IT IS a general rule in medicine that, when there are a number of different theories purporting to explain a condition, one can be certain that all of them are wrong, though each may have certain facts right. There are over 400 different models of psychotherapy in the West today, with the proponents of each model competing with the others and laying claim to primacy. How is it possible to have so many different models when there is general agreement about how the brain works? Can you imagine having 400 different schools of physics or mathematics? By dint of clear thinking, Joe Griffin and Ivan Tyrrell lead us out of this muddle. They have assembled verifiable scientific information on how the brain works, including important original work of their own, and created a new organising idea – the human givens approach – that has the potential to transform the practice of psychiatry, psychotherapy and counselling. Although my interest is in psychiatry and psychotherapy, it is obvious to me that this big idea also has great relevance to other important areas of life, such as education, social work and personal relationships. Some of the information in this book will be new and startling to many, some, at first glance, will appear familiar. But Griffin and Tyrrell’s assembly of it is unique in that the bits and pieces that stick out in other therapy models now fit together, and this fit is both aesthetically pleasing and of immense practical use.
For example, they succeed in making reading about depression exciting! This common, rapidly rising condition is costing Western society enormous pain; emotional and financial. It is also a major cause of premature death through suicide. Depressed mood, loss of interest and enjoyment, fatigue, poor concentration, guilt, suicidal thoughts, and disturbed sleep and appetite, are generally agreed criteria used to diagnose depression. Often a person with depression will complain of early morning wakening, with depressed mood and tiredness worst at that time. To overcome the fatigue he or she may try to sleep longer than usual but the tiredness persists. We also know that depressed people spend a greater proportion of sleep time in the REM (rapid eye movement) state, that artificially shortening the REM periods leads to a temporary lifting of the depression, and that antidepressants, when effective, shorten the REM sleep time.
Griffin and Tyrrell link these findings in a way that makes sense of the facts and provides the basis for rational treatment, which could save millions of pounds. The story begins with Griffin’s findings from his research into dreams and REM sleep and makes a convincing case for the central importance of REM sleep in depression. A trigger or Activating agent (which may be a divorce, death, unemployment and so on) sends the brain on a search for similar Patterns (previous negative events) setting off a train of introspection which gives rise to the Emotion of depression with resultant Thoughts (such as “I am useless”, “nothing ever goes right for me”) that the depressed person gets locked into seeing as absolute truth. The prolonged REM sleep periods are attempts to deactivate this highly arousing chain of introspection, explaining the early morning wakening (in the more severely depressed) as a mechanism to limit the exhaustion caused by the intense REM activity.
If, when depressed, we are locked into ruminating on all that has gone wrong in our lives, it makes sense that treatment should aim at reversing this deepening spiral. Griffin and Tyrrell explain how the REM state can be accessed to lift the trance of depression quickly using inborn biological mechanisms. Their insight into depression makes sense of the unfortunate, but not uncommon, occurrence that will be familiar to many psychiatrists. Often a patient with depression is admitted to hospital or seen in a clinic, and put on anti-depression medicine, but found to be even more depressed a few days or weeks later. Many such patients are often encouraged by well-meaning staff, including counsellors and therapists, to “talk about their problems”. In the light of the findings presented in this book, however, talking about problems and past failures can be seen to simply grind in a guilt-ridden, worthless, useless and unlovable self-narrative as ‘the truth’ from the patient’s locked-in perspective.
In contrast to insight and ‘getting to the root’ therapies, cognitive and behavioural methods have been shown to be effective for depression. We can now see that this is because they engage the cognitive
or motor circuits of the brain, thus allowing the locked-in, highly aroused emotional brain to calm down, so enabling the patient to see alternative truths, possibilities and stories for his or her predicament. In addition to pointing out the erroneous assumption that thought precedes emotion, which forms the basis of the cognitive behaviour therapy model, the APET frame, which they introduce here, provides a much broader perspective. Just as significant, perhaps, as the introduction of the Arabic numerical system with its zero digit was to mathematics, providing as it did a much wider vista than the Roman number system (I–X).
People love stories and this book is illuminated with a number of these, including those known as case histories. Case histories, stories, metaphors, pictures and jokes make things much clearer than a linear argument. Imagine describing a rose to someone who has never seen one and then asking him to identify one at a florist’s. But show him even a sketch (i.e. a pattern) of a rose and from then on he will recognise one regardless of the variety. Griffin and Tyrrell explain that we ‘see’ the world through such patterns, and run into problems when we use the wrong pattern to make sense of our predicaments.
Perception through pattern matching is of crucial importance in the development of post traumatic stress disorder (PTSD) and phobias. In both, the Activating agent (the trauma or phobic stimulus) is of such moment that it imbues a Pattern into the fast brain pathway (the limbic system) so that future experiences with even a fragment of that pattern evoke the terror (Emotion) of the original encounter. Again Griffin and Tyrrell explain how this can be reversed by accessing the REM state, with resolution of symptoms often in one or two sessions.
Another fascinating topic covered, and one of the human givens, is the attention factor. ‘Attention-seeking’ and ‘manipulative’ are often used pejorative descriptions of patients and clients, but if the importance of both giving and receiving attention as a normal human need was more widely recognised, the health systems of the world would be freed of an enormous burden. The ‘thick notes (or thick chart) syndrome’ is no doubt familiar to many hospital doctors: a patient is passed from one specialist to another with each doctor doing a set of investigations and often surgery to remove various organs, but the patient keeps coming back again and again! If their attention needs were met effectively in other ways these particular patients would not need to fulfil them through the ritual of history, examination, investigation, medication and surgery. On the flip side, if doctors and therapists were more aware of the attention factor, they would be better prepared for avoiding the trap of prolonging treatment in order to have their own attention needs met through their patients. As Griffin and Tyrrell relate, the evidence for the importance of the attention factor includes a shocking, ancient, but relatively unknown, experiment carried out by a European emperor.
And there are yet more treasures in this remarkable book including: why trance (focused attention) is a normal frequent everyday occurrence, during which suggestibility is heightened, and its role both in helping (the placebo effect, the transmission of culture and its morals) and harming (the nocebo effect, indoctrination); the conceptualisation of schizophrenia as waking reality processed through the dreaming brain; why autism may be the result of the genetic absence of mammalian templates; why unbridled anger makes you stupid and shortens your life; the therapeutic usefulness of seeing addictions as attempts to meet basic human needs; and why avoiding greed and helping others is good for your health.
The authors have put in a lot of work to show how knowledge of the way the brain works (gathered from a panorama of psychology, psychiatry, sociology, anthropology and neuroscience), can be used to help the distressed humanely. This book should be essential reading for all psychiatrists, psychologists, therapists and counsellors. For the general public, this knowledge is vital if they are to protect themselves, friends and relatives from the chicanery, often unwitting, which passes for much that is called counselling and psychotherapy.
But that is not all. In an intriguing afterword, using the new
understandings about the REM state, Griffin and Tyrrell cast a new light on the nature of consciousness and why it might have evolved, a remarkable achievement which should attract the attention of any truly curious human being.
Farouk Okhai
MBCHB, MD (Texas), MRCGP, MRC Psych, FHGI, Consultant Psychiatrist in Psychotherapy
CONTENTS
Part I: New discoveries about human nature
Chapter 1 Seeking completion
The need for meaning
The postmodernist fallacy
The science of human nature
Adapting to now
Chapter 2 Where does human nature come from?
The risk and the prize
Why the brain is a metaphorical pattern-matching organ
Without sleep, we warm blooded creatures die
Chapter 3 The dreaming brain
Modern dream theories
The all-important PGO spikes
Recording dreams
To dream, and let off steam
Anticipating reality
Is dreaming connected to learning?
Why we evolved to dream
A dream ship
Some bitter juice
Using dreams intelligently
Chapter 4 The mind entranced: sane and insane
First things first – directing attention
The trance state of dreaming
Posthypnotic suggestions and the REM state
Hypnosis and expectation
Scientific study of hypnosis
Focusing attention – inwards and outwards
Uses and abuses of hypnosis
Dreams and psychosis
The observing self
Part II: Appreciating our biological inheritance
Chapter 5 The human givens
The need for security
The need for intimacy
Love and resilience
The need to give and receive attention
The search for social support
The threats to community life
Keeping greed in check
The too many tribes problem
The law of 150
By helping others we help ourselves
The need for control
Coping with change
Symptom control
Taking responsibility
Chapter 6 The gendered brain
Rough and tumble
Educating facts
Brain differences
Violent men and violent women
Chapter 7 The body-linked mind
The stress and anxiety factor
All the rage
Why depression is linked to disease
The great addiction mystery
Using the mind to help the body
Chapter 8 Water babies and our distant aquatic past
Fishy features
Autistic fishlike behaviours
Oceanic feelings of transcendence
Support for the ‘water babies’ theory of autism and Asperger syndrome
Casualties of evolutionary pressure
Part III: Emotional health and clear thinking
Chapter 9 APET
model: the key to effective psychotherapy
The importance of perception
Emotions before thought
Three vital principles
The power of thought
Using the APET model
Panic attacks
Obsessions
Negative ruminations
Anger disorders
Addictions
Placebo – nocebo
Nocebo counselling
Metaphor, storytelling and learning
The bigger pattern
Chapter 10 A very human vulnerability – depression (and how to lift it)
Depression is not a genetic illness
Dreaming and depression: why depressed people wake up tired and unmotivated
Why some people get depressed and others don’t
Bipolar disorder – manic depression
The most effective way to lift depression
Taking the wrong road
An avoidable death
Chapter 11 Terror in the brain: overcoming trauma
Freeze, fight or flight
Creating calm
How to cure post traumatic stress disorder
Fast, non-voyeuristic and safe treatment for trauma
Curing phobias
Panic attacks and agoraphobia
Obsessive compulsive disorder (OCD)
The chair’s problem
Afterword: A new scientific metaphor:
Consciousness – more is less
The mystery of consciousness
Why all learning requires consciousness
Consciousness must be matter
The relaton field
‘Free’ relatons
Consciousness: what we don’t yet know
Another way of knowing
Back to the REM state
Developing consciousness
Glimpses of the possibilities
Appendices:
I Inducing relaxation using guided imagery
II Effective counselling and psychotherapy: What people should expect
III Human givens and social work
IV Human givens and disability
V Human givens and physical pain
VI Human givens and trauma treatment
VII Human givens and education
References and notes
Index
