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#444 Joel Paris: Psychoanalysis and Modern Psychiatry

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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'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 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 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

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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#444 Joel Paris: Psychoanalysis and Modern Psychiatry