Our medical ancestors sought to heal the mind long before they could treat diseases of the brain. Magicians and priests tended the sick through suggestion, therapeutic bond, and tincture of time, not by science. This has changed. During the last century and a half, our progress in understanding and treating mental suffering has been remarkable by any standard, drawing importantly upon lessons from the asylum, advances in psychology and the science of the brain, and what had been learned by doctors and nurses who treated shell shock during the First World War.
Psychotherapy has been described as the oldest branch of medicine, with roots in religion and magic that can be seen in the healing rituals practiced in Greek temples, on the Homeric battlefields, and in the consulting room of Freud. In earliest times, as in our own, the priests and doctors of antiquity drew upon potions, listening and words of consolation, suggestive power, and pragmatic counsel.
More than four thousand years ago, Egyptians built sleep temples that served as sanctuaries for worship and for the relief of suffering. Temple priests and doctors induced trancelike states in their supplicants, interpreted their dreams, and advised the most auspicious paths through life. Music, painting, and walking in nature were prescribed to calm the anxious and console the grieving. Egyptian doctors, and after them the Greeks, studied their patients as well as healing them. They detailed the symptoms and course of brain fevers, mania, melancholy, and other mental disorders. Against a background of myth and magic, they laid down rudimentary elements of medical psychology and psychiatry.
Centuries later, similar techniques were practiced by the followers of Asclepius, the Greek god of medicine and healing. They too healed the sick with herbs and words, suggestion, and dream analysis; as they did, they practiced a recognizable form of psychotherapy. Suggestion and place were critical to their work. The Sanctuary of Asclepius at Epidaurus, built in the fourth century B.C., was in every way designed for healing. It was set among the hills and trees, away from the interferences of the world. It defined arcadia. It was beautiful and restful; the air was pure, the diet simple; there were fresh springs in which to bathe, and a theater and library for arts and learning. Pilgrims sailed to Epidaurus from ports across the world to worship Asclepius and to be healed by magic, suggestion, herbs, and the arts. They came to a world perfectly cast for mending minds.
The priests in the Asclepian temples were tutored in suffering and were learned in the prescription of calming or enlivening herbs that had been used for tens of thousands of years. They knew and taught the rituals of remedy: Before starting treatment, supplicants purified themselves. They bathed in healing waters—mineral springs, the river, the sea—meditated in the sanctuary’s sacred grove, fed on a cleansing diet, and prayed. They offered sacrifices to Asclepius and proffered figs and honey cakes to the temple serpents. Hymns were sung, sacred lights were lit. The priests laid on hands and applied ash. Supplicants slept in special areas within the sanctuary where, lulled by suggestion, and perhaps by drugs, they waited for the priest to analyze their dreams and prescribe cures.
Thousands of years later, doctors and nurses who treated shell-shocked patients in World War one confronted terrible psychological suffering and brought to its easing as much as they could usefully glean from both ancient remedy and modern medical knowledge. Many of the war doctors who treated the traumatic damage caused by combat were influenced by recently published writings of Freud, Jung, and other European psychiatrists. Like the doctors of antiquity and the psychoanalysts, some put importance on the analysis of dreams. And like the psychoanalysts, they knew that memory must be grappled with: patients had to discover what was best to remember, what best to forget, and ways to reconstrue traumatic experience.
War, as Henry Adams said about the Civil War, sets the circumstances for advances in medicine and science. In the twentieth century, the hundreds of thousands of soldiers, wounded in body and devastated in mind, commanded not only urgency but improvisation. Science from the battlefield brought rapid change to psychiatry, as well as to general medicine and surgery. British psychiatrist and anthropologist W.H.R. Rivers observed that the Great War produced disturbances of the mind on a scale that could not be imagined. War, he said, was a “vast crucible,” an extreme trial that could rearrange or destroy the mind. Therapeutic pragmatism was imperative. Psychiatrists had to figure ways to help their patients reconstruct their shattered minds and how to reconjure their futures. Doctors needed to infuse hope and nerve and a semblance of calm. The war taught about the unconscious mind in a way that nothing else could. It also taught that psychotherapy saved lives. After the war, psychotherapy became a part of what doctors had to offer patients.
Psychoanalysis and electroconvulsive therapy came into their own in the early twentieth century; in the years following the Second World War, lithium, antidepressant, antipsychotic, and anticonvulsant medications were found to be effective for many individuals with previously untreatable mental illnesses. New treatments continue to be discovered—mood stabilizers and antidepressants for mood disorders, medications for anxiety disorders and schizophrenia, structured psychotherapies, brain stimulation techniques, ketamine, psilocybin, virtual reality therapies, and others—remedies that have helped millions. Less beneficial, however, has been the concurrent decrease in the time given over to psychotherapy. This in part is due to the presumption that medication alone is necessary; to the expense of psychotherapy and relative lack of reimbursibility by insurance companies; and to the time and effort involved.
Certainly, medication and other non‒psychotherapeutic treatments have profoundly changed the lives of those with mental illness. They have ameliorated suffering, made meaningful work possible, and allowed damaged relationships to mend and grow. For many, medication does these things more quickly, better, and less expensively than psychotherapy. Medication often falls short of actually healing the mind, however. Many patients, their suffering improved by medical treatment, remain raw and fragile. They cling close to shore, avoid risk, and fear returning to the fray of life. They do not expand the territory of their beliefs or curiosities, nor do they learn as much as they might from what they have been through. But for those who receive it, psychotherapy is an irreplaceable part of a greater renewal; it marks the channel home. Psychotherapy is an ancient and deeply human part of healing; for cause, it has been called the oldest branch of medicine.
Adapted from Fires in the Dark: Healing the Unquiet Mind
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Kay Redfield Jamison