Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...

A«—311[Exhibit No.14(c)]Significant Therapeutic Benefits Based on Peer Treatment in the CasrielInstitute ^ and AREBA ^(Daniel Casriel, M.D., New York, N.Y.)Historically, tlie treatment of emotional and behavior disorders has been theprovince of authority figures. We have called these authority figures witch doctors,priests, holy men, faith healers, doctors, alienists—psychiatrists. Societyin general, and the individual in particular have delegated to these men not onlythe rational authoriiy due them, but also an irrational authority premised uponthe possession by them of magical omnipotence in one form or another.Two hundred years ago the mainstream of western society ceased ascribingmagical curative pov.ers to its doctors and priests. But the sick or incapacitated,individual, in his state of helplessness, frequently—at times unconsciouslyattributes magical power to his doctor or other healer.Occasionally, the doctor or doctor-surrogate can utilize the role of magicalomnipotence, given him by his patient to help him. But the doctor can also usethis role has a cloak to hide his own feelings of therapeutic inadequacy and helplessnessHowever, once the contract is made, neither patient nor doctor can, eachfor his own reason, admit to the healer's lack of magic.Therapeutic improvement, limited by the nonverbalized contract of delegationand acceptance of magic on the part of patient-doctor, comes to a halt Treatment,by the very nature of the relationship, cannot be reconstructive, but at bestreparative, more often, just supportive. Very frequently after an initial improvement,the patient becomes worse when doctor-father-God cannot or will notcontinue to live up to the role mutually agreed upon. The doctor's magical rolethat he accepted, encouraged, or seduced from the patient has now backfired. Th*patient feels betrayeii and angry. The doctor feels annoyed and would like to ridhimself of the problem patientModern psychiatry, stemming from the basic concept of Freudian theory,attempted via psychoanalysis to use rational authority to reeducate the irrationalauthority the patient delegates to the doctor. Unfortunately, psychoanalysisis not only a very long and costly process, but it is also effectively useful onlywitii those personality structures that are both basically adult (versus childlike)and neurotic (versus character disordered) to begin with all the othercategories are, to a greater or lesser extent, unable to utilize psychoanalysis, ascan be seen in the following chart.BASIC PERSCNALITY TYPESLevel ofpersonalityintegration Psychotic Neurotic Character disorderedAdult Psychotherapy with Reconstructive analytic Classical forms of treatmentpsychcpharmacology. therapy. relatively ineffective.Adolescent..Perhaps reconstructiveanalytic therapy.ChildlikeReparative therapy_ Infantile Supportive therapy• The major difference between character disorder and neurotic has been published by the author in "Physician'sPanorama," October 1966.Currently, an ever-growing list of self-help groups are being established.Starting with Alcoholics Anonymous in 1936, we have seen the rise of GamblersAnonymous, Weight Watchers, Addicts Anonymous, Neurotics Anonymous andgroups for wives, parents and friends of the afflicted. Self-help therapeutic communitiessuch as Daytop and Synanon, and more recently, scores of lesser knownsmaller self-help communities and storefront operations such as Encounter andSPAN are sprouting and growing.'^The Casriel Institute : the treatment and training facility for the new identity groupprocess and theory. This new theory and process will be published by Coward-McCann in abooli called A Scream Away From Happiness to be written by the author.- AREBA : private therapeutic community for the rehabilitation of middle and upperclass drug addicts and other behavioral bankrupts. AREBA (accelerated reeducation ofemotions, behavior and attitudes).