Sunday, November 17, 2013

Dear Young Therapist: Are You Ready to Jump?

Hieronymus Bosch / The Stone Cutting / Prado
The anti-psychiatry movement has garnered increasing popularity within the last few years. Criticisms have been lodged against the medicalization of the human experience. In particular, many observers have noted the increasing movement toward pathologizing human suffering and categorizing that pain as a psychiatric disorder requiring medical intervention.

This phenomena isn't particularly new. As long as we've had emotions, we've sought ways to control experiences that are viewed as unpleasant, unwanted, or otherwise out of the norm. Starting in at least neolithic times, we attempted to drive out unwanted behavior through trepanning--drilling burr holes into the heads of those suffering. In fact, it is still occurring, assuming this website isn't some sort of strange parody. In our quest to help alleviate suffering we've also tried hydrotherapy, cold wet sheet packs, continuous baths, hot boxes, metrazol therapy, insulin induced shock, electroconvulsive shock, magnets, and lobotomies


I've worked with clients who have undergone all of these treatments with the exception of trepanning. I'm not that old. The video below offers glimpses of many of the various treatments. 

And then there is psychotherapy. So many kinds of psychotherapy.

The director of training of my postdoctoral fellowship, Joseph Shay, once handed us a list of every type of therapeutic intervention for mental illness that he could find. It ranged from some of the ones mentioned in this YouTube clip, to primal scream therapy, to dialectal behavioral therapy. We laughed at some and mostly we felt superior because we were being trained in the modern best practices.

As I've written before, Joe reminded us that in 10, 20, or 30 years we'd look back on our careers as psychologists and be horrified at what we thought constituted good therapy. Times change. We move forward. Joe taught us to remember that we have always tried our best to help, we can only help in the ways we know, and we can only know what we know when we know it.

We get better.

This doesn't excuse the bad actions of the past. It doesn't sweep away the ignorance of or errors. It also doesn't excuse away the very real abuses of the modern day psychiatric system.

However, I think sometimes in the name of activism, we forget that there are many psychologists, psychiatrists, social workers, and counselors who do the best they can--people who genuinely want to alleviate human suffering are working to do just that. We might not always agree on what is the best path toward alleviating suffering, and we certainly make mistakes that cause harm, but we move forward. We get better. We continue to try.

We shouldn't forget that.

I came across a collection of advertisements for psychiatric medications geared toward treating problems that faced women in the 50s and 60s. I was going to be critical of those advertisements in a snarky yet funny way. I thought more about it and realized that these images are much more complicated.

As we look back in time at this woman in a yellow gingham dress liberal minded people are likely to get filled with righteous feminist rage and conservative minded people might see traditional family values.

A more liberal individual might think this woman doesn't need medication to cope with her everyday situational stress. Maybe she needs a job outside the home. Perhaps her husband needs to do his fair share of the domestic labor. Your first thought might be of course she can't cope, she is being oppressed by a historic system of misogyny.

A more conservative minded person might view this same image and see something completely different. Traditional family values, perhaps, or maybe one might experience a yearning to an earlier time when people were more likely to conform to clear gender roles.

All of these things might be true. What are the ways in which this women is experiencing the phenomena of her life?  Could she possibility be thinking the same things we are? Do we even bother to ask?

Could it be that the woman in the yellow gingham dress really did experience herself as a person unable to cope, filled with worrisome emotions, and wanted the doctor, the priest on the high altar of science, to prescribe her an elixir that could make her troubles go away? Did the average woman seek liberation in a time before the second wave of feminism swept across our world?

I don't know.

I do know that this image holds many complicated tensions. I can see the medical profession turning the human condition into an illness to be treated. I see actual people, engaged in actual suffering, looking for actual help. I see a culture embedded in its own values, whether they be flawed or aspirational.  I see people helping (and seeking help, and being helped) in the best ways that are able to offer help. Who are we to decide if she was being oppressed or liberated by a prescription for butisol? Were we there then, knowing only what she knew? Did we bother to ask her? Or even wonder what she thought?

I find these tensions in my office every day when I work with patients. I often tell clients I make a horrible car mechanic. I'm not the kind of therapist someone wants if they are hoping to be put up on the lift, have something repaired, and be sent on their way. While I do have some technology to share, and share it freely, I'm also extremely worried about telling clients how they should experience their lives.

There are lines I draw. I cannot help a client take their own life. I cannot help a client kill another person. I cannot help a client who is engaged in violence against children, people who are disabled, or people who are elderly. I can, however, explore in deep and profound ways, the ways in which clients wish to take their own lives and have desires to kill or otherwise perpetrate violence against another person.

Anything before those ethical and moral lines I do my best not to render an option of what is right or wrong. It isn't really my place to tell people how to experience their lives, what is wrong with their lives, or how to fix what they think is wrong with their lives. Its my job to ask good questions about how people are experiencing their lives so they can find their own way to something that resembles a life worth living.

Sometimes I get this right. Sometimes I make mistakes.

Have you ever watched whales breach out of the water, Jason? It's really a glorious thing if you've never seen it. I'm told it's called spy hopping. The whales get up out of the water to see a perspective that they might not otherwise be able to have in their normal day-to-day vision in the water. That's the best you can hope to do: spy hop. You can jump out of the water and get a glimpse of a different picture, but most of your time will be spent swimming in an embedded world where things can only seem to be one way. 

A clinical supervisor, Glenda Russell, said this to me once while we were writing a paper together. Sometimes a therapist can help a patient jump out of the water for a little bit and see something in a new way. Often times patients spy hop all on their own and don't even need their therapist. That's the best we can do.

So about these vintage ads, young therapist: before you get all snarky like I did, think about what it must have been like swimming in the water with these women. Think about the water we are swimming in now.

Are you ready to jump?

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