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Healing the Soul in the Age of the Brain: Why Medication Isn't Enough

Healing the Soul in the Age of the Brain: Why Medication Isn't Enough

by Elio Frattaroli
We would all like a quick fix for our problems, a simple pill to take away our anxiety and lift us out of our depression. But there is no quick fix for the soul, and anxiety and depression may be signals of the soul's unmet needs. In this landmark work, Dr. Elio Frattaroli challenges our fixation on psychiatry's "Medical Model," which treats mental illness solely with


We would all like a quick fix for our problems, a simple pill to take away our anxiety and lift us out of our depression. But there is no quick fix for the soul, and anxiety and depression may be signals of the soul's unmet needs. In this landmark work, Dr. Elio Frattaroli challenges our fixation on psychiatry's "Medical Model," which treats mental illness solely with drugs instead of seeking a deeper understanding of our problems-in other words, treating symptoms rather than people.

Combining a Renaissance humanism with a sophisticated understanding of modern science, he makes an impassioned, persuasive case for "listening to the soul"-paying attention to the inner life of the emotions, both in psychotherapy and in our everyday lives. Drawing upon philosophy, literature, psychology, and riveting case histories from his own life and practice, Frattaroli explores what has happened to a culture that has been "listening to Prozac" and hearing nothing else.

Editorial Reviews

From the Publisher
If Freud experiences a revival, he may thank Frattaroli for it. (Booklist)
The Barnes & Noble Review
“Psychiatry today is in imminent danger of losing its mind,” writes psychiatrist and psychoanalyst Elio Frattaroli. In this, his first book, Frattaroli confronts psychiatry’s mania for medication by issuing a passionate, literate argument in favor of psychoanalysis. Instead of treating patients as mere chemical configurations, Frattaroli proposes, we should learn to recognize and find compassion for the feelings that inform our lives. For, he argues, it is only by dealing with our selves and our souls that we can ever create true healing.

Frattaroli begins his argument with a full-tilt assault on the medical model of psychiatry, which holds that emotions stem from brain chemistry, and brain chemistry can be altered. “The medical model of psychiatry…teaches us to think of anxiety, shame, and guilt as meaningless neurological glitches, not as urgent calls to self-reflection,” he opines. “It promotes the pharmacological quick-fix, neglecting the deepest long-term needs of the soul.” Frattaroli explains the issues that underlie this model, and then he explains why he believes that psychoanalysis -- that unscientific science, that ugly art -- is the only way to cope with the mysteries of human experience.

In support of this argument, Frattaroli offers us personal, quirky, revealing narratives of his own therapeutic practice. As he explores one human story after another, we come to realize how crucial it is that we see ourselves as people, driven by desires and needs and souls. In one instance, for example, Frattaroli explains: “It took [Anne] two months in the hospital, meeting with me forty-five minutes a day, five days a week, to tell me she had been raped.... Treating Anne’s depression with medication might have made it easier for her to hide the emotional trauma of the rape until it was too late.” With his own brand of literate, rambling intensity, Frattaroli introduces us to the real people behind the case studies and shows us why we must recognize them -- and ourselves -- as more than mere compounds.

In Healing the Soul, Frattaroli takes readers on a breathtaking ride through science, history, literature and art to lay bare the complexity and significance of the human spirit. In the course of this ride, Frattaroli considers the history of mind/body dualism as an idea; he tinkers with scientific and mystical models of selfhood; and he translates Freudian lingo into cogent, meaningful metaphors. But most important, Frattaroli brilliantly illustrates why becoming human -- conscious, emotional, and soulful –- is a challenge we must accept. (Jesse Gale)

Polly Young-Eisendrath
This is an absolutely necessary book. In America, we give dangerous psychiatric drugs to our children and ask 'Should I take Prozac?' instead of 'Why do I suffer?' Surely, we are losing our minds and our humanity. Elio Frattaroli is a wise, funny, and inspiring advisor who, as a psychiatrist and psychoanalyst, clearly shows us the risks we are taking, as well as the solutions available through our own insights.
Lucy Daniels
In this insightful, comprehensive book, Dr. Frattaroli offers an inside view of how psychotherapy works to change lives. As a psychologist, novelist and patient, whom psychoanalysis freed to be creative, I recommend this book as a valuable tool for professionals and as an illuminating resource for anyone interested in how human beings can benefit from facing the unconscious fantasies that hold them prisoner.
Samuel Shem
Healing the Soul is a fascinating, ruthlessly honest and poignant journey of one brave soul who happens to be a psychoanalyst. On all levels - from the exploration of the philosophy of mind/brain, through the brilliant critique of the drug cowboys who want to merely keep us "level" and smiling, to the intense work of being with his patients in a truly mutual, whole, and making-whole therapy process - Dr. Frattaroli's find book insists that we wake up and embrace the essence of that which is always with us, our souls.
Terry Real
We are not mechanisms! With the clarity of an insider, psychotherapist and analyst Dr. Elio Frattaroli takes on the current psychiatric infatuation with biological reductionism. As persons, we are more than the sum of our neurological interactions, even more than our neuroses. We are spirit and soul. With verve and freshness, Dr. Fratteroli leads us with practical steps toward a soul-centered psychotherapy. A lucid and important work.
John L. Schwartz
This is a terrific book. Elio Frattaroli illuminates hugely important truths about our innate human complexity in this fascinating excursion through psychology, neuroscience, literature and quantum physics. Along the path, he deflates several overblown sacred cows of 'modern medicine' while revealing himself to be humble, honest and a truly gifted psychiatrist.
Glen O. Gabbard
This superb new book is a much-needed wake-up call. Frattaroli reminds us that there is a person behind the symptoms-a human spirit yearning to be known and understood.
Publishers Weekly
A decade after Peter Kramer's bestselling Listening to Prozac (also published by Viking) refashioned cultural attitudes and beliefs about mental, emotional or personality disorders and their treatment, psychiatrist and psychoanalyst Frattaroli reexamines the "Medical Model" of psychiatry, according to which disturbances such as brain chemistry imbalances are treated solely with psychopharmacology. Lamenting that the brain has replaced the mind or the soul as the object of healing in psychiatry, he offers a clear and comprehensive description of how the alternative "Psychotherapeutic Model" works to bring the unconscious into consciousness, addressing inner conflicts that can't be medicated and ultimately offering deeper and more permanent healing. Using case studies from his own practice, Frattaroli makes a strong argument for the effectiveness of and need for long-term psychotherapy. However, he is careful not to condemn the use of drugs in treating mental and emotional disorders. Heavily influenced by psychologist Bruno Bettelheim, with whom he trained, and borrowing from Martin Buber's "I-Thou" vs. "I-It" principle, Frattaroli provides an unusually lucid explanation of Freud's theories of personality, inner conflict, transference and the therapeutic relationship. In view of the current "quick fix" culture and the "greed of the managed care industry," which doesn't usually pay for long-term psychotherapy, Frattaroli calls for an integration of biological and psychoanalytic approaches. His insights are fresh, highly readable, informative, passionate and memorable. (Sept.) Forecast: Ten years in the making, this thoughtful defense of the talking cure could be important and influential formany years to come. A six-city author tour is scheduled for January 2002. Copyright 2001 Cahners Business Information.
Library Journal
To his first book, Frattaroli, a psychiatrist, psychoanalyst, and teacher (Univ. of Pennsylvania), brings wide reading in science and the humanities, long experience as a therapist, and remarkable self-analysis. The result is a discursive, challenging, important meditation on the human process of helping others and ourselves through a complex empathic awareness. Frattaroli critiques the ills of scientific materialism, the medical model, and the culture of quick fixes, arguing that the soul needs another kind of healing. In this regard, he both defends and improves upon Freudian psychology with the help of Niels Bohr, Erik Erikson, John Searle, and even Plato and Descartes and arrays it against neurological and pharmaceutical evangelism. Yet while he crusades against a strictly materialist bias, Frattaroli does not engage in New Age soul-flashing, instead respecting brain chemistry, the conservative use of medication, and the tools of humane science. Ultimately, he brings out what is best in the therapeutic procedure. It is only disappointing that Carl Jung gets a mere footnote and that Otto Rank is not mentioned. A major achievement, this is essential for all libraries. E. James Lieberman, George Washington Univ. Sch. of Medicine, Washington, DC Copyright 2001 Cahners Business Information.

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Read an Excerpt

Healing the Soul in the Age of the Brain, Chapter 18 18. Repetition, Reflection, and the Search for Meaning

More and more, we are all becoming aware that our lives are being lived for us by influences that, however numerous they appear, are in fact only so many reflections of one kind of movement in the life of man, a movement toward externals, toward needs and gratifications that, however justified in their own right, become destructive when they pretend to represent the whole meaning of human life.
-Jacob Needleman, The Way of the Physician

The world is too much with us; late and soon,
Getting and spending, we lay waste our powers.

-William Wordsworth

Author's Message

Throughout this book, I have tried to convey a sense of the process of healing the soul-the inward journey of self-discovery and self-actualization-as I have experienced it in the psychotherapeutic process. My hope in doing so was to help individual readers to gain a greater appreciation of their own personal quest, especially of the ways in which their symptoms and other kinds of falling down are an integral part of the healing process. That is what I do for a living: as a psychotherapist, I work with individuals, helping them "in their becoming." But I probably would never have thought to write a book about this if my work with individuals was not being threatened by larger cultural forces: the popular craze for psychiatric drugs, the greed of the managed care industry, and a deeper problem of which these are merely symptoms-the dehumanizing materialism that pervades our culture at every level.

We are so consumed by the pursuit of physical appearances, material possessions, creature comforts, and addictive pleasures that we have lost touch with the deeper needs and values of the soul. We then rationalize the emptiness of our materialistic values by invoking another kind of materialism-that of positivistic science, which gives credence only to what can be seen and measured and which believes that only the physical is real. Any anxiety we might feel about the lack of meaning in our lives we can then dismiss as a chemical imbalance, transformable into a state of contented normalcy simply by taking a pill.

The dehumanizing influence of this shallow scientific worldview reinforces a dehumanizing impulse that is already present in human nature. We find it easy to ignore the inner voice of the soul in our pursuit of external tokens of happiness-not only because we are seduced by our culture's materialistic values but also because we are driven from within by our own materialistic passions and by our addictive need for quick, painless fixes for anything disturbing in our lives.

I have written this book in the strong belief that all of us-not just psychiatric patients-have a deep spiritual need for healing the soul, a need that cannot be satisfied with a quick pharmacologic fix. But unless we make a special point of listening to the soul, it becomes all too easy to ignore this vital need, and with it any sense of a larger meaning and purpose in our lives. The problem is, we are all tempted to do exactly that! We all fear consciousness-the knowledge of good and evil within ourselves-and so we would prefer to deny or dismiss the inner voice that calls us to the quest and content ourselves with the swimming-pool comforts of the quick fix.

The Cultural Problem

As a result, the tendency to short-circuit our higher consciousness and awareness of our deepest values in the shortsighted pursuit of the quick fix has become the dominating trend of modern life in the Age of the Brain. The quick fix is our prevailing cultural value, and we can see it operating at every level of society: from politicians who don't look beyond winning the next election, to CEOs who can't see beyond the next quarterly report, to news media clambering after sound bites and Nielsen ratings, to scientists doing only short-term, high-profile research (because that's what the businesspeople and politicians will fund and the media will publicize), to doctors who defer to the values of politicians, businesspeople, media, and scientists, and lose track of their inner calling.

In such a world, it is hardly surprising that addiction-the compulsive pursuit of quick fixes-has rapidly become our most pervasive societal problem. We are addicted to substances-drugs (both legal and illegal), alcohol, cigarettes, food. We are addicted to people-rock musicians, sports heroes, movie stars, TV evangelists, pop gurus, psychics, New Age healers, talk-show hosts. And we are addicted to activities-gambling, collecting, pornography, investing, shopping, dieting, exercising, spectator sports, video games, chat rooms, the World Wide Web. Some of us are even addicted to reading self-help books with inspirational titles. In every area of our lives, it seems, we are looking for external fixes and saviors to rescue (i.e., distract) us from the painful awareness of inner conflict-to give us a rush, a quick switch from feeling like a loser to feeling like a winner.

Unfortunately, the fact that our society and cultural values support and reinforce our addictions encourages us to rationalize the quick fix as "the American way" rather than to recognize it as an uneasy attempt to hide from our own higher values and deeper desires. One of the central lessons of dynamic psychotherapy is that people are always embarrassed and uneasy about their own deepest desires, and develop powerful mechanisms for remaining unaware of, and evading responsibility for, those desires. The pursuit of a quick fix, often manifesting itself as addictive behavior, is one of the most popular of these mechanisms, aptly captured in the well-known bumper-sticker slogan "The one who dies with the most toys wins!" The addictive pleasure never actually satisfies the deeper desire, but the endless pursuit of the next "toy" or "fix" serves to keep that deeper, more unsettling desire out of awareness. In this sense, the problem of addiction is a symptom of an underlying sickness in our society: a sickness of the soul, in which we are living on the surface, telling ourselves stories that somebody else has written about what we should be living for because we are afraid to listen to the sound of our own inner voice.

Does That Sound Too Preachy?

To those who may feel that I am being moralistic and judgmental here, I admit to making a moral judgment: that our current quick-fix culture is dehumanizing, destructive, and delusional. (We all know, after all, that the one who dies with the most toys doesn't win.) But I do not believe that making moral judgments is something we either can or should avoid. Having moral values and ideals-and making judgments based on them-is as intrinsic to human nature as breathing. Consciously or unconsciously, we are always making choices between the values of the swimming pool and the values of the quest, and every time we do that we are making an implicit moral judgment: falling down is bad or falling down is good.

I believe that our choice between two models of psychiatry is really a choice between two competing sets of moral values that will ultimately determine the kind of society we live in. One is the Psychotherapeutic Model's ideal of healing the soul with its values of self-awareness, autonomy, personal growth, an I-Thou spirit of love, respect, and compassion for others, and an acceptance of moral responsibility for our own egoistic impulses and emotions. The other is the Medical Model's ideal of the quick fix, with its swimming-pool values of stability and conformity, and an I-It orientation toward material success and other superficial addictive pleasures.

Psychiatry at the Center of Our Cultural Crisis:
The Case of Tony Soprano

This choice is the underlying theme of the recent television smash hit The Sopranos, which-judging from its immense popularity and the extravagant critical acclaim it has inspired-seems to have struck a deeply resonant chord in our cultural consciousness. The hero, Mafia boss Tony Soprano, is a modern American Everyman, suffering from a modern American problem. He needs Prozac! The plot revolves around Tony's symptoms of anxiety and depression, and the fact that he has to see a psychiatrist. Every episode poses implicit questions about Tony's predicament that are at the same time larger questions to us about our cultural predicament: What do Tony's anxiety and depression mean? What does he want from the psychiatrist? What should the psychiatrist be doing for him? Does he suffer from a chemical imbalance for which the psychiatrist should give him Prozac so that he can function more effectively as a mafioso? Or are anxiety and depression exactly what he should be feeling as symptoms of his inability to be at peace with being a mafioso. Tony's psychiatrist can't seem to decide. On the one hand, she treats his symptoms with Prozac. On the other hand, she tells him that his symptoms reflect his feeling trapped by a sense of loyalty to parents (and the "Family"), whom he has always secretly feared and viewed as destructive.

Ultimately, the point of the series-and the reason for its popularity-is that Tony's dilemma is our dilemma. He is torn between his deeper spiritual values-his desire to be a good person-and the values of power, wealth, sex, fine living, and family loyalty that define modern American society as much as they do Tony's Mafia. Significantly, religion doesn't help Tony resolve this conflict. The Catholic priest who claims he wants to help is a self-described "schnorrer" who eats Tony's food and lusts after his wife but never actually talks to Tony at all. The only person who even comes close to speaking for moral or spiritual values in the story-and helping Tony recognize his own values-is the psychiatrist.

The Cultural Crisis As Reflected in the Practice of Medicine

Historically, physicians have often spoken for spiritual values. In the traditions of both Western and Eastern medicine, as in the shamanic traditions of indigenous cultures, physicians have served a dual role as healers and priests. In his book The Way of the Physician, Jacob Needleman reminds us of this age-old relationship between medicine and religion, and warns of the danger inherent in our modern tendency to dissociate the two. He points out that the familiar symbol of the medical doctor, the caduceus, originated as an ancient religious symbol of transformation. The two serpents represent two intertwined but opposing movements of the soul-the movement outward of the ego (its emotional attachments to power and success, winning and losing) and the movement inward toward the authentic self. Needleman argues that the true physician is one who integrates within himself these opposing movements of the soul through the healing power of conscious attention-represented in the caduceus by the wings hovering above the opposed serpent heads-and in so doing provides a model for leading a fully human life:

Only through the appearance in ourselves of an attention that can care for both sides of our nature can we develop into the transformed being that is the real meaning of the symbol of the ... "priest-physician."

I agree with Needleman that our society suffers greatly from the loss of this vital role model that our physicians once gave us. The practice of medicine has now become an industry in which doctors are, in effect, employees of insurance companies, paid to put the needs of big business before the needs of their patients. The physician-patient relationship has been reduced from a sacred personal trust, as described in the Hippocratic oath, to a commodity-the delivery of a "product" by a "provider" to a "consumer" via a corporately managed "network of health care options." This rampant commercializa- tion of the practice of medicine-degrading it from a calling to a commodity-epitomizes everything that is wrong with our addictive, quick-fix society. It has left us with a gaping hole in the fabric of our culture that used to be filled by its physicians.


My intention here is not simply to add another voice to the chorus bemoaning the crisis of modern culture. Rather, it is to say that the Psychotherapeutic Model of psychiatry offers a uniquely valuable approach to understanding and healing this crisis. But perhaps I am being a bit preachy. What I have attempted to do above is to summarize the larger message of the book as implied by the title, Healing the Soul in the Age of the Brain: Becoming Conscious in an Unconscious World. Reading over my words, however, I recognize that it is an unbalanced summary. In my polemical enthusiasm, I have put too much energy into proclaiming what's wrong with our unconscious, materialistic world and not enough into explaining how we can heal our individual souls (and hopefully improve the world) by becoming conscious. That's really the point of the book, after all. That's why Part One was about "the im- portance of being conscious." That's why, throughout the book, I have gone into so much detail describing how people actually do become conscious through the psychotherapeutic process. But I realize that you may still be left with questions. You may be wondering how all those stories about my experiences with patients apply to you personally. How can you become more conscious in your own life, you might ask, whether or not the future of our culture depends on it?

You could begin by reviewing the steps of the psychotherapeutic process as I described them in Chapter 3. Recall that the process starts with the awareness of anxiety. If you are currently at a loss for something to be anxious about, try thinking about your relation to our addictive, quick-fix society. What is your own favorite addictive pursuit and what are you using it to distract yourself from? What kind of choices are you making each day between the swimming pool and the quest? Your choice could be watching TV instead of writing a letter to the editor. It could be writing a letter to the editor instead of playing a game with your children. It could be playing games with your children instead of working on your novel. It could be working on your novel instead of watching TV with your children. It could be having a beer with the guys instead of a conversation. It could be working late, or playing solitaire on the computer, instead of having a beer with the guys. It differs for different people, but we all spend more time than we like to admit following our own path of least resistance while avoiding or procrastinating doing what we consider more valuable. If you reflect on it carefully, I believe you will recognize that most of the time you aren't really choosing at all but are simply reacting to situations, unconsciously and automatically, according to the habitual tendencies of your personality-your repetition compulsion. In doing so you are instinctively following the swimming-pool values of the quick fix.

This is a crucial point. What I am really saying is that the addictive tendency in human nature-the inner pressure that impels us toward the quick fix and has become the major problem in society today-is none other than our old friend and nemesis the repetition compulsion. The ad- dictive sequence of discomfort->quick fix->relief is unconsciously organized by an emotionally charged personal scenario whose plot is something like victimization->revenge->triumph, or accusation->justification-> vindication, or oppression->rescue->liberation. If your quick fix is TV, for instance, you may unconsciously experience it as a liberation from oppression by your job or your family. If your quick fix is playing games, you may unconsciously experience winning as a revenge for painful losses or humiliations in your life. If your quick fix is some form of living through your children, you may be unconsciously needing them to succeed as a way of vindicating yourself to a world that undervalues you. We all have such a scenario and we all have a powerful need to produce, direct, and star in it again and again, day after day, throughout the course of our lives.

The way I began this chapter is a good example. Although I am confident that what I said is important, I said it in a way that was more polemical than it perhaps needed to be. There was a touch of the same self-righteous outrage that fueled my adolescent diatribes against Catholicism and American imperialism (as I described in Chapter 9). Instead of communicating with you at a personal emotional level-as I try to do when I am writing at my best-I was distracted by the addictive drama of my repetition compulsion into doing what Martin Buber calls speechifying:

By far the greater part of what is today called conversation among men would be more properly and precisely described as speechifying. In general, people do not really speak to one another, but each, although turned to the other, really speaks to a fictitious court of appeal whose life consists of nothing but listening to him.

Once More with Feeling

To restore the balance, let me give you the more personal side of what I have just been speechifying about. Perhaps the most important lesson about healing the soul that I hope you will take from this book is that the symptoms and painful emotions we instinctively want to get rid of are in fact integral to the process of becoming who we truly are. Symptoms are part of the healing process. Anxiety is consciousness trying to happen. Falling down is a way of growing up. In the Age of the Brain these are surprising, even radical, ideas. And yet they belong to a teaching that is as old as Western civilization. I learned them as people have always learned them-as you can, too-not from books or scientific experiments but from a disciplined practice of listening to the soul.

This book is the product of that practice. It reflects my ongoing personal quest to become conscious, to experience my anxiety, to feel and accept responsibility for the good-and-evil emotions of my own dark side. That's what I was referring to in Chapter 17 when I described how the passions of my repetition compulsion had put me into a state of inner conflict that produced writer's block. I was tempted-in fact, driven-to present myself as a white knight rescuing society from the evils of a dehumanizing Medical Model. But this made me anxious, because it involved an impulse to attack Peter Kramer as the villain in the story, which would have been unfair to him and would have made me guilty of the very evil I was objecting to: dehumanizing (demonizing) Peter Kramer, using him as a straw man to beat up on.

But that discussion in Chapter 17 was only the happy ending of the story, in which I became fully conscious of the problematic passion of my repetition compulsion and could then integrate it into what I hope is a responsible, balanced critique of Listening to Prozac. I didn't tell you the whole story of what my repetition compulsion and I had to go through-including a full-blown chemically imbalanced mental illness-to get to that point of integration. I'd like to fill in the rest of this story now, because I think it captures what healing the soul is all about. It illustrates how the impassioned need of my repetition compulsion to fight the evil dragons of materialism impelled me on an inward journey where I had to confront and accept the good-and-evil dragon within myself. The path of that journey was long and difficult, and it led directly through the writing of this book.

Ego Trip

My first attempt to challenge the cultural forces of materialism was an article I submitted in 1985 to a national essay contest run by the Psychiatric Times on the topic "The Most Important Problem Facing American Psychiatry." My essay was a polemic against "the philosophical myopia of [psychiatry's] materialistic bias." I argued that an exaggerated emphasis on the brain at the expense of the mind and soul served to "vitiate ideals ... of moral [and] legal responsibility" and "encourage the unrealistic popular drug-culture expectation of quick, painless solutions to problems." I took exception to the misuse of scientific research to justify a theory of mental illness-as a chemical imbalance-that was both dehumanizing and irrational. I cited the systematic misinterpretation of treatment-outcome research (as discussed in Chapter 4) that denied the obvious significance of the placebo effect:

The essence of the current psychiatric world view is captured by a description I heard recently of a psychotic episode as a "hurricane in the brain." This perspective is limited by its inability to account for a brain hurricane being stopped by a placebo, a phenomenon equivalent to a real hurricane being stopped by a fervently believed weather prediction.

I then went on a more personal rant against researchers Robert McCarley and Allan Hobson, whose neurological theory of dreams had gained con- siderable notoriety in those days because it claimed to discredit the classic Freudian theory of dreams. From experiments performed on the brains of sleeping cats, McCarley and Hobson had drawn a rather momentous conclusion about human dreams: that they consist of a series of random neurologically generated images inherently devoid of meaning. The reasoning they had used to reach this conclusion was specious, I thought, and I was less than polite in saying so. After taking them to task for their self-refuting neurological nihilism, I concluded that their theory was "far inferior to Freud's because it is, in the literal sense, Mind-less."

When Allan Hobson quickly responded to the essay by challenging me to a formal debate at a national meeting of the American Psychiatric Association, I was thrilled. Hobson's debate partner was philosopher of science Adolf Grünbaum, another well-known critic of Freudian theory, whose argument against Freud was different from Hobson's but seemed to me just as irrational. When the debate was over, I felt great, confident that, with the help of my partner, dream researcher Ernest Hartmann, I had thoroughly demolished the pretenses of those arrogant Freud-bashers. From what I could tell, the audience thought so, too.

But had I really accomplished anything other than indulging my own arrogant pretenses and gratifying my own ego? That's the question I should have asked myself, but I didn't. I was on a roll. The arrogant combative- ness of my repetition compulsion was like bananas in my ears. I felt entitled to be outraged because I was fighting the good fight. My friends were applauding me. The only people who complained were the designated bad guys in my scenario and I couldn't hear what they were trying to tell me from outside the box of that scenario. For example, when psychiatrist Ronald Pies published an editorial accusing me of "splitting the discipline of psychiatry" with my "self-congratulatory polemic against the medical model," I felt insulted and immediately fired off a caustic counterattack. In retrospect, however, I can see the truth in Pies's accusation. The colleagues who appreciated my self-righteous speechifying were those who already agreed with me anyway. The people I really needed to convince-people like Pies himself, who I thought overemphasized drugs but was also interested in psychotherapy-were the ones I was demonizing, arrogantly dismissing their strongly held beliefs and then expecting them to listen respectfully to what I had to say.

Meanwhile, I continued to devote most of my professional energy to treating individual patients with an attitude of empathic understanding, knowing that in order to help them, I had to be able to respect and accept them-including their illnesses-which often meant having to confront my own prejudices and expand my awareness so that I could see and feel things from their point of view. So where was this enlightened empathic awareness in my writing and lecturing? Again, that's a question I should have been asking myself. I might have been more concerned about the danger of splitting the discipline of psychiatry had I been more conscious of the dramatic split within myself. On the one hand, I was aspiring to treat my patients, family, and friends with an I-Thou attitude of love and respect. On the other, I was thoughtlessly railing against my Medical Model colleagues with a disrespectful I-It attitude of contempt.

Consciousness or Bust

And then one day I found myself standing at a podium, calm and confident as I began to speak, when I was suddenly blindsided by a certified DSM-IV panic attack. My voice began to shake, my heart began to palpitate, my eyesight went dim, my hands went numb, and my face burned with shame as I heard my normally lively, authoritative delivery collapse into a humiliating stammer. I felt sorry for the audience, squirming in their seats as they watched me struggling to maintain a semblance of dignity, trying desperately to continue reading from my prepared text.

Somehow I managed to get through that speech, but I felt physically ill for a week afterward. For several nights I was jolted awake by a furious pounding in my chest, with no recollection of having been dreaming. Fortunately, my work with patients wasn't adversely affected. In fact, I felt a deeper empathy with people who were disabled by their illnesses because I felt suddenly disabled myself. I couldn't imagine ever being able to speak to an audience again. I wasn't even sure I could continue writing, because if people read my articles and then invited me to speak, what was I going to tell them?

When I tried to listen to my anxiety-to recall how the panic began and feel more clearly what I had been panicked about-I didn't get very far. I remembered vividly the physiological affect state, but had no recollection of any preliminary anxiety feeling, a sense of something I was afraid of that might have triggered that visceral upheaval. This was surprising. Before every talk I had ever given I had felt some anticipatory anxiety-which disappeared the moment I began speaking-but this time I hadn't been nervous at all! In fact, I remembered remarking to myself, as I sat waiting my turn to speak, how unusually relaxed and self-assured I felt.

So if symptoms are adaptive, I mused, then perhaps my unconscious had produced this humiliating symptom to warn me that I had grown a little too self-assured, like Icarus flying too close to the sun. This seemed plausible. I knew that I had a penchant for challenging the conventional ideas of received authority, and a talent for finding dramatic, creative ways to do so. I hadn't yet realized that this style was a product of my repetition compulsion but I certainly knew it involved a tendency toward arrogance in my writing and public speaking. Was I too complacent about this tendency, I asked myself? Was the self-assurance I had felt before my talk really arrogance, and the panic attack a way of punishing myself for an overweening desire to show off?

I reviewed the circumstances of the talk. I had been assigned to prepare a formal discussion of a paper presented by a distinguished, nationally respected colleague, Dr. Glen Gabbard. Ordinarily, this would have been a wonderful opportunity to exercise my penchant for challenging authority, but Glen also happened to be a good personal friend of mine. His paper was an excellent discussion of transference projection. This put me in an awkward position. I could find nothing to challenge in Glen's ideas and, as his friend, I didn't even want to challenge him. Yet the impulse to challenge authority was still there, and I had always relied on it to energize my thinking and spur my creativity. So maybe I had been trying to show off, I mused, because I remembered how worried I was about not having any creative ideas, and how excited I felt when I finally came up with one: I would show mock hostility toward Glen, evoking an imaginary competition which I could then use to illustrate what Glen had just said about projection. Well, judging from the panic attack, my unconscious must have taken this imaginary competition as real. In fact, my unconscious did to me exactly what I warned the audience that Glen might want to do (influenced by my projection) in retaliation for my mock hostility. It publicly humiliated me.

Falling Down Is Good

My humiliation turned out in the end to be a blessing. If it hadn't happened, I'm sure that I never could have written this book. In fact, it was only through writing the book that I was eventually able to understand and deal with my symptom. Here's how it happened. Although I never had another full-blown panic attack, I felt seriously hampered by the fear of having another one. Over the next few months, I managed to give a couple of talks to small, friendly audiences who probably couldn't tell how terrified I felt, but the weeks of worrying about those talks beforehand were exhausting. I felt deeply that I had an important contribution to make to psychiatry, but my symptom was stopping me and I needed to learn why. I knew I could treat the symptom with medication, but if my unconscious was trying to send me a message, it would be foolhardy to try to suppress or ignore it. So I decided to go back into analysis.

I explained to my analyst that I was pretty sure my symptom represented a conflict over envy and competitiveness toward Glen, which, in retrospect, I had been somewhat aware of and had tried to defuse (unsuccessfully) by inventing a mock competition. But I couldn't imagine (or feel) how these subtle negative feelings toward a man I respected and admired could have been so powerfully disruptive as to produce a panic attack. It seemed only natural that I would feel a bit of envy and competitiveness over Glen's success. After all, he was the one invited to present a major paper and I was only the discussant. Still, I really didn't begrudge him his preeminence. I knew he had earned it. And he carried it extremely well. I remembered being impressed by his relaxed but commanding presence on stage.

What I didn't know or remember-and what took me six years of analysis and four major rewrites of this book to learn-was that, unconsciously, I didn't care whether Glen had earned his preeminence or not. He was alpha male and I wanted to be alpha male and so, like the sons in Freud's primal horde, I had to kill him. Or, more to the point (given the constraints of civilization), I was driven to vanquish and humiliate him with my powerful words. Though it was largely unconscious toward Glen, this was exactly the same arrogantly contemptuous attitude I had been displaying consciously for years in my attacks against Medical Model colleagues. The difference was that I had been thinking of those colleagues as pill-pushing bad guys who (according to the script of my repetition compulsion) deserved to be vanquished, so I had no compunctions about attacking them. Glen, on the other hand, was my friend, my brother. He had even been a kind of father to me, encouraging me in my early efforts at writing, giving me much-needed validation. My envious need to vanquish him put me in a serious Oedipal dilemma. Consciously, I wanted to (and thought I did) have an I-Thou attitude of respect for him as my friend/brother/father who had supported me and whom I admired. But unconsciously I considered this friend an enemy, an alpha-male rival who was in my way, just another I-It straw man for my Oedipal ego trip.

That's when the healing power of nature intervened with the powerful message of my panic attack. "Wait a minute," it was trying to say. "Remember that you aspire to having an I-Thou attitude of respect for all people. That aspiration is central to what you do as a psychotherapist. And yet for years you have been disrespectfully treating your Medical Model colleagues as enemies, I-It straw objects of your alpha-male road rage. If you really believe that your values are better than theirs, then stop being such a hypocrite and start putting your values where your mouth is. Treat your colleagues with the same respect you give to your patients and they might even want to listen to what you have to say."

—From Healing the Soul in the Age of the Brain: Becoming Conscious in an Unconscious World by Elio Frattaroli, MD, (c) September 2001, Viking Press, a division of Penguin Putnam, used by permission.

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From the Publisher
If Freud experiences a revival, he may thank Frattaroli for it. (Booklist)

Meet the Author

Elio Frattaroli, M.D., is a psychiatrist and psychoanalyst in full time private practice. He is on the faculty of the Psychoanalytic Center of Philadelphia and is also an assistant clinical professor of psychiatry at the University of Pennsylvania. He studied Shakespeare at Harvard and trained with Bruno Bettelheim at the University of Chicago before turning to medicine. He has written and lectured on Shakespeare as well as on psychiatry and psychoanalysis. This is his first book.

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