I’ve been reading an interesting book, lately – Healing the Soul in the Age of the Brain – Becoming Conscious in an Unconscious World, by Elio Frattaroli, M.D. It’s an interesting discussion of the place that the soul has in today’s world, and in the first 18 pages (which as far as I’ve gotten in about a week), the author makes pretty clear that he’s none to keen on the importance that modern science is placing on neurology as an explanation for why people are they way they are and why they do what they do.
Dr. Frattaroli is none too keen on the purely scientific explanations for psychological difficulties, and I can see his point. But from my own point of view and my own life experience, I have to say that neurology and biochemical explanations and scientific inquiries into the inner workings of my brain have helped me more than any amount of psychospiritual investigation. And I also have to say that understanding my brain as a physical entity which cannot help but physically affect the rest of my body in so many, many ways, has eased a great deal of discomfort in my life.
For hundreds, even thousands, of years, the Western world has very diligently separated the body from the spirit. Flesh versus soul. Earth versus eternity. And the highest form of activity seems to be the ability to transcend the limits of the physical, the manifest, the earthly, the mundane. It seems to me that this cultural interest in explaining psychological phenomena as physical conditions is a sort of redemption of the body. A grudging but almost inevitable admission that the body has much more to do with the psyche than we have heretofore been willing to admit.
I’m not sure if I’m going to finish Healing the Soul. I do respect the author for his contributions and his work, but A) the book is really long, B) the author’s tone is a bit pompous for my tastes, and C) the author worked with Bruno Bettelheim and still apparently idolizes him (Bettelheim was the psychiatrist who blamed autism on “refrigerator mothers,” thus sending countless mothers of autistic children into downward spirals of unwarranted guilt and shame, not to mention fabricating a past and credentials that were unsubstantiated. He committed suicide in 1990 at the age of 86, not long after biographer Richard Pollak started researching him. Let the record show, I am not a fan of the late Dr. Bettelheim, and I have to wonder about people who are.)
I also really reject the underlying premise that neurology and science tell us nothing about how the psyche works. It may not tell us about the psyche, per se, but it can tell us about the physical conditions that the psyche is dealing with, and help distinguish between what issues are causes of distress, and which are effects of distress.
Certainly, psychological challenges like PTSD and depression and emotional volatility can be eased by a psychotherapeutic process. But if the underlying physical issues, like TBI or extreme fatigue or sensory issues, go unrecognized, then what chance is there of us every actually doing anything about them? It’s all very well and good to explore the nether regions of the soul, to grasp the deeper meaning about life. But sometimes you just need ways to get through the day, whether or not you grasp the deeper meaning.
Plus, TBI and all its after-effects can really make you crazy with the intensity and unpredictability. It can turn you around and make you doubt your own sanity. It can trash your sense of who you are and where you fit in the world. It can strip you of your identity in subtle, subtle ways.
And addressing those issues from an exclusively psychotherapeutic point of view is worse than ineffective — it can actually make things worse. Because here you sit, week after week, trying to figure out the inner reasons why you’re so prone to losing your temper, trying to dredge up what terrible things you went through as a child that would cause you to be so volatile… here you sit, week after week, trying to figure out why you just can’t get started with things and why you have trouble finishing them, trying to get motivated and inspired and failing miserably at it… here you sit, week after week, trying to understand why you’re always so on-edge, making one attempt at another at some “breakthrough” introspection that’s going to reveal the secrets of your distress… And all the while, your brain is not cooperating.
When your brain has been rewired by injury to not take the same “cognitive routes” it did before, and it’s producing various biochemicals and hormones and responses very differently than before, I personally don’t believe that traditional psychotherapy is as effective as it is with the neurologically intact population (if there is such a thing). If the physical factors of the brain aren’t taken into consideration when looking at the spirit/soul/psyche, an important piece of the puzzle is lost… and you can’t be expected to really break through.
Missing the pieces of the TBI puzzle is like sitting at a table with a huge jigsaw puzzle in front of you, but all the pieces are exactly the same size and shape AND there are a percentage of them missing. How do you even begin to complete the picture? The edges don’t nest neatly, you can’t tell which ones go where, based on their shapes and sizes, and you’re not sure which ones are even missing.
The way I see it, it’s all connected – body and brain and mind and psyche. And just as I think purely neurological explanations can’t unlock the mysteries of mental health, I also think purely psychological explanations fall short. Physical problems, like brain injury, can create conditions that need to be dealt with. The consequences of those conditions can cause mental distress. Mental distress can be eased with psychotherapy, but as long as the underlying, precipitating conditions remain in place, the mental distress will continue to cause problems, all across the board.
Addressing issues only psychologically with someone who’s been brain injured is like building a beach house in a hurricane-prone area. You can do all you like to shore it up and design it well, but the right hurricane conditions can turn your lovely abode into a pile of kindling. It’s a physical fact you have to live with. And as familiar as you may be with seasonal weather patterns, it can hard to tell just when those conditions are going to arise.
That’s one of the reasons I sought out my new therapist. They’re a neuropsychologist by training, and they understand the back-and-forth interplay of brain and mind and body and soul. I can really tell a difference between this therapist, and my last one (whom I’m winding down with, over the next weeks). There’s less asking me subjective questions — how do I feel, how am I experiencing things — and there’s more objectivity — given my past, what makes me think that taking such-and-such an action will have different results than before? My new therapist is also a lot less reluctant to offer advice and ‘talk me back from the edge’ of bad or ill-conceived decisions. They also know how to snap me out of a downward spiral of frantic knee-jerk reaction. That’s good.
My new “psychotherapeutic process” is much less about exploring my feelings; it focuses more on results — looking at my actions and changing my decision-making/coping process, and looking at how that lets me live my life better — or worse. It’s a relief, too, because my emotional state is directly related to logistical problems I have, so it really varies, depending on how things are going for me, in everyday life. When I’m tired, no amount of therapy is going to help me overcome feeling down. When I’m all frazzled from a day that was totally screwed up by my cognitive impairments, 50 minutes of talking isn’t going to make all right with my world. It’s not even going to make a dent, if my brain is tired and overtaxed. And even with all the psychotherapeutic skill and experience in the world, a process that revolves around a broken brain is NOT going to be the same as with someone whose brain has never been bruised, their axons sheared, or their basal ganglia torqued past what’s safe.
One of my big issues with therapy has been this unspoken assumption that if I’m such a mess, certainly something awful must have happened to me as a child. Someone must have done something terrible and awful that I’m just afraid to approach. In the eyes of some trained professionals, my emotional lability and intensity and apparent depression are signs of psychological problems that stem from the Bad Things that were done to me. And if I can just get to the root of those things, I can resolve them and get on with my life.
Respectfully, I have to disagree. Brain injury has not been factored in nearly as well as it needed to be, in my prior therapeutic relationship. I do have an emotional subtext going on with me, but it is NOT based solely on things that were done to me. (It’s very frustrating for me to feel like I’m not entitled to make this assertion, as a client of a licensed psychotherapist, but I’m making it anyway.) There’s an emotional flavor to my life that’s directly related to things that have happened to me because of my mild traumatic brain injuries and the way my mind works as a result of them.
Again, my emotional well-being is not always the best, and it interferes with my ability to live my life, at times.
But my emotional well-being is often directly related to logistical problems I have with my brain… and my decreased ability to live my life follows on that.
My emotional state is not just a cause of problems. And it’s not purely psychological in origin. It is an effect of physical trauma I’ve experienced, and my psychological issues arise to some extent from problems with how my brain works.
It’s an important distinction. In this case, unlike chicken-or-the-egg, in my case there is quite often a clear, logistical, objective foundation for the messed-up situations that make me nuts. My brain is not working properly. It’s not cooperating. It’s giving me bad information about what’s going on around me, and how I should react to it. My brain — not only my soul — is having trouble.
And sitting in a room with someone who isn’t fully cognizant of that has been, at times, utterly maddening. And now and then it’s made me feel even worse, after sessions than I did going in. When I think about it, there have been a lot of times when I’ve felt a certain almost imperceptible pressure to chalk my mental health issues up to some form of victimization in my past. What my parents did. What my caregivers did. What my peers did. What someone, somewhere, in my foggy past perpetrated upon me.
But that didn’t sit right with me. Certainly, some would say I’m still in terrible denial about some Awfulness that I’ve blocked out, but logically and rationally and objectively, I can identify specific instances where my reactions and actions and choices just smacked of TBI — temper flares after long and tiring days… increasing anxiety and agitation following on sensory overload… difficulty getting started on things and finishing them during times of intense fatigue… and trouble paying attention in the midst of total, utter chaos. Those may be related to psychological disturbances for some, but they map pretty well to TBI in my case.
That all being said, I have to wonder what therapists have been treating, all these years. The psychotherapeutic/psychiatric profession is a relatively new one, compared to bricklaying and weaving, but they have really cornered the market on Fixing What’s Wrong. I do have a number of friends who are psychotherapists, and they’ve done a lot of great work. But a lot of them also don’t know shit about TBI, and I have to wonder how many of their long-time clients might have some physiological cognitive impairments. One of my friends, I know, has been seeing someone who was hit on the head with a baseball bat as a kid, and has been having light sensitivity issues their entire life. They’re also agoraphobic and claustrophobic. They also just put two and two together about their TBI, recently. Now, this person has been seeing my therapist friend for years, and I have to wonder if the length of their relationship isn’t directly related to the fact that nobody in the room knew a TBI had occurred. Maybe all this time, they were trying to get to a psychological cure for a physiologically based dis–ease. Maybe the TBI survivor went away from many sessions feeling like they were a lot crazier than they let on (as I have felt, myself, at times). Maybe the therapist tore their hair out, trying to get to the bottom of the psychological ill, when one of the biggest factors was cleverly hidden inside a skull.
For the record, I do believe that psychotherapy can be very helpful for TBI survivors. But it’s helpful in different ways, than with neurologically intact people. It can help us deal with the after-effects of our injuries. But it cannot truly heal the source. People need to face up to the fact that TBI alters the brain in ways that make it less likely to cooperate… and from what I can tell, the psychotherapeutic process has not evolved over time with TBI specifically in mind. It’s been nowhere on the map, from what I can tell. And all the Freudians and Jungians in the world with their explanations and their attributions can’t come up with an easy way to address the underlying issues of a brain-injured client.
So, maybe something awful did happen to me as a kid, and I’ve blocked it all out. Or maybe my brain was altered by injuries to make it less likely to retain certain memories. Maybe my MTBIs got my amygdala so worked up so often, from both inner re-wiring and general confusion about WTF was going on around me, that the cascade of stress response biochemicals fried my memory and ability to retain experience. Maybe I was plunged into social situations that would have been highly challenging for any normal kid, let alone a brain-injured one, so my system got even more fried than it already was.
Bottom line is, there is more to the psyche than the psyche. It interacts with our physical experience and it is shaped by our physical capabilities. People who “heal the soul” may complain that biochemicals and neurology fall short of the mark in understanding human nature and redeeming the human experience. But so long as they ignore the physicality of experience — especially with regard to the brain, injured or not — the chances of them truly healing a hurting soul are not nearly as good as they think.