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The Book:
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    The Price of Prozac
    Healing in a Time of Terror
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Healing The Soul in the Age of the Brain
Becoming Conscious in an Unconscious World

by Elio Frattaroli, M.D.

Why did you feel the need to write this book? What’s the book about?

I believe that psychiatry today is in a state of crisis and that it’s contributing to a larger crisis in American culture. Both in psychiatry and in society generally, we’re driven by the dehumanizing values of materialism and the quick fix. We’re focusing on superficials and externals—what I call the needs of the brain—and we’re ignoring the inner life of the emotions, the needs of the soul. Our culture encourages us to believe we should be happy all the time and so we have very little tolerance for emotional pain. When we do feel painful or disturbing emotions, we consider this abnormal and our first reaction is to look for a quick fix to get rid of the pain. That’s why we’re so preoccupied with materialism and with external things, and that’s why we have such a huge problem with addictions in our society. We pursue material possessions, physical appearances, creature comforts and addictive pleasures and we use these things as quick fixes, to get rid of emotional distress and distract us from our deeper emotional and spiritual needs.

How does psychiatry contribute to this cultural problem?

Psychiatry today is about pills rather than persons. It used to be that psychiatrists understood mental illness as an emotional problem and thought of treatment as a working through of emotional conflicts. Now they treat mental illness as a chemical imbalance or a glitch in the patient’s brain wiring—something without any particular personal meaning. So they are no longer interested in listening to their patients’ stories or understanding their disturbing emotions. They only want to get enough information to make a diagnosis and prescribe the right pill to make the disturbing emotions go away.

Why is that a problem? Isn’t it natural to want to get rid of disturbing emotions?

Yes it’s natural, but it’s a really bad idea. Disturbing emotions like anxiety and depression are not something we should be trying to get rid of but something we should be paying attention to and trying to learn from. They are emotional warning signals, messages from our unconscious that something is out of balance in our lives. When we feel anxiety we are anxious about something. When we are depressed we are depressed about something. So trying to medicate these emotions away is really a form of denial, treating our emotions as if they were meaningless chemical imbalances that are not about anything.

So you’re saying it’s not a good idea to take medication for anxiety and depression?

No, I’m saying it’s a mistake to think that medication is all that’s needed. When the distress of anxiety or depression becomes unbearable, it’s good to be able to relieve it with medication, but the medication doesn’t touch the underlying problem that’s making us anxious or depressed. Anxiety and depression are reactions to an emotional conflict, about a family problem, for instance, or a relationship problem, or a work problem, or a traumatic experience. If I ignore this inner conflict and treat your symptom with medication alone it might help you feel better today, but the deeper emotional problem doesn’t go away and it can surface in more serious ways later.

But is it always true that “medication isn’t enough”? Aren’t there some people who do just fine on medication without therapy?

The important thing to realize is that the goal in using medication is different from the goal of psychotherapy. What medication does is stabilize us, make it easier for us to function normally, to get back to the way we were before we got sick. With psychotherapy the idea is that we wouldn’t have gotten sick in the first place unless there was a problem with the way we were, something out of balance in our life. In that sense, the mental illness is actually expressing our need for change and growth. Medication quiets that need and helps us stay the same, whereas psychotherapy pays attention to that need and helps us grow.

What do you mean by “healing the soul”?

“Healing the soul” is the root meaning of the word “psychiatry.” To me it means that mental illness is not just a chemical problem. It’s a personal problem---an emotional disturbance of the self or soul---that needs to be resolved through an emotional healing process, as in psychotherapy.

Healing the soul means making whole the divided self, resolving inner conflict to become a more integrated and actualized person. We all have a disturbing part of our emotional life that we would rather not know about---an unconscious “dark side” that evokes anxiety, shame or guilt, and that we try to deny, suppress or ignore. Healing the soul means becoming conscious of this dark side, taking responsibility for our deeper desires, hates, fears and values. The healing is a process of getting in touch with what we really feel---allowing ourselves to experience and accept our disturbing emotions without needing to get rid of them but also without needing to act on them. In doing so, we reclaim the vital energy of our dark side and become more fully ourselves.

You talk about symptoms as part of the healing process—what does that mean?

When we’re unconscious, in a state of inner conflict, we tend to be driven by the passions and prejudices of our dark side without being aware of it and this leads to patterns of behavior that create unhappiness and cause problems for others but that we’re not really in control of. A mental illness or breakdown interrupts these patterns of acting and reacting – it immobilizes us -- and forces us to pay more attention to what we’re feeling.

One of the best examples I can think of is fictional, but very much on the mark: Tony Soprano. He is torn by inner conflict, wanting to be a good person and a loving husband and father, but driven to pursue the power and pleasure of being a Mafia boss. These two goals are totally incompatible and Tony’s symptoms are trying to tell him that. By immobilizing him they make it more difficult for him to continue killing and exploiting people and cheating on his wife. They force him to pay more attention to what he really feels: his hatred and fear for his father, mother, and uncle who molded him into a Mafia boss, and his desire to be a better person. For Tony it would definitely not be a good thing if Prozac worked to take away his symptoms. Depression and panic attacks are the best thing that could possibly happen to him.

Describe what you believe to be the most important things a therapist can do to effectively help his patients.

The most important foundation for all effective psychotherapy is that the therapist recognizes his or her common humanity with the patient. We call this empathy or compassion, but it means simply that the therapist accepts the patient without judging him because he can imagine himself in the patient’s shoes. This was a lesson I learned first from Bruno Bettelheim, who taught his students that when we didn’t understand what a patient was doing or feeling, we should ask ourselves “Under what conditions would I act and feel exactly that way?” This serves as a reminder that the patient’s disturbing symptoms and behavior, however abnormal they may seem, are expressions of the human condition—reactions to powerful emotions and traumatic relationships—that any of us could potentially experience. And this is true even if there is a chemical imbalance involved.

Many psychiatric patients are going to be reading your book. What’s the main message you hope they will take from it?

My first message is that patients deserve to be listened to, to be taken seriously. It just isn’t good enough to be given a pill, have a twenty-minute appointment, and be told to come back in a month for another twenty-minute appointment. Even when the pill does relieve your symptom, it may do so by making it easier to ignore the deeper problem that caused the symptom, which is generally not such a good idea.

And that’s related to my second message to patients: that symptoms and disturbing emotions aren’t just a bad thing that is happening to us. They have an important positive function. They are human nature’s way of forcing us to stop and pay more attention to what’s out of balance in our lives. So what looks and feels on the surface like an illness or a breakdown is at a deeper level the beginning of a healing process.

This is really a message of hope. If you have a mental illness, you don’t just have a chemical imbalance. Your suffering has important emotional meaning. If you’re not being helped to understand what your suffering is about, then you’re not getting adequate treatment.

Questions regarding therapy, Healing the Soul, and chemical imbalance