Work in a hospital or a community health agency of any kind and you’re likely to hear the term ‘evidence-based’ at some point, fairly early actually. Also, as a consumer of services you’re l…
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The War of Evidence-Based Psychotherapy
Work in a hospital or a community health agency of any kind and you’re likely to hear the term ‘evidence-based’ at some point, fairly early actually. Also, as a consumer of services you’re likely to have heard this term applied to clinical practices of various kinds, medical and not. In the field of mental health, this term, borrowed from medical science, has largely served as the cudgel of Cognitive Behavioral Therapy (CBT) advocates eager to promote their methods and mostly derivative theories to practitioners and third party payers (i.e: insurance companies). Since the late eighties, the ‘evidence-based’ tag has been used to assert or at least imply the superiority of cognitive behavioral therapy over traditional, insight-oriented or psychodynamic approaches to mental health. The strategy has been so successful that when people speak of ‘talk therapy’, the assumption (contrary to that of, say, two generations ago) is that a psycho-educational or cognitive-behavioral approach is being referenced.
The scope of this article cannot detail all of the differences between the apparently warring factions, though I will point in what I think is the right direction. First of all, a negative suggestion: ignore Psychology Today. It dilutes issues, in my opinion, versus opening the reader’s mind. It does advertise my practice capably enough, however, so that’s all I’ll say about PT for now. Second: besides combing through the one hundred and twenty plus unheralded yet worthy blog entries on this site, readers might seek out the writings of one Jonathan Shedler, psychology professor at The University of Colorado and perhaps the foremost crusader of the last decade for the restoration of the psychodynamic therapy’s public and professional image. For at least that long Shedler has been an outspoken critic not only of CBT, but of its advocates’ tactics in marketing their method to providers, third party payers, and consumers. In Working Through Rehab, my 2013 excoriation of adolescent drug treatment, I cite Shedler’s 2010 American Psychologist article, “The Efficacy of Psychodynamic Psychotherapy”, which outlines the essential features of a psychodynamic (BTW: an umbrella term for psychoanalytically-derived models) treatment, and offers comprehensive evidence for its efficacy, contrary to the dismissive claims of CBT supporters. In his latest paper, “Where is the Evidence for Evidence-based treatment”, Shedler ups the ante with scathing condemnations of research practices of CBT advocates, more or less mocking their claims. The result makes for some entertaining reading, which I shall review here.
Tracing the history of the evidence-based (movement?), Shedler calls out the National Institute of Mental Health (NIMH) as the biggest culprit of ‘evidence-based’ misinformation, starting in the late eighties. Citing research that began a decade earlier than that, he points out that studies pertaining to treatment of anxiety and depression (the two most prominent conditions presenting in MH), indicate only minor differences between experimental CBT-treated samples and control groups on outcomes measured by the Hamilton depression scale; differences that carry statistical meaning (as in not the result of chance) but, as Shedler explains, lack significance in clinical terms, as in discernible contrasts in symptoms, presenting problems. Examining a recent study by Driessen et al. (2013), Shedler derides a method wherein 341 patients were subject to 16 sessions of manualized CBT. Though the method was proclaimed as effective, Shedler points out that only 22% indicated remission of symptoms, based upon assessments taken the day treatment ended. Shedler then points to studies suggesting that even such improvements evaporate after a short period of time and that 50% of CBT recipients seek treatment again after 6 months. And these findings beg other questions: what happened to the other 50% of patients? Did they improve significantly? Did they not improve and then give up on psychotherapy?
Moving on, Shedler generalizes his observations: the average patient receiving manualized CBT is still significantly depressed after a time-limited treatment episode; that benefits assessed after laughingly short intervals after treatment typically evaporate quickly; that most ‘evidence-based’ studies are ‘shams’, suppressing evidence that doesn’t fit preconceived agendas, publication biases extolling what he calls a “master narrative”; that criteria for patients’ participation in studies excludes those who present with more than one diagnosis, or those with personality pathology, to which (I think) most therapists would respond: wait…those are the people we see. Furthermore, Shedler complains that the so-called control groups don’t accurately represent alternative models of treatment; that while prominent or even celebrity practitioners administer the CBT treatment that is studied, psychodynamic methods are carried out by graduate students given minimal training, rendering a comparison of technique unfair. Finally, there exists in research circles what Shedler calls the ‘File drawer’ effect: the phenomenon of studies, or data within studies being suppressed, as in not published, and thereafter shelved (side note: like my Tommy article between 2012 and 2014). The missing data can be inferred from what is called a funnel effect of data, wherein small samples yield a wide range of values, versus large samples which yield a narrower range. The data is then plotted on a graph which resembles a funnel. Shedler demonstrates that gaps appear on such graphs pertaining to manualized CBT research, indicating ‘invisible’ data.
Incidentally, the term ‘manualized’ used and mocked by Shedler merits some comment, as does the rest of Shedler’s arguments, of course, though I’ll shelve most of my comments until part two of this essay, likely a week hence. Anyway, Shedler’s reference to ‘manualized’ treatment is a snide rebuke of therapies that appear to make use of workbooks, often co-written by practitioners and academics. I admit that I have a few of these manuals adorning my bookshelves, though I rarely use them. They contain examples of questions posed to patients about their conditions, designed to challenge problematic thinking; suggestions for a ‘reframing’ of a problem, or examples of homework assignments given—CBT chestnuts, I guess. The comedy in Shedler’s writing—his dismissal of ‘cookbook’ technique—verges on the nasty, but what’s significant is the background context: psychodynamic or psychoanalytic therapies/methods have been taking it on the chin for some time now; dismissed as “that Freud stuff” by pedestrian instructors, psychiatrists, peddlers of psychotropic medication, or ignoramuses positioned at various nodal points in the industry; people who pull the purse strings, or who have those peoples’ collective ear(s), who have been willing to stereotype, quite ruthlessly, the forefathers of our profession. Jonathan Shedler is one of the people at last bothering to fight back. So It’s 2016 and everyone and thing has its advocates. Including the unconscious, it seems.
- I shall refrain from a list of references for this article, though each can be found via Shedler’s 2015 article, “Where is the Evidence for Evidence-Based Therapy”, available online
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The Elevator
The spider that slid out of the trashbag that was inappropriately stashed in the elevator was just shy of an inch long. Small and underprivileged as it was, it would still have struck terror into Sophie, an insurance agent, had she seen it. Luckily, her eyes were locked onto the ceiling, regarding what looked like a cigarette lighter caught behind a shield beside a light fixture, fossilized and forgotten. The five by five foot space was a tight squeeze for the current occupants: the unwelcome, abandoned trashbag; an attentive terrier, hitherto yapping in a hot car in the parking lot, now accompanied by a ten year old boy named Jason. Plus Sophie. The arachnid raced across the worn carpet base only to halt inches before the dog’s lowering nose. Unperturbed, the animal emitted a slight grunt but then withdrew, uninterested. Who knows what animals make of life that moves with unnecessary numbers of limbs, without apparent purpose other than existence? Science knows what kind of instinct or rather reflex will have stilled the tinier creature, motivating its sudden simulation of death.
Jason asked the woman if she’d press the button for the second floor. Though it was a short, benign request, he spoke nervously, as Sophie resembled his Aunt Julie, a severe woman who used to babysit him until he finally spoke up to his parents about her tendency to hit. Jason didn’t think the tall woman by his side would hit necessarily, but she seemed familiarly tense, and might have said something plaintive about his bringing a dog into the building, which would have been bad enough. The time it took for the door to close seemed protracted causing an awkward, silent stalemate, and in Jason’s mind, a complaint about machinery that doesn’t work properly. Someone ought to check its parts, do a thorough maintenance job. Someone ought to do something, Jason thought. When the doors opened for the second floor, he exited hastily, perhaps rudely, while the terrier shuffled beneath his feet, casting another nonplussed glance at the spider. Picking up the dog, the boy rushed across a waiting area to an office where his mother waited, eager to show her fellow realtors the new family pet.
Replacing Jason was a bulky man wearing a post office uniform, who reached in front of Sophie to press a button rather than ask her to do it. It was his rudeness that caught her attention, not that of the boy. The man’s vast armpit opened up like a beast’s mouth preparing to bite—the emanating odor more than doubling the offense of the trashbag that still sat on the other side. The man shook his head, observing the clutter that forced closeness. What followed was a guttural witticism, smothered in heavy breath: something terse, fragmented and nasty about lazy Janitors, people below post office workers in the food chain, he evinced. Sophie returned a look that was not quite a thin smile, more a twitch of lips, followed by a look away, back to that cigarette lighter up above. She changed her mind, looked away from that, thinking the man might follow her gaze, notice the lighter and attempt chatter about that as well. This situation was a quintessential fear for Sophie, and for many women, she considered: being caught alone, in an elevator, with a man who might be dangerous; especially one who was sizeable and seemed gruff and impolite. The halting movement of the elevator was uncomfortable, but at least there wasn’t long to go. At 1600 Sadler Street there were only four floors. Sophie had just one left to go before meeting with her therapist on the top floor. Soon she’d be talking about men, anxiety, tight spaces, spiders, and failed attempts to quit smoking, among other things.
Therapist Daniel Pierce left his fourth floor office early afternoon, hungry for a late lunch on an hour’s break. In the hallway, he passed Bob, a postal worker with whom he shares a manly nod on a daily basis. He and Bob aren’t on a first name basis, just observant of each other’s insignia: Bob’s nametag, the sign on Daniel’s office. By the waiting area Daniel pressed the button that summons the elevator. He hoped its clunky, cumbersome movements would prove quicker than usual, as Bob is surprisingly swift in his circuit of deliveries, and if the elevator didn’t arrive soon, he’d be sharing a ride with the malodorous mailman. Behind him was a familiar sight: a grim-visaged woman, alone in the waiting area, looking flattened, too self-absorbed to read the fluff array of magazines or even notice others. The elevator door opened. Daniel stepped in and hurriedly pressed for the lobby, but Bob made it in time, crossing the threshold just before the doors closed. With a second nod, he acknowledged Daniel but also cast a glance in the direction of Sophie. He faced the counselor as the elevator went down, muttering ugliness: “uptight bitch” was the term Daniel was meant to co-sign with a knowing chuckle, perhaps an exchange of misogynistic platitudes.
It occurred to him—no, it reminded him—that if he doesn’t collude with such beliefs, he risks a dreaded reprisal. Daniel had always been wary of men like Bob; had often worried since he was a kid, and especially since that one time years ago on a commuter train when a thug accosted a female passenger and Daniel was the only other male around, that he’d feel compelled to do something, risk his own health and safety, in the service of either disapproval or actual, as in physical intervention, which wasn’t and isn’t his thing. The smell of Bob—that acrid reek of sweat from walking in the sun—wasn’t the problem. Nor was it the class divide. As the doors opened on the bottom floor, Bob stepped out first, gave Daniel a curt farewell, perhaps registering the counselor’s haughty rejection of him. Daniel moved away with a sigh, noticing a mild jump in his heart rate. It doesn’t take long to feel the specter of violence, he thought, whether it’s real or not. At the brink of the lobby doors he stopped and pulled back suddenly. Cursing and not understanding why he lifted his foot, revealing that which he’d glimpsed an instant before his last step. The spider was crushed.
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1600 Sadler Street
The office building of 1600 Sadler Street in Worcester Massachussetts is four stories high, making it one of the tallest in town, save for the new Mobile T building that went up four blocks away nearly a year ago. Perched on a slight hill, it has an advantage on three similarly sized department stores across the way, which were recently rebuilt upon plots scraped from the earth. On a wraparound balcony outside his office, Daniel Pierce stands overlooking the teeming traffic of late afternoon. His five o’clock appointment has texted him, saying she’s running ten minutes late, which is typical because of the rush hour, though usually Shirley’s lateness is closer to five minutes than ten. When he first signed a lease, Daniel thought he’d enjoy times like this: late afternoon reveries, peering down over the city, feeling comfortably detached and taking in the view while collecting thoughts ahead of a session. In November, an orange tint blends with brown hues on the red maples that line Sadler Street. From above there seems more vegetation than what’s apparent at ground level. The tree-line even seems uniformly cut, as if there were above it a secret layer of atmosphere created especially for the birds. This rarified space costs more for the humans that occupy it so it’s a good thing Shirley’s fee is on its way, whether she’s late or not.
The hard, damp chill sends Daniel inside, thinking of the time his office mate first walked him around, boasting of the balcony area and the view, the then modest rents. Better in the spring and summer, Daniel thinks after just a few minutes outside. He figures he’ll head downstairs, check in with the janitor, as in remind him that some are still around, working. The guy will be making his end-of-day rounds, storing hefty bags of trash in the elevator as he goes from one office to the next, reeking of New Bedford waste. Daniel hates it when he does this, though he doesn’t say anything. It doesn’t look good to Daniel’s clients, this time-saving habit. What must it say to them to have bags of garbage accompanying their ride to the top floor where the therapists tend to have evening appointments? The janitor’s routine seems to privilege the loud and garrulous realtors on the bottom floor, the insurance company hacks on the second. They’re all typically gone by late afternoon, Daniel notices. For their benefit the dirty work and security is done after hours, or close to it. By the front door, the stocky, lumpen keeper of the building is locking up, only to see Daniel stepping out of the elevator, already sporting a wan, diffident smile.
“Oh, right. You’re here tonight, huh?” the man says, sounding vaguely disappointed.
“Thanks,” Daniel replies, indicating the door, which he needs left unlocked, and then, fleetingly, the garbage bag. He moves subtly to the side, as if beckoning the bag to step outside. No, after you, is what it looks like.
“Sorry,” the man says, taking the hint. Mission accomplished, thinks Daniel. Meaning, he didn’t have to say anything. After a gratuitous trip to his car, he heads back upstairs, there to pass his neighbor in the hallway. Charles Mandalay is a construction consultant from Cambridge originally. He has models of his projects all over his office, as evidence of his good work and career path. He’s arrived at the top floor of 1600 Sadler Street as its oldest occupant and has the best suite in the building, on the east side, facing downtown. Sometimes on a Friday he invites others from his floor to stop by for a quiet party, a few cheese and crackers washed down with a choice of red or white wine. Daniel sometimes partakes of one glass maybe, even if he has an appointment or two left to go, because Charles offers a mint to go with the libations. His think-of-everything generosity and hearty spirit seems easy and authentic, if weary and sad. Charles has the look of a man whom others have left behind with all of his goods and memories. To newcomers who fret over rising rents, he schools about the resilience of the landlord, the indelibility of 1600 Sadler Street, and as he orates he stares out his window admiringly.
“The building’s paid for,” he proclaims, suggesting all should relax. They can’t, including Daniel. From that top floor balcony, they see a city closing in, becoming more crowded, making it difficult to get places, arrive for appointments, of whatever kind they are. The building’s old, someone notices. It has the feel of a place that will be torn down soon, replaced by a clothing store, maybe a condo unit or apartment complex. Daniel comments on the elevator: not so much about garbage left inside, but rather the age of the apparatus. Looking closely, one of his clients recently observed that its permit had expired a year or two earlier, which explained its sometimes staccato movement from one floor to the next. Since then Daniel has preferred the stairs at the back. When he isn’t inspecting the elevator for trash, he’s exercising his limbs, getting a workout on the concrete steps that lead to a heavy door, whose warped sound upon opening heralds hasty arrivals.
For the latecomers, especially the younger ones who are spry in the limb department, the jog to the fourth floor is quicker than the elevator ride. Breathless, they sometimes stride in, crossing the threshold to the therapeutic sanctum, meeting Daniel at his door. He stands like a porter, waving them inside. Some take a moment to orient themselves, to gaze outside at that wraparound balcony, at the view outside, the red maples just about visible from their vantage points. Others flop on Daniel’s couch, relieved to have made it in. The sessions are typically fifty minutes long, sometimes a few minutes longer, in defiance of the managed care rules. Those who stick around beyond the evidence-based allocation, who are there for the long haul to do good, in-depth work, often sigh and comment on the security, the time-out from life. This is their safe place, they say. They don’t want anything to change.
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Listening To You
So I conclude this four-part introduction to my paper on Tommy with a reference to its finale: a pop hymnal that Rolling Stone author Dave Marsh once described as “a moving passage expressing that all power emanates from the mob”. For new listeners, “Listening To You”, a refrain attached to the song, “See me, feel me”, might sound a little like the “Let the Sunshine in” passage from Hair, which ran contemporaneously on Broadway in 1969. The sentiments of these songs are indeed similar: an uplifting message of hope for the future, set against the backdrop of a circular musical theme.
The layered meaning of “Listening To You” is addressed in the second half of my paper, which traces the drama of Tommy, proceeding from the opening crisis (the murder of Tommy’s mother’s lover), which his parents cover up, which half-intentionally generates the deaf, dumb, and blind condition which in turn is a manifestation of Tommy’s dissociative withdrawal/silent protest against all that is dishonest. Living his life, Tommy finds a talent, pinball, and becomes a champion of the game and a kind of rock star. Later, as was de rigeur in 1969, he becomes something more than an exponent of light entertainment, something closer to a spiritual leader, inspiring youth in particular. In the midst of this, he is “cured” of his solipsistic withdrawal, transforming from a figure of eloquent silence to one that is socially engaged, if rather didactic in his promotion of “awareness”.
This latter development, to which I had listened casually for years prior to writing my paper, led me to consider other aspects of Tommy’s psychology beyond the effects of early childhood trauma while retaining consideration of that early history. In the service of this task, I turned to the writings of James Masterson and Harry Guntrip, two figures from the psychoanalytic family tree who, like John Bowlby, were writing about things like attachment and loss, schizoid withdrawal, and/or schematics of intrapsychic structure around the same time that Tommy was being made. Drawing upon Masterson’s model of intrapsychic structure of self disorders, I played with the idea that Tommy Walker emerges as an adult displaying the features of Narcissism and Schizoid personality disorder (the combo presentation is more precisely delineated by Guntrip).
To explain, Masterson’s model is one of so-called object relations units, featuring representations of self and other, which constitute an individual’s false self (a kind of strategic way of being in the world, consisting of an aggregate of experience). According to Masterson, a person’s representations of self and other are nuanced depending upon the nature of their disorder: Borderline, Narcissistic, and Schizoid are the three main personality types his model outlines. Tommy’s Narcissism is exhibited in several ways: initially, his preoccupation with his image in mirrors seems the most obvious indicator; he is lost in himself. Later, he seems grandiose in his emergence as a star, in his upbraiding of followers, and in his general sense of himself as a “sensation”. Like a tragic hero, he seems destined for a fall. It happens in the penultimate song, “We’re Not Gonna Take It” in which disillusioned (kids?) rebel against the restrictions of the rather farcical “holiday camp” and revolt against Tommy’s leadership. The lyrics bring to mind the kind of scenes that might have happened had fans of Woodstock not tolerated sitting in down-pouring rain, suffering lack of food, overcrowding and poor hygiene conditions for days upon end. Meanwhile, Tommy seems like an aloof figure: essentially withdrawn, somewhat paranoid and alienated, still fearful of being appropriated for others’ needs. His lingering schizoid dilemma is that of seeking attachment while protecting himself from harm, real or imagined.
The hopeful conclusion suggests a resolution of such conflicts, a transcendence of false self strategies such that Tommy and his followers can listen more intently to both outside and internal voices, integrating complex experiences of self and other instead of merely reacting against fate. More plainly, the finale promises that artists and their listeners can learn to move on from trauma, grow up, and deal with life’s triumphs and travails. If that all sounds rather trite or precious, then it may be, but at least it’s more positive or mature than “hope I die before I get old”. Then again, the opera’s libretto (if I may use that term) suggests more or less the same as what “My Generation” did four years prior to Tommy: that The Who would bond with its audience (the mods of the mid-sixties), and reflect their values, dreams, including the nihilism; their love and their hate. So Tommy ends with a refrain that you can sing in the shower, sing from behind the wheel of your car; sing by yourself or sing amongst a crowd. Take your pick, but while you sing, listen:
Listening to you, I get the music
Gazing at you, I get the heat
Following you, I climb a mountain
I get excitement at your feet
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You Didn’t Hear It, You Didn’t See It
“1921” begins as a sentimental ballad, one of the few in The Who’s catalogue. The line, “I had no reason to be over-optimistic, but somehow when you smile I can brave bad weather”, is one of my favorites. Then, without reference to anything specific, the song turns: “What about the boy! What about the boy, he saw it all!”. Now, if Pete and the boys had plans to enact whatever “it” was, they didn’t let on. Actually, The Who toured with Tommy for at least two years without giving the slightest effort to elucidate the plot, at least not on stage. So it seems symbolic, this thing that Tommy Walker witnessed and shouldn’t have. Anyway, it’s more about the reaction than the event. In the next song, “Amazing Journey”, the opera introduces the famous deaf, dumb, and blind boy motif, which is the implied result of the trauma indicated but not specified in “1921”.
This incident, understood to be the murder Tommy’s mother’s lover by Tommy’s father (or the reverse for those who may have watched the film first), leads to the presumed psychosomatic reaction, manifest as Tommy’s disability. In my paper (reminder: due to be published in The Journal of Culture and Psychology next month), I don’t dispute this popular interpretation, but rather color the event in psychoanalytic theory, and open the matter of Tommy Walker’s early developmental history to further discussion. In covering the possibilities, I employ the theories of Melanie Klein, John Bowlby, plus the observations of researchers Jude Cassidy, and Besel Van der Kolk. Fancifully, I compare Tommy to Hamlet in so far as both protagonists suffer trauma that is as much about secrecy and lies as it is about violent horror. In the refrain of “1921”, Tommy’s parents, anxious that their son has witnessed their crime, exhort him, “You didn’t hear it, you didn’t see, you won’t say nothing to no one ever in your life”, and so on. Like many trauma victims, Tommy absorbs the message but extends the parameters of the injunction. He develops pervasive habits of dissociation, acting out, avoidance.
Then again, it’s possible that the crisis of “1921” is culmination of an already insecure attachment, perhaps established during Tommy’s infancy. Bowlby would at least argue that such a predisposition is attributable to external events: the back-drop of World War, the likely depression of Tommy’s mother in the aftermath of her husband’s earlier disappearance. Bowlby’s followers would assume that Tommy is afflicted with the consequences of maternal unavailability. Attachment researchers might speculate that his symptoms constitute avoidant, ambivalent, or most likely, disorganized attachment. Kleinians, meanwhile, might suggest that Tommy’s deaf, dumb and blind condition is an attack upon bad objects, and at least imply that such aggression, experienced within the murky back and forth of intrapsychic projections and introjections, had been within him since birth.
Cassidy’s paper, “Truth, Lies, and Intimacy”, is the centerpiece of an argument that Tommy suffers not so much from witnessing a murder, but from the distorted narrative that surrounds this horror. She and others, including Bowlby, suggest that distorted narratives lead to a profound confusion which prevents individuals from storing memories properly, hence flashbacks, nightmares, and other disturbances linked to complex PTSD. Of these, none are clearly indicated by Tommy’s affliction. Beyond defiant, he is like the early Who, lost in his own world and marching to the beat of a different drummer (BTW: rock has never known a more different drummer than Keith Moon), and his residues are behavioral, while his internal world is opaque. More than harmed, he is broken, alienated from society, even reality, and it’s hard finding a way back. This idea is axiomatic for many artists, psychologists, and historians, who reflect on this phenomenon, knowing it personally, but extrapolating, imagining collective obsessions around unresolved pieces of historical narrative: the assassination of JFK, the subjugation of Native Americans; conspiracy theories relating to area 51, even 9-11.
Now, had the narrative of Tommy lingered on things like flashbacks, nightmares, or broken alienation, the opera might have ground to a halt, become a drag, as the contemporaneous hippies might have thought. So credit Townsend for staying in the context of light entertainment, making it fun, giving Tommy a talent–pinball–for him to play with (his therapy), instead of wallowing in self-pity and gazing at himself in mirrors. How very rock and roll, I say. Then, when he’s either bored or emptied by games, he grows up a little, notices that his fans relate to him, and decides to broaden his message, speak out. He becomes a spiritual guru. How very late sixties, I say. So, rock stars mature. The paranoid-schizoid becomes a depressive, and it’s all fun and games until–well, someone gets hurt–and then something must be done, though what that something is…is unclear and problematic. After all, the play’s the thing.
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Your mind must learn to roam
A line from “Acid Queen”, one of the lesser famous yet wonderful songs from Tommy, The Who’s iconic 1969 rock opera, and the subject of my forthcoming article in the March issue of The Journal of Culture and Psychology. I reference the song “Acid Queen” in my paper, in a section that tracks the opera’s plot-line, thin that it is, plus its themes. The Acid Queen is a seductress, representing sex, drugs and rock and roll, that triumvirate of original rock and roll sin that, like the devil that once seduced blues musicians (the 20s and 30s blues myth), will tear the soul apart. In “Acid Queen”, a narrator ambiguously instructs that Tommy, or the listener, must “gather your wits and hold on fast”, for growing up, with or without rock and roll, is not easy. Straightforward narrative is not one of Tommy‘s strong points, yet a narrative replete with such ideas is what Pete Townshend wanted to give his music, and rock music in general.
In the 1960s, rock had an emerging narrative, albeit one that was mostly implied, and rarely made explicit. Previously, movies and books with a rock and roll ethos existed, but the most in-depth pop artifacts of the period (Catcher in the Rye, or On The Road) seem more like older cousins of the fledgling ‘rock’ sensibility. The groundwork for a different spirit lay in the context of the era: a relatively prosperous space following world war wherein youth had newfound access to disposable income, plus an evolving electronic media that would galvanize voices against the next war on the docket. I think those post-war kids demanded an art form to truly call their own, and rock and roll, more so than pop, jazz, or even blues, was it. In the 50s, rock and roll’s earliest fans, its infants, seemed to have modest needs, basic social needs: to go out and dance, and thumb its nose at adult squares; to have sexual freedom, and flex muscles. Social conscience, an awareness of life beyond borders of various kinds, of political or spiritual purpose: rock’s adolescent period, the now so-called classic rock period, developed a more mature (if still imperfect) outlook.
The Who weren’t the first, or even the most successful artists to push the limits of the form, or inspire society. Clearly, The Beatles, Bob Dylan, The Rolling Stones, and arguably several others were more impactful at the time. Also, The Who were unlikely heroes from the outset of their career: beyond rebellious, they were noisy, nihilistic, and sort of remote from the sexy, peace-loving milieu of the sixties. Boasting “I hope I die before I get old” in “My Generation”, they seemed the antithesis of mature in 1965. If you want proof of this, look no further than footage of their performance at the flower power-inaugurating Monterey Pop Festival of 1967. Observe the ferocity of their act, the extra layer of violence within their notorious instrument-smashing finale. The Who weren’t just breaking through to an American audience that night. They were staking out a position that ran against the grain.
Yet they were raised to fame alongside the aspirations, lies and traumas of the period, and despite the immaturity, the ugliness on the surface, they were as idealistic as any of their peers. Their violence, as oblique as an intelligent audience intuited it to be, was contained within their art and was therefore no more anti-social than a war movie or a western, but no less revolutionary than long hair or a picture of a Campbell’s soup can. Their loudness was an insistence upon being heard, at once petulant and logical; detonating of harmony yet music to the ears. Their legendary squabbles, conflicts of personality, were a microcosm of democratic values, rock and roll style. After a few years of roaming thus, on the road, from stage to stage (The Who were the first British Invasion band to build a following through incessant touring) they arrived at the decade’s climax, stealing the show at Woodstock, and delivering for an unsuspecting (even) larger audience a character–a mythic character–that was uniquely a product of the rock and roll experience.
Tommy Walker is a child of war: his caregivers are stolid and traumatized, and he is disoriented by their emotional absence. Acting out occurs, a crisis happens, and a secondary trauma concretizes insecure attachment, and begins the drama. Thereafter, Tommy goes inward, retreats from this older generation. Disillusioned (or some primitive version of that), he finds his own music within himself (a “vibration” that brings the raucous music of The Who to mind); he plays unusual games, discovers pinball, and becomes a bizarre celebrity through his talent–a rock star of sorts. He finds his voice, literally and symbolically, and seeks to redress social wrongs through spiritual awareness. And his celebrity, ultimately, is a different kind of hero. Not only talented, he is a unique voice, a social leader, reflecting the expectations of a new audience: that he be thoughtful; that he represent the values of youth, and be engaged with the world. Above all, that he be honest.
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Ever since I was a young boy
(opening line of “Pinball Wizard”)
Well, relative young boy. More like since I was a late teen or even an early twenty-something. That’s how long I’ve wanted to have an article, essay, story or something published in a bona fide professional or academic journal, about anything, but especially about the following subject. It’s happening finally, so it’s time to explain what it is; what it means to me, and what it might mean to others. See, it’s an everything and nothing thing, this paper I’ve written: a big deal and not.
The paper has an impossible title: “A Question of Pathology: object relations, attachment patterns, and a disorder of self within the rock opera TOMMY”. I can imagine eyelids weighing heavily over the first several words, that dense, psychoanalytic jargon. Only the last three words spark interest, jolting the pop consciousness. Not for everyone, I guess. For those of a younger generation, The Who’s iconic double album of 1969 may be little more than a crusty artifact of classic rock, one whose moment and meaning has long since past. Wasn’t the main guy in The Who busted for child porn some years ago? some might query. Others might know snatches of their songs: “Baba O’Riley”, “Won’t Get Fooled Again”, “Who Are You”, and “Eminence Front” will all be familiar to CSI fans, viewers of car commercials, or whatever the products were that my favorite band sold out to. Though their days are surely numbered, The Who continue to tour like cabaret acts of previous eras, even as their two surviving members, Roger Daltrey and Pete Townsend, glide past the age of seventy. They grind out the hits and the show goes on, seeming more professional than ever, actually. But their relevance to the world around them seems–if not diminished–then perhaps just less clear as time moves on.
That wasn’t the case back in the 80s when I first heard their music, or saw the odd video of theirs on MTV. I didn’t listen to them much at first, but knew of them, was aware they were deemed cool by peers who seemed to speak about music with authority. My family alluded to The Who, but were not fans. “Just noise” my sister opined on occasion, though she seems more respectful today, in deference to me I think. “Didn’t they smash their instruments?” my mother would incuriously ask, just hoping to join in the conversation somehow. In my household, lighthearted pop dominated: jazzy sounds of Sinatra, Streisand, or the rockabilly of Elvis stirred my father’s blood; the loving, cheerful beat music of The Beatles or The Bay City Rollers were my sister’s favorites; maybe a wistful Simon & Garfunkel ballad made it into the mix. Don’t get me wrong, I liked all that stuff, but it didn’t move me as The Who later did. Until I was a later teen, music didn’t speak to who I was, or who I wanted to be. Thirty years later it’s still hard to explain who I wanted to be, or how bands like The Who helped. All I can say is that rock and roll seemed more than commonly important back then. Its leading lights had much more than talent, or “class”, as the generation above me uses that term. Instead, there was something else, something more desperate. The giants of the classic rock era had brains and guts, and they played their music like music itself was about to die.
It was easy to get in arguments with friends (Ultimately, I wouldn’t bother with family) about whose favorite artist had the best chops, or the smartest lyrics; about which band was the only one that really mattered. My band was The Who, and for about ten years in my late teens and into my twenties, I was more devoted to them than I was to any girlfriend; more knowledgeable about their story and catalogue than I was of any author’s oeuvre, or any psychological theorist’s body of work. Had I been a thug, I might have defended them against critics like a hard-core gang member. Had they toured regularly during this period I might have followed them like Grateful Dead fans followed their heroes. I was down for The Who, and if I’d had the opportunity, the right context, and the confidence, I would have written about them also.
And so, to the paper. It started around 2006, when I was taking part in a study group with the West Coast Masterson Institute, led by my friend Joe Farley. In illustrating some point long since forgotten, Joe made some comment about modern musicals, narratives and psychopathology, and might have mentioned Tommy–I don’t recall the specifics. Anyway, we talked further, and Joe suggested I write up my then idea, which was to give the The Who’s deaf, dumb and blind boy a diagnosis or two. It was a fanciful suggestion, but little did Joe know how serious I was. Sometime later I presented him with a 3000 word essay that he thought worthy of passing on to Dr. Masterson, then still active and living in New York. Well, Dr. Masterson (who vaguely recalled meeting me once) read the paper, liked it apparently, but said it was too long for the institute’s then newsletter. Instead, he suggested I hawk it to academic journals, which I’ve been doing ever since.
Now, if you’ve ever submitted a manuscript to an academic journal, you are likely familiar with the lengthy delays, re-writes, and rejections that often follow. Between 2007 and 2012 I submitted my paper to about a half a dozen different journals: one Bay Area-based, the rest national, and in two cases, internationally-based. This might not seem like an ambitious spreading of the net, but let me explain something: When you submit to an academic journal, editors request that you not submit concurrently to other journals, as they are committing themselves to a rigorous review of submitted work and wish to have assurances that they are not wasting their time lest an author’s head be turned by another. Fair enough, but the commitment meant that I’d spend close to a year with each journal consecutively, four out of six of which expressed significant interest, requests for re-writes, before ultimately rejecting my work following a staff voting process.
By 2012, I was jaded with the sporadic task, forgetful of my original purpose, and ready to mothball my paper to the shelf, there to sit amongst my self-published, occasionally lauded but nonetheless un-celebrated collection of novels. Then in 2014, two things happened. First, The Who announced its 50th anniversary tour–likely its last. Secondly, I read an article in another journal, a psychoanalytic review of Henry James’ Portrait Of A Lady, that was similar in structure and style to my paper. Now, the journal in question had already rejected my work, but as I glanced at my 2007 list of prospects, I saw that there was one journal I’d yet to solicit: The Journal of Culture and Psychology. What did I have to lose except a bit more hope and narcissistic fuel? I thought, and thus I submitted my journeyman paper once again.
A familiar pattern ensued, save for one aspect: in the spring of last year, the journal contacted me, saying they were enthusiastically interested, but requesting changes. Sigh. Here we go again, I thought. Still, I soldiered through, reminding myself that this was, after all, a labor of love and there are much worse ways to spend my time than writing about my favorite rock band’s most famous work. Anyway, I made the changes, working hard on the paper over a space of a month, and resubmitted. I went about my life as patiently as ever until September when I received an e-mail suggesting I had just a week to meet the journal’s deadline for re-submission. Huh? I e-mailed a polite WTF to the editor, and within three days received an embarrassed admission that my re-submitted manuscript had been misplaced–lost in their system. I laughed sardonically, thinking this thing was just not meant to be. But once again I re-submitted, this time thinking what’s another six months or so in the life of an itinerant piece of literature. By this time, the lifetime of the project was a fifth of the length of The Who’s career. An apt parallel was happening, I mused.
The journal moved swiftly thereafter, however, and in early October I was told the paper was accepted. Hooray. Three months later, its modicum of copyediting completed, I was informed of a March 2016 publication. So that’s the backstory. My commentary on the paper itself is still to come.
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Somewhere in the notes
Somewhere in a pile of notes I found the sheets that I’d used last year for the presentation in Marin. There were several problems, and that wasn’t counting the main problem from last year: I’d taken too many sheets, overestimated, as is my habit, the size of my class. This year I’d get that part right, by taking fewer copies. But looking over a page, it occurred to me that I might not take any. First of all, the print was too bulbous and thus barely legible, the result of having been copied too many times. And the reason for that? The sheets were old, outdated. See, the top half was all about the DSM-IV.
As I groaned, I logged onto a DSM V site on my laptop, not having my expensive, thick volume with me. That’s one of those false norms, I thought, referring to the habit of placing books of presumed importance on the shelves of my office. Truth is I hardly do any reading there. My office is where I talk and listen, but not read. If I have a break or cancellation I make calls, or go for a coffee, or hit the phone and read e-mail, my favorite internet sites. I don’t read at my office, not in the old-fashioned sense at least. That I do at home, so there I was ready to read, but frustrated by an empty hand. Not for long. I found the necessary file, and soon I was scrolling down over the details of Narcissistic, Borderline and Schizoid disorders, the subjects of my forthcoming presentation. Having not bothered to review the now three year old descriptions, I was feeling precipitately sheepish, but also prejudiced. Footnotes about Schizoid personality regarding the less than 1% diagnosed with that condition had me scoffing with disdain, thinking some things will ever be missed, but the rest had me raising an eyebrow. Ten minutes later I was left impressed by the inclusion of fresh elements, or elements spoken of for years by many, but exiled from a generation by the DSM-IV edition. See, it’s now indicated in the diagnostic lexicon that Narcissistic personalities manifest an underlying vulnerability, one that has clinical utility, which is a crucial implication. Meanwhile, the new volume notes that Borderline personalities are not only labile in their relationships and emotions, but more broadly, disorganized in various aspects of their lives, and prone to fierce self-criticism.
These distinctions have been less emphasized over the last two decades as far as I can tell, and the impact upon training programs has been profound. The last time I provided a training to interns regarding James Masterson’s disorder of self model, I found that students, like my contemporaneous colleagues, tended not to observe the helplessness defense of the Borderline, or the exquisite sensitivity of the Narcissist–at least, not such that these qualities would determine the style of intervention. My biggest challenge over the next two Wednesdays is to convince relative novices not to explain too much, or to find solutions, problem solve or give ‘tools’ to their patients. It will be too late for some. Those committed to CBT, DBT, or whatever other fashionable methodology exists will want to know what to do long before they really understand who they’re sitting with. That’s the nature of our business, especially at the ground level, where everything is meant to happen quickly.
What’s meant to happen is difficult because patients in psychotherapy are largely unaware of how they block their own growth, or behave self-destructively. Therapists who think that statement disrespectful–not sufficiently positive–collude with the defensive intrapsychic structures of their patients. To the person engaged in a flight into health, proclaiming positive change in the immediate aftermath of calamity, they nod in passive support, vaguely unaware but not speaking to the patient’s likely effort to not deal with past damage. Regarding the patient who is late, not making appointments, saying “I hope you can find it in your heart to not charge”, they give slack, believing they are being flexible, empathetic, “meeting the person where they’re at”. To the person who is detached from emotion, uttering phrases like “it is what it is”, brushing off loss and pain, they are virtually applauding. Such “interventions” don’t hold people responsible for their behaviors or foster a sense of reality, and are actually disrespectful, for they don’t hold the standard or expectation of maturity.
I know I’ve thought these things for years, so I don’t really need the DSM-V to change anything with its subtly added footnotes. I just need to organize my notes.
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Graeme Daniels Psychewriter 