The Social Side of Psychotherapy

December 8th, 2007 Posted in Psychotherapy

Culture in action, expressed through its group carriers, can have a pernicious effect on selected group members. Some physical types can be valued, others not. Some psychological traits found attractive, others not. Some of these qualities are fixed beyond a person’s will. They are inside facts that feel as thought they are from the outside.

We can think of each person as a unity of diverse traits. Whether socio-culturally approved or not, there you are.

If you were alone on an island, the only human inhabitant, your combination of traits would be normal. No shame or guilt, no hiding, no invidious comparison. The only test would be whether you survive or not.

In the 20th century people entered psychotherapy because of the presence or absence of certain traits. Too timid or too aggressive. A falling short or an overreaching. There is a non-acceptance of an aspect of the self that reflects the ambient socio-cultural evaluation.

Illness and injury are a falling into a disability, a drop out of a state of well being. Therapy is an intervention designed to facilitate return to an approximation of previous wellness.

In psychoanalysis a theory was advanced that suggested an unconscious intra-psychic process underlying certain culturally rejected traits of character. An uncovering based on interpretation and insight permits a gain of control over self, opens the way for conscious sublimation and change. A therapy requiring a rare level of skill and training and an unlimited time beyond the economic capacity of most. But there is the premise of a psychically sick persona overlying a healthy one. The possibility of fishing for the real self.

A British fashion model, some seven feet tall, was considered a freak at school. She was ashamed, wished to escape the being she presented, this ego alien self. Then her essential beauty was recognized and valued in work. A switch in definition established a shift in psychic state. She is now tall and happy.

Alcoholism is an illness whose cure is within the willful means of the victim. There is no physical injury or infection. The alcoholic simply can not drink alcoholic beverages socially, that is modestly and with restraint, but once embarked on a course of imbibing must continue on to insensibility and beyond. This leads to unacceptable consequences like loss of work, inability to meet family and social responsibilities, and eventually actual physical illness and even death. Whatever the ultimate cause the escape from this unhappy sequence of experience is to avoid any use of alcohol whatsoever. This refusal is within the power of the afflicted person.

A whole series of compulsions and addictions take this form: smoking tobacco, drugs, gambling, theft, and so on. There is something that one does as a willful act that has unacceptable consequences. To stop these, one consciously gives up the initial act. The sequence does not begin.

Before this giving up one must accept the compulsion as being part of oneself. The initial fun and pleasure that the activity offers must be connected with the later pain and one must accept that this linkage is part of the self no matter the opposed experience of others. This admission of lack of mid-course control may be a discomfort in itself. A failing, a weakness; but there it is. A unacceptable trait of character must be accepted.

In these positive, active compulsions, habits, addictions a tradition of formal mutual help groups has grown. Each type of addiction has its own organization. Members set up a mini-culture that permits the acceptance of the otherwise unacceptable. This gives all the option to give up an illusory pleasure and to find an acceptable ordinary life.

A mass of neurotics, psychotics do not have this obvious connect. The illness is experienced as lacks and failings. One is fearful, timid, retiring but without apparent reason. Or one is angered, physically aggressive, troublesome and argumentative. Or in general, one is unhappy, lethargic, hyper-active. These people, unlike the addicts, can not find the sheltering social group. There is not an action that they can stop. Whatever pleasure their situation offers is unrecognized. These people have an option called psychotherapy that became a major industry in the U.S.A. and other western societies throughout the 2oth century.

The occupational model used was medical and seemed to presume that an uncomfortable psychic state or trait was an illness and that there was a possibility that it could run a truncated course and at some future time reduce to manageable proportions or disappear, that it like physical illness and injury had a cure, an end. For the most part this belief in itself was an illusion.

These unhappy ones, these failures, these debilitated, these assignees to the social periphery by their socio-cultural surround were left with the false therapeutic dichotomy. Like the tall model in a short school these people were saddled with devalued and rejected traits–culturally comical, or disgusting, shameful. But with all, an essential and definite part of them. Being unreasonably (according to conventional understanding) fearful is like being seven feet tall.

There is an general abstract sociological model involved here. A standard of normal is established by socio-cultural definition. This means that certain individuals who have or do not have the required trait in the correct measure are deviant, sick, freakish, comic, tragic, outside the pale. And the rule is imposed as a problem for these misfits.

The usual reaction involves guilt and shame and the seeking of the alternate hidden persona. The victims are driven to the professional psycho-therapies and the false promise.

Unlike the active compulsives and addicts those with rejected psychological symptoms or traits do not seem to have the option of the willful stop. Stop what? Being fearful, anxious, shy, a failure? Yet there is something that each troubled person can attempt that is similar to the stop. It is the difficult decision to give over rejection of the trait. One must embrace and accept the hated trait as part of one’s valid self. One must defy the cultural consensus.

This is what the physically disabled and maimed must accept head on. The difference is there and one must recognize it, own it, accept it. The athlete saying that he will stay within himself and meaning to accept his talent as it is and not measure it against the other. To stay within being seven feet tall.

Accepting-what-is changes the search for the alternate self, for the cure, into a search for development. Physical training, prosthetics, finding more compatible work and leisure. And, if at all possible, finding a compatible support group.

This does not mean giving up hope. A new drug, a new definition, a change in the law are all possible. But while waiting develop the self with the practical tools now here. Salvage what you can.

Certain traits, tendencies, compulsions, fantasies if acted out are a threat to life, property, and the public order. We all reject these in the name of our shared responsibility to one another. This is the limit in the other direction. The socio-cultural group is not invariably wrong.

For the critique of psychiatry and psychotherapy from the inside see…

Szasz, Thomas “The Myth of Psychotherapy”

Torrey, E. Fuller. “The Death of Psychiatry”