Many classics, such as those written by Dickens, can be viewed as a metaphor for psychotherapy. Beyond symptom improvement, psychotherapy addresses the meaning of one's life and how it relates to meaningful values of loved ones as well as the surrounding community.
PSYCHIATRIC VIEWS ON THE NEWS
A good part of the news last month surrounded the Christmas season. Now, I don’t really celebrate Christmas in the traditional way, but I do celebrate the annual mainstay theatrical production, A Christmas Carol. This year my wife and I saw three-yes, three-live versions over the period of one week. Why?
Over the years of seeing the family version of A Christmas Carol, it has come to strike me that Dickens’ story can be viewed as a metaphor for psychotherapy, even though psychotherapy did not exist in his time. But perhaps a spiritual kind of psychotherapy did take place, and Dickens was a psychotherapist without a license. Scrooge is his patient and is redeemed.
In case you don’t know the basics of the story, Scrooge seems satisfied with his money, but dissatisfied with life. He reacts to Christmas with calls of “Bah! Humbug!”
Returning to his home alone on Christmas Eve, he is greeted by the ghost of his former business partner, Jacob Marley, who warns him of a haunted afterlife if Scrooge doesn’t change his miserly ways.
Like a participant in the best psychodynamic psychotherapy, Scrooge visits his past, present, and projected future.
Even with the supportive, empathetic, and confrontative help of the Spirit of Christmas Past, Scrooge still shows typical psychological resistance in not wanting to see what is being presented to him. He is shown his feelings of being rejected by his father, including being sent away to school. Finally, a beloved transference father figure in his first job as an apprentice helps him to begin to find his way. He becomes engaged to a lovely woman and he is not too concerned with money. New technology and riches entice him away, similar to today’s for-profit managed care. He loses his beloved in the process because he still cannot trust the value of a loving relationship.
As the Spirit of Christmas Present emerges, Scrooge begins to gain insight into the errors of his ways. He is shown how others are happy being together and helping others. However, the life of his helper’s son, Tiny Tim, is in danger due to medical problems and inadequate money to get the care that may help.
The Spirit of Christmas Future reveals in the shadows not only Tiny Tim's death, but Scrooge's as well. He sees himself dying alone and his house gleefully raided.
Like many who face a terminal illness, Scrooge decides to change his ways. He and Tiny Tim live longer, and he provides gifts to all in the community. Dickens, coming from a family in which he and his father were humiliated, wanted to encourage people to help those in need. This was a kind of community psychiatry and medicine of the day.
What, then, makes psychotherapy more spiritual? Beyond symptom improvement, it addresses the meaning of the patient’s life and how it relates to meaningful values of loved ones as well as the surrounding community. This model can be applied to 15-minute medication checks by asking patients what gives their lives the most meaning then trying to see how medication can play a role in that.
Spiritual therapy transcends religious denomination. It is not Christian psychiatry, nor is it Jewish psychiatry or Muslim psychiatry, though religious-based psychiatry can be spiritual.
If you didn’t see A Christmas Carol live this year, try to do so in 2015. In the meantime, make a resolution to watch one of the movie versions, including the animated version, Mr Magoo’s Christmas Carol, which I viewed for the first time this past Christmas Eve. Magoo seems like a perfect visualization of Scrooge, for as usual his eyes are closed most of the time, and he exhibits little insight or outsight. It even visualizes Scrooge’s superego as he chastises himself.
Watching the classic is one way to keep the Christmas spirit alive all year long. It is also a way to enhance our work with patients, if not our communities. Incidentally, it should be required viewing for any for-profit managed care executives.