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To support a fellow psychiatrist who was being challenged for practising without drugs, we visited Foggia in south Italy, and found as follows.
IL METODO ALLA SALUTE – AN EXPERT PSYCHIATRIC EVALUATION.
1. the magnificence
2. three problems
3. the future
The magnificence of the Metodo alla Salute [Method towards Health] shines through all its problems. There can be no mistaking the confidence, the delight on the faces of the participants, who cluster around the group, like thirsty souls drinking from an oasis in an otherwise blighted desert. Indeed that is exactly what they are doing. Drinking fresh inspiration, self-belief and support, where they had none before. There are problems, there are pinch points in this Metodo that could benefit from being ironed out. But the reality is that today’s psychiatry – classical psychiatry – is so bereft, that what the Metodo alla Salute provides is exceptional – in a word, it is magnificent.
Human beings are complex. Everyone has a unique personality, unique experiences, and a unique view of what life is really all about. So what Dr Mariano Loiacono has achieved in Foggia is quite remarkable. There is no doubt in my mind, that this approach provides most of what classical psychiatry lacks. What is even more remarkable is that the great strength of character which Mariano needed to build this Metodo has not prevented it from finding its own voice, its own way forward. So many times, an innovation depends on a charismatic personality to start (strength is always needed to innovate) – but once started, it is this very strength which impedes progress. Here we have an example of a strong character building a flexible entity – not a common occurrence.
The most striking feature of the Metodo is the warmth. Individuals of all types, ages, and relationships cluster together, and support each other with warmth and humanity. The process and indeed the organisation itself allows and indeed encourages this – most unusual. And the key to all this, is the flexibility. So many times ‘new’ approaches are started by strong individuals, who then insist that what they have concluded is best for everyone else. But here, there are endless discussions on ‘theory’, here we have a flexible approach to what is actually happening, and indeed, what should be happening. In this way, like a sensitive plant, the human souls in the participants can find their own way to the light, and can flourish and blossom as was always universally their inherent human birthright.
The problems we can discuss later – first we need to emphasise quite what is going on here. The simplest way to do that, is to compare Metodo alla Salute with classical psychiatry – once you do that, it is entirely obvious where the choice, the prize and the praise must go. Classical psychiatry does not mention emotions – it has simply no way of discussing human feelings – and since it cannot ‘see’ them, it can do nothing about them. So a phrase such as ‘the healing hand of kindness’ well known in progressive psychiatry over the centuries – simply does not get mentioned. It’s like a surgeon not bothering to notice bacteria – infected gangrene was just what happened – there was nothing the surgeon could do, because the root of infection was never recognised. So it is with classical psychiatry – emotions, feelings, inclinations, what you want, is simply out of the window – far too woolly for scientific consideration. And yet that is precisely what human beings, human minds require in order to grow. They need support, we all do, and they need encouragement to see their fellows as more like themselves than different. They need to see that they are as good at giving social support as they are at receiving it, that they have value in being able to give support, and that they receive value in being given it by others.
Quite a complicated idea to write down in cold print – but when you see it in action, you cannot but react to it in a human fashion. We are all human, and we respond to humanity – if we do not, then we are suffering, or at least we are seriously handicapped. The Metodo sets out to grow human contact – hugging, sitting on laps, inviting people to express themselves, not only verbally, but also bodily – marvellous to see, and marvellous to experience. Bear in mind that so many damaged individuals have never, ever been hugged, or valued in their entire lives. Here it is, offered freely and for all. Such contact and communication, such freedom of expression is vital when it comes to promoting self-confidence, self-esteem, self-value – whence mental stability, mental health and peace of mind.
Continuing the comparison with classical psychiatry – in Metodo alla Salute there are no diagnoses. Classical psychiatry imposes a diagnostic pattern which helps no one – indeed it inflicts real damage on already vulnerable individuals. Many I have known have received a diagnosis for example, of Personality Disorder, and have been told they have it for life, there is nothing they can do, they are born with it, and must suffer with it, forever. Psychoses are the same – human minds do break down – but they are also enormously resilient and to instruct the sufferers that there is nothing, ever, that can be done is abominable. Once a schizophrenic – always a schizophrenic – what garbage ! It is deplorable, it is damaging and it must stop. But Metodo alla Salute does not even start on these futile and toxic diagnostic expeditions – excellent. Classical psychiatry has much to learn on this point.
Then again there are the drugs. Classical psychiatry has come to be even more dependent on chemicals than the alcoholic on drink. At least with alcohol, everyone knows its advantages, and its disadvantages. Many take it as a social relaxant. But everybody knows that if you rely on it too much, it damages you. Exactly the same applies to every psychiatric drug – they none of them alter the root cause of the disease, and they all have poisonous effects – the newer ones often worse than the older ones – but none are free of toxic damage, most worse than alcohol itself.
So with Metodo alla Salute we have an approach which encourages emotions, encourages self-expression, while at the same time avoiding the trap of ‘diagnostic categories’ and eliminating the obvious damage done by psychiatric drugs. It cannot be said too often that classical psychiatry has steadfastly ignored the abundant evidence that its drugs do harm – for 50 years, the evidence has been overwhelming, and has been equally consistently ignored. Likewise with the diagnostic patterns – in 1952 the first edition of the Diagnostic and Statistical Manual of Mental Disorders came out – a nice slim volume, humble not presumptive, with which I can fully agree. Things started to go badly wrong in 1980, with the 3rd Edition – and then worse in 1994 with the 4th Edition. The prospects for classical psychiatry are dire. It is clear to me that it is doomed – and what is needed to replace it, is on full display in Foggia today – with the Metodo alla Salute.
Nothing I now write with respect to problems must be allowed to detract from the praise the Metodo alla Salute so richly deserves. Indeed, the Metodo has had more than enough criticism already – so much so, that I hesitate to include this here. However, it is possible that what I have learnt about human distress can help make the Metodo even more effective, and more long-lasting – and it is solely on this basis that I now turn to some of the pinch-points I have observed in my brief visit.
First of all, the hospital establishment. It is perhaps difficult for members of this group to appreciate quite how different the Metodo is from normal psychiatric practice. It is important to understand that many doctors, especially psychiatrists, have moved into medical practice precisely because it is structured, limited and tightly organised. Human life is not actually like that – but never mind, that is what many doctors are most comfortable with. So an orthodox psychiatrist can find joining the group a most frightening experience – he or she would be lost, frightened, with too much going on, too little structure, far too disorganised and spontaneous for any degree of comfort. Much better the old rigidities of the classical psychiatry – despite the fact that it is exactly those rigidities that do so much damage to mental health, and it is the very spontaneity of the Metodo alla Salute which brings so much benefit.
So there is a distinct limit to what orthodox doctors will see, or even can see. In other words – don’t expect the Director or other local doctors to visit to see for themselves. They won’t come near the door, and if they do, they will flee from the ‘disorder’ they see going on. This is important because the fear that they will experience will feed the desire to stop the Metodo altogether. What they don’t understand, they will want to eliminate. This I see as the most serious threat to the Metodo that I have observed.
The remedy for this problem is to do a simple questionnaire, before, during and after. The one I mentioned to the Director, the GHQ, the General Health Questionnaire, is short – only 30 questions – it is filled in by the individual, so there is no problem with interviewer bias. And, above all, it is well recognised and standardised, internationally. Indeed the Director recognised it the minute I mentioned it, and was clearly delighted at the prospect of getting his hands on some concrete psychiatric data. In my view, any questionnaire, including the GHQ, is only of limited value – shall we say 60-80% accurate. But it is easy to use, takes very little time, does not damage the individual being tested, and it will supply the Metodo alla Salute with what it most needs – credibility.
Other questionnaires have been mentioned – but my advice would be to stick with one, in this case the GHQ would seem to be optimal – get to know it, get used to using it, and then flood the administration with concrete data, or at least with what they regard as concrete data, which they cannot easily dismiss as woolly or unscientific.
Above all, the GHQ does not rely on orthodox psychiatric diagnostic categories, it interferes least with the freedom of action and expression that makes the Metodo so brilliant, and it can be delivered quickly and easily. I checked on the web, and there is an Italian version available. For what it is worth, my advice would be to ask all newcomers to fill one in on arrival, or very shortly after arrival – this would be the ‘before’. Then I would ask them to fill in another say 3 months after first coming, and again 6 or 12 months later. Also 6 or 12 months after leaving the group. These would be the ‘after’. The more data the better. To begin with, it might make sense to have everyone who is currently in the group fill one in, and note how long they have been in the group – this again is just the sort of data administrators love – so why not feed it to them ?
The second problem I have noted may not be as big as it seems – I would need to spend much more time in Foggia to be sure. I would also need a lot more information. To assess the whole picture of the Metodo alla Salute it would be important to know not only how much it helps, but also, unhappily, who it does not help. In other word – how many drop-outs are there? Who comes to the door, and yet declines to enter, or having entered, leaves long before they have felt the benefit? The fears the orthodox doctors would experience are the same as those of newcomers – if they are too strong, both will leave prematurely.
As I say, I don’t know how big this problem is. I would need to see a break down of the number of people coming and staying only briefly, or indeed of those who would clearly benefit but who don’t even come to the door. I don’t know how many there are – I heard of one or two, but this is an area that the Metodo needs to be able to cover, to defend itself against outside criticisms. Also one person I spoke to did not press a certain individual to come because it was feared they would not be welcome if their parent did not also come. Again I don’t know enough about Metodo alla Salute to say how valid this criticism would be. There may be only a very small number who lose out in this way – but this is something that should be addressed and clearly made transparent. Human beings are curious, and sometimes rather mysterious – they do not always ask for what helps them most – but, when defending the Metodo it is important to be armed with facts such as these.
The solution to this second problem is also simple, and well within the resources of the group. It is to extend the excellent fellow traveller, or special companion role, and to strengthen it to those newcomers who are especially nervous or shy. Thus anyone coming into the group will be handled very carefully, will be protected from the fears that newcomers can be expected to feel, and will be encouraged to proceed slowly, at their own pace, so that they too can develop the confidence and self-esteem which are so difficult to achieve, and which the Metodo is so clearly successful at delivering. As I say, this may not be a big problem – I don’t know the numbers – but with such an excellent product, it is a shame that some who clearly could benefit, don’t manage to make the first step.
The last point I would mention is also one I hesitate most about – and that is the Box, la Scatola. I hesitate because when one comes across a living organism, in this case the Metodo alla Salute, the first priority is not to disturb it, not to make noises which upset or weaken it. However, following the interest shown in my description of the Box last Wednesday, I make one or two comments about it here. In my view, as I made quite clear then, the master emotion is fear – it is fear that stops thought – once the fear can be eased, with trust, then healthy thinking can start again. From this it follows that if, as a child, you experience a serious threat, a terror, then the fear from that time can continue into adult life, and leak.
The problem then is that you cannot think about the Box. If someone asks about it, and begins to approach it too forcefully, then you will shut down even tighter, and so it remains there, unthought about, and damaging. Now my researches have shown that the Box arises solely in infancy. It contains nothing but ‘infantisms’, and by addressing it directly, with support, trust, and consent, then it can be got rid of 100%. Indeed I offer my customers a guarantee of 100% cure, provided they finish the course – that is, continue exploring these infant-terrors until they have disappeared altogether. In my book, therefore, it is not so much alla Salute “towards health” – but cure – arriving at full health, an optimism which must be seen to be believed.
Without fear, there can be no psychiatric symptoms. Of course this is something which classical psychiatry attacks most vigourously. It has caused me to be evicted from 6 consultant psychiatric posts. It is also strongly resisted by those who do not see any way past their own Box – they don’t want it even to be discussed. However it allows me to be a most optimistic psychiatrist, and where I have been able to explain it well enough, and convincingly enough, it has indeed brought about cures. But if the Metodo has difficulties with the local health administration – you may be sure that I have had even bigger ones with those psychiatrists and others who have come close enough to understand what I am saying. However, like Metodo alla Salute I remain defiantly optimistic – and hope to develop clearer descriptions of this, and indeed to develop DVD and other training materials, which will explain what I am describing and help others to benefit from it, as I have done.
So a brief glimpse into the future. It is obvious to me, and to any who study the evidence that classical psychiatry is doomed. The present psychiatric diagnoses do not assist medical practice, instead they inflict damage on the sufferers. The drugs used in present-day psychiatry are doomed, every single one of them. They may serve as brief sedatives, as does alcohol from time to time, but they should then all be dropped into the bin. So what will replace classical psychiatry ? As will be clear from the above, it is obvious to me that we need much more of the Metodo alla Salute – this flexible approach offers access to emotions, it allows emotional development, and it encourages social support, without which we all perish.
What are the chances of the Metodo alla Salute surviving ? Indeed, in medical terms what is its prognosis? Well, from what I have seen on my brief visit, I see absolutely no reason why it should not flourish, grow, expand, and help enormous numbers of people. The danger with all institutions is that they come to serve the staff, and not the customers. From what I have seen, as I mentioned, this has not happened in Foggia – but this is a danger that must be recognised, and guarded against as the Metodo moves out from Foggia to the wider world, where it is desperately needed.
I have tried to highlight the three problems in the Metodo which occur to me most clearly. None of these three should deflect the Metodo from its future progress, indeed I include them here to assist that progress. As will be clear to those I talked to in Foggia, I loved my visit there – I found it tiring, but then energetic involvement is always tiring ! I conclude that this is the future of psychiatry – if classical psychiatry does not adopt the substance of this approach, then it cannot survive. It will be classical psychiatry that disappears, not the Metodo alla Salute. And further, if there is anything I can do, that will hasten this glorious transformation, then just show it me, and I’ll do it.
Thank you to everyone who made our visit so fruitful.
Dr Bob Johnson Tuesday, 26 May 2009
Consultant Psychiatrist, P O Box 49, Ventnor, Isle of Wight, PO38 9AA UK