12 - Psychotherapy, Consciousness, and Narrative
(EN: No chapter introduction)
Psychological Therapies and the Emotions
Emotions are at the core of our lives: we experience the results of our actions, and our actions (including hesitance to take action) are largely the result of our emotions. Any yet our interest in the topic of emotions has historically been vey superficial and dismissive, so our knowledge of them remains vague.
Emotions are the atoms of both the personality of an individual and the values of a culture. Logic may help us to plan how to achieve what we want, but emotions tell us what we ought to want.
In Eastern culture emotion is mitigated through spiritual practices such as meditation and philosophies that are dismissive of worldly concerns. In the West religion likewise seems to suppress and dismiss emotion and worldly concerns while philosophy provides an alternate route.
The author looks specifically to Christianity, which castigates individuals not merely for their behavior but for their desires, which are regarded to be "sins" when they are not in line with the desires of the church leadership. The expression of emotion (anger, pride, etc.) is discouraged, shame and remorse are cultivated, to control the behavior of adherents. This is not unique to religion (EN: One of the criticisms of Marxism, which preferred an atheistic society, is that the state became an object of reverence and compliance with the ideals of the "party" became the social standard - which is to say it did not abolish religion so much as it became a religion unto itself.)
In the broader context of a society, there is a desire to control the behavior of individuals - to get them to adopt the values of the culture and behave according to social norms. The reward for doing so is prestige and privilege within the society, and the punishment for failing to do so can range from confinement to execution. The legal and educational systems are very much mechanisms of emotional regulation.
In terms of psychology, its application depends on the degree of control that a culture wishes to exercise over its citizens. In totalitarian nations, those who fail to conform to the social norms are subjected to confinement and therapy for even minor transgressions (expressing an opinion contrary to the party platform), whereas in less totalitarian nations, mandatory therapy is reserved for those whose emotional disorders cause them to act in ways that are more severely injurious to themselves and others. But in both instances, psychology is a tool by which society encourages and insists upon compliance to group norms.
(EN: There is also the softer side of psychology, in which an individual seeks self-improvement of his own accord - to be consoled or contented with his situation, or to gain the motivation and self-confidence needed to pursue success - which seems to have been set aside for a time. The "self-help" approach to psychology has always been relegated to the fringes of the profession.)
The Basic Idea of Psychoanalytic Therapy
Sigmund Freud is the central figure in psychoanalysis, the process by which a subject is engaged for a long period of time in disclosing information to a therapist, who seeks to understand their cognitive process and identify and correct errors in their way of thinking.
Psychotherapy tends to focus on the traumatic events in a patients life, using various indirect means to elicit information that enable the therapist to understand the thoughts and emotions that pertain to a specific event, which have been extended to similar events in later years.
Freud specifically focused on sexuality, during an era in which people experienced desires but felt inhibited by the prohibitions of society, such that they experienced a more or less constant state of sexual frustration which resolved itself in peculiar ways - sexualizing nonsexual situations. The authors suggest that much of the early objections to Freud's theories were in effect a cultural phenomenon, attempting to suppress sexuality by castigating a figure who suggested that the suppression of sexuality was at the core of societal problems.
(EN: In fairness, Freud was a bit of a low-life. His early studies into hysteria read like the diary of a creep who hangs around at parties attempting to seduce women who are emotionally distraught and his single-minded fascination with sexuality to the exclusion of any other cause of trauma is fairly extreme. At yet, his contribution to the field is worthwhile, and it's likely the salacious nature of his obsession that drew consternation - there are scientists who spend their entire professional lives giving an inordinate amount of attention to one species of bug who are not considered to be perverse, but yet are so attentive to one species that it skews their perception of the ecology. Freud's sexually-focused approach to psychology may be the same - if you set aside the discomfort with the topic of sex, it is still a very narrow focus that ignores other causes of dysfunction that may be more accurate.)
Setting aside the character of Freud himself, the practice of psychotherapy has had a significant impact on psychology in the modern day: most therapists use "the talking cure" to some degree, if only in diagnosis of a patient.
In particular, the theory of transference has had a wide impact: the notion that a patient suffers from a dysfunction because they mistake the cause or source of their distress. In effect, a bad connection has been made: a person who has suffered a trauma places the negative emotions on an incidental detail. For example, a child bitten by a dog while riding a bicycle may associate their pain to the bicycle rather than the dog, and develop a fear of bicycles.
Transference is particularly a problem with the individual's desire to escape culpability: an individual who fails to win employment may wish to blame the interviewer, or the color of his own necktie, or something his father said to him in childhood, rather than accepting his lack of qualifications as the reason he failed to receive an offer.
Very often, transference is related to a childhood incident in which an individual suffered pain or humiliation, and as a result has adopted associations or modes of thinking that cause them distress in situations they perceive to be similar.
It's also noted that psychotherapy is often voluntary, and is sought by individuals who are frustrated at their inability to achieve goals related to their professional advancement or personal relationships with others. Specifically, it is not that a person's behavior causes loss, but prevents them from gaining. It is a matter of motivation to succeed.
At its core, the problem of transference deals with relationships - the way in which a person behaves, or refuses to behave, that cause him to fail to achieve the benefits of interacting with others.
Forms of Therapy
The authors assert that there are "several hundred forms of psychological therapy," most of which involve speaking with a therapist whose suggestions are tailored to adjust cognitive factors: the way in which a person perceives, analyzes, and is motivated to act. Given the wide array of therapeutic techniques, the authors will discuss a small sample of specific approaches.
Experiential Therapies
Experiential theories subject the patient to activities in order to elicit information. Role-playing is a common example, in which a patient is asked to act out a situation or speak as if they are having a conversation with another person - they can also involve more elaborate games and scenarios in which the patient is given a goal and the therapist observes the way in which they behave. It can be argued that psychoanalysis itself is a kind of experiential therapy, in that the interaction with the therapist simulates the conversation a patient might have with a trusted friend.
The central idea of experiential therapy is that the patients emotions have been suppressed or distorted in ways that the patient feels are appropriate, either to the identity he wishes to project or the way he wishes others to perceive him. As such his actions are contrived and unnatural to suit what he assumes to be the expectations of others. In essence, such a person is invalidating his own authentic self.
The failure to express oneself in a genuine manner also leads to the suppression of emotions - a process that causes frustration and prevents catharsis. That is to say that a person who suppresses his desires does not fulfill them, nor do the desires cease to be of concern to him - they are constantly there, constantly unfulfilled, and this results in constant agony.
It is also typical in this sort of therapy for the bottled-up emotions to be released dramatically: patients have bouts of anger or crying jags as the emotions they have suppressed come to the surface. Once this has occurred, the more sober and deliberate process of recognizing and dealing with emotions can occur. The net result is a change in perspective, resulting in a change in behavior.
In effect, the catharsis experienced in the context of therapy is itself a traumatic event that has the potential to reshape the way that the individual perceives, thinks, and feels ... and as a consequences, it influences the way in which they behave and the results they achieve in their daily life.
Behavior Therapy
Another approach to therapy provides a behavioral model for individuals, suggesting specific measures they can take in real-life situations that cause them distress.
A common example are the behavioral therapies that attempt to coach an individual with pronounced phobias to confront the cause of their anxiety. Once the cause of fear is identified, the behavioral therapist coaches the patient - first to maintain their mental tranquility, and then slowly to confront and interact with the cause of their fears. In extreme instances, hypnosis is used to enable the patient to overcome their panic.
The process is gradual, such that the patient can moderate the amount of stress they experience. For example, an agoraphobic patient might begin by standing in the foyer before an open door, then to standing in the doorway, then to standing on their porch, etc., until they have gradually developed the ability to leave their home for extended periods of time.
Behavioral therapy has evolved into a myriad of practices and techniques, but generally involve the process of exploring and understanding emotions, and then gradually modifying behavior.
Cognitive and Cognitive-Behavioral Therapy
Cognitive therapy is a recent development, pioneered in 1976 (Beck) as a "modern descendant of the Stoics' philosophical cure for the soul." It encourages patients to set their emotions aside and consider incidents rationally - seeking to mute the emotional overtones.
The core of this theory is that thoughts and emotions are separate things, and that thoughts cause emotions. If a person can recognize what they were thinking in a given situation, they can better understand the reason behind their emotional reaction - and if they can condition themselves to recognize and arrest thought patterns, they can prevent undesirable emotions from occurring.
While the approach is controversial, statistical studies suggest that cognitive therapy has a success rate that is comparable to that achieved with antidepressant drugs. As a result, there has been strong support of cognitive therapy as an alternative to pharmaceutical approaches.
Family Therapy
The traditional approach to therapy considers the emotions of the individual, and attempts to equip the patient to deal with his emotions on his own. Family therapy brings an entire household into the treatment process, recognizing that people interact and react to one another, such that changing the behavior of one individual can have a positive effect on others.
Statistically, there is strong evidence that a turbulent domestic situation is correlated to higher incidence of psychological disorders, and anecdotally, there is significant evidence that even when there is tension in a marriage without open strife, it affects the psychological development of the children.
Aside of the approach of dealing with the family as the basic unit of treatment, there are a myriad of techniques that can be utilized to treat people in groups or as individuals: psychoanalysis, behavioral, cognitive, and even pharmaceutical techniques may be employed.
Statistics based on a study of 90 families that engaged in group therapy (Hogarty 1986) demonstrate that this approach can be highly effective, in that those who are treated as a social unit demonstrate more rapid and lasting progress.
Emotions as the Center of Psychotherapy
Emotions have a central role in psychotherapy, though there is some uncertainty as to whether the emotions are themselves the problem or merely a symptom of a more functional issue.
It is suggested that motivation is central to many psychiatric disorders: it is not a matter of knowledge or rational thought: a person knows what out to be done and recognizes the need to do it, but simply does not feel like doing it. Until this barrier is overcome, treating perception and cognition is of little use.
It is also noted that emotions have a great deal to do with habitual patterns of behavior: people tend to do things that lead to success and avoid those that lead to failure and the degree to which a prospect assesses the outcome and risks is often based in emotion rather than logic.
Finally, where emotions are disjointed from their causes, they can appear as "vague but disturbing disquiets." Part of the task of therapy itself is to gain a better understanding of emotion to reduce the distress that results when it is experienced.
Does Psychotherapy Work?
General opinions of psychology wax and wane, but the typical perspective on psychology in general is dour, regarding it as a pseudoscience at best, and exploitation at worse. However, there is significant evidence that psychological treatment actually does work.
While a positive outcome is not certain fro all patients, there have been many hundreds of well-designed studies that establish its effectiveness with a statistically significant number of patients. In a broad analysis of nearly 500 studies (Smith 1980) it was concluded that patients who receive therapy showed a higher degree of improvement than 80% of the subjects in control groups.
The authors are quick to admit that not all therapy is effective, nor are all therapists helpful. Their success rates vary. A study (Orlinsky 1980) of 23 therapists remarked that the best six effected "improvement" in 86% of their patients - whereas the five worst therapists had success rates below 50%, and made 10% of their patients' conditions worse.
Psychotherapy Without Professionals
One of the most disturbing trends is the increase in the availability of "therapy" from counselors who are not recognized as competent. However, this seems inevitable: considering the percentage of of the (American) population who suffer from disorders of anxiety or depression, in light of the number of trained and accredited therapists, and the outcome is that even if every patient with a disorder were to seek treatment, only about a fifth of them could be served.
The author speaks of group methods of therapy, in which a number of patients (from a small group to a few dozen) may be involved - this approach has generally been found to be effective in instances in which the group was moderated by a legitimate therapist, and less so when the moderator was a recovered patient who merely guides others by his own experience.
There is a considerable issue of non-professional treatment, both for individuals and groups, by unqualified counselors. Whether they have therapeutic aims are an alternative motive, they operate well outside the bounds of accepted psychiatric and psychological practice - and are more akin to religious cults than to therapy groups.
However, the mere act of socializing and discussing issues with groups of people in an unscientific manner is not necessarily harmful. Prior to the emergence of psychology as a science, emotional issues were often addressed in a religious setting - administered by a minister, rabbit, or priest with the support of fellow members of the congregation. The outcome, while unscientific and somewhat haphazard, has generally been positive and at least marginally effective.
(EN: My sense is that the notion of psychotherapy can be considered in an even more informal setting: human interaction itself. The friends and family of an individual provide a support system for his emotional well-being and have long provided counseling - is not the psychotherapist a surrogate for a trusted friend or family elder? And given that psychology arose in the industrial age, perhaps the need to pay a stranger to perform this service is something of a comment on the fractured state of current culture?)
Emotional Consciousness and Culture
Emotions are considered to be instantaneous reactions to external stimuli, but over an extended period of time they become moods and character traits - components of mentality that inclines an individual to perceive and interpret things in a given way, and to be motivated to act accordingly. In an individual this is their unique personality - but when emotions are commonly experienced and expressed among a group of people, they become culture itself.
As human beings, we are conscious of our own emotions, and evaluate them. We consider certain emotions to be functional, desirable, and proper - and others to be dysfunctional, undesirable, and improper. Understanding our emotions is critical to shaping our own character, and being able to communicate to others the value we place on certain emotions is critical to shaping culture.
Governance of culture has been overtly effected by the encouragement or prohibition of actions, whether by a formal system of government, religious institutions, organizations, or individuals. Law, dogma, education, rules, and advice explicitly concern themselves with behavior and sometimes, but not necessarily, consider the values upon which specific actions are encouraged or discouraged. Values, however, are rarely explained and more commonly based on feelings, that are not often based on logic (though logic is used to justify emotions in arrears).
The area of a culture that deals with emotions is the arts, which explore and communicate emotion itself - perhaps in a subtle or oblique manner. And it is through the arts that culture attempts to define itself and communicate in direct terms about the emotional aspects of human existence.
Emotions in Literature
Literature is the art that most directly explores human thought and emotion, in the ability of words to describe not only human action, but to get inside the minds of the characters to demonstrate to the reader what an individual is thinking and feeling that motivates them to behave in a given way, to show the connection between emotion and behavior, and to show the consequences of the behavior itself. The dramatic element of story is conflict, and conflict is typically emotional in its origin.
In that way, literature is a means of modeling emotion - the reader understands a character, and can use this as a model for his own thoughts, feelings, and behavior. Literature teaches the reader to admire the hero and revile the villain, and at the same time to understand and pass judgment upon the emotions these fictional characters represent.
The earliest literature of many cultures are tales that address emotion in a very overt and primitive way: the hero of a folktale, saga, or myth clearly embodies certain values that are just as clearly presented with the expectation that the reader will admire and emulate such qualities.
The reader will and compare himself and others in the real world of his experience to the characters of literature, and be mindful of the outcome of the choices these characters made when faced with a real-world choice that seems similar or analogous. In that way literature models not only proper action, but proper values and emotions that underlie proper action.
From the perspective of the storyteller, crafting a tale is akin to education - whether it is his explicit intent or not, his story teaches others about values and emotions - and his story is accepted and retold if others find these values and emotions to have value.
On a societal level the stories that gain popularity, such that they are widely known and disseminated within a culture, are those that reflect the emotional values of a culture. They are a means of sharing information about what is considered to be right and wrong to serve as models of behavior and interaction.
Emotions in Art
The authors make the mistake of lumping the visual arts, music, and poetry into a single category of "art" - and as such do rather a sloppy job of describing how art in general portrays emotions in general.
(EN: Because it's so slipshod and piecemeal, it is not adequately clear and I am not taking notes except to suggest the basic premise is similar to that which they describe of literature - the difference being that non-narrative forms of art are less directly linked to action. That is a painting, poem, or piece of music may explore an emotion in an of itself, or may draw a connection between something that is depicted and the emotions that are or should be associated to it.)
Emotions in Drama and Ritual
The authors then consider theater as a venue for depicting emotions, though drama tends to omit the internal motivations of the actions depicted except in the instances in which an actor performs a soliloquy to disclose his internal state.
Drama was heavily used heavily in the middle ages by religious denominations in the form of morality plays, that modeled positive or negative emotions as an explicit means of teaching lessons to an audience, in the manner of a sermon. Secular drama likewise depicts behaviors and motivations and suggests to the audience the consequences of actions by way of modeling behavior.
(EN: A professor of mine described acting as applied psychology - whereas a psychologist addresses behavior buy diagnosing the thoughts and emotions of his patient, the actor begins with the actions of the character, considers the motivation behind them, and translates these into behavior that he will intentionally model.)
(EN: This also brings to mind the contribution of the actor to drama, who is given his lines by the playwright, but is left on his own to develop a depiction of the character who speaks them - it is in this way that a performance of a play or a remake of a movie has its own character in the context of the culture in which it is performed, which may be in a different place and time than the original script was written.)
As with literature, drama presents us with heroes and villains whose character is meant to be emulated or reviled, and whose actions teach lessons to be considered in real-life situations that are similar or analogous to those depicted in art.
A Culture of Understanding
The authors stroll through history a bit, depicting a path of evolution in both philosophy and art that suggests an evolution toward a culture of understanding - in which individuals who are taught and entertained are not merely absorbing what is offered them, but are expected to participate in the experience: not merely to obey principles or admire depictions, but to understand their underpinnings.
(EN: This seems a contrived. The degree to which the recipient of any message, be it a written law of a piece of literature, is expected to apply himself to understanding the intent of the author and considering the broader context has waxed and waned over time. While the nineteenth and twentieth centuries did seem to be linear in that they expected individuals to be more independent and circumspect as citizens and audiences, this has not been a continuous trend, but one that waxes and wanes through different eras and different cultures.)
The authors depict, with some derision, the regression of intellect in the late twentieth and early twenty-first century, particularly in the medium of television which seems to have grown progressively less subtle or thoughtful, and the arts in general have shed much of their underpinnings to become mere spectacle without any consistent basis.
Drama in the modern age still evokes emotions, and has become more sophisticated in the means by which it does so, but there seems to be little relevance to real life. Entertainment has become likened to junk food, a temporary taste that evokes pleasure but has no nutritional value, such that an entertainment experience ends when the show is over, offering nothing to the audience to consider in terms of their own experience outside of the venue.
If the entertainments of the present day are considered as reflections of our culture, then it would seem reasonable to conclude that as a society we are, perhaps, in the waning years of a period of discovery and progress, and possibly even in its wake.