Psychiatry often requires a magician’s touch…
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Psychiatry is often portrayed as a science, especially relevant as our knowledge increases with reliable research. It is also considered an art at times, how we have to creatively improvise when necessary.
Psychiatry, though, is rarely considered to be magic or magical, but the play “Grand Magic” at the Shakespeare Festival in Canada made me conclude that there is also a magic of psychiatry. It was written in 1948 by the Italian playwright Eduardo De Filipino and presented in a new English translation. Perhaps part of its meaning is a comment about the delusions of fascism in Italy and Nazi Germany, as well as how we all can be fooled by our need for illusions.
In the play, a magician down on opportunities is working at a seaside resort. There is a couple in which the husband seems “insanely” jealous of his wife’s affections. The wife asks the magician for help in escaping to her boyfriend, lending some reality to her husband’s jealousy. Her plan succeeds and her husband becomes even more obsessive, convinced she is in a box which he can carry around. Years later, the new couple is discovered. She will return to the husband, but only if she can keep her boyfriend. He cannot accept that reality and retreats further into his illusion.
If only he and they could see a good psychotherapist, I thought to myself. Our magic occurs especially in our understanding of the counterintuitive influence of the unconscious that the master writers like Shakespeare knew. Shamans seemed to use magic in their trance healing ceremonies.1
Freud presented the influence of unconscious conflicts and wishes. Research now indicates that our mind makes decisions before we are even consciously aware of it. Yes, children may unconsciously want to marry their mother or father. Yes, we seem to have a death instinct. Yes, confronting an erroneous belief in another often even makes it stronger.
So, in insight-oriented psychotherapy, the timing and content of any insight often must be done with the sleight of hand of the magician, getting around the resistance and denial in the patient. Perhaps if you were of a certain age, say my age, you were taught by a so-called master therapist with such magic, such as Leston Havens, who taught about using specific language to contact the patient.2 When I was a medical student at Yale on my first psychiatry rotation and having a session with an adolescent girl, a supervisor burst into the office and exclaimed: “Are you Judy Bell or for whom the bell tolls?” Her casual demeanor immediately switched to become more serious.
Perhaps nowadays our manual-driven psychotherapies do not need such master clinicians. Or, are we just fooling ourselves that such therapeutic relationships do not require a bit of magic?
Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times.
1. Kiev A, ed. Magic, Faith, and Healing. The Free Press;1964.
2. Haven L. Making Contact: Uses of Language in Psychotherapy. Harvard University Press; 1988.