EITHEROur medical ancestors sought to cure the mind long before they could treat diseases of the brain. Magicians and priests cared for the sick through suggestion, the therapeutic bond and the tincture of time, not through science. This has changed. Over the past century and a half, our progress in understanding and treating mental suffering has been remarkable by any measure, drawing heavily on the lessons of the asylum, advances in psychology and brain science, and what had learned doctors and nurses. which dealt with war shock during World War I.
Psychotherapy has been described as the oldest branch of medicine, with roots in religion and magic that can be seen in healing rituals practiced in Greek temples, on Homeric battlefields, and in Freud’s office. In the early days, as in our own, the priests and doctors of antiquity resorted to potions, listeners and words of comfort, suggestive power and pragmatic advice.
More than four thousand years ago, the Egyptians built dream temples that served as sanctuaries for worship and the relief of suffering. The temple’s priests and physicians induced trance states in their supplicants, interpreted their dreams, and advised the most auspicious paths through life. Music, painting, and walking in nature were prescribed to calm the anxious and comfort the grieving. Egyptian doctors, and after them the Greeks, studied their patients as well as cured them. They detailed the symptoms and course of cerebral fevers, mania, melancholia, and other mental disorders. Against a background of myth and magic, they established rudimentary elements of medical psychology and psychiatry.
Centuries later, followers of Asclepius, the Greek god of medicine and healing, practiced similar techniques. They also healed the sick with herbs and words, suggestion and analysis of dreams; as they did, they practiced a recognizable form of psychotherapy. The suggestion and the place were fundamental to his work. The Sanctuary of Asclepius in Epidaurus, built in the 4th century BC, was designed in every way for healing. It was nestled among the hills and trees, far from the interference of the world. It defined arcade. It was beautiful and calm; the air was pure, the diet simple; there were cool springs for bathing, and a theater and library for arts and learning. Pilgrims sailed to Epidaurus from ports around the world to worship Asclepius and be healed by magic, suggestion, herbs, and the arts. They came to a world perfectly shaped to mend minds.
The priests of the Asclepian temples were instructed in suffering and were instructed in the prescription of calming or life-giving herbs that had been used for tens of thousands of years. They knew and taught the rituals of the remedy: before beginning the treatment, the supplicants were purified. They bathed in healing waters—mineral springs, the river, the sea—meditated in the shrine’s sacred grove, ate a cleansing diet, and prayed. They offered sacrifices to Asclepius and offered figs and honey cakes to the serpents in the temple. Hymns were sung, holy lights were lit. The priests laid hands and applied ash. The supplicants slept in special areas within the sanctuary where, lulled by suggestion, and perhaps drugs, they waited for the priest to analyze their dreams and prescribe cures.
Thousands of years later, the doctors and nurses treating shell-shocked patients in World War I faced terrible psychological suffering and alleviated what they could glean from ancient remedies and modern medical knowledge. Many of the war medics who treated traumatic combat injury were influenced by recently published writings by Freud, Jung, and other European psychiatrists. Like the ancient physicians and psychoanalysts, some attach importance to the analysis of dreams. And like psychoanalysts, they knew that memory had to be dealt with: patients had to figure out what was best to remember, what was best to forget, and ways to reconstruct the traumatic experience.
War, as Henry Adams said of the Civil War, sets the circumstances for advances in medicine and science. In the 20th century, the hundreds of thousands of soldiers, wounded in body and devastated in mind, commanded not only urgency but improvisation. Battlefield science brought rapid changes to psychiatry, as well as general medicine and surgery. The British psychiatrist and anthropologist WHR Rivers observed that the Great War produced disturbances of the mind on an unimaginable scale. War, he said, was a “great crucible,” an extreme test that could either reshape or destroy the mind. Therapeutic pragmatism was imperative. Psychiatrists had to find ways to help their patients rebuild their shattered minds and how to reconjure their future. The doctors needed to instill hope, courage, and a semblance of calm. The war taught about the unconscious mind in a way that nothing else could. He also taught that psychotherapy saved lives. After the war, psychotherapy became part of what doctors had to offer patients.
Psychoanalysis and electroconvulsive therapy emerged at the beginning of the 20th century; In the years after World War II, lithium medications, antidepressants, antipsychotics, and anticonvulsants were found to be effective for many people with previously intractable mental illnesses. New treatments continue to be discovered: mood stabilizers and antidepressants for mood disorders, medications for anxiety disorders and schizophrenia, structured psychotherapies, brain stimulation techniques, ketamine, psilocybin, virtual reality therapies, and more. remedies that have helped millions. Less beneficial, however, has been the simultaneous decrease in time spent in psychotherapy. This is partly due to the assumption that only medication is needed; to the cost of psychotherapy and the relative lack of reimbursement by insurance companies; and the time and effort involved.
Certainly, medication and other non-psychotherapeutic treatments have profoundly changed the lives of people with mental illness. They have ameliorated suffering, made meaningful work possible, and allowed damaged relationships to mend and grow. For many, medication does these things faster, better, and less expensively than psychotherapy. However, medication often falls short of actually healing the mind. Many patients, whose suffering is improved by medical treatment, remain raw and fragile. They cling to the shore, avoid risk and fear returning to the fight of life. They do not expand the territory of their beliefs or curiosities, nor do they learn everything they could from what they experienced. But for those who receive it, psychotherapy is an irreplaceable part of a greater renewal; marks the beginning of the channel. Psychotherapy is an ancient and deeply human part of healing; for this reason, it has been called the oldest branch of medicine.
Adapted from Fires in the Dark: Healing the Restless Mind
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