the existence of so many intelligent, articulate, vocal and charismatic 66 protes- sionals. As they push their philosophy, the recognized boundaries of mental illness expand remorselessly until we are all to some extent "'not well, and are thus free to take the illness option. Whether it is done unashamedly, without apol- ogy in the name of the doctrines of classical analysis, or masked and camouflaged, wearing the persona of humanism, warmth and hope, we are all encouraged to slip passively into the illness mode in the face of difficulty, to acquiesce in the patient role, to learn the helpless reliance on the healer that will best foster the illusion of "cure. » Thus when well we take on the mantle of illness; when merely unhappy, anxious and ineffective we cling to the leaky raft of "'neurosis" and paddle it furiously towards the prison ship of psychodyna- mism, where the shackles of dependence and determinism await us. In our headlong flight from freedom and responsi- bility we do ourselves a terrible disservice, and those who collude with us in our attempted escape take our money as they compound our error. Freud's cardinal sin is that he has given a spurious validity to the illness excuse, has spawned a vast industry of talk therapists who ply their trade in areas where genuine mental illness does not exist, and occasionally and more dangerously, when it does. He is the grandfather of the talking cure, and although the therapies of today have strayed far from his path, the lines of communication between psychoanalysis and the mental flatulence of the California experientialist movement are clear. And so now the therapy industry is big business, with billions of dollars of annual revenue in the U.S.A. alone and hundreds of thousands of practitioners ca- tering to the "'needs" of approximately 40 million Americans who are considered by the Graduate Medical Education Ad- visory Committee to suffer from some "'mental disorder." Freudian Fantasies: Inventing the Illness Excuse 97 Freud started the process when he maintained that even the psychologically healthy, if indeed such a rare animal ex- isted, would benefit from psychoanalysis. Now, in the self-ac- tualization programs of the human potential movement, the logical conclusion of that philosophy can be seen. Apparently we are all ' "in need". -in need of gurus, in need of leaders, in need of philosophical psychologies that explain human na- ture, in need of greater "awareness" of ourselves and of how We "grow. 99 in need of more "experience, » in need of love, in need of meaning. And so, as we strive towards the perfection that is supposedly our natural birthright, we are helped on our way by the talking cure, encouraged to let it all hang out. A good talk has, since Freud, become the panacea for all ills. If we can but bend the ear of a caring listener, all our trou- bles will melt away. In the very act of verbalization we exor- cise the devils of our disability. A new and perhaps naive optimism characterizes the therapies of today, replacing the austere pessimism of psychoanalysis, but in both it is words more than anything else that are thought to provide the pass- port to salvation. But there are no easy transports to delight, no shortcuts signposted by "experts. » Instead there is toil and sacrifice, hard work and struggle, self-discipline and denial- that is the only road towards satisfaction. The hardships are necessary and valuable, providing obstacles in the overcom- ing of which we learn to like ourselves more. Never should we underestimate the importance of difficulty. 7 Mind Candy: Bitter Pills for Anxiety In contrast to the reaction of the talk therapists when con- fronted by a person weighted down by the problems of life is that of the doctor who puts his trust in pills. Mood-altering drugs (psychoactive medication) are prescribed in very large quantities; more than 130 million prescriptions were written in America in 1983. The large majority of these prescriptions are for CNS depressants with sedating qualities. These in- clude the sleep-inducing barbiturates prescribed to counter- act insomnia. Over recent years, however, there has been a dramatic increase in the prescribing of the minor tranquiliz- ers of the benzodiazepine group such as diazepam (Valium); chlordiazepoxide (Librium); oxazepam (Serax); lorazepam (Ativan); medazepam; and clobazam. These drugs are known as anxiolytics and are prescribed in the overwhelming majority of cases for general anxiety, ten- sion, apprehension, and agitation. On a short-term basis they are undoubtedly effective in relieving the symptoms of stress. This calming effect is probably the main reason that they are effective in the promotion of sleep, and other drugs of this group are marketed primarily as anti-insomnia agents. These include furazepam (Dalmane) and temazepam (Restoril). 98 Mind Candy: Bitter Pills for Anxiety 99 Can drugs cure unhappiness? By far the most common reason for the prescribing of these drugs is to bring about some change in the individual's psy- chological state, and it is worthwhile to quote from the litera- ture of the Hoffmann-LaRoche company, the manufacturers of the widely used Valium tablets. They state that "Valium is indicated for the symptomatic relief of anxiety and tension associated with anxiety disorders, transient situational distur- bances and functional or organic disorders. It is useful in psychoneurotic states manifested by tension, anxiety, appre- hension, fatigue, depression symptoms or agitation. So wide is this description that it is immediately apparent that one could make a case for prescribing Valium in very nearly any situation in which difficulties temporarily arise, and unfortunately many doctors do just that. But there are times when all of us are tense and anxious, tired and worried, fed up, sad and agitated. It is often an extremely appropriate response to trying circumstances, a natura), reaction to the problems that we face. We are short of money and there are bills to be paid. We worry about the health of those we love. We have problems at work and difficulties in our personal re- lationships. At times everything seems to go wrong for us. We may experience dreadful grief at the death of a loved one, and occasionally it seems as if life is hardly worth living. This is not unnatural. It is totally normal occasionally to feel this way. It is always unpleasant, but it is not without a use. For such problems exist to try us and to test us, and in successfully overcoming them our self-respect must increase. Our bravery and tenacity in such unfavorable circumstances will give us the self-confidence to face other trials. We may rely on our friends and those we love to help us through, but we need to know that in the end we did it all ourselves. We can and must learn to regard our feelings of anxiety and worry in a positive way. Very often our body's hormones 100 The Myth of Neurosis prepare us physiologically for action in response to external threatening stimuli. An example of this is the fight, fright or flight adrenaline response in which blood is pumped pre- ferentially to the muscles, the pupils dilate, and the heart beats faster as the body is made ready for an appropriate re- sponse to danger. So the psychological feelings of anxiety, worry and tension can be used to prepare us for positive ac- tion. For if we don't worry about our problems to a certain extent how can we summon up the necessary energy to solve them? If they don't make us anxious, can they be said to be problems? And if we have no problems, how can we respect ourselves by solving them? If at the first sign of psychological tension we condition ourselves to obliterate such feelings chemically, we will be tending towards that passive, specta- tor role that Moral Therapy is so keen to discourage. In most cases, therefore, we should not be afraid of anxiety, nor should we consider it abnormal or without use. Instead we should regard it as a spur to action, an unpleasant experi- ence whose job is to get us moving. Our anxiety should lead us to a brave confrontation of our problems and an increase in our self-respect. Having performed its function, it will then disappear, with the net result that we like ourselves more. Always we must avoid the mistake of concentrating on the anxiety itself and turning that into our problem. Encouraged by the constant expressions of the introverted psychobabble of the mind pundits, many of us end up worrying more about our anxiety than about getting on with our lives and behaving as we believe that we should. "I can't do anything to get rid of my anxiety because I am so incapacitated by it" is often the attitude. It may be of course that such a diagnosis is the correct one and that an actual "anxiety state 99 does exist, a genuine pathological condition that requires psychiatric intervention. This will be discussed later. More often, however, such senti- Mind Candy: Bitter Pills for Anxiety / 101 ments, encouraged if not actually expressed by the patient's doctor, will be used as excuses to avoid difficult but worth- while courses of action to the ultimate detriment of the indi- vidual. The tranquilizer tablet gives substance to the excuse, since surely no doctor would prescribe medicine unless there was an actual condition that needed to be treated. "'If I can just get rid of this anxiety for a few days I will be able to get on with my life, 79 runs the argument. Dr. Feelgood's happiness pill The doctor, knowing all too well that he has little chance to confront adequately the complex life problems of his pa- tient, both because he doesn't know how to and because he has neither the time nor the inclination, colludes with his pa- tient in the Valium solution. In thirty seconds the drugs are prescribed. The doctor is secure in the knowledge that they can do little harm and will bring him the gratitude of the pa- tient for the immediate relief that they provide. He knows that their side effects are minor, that they are of low toxicity and therefore unlikely to be used in any successful suicide at- tempt, and that they are one of the most widely prescribed of the psychoactive medicines. The patients are soon on their way, with the doctor's reassurance ringing in their ears. He has done his bit. Rather than admitting that he has no solution to the life problems of another individual short of making a commit- ment to him as a friend, an action that his medical ethical code, his natural predilections and his lack of time tend to exclude, he hides behind his prescription pad. Instead he re- duces the problem of the wife's extramarital affair or the husband's alcohol abuse, or the high mortgage repayments and the children's erratic behavior, and considers them as it they had some relation to an area in which he does have some expertise. He has after all been trained in brain anatomy, 102 I The Myth of Neurosis physiology and chemistry, and so, wearing his medicobiolo- gist's hat, he explains all these little upsets in terms of mo- mentarily disturbed brain function and reaches for his prescription pad, realizing all the time that he is playing the role that society has cast for him. It is not difficult for the doctor sometimes to confuse his job as healer with his task of relieving pain and discomfort. When confronted by a patient experiencing mental anguish, he has a strong desire to abolish it in the quickest, least dan- gerous and most effective way possible. He is a compassion- ate man and sees it as his job to relieve suffering whenever it occurs. Thus he dispenses the mind drugs like candy, treating the symptoms rather than the underlying situation of which they are the outward manifestation. Symptomatic treatment in the absence of the ability to cure is acceptable in medi- cine, but not when the particular treatment used itself exac- erbates the basic problem and when more effective methods are available. This is the case with the prescribing of tranqui- lizing drugs when the individual trades temporary relief for more lasting diminution of self-respect. The physician would not be so lax in the prescribing of analgesic drugs for the alle- viation of pain. He may prescribe them, but he would want to spend some time investigating and obliterating the pathol- ogy of which the physical pain is only the symptom. He would not expect analgesics to cure the basic pathology in a physical condition, and so he has no reason to believe that anxiolytics (anxiety-easing drugs) can have any long-term rel- evance to a psychological one. The fact that his behavior is understandable does not make it any the less blameworthy. The motive is good, but in failing to perceive the final results of his action the prescriber of the tranquilizers can do real harm. "Can I give you a little something for your nerves? many doctors will ask, to cover up the impotence they feel as they confront their patient's misery. Feeling that the doctor Mind Candy: Bitter Pills for Anxiety / 103 knows best and needing little persuasion to escape his predic- ament, the patient concurs, although he may know deep within him that he is doing the wrong thing. The patient may make it easier for the doctor to behave like this. He may well arrive at the consulting rooms de- manding the little yellow pills that had done so much good for his neighbor when he had been feeling that he could not cope. If he doesn't get them he may go elsewhere. The doc- tor, knowing what is expected of him and that an alternative source of supply will be found if he doesn't play the game, may feel that it is better to give in so that at least he will be able to exert some monitoring effect on the patient's use of the drug. The good doctor, who recognizes the dangers of the misuse of tranquilizers and who refuses to prescribe them incor- rectly, will have to be prepared to replace them with some- thing of greater value. He will have to suggest alternative courses of action for the solution of the problems that the pa- tient faces, and should realize that this will consume large quantities of both his time and his emotional energies. It is the vague awareness of this open-ended commitment that en- courages so many doctors to opt for the easier solution. So often the complaints are heard: "He wouldn't listen, 99 "He just gave me pills," "I wasn't in there for more than two or three minutes, » "He said if I took these tablets it would all be OK.» Too many doctors are extremely uncomfortable with patients who try to discuss their psychological and life prob- lems. Trained as scientists, they are only at ease when dis- cussing the body as a malfunctioning machine and thus many of them attempt to cut short all discussion and head immedi- ately for the biochemical solution. Doctors, too, tend to believe in the printed word. Through their letter boxes each day pour streams of literature from the big drug companies in which the virtues of various psycho- tropic medications are extolled. In the hospitals the drug- 104 The Myth of Neurosis company representatives give elaborate lunches in exchange for the watching of films and the listening to talks at which that company's products are advertised. The doctor is the target for an extremely efficient and well-mounted advertis- ing campaign in which the advantages of psychotropic drugs are emphasized and their disadvantages minimized. Unfortu- nately, drug companies and to some extent doctors tend to be interested only in what can be measured, or inferred from measurement. Such notions as self-respect, guilt and individ- al moral codes cannot be tested in double-blind clinical trials and are therefore ignored. And so these drugs march on, sapping self-esteem and draining the individual's will, until he is so conditioned that he is unable to face the day without his tablet. Surely we must come to terms with the fact that life was not designed to be easy or even pleasant, and that happiness and contentedness must be earned. How different is the gen- erally accepted theory that we have a natural right to a life free of psychological pain, a view that leads us to consult the "experts" whenever we experience it. It is this erroneous and harmful attitude to life that leads us to seek chemical pana- ceas that cost us our self-respect. Who, one wonders, was re- sponsible for the propagation of the myth that life should be good most of the time whether we work hard at it or not? Was it ever thus? Did the manual laborers of long ago feel that they had a natural right to unearned happiness? Do those in the underprivileged areas of the world today expect contentedness irrespective of what they do and how they be- have? Of course they don't. For the truth is that somewhere along the line, those of us who live in affluent societies have been exposed to the insidious intellectual myths of the psy- chodynamists and have come to believe that lack of happi- ness, discontent and psychological discomfort are not natural and are manifestations of some malfunction in our mental Mind Candy: Bitter Pills for Anxiety 105 processes. Further, they are responsible for the idea that such malfunctions can be isolated, examined and understood and that eventually they can be abolished and "proper" psycho- logical function restored by making us aware of the causal processes that have conspired to create them. Heavily in- fluenced by the metaphysical posturings of these talk thera- pists, the medicobiologists, although overtly out of sympathy with their methods, agree that psychological distress, how- ever appropriate and beneficial it may be, is a sign of bio- chemical disturbance, to be abolished whenever and wherever it occurs. They prefer to talk of electrochemical brain events. The currency of the psychodynamists is ideas. Both agree that there is a problem that requires their "'ex- pert» intervention. Science has provided the medicobiologists with a perfect tool, in the form of mind candy, to mount their onslaught against those mechanisms which alone provide the early warning system telling the individual he is behaving in a way which contravenes his moral system, and that he should cease and desist from such actions. In doing so they place him in the same position of danger as the person who experiences no pain. So keen is the doctor to abolish the symptoms, he effec- tively masks the awareness of their cause. As a result the indi- vidual struggles forward in the wrong direction, dimly aware he is doing so until such behavior is so entrenched it can only be eradicated with the greatest difficulty. In exactly the same way, the person who feels no pain will persevere in actions that are actually harmful to his body because he possesses no warning system to guide him. So with the tranquilizing drugs, guilt is dulled and a vicious circle is set up whereby inappro- priate actions continue, thus giving rise to increasing lack of self-respect the effects of which require even greater doses of tranquilizers to minimize. This circle must be broken and the idea disseminated that bad times are normal, and that although unpleasant they 106 The Myth of Neurosis have a value. They alone can make us strong, and the psycho- logical distress that we experience in the contemplation of perceived inadequacies is vital if we are to mend our ways and improve our lives. In the taking of tranquilizing drugs we solve not our own problems but rather those of the doctor who saves time and energy by prescribing them and of the manufacturers who derive profit from their sale. False progress and failed judgment It might be worthwhile to ask ourselves whether in terms of happiness, contentedness and mental health the world is in fact a better place since we have apparently acquired such expertise in the manipulation, and insight into the workings, of the mind. Have the prevalence of cunning psychological theories in which the mysterious mechanisms of the psyche are purported to be "'understood" resulted in widespread al- leviation of mental suffering and a more balanced and saner world? Or have they merely resulted in the growth of a lu- crative industry that panders to the weakness in humans and to their potentially self-destructive desire for dependence and attention? Is analysis, one might ask, psychologically ad- dictive? It seems to me that in societies in which such psy- chologists do not exist to satisfy the desires, which are not the needs, of the populace there is no noticeable diminution in psychological health. Similarly, have mind drugs of the minor tranquilizing type, in the few years since their discovery, in- creased the mental well-being of the population? The fact that they have failed to do so is not because they have been insufficiently used. I suspect that few people really believe that these drugs do anything but put off the day when we ourselves will have to confront our own problems. Surely we are all aware that insofar as they are a crutch, an easy way out, an admission of failures, they are not good for us and that it demonstrates a weakness of will to use them regularly. It Mind Candy: Bitter Pills for Anxiety 107 may be that the general public know the truth of this better than the medical profession itself, as they are the ultimate consumers and therefore the people who have to live with their effects. The doctor effectively treats his own feelings of anxiety and impotence by prescribing tablets to others, and because, quite rightly, he is loath to project his own feelings of right and wrong onto his patient he makes the mistake of ignoring the moral issue in toto and fails to consider his pa- tient's self-respect. What he fails to understand is the vital importance of the moral issue for the patient himself in terms of the patient's own personal morality. If the doctor were able to take the time and trouble to investigate that patient's own view of the consequences for his self-respect of the mind-altering drugs, he might avoid his mistake. But because doctors are taught not to judge their patients they forget that patients constantly judge themselves. The effects of this oversight are often profound. There is a major point that has as yet to be given the recog- nition it requires by both the medical profession and the pub- lic at large. The manufacturers of Valium hint at the problem when they state that "Particularly addiction-prone individu- al such as drug addicts and alcoholics should be under care- ful surveillance when receiving diazepam…. because of the predisposition of such patients to habituation and depen- dence. Here they are referring to the possibility of psycho- logical addiction, in which the individual shows a continual preoccupation with his drug and its source of supply, and has a strong psychological compulsion to acquire it and to use it regularly. Characteristically, such people show a high relapse rate after withdrawal. They also state that "Although infre- quently seen, milder withdrawal symptoms have also been reported following abrupt discontinuation of benzodiaze- pines taken continuously, generally at higher therapeutic levels, for at least several months. » This hints at the presence 108 I The Myth of Neurosis of a withdrawal syndrome that would indicate that Valium can cause physiological dependence or addiction. (Depen- dence and addiction are terms that can be used interchange- ably.) This situation is said to occur when withdrawal of the drug precipitates a recognized withdrawal syndrome specific to the particular drug. The alcoholic withdrawal syndrome in its mildest form is the well-known hangover and in its most severe the state of delirium tremens. Sudden withdrawal from heroin ("cold turkey ,*) results after a few hours in an ex- tremely unpleasant withdrawal state characterized by in- creased salivation and runny nose, vomiting, diarrhea, colicky abdominal pains, generalized cramps, chills, in- creased sweating and a tendency to yawn- all coupled with exquisite mental anguish and an overwhelming and desperate desire to obtain the drug. So, too, precipitous withdrawal of high-dose long-term Valium treatment can result in fits, while considerable psychological malaise, inertia and severe sleep disturbance may also be experienced. Although not mentioned by the makers, the Food and Drug Administration (FDA), the watchdog organization that monitors and controls the manufacture and distribution of drugs in the United States, has stated that the other condition for physical depen- dence, namely tolerance, is also a characteristic of these drugs. (Tolerance refers to the situation in which increasingly large quantities of the drug are required to produce the same effect.) There is now evidence that diazepam tranquilizers are ex- tremely psychologically addictive and can often produce physical dependence as well. Very recent estimates have sug- gested that as many as 100,000 people in the United Kingdom alone are to some extent addicted to tranquilizing drugs. In fact, United Kingdom Department of Health figures show that 21 million minor tranquilizer prescriptions were written in 1983; a formidable figure in a nation of 55 million people. Although it may be true to say that some people are more 108 I The Myth of Neurosis of a withdrawal syndrome that would indicate that Valium can cause physiological dependence or addiction. (Depen- dence and addiction are terms that can be used interchange- ably.) This situation is said to occur when withdrawal of the drug precipitates a recognized withdrawal syndrome specific to the particular drug. The alcoholic withdrawal syndrome in its mildest form is the well-known hangover and in its most severe the state of delirium tremens. Sudden withdrawal from heroin ("cold turkey ,*) results after a few hours in an ex- tremely unpleasant withdrawal state characterized by in- creased salivation and runny nose, vomiting, diarrhea, colicky abdominal pains, generalized cramps, chills, in- creased sweating and a tendency to yawn- all coupled with exquisite mental anguish and an overwhelming and desperate desire to obtain the drug. So, too, precipitous withdrawal of high-dose long-term Valium treatment can result in fits, while considerable psychological malaise, inertia and severe sleep disturbance may also be experienced. Although not mentioned by the makers, the Food and Drug Administration (FDA), the watchdog organization that monitors and controls the manufacture and distribution of drugs in the United States, has stated that the other condition for physical depen- dence, namely tolerance, is also a characteristic of these drugs. (Tolerance refers to the situation in which increasingly large quantities of the drug are required to produce the same effect.) There is now evidence that diazepam tranquilizers are ex- tremely psychologically addictive and can often produce physical dependence as well. Very recent estimates have sug- gested that as many as 100,000 people in the United Kingdom alone are to some extent addicted to tranquilizing drugs. In fact, United Kingdom Department of Health figures show that 21 million minor tranquilizer prescriptions were written in 1983; a formidable figure in a nation of 55 million people. Although it may be true to say that some people are more 110 / The Myth of Neurosis with incalculable effects on his self-esteem and psychological health. And so what started out as an ersatz way of dealing with problems, an occasional quick trip to instant pleasure and relief, expands into a vast problem as we become en- slaved and debased by mind candy. The possibilities for psychological dependence on the ben- zodiazepine tranquilizers are just beginning to be realized, but as yet they are only hinted at in the psychiatric textbooks, which tend to emphasize the safety of these drugs while of course avoiding all reference to the implications for the user's self-respect. Drug company literature is also remiss in failing adequately to warn of their possibilities for abuse. Those en- lightened doctors who have realized that diazepam and the other benzodiazepines are intensely habit-forming have con- tributed to some reduction in their use since 1975, but the vast scale of the problem still to be solved is shown by the fact that in 1978, the FDA estimates, five billion of these tab- lets were swallowed in the U.S. alone. So worried did the FDA become that in July 1980 it circularized all physicians in the United States, instructing them not to prescribe these drugs for "everyday stress, and in future the manufacturers will include in their information to doctors a statement read- ing: "Anxiety or tension associated with the stress of every- day life usually does not require treatment with an anxiolytic drug 29 Of course, it remains up to the individual doctor to decide whether or not the patient is suffering from everyday stress or more unusual anxiety and tension. Moral Therapy feels that there is no place for these drugs in the case even of unusual anxiety and tension where that stress is not thought to repre- sent actual psychopathology. It may be that severe financial problems have arisen or possibly a divorce. Such stresses would not necessarily be described as everyday, but in the view of Moral Therapy they should not provide sufficient reason for the prescribing of these tranquilizers, for the rea- sons given above. Mind Candy: Bitter Pills for Anxiety 111 However, so high is the consumption of these drugs, it is more than clear that their use extends widely into that cate- gory of normal, natural anxiety that all of us do and should experience if we are living our lives to the fullest extent. Such anxiety is good, not bad; it is valuable, not harmful; it is a sure indication that we are striving to accomplish difficult ob- jectives, testing ourselves, being courageous rather than timid, being active rather than passive, living our lives rather than merely enduring them. Anxiety is the emotion that tells us we have selected an objective or course of action that will be difficult for us, and it is in the attempting or achiev- ing of such objectives that we alone can increase our self- respect. The absence of anxiety, on the other hand, indicates that our objectives are easily within our capabilities, that we are not stretching ourselves but merely coasting along, doing little or nothing that will give us cause to like ourselves more. The uses of anxiety Moral Therapy will seek to instill in the individual this positive view of anxiety, and will emphasize that not all things that are unpleasant are bad for us in the same way that not all things that are pleasant are good for us-_that what we need is not often what we want or desire. For lasting self-re- spect is assured only by facing and confronting anxiety and never by seeking to hide from it or attempting to abolish it artificially. Apart from its function of demonstrating to us that we are engaged in activities that are worthy of us, that provide a suit- able test of our courage, ability and resolve, anxiety can also occur as an accompaniment to feelings of guilt, as an early warning system that we are not behaving as we think we should. As with guilt feelings, we should take note of our anx- ieties and learn from them. We should try to act or cease to act in a way that removes the necessity for feeling anxious 112 The Myth of Neurosis rather than attempt to obliterate the anxiety itself. We are worried about money, so we should economize, work harder, try to take an evening job. We are anxious that we are not loved, so we should attempt to become more lovable. We fear that we may lose our jobs, so we should strive to make ourselves indispensable. The important thing about anxiety is that we take up the correct attitude towards it, and instead of wasting time, energy and effort in attempting to deal with the emotion itself we should concentrate on action to deal with the problems that have given rise to it. We have nothing to fear unless we begin to worry about anxiety itself. And this is the mistake that the Valium solution encour- ages us to make. We begin to focus on the anxiety itself as the cause of all our problems, arguing that if it were not for the anxiety all would be well. Our problem becomes that we are anxious and that anxiety becomes institutionalized as the stumbling block that impedes our progress. Those inadequa- cies and failures that are the root cause of the emotion rather than its result are ignored as we attempt to escape responsi bility for our predicament. For the emotion of anxiety can be thought of conveniently as an entity in itself that has sprung from nowhere to plague us. After all, anxious people have low exercise tolerance, low thresholds of pain and high levels of blood lactic acid after exercise stress- so perhaps anxiety is caused by an imbalance in physiology. Or is it passed on in the genes, as the fact that anxiety tends to run in families might suggest to some? Such comforting theories reinforce the fundamentally unhelpful idea that anxiety be treated as an unfortunate impediment thrust upon us through no fault of our own, to be obliterated by any means available to sci- ence. So we are encouraged to swallow the benzodiazepine tranquilizers and risk addiction in order to rid ourselves of an extremely useful if uncomfortable mechanism for preserving mental health. It is not the anxiety, but our attitude towards Mind Candy: Bitter Pills for Anxiety / 113 it, that is at fault. If we react towards it in a positive way it will serve us well. By dampening anxiety and slowing down the individual, these drugs help to ensure that he is less capable of the in- tense activity that is usually required for the solution of the problems that he faces. Paradoxically, by removing the symp- tom they help to prevent or delay any effective cure. Tired and sleepy, passive and tranquilized, we are in no shape to do the things that need to be done. We have to some extent shifted our responsibility to the doctor who has prescribed the pills and is now in charge of our "'condition 22 -is seeking to "cure" our "'nerves" with his biochemical skills. But deep down we know that we have opted out; have sought a tem- porary truce in a war that has still to be fought; have tried to walk away from life rather than participate in it; have paid the price of diminished self-respect for a transient respite. It seems difficult to imagine how continual recourse to these pills can fail to be a potent source of guilt and self-dis- like, and this alone should provide a powerful reason for avoiding them. It is no surprise to the practitioner of Moral highly active, the doers rather than the thinkers, often re- spond to the benzodiazepines by becoming increasingly anx- ious. This is because the most effective way of dealing with anxiety is by that very intense and carefully directed activity and physical movement that these drugs are so efficient at re- ducing. No wonder such people may react in a panicky way methods of dealing with anxiety. On the other hand, the pas- "'introvert sive, introverted dreamers and thinkers may find Valium very much to their liking. Eschewing hard physical activity, they may have found that all attempts to defeat anxiety by intel- lectual means alone have been a dismal failure. Much used to the role of spectator, of dispassionate observer of life, they are well suited to the type of mental and physical state that 114 The Myth of Neurosis tranquilizing drugs tend to produce. They do not mind being less capable of action, as where possible they have avoided it. They tend to be eager for a synthetic reduction of anxiety, as they have never learned how to benefit from it. However, they do remain powerfully aware that they had no solution before and they have not found it in the use of drugs. Their anxiety may have been dampened, but their overall mental condition has deteriorated. Self-healing and self-respect Avoiding such an unhelpful approach, our task must be to instill confidence and self-respect in the individual himself, and to avoid the elaboration of complicated and virtually meaningless maneuvers, be they biochemical or metapsycho- logical, whose purpose is to build faith in the skills of the ex- pert healer. For this is the politics of dependence, and dependence is the mortal enemy of the self-respect without which mental health cannot exist. Many of the medicobiologists fail to recognize this, and their patients, too, are unaware of the pitfalls involved in prostration before and subservience to the professional who owes his position to the exams he has passed, to the conven- tional wisdom to which he perhaps unthinkingly adheres. The patient trusts the doctor because he believes in the myth of the doctor's superior expertise in an area in which he pos- sesses none. In reality the doctor's specialized skills are con- fined to what he has learned during his medical training and in his subsequent practice of traditional medicine. He is qual- ified to recognize mental and physical illness, but he is not necessarily any better than the man in the street at living his life or advising others how to live theirs. Life is not learned from books. It is something we all have to make up as we go along, helped by the voice of our own conscience and relying on moral imperatives that we alone have freely developed, in Mind Candy: Bitter Pills for Anxiety / 115 response to our environment and heredity, to keep us on the straight and narrow path. We should rely on our conscience for advice -not on some well-meaning but ultimately unin- terested stranger, and where we need support in the difficult courses of action dictated to us by our moral codes it should be to friends and loved ones that we turn. Those doctors who pose as experts in the art of living, while dispensing the Val- um solution in the absence of proper indications for it, are as irresponsible as they are inept, lowering self-respect, man- ufacturing illness, peddling excuses, increasing guilt, under- mining our ability to withstand and benefit from stress. Unwittingly they help to create a situation in which their pa- tient is misguided and misled, investing his confidence in his doctor rather than in himself. The widespread overprescrib- ing of mind candy is its own accusation, evidence that the patient's confidence is doubly misplaced. Any success that the patient achieves while taking such drugs is invalidated by the very fact of their presence in his bloodstream, as all failures are excused by the "'illness" that the "'necessity for the prescription of these medicines im- plies. The very "requirement" for this treatment reinforces the patient's own low opinion of himself, and at the same time he becomes increasingly dependent upon the drugs for the small degree of alleviation they afford from the pain of low self-respect. He is then in a vicious double bind. He feels guilty that he has to rely on the tablets, and yet in the very short term the tablets help to lessen the feelings of guilt. The doctor, seeing no improvement, may feel it necessary to increase the dose and frequency, thus exacerbating the situation further. The end result is a patient who can function but who can never experience high self-respect and who can never wholeheart- edly like himself. Stuck permanently on the edge of the 46:111- ness mode, " he struggles on, incompetent and unsuccessful, resenting the achievements of others, obsessed by his own 116 The Myth of Neurosis failure. Taking the lead from his doctor, he pretends to the outside world that his predicament is no fault of his own, but rather of imbalances in his brain biochemistry, which drugs alone can alleviate. Pathological anxiety It is necessary, however, to distinguish between that nor- mal anxiety which is appropriate to the situation that causes it, however severe it may be, and the type of anxiety experi- ence that is completely out of all proportion to the stimulus that gives rise to it, or exists in the apparent absence of any cause at all. The first, as we have discussed, is useful to us in the same way that pain is useful. The second type of anxiety, although similar as an experi- ence, may have characteristics that, to the person trained in their recognition, may indicate that psychological illness exists. This second type we will call pathological anxiety. The difterence between normal, healthy, valuable anxiety and its pathological counterpart is not easy to define, but in the pathological variety the cause is often more obscure. Patho- logical anxiety can occur as a secondary phenomenon in a wide variety of physical and psychological illnesses. Insofar as we are unable in these situations to cure ourselves, the anx- iety we feel has no useful function for us. It does not exist as a spur to effective action but is the result of processes over which we have no control. Thus we may experience anxiety as part of the symptoms of genuine disease like a depressive illness, schizophrenia, obsessive-compulsive states, delirium and dementia. Physical illnesses, too, especially hyperthy- roidism and heart disease, often cause considerable anxiety. Having excluded physical and psychological illnesses that might be causes of secondary anxiety, or treated them if they exist, the physician must satisfy himself that the symptoms of anxiety with which he is confronted are not evidence of the Mind Candy: Bitter Pills for Anxiety / 117 existence of that psychiatric diagnostic category, the primary anxiety state. In its most classic form this refers to a chronic illness during which the individual suffers from clearly de- fined entities known as panic attacks. These may occur out of the blue or be precipitated by minor stress. In such an attack the victim will feel a sudden and overwhelming sense of fear, apprehension and panic often associated with intense feelings of impending doom. He may feel that things around him ap- pear strange (derealization) or that in some way his body is unreal (depersonalization). He shows the bodily signs of in- creased sympathetic nervous system stimulation, with in- creased heart rate, sweating, palpitations, dilated pupils and dry mouth. He trembles and breathes faster as he experiences a sensation of being smothered. By washing out carbon diox- ide from his lungs, he begins to suffer from the hyperventila- tion syndrome, which exacerbates his feelings of anxiety. He becomes pale and light-headed and feels that he is going to faint and he may feel tingling sensations in his extremities. Such attacks finish as dramatically and spontaneously as they begin. In the absence of any physical or other psychologi- cal condition, they are regarded as diagnostic of an anxiety state. The situation is somewhat complicated by the fact that anxiety, itself a psychological subjective state well described as "fear spread out thin, 99 is almost invariably accompanied by physical sensations that we know collectively as the ex- perience of tension. This intimate relationship between the mental component of apprehension and the accompanying bodily one of tension has led some to question the commonly held Cartesian "ghost in the machine" explanation in which mental events are held to antecede and to cause physical ones. They have speculated that our experience of anxiety may be nothing more than the contemplation of the physical events occurring within our bodies- -that anxiety is an awareness of our physiological processes rather than a cause 118 / The Myth of Neurosis of them. Whatever the philosophical truths are, the fact re- mains that in feelings of anxiety the psyche and the soma are more than usually closely interrelated. This leads us to the understandable phenomenon that gross hypochondriacal pre- occupations are one of the most characteristic features of a pathological anxiety state. Because the body feels odd, the pathologically anxious person comes to believe that it is in- deed odd, and so complains to the doctor of symptoms in those systems most affected by the release of catecholamine hormones that, according to your viewpoint, either cause, accompany or constitute the anxiety process itself. The symptoms of pathological anxiety The most common symptoms are those of palpitations of the heart, while tiredness, breathlessness and chest pain are frequently experienced. The anxious person may feel dizzy and faint and complain of difficulty in breathing. All these symptoms occur against a continuing background of nervous- ness and apprehension, the so-called free-floating anxiety, for which it is often difficult to pinpoint a sufficient and appro- priate cause. Since many of the symptoms are the same as those of cardiovascular disease and because the individual is searching for explanations for his psychological and physical discomfort, it is understandable that he begins to worry that something is wrong with his heart. The doctor may share his concern and will have to satisfy himself in the physical exam- ination, and, if thought necessary, by performing chest X-rays, an EKG, full blood count and cardiac enzyme assays, that it is psychopathology and not physical disease with which he is dealing. The gastrointestinal system is also much affected by the sympathomimetic amines released during anxiety states. The individual may complain of loss of appetite, of a sinking feel- ing in the stomach, and of nausea. He may vomit and have di- Mind Candy: Bitter Pills for Anxiety 119 arrhea. In the central nervous system, headaches, paresthesia, trembling and shakiness are the most complained of symp- toms and signs. The feeling of tension often manifests itself as generalized or localized muscular aches and pains, and in particular chronic backache can probably be caused by, and is certainly exacerbated by, pathological anxiety. In summary so far, the existence of panic attacks should alert the physician to the near certainty that pathological anxiety exists, while gross hypochondriacal preoccupa- tions that severely hamper the individual's normal func- tioning, with or without marked physical disturbances, should also be regarded as an important indication of patho- logical anxiety. The existence of phobias, intense unreasonable fears of en- tities and situations that the vast majority of people would find unworthy of provoking such emotions and which lead to a considerable interference with the ability to lead an every- day normal life, is always indicative of psychopathology. Such phobias may be directed towards specific items such as cats or dogs or be more generalized, as fear of enclosed spaces (claustrophobia) or of large, public places (agora- phobia). In agoraphobia, women may experience acute at- tacks of panic on leaving their homes and entering such places as supermarkets, to the extent that they are effectively housebound and unwilling to go out at all. Such a debilitating phobia requires immediate psychiatric intervention. In other instances the borderline between idiosyncratic dislike of heights, of spiders, of flying in airplanes, etc., and pathologi- cal phobic anxiety states may not be so clear, but in each case the appropriateness of the reaction, gauged by the extent to which it is generally experienced and can be explained as a relatively reasoned response to a genuinely threatening stim- ulus, together with the extent to which it hampers and hin- ders our ability to lead normal and satisfactory lives, should 120 / The Myth of Neurosis provide sufficient information to enable the doctor to identify psychopathology where it exists. In these cases, then, of primary or secondary anxiety, it might well be necessary for the physician to prescribe some type of anti-anxiety drug, such as the benzodiazepine tran- quilizers. Such anxiety has no value for the individual, since it does not signify any contravention of his own moral code. It is through no fault of his own that he knows the pain of such anxiety, and there is little he can do to remove it. It is intoler- able, impeding rather than encouraging action, and reducing ability to function. Its biochemical removal will carry no negative implications for self-respect, and it would be mis- guided to allow the sufferer to struggle on in a battle in which he has little hope of winning or of acquitting himself with honor. Conversation opened. 1 read message. Skip to content Using Gmail with screen readers wood neurosis 2 of 25 Wood neurosis 171 kac attac Wed, Apr 10, 3:58 PM (11 days ago) to Stefan 8 The Therapeutic Friendship No experts in the art of living In this chapter I shall argue that in the field of helping others to help themselves there are no experts. In the absence of illness we all can, and should, be practitioners of Moral Therapy. We can practice it on ourselves and on others. We need possess no formal skills or qualifications except our common sense and our experience of life, and our capacity for empathy will be of infinitely more importance than a su- perior intelligence or a knowledge of psychology. We must all prepare ourselves to take back the role that the talk therapists have so recently hijacked, that doctors are so un- willing and often poorly qualified to fulfill. In our efforts to help others we should always avoid the hi- erarchical approach, refusing to pose as an expert who is in a position to dispense wisdom and "know-how 22 to somebody who does not possess it. We should never attempt to hide the persona of our private lives and should reject any spurious authority that the role of "helper" might seem to imply. We should react naturally as a person rather than as a protes- sional, when being approached by someone in trouble. A doctor, for example, should be keenly aware that he has no 121 122 The Myth of Neurosis superior knowledge of how life should be lived by virtue of his position. He cannot lay down the law and pretend that in some way he is more qualified to understand the complexities of human thought and behavior than anyone else. Certainly in the medical training no secret boxes are unlocked in this respect, otherwise we might expect doctors, psychiatrists, psychotherapists and others of that ilk to be conspicuously more successful at life than others, whereas there is, of course, no evidence to suggest that this is so. Instead, when we are approached by someone in trouble, we should remem- ber that at another time, in another place, we may experi- ence similar difficulties, and our attitudes and reactions should reflect this possibility. In contrast to the well-meaning questions of the doctor concerning the mood and spirits of his patient, the practi- tioner of the principles of Moral Therapy will seek to deduce them from more general conversation and empathic observa- tion of behavior in situations unconfined to the unpromising atmosphere of consulting rooms. Unlike the psychoanalyst, whose approach to the patient's emotional life is through such pseudoscientific methods as the interpretation of dreams and word-association games, we should rely on the institution of friendship to provide us with knowledge about the individ- ual we wish to help. For that is the natural way to get to know somebody. We must be prepared to reveal our own personalities, to give as well as to take. The "experts" and the professionals, 29 as one might expect, shrink from such an ap- proach, preferring to hide behind the mask of their expertise. But why should we expose our innermost feelings to an aloof 66 professional," who has given us no concrete indications that he really cares about us? So we should emphasize the equality of our relationship with an individual in trouble, while recognizing that in terms of contentedness our present position may be in contrast to his. If we wish to draw him out, it may well be that we should The Therapeutic Friendship 123 start by admitting our own insecurities and weaknesses. By equalizing the level of our interaction, we increase his confi- dence in us and restore his compromised self-respect some- what by showing him that his problems may be not dissimilar to our own. If we are to help another person we must know his prob- lems, and understand his felt shortcomings. We must discover the person he truly feels he should be, lay bare his moral code. To do that we need to gather information about him, and to ignore the disinformation that it may be part of his un- happy predicament constantly to provide. To get that accu- rate information we must above all gain his confidence. There is no quicker way to do this than to exhibit a genuine willingness to act as a human being rather than an expert. With our friends we are not afraid to express our own views, to disagree, to praise, to give advice and to receive it, to gather information and to dispense it. So it must be in any therapeutic relationship that can have lasting results in terms of increased self-respect. If we are to expect reciprocity we must be prepared to talk of our own self-image, guilt and moral imperatives. We must not be afraid to express opinions about ourselves, our own ideas, hopes and aspirations, al- though such revelations may not be enjoyable for us. To do otherwise would be to impose on the relationship an artifici- ality which Moral Therapy seeks to destroy. Nor should it be thought that the process of learning about another's problems and attitudes need of necessity be a har- rowing experience; laughter and jokes should be more usual than tantrums and tears. This is because the wise friend does not concentrate on the analysis of problems to the exclusion of a wider interest in all aspects of the individual's life. By searching for another's strengths and emphasizing them, we will contribute to the rehabilitation of self-respect. When gathering information we should not concentrate on the neg- 124/ The Myth of Neurosis ative aspects of the case to the exclusion of the positive ones, and in the search for the firm foundations on which self-re- spect can be rebuilt and guilt diminished, the individual's virtues must never be overlooked. Many of the medicobiologists and the more rigid of the psychodynamists would shrink from this friendship model, preferring to believe that the job of helping others to lead more fruitful lives is an exact science rather than an uncer- tain art. The here and now is of interest to them chiefly inso- far as it can provide information about antecedent causal processes in which they believe the key to successful treat- ment lies. The psychodynamist takes the immediate information and uses it to sketch fantastical scenarios stretching back deep into the past, which have the advantage that, if false, they can never be proved to be so. The medicobiologist attempts to explain the same state of affairs by referring to partially understood theories in the field of brain biochemistry, whose one constant feature is the rapidity and frequency with which they are continually dis- proved or revised in the face of a steady and unrelenting flow of new information. The Moral Therapist shares none of these preoccupations, preferring to think of people as unpredictable friends with minds of their own rather than as complex pieces of com- puter machinery programmed by external phenomena, as the psychodynamists think, or by random internal brain events, as the medicobiologists would have had us believe. To think of humans as machines is anathema to the Moral Therapist, who repudiates all intellectualizations and factual analysis as being irrelevant to the therapeutic process where they are not positively harmful. His interest in the information produced The Therapeutic Friendship 125 by the individual is not so much in its content, but in the way it is freely exchanged, which is an integral part in the build- ing of just that kind of successful relationship that is so vital to the proper working of the therapy. We tell our friends about ourselves and they give us infor- mation about themselves in return. It is a two-way street of give and take. The actual information is of subsidiary impor- tance, but what is vital for the construction of a good friend- ship is the style, manner and generosity with which it is offered and received. Return to common sense So the Moral Therapist learns about the individual not in the way that a scientist learns about the eating habits of labo- ratory mice or the pipe-smoking sage solves the clues to a so- phisticated crossword puzzle, but rather in the way that we learn about the next-door neighbor over the garden fence. He throws off the protective cloak of pseudoscientific expertise. Instead he chooses to be a person first and last, realizing that the greater his descent into impersonality the greater will be his failure in the field of helping others to help themselves. The main weapon in his armory will be that most neglected and underrated but valuable commodity, common sense, and the experience on which he draws will be the totality of his life's experience rather than the narrow, unverifiable and philosophically unsound mumbo-jumbo of the metapsycholo- gical system builders such as Freud. Friendship is then the model for Moral Therapy. It is per- formed in the home, in the street, at the football game, in the pub. There is no place, in the absence of psychological illness, for the stereotyped confrontations in consulting rooms whose occult purpose is to ritualize as far as possible the relation- ship, enabling the doctor or psychologist to retreat behind the paraphernalia of his professional environment and ma- 126 The Myth of Neurosis nipulate the "patient" so that all risks to himself and his pri- vacy are strictly minimized. Such subterfuges are clandestine methods of avoiding commitment. The risk to the doctor of such a commitment is that he will have great demands made on his time, and considerable calls made on his sympathy and patience. By avoiding commitment and involvement he avoids such risks. Unfortunately he avoids, too, the rewards of such a policy-namely, the trust and confidence of the indi- vidual, not in the doctor's superior wisdom as an expert but in his warmth and constancy as a human being. That faith is vital as a provider of the strength and support that will be required on the difficult path ahead when the individual breaks free from traditional landmarks and embarks on the rigorous journey towards increased self-respect. Without it there can be no progress. Over the years we have become used to the "patient" role and have colluded with the "'mind experts" in their ceaseless search to expand their fiefdoms, to increase the scope of diagnostic categories so that those who are well can be treated and regarded as if they are "ill." We do not expect, are perhaps faintly uneasy with, anything other than the hier- archical role in relation to the healer. Patients have to do lit- tle and there is a certain comfort in the passivity of their position. A "good" patient obeys his doctor and puts himself in his hands. He asks few questions and does not argue. His faith in science and in any of the mysterious ritualistic proce- dures the doctor might employ, such as listening with a stethoscope to heart and lungs, or the word-association games of the analysts, heighten his suggestibility and make him more malleable. He is thus more susceptible to "reassur- ance, " and certainly for the time he is in the consulting room, and perhaps for some short time afterwards, he may feel an increased self-confidence as he is told by such an august fig- ure that his fears are misplaced and his doubts unfounded. The doctor, too, is secure in this role. His privacy is protected The Therapeutic Friendship 127 and he can control the direction, length and content of the interview. In one sense he is totally in command, in another he may feel his impotence. The hierarchical situation allows him to conjure up atti- tudes from the patient, such as gratitude and transient bon- homie, that allow him to feel that he has done some good. By keeping his distance he retains his authority and power to do things to the patient; by failing to get close he loses his ability to help the patient to do things for himself. To the practi- tioner of Moral Therapy, for the individual to be grateful or subservient is not an encouraging sign. The more accurate and helpful view is that, in the sur- mounting of our difficulties, we ourselves are the architects of our own recovery, and the Moral Therapist has merely done what any concerned and trusted friend could be expected to do in the same situation. The respect that he may be afforded is not that of an inferior for a superior but of an equal for an equal. Some enlightened doctors subscribe to this view, but many more take effusive letters of thanks ("I could never have done it without you") as the highest compliment to their professional skills rather than as statements of depend- ency indicative of low self-respect. Moral Therapy then rejects the expert-layman approach, both because it does not work and because it is based on a misconception. The misconception is that some people are experts at living by virtue of their scientific training and that this knowledge can be imparted in a way analogous to the tablets being handed down from the mountain. In fact there are as many successful ways of living as there are lives to be lived, and all that can be done is to encourage others to live full and courageous lives within the framework that they have made for themselves. Each style of life is an original work of art and any attempt to redirect it externally is an assault on the individual's crea- 128 / The Myth of Neurosis tivity, on which his self-respect ultimately depends. The hier- archical approach does not work because it tends to diminish the self-respect of the person. It is so prevalent because its correlate is an increase in the self-respect of the doctor who takes on the problems and responsibilities of the individual and deals with them for him, thus demonstrating to him- self and the 66 patient" his greater capability and strength. He is trained to take on this role and it comes easily to him. He is good at it and enjoys it. It would be better if he were prepared to forgo the pleasures of problem- solving, decision-making and responsibility-taking and help his patient to experience the successful and rewarding confrontation of difficulty. By mere reassurance he will in effect deny his patient's problem, and will end by reassur- ing nobody but himself, for the patient will not be convinced that his problem is insignificant if it was sufficiently real for him to ask for help in the first place. The doctor may see it as his task to instill confidence into the patient, but mere words, even from powerful authorities, cannot accomplish this. Only he and he alone can increase his confidence by his own et- forts. Conditions of the bond In Moral Therapy, then, friendship is the model for the re- lationship between helper and helped. It should, however, be realized that all friendships are a form of unwritten contract. As with a contract, friends enter into a usually unspoken agreement that they will in future react towards each other in certain generally specified ways. They will be pleased to see each other; they will support each other when either is threatened; they will be available for discussions; they will publicly admit their friendship; they will have each other's best interests at heart; they will attempt to share each other's joy and sorrow; above all, they will be predictable and loyal The Therapeutic Friendship 129 within the confines of the friendship. As with contracts, there may be, apart from the general conditions, some more spe- cialized ones in which, for example, one party to the agree- ment contracts to provide a particular service in exchange for the other's providing a different one. It may be, for instance, that one uses the other as a semi- permanent shoulder to cry on in return for continual testimo- nials as to their wisdom, stability and sensitivity. Clearly there are as many types of friendship as there are friends, but the unwritten contract, while always different in substance, will nevertheless be similar in form. Often contractual obli- gations will be broken, in which case sanctions and penalties will be invoked. Your failure to seem pleased to see me may result in my being less available to you on the tele- phone. My seeming to be depressed by your success may lead to your being unkind about me behind my back. The contract of friendship is, then, a continually evolving phenomenon and the clauses are being continually rewritten and redefined. Occasionally the ultimate sanction is applied because of some particularly damaging breach and the con- tract is torn up and the friendship ended. More often the contract is renegotiated and on these occasions our friendship becomes stressed but ultimately recovers. I have elaborated this point to emphasize that friendship is never unconditional or it becomes slavery. It is just that the conditions are often so subtle that they are not understood even by those taking part in the friendship. That they are often unrecognized, unspoken and unack- nowledged does not mean that they are not there. In certain cases, however, old friends may be ill-equipped to help, owing in part to their attitudes, and in part to those of the person in trouble. Insecure and with low self-respect, he may find the company of others, and particularly of old friends, a considerable strain. In his debilitated state he feels he cannot adequately fulfill his part of the contract of friendship and 130 The Myth of Neurosis provide the liveliness and interest in their problems that friends so often demand. He does not want them to see him when he is "down" and the contrast between his depressed and anxious state and their continued cheerfulness may make him feel worse. He may even blame them for his predica- ment, resenting the fact that his low mood and pessimistic attitude have made his friends avoid him. For it is one of our most fundamental desires to be loved deeply for ourselves alone despite anything we may do or say, and we tend to ig- nore the fact that such unconditional and unquestioning ado- ration is as rare as it is valueless. Thus we may come to resent our friends for their understandable reactions to our persis- tent misery and may seek to change them when we should rather be attempting to change ourselves. Friends, too, may give us poor advice at such times. En- couraged by traditional attitudes, they may try to reassure us by belittling and denying what we ourselves know to be a very unpleasant situation. "Don't worry and "There iS nothing wrong with you" are respectively an optimistic com- mand that has little likelihood or possibility of being obeyed, and a misdiagnosis whose inaccuracy is painfully obvious to the sufferer. He does not want his situation denied but rather admitted and alleviated, and he can have little confidence in those who show by their well-intentioned but misguided re- marks that they are not really aware of the full extent of his suffering. But there is another insidious factor at work tending to put distance between ourselves and our friends. Fundamental to our predicament is our lowered self-respect, which may at times amount to an almost total self-loathing. Because we like ourselves so little it becomes increasingly difficult for us to believe that others do not share our view. If they appear to be fond of us they must be either stupid or weak and there- fore unworthy of our respect and admiration. Another possi- The Therapeutic Friendship 131 bility is that they are merely pretending to like us. Thus, paradoxically, when our need for friendship is at its greatest we may feel that anybody who would befriend us is not wor- thy of our friendship. In these conditions of lowered self-re- spect, old friends may become suspect while new ones are impossible to obtain. At times like this the requirement may be for the intervention of the concerned stranger rather than the old friend, and paradoxically the troubled individual may feel able to reveal himself more fully to such a person than to all but the very best and enlightened of friends. The role of clergy The ideal person to take on this role is the very person to whom until relatively recently it belonged. The priest, pastor or rabbi is well placed to step into the vacuum that may have been created by that unlikability that flows from a severely compromised self-respect. As a newcomer to our lives, he is free from the prejudices which friends may have. Solely in- terested in our well-being, he will not be in the business of competing with us, as so many friends are. Interested in helping us, he will not demand in exchange for his interest and concern any commodity that we, in our straitened emo- tional circumstances, may be poorly placed to provide. Firm in his own convictions and with a clearly defined sense of right and wrong, he can serve as an excellent example, a liv- ing testimonial to the positive value of ethical structure, to the importance for self-respect of obedience to the dictates of a strong and well-developed conscience. The very newness of such a relationship ensures that he will be free of the preconceived ideas and misapprehensions that the individual may feel characterize the attitudes of his friends. Above all, he will not recoil from allowing himself to feel for us and with us and from demonstrating that warmth of humanity which so frequently characterizes those who 132 The Myth of Neurosis have dedicated their lives to service with little thought or chance of material gain. Relating to us as a concerned but se- cure human being rather than as a cold, distant "'expert; he is far better placed to provide the support and advice that we may need as we fight our own battles. So, too, the articles of his faith, rather than standing in the way of a greater under. standing of the individual's predicament, do in fact shed con- siderable light upon it. For Moral Therapy upholds that the root cause of unhappiness in this life is the failure to closely observe our own acknowledged moral commitments that, at the end of the day, it is badness, defined as the contraven- tion of our own conscience, that makes us miserable through the mechanism of guilt. Conversely it is goodness, defined as the close adherence to our own moral imperatives, that is the basis of a happy and mentally healthy life. Insofar as mental health is prejudiced when we continue endlessly to do the things that we ourselves consider to be bad and wrong and conversely is strengthened when we strive mightily to do that which we earnestly believe to be good, the connection between morals and mental health is much closer than it has been fashionable to believe in recent times. Today it is a revolutionary concept to advance the the- ory that there is an element of "badness" in the lack of suc- cess in life which has been characterized misleadingly as "neurosis. "" But it will help no one to deny that unsatisfactory behavior, actions held to be unworthy by the individual him- self, are, in the absence of diagnosed psychiatric illness, indic- ative of moral bankruptcy and therefore worthy of blame. Only an awareness and acceptance of this unpalatable truth can help us to find the right way forward. To the extent that there is a continuum between felt worthlessness, lowered self-respect and the psychological pain of the guilt feelings that accompany it, and actual mental ill- ness of the affective typei.e., anxiety states and depressive illness- -there is a closer connection between psychological The Therapeutic Friendship 133 illness and immoral behavior than has for a long time been suspected. As the natural guardian of a particular type of morality, the religious practitioner may be far closer to a proper un- derstanding of the root cause of psychological pain than the pundits of psychodynamism and its related creeds would have us believe. We have seen how in the form and style of his approach the priest and pastor has a distinct advantage over the distant professional. I would argue that in terms of the content of his philosophical method he is no less superior, providing good practical advice and avoiding the attempted "explanation" of our predicament in terms of outmoded, outdated and unproved theories. Nor should it be thought that religious belief is necessary for such a person to be approached. It will not be demanded of the individual either that he believe or become a believer. But in fact he would do well to consider seriously the ethical codes laid down by the great religions. Tested through the years and usually coinciding closely with the moral codes of the vast majority of the society in which the particular reli- gion is widely practiced, religious canons may well provide the life belt that allows the troubled individual to learn to swim. They may provide him with the ready codified frame- work with which he can rebuild the structure of his life, re- create the ethical guidelines without which the way forward is always obscure. So we should remember that there are those who will help us and demand little for their help. They are accessible and easy to meet, requiring no introduction, no letter of referral. Friends, as we all know, are difficult to make and people are surprisingly difficult to meet. It takes effort and skill, time and a degree of psychological health, to make a friend in the ordinary way. Most of the time we take such attributes for granted, only realizing their value when we seem no longer to possess them. However, the priest or pastor can be ap- 134 / The Myth of Neurosis proached easily, requiring as introduction nothing more than the individual's failure to deal adequately with the problems of life. Thus the very characteristics that tend to preclude one from making new friends and keeping old ones are the means of obtaining the benefits of such a therapeutic friend- ship. 9 The Goodness of Guilt: The Road to Self-Respect What Moral Therapy requires It should be clear by now that Moral Therapy is more in- terested in action than in talk. But before embarking on a course of activity to increase self-respect, or to help another person to do so, we should understand the extent and quality of our own guilt feelings and those of others. We will dis- cover the particular ways in which self-respect is compro- mised, seek out the nature of uniquely individual ambitions and longings. To do so, in every instance, we must first lay bare the moral code and uncover the areas in which it is being contravened. We must learn about the sort of person we feel we should be, come to an awareness of the moral im- peratives of others. Only with this information can a proper plan of action be constructed. Whether we are dealing with ourselves or with others, we should not forget that this is a process of pure discovery, never of imposition or fabrication. Never must we try to force any set rules onto either a willing or an unwilling recipient. What matters is the individual's own morals- -for it is the dictates of his own conscience, not anybody else's, that he disobeys at his peril. This is no difficult process, because the information is read- 135 136 The Myth of Neurosis ily available. We know only too well what makes us feel guilty, of what actions or lack of them we feel ashamed; of how pleased or displeased we are with our progress; how much we like or dislike ourselves. We know intuitively what decreases or increases our self-respect. In any one situation we have a shrewd idea of how we ought to behave, and gen- uine conflicts concerning the rightness or wrongness of possi- ble courses of action are few. In those situations where our moral imperatives seem to be demanding different responses from us, one command will nearly always be stronger than another. There will, as it were, be a hierarchy of moral im- peratives. So although we are often unwilling to admit them to others and quick to deny them in public, we are almost in- variably aware of our shortcomings and of the ways in which we are contravening our personal morality, of the difference between good and bad. It does not require sophisticated intellectual skills to per- suade another to part with this information, the better to po- sition ourselves to help him. Far more important than the analytic powers of the "expert" talk therapist will be the qualities of warmth and friendliness and the degree to which we have obtained the confidence of the person we are trying to help. Given sufficient trust, it will not be too difficult to expose our secrets to another, and in our analysis of our own predicament we will not usually be mistaken. This is of course in direct opposition to, for example, the Freudian approach, in which the process of psychoanalysis constitutes a long, exhaustive, in-depth examination of the "patient's" mind, requiring "'skills" which can only be ac- quired during a lengthy and expensive training and which prefers, even demands, that the relationship between analyst and analyzed be as distant and impersonal as possible. It is different, too, from the attitude of the medicobiologist, who will tend to see his function as being to encourage his patient to air his problems in the pious hope that in the very The Goodness of Guilt: The Road to Self-Respect 137 act of doing so he will to some extent alleviate them. Having achieved this, he may use the information acquired to deter- mine whether or not some symptomatic relief from current problems may be provided by a chemotherapeutic reorgani- zation of his patient's brain biochemistry. Unable and unwill- ing to intervene in his patient's life in a more effective way, he produces his tablets, bland reassurance and sympathetic ear, hoping that such panaceas will tide the patient over until time and changed circumstances can effect a more perma- nent "cure." In Moral Therapy, it is not considered a complicated pro- cess to discover what is going on in people's minds, what is worrying them, what they desire, of what their ambitions consist. If the relationship is right, our friends will tell us their problems. It is only when we attempt an altogether more ambitious project and try to discover why we are the way we are that the waters become muddied and the difficulties begin. For we cannot know for certain what chain of events has made us embrace a particular system of morals or why we feel the need to be a certain type of person. A thousand wise men could produce a thousand different explanations to account for our present situation and none could be convincingly confirmed or refuted, as each would have analyzed the same "evidence to reach their disparate conclusions. The Freud- ians, however, do not shrink from such a daunting task, fail- ing to realize that it must be an impossible one, as their he- roic speculations can never be conclusively verified. For the minds of others can never be known directly but only inferred from the overt evidence of activity and speech. We use analogy to predict the nature of postulated underly- ing psychological events and analogy is an extremely inexact tool, relying as it does on the unverifiable presupposition that the phenomena being compared are similar in all important respects. It is, then, conceit to imagine that another human 138 The Myth of Neurosis being can be understood or explained in this way, and a hopeless quest to attempt to unravel the mysterious causal processes and past events that have conspired to produce the status quo. Such a formidable task would be as valueless as it would be impractical and time-consuming. Instead we should discourage all such speculative theorizing and resist any at- tempt at intellectualization and pseudosophisticated expla- nations of behavior and feelings, concentrating rather on a straightforward commonsense analysis of the problems at hand, so that we can move on to the more useful task of helping the individual bravely to confront his problems, and of facing up to our own. Problem-solving and self-respect Unlike the psychoanalyst, who feels that his job is largely completed once the subterranean processes of the psyche have been exposed and analyzed, the concerned friend, hav- ing apprised himself of the problems, has his major work ahead. He helps elucidate problems so that the individual can increase his self-respect by solving them, whereas the psycho- analysts and to some extent the medicobiologists subscribe to the view that the production of information by their patients is positively therapeutic in itself, and that the very identifi- cation of problems and their verbal admission constitutes the most significant factor in their solution. The practitioner of Moral Therapy, however, will regard the information-gath- ering process merely as a necessary prelude to that strenuous activity on his own behalf that alone will increase the indi- vidual's liking for himself. It will be the present to which the enlightened friend will address himself, and on its implications for the future that he will concentrate. He will discover how the individual sees himself and his problems and will use what he learns to plan future activities. Offering no theories and explanations, he The Goodness of Guilt: The Road to Self-Respect / 139 will encourage the individual to talk freely of his dreams and schemes, of his desires and difficulties, of his guilts and fears, and as he does so the areas in which he fails to measure up to his own expectations, thereby prejudicing his self-respect, will emerge. This pinpointing of the activities or lack of activities that make us feel guilty and diminish our self-respect is the fun- damental task of Moral Therapy. The concentration on the here and now coupled with a lack of interest in the events of the past frees both parties from the need for sterile and un- verifiable theorizing about the relative significance of dimly remembered events. All energies can then be channeled into the more productive process of solving current problems once they have been identified, rather than in the manufac- ture of academic and usually inaccurate hypotheses as to their causation. It may well be that the individual is little prepared for such a novel emphasis. The prevailing climate has ensured that most people expect a prolonged walk down memory lane to be the main feature in their relationship with an "'eX- pert" therapist. Certainly they would not be disappointed by the Freudians in this respect. Similarly the employer of the medicobiological approach will often start by taking a care- ful history in order that he may come to "'understand" the "sort of person with whom he is dealing. Both will tend to view the present state of the patient as a form of conditioned response to past events for which the individual is only mar- ginally responsible, and to the extent that it is largely prede- termined it will be of subsidiary interest to them. Eager to play the game, the individual may produce long lists of unfor- tunate events in his past that in his view have helped to cause his present predicament. He will present them proudly, se- cure in the knowledge that this is the very sort of thing that is expected of him. He may be unprepared for the studied un- interest with which the wise friend practicing the principles 140 The Myth of Neurosis put forward in this book will greet such unwelcome offerings. it is instead to the present and the future that such a person looks. It may be that both the psychodynamists and the medico- biologists fail to realize the profound pessimism implied in their approaches. Believing themselves to be scientists en- gaged in unraveling the "laws of human nature, 22 they choose to ignore the infinite possibilities of the human spirit. A genu- inely optimistic attitude on the part of a concerned and forceful friend may be all that is required to start the process that can turn the habitual failure into the habitual success, and so we should refuse to retread endlessly the battlefields of past defeats but instead concentrate on preparing the present ground for future victories. Others may emphasize their greater realism, maintaining that a careful analysis of the past is the correct way to under- stand the possibilities of the future and that it would be un- wise to hope for too much in situations where such an analysis indicates that the prognosis is poor. But without such hope we are condemned to certain failure, whereas the ap- plication of an enthusiastic optimism may be the one factor that alone is capable of turning the tide. In Moral Therapy, then, every day will be considered an opportunity for a new beginning, while every yesterday will be consigned without ceremony to the scrap heap of history. We should dismiss the past both because it has no significant message for the future, and because if it did, it would be wiser and more profitable to ignore it. Respecting another's values As we uncover the individual's ambitions and expose his ethics in order that we can help him to be more true to him- self, we should ignore the question of how he came to acquire The Goodness of Guilt: The Road to Self-Respect 141 this rather than another set of values; of whether or not such values correspond to those of the therapist; of whether or not such a value is "right" for that particular person. Always the attempt will be made to help the individual to make the best use of the heritage that he has, so that he can be more true to it, rather than to try to recreate his whole life de novo. It will not be the response of the wise friend, when asked to point the way forward, that he would not have started from here. Instead he will seek to discover the hidden advan- tages of setting out from that ostensibly unpromising start- ing point. It is the view of Moral Therapy that the individual's moral code and guilt system are developed early in life, shaped and directed by parental influences and those of the environment, and are constantly reinforced throughout the years. We are attached to them emotionally, and although in theory they can be changed with extreme difficulty, in practice this is neither feasible nor necessary. Thus the individual will never be asked to exchange one set of values for another, but rather will be shown how to use the value system that he has to greater advantage. He will never be told that he should not feel guilty but instead will be shown that he must cease the actions that give rise to that guilt; he will not be exhorted to redirect his ambitions and find new goals, but will be en- couraged to strive more mightily and effectively towards old ones. So Moral Therapy rejects the overambitious approach in which nothing less than the total reeducation of the individ- ual is attempted, in favor of a more conservative and realistic one. For why should a person who was unable to measure up to his old expectations be more likely to measure up to the new. The only way forward is for the individual to experi- ence success on the road that he himself has chosen. He must learn to deal with the person he is and the problems he has before he can become the person he feels he should be. The 142 The Myth of Neurosis processes of laying bare the moral code, of understanding the ways in which self-respect is diminished and of analyzing the nature and full extent of the individual's guilt feelings are to a large extent interdependent. Thus an understanding of the actions and thoughts that give rise to feelings of guilt will provide the surest signpost to the individual's ethical system and the areas in which his self-respect is threatened. There should be no great difficulty in obtaining this in- formation if the relationship between friend and troubled individual is the correct one, but there are several specific methods that can be used to simplify the task. These are not Machiavellian schemes for extracting information against the individual's will. Instead they comply closely with the un- written conventions that we all use when getting to know somebody. Good manners ensure that when we want to find out the opinions of others in sensitive areas we forsake the direct, frontal approach in favor of a more oblique one. Many peo- ple find it difficult to unburden themselves of their problems in front of others. So damaging and unpleasant for them are their feelings of guilt and self-loathing that they tend to deny them in an effort to shore up their compromised self-respect. They fear that if anyone else is allowed to see how much they dislike themselves, that person might all too readily come to share their opinion. Words, however, are only one form of communication between people and are often intention- ally misleading, as so many of us use conversation not to im- part the truth as we see it but to implant in the minds of others the thoughts and attitudes that we would like them to have. Actions are rather harder to fake. The protestation that an individual is happy and glad is contradicted by his miserable demeanor, sagging shoulders and general lack of interest and energy. We should not ignore these bodily manifestations of The Goodness of Guilt: The Road to Self-Respect / 143 mood and not allow mere talk to form the basis of the analy- sis of an individual's predicament. Similarly, lack of self- respect will show itself more readily in general conversation than in a direct question-and-answer interchange. Ask such individuals if they respect themselves and they must say that they do, so wary are they of revealing their weakness, and yet in ordinary conversation and in all their actions their low opinion of themselves may be all too obvious as ceaselessly they recoil from postulated future actions that they insist are beyond their capabilities and skills. The individual's moral code, too, will be best revealed in- directly. A straightforward request that he expose it is more likely to reveal an ethical system that he feels might be ac- ceptable to us and to conventional morality rather than the one that in reality he disobeys at his peril. He will be less in- clined to dissemble when discussing general topics which on the surface appear to have little relevance to his personal problems. His view of what is right and wrong will emerge very clearly, for instance, in discussions about politics, eco- nomics, art, history and sexual matters. The books he reads and the television programs he watches and the attitudes he has towards characters in films and the theater will provide a far surer indication of his real feelings than can be revealed by the straightforward inquisitive approach. Similarly the identification of the sort of people and their attributes that the individual admires and respects is a far surer method of discovering his ambitions and longings than asking him directly. Use can also be made of a person's day- dreams and fantasies for, however unrealistic they may be, they will often provide a useful signpost to the direction in which self-respect is likely to be found. Such imaginings are often the clearest statements of at once people's wildest hopes and their most fundamental inadequacies and yet, knowing as they do that they are fantastical and therefore un- likely to be taken seriously, they can produce them freely and 144 / The Myth of Neurosis easily in the atmosphere of jocularity that they can expect them to occasion. In practicing the principles of Moral Ther- apy with our friends and loved ones we will never foist our own values on the person we are trying to help. Approaching the relationship with no preconceived ideas, the concerned friend will be genuinely interested in discov- ering that person's moral code, however bizarre and dis- similar to his own. His job is not to change the code but to help to change the individual's behavior until it is in ac- cord with that individual's ethical value system, whatever that system may be. The friend's dilemma It is important to be clear as to the implications of this. First, in unusual situations it may be necessary for us to en- courage behavior that is directly contrary to conventional theories of morality and diametrically opposed to our own personal morality. For once we are convinced that another person firmly believes that he ought to embark on a certain course of action, we are bound to support that action if it is our primary concern to help him to avoid psychological pain. Moral Therapy maintains tht mental health cannot long sur- vive the continued contravention of one's personal morality, and its practitioners' prior consideration should be to act as the guardian of an individual's mental health rather than of the standards and rules of society. Let us consider a difficult example that clarifies this point. An individual is deeply devoted to a political cause. Further he believes passionately that violence is both justified and necessary as a method of achieving his political objectives. He calls himself a freedom fighter, while the majority, who fail to share his ambitions, believe him to be a terrorist. All Agree that he is an idealist although most believe his ideals to be misplaced and, according to their morality, his use of vio- The Goodness of Guilt: The Road to Self-Respect / 145 lence to be deeply wrong. In this hypothetical case it is agreed by all that his moral commands insist that he fight bravely and strenuously against his perceived enemy. Insofar as he fails to do this he must experience guilt and his self- respect must decline. Insofar as he courageously attempts to act as his conscience demands, his self-respect must increase. In this situation the practitioner of Moral Therapy, whose own code may, indeed usually will, disallow violence for political ends, would have to admit that this particular in- dividual would best preserve his personal psychological equi- librium by engaging in those violent activities in which he so passionately believes. For the hero of the French Resistance it would have been inimical to self-respect to shrink from killing Germans. I have examined this rather harrowing example to empha- size the vital point that Moral Therapy does not seek to lay down general moral laws. It has no ax to grind, no propa- ganda to make. It is not in the business of exporting ready- made codes that it would urge others to accept. It is rather a process of discovery in which the codes of others are ana- lyzed, so that they can benefit from a closer obedience to their own unique disciplinary systems. In Western democra- cies the dictates of the law and the dictates of conscience tend to walk hand in hand, and in the majority of cases the law of the land will reflect the moral code of those who live in it. But if we are to avoid the Nuremberg factor, we would do well to admit the supremacy of personal moral impera- tives and to follow faithfully, through thick and thin, the commands of our own unique ethical systems wherever they may lead us. Moral Therapy is then deeply committed to the necessity for discipline, but not to a discipline that is externally im- posed. For externally imposed discipline, by taking away the individual's freedom, renders him passive and uncreative, and insofar as he is not in control of his actions, he cannot 146 The Myth of Neurosis take credit for them in terms of increased self-respect. That is not to say that institutionalized moral systems as exemplified by the great religions tend to sap an individual's self-respect. On the contrary, the individual would be wise to freely choose a moral system based on such workable and pragmatic foundations as, for example, one of the Christian churches. But one must differentiate between this personal choice of a disciplinary system and the external imposition of a disci- plinary system. Thus the therapist will not give the individ- al rules to obey, but instead will discover that person's own rules and encourage him to obey them. It is then immaterial to Moral Therapy whether or not the individual is a Catholic or a Jew, a Communist or a Human- ist, a Protestant or a Buddhist, for as long as he has his own value system his mental health can be secured by the obser- vation of its dictates. In reality, we are seldom confronted by situations such as that of the terrorist-freedom fighter. The example is pro- duced as a dramatic illustration of an important point, for it is vital that there should be no misunderstanding. Moral Therapy is not in the business of peddling a particular moral system which is in some way regarded as superior to others. In point of fact, the practitioner of Moral Therapy will en- counter a remarkable similarity of moral values among the people that he meets. This will be due in part to standardiza- tion of religious and educational processes and parental atti- tudes within the various cultural and economic groups, and more often than not his own personal code will be roughly in tune with that of the individual whom he is trying to help. He can make use of this. For example, a person borught up in a strictly religious and authoritarian family may attempt to excuse his extramarital affair by pretending to embrace a moral system in which free love is not condemned and where there is a stigma attached The Goodness of Guilt: The Road to Self-Respect 147 to possessiveness and sexual jealousy. It may be correct that this is truly the case, but our suspicions should be aroused. It is just as likely that the individual knows in his heart that what he is doing is wrong and dislikes himself for his fail- ing, experiencing considerable guilt because of his actions. However, the flesh is weak and he is unwilling to give up the considerable short-term physical satisfaction that the re- lationship provides, although by contravening his true code he is endangering his mental health. Thus, on an intellectual level, he espouses the permissive morality and uses his con- siderable rational powers to argue for the validity and useful- ness of such a system. He may even persuade himself that his new morality is superior to the system provided for him as a legacy of his childhood and he may attempt to discard the old value system in favor of the new, imagining that one should be able to change one's moral system much as one might change one's car. But life is not that easy. However hard he might try, the moral notions of his childhood will not be changed and the guilt will remain until he ceases those ac- tions that give rise to it. So it may be that we dissemble in "revealing 29 our moral codes to others. There will be situations also in which we ourselves are genuinely confused as to what course of action our conscience is demanding. Such conflicts of interest are much rarer than we might think and are often more apparent' than real. We may pretend to others that we are confused about what action is the right one for us, but if we are honest with ourselves we will seldom be in serious doubt. This view would seem to be at variance with popular wisdom, which tends to think of moral dilemmas as being everyday occur- rences. This may be because when they do arise they are ex- tremely powerful and frustrating and thus assume an importance that is full of dramatic potential, implying as they do that whatever action we take, our self-respect must suffer in some area. Such a moral dilemma, involving certain 148 The Myth of Neurosis sacrifice as our conscience seems to be pulling us in opposite directions, is a frequent subject in art and literature, in the theater and the movies, and thus gains a publicity out of all proportion to its frequency in our everyday lives. Guilt doesn't lie Moral Therapy insists that conflict-of-interest problems vis-à-vis our moral imperatives are almost invariably smoke- screens behind which we procrastinate and vacillate; intel- lectualizations and rationalizations whereby we avoid taking difficult but necessary decisions. A fundamental assumption in Moral Therapy, however, is that the guilt mechanism is not deceived. We might be successful at persuading others that we are doing the right thing and we might almost come to believe it ourselves, but if we feel guilt about it then our self-esteem will suffer and we will have contravened the dic- tates of our own conscience. Confusion may arise if we mistake our feelings of fear for a similar emotion, that of guilt. Often we are fearful of doing something or of leaving it undone. But because most of us feel that fear is usually an insufficient and unworthy spur to ac- tion, we may pretend to ourselves that guilt rather than fear was the motive force behind our decision to behave in a cer- tain way. As an example, a man took on extra work in the office be- cause he was frightened of his boss. He felt guilty that he was fearful, for in his code, fear of his boss was an unworthy emo- tion, and his self-respect declined. He explained to his wife and children that he felt he really ought to do the extra work as it would increase his chances of promotion, allow him to get on top of his job, shift a backlog of work, etc. So plausible were his arguments that he to some extent came to believe them. All these explanations which he produced were true and the extra work did indeed provide tangible benefits for The Goodness of Guilt: The Road to Self-Respect / 149 him. Deep down, however, he knew that the real reason for his compliance was fear, and despite the fact that all others were impressed by his diligence and industry and nobody thought the less of him, his guilt mechanism was not deceived and his self-respect decreased. Another person may actually have experienced a genuine moral command to do the extra work irrespective of his boss's feelings and in doing it his self- respect would have increased. This example illustrates several points. First, there is no objective quality pertaining to actions that of necessity en- tails that a particular action or lack of it will inevitably result in feelings of guilt. Our guilt systems are our personal crea- tions and are unique. Second, it is often easy to persuade others that we are doing the right thing for the right reasons when in truth we are not, as other people can never know our innermost thoughts and feelings directly. Third, in fooling others we may be able partially to fool ourselves, but, fourth, in the final analysis we must always suffer when we contra- vene our moral code. The bottom line is whether or not we acutally experience guilt, and this is the surest indicator that self-respect and mental health are threatened. So guilt tells us of mental danger as pain tells us of physical danger. We don't wonder if we are in pain, and we don't wonder if we feel guilty. Both experiences are all too apparent. Most of the problems that an individual faces will be of a spurious nature, produced by his natural unwillingness to face up to the hard and difficult task that lies before him. The wise practitioner of Moral Therapy will not be misled by clever arguments, whose purpose it is to prove that the indi- vidual is doing all that he can to obey his conscience, and yet still feels miserable and discontented. Contributions to char- ity, considerable public spiritedness and long lists of attri- butes and virtues may be produced to demonstrate his wor- thiness, but if his self-respect is low and he still feels 150 The Myth of Neurosis guilty, then he is not doing enough, or doing it for the wrong reasons, or is satisfying the moral codes of others rather than his own. The friend may need considerable tenacity to side- track the individual's determination to hamper efforts to help him help himself by his insistence that he is already doing as much as it is possible for him to do, and that therefore some external agent such as an "illness" must be invoked to ac- count for his predicament. By following the guilt feelings, we will be led inevitably to the moral code and will come to understand how the individ- ual is failing to achieve the goals that he has set himself. By watching his actions and listening to his opinions on a variety of topics, we will uncover the individual's attitude to himself and the areas in which his self-respect is low. The hierarchy of guilt At this point, it should be emphasized that guilt is an emo- tion that admits of degree. When we contravene our moral codes in a minor way we experience low-volume guilt. If the transgression is major, and is continued over a prolonged pe- riod, then the amount of guilt experience will be correspond- ingly large. It may well be that from time to time in a given situation, of the several actions open to us, each will involve some contravention of our moral code with consequent guilt feelings. As we have seen, such moral dilemmas are rarer in life than in fiction, but undoubtedly they do occur. An example might be the situation in which a husband has broken his marriage vows and allowed himself to fall in love with another woman. He is still fond of his wife, who has learned of the situation, and demanded that he choose be- tween them. For the sake of this discussion we will assume that he is faced with two basic alternatives, although in life there are always an infinite number of possible actions. What should he do? He will feel guilty to some extent whatever he The Goodness of Guilt: The Road to Self-Respect 151 does, and his self-respect must be diminished. However, there is always a hierarchy of guilt feelings in such a situation. He must ask himself which course of action will make him feel the most guilty, and therefore lead to the greatest diminution of his self-respect. In attempting to reach this most difficult decision he will examine his conscience and his moral code, considering carefully his feelings on the sanctity of marriage, the inviolability of promises, etc. Deep within him the an- swer will be available, and he must follow the course that makes him feel least guilty, irrespective of other considera- tions. Usually it will be the hardest and most difficult of the possibilities, but the one that contains within it the most po. tential for increasing self-respect. So isolating the guilt feelings is not a totally straightfor- ward exercise as, to a limited degree, we may mislead our- selves and others with regard to the origins of these feelings. Similarly, it may not be easy to decide in hierarchical situa- tions which moral imperatives are the most powerful and therefore which guilt experience will be the most profound if the command is disobeyed. This is the area in which we can all act as detectives, sifting the evidence, reading between the lines, watching behavior and listening talk as we seek to come into contact with the individual's genuine moral code. With very few exceptions it will be there to discover. Created by us and for us during the earliest years, it is the framework within which we will operate for the rest of our lives. Changed only with the greatest difficulty, it provides the scaffolding around which we construct our future. 10 The Cruelty of Kindness The success within us In our efforts to help others, and as we try to extricate our- selves from unsatisfactory predicaments, we should always try to concentrate on those areas in which self-esteem is high, taking every opportunity to accentuate the positive wherever we discover it. For every individual has the necessary equip- ment for leading a successful and contented life. Nobody ac- tally is inferior; it is just that at times many of us feel inferior and act and behave in an inferior way. Often we are our own worst enemies in that all of our actions are aimed at short-term gratification at the expense of long-term self-re- spect, and most of our dissatisfaction stems from our own choice of the wrong path. Once this is realized, the rectifica- tion of our mistakes is within our power. By choosing to change our actions, we can choose to become more successful people. All that is required is a supreme effort of will. It is not easy, but it is far from impossible, and all of us carry the key to success within us. The well-meaning friend will seek out these hidden strengths and, by shining the spotlight on them, will persuade the individual that they are alive and well, just waiting to be 152 The Cruelty of Kindness 153 used. Our confidence and optimism should encourage that person in the belief that he is able to improve his lot and be- come more like the person he believes he should be. As he concentrates on the positive, so will he downgrade the nega- tive aspects of the situation. All pessimistic talk about per- sonal inadequacy and fundamental deficiencies of character will be strongly discouraged. Instead we should encourage others to indulge in immediate activity to counteract the de- pressed mood. It may seem harsh to appear uninterested and bored by pessimistic analyses and defeatist talk while being enthusiastic about optimism and positive things, but this is the way to condition the individual into feeling better. So often moods are habits that we have got used to. They need to be broken in the most efficient way possible. If we are not careful, misery and despair can become a way of life, an ex- pensive attention-seeking mechanism, a learned way of look- ing at the world that can only do us harm. Clearly a differentiation should be made between moments of intense sorrow and felt worthlessness, and general and semipermanent moods of pessimism and depression. At mo- ments of crisis we should be as supportive and sympathetic as necessary. However, the truly concerned friend will adopt a much tougher stance to the more malingering type of nega- tivism that is so frequently experienced. Such is the state of current attitudes in psychiatry and psy- chology that a patient may feel it is his role to produce such depressed sentiments in order that the "'expert" can do away with them. The "'experts, 99 steeped in the tradition of liber- alism, have cultivated sympathy to such an extent that they have forgotten their pragmatism. Endlessly they appear to provide the interested, sympathetic ear as their patients wal- low in self-pity, since this they feel is the area of their exper- tise. Their attitude is the reverse of Moral Therapy's position, as they unwittingly condition their patients into attitudes of mind that are positively harmful to them. Because both feel 154/ The Myth of Neurosis that the expert's role is the solution of the patient's problems, problems automatically become the staple diet of the rela- tionship. The patient is interesting and the professional in- terested only to the extent that the patient can produce examples of the things that are wrong with his life and per- sonality. Both tend studiously to ignore the things that are going right, believing that here everything will look after it- self. Moral Therapy, however, believes that concentration on the building up of the positive aspects will cause the negative ones to disappear of their own accord. It is a question of dif- ferent emphasis; of approaching the situation from a differ- ent angle. The traditionalists might feel that it is unkind not to allow the patient constantly to air his grievances and dis- satisfactions, feeling as they do for some strange reason that this is in itself positively therapeutic. But by teaching the in- dividual that such attitudes are unacceptable, and must and can be given up through an effort of will, and replaced with something of infinitely greater value, we are performing a far more worthwhile service. Kindness and sympathy are attributes that, while they are always good for the person who possesses them, may not be so useful to the person on to whom they are projected. We should not shrink, therefore, from being cruel to be kind, de- spite the initial resistance that such an attitude might bring forth in those accustomed to more generally accepted, though misguided, approaches. We may be accused of cal- lousness, of lacking sympathy, of insufficient interest in the well-being of the individual we are trying to help. "He is only interested in me when things are going well, )9 might be a common complaint. Of course, the truth is that we are deeply concerned that things should go well, but feel strongly that optimism is the best way towards that goal, and pessi- mism the least helpful. The Cruelty of Kindness 155 So in Moral Therapy all the virtues and positive attributes will be steadfastly developed that they may be expanded at the expense of the more negative ones. The individual will be taught to concentrate on success rather than on the analysis of failure. Once he firmly believes that all is possible for him and begins to act in accordance with that belief, the way forward to self-development and increased self-respect will be clear. It will be the end of the beginning. IT The Importance of Difficulty The danger of leisure To consider that one has the right to a "good" or an "'easy time is a dangerous fiction based on a misunderstanding of what our own best interests are. For there are no good times in the real sense of the word if we don't feel that we have re- cently and fully earned them. There are only scattered oases of predominantly physical or sensational transient satisfac- tions containing within them the seeds of their own destruc- tion in terms of lowered self-respect. Maybe in our hearts we know the truth of all this, but in our actions we tend to be- have as if it was not so. We may consider that after a bout of strenuous activity we have earned the right to rest and relax, to take things easy for a bit. But to relax after hard work is pleasurable only insofar as it is inseparable from the day's ac- tivity, the enjoyment that we appear to gain from it springing rather from this other source and in fact existing despite the relaxation rather than because of it. It has no lasting intrinsic value of its own. Thus a strenuous day in the steel mill or the office is followed by an unwinding in the hot bath, a relaxing glass of alcohol, a sedentary evening in front of the television. But it is the former and not the latter which contributes to 156 The Importance of Difficulty 157 the increase in self-respect that is the only lasting source of gratification. The relaxation panders to our desire for physi- cal comfort rather than to our need for emotional satisfac- tion. Relaxation is valuable, necessary and worthwhile for the efficient functioning of our bodies and minds, for our muscles and joints as well as for our psychological well-being, but un- like hard work, it is not intrinsically good for us and should not be sought for its own sake. Unfortunately, many of us fail to see the truth of this and mistakenly believe that it is relax- ation and leisure which are the real goals in life and that hard work is a relatively unpleasant but unfortunately necessary part in the obtaining of them. In fact the real pleasure lies in the contemplation of a good job well done and in the actual performance of the task. The feeling of increased self-esteem may spill over into the rest period but cannot survive in the absence of the effort and struggle which preceded it. We may feel that we owe ourselves a good" time, but with contin- ed inactivity and lack of application the time will soon cease to be good and we will be left with vague feelings of guilt which no amount of rational intellectualizations about how wrong we are to feel it can dispel. We may know that we have earned our rest, but unless we are constructive and active in our leisure time our self-respect will soon decline. Such is often the problem of retirement and old age. All our lives we have worked and striven to earn the right to a peaceful and relaxed old age. Insurance policies have been taken out and the premiums paid, savings set by and children had so that we will be able to bask in the relative inactivity of our twilight years. By a life of toil we have earned the right to be lazy. And so, when the old person gives up his job and his role, his strife and his struggle, he is frequently unable to replace it with something of value. As he does less his self- respect declines and his confidence in himself fails. While confidence decreases so his bitterness increases as his expec- 158 The Myth of Neurosis tations of tranquillity and peace evaporate. People sense the depressed and dissatisfied mood and explain it away, un- thinkingly, as the "'problems of aging. If, however, the old person had retained his activity and interests, striving day after day to acquire new skills or perfect old ones, constantly fighting to overcome any physical deficiency resulting from the aging process, then his self-respect and self-confidence will increase. He need never then accept the role that society so readily casts for those of its members who are different chiefly in that they have been alive for longer than most. By being interested he becomes interesting and he need never become "'old" in the traditional sense. Moral Therapy, then, will seek to show people that in their own interest their goals must never be luxury and ease, but rather activity and difficulty. Thus it will involve to some ex- tent a process of reeducation in which the individual is en- couraged initially to expect less from life so that ultimately he may gain more. As he begins to see life in a different and more realistic way he will begin to like and admire himself, not because he is told to do so, but because, in the brave confrontation of his problems, he will realize that he is genu- inely worthy of self-admiration. As he undertakes increas- ingly successful actions so his self-confidence will grow, and as he becomes more and more the person he feels he ought to be so his fear will diminish and, concurrent with new pride in his achievements, his feelings of guilt and self-loathing will disappear. Always he should be encouraged to live an active and committed life following closely the dictates of his con- science. As he becomes more true to himself he will increas- ingly be able to shoulder responsibilities and make decisions and relate more effectively to others. He will be helped to an- alyze, to understand and to listen to his feelings of guilt, and will be shown that they can be ignored only at the greatest risk to his psychological equilibrium. As we learn to obey our The Importance of Difficulty 159 own acknowledged moral commands our lives will acquire new purpose and direction. Fundamentally it will be a moral life, based on rules the validity of which we accept. Difficulty and self-respect So important is it in life never to spare ourselves, con- stantly to drive ourselves on, to immerse ourselves in the struggle of problem-solving, that the search for difficulty can be a valuable pointer to those actions and behavior which have positive implications for us in terms of increased self-re- spect. In the same way that guilt feelings warn us of inappro- priate actions, so the presence of difficulty signals a useful way forward. When confronted with various possible courses of action we should ask ourselves, "Which is the most diffi- cult?" In the majority of cases the most difficult choice will be the most desirable, for whatever else happens in the brave confrontation of difficulty, our self-esteem must increase. The converse is also true. Insofar as we recoil from difficulty, seeking instead the easy way, we must like ourselves less, having missed out on a valuable chance to expand our self- confidence. The test can be applied to the most important events in our lives, but also to the most mundane of everyday actions. Should we have an extra five minutes in bed? Yes or no? Which is the more difficult? That will be the correct choice for us. Of course, for most of us the difficult course will be to get up immediately, but that is not necessarily so. For the workaholic, obsessed with the need to get to the office, ne- glectful, perhaps, of his wife and her feelings, inconsiderate of her need to talk to him, for him to show her affection, the most difficult course might be to linger in bed a little longer. Whatever is the most difficult action for us is likely to be the right one, and this example helps clarify the intensely indi- vidual nature of our experience of difficulty. For me to lose 160 / The Myth of Neurosis weight, to demonstrate affection, to be untidy and to under. stand computers may all be difficult. For you they may be easy: For me to diet successfully, smother my wife with love, make a mess around the house and write a computer program would increase my self-respect immeasurably. For you such actions might make you hate yourself. The search for per. sonal difficulty is then a uniquely individual search in the same way that the experience of guilt is different for all of us. But although we have different ideas about what is difficult and about what is right and wrong, we do not have a problem in recognizing difficulty or moral imperatives. In both situa- tions a hierarchy applies. Of the various actions and behavior that will tend to diminish guilt feelings, which will bring about the greatest diminution? I am not suggesting that we should go out immediately and attempt the most difficult task that we can think of, but rather that, of the jobs and courses of action that we deem appropriate for us, to select the most difficult is usually the right thing for us to do. Thus it is not suggested that the in- numerate but successful literary editor should give up his job and enroll as a computer programmer or that the sufferer from vertigo should take up tightrope walking. Instead I maintain that in our everyday lives we should ensure that we are extending ourselves, pushing ourselves, developing our- selves by subjecting ourselves to the test of difficulty, without which self-esteem must always elude us. Should I protest when somebody is rude to me, to my wite, to my child? It depends. Which is the most difficult path for me? It will usually be the one that tends to diminish rather than increase our guilt, as increased difficulty and diminished guilt tend to walk hand in hand. I may take what is for me the easy way. I laugh off the insult, feeling secretly guilty while doing so as I contemplate my felt inadequacy. When I discuss it at home later I rationalize my failure. "It was the civilized response. 29 "The man was drunk." "He is always 160 The Myth of Neurosis weight, to demonstrate affection, to be untidy and to under- stand computers may all be difficult. For you they may be easy. For me to diet successfully, smother my wife with love, make a mess around the house and write a computer program would increase my self-respect immeasurably. For you such actions might make you hate yourself. The search for per- sonal difficulty is then a uniquely individual search in the same way that the experience of guilt is different for all of us. But although we have different ideas about what is difficult and about what is right and wrong, we do not have a problem in recognizing difficulty or moral imperatives. In both situa- tions a hierarchy applies. Of the various actions and behavior that will tend to diminish guilt feelings, which will bring about the greatest diminution? I am not suggesting that we should go out immediately and attempt the most difficult task that we can think of, but rather that, of the jobs and courses of action that we deem appropriate for us, to select the most difficult is usually the right thing for us to do. Thus it is not suggested that the in- numerate but successful literary editor should give up his job and enroll as a computer programmer or that the sufferer from vertigo should take up tightrope walking. Instead I maintain that in our everyday lives we should ensure that we are extending ourselves, pushing ourselves, developing our- selves by subjecting ourselves to the test of difficulty, without which self-esteem must always elude us. Should I protest when somebody is rude to me, to my wife, to my child? It depends. Which is the most difficult path for me? It will usually be the one that tends to diminish rather than increase our guilt, as increased difficulty and diminished guilt tend to walk hand in hand. I may take what is for me the easy way. I laugh off the insult, feeling secretly guilty while doing so as I contemplate my felt inadequacy. When I discuss it at home later I rationalize my failure. "It was the civilized response." "The man was drunk." "He is always The Importance of Difficulty / 161 like that." "He didn't mean it." But my guilt mechanism laughs at my attempted rationalizations, at my doomed ex- cuses, as it squirts psychological pain into my psyche. I know only too well that I avoided the difficult course did what for me was the wrong thing. So now I feel pathetic despite the fact that I had more than adequate warning, that I knew all along what I should have done. I have only myself to blame. Once again one must emphasize that what was "right" for me may well be "wrong " for you, as there is no such thing as universally "right" behavior if the criterion of rightness is the choice of action which in the long run will produce the great- est overall diminution of guilt. You may be quick to anger, accustomed to hit out, either verbally or physically, at the very slightest provocation. You may be ashamed of your ag- gressive tendency. Punching the offender is then for you both the easiest way and the one most likely to produce guilt feel- ings, turning the other cheek the most difficult and the most likely to increase self-esteem. Supposing on the other hand you reveled in your aggressive assertiveness, were actually proud of your "'manly 29 reactions, and that to punish the of- fender verbally or otherwise not only would be easy but would not produce guilt. In such a situation the turning of the other cheek would certainly be more difficult but it would not be appropriate--not really a course of action even to be considered. It is only in selecting from actions deemed to be appropriate for us that the test of difficulty is useful. Of course, when confronted with such an unusual attitude to- wards behavior that verges on the unacceptable we should ask ourselves whether or not we are dealing with a sociopath to whom guilt feelings are alien and for whom, consequently, the Moral Therapeutic approach is null and void. So of the courses of action open to us, those which we con- sider as realistic options, the difficult path will be the one to tread. This implies that we should seek a life of asceticism 162 The Myth of Neurosis and self-denial if we are not naturally self-denying and as- cetic, a life of hedonistic pleasure-seeking if we are- -always providing that we are dissatisfied, to some extent guilty, in our original situation. In turn this implies a life full of move- ment and action as we attempt to become more nearly the person we feel we should be. This brings us to another tenet of Moral Therapy: All action, change, movement and exer- cise of responsibility, all decision-making, tend to increase self-esteem in that such actions are often difficult, repre- senting the hardest choice, the greatest risk, the leap from inertia to action, from stasis to mobility, from being to be- coming. Dare to change Change for change's sake is not a motto on which many would look favorably, with its implications of revolution, im- permanence, the abandonment of security and comfort, its pungent whiff of danger, its intimations of imprudence. How- ever, I would argue that change, provided of course it is con- gruous with our moral imperatives, is good for us. Changes in oneself or one's circumstances usually involve decisions. De- cisions are difficult to make and imply responsibility for and control over one's own destiny. Often they involve actions and the expenditure of energy. They stress us and they test us. As such the decision-making process is a method of in- creasing self-respect, whereas vacillation, indecision, fear of responsibility and inertia have the opposite effect. In the decision-making process we imprint ourselves on life, choosing our own direction, impinge ourselves on events rather than merely drifting on the tide, floating with the cur- rent. It matters not that later we may change our minds. What is important is that we should demonstrate to ourselves that we have minds to change, minds that are ours to control, that life is something to which we happen rather than some- The Importance of Difficulty / 163 thing that happens to us. The decision to change our circum- stances or attitudes brings home to us the fact of our inde- pendence and helps to destroy the myth of determinism. We must exercise the decision-making process in the same way that we exercise our bodies, and should practice it con- stantly until it comes easily to us. As with our choice of the difficult path, we can start slowly and build up to more com- plicated decisions. I am not suggesting that we should simply pluck some unconsidered decision from thin air, and, acting on impulse, project ourselves into the unknown, but rather that with regard to the various appropriate decisions and changes which we have recently wondered about imple- menting, we should come down on the side of action as op- posed to passivity. It may be, for example, that we have for many years been dissatisfied with our job in which we are bored, unfulfilled, unstretched, our talents poorly occupied. Above all, perhaps, we just don't "admire 99 the job we are doing. And yet it represents security, there is a mortgage to be repaid, we are not as young as we were, millions are out of work, etc., etc. We may feel guilty that we don't possess the courage to change, to take the risk, to be adventurous when the arguments of reason counsel caution. Our self-respect is low in this area and we like ourselves less. In the hierarchy of guilt we feel more guilty about staying in the unwanted job than in the exposure of our families to financial risks and un- certainty if we give it up. What is the most difficult decision? To hand in one's notice. To decide to act. To make the change. Of course, it could be argued that every day we continue in the unsatisfactory job we are to some extent making a daily decision not to leave, but that is not a decision in the true sense of the word. The real decision is the one on which we ruminate during every lunch hour, every morning when we get out of bed. We recoil from it, from the responsibility that it brings, from the action and expenditure of energy it will 164 / The Myth of Neurosis involve, from the danger and excitement that it represents. Moral Therapy is on the side of bravery and courage, of risks and adventure, as long as they remain in harmony with the individual ethical code. If our advice is asked, and we are convinced that the signpost of guilt is pointing in the di- rection of change, then we should encourage our friend to leave his job, to clear his decks for action, to take life by the scruff of the neck and shake it. He will not regret it. If on the other hand the guilt mechanism points the other way, convincing him that his action in giving up his job would be wrong, bad-_that he would be neglecting the needs of his wife and children, indulging himself in his own fanta- sies at the expense of others for whose welfare he is responsi- ble, a dilettante, unreliable, untrustworthy--and if such guilt feelings swamp any such emotions he might feel at retaining his boring job, then we must encourage him to retain it. Now his task is no longer to decide to change his job, but to decide to change his attitude towards it, for if we cannot allow ourselves to change unsatisfactory circumstances then we must change ourselves. In effect, then, Moral Therapy asks you to do what others so frequently tell you not to do_to learn how to take deci- sions lightly. If the guilt mechanism is consulted, the decision will not be wrong and the value will lie not in the change of cirumstances which results from the decision but from the decision-making process itself. To remain static, avoiding change, emphasizing the difficulty involved in taking control and initiating movement, is never in our best interests but it does have the spurious advantage of safety, security and fa- miliarity, which is why so many of us prefer to suffer the pain of low self-respect which inactivity brings. Predictability and lack of uncertainty have strong attractions even when misery is the devil you know. But we must dare to change and must encourage others to do the same. 12 Activity Therapy In the same way that the body needs food, the mind re- quires stimulus if it is to do its job properly. Like muscles, it must have exercise in the form of input, of sense data, if it is to become strong and efficient. So as we work our bodies in order to become fit we should do the same for our brains. The converse is also true. If our minds are underutilized and lack- ing in stimulation they become flabby, atrophied, sluggish, and our mood correspondingly depressed and anxious. In Moral Therapy constant mental activity is advocated. This may take the form of bombarding the brain with informa- tion from the senses, or of concentrated and goal-directed thought. It is important that stimulation of the senses should involve the activation of the mental processes rather than the mere passive acceptance of sense-data input. Thus massage, while pleasant, is of limited value as psychic food. Exercise or the solving of complex problems is, however, of the utmost use- fulness. Purposeful physical labor is always positively benefi- cial, and the more strenuous the more valuable. We all know this. The devil finds work for idle minds no less than for idle hands. We all know that keeping busy is the best method of 165 166/ The Myth of Neurosis escaping uncomfortable psychological feelings, and that brooding inactivity is the very best way of prolonging them and of making them worse. And yet why is it that the "'experts" seem so often to sug- gest the very opposite, pushing pills, relaxation and passive introspection- suggesting that talk is the magic panacea? Are not these the worst possible methods of escaping our psy- chological torment? Do they not fly in the face of common sense, of our most profound experience? "Keep mother busy is the time-honored advice when father has died. "Don't dwell on it," "Let's get ourselves out of the house, "Throw yourself into your work. » These are the sorts of methods that sensible people use to deal with psychological pain-_far su- perior to the introverted philosophizing, the doomed search for cause and effect, the gnawing away at the bone of the problem in ceaseless and circuitous talk which is often advo- cated by the cosmetic psychiatrists, who have nothing to sell but their witch-doctor charisma, their naked appeal to the twentieth century's equivalent of superstition--the uncritical belief in "scientific expertise." Flexing mental muscles The mind can be diverted from gloomy preoccupations by giving it tasks to perform, jobs of a difficulty sufficient to de- mand all its powers of concentration. Insofar as those tasks are difficult and in tune with moral imperatives, they will increase self-respect as well as banishing the psychological unpleasantness of the moment. The senses can be stimu- lated together or separately. We should acquire a visual eye, train ourselves to "see both in the formal sense by exposing ourselves to the visual arts and in the more natural one by learning to concentrate with our eyes on the beauty of the ordinary things around us. Music, too, has the power to lift the spirits and we should experiment with it, catholi- "I Activity Therapy / 167 cizing our tastes and seeking out more difficult works. All the time we should be stretching ourselves, fexing our mental muscles, not necessarily in the narrow intellectual sense but in the wider field--in the business of experiencing life. Often neglected is the sense of smell. Of all the senses this is the one that we have learned to dampen and to ignore. We should recreate it, amplify it, using the information from the olfactory sense to bombard the brain with messages for pro- cessing so that it expands its capacity, learns to handle more input, improves our ability to relate to and to gain from our environment. We should experiment, too, with touch and taste, always learning new skills, immersing ourselves in the active experience of life guided always by the voice of con- science and the pursuit of difficulty. The theater, art, music, literature are there for all of us, but because for many they involve difficulty and the expenditure of energy we avoid them, failing to realize the value of such exertions. Unem- ployment is one of the great evils of our age, and immensely prejudicial to self-respect, but it can be a time of opportunity too -a time to learn new skills and to perfect old ones, to ex- pand our interests. If the attitude is right, and no force pre- vents it from being so, we can emerge from the test stronger than before, more resilent, more self-sufficient, liking our- selves more as we contemplate the way we have overcome difficulty. The alternative is to succumb, to accept the illness role that so many would force on us, to take the path of "neu- rosis, 99 citing the excuse of our circumstances, to give up re- sponsibility for our lives. Whether in work or out of it we must keep ourselves busy and active- not in the semimindless activities of the less en- lightened hospital occupational therapy department, of soli- tire and other time-filling activities, but in purposeful actions which are congruent with our ambitions and con- science, which require self-discipline and hardship. This is 168 The Myth of Neurosis the path we must follow, and we must encourage others to do the same. Mens sana in corpore sano For many centuries man has known that regular exercise makes one feel better. It is good for the body and good for the mind. It is only very recently, however, that psychiatrists have suggested that increased physical fitness and exercise programs might alleviate the symptoms of moderate anxiety and depression, although they point out that it is unwise to begin a program of exercise without first consulting your doctor if you are over forty. Their traditional indifference is not as odd as it might seem. First, few have suggested that exercise has a place in the treatment of actual psychological illness. Psychotic endogenous depression, for example, would not be expected to improve with exercise, while other effec- tive methods of treatment exist for this condition. Rather the areas in which depressive symptoms seem to respond to exer- cise are those which include the field of so-called neurotic de- pressions, those modifications of normal mood which I would maintain result from the choice of an inadequate life-style, from a failure to live up to one's own expectations and to ob- serve one's own standards. It could be argued therefore that exercise as a therapy has been ignored by the psychiatric pro- fession because the people for whom it might be of use are not really ill at all, although they might hover on the border of illness. There is another and perhaps more important reason for the lack of interest in exercise as a therapeutic tool. Although adherents of the biochemical-_the volts and pills men--are easily distinguishable from their more philosophically and psychotherapeutically oriented colleagues, both groups tend to be thinkers rather than doers, whose actions, such as they are, consist largely of talking, prescribing, of achieving the Activity Therapy / 169 "brilliant" insight--phenomena usually much admired by acolytes steeped in the same traditions of knowledge. Most of their work is done sitting down, pens and words are their stock-in-trade, and their most formidably exercised muscle is the tongue. If it could be conclusively proved that exercise had a part to play in psychiatric treatment, resulting, for ex- ample, in the provision of a gymnasium in the psychiatric wing of every hospital, then it could be expected that their sedentary way of life might be to some extent rudely disrupted. Sweating and working out with his patients is not the average psychiatrist's forte, and he might well be emo- tionally inclined to view with a jaundiced eye the experi- ments which seek to prove the efficacy of intense physical activity in relieving the symptoms of human psychological suffering. Such people might find themselves drawn to a con- sideration of the undoubted inadequacy of the trials and tests that have been conducted so far to investigate the effects of exercise on "'neurosis, 29 and in this they would not be entirely remiss. It is well known, for example, that some subjects will work hard simply because they want the experiment of which they are a part to be a success. They pick up on the experimenter's enthusiasm and apparent interest and repay him by actually getting better. The end result may be the same but the cau- sation is different. Others, while feeling no better, may fudge the results of the questionnaires which attempt to measure their mood because they do not want to let the experimenter down. Conversely, those of a contrary disposition may disguise any felt improvement for a variety of reasons- because they are unwilling to give up the illness excuse, for example, or because they are loath to admit that anything as relatively straightforward as hard physical exercise can ameliorate moods which they would prefer to believe are the results of infinitely complex and fascinating causal processes. 170 The Myth of Neurosis In Moral Therapy, however, such considerations pose no problems. Psychological illness has been excluded. We are only interested in leading more fulfilled lives and helping others to do the same. Common sense and personal experi- ence point to the efficacy of exercise. That is enough. Exercise and self-respect Exercise works to increase self-respect in several different ways. First, there are the physiological benefits. Regular ex- ercise helps to protect the body from coronary artery disease and strokes by lowering blood pressure, reducing weight and ameliorating blood fat levels. It aids the digestive system, promotes healthy sleep patterns, improves respiration and conditions the muscles. When we are physically fit we feel better. Few could deny it. Second, exercise results in an improvement in our personal appearance and in the shape of our bodies. This results in in- creased self-respect as we realize that through our own et- forts we have changed ourselves for the better. Third, regular exercise is difficult in that it requires consid- erable will power. In keeping at it we are showing ourselves that we possess strength of character. As we overcome the difficulty involved in the expenditure of energy and the deci- sion to act, we will reduce guilt and like ourselves more. On this renewed confidence in ourselves we can build, branching out into other areas of achievement. Fourth, exercise breaks the spiral of a depressed and anx- ious mood. We are not likely to indulge in unhelpful and pessimistic ruminations if we are extending our bodies in strenuous exertions. At the end of a four-to-five-minute mile there are more pressing considerations than our previously unhappy psychological predicament! Finally, as the strength of the body flows through to the mind, uplifting us both spiritually and morally, there is less Activity Therapy 171 time and inclination for the less health-making leisure activi- ties such as smoking, drinking, overeating and drug abuse, described in the next chapter. So those of us who would practice the Moral Therapeutic approach to life should take regular exercise and encourage our friends to do likewise. Inserted wood neurosis. Conversation opened. 1 read message. Skip to content Using Gmail with screen readers wood neurosis 1 of 25 Wood neurosis 213 kac attac Sun, Apr 14, 3:59 PM (7 days ago) to Stefan 13 Body Maintenance Through the body to the mind Moral Therapy believes that bodily health cannot be ig- nored in the battle for increased self-respect. In contrast to other theories, the vast majority of which tend to concentrate on thoughts and ideas to the exclusion of physical health, Moral Therapy argues that we should pay as much attention to the body as to the mind. There are two basic reasons for this. First, many though not all of us believe that it is our moral duty to look after our bodies. We may deny this while scorning those who, we feel, are overly preoccupied with their appearance and their health. However, most of us, if we are truthful to ourselves, would feel guilty if, through ne- glect, we have allowed our bodies to deteriorate in terms of increased weight, lack of physical fitness, chronic smoker's cough, etc. Knowing how difficult and time-consuming it is to lose weight and to exercise, while at the same time being addicted to the transient pleasures of fattening foods and the sedentary lite, we may choose to consider that we don't have the "will- 29 power or the "strength of character" to do anything about it. But by being out of condition we are admitting to our- 172 Body Maintenance / 173 selves and to the outside world that we have little respect for our bodies. It may be that for a few, such an attitude is healthy to the extent that they exclude their bodies when calculating their self-respect. The moral code of such a person might demand that he ignore his bodily health and appearance to free him, for example, for a more serious concentration on his art. He might truly believe that to care for his body is a weakness and demonstrates an unworthy obsession with appearances and that his body should be regarded as an old and dirty car, whose chief purpose is to get him from A to B. But this is an unusual and rather rare attitude. Most of us have been brought up to believe that our bodies are a precious gift that should be maintained and utilized to the very best of our abil- ity. Despite this, many of us spend more time improving the condition of our cars, houses and businesses than in doing something about our physical health. Neglect of our bodies is then an important source of guilt feelings and of diminished self-respect, and it is but a short step from losing bodily con- trol to losing mental control. If we cannot resist temptation to the detriment of our bodies, why should we be in any bet- ter position with regard to our minds? It may seem farfetched to suggest that there is a connection between the piece of chocolate cake and the extramarital affair, but insofar as both involve a failure of self-discipline and diminished self-re- spect, there is a significant similarity. The second reason why Moral Therapy is more than usually interested in the physical state is because it is well known that physical states have a large and important influ- ence on mental ones. A sound body is an excellent method of insuring that the basic conditions are fulfilled for the attain- ment of a sound mind. The precise nature of this mind-body interaction has puzzled philosophers and scientists through- out history. The fact remains that a poor physical condition is 174 The Myth of Neurosis often related to a depressed and anxious mood, while there would appear to be at least some correlation between ex- treme physical health and mental well-being. Moral Therapy would not want to overemphasize this second fact, and does not maintain that perfect physical condition is suff- cient for mental health as, in the absence of a strictly observed personal morality, it is of little worth. However, the achievement of a good physical condition is an important therapeutic tool in that it tends to diminish uncomfortable moods on a purely biochemical level, while contributing to an increase in self-respect on a psychological one. Certainly the mind can be more readily approached through physical activity than by introspective theorizing, and if we are feel- ing gloomy we are infinitely more likely to ameliorate our mood by embarking on some strenuous activity rather than by attempting the intellectual discovery of the causes of our emotion. The former will give us the satisfaction that always accompanies positive action; the latter is doomed to failure, both because we can seldom be sure of the cause of our moods and because even when we are, the discovery of the cause seldom results in its alleviation. The body, then, provides an excellent starting point on the journey towards increased self-respect. In general it is rela- tively easy, with encouragement, to embark on a program of exercise, dieting and body maintenance. As the days go by, the results are readily apparent for all to see, and we reap the twofold benefits of the feeling of increased physical well- being coupled with heightened self-esteem. So we should be on the lookout for any decline which can be reversed and that will then serve as a springboard from which we can launch ourselves forward on new and more successful careers. Self-respect is not gained immediately, at a stroke. It is a steady, hard, uphill struggle which one embarks on stepwise, Body Maintenance / 175 taking things one at a time, building confidence as one goes along. To start with the most difficult task, hoping for an in- stant increase in self-respect, is both dangerous and foolish, carrying with it the strong possibility of failure with a conse- quent lowering of self-esteem. The resulting dissipation of en- thusiasm may endanger our confidence and hinder our potential for growth. We should start to build self-respect at first in easy stages and then in progressively more difficult ones. The previous success will provide the impetus and strength of purpose so necessary for the achievement of much harder objectives. There are no sudden and instant cures in Moral Therapy. Thus the fat person will find a new spring in his step as he loses weight and also will experience an uplifting sense of physical and consequent mental contentedness. This will be combined with a pride in his achievement, in his self-disci- pline, in his ability to control his desires, change his behavior and resist temptation. His action in losing weight and the in- crease in self-respect that it brings will give him a taste for attempting yet more ambitious projects and so this relatively straightforward treatment may serve as the first brick in the foundation of the building of his self-esteem. Similarly, in the absence of physical or psychological ill- ness, rectification of a poor nutritional state may alone be suf- ficient to improve one's mental state. So we should be sure to eat properly and regularly. If we are having problems sleeping, this in turn may be a symptom of anxiety and depression. Or it may be that we are overworked to the extent that our competence to do so effi- ciently is diminished. Sleeplessness often responds well to simple, straightforward measures. Intense physical activity is a wonderful way to tire the body and calm the mind, with a resulting improvement in sleeping. There are even simpler measures, such as the avoidance of caffeine and spicy foods late at night, taking a hot drink be- 176 The Myth of Neurosis fore going to bed, reading for half an hour to clear the mind of the day's worries, ensuring that we are neither too hot nor too cold during the night by more efficient organization of the blankets, room temperature, etc. All these methods are infinitely preferable to the easy and dangerous solution of sedative drugs which ensure immediate sleep while compro- mising self-respect, risking dependency and upsetting normal sleep patterns to the extent that on withdrawal, successful sleep is even more difficult to obtain than before. Appearance and self-esteem It may be that our general appearance is unprepossessing and unsatisfactory. Is our hair too oily, or too dry and brittle? Do we suffer from dandruff? Is our scalp in poor condition? Is our skin greasy and pale, perhaps with spots and blemishes? Are our teeth well cared for? Are they clean and without cav- ities? Do we have bad breath? Are our ears full of wax? What is the state of our personal hygiene? Do we smell unplea- santly of sweat? Are our fingernails well manicured or long and untended? Are they clean, dirty or stained with nicotine? And what of our feet? Are they in good condition or uncared for, with long, uncut toenails? Are we generally obese, and out of condition? What is the state of our musculature? What is our exercise tolerance? Do we look as if we could run a mile without doing ourselves serious damage? Do we hold ourselves up straight and look other people in the eye, or do we slouch and evade their glance, hinting at a correspond- ingly inadequate mental state? Do we have any habits that we might well wish that we were without? Do we pick our hair, feet, the skin around our nails, or do we bite the inside of our mouths, our lips, our nails? Do we grind our teeth? Do we appear embarrassed and apologetic about our bodies, and if not, then what is our attitude towards them? In general, medical men and certainly psychologists pay Body Maintenance / 177 scant attention to these points, although many of them can- not be ignored entirely. They are regarded as being beyond the scope of the physician's proper interest, part of the indi- vidual's private persona. The doctor might feel that it would be impolite to comment on them, that they were a potential source of embarrassment, to be avoided or glossed over. And yet they are valuable signs that all is not well with the indi- vidual. He may worry more about his unsatisfactory aesthetic appearance than about the hernia that the diligent doctor has discovered, the varicose veins and the heart murmur. That he is letting himself run to seed says much about his self-attitude and general mental state. So the concerned friend will seize on those phenomena that the traditional physician will note but discard as being beyond his rightful domain and sphere of influence. For these are the things we can do something about. Nor should we wait for our friends to point out such deficiencies, but instead should not attempt to suppress our awareness of our own inadequacies with regard to body maintenance. It is not generally realized how psychologically debilitat- ing unwanted habits can be, and here we are merely discuss- ing unattractive personal traits rather than the use of drugs, etc. A tendency to pick at oneself is offputting to others and their distaste communicates itself in subtle ways to us. We ourselves would like to be without the habit, but somehow the effort of will required seems out of proportion to the dis- advantage of the activity itself. We need encouragement, somebody who cares, to give us the initial motivation to as- sert our will and to make that first choice to refrain and to help us renew our decision when we find ourselves lapsing from grace. Above all we need to elevate what on one level is a rather trivial little failure in life into a test case of our resolve. By putting our self-respect on the line in a situation that is well within our powers to master, and yet at the same time in- 178 The Myth of Neurosis volves considerable toughness of will, we learn success and can build on our achievement. Our friends can serve as wit- nesses to our investment in this struggle, being not uninter- ested observers but rather cheerleaders, the roar of the crowd encouraging us in our endeavor, men in our corner ever ready with advice and support. Who would deny that in looking better we feel better? It is no coincidence that popular clichés provide better advice on how to deal with psychological distress than the boring and convoluted theories of the "'experts. 22 After all, this "'science of the mind" is a latecomer to the scene and people have been dealing with unpleasant psychological feelings for thou- sands of years. We all know the value of the psychological uplift provided by efforts to improve our appearance and that low feelings do not long survive intense and rewarding physical activity, such as digging the garden or going for a run or a swim. We must not shrink from discussing those inadequacies of appearance and body maintenance whose rectification can be expected to provide a psychological boost to the individual. A trip to the hairdresser, to the dentist, to the health food shop, to the chemist, to the chiropodist, to the gymnasium, running track or swimming pool, to the sun, to the beach, to the tanning salon, may be amongst the very first activities in which we indulge in the long battle for increased self-respect. This is by no means to advocate that the basic goal of man should be to maximize his aesthetic appeal, nor does Moral Therapy suggest that the cult of the body is even of prime importance in the maintenance of mental health. It is not a charter for narcissists or an encouragement of vanity. Rather it holds that the body is often the best and easiest place to start in the long struggle against psychological discomfort. It is accessible to us in a way that the workings of the mind are not, and such is the intimate connection between mind and Body Maintenance 179 body, between physical and psychological well-being, that the benefits of physical improvement are inevitably reflected in more positive mental attitudes. For such reasons Moral Therapy will discourage obesity and bad habits such as smoking and the abuse of alcohol. Obesity is one of the great problems of our age, and is in- variably caused by the combination of eating too much and of doing too little. In our current climate of aesthetic values, it is thought unsightly. In our present state of medical knowl- edge, it is known to be positively harmful to health. It is, given the similarity in the moral codes of those of similar up- bringings, almost invariably damaging to self-respect and a source of guilt feelings. And yet it is a problem the solution to which is within the capabilities of all of us and so can be used as an excellent first step in Moral Therapy. If the individual can be encouraged to solve his weight problem it will be a not insignificant victory, with positive implications for his self-esteem. Alcohol Alcohol is a potentially dangerous drug. There are a large number of ways in which it can damage physical and psycho- logical health. In most cases the heavy drinker will suffer diminution of his self-respect as a result of his drinking be- havior. In knowing that his abuse of alcohol is harming his body as well as his relationships and career prospects, and in realizing that he appears to have little control over it, he will experience guilt as he contravenes his moral code. This is always assuming, of course, that his moral code dictates that he should be in control of himself, should not be weak and should not give in to self-destructive impulses. In effect, most of us do subscribe to such a code and, insofar as it is severe, alcohol abuse will tend to cause guilt and unhappi- ness for the individual quite apart from the consequences 180 The Myth of Neurosis of actions undertaken while under the influence of alcohol. At this point, we should be clear about the definition we are using. In Moral Therapy a person will be said to be abus- ing alcohol if his alcohol intake is sufficient to cause damage to his physical or mental health, to his ability to carry on suc- cessful relationships with friends and loved ones, or to his oc- cupation and career prospects. Most of us have no wish to impair our performance in any of these areas and will think the less of ourselves if we do. As usual at this stage, the proviso must be made that hypo- thetical cases can be postulated in which what would for most of us be considered abuse of alcohol may for others be a useful and even necessary adjunct to their careers and life- styles. Many great artists find in drink the liberation from more ordinary conventions that tend to hamper their origi- nality and creativity. There may be careers in which to re- main abstemious would actually hinder efficient working relationships, and where relatively heavy drinking is both ac- cepted and expected. Many people, too, would maintain that to be drunk occasionally is good for you, and might feel that the sober and abstemious person is too calculating and con- trolled for his own good, unable to trust himself to have a good time and let himself go, too wary perhaps of showing weakness, too obsessed by what others might think about him. However, these are the exceptions that prove the rule to be true and in general most of us will like ourselves less for drinking too much, and to that extent should be encouraged to cut down as an efficient method of increasing self-respect. The reduction in alcohol intake will be a powerful force for good in other areas of the individual's life, as the increase in self-respect will permeate all his activities and attitudes. We should be clear that from the viewpoint of the Moral Therapist there is a considerable difference between alcohol and the "hard' drugs that will be discussed later. Alcohol has been used by man since as far back as 6000 B.C., and for Body Maintenance 181 hundreds of years the drinking of it has been considered a so- cially acceptable activity, and widely regarded as normal. Few social gatherings are not lubricated by alcohol of some kind. Some doctors have suggested that a drink in the eve- ning is positively medicinal, helping one to relax after the stressful activities of the day. The point of all this is that moderate drinking is regarded by many as an activity that is in no way harmful to them, and insofar as it contravenes no moral code it produces for them no guilt feelings or decreased self-respect. At the other end of the spectrum is the down-and-out alcoholic on skid row, who drinks all day and whose life revolves around his drinking. Physically and mentally he is a wreck, perhaps drinking methanol because it is all that he can afford. He can't control his drinking and he can't abstain from it. Such a man will be beyond the help of Moral Therapy. He is ill and he will need specialist medical help to deal with his malnutrition, vitamin deficiencies and any other physical illnesses secondary to this e.g., pneumonia, chest infections, etc. At some stage he will probably be put in touch with Alcoholics Anonymous, whose contribution to the alleviation of the problem of alco- holism is without parallel. It is interesting to note that this or- ganization adopts a very firm moral tone, and aggressively promulgates the Christian ethic. In the twelve steps that they recommend an alcoholic take on entering their community, Step 4 suggests that the individual make a "searching and fearless moral inventory of himself. At these two ends of the alcoholic spectrum, Moral Ther- apy will have no contribution to make other than the vitally important one of realizing that there is no use for its methods in these instances. No greater harm can be done to a person than misguidedly assuming that one has the panacea for all ills or possesses expertise in a narrow and specialized field, where the skills and experience of others are infinitely greater than one's own. 182 The Myth of Neurosis Moral Therapy will be interested in the middle ground. Here the drinker will be caused problems by his drinking, but will still be to some significant extent in control of it. It will be an activity in which he overindulges because his will- power appears insufficiently strong to avoid it; he will dislike himself for gratifying his short-term desires at the expense of his long-term needs; he may feel guilty and worthless. Low in spirits and anxious, he takes a drug that depresses his central nervous system, thereby providing some short-term relief from his anxieties, a quick fix of self-confidence. As the effect wears off, he realizes that he has chosen an unworthy path that leads in the opposite direction to a lasting increase in self-respect. As hangover sets in, physical and psychological discomfort are added to the low mood that he had sought to escape. Thus the vicious circle is set up. He drinks to avoid guilt, unhappiness and felt worthlessness, only to have these feelings exacerbated by the supposed cure. Moral Therapy seeks to reduce the need for the "comfort" of alcohol by replacing it with something of greater value. The individual will be shown how to obliterate his low feel- ings by strenuous activity in all sorts of different areas, in- cluding exercise and bodily improvement. Swimming a mile will be every bit as efficient a way of escaping the metaphysi- cal blues as the drinking of alcohol. But because it is good for you, makes you feel better physically, look better aestheti- cally, increases self-respect and diminishes guilt, it can have only positive implications for peace of mind. Of course, the presence of our low spirits has the effect of making such activity an extremely difficult and, on the sur- face, unattractive proposition. The gin bottle is a less exact- ing and ostensibly more comforting one. It is at just this point, however, that the intervention of the concerned and forceful friend practicing the principles of Moral Therapy can tip the scale in the direction that will result in increased self-respect. Not only will he suggest activity, he will partici- Body Maintenance 183 pate in it as far as he possibly can. The individual will, there- fore, learn how to react to negative moods by positive ac- tions, as he finds out by trying them that they work. Without the enthusiastic directive of his friend he may never have made the discovery. The doctor will be well versed in the various signs that point to alcoholism or give early warning that the individual is heading towards such a state. All of us after overindulging experience the well-known withdrawal effects of the hang- over. We feel sick, psychologically ill at ease, tired, shaky and with an aching head and a vicious thirst. These are caused by tiredness, the dehydration effect of the alcohol, increased levels of the alcohol metabolite acetaldehyde in the blood, and the presence of substances known as congeners in the al- coholic drink, which give it its distinctive coloring and taste. Mixing congeners seems to produce particularly bad hang- overs. Fructose and high-dose vitamin C may have some ben- eficial effect, but by far the best method of alleviating hangover symptoms is to remain in bed and allow time to do its work. There is no evidence that exercise or stimulant drugs e.g., the caffeine in coffee- -have any significant ef- tect in speeding alcohol metabolism. Between the person who suffers the occasional hangover, and the person who is addicted to alcohol to the extent that only by continued drinking can he ward off classic alcoholic withdrawal syndrome, there is a wide gap. In its severest form the alcohol addict may suffer from delirium tremens. Before this stage is reached the withdrawal period may be characterized by profuse sweating, intense anxiety, and gas- trointestinal upsets with vomiting and diarrhea. The alco- holic may tremble uncontrollably and demand alcohol constantly. In the early stages the individual might increasingly resort to alcohol to escape problems, saying things like "I need a drink, rather than "I would enjoy a drink. " He may become 184 The Myth of Neurosis uninterested in the taste of the drink, being primarily con- cerned with its psychotropic effect. In this stage he may begin to drink secretly, going to moderate lengths to mislead others close to him about the amount that he is drinking. A person who has formerly drunk only on social occasions might start to drink alone. He begins to frequent drinking es- tablishments in a regular way, making new friends in those places who share his preoccupation with drinking. In an ex- pansive mood he will invite these new friends back to his home and entertain them generously, to the irritation of his wife and family. He feels increasingly guilty and depressed and drinks to avoid these feelings. He gets drunk more fre- quently, suffering constant hangovers, and tolerance devel- ops so that more and more alcohol is required to produce the same effect. This is probably because enzymes are induced in the liver so that it becomes more efficient at metabolizing blood alcohol. The drinker moves from drinks such as beer and wine to those with a higher alcohol content such as whiskey. Rather than sipping drinks he tends to gulp at them, and he begins to avoid regular meals. His expenditure on al- cohol increases and he spends less on food. Alcohol begins to preoccupy his thoughts and his day revolves around his visits to the bar or pub. A particularly sinister sign is if he loses his memory for events of the night before, despite being ap- parently conscious of all that was going on. Passing out and having to be put to bed is also a sign that things are moving fast down the slippery slope. Arguments and strife at home will be more prevalent as the wife gives voice to her worries, and resents the time spent on the drinking activity and the unsavory friends that go with it. Colleagues at work are wor- ried that things are not as they should be, as ability to con- centrate and work efficiency tails off, ambition is lacking, energy is decreased and self-confidence disappears. The boss may notice alcohol on the drinker's breath in the early morning (alcohol takes twenty-four hours to leave the Body Maintenance / 185 body). Gradually the individual becomes less predictable, emotionally incontinent, expansive but unrealistic, and in- creasingly unreliable. His libido may increase, but his sexual ability declines. Others may notice that there is a falling off in his personal appearance. Increasingly he seems unable to stop once the drinking has started, and most nights and some lunchtimes he is quite noticeably under the influence of alco- hol. In the early stages the heavy drinker will be amenable to the methods of Moral Therapy. In the later stages, he will be beyond Moral Therapy's help, as the problem becomes more severe and the decline gathers momentum, with work and social relationships suffering to a greater degree. Now self-re- spect declines dramatically and the person suffers uncontrol- lable guilt and anguish as a result of his alcohol-induced excesses. He fights to regain his lost control over his habit, and for a few days goes ostentatiously "on the wagon. » He misses more and more meals, as he is too busy drinking and feels too queasy to manage a substantial diet. Finally, in an effort to ward off his vicious hangovers and the guilt that ac- companies them, he starts to drink in the early morning. At this point the alcoholic has reached the stage at which he needs desperately to be withdrawn from alcohol if he is to survive, and must be under medical supervision, as the con- sequences of sudden withdrawal are severe. He will need tranquilization, high-dose vitamin replacement (especially B group vitamins) and possibly fluid replacement. Above all, he will require professional nursing care. Smoking The smoking of tobacco cigarettes is an activity that has been conclusively proved to be extremely damaging to physi- cal health. A heavy smoker can expect statistically to lose over eight years of his life compared with a nonsmoker. The 186 / The Myth of Neurosis increased mortality from the chronic lung diseases such as bronchitis and emphysema has a more or less straight-line graphic relationship to the number of cigarettes smoked per day; and the cessation of smoking lowers the death rate in these conditions. Smoking cigarettes is also a clearly identi- fied cause of lung cancer (carcinoma of the bronchus). Stop- ping smoking reduces the risk of death from lung cancer by about 50 percent in five years, but over a fifteen-year period death from this unpleasant disease is still twice as high for smokers as for nonsmokers. Data would also indicate some connection between smoking and the much rarer cancers of the mouth, lips, larynx, esophagus and bladder. Smoking is also an associated factor in ischemic heart disease, in which the excess death risk is over twice that of nonsmokers. Heavy smoking during pregnancy is associated with slow growth of the fetus and low birth weight babies, with in- creased risk of intrauterine and perinatal death. Nobody needs to be told that cigarette smoking is intensely addictive and that the average smoker is enslaved by his habit. He suffers from bad breath and his clothes are semi- permanently covered by ash. He coughs unpleasantly in the mornings and manufactures unsavory smells in enclosed places, to the considerable discomfort of others. The fumes that cigarettes produce permeate the clothes of nonsmokers and infiltrate their lungs, with a damaging effect on their health. Smoking is aesthetically unpleasing and socially ag- gressive. To the extent that smokers are damaging themselves and irritating others, most would wish that they could be freed from their compulsion. Insofar as their willpower is in- sufficiently strong to enable them to break their habit, their self-respect declines, and they experience guilt at the con- templation of their weakness. We should encourage such people strongly to take action and give up smoking, in the same way that we exhorted others to return to their proper weight and avoid obesity. Nobody has ever suggested that it Body Maintenance 187 is easy to give up smoking, or to stick to a weight-reducing diet, but both are within the capabilities of all of us. In mak- ing a start at learning to control himself and attain difficult obiectives, the individual will reap the benefit in other, less easily accessible areas. He will find that in the losing of weight and avoidance of cigarettes, his general mood will improve as he begins to like himself more. It may be asked what methods should be used to help the individual to give up cigarettes. There are very many methods, including hypnosis, slow tapering off, oral substi- tutes, aversion therapy (smoking associated with electric shocks), monetary fines, programs designed to make the ad- dict repulsed by his habit (like making him sit in a small smoky cubicle and chain-smoke endless cigarettes). All these have significant disadvantages in that they all seem to be de- signed to minimize the sense of "I did it all myself" which Moral Therapy is so anxious to develop. In Moral Therapy the main advantage in giving up smoking is the increase in self-respect that must surely follow from it. So the individual will be encouraged to see it primarily as a test of his will- power. Is he strong enough to master himself? Is he capable of freeing himself from this slavery? If he can prove himself in this area, he can prove himself in others. It can be the first significant victory in the war against felt worthlessness. We should seek to mobilize the individual's self-respect in the campaign, and impress upon him that it is a test of his resolve generally, and not just an attempt to rid him of an unpleasant and unhealthy habit. In order to maximize the increase in self-esteem, the smoker should be encouraged to make a solemn commitment never to smoke again. There will be no halfway measures. Each time he fails, he will renew his commitment. He must never give up. For if he reneges on one commitment, it makes it easier to go back on others. So each battle, however unimportant it may appear to be on the surface, will be 188 The Myth of Neurosis fought tenaciously and courageously. If we don't respect our behavior in small things, we will be unable to hold our heads high in matters of greater importance. So by discouraging obesity, smoking and excessive alcohol intake, the practitioner of Moral Therapy will help to allevi- ate those seemingly intractable problems that the psycho- dynamists and medicobiologists seem powerless to solve. By his oblique approach to those apparently inaccessible areas in which thoughts and ideas live and mysterious brain biochem- ical events occur, he will achieve far more than by the frontal approach favored by the traditionalists. The individual must be encouraged, first, to act positively, as from these actions positive thoughts will come. He will learn to like himself by watching himself do the things that he feels are admirable. Never must he be allowed to fall into the pit dug for him by the psychodynamists, in which he attempts to straighten his thoughts and attitudes as a prelude to successful action. All that will happen in such cases is that the pit will become deeper and deeper as the intellectualizing processes expand, as in Parkinson's Law, to fill the time available for their contemplation. Correct conclusions in this shadowy world are rare commodities. If they exist at all they are seldom recognized and never achieve a higher status than acts of faith, believed in with varying degrees of conviction by the psychodynamist and his unfortunate patient. And all the time, as these directionless meanderings continue through the meadows and fields of ghostly lands with names like "the unconscious mind" Or "the id, » the patient continues to suf- fer, isolated and introspective, unable to influence his des- tiny, as his psychodynamist pilot steers him along paths that have no existence except in the narrow speculative theories to which that particular therapist adheres. In Moral Therapy, talk will be considered the enemy of action. First we must act and then we can assess action. The discussion of what action is suitable should be minimal, as we ultimately know what Body Maintenance I 189 actions we should pursue. Always we must avoid the pitfalls of talk about talk about talk, an obsession that has bedeviled the successful development of people throughout this cen- tury, causing untold misery as "patients" are encouraged to find excuses for themselves, rather than encouraged to go out and act in the way that alone can contribute to an increase in their self-respect. 14 Sex, Marriage and Moral Therapy Nowhere are the views of Moral Therapy more easily clarified than in a consideration of its positions regarding the institution of marriage and the biological activity of sex. All of us are aware that in recent years we have been living through a sexual revolution during which traditional values have been cast aside. The pace at which these standards have been discarded and replaced with more radical views has been remarkable. Once again one need look no further than Freud and his disciples in the search for the people who are mainly respon- sible for current attitudes in this field. That their ideas have become so popular can be explained only in part by their in- trinsic attraction, and by the fact that these philosophical "breakthroughs" found a kind and hospitable environment and climate in which to flourish. And so at the turn of the century the process started as a revolt against prevalent atti- tudes before expanding into the current state of permissive- ness in which all values are discounted in favor of the unbridled pursuit of personal and transient pleasure, which has as its lowest common denominator the superficial gratifi- cation of the senses experienced through sex. 190 Sex, Marriage and Moral Therapy 191 Total commitment The reader by now will be no stranger to the view of Moral Therapy that so often what we desire is not what we need and that often we appear to be the worst judges of our own deeper self-interest. He will realize, too, that the surface ap- pearance is more often than not belied by the inner knowl- edge of inadequacy and experience of guilt and lowered self-respect that ensure that the individual will more than pay the price for the contravention of his ethical system in the currency of psychological pain, and this despite the fash- ionable views and teachings of society that are too often publicly held but privately disavowed. First let us consider the institution of marriage. Moral Therapy holds that marriage need have little or nothing to do with sex, a view that is more widespread in this world than "sophisticated • Western attitudes might indicate. Marriage represents a total commitment; the deepest evi- dence of love, affection and respect; a fundamental promise; the welding together of two spirits; a mutual onslaught on loneliness; a shoring up of defenses; a path towards selfless- ness without self-neglect or diminished self-esteem; a secure environment for the procreation of children; an efficient eco- nomic unit; a firm foundation from which both partners can build self-respect and in loving each other learn to like them- selves more. Our marriage partners are above all our special friends whom we care for as for ourselves; who will shield us from harm, from degradation, from unnatural stresses. At the start of this union we enter into a solemn and bind- ing promise in a ceremony witnessed by friends and loved ones. The promise is comprehensive, all-embracing, involv- ing a commitment to stand by our partners when the going gets rough-_to love, cherish, honor and obey in sickness and in health, in poverty and in wealth forever. 192 / The Myth of Neurosis What has happened to this most useful and efficient insti- tution in the eighty-odd years since Freud's theories pro- pounded the misleading and unhelpful view that the id, the primeval driving force of the personality, permeates us with a libidinous energy that directs us inexorably towards activi- ties that, despite outward appearances, are expressions of at- tempts to achieve what basically is a sexual gratification? Certainly marriage has not prospered since the promulgation of these speculative and unverifiable theories. As divorce rates in the Western Hemisphere exceed 50 percent, whole new industries have grown up to deal with and profit from this unhappy state of affairs. Marriage counselors, divorce lawyers and family therapists practice their "skills" but achieve little except to give an aura of respectability to mar- rage breakdown and therefore facilitate what is the most dis- astrous step that two individuals can take. The damage to self-respect caused by the failure to live up to the most im- portant commitment that we make is inestimable, while the guilt that we suffer from the contravention of our moral code is often unbearable. And yet the mind pundits, mouthing wa- tered-down versions of the Freudian myth, assure us that our primary responsibility is to ourselves and our self-gratifica- tion. This they interpret as a right to freedom, a right to hap- piness, a right to sexual pleasure, a right to the avoidance of hardship, of unpleasantness, of difficulty. If marriage has be- come too difficult and is hampering our self-development in this permissive age, then we are encouraged to cast it aside, and move on to the fresh pastures and greener grass on the far side of the hill, again to repeat our errors, compound our mistakes and learn to like ourselves even less as we struggle from failure to failure in our misguided pursuit of a success that seems permanently to elude us. Moral Therapy will try to give the individual a clearer view of the realities of life. He must realize that, although Sex, Marriage and Moral Therapy / 193 marriage is an institution of inestimable value, it is not easy but tough. He must accept a life of hardship, not of ease. He should know that there will be difficulties and problems, but he should know, too, that he must always be determined to deal with his self-admitted responsibilities, not to deny them; to strive bravely to keep his promises and maintain his com- mitments, not to renege on them. As the stresses and strains of marriage arise, he must struggle manfully to cope with them, secure in the knowledge that this is the nature of mar- rage and that in successfully surmounting difficulties both partners will like themselves more and increase their love for each other as steel is tested in the fire, as the broken bone heals stronger than before. He should realize that to break up the marriage would not solve problems for him but create them. For if he cannot deal effectively with a situation that he has freely and so enthusiastically chosen, he is unlikely to do better elsewhere. Divorces happen because the motive, the will to make the marriage a success is lacking. People are misled into believ- ing that circumstances have conspired against them; that the pressures are too great; that the partner has changed; that greater pleasures and opportunities lie elsewhere. But people do change, as do circumstances, and if we give proper em- coming marital difficulties both partners will achieve an increase in self-respect and diminution of guilt that will al- ways outweigh that admission of failure that constitutes di- vorce. It should be a rare thing indeed for us to counsel divorce, because it is a very rare thing for anybody to benefit from it. Whatever attitude we might hold superficially, most moral codes are contravened by that breaking of important prom- ises that the divorce process involves. Moral Therapy seeks to conserve that which is good by encouraging decision-making and change. This seeming paradox is at the heart of its doc- 194 The Myth of Neurosis trine. For if things are going badly we should not remove ourselves from them but instead should seek to change them, to remold our present situation so that original promises can be kept, not broken, fundamental commitments adhered to rather than abandoned. Divorce and breakdown of marriage are about mistakes, but not about mistaken choices of partners. Instead they are about mistaken decisions, mistaken attitudes, mistaken be- havior. Our ability to reshape and refashion our relationships, while maintaining them, is infinite. All that is required is commitment and determination. The bonds of conscience The promises that we make in our marriage vows are to our partners, but they are also to ourselves. We neglect and negate them at our own peril, as well as that of the relation- ship. Faithfully we keep them for our own benefit and for that of our marriage. There may today be little or no social stigma attached to divorce, no external sanctions mobilized against us, but we will know what we have done and our guilt mechanism will not be deceived or quieted by those fashion- able liberal attitudes that tend to regard a change of marriage partner as being analogous to a change of living place or a change of occupation. If we are to increase our liking of our- selves we must keep our promises and maintain our mar- rages while reorganizing our behavior and attitudes the better to achieve that purpose. It seems that sexual difficulties are one of the most fre- quently blamed "causes" of marriage breakdown. It may be that all sexual activity between partners has ceased and that they no longer find each other physically attractive, although in other ways they remain fond of each other. Both partners may find themselves strongly attracted to other people and may be involved with them in extramarital sexual relation- Sex, Marriage and Moral Therapy 195 ships. The strains, trials and tribulations that such illicit activity can have on the marriage are usually significant, whether or not the wronged partner is aware of what is going on. A guilty husband in the vast majority of cases will suffer from guilt knowing that he is breaking the promises that he so solemnly made. He exchanges that psychological pain for the transient pleasure of the sexual relationship, but he feels resentful that he is not contented. Why should he feel so guilty, he may argue, when he is merely indulging in a little harmless extracurricular activity? After all, he is in good company, for it would appear that many others are doing the same thing. He may feel that it is his partner's fault that he no longer finds her attractive. She may feel that it is his be- havior that has caused her ardor to cool. When we know we are behaving in an unsatisfactory way and we have nobody to blame but ourselves, we attempt to find a scapegoat and the marriage partner is conveniently at hand. Always we listen to, and are influenced by, those pundits who are so willing to tell us that we owe it to ourselves "to have a full and active sex life, 22 that sex is something that nobody should be with- out, a sine qua non of human activity, the ripest plum on the tree of life. Nobody today thinks of it merely as a means to an end. Instead it is now widely considered, thanks partly to Freud and his co-conspirators, of prime and vital importance in itself, permeating and instigating behavior, whether recog- nized or not. Some would go so far as to judge the success of a marriage or relationship in terms of whether or not sexual ac- tivity was mutually satisfactory. Good sex is something that we are entitled to, we are told. Others have it and so should we. If something appears to stand in the way of our natural right to sexual fulfillment, we should consider seriously doing away with it. Others may take a less liberated view, but still fall into the trap of overvaluing and giving far too much weight to what should be considered a relatively unimpor- tant part of human behavior. 196 The Myth of Neurosis Moral Therapy has no truck with such "liberated" views. It may well be that we have come to feel intellectually that it is vital to have good sex and that we owe it to ourselves to ex- perience it. Furthermore we are encouraged to believe, by the media and the protestations of others, that nearly every- body else apart from ourselves is busily enjoying a satisfac- tory and fulfilling sex life. In reality very many people find that sex is a relatively unimportant and overrated part of their lives and are happy to do without it. They can take it or leave it, as it is a matter of small concern to them. When, however, sexual activity cheapens and demeans us, causes pain to those we love and results in our breaking our most formal and binding commitments, few of us will like our- selves more by indulging in it. Despite our intellectual stand- point, our deeper emotional instincts will tell us that we are unworthy. In contravening the dictates of conscience, we will like ourselves less and suffer the pain of guilt. In Moral Therapy, then, extramarital sex will be disallowed because in the vast majority of cases it will contribute neither to our self-esteem nor to our mental health. Moral Therapy is also interested in giving the lie to popu- lar misconceptions in this area that have grown up in an in- tellectual climate that has for too long been dominated by theories whose wide acceptance has been founded on the fact that they have pandered to, and encouraged, the expression of man's baser desires at the expense of his more fundamental needs. Once the theory that man is governed by unconscious and primitive urges for pleasure and gratification that can only with difficulty be repressed, controlled or redirected has gained wide credence, then full and unfettered freedom of sexual expression tends immediately to become valued as a very natural and consequently proper activity. It follows from this elevation of the desire for physical gratification to a point where it is used to explain all our motives and ambi- tions that those who do not divine such urges in themselves Sex, Marriage and Moral Therapy / 197 are mistaken, or are in some way seriously deficient, and are in need of help. Common sense Most of us, however, despite the advice of the intellectuals and mind pundits, embrace a more commonsense view. We have been brought up to believe in keeping our promises, in marital fidelity, in the valuelessness of casual and irresponsi- ble sex. We know that we indulge in such 66 pleasure 29 illicitly and that there will be a price to be paid. Other such "plea- 22 sures exist, of which drugs and alcohol are good examples. We indulge in them moderately or immoderately, knowing that they are not good in themselves and will provide no last- ing benefits. They are used for what they are, for the immedi- ate satisfaction that they provide, as "rewards" for hard work, as relaxants to banish strain, as part of our habitual be- havior that we are unwilling or disinclined to resist. At the very best we might argue that they "do us no harm. .3 Few would go so far as to argue that they are fundamentally and positively beneficial-_-that their use or abuse signals a natural and healthy self-expression that we repress at our peril. And yet prevalent attitudes towards sexual promiscuity reflect the view that not only is it harmless but in some way it is harmful to suppress it. "It can't do any harm to have a discreet af- fair, 29 "If nobody knows, then nobody can be upset," "It doesn't mean anything, I still love my wife, 99 "'It's unnatural to do without sex, 29 "I owe it to myself to have a good sex life, ," are all sentiments that are frequently expressed. While some would be prepared to go so far as to maintain that such behavior is valuable, important, good in itself, others prefer to emphasize its harmlessness, its inconsequentiality, its natu- ralness, and point to its prevalence in order to justify it. But in truth all these protestations reflect an unsuccessful at- tempt to conceal what the individual knows in his heart- 198 / The Myth of Neurosis that he is behaving badly and suffering the consequence in the psychological pain of guilt. Moral Therapy takes the hard and uncompromising view that all "pleasures" that tend to decrease self-esteem should be avoided, for in reality they will not be pleasures in the only valuable sense of the word but will instead be the cause of guilt feelings. Transient pleasures are easy, not difficult, and it is their avoidance that constitutes the harder and therefore the more valuable alternative. To those who would ask whether Moral Therapy advocates a life free of sex for the married person who no longer desires or is desired by a partner, the answer is 61 yes. » Sex is not of necessity important. It can be dispensed with, and very fre- quently and in many successful relationships it is. When the truth of this assertion is widely recognized and the stigma of "an unsatisfactory sex life 22 is removed, many will come forward to admit that for them sex is not as important, plea- surable or essential as so much of popular wisdom would have it be. Today an unsatisfactory sex life is regarded as a disease, and those who suffer it are encouraged to consult the expert, a doctor, a sex therapist, a marriage guidance coun- selor. It is not considered natural to miss out on this central and seminal activity, this fount of all pleasure, this ultimate expression of life energy. Sex, in short, is considered to be too good to miss -food, warmth and water are considered to be hardly more vital for our continued well-being. In truth, to dislike sex need be of no greater significance than to dislike oysters. It is a question of taste. Some feel the need for it, others do not. Some are good at it, others bad or indifferent. Yet publicly to admit that you dislike or are indif- ferent to sex or, worse, that you are bad at it would be to give rise to a series of responses that would be as inappropriate as they would be predictable. People would feel sorry for you, would disbelieve you or would scorn you. Recommendations Sex, Marriage and Moral Therapy / 199 might be made as to what course of action should be taken. Speculations would be made and hypotheses advanced concerning the causal processes involved in your descent into this "unhappy and unnatural" predicament. In all cases it would be assumed that this unhealthy status quo could not be left undisturbed, in view of the deep unhappiness that such attitudes must of necessity cause. Even if it was believed that you had come to some uneasy arrangement with your own in- adequacy, there would be sympathy for the unfortunate mar- riage partner who would be assumed to be suffering intolerable deprivation as a result of being denied the funda- mental human right to a full and satisfying sex life, a right that is for some reason considered as basic and inalienable as the right to freedom before the law and the right to vote. The option of abstention Moral Therapy maintains that, of the many different types of pleasure, sexual satisfaction is not of necessity the primus inter pares. From this it follows that in the absence of illness or physical disability, which should always be excluded by a doctor, the so-called sexual dysfunctions such as premature ejaculation, impotence, frigidity, vaginismus and anorgasmia do not represent real inadequacies. In the majority of cases they represent a dislike or fear of sexual activity which may be totally natural and normal. In all these cases the problem will disappear if the individual merely refrains from all un- pleasurable sexual activity. It is difficult to overestimate the opposition that exists to such a simple solution despite the undoubted fact that many of those who lead the most conspicuously successful lives- Roman Catholic priests, for example -have done so while voluntarily denying themselves all sexual contacts. It seems extraordinary in the presence of so many examples of the lack of importance of a busy sex life to psychological health that 200 The Myth of Neurosis the idea should be so prevalent that to be sexually incompe- tent represents an inadequacy for which expert intervention is automatically required. But it is part of the great tendency of our age to attempt to make patients of us all. As an example of Moral Therapy's attitude towards sexual problems let us consider the plight of the premature ejacula- tor. Premature ejaculation is one of the most common sexual malfunctions, causing much unhappiness and discomfort. Very often the person who suffers from this condition is un- aware that techniques exist that have a very high success rate in solving this problem. Because he feels he wants to be able to satisfy his wife, and also that it is his duty to do so, his self- esteem is often seriously compromised by his inability to control his orgasm, and he may feel extremely guilty about this failure. Because he is naturally shy of discussing such problems, he is not well placed to receive good advice. His doctor will be able to put him in touch with those whose job it is to explain and organize the behaviorist "'squeeze 99 tech- nique, pioneered by Masters and Johnson, by which this seemingly intractable problem can be overcome. For prema- ture ejaculation is a failure of bodily function and in such sit- uations the doctor will always seek specialist help, unless the problem falls within his own particular area of scientific ex- pertise. Premature ejaculation interestingly highlights a gray area where the individual's actions are making him feel guilty, but he apparently is not in a position to do anything about. it. It would be simplistic to suggest that he can just cease to ejacu- late prematurely in the same way that one might suggest that he cease to be unfaithful to his wife. However, Moral Ther- apy maintains that there are always courses of action open to us to alleviate our guilt feelings. In this case the natural ten- dency might well be for the individual to do nothing, talk to Sex, Marriage and Moral Therapy 201 no one and merely suffer in silence, while hoping that things would improve by themselves. The more courageous ap- proach is bravely to confront the problem, seek advice on how it should be conquered, and then for the individual to mount a frontal assault on it with all his energy and enthusi- asm. In overcoming his problem he has the double benefit of a more satisfactory sex life and a large increase in his self-re- spect, resulting from the contemplation of his hard and suc- cessful campaign. Again it is worthwhile to point out that in Moral Therapy nothing is a problem if it is not regarded as being so by the individual. It may well be that the individual is a person who regularly ejaculates within seconds of penetration, but who truly believes that there is nothing wrong with this. He may make the very valid point that for him sex is a method of pro- creation, and nothing else. He may argue that his behavior in this respect is very similar to that of other higher primates in the animal world, who find that speed is of the essence in their performance of the sexual act. In the animal kingdom, when the risk of intervention is considerable, it clearly does not pay to hang around! If the Moral Therapist is convinced that such arguments are not mere casuistry designed to paper over genuine guilt feelings, he will not suggest intervention in this area. His only concern is the mental health of the indi- vidual, which in this case would remain unthreatened. The more traditional approach would involve an attempt to widen the issue. Forgetting that his only real responsibility is to his patient, the medicobiologist, well-versed in the lib- eral attitudes of the age, might "knoW 79 that sex is a won- derful experience to be enjoyed for its own sake and that any failure to extract maximum pleasure from it must carry with it important implications for his patient's psychological well- being. He would also be interested in the predicament of his patient's wife. Why should she be denied the pleasures of a full and satisfying sex life? 202 The Myth of Neurosis The psychodynamist would be far too interested in the oc- cult causes of this condition to worry too much about whether or not anybody closely involved with the situation regarded it as a serious problem. For him such speculations as to whether or not it represented a subconscious act of aggres- sion towards his wife, perhaps occasioned by his latent homo- sexuality, would be the only valuable way to proceed. Both approaches are widely different, but in that they both fail to discover the individual's true attitude towards "'the problem of his premature ejaculation, and tend to insinuate that this phenomenon would be a problem whenever it occurred, the net result is that they find themselves in the position of hav- ing to persuade the individual that he really does have a problem. Effectively they would be attempting to force guilt and low respect on to their patient against his will. Is he se- cretly an aggressive latent homosexual? Is he a selfish chau- vinist who has no feelings for the rights of others (e.g., his wife)? Is he so shortsighted that he can forgo the excitement of prolonged lovemaking? But if the wife objects to her husband's inability success- fully to control his orgasm, then, if he does not truly regard it as a problem, it becomes hers alone and not his. For in the same way that some people experience no moral imperative that they should take care of their bodies, so some others hear no ethical commands that they should receive and dispense pleasure in the sexual act. It may not be the view of tradi- tional wisdom and may be contrary to society's dictates, but if the individual is honest to himself in holding these atti- tudes, then we do him no service in trying to disabuse him of them. They may be unusual, but they are in no way mentally unhealthy. The female sexual dysfunctions consist chiefly of inability to become sexually excited (frigidity), inability to have an or- gasm during sexual intercourse (anorgasmia), and the ten- Sex, Marriage and Moral Therapy 203 dency to experience intense vaginal spasm on attempted penetration (vaginismus). Once organic causes for such con- ditions have been excluded, an attempt should be made to discover whether or not the individual is really worried about her condition or is merely reflecting the attitudes of others e.g., boyfriend, husband, well-meaning friends, etc. For it should be remembered that there is no law of nature which says that all of us should be able to enjoy sex, and if we are unable to do so we are not necessarily deprived, rendered in some way crippled and incomplete, as so much of tradition- alist psychodynamist doctrine would suggest. The "frigid" person may be free to channel her energies into, for her, more productive areas, while the person who has never had an orgasm need not necessarily worry that she has missed an experience which, although universally regarded as pleasur- able, can seldom be said to increase one's self-respect. Con- tinually, Moral Therapy would emphasize that in the world of the mind nothing has to be. It may be usual to worry and feel guilty about frigidity, anorgasmia and vaginismus, and in such cases specialist help can be sought, although informa- tion about methods of dealing with these situations is avail- able in books which require no specialist knowledge to understand. However, in very many cases the individual pays lip service to the fact that she regards these conditions as seri- ous problems because the world tends to view them as such, because there are sections in psychiatric texts concerning them and because "'experts '" have invented long names to de- scribe them. Moral Therapy holds that in cases in which the woman feels that sex is unpleasant, unsatisfactory, lacking in aes- thetic appeal, and demonstrates this attitude by her "frigid- 99 ity, preferring to concentrate her energies on other activities, then rather than attempting to change her attitude she should be encouraged to avoid the sexual activity that she finds so distressing. If sex makes her feel guilty she should 204 The Myth of Neurosis give it up. If avoiding sex makes her feel guilty she should in- dulge in it. If she feels guilty in both situations she should follow that course of action which she truly feels will give rise to the least guilt, to the least diminution of her self-re- spect. Whatever happens in this way and in the particular circumstances, she will maximize self-esteem. It is as simple as that. 15 Drugs and Moral Therapy: No Escape from Reality We have considered the case of drugs misprescribed by the medical profession and the dangers of drugs such as alcohol and nicotine, which we prescribe to ourselves. Now we come to a discussion of those drugs which are obtained illegally. As a general principle Moral Therapy maintains that insofar as their use tends to contravene private individual moralities, such substances are potent sources of guilt and lowered self- respect. Many attitudes and behavior propensities are implied by the use of drugs and all are potentially damaging to self-es- teem. The drug user will demonstrate a desire to escape problems rather than facing and solving them; a willingness to surrender control of himself, rather than striving to main- tain it. He will indulge in attempts to gain bogus "'insights" and experiences on the cheap rather than by working for them; tend to withdraw from active participation in life rather than attempting to contribute to it; be prepared to harm his body and mind, rather than seeking to maintain and develop them; show preference for the easy rather than the difficult way; seek to avoid responsibility for his actions; be prepared to hurt and frighten those who care for his physical 205 206 The Myth of Neurosis and mental well-being; be willing to exchange the future for the present; and above all he will demonstrate to others a weakness of character and a failure of will. Let no one doubt that the use of drugs is not conducive to contentedness. Some may desire and want them, but never do they need them, and we should ensure that our friends recognize this. At no stage, unless physical or mental illness is thought to exist, or to be about to exist, should psychotropic drugs of any sort be coun- tenanced. If an individual shows that over a period of time he is un- able to desist from a drug habit and is addicted in the medical sense of the word, to the extent that physical dependence with tolerance has occurred, e.g., to one of the dangerous narcotic analgesics such as heroin, then that patient should be referred immediately to specialists who are trained to deal with these problems. Pleasure, oblivion and guilt Traditional therapists and doctors often see it as their task to busy themselves with attempts to understand the drug user and his problem. In time-honored fashion they will try to ex- plain the reasons that led him to this unhappy state of affairs. Was he predisposed towards alcohol abuse by his "inade- quate personality" or had he become, in Freudian terms, fix- ated at the oral stage of his development, seeking pleasure by putting things into his mouth (drink, cigarettes)? Or perhaps again it is the fault of that long-standing scapegoat, society itself, whose capacity for causing the individual intolerable stress is continually emphasized by those of a liberal disposi- tion. Endlessly such "experts" will seek for excuses so that the individual can be forgiven his unfortunate behavior and be absolved from all blame. After all, they might argue, alcohol- ism does run in families, so perhaps there is a genetic compo- nent, an enzyme deficiency, a chemical imbalance which Drugs and Moral Therapy: No Escape from Reality I 207 determines this unfortunate person's condition and therefore removes that responsibility for his own actions which alone would provide sufficient grounds for his feeling of guilt. Needless to say, the individual is not persuaded by such well- meaning arguments and continues to be racked by guilt at what he knows ultimately to be his own failure. But the short answer is that the taking of drugs provides instant pleasure, occasionally coupled with instant oblivion. In facing difficulty and psychological discomfort, the individ- ual, by using his drug, escapes his stress at the cost of in- creased guilt and lowered self-respect. He exchanges current gratification for long-term psychological pain. It is a very or- dinary human reaction analogous to, although vastly more dangerous than, the enticing but fattening pudding or the sleep in the sun when there is work to be done. No further ex- planation is necessary, and we should see it as our job not to understand the use of drugs but to prevent it. Drug abuse signals a weakness of character and a lack of foresight that the individual must eliminate if his self-respect is to increase. It is a straightforward problem to be confronted in a straight- forward way- "If thine eye offend thee, pluck it out." This is not to imply that the breaking of a drug habit is easy. It is far from that. But although difficult, the task is not complex, in that the objective is clearly visible and the methods, although involving hardship, are there to be used. As with all such problems in Moral Therapy, the taking of drugs will be used in a positive way to build the individual's belief in himself as, by breaking their hold on him and re- versing long-established behavior patterns, he will experi- ence a significant success and learn to like himself more. The position of Moral Therapy with regard to cocaine and heroin is quite clear. While it recognizes that we may all need occasionally to escape "the intolerable clutches of real- ity, ," the easy way of achieving this should always be avoided. 208 / The Myth of Neurosis Physical exercise on the one hand and immersion in literature and the arts on the other are infinitely more acceptable ways of removing ourselves from the humdrum reality of everyday life. They are more difficult and therefore more rewarding, having positive implications for self-respect. Half an hour of intense physical effort can provide a sensation of transcen- dence of reality and euphoria every bit as rewarding as that provided by any drug. Similarly, when we wish to get away from our worries and anxieties we must learn to immerse ourselves in books, plays, hobbies. It will not be easy, but it will be worthwhile and far preferable to the synthetic moods created by the swallowing of chemicals. While bending our minds in this irresponsible way, we may see in the eyes of others the low opinion of ourselves that we strive so ineffectually to escape. So the user of cocaine, for example, begins to mix preferentially with those who share his habit, seeking to escape the adverse judgments of others, making the mistake of failing to realize that the harshest and most omniscient judge of all will be himself. Others are per- suaded with considerable tenacity to do as he does. He uses his influence over those who feel they have reason to defer to him, girlfriends, subordinates, those new to and impressed by his "sophisticated" milieu, who feel they must observe all its rituals to gain acceptance. All are encouraged to try it "'just 97 once and the pleasure will do the rest. It is difficult to overestimate this peer group pressure with its implied threat of sanctions in the form of personal and social disapproval if the individual does not conform to the drug-taking behavior: a girl is in love and wants to please her loved one; a house- guest does not want to spoil the party; a stranger wishes to be a stranger no more; a friend is frightened of losing the benefit of friendship; a subordinate wishes to ingratiate himself with a superior. In each case the spurious arguments are trotted out as the " conversion" " process gets under way. «What pos- sible disadvantage can there be in trying cocaine? It is not a Drugs and Moral Therapy: No Escape from Reality / 209 hard drug like heroin. There are no side effects, just a won- derful experience. It is not addictive. You don't have to inject anything. Why are you making such a big thing out of it? Have you no spirit of adventure? What an old stick-in-the- mud you are! You are spoiling our party. Let's just forget about him. Let him be a bore. I can take it or leave it, but he's frightened that he may be too weak and will get hooked. Please do it for me just this once. Trust me. It's fantastic stuff better than anything you are likely to get anywhere else. This is the time and the place to try it. Everybody takes it. It's better than alcohol. It's less dangerous than cigarettes. It will be legal soon. How can you know about it until you have tried it? Use my silver spoon. Use my hundred-dollar bill. Let me show you. Just sniff. Just once and then we prom- ise not to badger you anymore. He's frightened of letting himself go. He's weak. He's wet. He's pathetic. If you take it, I will love you more, like you more, help you more. If you don't take it, I will love you less, like you less, help you less." So the charade continues. The pressure to conform in a drug society is every bit as formidable as the forces favoring con- formity in society at large, and all of us who have been to a party and tried not to drink alcohol have experienced it to a minor degree. What of course is happening in such situations is in fact a mirror image of the sentiments most often declared. For it is the person who resists the pressures who is strong and if he is successful then all who witness his stand will admire him for it. They do not like him less, they respect him more. It is themselves that they like less as they sense the disapproval that his behavior implies. They know he is strong as they call him weak. They know they are weak as they pose as the strong, the brave experimenters, the pioneers. For those reasons we are never justified in trying drugs, even though we believe them to be relatively harmless. Our refusal must be a matter of principle, a way of enhancing 210 / The Myth of Neurosis self-respect, of increasing our stature. If it starts as that, then the arguments of those who would persuade us to use a drug just once are without avail. For we elevate our refusal to the level of a conscious test of our willpower, in which our self- respect will be compromised if we succumb. There can be no value in experimenting with drugs since they can never, in the absence of illness, be of permanent benefit to us. They may please us but they must harm us, and we should always avoid them. The virtue of saying no Moral Therapy would urge that we unfurl the standards of our own personal morality when we are confronted by temp- tations, and encourage others to do the same. We must learn to be proud of our moral system, of our ethical code, and should not be afraid to give voice to it, to display it at all times and in all situations. For some years we may have felt the climate to be unfavorable to such declarations of senti- ment-_that others will mistrust us, pour scorn on our "'old- fashioned standards, 99 think of us as narrow, bigoted or 99 "'square, out of tune with the permissive age in which any- thing goes, and in which experiences are to be had for their own sakes a world in which knowledge and freedom are the gods, and in which self-discipline and personal restraint are regarded as unnecessary hindrances to our personal devel- opment." It is enough to say no because we feel it is right to say no. We need justify ourselves no further. The time has come once again to place our individual morality in the forefront of our lives- -to live according to our ethical code and to be proud that we are doing so. Only in this way can we regain our self- respect and our mental health. For the truth is that, in this unhappy century, morality has not ceased to exist but has been forced by the dictates of fashion to lie dormant. As a re- sult we have indulged in behavior and activities that are Drugs and Moral Therapy: No Escape from Reality / 211 basically alien to us, and have reaped the whirlwind in terms of guilt and lowered self-respect. On every side, the mind pundits have urged us on. "You have a right to be happy. A right to a full and pleasurable sex life. You have a right to be free from guilt, to be equal, to be comfortable, to be loved." Insofar as you do not experience these things, there is a mal- function either in the mysterious depths of your psyche or in the little-understood biochemical pathways in your brain, in society itself, or in those who misuse and maltreat you. And so the myth is disseminated and the "experts" carve out their fiefdoms, posing as the only ones who can rectify the imbalances that have occurred in our minds, in our brains, in our lives. They shrink from all talk of right and wrong, good and bad, morals and ethics. Are they not scientists interested in the workings of the human machine, which they interpret according to the rules of their narrow disciplines? So the indi- vidual is left, bemused and uncertain, encouraged not to use the rudder of conscience, to ignore the pilot of personal mo- rality as he drifts directionless across the bewildering sea of life. Moral codes, insofar as they are associated with that dreaded emotion of guilt, are to be thrown overboard. After all, it is argued, we did not freely choose the moral code that we have. Rather it was a thing forced upon us at an early age, when we could not be considered arbiters of our own destiny, by parents, by schoolteachers, by that scapegoat for all ills, "society itself. 99 Now, it is suggested, we should discard our moral codes where they are too exacting, where they give rise to guilt, where they displease us, where they conflict with the new permissiveness. They should be replaced with something more sophisticated, more in tune with the times, something that enables us to become more plastic, less hide- bound, less rigid, more "free. ." All the time this facile talk as- sumes that personal codes can be shed at will; that we can change ourselves as easily as we can turn the pages of a book, 212 The Myth of Neurosis when in fact our ethical systems are as deeply ingrained in us as the eyes are set in our heads, as our heart beats within our chest. Our moral systems may not be perfect, but they are all that we have. In all their most significant features, they cannot be changed and we ignore them at our peril. We may act against them, but we can never feel good about doing so, and we must suffer the inevitable psychological pain of guilt. So in- stead of recoiling from our moral imperatives we must em- brace them, for however outmoded and out of tune their rules may be, we can never successfully contravene them. We must resist the siren voices of those who would lead us astray by painting a picture of the world that bears little re- semblance to reality. Life is tough, hard and very frequently unpleasant. Much of the time we are all unhappy, discon- tented and sad. When we are thus it is not necessarily a sign of malfunction. It is as natural to be unhappy as it is to be happy, and "expert" intervention is required no more in the one case than in the other. So many of our crises and expectations are built on mis- conceptions regarding the nature of life. When we hear somebody describe life as nasty, brutish and short, we smile and wonder what is wrong with him, despite our inner awareness that there is much truth in the remark. Paradoxi- cally, by reaching an awareness that our expectations are too high, we may be able to come to terms more comfortably with our predicament. Only then can we acquire the knowl- edge that all satisfaction in this life must be earned- -that it will require effort and hardship on our part to achieve it, and that "expert" intervention is at best irrelevant and at worst a hindrance to our attainment of that contentedness. Attitudes must change. Increasingly we must live and be seen to live in harmony with the dictates of our own con- science. Nor should others be left in any doubt what those Drugs and Moral Therapy: No Escape from Reality - 213 rules are. We should not be afraid to wear our own personal morality on our sleeves, and should encourage others to do likewise. As we begin openly to live by our own rules, and as we expect less from life, realizing that all our worthwhile achievements must be paid for by our own efforts if we are to increase our self-respect, guilt, anxiety and despair will begin to fade and our mental health will improve. Then we will be able to afford the luxury of finding other employment for those psychologists who have made it their business to pan- der to people's misguided desires to escape their problems and responsibilities. As with other industries that have be- come obsolete and irrelevant, the practitioners of the various talk therapies will become redundant as the concepts that they have fought so hard to promulgate, and in which they have such a vested interest, are discarded as unnecessary and misleading. Doctors, too, will be able to concentrate once again on their primary function of dealing with physical and genuine psychological disorders, rather than ladling out bio- chemical panaceas to little effect and at considerable risk. Such is my dream. It is my hope that this book is one small step towards making that dream a reality. Inserted wood neurosis.