Written by Avigail Abarbanel

THE KEY TO MENTAL HEALTH IS UNDERSTANDING

Review by Gunnel Minett

Soon after psychotherapy had first emerged, it became a situation of ‘patient and doctor’: we needed a doctor who knew ‘what was wrong with us’ in order to ‘treat our illness’. And to this day we often hear that people who feel unhappy with their lives need ‘expert treatment’. Not necessarily, says Avigail Abarbanel. Rather, she says, what we need is to understand how we function as human beings. In particular how the evolutionary process has formed us into the beings we are today. 

The attitude of expert treatment is not just costly to society but also to the individual who may struggle with the label of being ‘unwell’ and in need of ‘treatment’ to get better. In contemporary societies, this is particularly bad for young people, who struggle to make the change from childhood to adulthood without understanding the cause of their struggle. 

Avigail Abarbanel has a solution that does not require psychotherapeutic help. All that is needed is a better understanding of how we function as human beings, and in particular, how the human brain works. Following the Triune Brain theory (developed by Paul Maclean) Abarbanel explains how many of the ‘problems’ we experience as mental and emotional distress have a perfectly clear explanation, when seen from an evolutionary perspective. 

According to the triune theory, the oldest parts of the brain (the reptilian brain) handles the basic bodily functions, such as breathing, reproduction, defence etc. Further along the evolutionary time line, we and other mammals developed the mammalian brain with the limbic system, that handles functions that are ‘tools’ for living in social groups. This part communicates via what we know as ‘feelings’. The youngest part of the triune brain is the Prefrontal Cortex. This part facilitates higher human functions, such as thinking, planning, decision-making and integrates goals from the inner world with the outer. In short, the Mammalian brain is in charge of creating the best environmental conditions for us to survive as individuals and the prefrontal cortex is in charge of giving life a meaning. `

It order for these various parts of the brain to work together in harmony they need to be fully integrated and working in cooperation. But, as Abarbanel argues, this is not an automatically  pre-given condition. In order for the different brain parts to work in harmony, the brain needs the right environment during development. Children growing up need to get support from their carers and environment in order to learn how to develop the brain mechanisms necessary for integration. 

But, as we know the ideal world, is not the actual world we live in. So, if and   when we grow up without a chance to develop our ability to handle the outer world around us, we turn to the second best alternative, i.e. to store away experiences in the hope that we can deal with them in a safer way later on. This ‘solution’ can lead to inner conflicts between the different brain parts, with their different goals. The limbic system, with its focus on survival, and the prefrontal cortex, wants in addition meaning and purpose in life, may start to ‘pull in different directions’. 

This is where psychotherapists such as Abarbanel come in – but not to be the expert who will treat the ‘disorder’. On the contrary, the first thing she tends to point out is that there is nothing wrong! Both parts of the brain are probably doing exactly what they are supposed to do, but not necessarily in cooperation with each other. So her role as a psychotherapist, is to help people understand how their brain works and what it needs for integration. She talks about both Vertical and Horizontal Integration. We need to help the different parts of the brain to communicate and work together. Once we can achieve this the brain will be able to re-route its neural pathways and open up, working better as a complete unit. The end result of this is healing and increased wellbeing. 

An important part of this process is to move away from the previous idea that we need an expert to tell us what is wrong with us. And in particular to move away from all the ‘syndromes’ and ‘disorders’ – all the labelling and medicalisation of mental and emotional problems (mainly created by the American insurance-based, health system that only compensate for identified ‘syndromes’ and ‘disorders’). A big role for psychotherapy, Abarbanel claims, is to teach the client that there is nothing wrong with them. Such as taking away the D from PSTD. Post Traumatic Stress is not a disorder. It is a perfectly normal reaction to an overload of stress. The problem is lack of understanding as to how the brain works.

The end of the book deals with a wider perspective of our lack of understanding as to what is causing us to feel unhappy or distressed in life. Looking at the world today, there are many examples of the consequences of world leaders and even countries being stuck in the fight/flight mode of the Limbic System. This results in conflicts, inequality, lack of freedom, disrespect for individuals, etc. So it is important to realise the importance of giving children support and understanding in learning to use all parts of the brain in cooperation, as they develop. Such an effort can have consequences for the future of the whole world. 

The way to do this is to ‘front-load’ the money spent on each individual in society so that children (and parents) are given the best possible opportunities to get a good start in life. This is much better than trying to prevent problems later on in life. And there is enough statistical evidence to show the strong correlations between poor childhood and adult problems to see that this is the obvious way forward.

It is only when we are able to see the world around us as a benign place,  and our fellow human beings, not simply as unwell and in need of care, but rather as having problems understanding what they need to do to improve their wellbeing, that we can create long-lasting change. This book may be short but it is an absolute pearl of wisdom and should be essential reading for all of us, and in particular for politicians and other decision-makers. 

Published by Fully Human Psychotherapy Tools for Life Series, 2020, 127 pp, £8.50 paperback,ISBN 13-979-8581379981 www.fullyhuman.co.uk