In the face of mounting public concern over the visible dilemma of the cults, and with an increasing number of Americans falling victim to mass-marketed therapies, America's mental health establishment has had almost nothing to contribute to our national understanding of the problem. Their old theories fail to match up with the new facts; their analyses are based on concepts left over from eras that bear little resemblance to America in the seventies. While parents and cult members alike cry out for help, few professionals are looking at the cult experience itself, at the specific techniques used by the cults, and at the effects of those techniques on the mind.
Above all, America's mental health community has shown no sign of assuming the leadership role that would seem to be its responsibility. To better understand why, we felt it necessary to extend our investigation into that field's problems and dilemmas. In our research it became evident to us that -- like so many other people and institutions in the United States today -- the mental health community is showing symptoms of a sudden, drastic alteration of its own identity, a refocusing of awareness in the wake of the consciousness explosion. This sweeping transformation, we discovered, has brought it to the point of crisis in its dealings with the public -- and within its own ranks as well.
8 The Crisis in Mental Health
The present crisis of psychology (which, however, has already lasted
for some 30 years) can be summarized as the slow erosion of the robot
model of man.
-- Ludwig von Bertalangy, General Systems Theory (1968)
The entire range of phenomena that fall under our general heading of snapping comprise a domain of personality disorders that the mental health community has been unable to explain or treat. America's epidemic of sudden personality change, however, is itself a symptom of a far-reaching crisis in the mental health of the nation as a whole. This crisis can be traced to the consciousness explosion of the sixties, which had a profound impact on mental health practice throughout the country and on the personal lives of many mental health professionals as well.
Until the early sixties, Western psychological thought cleaved neatly along two theoretical lines: the Freudian, or psychoanalytical, and the behavioristic, often called experimental, Skinnerian, or positivistic. The psychoanalytical branch separated human personality into a set of mental subdivisions called ego, id, and superego, which were governed largely by the subconscious. The behavioristic school, on the other hand, dealt solely with observable behavior, insisting that mental activity and "internal states" were of little significance in human affairs because they could not be observed or reproduced experimentally.
The psychoanalytical and the behavioristic schools of psychology are generally considered to be diametrically opposed to one another in both theory and therapy. The first looks inside the "psyche" to the subconscious; the other stands back to validate only the observable product of behavior. Yet both psychological models share a common assumption about human beings: that an individual's conscious experience of the world around him is, at best, of secondary importance in the development of his personality and the determination of his behavior. In the Freudian tradition, the unknowable and unreachable subconscious governs personality. In behavioristic theory, a mind-boggling number of environmental forces automatically condition an individual's responses. This common assumption unites the traditional forces of psychology in our culture; both relegate an individual's awareness of his thoughts, feelings, and actions to some form of external or hidden internal control. Taken together, they comprise the "robot model" of man, the theoretical base of psychology upon which our modern technological society has evolved.
In this century, application of the robot model has become a major preoccupation of our free enterprise system in particular and of our society in general. American business has developed perhaps the most sophisticated fusion of the two schools. Its marketing and advertising strategies prey upon basic human needs and fundamental insecurities in order to create and fulfill consumer demands with scientific predictability. Throughout our society, the unconscious control of human beings has become the focus of some of our most powerful institutions. It is taken for granted in education, where the principles of behavior modification govern teaching, not only in school but also in the home. It is the subject of continuing experimentation in factories and other work environments. It has burgeoned in the seventies in a spate of best sellers advising readers how to exploit tactics of "power," "assertiveness," and "winning through intimidation" to turn the unawareness of others to their own personal advantage.
Predominant as the robot model of man has been -- and continues to be -- in American business and social life, there has always been an alternative force in psychology. It, too, has gained strength and popularity in recent years. In the late fifties, a number of splinter groups from the main currents of Freudian and behavioristic theory began to coalesce into a new and comprehensive school of thought on human nature. This so-called Third Force in psychology was made up of many of Freud's early disciples and later rivals, among them Alfred Adler, Otto Rank, and Freud's protégé, Carl Jung. These towering figures were joined by emerging existential or humanistic psychologists such as Gordon Allport, Gardner Murphy, Carl Rogers, and Abraham Maslow and by dynamic social psychologists such as Kurt Lewin and Jacob Moreno. By the early sixties, after many of its founders had died, this Third Force came to be known as humanistic psychology, the new discipline that would lead the way in the exploration of man's uniquely human capacities. In recognizing this unlimited potential, the Third Force rejected the robot model of man and gave primacy instead to the shaping power of human awareness. The new techniques and therapies of humanistic psychology offered impressive demonstrations of that power. It used intense, immediate experience to alter not simply patterns of behavior but the individual's state of awareness, even his whole personality. During this time, "experience" came forward as if it were a new discovery of human nature, and "consciousness" burst upon the American scene as an exciting new arena of adventure.
Almost overnight, humanistic psychology and its offspring, the human potential movement, transformed our popular attitudes toward mental health beyond recognition, first on the West Coast, then spreading quickly eastward. Suddenly, people drastically reduced their participation in psychoanalysis, psychotherapy, and traditional group therapy -- small weekly or twice-weekly groups led by a psychiatrist or psychologist, devoted primarily to open discussion along traditional lines. Instead, they entered into weekend encounter groups and radical therapies, therapies that used physical and emotional experiences such as arm wrestling, body massage, intense verbal attacks, and prolonged confinement to produce those now familiar peak experiences and breakthrough moments.
In the beginning, the new methods of humanistic psychology received a cool reception from tradition-bound mental health professionals. Most psychoanalysts, psychiatrists, and clinical psychologists were content to work with the tools they had available; the field already seemed more than adequately fragmented with its long-standing theoretical dichotomies and splinter factions. But more importantly, the basic principles of encounter and other experimental therapies contradicted almost every rule of traditional mental health practice. By urging physical contact and personal confrontation, these new approaches trampled the sacred accord of the doctor-patient relationship, overturning inviolable canons of formal conduct and professional detachment.
The first results achieved by the new techniques were difficult for the mental health establishment to ignore. Very often, people would return to their traditional therapy sessions raving about the fun and excitement they had had in an encounter group and declaring that they had accomplished more in one weekend than they had in years of private analysis or group therapy. As the consciousness explosion took off, and despite their skepticism, many of the professionals were forced to pay attention to this personal testimony. Before long, however, the brush-fire spread of these new concepts and therapies c
ircled back and threatened to consume the profession of psychiatry itself.
The dark side of this new world of human potential was evident from the beginning. In a climate of heedless experimentation, many searchers strayed into no-man's-lands of human awareness. As new attitudes burst forth to fuel the sixties' environment of revolution and alternative lifestyles, a growing number of individuals began to find themselves adrift or run aground -- and they began to react accordingly. Around the country, people began to "flip out" and go visibly crazy, engaging in violent and self-destructive behavior. Others, in contrast, "flipped in" and snapped, dropping into states of fantasy, terror, and disorientation that were, in those early days, wholly unforeseen and inexplicable.
Predictably, the burden of treating the new casualties of the consciousness explosion fell squarely on the shoulders of the psychiatric profession, on the medical doctors who manned the nation's emergency rooms, crisis units, and psychiatric wards. They were the first to see those people in most urgent need of professional help. However, psychiatry was not prepared to deal with this new monster of "experience," nor was it capable of treating the unusual disorders of personality that resulted. Psychiatrists are doctors, trained in physiological diagnosis and grounded in the traditional models of psychology. When in the sixties they began to identify a brand-new category of mental and emotional disturbance, one that was caused neither by chemical, motor, or neurological dysfunction nor by childhood or environmental factors, they found they could not diagnose it as either medically based mental illness or traditional psychological malaise. It came to be called a "critical situational response," a crisis brought on by some new and intense experience, such as psychedelic drugs, encounter groups, Eastern mystical practices -- or by everyday social problems of undefinable origin.
For treatment, the traditional tools of psychiatry proved ineffective. There was no longer time or reason for the leisurely analysis of a person's entire emotional past; the principles of behaviorism likewise were inadequate for understanding and treating these new afflictions of human awareness. Psychoactive drugs were helpful in dealing with severe emotional traumas and nervous breakdowns, but the vast majority of patients never deteriorated to these extreme conditions. Instead, they succumbed to fantasies and delusions, withdrew into themselves, or simply behaved in odd and eccentric ways.
Slowly, as the old approaches proved increasingly useless, the recognized limits of psychiatric treatment began to give way to whole new systems of interpretation. For the first time, psychiatrists began to look beyond the clinic, the couch, and the laboratory in an effort to incorporate the insights of humanistic psychology into their own models and practices. By the late sixties, comprehensive new approaches to mental health, such as family therapy and community counseling, were being developed to deal with the new problems affecting individuals in all kinds of groups and everyday life. In addition to psychiatrists, other mental health professionals -- clinical psychologists, social workers, and rehabilitation counselors -- began to create expanded follow-up functions and move into new supporting roles in order to cope with the greatly increased number of adults and adolescents who had begun using counseling services, drug rehabilitation facilities, and crisis centers from coast to coast.
Not all the changes taking place in psychiatry and the mental health field were confined to questions of patient treatment, however. By the end of the sixties, professionals at the forefront of American psychiatry and psychology were immersed in firsthand experimentation. In their quest for insight many of them ran into a peculiar double-edged dilemma. On the one hand, they were looking into these new techniques in search of new modes of treatment and understanding; yet, like others around the country, they themselves were not immune to the effects of the techniques. Faced with the added problem of distinguishing their research and experimentation from its inevitable personal impact, many professionals found themselves unable to integrate their dual paths of experience. In many instances, their traditional backgrounds in physiological disease and psychopathology left them ill-equipped to deal with the emerging humanistic notions of creativity, play, and spontaneity and unprepared for the moving peak experiences and alterations of awareness they encountered. Like a growing number of their patients, many psychiatrists became victims of the search.
By the early seventies, surviving traditionalists within the ranks of psychiatry continued to mind their own business while the rest of the profession was growing overloaded and exhausted. As many of its younger and more vocal members fled the field for other careers, psychiatry no longer had the internal strength or organization to exert the leadership that was in order. The profession ignored its social responsibility to issue warnings, establish guidelines, or set any other criteria that might aid the millions of Americans searching indiscriminately for some ill-defined personal breakthrough. By mid-decade, the mental health establishment had pulled back even farther from the wave of experimentation still coursing through the country. In an effort to reestablish itself as a valid field of scientific inquiry and medical practice, the psychiatric profession took a protective step in the direction of its traditional medical foundations. With no clearer alternatives, psychiatrists turned increasingly toward pharmacologieal methods of treating emotional disorders. In many areas, they simply abandoned their earlier clinical commitments and public service activities. Left without leadership, the rest of the mental health community remained silent while powerful new group techniques, radical therapies, and other tools for the alteration of awareness and personality slipped into the hands of cult leaders and mass-market entrepreneurs.
At the end of the seventies, Ameriea's varied mental health professions remain visibly divided. Psychiatry is once again anchored to the biological foundations of traditional medicine, and pharmacology has emerged as the focus of most new research in the profession. In major psychiatric institutions around the country, however, other vital clinical, counseling, and rehabilitation functions of the field are being dramatically reduced in size or cut back financially, prompting the public to seek out religious and commercial versions of these much-needed services.
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In our conversations with representatives of the mental health profession we found confirmation, not surprisingly, that psychiatrists and psychologists are as susceptible to snapping as anyone else. We even heard of some professionals who had become entrapped in religious cults. Furthermore, we discovered, quite apart from any experimentation with specific cult or group techniques, that the profession seems to breed its own strain of snapping. We gained perhaps the most insightful view of this peculiar problem from an articulate young doctor named Gina Prizant, whom we met one smogless afternoon in Los Angeles.
Dr. Gilla Prizant is a representative of the new generation of young psychiatrists coming out of the nation's medical schools to take on the challenges of turbulence and retreat within their profession. Graduating from Northwestern Medical School, she began her psychiatric training at the end of the mental health field's period of great upheaval. Ever since, she has been earnestly engaged in finding a responsible direction for herself as a professional. When we spoke with her in her office at UCLA's Neuropsychiatric Institute, she shared her private thoughts concerning a side of America's mental health crisis that the general public rarely sees.
"I went to med school wanting to be a doctor," she began, a little wistfully, "but I had tremendous problems on rounds, especially with surgeons, who are notorious for looking at a piece of anatomy rather than a human being. Since then, my orientation has changed considerably."
Her introduction to psychiatry, Prizant told us, got off to a particularly unpleasant start. She interned at one of the nation's largest psychiatric training institutions, a county hospital located in southern California. There she was appalled at the hospital conditions and the quality of psychiatric care available to the poor and underprivileged.
"I was simply overwhelmed," she said, looking back. "It was probably the most chao
tic patient experience of my life. We were overworked and understaffed; there was pandemonium. In the admitting area, we were encouraged to 'expedite.' There was no time to evaluate incoming patients. The ward situation was completely drug-oriented. In the adolescent ward, they checked to see how many staff members were going away for the weekend, and if there were marginal numbers of staff they would just go through the charts and raise everybody's medication."
For the young intern, this rigorous on-the-job training proved to be a long nightmare of physical and emotional strain.
"I remember one day the temperature inside the hospital was a hundred and five degrees," she recalled. "Each intern had at least twelve patients. We were walking around with huge plastic containers filled with ice chips. We were becoming dehydrated, popping salt tablets. And that was us ! We were the healthy people! I had one drug-overdose patient hooked on intravenous, so she was confined to her bed. As I was leaning over listening to her chest, a huge cockroach ran across her bed."
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