The Political Self: Understanding the Social Context for Mental Illness
By Roderick Tweedy (Ed.), London, UK: Karnac Books, 223pp., $46.95, 2017
Talking Politics in the Therapy Room
Over the last year, politics and social justice are moving to the front of the discussion in my exchanges with friends, family, acquaintances, the personal and professional groups in which I participate (both online and in person), and the conversations I am having with my patients in my work as a psychotherapist.
The topics my patients want to talk about have changed. They feel that they are living in a new context since the election. None of my patients support the Trump administration. They often want to talk about politics during sessions, and I have dispensed with whatever illusion of neutrality there may have been previously, sometimes commiserating when it comes to these topics. Many of my patients are now struggling more than they were before with questions of balance: how to tolerate the constant flow of new information, much of it distressing; how to take action on issues that seem urgent; and meanwhile, how to go about the business of being alive and being their “old selves” at the same time. In some cases these needs seem at odds. I find many of my patients to be swooping dramatically back and forth between the feelings of anger, fear and helplessness associated with following the events in our government, and daily life activities like preparing meals for themselves and, in some cases, their families, getting enough sleep, and completing whatever tasks are demanded by jobs or other pursuits. For many who had not been as politically tuned in or outraged previously, these two poles seem utterly unintegrated. It is almost as if each of us is two people, and we are allotting great effort to the job of being each of these two people, exhausting ourselves. My hope is that, over time, a more integrated sense of ourselves grows out of the current crisis, where an idea of ourselves as both grocery-shoppers and protesters can co-exist in our minds.
If you go by what is happening in my practice, people have become politicized. Some already were, and those that weren’t are now. We are involved. This essential fact, observed widely, is remarkable, and has helped energize me since the first day back at work after the election. This engagement has developed and grown rather than waned since November, and I continue to feel quite hopeful in my work. Based on this experience, I suspect that the election outcome may, in fact, be making people less myopic and self-involved.
People who were comfortable in the belief that progress was happening without too much of a fight, and that we could just sit back and more or less let it march forward, were rudely awakened. While some in my office do feel at times hopeless and overwhelmed, there are other moments in which they feel more resilient and clearer of purpose than they have in the past. There is a new awareness of the larger world and a sense that “now, it really matters what I do.” This is giving some who were not previously able to focus their attention on much, something to focus on. The Political Self, a collection of essays on the ‘social context for mental illness’ edited by Rod Tweedy (2017) thus arrives in a timely manner.
In Sue Gerhardt’s chapter, “The Selfish Society: the Current State of Things,” she writes about the erosion of empathy in individuals, and the rise of narcissism and self-interest (p. 69). Gerhardt points out that for those with depression and some character pathologies “the bottom line is that they have difficulties with the quality of their attachments to other people and often find it a struggle to think of others’ needs” (p. 84). Gerhardt argues that selfishness or unselfishness within a society is cultural—and that selfishness is connected to social isolation, impulsiveness, addiction, etcetera (pp.81-82). She is a drawn to a feminist “ethic of care” in which we become aware of and deliberate about the ways in which we care for, and are cared for by, others all day long. It promotes an openness to the ways in which others are different and experience things differently from ourselves (p. 76). Around me, in my practice and beyond, I see people forming community groups, gathering with others to talk and process what is happening, and strategizing actions and protests. Many have more of a connection to their neighbors and larger community than they did a few months ago. I really wonder whether this current Trump-resisting climate of raised consciousness, protest, and urgency, if sustained, could lead to a greater collective empathy and the ability to look beyond one’s self toward the interests of others. Perhaps this moment in history is an opportunity to change the culture.
But how does the shift on the cultural level translate into the work in the office? This leads to a point that has sharpened for me in these last weeks: my sense that actually being “in this together” with my patients has created something of therapeutic opportunity. The experience of learning about extraordinary developments in politics, and processing them simultaneously with my patients, having something momentous happen to us together, has been an equalizing force in the therapy room.
The principle that we are collaborators in the work of therapy, that I don’t hold the answers or possess any great wisdom to hand down to a patient about themselves, has guided my work as a central belief since long before the election. Believing in that principle, however, doesn’t by itself erase the power dynamic between therapist and patient. As Nick Totten explains in the chapter, “Power in the Therapeutic Relationship”, my role in the relationship with my patients automatically confers on me some authority, and some of the ability to convince that goes with authority, whether we like it or not. To pretend otherwise is to willfully deny reality, and Totten writes that for therapists “its bad practice to pretend that we are not operating from a set of beliefs.” ( p. 36) He posits that we can work to repair this imbalance by not being seduced by the part of us that wants “to assert our authority as expert and healer” and by bringing “awareness, the magic ingredient, to the situation” (p. 39).
A positive byproduct, then, of this experience of our political climate, in which I am quite openly as perplexed as anyone else, is that it moves my idea of being my patient’s collaborator from principle into practice. Any perceived authority is diminished by my clear lack of expertise in at least the area of the current crisis. Now, in conversations with my patients, I feel as though there is a freer way between us than there used to be, and that when I “throw an idea out there,” my patients are more likely to genuinely regard it as what I say it is: a trial balloon. This feeling now often pervades sessions. Whether we are speaking about the latest news out of Washington or about their grandmother’s possible motivation for commenting negatively on their appearance, I feel as if several of my patients are giving my words a little less weight. Because of the frequent reviewing of our social context, we are in the “conversation zone” more safely than we used to be, and I consider this an improvement over what, in retrospect, seems like it was at times a somewhat manufactured “therapy zone” which was more stilted, and at times awkward. This zone feels more creative and spontaneous. It feels as if, now, we are thinking together, rather than you, the patient, thinking over there in your chair, and me, the therapist, thinking over here in mine.
The idea that we, as therapists, think we are meant to be the source of insights is deeply flawed and always has been. It must be questioned repeatedly as we engage in psychotherapeutic processes. It turns out that when it comes to their own lives and choices, patients hold the keys and our job is to be able to be present, listening, and deepening the understanding on both sides, when the answers emerge. Totten compares this process to creating a new, unique language, a mixture of the languages with which the patient and therapist entered the treatment (p. 40). When it comes to larger questions of how to come back from the current crisis as a country, this small-scale creative action between two people may be transferable. The act of listening more carefully to one another, and acknowledging all the moments and all the ways in which we each don’t hold the answers, but are groping along together in the dark, is more essential than ever.