Consultative Psychiatry

Consultative Psychiatry

By John Taylor; 2006 November 18

I just finished reading "Introducing Psychiatry," (Nigel Benson and Piero, Cambridge, 2004) which fills in and modernizes what I already knew about headshrinking. Not only do the mentally ill suffer from horrible stigma, the mental health profession itself suffered tremendous criticism in the latter half of the 20th Century. To my surprise, psychiatrists have actually taken much of it to heart. There is talk of "open psychiatry," where the information in medical records will not be kept secret, where the arbitrary judgment of one examiner will not hang over peoples' lives, unread and unchallenged. Plus, there are second thoughts about head shrinks as pill pushers. Benson writes,

"The heavy reliance on "taking pills" to solve psychiatric problems needs to be continuously questioned. Both the medical profession and the general public must realize that drugs alone are not answers and that changes in life-styles -- combined with personal responsibilities -- are the keys to mental health." (p. 169)

The working model of the shrink has been too authoritarian and, like the rest of medicine, too passive. The tendency is to wait for disease to worsen, then treat it. Instead, now there is talk of "proactive psychiatry,"

"Perhaps psychiatry as a profession could ... do more preventative work, rather than just being there after personal crises have occurred. Educational programmes could be developed to help the general public become more aware of psychological dangers, for instance, by recognizing symptoms of excessive stress in themselves and others. Employers could be far more involved in work-place stress reduction and stress-management -- which would actually be of benefit to their organization as well as to individual employees."

This is followed, as in every page of an "Introducing" book, by an illustration:

Boss, standing over worker at sewing machine: "I understand that your child is ill, so you cannot concentrate on your work today. I suggest you go home early..."

Worker, perplexed: "Boss, are you feeling OK?" (p. 172)

The author says that in relative terms psychiatry is a shrinking profession and that it is in danger of dying out in a few decades. Many, he recognizes, would say that this is a good thing. But the author is probably right that people in crisis will always need a trained mind-examiner to help them out. Myself, I would like to see new professions arise to take over most of what is now done by shrinks. There should be more consulting philosophers available to confer with, since rarely are stresses exclusively mental, at least not in the early stages. They are as often as not existential and spiritual. There should be more helping professions, like the Chinese-inspired "neighborhood helper" that I have suggested for every locale in past essays. Plus, perhaps most important, there needs to be more prayer and reflection going on, intermixed into our daily lives. A Mashriq at the center of town will no doubt act as a giant, "silent psychiatrist" as people seek its shelter to pray and worship and get their heads straight every morning before going to work.

Another help will be cradle-to-grave training in good consultation skills. I am sure that our constant misuse and abuse of consultation not only leads to more violence, it also is a forgotten cause of many, if not most, mental illnesses. As the saying goes, a stitch in time saves nine, and no doubt we could all be better friends and do one another great good if we knew how, using consultation, to lovingly discover problems and cure them at exactly the right moment, before they can grow into mental health crises.

At the end of this essay, I am including the complete text of one section of a memorandum from Haifa, dated 7 February 1993, called "Issues Concerning Community Functioning." It addresses the very interesting distinction between normal Baha'i consultation, whose goal is to search for truth, and its use as therapy, where the object is to cure. When we are consulting for cure, truth takes second place to the needs of that person at that particular time in their lives. It takes skill to steer such conversations away from confession and gossip while still addressing the problem that person has -- and in my experience people are almost always troubled by people, not theoretical problems or intellectual quandaries.

This week I came across a memorandum taped on a table in our local St. Vincent de Paul store (the place is open but empty of workers there for half the day; buyers are left on the honor system to pay for items there at a neighboring store). It admonished volunteers not to engage in backbiting, especially in front of customers. It declared that such talk sets back the good name of the Christian message their institution is designed to uphold. This made me wonder how many of our mental problems come from backbiting; certainly Baha'u'llah's image of a fire that lasts a century, and His harsh threat in the Hidden Words that the backbiter is "accursed" of God, all imply that this is a very dangerous, volatile quantity. Yet in the people I have known, the more sociable they are the more prone they are to gossip, and their gossip all too often slips into backbiting. The same is true of myself; the more time I spend talking to people the more likely it is that I will be singed and cursed by my own tongue.

This is probably where we should apply the consultative self-defense skills, pro-active conciliation and fear of contention, that we discussed here the other day. Just as a wise person breaks off a contact that threatens to become violent, they should be just as willing to break off a contact, no matter how friendly, if it threatens to break somebody's back. It is a matter of self-defense; we defend other creatures of God from condemnation in order to protect ourselves from the fiery curse of backbiting. The soul is a mirror of God and any attack on another soul insults God and does as much spiritual damage as insult to self. This is a problem that Plato deals with in the Georgias: Is it worse to do an injustice oneself or to have one done to us? The answer, difficult as it is, is the former. It is better to be beaten up and killed than to utter a word of condemnation about our brother or sister. Our brother or sister may not hear it or know it, but God knows, and the mirror of our soul knows, and it sickens us, deep down. God protect us from betraying this fundamental aspect of God's best-beloved issue, justice.

Issues Concerning Community Functioning

The Universal House of Justice

M E M O R A N D U M

From: Research Department

7 February 1993

2. Consultation and Expression of Feelings

The view has been put forth that the open expression of feelings and honest expression of ideas are fundamental to productive Baha'i consultation, and, further, that the Alcoholics Anonymous (A.A.) 12-Step programme can make an important contribution to honest and open communication. In this regard, guidance was sought concerning the expression of feelings in the course of consultation.

While there may well be similarities between elements of the process of consultation and the 12-Step programme, they differ in their overall goals. The intent of the open expression by the individual as practiced by A.A. is, by and large, to effect a healing and a release from the habit of drinking. Consultation, on the other hand, has as its object "the investigation of truth".

The distinction between the purpose of consultation and therapeutic endeavours is made explicit in the following extracts from letters written by or on behalf of the Universal House of Justice:

"It should be borne in mind that all consultation is aimed at arriving at a solution to a problem and is quite different from the sort of group baring of the soul that is popular in some circles these days and which borders on the kind of confession that is forbidden in the Faith." (Consultation: A Compilation, p. 22)

In regard to your question about the fifth step in the "A.A. 12-Step Programme", we have been asked to share with you the following extract from a letter written on behalf of the Universal House of Justice on 26 August 1986 to an individual believer: ...there is no objection to Baha'is being members of Alcoholics Anonymous, which is an association that does a great deal of good in assisting alcoholics to overcome their lamentable condition. The sharing of experience which the members undertake does not conflict with the Baha'i prohibition on the confession of sins; it is more in the nature of the therapeutic relationship between a patient and a psychiatrist. (On behalf of the Universal House of Justice to an individual, 5 November 1987)

The honest expression of feelings in general communication requires wisdom and moderation. In Gleanings, Baha'u'llah counsels the believers thus:

"They who are the people of God have no ambition except to revive the world, to ennoble its life, and regenerate its peoples. Truthfulness and goodwill have, at all times, marked their relations with all men..." (pp. 270-71)

"Beware lest ye contend with any one, and strive to make him aware of the truth with kindly manner and most convincing exhortations...." (p. 279)

"Whatsoever passeth beyond the limits of moderation will cease to exert a beneficial influence...." (p. 216)

And Shoghi Effendi, in a letter dated 5 July 1947 written on his behalf, makes the following statement about the importance of "balance in all things":

"One might liken Baha'u'llah's teachings to a sphere; there are points poles apart, and in between the thoughts and doctrines that unite them. We believe in balance in all things; we believe in moderation in all things -- we must not be too emotional, nor cut and dried and lacking in feeling, we must not be so liberal as to cease to preserve the character and unity of our Baha'i system, nor fanatical and dogmatic."

Concerning the open expression of feelings during consultation, clearly the expression of feelings and the emotional tone of the interaction make an important contribution to the consultative process. In one of His talks 'Abdu'l-Baha describes "love and fellowship" as the "foundation" of "true consultation". He states:

"...true consultation is spiritual conference in the attitude and atmosphere of love. Members must love each other in the spirit of fellowship in order that good results may be forthcoming. Love and fellowship are the foundation." (Promulgation of Universal Peace, 1982 edition, pp. 72-73)

The Tablets of 'Abdu'l-Baha that are cited in Baha'i Administration: Selected Messages 1922-1923, 1980 edition, pp. 20-23, provide helpful guidance concerning the expression of feelings during consultation. For example:

'Abdu'l-Baha calls upon the members of a Spiritual Assembly to unite such that their "thoughts", "views", and "feelings may become as one reality, manifesting the spirit of union throughout the world...." (pp. 20- 21) The Master advises the members to "take counsel together in such wise that no occasion for ill-feeling or discord may arise". He affirms that:

"This can be attained when every member expresseth with absolute freedom his own opinion and setteth forth his argument. Should any one oppose, he must on no account feel hurt for not until matters are fully discussed can the right way be revealed. The shining spark of truth cometh forth only after the clash of differing opinions..." (p.21)

It is important to note that truth emerges after the "clash" of carefully articulated views (which may well be expressed with enthusiasm and vigour), not from the clash of feelings. A clash of feelings is likely to obscure the truth, while a difference of opinion facilitates the discovery of truth. 'Abdu'l-Baha provides the following advice concerning the manner in which views should be expressed in the course of consultation. It is suggested that this guidance could also pertain to the expression of feelings:

They must then proceed with the utmost devotion, courtesy, dignity, care and moderation to express their views. They must in every matter search out the truth and not insist upon their own opinion, for stubbornness and persistence in one's views will lead ultimately to discord and wrangling and the truth will remain hidden... (p. 22)

For additional statements from the Writings which could be pertinent to the subject of the expression of feelings in the consultative process, reference could be made to "Consultation: A Compilation."

(The Universal House of Justice, 1993 Feb 7, Issues concerning community functioning)