The eyes are the window to the soul, the poets have long told us. And it may never be more true than when that soul is a troubled one.
Startling connections between visual perception and mental health have been revealed in recent years. Cases in growing numbers that had been considered mental in nature are being addressed through vision therapy - exercises some optometrists have long used to teach the eyes to function more effectively.
``As the vision opened up I found my learning and memory and everything else opened up with that,'' said Larry McMillan. The former airline pilot credits vision therapy with catalyzing his recovery from a head injury seven years ago.
The key in cases like his is the role of the eyes in gathering information for the brain. Healthy eyes refocus on a new subject every fifth of a second or less, organize it in a meaningful context and effortlessly send new signals to the brain about what is going on out there.
``That's not to say you don't need any other systems (senses). It's just a leading system, and all the other systems are interdependent,'' said McMillan's developmental optometrist, Dr. Glen Steele, chief of vision therapy at Southern College of Optometry in Memphis, Tenn.
Vision therapy is practiced most seriously by about 1,000 developmental optometrists like Steele - a small group within the profession.
Dr. Amiel Francke, a developmental optometrist in Washington,
said, ``There are lots of optometrists around the country working with brain-injured patients - lots of them. There are a few around the country working with people who are mentally ill.''
He has worked with both and is familiar with the role vision can play in mental illness.
``If you have a person who is taking in very little (visual) information and it is poorly organized, and they are putting a tremendous amount of energy into it, they are not going to be a very stable person. So in a case like that, it doesn't take much in the way of psychological stress to push them over the edge.''
One of the most dramatic cases of this eye-mind connection is told in ``Rickie,'' a book published last year by Random House. In it, Dr. Frederic Flach and his daughter, Rickie Flach Hartman, recount the story of her recovery from years of harrowing mental illness.
Until she was 13, Rickie seemed a happy, well-adjusted child.
When her behavior turned inexplicably bizarre, her father - an accomplished psychiatrist in New York - sought the best conventional medical care available. However, Rickie spent a decade in institutions, diagnosed as a schizophrenic, attempting suicide, slipping in and out of rationality.
In 1975, Rickie was 23 and her condition seemed to be getting worse. She had just attempted suicide, and was a patient at the Poughkeepsie State Hospital.
As a respected member of the mainstream medical community, Flach had long been just as skeptical of alternative treatments as were her doctors.
However, while working on an instructional film on depression, he met a producer who suggested he have Rickie's eyes checked at the Gesell Institute, a center in New Haven, Conn., for the study of childhood development.
The idea seemed bizarre. He thought he had a working knowledge of eye problems from his medical-school ophthalmology courses, and he believed previous eye exams would have revealed any problems Rickie had visually.
But through Gesell, he was referred to Dr. Melvin Kaplan, a developmental optometrist.
With a standard eye test, Kaplan found Rickie's vision to be 20/30 in each eye - only slightly worse than normal vision. Upon further testing, he was startled to observe a strange ``scissor motion'' in her retina.
Kaplan immediately asked her to read the eye chart again.
``My God! Her acuity's dropped to 20/200. That's legally blind. She's totally compressed her visual system.'' Minutes later, her vision returned to normal.
``Unpredictably, especially when she's stressed, she shuts down her whole visual system. That can last minutes, hours, even days, during which time she's not really seeing at all. The rest of the time she's getting by, but only by a great expenditure of energy,'' he later summed up what seemed to be happening.
``Rickie can't sustain a visual image for more than a minute without beginning to shut down everything else. I'd assume she's been struggling with this since she was 3 years old.''
``Isn't that the way everybody sees?'' Rickie asked. She had never suspected there was anything unusual about it.
Kaplan explained that routine eye exams wouldn't reveal her particular problem, because they generally seek only what the patient sees at one moment.
He said it was not surprising to him that Rickie had been crippled in trying to deal with life. He guessed she had had difficulty making friends as a child ``because the world outside seemed to encroach on her limited space and frighten her.''
He also speculated she had probably been afraid of the dark and accident-prone, and had increasing difficulty in school as the course work grew more advanced. Upon recollection, her parents found all to be true.
At the time, Kaplan had treated many people with visual disabilities, but never a psychiatric patient in Rickie's condition.
He began teaching her exercises that would assist in retraining her visual systems.
Some exercises, for example, simulated archery, requiring Rickie to aim at a target, see where she would have to hit, then try to correct for her error the next time.
There were many other aspects involved in Rickie's recovery. She also began seeing a rehabilitation counselor - a new specialty in mental health, which involves teaching the patient to deal with the world in practical ways.
In addition, she enrolled at a residential rehabilitation program in New Jersey called Earth House, which emphasizes nutritional therapy and teaches psychiatric patients about their illness, its biochemistry and history. The program is affiliated with Brain Bio Center in Princeton, N.J., a research center.
After several months, Rickie began to show progress. Though her recovery was not without setbacks, some of them serious, she eventually began to make a life on her own, married and became a mother. Today she works as a consultant at Earth House.
Though other stresses were involved, Flach believes Rickie's visual problems were a key to her illness.
``That Rickie was functionally blind is indisputable. She had probably been visually disabled since the age of 3, and it is conceivable that until that disability had been corrected, no form of treatment could have produced lasting results,'' he writes.
Steele sees a growing potential for vision therapy in such cases, though he cautioned against considering it a solution for all head-injury or mental problems.
``Personally, I feel we have only scratched the surface of what we understand about visual-information processing. This body, this brain, this eyeball is such a powerful instrument, that I sometimes think we don't give it the credit that it deserves.''
``Is it accepted by the medical community? Most of them, my feeling would be, is they really are not aware of it. There are medical centers across the country - not great numbers - that now are having their head-trauma patients seen by optometrists that provide this kind of therapy.
``And again, it depends on the patient. There are some patients that no matter what you do, nothing is going to change.''
Francke also cautioned against unreal expectations. ``We are not successful with all of them. Let's make that very clear.
``Visual training is not the answer to all psychiatric problems - period,'' he said.
``With people who have traumatic injuries, obviously there is neurological and other damage, and you can't undo that. . . . In mentally ill people, all causes of mental illness are obviously not visual. And many people who have inefficient visual systems are not mentally ill.''
However, he is equally emphatic about the help vision therapy can offer. He said he has had tremendous success in many cases similar to that recounted in Rickie.