The United States' society's perception of the world shrinking into a small global village thanks to the geometric proliferation of electronic communication is understandable. This on-line magazine is a product of cyberspace interactions. Our universities and research centers are in touch with each other and it is fairly standard for undergraduate college students to receive their designated email addresses along with their course schedules. In an instant we can dispatch a message to the White House, to our senators, to our TV broadcast companies. We conduct financial transactions and consult with hundreds of professionals in any field imaginable from formats of list services to bulletin boards and support groups on the INTERNET, (which had its beginnings as a U.S. government research project in the 1970s).

So it is easy for Americans to feel as though the entire world is interacting with the same intensity and energy, a perception not fully supported by reality.

My first column in this series of therapeutic approaches outlined the need for the role of a Œtherapeutic advocate,¹ the primary psychotherapist who, in addition to providing counseling services, would facilitate and monitor the patient's interactions with other helping professionals, (i.e. consulting psychiatrists, medical practitioners, school teachers and counselors,) and even follow the patient's progress through in-patient residential programs if such a referral was deemed necessary. Thus patient, family and all practitioners join as a team and the therapeutic process becomes a community venture.

In many highly technological and industrial countries, such as those of the now emerging European union, ignoring for now the Œthird world¹ and Œundeveloped¹ nations, where one would expect levels of practice to be similar or on par with that of the U.S., realities fall short of expectations.

This shortfall is not due to any technical inability to join the communication system with the needed hardware and electronic infrastructure (Just a short walk from the Arch of Triumph in Paris I had coffee at a Burger King that had several tables equipped with computers, ready to exchange a half hour on line for some francs.)

During my last visit to France in 1997, I expressed interest in observing a school in session and exchanging views with teachers on managing learning disabilities and neurological disorders in children which shape behaviors and academic performance, a welcomed occasion in the states. I consequently learned of the virtual impossibility of such an exchange as it was explained that even the children's parents cannot observe their children or teachers in the school. Should there be a need for a parent-teacher conference, typically an appointment is made and the conference is held at the school gates, outside the building, close to the street, even in inclement weather.

In one school I walked by many times on the way to the subway station, the parent-auxiliary was permitted entry to the school only once per year to inspect conditions in the cafeteria. School is definitely the exclusive domain of the teachers devoid of any sense of community partnership between educators, parents, local social agencies and businesses. Advocacy in any area would be stifled, to the detriment of the student.

Children born genetically clean of disorders that would inhibit their learning receive an excellent and demanding education and thus score competitively against other nations in the mathematics, sciences and language arts. The others fall to the wayside, out of the mainstream, and must leave their families for distant boarding schools or never complete their high school education.

This prevailing and all controlling mind frame permeates the mental health field as well. Many European countries are still grounded in Freudian ideas with the prevailing method of treating all disorders and dysfunctions being psychoanalysis, a seven to ten year process. (I teased a colleague trained in that process with the comment, "Well, I'll give you a child entering first grade with school phobia, you begin the psychoanalysis, five years later when that kid is in fifth grade, he should be cured, right?" "Yes," he countered, "and I will have uncovered other problems which need further analysis." We both laughed. By the way, he does not practice psychoanalysis except for the wealthy in whose circles it is Œfashionable.¹)

One of the pediatric psychiatrists who graciously hosted me in his Paris office had been introduced to Ericksonian hypnotherapy only since 1995 and was quite interested in my clinical experience along with other therapeutic strategies I use in addressing Tourette syndrome, OCD, ADD, Learning Disabilities, panic and anxiety. He explained how a new school of thought and approach is gradually getting stronger among the younger practitioners, but the prevailing response is still psychoanalysis. While the newer group of psychological professionals are increasing their reliance on the DSM-IV for diagnostic criteria, most French practitione do not hold to a common standard or language.

In 1980 I was bit by a rattlesnake and hospitalized for ten days. In recovery, (and even during emergency room treatment while still conscious), I had some questions and was politely but sternly put in my place. One doctor asked me, "What is your profession?" "Educator," I replied. His response was, "I would not question your practice so don't question mine." A verbal response would have been to note that I do welcome questions and challenges to my professional practice by even those outside of it, and furthermore, while that doctor had responsibility over my body and physical health, so did I and was the boss in this case since I live in this body and he was my employee, hired to provide me a service. I did not bother with this argument, responding only that I would no longer permit him to examine me. The hospital assigned me another doctor and we had mutually edifying conversations about my recovery and the nature of medical interventions in general.

There are pockets of professional arrogance in the United States, although generally the medical and mental health practitioners welcome the Œteam¹ approach, involving family and helping agents in the patient's treatment. When a practitioner operates independently and maintains an approach that does not honor the patient and his entire person, (physical, emotional, holistic and spiritual), then we risk subjecting the patient to ineffective treatment at best and damage at worst.

When entire nations follow suit and do not avail themselves of current literature and research data bases published outside their countries and in the world wide networking through the INTERNET, they not only disservice their own people, but also deny the rest of the world the gift of the resource of their great minds and collective knowledge. A country such as France has been, throughout history, a tremendous contributor to the development of Western Civilization in the arts, sciences and literature. It possesses too rich a legacy to be strangled by cultural and academic arrogance and national narcissism.

Another Parisian clinician in a well known children's hospital I met described the long road yet to travel. This road must overcome not only training, education and traditional thought, but the need for a new language as well. In the French language, for instance, the term Œdisorder¹ has no meaning medically. Say Œdisorder¹ and the French think of a disorganized filing cabinet or an unmade bed. To have a disorganized or disordered neurology or biochemistry makes no sense. So TS, OCD, ADD, are Œdiseases,¹Œmaladies,¹ and Œtroubles.¹ In French, OCD is ŒTOC¹: Troubles Obsessive Compulsive. ŒToc' is also the layperson term for Œcrazy.' So an American says, "I have Obsessive Compulsive Disorder," and the Frenchmen hears, "I am crazy." Worse, let a French child or adult explain, "I have OCD . . . " then it is time for psychoanalysis.

Traditionalists in Europe have even accused the U.S. of Œinventing¹ neurological disorders, such as ADD. (Implying we are making excuses for a generation of undisciplined and unruly children. Maybe to an extent we are, since many researchers have commented that ADD is over-diagnosed in American school children.) Made in the U.S.A. perhaps? Anyhow, linguistics is a powerful determiner of behavior.

Muscular Dystrophy was never described or reported until the middle of the 19th century. Within a couple of years, however, hundreds of cases were then documented. Jean Martin Charcot, a prominent Parisian neurologist who taught doctors Gilles de la Tourette and Freud, was struck by this circumstance enough to remark, "how come that a disease so common, so widespread, and so recognizable at a glance, a disease which has doubtless always existed, how come that it is only recognized now? Why did we need Duchenne to open our eyes?"

Just 20 years after Duchenne's description of MD, Doctor Georges Gilles de la Tourette of France described another unrecognized syndrome. Soon after that, Carl Jung, a student of Sigmund Freud, left his teacher in the midst of a bitter argument over the forces that shape human behavior. Gilles de la Tourette, a son of France, was left in the dust and still remains, ironically, forgotten by the medical society of his country, overshadowed by Freud, to this very day. Dr. Gilles de la Tourette and his associates were among the last in their field to espouse the connections between body and soul. The early 1900's reflected a loss of soul in neurology and a psychology in the sky, no longer grounded in the physical.

If Tourette syndrome is, as some suggested, a missing link of understanding between body and mind, then it is no wonder that, for the last seventy years and more, it has disappeared, or, at best, relegated to the Œextremely rare disorder¹ list, which it is not.

Davison and Neale wrote in the psychology journal Abnormal Psychology: "Consider an example from analyst Main: 'The little boy babbles tenderly to himself as he soaps himself in his bath does so because he has taken into himself his tender soaping mother.' What, in fact, is readily observed by the average onlooker is the child bathing himself. To see his mother incorporated in the soapy bath play is to operate at a very high level of inference. The paradigm problem is again evident. What we perceive is strongly colored by the paradigm we adopt . . . If the Western view of the Scientific Method requires concepts to be measurable, and theories testable, psychoanalytic thinking cannot be regarded as scientific."

"Anna O., the young woman treated by Breuer with the cathartic method or 'talking cure,' has become one of the best known clinical cases in all the psychotherapy literature." They write that this case along with four others, formed the basis of Freud's theory. However, Freud later admits that Anna O. had never been cured and hospital records later reported she continued to treat her problems with morphine. Davison and Neale continued, "In fact, evidence suggests that some of her problems were organic, not psychological. It is fascinating and ironic to consider that psychoanalysis traces its roots back to an improperly reported clinical case." Typically, Anna self-medicated. (1)

The French never recognized a grand homme of their own. Freud and his quagmire of psychoanalytic theory are still revered. The Tourette Syndrome Association, Inc. of the United States revived the contribution and heart of Dr. Gilles de la Tourette. Indeed, Made in the U.S.A.

Einstein, a humble visionary noted for his work on relativity and frames of reference in astrophysics, indicated that believing and imagining it to be will allow you to see it, in opposition to the cliché phrase, "I'll believe it when I see it." Einstein's powerful vision of a new physics would have not been possible had he espoused rigid paradigms and set ways of interpreting and examining. We need researchers who will boldly approach the edge, humble doctors and therapists who will honor and journey with the patient, and be a team player in a world of tremendous resources and minds and skills. It really is not a small world after all, regardless of the INTERNET.

The gaps of cultural, medical, scientific, educational and linguistic arts and understanding are huge. We have the means to close them. We need the vision and the heart.

-- John S. Hilkevich, PhD, is the Director of
Integrated Counseling Services, in New Jersey.
He can be reached by email at 'Counserv@AOL.com'.

Footnote:

1. Davison and Neale, Abnormal Psychology, Wiley & Sons, Inc., NY, 1990, p 22