Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. I aim to show how contemporary developmental science points us on a path to effective prevention, intervention, and treatment, with the aim of promoting healthy development and wellbeing of all children and families.

Tuesday, September 10, 2013

Did Electroconvulsive Therapy or Storytelling Cure Simon Winchester?

Joe Donahue, the brilliant host of WAMC's Roundtable recently interviewed Simon Winchester about his short e-book "The Man With the Electrified Brain. In the book Winchester describes his four-year experience as a young adult with an undiagnosed serious mental illness that was at the time apparently successfully treated with electroconvulsive therapy (ECT.) 

There is much speculation of the nature of the illness. Winchester himself, on discovering DSM (Diagnostic and Statistical Manual of Mental Disorders) IV many years later while writing The Professor and the Madman, diagnosed himself with a "dissociative disorder." A professor of psychiatry at Stonybrook who is a proponent of ECT, based on correspondence with Winchester,  has diagnosed him with "simple melancholia," an illness he recognizes is not in the DSM and attributes to "abnormal hormone functions."  A Psychology Today post entitled What Did Simon Winchester Really Have?" refers to "psychotic episodes."

In his introduction to the e-book Winchester explains his reasons for writing about this subject so many years later. He describes living with feelings of shame, and, following the death last year of both his parents, a desire to "come clean." He writes; 
My mother and father, tough old greatest-generation Britons who lived well on into their nineties, belonged to a time and class that disapproved mightily of any kind of mental infirmity...Stuff and nonsense, my father would bellow on hearing of my troubles. Damn tomfoolery was his only diagnosis, Pull yourself together his only prescription.
The answer to my question may be found at the end of Donahue's masterful interview. After covering the scope of Winchester's story, Donahue moves on to material that is most definitely not in the book. "Without getting overly psychological," sharing that he, like Winchester, had recently lost his parents, Donahue wonders about a wish to " fill in the blanks," about his history, and in particular his genetic history.

What follows is, in my opinion, the most fascinating and important part of the interview. Winchester tells of his elderly mother going with him to Buckingham Palace in 2006 when he became an OBE (Officer of the Order of the British Empire) He describes her getting tipsy on two glasses of sherry and telling "unbelievable stories about her life," stories of "espionage and affairs." Winchester tells of his father's history of being badly treated as a prisoner of war, and in the final weeks of his life, after suffering a stroke, beginning to open up about his own history. He speaks of his father's growing tolerance of talking about mental illness. Then, most poignantly, Winchester says, It was brimming, I could feel a sense that this is all going to break, and then he died."

After this comes an exchange where Winchester describes an uneasy sense that his illness may return, having been told by a number of people that the ECT, " didn't cure you."

I wonder if it is this very telling of the story, including his incomplete yet meaningful connection with his parents towards the end of their lives that will prove to be the cure.” This telling of stories as cure is well known within the discipline of psychoanalysis. I describe it in a previous post Childhood Trauma: Stories that Must Be Told:
French psychoanalysts Francoise Davoine and Jean-Max Gaudilliere have an adage on the cover of their book, History Beyond Trauma; "Whereof one cannot speak, thereof one cannot stay silent." They argue that personal stories of war and societal trauma, if not told in words, emerge as symptoms, sometimes as mental illness, sometimes in subsequent generations. 
Of course I do not know if Winchester's family history had any relation to his illness. Yet I cant help but wonder, if this silence, this "British reserve" had a role to play, both in the illness and also in Winchester's chosen profession as a writer, or "storyteller." Perhaps it is his storytelling that was/is the cure.

We are currently in hot pursuit of the science of mental illness. This past Sunday, in an op ed in the New York Times, The New Science of the Mind,  Nobel Prize winning neuroscientist Eric Kandel writes about our growing ability to understand the biological basis of psychiatric disorders.

Listening to Winchester's story motivates me to again point to the need to attend to the relational and historical context of being human in our quest to understand mental illness. If we focus exclusively on the "biology" without attending to the way the brain grows and changes in the context of relationships, we miss what a colleague referred to as the "poetry" of human nature. 

I have great respect for the complexity of the kidney. But the way the proximal and distal tubules transport ions is likely not related to, for example, the owner of those kidneys' relationship with his mother, or his father's survival of the Holocaust. But the function of his brain/mind most certainly is.

My hope is that what we will take away from Simon Winchester's story, thanks to Joe Donahue's  interview, is that in our pursuit of the science of mental illness we must find a way to make room for storytelling.

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