In the week of World Mental Health Day, we thought we’ll do our bit in terms of raising awareness about the condition which is increasingly prevalent yet not fully understood nor given due importance. This is a piece adapted from a new book Strangers to Ourselves by Rachel Aviv. The Guardian describes the book as:
“The highly anticipated debut from the award-winning New Yorker writer Rachel Aviv is a ground-breaking exploration of illness and the mind
Strangers to Ourselves is a compassionate, courageous and riveting look at the ways we talk about and understand ourselves in periods of crisis and distress. Drawing on unpublished journals and letters, along with deep reporting, it follows people who feel as if they have reached the limits of psychiatric explanations for who they are. Their diagnosis, while giving their experiences a name, also shapes their sense of what their future may look like-and their identities, too.”
This article is about one of the cases from the book which busts the myth that all mental illnesses are caused by external problems such as trauma, loneliness, professional or marital stress, etc and hence the use of psychoanalysis as the predominant cure for it as opposed to the cause often being biological and requiring medication. The patient in the episode, formally a successful physician himself, received psychoanalytic counselling for years at a rather renowned hospital called Chestnut Lodge and ended up suing the hospital for refusing to treat him with anti-depressants. The lawsuit has since driven significant change in the medical system’s approach towards usage of drugs to treat mental illness, now even involving psychedelics.
“Dexter Bullard, the director of Chestnut Lodge for nearly 40 years, believed that the Lodge could do what no other American hospital had done: psychoanalyse every patient, no matter how far removed from reality they were (as long as they could pay the admission fee). The possibilities of pharmacology did not interest him. His goal was to create an institution that expressed the ethos of the analyst’s office. If a patient appeared beyond the realm of understanding, the institution had failed – its doctors weren’t trying hard enough to see the world through the patient’s eyes. “We don’t know enough yet to be able to say why patients stay sick,” Bullard told a colleague in 1954. “Until we know that, we have no right to call them chronic.
…The “queen of Chestnut Lodge”, as people called her, was Frieda Fromm-Reichmann, a founder of the Frankfurt Psychoanalytic Institute who lived on the grounds of the Lodge in a cottage that had been built for her. She described loneliness as the core of mental illness. It was such a deep threat, she wrote, that psychiatrists avoided talking about the phenomenon, because they feared they would be contaminated by it, too. The experience was nearly impossible to communicate; it was a kind of “naked existence”.
Fromm-Reichmann and other analysts at the Lodge were described as “substitute mothers”. Younger therapists vied for their attention, working through what they called sibling rivalries. The doctors, all of whom had undergone analysis themselves, felt that they had been incorporated into one household – as one psychiatrist put it, they were “part of a dysfunctional family”. As patients walked down the hallway to their appointments, others shouted, “Have a good hour!” Alan Stone, a former president of the American Psychiatric Association (APA), described the Lodge as “the most enlightened hospital in North America.” He told me, “It seemed like Valhalla, the residence of the gods.”
At the time, faith in the potential of psychology and psychiatry seemed boundless. The psychological sciences provided a new framework for understanding society. “The world was sick, and the ills from which it was suffering were mainly due to the perversion of man – his inability to live at peace with himself,” declared the first director of the World Health Organisation, a psychiatrist, in 1948. The psychologist Abraham Maslow said: “The world will be saved by psychologists – in the very broadest sense – or else it will not be saved at all.”
And when the patient was eventually moved to a hospital which adopted anti-depressants, there was material improvement in weeks, which drove the conclusion that he was suffering from chemical imbalance.
“The chemical-imbalance theory of depression was first described in 1965 by Joseph Schildkraut, a scientist at the National Institute of Mental Health, in what became the most frequently cited paper in The American Journal of Psychiatry. Reviewing studies of antidepressants and clinical trials in both animals and humans, Schildkraut proposed that the drugs increased the availability of the neurotransmitters dopamine, norepinephrine and serotonin – which play a role in the regulation of mood – at receptor sites in the brain. He reasoned backwards: if antidepressants worked on those neurotransmitters, then depression may be caused by their deficiency. He presented the theory as a hypothesis – “at best a reductionistic oversimplification of a very complex biological state”, he wrote.”
Whilst research in neuroscience has progressed significantly since then, this lawsuit drove significant adoption of the theory that depression was a biological condition and hence can be treated.

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