(Transcribed by TurboScribe.ai. Go Unlimited to remove this message.) [Speaker 2] What does it mean to be called crazy in a crazy world? Listen to Madness Radio, Voices and Visions from Outside Mental Health, an affiliate of Mad in America Radio, broadcasting on KBOO in Oregon, sponsored by Portland Hearing Voices and the Icarus Project, and syndicated on the Pacifica Network. Madness Radio is online at KBOO.FM slash Madness Radio and at madinamerica.com. Welcome to Madness Radio. This is your host, Will Hall. Today, my guest is George McCouch. George is a psychiatrist trained in Jungian analysis and process work. He's in private practice based in central Oregon. George is the author of the recent book, While Psychiatry Slept, Reawakening the Imagination in Therapy. So welcome to Madness Radio, George McCouch. [Speaker 1] Thanks, Will. Great to be with you. [Speaker 2] Yeah, welcome to the show. I'm very excited about your new book, While Psychiatry Slept. There's a lot that I think the listeners are going to be really interested in, and especially in your work with what gets called psychosis, your understanding of shamanism, your understanding of the meaning in altered states and extreme states, and your real effort to try and get psychiatry as a whole to step back from the more mechanistic neuroscience, brain oriented reductionism that often happens. So it's great to have you on the show. [Speaker 1] Thank you. I love the way you said that. I'm going to have to write that down. I love the brain oriented mechanism. That's exactly right. It's way too much that way right now. [Speaker 2] So why do you think that it's too much? What would be the sort of the devil's advocate would say, hey, we have all this new science that's coming in, neuroscience, brain imaging, therapy, and psychotherapy for psychosis, or people with schizophrenia, or bipolar diagnosis. That's kind of in the past that really now what we need is these new approaches. And what would you say to a devil's advocate question about that? [Speaker 1] Let me stay semi-scientific for a second and say, I was always trained in what's called the biopsychosocial model, that there may be something biological that you have to look at, something psychological and something sociological system based. And way what's happened now is everything, there's such a push to the biology of it that when you see a lot of these writings and people say, well, this is the scientific or this is the evidence based, what you find out is that they become so blinded by those set of glasses they put on that they'll exclude other data that's so compelling that if you're truly being scientific, if you're truly willing to look at what's going on, then you have to include this other data, which often is the amazing psychological things that you have to work hard to not find the meaning in. For instance, I mean right away in the book, I tell about working with a woman going through an extreme state, and you can make cases for the biology of it, of course. And she was in a hospital at that time. And we're sitting there in the office, she had trouble in her life where she came from a very religious family, her father was a minister, and he was very against her doing anything but giving her life over to God. And when she came in to see me that day, she had begun to have a relationship with a young man and said at that time to me, if she was pregnant, she was going to keep the baby. Now, this was a huge thing for her. And just as she said that, just as she said that, there was a blue jay that hit the window we were sitting by. And I had an office that was in the back of the hospital way out in the field, no trees. I'd never seen a blue jay or any other bird there. And this blue jay hit the window, and then it hit the window over and over and over again. And I said to her right at that second, I said, what do you know about blue jays? And she said, they steal the eggs from the nest and kill the babies. And I said, what was happening just as that happened? And she said, I had a thought that said I was evil if I had a baby. Now that you can't exclude that if you're truly being scientific. And when we began to then work together on how we called it blue jay, man would come and steal her and come in with those thoughts and try and steal her real feelings. There was a huge change in how she did. [Speaker 2] So this is the data that you're saying that science, if to be truly scientific needs to listen to, there's something with her very religious father being against her having a child with this, this man she was having a relationship with. Yes. And that makes me think of one of the, one of the things that caught me right away in your book was that the first thing you talk about is a dog named Boomer. And my mom's dog is named Boomer. So I thought, okay, that's a very interesting synchronicity there, I'm going to explore this. And, and so I like, I like that, George, that the idea is not to be rejecting of science or anti science, but actually to kind of call out leading and mainstream and dominant science, because it's not scientific enough. It's not actually taking all of the evidence and all the data, because it may be that if a blue jay hits the window and behaves in this very unusual way, and it has real meaning for a patient, then wait a second, what's the so called official normal scientific explanation for that. And we don't have one. But guess what, that's what nature is all about. There's a lot of mysteries in nature. And I think to actually be scientific, you have to be open to data that doesn't fit into established theories or schema, because it's there in nature, it's actually evidence, it's data that you can't ignore. And that I think is one of the biggest tragedies of the emphasis so much on neuroscience and the brain and the kind of chemical causality view, is it makes a claim that science knows more than it actually does. And it actually life, especially human life, is filled with a lot more mystery and meaning than science wants to admit. [Speaker 1] Yeah. And I think, you know, one of the things that I say early in the introduction, as I say, you know, there's, I'm not, I'm not trying in this book to just overthrow what's been done. And there, you know, certainly, I've seen things by working as a psychiatrist that have been quite useful. But I, you know, one of the points I make is I say, you know, even though there may have been progress, that there's really what I say in the book here is however, in my opinion, all this process has had a dark side, or at least to parallel development heading in the wrong direction. As the age of the brain revolution has captivated psychiatry and its training and residencies, a corresponding loss of soul can be increasingly witnessed. Young doctors emerge from training steeped in the latest biochemistry and DSM diagnosis, but without exposure to dreams, the history of psychiatry and psychology, great literature, the body and its connection to the psyche, or any idea of alternative ways for viewing symptoms, except through a prism of causality. That's one of my big complaints is that it leaves out the art, it leaves out all the aspects of soul and it's not, it's not trained in. And so there was a psychiatrist now sits and sees somebody only look through that prism, they try and squeeze people into diagnostic categories, even when they don't fit, because they have no other way of seeing it. [Speaker 2] I think that is a very much true of the human crisis in general, that we've proceeded with this technological advance, but the dark side is a loss of soul and it affects mental health, it affects health care in general, it affects everything about how we live. And so I think what's beautiful about your book is that you really get into the detail of what would it be like to bring soul and story and meaning back into the center of what it is to be a healer in the mental health realm. One of the things that's striking about your book, and I think it makes a lot of sense to me, is that when I was doing my own clinical training, I was encouraged and basically required to write up these case examples. And it became very clear to me very early on, that there was no way that I could do that in any kind of objective way, that really what these cases were are stories that I'm telling, and that it reflects as much my own creativity. And so I've always backed away from giving kind of case stories as if it was some kind of objective. And so that's what you do in the book, and I think you talk a lot about the people that you work with, but in a more general way, as stories and examples. And it points to the fact that if we go back to Freud and Jung, that actually the practice of psychiatry is very strongly rooted in literature, in philosophy, in the study of the world's religions, because this is what we need if we're going to actually address what it is to be human and what it is to suffer as a human. So tell us a little bit about story and why you chose to take a storytelling kind of approach in your book and in your work, and why is that important? [Speaker 1] There's a great quote from Hillman in religion, a book called Religion is Story, and he says that he has seen that children who have a connection to story and fantasy and reading stories and their parents help them with story seem to emotionally be much more grounded as they get older, that there's a sense that great literature and fiction is really the way the soul talks, the way this middle realm that is the realm of imagination and fiction and metaphor is really the way that we connect in the world. And it keeps it more fictional. The psyche is always trying to fictionalize things. It's a very, very interesting thing. A lot of people don't know that in PTSD, when patients come with the objectified, you know, horrific dream of the trauma, that over time, the way you'll see that they're getting better is that the dreams now become more and more fictionalized, more mythic. It seems as if that's what's trying to happen all the time is that stories are moving in that direction. [Speaker 2] So break that down for us a little bit more. In trauma, you're saying that there's a fictionalization process or there's a storytelling process that evolves in the psyche as part of healing. How does that happen? What exactly is that about? [Speaker 1] It seems that the psyche itself is always moving towards fiction. As it moves closer to imagination and fiction, that's also when healing is occurring, when people can step away and start to see, oh, you know, I'm caught in this figure or this or the dream world seems to move it more into imagination and less into the literal aspect of this is what exactly happened versus it moves it more into the imagination. And that was discovered originally by Harry Wilmer, a great Jungian analyst down at a work down in Texas. And he had a whole ward for Vietnam veterans with PTSD. And he discovered that and then it's been written about more. And I've seen that not just in PTSD, but in what we'll call extreme states or psychosis, things are very fictionalized, very imaginative and what comes up. And then people call that psychosis rather than seeing it as an older reality that moves in that direction. For instance, I talk about some other psychiatrists in the book that I've written in this kind of storytelling fashion. And I say that they've mastered a genre of fictional case histories by embedding their psychological wisdom and methods in their writing. In this style, simile and metaphor, image and sensual character are solved and the cold abstractions of the scientific are issued. The great Graham Greene, the great writer Graham Greene thought that this allows for literal memories to come out not as journalism and purported fact, but by being thrown into the compost heap of time, they're altered into the deeper truth of imagination. [Speaker 2] I would say that definitely the arc of any healing trauma is really about the stories that we tell about the trauma and then our role in the trauma. And that's really what you're doing when you're sitting with someone and talking and bringing in different aspects that may have been excluded or blocked out or too overwhelming, that that starts to come in and the body plays a really important part in generating this. And there's always this sort of frozen quality at the beginning or even an avoidance. And then when the storytelling happens, and what you're describing is this actually is a creative process. It's a fictioning process, but it's a fictioning that comes from the truth of some kind of soul experience that the person is having. [Speaker 1] It seems to be natural to the psyche to do that and move it. And as it moves there, one gets more distance on and is be able to act, be able to see the figures, you know, if we stay with trauma for a second, you know, the horrificness of trauma and being the victim of it. So it's a huge thing. I'm not downplaying that at all. But as a person starts to move in any kind of therapy, what starts to happen is that they are able to move into what are the more marginalized figures, they start to see that they're not the only being in their psychic house. And as that happens, that's when healing is also happening. [Speaker 2] They may remember the story a little bit more fully. And oh, there was a figure or a person that was actually a positive element, or there was something that I did, where I wasn't just a passive experiencer and victim of this trauma, there's something that I did was actually had power or agency. And so the story starts to reflect an actual healing process. And so you're saying what I think actually, a lot of neuroscientists are now saying, which is that storytelling and creating story and the fact that the memory is a creative process and not some kind of like data entry, you know, photography of some kind, it's actually memory itself is creative. Neuroscientists are starting to say that we are storytelling animals, that that's at the very core of who we are. And you're pointing out how that storytelling quality is really at the core of healing, and has to be part of any kind of therapy with people to help them with their emotional, psychological struggles. [Speaker 1] Yeah, storytelling animal, that's one of my favorite books by Jonathan Gottshaw. [Speaker 2] And so therapy is really more art than anything medicine is really more art than anything, would you would you agree? [Speaker 1] 100%. And I talk about Bernard Lowne's book in the chapter that I wrote on the placebo effect and an incredible book by probably the greatest cardiologists of the last hundred years. [Speaker 2] Now this is a really important book. Can you tell us the name of this book? Because when I discovered it, it just resonated so strongly about how to do medicine in a different way. [Speaker 1] The Lost Art of Healing by Bernard Lowne, L-O-W-N-M-D. [Speaker 2] It's kind of considered a classic, although now it's a little bit kind of falling by the wayside. [Speaker 1] Yeah, it really is a classic. But when I was teaching psychiatric residents at the end of each rotation, I would give them that book as a gift because it's so falling away in the teaching. But it's an amazing book. And again, see affecting and going into the imagination from a standpoint of the placebo and how words can heal. That's an amazing, everyone should read that book. [Speaker 2] One of the things that it's the heart of his message is that healing is about listening, which I think is going to resonate with the madness radio listeners, because that's really the message of what we're trying to get across in madness radios, that we have lost so much of our capacity to listen, to connect with each other. And so tell us about the bedside manner that you discuss in your book and the placebo effect and how this all weaves together with listening and storytelling. [Speaker 1] Well, Lown does a great job in just saying that the listening is more, the art of listening is about hearing and seeing all that's going on. Story after story of Lown is about him noticing somebody's signal, looking the other way or hearing a change in the voice drop or listening, not just as a conveying information, but actually being present to all the different, the body, all the things that are happening, the nonverbal. [Speaker 2] Exactly. [Speaker 1] If he and I were talking, I would be talking about that these are all the conduits, these are all the channels that the soul can enter from or that word that basically the dream world is entering from. And he discovered that more as a cardiologist and had no just he's got story after story of when he followed those thing, you know, wonderful things happening independent of what he was doing with medication. [Speaker 2] So we think of cardiologists as like, Oh, your heart is a pump and it breaks down. And so the cardiologist just takes a look at it and goes in there and fixes it. But actually, no, that's not, we're saying that, that in medicine in general, listening is actually central. And how does this relate to the placebo effect? And what are maybe some examples of the power of this because you write in your book that words can heal. And I know this from my own experience, because when I was told your schizophrenic, those words injured me. And then when I start to claim different words, I feel like the word and that identity in that story is a healing experience. So tell us more about the placebo effect and how that fits into this. [Speaker 1] As you're moving in the process of life and your psyches moving in this more fictionalized way, if you get off at a station called schizophrenia, or a station called depression, or a station called anxiety, that word literalizes and fixes right in time, the way you start to see it, it freezes you and an identity and the identity itself becomes part of the problem. [Speaker 2] Exactly, exactly. [Speaker 1] And then and so this idea of fictionalizing things, you've got to get back on the train. And so why I see people and they come in, they tell me depression, I say, well, depression is a word that describes experiences, but it's abstract, let's go into yours. Now you're into the individual. And, and that's what Lowne does in his book also he's, he's going into what's the yeah, you say you have this and this, but let's go into the individual thing about what you're feeling or thinking. One, one woman in there says, well, well, well, the cardio version that you're going to do to change my arrhythmia will help my back pain. And, and Lowne says, Oh, of course it will. Now, he, there's no scientific evidence that it will, but, but why not do that? It's not going to hurt her. And the resident that was with him, right with the woman, the patient said, Oh, that's absurd. He got in a fight with Lowne. And Lowne said, Lowne chewed him out later. But anyway, the woman's back pain got better. You know, why is that same thing? The most incredible story he tells in that book is when they went in to listen to a patient, a whole group of young doctors with him, and the patient had what's called an S3 gallop. Now that's a really bad sign in cardiology. That often means that the person his heart is completely failing and they're going to die. But this young student said, Oh my God, listen to that gallop. And day or so later, the patient was checking out of the hospital and, and Lowne only found out the story later that the guy said, when the, when the patient were, when the resident, young residents said, Oh, listen to that gallop. I thought, Oh my gosh, my, my heart is really strong. It's galloping like a horse. What am I doing in hospital here? And he lived like two years ongoing after that before he finally passed. [Speaker 2] So he was told something positive about his, what his heart condition was, and then actually got internalized and actually served a healing function for him. Now this is something that's unique, you know, to humans and living beings. You don't send your car to the, to the shop and there's a kind of a sudden unexpected, but actually if doctors are honest, they don't have control over the situation. There's all kinds of unexpected twists and turns, including unexpected healing. And in the mental health recovery world, we talk about being strengths based. So you're not just focusing on the problem, but you're also recognizing that there's always strengths here because those are words that now come into the person's story that they do have strength. And then that actually has a, a strengthening and healing. And, and, and so give us an example of how that has played out in, in your own work. [Speaker 1] Let's say an average, you're getting a placebo effect at least at 38% or 40% response rate with placebo. And in actually in medicine studies, you only have to beat that by a couple percent. And you only have to have two studies that beat that to get it approved by the FDA. [Speaker 2] So you're saying that for a drug to get licensed and to go onto the market, it just has to be better than placebo, but actually placebo is actually really effective and it just has to be a little bit more effective than placebo to say, Oh, this is the drug. That's helping you. [Speaker 1] Exactly. So from just one standpoint, as a physician, you want to use all that placebo effect. You want to be not going, Oh, it only it's, you know, the drug is a little better than placebo. You want to go, can I get all that effect from the placebo? So the stories that you tell the way you watch the client, how many doctors are suddenly going to their computer and writing the script or they're looking down and writing the script and they're not watching the patient. I let's say when I'm prescribing or have prescribed medications, the most important time, the absolute most important time for me to be watching is when I say, well, you know, with this, I've had some luck, let's say with Zoloft, but now I've got to absolutely watch that person because right at that moment, let's say they sit back, take a breath. They, I see them look down and they say, okay, I'll try that. And then I watch that signal. Like I said, that lounge would do, and I call that out and I bring that out and they go, well, you know, I didn't really want to use Zoloft, but I'm going to, you know, you're the doctor, but my sister had a suicide attempt when she tried. [Speaker 2] It just reminds me of the very first time that I took an antidepressant drug. This was before I was in the hospital and before I went through that whole experience, but I started taking Prozac. And I remember my decision, I wrote in my journal that it was definitely a giving up experience. It was almost like a suicidal thing that I could feel like, okay, I'm just, I don't care anymore. I don't care. Just give me a, give me a drug. And, um, you know, that's, that was a big part of the meaning of that drug for me was it was, it was very destructive in a lot of ways. And I think that a lot of times people who have positive experiences with medications because of the set, the mindset that they bring in, you know, it has a meaningful, I mean, you quote, um, Hippocrates, I think there's a very famous quote from Hippocrates, where it's the patient's belief in the goodness within the doctor that actually is what provides some healing. [Speaker 1] And they, and these things are way under trained now. I mean, I've been teaching for 40 years and there's nobody that comes in really understanding about placebo or, or what's also called nocebo, which is the negative effect with them, with the mindset, like you just talked about with the Prozac and all of those things make a huge, huge difference. And there's no training in that. There's no training. [Speaker 2] It used to be, because we're kind of talking about something broader than pills. We're talking about something like bedside manner or the presence of the healing, listening presence of the, of the soul attendant in a sense. I think that's what psychotherapy means. So, and there's no training of that anymore. It's actually dismissed. It's seen as noise to statistical noise in our technological pursuit of these pills as machines. [Speaker 1] I tell a story in the book of being at a major worldwide conference for child and adolescent psychiatry. And there's a major researcher said that they were having a 75% success rate with Seroquel for kids with bipolar disorder. But the problem was that they were having a 73% success rate with placebo. [Speaker 2] That was the problem. [Speaker 1] Yeah. And that's what she said, but we got to figure out how to get the placebo effect to go down so that we can get the medication approved by the FDA. Right. I remember, I remember running out of the room with my iPhone and dictating like, Oh my God, I got to remember this. [Speaker 2] Yeah. Yeah. Because we, we forget that it's not just a pill. It's the attention. It's the listening. It's the expectation. It's the ceremonial ritual of going in to a doctor. It's the encounter with this powerful person with all this science behind them. It's the entire array of everything that the person has ever read on the internet or in the media. A pill is actually a meaningful event. It carries stories. It carries all kinds of symbols. And it's not just a technological or chemical factor in someone's brain chemistry. George, both you and I have been very influenced by the work of Carl Jung. And I was just wondering if you could just explain a little bit, why is Jung so significant in what we're talking about? Because when we think about placebo and bedside manner, and we don't necessarily think of Jung, but Jung is actually very central to what has formed your own thinking about this. So can you tell us a little bit about why Carl Jung is important? [Speaker 1] You know, to say why is Carl Jung important, I get caught also just in my personal, there's a way he was so true to what was happening. So true to what was coming up and looking at it. And not even though he came out of being born in 1875 and coming out of the whole time when things are moving towards enlightenment and mechanism and Darwinism and that whole direction, he somehow was able to be absolutely true to the imagination and the psyche and the dreams and deeply go into him. When he went into his own confrontation with the unconscious that's so beautifully written about in his biography, Memories, Dreams, Reflections, and had broken away from Freud because he didn't believe that dreams were just about causality and that he came to believe and says very clearly, I didn't any longer have anything. I didn't believe what Freud was doing. I didn't believe in the way those dreams were being interpreted. So I started to see my patients and I was just open to what he called Gesen Lassen. What was there? What was naturally happening? And then he said, I would give it the Tracten, which is in German, means to give it special attention. And when you did, it would become pregnant and begin to move. And that was also then when he was going through his confrontation. So he began to do this amazing 16 year experiment where he wrote down his fantasies and he went into him and he went into him so openly with such imagination. One of his great, great sayings is treat us as if we are real and listen attentively to what we say. That's what he would say that the (This file is longer than 30 minutes. Go Unlimited at TurboScribe.ai to transcribe files up to 10 hours long.)