Tuesday, December 27, 2011

Nietzsche and Tolstoy: Two book reviews.

I want to mention two book reviews that crossed my path this week that might be of interest to existentially-minded individuals. These works are not specifically psychotherapeutic in nature, but I believe that writers and philosophers throughout history have addressed themselves to the same concerns that trouble us in this modern world, and so I think it is always useful to maintain a connection with classic literature and philosophy.

The first is a review of Jennifer Ratner-Rosenhagen's book American Nietzsche. (The review is written by Thomas Meaney.) Nietzsche has been a topic of fascination for existential psychotherapists since Rollo May, and Irvin Yalom wrote a novel to answer the hypothetical question, "What if psychotherapy had been invented with Nietzsche as one of the first patients?" Yalom sees in Nietzsche a patient who views his intrapsychic difficulties (and in fact, physical difficulties, as Nietzsche is being treated for migraines in the book) as a source of strength, not as something to be avoided. Rather, the quote "What does not kill me, makes me stronger" is taken literally and shaped as a part of the treatment plan. (The quote is Nietzsche's own of course, from Twilight of the Idols.)

Nietzsche's gift to psychotherapy is quite large. Nietzsche questioned authority in a big way, writing "As long as the world has existed no authority has yet been willing to let itself become the object of critique." He insisted that meaning, purpose and morality could not spring from traditional beliefs and be unquestioned merely because they were traditional. He looked at the genealogy of ideas, engaging in a kind of psychoanalysis of the history of morality, and resolved that humans have responsibility to create their own meanings about morality--and even about existence. Today, the idea of taking a rigorous study of the source of a particular belief sounds like something we would do in a therapist's office, and we owe a debt to Nietzsche, who in his own way said, "Let's take a look at where these things that we believe to be true actually came from."

I have used Nietzsche's work in treatment myself--sometimes asking clients to read his work, sometimes just using quotations such as the one above, or "When we are tired, we are attacked by ideas we conquered long ago." Nietzsche's idea that we are constantly becoming ourselves--shaping ourselves into who we are--is a very useful idea for psychotherapists. According to the review of Ratneer-Rosenhagen's book, she shows how Nietzsche has been viewed by Americans since the publication of his works--both understood and misunderstood.

The second review is of Tolstoy: A Russian Life, by Rosamund Bartlett. (The review is written by Martin Rubin.) If for no other reason, Tolstoy deserves a place on the existentialist psychotherapist's bookshelf for the famous first line of Anna Karenina: "All happy families are alike; each unhappy family is unhappy in its own way."

Tolstoy has certainly given us much that is useful and engaging when it comes to examining our lives and our mental health. His short work The Death of Ivan Ilyich is one such work, which addresses the terror of death as well as the definition of a good life.

Of special note for psychotherapists who are also social workers: Leo Tolstoy was a great influence on Jane Addams, the mother of social work. She admired his ideal of working in solidarity with the "common person," rather than standing apart and working for change from a distance. She was an active admirer of Tolstoy until her death.

My favorite story of Jane Addams is of her visit to Tolstoy. Addams made a pilgrimige of sorts to visit Tolstoy on his estate, where he worked along side of the laborers. He met her dressed in working clothing, and proceded to comment on Addams' dress, criticizing her for wearing fashionable clothing rather that practical working garb. He also critiqued her for not working next to the laborers in Hull House. Addams was taken by this sentiment, and upon returning to Hull House she resolved to bake bread for two hours each day, as a way of living up to Tolstoy's values. However, she quickly saw the folly in this arrangement, writing: "The half dozen people invariably waiting to see me after breakfast, the piles of letters to be opened and answered, the demand of actual and pressing wants–were these all to be pushed aside and asked to wait while I saved my soul by two hours' work at baking bread?" (from Twenty Years at Hull House.) I think this story shows so clearly how Addams' idealism and vision were tempered by her practicality, as well as the beginnings of the professionalization of social work.

Thursday, December 22, 2011

A Christmas Carol: A model of psychotherapy?

I was working on my holiday cards the other day, which is mostly a mindless task. To keep myself entertained while addressing, folding, stamping and sealing, I was watching the 1984 version of A Christmas Carol, staring George C. Scott. I always enjoy this movie, and usually watch it once a year.

Apart from Scott's excellent portrayal of Ebeneezer Scrouge, and apart from the lush sets, I find the story to be an outstanding example a course of psychotherapy. I am sure that I am not the first person to recognize this, but I think that it is nice this time of year to remember that Charles Dickens foreshadowed modern psychotherapy in his short story.

(As a side note, Irvin Yalom says that it is a mistake to believe that the history of psychotherapy began in the 19th century, and that we should look to literature and philosophy for the true origins of the profession. I could not agree more. I came to be a psychotherapist through studying philosophy first, and becoming aware of human problems. I have also believed that it is useful to remember that the same delimias that plague humans today--death, relevance, meaning, power, and so on--have been the subject of and motivation for some of the greatest works of art and literature.)

So what can we learn from looking at Scrouge's journey to mental health? Well it usually starts with feeling that there is something that needs to be changed or resolved. In Scrouge's case, he receives a great existential wake-up call in the form of visitation from his former partner, Jacob Marley. As you remember, Marley was a man of great achievement in business, but as much (or more) of a miser as Scrouge. For his part, Scrouge had admired Marley's mind for business. But when Scrouge reminds Marley of his work ethic, Marley's restless ghost reflects on his priorities in life: "Mankind was my business. The common welfare was my business; charity, mercy, forbearance, and benevolence were, all, my business. The dealings of my trade were but a drop of water in the comprehensive ocean of my business!" Think of this as the intervention: Scrouge's friend--the only one he has in the world, as Dickens describes him as "solitary as an oyster"--tells him that he needs to change because Marley is worried about him.

Scrouge is then famously visited by three spirits. The first, the Spirit of Christmas Past, takes him to his childhood. He visits his old school and confronts his overbearing father, who we learn bears Ebeneezer a grudge because his mother died in his birth. We are reminded that Ebeneezer's beloved sister Belle died in the childbirth of Ebeneezer's nephew Fred, whom Ebeneezer spurns. We see the family patterns repeating here, and we begin to understand why Scrouge thinks and acts the way he does.

Further, we notice that Ebeneezer's upbringing was weak in attachment and empathy. He was not socialized in a loving family, but was turned over to a boarding school. This surely impacted both his ability to form bonds with his fellow persons and also possibly helped shape his work ethic, since schoolwork was valued above human attachment. We also learn that young Ebeneezer longed for human contact--he references his "beloved books" as though they were friends, in denial of the actual emptiness of his youth.

The Spirit of Christmas Past then shows Scrouge a scene from his time at Fezziwig's, in which Scrouge was happy and celebratory. Scrouge was surrounded by love, joy and human connection. For a moment, it looks like Scrouge has cast off his past of isolation and loneliness, and learned how to have satisfying human relationships. But there are underlying currents of discord: Fezziwig warns Scrouge not to put too much energy into his work, and to focus on finding a partner and starting a family.

The Spirit of Christmas Past is not done, as the process of excavation in therapy is often lengthy. She then shows Scrouge the Christmas eve in which Belle left him, as a result of his prioritizing his work over her. Scrouge becomes so distraught he refuses to see any more memories from his past. He attempts, as do many people, to put the blame for his unhappiness on the person who is reminding him of the memories that he would rather keep burred. But The Spirit of Christmas Past leaves him with a wonderful therapeutic sentiment: "You fashioned these memories yourself," reminding Scrouge that he must take ownership of his own life.

The Spirit of Christmas Present shows Scrouge, over the course of several scenes, the joy and love that exists in the here-and-now that Scrouge is refusing. They see the market place and children playing. Scrouge first sees only the money being transacted, and then is instructed by the Spirit to see more than that--to see the humanity all around him. Scrouge and the Spirit visit some of the citizens of London who are not as fortunate as Scrouge and his family, and even then Scrouge sees the love and connection as well as the hardship that Scrouge himself refuses to see. In this way, Scrouge confronts his privilege as well, and beings to think of his social responsibilities.

The Spirit of Christmas Present also takes a hard look at the way that other people view Scrouge: Cratchit and his family discuss Ebeneezer, as do his nephew and his party guests. They are not favorable in their assessment of Scrouge. At first, he defends his reputation, but as more and more evidence is gathered, his defense mechanisms begin to quiet down and he beings to see the reality that he is perceived to be a tight-fisted miser by others.

Finally, the most frightening apparition is the Spirit of Christmas Yet-to-Come. This Spirit will not speak to Scrouge, but forces him instead to draw his own conclusions, to make his own explanations. The focus this time is on Scrouge's death. The existential therapy here has been remarked on by many other clinicians: Scrouge must face and acknowledge his own death and his legacy. He must fact the fact that he is not grieved: The only person showing some emotion in relation to his death is a cleaning woman who is pawning his possessions. In contrast, Scrouge and the Spirit visit the Cratchit family, where Tiny Tim has died and is still grieved and missed. Scrouge is deeply shaken by this, and in terror he confronts his own lonely grave in a cold cemetery.

At the end of Scrouge's therapy (The spirits did it all in one night! Imagine how managed care would love that!), he makes a commitment to behavioral change, and engages that change. He finds that the real benefits of therapy come as he manifests real change in his life. Insight motivates the change, to be sure, but it is the generosity and kindness that he consciously engages that redeems Scrouge.

I encourage anyone who has any interest in mental health to watch whatever version of A Christmas Carol that appeals, and to notice the ways in which Dickens shrewdly lays out the workings of the human psyche. In particular, notice all of the interventions used on Ebeneezer Scrouge that are used in psychotherapy today. Apart from making a case for Dicken's deep understanding of human behavior, it shows that the great works of literature and art have much to teach when it comes to mental health and psychotherapy.

Tuesday, December 20, 2011

Holidays are what we make of them

While listening to to the radio on my drive home from the office, I heard an advertisement which reminded me that the "true spirit of the holidays is giving. And specifically, giving them the brand names that they want."

At one point I think the messages were limited to Christmas. But I suspect that somewhere along the line, advertisers realized that they were missing out on other opportunities to sell people stuff, and they broadened their message to include all the "holidays."

Now, the "Holidays are too materialistic" has become an old cliched trope, and I know it. But I think it is cliched for a reason--every year, we are assaulted from all sides from advertisements that are not selling us food or clothing or perfume, but holiday cheer and family harmony. The message that our lives will be better if we just purchase whatever product is on offer is not subtle.

On a par with this is the message that our holidays need to be perfect. Images of the holidays include immaculately decorations, well-dressed and smiling family members, and a lush spread of food. A Google search for "perfect Christmas" brings up "Pick the perfect Christmas gift," the "Perfect Christmas Tree," and Barbie's Perfect Christmas.

And so it deserves to be said, as it is every year, that the holidays do not have to be a frenzied time of over-spending and high expectations. Instead, this time of year can be a time to reflect on family, on the ending of one year, on celebrating what is good in our lives.

Instead of stressing over the perfect holidays, I can choose to take time to remember what it is about this time of year that is meaningful for me. I can remember traditions that I enjoy, and I can listen to music that makes me feel connected to the season and to my family. I can put up decorations that make me feel good, and I can eat foods that I associate with good memories.

Let me end by paraphrasing Nat King Cole: Although it's been said many times, many ways, remember that your holidays are what you make of them.

And a couple of links... Here is a blog entry from psych central with some ideas for gifts that do not cost money.

And below is a satirical video I found on YouTube that made me laugh.

Friday, December 16, 2011

How to Confront Privilege

I attended a great presentation on "Transgender 101" on Wednesday of this week, and the experience has caused me to think about what it is to challenge privilege.

I was talking with a colleague a few weeks ago about this specific training, and I said, "I'm looking forward to it, like I always look forward to opportunities to challenge my privilege. I think of it like working out--it's painful for a minute, but when you're done, you're better for the experience." To which my colleague replied, "Yes Matt, but not everyone enjoys working out. Some people avoid it for that exact reason."

I see that there is some truth in what my colleague said. So, I started thinking that there are certain skill-sets that might be useful in a wide range of contexts in which one is expected to confront privilege, be an ally, or work for social justice. So I thought I'd offer a quick and dirty list here, which is designed not to be specific ways to be an ally (there are lots of resources for that) but rather a "how do deal with the feelings you might have when you look at privilege." First, a disclaimer: This list is probably not complete, and represents my thoughts at this moment. With that said, I present...

Five Skills Useful in Challenging Your Own Privilege.

1. It's not about you personally.

It's really not about you as a person. It's about systems of oppression, systems that probably have in place for a very long time. It's not your fault that you may have benefited from white privilege, or heterosexual privilege. Whatever is being said or confronted, it's not a judgement on your own skills or work ethic or education. Which leads me to...

2. There is a difference between "fault" and "responsibility."

The fact that we live in a society that privileges certain groups over others is no one's individual fault. However, it is everyone's individual responsibility. There is an important difference here: "Fault" implies that an individual caused something, either directly or indirectly. "Responsibility" means that an individual takes ownership of something. No one individual caused any kind of oppression (by definition, because oppression is systemic); every individual is responsible for challenging and correcting oppression.

3. Avoid shame, and recognize that guilt doesn't help anyone.

Here's the thing about shame: It can make us feel powerless, disconnected, worthless, and anxious. Those are exactly the opposite of what is useful in confronting privilege. Further, when we feel shame, our first instinct is often to cover up whatever we are feeling shamed about. This is also not helpful, as examining privilege means being willing to talk about that which is often hidden. So ultimately, getting stuck in shame means that the likelihood that something is going to change are poor. If you are feeling shame, ask why, and examine that carefully.

Further, guilt does not help. Feeling guilty is not enough, and I do not believe that guilt is a sufficient motivator for long-term commitment. If you are feeling guilty, it is probably going to be useful to cope with that guilt: Examine where it comes from, see if you can shift it.

4. Trust.

Maybe this should have been #1, but I'm putting it here because I like to address emotions first. Essentially, it is important to trust that what you're hearing is accurate. When someone calls attention to the fact that you have privilege, or that society is tipped to favor one group over another, trust them. This is not the time to find counterexamples or challenge them on their logic--just trust them.

Now, not everyone is trustworthy, to be sure. If you cannot trust, then find someone you can trust. If you cannot find someone you can trust, ask yourself why. Can it be that everyone else is wrong?

5. Listen first, then act. But listen first.

Really, really listen. Listen carefully. If it helps to think that you will be tested on the material later, then think that. If it helps to take notes, then do that. When someone is sharing their experiences, listen. Do not change the subject. Do not shift the conversation to being about you and your experiences. Do not justify, or attempt to fix whatever is happening. Just listen first.

Once the listening is over (hint: That's when the other person stops talking, not before), then it's time for action. You may have to ask what kinds of actions will be helpful. You may be given a list, or some suggestions. But remember that listening comes first.

Monday, December 12, 2011

Can you tell how sexual someone is by looking at them?

Three studies caught my eye this morning. First, the question I asked above: Can you tell how sexual someone is by looking at them? According to this study from 2008, trained sexologists can tell how orgasmic a woman is by watching her walk.

Additionally, According to Gordon Gallup, an evolutionary psychologist at the University of Albany, you can tell by more about someone's sexual history by their handshake. He links a firm handshake (in men) to a host of factors: longevity, bone density, fat mass, and sexual behavior. Men with firm handshakes have more sexual partners, and begin having sex earlier.

Finally, this study from 2009 suggests that there is a correlation between a man's lean muscle mass and his sexual history: Specifically, more muscular men have more partners and begin having sex earlier.

All three studies have their limitations and raise questions, and could be subject to all kinds of scrutiny. I have only one that I would like to raise--that correlation is not the same as causation. In other words, while these studies look at the correlation between certain seemingly unrelated factors (1) and sexual behavior, there is nothing beyond speculation that accounts for this correlation. Evolutionary psychologists are likely to argue that anything that increases mating behavior is likely to be beneficial for an individual's chance at passing genes on, and thus the connection is in some way related to biological attraction. (One of the articles goes so far as to suggest just this--that the factor studied shows that the individual is more likely to be robust and to produce healthy offspring.) However, it could also be that definitions of masculinity and femininity in our culture account for these distinctions, as well. It could also be that our culture has evolved to value some traits over others, and the difference is related to natural selection, but cultural natural selection and not biological natural selection.

1) I say "seemingly unrelated," but I posted the article about men with more muscle mass having more sex to my Facebook, and my friends commentary could be summed up as, "Well, duh." Apparently, that connection is not seemingly unrelated.

Wednesday, December 7, 2011

Performance-based Masculinity

I came across this site today for "AlphaNail," a brand of nail polish marketed at men, and it made me think about masculinity-as-performance, masculinity-as-commodity, and the intersection of the two.

I've noticed an increase in the marketing of masculinity as a way of selling products to men. (Maybe I've noticed this because I am a white cisgender adult man, and therefore the target of much of this advertising.) A quick Google search confirms that bloggers and other commentators have noticed the same thing: Masculinity linked to consumption. Masculinity as a commodity that can be purchased.

(Interestingly, I want to note that I did a search for "Masculinity as Performance" and the Google Ads that came up were for PDE-5 inhibitors, like Viagra. Interesting and unintentional commentary, to be sure.)

I suspect that this is not a new thing. But I'm wondering what the effect of masculinity-as-consumerism is on individual conceptions of gender? Where do we get our ideas of what it is to be masculine? Certainly, advertisers are willing to sell us candles, irons, pop, anti-aging cream and other products to help us define our masculinity. But are we willing to allow part of our gender identifications to be crafted and shaped by advertising? And more--what if we do not fit into the traditional view of masculinity?

I spend a fair amount of time in my office talking to men about what it means to be a man, what it means to be masculine. Frequently, the identifying features are virtues like strength, flexibility, endurance, loyalty, devotion, protection, and so on. These are virtues that people generally want to have more of in their lives. (And I'm well aware that things like "loyalty" are not in any way the property of any one gender, but that's another article.) Lest the reader think I am portraying an overly-rosy picture of traditional masculinity, remember that these conversations are happening in a therapy, and so we do look at some of the less healthy attributes of masculinity: emotional numbness, rigidity, alcoholism, violence. For the sake of the individual's physical and mental health, we try to identify where these messages came from, and look at which values and attributes the person would like to commit to and which ones the person would like to let go.

And there's my concern with all of this, I suppose: It's hard enough to identify with masculinity in the context of a history that's equated masculinity with violence, patriarchy, and so on. It gets even harder when an advertiser is trying to sell something by playing to someone's perceived notions of manhood. For example, on this page on the "AlphaNail" website, to the right, is a picture which could have the subtitle, "It's OK to wear nail polish as long as you punch someone in the face." Is this how we want masculinity to be defined?