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Gary Schouborg, PhD
"Review: Healing the Soul in the Age of the Brain,
Journal of Consciousness Studies, 9(8), 92-93.
In the waning summer of 1976, I found myself alone in Monterrey, Mexico unable to speak Spanish, seeking directions from a man who spoke little English. Whenever he could not understand me, I would in spite of myself bug out my eyes and repeat myself more loudly, as if I could somehow force understanding into him. The long, tired debate between humanism and scientism is often like that, each side trying to communicate its view without learning the other's language. Healing the Soul is like that, a parochial book that only preaches to the psychoanalytic choir against psychiatrists who lean more toward prescribing medication than providing talk therapy.
This is a dispiritingly muddled book, though its thesis is fair enough: psychiatry is currently dominated by a Medical Model that leads psychiatrists to treat patients too quickly with pills rather than spend time exploring how their behavior and thinking might have contributed to their suffering. Frattaroli acknowledges that pills have their place, but he argues that they are unable to give what people fully need, an integrating awareness of their thinking and feeling. For this he offers his Psychotherapeutic Model. Unfortunately, he fails in at least four ways to counter the Medical Model effectively: he conflates clinical and ontological issues; he inadequately supports his thesis that long-term psychotherapy is more effective than medication; he is unclear about the relationship of psychotherapy to other alternatives to the Medical Model; and although he acknowledges the economic pressures that motivate psychiatry to prefer the quick fix of medication over the longer and more expensive intervention of psychotherapy, he fails to address them.
Frattaroli repeatedly confuses the clinical issue of what causes mental dysfunction with the philosophical one of reductionism: whether conscious experience can be understood completely in reference to brain states. He is rightly concerned that viewing all mental problems as organic, and therefore treatable simply by medication, overlooks how psychological and behavioral processes contribute to mental problems. However, the way to address this oversight is not to refute reductionism but to refrain from oversimplifying the clinical account of depression. Reducing depression simply to mood because one has pills that can elevate mood fails to address depression in all of its organic, behavioral, and psychological complexity. That is the clinical issue that Frattaroli rightly wants to address but fails to do so adequately, in part because he distracts himself and his readers with his concerns about reductionism.
To counter the Medical Model, then, we cannot, for example, irrelevantly condemn using Prozac as a reductionist's method to elevate moods. Nor can we simply show that there are also behavioral and psychological methods that elevate mood. We must identify the relationship between elevated mood and depression. Knowing that Prozac elevates mood, we can then determine Prozac's effect on depression. It is likely that under some conditions mood affects thinking and under other conditions thinking affects mood. In the latter case, prescribing Prozac to elevate mood will not affect the thinking and therefore will not cure the depression. It will be as Frattaroli says, attacking only the symptom and not the cause. But in the other case, prescribing Prozac does address the root cause, a brain condition that causes negative mood which in turn causes depressive thinking. In that case, it is psychoanalysis that is treating the symptom and not the cause. Frattaroli does nothing to help us determine which causal sequence is operating under what conditions.
Buried in his philosophical and psychoanalytic speculations is one important empirical claim, that medication is more effective than psychotherapy in the short term but not the long term (pp. 159-160). The reference cries out for further analysis to establish its precise implications, but Frattaroli simply takes it as unqualified confirmation of his Psychotherapeutic Model. Furthermore, that model is itself unclear. Early on, Frattaroli says that to achieve the goal of integrating thought and feeling into consciousness, psychoanalysis is more comprehensive and effective than any other therapy or spiritual method, including meditation (p. 78). Yet he later claims that all roads lead to that goal, distinguishing psychoanalysis from meditation in that the former focuses initially on the content of one's thoughts and feelings only finally to give them up to the "inner presence" of the "inner observer", to which meditation leads directly (pp. 350-351).
Healing the Soul is not without its occasional insights. However, in order to find them the reader must trudge through the conceptual tangle that Frattaroli unnecessarily creates. Doing so is probably not worth the effort for most readers, especially since the insights have been expressed more clearly and cogently elsewhere.