The Only Thing That Matters

“Write poetry, for God’s sake, it’s the only thing that matters.”

—e.e. cummings

Poetry isn’t en vogue these days but it should be. I think we need it. I know I do. My guess is that most people don’t think they have much use for poetry – they don’t relate to it – they find it obscure or archaic. Perhaps it isn’t in our nature anymore. We’re too hurried and intellectual. Too focused on doing and being productive. En masse, it seems we’re too self-sufficient to need and to take what poetry offers. But I disagree.

I’m not one of those people. I’m not self sufficient enough, nor am I stable enough. I need poetry (among other things) to help keep my sanity, to find calm, and to see the other side of things. I regard poetry a fundamental part of my education in taking life on life’s terms and learning to love it – or at the very least, to survive it. When I hear a man has used a truck to run down families on a road in Nice, or about any one of the countless tragedies that takes place every day, I need something to help carry the weight. And poetry does. It can hold what we can’t. It can hold the unimaginable, the unendurable.

Poetry lives perfectly and powerfully juxtaposed the worst in the world and the worst in us. It contradicts the hate and violence that seem ubiquitous today, and challenges the vapid and rancorous parts of our selves, coaxing us to live an examined life.

So, in a world both harrowing and sublime, I encourage you, if you haven’t already, to consider this lifeline. Sift through the innumerable varieties of poetry and like everything else, take what you like and leave the rest. It’s not all uppity and esoteric and I assure you, if you search, you’ll find something that will transform you. Here are a few that have changed me. Enjoy…

_______________________

Magdalene – The Seven Devils

By Marie Howe

The first was that I was very busy.
The second — I was different from you: whatever happened to you could
not happen to me, not like that.

The third — I worried.
The fourth — envy, disguised as compassion.
The fifth was that I refused to consider the quality of life of the aphid,
The aphid disgusted me. But I couldn’t stop thinking about it.
The mosquito too — its face. And the ant — its bifurcated body.

Ok the first was that I was so busy.
The second that I might make the wrong choice,
because I had decided to take that plane that day,
that flight, before noon, so as to arrive early
and, I shouldn’t have wanted that.
The third was that if I walked past the certain place on the street the house would blow up.
The fourth was that I was made of guts and blood with a thin layer of skin lightly thrown over the whole thing.

The fifth was that the dead seemed more alive to me than the living

The sixth — if I touched my right arm I had to touch my left arm, and if I touched the left arm a little harder than I’d first touched the right then I had 
to retouch the left and then touch the right again so it would be even.

The seventh — I knew I was breathing the expelled breath of everything that
was alive and I couldn’t stand it,

I wanted a sieve, a mask, a, I hate this word — cheesecloth — to breath through that would trap it — whatever was inside everyone else that entered me when I breathed in

No. That was the first one.

The second was that I was so busy. I had no time. How had this happened?
How had our lives gotten like this?

The third was that I couldn’t eat food if I really saw it — distinct, separate
from me in a bowl or on a plate.

Ok. The first was that I could never get to the end of the list.

The second was that the laundry was never finally done.

The third was that no one knew me, although they thought they did.
And that if people thought of me as little as I thought of them then what was
love?

The fourth was I didn’t belong to anyone. I wouldn’t allow myself to belong
to anyone.

The fifth was that I knew none of us could ever know what we didn’t know.

The sixth was that I projected onto others what I myself was feeling.

The seventh was the way my mother looked when she was dying—her mouth wrenched into an O so as to take in as much air…
The sound she made — the gurgling sound — so loud we had to speak louder 
to hear each other over it.

And that I couldn’t stop hearing it—years later—
grocery shopping, crossing the street —

No, not the sound — it was her body’s hunger
finally evident. —what our mother had hidden all her life.

For months I dreamt of knucklebones and roots,
the slabs of sidewalk pushed up like crooked teeth by what grew underneath.

The underneath —that was the first devil.
It was always with me.
And that I didn’t think you — if I told you — would understand any of this —

___________________________

The Road Not Taken

By Robert Frost 

Two roads diverged in a yellow wood

And sorry I could not travel both

And be one traveler, long I stood

And looked down one as far as I could

To where it bent in the undergrowth

 

Then took the other, as just as fair

And having perhaps the better claim

Because it was grassy and wanted wear

Though as for that the passing there

Had worn them really about the same,

 

And both that morning equally lay

In leaves no step had trodden black

Oh, I kept the first for another day

Yet knowing how way leads on to way,

I doubted if I should ever come back.       

 

I shall be telling this with a sigh

Somewhere ages and ages hence

Two roads diverged in a wood, and I –

I took the one less traveled by

And that has made all the difference.        

________________________ 

I Felt a Funeral In My Brain

By Emily Dickinson

I felt a Funeral, in my Brain, 

And Mourners to and fro

Kept treading – treading – till it seemed 

That Sense was breaking through – 

 

And when they all were seated, 

A Service, like a Drum –

Kept beating – beating – till I thought 

My mind was going numb – 

 

And then I heard them lift a Box

And creak across my Soul 

With those same Boots of Lead, again,

Then Space – began to toll,

 

As all the Heavens were a Bell, 

And Being, but an Ear, 

And I, and Silence, some strange Race, 

Wrecked, solitary, here –

 

And then a Plank in Reason, broke, 

And I dropped down, and down – 

And hit a World, at every plunge, 

And Finished knowing – then –

______________________

Poetry resources:

http://flavorwire.com/217118/10-poems-everyone-needs-to-read

http://poetrysuperhighway.com/psh/

http://www.brit.co/modern-poets/

http://flavorwire.com/217118/10-poems-everyone-needs-to-read

https://www.poetryfoundation.org/

http://www.theatlantic.com/past/docs/unbound/poetry/gioia/gioia.htm

 

 

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Neoliberalism and the Death of the Art of Psychotherapy

Today, as a result of external pressures from a state-driven audit culture brought about by the cultural components of neoliberalism, there exists less and less space for thoughtful psychotherapeutic study and practice, and a questioning of the assumptions of our ever-shallowing field and current organizational practices. The overregulation of psychotherapy, the manualization of both treatment and training programs, and an overwhelming focus on modalities that offer little more than symptom reduction and short term fixes have cumulatively sacrificed the art of psychotherapy with deleterious consequences spanning client, psychotherapist, and culture.

For thirty years we have lived within the zeitgeist of neoliberalism – an economic paradigm that came into the mainstream in the late 70’s and proposes that human well-being is best advanced by ensuring individual entrepreneurial freedoms and skills. This is it’s economic interpretation but a growing number of scholars view and refer to neoliberalism as a political ideology, mode of governance, and form of public pedagogy that deems profit making as part of the essence of democracy, consuming a primary action of citizenship, and the market able to solve most problems and adequate to serve as a model for structuring social relations. The most prevalent cultural components of neoliberalism include hyper-individualism, the tendency to act in a manner that benefits the self without regard for or accountability to others, society, the world, or the environment; commodification, the transformation of goods, ideas, and services, into objects of trade to include those items, which are not generally considered commercial items, such as education and human capital; and market ideology, an economic or transactional way of viewing something that focuses on efficiency and potential advantage. Though each of these is not unique to neoliberalism, together they offer a comprehensive account of the sociocultural effects of neoliberalism within the United States. Although it began as an economic paradigm, neoliberal characteristics now dominate personal, public, and systemic ways of thinking and behaving in the United States and around the world.

As a result of thirty years of a pervasive neoliberal ideology, negative outcomes within the United States are evident across a variety of domains from personal to public. Individually, we see unacceptable rates of suicide, depression, and anxiety among children, adolescents, and young adults. Narcissism has risen. Empathy has decreased. In our relationships, child neglect in the United States is up while contact time with children has declined as a result of labor policies that place the market and profit over family. Institutionally, in tandem with the implementation of neoliberal policies in the 1980s, a shift began in the U.S. educational system. By adopting neoliberal policies and practices, the U.S. educational system has begun to function as a business rather than an educational institution driven by a human-centered purpose. The past 25 years have brought with them an institutional emphasis on standardized testing and most recently, the invention of value-added measures, evidence of business models and paradigms being implemented within the educational system. In the same way the cultural components of neoliberalism have influenced our relationships, families, workplaces, and educational system, so too have they influenced entire disciplines and fields of thought and practice, including psychology and psychotherapy.

Traditional, mainstream psychotherapy has adopted a hyper-individualistic ethos by focusing primarily on the individual, and addressing pervasive, systemic problems as individual problems.

I recently spent a year providing individual and group psychotherapy to a primarily adult, outpatient population at a local community mental health organization. I discovered that despite the uniqueness of each client and their conceptualization of and experience with a variety of symptoms, I really only ever heard and helped treat a handful symptoms and disorders. Of course similar symptomatology is to be expected, as it is what any diagnostic system is based upon – a more or less homogeneous group of symptoms constitutes a particular diagnosis. However, it seemed that in the same way a group of homogeneous symptoms constitutes a particular mental health disorder, the prevalence and pattern of depression, anxiety, social phobia, panic, and substance abuse in the United States constitutes a larger and more systemic problem. Enter the cultural aspects of neoliberalism.

It seems we need a sort of public health model for mental health to hit the mainstream. Nearly 50% of the U.S. population will experience a mental health disorder at some point in their lifetime, and we have higher prevalence rates of mental health disorders than any other country in the world. And yet, though millions and millions of individuals are experiencing the same afflictions, we continue to conceptualize, diagnose and treat these disorders as disorders of individual functioning.

Cognitive Behavioral Therapy is the most widely studied and utilized evidence-based treatment for a number of common disorders including depression, anxiety, PTSD and OCD. It, along with several other similar treatments (i.e. DBT, Brief CBT), has proven effective at symptom reduction. Despite its evidence base and widespread use, I and others view this modality (and those similar) as a technique that treats little more than symptoms, and as ill equipped to elicit deep and substantive change. Rollo May, refers to this type of therapy as gimmick:

“Psychotherapy is facing a very profound crisis. I think the teachings of the fathers – Freud, Jung, Rank and Adler has been, in this crisis, almost completely lost. The problem is that psychotherapy has become more and more a system of gimmicks. People have special ways of doing their own therapy. They learn which particular buttons to push. They are taught various techniques by which they can cure this isolated symptom or that. And that wasn’t the purpose at all of Freud and Jung and the rest of the really great men who began our field. Their purpose was to make the unconscious conscious and there’s a great deal of difference between that. The gimmick approach leads to a general boredom. And the reason so many new systems in psychotherapy spring up is that therapists are bored. They are bored because they deal with the minor problems of life. They patch a person up and send them out again. I don’t regard that as real therapy at all. The therapy that is important as I see it is the therapy that enlarges the person, makes the unconscious conscious, enlarges our view. It enlarges our experience, makes us more sensitive, and enlarges our intellectual capacities as well as other capacities. This is what Freud was setting out to do. It’s what Jung, Adler and Rank tried to do. These people didn’t talk about gimmicks. It just didn’t interest them. What did interest them was making a new person.”

Amen. We need to look upstream, think broader, and examine what might be going on culturally that may be causing or contributing to this epidemic.

I would go a step farther and suggest that rather than traditional, mainstream methods of psychotherapy simply fitting into and adopting an individualistic ethos, perhaps these methods were born of it and now act as its extension – as a mechanism – of the status quo. Culture seems to me a central determinant in the outcome of therapy. Perhaps it also is, and has been, a determinant of theory, methodology and practice.

In the name of efficiency, effectiveness, and protecting the public, and with insurance companies and evidence-based modalities leading the cause, traditional, mainstream psychotherapy has adopted a market ideology and an audit culture.

Managed care has infiltrated the therapeutic relationship and is dictating treatment decisions. Insurance companies insist on a diagnosis within roughly 3 sessions – far before a therapist has had the opportunity to develop a deep and meaningful understanding of the client, and their symptoms and context. Insurance companies limit the number of sessions a client can be seen and only cover treatments, interventions and techniques coined evidence based – regardless of the reasons behind why some are evidence-based and some are not, and regardless of the fact that not-yet-evidence-based does not mean ineffective.

Over the past thirty years, the field of psychology seems to have developed an inferiority complex over the fact that it isn’t a harder science. Its attempts to prove itself otherwise by myopically focusing on the use and dissemination of only evidence based treatments (EBTs) and interventions (EBIs) – have contributed to the slow death the craft of psychotherapy is experiencing.

Like Empirically Supported Treatments in the medical field, EBTs and EBIs dominate training and practice in psychotherapy. And why shouldn’t they? Increasing health care costs and inadequate health care systems mean it’s in the public’s interest to utilize only those treatments and interventions that have proven effective. Although this sounds quite reasonable, often times the golden appearance of evidence-based treatments and interventions can be determined spurious upon further inspection. Consequently, a growing number of people, including myself, believe that many EBTs and EBIs treat little more than symptoms, that they are not conducive to deep and substantive change, and that there are very real risks to focusing on them so exclusively.

First, despite what we’d like to think, we are not living in a world where all research is conducted with the public good as its highest priority, with transparency, or without funding sources that elucidate severe biases. A recent study at John’s Hopkins shows the drug and device industry funds six times the clinical trials as the federal government. So, often companies with great financial interest in the outcome of trials will have more control over what doctors and patients will learn about new treatments than the National Institutes of Health.

Allen Francis, chair of the DSM-IV Task force and part of the leadership group for DSM III and DSM-III-R is Professor Emeritus and former chair of the Department of Psychiatry at Duke University School of Medicine. In his latest book, Saving Normal, he discusses how commercial interests have hijacked the medical enterprise, putting profits before patients and creating a culture of over-diagnosis, over-testing, and over-treatment. He blames diagnostic inflation for the fact that an excessive proportion of the population relies on psychiatric medication and the myriad of subsequent problems.

  • 1 in 5 adults in the United States uses at least one psychiatric drug while roughly 4% of our children are on a stimulant.
  • Psychiatric meds are now the star producers for the drug companies – in 2011, over $18 billion for antipsychotics (6% of all drug sales), $11 billion on antidepressants, $8 billion on ADHD medications. Antidepressant use nearly quadrupled from 1988 to 2008.
  • Primary care physicians, who have little training in psychiatric illnesses and medication and are under significant pressure from pharmaceutical companies and representatives, prescribe 80% of these.
  • The misuse of legal drugs has now become a bigger public health problem than street drugs, with more emergency room visits and deaths due to legal prescription drugs than to illegal street drugs and 7 percent of our population is addicted to prescription drugs.

Second, even if it is transparent and as unbiased as is humanly possible, research done in a lab or with “gold standard” experimental methodology (a randomized controlled trial) does not mimic the complexity of real life or the unique experience of psychotherapy, nor is it adequate to reality. Their findings can only be accurately extrapolated to those individuals living within the exact parameters of the carefully designed experimental setting.

Third, EBIs and EBTs are based on statistics. The individual is not. “In the aggregate, man is a statistical certainty. But the individual is an insoluble puzzle” (Sherlock Holmes). Similarly, William James believed the uniqueness in every individual defies all formulation.

And finally, today’s EBTs and EBIs are the “best” answers we have today, with the tools, instruments, and knowledge we have today. But theories and “best” practices come and go. Let us not forget that until 1973, our best psychiatrists and psychologists believed homosexuality was a psychiatric disorder. At any given moment, we seem to think we have the best answers from the most exhaustive information, and we have far too much confidence in what we think we know.

Prior to beginning my Ph.D., I earned an M.A. from the University of Denver in International Security, and extensively studied Intelligence and Counter-terrorism. For two years I was educated to be extremely wary of relying on patterns of data and behaviors that are most ‘expected’ of a population or group. I was taught to be continually cognizant of the elusive Black Swan – an event or occurrence almost completely beyond prediction through conventional measures, that will have an immense and overwhelming impact on an individual, group, society, nation or world (i.e. 9/11). Black Swans are, in effect, outside of the “best practices” of analysis.

As a consequence of this training in a seemingly unrelated field, I have a difficult time seeing and analyzing individuals through a paradigm of statistical norms, or how “most” people experience the world and behave, and I have trouble swallowing the overwhelming weight given to EBTs and EBIs by our field. It’s dangerous to view a client – a person – through a paradigm of statistics because although means, standard deviation and other forms of statistical analysis may tell you about a small piece of a client or their story, they won’t tell you the most important pieces, and more likely than not, they will deter you from their deepest truths. I tend to liken individuals to the Black Swan and believe that in effect, every individual is one.

As a result of viewing the world through the cultural framework of neoliberalism, which positions efficiency, effectiveness, and profit top priorities in all affairs, we have packaged psychotherapy as an evidence-based, educationally sound and manualized program, effective and able to produce quick changes in behavior. Perhaps our efforts to package this as such have helped us avoid acknowledging and dealing with the variability and uncertainty inherent in the psychotherapeutic process. However, as this process and the therapeutic relationship are each a mechanism from which the client’s most salient struggles emerge, in avoiding that uncertainty, we also avoid the means of helping them find the most profound and cathartic answers they seek.

And so, in an effort to mitigate the deleterious effects of the cultural components of neoliberalism, and restore the art of psychotherapy, we must begin to view symptoms and disorders from a distance, and as indicative of larger, systemic problems and characteristics, while simultaneously viewing the individual as completely and utterly unique. We must be willing to seek with our clients rather than espouse a prescribed, and evidence-based answer. We must be willing to face uncertainty and the precarious nature of therapy and life along side those we aim to help. And we must always think critically about the extent to which the treatments and interventions we chose may or may not be an extension of a system whose goal is not the growth of our client but rather a bottom line. These qualitative shifts in paradigm combined with considerable amounts of empathy, and clinical expertise and skill will help reestablish psychotherapy as a thoughtful, rich, and deeply transformative experience.

 

 

 

Black Lives, All Lives, Oppressed Lives

Some disclaimers:

First, this is in no way a presentation of answers, but rather a brief outline of what I understand and what I don’t, with a few hypotheses thrown in for good measure. Some of this is specific, while some is quite broad, which seems representative of the issue itself. I’m genuinely confused as to which factors are most heavily behind what is happening in the U.S. these days, and despite my fear of being deemed racist, ignorant, or insensitive, I thought I’d outline them.

Second, it seems to me that the more sides of a topic we can view, the better we will understand it – that is, if we can respect ourselves and each other enough to allow questions, confusion, and differences in thought and opinion. I take it a sign of wisdom rather than idiocy to be able to hold two opposing viewpoints in one’s mind and be able to understand and subscribe to some parts of each. Besides, most “sides” of this discussion hold a piece of the truth, and it’s unlikely that everything you or I or anyone else thinks and believes holds the entire story.

Third, apart from the few years I spent as a raging evangelical Christian, I in no way feel it my responsibility or duty to change anyone’s mind, opinion or belief. I assume people are doing just fine with the answers they’ve come to, and so in the same way that there are no answers here, there is no proselytizing.

Finally, like most of you, I don’t hold an opinion about something (at least any strong enough to write about publicly) that I haven’t spent a decent amount of time and energy thoughtfully considering. Sometimes however, the issues are so complex that even with ample reading, thinking and listening, the “answers” remain elusive. This topic is exactly that for me. And with that, here we go… gulp.

What I understand and/or believe.

  • Systemic racism is very real and very destructive – not only for the individual lives weakened and inhibited by it, but for families, schools, communities, and society.
  • Explicit racism at the level of the individual, though generally rare, is very real.
  • Implicit racism at the level of the individual is very real and pervasive. Most of us, no matter how non-racist and nonjudgmental we think we are and genuinely try to be, (I’m lumping myself into this arena) have some amount of implicit racism. If you don’t believe me, please test yourself with this widely researched assessment of implicit bias:                                     https://implicit.harvard.edu/implicit/takeatest.html   (Click “I wish to proceed” after having read the preliminary information then click the Race IAT – and any other you’d like.)
  • In some instances, the advent of video seems to have added more confusion, rather than less. When you can see most of the actions of each individual, it inherently means that you cannot see every action. Having hours to examine a situation that in real time allowed for only split second decision making isn’t adequate to reality.
  • We are all human. There is good and bad judgment in all of us. We are too quick to judge and we forget that every single case is unique.
  • Police need more training in non-lethal alternatives and in CPI.
  • The media focuses on what creates more viewership and profit.
  • Each year, despite the higher total number of whites killed by police, when adjusting for population, (proportionately) blacks are killed by police at more than twice the rate of whites.
  • Each year, minorities (blacks, Native Americans and Hispanics) are killed by police at higher rates than whites. (Again, proportionately.)
  • In the 75 largest counties in the United States, 62% of robberies, 57% of murders, and 45% of assaults were committed by black people, despite the fact that this population comprises only 15% of the total populations (of the same counties).
  • Black on black crime outnumbers white on black crime.
  • Blacks commit the most crimes on blacks. Whites commit the most crimes on whites and Hispanics commit the most crimes on Hispanics.
  • 40% of all individuals who have killed a police officer in the United States are black.
  • Black and Hispanic police officers are more than 3 times as likely to fire a gun at a black individual than is a white police officer.
  • Graduation rates in the 50 largest cities in the U.S. – cities where larger proportions of black and Latino students exist – average 53%.
  • The poverty rate for blacks and Hispanics is more than double that of non-Hispanic whites.
  • Whites are underrepresented in prisons. Minorities are overrepresented.
  • Incarcerated individuals have a median annual income of $19,185 prior to their incarceration, which is 41% less than non-incarcerated people of similar ages. Meaning, our jails are filled with the poor. More specifically, our jails are filled with poor minorities.

Those are the specifics. Then I pan out and my hunch is that all of this might be more about class, power, and distraction than it is about race.

Things I don’t understand and/or question:

  • Why saying “All Lives Matter” is racist. I don’t get this. I’ve read all the “saying all lives matter is like saying…” posts and I still don’t get it. It’s not that I don’t understand the explanations, I’m just not certain I agree. In my opinion, our ultimate goal should be something like: Every individual is afforded the same opportunities, rights, and protection under the law and will be allowed his or her individuality, in whatever and in every capacity he or she wishes (without infringing on the rights of others) without being subject to systemic and or individual discrimination or prejudice. Maybe this goal is too lofty to be practical at this moment, but it seems less productive to focus on the issue of race so specifically, and more effective to address larger, faulty contexts and constructs (i.e. class and power structures) simultaneously. I think some people with the propensity to claim “All Lives Matter” might be coming from this place rather than one of ignorance or racism. I know I do. Great changes need to take place but I’m not sure such a fine tuned focus (Black Lives Matter) is the most effective way to create substantive, long-term and not just reactionary change. Maybe I’m wrong.
  • Finally, I question whether the general public fully understands the variety of circumstances within which an officer is legally allowed to use deadly force. There is more leeway than the general public might think, and though it might very well be the case that these policies need to be changed and are in fact an extension of systemic racism or discrimination, this may explain some of the discrepancy between the public’s expectations of justice and trial outcomes and lack of punishment.

And there they are – my confusion and sometimes-contradictory thoughts and beliefs in bullet points. If there is a culminating thought, it’s something I previously alluded to – that beyond racial disparity, the ills of our country and the reasons behind the fact that we are urged to focus on some rather than others are intricately and carefully connected. Perhaps a focus on racial disparities distracts us from uniting against the ruling corporatocracy – that system perpetuating systemic racism, tying the hands of the poor and middle class, educating some and not others, and killing democracy, the environment and millions around the world in the wars it continues to wage.

We have a race problem in the United States, undoubtedly. Part of it is our fault, part of it is the media, and part of it is something else. I tend to view it as symptomatic of something larger and believe that if we take a myopic focus on only this piece of it, the larger problem will continue unabated. Perhaps a simultaneous and multi-tiered approach is needed and perhaps it’s our responsibility to connect those dots and demand that type of change.

“How can the oppressed, as divided, unauthentic beings, participate in developing the pedagogy of their liberation?”                                                              – Paulo Freire

If you’re interested in further reading on the topic, here is a link to a related piece: https://missyracho.com/2015/10/02/the-problem-is-not-gun-violence/