Thomas A. Ban
Neuropsychopharmacology in Historical Perspective.
Lehmann Collection 18
Neuropsychopharmacology in Historical Perspective.
Heinz E. Lehmann: Dreaming about Mental Health*
I have been asked to speak about Mental Health but chose to speak about "Dreaming of Mental Health." I wish to start by warning you, like in some television programs, that some of what you are about to hear may be offensive and outrageous to you - or, at least, very questionable. Now, I also want to warn you that I do not intend to let us all escape into dreamy, un-doable fantasies - but rather, wish to build my dream theme on rational, modern psychological and psychiatric thinking.
Many of the "family values" I will propose, as a passport to future mental health, actually may sound like a cliché or a replay of The New Testament. But how seriously do we take them and what priority do we really give to these Pollyannaish principles?
I am convinced that we could prevent at least 25-30% of serious mental or emotional problems in the population - if we start early, that is, in raising our children wisely. Anxiety and depression are the most common psychiatric disorders - and probably the most preventable. Even if we cannot do much about externally caused stresses, like disasters or losses, or about genetic factors, I submit that internal stresses are caused, to a very considerable degree, by misguided or psychologically unsound values.
I don't want to righteously preach to anyone how to live. But the values and the changes I am proposing, I very deeply believe, are the pragmatic keys to the improvement of our mental health and that of our successors - just as through the enormous new emphasis on exercise, better diets, smoking cessation, etc., we are actually now achieving a real reduction in heart disease and stroke. This is happening despite the considerable influence of genetic factors we are up against, along with a lazy lifestyle.
Values are the mental counterpart of diet, exercise and shedding bad habits.
Probably the biggest and most achievable breakthrough in prevention of mental disorders and the promotion of mental health would be the wholesale adoption of these most basic parenting principles and values:
1. Expressed love and affection - as the child's source of self-love and personal validity.
2. Basic trust - this must be absolute. An infant must learn that he/she can be positive that the mother or father will return within a reasonably short time of departure from the room. Later, all promises, even small promises, must be kept as a highest priority. I really mean that. Such relative trivia as a meeting with the prime minister or a merger conference must take second place in the order of priorities. Prime Ministers and corporation presidents are adults and can handle broken engagements far more easily than a child who cannot yet fully understand the difference we make between trivial and important when it comes to promises. If a promise to a child must unavoidably be broken, explain the circumstances or apologize elaborately afterwards.
3. Respect - for privacy, for example - should be scrupulously practiced. Knocking on a two-year-old's door may sound ridiculous, but it is probably the quickest and best way to teach that child respect for other people's privacy through life - not to mention enhancing the child's own self-respect at the time.
4. Give children as much freedom (choice) as you possibly can, to strengthen the child's autonomy. But use also discipline - and control rather than punishment - sparingly but consistently, as a limit-setting device to connect children with the real world and its laws.
5. Keep in touch with your children. Even if you are a busy executive or doctor or salesman, spend an hour - at least half an hour - a day playing with your child; play the child's games, not yours, by his or her rules, on the floor if the child chooses so. Give that time a very high priority in your daily schedule. You and your child cannot help but learn a lot about each other that way and become very close to each other.
I remember being favorably impressed by then Prime Minister Trudeau when he cut short a politically beneficial encounter with the press on the grounds that he had a lunch date with his children.
The cumulative effect of these deceptively simple-sounding parental behaviors simply cannot fail to create a powerful bonding base and power base of parents as models which will serve as a protective shield against negative peer pressure later - a vaccination of sorts against drug abuse, juvenile delinquency and other undesirable behaviors in adolescence.
A child's temperament, habits and basic value system are to a considerable extent formed by the time he/she goes to school, and by teenage it is almost defiantly difficult to change anything important in his/her personality, except perhaps his/her value system.
Let me throw in a day-dream here: I dream that in some future, economic and status considerations will not make it necessary anymore for mothers or fathers to work outside the house before their children have reached school age.
Perhaps we could consider it a not-too futuristic challenge to a variety of businesses to adapt the hardware and to develop the how-to, to permit one of the parents to perform more sophisticated work, part-time, in their homes. Today's data and communications industry is just one that comes to mind.
One of my dreams that would not really be difficult to realize soon aims at teaching all children early, before they are 10, to understand other children. To understand their frustrations, anxieties, jealousies or ignorance - to learn why they behave the way they do, rather than fear or hate them, fight them or complain about them.
Is that too complicated a task for children? If grade school children can learn to understand the complex rules, convoluted statistics and strange language of baseball which, to the embarrassment of my grandchildren, I have never been able to master, then they can certainly learn to understand basic human feelings in others.
Madonna, the "material girl," has plenty of company in our society today. Materialism takes hold in earliest infancy - with a myriad of mobiles, pacifiers, sight and sound devices and clothes targeted at babies as well as very young, ambulatory children. The "Keep up with the Joneses" message is sounded very early, too, and teenagers have become a major economic force in our marketplace.
Money - and the things it buys - has become one of our earliest and most firmly implanted values. What used to be luxuries and wants have become needs and necessities of "normal" life in North America. Money as a principal value becomes the key measure of success, often at the expense of such other values as autonomy, creativity, altruism, learning/knowledge, compassion.
For many, money, along with power, temporarily provides the status they are seeking. But after the personal, economic "pinnacle" has been reached - usually somewhere in middle age - the "successful" individual in aging must confront not only the empty nest, but also an uncomfortable sense of satiation as well as emptiness and perhaps painful job-discrimination, plus physical limitations. There's no more "more" and the going can get rough indeed.
Furthermore, a certain paranoia almost inevitably accompanies money and power. You have to be on constant guard against others who might want to relieve you of one or both.
Unless money is available in great quantity, it can quite abruptly cease to serve the retiree as a power base. Many must scramble for a new set of less perishable values which they might have had in place in the beginning. NOT overvaluing money and/or power from the beginning is a powerful preventive for stress, anxiety and paranoia in later life. NOT subscribing to competition - often cutthroat - as a "way of life" means the individual, starting in childhood, does NOT have to suffer the continual stress of trying to keep on top.
I once offered a bribe to my son, then in grade school and at the top of his class. The bribe consisted of a bicycle only IF, he was not first in school the next year. He wasn't - quite - and I delivered on my promise. The benefits to both of us for not engaging in that kind of empty ego trip went far beyond the bicycle.
Let me tell you about a dream I have: that in some future people will collect money only for its immediate or reasonably planned use; that nobody will want to collect estates or millions or billions for their intrinsic or, power value. Collecting stamps or crystals does not, unlike money, impact on other peoples' economic needs.
Another dream I have - again, primarily in the interests of mental health - is that violence and war will be eradicated from the earth. If that sounds like a tall order, just remember that over the years we have gotten rid of smallpox, public beheadings, lethal gladiator games, cannibalism, legalized torture, the lions' dens for the disposal of Christians, slave trading and a few other evils.
Nonviolence is not exactly a radical idea, having been adopted as a basic value by the likes of Christ, Gandhi, Martin Luther King and the Quakers. Utopian and naive, all of them? Or inspired to believe in the truth and beauty of their dreams? Killing on political or nationalistic grounds should be sent the way of the gladiators. Even if it will take another century or two until now unquestionably correct political values become archaic and grotesque.
Former U.S. President Reagan spoke of the Soviet Union as the "evil empire" against which so many of the world's resources were rallied during the long cold war. But even this massive, global empire - eventually and inevitably - self-destructed, to the surprise of most of the world.
I personally carry this thought back to include Hitler's Third Reich which I believe would have been brought down by its own evil weight, probably at less human cost than World War II.
Counter-aggression may be the "natural," instinctual and still widely recommended tactic in dealing with the school bully - or the evil empire. Although it may work quickly - it does not work in the long run, since it sets in motion a continuing vicious cycle of aggression and counter-aggression leading to endless insult, injury and loss. Each major war is billed as the "last war - to end all wars." And now, ladies and gentlemen, we have not only concentration camps, machine guns and ordinary explosives, megaton bombs but also nuclear arms to threaten us all. The only question is whether mankind will learn fast enough to put a stop to the whole business of war.
The preservation of national "honor," and political "justice" by war, then, often amounts to the ultimate stress on whole populations. The absence of national violence - if and when that could be achieved - would certainly make for better mental health around the globe.
Curiously, there is not much mention of justice in the New Testament and our institutionalized, legal justice is not always fair and more often serves vengeance than deterrence, necessary control or rehabilitation.
Is national, or even personal honor, really worth dying or even spending much emotional energy for? Or are the concepts of nationalism and personal honor just traditional, public notions? But traditional mind sets can easily turn into prejudices, like tribalism and racism.
Some well-known persons have considered themselves citizens of the world rather than of a single nation. And my personal honor and self-respect certainly cannot be hurt by someone's stupid and vulgar words or actions.
Clearly, we are not likely to banish war from the world anytime soon. However, we must start somewhere. To bring the issue home, where is the line between disciplining children physically and physical abuse? What message does spanking a child relay to that child - aside from often effectively - and temporarily - stopping some form of misbehavior? Might is right? Where is the difference between the father bully and the school bully who also carries a weapon to make himself bigger - and implies that other children also need weapons to protect themselves? You just don't hit children. Never.
So what are we supposed to do with our justified anger? What defenses do we have if we turn the other cheek and lay down our arms? Is there any way to still "win the day" - and stop the threats of violence against us?
Personal pacifism is actually baffling and disturbing to most villains. Once, in Naples, I boarded a trolley and handed the ticket man a sizable bill - say the Italian equivalent of $10. The conductor gave me change for $1. My son was observing the proceedings and looking to me for a macho-style heroic solution to the rip-off. I told the conductor - in fractured Italian, but clearly - that I was fully aware I was being seriously shortchanged and that I knew he knew it too. However, I also invited him to keep the change if he wanted to - utterly without expressing anger or criticism in my voice or facial expression. Then I sat down with my disappointed son. A few minutes later, the conductor found his way to where I was seated. He was actually blushing and told me that he had discovered I was right - and gave me the correct change. I had given him no opportunity to punish me for criticizing him. Did I disarm him?
When is a game not a sport - but becomes an invitation to violence? A recently released film about, of all games, chess, revealed that a young aspirant to Bobby Fischer's fame was advised by his teacher that if he really wanted to win, he would have to develop a "killer instinct" against his opponents.
Even if the players themselves are not endowed with a "killer instinct," their fans sometimes are and are given to outbreaks of mayhem and murder after the games, for instance at soccer games abroad.
A variety of role models - and even some parents - are often unwittingly promoting the violent approach, the "killer instinct" to solving problems and winning games.
Am I advising against all competition? Certainly not. However, competition with oneself is probably far more productive than competing with others - particularly if it takes a "killer instinct" to win. You know your own potentials and your own limitations and can probably criticize yourself, or be tolerant about yourself, better than others who do not know your limits or potentials. The recent violent attack of an Olympic skating aspirant, or her aides, on her competitor grimly demonstrates to what excesses competition in sports - games - can lead, particularly if millions of dollars are involved in winning.
The other day I had an encouraging experience showing me that my dream is not impossible. I was watching the television interview of a 14-year-old girl acrobat whose name was not given, who is studying in a circus school beside her regular studies. She is unusually gifted, attractive and bright. Having already won a medal in gymnastics she is no longer interested in sports because she dislikes competition. She has rejected lucrative offers from abroad to perform - she is already quite accomplished in her art - because she first wants to finish her studies. When the interviewer asked her whether she was not afraid to practice without a safety net, as she always does, she replied: "Yes, I am a little scared, but I have to concentrate very hard and be my own safety net." An adolescent who rejects money and competition and has education and autonomy as her first priorities - there are not many, but some exist.
Virtually all of us are aware that retention of anger or other negative feelings against those we consider our enemies is very destructive to the bearer. Many of us have our secret "hit list" of enemies who have hurt or wronged us. And we know we are bearing the burden of carrying that list. Since murder or bodily harm is illegal and an inappropriate way of letting off steam, what are the alternatives? One way is to verbally confront the wrongdoer, which takes courage - but this may not do the whole trick. A further tactic is to neutralize the enemy - and dissipate the toxic hostility either by forgiving him or by finding excuses for his actions.
Scriptures: when Peter asked Christ how many times he had to forgive his enemies - seven times? No, said Christ, seven times seventy.
Forgiving is not simply a godly, charitable gesture - but rather provides a crucial, sanitary removal of toxic thoughts from the forgiver.
There is a widespread belief which, years ago, we psychiatrists have helped to encourage, that if a person can just dig out the "root cause" of his problem or behavioral hang-up, the problem can then be summarily banished. Psychiatrists and psychologists have learned, long since, that things are not so simple and that problems can and must be "worked through," even if the cause is never discovered. The public has not caught up with the times, however, and is still pursuing the "whodunit" detective work to find the culprit.
More to the point - for all concerned - is to figure out what to do about a problem, here, now and in the future, rather than waste time searching for the "why" somewhere in the past.
To make this point more concretely, the current, much-publicized legal proceedings about Woody Allen's allegedly-abused daughter - my own instinct as a therapist would be to put at least as much attention to helping the child recover from either the abuse or the legal proceedings from here on - as searching ad infinitum for the "truth" of the matter in the past.
On the contrary, everybody these days seems to be trying to figure out what to do about their guilt feelings. They seem to stick to us like glue and tend to keep coming back. Seriously, they are a very major factor in mental health disorders.
Unfortunately, many almost resign themselves to the idea that guilt feelings have become permanent residents in us.
But, much like bodily pain, guilt feelings really should be viewed as signals of something wrong that needs attention and correction. The "something wrong" may be the realistic fact that a person is guilty of some wrong - and needs to atone somehow for this wrong in order to defuse the guilt. Or it may have been wrongly bestowed on you by someone else who, for his own sick reason, just wants to make other people feel guilty. This source must be understood and put into accurate perspective. Or, if the cause cannot be found despite a reasonably diligent search, then it has no right to exist and the bearer has no obligation to bear it. Professional help well may be needed to unload such an unwarranted burden.
Guilt - and guilt feelings - are universal and "normal" in humans; only those without the capacity to feel guilt are really sick - the psychopaths. The therapist can also help teach patients to better co-exist with a "normal" load of guilt about our many misdemeanors.
I think we need more suckers and should invest more time being suckers, every one of us. Altruism is almost a corny concept - to which everyone officially subscribes.
Yet, marriage counsellors are inundated by complaints that one spouse is "doing all the giving," that both spouses are keeping accounts of giving and taking - and often both find themselves at the short end. What so many still don't seem to realize is that the giving goes on the plus side of achievements for the giver, rather than on the minus side. As a side effect, it is giving which also benefits the recipient. It creates a sort of positive chain reaction. This is, again, simply psychological fact, not do-goodism.
How achievable are my dreams? I maintain they are quite doable - and in fact even today, many are already living by such sanity-preserving principles. No special training or skills are required; no government grants; no revolutions. They are no cost dreams.
But there certainly will be great difficulty overcoming deeply-ingrained, popular mind sets and our collective blindness to the fact that many of today's mind sets don't work. Undoing the old values could be a lifelong effort. It takes courage to dare to make big personal changes - sometimes in seemingly bizarre directions - and forcing ourselves to venture into uncharted waters. But I am an optimist.
Einstein said, “God doesn't play dice.” Our destiny is probably not simply a matter of chance.
Buckminster Fuller was convinced that whoever or whatever shaped the universe did not intend for it to be a flop because of man-made dilemmas.
I believe that mankind is intelligent enough to change over time for purposes of survival and progress - and also, that individuals are quite capable of changing and growing and progressing throughout their lives.
And I might even learn one day to understand baseball!
*“Dreaming about Mental Health” was presented by Heinz E. Lehmann at a meeting of the Canadian Mental Health Association Quebec Division, in Quebec City, Quebec, on November 20, 1992, and at a meeting of the Manitoba Mental Health Association, in Winnipeg, Manitoba on November 3, 1994.
December 24, 2020