12 Talk Therapy Dr. Daniel Weinberger
…Every patient with schizophrenia has difficultly processing complicated information. They all do. Their mental apparatus is a little bit slower. And particularly as the load on mental processing increases, it’s increasingly hard for them to keep up with it.
This is very disorganizing; it’s stressful. It creates a mindset of distrust, because you can’t quite make sense out of everything. So when you can’t quite get everything to fit in what it should fit so you can operate efficiently, you have, as any human being would, a tendency to wonder—maybe things aren’t quite right here.
…Psychiatry, for a hundred years, focused on the superficial appearance of how it got there. What happened to the talking therapy approaches—and I should point out, by the way, that it’s not that talking therapy doesn’t help patients with schizophrenia, of course it does. It helps everybody in some way.
So part of the way it helps people with schizophrenia, is it helps them deal with the problems that they have to deal with. It helps them maximize their approach to their own treatment, it helps them operationalize and maximize their adaptation. There’s no substitute when you’re ill for having a trusted person to help you deal best with the incapacities that you have, whether you have diabetes, epilepsy, multiple sclerosis, or schizophrenia. This is called having an ally in treatment, whether it be a doctor, a therapist—of course you’re helped by this.
Where I think talking therapies in psychiatry went off track was the expectation that they would cure these problems. And that was the promise of early psychoanalytic therapy, which clearly did not—could not be possible. So it’s not a black or white thing, that there’s no role—of course there’s a role for talk treatment. There’s a role for talk treatment in diabetes and epilepsy and multiple sclerosis too.
But because the illness of psychiatric illness is at the interface of social interaction and psychological function and intellectual, emotional function, what else do you have, other than the medicine, but talk? Talk could be at group level, it could be at a social level, it could be at a structured, environmental level, you know, the rehabilitation kinds of programs. These are critical for outcome, and improving the adaptation of patients.
But they’re not about the basic, causative mechanisms that might be reversible that way.