Transcript

Dr. Albert Rossi: Today’s interview is a follow-up of the last interview, two weeks ago, with Dr. Dan Hinshaw. Those of you who haven’t listened to that can go back into the archives; it’s sitting there. Today I have the enormous honor and privilege of interviewing Dr. Jane Hinshaw, psychiatrist, who is here at St. Vladimir’s teaching St. Vladimir’s seminarians with her husband, Dan.

Dr. Jane Carnahan Hinshaw is a clinical instructor of psychiatry at the University of Michigan health system and staff psychiatrist at the medical health clinic at Ann Arbor, Veterans’ Administration Medical Center. Her area of special interest involves psychiatric issues in palliative care. Fas-cin-ating! Jane, would you begin by talking about your place in the current course? What is it you’re adding to Dan for the St. Vladimir’s students?

Dr. Jane Carnahan Hinshaw: Thank you, yes. We are teaching a course entitled, “The Therapeutic Encounter.” So we’re hoping to help the students understand better how their encounters with others can either be damaging or, hopefully, healing. For this, I particularly wanted to help them understand a little bit about serious mental illness and how they can be healing in reaching out to this population that is dear to my heart. As we teach palliative care together, we base it on the model of Cecily Saunders who is the founder of the modern hospice movement. She coined the term “total pain” to describe the holistic approach that we try to bring to healing, of dealing not only with physical pain but also psychological, social, and spiritual pain. So that’s hopefully where my experience working 30 years with mentally ill veterans can come into play with better understanding the psycho-social issues.

Dr. Rossi: Thank you, Jane. You and I were talking yesterday about your work at the VA hospital, and I was saying, “Oh, man, I’ll bet that is just strenuous work in the extreme, because we here at St. Vladimir’s—we don’t have right now, but we have had—a number of returning soldiers who leave the military and then go on to want a seminary education and to be ordained as priests. They talk about the VA hospitals and the difficulties there. We have CPE students in the VA hospital. You were saying that the soldiers, both men and women, some of them come into the military fragile for various reasons, and then get exposed to these traumas. Would you say a word about that?

Dr. Hinshaw: Well, obviously anyone who serves in a military setting knows that they will be put in harm’s way, so there are many traumas that can happen to soldiers, both in the line of duty, on the battlefield, so to speak, but unfortunately also in other settings. Many of them suffer from what’s called post-traumatic stress disorder, and we describe this syndrome by people who develop these symptoms later, often after the trauma has occurred, but they’ve experienced some kind of extreme trauma beyond what normal human experience is, and then they have symptoms or waiting reminders that might bring up those symptoms again, of re-experiencing the trauma again, through nightmares, through intrusive thoughts, through flashbacks, and hyper-vigilance, which is a state of high anxiety, readiness for potential further traumas coming.

So any of us who are exposed to a trauma extreme enough will probably have these kinds of symptoms afterwards. However, many of our young soldiers unfortunately have had very dysfunctional homes where they have already been traumatized in different ways as children, so I particularly feel for these veterans who have had double traumas coming into difficult situations.

Dr. Rossi: And for the listeners, this is a really fascinating topic. I have a podcast in the archives on returning soldiers and how parishes and humans can help and be more alert to ways of helping returning soldiers. So I would certainly suggest you might want to take a look back there for further help on the military and how we might engage that better.

Jane, back to here and our listeners and the St. Vladimir’s students. The therapeutic encounter, the therapeutic intervention—all of us, in one way or another—certainly most of us, virtually all of us—know of a seriously disturbed functioning human being, mentally, however it goes, in the family, out of the family, in the parish, wherever. What might you say now to the average parishioner who would be listening to this that we could be alert to, or the delivery system personally, to others, close or not so close, with serious mental disorders?

Dr. Hinshaw: One thing that I’m hoping that I will be able to convey to our seminarians this week and hopefully can convey that here to your listeners is that mental illness is a medical illness. Serious mental illness is not something that’s a choice that people can “snap out of” or even just pray about and be healed generally. God typically heals us through the means he’s given us. He’s thankfully given us an understanding of some of these mental illnesses. He’s given us some healing medications that don’t necessarily eradicate the symptoms but control them so people can have better lives. I would say if some of your listeners are feeling like they have symptoms that they cannot deal with on their own, or family members, that they get assessed by a mental health professional and that if they are recommended to be on medications, they will be open-minded and feel like maybe that is the way the Lord is answering their prayers, with these God-given compounds.

I have many of my patients who I think are particularly close to the Lord and can give him thanks and praise for the treatment that they get and the medications that they get to help their minds work more effectively so that they can grow spiritually.

Dr. Albert Rossi: I think from my perspective, having been at St. Vladimir’s 34 years, the ground is shifting in a very positive direction by my standards, toward much more awareness of being able to help human beings pastorally, in their spirit, in their mind, and in their bodies, this way, with mental illness. There was a famous theologian, now dead, who said that we humans, especially Orthodox Christians, must choose between the Cross and the couch. Well, that certainly is extreme and it certainly was present in Orthodoxy a few decades ago, but in the world where I travel, I don’t hear that any more, but that dealt with verbal psychotherapy: Don’t go.

Following that was a wave of total resistance to medication, psychotropic medication to change brain chemistry and to alter a person’s mental dysfunction. I found that a great deal, but it’s diminishing greatly, as we were talking earlier. Now in this class, our current seminarians, our seminarians seem to be pretty much on board with the use of psychotropics if they’re needed, drugs for mental illness.

There are a couple of prominent Orthodox writers—I’m not going to mention names—who don’t have this view, and they’re popular. Their view is: “Oh, just do a vegetarian diet and”—I don’t know—“say a whole bunch of Jesus prayers and be spiritual and let God take care of it.” Well, we believe in a much more incarnated theology—body and mind and soul—and we’d want to disabuse any of our listeners of withholding or resisting medication for persons with mental dysfunction. Jane, would you say another word on that just to reinforce the point?

Dr. Jane Hinshaw: Sure. I often will just use analogies like: You have a chemical imbalance that we can’t cure, but we can control it. I may liken it to diabetes, where we can give a compound like you would give insulin to a diabetic to keep them stable and functioning at their best rather than an antibiotic that’s going to cure a mild infection and then it will be gone. So this is something that they will need to stay on. This is to help them be their best person that God intended them to be; this is not to make them high or to be used in an abusive way at all.

Dr. Albert Rossi: Thank you. I mean, this is so clear and so important, because every so often I run into someone of the opposite mindset. I have to say, well, yes, God will heal this, but God uses other human beings, namely, psychiatrists, doctors, who can help with conditions. We are all fallen. We all come with fallen bodies and souls, so each of us has brain chemistry that’s far from perfect, and if there’s medication to counter-balance all of those neurotransmitters, well, then, we use them. As Orthodox Christians, we simply use them. So I’ll begin.

Part of going along with medication are other kinds of interventions for mental disorders. One of them, historically more prominent, is shock therapy, known in the business as ECT (electroconvulsive shock therapy). [It] has been used, and it’s been given a very bum rap in the movie, One Flew Over the Cuckoo’s Nest, bum rap by my standards. In that movie a patient was put on a table and a rubber hose put in his mouth, and his wrists and ankles were lashed to the table, and electricity was sent through his body, and he arched and writhed and screamed. Well, that was then, and I don’t know that that even did occur—it probably did at one point—but that’s not the case at all for ECT. ECT these days (electroconvulsive shock therapy) is a very refined science. It can be delivered to one lobe. There’s a lot more, for a lack of a better word, delicacy in its delivery.

Also I know that here in Westchester County, which is adjacent to New York City, which is a very affluent county, shock treatment is on the increase. Now that might shock some people’s minds. It shocked mine when I first heard it, but it happens to be a fact of life. But we have smart doctors and smart patients here, and the point is, it works for those who need it. So the point is: if it works, use it. It’s used for extreme cases of depression. First you try verbal psychotherapy. If that doesn’t work, you try medication. If that doesn’t work and the person is either going to have to be severely depressed or gotten out of it some by electro-shock therapy, then it’s used.

Dr. Jane Hinshaw: As you said, it’s not an initial treatment. It’s something that we use when other very good treatments fail. It sounds very frightening to people, but as you also said, it’s a very refined treatment now. It’s actually done in an operating suite under general anesthesia, so the patient is actually paralyzed with a breathing machine during the time; they remember nothing about it. We don’t understand fully how it works.

The most dramatic case that Dan and I both actually had was a man [whom] he was asked to change a feeding tube on, because he was on a back ward of a psychiatric hospital due to what they thought was dementia. He had come to an in-patient setting because of another problem—I think it was bleeding. So when Dan consulted on him, he said, “That hurts,” very slowly, but not in a way that a demented person would. He asked me to consult on the man, and I agreed that it looked like he had profound depression, which is sometimes called pseudo-dementia or false dementia. We got him into the hospital on the psychiatric ward, he had a series of shock treatments because past medication had not helped, and he was restored to a full life including reconciling with his wife and having many years of productive, joyous living.

Dr. Albert Rossi: I’m very grateful that you’re saying this, Jane, because we’re sort of double-teaming those who might have a pastoral allergy to shock therapy. I would plead with the listeners, and whether you the listener are a pastor, a priest, or a deacon, Orthodox or not, oftentimes we can be the first responders, so to speak, the person someone else will turn to for advice, and we don’t want to block persons from real help that’s out there because of our own prejudices. So I would ask all of us, me and you listeners, to disabuse ourselves of a resistance to electro-shock therapy, if needed, for serious depressed people, on some fanciful set of ideas and philosophies. No, it’s medical, and it is used effectively for those few people who need it.

Dr. Jane Hinshaw: I have one more case that I’d like to share with you, and that’s a man I’m currently treating, a veteran who has very severe, recurrent depressive illness. He gets so depressed that he gets delusional. He’s not able to pray. He hears voices, and he feels that he’s compelled to harm himself. This is in spite of being a very devout Catholic who attends Mass regularly and has an active prayer life. So there’s nothing more thrilling than to see him after he’s had treatment—and he’s had to have this more than once; often it doesn’t last forever and you have to come back for a refresher—but to see him after he’s had treatments: smiling, engaged in his life again, and again, most importantly, engaged in his spiritual life again.

Dr. Albert Rossi: One other note I would say: The most common mention of side effects of shock therapy is a small loss of short-term memory. Is that the case? Well, it seems to be. What can we say about that? Well, it’s not serious. Those I know… I have a biological aunt who had shock therapy who swears by it. That the brain has dissociative neurons and somehow makes up for that little loss. I don’t think that alters life functioning. So again there’s no major side effect that I would want to mention at this point.

What else comes to your mind that you might want to say at this moment about your role teaching the seminarians, about the listeners who will be hearing this, and about therapeutic interventions?

Dr. Jane Hinshaw: Well, I guess one of the things I’m trying to emphasize to the seminarians is that a lot of times when people have mental distress, they will turn to their clergy or to other Christian friends for help. This is a natural thing. I hope that we can not only love them and pray with them and pray for them but also get them the care that God has already brought here to us in the case of serious mental illness. That would be medication before we can do other kinds of interventions.

Dr. Albert Rossi: Thank you for that. I know that the presence of YouTube on campus and in Dan’s book and in the correspondence you have with our seminarians, you make a huge difference. I know, because I talk to the seminarians and say to them—I like to ask those open-ended questions—“So what did you remember from the last semester?” or “Who has impacted you most?” or whatever, and your names come up as professors, persons who have altered their pastoral awareness, and that’s just vital. So that’s why we exist. It’s so vital.

With that, we’ll wrap up, Jane. Any last words you want to say?

Dr. Jane Hinshaw: Thank you for inviting me.

Dr. Albert Rossi: It’s a joy. It’s a total joy to be with you and with Dan who is still sitting here.