One of the UK’s most distinguished psychiatrists has welcomed the advent of online psychotherapy as a potential life saver. David Enoch, who has 65 years of active clinical practice under his belt, has worked hard over the years to present a credible and attractive Christian voice within his profession, authoring such acclaimed works as Healing the Hurt Mind, I Want a Christian Psychiatrist and the foundational Uncommon Psychiatric Syndromes (the 5th edition of which is due for publication in January 2021).
I spoke to my good friend David following the publication of his blog last month, ‘Online psychotherapy for the COVID era: digital healthcare with insights from Auschwitz?’, on the Mental Elf website, which exists to “facilitate a democratic conversation between patients, clinicians, researchers, carers, policy makers, health and social care professionals and others.”
“I have been a psychiatrist for 60 years,” he explained, “and I have seen many changes in clinical practice, but I have to admit that the present situation is without precedent. The flow of people suffering from mental illness is likely to be accentuated by Covid-19.
“There will be an increased need for treatments such as psychotherapy. However, the need for social distancing makes face-to-face treatments more difficult to deliver, whereas online therapy presents several possible advantages compared to face-to-face treatments.
“One of the main advantages of online therapy will be its accessibility. Treatment can be offered to people who cannot physically visit therapists, as well as to those in low- and middle-income countries.
“It also gives us the potential to lower the cost of treatment, thereby bringing it within the reach of lower income people without access to free healthcare, and those who do not meet the criteria of healthcare services. Indeed, the expansion of digital technology could control the increasing costs of healthcare within the UK too.”
In fact, Enoch agrees with the Public Health Consultant John Ashton, who has argued that this global crisis will be seen as marking the “end of one and the beginning of a new one” in which the new technologies will take centre stage.
“There will surely be a total transformation of the way we practise medicine,” says Enoch.
He knows the school of psychotherapy that could prove particularly appropriate in the aftermath of the current pandemic too.
“In my six decades of clinical practice, I saw many therapies come and go. Some, like insulin coma therapy and lobotomies, were rightly consigned to the history books. However, some useful modes of treatment have been neglected. In this respect, I am of the opinion that a little-known form of psychotherapy will prove of particular value in this Covid-19 epoch.”
That form of psychotherapy was developed by Viktor Frankl and is known as the Third School of Viennese – the School of Logotherapy.
“Frankl, the Austrian Neurologist and Psychiatrist was Jewish. He and his family were deported to the concentration camps where his wife, father, mother and brother were killed,” Enoch explains.
“Not only did he survive, which was itself a miracle, but he helped others to survive, too, by his psychotherapy, whose central idea is summed up in the title of his most famous book, Man’s Search For Meaning.
“Frankl emphasised that in order to survive the hellish concentration camps, one needed a reason for living. Without that, you lost the will to live, and died. Frankl agreed with Nietzsche that those who have a ‘Why’ can withstand any ‘How’.
“Frankl also articulated that although the dehumanising conditions turned prisoners into walking dead, the prisoners had to keep their sense of identity. They had to realise that whatever possessions were taken from them, they still had the freedom to choose.
“This speaks eloquently of the way that we can survive today. Individuals and families are facing grief, financial hardship and educational disruption, added to the loneliness of social distancing. In our efforts to provide online psychological support we must help them to find a reason for continuing to live; to see that there is a light at the end of the tunnel.”
But just as importantly, Enoch admits, is Frankl’s insight that “the most depressing influence of all was that a prisoner could not know how long his term of imprisonment would be; he had been given no date for his release.”
“This has become a great issue in the present crisis, reflected in the constant questions regarding when lockdown restrictions may be lifted completely,” says Enoch.
“Unfortunately, the answer is still in doubt, and honesty insists that we depend on the scientific data, which suggests that the danger may not pass for many months. This will be a cause of great tension to be addressed in any psychotherapy. Even as Frankl states, ‘With the end of uncertainty, there came the uncertainty of the end’. It is already clear that the world may never be the same again.”
Despite the turmoil and upheaval generated by Covid-19, Enoch is convinced that the Christian Gospel is as relevant now as it’s ever been.
As he said: “On my long journey, I have come to realise that He is the ever-faithful God, present in the triumphs and the tragedies of life. And in these difficult and anxious times we hear Him cry to us: ‘Fear not I have called you by name. You are mine.’ And ‘no one will snatch you out of my hands’. The widespread arms of the crucified Christ embrace us with His saving grace and the Risen Christ with nail prints in His hands endue us with the power of His resurrection.”