Prof. Joseph Levine

Introduction to the new blog

By Prof. Levine & Dr. Salganik

Hello everybody!

This is an introduction to the new blog on our ongoing research in psychiatry and psychology.

We, Igor Salganik and Joseph Levine,  are senior psychiatrists and researchers with accumulated and extensive experience in psychiatry, neuroscience, and a variety of psycho-therapeutic treatment approaches.

Over time we have come to an inevitable conclusion that the field of psychiatry, unlike most other fields of medicine, has undergone relatively few changes in recent decades and in many ways  seems to be on the spot.

There seem to be several reasons for this: one is the sheer complexity of the subject which is based not only on the processes related to the human body but also on mental processes like thought, behavior, and emotions. Another reason stems from the very definition of the psyche which is essentially metaphysical and cannot be easily or at all translated into materialistic concepts or, in other words, the body-mind connection is anything but trivial. Another reason is the paucity of the appropriate tools for the profound scientific analysis of mental processes. And finally, due to the stigma still associated with psychiatry, the funds invested into this field are sadly far away from those invested in the research of physical illnesses.

Let us also note that psychiatry is generally based on the phenomenological expressions of the mind and  is, in many aspects, combined and intimately merged with psychology, the science whose roots stem from philosophy and other humanities, although, in recent decades, psychological research  widely uses brain imaging tools.

All this led us to the decision to try and develop a new theory with the goal to merge between the well established knowledge in neurosciences on one hand  and psychological processes of an individual and social nature on the other hand. The conceptualization of this theory should be held as simple as possible in order to facilitate both  the understanding of intra-psychic processes as well as the treatment of psychological disorders. It will attempt to avoid psychiatric “slang” as much as it goes and use the model of internalized images and their development along the time axis as representing the “Social Self” of an individual.

It should be mentioned that Dr. Peter Soifer contributed his part alongside with Dr. Igor Salganik in the initial stages of the development of a therapeutic method called Reference Group Focused Therapy known by the acronym RGFT. This method will be for us a starting point for a new theory that will be based on an array of internalized images establishing in their entirety the “Social Self” of a person.

In the first chapter of the blog we are going to briefly introduce the RGFT method. This method is based on the assumption that the individual internalizes images (or figures) and cultural characteristics originating from the society around him. This internalization of social influence is probably a cornerstone that enables the integration of an individual into the surrounding culture. The basic premise of the method is that the psychic life [in part] and the mental disorders may be often, but not necessarily always, described and analyzed according to the set of images (figures, characters) the individual faces in his life and the nature of their internalization.

In general, in the treatment method itself, the therapist reflects to the patient the role of those internalized images and their influence on his inner world, attitudes, and behavior. This serves as a basis for a change in the internalized images set, which carries with it a change in patient attitudes and behavior enabling more  adaptive behaviors of a person himself.

Below we will provide a more detailed explanation of the treatment method.

In Judaism; "each person is important and represents an entire world" — there is nothing like this statement to emphasize the connection between the environment in which man lives and his inner world. From the moment a person is born until his death he is subject to environmental influence. Like a sponge, he absorbs the images of the significant people in his life. These images can be called "group or reference groups". These actually shape us, our attitudes, our emotional world and ultimately – our behavior as well. These groups influence both directly, with greater social impact if the influencing group is perceived as more significant, and in a more complex way that is not immediately recognizable. These significant reference groups undergo an internalization process and become an integral part of the person and operate within it even when the original groups no longer exist.

Some of these effects take place without permeating  human consciousness, making a person in some sense a "robot" performing a role that is not his own, according to the "software" inserted by other people who have now become his internalized images and an essential part of his inner world. Many conflicts that take place between these inner images, between the internalized group itself and the contemporary reference groups in the external reality of the person can cause the person to undergo through mental crises up to the degree of frank mental disorders. It should be noted that most mental disorders initiate or worsen due to stressful situations. It turned out that a significant proportion of these situations occur in a background of the external social groups [in the external world] as well as internalized ones which are part of a person himself.

The aforementioned therapy sets as one of its important goals to bring to human consciousness social influences  upon which a person is subjected to  and that are for the most part  not conscious. The treatment allows the patient to better understand the psychic forces at work within him and help him reach a better adaptation to the society in which he lives. We add that the treatment is based on a number of theories originating in social psychology and in addition theories of object relations, the Gestalt theory, Learning Theory, Attachment Theory, Transactional Analysis, (Eric Berne) and others. Patients with various and varied mental problems, for example, adjustment disorder, phobias, obsessive-compulsive disorder and others, were treated with this method, it was found suitable for different age groups, including the third age where  a corresponding breakdown of the support system is often observed.

The following is a therapeutic example demonstrating the use of the RGFT method:

Eating disorders are the plague of the century and are especially common among young women. 5-7% of them treat food in an extreme way at one of two extremes: either they have an uncontrollable urge to eat in eating attacks – a disorder called bulimia nervosa, or they have an obsessive urge to avoid food at all costs — anorexia nervosa. Anorexia nervosa can become extremely dangerous and in 6% of women with anorexia the disease can even result in death.

Eating disorders have many causes, but one of the main ones is social impact. Young girls are constantly bombarded by the media that uses  models who are mostly on the verge of anorexia as a role model. The girls are exposed to countless advertisements of “ultimate” diets that guarantee a "happy life" if used. Unflattering criticism and comments from boys and girls of their age, family or even their spouses 'complete the job' …

Many methods are used to treat eating disorders. Among others, various types of behavioral therapy, psychodynamic therapy based on a psychoanalytic approach, and psycho-pharmacological therapy mostly based on antidepressants and anti-anxiety medications.

Ricky (pseudonym), 21, was diagnosed with bulimia nervosa [obsessive-compulsive disorder of binge eating often followed by the use of laxatives and / or vomiting and even periods of starvation leading to extremely low weight] and came to treatment after undergoing a long series of treatments such as psychodynamic therapy for about a year and a half, and even hospitalization in the Department for Eating Disorders for about two months. All her life and family life revolved around the disease and although she had ambitions to learn a therapeutic profession, most of the time she dealt with things related to the "refrigerator".

"I've been suffering from bulimia since I was 11," Ricky said at their first meeting. "I'm in endless quarrels with my dad and mom. They always explode with rage when they find out the fridge is empty again, but it's really out of my control. Everything I tried to do so far didn't help. The long treatments that also included family therapy only increased the chasm between us."

In choosing who were the most influential and significant figures in Ricky's life, she brought her father up as the first figure. His character was portrayed as a man with very rigid character traits with a striving for perfectionism at all costs and a desire to impose his views and positions on his family members, including Ricky of course.

"I'm so much like my dad", Ricky admitted in astonishment after returning from her "hot seat" where she played her father. She realized already in the first meeting that a number of things in her character and behavior that bothered her and that she saw them as part of herself, stemmed from his strong influence – on her. “I understand him a lot more now and can understand that he was totally himself captive to his perfectionism which did not allow him to really enjoy life. I do not want to go that way and live that way. "

In the second session Ricky asked if as a part of the treatment, she could be allowed to talk to herself. When asked what kind of an internalized image she wanted to talk to, it turned out that it was herself when she was 11 years old, just before the birth of her little sister Mazal [pseudonym]. "I'm probably a failed experiment, if mom decided to try again" – said the "character" of the 11-year-old Ricky. “They (the parents) even told that they wanted another daughter and did not ask me what I thought about it”. Her words revealed great frustration and pain. The little girl felt she was unnecessary and unwanted.

The next internalized character that Ricky decided to bring to life was she herself, at the same age, but already after Mazal was born. This character was already much more decisive in her rage towards her parents and felt that she was left alone in a world without parents when her mother decided to be the mother of another child – her younger sister Mazal.

"But, nothing, they will pay dearly for it. I have no father and mother and they will not have a daughter" – said the "internalized character" – 11-year-old Ricky whose anger broke all the boundaries of logic. When Ricky returned to her place from the "hot chair", she could not hide the magnitude of pain and surprise, as well as the revelation of the insight, which her own words managed to evoke in her.

"It's that simple," she said. "Things suddenly start to work out and I understand where they belong. When I was inside my own character as an 11 year old girl, I sat and thought to myself – what have the parents really done to me so that they deserved all that they got from me following my sister's birth? The truth? I did not find. Even if they were guilty of something, they had long since paid off the debt! I also suddenly realized that they did not ignore me, but I ignored them, thus taking away the right to be my parents' daughter. And I took revenge on them by my bulimic eating and self-starvation that forced them to engage in me constantly while experiencing mental suffering, rather than being available for my sister’s needs.”

After the second session, things started to happen at a relatively fast pace. Not only did the refrigerator remain "full" but, no less important, she returned to her rightful place – to be her parents' daughter. She discovered and reconnected to the warmth and love that the family had previously tried to give her (that she rejected), whereas today  she is ready to accept it and even willing to give the same feelings back.

Finally as she described it, the "demons" who controlled her emotional life turned out to be 'not terrible at all'. Paradoxically, she no longer felt a compulsive need to be in control all the time whether about her eating or other life issues, and began to live in a flow out of understanding the truth in her life from a new and better place!

And once again, we would like to emphasize  that in this blog the RGFT method will be a starting point for creating a broader model for the “Social Self” where we hope to present a simpler model for understanding and therapeutic application of mental systems and mental disorders.

In every blog we will represent (quasi in real time) a further step in the development of the model, including relevant clinical cases.

We will be more than thankful  to see for active participation of our readers in this creative process and will promptly respond to every comment.

 Regards,

 Dr. Igor Salganik and Prof. Joseph Levine