Peaceful Impact Publisher

Theory and Practice

Anssi Leikola, Psychiatrist, M.D., psychotherapist, work supervisor,
trauma survivor

3.9.2018

Owing to a peculiar personal history, I am a very theoretical person. Driven by a somewhat unbearable and inexplicable urge to understand what it means to be human, I have been constantly questing for new approaches. The resulting insights have allowed me to take some developmental steps in my thinking. Currently, they are beginning to find a new form and visibility online. Through certain theories, many doors have opened to me regarding my practical work, therapeutic approach and effective treatment of emotionally traumatized individuals.

Considering my own life, it has been crucial and downright necessary for me to find explanations, or rather models and general principles, that is theoretical explanations. I have been urged to understand and conceptualize basic psychobiological structures, needs and behavioral patterns of a human being, and also his/her relationship to the environment. This work has been persistent. An inner life of a certain kind, at the expense of social life, has borne some fruit that I am now sharing online, in the spirit of the digital age.

This personal situation, although adverse to my intimate relationships over the time, has finally after decades of work resulted in collective advantage.

This theoretical quest might now come out beneficial even to psychiatry as a whole, and particularly to those patients with childhood emotional damages, or trauma. On this site, I want to highlight some practical general principles that have proven immensely important. That is to say, to illuminate how this theoretical understanding yields reasonable practical applications particularly helpful for individuals suffering from trauma-related psychological disorders, i.e. various dissociative disorders.

Picture Freymark Franke via Unsplash

Thus, after the manifold phases of my life, I have turned into a more pragmatic person, one could say a sort of pragmatic advocate as well – a communicator striving to apply the theoretical knowledge acquired and digested for the benefit of healing, integration, sustainable human growth and development. In order to come to this point, I have had to meet numerous wise and benevolent people, so that I have been able to elaborate, elucidate and integrate my vision in the spirit of constructive communication. Today, we are able to create a completely new, shared culture of care that respects people’s past wounds and heals them thoroughly instead of merely bandaging them.

Along with applicable theories, the process of paving this rocky road has pushed me to find philosophical reorientation; in other words, to find an unconventional, appropriate and fruitful approach in this regard as well. On this site, I can now share a hopeful message in the middle of all the painfulness related to the subject of trauma. This kind of philosophical enlightenment has been crucial for me on the way, allowing a chance for a peaceful “space” to find what is essential and focus on that. It has also promoted my understanding on why the prevalent, scientifically based psychiatric (and psychotherapeutic, for the most part) culture of care, due to its premises, could not have helped me or the numerous other peers with our problems.

The theories I have found most useful are that of structural dissociation of the personality (SDP) and the recent theory of the autonomic nervous system, i.e. the polyvagal theory (PT). I will cite these frequently in my articles with the corresponding abbreviations.

 

These theories are so elegant and aesthetic – that is to say, so simple in their basic ideas – that things can be shared and discussed by their means in completely ordinary, inquisitive conversations. No former knowledge, let alone higher education, is required for that.

“These theories are so elegant and aesthetic – that is to say, so simple in their basic ideas – that things can be shared and discussed by their means in completely ordinary, inquisitive conversations. No former knowledge, let alone higher education, is required for that.”

These theories, along with the philosophical field of phenomenology, have provided me with a firm “grip” on the world, so that I feel like I can now understand both myself and other people. In practice, this manifests as a possibility of sustainable psychiatry with the goals of constant development of one’s view of life, humility, possible critical re-evaluation, and increasing integration. Instead of economic growth, there exists an aspiration for something sustainable, for spiritual growth and peace. Great work can yield sustainable results. And without question, these outcomes truly reflect and radiate around us with real significance.

What causes a contradiction is that I can deeply feel how the agenda spotlighted here does not meet the current objectives of psychiatric care. This is a fundamental problem, because contemporary psychiatry is not based on any recognizable theory. And still, all the things in the world are based on some approach. The only thing that can be said of the philosophy of psychiatry is that it is founded on non-theoretical basis; that is to say, a lack of actual theory. This “lack of theory” is a standpoint of principle of one kind, and as such, a theory as well. This, however, is a problematic basis.

One could imagine the world of science as the very center of theoretical knowledge, but in the case of psychiatry, this is not true. The prevalent (and largely ignorant) so-called positivist philosophy of science values the method over anything else. At the same time, theory is put aside. To its misfortune, psychiatry has been following other fields of science here. The theoretical basis has been replaced by mathematical statistics. However exact numbers these means would yield and however finely they would be analyzed with the most recent methods of biometry, this will never replace the firm ground of theory under our feet. So the question is, is it relevant to study something without strong ties to the real world?

 

The problem with the theoretical basis of medicine has been highlighted by Pentti Alanen: as the agenda of medicine is to cure an already sick person, the focus is hardly in etiological questions. This is manifest in psychiatric diagnostics, in the starting point already: it has no opinion on the origin of the disorders, i.e. etiology.

 

Secondly, because of this principal problem, the science of psychiatry is unable to define and explain what mental health actually is!

“This is manifest in psychiatric diagnostics, in the starting point already: it has no opinion on the origin of the disorders, i.e. the etiology.”

According to the Hippocratic Oath, priority should be given to what is best for the patient. At this point, I dare say this is in radical contrast to where the so-called official medical psychiatry stands. I can say that because I understand and can explain things in a way that can be shared with patients. I work this way because it promotes recovery. There is an apparent contradiction.

These days, the radical lack of theoretical consideration in psychiatry seems to be resulting in the fact that there exists a great and increasing demand for theoretical applications regarding e.g. the subject of emotional trauma, both in people’s everyday lives, on the grass root level of psychiatry, and in the world of psychotherapy and supervision of psychiatric work. One can assume that the same effect will be reflected, with delay, in the world of scientific psychiatry. Academic ships seem to turn really slowly.

This certain kind of restricted or tenuous nature of psychiatry and medicine has been a difficult issue for me ever since I started studying medicine. I can feel how my attitude and relationship to practical work stems from something very different and how it can be tricky to find interfaces with scientific psychiatry in particular. There is a lack of common language, and too often a lack of common ground or interests at all. This situation of an unchanging, challenging and frustrating nature has existed for over a decade. In my case, this is exemplified by the fact that, regardless of good effort, it has not been possible for me to work on a dissertation on how trauma theories affect psychiatry (cf. Katkennut totuus [The Broken Truth], 2014).

Now, this definitive difference in attitude and orientation has yielded novel results because it seems that the trauma-related theoretical approach is regularly leading to the integration of the patient’s personality. One could say that the chasm between conventional psychiatry is radically widening.

These theoretical considerations encourage us to open a discussion; that is, to also pose a large (meta) question concerning the objective of psychiatry. What is the goal? What kind of results are satisfying?

According to my current perspective, the objectives of psychiatry are predominantly too modest. This is an important message because it can give people hope. Possibilities remain unused. For the existence of many very different premises, there seems to be considerable qualitative variation among the objectives.

Therefore, in raising the issue of the theoretical basis of psychiatry, it is my intention to give people reasonable hope of better treatment, better therapy, better realization of human rights, better life. I know that by stating things like these I might be looking for trouble but, on the other hand, I am assured that this will result in something really good. I am willing to take all the risks concerned in bringing these issues to light because there is potential for great collective rewards.

These are big words indeed, but they will gradually be given more substance to on Peaceful Impact’s website. Otherwise, they would be just another example of the empty talk so typical of the market-driven world.

“In raising the issue of the theoretical basis of psychiatry, it is my intention to give people reasonable hope of better treatment, better therapy, better realization of human rights, better life.”

Theory can fulfill its actual purpose only if it can help people in their everyday life. When properly applied, theories can be very beneficial, as they can give sensible direction to practical activity, and increase understanding and well-being at the same time. This implies increased choice and freedom from past burdens and cages, difficult bodily states and reactions, and haunting traumatic memories. This way, theories can produce happiness that can be shared. We are now lucky to be able to share this message online, too.

Theory can fulfill its actual purpose only if it can help people in their everyday life. When properly applied, theories can be very beneficial, as they can give sensible direction to practical activity, and increase understanding and well-being at the same time. This implies increased choice and freedom from past burdens and cages, difficult bodily states and reactions, and haunting traumatic memories. This way, theories can produce happiness that can be shared. We are now lucky to be able to share this message online, too.

At this point, I cannot but wonder what a fortune it is that my persistent inner urge has pushed me to explain the unexplained – and no halfway explanations have ever sufficed. Secondly, and above all, I want to thank the numerous genuinely interested people for rewarding conversations. Every day, my work is complemented by the interactions (at the practice), by all those experiences that stimulate my thinking.

#sustainablepsychiatry

Translated by Viivi Wahlstedt from the original Finnish article “Teoriat ja käytäntö” published on (08/17/2018) 

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