sociatry91007

[Adam Blatner]

Dear Rebecca and all, reviewing your response, feeling much in resonance!
    1. "The Politics of Therapy" and "Radical Therapy" -- Much of this was before the many 
writings on oppression were publicized.
     However, I find very few examples of people subjected to involuntary treatment 
today--- especially inappropriately. Yet there are occasional cases and it makes one 
think. I'm interested especially in what you all observe---specific issues in our 
practices. There was also a romanticization of schizophrenia as not being abnormal, out of 
control, but more a response to crazy family and society. I think this has been largely 
deconstructed. Admittedly, communications mixed messages (e.g., the classical "double 
bind") and other family stress can make any mental illness worse, but that's far from 
being a cause.

    2. Just read in the New Yorker a story of a bright music critic who was relieved to 
recognize that the diagnosis of Asperger's Syndrome made sense of much that was 
bewildering in his life, and it also helped his caring family. Yet he also notes that such 
folks have a website for being considered just different, and many would not give up their 
condition even if it could be "cured"---and there is (by the way) not the slightest hint 
of a cure known or offered.

    3. "Revolution not Adjustment." On the dramatherapy listserve a re-discussion of the 
shifts in Gay, Lesbian, now linked to Trans-gendered, bisexual, and questioning in their 
advocacy identity... and a case of the proper way to address a 5 year old child who is 
very possibly a little boy fascinated with and half into being a little girl...  I noted 
we have not only the social definition problems, but also the question of the "rights of 
parents"-- and how far those should be recognized.

   4. Rebecca says, "we are still labeling and treating people for disorders that arise 
from asking them to adapt and adjust to unfair situations that need to be changed.
      AB: I am becoming concerned for personal responsibility being an issue here. Most 
people don't get mentally ill or become criminal from hard situations. I'm all for social 
action, and all for trying to remedy such situations, but there are also some folks who 
would excuse maladaptive behavior, or try to treat it by offering excuses to the addicted, 
the antisocial... what about that?

   5. It would be helpful to offer three or four examples of people who are being 
medicated inappropriately. Also, there's a related problem of psychological "fascism." 
... It is still much easier to give a person a pill then to help them look at how to make 
social changes.
       ab Help them look at... is the key phrase. I've found that a great many people, 
perhaps the majority, passionately resist consciousness, reflectiveness, thinking about 
thinking. This is so guilt-producing, and for many, so demanding, that it would be like 
strapping them down and pouring acid down their throats. No way do they want to look at 
anything about the situation, much less the seemingly overwhelming "how to make social 
changes."  Hey, I find it hard to get healthy, thoughtful people to think such thoughts! 
Especially the how, the specifics.

   6. RW It is much easier to look at an individual's emotional/psychiatric problem as 
being rooted in biology or poor upbringing then it is to look at it being rooted in 
societal ills.
        AB  what if it's 50-50? What if the causation is mixed, rather than either-or. And 
rooted in .. okay, then what. How to effectively diagnose a societal ill that can and 
should be addressed? What can we say that hasn't already been said many times?
        (Are our readers aware of the movement to promote social and emotional learning in 
the classroom? How many are active in becoming informed about their own local school 
curriculum, the various school board advocates for each position, the politics in 
promoting people whose position fits our own, the activity of supplying these politicians 
with professional information that would support their position, and a score of other 
political adjunctive tasks. A major problem with politics is that it requires a major 
investment in time and energy.)

   7.  RW It asks less of us middle class practitioners, makes us less uncomfortable...it 
demands nothing other than we give some one an hour of paid time and/or a prescription.
          AB Also, that's all many patients want, all they can afford to pay for under the 
present health care system. Otherwise, we'd have to spend a great deal of free time doing 
social work unpaid ...
        And even if they can pay, they don't want more, so there's the mixed challenge of 
"educating" them and "overcoming their resistances" and wondering if that's ethical... 
etc.
          Sure, there are a few patients who appreciate a more holistic approach... but 
let's all remember the others, too..

8. RW   It is also much easier to think of a person's problems as theirs, rather than the 
communities' ...that is one of the wonderful things about psychodrama in that it looks 
outside the individual. But interest in group therapy and family therapy is on the wane 
and individual therapy is now mostly solution focused short term work geared to helping 
the individual solve the personal problem du jour.
          ab: good point about fashions in therapy also adapt to socio-economic stresses. 
With the squeeze of the middle class and a major 4-fold escalation of fees charged by most 
professionals in last 30 years, "therapy" no longer is a benign procedure. Legal fines for 
misdemeanors are less than the cost of brief therapy!

  9. Although I do think the discovery of the SRI medications has been a real and true 
godsend for many, many people, I can attest (through my work in the hospital) how they are 
being used/misused to treat depressions caused by situations that you or I or most adults 
would not put up with, in fact we would run from as fast as we could . So we use meds to 
help young people tolerate living in such situations.
          AB: The question is whether such situations are even being clearly and correctly 
diagnosed: Are the families informed, and are social services optimal? Even then, there 
are interesting social policy questions, collective ethical questions, as to how much can 
we force people to do this or that. Is it better to do what 35 years ago was called a 
"parent-ectomy," removing kids from their nuclear (and pathogenic) families? Where are the 
funds, who has the willingness even to offer really therapeutic milieux for foster kids? 
And so forth.
       (Also, what about when the diagnosis of family causation of mental illness was 
itself untrue?---see good book titled "Madness on the Couch" about the heyday of 
psychoanalysis and the pressures put on parents of autistic kids, for example. The 
presumption that therapists know best may itself be very mistaken!!)

    9. RW  Why are not we, as therapists, educators, community people agitating for the 
political and social change that would improve our clients/students/friends lives WITHOUT 
medicine.
      AB: For starters, we need to pick a single, specific issue; identify what exactly 
needs to be done; identify then how to proceed to follow this goal; and prioritize. 
There's also the "squeeze" of the middle class financially that leaves little surplus 
energy for participating even in ASGPP, much less community politics. (This squeeze has to 
do with the rich growing richer, the growth of China and the cost of oil, Thomas 
Friedman's book, "The Earth is Flat," and thousands of other factors.)

    10. RW I get tired of going into work and being asked to use psychodrama to help 
children with their anger...which means teaching them not to explode but to ask/talk 
nicely....when talking nicely has not worked for them; when they are asking "nicely" of 
addicted parents or parents who have to work two jobs to pay the rent or parents who are 
keeping them inside the apartment all the time because there is too much danger on the 
streets...etc, etc... And we give the children medicine to 'calm them down." Isn't this 
what the Russians were accused of doing to dissenters?  I am ranting. Obviously I do know 
that for some of the kids with whom I work medicine is making the difference between 
allowing them normal lives and living in  a residence among other disturbed kids.
       AB: Yeah, and who can afford to maintain such residences? Often these "therapeutic" 
environments are staffed by young and not-so-young, not-so-educated people who can't get 
better jobs, and who are themselves inclined to engage in petty and authoritarian power 
struggles with the kids! Yikes!

   11. RW But you get the point...I think Anath is correct about helping people learn to 
tolerate some level of despair/depression/anger as long as it doesn't cause the level of 
inaction that won't lead to change.
         AB: I agree that we need a level of what I call "creative discontent" that 
includes political and economic awareness, in contrast to complacency. We need to ask 
awkward questions. Forgive me for pushing for specifics, but that's the way I think more 
effectively. Too many generalizations gets me feeling, well, despair.
           Warmly, Adam