The Helping Relationship: Healing and Change in Community Context

VI. The Medical Model of Psychotherapy: In Historical Perspective

130 One usually goes to a doctor when one is sick. That has been true for time immemorial. Hua T’o was, according to the annals of the later Han Dynasty, an excellent Chinese surgeon who practised around 220 AD. He possibly used opium dissolved in wine as his anaesthetic. Western medicine was introduced to China in the early 17th century, while Emperors Fu Hsi, Shen Nung, and Huang Ti were said to have founded the art of healing long before. Tao—the method of maintaining harmony between this world and the beyond—was subdivided into heaven, earth, and man. The psyche or maintenance of one’s ability to see this harmonization was probably the closest the Chinese came to the modern concept of psychotherapy. When one, as a doctor, orchestrated this harmonization process, one assumed the “Mantle of the Healer,” according to my old teacher, Dr. Sarwer-Foner. As a young resident, this was the mantle that I proudly bore. I was the provider of care, the modern medical therapist . I wasn’t aware that this could simply be seen from the point of view that this mantle was a herb with a wide range of uses, from bleeding to dysentery, due to tannins contained in the plant. Or, more esoterically, the reference was to the doctor, assuming upon graduation some power or other that influenced the healing relationship. VI The Medical Model of Psychotherapy: In Historical Perspective John Dimock, MD Dimock 131 With the modern preference for health care to be a teamwork concept, the Mantle of the Healer would simply place the physician as leader of the team. The mantle begins to tarnish when considering the economic constraints on medicine today, which, certainly in the United States and increasingly here in Canada, would place leadership in the hands of the economic provider (government or insurance company usually). Another blow is firmly laid by development of the Internet, which gives patients the knowledge to increasingly challenge the health care provider, which, in my opinion, is a healthy development. Yet another salvo of blows comes from the increasing diversity of opinions about the healing process, with the insistence that healing be a quick and cheap process. Internet sites packed full of information, particularly in specialty areas such as psychiatry, create great pressure. Much of psychiatry is very subjective and based upon years of experience. In a culture dominated by the impulsive, quick fix mentality, experience tends more and more to count for little. The old “father image” is under attack, particularly when traditional marriages break up in 50% of cases and relationships are based on shorter periods of time. Hence, the experienced father is passé, and the impulsive, toothy-grinning bearer of instant relief is “in.” This, in my opinion, is related to a more paranoid element of society— after all, the guy next to you on the subway may suddenly explode! Hence, the best solutions to one’s problems come from oneself, and the toothy-grinned is second best if you can’t seem to find that nirvana on the net. The traditional psychotherapist is under attack. Yet there are many who still seek out therapy. Waiting lists only get longer. There is an explosion, probably also related to the information highway, of knowledge of that which affects the “Tao.” The physician has the edge in this scramble for help, not necessarily because of traditional turning to the healer processes, although tradition plays a large role. In Canada, the support of government in terms of universal health schemes has, at least so far, meant that the 132 Medical Model of Psychotherapy availability, albeit after a long wait, of free therapy from a psychiatrist has placed the physician in many people’s eyes as the person to seek for therapy. However, that cannot last forever, as more clamour for therapy and fewer psychiatrists are trained since the training is so expensive. Rumours abound about the imminent limitation on the number of therapy sessions, as is already done by managed care in the United States. Indeed, the psychiatrist has largely become either a consultant or a “med checker”—15 minutes are billed as the psychiatrist assesses the effectiveness of medication and side effects thereof and makes adjustments based on these rushed observations. Repeated four times an hour for 8 hours a day, this is far removed from the hour-a-day therapy sessions of traditional psychoanalysis—from 8...