Search for mental health; The importance of human behavior

Forest Hospital located in displaying the presents the search for mental health and exploration of the newest advances in psychiatry during this series. Physicians and other professional personnel working in the area of mental health at Forest Hospital. A hundred bed treatment facility will discuss the latest advances in mental health care research and education. Such topics as alcoholism adolescent behavior marital problems problems of suicide emotional problems and others will be presented on the search for mental help. Your host for this series is Mr. Morris Squire administrators of Forest Hospital this is Morris Squire and our special guest for today is Dr. Ian Alger who is a training and supervising analyst of the New York Medical College and the co-director of a very interesting organization of the groups for a living.

Now tell me what groups for a living mean doctor groups for a living. The title that my associate Dr. Peter Hogan in myself I decided to use for a type of group therapy program that we're operating in New York. And I think we chose groups for a living because so often in psychiatry particularly emphasis has been put on the pathological aspects of behavior. Some people sickness. And a kind of probing into the inner most parts of people and it's action is fine but our whole aim and goal is to help people find life for them south and in life. And so we decided we kind of groups for a living. Just good medicine is based on you know the cadaver you he will learn from the sickness. Right now you're saying that you're learning from the health or you're striving towards health. Is isn't is this just a simile. I think actually how this begins is that as as

a psychiatrist developing the medical model of understanding the mental quote illness is becoming less and less appropriate in many areas. And we're turning more and more to learning models in an attempt to understand people's problems in living and rather than talk of people being sick. We say that they're living in a certain way. ADLER talked about people's lifestyle and not people's life pathology but a style the way we live. And I think our use of videotape recording which we've been very interested in since 1965 has precipitated as into this whole area of trying to understand human behavior very much in terms of the way people operate together. This is in the tradition of Harry stock solid in the interpersonal psychiatrists and the communication theorists particularly those of Bates and his workers in Palo Alto where we found a great deal of help with their theories of how people communicate on different levels.

You want me to worry about that because. Please. We tend often to become frozen with the idea that we communicate through words. And we get ideas an abstract logical sequence. But obviously we communicate each other by the way we glance at each other by the tone of our voice the rate we speak. And we even communicate by our dress and fountains of different ways we send messages to one another and one way to understand human behavior is to see that we tend to respond to the cues that we're given and the cues that we learn in a particular society that we grow in. So if a nice bra is raised to bed I may alter my behavior very much without even realizing why I'm doing it without having any conscious awareness that I'm responding to the cue of the other person. And. For a long time human behavior particularly behavior that was called quote symptomatic or psychiatric was understood in terms of a person being a kind of closed system that

inside that person somewhere deep down in his unconscious were bubbling sources of some kind of odious and painful forces which were going to disrupt and erupt three witches in the cauldron. That's right. I think more and more people understand that we are social beings that our behavior is so crucially related to our life experience right from the time we're born which has to do with our interactions in our experience with other people and that we are never alone and no person can be understood alone. You don't understand behavior and the context in which it's occurring. And with an understanding of the kinds of interactions that are going on with the other people present or imagined present then why have for so many years psychiatrists as a group dealt with the patient as an individual in a closed room with no participation in the family or the maid or anybody else. I think because. There's been a great locking in to the idea that the

pathology lies within the quote personality of the patient locked within him. And that somehow this can be altered and the patient can go forth from this very holy kind of chamber and begin to operate in a different way in his life and my own feeling is that a person cannot really be understood apart from the rest of his living. When I do see a patient alone that is the patient and myself because we're never really alone there are two of us there. The only thing I really have any data about is what is going on right there in that room than with that person and myself. I think that because of this that's why interest in the transference reaction was very early focused on by Freud because he realized that unless he dealt with what was going on between him and the patient he couldn't really understand anything out anyway and so the transference or the interaction between the patient and a doctor became of crucial focus. Where I have some disagreement is that. What goes on between the patient and the doctor is not a projection alone of what the patient feels

but the patient is responding to actual cues and real behavior on the part of the therapist most often which the therapist is unaware. And so when we began to use video tape recording in 1065 and we included ourselves in the picture. We began to see that the patient's symptom wasn't something that was coming out of the inside of him alone. It was a response to something I was doing. And one interesting little example my colleague was working with a patient and he showed some interest in what she was saying and she began to get away from the point and he stopped and he said you know I think this shows that when someone shows interest in you you have some inhibition about intimacy and you start pulling away and getting more distant he said. Fortunately we're videotaping this I will just turn back the video take more take a look at this. So he ran the tape back. I showed the picture. Sure enough the patient was starting to talk and he even saw interest by saying Well tell me more about that.

But when he looked at the picture he was glancing down at his own fingernails as he said this The therapist was on one level he was saying I'm interested in the other level he somehow was giving the message that he was very into this fingernail and careless. That's why it seemed that way. And so the patient then began to show less eagerness to talk to him. Well when I began then to trade their feelings of the moment because this is what the tape allows you to do to live back to that moment Peter Hogan I call a second chance phenomenon because you have a second chance to live over a moment that was just there but was lost. So you go back and you can recover the feelings and communicate the feelings which may not have been clearly understood by the other person. It wasn't true that the doctor was not interested at that point as a matter of fact he was anxious himself at showing interest in another person. And he got in touch with that feeling and he was able to clarify to the patient that as he began to show interest in her he experienced some anxiety himself and one way he has of covering that is to distract himself

and pretend that he isn't that interested. He really was interested but he didn't look at it and then she was able to get in touch with the fact that she was responding to this overt message with the fingernails and she pulled back within a few moments this was clarified by really looking at what had happened. I that sound like an extremely interesting and I'd like to continue with input you put you into it a little further but I want to go back to a point that you made it is hit me what side to the business about health instead of sickness. Right. Adults and this is about living miles and business about communication and also how we look at sick people. Right. Would you talk some more about ways. I feel that. Well commented You once wrote an article about labeling people and what happens when we label people and just pinning the label sick on someone or the label healthy tends to make them static. And as soon as you're labeled or objectified I think you kind of feel more

alienated from other people. Now in my own approach to fair AP I'm not interested and I try not to label people. How do we grow up in a culture where we label all over the place and so I'm having a hard time getting out of that whole site myself. But I try and understand with a person in an interview what's going on with us and one of the ways I do this is to try to include myself as a person and I belong before the videotape came I was attempting to include my own reactions as openly as I could in the therapeutic session. So the patient would have some more feedback about what was happening with me so they wouldn't feel so much on the microscope slide so they wouldn't feel that they were the object of someone's scrutiny that their behavior was somehow isolated from what other people were doing. For instance if you say to someone you're shy now that's a label we're saying you are. These were of the verb to be. Tends to say you are this and it makes a

person static. We don't say them. I see you're acting in a shy way at this moment. It must be related to something I'm doing or what's going on here and other words the whole attempt to find the relationship of a person's behavior to understand it in the context of what's going on rather than to stand above it and judge it is what I'm talking about. As soon as we start standing above a person and trying to. Label them or objectify them. I think we lose a human contact. And we also give the idea that their behavior is very peculiar or very related just to them and they must bear the onus for it. Innocence is very guilty voting very judge mental very isolating and I think tends to produce the very kinds of feelings and behavior that we label quote. Second because in order to struggle against this a person has to start trying to fight back and to make some contact. And one of the ways to make contact if you're driven far far enough with this sort of alienation you begin to try and

swing out wilder and wilder. You may actually hit out physically eventually in order to break through and to try and make contact with this person who's withdrawing from you. And so the doctors often are very withdrawn and detached. Well is this true for people who are extremely sick the psychotic patient patient who is really I think this is one way of defining the psychosis is that people behave this way because they have been so driven into corners that this is the only way they can effectively make some contact at that point. Well how do you approach this patient and you as a physician and a psychiatrist. Well that becomes difficult when we say this patient. Patient patient who is and who is he out of it. You don't have a hospital practices so no I don't have a hospital what I consider also in the office so we have some people who are quite withdrawn and quite distant. For example there is a patient who had a very very obsessive feeling about colors. He began to feel no matter where he looked he

would see a color in behind the paint on the wall for example and he became obsessed with this was unable to function was unable to pursue his own own life. And when it come to sessions this is all he would talk about it is the colors. Now there are various ways to break through this. But the way I chose it was to deal with him as he was there to tell him how frustrated I felt how I didn't want to hear about his colors that I wanted to find out where he was at the moment and by insisting on having immediate contact with him in the therapeutic session. I was able to not get trapped in this obsessive system of his last a very brief. Example and perhaps doesn't elucidate a little south of what was able to tell the system what what began to happen as he began to talk with me to get angry at me and to stop talking about these colors and obsessing about them. I wouldn't deal with him at that level. So was the anger the pride of it that he had to get to anyhow. Well his fear that no one would really want to having to do with him was one of things we had to get through. Dr. Andrew why don't

you hospitalized some of these very sick people you see in your hospital now who I see in my hospital you see. Will you have an adult or a hospital and that's what I wrote and I think that was a good slip you made because what I'm what I'm saying is that. I don't think you can judge a person by whether he's inside a hospital or outside of a hospital. And actually this is another where we objectify people by saying he's a hospital patient he should be a hospital patient. Or he's able to be outside. It's not a good criterion by which to evaluate a person's movement in life. And being in a hospital may be a phase that a person goes through. And it's important to not let that hang over them forever either and lock them into that picture that oh yes he's a hospitalized patient he was a hospitalized patient. Oh yes he was a formerly psychotic guy. Now because this is like having the record of an ex-con that can hang over you forever so you think they're healthy.

All people are healthy. I think all people are living and trying to grow and live. And it doesn't make any sense to me to talk about whether someone's healthy or sick there are a lot of you have their emotional life back to groups for a living. Tell me what is it group for a living. How many groups are there. Who is in the group how long it will last how many hours Well I'd be I'd be fascinated to because this has been one of the sources of great excitement and hope for me in my work. It originated about two and a half years ago and anger with New Jersey when the minister of an Episcopal Church there David Gillespie gave a sermon in which he said he wished the church could in some way minister to the problems and living that people were having as a church had a tradition in the past of meeting the physical illnesses of people. And as a result of that sermon about 40 people in the congregation got together a lot of professional people myself included we began to think of starting a church clinic because this is a very common thing across the country. But many of us had worked in clinics and in some ways find

it discouraging to work in mental hygiene clinics. The whole nature of the institution tends to make it difficult sometimes to move with people in that setting. And we came up with a an idea which we call groups for living in this idea. There is a. Section of 36 people these are people from the parish or from the community. There are no criteria for entrance except that you have to be willing to work in this program. It's a low cost program. The cost is $25 a month per person and in addition if people cannot afford that low fee there is a sort of scholarship fund set up so that no one is turned away. And each section we have 36 patients and these people are divided into three groups of 12 each. Now each group meets once a month for a four hour saturation session. And the leader of that group is a professional consultant such as myself plus one of the ministers in the church. Now these ministers have

had a great deal of training in group dynamics and group methods and they've had some individual training themselves to train them. They train through some church programs originally and there is a very large church program going on in this country to train ministers in the sort of thing. In addition they had some personal group experience with myself and this particular case. Now we have these core purpose and we also use our video tape recording in these four hour sessions. All this is done the four hours the to therapist and the video taping to make it as intensive and deep experience as possible with as much impact as possible. The same 12 people meet once a month. You have been there for a minute you know it's an hour it's an open group we meet and I say we meet for two hours take a 10 minute break and I meet for tomorrow. It's icy. Now in addition to that monthly meeting there's a daily group meeting of an hour and a half length which is led by one of the ministers morning or night. And this occurs at different times in different days to a lot of people some selectivity depending on their working habits.

And to these daily groups everyone in that section of 36 that is the three other groups of 12 each. Everyone there is eligible to come to this daily group at his own option. Is there only one unit 36 or are there several units now there are several units of 30 secs but each unit of 36 has its own daily group correct. And so we have an average of from 10 to 15 people come at their own option each day. They don't know who else is coming on that day and what we hope to accomplish by this is first to provide a service on the day someone feels he wants to work on his life problems and secondly to keep putting the responsibility back on the person involved. No one will say I have to go to therapy today. Instead they say I want to go to the group today. I want to. And this way also by changing the daily therapist or the Daily Leader. We try and prevent an over dependence on another person and try and break down this lock that kind of current therapy so that each individual

is repeatedly reinforced in the understanding that his life growth depends first on himself that other people will help. But he has to make a move. Now we also have a duplicate system a therapy set up in our private practice in New York City and that's the groups are living in New York. Now we also run exactly the same but these are private patients. The fee is higher it's one hundred twenty five dollars a month for that. But this can give a person up to 20 daily group sessions a month plus the four hour intense a video session. So when it's broken down on a session by session basis it still is within the grasp of many people. Hundred twenty four hours a month you can come every single day come every single day 25 nationally 25 days a week 20. I said that's not the incredible you that's so cheap and well for an analyst's it certainly is a reasonable thing and yet it's profitable for us to run this and it opens up a possibility for a lot of people for experience that they wouldn't have otherwise.

And he's always got his analyst there every day the way he always has a therapist there yes. Well are there other therapy. Yes there are the therapist. Are they clergyman or are they no interest at all interesting Lee. Not a therapist we are now using. There is two psychiatrist a social worker two psychologists and two ministers and this is in the private practice and you've got a real good treatment team and you can see that this goes along with my idea that we're not going to talk about illness in the old medical terms. But these are problems of living and so we brought people from various fields to help us with that you know I got a funny feeling about sickness and health. Yeah. Explain to you. I think that doctors deal with sickness in pleasure. I've always traditionally dealt with health. And so this is a real bridge a very positive thing and I like the way you put that. Yeah. And my own experience when I was in medical school I became interested in psychiatry quite early and I felt that there was a great connection with religion and I learned about the clinical training programs that the church was running at that time were ministers in the seminaries

went to mental hospitals so when I was in my third year medical school I went to Philadelphia State Hospital in that ministerial program. They accepted me as a medical student. I think I may be the only one that they ever accepted. And I had I was I was seven minister ministerial student. Are you religious man. Not formally and so I don't really have a formal religious belief but they let me attend this church. But my interest is in people and it's at this point that I find that we cross in our interests and so a lot I can't profess any formal beliefs. I'm very excited by the kind of immediacy and the connection that people have you see. One of the things I found in the church is that this is one place in our society where a group of people get together and seem to have some interest in each other in some attempt to try and find something. Yes. And there are very few groupings like that. So a lot I can't go along with the formal ritual that they have or the formalization of some of their beliefs. I can certainly connect with what they're looking for and I can work with them.

They're talking about living and they work with me. Now how does an analyst look at a group. As a positive thing group of course was innocent and well I think there is that great shift coming. Look magazine wrote an article about our group work in January this year and in it it said that group therapy psychiatry stepchild to this you're referring that group therapy has been thought of as a stepchild but no longer sought with innovations in theory in communication and interpersonal theory becomes clear that two people form a group. But there is no such thing as an isolated individual and we can only understand ourselves in terms of groups. There's an organization called the Society of medical group psychoanalyst. And I think that with the innovations in group theory and group therapy with the innovation of video therapy which allows the inclusion of so much objective data we're moving into a whole review of our psychiatric theory and a whole openness towards finding a new way of living together.

It sounds like a tremendously interesting and vital feel. It brings vitality to me. Well I think this and this your investment in this particular area and your service to so many more people now than you were able to serve in a previous time. Sounds like a brave new adventure really. Thank you. Thank you very much Dr. Irene Alger who is a training and supervising analyst of the New York Medical College and the co-director of the groups for a living both in New York and in New Jersey and this is more squire. For further information regarding this program. Please write to this radio station or to Forest Hospital in the splines on I. You have just heard another in the series the search for a mental health produced by Forest Hospital in display in cooperation with this station. During this series decisions and other professional personnel working in the

area of mental health at Forest Hospital a hundred bed treatment facility well discuss the latest advances in mental health care research and education. Other topics such as alcoholism adolescent behavior problems problems of the aged and others will be presented on the search for mental health. Your host for the series Mr Morris Squire administrator of Forest Hospital the search for mental health is produced and directed by Jack rigamarole. This program was distributed by national educational radio. This is the national educational radio network.