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S O M E T I M E S I AC T C R A Z Y
with medicine, minimize the environmental dangers, and educate the patient about his illness and its impact on himself and others. Ideally, the pathology is erased and health is regained. Similarly, some psychiatrists perceive psychiatric symptoms as primarily a disruption in normal biochemical processes and explore ways to restore equilibrium. Doctors with this biological orientation use medications, electroconvulsive therapy, and, rarely, psychosurgery to alter psychopathology, which, like tuberculosis, transpires on a submicroscopic, cellular level. For these doctors, the subjective experience of emptiness is caused by a flaw in the human physiological mechanism. The symptom is perceived to be part of the syndrome constellation of depression and is treated as such. In this medical model, symptoms are pathological—by definition, “bad”—and must be eradicated by treatment. Treatment includes medication and education about environmental and genetic risk factors. At the other extreme in psychiatric thought are those who focus on the mind instead of the brain. They perceive mental illness as the result of an individual’s internal struggle, which has diverted from the path but remains tethered, however tenuously, to normality. Treatment for this group focuses not on microscopic manipulations but on person-to-person communication, with a goal of understanding the whole person’s past and present experience within a social context. In this paradigm, healthy change results not from passive introduction of chemical compounds, but through the afflicted’s active, willful participation in the process. If the struggle inside is unconscious, psychoanalytically oriented psychotherapy may, by making these conflicts conscious, move the person back within the boundaries of what we accept as “normal.” If pathology is a result of erroneous thinking, cognitive techniques can cleanse the psychic wounds. If the struggle results in habitual behaviors, behavioral modification can convert pathology. Symptoms are not seen as particularly “bad,” so much as representative of the person’s pain caused by a wound as opposed to an invading organism or breakdown in biological function; thus treatment means healing, not excision. In this model, emptiness may be perceived to be the result of past disappointments and traumas, resulting in a fear of caring or of commitment, or as a failure to develop values for one’s world or oneself. Whatever the etiology, active talk therapy is the primary treatment approach.