Hope at the doctor´s office
Anssi Leikola, psychiatrist, therapist, author, trauma survivor
18 February 2018
In general psychiatry and also in the whole medical world the meaning of hope is not valued enough. It is perhaps a too vague and “soft” concept. But I think it is crucial in every recuperative process, at least in psychiatry. It is the sister of safety. And safety is the most important precondition for gaining mental health.
Besides medication there are many other realistic paths for getting better, even for the most severe mental issues. In this era there are powerful forces trying to ignore or blur the reality: medication never really heal psychiatric conditions. At its best it alleviates symptoms to be more bearable, which of course could indeed be very important, as it can create experiences of safety. But still, no true cure is gained by medication. In psychiatry it feels like the medication may too often become some kind of a shield between the patient and the professional, not a bridge. I like to call this zeitgeist pharmacological imperialism.

As said in trauma vocabulary, my special concern here is: there is a risk that medication will silence or suppress some parts of the personality. These parts need to be heard in order for real recovery to be possible.

The trauma point of view and Pierre Janet´s psychology of action changes how we perceive the psychiatric symptoms and even the human behavior in general: what we see and hear at the office, and how we understand all the meanings. It all gradually becomes much more logical, or even suddenly, it just makes sense. This is big news.

I become annoyed as I see how in general psychiatric practice it all intertwines around medication. If you have serious mental issues is then medication really considered to be the only hope? I have a strong opinion on this; no, it is not.

So much can be gained by the plain respectful interaction and particularly shared understanding.

I love to hypothesise gently the real meanings of patients symptoms. By understanding together the messages carried by them, it also brings one to be an active agent of your own life. How I know these are real meanings? How do I even dare to say so? When the relief comes repeatedly after realization. This relief (a bodily experience), which is also shared and verbalized between us, is my best garantie, better than any scientific truth.

One part of my discussions with patients is about the philosophy of diagnostic categories in psychiatry. I have seen many times also the relief in their faces as they understand the real nature of official psychiatric diagnostics. There is no need to get stuck with them, because we can understand so much more if we use the trauma approach.

What if professional understands the trauma behind patients symptoms? And what if a patient feels like he is eventually understood completely, because the professional knows how structural dissociation reveals itself at the office?

When it comes to the effects of traumatic experience in scientific psychiatry, the usual avoidant story has been something like this: “we can not say anything certain, as we really don´t know yet, the evidence is not clear”.

But actually this is not true. It depends on who you ask.

I find so interesting news in our field during the last two decades, as psychiatric conditions can at last be understood upon solid theoretical basis. This is groundbreaking development. And even more, this theoretical knowledge can be embedded on everyday practice, as trauma-informed long-term therapeutic interaction is already applied at the office, with very good results.

But to my knowledge the general psychiatry is only slightly interested in these most promising and precious issues.

The most important is to ask the right questions! To put the big one briefly: how does traumatic experience effect a person? It is here where psychiatric possibilities lie. There are already many useful theories to be applied, answers available and to be realised together. The possibility of integrative understanding and recuperation is already at hand.

Photographs via Unsplash

Rethinking psychiatry

There are fortunately a lot of people who share the opinion we should rethink what mental illness is. I have felt myself lonely, but not any more!

As a traumapsychiatrist I can honestly say, the current psychiatric diagnostic system do more harm than benefit my patients. We have thus a problem of the whole system of classification. One of the main problems is that it tend to hide more than reveal important information. And this gives the possibility for the whole (mental) health care system to avoid many real problems.

I have a lot to say about this. And in this blog I will be giving many examples soon. So, many provocative thoughts to be released here in the future.

I start like this:

1) many psychiatric problems are related to subjugation, thus relational injustice

2) traumatic experience is highly correlated with social submission and alienation

3) the autonomic nervous system is most useful in linking the crucial issues between psychiatry and neuroscience, more useful than the brain

4) enhancing safety in social interaction is the most simple and cost-effective way of raising the level of positive outcome in psychiatry

5) clinical psychiatric understanding could be based on multidisciplinary approach, for example evolution, philosophy and neuroscience

6) we should have a clear idea what mental health is, in order to provoke it in the mental health care system

7) there exists already many good reasons predicting emotional trauma to be the key issue in psychiatry during the next decade

Everyday at office I share a safe atmosphere with people. This is not a given, but reached and refreshed by repeated and patient actions of understanding together something new and important. This gives the feeling that the process is getting somewhere, ahead. Sometimes this safety needs to be regained after very challenging moments, for both parties. We probably at the same time take in all the placebo effects of medication (if there is medication required!). This regularly happens when medication is combined with trust, respectful interaction and sincere care. This trust is earned by sharing some crucial information that patient can accept. When the environment is safe miracles happen. Atmosphere of safety must be experienced by patient and therapist alike. It is created between people by interplay, but it is the therapist who is responsible for the safe atmosphere to happen, time and again.

Photographs via Unsplash

Our mission

As a coequal community we can do a lot. After such a long journey behind us we have the motivation and all the tools, the knowledge and the experience. Above all we enjoy what we do and inspire each other. We have become masters of sharing. At the same time we are growing. We strive to find new ways of understanding.

We trauma survivors tell the story by our behaviors and words. Our message is hope. We are proud to be the answer for all the cynicism in this world.

Together we are safe enough for creating peace and trust in places it never existed before. We are not the only people on earth who can reach and experience liberation from the traumatic past. We would like to invite people to join us.

This means hope for anyone who is able to receive it.



In our next blog post we will discuss justice and answer a question from a reader. 


Are you on your way for recovery? Are you working with people heading for recovery? Would you like to share your story?  We warmly invite you to write in our blog. We promise anonymity if you don’t want your name to be published.

You can write to us at contact(at)peacefulimpact.com


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