PSYCHIATRY AND PSYCHOTIC DEPRESSION: Experiences of Stan Mayerson
George: I want to make a small introduction. It is interesting for us, because in some cases we will have to deal with hospitalization of cases of mentally ill people during a crisis. It will be very interesting to hear of the experiences of Stan.
We saw that case and prescribed a remedy. Somebody said that “George was very sure of what he was prescribing” ‘and yet 1 saw you talking with Stan and he was not so sure and he wanted to know what was going on. I want to make a point clear here. I was not sure at all what was going to be the outcome of such a case. We do not allow such experiments in Greece because of the Attorney General. In case something happens, the doctor who is in-charge of the case is going to run into trouble, whether he is a psychotherapist or not. If something happens to the patient or the patient dies, then he would run into big trouble because we had not hospitalized that individual. We are allowed two days at the most in such cases before they are taken to the hospital. And so my experience in such cases has been very limited.
Actually once or twice I found myself in a position to prescribe in such cases which were in very acute psychotic crisis. But here is another view of the whole matter.
Stan says that he has been through such cases two or three hundred times personally. His experience is very important. He described certain support that the patient needs, and then after they go through such a crisis they seem to come out stronger than before.
Stan : Under the right conditions of follow-up.
George ; This is a very interesting thing for us that we believe that the symptoms are exactly the means through which the organism tries to recover. So we leave the symptoms alone and the patient recovers. It would be interesting to understand the types of people he has worked with. So we do not much care to leave somebody 10 or 15 days in such a state – then we will have the time to prescribe and perhaps a crisis which might take one month may now take 15 days. This would be through homoeopathic prescribing. I will ask Stan to give us in a nut-shell the conditions under which he is doing thar and what type of people he is taking through such CRISES.
Stan : I’ll give some general background. Most psychiatrists or psychologists when they work with people who are psychotic only get a very small slice of the picture. The doctors get what is almost like a still picture. They go in, they do the intake, they make a diagnosis and it is almost a freezing in time of the symptomatology, the functionality and how the person relates. That is what most psychiatrists see first. Then they pull back and write their orders. Of course, they want to get rid of the symptoms and of course they ask the person to relate to them and of course they want the person to take care of themselves. They want all of this as fast as possible – that is the unspoken ground rule through which all psychosis is dealt with.
We have something called PSYCHOTROPICS which in a sense puts the patient in a biochemical straight jacket We can put a ceiling on the symptomatology to a certain extent. Sometimes we can even get the person to relate to us in a conditioned way – the way we want and train them to do.
Patients learn very quickly how to confess and admit their sickness and learn how to depend upon doctors to tell them what to do. As soon as we start a process in which we do not allow symptoms, we will also have to say, “Hey. I can tell you what is good for you.” And we tell them, “Here is what you have to do to get out of it.” Normally, for the first period of time, the individual looks much better. You give them the drugs and their symptoms appear better and they seem to relate. They are “good patients.”
What happens though is that statistically 98 per cent of the people walk out of that situation, they will not take that medication. “No Phenothiazine is the role of the streets.” It is the one drug that no one will take. You can’t even give it away. The answer is , “Keep going and push it.” That is the symptom reliever. Since they won’t take it, even if it did work, you would have to come down strong on everybody to do it. But there is some inner body wisdom in the 98 percent who will not touch the medication. They reject it.
This is a graph that was developed in the Agnews Project and verified with the double blind studies and subsequent program in 1967. You can take this in the three areas of functionality, symptomatology and interpersonal relationships.
So if you gave people medication and worked with them in the usual way, if they had a reasonably decent history, they would function.
Even if they had had a couple of hospitalizations up to the point of the firsr hospitalization they had done fairly well. Now I am not ralking of the childhood schizophrenia. I am talking about the person who functions okay from 13 to 16 years and from thereon in there was a break. If you got them early, you would find this happening: if you gave them the medication and the hospital routine of bringing them in fast and getting them out fast, the ones without the medication didn’t look nearly as good at that point. But then a really remarkable thing would happen.
If you look at them three to five years later, they will look worse on release for six months and then them is a cross-over point which is almost diametrically opposite. There are about 80 percent in that sample who would come back to the hospital and in time would be considered chronics. After the Agnews Project, I followed them in the Contra Costa Program. And I found that if they had gotten into this cycle of looking real good, they would tend to appear degenerated over this time. And what we never see is that long-term history.
What I want to relate to you is that the best experiences that I have had over the past 10-12 years is that the whole psychotic history of a variety of different people, with pre-morbid backgrounds in functionality … For example, B. is an example of a very exceptional pre-morbid. She has functioned well and the genetic family history is stable.
The mother was probably very depressed and suicidal, but by and large, B. has had a good history. Now she is one that is a prime candidate forgoing through this. She was in hospital during her first break. Five days later she got out and ripped. She pulled herself together, she was medicated and she went there. She was wobbly, but she didn’t look bad. If you had looked at her after she got out of the hospital you would say that she sure looked better after five days than she looks now after two weeks. But if you keep following it, you see those changes down the line. She was in the hospital in May. So there was that need to re-do the material that she did not get to do then. Rarely do we get this nice match of procedures. There is one process one way and here we are doing another process.
I think this is much more congruent to what you are saying in letting that process go. This is within a structure, however. It is a really tight structure. It does not look like that, but it is a matter of sitting and saying, ‘Okay, let yourself go.” But it is a structure in which we are dealing in both symbolic form – labelling the issues. So this is a crisis and it is not a degenerative process at all. She has reached a point in her life where she is unable to deal with what is usual any more in the same way, either consciously or unconsciously. The world is not any more predictable in that same old way. It is not working. I think that suicide was a real threat.
I think that the options were depressions, possible suicide because there had been suicide in the family, and I think that madness was a real alternative for her. That alternative in a sense precludes or prevents her from suicide. It is an option that negated the possibility of suicide. With her, it is almost too simple. With those roots, you can almost predict day by day what she is doing and what she is going to do. She is prime. She is easy. I can watch her and she is almost classically the someone who will go through the process, and I can tell almost to the day when she is going to start to stabilize and when she will tell you this and that, and when she will go in and out of it.
She went into the acute part and she went as far as she wanted to go with that. She lays out the single issues and during the acute phase those issues that she is going to deal with will be laid out. “Who am I” in relationship to mommy and daddy, and in the world as a woman, and as an individual person. The Jungians call it an individuation process. I think that is a good term. It is a key term to use -“How do I separate myself out?’
But at the same time you separate yourself out, you cannot deny those parts that are like your mommy and daddy. So with B., she would fit in this category 1. She is phase 1 of the acute phase of the process. She lays it out. It seems like a maniac stage, but it really isn’t. If you look at a true maniac, they don’t project and they don’t connect or have the identification or stay close. That is hard for them. But they don’t do the projections that well.
With B. you will see that she will connect with it and stay with it. So she is not a true maniac. Now a lot of times she would be diagnosed as maniac under usual conditions.
So, she looks a maniac and that is just phase I. If we were to continuously medicate her and continuously stop that process, we would start to see her emerging with paranoid elements. And so, oh boy, we can diagnose her as a paranoid schizophrenic, or as a true manic-depressive. She would continuously try to connect and would be told, “No, no, that is too extreme”, and stop. So you get this touch-go, touch-go, touch-go, like you will see most manic-depressives do. They don’t stay. There is a critical difference. So they gave Lith. and by and large interestingly enough I have seen enough people after one day come down through Lith.
We also gave placebos at one point and those people also came down. You learn that process and you learn to come down with it. There is a real effect with Lith. but again I think that years from now, and on down the line, we are going to find that it is another toxic substance. Everybody will disagree with me on that.
Comments : Not in this group.
George : This group, Shan, is a group that believes exactly what you are talking about. If we medicate a person, we are going to degenerate their abilities to heal themselves. That is why we are here. We give a remedy which stimulates and makes the individual worse FOR A WHILE, so that they go through the process quicker. This is the idea. It makes the crisis situation even stronger fora time, and then what we see is a recovery. This is EXACTLY THE SAME THING that you do by supporting the process with your group.
Stan: Exactly! Let me just give you the parallel. You would deal with it homoeopathically. I have what I call a treatment system. You may not like the word treatment, but I don’t play games. It is a program.
The way I will work with somebody is that I don’t just stay out of the way. In some ways I grease the skid so they go down in it further. I don’t want to stop the symptoms. I have a process in which I don‘t mind those symptom getting really more extreme. Let them get VERY extreme. You find that if you do the session right, and if you have good surrogates there that she can relate with what can be labelled mommy or daddy or whatever, the symptoms will get worse fora short time. Then you can pull back and she will integrate some more material. So the things I do in terms of interacting is a certain kind of exacerbation and increase in symptoms.
George : What we do is to let hundreds of patients like that going through such a crisis and we do not know exactly what is going to happen. I have never seen somebody left to go through that state in the way they need to. So what we would actually like to hear from you is what types of people are manageable with this kind of approach and to what extent can you go, and with what kind of people. That is what we would like to hear.
Stan : Okay, let me give you a description.
George: You said before, for instance, that the real manic-depressive is one who does not relate at all. Now if you have a case like that, would you follow the same procedure ?
Stan : Up to six weeks is the emount of time that I am willing to give that person. Basically what I am doing is that when I look at the history of the person and they have not had neurosurgery or shock – those are two major crippling procedures that I do not think you can reverse the effect of. Question : Are you talking about ECT?
Sten : Yes. If they have had ECT at certain developmental periods of their lives, that is almost the most important point … there are developmental crises in which you are more or less open during the course of your lives.
At certain developmental points in this person’s hie if they were given ECT a lot, they will never come together. At that critical period, anyone who has had 15-20 shocks, they will never come together. I have had maybe a couple of dozen that I have tried to work with. They almost get closure and then they pop. I don’t know what goes on. There is some major damage done if they have had shock treatments at certain critical periods in their life.
There was a 17 year old honors student brought into Langley-Porter. I got her a year down the line. She had been pregnant. She was in an Irish Catholic family. She had had a break. They aborted her and shocked her. A year down the line she was capable of functioning with minimal tasks and maximal supervisions. That was what was expected and that was what happened one year later. That was as far as she got. I worked with her for almost a year and she didn’t do much better. There was a permanent lockin. Except for those situations, if I have anybody … let me give you who we can work with.
Question : Do you feel that if you had gotten her before the …
Stan : Oh, she would have been easy. Somebody that has been functioning that well up to 17 years old and then they have a break, almost routinely I would take 95 percent of those people through, do the follow-up for a year, and do the family work as well. We would never have to see them after that. If they make the year to year and a half, there will be a lot of fluidity. That is part of the reconstitution phase. They would make it at that point. They would be home free.
Question : Do you follow the work of anybody else in particular ?
Stan: No, I don’t have a place where people are encouraged to be crazy and produce a mad house. That is not where l am. I believe in functioning in the world. I believe in one’s ability to manipulate the world for one’s needs and that you have to learn that.
I believe that in the acute phase, you deal with a lot of inter-psychic and inter-personal issues have to do with relationships, intimacy, nourishment and functioning and then you start to stabilize and deal with how you want to be and can be in the world. You can manipulate it to your own end. One of the biggest problems that we have now, is that we have professional mental health which may even take the first phase. but then rhar stick them in the resident phase where they learn to be crazy in-house.
George : I would like to know how many of your patients reach a catatonic state, where they just go rigid. What are you going to do then?That is okay, hut they don’t provide a work-out outlet or training. In the people that [ have, within 3 months after the acute phase, you had bloody well better be in training in a program in which you are not being treated as a mental patient. I don’t believe in that. Go it any way you want, but function in the world and be there.
Stan: By and large we get people who … we get two kinds of people who are catatonic. These are people who have been coming into it for a long time. They may be in the house fora year or so. They pull back from school … please interrupt me if I am not clear. I am used to working rather than describing.
George : You were saying about the catatonic states.
Stan: Usually they have started to pull back early. We get them after they have pulled back a year or two in the home. They have been allowed to withdraw from school and the family has protected them. There are a lot more of those people than we want to realize who are being held in homes now. I got a chance to really look at that at Turlock.
This Turlock is in Central California and it is a farming community near Modesto in Contra Costa County. There is a real hostility towards hospitals and any sort of program. So they were put to work and told that they could talk to the wind. If they wanted to as long as they could splice right or hoe right. So I saw a lot of people being dealt with in the homes, but a lot of the catatonic that we see in the hospital is only a fraction of what is being held in the homes. They usually have a history of building up to that and it is interesting.
The second group of catatonic that 1 see are those that go through a lot of phases. They are initially very active or paranoid. They almost give up in a sense. The second group almost gives up and regresses. This is a regressive catatonic. With them you have the best prognosis. You can bottle feed them, wash them and like that and they will come out if you are really careful about nourishing them and seeing that they do not get into a catatonic exhaustion. But they will come out. That is the reressive catatonic.
There is another brand of catatonic that I have no magical insight to, but there they are. They just lie there. You can give them all you have and anything that they might want, but they will just lie there. I have had mixed success with this group.
Question : What is their history ?
Stan : Most of those people have had multiple breaks in homes in which they were protected. But then they have been dumped back and forth. If we found one word which can characterize their stance with the world, it is the word “NO!” There is extreme stiffness. So your success lies in just being there and making sure that they don’t die. In some cases they have gone on in this state for four to five months.
George : Four or five months in that state? You are talking about feeding them with a bottle and taking care of them?
Stan: And every day somebody is connecting with them and checking in with them and being there in whatever way.
We have had really good success that way with those people. They have come out. They come out angry – totally angry. And they take the longest time. Those people, if you can work with them in a program for six months, will come out. Almost everyone I have had has come out when worked with in this way. I have seen two Wilsons – it mimics catatonic – but they were not diagnosed that way. A psychic told me.
Question: You say that they had Wilson’s?
Stan : Yes, I had a full time psychic working at Turlock. They can point to something going on at a point in the body and say that there is a storage of copper. I had then checked out at Stanford too, but we don’t talk about that stuff. The catatonias are really the most difficult because in some ways they are further along.
I don’t believe that people begin off catatonia, they are usually active and you have to beat them at it. I saw a 17-year-old boy become catatonic. I watched that progress in a program. People would start dragging on him and say,”Hey, wake up, wake up!” I watched him close down, down, down. The system closes down. Julius Silverman has done some of the work in evoked response and some of the reducers who do not take the stimulation well. The system closes down when there is more input. These are more vulnerable to the catatonias. I am not sure.
There is usually a history of someone having become disgusted with them and gotten rid of them. They are trying to hold on until they can get back. Family work is absolutely critical with them. When I say “surrogate work”, every person who comes into the program recreates the nuclear family system. It may be a wife or a mother-father relationship, but they recreate it. When l say “surrogate”, I mean that they pick the family system that makes sense to them and you let that happen. You provide that structure. You let them draw you in and allow them to project that thing that they need to. You work in surrogate, but then you also interject thereat family if it is available. It is a very powerful interacting back and forth.
We are doing that with B. now. Her sisters are up here. We will have all of the parts of the family together by the weekend. There are some very powerful things going on with her. She did a lot of stuff with her father and has become a father lover. She really lays it out there. Dad came in and that is how he was relating to her. He was really letting himself do that with his three daughters.
George : I would like to ask you something. There are some things with epileptics which are quite advanced. You get psychotic symptoms. Have you ever worked with epileptics and have you let them go through a crisis?
Stan : I have never seen someone who was very psychotic become epileptic.
George : Yes, this is a completely different group that I am talking about now in the epileptics. I am asking you if you have had any experience with them.
Stan : Not really.
George : They can have a grand mal which can go into a sort of catatonia.
Stan : If they come into catatonia, then I have worked with them and have not known about the epilepsy. I get them AFTER the doctor has said, “Hey, this guy is really catatonia.”
George : Yes, the epileptics are much more easy to manage because all of them have contact. But if they go into a crisis, it will last five or ten minutes, and then they will come out of it. Sometimes they will go into a deep crisis and just stay there. Usually such cases are hospitalized and I do not know how long they stay in that condition.
I would like to know if you have had experience without their being hospitalized and drugs being given.
Stan : I get them if they have been epileptic and have not come out of it I get that group, but they have already had Dilantin and Phenobarbital and all that stuff. They have already had all that and they have not come out of it. When I get them they are usually diagnosed as catatonic. So I discontinue all of these medicines and work along with that. I have maybe had a dozen of those.
I followed about four people who had a seizure history. They had no history after that. Somehow-it is too small a number to say-but the ones than have seen haven’t become epileptic afterwards. This is a sort of check mark in my mind that I do not know the meaning of yet.
Question : But do they recover?
Stan : Oh yes. Regardless of what state. If I have a catatonic, as long as I can keep them alive, 1 will find a way to reach them, one way or another. T har system is re-doing itself. There is an active process going on inside that person. It is not static. It is not, “Klunk!” I don’t even know any more what chronicity means, except with some of the people who are given shock treatment or brain surgery. I feel that even the so-called ” burned out’ 30 year Menlo Park, Veterans ‘Hospital patient, who has been shoved into a house with a check book that has to have five signatures on it and who have been told that they are not going to get better, can get better. He has been in this process for thirty years and he will just sit there, after this, afraid that he is going to die. There are 8 houses in the Peninsula that you cannot find. They are unknown. They are full of people who were pulled out of Menlo Park. They have janitorial services, cooks and it is a very closed corporation. They are functioning in these houses. They need the stimulus of a kind of encounter with the projected images. It is part of the system. They have an encounter with that image. You have the mechanism for starting to feed back. In a sense, they reconstitute themselves. We just provide the structure for them to hit off of. Sometimes people get stuck and we get uncomfortable and we push a little. People redo this internal structure.
Then you have people with good histories. They have done well in their history up until the time of the break and you have them early on. You have gotten them after a short period in the hospital or maybe even a couple of years. We have gotten them in and have been able to do the follow-up. You can’t detach the follow-up from the work itself. It has to be. I try to do the network as well. If I can do that, between 70 and 90 percent of those people don’t come back. They really stay out there.
George : Can they work ?
Stan : They can work and they do not need to be in a mental health system. They are not professional patients. If I had those conditions for that group of people, comprising anywhere between 15 and 20 percent of the population that come into the hospital, then 1 could work with them. Part of my system is to try to get them as early as possible. People with childhood histories we were MUCH LESS successful with. There are people who have a history as far back as the person can remember of not being able to relate, not being able to function in school and so the symptoms went a long time.
It is the same with an autistic child. We are just beginning to get some sense there.
Question: Do many of these people get physical illness? Particularly in the years following the major mental crisis.
Stan : I never saw a healthier bunch. Sometimes they will go up to seven days straight without eating, they are exposed to everything, they don’t exercise and yet they are a healthy bunch of people.
George Yes, they are very healthy while they have the crisis, but later they get stomach troubles or liver troubles or arthritis or any other chronic disease.
Stan : In Contra Costa I had the records – the medical psychiatric records – of about 150 people. These were actually taken from one to three years later. I don’t see any major physical problems. They had run off the mill stuff. That is a few hundred people.
Question : Did I understand you to say that if you have somebody in a crisis like this and you can work with them for up to six weeks, they should be showing signs of improvement within that time or, on the other hand, if they were not improving in that period of time then …
Stan : I have learned not to count time. People are really different. B. is easy and so she will be in a 3-4 week person. She has a fairly clean history and she will be easy. That is the acute part of it. She is still very shaky underneath and will be almost a year later. You can’t ignore that. That is why I keep emphasizing the follow-through work.
Question: What are the man-power needs and the cost-effectiveness of such an approach? I agree that it cannot be measured in dollars and cents, but how many people and how much time is involved?
Stan : That is a question that I have to deal with all of the time. A hospital bed costs between 5300 and $400 per day these days. You have to understand that a psychiatric hospital absorbs the costs so that each department gets a fair share of all the costs – surgery, laboratory, medical records and all of that.
Dick:. Stan, let me just give the figure here in Community Hospital in Carmel. I think it is $250 per day, as opposed to a half-way house which is $37 per day.
Stan : That is not acute work.
Dick: No, he is beginning to do acute work.
Stan : To do the acute work, even to do it optimally, like we are doing it here, you could do it for maybe $ 80 to S 100 per day. Again, we do not throw a lot of money into bricks and mortar. I have three modes. I will put the money into a team, including a family practice doctor, and a 24 hour team of about six people and ,o right into the home and work there. That is if it is appropriate. If I can use a residence of four to six beds, then it is even easier. At any rate, the costs do not run anywhere near that S 300 figure. And thar is better care than you will EVER get. I am talking about 24 hour care.
Question : Can you also describe that cost in terms of the length of time that it takes before the person is functional ?
Stan : Do you mean comparatively ?
Answer : Yes, I realize that after a year or two that things cross over and start getting better.
Stan : Well, I could give you the figures that we had at Contra Costa, but that is really not true everywhere.
Dick : In terms of cost-effectiveness, the biggest thing is hospitalization.
Stan : If you take a six month period, the hospital works better. For a short period, a hospital almost works better. 95 percent of the people hospitalized never get follow-up. So for short term people it appears almost cheaper. But after six months it drops dramatically. This is the cost per day of working after the acute phase. Over that period it starts to drop down to a third of the cost of hospitalization and re-hospitalization. You can predict re-hospitalization and within a year they will be coming back. If you take a three year period, which is the only way to take it, it is about 40-60 percent of what it would do to go back and forth.
Question : How many patients are you able to work with at a time ?
Stan : In acute care per 50,000 population, you will need 10 beds. In a county with 100,000 people, if you have 10 beds and 10 teams for the acute phase, that would cover it.
Question : Would that be 10 teams of 6 people each ?
Stan : No, some teams would not need to be present 24 hours. I can usually do 6 teams for 24 hour care. With 10 beds, I have found that I do not need to turn anybody away and can do the other short-term crisis work. I can take 60-70 percent of the people who would ordinarily go into a hospital for long term care.
In 72 hours I can parcel out the drug-related stuff, the short crisis experience stuff where people will come down quickly. Those constitute 60-70 percent of what are called acute breaks.
Question : What is the size of your staff for 10 beds ?
Stan: About 18 people for full 24 hour coverage and the acute teams.
Question : These are 18 trained psychologists?
Stan : No, they are not. There is no training in this country that prepares people to deal with this kind of crises, the kind of acute emergencies. There is no training. General purpose psychiatry does not prepare people to do this. It took a year for me to develop what was needed. Whatever your credentials are, if you are willing to come in and to do the work, it takes a year of extra treining. If you are not stuck in your professionalism to learn how to do this kind of work. A year. It is really hard because most people think that they have been trained when they receive their degree. Everybody begins right at the beginning. It is a speciality unto itself. That has been my experience. Even with the speciality, people who deal with the acute phase are not necessarily good in the follow-through part.
Question : How long do you usually work with people? I know that there must be wide variations, but could you give us an average length of time?
Stan : The range is from 3 days to 6 months.
Question : But afterwards, what does your follow-up consist of?
Stan : Okay, first there is part of the team that is working in the acute phase. With B. I called the county and got someone to do the follow-up work. He will assign someone to her to be part of the acute phase. They will follow that person outside. I hate to use the term “continuing care”, but that is the nomenclature of the speciality. A good continuing care worker who has a small case load for these people is available almost 24 hours at first. Believe me they do not get abused if they have connected in the hospital, or in the acute situation. Initially the person is going to he very shaky and you will need periods of time when it is okay to have a member of the team sleep in the person’s house or have that person come in overnight. For the first 6-8 months you are going to be fairly available to go out or have them come in, but you have to be persistent. Then it drops back. Usually I have found that 6-8 months later they will ask the people not to call them up. They will call.
Question : Are you getting any recognition from the state or other psychiatrists ?
Stan : Oh yes. Let me tell you what I was also involved with. Two bills: The Bates which is the State Mental Health Alternatives Act, and the Kennedy Waxman bill, both which have been passed. So there is money and recognition at this point. I am almost scared that it is recognized because I am afraid that it is going to end up becoming a folklore because the data does not stand behind it at this point.
We don’t want hospitals. We have another axiom. Every time when I hear an axiom I break it. No hospitals, please. So there is recognition and there is a growing kind of concern that we are overusing medications.
Incidentally, I have copies of the Willie Brown report on medication use in the state and I-ward statistics. These are mentioned as good alternatives. There is a whole study on that. It is really becoming kind of recognized that we are on a track which is presently reaching a dead end. All of you had a lot of experience, so correct me if you had other experiences than what I am describing. I think the field has reached a dead end in the psychotropics. I ran a ward that was abetter program than almost any around, and that was a hospital.
Question : What would you say are the most dangerous kind of patients to not bring into a hospital ?
Stan : People who confuse the symbolic for the real. I am willing to use medication on because l don’t know enough yet. Traditionally one of the problems with allowing this process to go on is that people will not deal with aggressive behavior. It is the same problem everywhere. A person can act seductively or a lot of different ways and that is okay, but you can’t act aggressively. There is the great big guy who is in a rage and that is frightening. If a person is completely out of control I am going to sey “uncle” and use medicetion if I do not have the wherewithal to provide safety – physical safety – to that person and the people eround him. I am going to use what I have to put a lid on that until I can get lnformation. That is a real danger because sometimes something comes out that we can’t deal with and l don’t want anybody to get hurt so we have to put a lid on it. May be the next time they won’t act things out this way. I don’t know. It is physical damage that we are really careful of. That usually happens when the patient takes the symbol and acts as if it was real. When a person projects… when B. projects sexually onto somebody, I don’t want to follow through on that. Don’t fall into that and reify that. Don’t make it real. The person will stop at that point and won’t be safe any more. That is a major situation where there is a physical chance that that symbol is real and we stop it.
George : Thank you very much for coming.
Sten : Becky has been working with mc. Give Becky sometime. This is the first time we have worked together.
Becky : Mostly I think what I provide in the situation is a female who does not back off from B. or Stan or the family. Our work styles are compatible. He is very aggressive and he is comfortable with that. B. is getting into the process that I think you talked of today. She is really examining suicide and her alternatives. Going crazy I think was a way of avoiding the decisions. She has been talking about that kind of issue today.
Question : She was looking good, so to speak for a while?
George : Yes, as they come out from the crisis, usually they consider these possibilities.
Becky I feel that we are past that at this point. The fact that she is able to be clear enough with her own process and how painful life had been is valuable. In fact today she said … she is concerned about her son and it is not clear why he killed himself.., but what is relevant is that she was feeling guilty and was talking about letting go of that. She said, “I don’t want to be a masochist”. That is a very clear statement Stan : I am not so worried about suicide in her case.
George : You would let her go by herself? Stan : Right now ?
George : Yes. Even after a month or two ?
Stan : Sure.
Question : Are there any suicide risks in this group – significantly ?
Stan : In 12 years I have had one suicide in a person who had had a long history. They had taken a car with a woman, jammed the accelerator down, aimed it at a pole, and I got that person after they had hit the pole. So there was a whole history of that kind of behavior. That was the only one I had in 12 years.
Question : No attempts ?
Stan : Yes. There was a psychotic depression which she didn’t get into. I think homoeopathic approach has a lot of relevance in psychotic depression. In some ways it feels like we could do something different there. They are the toughest to work with. They are depressed. They are psychotic, and they are acting out.
George : We can do a lot as long as the person is not medicated. With homoeopathy, we can shorten the periods they are being involved in.
Becky: I want to say to Stan that the most exciting thing for me about his work is that he helps the whole family to do this. The family becomes a client-system. I saw him doing a lot of prevention work with the two sisters today. There was a 70-year-old father who is about to get married again. So he was touching several systems – four other systems – in the way in which he has been working. So that has been exciting and I have enjoyed that a lot.
George: Thank you very much for coming.