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Epater Le Patriarchie*

 

The ontology of addiction has been the central controversy in the sex addiction treatment industry for quite some time, alongside the quieter issue of whether upward interpretations (those that pre-suppose capacity) are appropriately directed at the habitually acting out. But neither of these should be the most controversial topics in this field anymore. What should be? Well, the clues are in the demographics of who presents for treatment; who typically presents as the impacted others, and thirdly, who are the treating professionals holding the protean sexual ethics that gird the treatment process. In communities with a diverse client base, those ethics reflect progressive values that obviate the casual pathologizing of sex, but in my suburban neck of the woods, a curious blend of traditional biases and menu-feminism continues to dominate discussions. More often than not, women presenting as betrayed partners exhibit authority with respect to intimate relationships; they are the standard bearers of what constitutes emotional maturity. This is a real problem in our profession: women who enter individual therapy, or couples therapy, or who direct their hapless male partners into therapy having read pop psychology literature that teaches that they have more empathy; that they have bigger limbic systems or thicker Corpus Callosums connecting their right and left hemispheres, thus enabling greater sensitivity to blah, blah, blah…ya know, that BS. Read feminist author Cordelia Fine’s Delusions of Gender, one of several books profiled in mine and Joe Farley’s forthcoming book, Getting Real About Sex Addiction, plus one or two recent studies we quote, to obtain a proper debunking of such femicentric myths.

And the myths extend to sex addiction treatment, skewing conceptions of male and female sex addiction, leading to diagnoses as well as intervention strategies with essentialist biases. I wouldn’t suggest that practitioners do not hold their male patients in high regard—that they do not sympathize with their lives or wish them well. I don’t mean anything as caviling or facile as that. However, I do suggest that our professional models of care, with their catalogues of nomenclature, jargon and assumptions now privileges feminine perspectives in psychotherapy because A) that’s now the dominant consumer base for psychotherapy in The United States, and B) Women represent the majority of practitioners in mental health care. I know it’s not like this from the female perspective. I’m sure my female colleagues would report that many domineering men enter therapy, including couples therapy, making their wives’ lack of sexual appetite the identified problem of treatment; overbearing fathers who assert that “lack of discipline” is the prevailing problem of all systems. But at least such clients are publicly and professionally decried, whereas the analogous excesses of our feminine client population are not. It’s becoming more common, for example, to read articles or hear of workshops that draw attention to negative patriarchal attitudes, masculine narcissism; the problem of “difficult men”. Do we read about or hear of ways to combat the problem of matriarchal attitudes? Female narcissism? Would our profession’s proletariat tolerate a workshop—especially one taught by a male therapist—entitled, “How to work with difficult women?”

The word is out upon patriarchy: heavyhanded parenting, sexual entitlement, and while many men do bring their passive Stepford wives to female therapists for a corrective talking-to, I think the example of women directing men to a redeemer class of men is more common these days. Thus, the worst offenders on this matter of skewed approaches may be male therapists. I’m speaking of a certain type of male therapist: he’s a rock star type—knows how to patronize feminine needs, advocate for them; be that man who will show other men how to be men in the 21st century. Ugh! I can conjure this hero in a couples’ session: he sits forward, talks straight, emphasizes action over words, patronizing the bias that thinking or the expression of it is overrated, and stares “man-to-man” into the eyes of his adversary, that “narcissistic” guy who won’t show his vulnerability, but instead terrorizes the women in his life, plus his kids, with his bad temper, his selfish entitlement. This rock star therapist will set him straight, and some women will love this guy, privately wishing he could replace the dinosaur that’s the subject of intervention. And can you imagine how this scenario is exacerbated when the context of treatment is that dinosaur’s sexual acting out? His mooted sex addiction?

The skewed approaches are grounded in a plethora of orthodoxy about how men and women are raised and therefore what shapes their development; and though careful women therapists may leave to those rock stars the harder foot work of confronting angry, hypersexualized men, the marching orders they carry out still reflect a feminine hegemony. Even popular figures like Esther Perel, admired perhaps for her paradoxically challenging neutrality, betray bias in how case illustrations are conceptualized. For example, in State of Affairs: rethinking infidelity, she rightly challenges, in my opinion, the common supposition that women’s sex drive is inherently weaker, only to then imply that the feminine drive is imbued with more imagination and relational intensity. Now, in keeping with the spirit of my last entry, I’m not one to pull the science card and say, where is the evidence for that theory? At the same time I think, where’s that opinion coming from? Who decided that it was a given, that it needn’t be substantiated? Next, in comparing (I think anecdotal) accounts of men and women’s regrets upon having affairs, she reports that women say things like, “I lost myself”, while men are more prone to say, “I lost my woman”. In descriptions like these, Perel accentuates the theme of self-determination in the meaning of women’s affairs, and while a traditional interpretation of the “I lost (her)” expression may assign romantic longing to the grief-ridden man, I think Perel is attaching a proprietorial connotation to the male figure’s experience. By doing so she suggests a lesser sympathy for him, instead joining the progressive critique of masculine possessiveness that is so fashionable in contemporary psychotherapy.

There are other subtle examples of bias in Perel’s largely admirable text, but the most egregious case of epater le patriarchie lies in her equally subtle adherence to an Oedipal Complex-derived theory of male infidelity, plus a diatribe about how female adulterers are treated worse by society than male infidels. Intrigued by a commonly-observed figure that is a decent, genteel man who nonetheless engages in affair-seeking or compulsive porn use, she paraphrases collegial psychologists who profile for such men a background of abuse at the hands of alcoholic fathers. The result is a hapless, codependent figure caught in the middle between a castrating patriarch and a downtrodden wife and mother. Subsequently, these boys become men who protect vulnerable women who are blurred in their minds with their mothers; hence, they deny their own feelings, including their libidinal impulses, which they believe are intrinsically harmful to these women—such is the distorted identification with the bad father. Sex with the mother/partner blur becomes a taboo—incest, even. The affair-seeking behavior is therefore a splitting defense: the man must keep separate his libidinal self, protecting the good, as in his image and her delicate feelings. Now, on the one hand, this is a fair interpretation of an Oedipal triangle, but one that relies upon the conscious memory of the abusive father and a bias towards blaming pathology upon that phenomenon. Robert Bly, in his then-zeitgeist writing of the nineties, observed a similar triangle between “nice” men and their enmeshed mothers and distant, angry fathers. But while also observing that such men fear their own feelings, Bly’s men’s movement slant afforded more sympathy to the exiled father, and more blame, I think, to the emotionally incestuous mother.

For the most part, Perel is not hamstrung by the need to appear “evidence-based”. Her book is riddled with pronouncements that she doesn’t feel compelled to substantiate, alongside an arbitrary few that she does feel obliged to support. For example, when asserting that infidelity is the worst thing that can happen to a marriage, according to Americans—even worse than incest of domestic violence—she cites Gallup polls indicating that people condemn cheating more than they do reckless gambling, divorce, or even suicide. Strangely, in a passage that’s only a few sentences long, she fails to give numbers supporting the claim that infidelity is deemed worse than incest or DV. That’s because that claim is unlikely, I say. Next, there’s a passage claiming that society judges more harshly “other women” than it does cheating husbands. Honestly, this complaint makes me laugh. It never seems to occur to plaintive women, whether they are feminist in sensibility or traditionalist, that this bias, which I agree does exist, is actually grounded in feminine chauvinist beliefs. This is like men complaining that they are “expected” to make more money than women. Yes, you’re expected to make more money because you do make more money. Correspondingly, the flip side of women’s relative lack of sexual freedom is an assertion of either moral superiority, superior self-control as it relates to sexual urges, or in general, a belief that women are the more mature gender, both emotionally and sexually. There. That’s my unsubstantiated, non-evidence-based pronouncement. After all, it’s women who covet and lay claim to the white dress, as there is nothing in a groom’s sartorial splendor that affords him a virtuous, as in virginal air. So yeah, I guess Beyonce was more pissed at that “other woman” than she was at her “errant” husband, as Perel asserts. But that’s a result of traditionalist assumptions. The woman lapsed to the man’s standard. That Jay-Z is a dirty dog is deemed a given. Duh!

Most subtle, however, and likely unintended, except on an unconscious level maybe, is the echo of the ancient feminine voice in the lament, “I lost myself”, that Perel attributes to women who have sought affairs. Yes, I know that thought—mine or hers—may sound a little precious, but my thought pertains to a series of passages in Getting Real About Sex Addiction that cite feminist historians’ theories of prehistorical societies. One such theory asserts that society was once matriarchal in its power structure and only became the opposite when men discovered the significance of their role in procreation and proceeded thereafter to usurp social authority. After this, the story goes that women were subjugated, their mythical images consigned to the sea, hence the ubiquity of metaphors that link womankind with water, and man with the later emerging dry land. Ontogeny recapitulates phylogeny, said biologists in the nineteenth century, to indicate that an embryo’s development mirrors that of a species. Freud subscribed to this principle, also. So, for each individual man, one woman, the mother, was once in charge of everything. For man as a collective, women were once in charge of everything. Then came the battle. Women lost. The battle continues, and man’s love/hate of woman manifests partially in his sexual liberty, taken to excess says one of several polemical movements taking aim at masculine privilege: sex addiction treatment.

It’s funny, but I’ve known a lot of people, clients mostly, who identify as addicts. Wait, that’s not the funny bit. What’s funny, as in strange, is that most of the addicts I’ve known will lie, blame, deflect, self-pity, act out, lie, blame, deflect, self-pity, all in a perpetual cycle, over and over again, until they die in some cases. Some of them stop. Seriously, in a manner that only addicts seem to manifest, some stop their behaviors and become hardcore acolytes of a “recovery” lifestyle: assiduous participants in treatment, therapy, 12-step meetings and general fellowship; dogmatic proselytizers of religiously inflected principles; somewhat closed-minded yet reliable stalwarts of rectified living, complete with rigorous diet plans, exercise regimes and otherwise clean habits that would put the average person to shame. In the aftermath of their active days of excess, the lying, blaming, deflecting and self-pity are not so much extinguished as muted—a stoical nod of acknowledgement and regret hides a repressed hatred of something, subdued under a remainder-of-life gag order. Of the heterosexual male sex addicts I’ve known, some betray residual resentment towards the officious women in their lives—wives and girlfriends, mostly (there’s that phrase again). Others, those “decent” men that Esther Perel writes about, have picked up the narrative of abusive fathers, sinister uncles, cousins and violating mentors, implying with ambiguous, half-formulated though not wholly misguided logic that such abuses are the root causes of both low self-esteem and the addictive behaviors that soothe. The one thing they won’t do is blame mothers. The one thing men will rarely do—not with words, because it breaks the world—is blame mothers for the bad that comes from sex.

*a play on the term epater le bourgeoisie, a rallying cry of the French decadent poets of the 19th century. The term epater means “to shock”.

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Life weans the giraffe

 

Not so randomly placed in mine and Joe Farley’s book, Getting Real About Sex Addiction, are the ontological issues surrounding the term sex addiction. It’s in the title, even, this suggestion that what we’ll be doing is examining the term sex addiction more than any other mental health abstraction and therefore addressing the problem of problem sexual behaviors: is this a thing, a variously skeptical public asks? The members of Sex Addiction Anonymous (SAA) have of course made their decision on this question. Committees of The American Psychiatric Association and The World Health Organization have not quite made theirs, rejecting the proposed diagnosis Hypersexual Disorder in the case of the former body, and recently (and provisionally) accepting the diagnosis Excessive Sexual Drive in the case of the latter organization. To be clear (or not), neither of these terms are synonymous with the construct of sex addiction, but we’re in the same ball park here. The issue is complex. It is medical, psychological and meta-psychological, as in ontological: is a human being’s sexuality a function of biological drive and are problem behaviors therefore a matter of excess desire? And even if that natural conclusion is drawn, where is the role of nurture in the matter of etiology? Are we talking about an interpersonal versus an intrapsychic event, as in a phenomenon derived from early childhood development—a weaning that went awry versus a web of innate fantasy (or phantasy as Object Relations terms it) within an infantile mind? Or is the broader social and cultural environment the more prominent accomplice in a dysfunctional sexual development?

We’d prefer to think so, at least. And so we hear weary chestnuts that even the most progressive-minded observers must be tired of hearing by now: theories of pubescent or post-pubescent development wherein boys are subject to mores that encourage their essentialist aggression, their concomitant sexual freedom, with consequent pressure to conform and therefore perform when being so deterministically sexualized. Meanwhile, girls are discouraged by societies across cultures from expressing freely their sexuality; they are raised to be demur, ashamed of their sexuality, and therefore passive or possibly manipulative in their sexual expression. And even if this is changing somewhat in a millennial age (really, have you noticed?), then it is surely a reaction to those previous oppressive norms, yielding a confusing transition phase wherein girls, boys, or those along the gender fluid continuum (suggesting a flight from binaries) switch roles at times, thus conforming to a newly burgeoning if less-defined ethos. And so we observe a faction of diffident men and boys who speak of respecting the feminine as if they are resisting in their stance a combined biological and social force upon their being. And we observe women and girls who seem increasingly aggressive and entitled in their sexual freedom while proclaiming the lack of freedom that is afforded them by an arbitrary social reality. In analytic terms, this is the realm of the unconscious but not the repressed, these habits and mores that we download from the culture. By unrepressed I mean something that is not kept away. Isms and other mores may be unconscious, but as we routinely observe, they are hardly kept away. They leak and make a mess, pervading our experience.

The premises of these positions must be difficult for the average mental health professional to sustain given the contradictions of theory and life itself. Firstly, within our profession’s demographic map, that average person is likely female, white and therefore privileged in terms of race, at least. She has been raised and subsequently educated within an atmosphere that encourages or affords (not privileged—we only use that word in this context if we’re feeling critical) a social justice lens, which means supporting narratives that advocate for the underprivileged. In Getting Real, I argue that within the niche field of sex addiction treatment (and perhaps psychotherapy as a whole), this demographic phenomenon of recent generations results in a skew that targets a privileged (non-ironic diction) client population–heterosexual men—for devaluation. The aggregate of thought suggesting how males and females are socialized towards sexual behaviors and identities emphasizes the post-pubescent experience, which for some might imply agreement with an embattled psychoanalytic idea: that pre-pubescent and certainly pre-verbal sexuality is repressed, as in kept away, and for the most part is not leaked and is therefore a lesser factor in pre-teen childhood development. There is no scientific evidence of an Oedipus Complex, say critics of psychoanalysis. There is evidence of pre-verbal attachment styles, the capacity to communicate and comprehend on a pre-verbal level, thus children’s psychological development is profoundly impacted from birth onwards by events, both benign and traumatic, that occur perpetually.

The onset of sexuality is a function of hormonal development, says a medical argument—not some manner of release from childhood repression. Puberty is the psyche’s sexual alarm clock, indicating that it’s time for play of another kind; an incipiently adult kind. Feelings like joy, excitement, wonder, fear, shame, and guilt may all be observed in small children, some pre-verbal, some not. Emotional expression, proximity-seeking, may be developed or not, contingent upon the presence and consistency of a capable adult. The nature of a child’s attachment to a parent (or primary caregiver) will be internalized as a working model of attachment that will further shape development and relationships, possibly over a lifetime. That was John Bowlby speaking and writing over fifty years ago, saying something similar to what D.W. Winnicott was teaching, only with more attention to physical need than the fostering of a distinctive, creative mind. If you the reader are silently nodding in agreement, then you’re joining at least two generations of mental health providers who generally agree with these principles while implicitly thinking that sex is not part of the early attachment equation. You’ve likely been taught to believe that proximity or object seeking, plus patterns within those relational drives, are shaped interpersonally and by broader environmental norms; that we have implicit (neurobiologyspeak for the unconscious) memory of early attachment patterns, whether they were traumatic or not; that we have implicit bias (social justicespeak for the unconscious but not repressed) in relationships, yielding prejudice directed at distinct social groups. Yes, joy, creativity, and some of that bad feeling stuff is indeed fostered in a child’s development, but not sex. Not arousal, or longing. That potential is activated later…when it’s appropriate, of course.

So, why are there excesses? Why this untidy disorder, this chaos of spillage, as if life were some kind of cosmic dumping. There, says…something: here are your tools in a pile and a flood. Do with them what you will. Is addiction, for example, a blend of natural hormonal excess negatively complemented by an insecure attachment style, of weak or failing repression barriers? And if this shaping does occur both intrapsychically and interpersonally, shall we break with our profession’s current theoretical orthodoxy and resolve that sexual nurturing largely coincides with biological schedules and is dominantly imparted with the help of the cultural village? A village that also fails, perhaps. Because if this isn’t the roughly hewn plan then we must revisit what our developmental theories otherwise imply: go back to society with ideas it doesn’t want to hear and consider taboos, as in pre-teen or even pre-verbal sexual exposure, as the original source of sexual development. We’d have to imagine that arousal and longing are part of the same dyads or village-child-passing-around norms that bring food, enable good sleep, play and a spark of imagination. We’d have to imagine that breast-feeding, or the bathing of infants’ genitalia, or the physical control of their evacuations are truly antecedents of sexual desire, or that excesses in this private realm nurture later distortions of sex as much as any unconscious yet unrepressed social message conveyed via so-called modeling to a conscious mind.

Though it would likely elicit thought-blocking accusations of misogyny or homophobia, we’d need to re-think child-rearing in a way that might stir panic; contemplate sexual orientation in a way that would challenge etiological assumptions. If the excesses of sex addiction are rooted in early childhood development, trauma specialists sometimes suggest (but don’t prove) that childhood sexual abuse is an accomplice to later sexual acting out. In this way, modern psychology comes full circle, revisiting Freud’s original Seduction theory, only with a significant permutation. Instead of conversion symptoms like the paralysis of limbs, patients present with compulsive behaviors, what Freud described as repeating versus remembering, or the shorthand, repetition compulsion. Sandor Ferenczi later gave us the term and concept “Identify with the aggressor”, attempting to rescue Seduction theory from its then-exile, to denote a relational identification between victim and abuser—to indicate a kind of psychic hostage-taking. If the vast majority of sexual abuse perpetrators are male, as a mother-idolizing culture would have us presume, then why doesn’t a corresponding majority of male molestation victims report or manifest ego-dystonic feelings of same-sex attraction? Or perhaps they do and are therefore, in keeping with analytic thought, manifesting the defense of reaction formation via a false heterosexual identification. Does it seem complicated, this human development? Maybe that’s why it seems to be taking longer and longer for children and young adults to grow, with the meta-tasks of an internal, interpersonal, and collectivist set of systems to navigate. I understand that some animals in the wild are able to walk within a day or an hour of their births. They grow up quickly in less complicated systems, with simple brains that are mindlessly free of sexual neurosis. Are the plainer brutalities of nature—the ubiquity of predation, or the threat of being left behind if not ambulatory—the forces that force giraffes to their feet? Do their hormones help? Or do they “grow up” quickly in other ways, if you know what I mean? What if our life expectancies were less than a decade? Would we evolve a quicker, more expedient onset of the pubescent watershed, becoming unrepressed yet thoughtless, and actively or relentlessly sexual, all because it was necessary to survive?

 

 

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Many a true word (aka no joke)

 

 

Okay, so what’s the deal with the comedy? Why this thing about flippancy versus an appropriately sober and earnest tone, one might ask? Well, first of all, I don’t want to give the wrong impression. Mine and Joe Farley’s book, Getting Real About Sex Addiction, is filled with serious comment, academic rigor, and “getting real”, thumb-on-nose zeal. We have over a hundred references in our bibliography—perhaps close to one fifty—reflecting a studious approach and a whole lotta reading. And I think Joe read at least one book about sex addiction. But seriously, what’s there to be serious about? Who said that being serious was the thing to be when discussing controversial subject matter? When did humor get cast away to the deleted files, and who or what institution made that call, anyway? I get that most psyche lit is dry and pedantic. Sometimes it’s plaintive and proselytizing, offering nomenclature with assumptions about reader literacy—like thinking he or she knows words like nomenclature. Read analytic literature and all this is on another level: words and terms that may be obscure or unexplained are rampant and oblique turns of phrase are ubiquitous. Take phrases like Winnicott’s “going on being” or Wilfrid Bion’s “attacks on links” (actually the title of a paper). This is well-known verbiage to students of psychoanalysis. In a recent article by analytic writer Arthur Nielsen, the concept of projective identification (PI) is explained with sentences like, “inducers, by contrast, continue to be involved with the projected qualities in what Meltzer and Fisher have felicitously termed a bifurcation of experience.” Yes, in English please, I hear the reader ask.

Actually, it is English, and Nielsen’s article in the latest issue of the Journal of the American Psychoanalytic Association is a pretty interesting, if complex take on why one in five marriages in the US will fail in the first five years. Hey, that’s not that bad, I think, given what I notice in couples that come to my office. The PI is off the charts, back and forth and all over the place. I’m near dizzy after an hour with a couple in a PI mess. I’m in need of a good joke, and I’m often tempted to make one. Not a stand-up joke. I don’t mean a “hey did you hear the one about the…” overture, or an ice-breaking aside for a couple who walk in with stony expressions like they’d just been sitting in ice. No, I mean the kind of plays upon words that circle back to previous things said in a session; to matters raised in some other context but which might be raised again, thrust into a new moment and therefore given an altered and—if the satire takes aim—a diminished, possibly diffused meaning. Satire. Now there’s a word. Again, that’s a concept that doesn’t belong in a serious discussion of psychology or mental health problems, and in a sensitive moment, one ought to be careful with humor lest anyone get their feelings hurt versus diffused. Humor can hurt. Truth hurts is a permutation on this theme. Humor as truth: is that your point, Graeme? No, I reply to invisible heckler X. Actually, it might have been Sigmund Freud’s idea. Seriously, I don’t think he ever decreed that analysts should abstain from using humor like they were meant to abstain from sex (with patients that is).

See, Sigmund taught that the unconscious is a free reservoir of instinct, feeling and ideas, albeit largely objectionable ideas. There is no “no” in the unconscious; it knows no limits, doesn’t get endings, of pleasure especially. That’s the ego or Superego’s job, to effect limits in the case of the former apparatus; impart morality and civilized order in the case of the latter. Humor represents that which has slipped from the truthful, as in uncensored, unconscious realm of our mind. It’s contrivance as a quip, a witticism, or an infantile gesture is a compromise, one that grants distance but at the same time allows a glimpse of what is really on a person’s mind. Many a true word, wrote Shakespeare, and there are many true words in Getting Real About Sex Addiction. Some of my favorite writers and filmmakers are comic in their style, thinking this the best way to provoke or inspire. Meaning, they determine that the best way to convey reality is through absurdism. Go figure. This brings to mind (again) Dr. Strangelove, Or How I Learned to Stop Worrying and Love the Bomb, about which I’ll be giving a talk in Charleston, South Carolina of all places, next spring. One of my bullet points to be is to point out that Stanley Kubrick’s black comedy, cold-war classic was preceded or released contemporaneously with ponderously sincere fare like 1959’s On The Beach, or 1964’s Fail-Safe. Back in the fifties and sixties, producers thought audiences wanted to be soothed and orated to by the likes of Gregory Peck and Henry Fonda. Who woulda’ thought that nebbish Peter Sellers playing three ridiculous roles, all of them with a latent smirk, would be the one to deliver the most impactful messages of social warning: we’re all gonna die so let’s have some fun while we talk about it.

In co-writing Getting Read About Sex Addiction, I took a similar approach after having read so many books and blogs about sex addiction that left me deadened and therefore needing some fun to rouse me; or, I’d listened to TED talk or You Tube mini stars, speakers who took themselves, it seemed to me, a bit too seriously. It’s not all fun and games, our book. Much of it’s a trauma, or has been, for someone, or maybe everyone. No laughing matter, but the contradictions in the field are what’s funny. You’ll see, or read. I dragged Joe and his infectious giggle with me on this thing, and he soon got into the spirit of drive and mischief, calling me up with mock-homophobic questions like “what are you wearing?” and joining me in this simultaneously, ambiguously serious yet irreverent endeavor. I’ll continue in this vein for a while in blog-space, gauging when to laugh and when not too. If I offend, either in the book or in these pages I’ll take a return joke on the chin, thinking that will be fair play, maybe hate play. Or I might circle back to something I’ve said or written before, because ultimately, for better or for worse, in sickness and in health, most people are still laughing about sex.

 

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Politics and psychotherapy

 

“Hi all, been thinking about political content on this list-serve recently, especially after a member was recently rebuked for posting a link in support of Bernie Sanders. I asked administrators for the policy pertaining to such posts and saw in the supplied policy an item that asks members to refrain from making political endorsements.

Endorsements of what? I wondered, as the policy didn’t specify endorsement of individual candidates or campaigns, which appears to have been inferred. What about endorsement of political opinions, or of political realities (via presumed consensus), as they are implicitly described sometimes in this forum. For example, when members post articles about single payer/payor systems, or police brutality, or white privilege, the articles don’t so much endorse candidates or specific referendums, but they tend to presume consensus as to what our world is like. So, when clinicians speak of “bringing awareness” about a social condition, they are not inviting debate so much as asserting authority, more or less dispensing what they think are facts about a world situation.

This sets up a tricky situation for mental health professionals and for this list-serve. If we have clients who proclaim a mental health condition that is dominantly attributable to an external reality, such as a social condition or political situation, versus a greater weight of attention to an internal disorder, then the onus is upon us to become educated as to that external reality, (perhaps eschew focus upon internal pathology) to educate colleagues about that external reality, which in effect means we will be endorsing a social/political view, and instructing those who don’t appear to perceive the political reality, such as others on a list-serve.

In light of this, it seems arbitrary to censor endorsements of individuals or their campaigns–merely a rebuke of the unsubtle–when the infiltration of politics into our profession is another kind of reality.”

That’s from a message I posted last week on an EBCAMFT list-serve. About the same time I fielded a compelling suggestion from a client who hadn’t read my post, to the effect that politics were a part of people’s lives and are therefore a valid topic for psychotherapy. Didn’t I agree? she more or less challenged. Sort of, I more or less replied, intrigued by her argument, but not wanting to study up on each political topic she seemed to want my interest in.
What’s most compelling is the idea that a person’s external reality, the community (or polis) in which people live, is inextricable from a person’s psychology, no less so than a person’s intimate relationships, or their unconscious functioning. I am reminded of a discussion some years back with a Mastersonian consultant, to whom I asked about the cultural lens within the Masterson model. It’s not there, she said, though I’m paraphrasing her. Indeed, it’s not explicit or otherwise clear, unless you comb through libraries worth of material, that the discipline of psychoanalysis has ever been influenced by cultural relativism, though it surely has by politics (think influence of two world wars on notions of death instinct and repetition compulsion).
However, I think the reverse is true. Take the concept of internalized oppression, for example. This idea, derived firstly from Sigmund Freud’s writings, latterly from object relations theory, holds that individuals formulate representations of self based upon what is introjected from caregivers. Thus, if a child is demeaned, he or she will formulate a negative experience of self and act accordingly. Cultural relativists simply take this principle and apply it to peoples, especially those marginalized. And so this is part of the individual’s experience, this attachment to a community, a system. Well, that’s a lot to fit in the room, at least.

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