The interview with Barbara Fitzgerald which took place in Ukraine during Anniversary Congress of ECPP " Education in psychoanalysis: challenges and controversies"
Q.: There are four notions that people often mix with each other – psychologist, psychiatrist, psychotherapist and psychoanalyst. What do these notions have in common and where they differ from each other?
A: What each of these professions have in common is to find some way of alleviating emotional suffering for the patient/client. However, they carry out their work from different viewpoints. The direct aim of psychiatry is to cure symptoms, imposed by mental distress and disorder. These symptoms are often related to depression, but depression or anxiety that has completely overtaken a person's life, leaving no separate place for a person to reflect over his/her condition. So, a psychiatric background includes a medical training, which is not always the same for the other professions. The treatment is carried out primarily through medication.
A psychologist applies clinical theory and research in their assessment and intervention work across the life span. Sometimes it includes doing an assessment of a person – to assess the educational level or to understand a person's behaviour. Sometimes the task of a psychologist is to form a clinical picture or make a diagnosis. Methods of treating a person also vary. They depend on whether a person is an educational psychologist, clinical psychologist, child psychologist. ..
With regard to the work of a psychotherapist, there are different modalities of psychotherapy. The word “modality” refers to an approach or a way of understanding something. It is based on the philosophy and knowledge basis of the method. The common modalities that are widely accepted are psychoanalytic psychotherapy, humanistic and integrative psychotherapy, systemic family therapy and cognitive behaviour psychotherapy. All other methods fall within these categories.
The difference between a psychotherapist and psychoanalyst is based on the field of activity that they engage in. A psychoanalyst is specifically interested in unconscious activity of a person. He/she would explore the deeper levels of the persons psyche, tracing how symptoms which may be causing distress, have been formed in the origins of the person's life What I mean by the origin of someone's life, is how they have been shaped by their early history. In psychoanalytic understanding, the behaviour of the client is shaped by his early experiences of conflicts and trauma in childhood and adolescence and is constantly re-worked in actual experiences. Psychoanalysis is basically the art of deep listening. But it is not just listening, but listening in a particular way, i. e. listening to the processes, deeply rooted in a person.
Whatever their conceptual framework there are many areas in which the work of all these professions overlap. Research shows that across all the professions the catalyst for change is the relationship
Q.: One of the greatest psychologists of the 20th century Erich Fromm said that founders of all great religions – Eastern as well as Western – had one common task, and that task was to alleviate psychological pain. This same task is the goal of modern
psychiatry. Addressing a psychotherapist has become for modern people a substitute for confession. How would You define the relationships between psychotherapy and religion?
A.: It's an interesting topic. I'll give the example of Ireland, where the majority of people belong to the Roman-Catholic Church. Until recently religion played a very important role in people's external life in terms of following the Judeo-Christian tradition. Over the past twenty years, there has been a breakdown in religious structure and disillusionment has arisen from disclosures of sexual abuse and in particular the church’s way of dealing with these disclosures.
But that is different from what we call a religious impulse within a person. The religious impulse doesn't die because a religion, as a set of traditional institutions, dies. Speaking more broadly, that religious impulse – the desire to know beyond the rational – is also part of the philosophical seeking of a person. Now, that seeking is part of human nature and it has also become part of the psychoanalytic enquiry
Society faces difficulties where psychotherapy and psychoanalysis become a substitute for questioning of meaning and everything is reduced to a psychological landscape . The religious impulse, which is – broadly speaking – the desire to know truth, needs many landscapes , including that of philosophy, religion, art and culture. So, it can be a mistake if a psychotherapist takes over all the views, in which we can see life. I think that is happening at the moment in Western countries. And I think it is because there has been such a shock and dismay of what is actually happening in the religious structures. But what is happening with religious structures should not be mixed with the internal religious impulse of the person.
Q.: People often make a distinction between addressing a doctor who cures physical diseases and a doctor who deals with mental ones. While people find it normal to go to the doctor, who cures physical illnesses, they often shun addressing a psychologist or psychotherapist, as there's a stereotype that a person should face his (her) emotional problems himself (herself). What are origins of this stereotype and is it changing in modern societies?
A.: Yes, I think there was a lot of fear about talking about mental problems and emotional problems. In Ireland there are a huge percentage of young men between the age of 19 and 25, who commit suicide. This problem is linked to a drinking culture, alcohol, but it is also linked to the fact that young men , in contrast to young women ,can limit their world view and need to talk more. So, there has been a broad campaign on TV and social media with a slogan: " please, talk " . It is one of the ways of trying to take away the stigma about talking to another person and create an ease in such talking. And when the extent of such talking isn't enough, one may also talk to somebody who's an expert, who can listen in a different way than just a friend.
Change is happening, openness comes more through media campaigns and health promotion at national and international levels emphasising positive mental health, and focusing on mental health awareness which is based on resilience rather than symptoms and deficits. This trend helps considerably in breaking down the barriers created by stigma.
In western societies the stigma about mental illness is changing. Because, it has to. The universities are involved in this process, as they are doing more research in the field of psychology, psychotherapy, neuroscience.. There's more statistical data available in relation to the origin of depression and emotional and mental disorders. So, it becomes something that is being discussed at the level of national discourse.
Q.: Life today is different from the experience of our parents or grandparents. It is much more stressful than it was just a few decades ago. While our physical health improved, our psychological health, obviously, declined. What advice can You give to modern people? What should they do in order to avoid negative consequences of modern lifestyle?
A. A particular advice may be to find more ways to slow down and develop capacity of having time to reflect and think. The ever-accelerating speed of outside stimuli is what makes the largest difference between " now " and "then " Take, for example, movies of 1940s-1950s. You will see the pace of society of that era reflected in the narrative as, for example, it might take almost 5 minutes for an actor to walk towards a mantelpiece, smoke a cigarette and walk back. Compare these movies to modern films, such as Batman or the Matrix. Everything there is moving very fast and this too reflects the pace of our modern society.
In terms of cyber space the fantasy is cultivated that everything is immediately available. People don't have to reflect or digest the information they receive. I call this a technological consciousness. What is it grounded in? The process of digesting and assimilating information is a very important psychological process. The point is that our psyche is programmed to always ascertain something, to try to find out what is true and what is not. Therefore, when people always receive truth in a " ready " form, they start to feel anxious and uncomfortable. These complexities need to be discussed.. The ability to think and reflect must be harnessed so that the innate expressive capacity to live life in both its outer complexity and inner ground will be able to be considered and included in all sides of discourse in politics, societal and daily life.
In modern societies the educational curriculae have become oriented toward achievements only. In Ireland, for example, there's an exam that pupils take under the age of fourteen. From their early years onwards people go through the process of continually striving. While this attainment is important developmentally. There must be a place in our lives where we don't just strive to achieve. There must be a place where we could listen to ourselves. We must not let the process of achieving usurp our whole life and worldview.
In Ireland there was a older tradition called the Bardic tradition. Bards were advisors to the kings and to the leaders in society. They were steeped in the old tradition of oral story telling and it took 11 years to complete their training to become a Bard. They were seen to be wise but were also great listeners and not only received their wisdom from the old stories which they were seeped in, but they got their wisdom also from the ordinary folk. This capacity to listen, or as Seamus Heaney the Irish poet laureate said to ‘listen in’ is worthwhile to develop.
The recent conference of the European Confederation of Psychoanalysis In Ukraine was titled. «Education in psychoanalysis: challenges and controversies. It was an important forum for the exchange of ideas and discussion among psychoanalysts, psychotherapists, psychiatrists and other professionals. We were not trying to compete with each other, but to find ways to understand our ideas which are embedded within our different cultures and professions.
Q.: In former Soviet Union psychoanalytic and psychotherapeutic activity was banned. In Ukraine these fields just begin to develop. Since You had the chance to see psychological institutions both in our country and in Western societies, how can You evaluate the level of their development in Ukraine?
A.: I think the comparison should focus on stages of psychoanalytic culture. What happens in the beginning ? A group of psychoanalysts come together, who, maybe, received their training from abroad. They became interested in a particular teaching or a particular theory and bring it back to their own country. What usually happens at this first stage is that people start to meet together. They are very excited about particular authors and books. On this stage of development you have a distinct interest on the psychoanalysis itself. This was true both for Ukraine and in Ireland.
What happens on the second stage – there appears the climate of discussion. Here people start thinking about standards – profession, training . Who authorises us to do what we do?
In a third stage there is a collegial support, dissemination of ideas, development of training schools and a recognition of the culture and society within which Psychoanalysis as a profession is embedded. In that third stage psychoanalysis starts to interact with policymakers and the government and acquires the capacity to influence not just the patients but also the society in general.
I see that Ukraine is between the first stage and the second. In Ireland and in Western
Europe we are between the second stage and the third.
The transition stage, where Ukraine is now is a very exciting time. As a psychoanalyst, psychotherapist and teacher I am encouraged by what I hear and see in Ukraine in the freshness of the perspectives, the interest in new ideas, the richness of the philosophical tradition. It gives me an ability to think about ideas from different perspectives. There isn't a better way to develop ones ideas, than to listen to someone with a fresh and open mind.
This lively psychoanalytic culture, in time will have an influential effect of the mental health in our societies.