The Psyche in the Modern World: Psychotherapy and Society

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The Psyche in the Modern World sets out to open consulting room doors and bring the concept of the Psyche, and its main advocate, the psychotherapy discipline, into public space and into the realm of interdisciplinary discourse. A culture of carefully guarded clinical confidentialities inadvertently turned the consulting room into a proverbial ivory tower which has done much to obscure the psychotherapeutic body of knowledge and contributed to the myths and misinformation that surround and veil psychotherapy in the public space. This book redresses the balance and confronts some challenging, and sometimes uncomfortable, questions about the dichotomies that both characterize our relationships with the Psyche and contextualize the provision of psychotherapy services today. The contributors present contemporary discussion on a broad range of current subjects, encompassing socio-political as well as philosophical, theoretical and clinical dimensions, in an accessible manner.

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Chapter One - Psyche and Agora: The Psyche at the Crossroads of Personal and Societal Contexts

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Tom Warnecke

Psyche enjoys a prominent but peculiar presence in the public spaces of our societies through a host of words that build on the term. In common use, Psyche stands for an inner dimension and for the emotional life of a person. Perceptions of the human inner dimension vary greatly, however, depending on the discourses the Psyche is placed within: modern societies impose great dichotomies between the personal realm of the individual and their social environments.

Literature, the arts, and the entertainment media thrive on portrayals of the personal and compel with the human element. Feelings, emotions, and inner conflicts inspire artists and attract audiences. Or they enhance a story with a “human touch” when included in the margins of history books or with a current news item. Modern societies ostensibly value the human psyche, feelings, and emotions. Or do they?

For this image of societal values changes significantly when we look from up close, from the perspective of the individual. In our daily lives, we disclose feelings and inner struggles at our peril and to our shame. Emotions are feared, trivialised, or avoided. Social norms dictate that we should pull ourselves together, not make a fuss, not become hysterical, weak, or unmanly. The private and the personal, our vulnerabilities and needs, are embarrassing to us in the social space and ought to remain hidden from others and perhaps even from ourselves. Social norms require us to control or tame our feelings and inner conflicts, and we reward ourselves, above all, for not needing from others. And those who deviate, those who cannot tolerate the intolerable, commonly become stigmatised as “challenging”, “disordered”, or “mentally ill” by their social environment.

 

Chapter Two - The Politics of Intelligence: Working with Intellectual Disability

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Alan Corbett

Introduction

Intelligence has become the cornerstone of how we judge ourselves and others, and society's relationship with intelligence elevates cognitive ability at the expense of other phenomena, such as affect and emotion. In Western societies, intelligence is a lens through which we see and interact with our world, and its measurement has become a political as much as a social practice. In this chapter, I will explore the notion of intelligence—how we conceptualise and measure it, and how these measurements affect where those with low intelligence are located within society. Through an examination of the way in which the psychotherapeutic profession has tended to avoid engaging with patients with disabilities, I will consider what it is about intelligence that can evoke in others feelings of fear, disdain, and confusion, and how we seem to need to idealise intelligence while denigrating disability. Taking consent as a metaphor for how we relate to and understand those with intellectual disabilities, I will consider the notion of working with intellectual disability as being, at its heart, a fundamentally political act, the avoidance of which results in our own fears concerning mental frailty, cognitive deterioration, and difference being projected aggressively and unfairly into those with disabilities.

 

Chapter Three - Clinical Snobbery—Get me Out of Here! New Clinical Paradigms for Children with Complex Disturbances

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Camila Batmanghelidjh

Introduction

Isabella is fourteen years old. Her behaviour is described as “savage”; she assaults other people, attacks the wall with her fists, slams her head into the concrete, and licks the blood that pours down her face.

Henry won't move from under a car. Wherever he goes, he finds the nearest car and crawls beneath it for shelter.

David is lethal: his personality is very disturbing. In conversation, he calls you “madam” or “sir” as if he is about to stab you with the razor-sharp rigidity of his fake politeness.

These young people are too high-risk to be treated in a clinical setting through one-to-one or group psychotherapy. Having acquired the label “hard to reach”, they survive in the underbellies of our city, ducking and diving national hatred.

In the 1800s, the social reformer Mary Carpenter declared such behaviour the result of poor parental care. She didn't have brain-scanning machines or sophisticated psychological tools, but she observed that these children were different and required a comprehensive package of care: “These children have been hitherto so despised that they hardly know whether there is within them anything to be respected. They therefore feel no respect to others” (Carpenter, 1851, p. 83). Her remedy was to give them love, respect, and kindness.

 

Chapter Four - Why aren't we Educating? Psychotherapy, Psy-culture, and the Psy-ber World

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Alison Bryan

Definitions

In this chapter, “psychoanalysis” and “psychotherapy” will be used interchangeably, to highlight the importance of contemporary psychoanalytic thinking, whether undertaken by an analyst or a psychotherapist. Perceptions of clinical differences between these modalities are acknowledged. The term “psychoanalysis” is equally understood as a theory through which to think about subjectivity, with political and social implications.

Introduction

Psychoanalysis, Sass (1992, p. 20) argues, “is by far the most influential contemporary vision of human nature”, but much of the peculiarities, inherent demands, and values of the psychoanalytic process are currently being lost from view within a world where the discourses surrounding therapeutic culture have led to an obfuscation of this foundational practice. Frosh (1991, p. 1) notes that “psychoanalysis has never had more to say about contemporary culture than it has now. On the whole, however, it is not psychoanalysts who are saying it.” Yet the core concepts of psychoanalysis have contributed to and constructed the root systems upon which the current therapeutic diaspora flourishes. To this day, psychoanalysis and its closest relatives psychoanalytic and psychodynamic psychotherapy continue to provide a distinctive and relevant mode of treatment—although their tenets of the existence of an unconscious and how its existence may be observed in the therapeutic relationship are under threat.

 

Chapter Five - Psychotherapy, Relationality, and the long Revolution

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Mary MacCallum Sullivan and Harriett Goldenberg

This chapter will explore whether and how psychotherapy may have something to offer beyond the consulting room; whether this living craft can participate in “the great process of change”, the developmental curve of what is proposed as an historical process of transformation, a transition from an age of scientific reductionism to an understanding of the importance of complexity and emergence, named by cultural critic Raymond Williams as “the Long Revolution” (Williams, 1961, 2011). The scale of the whole process thus described by Williams, is, he points out, too large and too “long” to know or even imagine, but rests, first, on a methodology of self-reflectivity; second, on an emphasis on relationships and inter-relationship; and third, on human lived experience. Williams sees revolution, in this sense, as “the inevitable working through of a deep and tragic disorder”, to which we can respond in different ways. He goes on to argue that “the absolute test by which revolution can be distinguished, is the change in the form of activity of a society, in its deepest structure of relationship and feeling” (Williams, 1961, 2011, p. x).

 

Chapter Six - Human-based Medicine—Theory and Practice: From Modern to Postmodern Medicine

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Michael Musalek

The world of modern medicine is shaped by positivism and revered as a place of reason, a world in which mathematical calculation and “objectivity” are prized above all else. “Evidence-based” has become a buzzword, standing for safety, state of the art and high-quality patient care, while medicine has become a world of sober number games, reduction and fragmentation, demystification and desubjectification. However, much is lost in attaining this so-called objectivity, namely ourselves as human beings. In evidence-based medicine, the suffering human being in all their individuality is sacrificed on the altar of medical research to the manmade construct of disease, which, contrary to its characteristics, is regarded as natural. Surely, this process is only comprehensible as a final act of resistance by a science indoctrinated with positivism and propelled by a drive towards objectivity.

From eminence-based medicine to evidence-based medicine

 

Chapter Seven - Routes Out of Schizophrenia

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Theodor Itten

If we travel to St. Gallen in Switzerland by train, then, coming from the east, we emerge from the tunnel and pass first one set of points, then a second and a third, which determine at which platform we can alight. Or, if we know which direction the train will take from there, we can always remain seated. Some trains continue to Herisau, Rapperswil, and Lucerne; the stopping services dawdle on to Gossau and Wil. For the fast train to Zurich, Lausanne, or local trains for Teufen and Trogen, passengers are advised to change. Depending on what ideas we have about a journey, and the routes that can be taken out of “schizophrenia”, we may choose one of the three platforms in the main station, or depart from the smaller branch-line station nearby.

What do we necessarily already recognise and acknowledge about the experience of, and insight into, a disorder that today I will call by a German name: die geistige Zerrissenheit—mental fragmentation? You will all have known people who, in the past, or perhaps more recently, have received a psychiatric diagnosis of mental fragmentation—and have therefore also been affected yourselves. How do you—how do I—deal with these experiences, these phantasms, these labels?

 

Chapter Eight - Counting the Cost

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Claire Entwistle

After years of neglect, “talking therapies” are both in demand and in short supply in the British National Health Service (NHS), the new market being dominated by Cognitive Behaviour Therapy and other short-term focused techniques. At the same time, there are many private and public institutions training psychotherapists for in-depth, long-term work which NHS commissioners are unlikely to fund. Most are training at their own expense. In this chapter, I explore the motivations and commitment of this group who are expending considerable financial and other resources to train and practice in what might seem to be an inhospitable climate.

I became interested in this questions when I realised recently that I knew, in contexts unrelated to my clinical work, a surprising number of people who are training as psychotherapists or psychotherapeutic counsellors. Weekly personal therapy is required at least until the practitioner is qualified, and unpaid placements are often compulsory, with supervision that may be paid for by the student. All in all, these trainings are very expensive and time-consuming, as well as emotionally demanding.

 

Chapter Nine - How Broader Research Perspectives can Free Clients and Psychotherapists to Optimise their Work Together

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Peter Stratton

This book is a sustained attempt to get beyond culturally accepted obviousness. An alternative image to the title of the first chapter is not of the psyche being at a crossroads but more of being stuck in the swampy lowlands (Schön, 1990) under the flyover of societal assumptions. As previous chapters have stressed, it is not just clients but also psychotherapists who can become trapped by dominant societal discourses. Perhaps in this final chapter, it is useful to go beyond reasonableness. In fact necessary, in order to promote the liberation not just of psychotherapy, but also research, to a point at which they can cooperate to offer increased benefit to everybody.

Let me propose a stance from my own background of systemic family therapy: of irreverence (Cecchin, Lane, & Ray, 1992). In proposing irreverence as a strategy for therapists’ survival these authors direct us first to be irreverent to our own assumptions so that we can be freed from the taken-for-granted within our profession and our culture, and more likely to recognise our favourite beliefs not as truths but as provisional hypotheses (Cecchin would say “fantasies”). For the purposes of this chapter, I am inviting you to join me in a constructive irreverence to dominant assumptions about the relevance of research to the practice of psychotherapy.

 

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