Before pills were available to treat depression and mental illness, doctors—psychriatrists in particular–relied on talking with patients and probing for unconscious factors. Psychoanalysis had its golden age
Dr. Noel Schweig, who hung out a shingle in Crozet at Clover Lawn nearly a year ago, is from that old school known as shrinks, reluctant to resort to drugs if they can be avoided. “People feel a drug takes away their spirit,” he said.
“There’s been a tremendous loss in American life by the fact that insurance companies refuse to recognize anything that does not fit medical protocols. Primary care physicians are ready with their script and pen. They are ready to give out Ritalin for children. But for all our advances, we don’t know how the brain works, so those drugs are an unknown entity with questionable effects. Take Zoloft: in one-third of patients it has no effect. One-third have uncomfortable side effects, bordering on damage. One-third have some positive effect, part placebo and some part sedative. But even in that one-third, the patient develops resistance. And if it is effective, it’s just treating symptoms and does not help the patient grow or increase his self-awareness.
“Even if mood swings are contained by lithium, there is still the question of what the cause of the problem is. Even if there is a chemical cause, there is another psychological factor. Dynamic psychotherapy helps the patient in the envelope of an alliance with a sense of safety and trust. It helps the patient learn how his mind works and helps him see what’s going on under the surface from the past and in the present.”
A person’s reality is affected by their childhood, he said, and strategies we adopt as children to cope with situations too big or too painful for us.
“There is a dialog to learn about who the person is and how he got to be where he is and to help to understand self-defeating patterns he is using to adapt,” said Dr.Schweig. “American culture wants a quick fix. Self-awareness takes time and patience and motivation and money.
“So I’m a dinosaur. I believe in this. Dynamic therapy has more of a relationship with earlier influences on a patient’s life that he was unaware of. A patient says, ‘My brother died when I was five. How is that going to be changed?’ But how he reacted and how parents reacted and how it changed the family can be brought out.”
“One continues with what was adaptive at the time of the crisis. It gets incorporated and in adulthood becomes nonadaptive in dealing with the same reality. My life is dedicated to this and I find it fascinating and sometimes frustrating in terms of my own self-understanding. I mourn those days when people took the trouble to explore personal psychology and the spiritual side. Why am I here? What does it mean? Who do I really want to become?”
These are questions commonly associated with religion, and Dr. Schweig said he is neutral toward religion in its organized sense.
Dr. Schweig went to Duke Medical School in the late 1950s. He spent three years abroad in the Netherlands and then moved to D.C. to work for the National Institute of Mental Health. Next he did another 10 years of training in psychoanalysis, mainly along then-dominant Freudian lines, including years of being psychoanalyzed himself so that he wouldn’t bring his own unconscious influences into relationships with patients.
“It’s no longer practiced the way it classically was,” he lamented. “It’s outmoded by life today and the need for faster treatment. But we can understand our relationships, which are the most important things in our life.”
He practiced solo in D.C. for 20 years, then moved his office to Middleburg for another 15 years.
“I fell in love with Wintergreen and bought a mountain home with 200-degree views,” he explained. After three years in Wintergreen, he leased space in Clover Lawn and opened the office, which he shares with his wife, Lois Vitt, a sociologist who researches financial education (specifically how to teach financial literacy to people). He is a hobby photographer who is developing a portfolio for a gallery showing and the office walls display his photographs. Otherwise, the office mood is serene and comfortable with no overhead lighting in use.
“Crozet is a wonderful community and it is expanding and I wanted to reach out to it. You can achieve well-being and help with conflict without resorting to medication.” He sees families, couples and individuals. He is not connected to an insurance carrier.
“Confidentiality is over-archingly important and I maintain that strictly. I take no notes and have no tape recorders. My job is to help patients trust me so they don’t cover up.
“You see the same sort of problems in every town. It’s not a question of if people need help, but if they know they need help. It’s a painful awareness to acknowledge that one needs help. There’s still some stigma about asking for psychological help.”
The typical problems are marital conflict that keeps recurring with escalating damage, a general feeling of malaise in a person, perhaps realizing they are depressed, or their having a sense of being detached. There’s also anxiety.
“People are uneasy about talking to their family and their problem eats away at them. A good resolution is achieving a sense of being liberated. The most important factor in that is the fit between the therapist and the patient and how motivated a patient is, how eager, to find the problem and make changes. Part of my job is to motivate them to want to understand how they operate.”
Another problem is Alzheimer’s disease’s effect on families. “A big modern problem,” he called it, “that is causing lots of feelings of guilt.”
Fear of death often manifests itself, too, Dr. Schweig said, noting that “a study of centenarians showed commonalities; one was an ability to tolerate loss of loved ones, accepting that dying is part of life.
“But people are more afraid of aging than they are of death,” he said. “The suicide rate is enormous. I think it’s isolation. The family breakdown and the loss of connections—who knows me?—and fear of losing independence and fear of having no one to take care of them. A sense of anonymity is a factor. Suicide is a way of avoiding death by maintaining a sense of control. It’s a way out of despair that comes from a feeling of no hope of being understood. Shame also plays a big role.”
Dr. Schweig said his professional duty is to objectivity, being non-judgmental and nonsocial and keeping things strictly private. “I have no plans to retire. I love what I do and I can still do it effectively.” He has a sliding scale of fees and does help file insurance claims. “I often do sessions with people who I know on the phone, if it’s comfortable.”
Dr. Schweig recommends a recent book, Unhinged, by Dr. Daniel Carlat, which he described as a New York psychiatrist’s account of how he came to the realization that he was hostage to drug companies.
Now, after nearly a year in the office, his Crozet connections are beginning to develop. He writes prescriptions only long enough to get someone weaned from a drug or if a patient’s anxiety is interfering with treatment. “Ultimately I want the patient to respect his own internal resources—that are so powerful—to find the healing he needs.”
“I think psychoanalysts were arrogant in thinking they had the truth and were superior to ‘superficial means of help’ [meaning drugs]. That alienated the community. After the war, medications came out and insurance companies wanted quantifiable evidence. Counseling took over psychology and psychology became ‘eclectic.’”
Nonetheless, he insists, the old schools of psychoanalytic theory still have something to offer. “A good Freudian, a good Alderian, a good Jungian, if they have empathy, any one can be effective.”