Paula VegaIt is essential that we succeed in answering the vital questions".Aquilino Polaino has practiced psychiatry for almost fifty years. In addition, he has been a professor at the Complutense University for three decades, and is a member of the Royal Academies of Medicine of Valencia, Cadiz and Granada. In his long career he has met important personalities of the twentieth century, such as the psychiatrist Viktor Frankl.
On the occasion of his retirement, he has recently published with Ediciones Encuentro the book "We are all fragile (even psychiatrists)."The interview with more than 100 questions was conducted by journalist Álvaro Sánchez de León.
We are all fragile
In this interview, Aquilino Polaino tells us some of his reflections on current issues such as family breakdown, freedom in patients with mental illness or suicide.
In the book, you talk about the importance of not ideologizing psychiatry. Can you elaborate a bit on this point?
I consider that psychiatry, like all sciences, can be phagocytized by ideologies. One must be careful, because, as psychiatry has so many dimensions, any dimension that is overemphasized in relation to the others would be incorrectly nuanced. For example: it is a fact that people's socioeconomic level influences mental health. It is a true fact, and in some way psychiatry takes it as a banner so that inequality decreases a little. However, if this were to be radicalized, we could convey the idea that all mental disorders are a consequence of inequality, which is absolutely incorrect. That is why, in my opinion, each dimension must be given the weight it has. And this is not always easy. Ideological contamination begins because people themselves make erroneous attributions. For example, they say: "Why are we so bad psychologically? Because we have a lot of stress. Stress is a physiological mechanism, without which we would not be healthy enough. Stress is not the cause of the psychological discomfort that you have, but the cause is in the environment, which has to be modified, or in you, which has to be modified.
Can the psychiatrist's personal beliefs, for example, influence therapy?
It could happen, but in my opinion this, fortunately for us, has diminished a lot in recent years. Perhaps since an amendment that came out in the United States around 1992, from which every candidate to become a psychiatrist has to pass some very hard tests to handle diverse patients with diverse religious beliefs, and to be respectful with all of them. So this, in a way, has permeated the world of psychiatry. It seems to me that this conflict, which could occur, is today very controlled and practically neutralized.
Can you tell us how you met Viktor Frankl?
I had a scholarship at the University of Vienna in 71-72 of the last century, and in Vienna I had a colleague, also a psychiatrist, as well as a priest, Professor Torelló. I was very friendly with him and we saw each other practically every other day and talked about many things. Then he told me that he was a close friend of Frankl's and that he was going to go to see him at his house, and asked me if I wanted to accompany him. I told him I would be delighted, and we went, and that's how I met him. And then in other trips that I have made to Vienna, throughout my life, I used to coincide with Professor Torelló -who has already died-, and in some occasions we also met with Frankl, therefore the contact continued.
What was your impression?
Very good. It seems to me that he was very rebellious from a very young age. I think he is perhaps the first psychoanalyst under twenty years of age to publish a paper denying Freud's theses in Freud's journal. And this is not usual, and even less so in those times. Then, on the other hand, it is worth noting his spirit of independence, because, although trained in a psychoanalytic environment, he was always very critical and thought on his own. Moreover, he made good use of the opportunities in life. The disaster with his first wife, who died in a concentration camp, his stay in a concentration camp... However, it is curious how that, which can be an experience that breaks all resilience and all strength, to the point of destroying the person, was for him a spur to the opposite. And it led him to the search for something that transcends him as a person, which is the meaning of his life and that is beyond his own life. I consider those to be very valuable contributions. Perhaps it must be said that I would like the foundation of all that he developed to have a clearer implication in Western philosophy, a clearer support. But he has done enough with all that he did and all that he bequeathed to us, and the proof is that it is still working and that in many countries, such as Latin American countries, it has more strength than in Europe.
In mental illness, do patients have freedom?
I believe that all mental illnesses cannot be taken as a homogeneous and singular reality. Because, of course, in a schizophrenic outbreak the subject is probably not free and does things that he will later regret all his life, when he is told that he has done them, because he has not been aware of it. There may be a total lack of freedom. Or in an acute psychotic break. In a dementia case it could happen, but already in dementia the physical strength diminishes a lot, and the initiative also. Now, in most of the most common conditions (depression, anxiety, post-traumatic stress, acute anguish, phobias, obsessions), freedom may be somewhat restricted, or limited, but not abolished. In fact, in a certain way, when we do psychotherapy, what we try to do is that the patient takes back the living part he still has of responsibility to lead his life and that from there he conquers the freedom he was lacking, because he is the one who has to move forward. In the end, his life cannot be carried out according to what the therapist tells him, but according to what he does, choosing options one after the other, and that is why it is important to always push that freedom towards where it has to go.
You comment that many depressions may have their origin in part in the destructuring of the family that today's society is experiencing. In what sense?
We are born in a very destitute and at the same time very needy state. A baby, for example, does not know how to love, nor does it know what love is, and yet it needs a lot of affection. But it needs it because it receives it, not because it gives it. Then, with time, he grows and learns, and there comes a time when, when his mother approaches him, he also opens his arms to embrace her, but it has been a learning process, because initially he knew nothing about it. Because of this indigence with which we are born, the relationship with the mother and the father is absolutely necessary, because if a child is born in an environment that he perceives as insecure, there are already psychic aspects that do not work for him, and they will not work for many years. Therefore, the first thing the child needs is security, through what the mother says, what the father does, what he is taught. On the other hand, there is the issue of food. A child would not know how to make a bottle for himself. Or even hygiene care: if a child pees and his diaper is not changed, he will get an infection, and so on. That is why the child, when he is very young, has the perception that the father is omnipotent, because he is the one who gives him all the security.
In childhood, the family is radical. And, without a family, it is very difficult for a person to grow up normal. Therefore, if the family is unstructured or very abnormal, or does not exist, or has been broken fifty times, people have psychic wounds, and this sometimes heals and sometimes does not heal. And therefore they are going to have a deficit all their lives. That is what I think it would be good for parents to think about before choosing an option such as divorce, or even the continuous controversy itself, the argument between man and woman within marriage, which is very frequent, and which embitters children so much. Because, where does the child learn to love? Well, in the people who are closest to him and who should love each other, that is, in the love of the father for the mother and of the mother for the father. If there, instead of a loving relationship, what there is is a permanent conflict, the child does not learn what it means to love and be loved.
Is there anything that is irreversible?
Irreversible as a whole, I think it is difficult. Although there are cases of people who have had a conflict with their father and have never been able to overcome it. I am afraid to talk about this subject, because I think that if parents hear this, they can become very anxious thinking that, when they mess up in their child's education, they can organize an irreversible problem, and then they will not do it well. You have to tell them: "Don't worry about anything, you are doing well, but you have to do better".
So, in my opinion, there is a bestial ignorance about the family. And perhaps that is one of the reasons why there is more family destruction. Because if you do not take care, and you do not know how to take care because you are ignorant, you take any decision very suddenly and without evaluating the consequences.
In addition, it is important for the happiness of both men and women that the family functions well. Even today, most young people do not give up the idea of starting a family, and it is one of the goals they want to achieve. Probably because they come from families in which, with all their faults, the balance has been very positive. And they say: "This is what I want to replicate, but improving it". But for that you have to be trained, and people are not trained. I don't think it's enough to take a weekend course before getting married. On the other hand, you can't demand a whole course either, because natural law forbids it: marriage is a natural institution, you can't bring the academy into it. But I believe that much more needs to be done.
What do you think is the reason for the current high suicide rate?
Many factors. Perhaps also the covid has conditioned a lot what we are seeing now. In addition to social networks, internet, looking all day whether we have followers or not... That organizes a kind of constellation, on the one hand virtual, because there is no real contact, and therefore isolationist, and on the other hand pseudo-transcendent, in the sense of pushing the self to be the king of creation. Is being a millennial already the maximum you can be? Well, I think it is the minimum, or even the null that one should be. The important thing is what you have done with your life, to what extent you are giving it meaning, to what extent you are happy with how you live every minute of your life. It seems to me that this is what justifies human existence and what gives happiness. If on the other hand more people follow you or do not follow you, or if one praises you and the other criticizes you, that is their problem. But what does your conscience say about you?
In addition, young people in general are very insecure, because they have no life experience, and they underestimate their worth. As we perceive ourselves, that's how we act. And then, if in the context in which they are, they see everything negatively, because they don't seem to have a very prestigious working future and the salaries are miserable, and they have the experience of other older colleagues who tell them horrible things, then they start to sink. In addition, if they have had no training in overcoming everyday frustration, any small frustration for them is a giant. And that can cause that, in the face of a very big frustration, they do not have the strength to tolerate it and redirect it, but they collapse. And that is when all the nihilistic and pessimistic attitudes and the search for an absurd way out begin. But there are many factors. In addition to the fact that suffering an anxiety crisis is very hard, and it is unbearable, suffering a depressive condition is more of the same, but with more continuity, and therefore the way out of the tunnel is never seen. If to this is added that very bitter things happen, added factors that are swarming in the environment, such as the girlfriend leaving you, or that the father has gone to buy tobacco and has not returned, everything starts to be very complicated.
Do you see God in the lives of your patients?
I try to see him, and I have done very well, because it seems to me that you change the way you deal with any patient if you see Jesus Christ himself there. That is a different horizon. It happened to me once with a lady with a depressive condition, who worked as a prostitute, had a little daughter, and she was very depressed, she had a very bad time. But, of course, as she did not change her environment, there was not much chance of improvement and the medication was not very effective. One day, already a little tired, having the person in front of me, I asked myself: "What am I doing here with a person for whom I do not charge, who on the other hand I am not fixing, and it is going to be very difficult to get her out of it? I was about to throw in the towel. And then somebody must have said to me, or at least I saw it in my head, "Imagine this woman is Jesus Christ. How would you treat her?" And that changed my mind. I began to treat her differently, I cared less that she didn't pay me, and I began to relativize what before seemed to me to be more important categories. From that point on, it got a little better, although in the end I don't think I was able to get her to quit her job.
