Although as a mental health professional it is a bit embarrassing to admit this, the treatment provided and the things believed by (non-medical) therapists has been a bit akin to having used magic and witchcraft to explain the inexplicable in times past. The parallel is pretty straight forward. Lacking other explanations, people once ascribed many things in the realm of natural phenomena that they could not understand to magic, witchcraft, myths or the divine.
As science grew, so did more reasonable explanations. Psychotherapists have believed, from the time of Freud, that mental illnesses are types of maladaptive syndromes that develop in response to life realities and that the ‘cure’ for them involves one form or another of talk therapy.
That belief is being whittled away at almost daily as our ever-expanding knowledge of neuroscience increases. Already, many disorders we once believed to be (and treated as though they were) inherently reactive or psychological in nature have been proven not to be.
One classic example that has been in the news a great deal in recent years is Autism. As recently as the early 1970s, this condition was believed to come about a result of poor mothering. The paradigm work on the subject at the time was Dr. Bruno Bettelheim’s “Love Is Not Enough” which posited that Autism was created in children by what he called ‘refrigerator mothers.’
Modern science tells us that this is not so. It was something like ascribing a solar eclipse to the unhappiness of the gods. Autism is now understood to be a developmental disorder. People are born with the disorder and/or the strong proclivity toward developing that disorder in early childhood. It didn’t and doesn’t have anything to do with what the mother did or did not do. However, when I was a young clinician, we did not know that. Perhaps more importantly, we did not know what we did not know.
Bi-Polar disorders, depressions and various thought disorders are also now understood to have a physical/biogenetic base to them. With this knowledge, medicine has played a more substantive and more effective role in the treatment of these disorders that all the good therapeutic talk in the world.
Medicines in the past only were able to tranquilize agitated people. Now, there are medicines that interact with a person’s brain in ways that stabilize these disorders to one degree or another.
As scientific evidence grows demonstrating that many ‘mental illnesses’ are actually manifestations of specific developmental and biogenetic realities, the role of medical intervention has increased and will continue to increase exponentially. Conversely, the role of ‘talk therapy’ will not disappear but will change in its focus as we learn what it really can and cannot achieve.
The same evolutionary line that brought our understanding of Schizophrenia from being a condition caused by demonic possession to being one reactive to life experiences to one caused, largely, by brain cell and chemistry issues will continue to bring us to new understandings. What we know most reliably today is how little we really know.
Will there always be a role for non-medical ‘talk’ therapy in mental health work? I think so but it will likely be focused on dynamic issues between people. Relationship work, parenting issues and adjustment problems are likely to remain, appropriately, within the purview of psychotherapy. The more pronounced and biogenetically rooted disorders will remain the subject of further scientific investigation and medical development.
There will always be roles for both talk therapy and medical intervention in treating serious mental illnesses. Knowing which is most helpful when is the responsibility of every fully trained, licensed and caring mental health practitioner.