Gardening vs Dishwasher repair?

 

I am sometimes asked to describe how the work of a psychotherapist differs from that of a psychiatrist. The first thing that I say is that the range of problems that psychotherapy can help with is not the same as that which psychiatry can accommodate. Psychotherapy is best at treating neurosis, which includes the anxieties and depressions and despairs that are the commonest experience, and is of less use in the treatment of psychotic illness, where there is a greater or lesser loss of grasp of reality, and where psychiatric drugs are usually more effective. (Which is not to say that the combination of psychotherapy and medication is not extremely effective: in some cases it certainly is).

But psychotherapy, and in my view especially Jungian psychotherapy, has something to offer which is not generally available from psychiatric medicine: it aims to encourage the development of new pathways, new ways of thinking and of experiencing one's existence which have not existed before. It is not a question of restoring a previous state. The metaphor that I would like to use to use puts it this way: for the psychiatric approach to neurosis: “ Approximately a dishwasher repair ethos?” and for the Jungian attitude: “More of a gardening ethos?”

I think that there is a justification for making this distinction, though the shorthand of ‘dishwasher repair’ perhaps has a slightly pejorative ring which is not intended. Here it carries the sense of a somewhat mechanistic view, including the notion that a discrete fault is suspected that might be rectified if it could be found. I think ‘might’ is important here. How? It seems that the psyche is very much an organic entity: massively complex. The fault, which almost certainly exists in some way, may not be repairable in the general sense of the word, since organic entities are not really like that.

Psychiatry distinguishes very many kinds of faults in the activity of the psyche, and these are all detailed in the great volume of the DSM IV*. If only the tool kit were more suited to this complexity. The methods that psychiatry has at its disposal are fewer than the types of fault, and (unlike spanners)they mostly tend to have to be globally applied. Given the problems of dealing with so many different types of fault with relatively few tools, the job is usually done as well as may be - which can range from perfectly effective to non-effective - for reasons that are all too unclear.

Perhaps in reality the underlying modes of disorder in neurosis are not as varied as might be expected from looking at the DSM IV, despite the enormous variation in the way neuroses actually reach expression. If one takes a crudely causal view, then these distinct outcomes must have distinct causes, and the many ways in which neurosis can manifest must have equally many different underlying defects. But it may not be quite like that, and a one-to-one causal view by itself may not be really helpful. The physical events behind neurosis, even if they were known, would almost certainly be too complex for the trains of causality to be followed on a ‘microdeterministic’ level. The whole thing can perhaps be followed better on a much higher level, where there appear to be overriding psychological principles and formats which, although they are still very complex and only partly understood, might point to an underlying picture that was more coherent and less unmanageably diverse and obscure than is implied by the DSM IV.
But all is a long way from being revealed. For this reason there is another important way in which what psychiatry is doing is not like dishwasher repair: apart from the inadequacy of the tool kit, there is no real manual for the repairer. The psyche in the psychiatric outpatient department is to that extent a black box, since the internal workings are not clear. The symptoms are noted and a treatment has to be selected on the basis of having been found to be the best treatment for that sort of thing before. The actual, deep and true nature of the fault is never really revealed; a fishbone is not suspected in, discovered in , and removed from the water pump. So it is not really dishwasher repair, although it might like to be. If it successfully could be, it might be a great boon.

Yet perhaps whatever the further developments in the tool kit may be, psychiatry may never just be able to go in and fix. The object of repairing a dishwasher is to get it back to the condition it was in before. It is not quite like that with people. A return to the previous configuration is not generally what is required, all the more so since that was the configuration that preceded the neurosis.

Unlike dishwashers, people differ greatly in their nature, and where they are heading. The objectives of ‘repair’ in people are therefore manifold, and the desired end result of therapy is not quite predictable. One could not take a dishwasher repair approach to making a garden out of scrubland. There seem to be fundamental differences between the nature of repair, which leads back, and that of growth and development, which lead forward.

For the relief of neurosis, the change really needed would generally seem to require the person to contact a lost or never-before-found potential inside themselves, which is in pressing need of attention and of being allowed to emerge and develop. This does not sound like repair or restoration to a previous state, but a living process, one that would need time, and which would lead to an inner situation which had not existed or been possible before.
All this seems almost too complex to meddle with; but we know that in some cases the psyche needs outside assistance, and that it is possible to provide this. Such assistance could be seen as having much in common with gardening; particularly in that beyond a certain level one cannot interfere. The process of self-elaboration in plants is scarcely understood, and in the psyche perhaps even less so. In each case one does what one can to provide the right conditions and free the process from obstacles. In the case of the psyche, the conditions include companionship and trust and a feeling of mutuality and reassurance. These factors work both within and outside of therapy. Within therapy there is also the provision of the security of the analytic frame, a general atmosphere of positivity, and then also what is made available by the experience and particular abilities of the psychotherapist. But whatever the gardener, or the psychotherapist do, there is an absolute dependence on the growth potential of the plant or on what has been called the ‘inner healer’ of the patient. Without these nothing happens. This could be said for gardening, and for Jungian psychotherapy, and in a way perhaps also for psychiatric treatment.

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*DCM IV = Diagnostic and Statistical Manual of Mental Disorders - 4ed