Frank Weil lectures; #2 (Reel 1)

From Cincinnati. WG you see the University of Cincinnati station presents this second in the series of Franco while Institute lectures by Dr Maurice Levy professor and director of the Department of Psychiatry at the University of Cincinnati College of Medicine. Dr. Levine is the author of psychotherapy and medical practice a book which has gone through 18 additions and has been translated into three foreign languages. He was also president of the American delegation to the First International Congress of psychiatry first in Paris. These wirelessed to the lectures were given at the Hebrew Union College Jewish Institute of Religion in Cincinnati and the topic is psychiatry and ethics. The title of today's Leichter is defense of ethics. And here is Dr. Murray's living right in the first lecture. We focused on the recent studies about animals other than man. Tonight we'll concentrate on the understanding of man with our

focus on the intensive psychiatric and psychological study of many patients of many and we'll discuss the impact of that knowledge on our thinking about ethical principles and ethical behavior. No many good books have been written on psychiatry and psychoanalysis. Therefore one of the challenges in preparing these well lectures is to present significant material which would not merely duplicate what can be found in the library to meet this challenge. I'll start in a way that is different for me in a way that I've not seen you lose. I've just not discussing the facts or the ideas of parade director day but instead I'll discuss the kind of thinking about life which has been so amazingly productive in the field of psychiatry as

well as in many of the physical sciences and the social sciences. And it seems inevitable to me that the same kind of thinking can be productive when it is applied to the field about us. And as you know I like to use the light touch and I want to give this section of my lecture at least a touch of the lighter touch which is not easy to do when one thinks about thinking but the like tech that doesn't start the jingle that's not going to be tonight. I'm sorry to say but the light touch maybe. I think they pop a bar when I say that we don't discuss three types of thinking the first of which I call the life is simple kind of thinking. Or the one sided approach. The second is the life it is double kind of think game. The either or or the two sided approach. The third is the life is life is purple or more or the tell it like it is kind of thinking

it might be called the three sided approach or the triangle but this could be confused of course since I talk about sex occasionally. This could be confused with the sexual triangles which appear in the lives of human beings and so in the discussions of Man by psychiatrists or we might have called it the Trinity approach but that might be regarded as a specific religious term and using that term might interfere with one of my primary fantasy is that I may be able to talk about an ethics which can be used by many religious groups as well as by those whose responsibilities are sucking. Now the first kind of thinking that life is simple the one sided is the least effective and the second kind the two sided is more effective. The third is the most effective. It's the one I mentioned as having been so productive in psychiatry and in many other fields. But the third type of thinking is not

rare nor is it unusually difficult in everyday life for all of us often use this high level third kind of thinking. But all of this under pressure or because of prejudice or simply because of a lack of information often slip back into the first or second kinds of thinking. And if that happens and if one catches oneself doing it the remedy is clear. One must refuse congenially but from later let oneself take the easy way out. One must set limits on oneself must use the self respect which in a way is the essence of a workable ethical system in spite of rumors to the contrary. Psychiatry does not recommend an overly permissive about attitude in life. One must say no especially to oneself. Many times every day. Hopefully one can say

yes even more frequently and in the third kind of thinking that I'll talk about. One can even more often say yes if it's the right time and the right place and the right person to be funny I am not yet. It sounded funny to me this afternoon. Now maybe the ice is broken now I see in scat 3 we think about what's wrong with ourselves more or more often than we think about what's wrong with Asians or others. So are I when I haven't been able to get a laugh to that point as I was reading and thinking and reading and talking. I was trying to think as to what was up in myself for tonight. It seems to be a bit

different from the atmosphere of Wednesday night out to bringing back by something unexpected a couple of times at least. Now the first kind of thinking the life is simple approach is one sided simplicity it may be the expression of a simple prejudice or a pre-formed opinion. It includes the use of stereotypes typical of this kind of thinking are such expressions as he is a bad boy. She is a good girl and fever is bad. Another example of this kind of thinking is a description of a person in terms of a single character trait. For example Tom Smith is an independent person or John Jones a selfish Smith as is generous a merry Brownie is oversexed now such a simple sentence may be taken as being true at times if it is recognized as being the merely the labeling of a person

by a single file or the describing of a person by a single fact which appears most frequently or most obviously but each of the simple sentences can be seen to be badly over simplified and merely a minor fragment of the truth if one takes more than a quick glance at the plot. Then one can see that other facets of the situation of present also John Jones labelled as selfish maybe selfish in a sense. But he can be seen to be much more than that. If several words are used rather than one they could give a picture a hundred times as volatile. Now the first approach is good enough for casual or on important issues for moments or days of relaxation and for carefree or careless conversation. But it is unworkable in a situation in which one must think clearly and deal adequately with the clouds. For example when a medical student becomes the youngest member of a hospital team which is responsible for the

diagnosis and treatment of patients he must be good beyond the first kind of thing. Again he learns that fever is not altogether bad. In fact most often it is a part of a lifesaving or at least basic restoring defense against infection and he will learn that Mary Brown who's repeated promiscuous behavior resulted in her being called a oversexed. May surprise him when she trusts him enough to be honest by telling him that usually she finds that sexual experience is unpleasant. So the spirit type the one angle approach does not work when the chips are down. Usually anyone who has been using it and who now is trying to think straight has sensed it shortcomings and has begun to use the second type of thinking. This is the two sided or bilateral approach the either or or way of thinking. The use of dichotomy is the observer who in the first cut the thinking at said that

Smith is generous. Now in the second type of observing and think you might say Smith is inconsistent. I've seen him be generous not seen him be stingy. I can't predict which it will be but he always is one or the other. At this stage the observer can see that life is more varied than you are. You now can see at least two sides or two possibilities and sees that no amount of wishful thinking can keep it more simple and easy. The observer has made a major step toward a workable testing of reality and here we can insert the comment that a workable set of ethical principles surely must be based on reality rather than on wishful thinking. Reality as seen by oneself. Plus a consensus of if necessary about reality as seen by those one regards as reliable. See it starts out simply but then the difficulties come in

as to whether in all instances one can trust one's own reality testing and certainly in many disturbed states one cannot be. And also in states of acute emotion one cannot. But now back to the medical student then what has the consensus to back. Now back to the medical student who is using the second type of thinking he knows now at least two facts about fever first that often the fever is favorable as a sign of a protective reaction of the body against germs or other invaders and the student must know it's a second fact that occasionally the opposite is true. That fever can be unfavorable that the temperature mechanism can get out of hand or the temperature goes highest spire high and the patient can be in danger of being damaged in that process. The second kind of thinking the usual concept of human nature is that there are two kinds of people good guys and bad guys. In many TV programs there must be the good guy the shy the marshal the missionary impossible.

And then then again and then the bad guy the outlaw the thrush organization the enemy of the law and order are the enemy of justice. You know what I had. What does this mean to you. Part of the time I was writing this. The two sided concept of human nature is found not only in a melodrama in the personal life of many a man. There are important dichotomies important two sided polarizations in his thinking and feeling. Many a man and even more boring ays think of women as belonging to two sharply demarcated types. One is the pure sweet tender nonphysical non-sexual all Madonna like figure like mother or sister. The second is the prostitute figure or the permissive us figure completely sucked all who wants to arouse sexual feelings in men or boys and women. A woman who is devoid of love and

tenderness or ethical and aesthetic feelings and so is completely unlike the woman a purity such a dichotomy often is based on a boy is it an anxiety over his own unacceptable impulses. If he is convinced that this sharp difference between the pure woman and the sexual woman is in fact true he has an automatic out which blocks his thinking of a girl or a woman of the first group as having sexual feelings or as arousing sexual feelings in him since she is pure and non sexual. So the dichotomy if he's convinced of it prevents his feeling anxious or guilty person thought it the way I did. The adage Madonna prostitute dichotomy provides a real hurt all for a man when he marries and must accept the five of the normal equivalent of both types can and should exist in the same woman. Several years ago when

Gershon Scholem was visiting professor this Hebrew Union College he gave a seminar in the Department of Psychiatry on his research on the life of shopper types be the so called false messiah of the seventeenth century. One recorded fact was that shopper types B was totally impotent with these waves whom he respected and loved. They had no children. Later he married a prostitute and was pope and they had several children. Another example of the second approach the either or approach is that the observer no longer says merely that Tom Smith is an independent person. As you said in the first type of thinking the observer now can see that Tom Smith has another side of his personality that it times his attitude is inconsistent with his usual independence. In fact seems to be a bi polar opposite.

The observer sees that Tom Smith then behaves in a dependent and rather infantile fashion when he comes down to attention from his wife or the hospital nurses in the observer's second type of thinking. Tom Smith now is regarded as inconsistent or contradictory with two sides to his character. At times independent and self-sufficient at another times dependent in clinging to others for help and protection. Further it's clear from these examples that the Dr Jekyll and Mr Hyde story is a paradigm of the either or kind of thinking. Now for a change of pace. The either or kind of thinking reminds me of a joke. As you know I like to have an audience stay awake. Also I want an audience to be as interested during a session as it was before I started to talk. So if I have a hunch that the attention of the

group is lagging and can't altogether blame the temperature of the room I may talk about sex. But if I have been talking about sex as I hare now if I have been talking about sex and even so I think the attention seems to lag. I declare an emergency and I get permission or special permission from my conscience to tell a clean job of this clean story points up some of the practical problems that result from the either or approach. Mr Jones was the president of a railroad. He decided that the company needed a new lawyer. He talked to the senior partner of a large firm who was very pleased to hear that the new client might shift to his new lawyers a large part of the railroad company's law business. But Jones said that he would do so only on one condition. The lawyer who would be assigned to handle his business must be a one armed man. Jones gave no explanation and said that he did

not want to discuss it. The senior partner of the law firm said that one of his best friends was a man who had only one arm but it didn't so I and one of his best friends was a man who had only one arm but he wasn't a lawyer. There was no one Army lawyer on their staff at the moment but they would look for a while and finally they did. They found one whom they like who had lost an arm in military service. He joined the firm and he and Mr. Jones worked well together. The pending railroad case went well and Jones decided that he would transfer all of his legal work to the new firm. The atmosphere but this time was very congenial and the senior law partner thought it was safe now to press the point. He told Mr. Jones that he still was very curious about his insisting that the new lawyer have only one arm and Jones said Look it's simple. I just couldn't take it any longer with that other firm. Every time I asked one of the lawyers a question

about my business he would say well on the one hand it could be this. But on the other hand it could be that way. I just couldn't take it anymore I had to have a one armed man. I want a handed lawyer that's for sure. We come down to the transition from the second type of thinking to the third type in this capability the observer the one who wants to think clearly has come to see that the either or the two sided approach Sapir ear as it is to the one sided stereotype still does not work effectively or 40 in many instances it is good enough for a relaxed enjoyment of most TV programmes and of simpler novels to have the characters be good guys or bad guys but even this soon all the writers of good literature a great good juror Sophocles Shakespeare Dickens get it

just the FDA the great galaxy of dramatist novelists poets biographers all have recognised the fact or know it without thinking about it that they must good beyond the either or or the good guy bad guy portrayal of the characters. The basis of great literature certainly is the good guys often or bad in action or in impose in general ways or in specific an idiosyncratic ways. And further the villains in many ways are good guys and may be heroic. Captain Ahab but in Melville's Moby Dick is not merely our hero and not merely a zealot. Now I can be dramatic turn toward be closer to the loudspeaker turn up the volume and say that they like the drown cannot rest content with the idea that one man is good and another man is bad. I will postpone my attempt to define that difficult

word bad in a meaningful way. But even so I can see the mooste often the real enemy is not the bad man or the bad route rather the real enemy is the bad in or man or the path all like he medically speaking. You know man but one must add that when a man or a group actually bad he is overtly in a bad way in an important and serious areas in life that man or that group. In practical terms does become the enemy. Now we return again to the contrast of the second and third types of thinking. The either or by bipolar approach is much too naive for the average or for scientific understanding and for ethics we must further develop our ability to use the third kind of thinking the dynamic one the one which recognises the existence not

merely go to separate forces but many two or three or many interacting forces in human life. This is the approach that is more realistic more mature more workable. Several other phrases are of value in clarifying this third kind of thinking. One is a prodding at the use of the third alternative. For example when the either or approach insists that a man is either a good guy or a bad guy the third kind of thinking would take for granted that these two alternatives are not enough. There are many other alternatives by the way the most recent issue of the big Webster dictionary gives. I says that the alternative refers to three the third or more. More possibility is that even though originally the word alternative was limited just to it can be one can now speak of third alternatives or more many other alternatives one it

is that a man may be really a good guy as one of the third alternative is manly but be a good guy and probably a bad guy most of the time and change the gender from guys to dames and women may be a very good way to end her overt behavior. But in her thoughts and fantasies be full of anger of hate grit and even of murderous impulses toward her husband. Another alternative. Different from this is that she may be a good wave in her overt behavior and good also in her conscious thoughts but unconscious be shown in various ways unconsciously before a lot of repressed rage toward her husband. Now most of the time life is not simple enough for dichotomies as was not simple enough for stereotypes. And this has implications for ethics as I began to indicate above. But let me carry this further now by putting a case putting the case of a patient but modifying the report in a

way that preserves confidentiality of stupid today but does not change the essential dynamic. The case is that of a fireman who was admitted to the hospital with advanced cancer of the bladder. He was an intelligent man but he had not had a physical examination during the past six months even though he saw traces of blood in his urine several times a week during the six months. And even though as a fireman he was entitled to medical examinations without cost to him. He knew intellectually that the Cancer Society warnings about such changes were correct sex changes said believing was correct and he knew the blood in the urine deserves serious consideration. Even so he delayed with the rationalization that it was only a cold or a scratch or an irritation. Obviously he must have been afraid that he had a serious illness and we knew that those who were anxious about physical disease may

unconsciously defend themselves from finding out whether they have it or not. But the defense of not finding out can be like the defense given by the measure no line merely a false feeling of security. There are better defenses in this man. However there was a pattern which was even more important than his anxiety in parsing his delay in asking for medical care. The overriding point in this was that all through his life his central principle ethical principle was that a real man must be strong and be unafraid it should not be frightened by minor illness should not be anxious about blood. But this pattern which ordinarily is regarded as valuable and as a good article standard had played a part in leading him to a denial of the danger inherent in urinating blood. When he came for help he was beyond the

ethical treatment and he died there. His death was due to cancer but also his death was due to the fact that he had delayed coming for a while such a death cannot be understood sufficiently by asking the typical question of the either or type of thinking of whether the illness is organic or functional all the understanding must be in terms of a some nation or a combination of two sets of five. It's not either or but and. And his death was due to the organic cause the cancer and it is death was due to the personality patterns that led him to delayed medical care beyond the point of recovery. A closer look at this case can threw some light on I thinking about it. I think first it's important to say that this patient's failure to take care of himself was not based on stupidity on lack of intelligence. Even though he behaved it don't like

to play rather his failure to take care of himself was based on the dynamics of his emotional life. Part of this process can be visualized as a hundred richt of the ethical standards and this is one of the things I'm most eager to have a chance to make clear the conflict about the old standards the problems of the conflict between good and good not merely between good and evil. Conflict about equal standards within himself and that between two voices of conscience each voice contradicting the other. To clarify this we can say that we know that he had one set of ethical principles centering around the need to be strong and brave and to avoid excessive complaining. But we know also from many other facts and events in his life that he had a second set of ethical principles even though it was not stated in so many words. This would be the ethic of the living rather than die. And of preventing an unnecessary death.

The ethics of continuing to live because one's life is valued to oneself and to others whom one wants to love and to help and to be helped by the ethics of the living because others also want one to live so they can love one help one be helped by one. This set of principles of the were not opposed by other forces with wouldn't not have if it had not been opposed by other forces in Yemen would have led to him quicker to seek early diagnosis and treatment. Further it is essential to see that in this man not only where there are two sets of ethical principles but also to some degree the two sets could lead in different directions but being a con man each set a principle on its own is a good one and deserves our respect. But two good ethical systems when they are in conflict in the same manner can result in a serious miscarry not about justice but about their use and to the death of a man.

Now if the observer can recognize the conflict about the principles he may help the patient if it's not too late. But if it is too late the observers still must consider the ways in which in other patients of the gentle conflict between two such ethical systems can be avoided or resolved or the ways in which this pattern of the conflict about school systems can be discussed as a part of the general teaching about outing us. There are several ways in which the ethics of bravery in a non complaining attitude could be integrated with the ethics of preventing unnecessary pain and disability and debt. It is getting to the third way of thinking about this two conflicting things that had become either bored to his got government out of the possibility now or are about integrating the two. That is the I think it's a bravery and uncomplaining out of food to be integrated into the ethics of preventing unnecessary pain and disability and

get one solution is to work toward having a flexible combination of the two ethical principles. For example the pattern of being unafraid and non complaining could be dominant. Most of the time and the ethics of a four sided attention to signs or symptoms of possible medical illness could be dominant at other times.