Replacing Psychiatrists and Psychotherapists
During World War II 60,000,000 people died, 2.5% of the world’s population. The Soviet Union alone lost between 18,000,000 and 24,000,000 lives. Germany lost between 7,000,000 and 9,000,000, upwards of 10% of its population. Europe’s Jewish population was reduced by between 5,000,000 and 6,000,000, or 55% of European Jewry. A country like Portugal lost “only” 50,000 souls, but those 50,000 amounted to 10% of the Portuguese population.
Forget for a second about who was in the right and who was in the wrong. Rather, imagine a German youth of 18, A Russian youth of 18, a British youth of 18, an American Jewish youth of 18, a French youth of 18, a Japanese youth of 18. Think of the parents of each of these young men, parents, say, between forty and forty-five years old. Think of their grandparents. Think of their sisters, their younger brothers—think about everyone affected by that calamity.
To say that the “mental health” of all of these people was affected by the fact of a world conflagration is to make a bad joke. Affected, indeed! It may have been the defining, pressing, most important matter on their radar, completely altering their lives and producing year upon year of unbearable stress. The whole world’s population was “motivated” in drastically new ways—and unmotivated as well. How motivated would you have been to open up your grocery store each morning if you were now selling to your Nazis oppressors? How motivated would you have been to get out of bed if your city was under siege?
Psychology posits many “theories of motivation.” These include the instinct theory of motivation (think: birds migrating), the incentive theory of motivation (think: external rewards), the drive theory of motivation (think: drink water when thirsty), the arousal theory of motivation (think: cure boredom with an action movie), the humanistic theory of motivation (think: self-actualization), and so on. To vote for any of these is of course to make a fundamental mistake. The mistake is the way that these theories exclude the human experience. We aren’t machines, functioning or not functioning: we are human beings living.
The problem isn’t that all of these theories are wrong or that all of them are right some of the time. The problem is that this way of thinking prevents us from understanding human beings. Think of that mother of that young soldier. It doesn’t matter whether he is a German soldier, a Russian solider, a French soldier, a British soldier, or a Japanese soldier. Her son goes off to war, he has, say, a 20% or a 30% chance of dying, and for the years that he is away she is fundamentally not motivated at all, though of course she still drinks water when she is thirsty, plays the lottery in the hopes of a windfall, and so on.
She is “motivated” in all the textbook ways—she gets to work, she buys lottery tickets, she drinks water, she has sex—but her reality is that she is holding her breath. If you ask her why she is having headaches, stomachaches, sleep problems, an inability to orgasm, and sudden crying fits, she may well say, “I am waiting for my son to come home.” Will we really stand for a psychiatrist answering this with, “I have a pill for you!”? Will we really stand for a psychotherapist exclaiming, “Oedipal issues!”? Absolutely not! Our new helper of the future, one who does not exist yet—a new “human experience specialist”—would provide her with a genuinely human answer: “I know.”
Our new helper would say to her, “I understand. I want to make the following suggestions, none of which make any fundamental difference in your situation. Your fundamental situation is that you are waiting, that you are holding your breath, and that you are scared to death. Nevertheless, I have some suggestions to make, and each is very different from the next. Some even contradict one another. Shall we look at them?”
This isn’t psychiatry or psychotherapy, it isn’t mentoring, coaching, or counseling, and it isn’t friendship. It requires a new category of helper, a person not bound to set goals and cheerlead like a coach, not bound, like mental health counselors, psychologists, and psychotherapists, to buy our current “diagnosing and treating of mental disorders” model, not bound, like a psychiatrist, to dispense pills, not bound, like a cleric, to toss in gratuitous gods, not bound to ignore a human being’s real, pressing, and defining experiences and circumstances. There would be no “diagnosing” and no “treating.” Instead there would be a human interaction in the context of calamity.
And who isn’t in the middle of calamity? Forget about world wars. What is it like for the quarter million women diagnosed with breast cancer each year and the one in eight women threatened by it? What is it like for a gay youth in a fundamentalist town? What is it like for a workingman or workingwoman living in a tract home in Amarillo, Queens, or Dayton? What is it like for a writer with no publisher, a painter with no gallery, a musician with no gigs? What is it like for an obese man or an obese woman with no sex life? What is it like for the millions who hate their jobs, the millions with no job, the millions who cringe when their mate enters the room, or the millions who have aged into invisibility?
Against this backdrop of mental stress, distress, and misery, we are supposed to stand “mentally healthy,” as if life were a lark and as if sweet smiles were not only our birthright, but also an obligation. Why should we be smiling? Why should we be “mentally healthy,” whatever that phrase is supposed to mean? For the whole history of our species, until very recently, your drinking water could kill you. In our age of good drinking water—which is only a reality for some percentage of our species—we have only had world wars and nuclear weapons to contend with. And what is life like for someone living under a dictator, where you can vanish for speaking? And how pleasant is your boring, taxing job? How pleasant, for that matter, is your own seething mind, packed with worries, regrets, resentments, and to-do lists?
But you are supposed to keep smiling. You are supposed to stay positive. No matter that every human right is a fight that must continually be fought for. No matter that in this modern age of plenty, which advertising tells us comes with beautiful homes, beautiful cars, and beautiful bodies, insomnia is an epidemic, obesity is epidemic, sadness is an epidemic, and meaninglessness is an epidemic. You must not notice the machinations of the powerful: none of that should affect your mental health. You must not notice your aging, your illnesses, or your mortality: none of that should affect your mental health. You may not even look in the mirror and announce that you might strive to be a better person: none of that!
Against this backdrop of great difficulty, stresses to our system, dangers as real as wars, famines, and pestilences, and a mind that clearly recognizes injustices and indignities, has grown a mental health establishment that takes none of that into account. It acts as if our baseline is “mental health” and that deviations from that unreal, made-up baseline are “mental disorders” or “mental diseases.” It calls the warehousing of distressed and difficult people, people who are no picnic and who are having no picnic, the “institutionalization of the mentally insane.” Its psychiatrists spend fifteen minutes with patients, not exploring human matters but prescribing and regulating chemicals. That is where we are.
It creates countless labels for human distress, individual differences, natural reactions to painful stressors, and socially unacceptable behavior and it announces that this hungry, sad boy has a “clinical depression,” as if something blew in the window and into his brain, that this unhappy, bitterly unfulfilled woman has a “clinical depression,” as if her husband despising her wasn’t about as real as bricks, that this arthritic old man whom his children have long since stopped visiting has a “clinical depression,” as if it were really a lark to sit in a wheelchair in the corridor of a nursing home from morning till night.
It takes no account of the extent to which human beings fail and how failing hurts. For every PGA champion there are thousands of golf pros and would-be golf pros chastising themselves for not playing well enough, down on themselves for their lack of talent, their lack of discipline, and their lack of success. For every NBA star there are millions of young men completely thwarted in their dreams of rising out of the hell of tenements, drugs, gangs and violence and who at some very early age throw in the towel and live a life of menace. For every country western singer who wins multiple Grammys there are legions of waitresses in dives all across America singing along to the music they wish they were singing on The Voice as they wipe up coffee spills and scrape dried eggs off table tops. We fixate on that PGA champion, that NBA star, and that celebrity singer—each of whom, by the way, is having his or her own meltdowns, as any tabloid will tell you—and not on the “boring” ordinary people with failed dreams and bad lives who are supposed to keep smiling.
Against the backdrop of our species’ continuous history of difficulty and its ongoing difficulties, difficulties that can be increased any day of the week by a new war, a new plague, a new drought, a glacial winter, or just the continuous barking of your neighbor’s new dog, the mental health establishment, with your willing participation, has contrived to make all of these virtually ubiquitous outer and inner difficulties “abnormal” and, as a result, profitable to them. When you get very sad because life feels horrible or very anxious because everything from your bills to your mate feel threatening, they say you have a “mental disorder.” Then either you nod your head in agreement and partake of their pills and their “expert talk” or you announce your defiant disagreement and … what? If you do not accept the mental health establishment’s way of viewing your pain and if that pain remains, what will you do then?
In the future—a future that is not coming—you might speak with a new helping professional, a human experience specialist. Our new human experience specialists would replace psychiatrists and psychotherapists. Yes, this is fanciful; it would take another several thousand words to outline why this can never happen. But it also requires only a few words: follow the money. And follow the prestige, the power, the insider connections, the holding of hands and the washing of hands, the intense ties among pharmaceutical companies, academics, the hospitals, the magnates of mental institutions, the courts, the expert classes, the jailers, the advertising industry, the politicians, the bureaucracies, the talk show hosts, the establishment in all its colorful garb.
Nor, really, should psychiatry and psychotherapy actually vanish. It requires a full-length conversation to explain the profound difference between chemicals-with-powerful-effects, which is what psychiatrists prescribe, and psychiatric medication, which is what they claim to be prescribing and whose rationale for existence presumes the presence of diseases and disorders that not only have never been proven to exist but that on the face of them, by the way they are created around committee tables, ought to be disbelieved. However, some sufferers may want the effects of these chemicals-with-powerful-effects: and for that reason psychiatrists would still be needed.
Likewise, many psychotherapists, violating their licenses and their oath to diagnose and treat mental disorders for the sake of doing good and reasonable work, actually already function as human experience specialists—and could be converted over quite easily, so ready are so many of them to be untethered from the current false system of “diagnosing and treating mental disorders.” This is of course what psychotherapy should have been—a human experience specialty—rather than a pseudo-medical profession where even master’s level professionals claim to have “patients,” which must make them feel superior but which ought to make them feel ridiculous.
We need a helping class that cares about the human experience and that takes human difficulty as baseline. There are many therapists who could be retrained and released from the grip of the medical model—they are actually waiting for that and pining for that!—and there are many compassionate, psychologically-minded, willing helpers who would love to learn this new stance and become human experience specialists. But the stage is not currently set. Nor is likely ever to be set, given the establishment’s power and our secret desire to explain away our difficulties as the result of illness. The time is not ripe—even as countless millions are suffering.