What is the business of
psychotherapy? A socially conscious approach
by Brooks Mitchell
"In the field of mental health, most attention has been given to psychotherapy; some to mental hygiene, but very little as yet to the design of a whole culture which will foster healthy personalities." Maxwell Jones, 1953. The Therapeutic Community.
In today’s world in which almost everything that matters is calculated in terms of an exchange of money for goods and services, psychotherapy is not exempt. Therefore we might ask, in examining the value and role of psychotherapy, what is its business? Is it to help people see the predicament they are in as a result of modern cultural forces that weigh upon them, or is it to ask people to see (and blame) themselves (and/or those close to them) as the source of their predicament? There is a big difference between the outcomes of using these two perspectives to give those coming for help an enlarged perspective of their problem. (The latter might better be called a narrowed perspective of their predicament.) From the beginnings of psychotherapy, the answer has been to treat people as though they were the source of their own problems, and to mostly ignore culture (other than to suggest that a change of heart will lead to a change in the culture). As this viewpoint leads to increasing a sense of shame, anger and alienation in people, it may be good for the “business” of psychotherapy, keeping people dependent on therapy based on their deficiencies and neediness. It is not, however, good for either the health of people, or of society.
I entered the field of psychotherapy following many years of designing schools for children – designing them to prevent mental health problems that come from the strife and stress of competition and failure and other fear producing motivators. In designing school, I threw out everything that I did not like having in school when I was a child. Out went ways of “developing my character” and reducing my intelligence by means of bossy, criticizing teachers, grades, tests, homework, grade levels, various other forms of punishment and rewards, and the idea that the world can be cut up and studied in small pieces disconnected from each other. These are the essential implements for motivating students through fear and confusing them through a meaningless curriculum found in almost all schools. I replaced these methods with a “big picture” and integrated approach to knowledge in which respect for the child was paramount. In this environment children understood they were learning for the sake of learning, including as a lifelong pursuit, and what that learning may mean for them to help themselves and others. They were not attending school for the sake of pleasing a teacher, which is a very slow way to learn most things, and also does nothing to further the practice of democracy, including learning how to live in a flattened hierarchy of power. In my schools, if a child was having difficulties, it was assumed that the problem was with the environment. Changes were made to the environment in order to strengthen the child.
The schools were successful but they did not become the model of a better way of ensuring student achievement, creativity, and happiness that influenced the broader community. Most of the modern industrialized world I am familiar with, including the USA does not seem to want a flattened hierarchy of power. Three other women who joined me in the early years of my school creation work broke away early, by the mid-1970’s, and all went to graduate schools for degrees in mental health areas. One summed up their collective attitude when she said: “If people in charge aren’t concerned with preventing problems, I might as well figure out what to do to help people later on.”
Years later, with the knowledge of how people behave in supportive environments that are largely devoid of fear, I followed my friends into the field of counseling. There I discovered the same biases against human nature, and intent to control it, that I had been designing classroom environments to thwart. The negativity of the situation I observed early on in my training set me on a course of looking for others who felt the same way as I did. As I have come to believe that the best education possible for a professional in any arena is through the literature of criticism and dissent from popular notions governing the profession, I began reading all that I could find from those questioning the basic tenets of psychology and psychotherapy. Among those books was Jeffrey Masson’s Against Therapy, where in the introduction I saw David Smail’s name, and via the Internet was able to find him. Since then we have communicated frequently. The language he has given to the problems of social power and psychotherapy has been a great impetus to my own thinking in working with these concepts.
My interest, just as it was in education, was to give practical application to the idea of the essential connection between humans and their biology and social constructs. I have developed a basic statement that guides my work with others, and now my efforts are expanding to speak to the profession itself through workshops and writing. What follows is a slightly amplified excerpt from an article I wrote for the quarterly newsletter (Autumn 2002) of the Tampa Bay Association for Women Psychotherapists. That is followed by a clinical example of how the business of psychotherapy can be defined as helping people see the predicament they are in as caused by cultural forces.
How does changing the culture change the individual?
I came to the following conclusions and have been practicing them, with increased awareness of why they work, for a long time. It’s probably early enough to say that in 1970, given the opportunity to create a new school however I wanted it to be, I asked myself how I would have liked a school to be when I was a child, and used that for my model. Once we figured out how to teach teachers how to implement this model (the children understood it immediately!) we had an environment in which achievement, creativity, kindness, and happiness soared effortlessly, even as many students came because they were considered to be failures by themselves and others. Later I realized we had created an environment that eliminated fear. I saw the connection to the environment of our powerful autonomic nervous systems – our sympathetic one which responds to fear by a fight, flight, or freeze response, during which time learning abstract ideas is virtually impossible as are feelings of happiness or ability to nurture or be creative and altruistic, and the parasympathetic system when the individual feels safe, and can rest and heal, digest food, and the mind is open to play, learn, invent, and love.
Add to this my work with victims of exploitation, often in the form of sexual abuse, by the professional elite, including therapists and the clergy, creating in some victims a trauma of epic proportions for which they feel responsible. It is helped when they hear “It is NOT YOUR FAULT! Your abuser and those who do not listen to you represent our culture. You are seeing the emperor naked. No wonder you are distressed!” This difficult concept, when accepted, has calming power. Victims see ulterior cultural forces. This new awareness can even lead some to work to change negative societal norms. (Much of this work is with people who find me through www.advocateweb.org where I am Coordinator of Medical and Mental Health Resources, and am currently editing a book of victim/survivor stories.)
The way I see it, the seeds and roots of emotional problems are planted and nourished in the medium of fear. Study America: fear based educational and economic systems, and childrearing practices that isolate infants and discount their needs. Concerning infants, we are just beginning to realize the traumatic impact on infants when they are required to fit their needs to those of their otherwise-committed parents, left to cry themselves to sleep and in other ways purposefully neglected, while experts assure parents this is best for the child’s development. Fear also is the foundation of many religions. One hallmark of traumatized people is seeking safety through dualistic thinking, characterizing things in either/or, us/them, good/evil terms, and maintaining a constant vigilance for the enemy. It is no wonder that it is reported that we in the US lead the developed world in aggression, homicide, suicide, depression, and ignorance – in our children!, that we have burgeoning prisons, out of control addictions, illiteracy, citizens who seldom vote and now are lining up behind a strong warlike leader – all fight, flight, and freeze responses.
Increasing mental health services are not solving underlying problems by treating symptoms. Changing our focus may.
Bases practice on the following core beliefs:
A healthy society creates a populace that feels secure. Secure people have these qualities:-
A sick society creates a populace that feels insecure. Insecure people have these qualities:-
Clinically speaking…
Although either social milieu has a few people out of step with the norm, it’s easy to see which column (“A” Secure Populace, or “B” Insecure Populace) describes people most seen in counseling. People who may be freer of negative symptoms may also come – as a result of living with people with column B behaviors.
Those people who have few of the symptoms created by their cultural norms, due to having more or less resources available, find themselves in a lonely position, and many gravitate towards the center – meaning that a healthy society may be self healing, and a sick society keeps itself sick.
Living in a society that produces fear in people makes it unlikely that most therapeutic fixes have lasting effect, because problems are both caused and nourished by the culture.
Many private practitioners enjoy and want to see the “worried well” who already have resources and many column A qualities.
Common sense would suggest that cultures based on providing a sense of security by providing all members with
1) enough resources to feel secure,
2) provide strong safety nets for those who have limited resources due to age, illness, or economic downturns; and otherwise reduce economic fear,
3) put childcare that prevents fear in children at the top of the national agenda, mirrored in homes, and
4) and support wonderful schools, including for lifelong learning
are more collectively prosperous and rational, and have less need of helping people heal from emotional illness.
Working from a socially conscious perspective may eventually eliminate the need for great numbers of psychotherapists because as people are helped to shift their perspective from the interior to the exterior and to otherwise see the reality of their situation, they will understand the need to change society that is making them ill. In the process there is much work to do on the part of all concerned with society and mental health, but from a different perspective.
The question becomes: What responsibilities do mental health professionals have to aid the design of a whole culture that fosters healthy personalities? We are so conditioned to see only personal and family responsibilities and deficits. It will take people with a lot of column A behaviors to take leadership here, to know better where and how to place responsibility and focus.
Clinical example
Given the premise that we live in fear-based cultures, problems brought into therapy can be viewed in this way, too. For example:
A woman past her mid-thirties, anxious to find the man of her dreams and begin having children while there is still time for her to do so, is living with her brother, a divorcee. It was her brother who asked for my perspective. He was upset with the up and down nature of the romance his sister was involved in. His sister had fallen in love with a man living in another city more than a year ago, at a time the man was finalizing a divorce from his second wife. She visits him frequently. He seems interested in having children, and together they have fantasized their first baby's name. She is looking forward to becoming engaged officially and setting a wedding date. The brother, also in a transition time, is anticipating his sister's departure in order to better plan his own future. Most of the time things go very well between the couple, but too frequently he seems to go berserk, at first seen as getting cold feet, but seriously affecting the woman when he takes off emotionally and even physically from her, for no reason that makes sense. The sister's response is to come home, collapse in tears in bed, and want to stay there for days. Each time the man returns and they get back together. The brother's response is anger at this man for his bizarre behavior. This anger too often results in anger back at him from his sister when the sister rejoins with her man.
We can well imagine how various schools of therapy would view this. I would invite readers -- clinicians – and non-clinicians (since we have become such a "therapized" culture, most people can bring psychological theory of one sort or another to this) to think about what to do about this unhappy family. The psychoanalysts, psychodynamic therapists, cognitive behaviorists, Rogerians, Gestaltists (and hundreds of other theorists) would all have opinions about the roots of the problem and what to do here.
None of these theories acknowledge that living in a fear-based society creates layers of insecurity in people. Feelings of insecurity shape and limit people as already explained. For many people this indoctrination in fear begins in infancy, resulting in primal reactions to threats that are rationalized away in various ways by those acting in disturbing ways. Their behaviors also create other fear responses by those immediately affected, as in this example.
If we acknowledge that we live in a fear-based society, we might first look at fear for an explanation, while knowing that as an explanation, normally it would be only considered secondarily (if that) by those affected, because we are not encouraged to see our culture as damaging us in core ways. The effects of societal pressures on us are maintained largely through our not even acknowledging the role of our culture. If we do acknowledge socially induced primal levels of fear in each person, what we can then see firsthand are the ways each member of the group reacts to fear. Without yet knowing what it is that triggers the initiating fear reactions, we can see that the man here reacts to fear by flight. This creates fear in the woman who has a response of collapsing – freezing. The brother, on the sidelines, seems to want to fight to protect his sister, spurred by her anger at him. A great deal of his anger comes from how unpredictable he is.
The good news for the couple is that his primary reaction apparently is not fight, meaning she is not pummeled, and hers, also, is not fight, and so not likely to end her up in jail on domestic violence charges. If they both had flight responses, they probably would have broken up long ago, with an end of story except for the explanations about themselves and the other that would likely add to their burden of fear. So, given that we are living in a fear-driven society, and it is unlikely not to encounter primal fear reactions in everyday life situations, we might start out by seeing this as the best of all possible situations. That is, it is if the couple is to stay together. When the flight response is finished the one who took off in flight knows where to find the other one, who has stayed frozen in place, and they can begin anew. They can repeat this pattern again and again until one feels too hurt by it to continue, or too numbed to object.
The other good news is that his behavior is NOT unpredictable. When seen for what it is, his responses are very predictable. This understanding may reduce the impact of further fear that comes from behavior seen as erratic and unexplainable. When threatened, (perhaps with the thought of taking on responsibilities for a wife, or for losing his freedom, or who knows what?) he flees every time. Nor is the daughter’s behavior unpredictable. When threatened she collapses every time. This was as far as the explanation needed to go for the brother to express a great sense of relief, and to feel a lifting of the anger he had for his potential future brother-in-law. If the couple came for counseling, their fear reactions could be a starting point, and figuring out what triggers them a next step, including in this a perspective of societal pressures that shape the way humans today treat each other that create fear. This includes childcare practices that may result in expressions of fear so strong that fear may override even the urge and ability to successfully find lifelong mates. When the roots of these ingrained behaviors are seen as being formed while growing and living in a culture that promotes insecurity, it removes the target of the blame from the personal to the environmental. At the least, there may be explanatory relief that is positive.
Fear reactions instilled in individuals by cultural forces are not likely to go away through “illumination”. Still, through knowing what they are, this couple may have information to decide if they can weather these reactions in each other, or if they want to choose anew in a quest for a mate. In reality, they may be not be able to find someone with no primal fear based reactions, so realistically their choice is to determine which primary fear reaction they would rather live with.
Couples and family counseling might result in members involved to learn to stand together against cultural influences. They might learn to recognize the responses to fear each member feels, and understand that, although now the responses may be somewhat irrational (the present danger is not THAT great), it is not likely that reactions to primal fear developed as survival strategies in infancy and later, vanish permanently – by willpower, the power of love, or any other way.
At the same time, in the case of this couple, they want to bring new life into the world. What an ideal time to understand about fear, and to make decisions to work to make the world safer for their offspring. Will yielding to the Sirens’ song of material possessions keep both of them in the workplace, earning enough money for consumer goods, or will they return to older childcare practices in which babies were seldom apart from a parent, a baby’s needs for immediate gratification when hungry, cold, wet, feeling lonely or needing stimulation – not on a schedule for the convenience of working parents – were primary. In later years will they demand schooling for their children in environments that do not rely on fear to motivate? Will they take an interest in furthering their own education in history, current affairs and cultural values, to gain a broader and deeper perspective of their world, and find opportunities to work for changing societal norms that maintain fear in people? They know firsthand how it feels to be constantly reacting to fear. Perhaps that is enough of an impetus to want to make a more secure world for children – theirs and others.
Like this couple, I believe in order to help make the world more secure, we need ways to stand together in a common vision of the problem as cultural and to resist efforts to keep returning it to “personal responsibility.” Returning to the question, “what is the business of psychotherapy” and seeing it as helping people see their predicaments are the result of cultural forces that are not serving them well, is the best way I can think of at the moment to retain a change in focus, without freezing it into a method. Otherwise, my fear in setting these ideas into words is that with words methods and formulas often follow, become quickly ingrained and then dogmatically accepted and implemented in ways that perversely continue to reduce the problem to the immediate and the personal. Culture, as it exerts a strong force that seeks to maintain itself by keeping the spotlight off of itself, will work to defeat the intention of these ideas. As a result one more theory for ultimately blaming people for their distress and keeping them within the confines of their own immediate horizons will have been pulled from a far different intention.
At the same time, if these ideas are to serve as a direction, not a method, we DO need guideposts, maps, and channel markers. Even if maps are not the territory maps at least show that there is a territory –i.e. the world is round, a storm in the Pacific will affect the Atlantic, a baby’s isolation and unheeded cries and a school child’s daily humiliation can result in the subsequent adult’s perspective of the world as fearful, and the adult powerless other than to yield to its expectations or try to escape. We need to attend to the growing voices in support of these assertions, and as possible, add to them.
Here is one more example of a cultural viewpoint. It concerns a growing problem that begs for a socially conscious psychotherapy perspective.
If…
…ADHD were seen as the result of environments not friendly to children, would the diagnosis be:
Based on these diagnoses, how would treatment change?
Children are early signals of a poisonous social and physical environment. Like canaries in the mine, their needs are primal. Do we put them in gas masks so they can cope, last a little longer, or do we remove that which is leaving them struggling, and add that which will assist them to naturally thrive?
How about for the rest of us?
Email address: brooks.mitchell2@verizon.net
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