Did Electroconvulsive Therapy or Storytelling Cure Simon Winchester?

Joe Donahue, the brilliant host of WAMC's Roundtable recently interviewed Simon Winchester about his short e-book "The Man With the Electrified Brain. In the book Winchester describes his four-year experience as a young adult with an undiagnosed serious mental illness that was at the time apparently successfully treated with electroconvulsive therapy (ECT.) 

There is much speculation of the nature of the illness. Winchester himself, on discovering DSM (Diagnostic and Statistical Manual of Mental Disorders) IV many years later while writing The Professor and the Madman, diagnosed himself with a "dissociative disorder." A professor of psychiatry at Stonybrook who is a proponent of ECT, based on correspondence with Winchester,  has diagnosed him with "simple melancholia," an illness he recognizes is not in the DSM and attributes to "abnormal hormone functions."  A Psychology Today post entitled What Did Simon Winchester Really Have?" refers to "psychotic episodes."

In his introduction to the e-book Winchester explains his reasons for writing about this subject so many years later. He describes living with feelings of shame, and, following the death last year of both his parents, a desire to "come clean." He writes; 

My mother and father, tough old greatest-generation Britons who lived well on into their nineties, belonged to a time and class that disapproved mightily of any kind of mental infirmity...Stuff and nonsense, my father would bellow on hearing of my troubles. Damn tomfoolery was his only diagnosis, Pull yourself together his only prescription.

The answer to my question may be found at the end of Donahue's masterful interview. After covering the scope of Winchester's story, Donahue moves on to material that is most definitely not in the book. "Without getting overly psychological," sharing that he, like Winchester, had recently lost his parents, Donahue wonders about a wish to " fill in the blanks," about his history, and in particular his genetic history.

What follows is, in my opinion, the most fascinating and important part of the interview. Winchester tells of his elderly mother going with him to Buckingham Palace in 2006 when he became an OBE (Officer of the Order of the British Empire) He describes her getting tipsy on two glasses of sherry and telling "unbelievable stories about her life," stories of "espionage and affairs." Winchester tells of his father's history of being badly treated as a prisoner of war, and in the final weeks of his life, after suffering a stroke, beginning to open up about his own history. He speaks of his father's growing tolerance of talking about mental illness. Then, most poignantly, Winchester says, “It was brimming, I could feel a sense that this is all going to break, and then he died."

After this comes an exchange where Winchester describes an uneasy sense that his illness may return, having been told by a number of people that the ECT, " didn't cure you."

I wonder if it is this very telling of the story, including his incomplete yet meaningful connection with his parents towards the end of their lives that will prove to be the “cure.” This telling of stories as cure is well known within the discipline of psychoanalysis. I describe it in a previous post Childhood Trauma: Stories that Must Be Told:

French psychoanalysts Francoise Davoine and Jean-Max Gaudilliere have an adage on the cover of their book, History Beyond Trauma; "Whereof one cannot speak, thereof one cannot stay silent." They argue that personal stories of war and societal trauma, if not told in words, emerge as symptoms, sometimes as mental illness, sometimes in subsequent generations. 

Of course I do not know if Winchester's family history had any relation to his illness. Yet I cant help but wonder, if this silence, this "British reserve" had a role to play, both in the illness and also in Winchester's chosen profession as a writer, or "storyteller." Perhaps it is his storytelling that was/is the cure.

We are currently in hot pursuit of the science of mental illness. This past Sunday, in an op ed in the New York Times, The New Science of the Mind,  Nobel Prize winning neuroscientist Eric Kandel writes about our growing ability to understand the biological basis of psychiatric disorders.

Listening to Winchester's story motivates me to again point to the need to attend to the relational and historical context of being human in our quest to understand mental illness. If we focus exclusively on the "biology" without attending to the way the brain grows and changes in the context of relationships, we miss what a colleague referred to as the "poetry" of human nature. 

I have great respect for the complexity of the kidney. But the way the proximal and distal tubules transport ions is likely not related to, for example, the owner of those kidneys' relationship with his mother, or his father's survival of the Holocaust. But the function of his brain/mind most certainly is.

My hope is that what we will take away from Simon Winchester's story, thanks to Joe Donahue's  interview, is that in our pursuit of the science of mental illness we must find a way to make room for storytelling.

NYT on mental illness, talk therapy, drugs: what about children?

Last week there was an invitation to dialogue in the New York Times on this subject.  In today's Times there is a fascinating array of responses, but none addresses the issue as it relates to children, for whom there has been an exponential rise in prescribing of psychiatric medication in the last decade. Here is the letter I sent in.

We live in a culture of advice and quick fixes. Increasingly, understanding of human experience is reduced to lists of symptoms, diagnosis and medication. There is less curiosity, less careful listening to one another.

Talk therapy, which perhaps should be called “listening therapy,” offers space and time to create a meaningful narrative, including an opportunity to experience feelings of grief and loss.

This is particularly important in work with children. When symptoms are medicated away, the opportunity to tell stories that give meaning to behavior may be lost. Research has shown that a child’s knowledge of family narrative, both the ups and downs, is highly correlated with self- esteem, resilience and mental health. Giving a parents an opportunity to tell their story to a nonjudgmental listener, to integrate their own narrative,  is critical to treatment of childhood “behavior problems.”

I am not advocating for talk therapy for children. Rather, in order to help children who are struggling with a range of "behavior problems," it is essential to listen to their parents, to give them an opportunity to reflect on the meaning of behavior. The behavior is a symptom, perhaps even an adaptive response, to the underlying problem. There is extensive evidence, that I describe in my book Keeping Your Child in Mind, that when parents reflect on the meaning of behavior in this way, they have the opportunity to promote healthy development at the level of gene expression and structure and biochemistry of the brain.

In my practice, where I see children under the age of five, parents typically present with concerns like, "he never listens" or "she is defiant." But as we take the time to think about how the problem developed, meaningful shifts in understanding occur. For example, parents may recognize the way a child's behavior pushes their buttons because of their own history of abuse. Or serious marital conflict, that often has zeroed in on the child's behavior, comes to the fore.  Or the impact of an easygoing sibling may be recognized. Tantrums and meltdowns at birthday parties may be understood in the context of a child's longstanding difficulty with processing sensory input.

Creating this narrative, this story that makes sense of the problem, may only be the beginning of the treatment. Intensive work with parent and child together, to address the way the child's behavior provokes the parent, is often indicated. Marital counselling, or even working with a couple who are not together, to help them work together to support their child may be necessary. Quality occupational therapy can be invaluable to help a child to feel calm in his body. Parents may benefit from things such as yoga to help them to calm their own reactions.

Here is where the trouble really starts. Quality clinicians who offer these services are in short supply. Insurance is often a huge obstacle. But, creating perhaps an even bigger obstacle, is the cultural norm of the "quick fix" approach of medicating symptoms, even in children as young as 5.  Not only must parents overcome these obstacles of finding a provider, making the time, allocating funds, as well as doing the important but often challenging emotional work of addressing these issues. They must go against pressure from teachers, relatives, friends and  health care providers.

I will continue to offer parents space and time to be heard, to create meaningful narrative, because I am confident that telling stories, and working through the feelings of grief and loss that often accompany them, is the path to meaningful connection and healthy emotional development.  It causes me great heartache when these efforts are thwarted by a system that works in opposition to this approach.

Animal Therapy for Children (and Parents)

Recently there was a beautiful article, Wonder Dog , in the New York Times magazine about an emotionally troubled boy who was helped significantly by a devoted dog. I thought about this story this past week when my beloved dog, a lab-border collie mix who we adopted 9 years ago at the age of two , died rather suddenly. It turns out he had a tumor on his spleen and bled internally-at least it was quick and painless.

The thing is- he really helped me out with my emotional regulation, especially in my role as mother to my daughter, who as a young teenager had an incredible capacity to push my buttons. In the interests of full disclosure, I also had a lot of help from a wonderful therapist in understanding the roots of this issue. But Jasper was there with us on the front lines.

Whenever we would get into any kind of conflict and I would start to raise my voice, Jasper would immediately get up from his dog bed and come and lie right next to me. At once I would feel calm. My breathing slowed and I am quite sure my blood pressure went down. Rather than continue to butt heads with her, I would be able to think more clearly about what was happening and to reflect on the meaning of her behavior. Often I could identify some event in her life that was causing her stress and anxiety that she was now taking out on me. I was able to remain calm in the face of assault. Jasper helped me to much more rapidly defuse these encounters.

Now that he is gone, I think of his beautiful soulful eyes and his oh-so soft head, and I hope that I have internalized his presence enough that I can just think of him to gain that calm feeling. My daughter is older now and she herself has learned to regulate her own emotions. Part of this is simply development and maturation. But to some degree I believe she has learned this from me, and I in turn learned it in part from Jasper.

In my book, Keeping Your Child in Mind, I talk about how parents themselves need to find ways to manage their own emotions in order to be present with their children in a way that promotes healthy development. This involves having someone to hold them in mind, be it a spouse, friend, family member or therapist. I should add animals to that list.

The therapeutic value of animals for children is well known. I often recommend horseback riding as an activity for children with problems of emotional regulation. Child psychiatrist Bruce Perry, in his description of the Neurosequential Model of Therapeutics that he developed for working with traumatized children, writes:

Dogs have the capacity to provide the unconditional accepting and repetitive nurturing experiences required to help some of these children.

The wonderful documentary film Buck, clearly demonstrates how Buck's close relationship with horses has helped him to recover from the severe physical and emotional abuse he experienced as a child. He now uses this experience to help others. In training workshops he runs all over the country he shows the importance of managing your own emotions in order to be present with your horse in a way that helps him to manage his. It's an amazingly similar concept to my book!

If your child wants a dog, and you worry that you will "get stuck" taking care of it, remember that the dog can be a wonderful asset for the whole family. I know it will take our family a long time to heal from this terrible loss. I would often say to Jasper, "You are truly a good person ( as dog)." I hope that in writing this I can to some degree immortalize his gifts to us.