Care of the Psyche
April 1, 2005

In regard to recent postings on our listserve, the word "psychiatry" is rooted in "psyche" (soul) and "iatros" (healing)-physicians of the soul. There is a long tradition (centuries long) in which what we call affects (passions in prior centuries) have been the focus of medical therapeutics-particularly the principle of "contraria contrariis". Passions and imagination were thought to be able to induce bodily illness and could be used to induce health and well-being. When I read medical documents from the classical Greek and Roman ages through the 1600's up to the 18th & 19th centuries, I am impressed by the degree of sophistication and insight some physicians of the soul had into severe mental disorders (psychosomatic and somatopsychic perspectives). We still adhere to the principles of "contraria contrariis": antidepressants are used for depression, antipsychotics are used for psychosis, antianxiety meds are used for anxiety, etc. Stanley Jackson MD, professor emeritus at Yale University , wrote a superb volume on the history of the basic elements of psychological healing used through the centuries: Care of the Psyche: A History of Psychological Healing published in 1999 by Yale University Press. I am reminded here of what Manfred Bleuler told Gaetano Benedetti: "Psychotherapy is the soul of psychiatry."

Materialistic and mechanistic scientific approaches, as well as logical positivism, have been displaced in physics by quantum phenomena which do not obey classical laws of physics (in quantum physics there is indeterminacy, also effects can take place without a cause, there is also the principle of complementarity - in psychoanalysis, the self could be understood along the dimensions of autonomy and relatedness, each nested recursively within the other, the two, I believe, could not exist independently of the other, etc.). For a very interesting volume on the relationship between quantum physics and psyche see Pauli and Jung: The Meeting of Two Great Minds by David Lindorff (2004) published by Quest Books. Pauli, a prominent quantum physicist, saw the need in science to focus beyond the rational realm. Opening science to consider the psyche would add a crucial humanistic dimension (there are interesting passages on the relationship between mysticism, a sense of the ineffable and irrational, and quantum physics). Gaetano Benedetti (1987) wrote an interesting article "The irrational in the psychotherapy of psychosis" which is contained in his volume Psychotherapy of Schizophrenia published by New York University Press-a must read for those who are engaged in the long-term psychotherapy process.

For me, at first blush, the phenomena of delusions and hallucinations, seem as outside everyday experience as quantum realities. They do not seem to follow the laws of logic and consensually agreed upon social reality. However, if one can allow oneself the opportunity to enter into a relationship with the person who is delusional, one can accept the 'rationality' of the 'irrational.' It is to be seen in oneself. Benedetti points out that the psychic dissolution can be experienced within the physical realm (one of my patients experiences the indifference of others as a piercing of his skin, a humiliating transformation of his body into a shameful object). It is the stuff of dreams (Shakespeare). The therapeutic relation extends beyond transference. Integration occurs within a relational matrix. Through a therapeutic mutual symbiosis, integration is consolidated. Insight, rationality of cause and effect, emerges from a deeper ground of the relationally irrational. The therapeutic partners each take the other 'inside.' It is an irrational being in the other. I have had this experience countless times in long-term psychotherapy. For me, this is what leads to a more cohesive self, one less prone to fragmentation and annihilation anxiety ( on the latter see the excellent work of Marvin Hurvich).

Brian Koehler PhD
New York University
80 East 11th Street #339
New York NY 10003
brian_koehler@psychoanalysis.net
212.533.5687