There seems to be something in the human condition that searches for the answer and the solution. Somehow finding the answer becomes more important than what drives one’s efforts. Is learning a process or a product? Intentions may be laudatory but “side effect” may be worse than the original problem. Much scientific effort is based on extreme reductionism, a search for the smallest unit. The assumption is that a “cure” will follow this “discovery”. As a result, more and more drugs are “discovered” and marketed and then demanded by the public. Again, the assumption is that the newer drug is better than the old one (e.g., Ambien vs. trazodone).
An important question is how does one think about major problems, such as emotional problems. Do solutions come from the environment (e.g., more and better medicines)? Will one’s efforts be aimed toward the cure answer or on the management process? Is DSM-IV “better” than DSM-I? Is mental illness “like any other disease”?*
How will one direct one’s efforts? Are principles involved? Dr. Bowen’s letter of May 1970 is a response to one inquiring about a certain family therapist who was both thinking and practicing differently. The assumption of the writer is that dead-end alleys are a bad thing. Dr. Bowen’s response reflects on his thinking and beliefs about thinking about major emotional problems and therapy issues.
* See Norton Hadler’s The Last Well Person, which reviews the scientific evidence behind many current medical practices.
This family world is more disorganized now then ever, with therapists going in all kinds of different directions. The “encounter” and “marathon” movement, which I consider regressive, has taken over many of the well known family centers. I do know that my people from Georgetown and MCV stand out in a group by themselves in any of these gatherings. I went into the NIMH projects with a fairly well defined hypothesis which was extended into a concept by the time that ended. Over the years I have added other concepts which by now make up the general framework of a theory which I think will stand pretty well, at least until something better comes along. The central core of the original concept still stands, not much modified, but the interlocking concepts have been defined and redefined several times since then. When I became completely inundated with practice, I begin training which has been my central effort for some years now. The main gratification from that comes in an ability to help young men master as much in 2 or 3 years as it took me 15 years to grasp. So, I have a bunch of promising young colts who have been carefully chosen and who I hope can advance the ball farther than was possible for me. Thats my goal for now. I am far from ready to fold. It is simply that the job is too big for any one man effort and one needs more people seriously working in several different areas. In the meanwhile, the central body of psychiatry has not yet really accepted the “family” idea and it may be a couple of more decades before family is really accepted by a significant percentage of psychiatrists. What the hell. I will keep on trying. Social institutions change slowly.
It sounds as if you have had the most satisfying experience with Dr. of any in your long experience with a fair sample of what psychiatry has to offer. When one has a profitable working situation on emotional problems, I think its unwise to to start shifting about for something perfect. Psychiatry is too young and there are no single answers for anything. Personally, I think there will never be answers that simple, but who knows what the world will be like in the far distant future. For now, the “right” answer is the one that works and the “wrong” answer is the one that did not work. There is no way of going that does not have both advantages and disadvantages. One estimates the percentages and tries to watch for the disadvantages. You spoke of the wasted time and wasted energy and the blind alleys one encounters in an effort to change. I have spent more time in blind alleys looking for the main road than I ever spend going forward. I wish one had percentage figures on those who spend their entire lives without ever changing. I suspect the figure is higher than we would want to admit. How do you know that any change noticed in the past ten years could not be accounted for by the fact that we are ten years older? No one has ever answered that question. Any answer is no more than impressionistic. The only answer I have ever found for the “blind alley” problem has been to try to find some way to have fun in the “blind alleys”. At least it is not a total loss.
I am glad you are concerned about the terrible state of the world today. Without plenty of people to do the worrying, we might go to “pot” faster. If we’d all get behind the thing and worry more, maybe we could find an answer quicker. Personally, I am not too concerned about the future of the nation and the republic. I would go along with the notion that the “young” probably have the answers but I would not go along with the notion that the loud mouthed dissidents have the answers. I think the thoughtful, serious youngsters are the ones just as the thoughtful serious ones had the answers for 50 or 100 years ago. I have a lot to say about this whole issue but I would go too far if I opened that subject. There is one big difference between the loud mouths now and the loud mouths of a generation or two ago. Fifty years ago there were the same kids who acted as if they knew everything except the adults considered the irresponsible part of it as the foolish antics of those not yet dry behind the ears. Now for some reason, the adults (who probably have less book education) listen seriously to the irresponsible loud mouthing. The absolute smartest I ever was in my entire life was the year I graduated from high school. I couldn’t convince others that I had all the answers but I secretly knew it. The next smartest stage in my life was the year I graduated from medical school. There was not a single subject in all medicine that I could not discuss like an expert. Since then I have been getting stupider and stupider every year. The more I learn the more I find I do not know. If this keeps up, I will end this like not knowing anything, ready to turn it over to the kids who know they know it and the parents who agree their kids are the smartest.
I am talking too much. Best wishes to you.
Sincerely,
Murray Bowen, M.D.