J.R.: sISTEM DELA (ENGLISH)

Dr. Sc. JANEZ RUGELJ, M.D.

THE SYSTEM OF RADICAL PSYCHOTHERAPY
AND PERSONAL TRANSFORMATION OF PEOPLE IN DISTRESS (NEUROTICS AND ADDICTS)
– AN OVERALL PRESENTATION

(Symposium for Visiting Psychiatrists from the USA, Ljubljana, 10 October 2002;
Head of the Delegation: Dr David A. Deitch, professor of psychiatry)

1. INTRODUCTION

The Alternative Therapeutic Community (ATC) that I manage comprises from 110 to 120 people; amongst these, there are currently eight members with doctors’ degrees, seven masters of science and over sixty people with university degrees and specializations. It is a unique community, I believe also in an international scope, of people who once suffered various sorts of distress, and are today all non-alcoholics, non-smokers, all engage in rigorous physical exercise, are long-distance runners who run marathons, love hiking in the mountains and literature. All of them also endeavor to become good partners, parents and colleagues at work, and to be successful in their profession, aiming to find what we could term their “calling”, and through this achieve self-realization in life.

Of course, there will always be a few in the Alternative Therapeutic Community who attempt to manipulate and evade their duties, but invariably these sooner or later leave the community, continuing their low-quality lives.

Although at the time of their joining my program virtually all members of the community were in a state of severe emotional distress, today, the group forms a healthier segment of the Slovenian population than any other “outside” community.

2. OVERALL STRUCTURE OF THE SYSTEM OF RADICAL PSYCHOTERAPHY AND PERSONAL TRANSFORMATION FOR NEUROTICS AND ADDICTS (Rugelj, 1981, 1983, 1984, 1985, 1992, 1999, 2000)

– Within the Alternative Therapeutic Community (ATC) I manage five permanent therapeutic groups and clubs, which include from twenty to thirty people. Meetings with a duration of three hours are held from two to three times a month (depending on the group). In addition, there is a monthly four-hour session (meeting) of the entire therapeutic community.
– Occasionally I form various parallel and ad hoc groups, such as groups for singles or students and workshops for curing sexual problems. These groups are terminated once the purpose for which they were established has been achieved.
– 20 per cent of the population are alcoholics and 5 per cent people with addictions; the remaining 75 per cent are neurotics, mainly people in partnership crises.
– The basic program lasts for three years. However, the continuative or stabilizing program can last up to ten years. This is the stage of “giving”, when members give to others what they themselves received. This, I believe, is a universal law, which we could paraphrase as follows: what we have received from our parents, teachers and therapists must be passed on to our children, our students and also our colleagues in the community. I consider all who break this law to have a personality disorder, or what Victor E. Frankl called “inhuman people” (Frankl, 1992). There are very few – only from two to four per cent – who respect this law, which illustrates to what extent neurotics also suffer from various types of personality disorder (Horney, 1964, 1965, 1966, 1976, 1980).

– The program is unlike any other psychotherapy program described in the professional literature, since it requires the following of the patients:
– Morning exercise on a daily basis,
– Regular long-distance running (at least 30 km a week), training to run at least one marathon per year,
– Regular mountaineering (in the first year members are required to complete at least one short Slovenian peak-to-peak mountain hike along a set route, and a hike along the longest such route within the next four years),
– The regular submission of (creative) written contributions either of a narrative or a self-expressive (reflexive) nature, such as: diaries, the patient’s thoughts related to the set literature in the program, the group mountain trips, meetings, and other topics. The writing in this case must be in accordance with special instructions, which the group members also receive in written form. “Makeshift” writing is not accepted. In three years, an average couple produces from 1500 to 2000 pages of such writing (on computer);
– The regular reading of books prescribed within the program, which include both literature and works from various areas within the social sciences and the humanities. Meager readers are required to read at least two books a month, while candidates aspiring to be regarded as intellectuals are expected to read at least one book a week;
– Regular attendance of weekly therapy group meetings and monthly community meetings.

3. THE PROFESSIONAL STARTING-POINTS IN OUR WORK

1. The fundamental characteristic of virtually all patients who seek psychiatric help, with the exception of psychotic people, is neurosis, which I define as personal immaturity, which subsequently results in the person’s incapacity to cope with the normal difficulties encountered in everyday life.

2. The essence of neurosis has, in my opinion, to date been most convincingly described by Karen Horney, who explicitly stresses that neurosis involves various personality disorders. She also attributes its origins to both an environment that is non-stimulating for the psychosocial development of the child in its primary family and to parents’ aggressiveness towards children. Psychiatrists throughout the world do not reveal and disclose this fact sufficiently, and in this way defend (indirectly) the psychopathic structure of parents who “generate” people in distress. Moreover, by doing so, psychiatrists cover up for the pathology of the responsible state institutions which also keep hidden from public knowledge the fact that a large percentage of families in our society suffer from various kinds of pathologies.

3. All addicts are immature, which means that nothing is achieved through abstinence alone (be it from alcohol, drugs or any other substance). Rather, the solution is in providing a program that will encourage their delayed coming to maturity, in which their families must necessarily also participate. The reason for this is that in those cases when it was not possible for a person to reach relative maturity during childhood or early adulthood, they can accomplish this only by taking part in a long-term and extremely active program of “personal correction” and delayed coming to maturity.

4. The defining characteristics of neurosis:
– Fatal deficits in an individual’s psychosocial development due to a non-stimulating environment within the family, at school and in society in general, which subsequently bring about a multifaceted reduction of the person’s abilities to function in life. This, in turn, causes the person to lag behind his or her most successful peers.
– Traumatic events caused by psychopathic parents and other adults who “took care” of the child are repressed in the unconscious. However, these events still preserve their energy potentials, which results in their exerting irrational control over an individual’s behavior and mood, and especially in the formation of various neurotic symptoms, such as anxiety, impotence, asocial behavior, alcoholism, drug addiction, unsuccessful schooling, vagrantism and criminal behavior.

The psychotherapy of neurosis is stressed because all addicts are also neurotics, whose treatment begins only after they have stopped using the substance they are addicted to.

The in-depth and thorough psychotherapy and re-education of a neurotic person as described by Plato and Emmanuel Kant (Platon, 2002, Kant, 1991, Hribar, 2000) is an extremely demanding and long-term process, since it should include partner therapy in a group, and sometimes even family therapy in a group, as well as various combinations of individual, partner and family sessions, whereby the patient should (unconditionally) always either establish healthy relations with their primary family through a series of joint family sessions or the participation of its members in the program, or terminate all contact with their primary family (which is without exception always pathological).

It is necessary that the person gain a sense of being “purified” of his of her suppressed traumatic experiences. His or her potentials should be developed to the full, while the following should also be achieved: the genital (orgasmic) state of personal development, good partnership with creative sexuality, parenthood, a sense of vocational “calling”, and self-realization (Maslow, 1976).

There are very few neurotic persons who resolutely and unwaveringly step on this path. Even when they do, they normally are unable to find appropriate therapists and programs, as there are as yet few of both available that aim at providing all this. For this reason also, traditional psychiatry can offer no case study of the complete rehabilitation of core neurotics.

As a rule, neurotics do not respond to the normal instructions and encouragement of their psychotherapists and re-educators. Consequently, due to the resistance they demonstrate and the way in which they “regurgitate” their problems, the therapists simply do not take them seriously. They consider them incapable of participating in the character transformation process by responding to normal interpersonal stimuli and come to the conclusion that neurotics might make some “progress” only under the influence of special psychotherapeutic means such as: reflection, interpretation, (resolute) confrontation, ultimatums posed by their nearest and dearest, examples set by positive role-models, and similar. These are, I believe, the main reasons why virtually no one practices radical and serious therapeutic work with neurotic patients.

The results of the psychotherapeutic treatment of neuroses are extremely poor: not a single psychiatrist in Slovenia has so far published a case of psychotherapy that has ended successfully (according to the indicators I listed earlier). Unfortunately, the only positive results published are to be found in my books, papers and other reports.

As a rule, the neurotic state of distress or crisis is a consequence of the person’s irresponsible attitude towards education and all other general skills required in life. In normal language we would call this laziness. My own examination of no less than thousands of cases brought me to the realization that laziness is in fact the key reason why the majority of people lag behind their most successful peers. What I call “laziness” here, is of course the result of a lack of curiosity, caused by the non-stimulating atmosphere and environment in the patient’s primary family, at school and in his/her social environment.

I realized that conventional psychiatric methods, when dealing with lazy people, do not aim to achieve their activation on all levels, which would enable such patients to overcome the often fatal distance between them and their more successful peers, but instead directs its focus towards achieving merely a temporary alleviation of the actual problems. This is why I decided to move away from traditional psychiatry and in particular from the traditional (deceptive) psychotherapeutic sit-and-talk methods and opted instead to develop an original system of therapy and re-education which I describe as a system of radical psychotherapy and personal transformation. This system is based primarily on the philosophical positions of Plato and Kant and on Watzlawick’s “second-order change” (Watzlawick, 1974). The essence of this system, however, lies in the activation of the individual in all crucial areas of life with the aim of eliminating the shortcomings that were caused by laziness and indolence. The process of shedding these shortcomings can be a lifelong one, while its initialization and starting phase have, in most cases, a duration of no less than 10 years.

Naturally, the great majority of people in a neurotic state of distress is reluctant to admit (or to realize), that they themselves are also personally responsible for their crisis and/or their failures in life, and therefore set up defense mechanisms such as: minimalization, projection, rationalization, fragmentation, and so forth.

I have analyzed literally thousands of people in distress. Without exception, all of them spent their infancy and childhood (the first months or years of their lives) with a mother who was normally in a situation-induced neurosis, which gave her no opportunity to build a symbiosis with her newborn child.

The children of alcoholics also spend the first months and years of their lives with mothers who were unable to build a symbiotic relationship with their babies. The wives of alcoholics, with whom I jointly analyzed the period immediately after the birth of their children, told me how profoundly ashamed they were of their husbands, who swaggered drunkenly into the maternity ward.

These developmental deficits arrest the development of the person’s potential to actively engage in the activities of life in all areas. Subsequently, the child lags behind its successful peers, which gradually intensifies its anxiety, bringing about a series of secondary problems. As a consequence, these children suffer from various repressions and inferiority complexes. They feel miserable, have a poor school record, and are awkward in their relations with the opposite sex. All this inevitably leads to a general failure in life, which results in a build-up of secondary anxiety-related problems.

The traumata generated by deprivation or maltreatment in childhood remain imprinted in the child’s consciousness, or are repressed into the unconscious, from where they influence the behavior and total experience of the affected person by means of “hidden” mechanisms.

4. THE PROGRAM

The program falls within Plato’s and Kant’s philosophical positions on the education of children, and the radical pedagogics of Anton Semyonovich Makarenko (Makarenko, 1959); in addition, my fundamental conclusion is also completely congruous with that of Erich Fromm (Fromm, 1970), who stated that a large majority of people die before reaching maturity.

Within this framework, it is understandable that traditional sit-and-talk psychotherapy is simply inadequate and does not ensure the fulfillment of the delayed process of coming to maturity. Instead, neurotic people should join a system geared towards the general and long-term activation of their potential in all major areas of life.

Neurotic (immature) persons are disturbing: their immature reactions cause problems to anyone near them. Because of their immaturity, these people, though not deliberately, hand down the neurotic and pathological atmosphere from one generation to the other. The paradigmatic representative of this type of immaturity and pathology is the male alcoholic, who has an utterly destructive effect on his wife, children, co-workers and neighbors virtually until the day he dies. According to my estimate, there are over 200,000 alcoholics in Slovenia (with a population of two million), which means that we have an army of persons with personality disorders (alcoholics who develop secondary psychopathologies), sufficiently numerous to have a devastating effect and which is self-destructive for the Slovenian nation. (Alcoholics and their families can step out of this “army” only if they join a long-term program of radical psychotherapy and re-education).

For this reason, I tell each candidate who wishes to join my therapy program the following:
I do not practice “treatment” by means of medication (sedatives, anti-depressives, neuroleptics). Moreover, participants in my program are prohibited from taking these medications on the following grounds:
– None of these medicaments cure the condition but only “alleviate” the progression and the symptoms of the illness (especially with psychotic persons);
– Because these groups of medicaments “relax” the person to an extent where he or she is no longer capable of complete perception and full emotional response, these persons are subsequently also incapable of normal human empathy, which is the precondition for any psychotherapeutic or re-educational work. This work must later necessarily become a process of thorough self-education on the part of the person undergoing therapy, or we cannot hope for any real results.

Upon their first consultation, I advise candidates for my program to purchase the first set of my books (“Pot samouresničevanja”, “Uspešna pot”, “Dramatična pot”, “Zmagovita pot”, and some other publications), study them and report at our next consultation whether they believe they are capable of following the program consistently and for a long time.
Only those “people in distress” who express such willingness can join the program; others are free to turn to psychiatrists whose programs are less demanding, or who have none at all.
After the second consultation, the candidate is requested to start writing a diary.
The candidate is then obliged to bring along this diary to each further consultation, together with self-expressive writing about the other books that are on the program. In addition, the candidate is also required to purchase other relevant books for study and write about them.

Although most of the books that I recommend during the first few consultations deal with alcoholism, non-alcoholics are also required to read them. They should “translate” the diagnosis of alcoholism into their own in a way that is meaningful to them, be they a drug addict, smoker, overeater, neurotic, psychiatric patient, “failed student”, or suffering from a long-term single status, a partnership crisis or a family crisis; whether they are an idle person, a “couch-potato”… etc. The basic program is identical for all types of problems, while the special program is individualized for each type of disturbance.
All requirements set for the candidate for treatment (the “identified patient”) also apply also to his or her partner or the candidate’s key relative, since the basic program is identical for everyone.
When the candidate shows a considerable amount of motivation for change and agrees to follow the program (i.e. the therapeutic pact), he or she is invited to join the program together with his or her partner or spouse.

During the preparatory stage the candidates’ potential abilities and readiness to follow the program are revealed on the physical, intellectual, social and spiritual levels. Those who lack such potential cannot join the program. Most likely these will be able to cope within some other, less demanding program, normally of the type that merely ensures the patient’s elemental survival – a situation that an increasing number of people (especially those who are less active) will face during the process of globalization. However, any “lazy” person is always free to change his or her mind, leave the “mere-survival” program, and join our program for self-realization.

I should stress the immense importance of what we call the “healthy core” of our community in the process of rehabilitation. Only those rare few members of the community constitute its healthy core who have, not only by consistently following the program, but by a long-term above-average activation of their potential in all essential areas of life, managed to “rise above” their distress, rehabilitate themselves, and achieve a high level of personal maturity.
The members who constitute the “healthy core” of the community function as role models for new members. They also play a major role in providing feedback for the therapist, for example through written contributions on the therapist’s confrontations and other interventions.

The following fundamental goals should be attained by every member of my program:
Since in the civilization we live in, work is the chief area of operation as well as the means for achieving personal affirmation and establishing oneself in society for virtually every person, a person’s main efforts should be aimed at attaining the highest possible level of mastery in their profession. The following commitment should therefore be made: “I shall achieve such a level of mastery in my profession that my employees won’t even consider firing me; instead they will be demanding my services long after I have retired. I shall also set as my permanent goal to never accept heteronomous degrading wage-work, and instead become an autonomous agent, whose position in the work process can be compared to that of a king amongst heteronomous working ‘slaves’”. This position is in fact a paraphrased version of that assumed by the distinguished Slovenian criminologist Zoran Kanduč in his work, in which he gives a summary of his most recent findings in various contemporary sociological sources on the structural violence against heteronomous workers (Kanduč, 1995).

Professional mastery and, especially, autonomous professional work, are the basic preconditions for leading a successful life in this civilization, since they facilitate well-being, self-esteem and professional affirmation, which all have a positive effect on a person’s position within a partnership, their family and society. However, such mastery can be achieved only by a person who since his/her youth has been putting great efforts into acquiring a multifaceted education and achieving mastery in all the main areas of life. People in distress who – also due to their own laziness – lag behind their most successful peers, must on the other hand put tremendous and long-term efforts into achieving such mastery. Still, from my experience, this is the only creative path that can lead a person from “back-sliding” in life to a state of good physical, mental and social health.
With a high level of certainty, our program of long-term activation in all major areas of life guarantees every motivated person that they will rise from out of their troubles and succeed.

Some other important goals are: regular recreation, creative partnership and parenthood, and optimal participation in social life.

5. ORIGINS AND DEVELOPMENT OF THE PROGRAM

There are two major types of psychiatry:
5.1. Controlling psychiatry (defined by the American psychiatrist Thomas Szasz as a social service for non-criminal delinquency), which in cooperation with the police, the juridical system, prisons and asylums for the aged ensures that persons with personality disorders are sedated and placed into asylums… and then there is
5.2. Therapeutic psychiatry which, in combination with medicaments and psychological treatment in various forms of individual and group psychotherapy, aims to achieve a change for the better.

I feel I should again stress at this point that I have yet to see or to read in either the Slovenian or international professional literature about a convincing case of a person who suffered a neurotic breakdown and who, by means of (therapeutic) psychotherapy achieved the level of rehabilitation that can be demonstrated by the more active members of our program.

Therapeutic psychiatry draws its theory and practice from around 500 different psychotherapeutic schools, the work of most of which is essentially reduced to the “sit-and-talk” form of therapy. It also requires no engagement in activities that would assure personal development.

Over the past thirty years I have gradually developed an original method of long-term activation in all essential areas of life which involves neurotics, alcoholics, drug addicts, psychogenic psychotics, “failed students”, and people in partnership crises. For all of these people it can be argued and proven that they simply lived their lives the wrong way due to their neuroses, which I define as immaturity. When they ask for help, they should therefore be offered a complicated long-term process of delayed coming to maturity, which is the only sure way to prevent repeated relapses into the pathetic and miserable life of an immature person.

This principle of course applies only to the relatively few “people in distress” who are willing to enter a long-term activation in all major areas of life and make their best effort to “make something of themselves”.

5.3. This new, third school of psychotherapy is based on the social system of psychiatric treatment of alcoholics. The beginnings of this system date back to 1964, when it was developed by the Croatian social psychiatrist Vladimir Hudolin from Zagreb.
Hudolin’s system was based on the following cornerstones:
• Alcoholics were treated in groups in hospitals or outpatient clinics, and in clubs for treated alcoholics;
• The participation of both the alcoholic’s family and children was mandatory;
• The patients had to study alcoholism and in the end take an exam in the subject;
• Treatment continued in clubs for treated alcoholics (Hudolin, 1977, 1981, 1982, 1991).

My work was originally based on Hudolin’s method. During the course of my work, I conducted ongoing evaluations of the results of the treatment (especially in the failed cases), and on the basis of these evaluations created over 500 modifications of Hudolin’s system, finally forming a system of radical psychotherapy and personal transformation.
It took over thirty years for the community to reach its current stage of development, during which it has reached a peak that I would have found hard to imagine when I first started out. If a therapist of my format were to establish a similar therapeutic community, it would take them at least fifteen years to come only close to my therapeutic community’s level of operation.

A systematic overview of past work
The following are only some of the results of the thirty years of my past work:
• Over 15,000 identified patients and their spouses have so far turned to me for consultation,
• I have listened to over 20,000 patient’s club or group presentations of various types,
• I have spent around 20,000 hours in meetings of therapy groups, clubs, and the therapeutic community,
• I have read around 500,000 pages of my patients’ self-expressive writing, where they express their traumas, experiences, feelings, etc.,
• Together with the members of my groups, clubs and the entire community, I have participated in nearly 150 long or short distance runs (organized events),
• Together with my patients I have spent over 150 days on trips in the mountains and camping trips, which lasted from one to several days,
• I have spent over 1,500 hours at meetings of the Slovenian Society of Therapists for Alcoholism, Other Addictions and Help to People in Distress, which I chaired myself.
• I have headed various seminars on alcoholism, which altogether total to around 150 days,
• I have written ten books and over a thousand articles and papers,
• I have edited over a thousand miscellanies on our work (single copy) and anthologies of case studies covering over 400 specific cases,
• My documentation includes a chronological record of the minutes of all group, club and community meetings that I have conducted in the past 31 years of my work, and which total to around 7,000 meetings.

6. RESULTS (schematically)

– Amongst the successful cases and results I only count those members who satisfactorily completed at least the basic three-year program.
– In the past twenty-five years, over 200 alcoholics completed the basic program, of which only five experienced a relapse, two have returned and currently abstain, while three have re-entered the process of self-destruction. Within the context of evaluation methods in traditional psychiatry, these results are phenomenal and unprecedented.
– Also nearly 200 neurotics completed the basic program. All of them improved the quality of their lives considerably.

Having said that, I must add that there are relatively few who are able to preserve the intensity of intellectual, physical, social and spiritual life, such as we promote within the Alternative Therapeutic Community, after they have left this community.

The tragedy in the initial stages of alcoholism as experienced by the alcoholic’s partner has been researched in depth, and could be summarized thus: when the alcoholic husband comes home late for the first time after marriage, drunk, staggering and babbling, he commits the first in a series of crimes against his young wife, who had anticipated him with great love. With this he forever ruins her feelings of love, trust and respect.
The alcoholic’s first insolence, which I also call “the first alcoholic crime to partnership”, defines the essence of the future sadomasochistic relationship between the spouses, which only young wives and partners with enough dignity can terminate by immediately separating themselves from their husband or partner.
Because of their criminal behavior of the type I have **** described, alcoholics can be completely rehabilitated only in exceptional circumstances: the former alcoholic must change radically and work hard to become an exceptional person. Only in this way can he hope to wake feelings of love again in his wife. So far this has indisputably happened only in a few rare cases.

We have also witnessed a unique discovery and finding: neurotics who have suffered a neurotic break-down can completely rehabilitate only in exceptional circumstances, provided that they undergo at least five to ten years of partnership treatment in a group and within a therapeutic community. Such treatment should focus on the organization and stimulation of a delayed coming to maturity in all essential areas of life with the help of various factors of socialization (partnership, parenthood, professional work, and on average eight years of participation in a program together with the partner). This should be done in combination with a process of the participants “purifying” themselves of the traumatic events experienced during childhood and later on in life (recalling them from the unconscious).

The perspective for the rehabilitation of drug addicts is normally close to zero: they usually have no working habits, their pathological families in most cases refuse the requirements for their own treatment, while the partners of drug addicts, when these have them at all, are as a rule utterly inappropriate.

Small chances for the rehabilitation of drug addicts exist provided that they join, together with their families, groups that are similar to those within the Alternative Therapeutic Community, and participate in them actively. However, for various reasons, groups cannot cope with more than two drug addicts.

The same applies to drug addicts as does to neurotic persons: the repression of the child’s natural curiosity by neurotic (pathological) parents, by the child’s school and by society results in what we call “laziness” in normal language. All lazy people lag behind their most successful peers – a situation they cannot stand if they are bright or have a ‘normal mind’ without attempting to alleviate their frustration through the use of some sort of drug such as alcohol, nicotine, exaggerated consumerism or shopping fits, showing off, neurotic behavior, etc.

Over the entire thirty years of my work, only one couple has completely overcome their “laziness”, and persists in its long-term endeavors in all four major areas. During the past eighteen years Mr and Mrs Perko have achieved the following:
– Mr Andrej Perko built a home for his family, graduated, obtained his master’s degree, completed his specialization, and will shortly defend his doctoral thesis;
– He designed an excellent program for the delayed coming to maturity of young people in distress;
– Mrs Verena Perko obtained her master’s and then doctor’s degree, and established a scientific reputation in her field. Recently she obtained a second doctor’s degree;
– Both are caring parents to their three children (now adults), and live a healthy and creative life – neither of them showing any signs of growing tired yet (!).

Mr and Mrs Perko have achieved outstanding results in therapy, and deserve at least a mention here, as in all major areas of life they set a positive example to all young and educated people in distress, showing them that they can succeed, provided that they too activate themselves. This case supports my basic finding that no results are to be expected unless the patient overcomes his or her laziness forever.

The evaluation of my results is always based on the basic parameters of life: education, profession, age and place of residence. If all of these circumstances are taken into account, a large number of other people have also achieved a relatively high level of rehabilitation within my program.

Scott Peck (1990) argues that psychotherapy can be successful only with those neurotic persons who take full responsibility for their “failure” in life, sometimes an excessive amount of it, while psychotherapy is doomed to fail in the case of neurotics with a personality disorder, who do not perceive themselves as the source of their problems. People with a personality disorder are unwilling to change themselves, expecting change instead to come from those who allegedly caused their problems. Peck’s findings have also been confirmed in our case. People with a personality disorder can change at least to some extent when psychotherapy is used alongside certain repressive means.

This important finding is pertinent also for alcoholics, who develop secondary psychopathology. Only those alcoholics can therefore be successfully treated whose primary problem was neurosis, whereby alcoholism was only the secondary problem; but not those who behaved in an asocial and irresponsible way in school, within the family and in society and at work already from early childhood on. The only therapist who I believe could successfully treat persons with a personality disorder would be Anton Semyonovich Makarenko, director of the Gorky Colony for juvenile delinquents in the Ukraine in the 1920s – provided that these people came to participate therapy in their youth.

We have also found that it is counter-productive to accept persons with a personality disorder in therapy groups for neurotics, since they are disturbing to the therapeutic process and will also, sooner or later, leave – in most cases in a worst condition than the one they came in.

Psychiatry and society are currently therefore facing the major problem of how to start treating the increasing number of people with a personality disorder in our society. The causes of this phenomenon are well known: the disintegration of the family and parenthood, permissive society and globalization with all its implications.

Another psychiatrist whose findings have been confirmed through our work is the French psychiatrist Maurice Nicoll (Nicoll, 1996), who summarized the experience and techniques of a few experts in the area of group transformation of immature people with the statement that only those among men have optimal chances for personal development who have achieved the level of development of the “good householder”. Immature men must first reach this state in various programs. Only then can they become the subject of serious efforts aimed at achieving their personal development.

In our work we have also encountered the tragic fact that the great majority of the parents of our adult patients oppose their treatment. They are aware that in radical psychotherapy the role played by normally pathological parents in the formation of the emotional distress of their children will inevitably be analyzed and estimated. The parents’ resistance grows as I demand of my patients that they initialize an appropriate inter-generational form of family psychotherapy. When the parents refuse the proposal, the patients are required to terminate all contact with their primary families (in the context of the theory and practice of the American psychologist Arthur Janov (Janov, 1989)).

I should expound the basic differences between controlling and therapeutic psychiatry on the one hand, and our system on the other.
The differences are both qualitative and quantitative:
• The Qualitative difference concerns the fact that in addition to an eclectic form of group psychotherapy as well as individual, partnership and family psychotherapy, my patients also benefit from my guidance in the areas of bibliotherapy, creative writing, obtaining an education, therapeutic fasting, aerobic exercise, restoring the ties with nature (through mountaineering) from which the patients are alienated, and a number of other stimulations, such as other members who act as role models in the areas of partnership, parenthood, sexual life, etc. and who constitute the “healthy core” of our therapeutic community
Or to put it a nutshell: The members of our Alternative Therapeutic Community develop their reading, writing and oral skills, and gradually learn to start living a full and healthy life. There seems to be no other place where this would be possible, which explains the immensely high number of applicants for this program, including candidates who unfortunately do not meet any of the requirements for enrolment.
• The Quantitative difference is reflected in the structure of my Alternative Therapeutic Community, which is unique. It encompasses:
– Therapy clubs and groups,
– Various parallel groups: the family group, the workshop for sexual problems, the group for analytical psychotherapy,
– Various ad hoc groups: the group for adult children of alcoholics and tyrants, the group for failed students, the group for singles.

Members of the community are free to join any of these groups, which are all conducted and run by me. Traditional systems are acutely lacking in such programs.

7. PSYCHOTHERAPY – A FRAUD?

In his famous work Against Therapy, Jeffrey Masson reveals the pathological background of psychoanalysis (Masson, 1990). He states that he no longer believes in any form of psychotherapy. For that matter, neither do I. In my long psychiatric practice I have witnessed not a single case of a person who had been in distress and was rehabilitated through psychotherapy. Slovenian traditional psychiatry has also failed to publish a single case of a successfully treated core neurotic.

In Feet of Clay, Anthony Storr, one of the key figures of British psychiatry, reveals that some of the founders of psychotherapy, such as Freud and Jung, were in fact narcissistic gurus who manipulated and exploited their patients for their own ambitious goals (Storr, 1997).

Having a passionate life-long interest in history, anthropology and social sciences, I have always paid attention to the factors that have molded mankind into its current state of development, and which continue to do so today. My conclusions were: if family, work, education, warfare, art, literature and religion have molded and shaped man into what he is today, then “people in distress”, who lag behind their most accomplished peers can be made to “rise” in life only by employing these and other similar means. We should therefore rely on sciences such as philosophy and pedagogics, and not on Freud and other gurus.
Based on this, I gradually introduced various “educational and therapeutic” means, such as physical exercise, running, mountaineering, bibliotherapy, creative writing and the like in my psychotherapy program, which initially had been designed for alcoholics.
In order to discretely suggest my departure from traditional psychotherapy, I named my method the “socio-andragogical system of aid for people in distress”. However, for the sake of caution, I added in brackets that my method is an eclectic form of psychotherapy.

In 1995 I was granted a state license and a concession for practicing psychotherapy according to my own socio-andragogical method. This is exceptional not only for Slovenia but also some other countries as well.

To summarize: psychotherapy alone cannot help people in distress (who are normally socially isolated and not truly loved by anybody) to “rise” above their troubles and put down healthy roots within the family, their profession and society in general. This can only be done in a patriarchal society or “tribe”, which our community functions as a relative substitute for, and by employing various educational and re-educational means, the right combination of which can be termed as being “artistic”.

8. THE PSYCHIATRIC PERSPECTIVE OF HYSTERICAL FEMINISM

Men run away from their dominating wives, who tend to be too inquiring, instructive and controlling, and escape to their lovers, Ahasuerus professions, and through alcoholism and suicide.

Men in socialist countries suffered additional traumas through their subjection to the mechanisms of “Bolshevist psychological castration”, which took the following forms:
– The nationalization (state ownership) of property and the degradation of people to wage workers,
– By means of women’s and youth organizations, the political police solicited wives and children to spy on their husbands’ or fathers’ political outlooks and activities. This form of the communist repression of people with different outlooks is based on the Catholic and Protestant conviction that basically argues, although in ironic contrast to all we know from the natural sciences, that already intent alone is sinful.

Men who are first broken down by their alcoholic fathers and hysteroid mothers, and then psychologically castrated by communism and the permissive education system, start drinking at a very early age. Besotted by alcohol, they tolerate the arrogant dominance and humiliation of their wives. The domination is not without consequences, however: those men who are not completely without self-respect take their revenge against their wives in scenes of alcoholic outbursts, but normally only after being provoked by the hysteric reactions of their wives. In this context I see alcoholism as having a function of a means that allows the alcoholics at least mere survival. We should understand that alcoholics are a socially privileged class: both discretely and actively they are supported by the majority of the population, who also drink and whose motive is the preservation of the pathological patriarchy.

9. MY ROLE IN THE THERAPEUTIC PROCESSES

My role is basically that of a special organizational engineer who manages a system for the activation of neurotic people in all major areas of life, and which involves psychotherapy, re-education, self-education, and self-realization. I am also their teacher in the areas of physical exercise, long-distance running, bibliotherapy, creative writing, therapeutic fasting, and the struggle for the individual’s personal dignity.
Since I am above all a psychiatrist, and have a good knowledge of various techniques of education, re-education and psychotherapy, all these activities (i.e. the various educational and therapeutic means) are used in reflection, analyses, interpretations and confrontations.

I manage the entire program, including the meetings of the therapeutic groups and the Alternative Therapeutic Community, in a strictly authoritative (but not authoritarian!) manner: my attitude to all those who are successful and function optimally is close to partnership, yet I behave strictly authoritatively towards all those who are lazy and evade their duties. With respect to fulfilling the program, I am lenient and considerate towards all members whose professional, study-related, parental and other obligations are numerous and exigent.

I am therefore a doctor, a psychiatrist who does not perform biological interventions on people, and neither do I prescribe medications (sedatives, neuroleptics, antidepressants) nor do I console them and offer them comfort. I do try my best, however, to understand them and help them find a way out of what are normally fatal life crises. I offer them the possibility to join my Therapeutic Community and benefit from this unique »laboratory« that allows immature (neurotic) people to join in the mutual study of the process of Delayed Coming to Maturity (DCM). There they can follow the examples set by the rehabilitated members who form the »healthy core« of the community (most of whom have been members for over five years). In observing these rehabilitated people, the new members can obtain insights and activate themselves in all major areas of life, to make up – at least partially – for the deficits they have suffered due to circumstances that were non-stimulating for their personal development.

This is my most fundamental message: my work is alien to the human experience as there is no psychiatrist in the world who would dare to place before people in distress the unconditional requirement that they may participate in partnership psychotherapy only if they are willing to accept a program of intensive, comprehensive and long-term activation (lasting for a minimum of 10 years), the aim of which is that they achieve an optimal level of (re)education and (re)habilitation. I have worked thus for thirty years, naturally with increasing depth and intensity, despite the fact that for all of these thirty years the entire corpus of Slovene psychiatry has acted against me. In 1994 a WHO inspection was even sent to assess my work. The assessment was a positive one.

10. GREAT PERSONAL EFFORTS WERE PUT INTO THE DEVELOPMENT AND PRESERVATION OF THIS SYSTEM

For thirty years, the entire corpus of Slovenian psychiatry has acted against me. They have used all legal and some illegal means at their disposal in their attempts to both arrest my professional work and cause my personal breakdown.

After the publication of Dramatična Pot (Dramatic Path, 1992), in which I disclosed the activities of political psychiatry in the Communist era, my adversaries decided to take action in six different ways that seemed to be sure to bring them success:

1. A former patient, an alcoholic, who had been accused of raping his own daughter, was used as the “star witness” in various processes against me.
2. Another attempt at disqualification was made through an inspection by the World Health Organization. It also failed, however. For the WHO inspector, I organized a one-day symposium on my work in English. The Slovenian Medical Association had organized the WHO inspection because I refused to acknowledge the competence of Slovenian psychiatry to assess my work. The WHO inspection’s assessment was positive.
3. I was expelled from the Slovenian Medical Association. After six years, the Ljubljana District Court annulled the decision.
4. Three attempts have been made so far to force me into retirement (in 1982, 1985 and 1995). All of them had to be revoked.
5. The alcoholic accused of pedophilia and the rape of his own daughter was used also in an attempt to annul my medical license. I prevented the realization of these intentions through my second hunger strike, which in 1995 lasted for thirty-six days.
6. When none of these attempts worked, my adversaries decided to eliminate me in 1995 by forcing me to start up a private practice. The intention was basically to cause my professional ruin, since at that time, the general practitioners were being largely indoctrinated not to send their patients to me. In this way I am the only specialist in Slovenia to whom patients are not referred to by other doctors. The number of people who turn to my private practice for aid is nonetheless far above the average. As is my work in general.

11. WORKS CITED

Note: The list comprises only the works that are cited in this presentation. A comprehensive list of the literature relevant for my method is included in Pot samouresničevanja (see: Rugelj, 2000).

Frankl, VE. 1992. Kljub vsemu rečem življenju da. (Translation of: Ein Psychologe erlebt das Koncentrationslager.) Celje: Mohorjeva družba.

Fromm, E. 1970. Zdrava družba. (Translation of : The Sane Society). Ljubljana: Državna založba Slovenije.

Horney, K. 1964. Neurotična ličnost našeg doba. (Translation of: The Neurotic Personality of Our Time.) Titograd: Grafički zavod.

Horney, K. 1965. Novi putevi psihoanalize. (Translation of: New Ways in Psychoanalysis.) Beograd: Kozmos.

Horney, K. 1966. Naši unutrašnji konflikti. (Translation of: Our Inner Conflicts.) Titograd: Grafički zavod.

Horney, K. 1976. Neuroza i razvoj ličnosti. (Translation of: Neurosis and Human Growth.) Titograd: Pobjeda.

Horney, K. 1980. Upoznaj samog sebe. (Translation of: Self-Analysis.) Sarajevo: Svetlost.

Hribar, T, 2000. Vzgoja za resnico. Delo, 11 March 2000: 10.

Hudolin, V. 1977. Bolesti ovisnosti. Zagreb: Klinička bolnica “Dr. M. Stojanović”.

Hudolin, V. 1981. Psihijatrija. Zagreb: Jumena.

Hudolin, V. 1982. Klubovi liječenih alkoholičara. Zagreb: Jumena.

Hudolin, V. 1991. Alkohološki priručnik. Zagreb: Medicinska naklada.

Janov, A. 1989. Primalni krik. (Translation of: The Primal Scream). Novi Sad: Obzor.

Kanduč, Z. 1995. Temelji kriminologije vsakdanjega življenja – delo kot vidik strukturnega nasilja (The fundamentals of criminology of everyday life – work as one of the aspects of structural violence). Revija za kriminalistiko in kriminologijo 46 (1995): 225-236.

Kant, E. 1991.Vaspitavanje dece. Beograd: Bata.

Makarenko, AS. 1959. Pedagoška poema. Ljubljana: Mladinska knjiga.

Maslow, A. 1982. Motivacija i ličnost. (Translation of: Motivation and Personality). Beograd: Nolit.

Masson, J. 1990. Against Therapy. London: Fontana.

Nicoll, M. 1996. Psychological Commentaries on the Teaching of Gurdjieff and Ouspensky, ol.1-6. USA: Samuel Weiser, Inc., York Beach, Maine.

Platon, 2002. Izbrani dialogi in odlomki. Ljubljana: Mladinska knjiga.

Rugelj, J. 1981. Dolga pot – Vrnitev alkoholika in njegove družine v ustvarjalno življenje. (2nd edition). Ljubljana: Rdeči križ Slovenije.

Rugelj, J. 1983. Uspešna pot – Partnersko zdravljenje alkoholizma in bolnih odnosov v družini. Ljubljana: Rdeči križ Slovenije.

Rugelj J. 1984. Alkoholizem in združeno delo. (2nd edition). Ljubljana: Univerzum.

Rugelj, J. 1985. Zmagovita pot. Ljubljana: DZS.

Rugelj, J. 1992. Dramatična pot, 1. del. Ljubljana: Published by the Author.

Rugelj, J. 2000. Pot samouresničevanja. Ljubljana: Published by the Author.

Scott Peck, M. 1990. Ljubezen in duhovna rast. Ljubljana: Mladinska knjiga.

Storr, A.1997. Feet of Clay – A Study of Gurus. New York: Simon and Schuster.

Watzlawick, P., J. Weakland, R. Fisch. 1974. Change. New York: W.W. Norton & Company, Inc.

I couldn’t care less…