'A woman once came to me, complaining of depression and suggesting she might need medication," recounts Paul McHugh, here on a personal visit last month - his first to the Holy Land and Jewish state he has always admired. "So, I started taking her history, and asked her whether anything in her life had changed recently. She said that her husband had died suddenly two and a half months earlier. I asked her why she thought she needed medication. Her answer was that her friends had told her she should be over her grief by now. 'You have lousy friends,' I replied."
In denial. 'Along came a new unconscious driving force that psychiatrists could unveil, and in the process display their capacity to "rescue" patients from their victimhood.'
Photo: Esteban Alterman
The point, says McHugh - former psychiatrist-in-chief of the Johns Hopkins Hospital in Baltimore, Maryland, (and currently University Distinguished Service professor of psychiatry at Johns Hopkins School of Medicine, professor of mental health at the Johns Hopkins Bloomberg School of Public Health and a member of the President's Council on Bioethics) - is that maladies may and often do differ from one another, even when their symptoms are similar. In other words, he explains, the grief this woman was experiencing was not necessarily a clinical manifestation of illness requiring a chemical anti-depressant, but rather a natural, "impairing" response to a difficult experience - one which she needed help getting through.
This may sound self-evident. Everyone knows by now, for instance, that a sore throat can be caused by a bacterium or a virus - and that treatment for it, therefore, is not uniform.
Where malaise of the mind is concerned, however, the picture is less clear and - according to McHugh's chilling accounts - is growing murkier by the minute, thanks to the politics of his profession, and the fertile societal ground which enables it to flourish.
McHugh's teachings, writings and breakthroughs have had a far-reaching impact (The Perspectives of Psychiatry, which he coauthored with Phillip R. Slavney, is considered one of the most influential texts in the field). He has spent the bulk of his decades-long career focused on separating fad-based suppositions from fact-based science. In the process, he has come up against much criticism and controversy. Being a practicing Catholic on the less fashionable side of the assisted suicide and other such debates will do that - especially when championing personal responsibility over victimhood.
BUT NO battle came close, in scope or span, to that which McHugh found himself fighting, and eventually winning, against the "discovery" of multiple personality disorder (MPD) and its "cure": recovered memory for the purpose of "integration."
The disturbing details of this internecine war between camps within the psychiatric community are spelled out in Try to Remember: Psychiatry's Clash over Meaning, Memory, and Mind (Dana Press), McHugh's latest book, which is being released next week. Stories of families across the United States ripped apart by accusations of incestuous pedophilia - based on nothing other than certain psychiatrists' dubious assumptions about patients' mental states and dangerous methods of treatment - hit home how suggestible an entire society can be when its cultural climate is ripe. Thousands of women in treatment for one form of malaise or another began to be persuaded by their therapists to "remember" acts committed against them when they were children, and encouraged to bring forth their alternate personalities.
McHugh refers to the psychiatrists whose methods he questioned as "mannerist Freudians."
Their movement, he asserts, was one of "social change based on a myth."
And though recovered memory was something McHugh proved successful at countering, through years of research and endless court appearances, he is still confronting other aspects of the same agenda that he believes are running rampant. A prime example, he says, surrounds post-traumatic stress disorder:
"The promotion of PTSD among our soldiers now is similar to the memory recovery movement. The idea is that any problem that emerges must be caused by the trauma of military duty. It is now being massively diagnosed, and I think there is a political reason for it. It denies valor, and the validity of their enterprise," he rules, adding, "We used to call them heroes and give them medals. Now we call them victims and give them diseases."
Lest the complexity of his argument be misunderstood, McHugh clarifies: "It's not that I deny the possibility of psychological problems arising among soldiers, but such problems could include homesickness and uncertainty of the future - normal reactions to having been in the military - and treating them accordingly usually leads to their end."
It is this kind of commonsense attitude that comes across again and again during our hour-long interview at the King David Hotel in Jerusalem. What is most striking about it (not to mention the jolly way in which he conveys it) is that it is accompanied by his incessant stressing of the science behind the brain.
His purpose: to restore psychiatry to its rightful place in our minds - and in the laboratory.
How does memory actually work? Those of us who grew up in a certain generation were taught about the phenomenon of repression - of our mind's ability, and often desire, to block out unpleasant experiences. In your book, you indicate that, in fact, it is the unpleasant experiences we are unable to forget, no matter how much we wish we could. One example you point to is Holocaust survivors.
It's complicated. Freud was the first to bring to light the idea of repression - that you might hide something objectionable from your consciousness. Initially, he thought this "objectionable something" might be some kind of trauma. Later, he came to believe that what you are hiding from yourself is not an actual, historical event or experience, but rather feelings toward your parents that you believe to be inappropriate and shameful. Incestuous feelings for the parent of the opposite sex. It is this emotional state he said you would repress - not that you would forget who you are, or who abused you. It would then enter your unconscious, the "world" from which he believed that all mental life ultimately derived.
