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Tuesday, election day for us in the USA, I was barely able to get productive work accomplished. It wasn’t just a matter of being concerned that “my” candidate for President might lose. It was a mixture of many things, including:

  • the sense that our country stands at a unique moment – we either embrace the serious challenges facing us, or fall farther behind other countries who already are assuming a leadership position in the world relative to matters such as universal health care, a rational national energy policy, and an active commitment to economic, cultural, and social justice for all its citizens;
  • the sense that this long election campaign so much needed to end, for all our sakes, coupled by amazement at the apparently limitless energy of all four of the major national candidates, right until the final hour;
  • indescribable amazement at the fact that someone who was a state senator a mere four years ago appeared about to win the Presidency, someone whose intelligence, emotional balance, and capacity to organize his campaign in a manner never before seen has been commented upon by virtually everyone who wasn’t actually running against him (and at times even by them).
  • amazement every time I saw the Obama family on a public stage; when I was a child, and even a young adult, this family could simply not have been in such a position, running for a national office. Could we really have come this far?

And now that it’s all over, a new surprise: it seems that virtually everyone is celebrating. It appears nearly universal – that we recognize that as a nation we have turned a corner. This is a national Affirmative Action moment.

I say that because I can see the effect Obama’s election is already having on African Americans – there is an apparent sense of personal validation. THIS, for those who just don’t get it, is why we need people of all “flavors” in leadership positions. “Equal” mean equal access, and not just in theory. In actuality. Equality simply needs to be a visible reality, so that our children can see it. Now, in a sense that has never before been true, for African Americans, it is.

BUT…the caution: We still have a long way to go. The trans-generational effects of slavery, and of Jim Crow racism, are with us still, and will be for quite a while yet. The solution isn’t to make black people white, but to make our society brown – a mixture, at all levels. It simply has to be acceptable to appear, sound, and (even!) act black, at all levels. I can say this, as a Caucasian: too many white people simply don’t yet get this. And it isn’t just true for black people – tolerance for diversity remains one of our most central social challenges.

Now….to stay on topic – does any rational person doubt that social inequality has mental health consequences? It isn’t enough to have “equal access”. Only equal achievement will do the trick, and we have yet to achieve this, on so many fronts.

Social intolerance, and inequality of achievement affects everyone. What hurts one hurts us all. We cannot fail to care about our neighbors. We may well disagree about how to turn our caring into social policy, but about the goal there cannot rationally be disagreement. When one of us is injured by life, by social circumstance, by accident of birth, we all are injured.

This is a rare and shining moment we are having this week. We are not likely to pass this way again any time soon. I savor this moment, and seek to draw energy from it. There is a great deal of work to be done, by us all.

We really do need all hands on deck. I’d like to think that this week, “the crew” increased very meaningfully. I’m grateful to Obama, for who he is and what he has done, but I’m probably more grateful to my fellow citizens. As he said, we did this. It is our moment more than anything else – and no ones more than those folks who voted for the other candidate but still feel good about this moment. The last time we came together like this – and world drew close to us – we had just suffered a national terrorist attack. This time feels very much better, and will surely have more far-reaching consequences.

As we look at the challenges the whole world faces, in this and the next generation, we all need to believe “Yes, we can”. Then, we need to act on our belief.

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(continued, from previous post | part 1 | part 2 | part 3 )

WHY I (AND YOU AS WELL) SHOULD CARE

We’re part of a critical historical time – and science is at the center of it. I can easily predict that 2000 years from now our times will be noteworthy by virtue of three things, the first being the most important, because it’s the cause of the other two:

  • the emergence and cultural dominance of scientific method, as a way of validating and creating knowledge;
  • our managing not (yet) to blow ourselves up with weapons which were capable, for the first time ever, of removing most life from the planet; and…
  • whatever it is we do about the approaching global climate change and resource exhaustion crises.

So, I urge that the first thing we need to do is have respect for our place in history – all of us living at this time in human history, as educated, thoughtful people.

Psychotherapy is a part of the culture of science. That’s why we study it only at the graduate level, after getting a general education which includes non-trivial introductions to mathematics, physical science, biological science, and social science. Without science, we are reduced to the nonsense of prior ages – to things like ether, and phlogiston, and to the notion of evil spirits as a cause of plagues. With science, we have fought back magnificently against these erroneous idea and perplexing problems, and others as well such as Ptolemeic astronomy, infectious disease, and instability in large scale economic systems. We are even beginning to fight successfully against genetic disease, a truly astounding achievement.

We have erected a vast and well-oiled machinery for validating critical propositions, such as:

  • Does every cancerous breast really have to be surgically excised? (It was thought necessary, before the matter was empirically investigated.)
  • Is an extract of cocaine a good ingredient for a popular soft drink (Coco-Cola)? (Once science understood a little about cocaine and the brain, this seemed like a not-so-good idea; the practice was discontinued, but not the name.)
  • Is schizophrenia best treated with restraints and cold water baths? (Well, not any more. We actually can do some helpful things now, and science brought them about.)
  • Does vitamin C in large doses prevent the common cold? (Science found that it didn’t, sadly, but large doses ARE a dandy way to mess up certain parts of your body and biochemistry.)

You get the idea, I hope. Taking psychotherapy away from the science of psychology is unthinkable, howsoever much the science at its core must be tempered by, and enlivened with, the art of human relationship and the intermittent irrationality of existential optimism.

Professional psychotherapy is part of the democratization of knowing. Psychology, and its rowdy child, psychotherapy, is a part of a much larger historical movement. For many reasons, in western European culture there slowly developed a concern for the kind of knowing which allows for reliable prediction. This turns out to be best developed when what is “known” can be experienced by more than one person. Prediction came to be based on process accessible to all, rather than on the dogma of person or tradition. If this change of value hadn’t gotten real results, it would merely have been another dogma, and thus not very important at all.

That didn’t happen. Instead, what slowly emerged was the notion that the basis for our best knowing had to be accessible to our senses. Not MY senses, or YOUR senses, but OUR senses. Knowledge and the making of knowledge took on a decidedly democratic flavor. It could no longer be private, dispensed by the knowing to the unknowing. This criterion rules out what cannot be seen, heard, touched, etc. Use of instrumentation, as sense extenders, is allowed, of course. Astronomers and microbiologists, among others, do it daily.

Our own profession, psychology/counseling/psychotherapy, clearly developed under this umbrella. The critical distinction that sets all domains in this group is that between dogma and science. Dogma is validated by the authority of person or tradition. Science is validated by anyone who is informed enough to set up the conditions of observation. If you know how to operate the Hubble telescope – or access its photographs, you too can observe the Cat’s Eye nebula (and I hope you get to – it’s extraordinary). But, I have no way of observing a past life, or the archangel Michael – at least not in a way that can be reliably replicated by other people. The culture of science insists that we draw a firm line, placing that which can be known reliably by all on one side, and all else on the other. So: general principles of psychotherapy go on one side, angels and space aliens on the other.

Ersatz reality – it does nothing for us. When we take something that is a concept and act as if it is a validated reality, we commit the logical fallacy of reification. I have seen too much of that in my profession. I don’t mind creative thinking and unusual concepts – far from it. I do mind blurring the distinction between (a) a mere idea and (b) reality as it may be known by any adult of sound mind.

There is a large class of concepts which may be used to account for observable phenomenon in psychotherapy: among the ones I don’t think we can use are evil (or good, or ancestral, or whatever) spirits, space aliens, past life re-experiencing, the archangel Michael, and so on (see note 1, below). Some of my clients freely use such ideas (as do some of my Texas relatives!). Therapists I know have had clients who speak of alien abductions. I even had one once (such a client – not an abduction!). I see no need to contest such concepts with our clients. But, we must not, in our own thinking, glibly take them at face value, either, for several reasons:

  1. We usually don’t have enough information to validate much beyond what we can observe in our consulting room. We tend to forget this, and at that point we commit the sin of reification. Bad dog! Heel!
  2. Our job is to validate a client’s feelings, not their thinking. People have a need to explain, and particularly so when they are experiencing painful feelings. People are also inherently creative – we are all natural storytellers. Just because I can concoct some colorful or compelling explanation for something does NOT mean that I understand it, or that my explanation is valid. We must not forget that people make explanations (or borrow them from others) for many reasons. In trying to make sense of what’s happening to them, psychotherapy clients sometimes get it right, and sometimes it’s just a desperate grab. Any port in a storm. This is not a problem as long as we ourselves stay on track concerning what our job is and is not.
  3. Our OWN thinking does need to be as valid as we can possibly make it. Someone may think that their heart pain is due to messages from their dead mother, but their cardiologist had better not pursue this line of thinking. Better that she/he consider that anxiety or fear or some other stress may be related to the pain, as that sort of linkage does have an empirical basis and may thus lead to a useful intervention. In fact, what a competent cardiologist will likely do is look first for organic explanations. As psychotherapists, we have exactly the same objectives and priorities. Again, let me urge: when science is available, don’t use art. Culture (including religious beliefs and their many relatives) supplies art. Hard thought and work supplies science. (Ever wonder why they call it “hard” science?)
  4. Effective therapy is focused on client feeling. A client’s thinking is of primary interest only when it fairly directly connects to this. This principle is the basis of cognitive therapy, and of good case management. We can leave our clients free to do their own cognitive investigations, as long as their affect (feeling) dynamics please them (in which case we have no work to do). We need to focus on the causes of their affective distress, using the best information available to locate those causes. To look to spirits (or whatever) when relevant personal history is at hand, or evidence of mal-formed thought about self, or any other ordinary psychological explanation, is simply irresponsible. It is incompetent. I regret to say that I see my peers do this far too often. (see note 2, below)
  5. Strong feelings never validate; data validates. When client thinking matters, and it often doesn’t, it gets validated by reference to other thinking, and ultimately by reference to data – the stuff we can see, hear, touch, etc. Feelings are great – they give life meaning. They do not, however, validate anything. If you’re up on your neuropsychology, you’ll know that the function of feelings in the brain is to cause a temporary unity of otherwise relatively dissociated brain parts, in order to bring about some act or additional thought (see note 4, below). For that reason, feelings are utterly essential to life itself…but not to scientific method – at least not a means to validation of any hypothesis.

We should care because history demands it. Rarely do we return to a former mode of thought in order to improve our effectiveness. I see no reason to retreat from that which may be verified (even if it hasn’t yet been, as is the case with much in psychotherapy) and embrace that which we have for good reason abandoned: thought which merely is coherent, or which merely appeals to us for some reason, or which “feels” right. All those things may well lead us to a good place, and are often our starting point in the search for new knowledge, but we must not go there if we have better places to go.

The thrust of our history is that science is what we are about, whenever possible. In science, we strive mightily to stay on the ground, to get our fingers dirty. It’s often not glorious work, and it’s not for the lazy, the ill-trained, or those lacking in long range vision. It is, however, for those who have some grasp of human history. It’s clear which direction history is headed, and it certainly isn’t toward the use of astrology or past lives in psychotherapy!

An age is called Dark not because the light fails to shine, but because people refuse to see it. ~ James Michener

I am unable to account for how it is that, in a time when we are literally peering into the brain as human personality expresses itself in real time, some of us are retreating to Chinese folk medicine and the like (see note 3, below). For that you need a graduate degree, and years of supervised internship? Someone, at some point, has taken leave of their senses.

THE FIX FOR PRESUMPTUOUSNESS

Honesty, and a degree of humility, will do the trick. The last thing in the world I want to do is discourage innovative thinking in the best field of work I’ve ever known. That is not to say, however, that anything goes. We do have standards, and they have been both hard won (remember Galileo’s run-in with the Roman Catholic dogmatists?) and well tested (it wasn’t Chinese folk medicine, or astrology, which produced a vaccine for polio, or a treatment for HIV AIDS).

In professional psychotherapy, we are obliged to do our best. We are obliged to learn about both belief and knowledge, and respect both in their proper place. We are obliged to be transparent, and not to appear to have knowledge when we have something less than that. We are obliged to be honest – with ourselves, between ourselves, and with our clients. There is much that we do not know, and some that we do. Let’s be clear about which is which, and not seek to fly where we can only crawl. Let’s simply get it right, because this is not a game for children, or for the mind of a child.

WHAT PSYCHOTHERAPY IS NOT – AND IS – ABOUT

Aside from issue- and context-appropriate psycho-education, as part of our case management of a client, psychotherapy is not about validating a client’s thinking. It is not about uncritical acceptance of a client’s way of thinking about themselves, or anything else – or uncritical rejection, either. It is not about being distracted by the inherent creativity of human cultures and human minds.

It IS about compassionate relationship – after all, we’re all trying to solve the same problem, albeit with differing tools, and different skills. It IS about embracing the core of meaning: our feelings about what has been and is happening to us, and about doing what we can to change the essential nature of that core for the better.

So – they report being abducted by aliens? You know what to do: Screen for the many flavors of psychosis, then get on with helping your client make their peace with their universe, howsoever they see it. Don’t get distracted by the exotica. Stay focused on the dance, and the music driving it. The costume may or may not interest you, but unless attending to it helps you to make a happier dancer, don’t go there.

Lion and tigers and bears…oh my! And angels and aliens and reincarnation…oh my, for sure! But…we really do need some kind of “parental block” device for errant concepts in psychotherapy models. Until that device arrives, it’ll be up to us to keep things in order. We must not let our clients, ourselves, or our historical destiny down.

Little children, when asked to run, sprint full out, then collapse. We must run as adults, knowing our capability and conserving our resources. This approach has taken us far, and the journey is not over.

NOTES

1. I can just hear the howls from certain quarters, so allow me throw a little cold water: I fully realize that all human thought rides on wheels of pure assumption, including physics. Especially physics – witness the miasma of modern pre-empirical (theoretical) physics – things are orderly enough until one looks beneath the hood, as it were, then out come the strings and the quarks and the quacks and the klinks (OK, I made up those last two, but who really noticed – come on , be honest…)

However, the realization that all certainty is built on a foundation of uncertainty does not give one license blythly to be presumptive. One legitimately presumes only when these is no other option. Filling that pot for supper is always a priority. Elegant theology is a lovely thing, but doing something about birth defects is a whole different order of concern. They simply cannot be put on the same level by sane people. At some point, the ability to actually DO science really matters. Wait until you get cancer, then you’ll understand, if you don’t already. Until then, you have the luxury of denial, if that’s the best you can do.

2. I’m sick of hearing about “energy” in psychotherapy discussions when what is clearly being talked about is “feeling”. We can observe the latter in brain scans (indirectly, of course, but rather convincingly). But what in blazes is “energy” – as in “energy psychology”? I can make no sense of this, nor I suspect can anyone else, yet there are a number of books about it. I do have some comprehension of energy – physics was my favorite hard science, in high school and college. But “energy psychology”? Well, my best guess is that someone’s battery was a bit drained one night, and they continued to think past the point of reason, and out came “energy psychology”. I recommend a conceptual recharge.

Seriously, though, while there do exist coherent expositions of energy psychology, there also exist coherent expositions of the politics of heaven, as conceived of by Scholastic Catholic philosophers. The problem should be obvious: these ideas aren’t falsifiable. They don’t belong in science OR psychotherapy, for that reason.

3. Chinese folk medicine, I will remind you, has been busy for years supporting a trade in bear gall bladders, tiger penises, rhino horn, and other assorted animal parts, for their purported healing properties. I can predict that these aspects of Chinese folk medicine will soon be no more, as various animal populations it preys upon depart our planet forever due to breeding stock decimation. What does that do for your chi? If only we could sneak a little real science in the back door here we might save a few of our precious animals.

4. Siegel, D. J. (2004). The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are. New York: Guilford.

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