Will novel treatments from around the world be treats or tricks? Whatever they turn out to be, they are as fascinating and varied as Halloween costumes.
PSYCHIATRIC VIEWS ON THE NEWS
As we approach Halloween, news stories on mental health treatments are popping up much frequently than usual, and mainly from countries outside of the US. Perhaps that reflects the more stringent approval requirements in our country. The history of medicine and psychiatry is strewn with promising treatments, from bloodletting to primal screaming, but those failed to live up to their hype and hope.
Yet we need to continue to find better ways to help patients any way and anywhere we can. Will novel treatments from around the world be treats or tricks? Whatever they turn out to be, they are as fascinating and varied as Halloween costumes.
1. Behavioral activation
Who wouldn’t want a psychotherapy for clinical depression that would not only work faster than the current gold standard of cognitive behavioral therapy (CBT), but conducted by mental health workers with no formal training in psychotherapy? Wouldn’t primary care physicians who are inundated with psychological problems embrace the technique, given its relative simplicity and short timeframe? A trial in England suggests it is a possibility.1
Behavioral activation is a technique that tries to help patients identify the triggers of their depressed reactions and then encourages them to seek out unrelated positive experiences to develop alternative behavioral responses to rumination. After 12 months of the study, for those receiving at least 8 sessions of behavioral activation or CBT, both groups reported at least a 50% reduction in symptoms. Now, we must await further replication.
The successful treatment of PTSD continues to remain a challenge. There is no specific anti-trauma (eg, anti-depressant or anti-psychotic) medication. Various standard psychotherapies are tried, sometimes beneficially, sometimes not. One experimental treatment like eye movement desensitization and reprocessing (EMDR) has gained a small foothold, but we still need more and better strategies to treat PTSD.
In Israel, where war or terror trauma involves most families, a team of mental health professionals and filmmakers invented another possible treatment.2 They tried to see if a connection between filmmaking and psychotherapy-videotherapy-would have unique healing potential.
There are no videotherapy studies yet, but the participants of the experiment-middle-aged men who had lost children to disasters-apparently have reported that they are feeling and functioning better. In 24, 2-hour sessions that incorporated group support, participants learned how to make a short film with no words, but only music, that depicts how an ideal man may solve a problem that could be like, or unlike, their own.
The key was to empower participants to make a story that is not threatening and that is revised over the time of making a film, as if their own reactions to their own losses could be revised.
3. Family constellation
Germans have a historical habit of mind that mixes the mystical and scientific. This new therapy, often translated in English as family constellation, is a reflection of that tradition.3
The treatment helps Germans wrestle with the remaining guilt over World War II. To be German is still to be part Nazi in a psychologically inherited way. Even with Germany’s attempt, although belated, to talk about the role of the general population, as well as the more recent attempt to reverse their past by welcoming refugees and Jews once again, many have still not processed their relatives’ involvement with the Nazis.
Somewhat akin to psychodrama or family sculpting, participants are asked to intuitively play the parts of any participating family member. During a 2-day retreat, the therapist guides the process, which is described as part theatre, part therapy, and part sÃ©ance. Each role player would attempt to channel the person or emotion they were asked to represent. Family secrets are often revealed and a sense of reconciliation obtained.
The theory behind this technique is that in addition to a Freudian individual unconscious and a Jungian collective unconscious, there is a family unconscious that can be tapped. Again, there is hope that such a treatment can work quickly. But could it produce something like false memories? Research has begun and seems promising so far.
Given that the pipeline of innovative new psychiatric medications has dried up for now, it is no surprise that some people turn to other countries for different medications. One of them is ibogaine, a substance derived from a rainforest shrub. It is touted to reduce drug cravings by resetting damaged neural pathways involving pleasure.4
It is illegal in the US because of potential (but unlikely) adverse effect of cardiac arrest. Nevertheless, it hasn’t deterred people who have failed standard treatments for opiates or cocaine addiction from traveling to Mexico and Costa Rica for ibogaine-centered programs. When given ibogaine, the patient undergoes a day or two of intense hallucinations but then reportedly no withdrawal or cravings emerge for a period of time.
To get around risk from ibogaine, a derivative of it, noribrogaine, shows promise. Moreover, it is being tested for reducing clinical depression.
This treatment technique is the one I feel most connected to. I had been reading Alejandro Jodorowsky’s “imaginary autobiography” as I wrote my work-related memoir. I had been fascinated with him since I watched the cult classic movie El Topo. He wanted to make a movie of the science fiction novel Dune, a favorite of mine, but the funding ran out. Dune is renowned for many things, including the psychologically informed mantra that the hero says over and over for courage, “Fear is the mindkiller.”
Jodorowski, who grew up in Chile, wanted to expand his mind in all his activities, even when there were fearful secrets causing problems in functioning. When his son died of an overdose, he sensed that it happened to heal his family. Consulting with the Tarot and visiting with many shamans and other folk healers, as well as studying mysticism (like the Kabbalah), he developed what he called psychomagic.5 He also studied charlatans and quacks, if only to know how they fooled people. Though psychomagic is not a new technique, it was new to me, and I suspect to you, too.
One method is through symbolic acts. An example is given by another son. His mother, Jodorowsky’s first wife, used to weep while playing the piano. He wanted to be a pianist, too, but that was a troubling association. He learned that his grandfather left his mother when she was 3, so perhaps whenever she played the piano, she was unconsciously connecting with him. The son’s solution was to bury the piano in a hole and put a cherry tree on top of it!
The Wizard of Oz provided inspiration for the advice he gave clients. The Tin Man wanted to have feelings, so the psychomagician places a heart-shaped watch on his chest. The Scarecrow wants to be intelligent, so the psychomagician gives him a university diploma.
To deliver treatments to the public without a license, he would hold classes in Paris and southern France, using volunteers for Tarot divination and live demonstrations. He reports that he also taught other clinicians, including the founder of Gestalt therapy, Fritz Perls. Instead of verbal interpretations of conflict, psychomagic could provide relief via symbolic nonverbal activities and, once again, not take too long.
I realize that I have probably dabbled in psychomagic without knowing it. For instance, Jodorowsky says that when a child is given a problematic name, such as someone who died a tragic death, he advises changing the name. Perhaps this occurred when I was a child. My given first name is Hillard, named after my mother’s brother who died right after he graduated from medical school. Not liking the name for as long as I can remember, I have used my middle name, Steven, except that my formal doctor name is H. Steven Moffic. Perhaps that was a psychomagic way of becoming a doctor, but avoiding the subconscious fear that I, too, would die after medical school.
My work office was filled with artistic pieces of healers ranging from Freud to witchdoctors, and Jodorowsky stresses that art should be healing. I had a small palm-like tree that would grow while it was cold and snowy outside, perhaps a symbol of thriving under duress. My home office is filled with masks from various cultures and people, filling me with imaginative empathy for patients who were culturally or psychologically different from me. I also wear clothes to convey a healing message. Take wearing a red tie of hearts when I delivered my Administrative Psychiatry Award speech recently given by the American Psychiatric Association. Or, the t-shirt I have begun to wear to events with the logo: “Make America Sane Again.”
Perhaps you do some psychomagic or some other new or unusual therapeutic techniques? Let us know.
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1. Slomski A. Simple, less expensive psychotherapy effective for depression. JAMA. 2016;316:1250.
2. Horwitz S. How video can heal the bereaved in Israel. Forward. 2016;13:23-24.
3. Bilger B. Ghost stories: Making peace with the dead in Germany. The New Yorker. 2016;12:56-65. http://www.newyorker.com/magazine/2016/09/12/familienaufstellung-germanys-group-therapy. Accessed October 28, 2016.
4. 4. Nestor J. An Antiaddiction Drug Called Ibogaine Could Be a Wonder Cure-Or an Addict Killer. Scientific American. 2016;315(5):62-69. https://www.scientificamerican.com/article/an-antiaddiction-drug-called-ibogaine-could-be-a-wonder-cure-mdash-or-an-addict-killer. Accessed October 28, 2016.
5. Jodorowsky A. The Dance of Reality: A Psychomagical Autobiography. Rochester, Vermont: Pork Street Press; 2001.