hello everybody welcome to a new episode
of the
center i'm your host ricardo lopez and
today i'm joined by dr
joel perrys he is professor and chair of
the department of psychiatry at
mcgill university and research associate
in the department of psychiatry at
sir mortimer b davis jewish general
hospital his research interests include
developmental factors in personality disorders
disorders
and culture and personality is the
author of many books
including an evidence-based critique of
contemporary psychoanalysis the fall of
an icon psychoanalysis and academic psychiatry
psychiatry
and feds and fallacies in psychiatry and
today we're going to focus mostly on
psychoanalysis and its impact on
psychiatry so dr parris welcome to the
show it's a pleasure to everyone thank you
you
thank you for inviting me by the way i'm
no longer chair of my department fortunately
fortunately
but all everything else you said in your
introduction is current
okay thank you for that correction
okay so let's start with a little bit of
history here
so um if i'm
correct i think that psychoanalysis dominated
dominated
psychiatry and even perhaps i mean
of course there were ba there was
behaviorism in the 50s
60s in theoretical
scientific psychology let's say but
psychoanalysis was very
popular right until the 70s
well i mean it didn't totally dominate
psychiatry because there was always a
biological psychiatry particularly in
psychiatric hospitals
but in general hospitals and in office practice
practice
i think it's fair to say it had a
leading role and
in north america most of the heads of
departments were psychoanalysts in those days
but do you think that there were any
particular reasons
why psychoanalysis was so appealing
to people well
it's interesting it's interesting even
when it's wrong
i mean the students the students still
have a kind of a bit of fascination
with it and are often attached to
teachers who
who who ex who uh take this point of view
view
uh i think it was mostly it filled the
niche which was vacant
where whereas in those days uh
biological psychiatry of course dominated
dominated
already the treatment of schizophrenia
and bipolar illness and all the severe
mental illnesses
the more common illnesses like
depression anxiety were mostly
treated with psychotherapy and the
medication was used less in those days
than it is now and uh
in the psychotherapy field i mean there
was always a lot of different
methods and you mentioned behaviorism
was one of them
but behaviorism really wasn't very
appealing because it said that
the mind was a black box and we
shouldn't even talk about it
and uh it's a stimulus response and
i don't think anybody was took that
point of view
that seriously except you know people
who were david hayes of skinner and
and so
those were the two main forms of psychotherapy
psychotherapy
and uh it was only when the cognitive behavior
behavior
of therapy came up you know with aaron beck
beck
a little later that we had a
competitor which was not only
as deep if you like a psychoanalysis but also
also
was evidence-based and and there was evidence
evidence
in the from randomized controlled trials
that it actually worked
so cognitive behavior therapy was evidence-based
evidence-based
does that mean that psychoanalysis wasn't
wasn't
or was it it never was uh freud was
asked at one point
late in his career if if there should be
clinical trials
and he was kind of so so about it the psychoanalysts
psychoanalysts
they they were they were like
charismatic teachers uh they could
explain everything they were uh
eloquent they still are uh and
and often charismatic but
it was very rare for them to conduct
research and
psychoanalysts being involved in
research is a relatively recent phenomenon
phenomenon
in the last 25 years perhaps
but since freud's psychoanalysis has been
been
revised several times am i correct
it's been revised a lot and i think that
the average psychoanalyst that today
doesn't pay too much attention to
oedipus complex or things that
that freud thought was central uh
i think many of them for example will
follow bolby's attachment theory
uh which is you know which is
to be considered as a as a more
scientific model
of of human development but
uh but you know still formal and formal psychoanalysis
psychoanalysis
got kind of uh if you like
made more available by by something
called psychodynamics
therapy in which patients were seen once
or twice a week and a couch was not used
but you know so many of the same
concepts are still there
among the psychoanalysts who are have
not disappeared
they're just now in a minority group
and what are some of the differences
between psychoanalysis as
uh let's say theoretical discipline
regarding the how the human mind
functions and
psychodynamic therapy
well i think the theory is is about the same
same
uh the issue is does it is it really necessary
necessary
to see people four five times a week
in order in order to help them is the
first question the second question is
is it necessary to see people for years
i mean when fraud started
people were seen just for a few months
and that was normal but when they didn't
improve people thought well let's make
it longer let's keep going
and eventually you've got this kind of
interminable woody allen
situation where people would would go
for many
many years psychoanalysis and it still
happens i still hear about it
uh because there's no definite end point
the psychodynamic therapy is more
accessible because it's less expensive
i mean in fraud's day if you went four
times a week
i don't think the i don't know what the
fees were exactly but it seems like
people could afford them
today you know charging 200
and more per hour only the richest people
people
could could afford can afford to go for
a formal psychoanalysis where
seeing people once a week uh
which which is more if you like there's
not an evidence base for
seeing people more than once a week and
so a lot of therapists just see people
once a week
and and another
development is brief psychodynamic therapy
therapy
for which there is evidence by the way
there is good research on it
that is probably quite effective maybe
even equal to cognitive behavioral
therapy and that usually involves
something like 10 to 20 sessions
total so that's
and i think there's a lot of a lot of of that
that
in in the available in the today
and it makes it more accessible so could
we say that contemporary
psychoanalysis is evidence-based well i
would say
mostly not because uh
but there are psychoanalysts who
have done really good research and
an example would be peter fonegae from
the uk
you know who's been very active in in research
research
and his work has a sophisticated
understanding of research
um there are a number of people like that
that
but the class where but
the issue is whether or not
it is necessary to follow all of these
procedures or whether we should have a
more eclectic model
which retains some of the good things
about psychoanalysis like
like understanding patients empathically
and being able to take a life history
and understand the connections between
between events and people's lives and
their later symptoms
these things need to be retained but an
eclectic model or
or integrated model of psychotherapy
could retain that while using some
more of the principles of cognitive
behavioral therapy
to actually get people better i think
one of the reasons why
psycho analysis is problematic is
that is the belief that if you just dig
up the past
and quotes work through all these past events
events
that's enough to make you better and it
isn't because you because people need to
learn how to be
to have skills that allow them to
function better in the present
and that's more the domain of cbt
and perhaps also in psychoanalysis and even
even
maybe perhaps in psychotherapy in general
general
people also have to take into account individual
individual
variation right because now we have
disciplines like behavioral genetics
that tells us that i mean
our behavior is at least partially
genetically based no i totally agree
with you and that's
that was never part of psychoanalytic theory
theory
and i think one of the reasons why
psycho analysis hit a wall so often where
where
patients would get to a certain point
and they wouldn't get any further was
because of their
of this genetic influence which is particularly
particularly
affects their personality traits and
their personality traits affects their
interpersonal functioning
and their behavior and their emotional control
control
and all these things and this was not
part of
the model of psychoanalysis so we need
we need to help people with this and you know
know
you know in my particular area
personality disorders there's been a lot
of interest in but dialectical behavior therapy
therapy
which focuses on emotion regulation this
was not at all in psychoanalysis
and so i think the fact that there are
200 forms of psychotherapy is crazy because
because
they're not all that different but uh i
i personally are in favor of an
integrative model
and there are there are a number of
movements and
journals and conferences which
attempt to to move towards psychotherapy
integration we should have one psychotherapy
because because each one becomes it's
not just psychoanalysis i mean each one
of them has been
dangerous as the danger of becoming a
cult in its own right
and i mean again referring to these
individual differences
isn't it also the case that
psychoanalysis focus
a lot on people's personal stories and i mean
mean
perhaps some of the things that they
call traumas for example i mean they don't
don't
affect all people in the same way i mean certain
certain
episodes in life this is absolutely true
i mean uh if you're a psychotherapist
and people come into you with stories of
childhood trauma you said you could
you're very tempted to say well that's
the cause of their problems
what you don't see is that there are for
every person you see there are maybe
10 people who have never come to therapy
who don't need therapy have had
childhood trauma
and but are resilient and got out and
got past it
and if you look at in in the research
literature you'll find
that the relationship between early experience
experience
and adult behavior is not very strong
because of exactly of your point of that
there are these powerful individual
differences particularly
in terms of uh in terms of personality i
mean we
we we did some research in my own
center where we compared sisters who had
grown up in the same family
and it's been said that siblings are about
about
as similar in personality as perfect strangers
strangers
but what we found was that they had
totally different function
functioning in spite of living in the
same environment uh
and i think this is related to the
to the heritable portions of
personality that you that you're talking about
about
when we talk about contemporary psychoanalysis
psychoanalysis
is it still fundamentally freudian or
are there different schools of thought
out there and
some more or less freudian and more or less
less
scientific let's say there
are definitely uh different points of view
view
i think one of the mistakes that was
made though was to
teach psychoanalysis outside the universities
universities
and to create institutes where
psychoanalysis was taught without accountability
accountability
to the larger scientific methods and
and and academic standards so
a lot of people are trained in
psychoanalysis and don't do very much of it
it
it's just another thing that that they
can add to their curriculum visa but
the demand for psychoanalysis is not so
high as it was
i mean 30 years ago people would come
into the clinics and say
how do i get a cycle on our analytic
treatment and today you never hear that
they say where
where is cbt where how can i get access
to cbt
there are these schools i mentioned
attachment the attachment approach
in the uk which is which is much broader
and it does and although it doesn't take
genetics into account
it definitely takes individual
differences between people into account
and uh but you know
i think the method of psychoanalysis is
what i question the most because it's
there's no evidence that
going four times a week or lying on a
couch is better than going once a week
there's no evidence in fact that going
for five years is better than going for
six months
yeah so what would you say
mental disorders that psychoanalysis
is scientifically proven to be effective against
well i don't think there's any evidence
that psychoanalysis is
is indicated for any particular mental disorder
disorder
uh the study the the studies which are
strongest are the ones which have examined
examined
brief courses of of psychoanalytically
based psychotherapy once a week
over a period of say three to six months
up to 20 sessions of psychotherapy uh
and these are often given for people
with depression
not so severe anxiety disorders
and also people with personality
disorders which just means that they
don't don't function interpersonally and
they don't have a direction in life
and that sort of thing so these are the
kind of conditions for which is offered
these are the same conditions for which
cbt is offered
so i don't think there's any specific relationship
but would you say that because aaron beck
beck
was originally a psychoanaly
psychoanalyst that cbt is
at its core psychoanalytic
there is an element of cbt which is like
that it's called schema
it's a theory of schemas so there is
something in there which is
sounds a bit like psychoanalysis which
is that you have certain experiences
maybe earlier in your life
which shape the way you think about the
world and
leads you to certain misjudgments
and that these can be corrected but
beck's model is more educational
it's let's they remind me of a plumber
who comes in
with a big box of tools and they have
some a screw
and a you know for everything so uh
the the the
they don't have the same point of view
as psychoanalysis and i think
i think you know i think i think
he didn't keep it keep very much of
psychoanalysis in his his system
there's only a little bit so we've
already mentioned
bolby several times in our conversation
isn't it the case that with attachment
theory or at least
the schools of psychoanalysis that
adopted attachment theory
moved from a more interest psychic approach
approach
to a more relational approach
absolutely absolutely right and there is
also something called
relational psychoanalysis or relational psychotherapies
psychotherapies
which you know mitchell i think i
mentioned him in my book
uh a number of people have worked on a model
model
which is more and then there's
interpersonal psychotherapy
which which was also developed by peop
by people who had
who are coming out of psychoanalysis and
looking for something different
so interpersonal psychotherapy which was
developed in
uh in in america
uh is i call it psycho
psychoanalysis without the past because
it's all about the present
it's all about how are you getting along
with people now and how can you do better
better
and it's so again this leads to a kind
of a more teaching model
and less of an exploratory model
so in these newer methods including
attachment theory the therapist is much
more active
and talks more the idea of sitting there
and just listening for an hour and then
making some kind of
statement ex cathedra you know
at the very end this i don't think is helpful
helpful
and if you read people who had sigmund
freud as an analyst
he wasn't even he wasn't even like that
himself he gave advice
uh and this i don't know where this idea
came from that you should be silent
uh but you know psychotherapy is a kind
of education
and you have you have to explain things
to people
and have methods of of of showing them
that they could do better
life and handle their problems better
and what were some of the aspects of psychoanalysis
psychoanalysis
that perhaps i mean
cut short in terms of understanding how people's
people's
psychology develops that
with the more relational approach got
better we got a better understanding of
how people how people psychology develops
develops
well i mean a relational approach
doesn't exclude the possibility
of saying to people you know given the
way you were
you were brought up in your early
environment it's not surprising that
that you don't trust people it's not
surprising that you qualify
you know these are problems which do
have a past history behind them
but let's but that but the past is past
and we're going to work in the present
is is more that's more of a relational approach
so since there are these
genetic bases for people's behavior and
individual differences as we've already
mentioned here
how do you look at how psychotherapists
should approach the sorts of
relationships that people have
with their parents for example because
if i understand it correctly
behavioral genetics says that
the shared environment isn't
that impactful in terms of our
of our psychological traits developed
yes well this still remains quite
controversial i mean there are some
behavioral geneticists
like robert ploman for example who
imply that the family doesn't count for
very much
and and there have been a number of
others who have taken this point of view
i think that's a little going a little
too far
i think people with i think if children
have a difficult temperament
genetically they need something
different from their parents
so i think these results reflect the
fact that most children don't have a
difficult temperament
and unless you do something really bad
to your children you're not going to
ruin them
and and children develop in their own
trajectory but there are
a certain number of people who have a
difficult temperament i
and you can see this from very early in
life where they get upset easily they don't
don't
calm down easily where they're anxious
where they're gloomy
uh these are things which you can see
early on in life and those children i think
think
if you add on to that an interaction
a gene environment interaction between
their temperament
and a bad environment you're going to
so i think i think the reason the
behavior of genetic
studies don't don't show this may be
because the majority of people their parents
parents
are sort of okay maybe not not the
greatest don't
completely understand them but but there
are lots of other
such things in life which can make up
for that friends and
peers and teachers and all kinds of
other people
so i think there are some people who are
deeply affected by their environment
and but that's because they're extremely
sensitive to their environment and
that's one of the newer ideas in
psychology something called differential
sensitivity to the environment
associated with jay belsky who is
an american psychologist yeah i've had
him on the show
so um i mean is it the case
that there are aspects of how freud
understood how our subconscious mind
worked that are still scientifically
well we well no one is denying the
existence of an unconscious but the
question is what do you mean by the unconscious
unconscious
yeah i mean uh the problem with freud's method
method
is that he had his preconceptions and he
shaped what his patie the the narratives
that he heard from his patients into his preconceptions
preconceptions
the mind is mostly unconscious but you
know if you look at daniel kahneman's
system one and system two you know in
terms of the way we think
most of the things we do with our minds
are sort of automatic
and we don't even think about them
that's a kind that's been called the cognitive
cognitive
unconscious uh so it certainly is an
unconscious mind but the idea that the
unconscious mind is full of
horrible things which we all which we
have to suppress
i think i don't think this model is
really quite correct
uh the so i think we need a different model
model
of the unconscious mind and the idea of
making the unconscious conscious
and that it's a bit as if you had it had had
had
injury and it got infected and you have
to lance it
to get the pus out i mean this is the
model that freud was
and talking about the subconscious mind
there's also
that thing about repressed memories i mean
mean
this does it make sense i mean do people really
really
repress their memories in a sort of
defensive way
i would say no i would say that there's
a lot of mostly evidence
points to the fact that that's not
correct uh
one example is post-traumatic stress disorder
disorder
in ptsd you're pro bad things that
happen to you and you can't stop
thinking about them it's just the opposite
opposite
so trauma does not cause repression
it may cause suppression because which
is different because suppression
just means i know it happened but i
don't want to think about it
which is kind of adaptive it's found
was found found by in uh
some of the studies of defense
mechanisms to be one of the more
adaptive ways
of of handling uh painful ideas
but i think the idea of repression and
undoing repression
i reject that i think the scientific
evidence is strongly against it
the memory experts people like schachter
and mcnally at harvard they don't think
and i think the repressed memory story
i should say encouraged or brainwashed
into thinking that they have
they've been traumatized i think this
was a terrible scandal
which brought this psychotherapy into this
this
repute uh this was particularly 20 years
20 25 years ago in the 90s and
it was a big fad in psychotherapy it led
to all kinds of
legal issues and was constantly in the media
media
you don't hear as much about it today
what about the case of defensive
mechanisms in general is there
good scientific evidence for that sort
of phenomenon
there is some evidence for that but
maybe they shouldn't be called defense
mechanisms because that
that depends on the theory of the unconscious
unconscious
and you have a defense against the
unconscious becoming conscious
yeah if you just think of them as
adaptive mechanisms which don't
necessarily mean they're unconscious
uh there is there is quite a bit of research
research
on this uh some of it has been done at
my own
at my own university mcgill
uh and uh there are ways of scoring
these things
there are questionnaires you can give
people as with any other psychological
dimension self-report questionnaires
are the usual way of measuring these
things and they can be shown to have a relationship
relationship
to certain outcomes and certain uh
quality of relationships in life there
is some evidence in favor of them i just
think the word defense
is should be changed to adaptive mechanisms
mechanisms
would you agree that another problem of psychoanalysis
psychoanalysis
is that i mean people have a theory
and they try to gather information from different
different
areas to support their preconceived
theories like for example they draw from
more recently epigenetics they also drew from
from
neuroscience from effective neuroscience
for example
i mean would you agree with that
yes well this well certainly
there are people in the the in the
biological sciences who have been
interested in building a bridge to
psychoanalysis and
psychoanalysis within in an age of
neuroscience i've wanted to build a bridge
bridge
to them so we had panscott for example
who supported uh psychoanalysis
and and he was a famous neuroscientist
and he
he wrote in favor of the of the validity of
of
of psychoanalysis uh
quite a bit and so i think everybody's
using neuroscience these days even
even uh humanistic scholars are quoting
neuroscience these days
where they used to quote freud uh and
the problem is neuroscience is kind of
people don't realize this but
neuroscience is just beginning
i mean 50 years from now we will
i i will guess that we'll find the ideas
our ideas about the brain as primitive
as those of night
today would if we look at 1970 we think
uh we didn't understand very much we're
going to say the same thing in 2017.
a neurosciences on it is on it i mean
studying the most complicated
thing in the entire universe the human brain
brain
and it's going to take centuries to
really to really
sort this out so i i think the problem
of applying today's neuroscience which
is sort of pretty
general you know you can do functional
magnetic resonance imaging
and certain areas seem to light up often
it doesn't tell you much more
than you could have known just by
talking to somebody
you know but it it gives you a
scientific grounding for your
observations it's
it's a good thing but it's not like
it's it's not like this is going to this
should be used to validate ideas
i mean psychoanalysis comes from
1900 originally approximately
how many scientific ideas you know
are continue unmodified for for over a century
century
very few i mean newton einstein you know
darwin you know there are fewer
you know but things have to change
right what about the efforts by people
like mark solms that developed the field
that i think he calls
neuro psychoanalysis
i don't i don't i don't feel much
impressed by his work
and i said so in the book
i think you're trying to to attach
neuroscience to psychoanalysis but
in science you have to question everything
everything
uh so if if you're building a new science
science
you don't use the latest science to confirm
confirm
an old science which is already out of
date that's not the way science works
you if psalms had wanted to develop a
new theory
with some in which psychoanalytic ideas
and the findings of neuroscience were
somehow integrated
that would that would be interesting but
what he what he did was to try to show
freud was right all along and i can
prove it with an fmri scan
you know this is not science a
and i mean was just looking at
image image brain images
of different regions firing for example
or being activated
i mean we can't really draw that much
information just from that right it's a
it's a it was a tremendous advance
you know to have this technique
but in fact the brain is not localized
in this way it's not like
you can look at the picture i mean all
it tells you really is the blood flow
has increased
on the average to a certain part of the
brain meanwhile
everything we think and feel is complete
is is unlocalized it has broad effects on
on
on areas all over the brain
so we're talking about a brain with
billions of neurons and we're trying to
explain it by which area
lights lights up on fmri it's an oversimplification
oversimplification
and i think it's an
it's an attempt to validate psychoanalysis
psychoanalysis
instead of just trying to say what are
the good things about psychoanalysis
that duke
that are supported by research and let's
keep them but let's build a new model because
because
we don't need to go back to freudian
he's been gone now for
80 90 years
so i've asked you several things about
different forms of
psychotherapy what about psychiatry can
psychoanalysis still provide informative insights
insights
to the practice of psychiatry
well i think the problem in psychiatry
which is something which makes me a
little bit unhappy
is that we now are dominated by
neuroscience or at least by
the present state of neuroscience to the
point that most
psychiatrists are see are
writing medications prescriptions
they're treating patients almost
entirely with drugs
and only a minority of psychiatrists
really do any serious psychotherapy to
begin with
now clinical psychology is different but
there you'll see that cbt is dominant
and psychodynamic thinking all
is is uh is still isn't a minority
just like what now i don't think
psychoanalysis has done much
to explain the causes of mental illness
i have written a lot about the need for
gene environments interactive models
putting nature and nurture together
embracing complexity anything which is a
simple explanation
of something like the human mind is
almost bound to be wrong
and i think psychoanalysis i mean i was
i mean i received training in psychiatry
50 years ago
many of my teachers adopted this model
and i did use it up to a point but like
most people i've evolved
into a more eclectic and integrative approach
approach
to psychotherapy i'm one of the minority
of psychiatrists who still does
psychotherapy and
and that's because but that's because
i have i specialize in a condition which
for which psychotherapy is the main
treatment that's borderline personality disorder
disorder
uh that that's been my research and my
interest in my clinical interests now
for many decades
so i still do a lot of do still do a lot
of psychotherapy
i mean i'm sure some of the things i i do
do
might still reflect my training in
psychodynamic psychiatry
in the past but i think i have evolved
into a different model which is which is
more skill oriented
uh more related to to helping people
to function in the present and and with
less emphasis
on their past experiences that's the
main difference
as i've evolved over since i was young
you mentioned psychopharmacology and
that it has some problems what are some
of those problems and do you think that
there are at least some conditions that are
are
better treated with um
with with drugs in this case well
certainly there are such
conditions i was present
at the at the psychopharmacological revolution
revolution
in the 1950s as an undergraduate student
i visited psychiatric hospitals where
people were spent years and they were
just starting to use medications
to help and 10 years later
we had effective treatments for schizophrenia
schizophrenia
and bipolar disorder and these conditions
conditions
still absolutely require drug treatment
and it's the main treatment
so if i worked on a psychiatry ward where
where
psychotic illnesses were were the main thing
thing
i would be doing that kind of biological
psychiatry practice
mainly i work in an outpatient setting though
though
where depression anxiety and personality
disorders are what
dominate the diagnostic spectrum
now those conditions do respond
some of them do respond to medication up
to a point
my complaint is that a lot of these
patients cannot access psychotherapy
which has been
and psychotherapy has been shown to be
just as effective
if not maybe a little bit better than
drug treatment alone
and maybe the two of them together
for many patients are more effective
than either separately
but psychotherapy is not not always insured
insured
either by by governments for example i
know in europe it's better
than it is in north america we have
insurance in canada
here but it does but it doesn't ensure
psychologists it only insures
psychiatrists so
so this makes psychotherapy much less
available because psychologists are
doing most of it
so they can so in the in the personality
disorders and
in depression and anxiety
psychotherapy is still the major
evidence-based approach but it's
because of its expense because the luck
because it isn't supported by the system
one two three four five drugs the
prescriptions keep adding up when they
don't get better
nobody and they're often added without
subtracting anything
this makes me sad because it's not the
do you think that psychotherapy more accessible
accessible
do you think that there are any mental conditions
conditions
for which people are nowadays over
diagnosed or even certain things that
should be considered
normal that have a diagnosis attached to them
them
well absolutely i don't know if you've
had alan francis
on your on your on your program but
he's written a lot about this i also
wrote a book called overdiagnosis in psychiatry
psychiatry
uh if not so much
that normal i'm not so concerned that
normal people are receiving diagnosis
i'm more concerned they're receiving the
wrong ones
because that because they're popular and
they're fad and everyone's looking for
it so the examples i gave in my book
were bipolar disorder which was often
diagnosed in people who
are just moody
highly moody and maybe they have a
personality disorder
but they don't really have bipolar
disorder another example
that i gave was attention deficit hyperactivity
hyperactivity
disorder adhd of course there are
it's a real thing and there are such
cases but almost every
but you have a situation where you know
the prescriptions for both children and
adults have increased by a factor of 10
over and obviously a lot of people
who might be whose problems might be
thought of in a different way
are receiving drug treatment because
because there's a fad for adhd and it's
extremely hot it hasn't stopped it's
getting worse every year
uh and there are other examples autistic
spectrum disorders
you know everybody's a little nerdy and
overly introverted
is told is going to be told they're on
an autistic spectrum
at least that doesn't lead to drug
and so and even depression
i think is over diagnosed because if you
look at the criteria for what's called
they're very soft and if you have two
weeks of misery
you already have the diagnosis and i
think this is
it's not that people let's put it this way
way
unhappiness and grief are part of the
human the human condition
we all have times in our life when we
feel miserable
if you look at major depression in the
population you'll see that at least half
of us and maybe
three quarters of us have met criteria
sometimes during our life because it
only takes two weeks of
two weeks to make that to make it such a diagnosis
diagnosis
it's called somebody is called this
concept creep where you have
a good idea and then you start expanding
the idea
to include everything that you see
and in the specific case of depression
couldn't it be
the case that sometimes at least
people receive that diagnosis
when they are simply going through a
period of
sadness where they are reacting to something
something
bad that that happened in their lives
recently and
yes or
if they these are the people who could
benefit from a short course of psychotherapy
psychotherapy
and they're like and since they are
likely to get better anyway but you want
to get them better faster
this is one of the main indications for psychotherapy
psychotherapy
i think which is you know a situation
where people are overwhelmed by some
negative event in their life and can't
cope with it so
and you know this raises the question of
whether psychotherapy is also given to
normal people
and i guess it is you know but
um certainly
uh if you see a psychiatrist
or or even a general doctor
you tell them that the press they're
reaching already to write the prescription
prescription
for the antidepressant before they even
hear the story
this is what's happening today
right so i have one last question here
we've been talking a lot about
psychoanalysis and the several
limitations and drawbacks that it has
from a scientific perspective
do you think that it's possible to reconcile
reconcile
traditional psychoanalysis with contemporary
contemporary
i don't think so i think that psych
i think psychoanalysis has to be
brought back into the university
and become part of an academic mission
and make contact not just with neuroscience
neuroscience
like the psalms but also with other
forms of psychology
i think there's room for a kind of a
melding or a sense of connection between
the cbt
community and the psychodynamic community
i think that the idea of psychoanalysis
outside the academic frame
is killing it because because
in science you always have to somehow
have to have someone
around you who tells you you're wrong
and maybe you're
completely wrong and this is what's
exciting about working in the university
it's uh if you're surrounded by a small
group of people
who have maybe minor differences which
they might fight about
but basically adopt
a particular theoretical position and
they're constantly validating each other
this is not going to produce progress
and i think most people would agree
but the progress in thinking and psychoanalysis
psychoanalysis
has not been great i mean there was a
time in the 1970s
you had something called self-psychology
at that time
and it was very popular for a while on that
that
but it was not connected to science and
it died out or disappeared
attachment theory is the best bet for
psychoanalysis because
it also belongs to the academic world
and what bolby wrote about the 1970s
i was amazed because he the first time
i've seen a psychoanal
analyst quoting research and talking
about what supports and what doesn't
support his theory
and being open to the integration of
ideas from this for different disciplines
disciplines
this was a great man john bulby
he didn't understand genetics and
individual differences
that was missing from the model but that
and uh so this is why
i think that the the best trends
among art psychoanalysis are among the psychoanalysts
psychoanalysts
who work at a university
are involved with the academic mission
and don't and don't
have a separate world where they can go
once a week and talk to their friends i
mean this is
this is what's needed okay so what
paris let's end on that note just before
we go
i've mentioned some of your books in the introduction
introduction
would you like to mention some places on
the internet where people can find your work
work
well amazon has i i'm an amazon author
so if you look me up under amazon
authors i published 25
over 25 books but most recently
i i did a whole bunch of new editions
of books i had written in the past which involved
involved
usually rewriting the whole thing
one is called nature and nurture and
psychiatry where i talk about
gene environment theory another one is
the treatment of borderline personality disorder
disorder
which is making a lot of progress
uh and that also went into a second
edition and
my over diagnosis and psychiatry book
also went to a second edition so i wrote
a lot of second editions
and i'm also writing some new books but
they're i'm still writing them so
they're not on amazon yet
yeah i will be leaving links to all of
that in the description box of the
interview and dr perry's
thank you a lot for taking the time to
come on the show it was a real pleasure
to talk to you thank you for inviting me
and i enjoyed talking to you
hello everybody thank you for watching
this interview until the end
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