Thursday, August 7, 2008
Psychiatry and Psychotherapy
The recent article and buzz about the decreasing use of psychotherapy by psychiatrists (http://www.healthexperiment.com) is further evidence of a social shift away from relating to others as people. Our use of torture as a nation, the "axis of evil" language from our government, and the increasing psychiatric view of symptoms as reflections of neurons and chemicals suggests that we may be in a social withdrawal from being able to face and bear the pain of human experience. The Austen Riggs Center' s Eric Plakun speaks for the tension in psychiatry between two models of treatment: biological and psychological(http://wkim83.wordpress.com ) . He argues that they must be integrated for a full picture of our patients. Shifting away from the area that psychoanalysis has so carefully developed of listening to others with disciplined empathy runs the risk of losing the embedded set of values about the significance of the individual life.
Monday, January 28, 2008
Our National Election and Transition to the Future
In 2000, I participated in a study of unaffiliated American voters and wrote about the findings in 2003 in a paper called, "The Maturation of American Identity:A Study of the Elections of 1996 and 2000 and the War against Terrorism." The findings of that study focused on the meaning of ethnicity in America. The incredible fact of our now having three passionate and brilliant Democratic candidates for President -- a white woman, a black man and a white man -- suggests that the dynamic theme we were able to discern in 2000 continues to be developed.
My article appears to me to have relevance for our current presidential election and I have excerpted aspects of this paper below:
"Nations have identities as well as individuals. Erik Erikson’s formulation about identity formation can be applied to the identity of nations, which is negotiated and re-negotiated both between its citizens and across its borders. A mature identity would incorporate an increasing congruence between internal and external views and include mature openness to complexity, increasing tolerance of differences and acceptance of limitations. Such a maturing identity would result in a modification of national narcissism and strengthen the capacity for flexibly grasping the realities of the larger world.
America, as a nation, emerged from its home in England over two centuries ago. American identity has developed over time and is in the process of continued development. A review of the ... two presidential elections (1996, 2000) and the terrorist attacks of September 11, 2001 suggests the presence of a national struggle within our citizenry about grasping an American identity in transformation. Changes in the world are pushing us to give up a narcissistic position of moral superiority and to move beyond subgroup identifications in order to find ourselves as Americans in an increasingly global society and claim a role in the larger world.
Our research strongly suggested that in order to engage the spectrum of voters, political leaders needed to recognize individual competence while affirming the importance of neighbors, neighborhood, and community. Leaders should articulate the dangers of isolation, acknowledge resource limitations (including their own), and define a mission that capitalizes on American strength in diversity, a central value this country represents to the larger world. Leaders should demonstrate how painful differences could be both affirmed and transcended in the service of an American identity. This would allow citizens to move beyond identifications with others in their subgroups toward an identity that both affirmed their individuality and allowed them to join a larger common purpose. Though the larger purpose required definition, what emerged in our study was the binding power of ethnicity and America’s historical commitment to incorporating, recognizing, bridging and transcending differences...
Discussion
The dynamics of ethnicity have long been a major focus of irrational psychological and political behavior. Members of ethnic subgroups become symbols that hold emotional meaning; all diversity can serve as foci for projection. As Singer (2001, p. 16) notes, “Enormous psychic and political energy, locally and globally, centers around the theme of diversity, whether it concerns the Aborigines in Australia, the Blacks in Africa or America, homosexual people throughout the world, women in the workplace, the disabled in public places – all the minorities as defined by whatever differences one can think of. The shadow or darker side of diversity, we call “disintegration”, which expresses itself in the fragmentation of families, the breakdown of nations, the rise of tribalism, fundamentalism and factionalism at every level of social organization.” The alternative polarity is “integration,” where diverse forces come together into a differentiated whole. This polarity contains a major focus for irrational behavior in the behavior of individuals, groups, and nations.
American identity was first crafted in opposition to experienced tyranny. The openness, spaciousness and freedom in our nation supported a powerful sense of American individualism. As we developed, we recognized the significance of community, of interdependence, in accomplishing national goals. In fact, acceptance of diversity was one of America’s greatest strengths, particularly as long as those who were accepted were white. Is our current collective use and misuse of ethnic boundaries a larger group manifestation of American individualism? Is the way we so easily define ourselves as individuals or in narrowly defined subgroups a collective defense against our difficulty in discerning a larger identity as Americans? Do we need an external enemy to discover the ways that freedom and interdependence are inseparable? Or, can we finally discover a collective identity in which we learn from our differences, integrate our unique history and values, and face -- without flinching -- others’ complex reactions to us?
There may be congruence between the way the white power elite currently see our nation and the way we are seen from the outside. Our collective picture of America as a nation run by affluent, powerful white men -- while manifestly accurate -- is also a defensive compromise formation, requiring a repression of our multiethnic complexity. Like any defensive structure, this view helps us manage the anxiety derived from a full engagement with our history and our internal diversity. Such a defensive American identity will inevitably continue to sap us of the creative energy we might discover with a more complex integration of our differentiated strengths and capacities.
One voter, Frank, says, “If a Black man represents the restaurant, the customers get scared.” As long as this is true in America, we will be illustrating the ways in which we cannot convincingly sell our mission of integration, interdependence and democracy to the world’s customers. Though it is manifestly simpler to form our identities along ethnic lines, we are now faced with a more complex challenge. American citizens have psychological and political work to do in order to discover all of ourselves in each of our multiethnic representatives. And, if we discover that we cannot identify with some of those who are different, we might, in the service of our national mission, be able to approach those differences as opportunities for learning from our diversity rather than to hate these others as “not us.”
The former Assistant Secretary of State for Human Rights, John Shattuck (2000), when asked about his learning in his role said, “The good guys don’t always win.” America, as a developing experiment in bringing together different ethnicities, histories and capacities can have a significant international role in reducing the projective distinctions between the “good guys” and the “bad guys.” This might reduce the dangers of political disintegration as ethnic conflicts challenge the integrity of existing multicultural nation states (Ferguson, 2001) In assuming its own mature responsibilities for contributing to the marginalization of subgroups both within and without, this country can offer a realistic hope for transcending differences in the service of a larger integrative mission. The hope for a more complex vision of a global community may depend on the integration of America’s identity and its willingness to recognize that the so-called “good guys” have to take their share of responsibility for their creation of disorder and rage in a evolving world."
References
Barber, B (1995) Jihad vs. McWorld. New York: Ballantine Books
Conant, J. (2001) In the electoral colony: Kafka in Florida. Critical Inquiry 27:662-702.
Center for National Policy (1996). Diagnosing Voter Discontent. Washington: CNP publication
Erikson, E.H. (1956). The problem of ego identity. J. Am. Psychoanal. Assoc. 4:54.
Ferguson, N. (2001). 2011. New York Times Magazine. December 2, 2001.
Lewis, Justin (2001). Constructing Public Opinion. New York: Columbia University Press.
Political Staff of the Washington Post (2001). Deadlock. Washington: Washington Post.
Shadduck, J. (2000) Personal communication.
Shapiro ER. (1982) On curiosity: intrapsychic and interpersonal boundary formation in family life. Int J Family Psychiat. 3:69-89.
Shapiro, ER. And Carr AW (1991) Lost in Familiar Places: Creating New Connections between the Individual and Society. New Haven: Yale University Press
Shapiro, ER. and Fromm, MG. (1999) Erik Erikson’s clinical theory. In: Sadock, B.J. and Kaplan, H.I. (eds) Comprehensive Textbook of Psychiatry. New York: Williams and Wilkins.
Shapiro, ER (2000) American voters: optimistic and disenchanted. The American Psychoanalyst. 34:14
Shapiro, E.R. (2001). The changing role of the CEO. Organizational and Social Dynamics. 1: 130-142.
Singer, Thomas (ed). (2000). The Vision Thing. London and New York: Routledge.
My article appears to me to have relevance for our current presidential election and I have excerpted aspects of this paper below:
"Nations have identities as well as individuals. Erik Erikson’s formulation about identity formation can be applied to the identity of nations, which is negotiated and re-negotiated both between its citizens and across its borders. A mature identity would incorporate an increasing congruence between internal and external views and include mature openness to complexity, increasing tolerance of differences and acceptance of limitations. Such a maturing identity would result in a modification of national narcissism and strengthen the capacity for flexibly grasping the realities of the larger world.
America, as a nation, emerged from its home in England over two centuries ago. American identity has developed over time and is in the process of continued development. A review of the ... two presidential elections (1996, 2000) and the terrorist attacks of September 11, 2001 suggests the presence of a national struggle within our citizenry about grasping an American identity in transformation. Changes in the world are pushing us to give up a narcissistic position of moral superiority and to move beyond subgroup identifications in order to find ourselves as Americans in an increasingly global society and claim a role in the larger world.
Our research strongly suggested that in order to engage the spectrum of voters, political leaders needed to recognize individual competence while affirming the importance of neighbors, neighborhood, and community. Leaders should articulate the dangers of isolation, acknowledge resource limitations (including their own), and define a mission that capitalizes on American strength in diversity, a central value this country represents to the larger world. Leaders should demonstrate how painful differences could be both affirmed and transcended in the service of an American identity. This would allow citizens to move beyond identifications with others in their subgroups toward an identity that both affirmed their individuality and allowed them to join a larger common purpose. Though the larger purpose required definition, what emerged in our study was the binding power of ethnicity and America’s historical commitment to incorporating, recognizing, bridging and transcending differences...
Just under the surface of . . . political discussions, the population is undergoing a significant change. Immigration, increasing ethnic identifications, and the emergence of major cultural voting blocks are changing the definition of “American.” At the millennium, ethnic subgroups, once considered minorities, are becoming a larger part of the population, the majority in many cities and states. This change coincides with a similar shift away from the majority of American families being a heterosexual couple with their own biological children. The politics of diversity is moving into a new era.
In American society, whites have always held power and, in recent years, have used that power to increase the economic gap with non-whites. The white majority has managed a sense of unity through projection of difference. The unconscious message is, “We whites are all the same; you ethnics are different.” These dynamics, characteristic of unconscious group functioning, provide external support for ethnic bonding in racial and ethnic subgroups. . . the shared feeling is, “If we ethnics are not in power, at least we are together with our brothers.”
On election night (2000), David Letterman said on American television, “Al Gore is not the President of the United States. George Bush is not the President of the United States. Can’t we keep it that way?” The electorate tried, but the election came down to a polarized, Kafkaesque (Conant, 2001) vote counting that laid bare the inequalities in the mechanics of voting. We learned from the U.S. Civil Rights Commission, with little surprise, that “Voters in congressional districts with low average incomes and high percentages of Black and Latino voters were far more likely to have had their ballots discarded in the presidential election than voters in wealthier districts with fewer minorities (Boston Globe, July 9, 2001).” Government, organized by white elites, does not pay attention to upgrading voting facilities in low-income, ethnic neighborhoods. Despite our democratic ideals, we have a system that suppresses ethnic minorities and sustains the power – both political and economic -- of the white establishment. . .
The terrorist attacks of September 11 transformed everything. Led by an affluent Saudi, the terrorism was fueled by the passions of marginalized Islamic ethnic groups enraged at affluent, white organized American culture and society. Suddenly, the unconscious anxiety that ethnics would take our country over from within (manifest most clearly at our Republican center) was transformed into a shared conscious anxiety that ethnics would destroy us from without.
Terrified by our sudden vulnerability and facing an unprovoked attack, our response has necessarily been to use our vast military might to attempt to destroy those disaffiliated ethnic groups that we experience as “other.” As one general put it, “We must destroy the conditions that lead to terrorism.” While we have the power to be successful militarily, only our coalition building can support the deeper integration and renegotiation of identity that we need. Without the coalition, we run the risk of deepening America’s regressive narcissistic position of invulnerability that contributes to isolation, withdrawal and mutual projection. This would entrench us in a familiarly rigid defensive posturing in which ‘otherness’ remains projected out, our illusion of internal goodness and certainty is maintained, and the integration of our internal differences is once more postponed.Discussion
The dynamics of ethnicity have long been a major focus of irrational psychological and political behavior. Members of ethnic subgroups become symbols that hold emotional meaning; all diversity can serve as foci for projection. As Singer (2001, p. 16) notes, “Enormous psychic and political energy, locally and globally, centers around the theme of diversity, whether it concerns the Aborigines in Australia, the Blacks in Africa or America, homosexual people throughout the world, women in the workplace, the disabled in public places – all the minorities as defined by whatever differences one can think of. The shadow or darker side of diversity, we call “disintegration”, which expresses itself in the fragmentation of families, the breakdown of nations, the rise of tribalism, fundamentalism and factionalism at every level of social organization.” The alternative polarity is “integration,” where diverse forces come together into a differentiated whole. This polarity contains a major focus for irrational behavior in the behavior of individuals, groups, and nations.
American identity was first crafted in opposition to experienced tyranny. The openness, spaciousness and freedom in our nation supported a powerful sense of American individualism. As we developed, we recognized the significance of community, of interdependence, in accomplishing national goals. In fact, acceptance of diversity was one of America’s greatest strengths, particularly as long as those who were accepted were white. Is our current collective use and misuse of ethnic boundaries a larger group manifestation of American individualism? Is the way we so easily define ourselves as individuals or in narrowly defined subgroups a collective defense against our difficulty in discerning a larger identity as Americans? Do we need an external enemy to discover the ways that freedom and interdependence are inseparable? Or, can we finally discover a collective identity in which we learn from our differences, integrate our unique history and values, and face -- without flinching -- others’ complex reactions to us?
There may be congruence between the way the white power elite currently see our nation and the way we are seen from the outside. Our collective picture of America as a nation run by affluent, powerful white men -- while manifestly accurate -- is also a defensive compromise formation, requiring a repression of our multiethnic complexity. Like any defensive structure, this view helps us manage the anxiety derived from a full engagement with our history and our internal diversity. Such a defensive American identity will inevitably continue to sap us of the creative energy we might discover with a more complex integration of our differentiated strengths and capacities.
One voter, Frank, says, “If a Black man represents the restaurant, the customers get scared.” As long as this is true in America, we will be illustrating the ways in which we cannot convincingly sell our mission of integration, interdependence and democracy to the world’s customers. Though it is manifestly simpler to form our identities along ethnic lines, we are now faced with a more complex challenge. American citizens have psychological and political work to do in order to discover all of ourselves in each of our multiethnic representatives. And, if we discover that we cannot identify with some of those who are different, we might, in the service of our national mission, be able to approach those differences as opportunities for learning from our diversity rather than to hate these others as “not us.”
The former Assistant Secretary of State for Human Rights, John Shattuck (2000), when asked about his learning in his role said, “The good guys don’t always win.” America, as a developing experiment in bringing together different ethnicities, histories and capacities can have a significant international role in reducing the projective distinctions between the “good guys” and the “bad guys.” This might reduce the dangers of political disintegration as ethnic conflicts challenge the integrity of existing multicultural nation states (Ferguson, 2001) In assuming its own mature responsibilities for contributing to the marginalization of subgroups both within and without, this country can offer a realistic hope for transcending differences in the service of a larger integrative mission. The hope for a more complex vision of a global community may depend on the integration of America’s identity and its willingness to recognize that the so-called “good guys” have to take their share of responsibility for their creation of disorder and rage in a evolving world."
References
Barber, B (1995) Jihad vs. McWorld. New York: Ballantine Books
Conant, J. (2001) In the electoral colony: Kafka in Florida. Critical Inquiry 27:662-702.
Center for National Policy (1996). Diagnosing Voter Discontent. Washington: CNP publication
Erikson, E.H. (1956). The problem of ego identity. J. Am. Psychoanal. Assoc. 4:54.
Ferguson, N. (2001). 2011. New York Times Magazine. December 2, 2001.
Lewis, Justin (2001). Constructing Public Opinion. New York: Columbia University Press.
Political Staff of the Washington Post (2001). Deadlock. Washington: Washington Post.
Shadduck, J. (2000) Personal communication.
Shapiro ER. (1982) On curiosity: intrapsychic and interpersonal boundary formation in family life. Int J Family Psychiat. 3:69-89.
Shapiro, ER. And Carr AW (1991) Lost in Familiar Places: Creating New Connections between the Individual and Society. New Haven: Yale University Press
Shapiro, ER. and Fromm, MG. (1999) Erik Erikson’s clinical theory. In: Sadock, B.J. and Kaplan, H.I. (eds) Comprehensive Textbook of Psychiatry. New York: Williams and Wilkins.
Shapiro, ER (2000) American voters: optimistic and disenchanted. The American Psychoanalyst. 34:14
Shapiro, E.R. (2001). The changing role of the CEO. Organizational and Social Dynamics. 1: 130-142.
Singer, Thomas (ed). (2000). The Vision Thing. London and New York: Routledge.
Saturday, January 5, 2008
Foreign Relations
A small group of citizens from Turkey, Iran, Jordan, European Union, Russia, Israel, America, India gathers to think about the tensions between the West and the Islamic world. The picture emerges of an America that intervenes but does not understand. In order to grasp the impact of centuries of trauma described by representatives of older civilizations, the Americans who are present find themselves turning to their own ethnic identities. As Americans, they don't know from their national history about humiliating domination, murder, rape, submission and national tragedy. But if one American mobilizes his other identity as part-Native American, he can find a resonance to the "trail of tears"; as a Jew, another can access feelings about the Holocaust; as a Russian, a third knows about Germany. Through these ethnic connections, Americans can begin to understand the experience of other nations.
The differences are staggering. For example, what does a representative from a 5,000 year old civilization (Persia) feel when a representative from a 200 year old civilization (America) calls his nation a "rogue state"?
The impact of historical trauma gets clearer. For example, the European Union was conceived by economists. The EU structure suggests that problems between European states can be dealt with rationally. But in the midst of a discussion, old hatreds can suddenly break out between French and Germans. Contaminated by history, they find themselves "lost in familiar places."
If irrationality and historical scars are taken seriously as data, what structure is necessary to engage a deepening discussion with citizens from different cultures? In an effort to find a voice as a citizen, what aspects of his generational history must an individual mobilize and how? And. how is the experience of working with "treatment-resistant" patients in a therapeutic community relevant to these questions?
I hope we can begin a conversation about these issues.
Correction: here is the correct link for Lost in Familiar Places.
A small group of citizens from Turkey, Iran, Jordan, European Union, Russia, Israel, America, India gathers to think about the tensions between the West and the Islamic world. The picture emerges of an America that intervenes but does not understand. In order to grasp the impact of centuries of trauma described by representatives of older civilizations, the Americans who are present find themselves turning to their own ethnic identities. As Americans, they don't know from their national history about humiliating domination, murder, rape, submission and national tragedy. But if one American mobilizes his other identity as part-Native American, he can find a resonance to the "trail of tears"; as a Jew, another can access feelings about the Holocaust; as a Russian, a third knows about Germany. Through these ethnic connections, Americans can begin to understand the experience of other nations.
The differences are staggering. For example, what does a representative from a 5,000 year old civilization (Persia) feel when a representative from a 200 year old civilization (America) calls his nation a "rogue state"?
The impact of historical trauma gets clearer. For example, the European Union was conceived by economists. The EU structure suggests that problems between European states can be dealt with rationally. But in the midst of a discussion, old hatreds can suddenly break out between French and Germans. Contaminated by history, they find themselves "lost in familiar places."
If irrationality and historical scars are taken seriously as data, what structure is necessary to engage a deepening discussion with citizens from different cultures? In an effort to find a voice as a citizen, what aspects of his generational history must an individual mobilize and how? And. how is the experience of working with "treatment-resistant" patients in a therapeutic community relevant to these questions?
I hope we can begin a conversation about these issues.
Correction: here is the correct link for Lost in Familiar Places.
Saturday, December 29, 2007
FIRST POST
Why would a 60-ish psychoanalyst, who doesn't really understand this medium, start a blog? And who would be interested? And, why Lost in Familiar Places? This, in addition to being the title of a book I wrote a while ago with Wesley Carr, the former Dean of Westminster Abbey, is a statement about where many find themselves in the world. In addition to referring to many of our patients, the phrase evokes a series of questions that I'd like to muse about in this format from time to time. And, I hope others will join me.
This is not an official blog from the Austen Riggs Center. It is my own -- speaking as an individual with a particular set of experiences. Riggs has no part in this. But my patients and their familes have, over the years, been my teachers. And, in addition to my ongoing interest in their treatment, I am particularly focused on what I have learned and am learning from them that applies to what we all struggle with in the larger world.
What happens to us that we get lost in the familiar? What does it take to create something new that is not simply shaped by the past but connects to the creative learning of others? What kinds of other people do we need to engage in order to go beyond fruitless repetition -- and in what kinds of settings, with what tasks? I have had the extraordinary opportunity to bring my learning into other settings: schools, organizations, health care settings, politics and international relations. All of these will be the subjects of this blog -- if I can find the time to do it -- and can find a way to engage those of you with linking ideas.
At the Austen Riggs Center, where I am the medical director, we work with so called "treatment-resistant" patients, their families and the therapeutic community that they structure with our help. Our patients, unable to be helped in other settings where biology and behavioral controls predominate, come to our open setting to be as much in charge of their lives as possible. And they teach us -- in their intensive psychotherapy, family and group treatment and community meetings -- about the ways past traumatic experience may be so all-consuming that it dominates their orientation to the world. They show us the kinds of help people may need to find their own voices. They demonstrate how particular kinds of organizational structures can support individual and group creativity. They teach us about the ways that so-called "personality disorder" may be a way of speaking to the world about history. And we take our learning and go out into the world, where we find similar communities with similar needs and questions. Schools, health care settings, organizations, local communities, governments -- all filled with people who can't find ways to use the best of themselves. Oppressed by feelings about others, they have trouble finding and using themselves. And we learn from them.
The first question seems to be: how can listening to psychiatrically ill patients help in learning anything about other social problems? There may be others of you interested in what flows from this question. I'd like very much to hear from you.
Ed Shapiro
This is not an official blog from the Austen Riggs Center. It is my own -- speaking as an individual with a particular set of experiences. Riggs has no part in this. But my patients and their familes have, over the years, been my teachers. And, in addition to my ongoing interest in their treatment, I am particularly focused on what I have learned and am learning from them that applies to what we all struggle with in the larger world.
What happens to us that we get lost in the familiar? What does it take to create something new that is not simply shaped by the past but connects to the creative learning of others? What kinds of other people do we need to engage in order to go beyond fruitless repetition -- and in what kinds of settings, with what tasks? I have had the extraordinary opportunity to bring my learning into other settings: schools, organizations, health care settings, politics and international relations. All of these will be the subjects of this blog -- if I can find the time to do it -- and can find a way to engage those of you with linking ideas.
At the Austen Riggs Center, where I am the medical director, we work with so called "treatment-resistant" patients, their families and the therapeutic community that they structure with our help. Our patients, unable to be helped in other settings where biology and behavioral controls predominate, come to our open setting to be as much in charge of their lives as possible. And they teach us -- in their intensive psychotherapy, family and group treatment and community meetings -- about the ways past traumatic experience may be so all-consuming that it dominates their orientation to the world. They show us the kinds of help people may need to find their own voices. They demonstrate how particular kinds of organizational structures can support individual and group creativity. They teach us about the ways that so-called "personality disorder" may be a way of speaking to the world about history. And we take our learning and go out into the world, where we find similar communities with similar needs and questions. Schools, health care settings, organizations, local communities, governments -- all filled with people who can't find ways to use the best of themselves. Oppressed by feelings about others, they have trouble finding and using themselves. And we learn from them.
The first question seems to be: how can listening to psychiatrically ill patients help in learning anything about other social problems? There may be others of you interested in what flows from this question. I'd like very much to hear from you.
Ed Shapiro
Sunday, December 16, 2007
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