About Psychiatry, Psychology and Psychotherapy

gregorkowalnew

Dr Gregor Kowal
Senior Consultant
in Psychiatry and Psychotherapy,
German Board Certified,
Medical Director,
Clinic for Health and Medical Care
Phone: 00971-4-4574240

For most people who are no experts, it is very difficult to distinguish the difference between the fields of psychiatry and psychology. Most people also have no idea what is psychotherapy and which therapies are used for treatment of the diseases of the soul.

This text, which is an excerpt from an Interview which Dr. Kowal wrote for a magazine, will allow you to gain an overview concerning this difficult theme.

N. Dr.Kowal, what is the difference between a psychiatrist and psychologist and the two fields: psychiatry and psychology?

Dr. K. The psychiatrist is a doctor with very rationalistic reasoning who must act rapidly. He tends to consider illnesses of the mind as a chemical imbalance of the brain which should also be cured by chemical substances (i.e. Drugs).

The psychologist however tries to fathom and therapeutically influence the patient`s psychic needs with the aid of conversation and without drugs.

This is of course a simplification. There are also psychiatrists trained as psychotherapists.

N. Which treatment as well as point of view is right?

Dr. K. Both points of view and both therapy methods are appropriate they merely intently regard only one single aspect of a more complex coherency.

Nowadays everybody knows how a computer works. It is basically composed of a calculator unit, a processor (i.e. Pentium) and of hardware. The hardware would be utterly useless if there were no software (for instance Windows).

Our brain, even compared against the most powerful microprocessor, is the most complex creation known to us throughout the whole Universe. It consists of billions of nerve cells linked to one another by trillions of controlling cells and synapses.

Our mental functions could be compared to the software. If someone were to claim that Pentium equals Windows one would declare him naïve. Based on this example our brain would equal to the microprocessor and our soul/mind could be compared to the software. They combine into a unit but are not identical.

N. Medicine deals more with the hardware i.e. the brain, than the software, the soul?

Dr.K. Exactly! Medicine (Psychiatry, Neurology and Neurophysiology) sets out from the point of the brain`s material constitution. You will, of course, be able to relate to the fact, that the functioning of the software cannot be experienced by cutting the Microprocessor into thin slices and examining the pieces under an electron microscope.

Psychology devotes itself mainly to psychological functions, i.e. the software. Here a further problem crops up: the object to be watched, the mind, is likewise the observer himself, thus subject. The results of the observation will inevitably be furnished with subjective contents.

N. Which methods are used by psychology?

Dr.K. Basically psychology is divided into two large factions. On the one hand there are various different psychological schools trying to glance into the depths of the soul, this tendency is called “depth psychology”. The first historically established method of psychotherapy, psychoanalysis by Freud, belonged to it.

The second tendency, behavioural psychology, regards the psyche according to the stimulus-reaction model which is a kind of response-apparatus that shows a certain behaviour complying with the stimuli given. This method tries to examine processes in terms of quantity and to apprehend psychological treatment into standardized algorithms. This way of thinking is strongly influenced by medical approach and has it’s tightly put limits. If someone is lovesick, for instance, how can this be revealed in figures and treated within an inflexible scheme?

N. Do both tendencies have the right to exist?

Dr.K. Yes, fortunately the trenches between behavioural therapists and psychologists active in depth psychology are not as deep as they were 30 or 40 years ago. There are illnesses which can be treated better by behavioural therapy and others, where depth-psychological methods will have priority.

N. You have repeatedly mentioned the word “psychotherapy” and elucidated a rough classification of the different psychological schools. What exactly is psychotherapy?

Dr.K. Psychotherapy is counselling a so called “talking cure”. The first form of psychotherapy was psychoanalysis, which was introduced around 1900 by Sigmund Freud. Up to that point there were no known methods for treating neurosis for instance. Back then hypnosis was used as a treatment method. The accomplishments made were neither controlled nor for a long time. Even the treating therapist didn’t know exactly what he was doing.

N. You mention the term “neurosis”. What is a neurosis?

Dr.K.

The term was established by Sigmund Freud. It is rather difficult to explain this term in only a few words. To be able to do this one would have to introduce an area of the mind which Sigmund Freud called “the subconscious”. It is a part of our mind to which we have no direct access. Experiments have proved that this area does actually exist. Processes take place in this “dark area” which defy control by our conscious perception but can often lead to various bodily and emotional changes.

N: Such as?

Dr.K. Neurotic symptoms can affect every region of the body and influence all mental functions. In bodily terms uttered as pains, paralysis, sexual dysfunction, herniated discs, mentally induced blindness, dumbness, skin rashes, high blood pressure, hair loss, eating disorders and others. On the emotional level the symptoms can be depression, insomnia, fears, compulsions, phobias and so on.

N: How do these emotional problems develop?

Dr.K. This is a very complex mechanism. Many neurotic symptoms develop by conversion, a metamorphosis of strongly affect laden contents (i.e. conflicts) into physical and mental afflictions. Symbolization which lies behind our conscious façade plays a major role in the development of neurosis. Let us take obsessional washing, for instance. Every culture/religion knows washing rituals which own a symbolic character and wherein the soul is freed of “dirtiness”. Behind a patient’s neurotic washing obsession lies an unconscious sense of guilt.

N: You have explained the symptoms and development mechanisms of a neurosis but I have not yet grasped the term

Dr.K. Neurosis is a dysfunctional occurrence. This sounds complicated but is easy to explain: one piece of awareness is split off (disassociated) from the conscious section of the psyche. It is the area of perception which surrounds a conflict. The unconscious conflict is like an abscess; it emerges, when a foreign body (i.e. a thorn) intrudes healthy tissue. Similar to the body isolating a foreign body an inner unconscious mechanism tries to isolate the conflict and take the pressure out of it. From this point of view a neurosis is an attempt to heal the soul; an effort to restore lost balance. As I said the process takes place beneath the verge of consciousness. Nevertheless it can have disastrous effects on the individual’s functionality if they generate paralysis, claustrophobia, anxiety, depression or the above mentioned washing obsession. This subconscious conversion mechanism doesn’t bother about the conscious effects this process has.

N: What exactly is a “conflict”?

Dr.K. Psychologically speaking, conflict is a product of duality. This means the existence of two opposing tendencies within our psyche. Thus the result is polarity – a psychological tension. Picture a stern rider sitting on a horse. The horse would like to devour the green grass on a field and pulls to the left whereas the rider steers the horse to the right. The rider is the “I” (Ego), the horse symbolize the emotions, the “Id” as Freud called it. This is the essence of conflict. Depth-psychology deals with the recognition of conflicts and communicating insight to concerned persons.

N: Can you also come across conflicts in healthy people?

Dr.K. But of course! We all have our conflicts. Every time you walk past an ice-cream stand and buy an ice-cream contrary to your decision to loose weight – you have a conflict. Good reason tells you: „no ice-cream, think about your weight!” but you still go and buy one. This is a conflict of which the individual is aware. Conflicts which cause illnesses are most often of an unconscious nature.

N: And how can one’s own conflict be controlled?

Dr. K: You are asking me a very difficult question! Not by inner discipline. This might help when passing by an ice-cream stand because there is awareness for it. You will be able to resist more easily if you are not frustrated and have had a successful day and feel emotionally balanced. Most conflicts, though, are not conscious to us. If something is unknown to us how can we deliberately operate contra to it? What can be helpful is knowledge of our psychological “dark room”. If you know through which door the devil will enter you can guard it so much better. Which does not implicitly mean you will arise from this struggle victoriously…But if you refuse to believe in the devil at all he will definitely walk through the door. I have got to know highly educated people who were logically brilliant. They separated their feelings by rationalistic attitudes and suppressed these with implacable hardness. Then they looked me up because they were suddenly doing utterly crazy things. They were overpowered by inner conflicts and their logical thinking was abrogated.

N: Have I understood you correctly so far: a conflict underlies each psychic disorder?

Dr.K. Yes, the conflict generating the illness is like an abscess. If you don’t cut it open it will poison the whole body. An unconscious conflict can also infect the whole psyche and, in extreme cases, lead to the decay of personality. This condition is called in psychiatry “schizophrenia”.

The treatment should give the patient a conscious access to his emotional life, open the abscess and get rid of its contents.

N: Is there such a thing as a “normal” person at all?

Dr.K. I will answer this question with a sentence by the great Swiss psychiatrist Carl Gustav Jung: „Show me a sane man and I will cure him for you“. This is an exaggerated phrase but meets the basic problem very well. As a representative of the Homo Sapiens species one is equipped with an emotional apparatus which is basically identical amongst all humans. Every one of us has feelings, sometimes really strong feelings, hopes and worries. Every one of us can become depressive, for instance if he looses a beloved person, is furious if feels unjustly treated. We all have love, jealousy, grief and happiness in common.

N: Who goes to see a psychiatrist?

Dr.K. Take a look at the people in the large cities of this world. Most of them are exhausted, stressed, and very often depressive. How many happy faces can you spot in the crowd on the street? It’s hard to believe but the highly intelligent, highly sensitive and highly moral people are especially vulnerable. I say the following to such patients “You are a human being not a block of wood. Consider your crisis as a chance. Of course, nothing is for free! This controversy with yourself will hurt you…”

It is especially satisfying to support someone during a crisis and see them get back on their feet again, more conscious of themselves and returning to the struggles of daily life invigorated.

N: But there are not always suchlike accomplishments?

Dr.K: Certainly there are illnesses which can unsettle the whole personality structure, as in the above mentioned schizophrenia. Fortunately only a minor percentage of psychic disorders take such an unfavourable course. But even then sensible help can be accomplished and suffering moderated. The achievements of today’s psychiatry must not be underestimated here. In the meantime we have modern drugs and sophisticated methods which enable therapeutic influence on numerous illnesses and frequently make it possible to obtain a complete cure.

N.: What can protect us from psychic ailments?

Dr.K. I would like to answer that question with an example:

I treated a patient who had heavy depression after separating from his wife. His profession was gardener and he conducted a tree nursery. I wanted to buy a certain tree for my garden. Towards the end of the treatment, when he was feeling better, I let him advise me. I asked him where I could buy such a tree. He considered and said: “You can get such a tree at the supermarket for 25 Euros, if you buy the tree of me it costs 125 Euros.” I asked him what made the difference in price. He said: “My tree has had a happy childhood! It grew on a number of square meters earth had sufficient sun was regularly cultivated. If you buy a tree at the supermarket you have to assume that this tree grew up cramped in a small pot of earth with insufficient light.” I asked him: “But both trees appear to be identical.” To that he answered: “Yes they do, but my tree will survive drought, strong winds and extreme cold because it has developed splendid strong roots. The other tree will die… “

The gardener described very well what 80 years ago C.G. Jung conceived in the sentence: “Warmth is the vital element for the growing plant and for the soul of the child”. Just as the light is important for growing plants, a stable parent-child-relationship and love for the adolescent child is necessary. This experience underlay’s the attachment theory of the British psychiatrist John Bowlby which was developed by him during the 50’s of the past century and was proven by extensive studies. He was able to gather sufficient observation material in Europe which had been destroyed by World War II. Many families were torn apart and a great number of children violently parted from their parents.

The most important statement of the attachment theory is that the quality of the bond between a child and its key caregiver (parents, other members of the family) basically impresses reactions, feelings, thoughts and expectations during adulthood. How can you give love to others if, as a child, you were not loved at all or only somewhat? From the love of the parents the trust in oneself, in other human beings and in society is skimmed.

Love is an all-embracing element…