(Posted February 12, 2010)
This is the first of two related
papers I’m posting on this website. I welcome your feedback. (With your
feedback, I can always change my wording or insert your comments.) This
paper notes how psychotherapists came to be called “shrinks;” how this
term in some ways is a little bit true; and how in some ways many
modern therapists might better be recognized not as shrinks but
expanders.
The second webpage,
"Beyond
Psychotherapy," notes how there are domains of consciousness
expansion that require socio-cultural changes, and though
psychotherapists can help by recognizing these issues and talking about
them openly, helping with the consciousness-raising, these changes can
be implemented only to a limited degree by the individual in his own
personal life. Ideally, the changes desired need to happen in a broader
arena and therapists can help by at least being advocates for such
changes. However, any thoughts that therapy in itself is sufficient to
relieve all forms of psycho-cultural sources of stress, oppression,
dis-ease would be reductionistic. So that page considers some of the
wider issues that might be involved in a true program of mental hygiene.
As a preamble, I think the goal
of healing should be “wholeness,”—and
both words derive from a similar Indo-European word root. How can
humans manifest their human potential more fully?
"Don't ask yourself what the world needs.
Ask yourself what makes you come alive, and then go
do that.
Because what the world needs is people who
have come alive."
--
Howard Thurman (1900-1981)
In the late 19th century the field of psychology began to develop, and
Freud’s methods were the equivalent of an early model of the telescope
or microscope: They opened up vast and complex realms of phenomena that
had been previously ignored or treated as an unreachable mystery. As
the field developed it became broader and more refined—as has been true
with the advance of most other scientific fields of exploration. Those
who stayed stuck in the earlier theories seemed old-fashioned.
Relatively, their work seemed to “shrink” the human potential to the
“Procrustean Bed” of the limitations of their theories. (Procrustes was
a bandit mentioned in the story of Theseus in Greek mythology, a rogue
who invited guests to sleep in his special bed: But if they didn’t fit,
he made adjustments: If one was too short, the bed acted as a rack,
stretching the victim to size; if the victim was too tall, the villain
sliced off bits of the feet that didn’t fit! Finally killed by
Theseus.)
The Origins of “Shrink”
In the 1950s and 1960s the term “shrink”—perhaps short for
“head-shrinker”—became a slang term that referred to psychiatrists,
psychotherapists, and especially psychoanalysts. It was a way to mock
the mystery and authority of psychiatrists and psychotherapists—and
mainly of the mysterious and odd procedures associated with
psychoanalysis, which was the dominant approach in the Americas and
Europe in the mid-20th century. Even patients or “analysands” used this
term to soften their one-down status: Having a slightly derogatory but
almost affectionate pet name—i.e., my “shrink”—seemed to neutralize or
even reverse the intuitively perceived status gradient experienced by
clients. In some urban sub-cultures it was common for several people in
a social network to each have their own analysts, and phrases such as
“My analyst said...” became part of the cocktail party patter. (I
remember drawing a cartoon of two kids and one said, “Oh, yeah? Well my
analyst can see right through your analyst!”—a play on the “my dad can
lick your dad” gimmick.)
The term also had an edge of the idea of “head-shrinkers,” reacting to
the discovery of tribes in South America who actually engaged in a
process of removing the skulls of enemies and slowly curing the skin
over a smaller frame. (I remember reading about this in Ripley’s
Believe It Or Not and/or some other articles—it appealed to the
pre-teen fascination with Halloween Horror.) Stories of cannibalism and
voodoo also were an emerging part of the legends in that early
mid-century era of comic books and pulp fiction. These images also bled
over to the emerging fields of psycho-analytic psychotherapy and
similar approaches, because the terminology was obscure and the whole
enterprise had an aura of magic and mystery.
Some Historical Perspectives
Actually, the early psychoanalysts were in a sense the “expanders” of
their time. Psychoanalysis caught on more among the intelligentsia in
the 1920s through the 1940s even more than it caught on in the medical
fields—although that came a little later. Considering the depth
psychology of human affairs seemed to be an exciting new approach to
“mind expansion.” In comparison, the earlier generation, the
old-fashioned, post-Victorian world-view, came to be viewed in the
early-mid 20th century as self-deceptive. Its “stiff upper lip”
attitude relied overmuch on the psychological defense mechanisms of
repression and denial. By confronting the “terrible truth” about the
unconscious, darker drives underlying human nature, psychoanalysis
seemed positively enlightening (Douglas, 1995).
Because of a number of other sociological currents such as the glamour
of the European professor, the immigrations from pre-WW2 Europe, the
adoption of psychoanalysis by mainstream psychiatry, and so forth,
Freudian thought held a hegemony in the USA and Western Europe in the
late 1940s and 1950s. (There were also some practicing Jungians and
Adlerians, but they had nowhere near the organization or relative
popularity.)
To note again in its defense, psychoanalysis seemed mind-expanding to
its own practitioners at the era (Hobson & Leonard, 2001, pp.
37-41; Dolnick, 1998, pp. 64-68). For a time, many of the brightest,
most introspective medical students went into psychiatry because of
this many-faceted frontier. (I admit that this was also one of my
motivations: Going into psychiatry allowed me to integrate a range of
my interests in medicine, philosophy, the history of religion, art,
anthropology, and so forth.) Dynamic psychiatry also offered a
humanistic alternative to what had been available in psychiatry in the
1930s and 1940s—a tragic and somewhat stagnant impasse and heavy
hospital load of the mentally ill. (A muckraking movie at the time
titled The Snake Pit portrayed the horrible conditions in some
psychiatric hospitals at the time.) Although some well-meaning
psychiatrists attempted to promote a variety of of programs, for the
most part these reflected the innovator’s own personality and lacked a
theoretical foundation that could be used by others. Other treatments
offered were desperate—though on occasion able to offer surpising
relief for a time—e.g., electroshock treatment, which still offers
value for a few patients who are severely disturbed and yet
unresponsive to other approaches. For the most part, though, in that
era, patients were simply warehoused. Psychoanalysis seemed far more
caring, patient, and humane—though its actual effectiveness with the
severely mentally ill was minimal.
In actuality, though, psychoanalysis as a socio-economic field made its
major inroads not in psychiatric hospitals but in consulting offices in
major urban centers where it catered to the much milder neuroses of
otherwise fairly highly functioning clients who could afford to pay for
this prolonged and intensive treatment. For them it was not just a
treatment but a type of mind-expansion.
So, in its defense, Freudian psychoanalysis offered something exciting
and expanding, and it was only later that this first generation and its
methods were judged as (relatively speaking) more likely to shrink than
expand the personality. The theories also were both insightful and yet
unrefined. These ideas sometimes overgeneralized, sometimes
under-estimated. As a whole, though, they opened up the idea that there
were realms of experienced that were to varying degrees not disclosed
to others, to oneself clearly, or to oneself at all—i.e., the
subconscious and unconscious mind.
Relativism and History
New generations tend to see older ideas as old-fashioned. Saying it
another way, as a field of study develops and expands, or as a
technology and cultural trend flourishes, it gives rise to a
dialectical process: a given set of ideas, a thesis, attracts the
attention of critics who notice that some of these ideas merit certain
criticisms, which represent the antithesis. Eventually still other
theories emerge that seek to capture the best elements of both the
thesis and antithesis and generate from these a new synthesis. This set
of ideas then acts as a thesis for a further dialectical go-round of
thesis, antithesis, and synthesis, and so it progresses.
In this model, then, the dominant school of thought stimulates people
to notice what in their opinion is neglected or over-emphasized, and
from this they develop compensatory therapeutic and theoretical
systems. So, beginning in the 1950s (or earlier!) and flourishing more
in the 1960s, a number of approaches emerged as antitheses to the
theses of psychoanalysis— within that field as alternative schools of
thought and beyond it, as alternative non-analytic therapeutic methods.
By the 1970s, there were hundreds of various types of therapy, many of
them structured as approaches that compensated for perceived lacks in
the mainstream analytic approach. From all these, though, the classical
types of psychoanalysis might plausibly have been seen by others as, in
a sense, “shrinking” its patients, meaning that this approach was
viewed as interpreting the range of human experience within the
limitations of its own theoretical boundaries.
This paper will briefly address some of the dimensions of psychotherapy
and/or consciousness-raising that emerged in the 1950s through the
1970s that might be recognized as expanding rather than shrinking the
image and potential of who patients are and might become. Let us
consider then some of the categories that lead to a view of the human
mind as something that can be expanded in many different ways.
Beyond the Individual
The first expansion beyond the early model was the opening of the
perspective of appreciating that dis-ease can arise not just from the
individual, but equally from the relationship. Individuals, as a matter
of fact, can be quite healthy in some settings but they just don’t fit
or trigger each other off in certain relationships—marriages, groups,
etc. Corollary: All dysfunctions may not be traceable to the faults of
the individuals involved. There is such a thing as incompatibility.
Attention, then, needs to be given to the dynamics of relationships and
groups.
Although precursors to group and family therapy emerged from the 1920s
on, they were mainly the work of scattered individuals. The movement to
group work accelerated after the Second World War (necessitated by the
problem of working with veterans). Still, groups were more difficult to
work with—an order of magnitude more complexity.
Nevertheless increasing numbers of pioneers sought to note the way
humans could be appreciated as much as social beings as individuals,
and helped not just through individual work in therapy, but through the
power of the group.
Moving outward from this, research in group and family dynamics, the
interactions of three or more people in a system, work with business
and healthy people as well as patients, all these expanded the sense of
what people were about and what they could accomplish together.
Theoretically, it became clear that people operated on multiple levels
simultaneously—individual, interpersonal, family, group, organization,
culture. We cannot in fact separate neatly that which is
micro-sociology from general sociology, or micro-sociology from family
or small group dynamics, or family-group dynamics from interpersonal
relationships and intrapsychic dynamics. Each level of function affects
the others. J. L. Moreno saw this more clearly, though there’s still
room for developing the theory in a more systematic fashion (Blatner,
2000). (Moreno was also a pioneer of role theory, which helped to frame
this inter-disciplinary sensibility. I think this approach still has
great promise as a user-friendly language for psychology).
As psychoanalysis continued to evolve, analysts such as the
neo-Freudians such as Harry Stack Sullivan were a bit more alert to the
interpersonal transactions and their implications. In the 1960s, Eric
Berne took these ideas beyond the boundaries of psychoanalysis and
called his approach “Transactional Analysis.” Berne also wrote of the
need for recognition, for what he termed “strokes.” Later research in
social psychology has confirmed and extended this idea of the power of
interpersonal recognition. So widening the focus from individual to
include also the family system and group was one kind of expansion.
Body Work
In addition to the levels of social interaction, there’s another
direction for expansion: Include non-verbal communications in
relationships and more, the way people work their body into habitual
patterns of tension and irritability in order to maintain certain
subtle attitudes—belligerence, appeasement, anxiety, defensiveness,
etc.
Wilhelm Reich was a relatively early pioneer in psychoanalysis who
observed this “body armoring” and wrote about it in a classical book
titled Character Analysis. (He was also aware of the socio-economic
factors in life and flirted with socialistic ideas.) In some ways he
went too far for many of his colleagues and lost credibility—his story
is too complex to be summarized here. Alexander Lowen resurrected some
of Reich’s ideas and around the 1950s systematized them in his own
method called “Bioenergetic Analysis).
Other people in the 1960s also worked on the body and its “blocks,” and
later people mixed these ideas with other approaches—bits of
psychodrama, massage, “subtle energy healing,” and so forth. For many
people, expanding into this frontier fostered a greater degree of body
awareness.
A related field involved touch—allowing the therapist to touch the
client, or patients or family members be helped to touch each other.
Though mocked as “touch-y feel-y” by the mainstream of the population,
the point was just that: The social norm had become excessively
up-tight about even non-sexual forms of comfort and friendliness. This
continues to be a frontier for mind-expansion.
Action in Psychotherapy
Equally uncomfortable for many people is the idea of getting out of the
chair and showing how one feels or how an uncomfortable interaction was
played out. This form of controlled “acting-in” bypassed the defenses
that could be used when talking about a problem. Psychodrama’s use of
therapeutic role playing, invented by J. L. Moreno (1889-1974) was a
most powerful approach, and when people did enact situations, they
sometimes experienced more of a catharsis than they might by just
talking about the stress. By having patients get up and act out their
problems,
their feelings, and their fantasies, psychodrama might
also be recognized as overlapping with the aforementioned "body"
therapies, the following theme of "touch" in psychotherapy, an
expansion of the use of imagery (by playing out dream images, for
example), and so forth. There was a good deal
of insight to be gained from physically encountering, through pulling,
pushing, throwing, hitting, and other exertional behaviors. Many
people—therapists and others—found all
this threatening, too out of control. Those who learned about it
correctly found that the seeming out-of-control-ness was really not out
of control at all, but rather just more expressive than many people
knew was possible. Other approaches, such as Gestalt therapy (using the
"empty chair" technique; or Satir's family therapy (using the technique
of "family sculpture") adapted some psychodrama techniques, though
few acknowledged the source, because these role playing methods are
powerful and effective when done well. Action is another part of the
opposite of being “shrunk,”—it’s a kind of expansion.
Touch
The late Victorian era had become phobic about sexuality, and phobias
tend to generalize: Anything that would even vaguely remind people of
sex becomes taboo also. Euphemisms were employed, such as the
substitution of “limb” for the more suggestive “leg.” Many people never
learned actual descriptive words for parts of the genitalia—it was all
“down there.” There was a taboo also about touch, not that those of the
lower classes, including nannies and wet-nurses bothered with such
nonsense. The discomfort with the idea of touching has continued in
Europe and the USA, so that being touched, cuddled, held, massaged, and
the like became sources of discomfort instead of comfort. Early
psychoanalysis was equally ambivalent about this dimension of human
experience, and Sandor Ferenczi was scolded by Freud for his
explorations of this domain in the 1930s.
A related development was the widespread influence of the behaviorist
psychologist John Watson, who believed that babies could be “spoiled”
by being picked up and cuddled and held. It was the anxiety generated
by this fashion in child-rearing in the 1920s and 1930s that was
addressed by the so-called “permissiveness” of Dr. Benjamin Spock in
his popular book of the late 1940s. He wasn’t advocating a lack of
moderate discipline in child-rearing, but rather just freeing mothers
up to not be afraid to pick up and cuddle their babies when they cried!
Gradually, other pioneers began to explore this wider view of the needs
of human nature. A few types of mind-body healing emerged that entailed
the therapeutic use of touch and pressure, both from others in the
group or the therapist. The point here is that touch is a powerful
associated modality of healing and enjoying vibrant good health, and
touch needs to be recognized as separate from genital sexuality or
seduction. Physicians started to be encouraged to touch their patients,
hold hands when it seemed right, and break the phony barrier of
clinical distance. So this was another type of expansion rather than
“shrinking.”
Biological Factors
The renewed attention to the genetic and physiological contributions to
dis-ease can be used either to shrink or expand our view of human
experience. On one hand, there is such a thing as too much
psychological-ization, so that, for example, conditions now appreciated
as biological, such as autism, were for a while attributed to defects
in parenting. Many parents went through decades of guilt and imposed
therapy—if only they weren’t so subconsciously rejecting their child
wouldn’t be sick in this way. It turned out not to be so (Dolnick,
1998).
There’s a kind of expansion in recognizing the power of innate
temperament and ability, and that such factors transcend what can be
willed. This is also true for the proper use of medications to fight
major neuro-physiological dynamics in mental illness. Many patients
went through—and still go through—years of trying to control these
symptoms themselves—and suffering mightily, as well as making others
suffer too—because they’re too proud or ignorant—and sometimes under
the influence of a “therapist” who is similarly benighted.
I’m ambivalent about the new trend towards biological psychiatry,
because there is a fair amount of shallow thinking, overdiagnosis,
over-treatment, and art-less treatment. But there’s also a good deal of
under-diagnosis and under-treatment because of old-fashioned attitudes.
I do think there is a relatively wise and art-ful optimal response, and
it’s an expansion of our view of psychological dis-ease to recognize
this.
There’s also an incresaing sensitivity to innate differences in types
and sub-types of ability and disability, with the paradigm of reading
disability as a relatively early opening of this category. Other types
of over-sensitivity or relative insensitivity are being recognized.
There’s a kind of consciousness-raising or mind-expansion in knowing
how better to assess strengths and weaknesses and to deal wisely with
them—for self-development and education.
Self-Development
A major expansion of psychotherapy has been in the direction of
recognizing that while some issues really have to do with more
significant degrees of disease or disability, many if not most of the
insights and methods developed in psychotherapy can be adapted for
helping healthy people become even healthier, more resilient, wiser,
more mentally flexible. The “human potential movement” involved the
adaptation of many types of psychotherapy, plus the power of the
“encounter group” or other group contexts, to further this goal of
consciousness-raising or mind-expansion. Indeed, harvesting these
insights and applying them in education, business, and other parts of
the world may be the most important derivative of dynamic psychology in
the 21st century.
Imagery
It might be plausibly argued that our industrial era has failed to
adequately investigate and promote the true power of imagination. I
think the dynamics of hypnosis have only begun to be tapped.. Imagery,
guided fantasy, and other ways of cultivating imagination were proposed
by a number of therapeutic innovators. Some cases responded
dramatically. These approaches should continue to be explored.
Expressive and Creative Arts
Related to imagery, it became recognized also that working through art,
sculpture, poetry, drama, dance, music, sculpture, drumming, creative
writing, story-telling, puppetry, mask-making, and other expressive
approaches could be used for several purposes: First, these productions
could be a source for reflection and analysis, insight and appreciation
of the aesthetic complexities of the subconscious mind. The
aforementioned Moreno emphasized the power of spontaneity, and
improvised expressions through these art media also offered a
strengthening of the connection between the ordinary self-controlled
sense of self and the source of inspiration, the creative subconscious,
the muse, the soul. Developing such connections generates a more
multi-dimensionsal sense of self, a kind of “expansion.”
Humanistic Psychology
Around the 1950s and 60s, a number of eminent psychologists such as
Abraham Maslow, Carl Rogers, James F. T. Bugental, James Fadiman, and
many others generated a loose association of “humanistic psychologists”
who emerged as a “third force” to counter the first two forces in
American Psychology in the mid-20th century—i.e., the reductionistic
and deterministic (“shrink”) forces of behaviorism and psychoanalysis
(Goble, 1970). Humanistic psychology sought to explore and utilize
those potentials that only mature humans could manifest—not rats or
young children—, such as creativity, community-building, more refined
arts, the potential of the mental mechanism of sublimation to truly
contain and expand the human potential. (A fair number of
psychiatrists, clinical social workers, pastoral psychologists and
other therapists also were part of this trend.)
Transpersonal Psychology and Spirituality
Emerging from Humanistic Psychology in the late 1960s, a group of
psychotherapists sought to bring some emphasis to the realm of
spirituality, as the earlier approaches tended to marginalize this
major source of conflict and healing. Drawing on Eastern (e.g., Zen,
Yoga, etc.) traditions as well as the mystical and contemplative
practices of Western religions, this approached recognized the
artificiality of psychology and psychotherapy as imagined to be
separate from spirituality. Explorations into ways of expanding the
mind in this direction have continued to make progress.
The analytical psychology of Carl G. Jung and a number of his followers
for many holds value because it partakes of a sensitivity to such
spiritual categories as soul or deep psyche—not just as a repository of
the repressed, but as a source of comfort and inspiration. There has
been increased interest in this general field because (it seems to me)
only those psychologies influenced by Jung’s thinking about archetypes
have been able to truly illuminate the kinds of experiences associated
with psychedelic agents or mysticism. Joseph Campbell’s expansion of
Jung’s sensibility in the direction of considering our culture’s myths
has extended this approach further.
Though not widely appreciated, the Psychosynthesis system developed
Roberto Assagioli, beginning in the late 1920s, offers further
insights, extending elements of transpersonal psychology, inner
dialogue, and the like.
Feminist Psychotherapy
Another important development associated with the feminist movement of
the 1960s through the 1980s has been the recognition of what will be
discussed further in the essay on the other website (Beyond
Psychotherapy), namely, that in addition to working one-to-one or in
groups, some recognition of our problems needs to open out to the idea
that the socio-cultural system also merits analysis and change.
Sometimes what seem to be our personal problems are really due to ways
the social systems is set up so that some folks are stressed far more
than others, and far more than they really need to be. A “good
diagnosis” of this predicament itself serves to relieve a fair amount
of self-blame.
Interestingly, this idea is not entirely new. A number of early
psychoanalysts came to a similar conclusion, that the social,
religious, cultural, and economic systems of the time added a
significant burden on the individual’s psyche. The aforementioned J. L.
Moreno as a beginning medical student around 1912 noticed that the
prostitutes in Vienna were being exploited not only by their pimps, but
also harassed by local governmental bureaucrats. He encouraged their
organization into self-help groups. Social action might be recognized
as being as much a part of a more holistic view of psychotherapy as any
action in one’s personal life.
Beyond Psychotherapy
In the last few decades, even the idea that significant problems can be
“solved” or “worked through” on a personal level seems to be a kind of
“shrink”-like thinking. We need to recognize the power of the larger
culture—carrying forward the insights of the aforementioned feminist
psychotherapy. To be an expander may require a willingness to include
other issues of oppression. This will be explored more in Beyond
Psychotherapy paper on this website.
Thus, the social institution of psychotherapy may be a kind of
shrink-like thinking, including many of the following components:
- One-to-one or office-based psychotherapy, requiring some
participants to be in the sociological “sick role.”
- Patients or clients expected to pay substantial amounts of
money—or to arrange for third parties to pay therapists for consultation
- The gradient of expertise, the qualifications of the
“therapist” as a professional (versus those not so qualified),
including government-supported licensure requirements and sanctions for
those practicing without a licence
- The infrastructure of payments from third party
payers—insurance companies, government disability or medicare programs
... some day all these elements might be
viewed as having some “shrink-like” elements, compared to an even more
expanded view of dis-ease and healing!
Summary
Psychotherapists have been called “shrinks” for largely invalid
reasons—to soften the power gradient felt by patients—, but there is,
ironically, a germ of truth to the term. Whereas in the early years,
therapists—mainly psychoanalysts—were “expanders” insofar as seeking to
raise consciousness about the realities of the inner life, by the 1970s
the first generation came to be viewed as overly constrained by their
own theories. The theories arising in the last quarter of the 21st
century seek to expand the vision of the human predicament and the
variety of approaches that might be useful in maximizing the human
potential. Many therapists nowadays might better be thought of not as
“shrinks” but rather “expanders.”
(Nevertheless, there are perspectives that might expand the vision of
the nature of health and disease even further—to be continued on a
related page,
Beyond Psychotherapy.)
References
Blatner, A. (2000).
Foundations of
psychodrama: history, theory, &
practice (4th ed.). New York: Springer.
Dolnick, E. (1998).
Madness on the
couch: blaming the victim in the
heyday of psychoanalysis. New York: Simon & Schuster.
Douglas, Ann. (1995).
Terrible
honesty: mongrel Manhattan in the 1920s.
New York: Farrar, Straus & Giroux.
Goble, F. G. (1970).
The Third
Force: The Psychology of Abraham
Maslow. New York: Grossman.
Hobson, J. A. & Leonard, J. A. (2001).
Out of its mind: psychiatry
in crisis—a call for reform. Cambridge, MA: Perseus.
Comments are welcome.
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