Reply to comment

Rich conversation last Monday night and here. Glad to have it noted, appropriately, that Freud/psychonanalysis remain relevant, despite social/cultural fads (more in the US than in Europe, for example), and think the situating of CBT somewhere between dynamic psychotherapy and pharacotherapy makes sense. Think as well it makes sense not to debate the merits of different therapies in the abstract but instead to note that they seem to have different underpinnings and may each prove useful in one or another set of circumstances. For what its worth, Freud developed the position that psychoanaysis might best be thought of not primarily as a therapeutic procedure for particular problems but rather as an empowering mechansim for anyone. Glad too to have the loop through culture appropriately and usefully noted. I'm myself intrigued by the idea that not only are all mental health problems related to story telling but that a major subset of them have to do with the centrality of story in interpersonal relations.

Like others, I too heard the issue of how to think about discomfort/pain in a mental health context as a major theme of our Monday conversation and that discussion seems to me to have been usefully extended here. For more on my evolving thoughts along those lines, see "illness as metaphor revisited" and "an alternative to fight and flight." Relief of pain/discomfort should certainly be a consideration in mental health but not at the price of abolishing generative conflict. To put it more positively, the objective should be to facilitate the brain's ability to use conflict creatively and this may at times depend on reduction of pain/discomfort. The latter is not the sine qua non of therapy but can be a valuable aid. One may think of this as a difference from the "medical model" approach, or, alternatively, as a needed feature of that approach as well.

Along these lines, Julia challenged me on my suggestion that epilepsy is a one-time "mental health" phenomenon that is now well enough understood to have been reclassfied since it has little or no "story" component. And, depending on how one defines things she's right.

"on average, 20 per cent of people referred to specialist epilepsy centres because their epilepsy is difficult to control turn out to have NEAD and not epilepsy."

NEAD = "non-epileptic attack disorder." So, 1 in 5 people with behavioral symptoms that would have been called "epilepsy" several decades ago ... don't have "epilepsy" in the sense that they are not helped by existing treatments for epilepsy. I can't help but wonder what they do have, and what the role of story telling might be in it.

Also had some thoughts about a "good therapist", ie what the "professional skills" are that result in something more than one can get from a good friend ...

• more patient, more able to accept responsbility over time
• less judgemental, less personally committed to any particular story
• better reciprocator
• better story writer

Finally, for those of you waiting breathlessly, here' the results of our Monday survey . Values in the table are numbers of the eighteen people present for the discussion whose experience with pharmacotherapy and talk therapy is as described in the table heading. Better than 80% of us have some experience with one or another form of mental health procedure. It would be interesting to know how these compares to other groups of people, both today and in the past.