Cities without landmarks
Niagara Falls, U.S./Canada
A few years ago I went shopping for a therapist. I visited several psychoanalysts, a psychologist with a second Ph.D. in sociology and a highly recommended woman with an MFCC. I explained to each of them that though I had few big problems, I wanted to become more courageous.
“What makes you think you’re not courageous?” they invariably asked. “Did someone tell you that?” Sooner or later they had me talking about all those past experiences that taught me to perceive myself as cowardly. I was trying to build a new positive character trait; they insisted on pathologizing this endeavor as a sign of low self-esteem. Eventually I abandoned my search and started taking hip-hop dance classes instead.
But if Martin E.P. Seligman has his way, therapy might yet become a discipline aimed at helping people become braver, stronger or happier. Seligman has recently called for the beginning of a movement he’s dubbed “positive psychology” — a humanistic, optimistic theory that challenges some of orthodox psychology’s deepest assumptions about how the mind works and how we ought to heal it. When Seligman, author of “The Optimistic Child” and “What You Can Change and What You Can’t,” took over as president of the American Psychological Association in 1998, he immediately began a campaign to change the face of that pathology-hungry discipline. He discussed his vision in an article in the New York Times; he spoke at conferences; he even invited 25 graduate students to a week-long retreat in Mexico (planned for January 1999) to groom new leaders of the movement. Declaring the theme for the American Psychological Association’s annual conference this August in San Francisco to be “Prevention: Promoting Strength, Resilience, and Health in Young People,” he professed his hopes that psychologists could finally focus on learning how to prevent the illnesses they have spent the last 50 years attempting to cure.
Freud never imagined making people happy to be part of the therapist’s job description. The point of psychoanalysis, he once wrote, was to transform neurosis into “ordinary unhappiness.” He acknowledged the centrality of the desire — in “Civilization and Its Discontents” he noted that most people “strive for happiness; they want to become happy and to remain so” — but simply denied that it was realistic. “One feels inclined to say that the intention that man should be ‘happy’ is not included in the plan of ‘Creation.’” Methodically dissecting different sorts of pleasure to expose their weaknesses, he drew a bleak picture: Sex is ephemeral, beauty but “mildly intoxicating,” romantic love makes the subject especially vulnerable to suffering and the inner peace achieved through yoga is merely the “happiness of quietness” induced through a form of “coanesthesia.” In two concise sentences, he summed up our sorry fates. “Unhappiness is much less difficult to experience. We are threatened with suffering from three directions: from our own body, which is doomed to decay and dissolution … from the external world, which may rage against us with overwhelming and merciless forces of destruction; and finally from our relations with other men.”
Freud’s emotionally pessimistic, intellectually vibrant worldview has lived on in psychology’s adoption of the medical model — a model he both embraced as a source of scientific authority and ignored when it hampered his creative verve. Now, however, that model has come under increasing attack — and Seligman is one of its most articulate opponents. Speaking to a packed house at the APA conference, Seligman critiqued psychology’s increasing reliance on this essentially negative approach, arguing that since World War II psychology had narrowed from being a discipline that cured mental illness, improved people’s lives and nurtured their talents to one dedicated almost exclusively to pathologies. Calling for a psychotherapeutic practice focused on “nurturing what is best within our selves,” he explained the motivation for this paradigm shift in grand historical terms. On the one hand, he said, our nation is experiencing a period of unprecedented peace and prosperity; on the other, studies show that individually we’ve never been so depressed. It was high time that psychology learned to nip the spread of mental illness in the bud, he contended, rather than continue to try to chop down one forest of misery after another.
Although learning to be optimistic may seem like a bold new idea in research psychology, America has been swimming in such notions ever since Norman Vincent Peale wrote “The Power of Positive Thinking,” which gave birth to the current self-help movement. Now Seligman is breathing scientific life into Peale’s shopworn Christian message.
Just how influential his ideas are is hard to say. His cognitive, get-in-and-fix-it approach certainly has its backers: Even at an APA panel on “Terror Management Theory” — a classically morbid field of study — a wild-haired man named Tom Pyszczynski from the University of Colorado at Colorado Springs suggested that terror management could benefit from drawing from more positive, humanistic theories. But most of the psychologists I interviewed, even at the conference, had only the vaguest awareness of Seligman’s ideas. “Therapy all comes down to individual practitioners,” a psychologist friend said after I told her about Seligman’s theories. “Each one of us must create our own theory. I’m busy reading the tomes from 100 years ago, I don’t have time to follow every blip on the scene.”
Seligman may not be as influential as a Donald Woods Winnicott or an Alfred Adler, but he’s more than a blip. For the past three decades Seligman has been conducting research on animals and humans that has garnered broad attention from popular as well as academic circles. Best known for his work on helplessness, in which dogs subjected to electric shocks gradually lost their wills, he then went on to apply these ideas to human studies. His theoretical orientation tends toward a cognitive and behaviorist model, which focuses on learning processes and conscious thought rather than life narratives and the unconscious. In clinical practice, the cognitive/behaviorist client learns to rethink or re-experience an emotional problem and thereby solve it, often in just a few sessions. This orientation has gained more credence in the past decade, as a growing body of evidence shows that for certain afflictions, cognitive and behaviorist techniques are both more effective and cheaper than long-term therapy.
Seligman’s research on depression over the last three decades has led to surprising conclusions — ones that call into question the two most common explanations given for depression. Unlike psychopharmacologists, who treat depression — whatever its origins — as a biochemical imbalance, or psychotherapists, who treat it as a result of bad experiences, Seligman has posited another theory. What if “negative thinking,” which most therapists would construe as a symptom of depression, is actually its root cause? Seligman also found that positive thinking, or optimism, a mind-set that he claims has been shown to make people happier and more successful, can be learned, a proposition he set forth in his popular 1991 book “Learned Optimism.”
Many psychologists and psychiatrists schooled in psychodynamic therapy, in which an intimate bond between psychologist and client is central to the work, are leery of embracing the cognitive model. “I’m not a great fan of cognitive therapy, but my lack of enthusiasm is not scientific,” says Peter Kramer, author of the bestselling “Listening to Prozac.” “There is lots of evidence that it is effective for lots of disorders, but I have an aesthetic problem that it doesn’t seem deep enough. As a doctor, that’s a pretty odd thing to say, I realize. But there’s something about both the biological model and the psychoanalytic model that has a kind of depth to it.” Many psychologists I spoke to echoed Kramer’s concerns with the limits of these theories, although almost all endorsed Seligman’s call for a less pathological framework and a focus on prevention.
“I agree with him so far as prevention is concerned,” says Marsha Levy Warren, author of “The Adolescent Journey: Development, Identity Formation, and Psychotherapy.” She contends that prevention is already an increasing concern for many researchers and has been since the ’60s. “We are learning to intervene at earlier and earlier ages in the action between caregiver and infant,” she says of her work with children. “And this proves to be preventative.” But after years of personal confession, dream interpretation and reassembling complex family narratives, many psychologists are loath to embrace the simple — some might say shallow — pragmatism of cognitive methods. “Cognitive methods work for isolated problems like panic attacks or phobias,” says Debra Rosenzweig, a clinical psychologist in New York City. “But I’ve never had a client come to me with so specific an ailment. Long-term psychotherapy is still the best way to help people with depression and other borderline personality disorders.”
Seligman’s positive — and positivist — views are just one trajectory on a larger movement away from psychology’s psychoanalytic framework. Perhaps the apogee of that swing came this year with the publication of Judith Rich Harris’ “The Nurture Assumption,” which attacked one of the foundations of the psychological narrative: the idea that parental behavior has a lasting effect on the adult personality. Harris, an ailing, undoctored grandmother whose controversial ideas have put her on a fast train to fame, fortune and notoriety, spoke at the APA to a packed house of grimacing faces. Her paper “Don’t Blame Your Parents” set forth the thesis of her book: that the adult personality arises from two primary influences — our genes and our peers. Even in the case of child abuse, she maintains, there’s no data to prove its permanent influence on the adult personality.
An outsider to psychology who was once kicked out of graduate school, Harris has been easily dismissed. But Seligman, in his 1994 book “What You Can Change, and What You Can’t,” posited a very similar argument. Although he takes no stand on the issue of peer influence, he does argue that studies of separated twins and adopted children (the same literature Harris draws from) contain no evidence that childhood traumas lead to adult troubles. “If you want to blame your parents for your own adult problems,” he writes, “you are entitled to blame the genes they gave you, but you are not entitled — by any facts I know — to blame the way they treated you.” On the issue of catastrophic abuse he’s somewhat more relenting than Harris. “Traumatic events, like brutal sexual abuse, exert destructive effects on later life,” he writes. “But childhood trauma is not more destructive than adult trauma. If anything, children heal better than do adults.”
The ebb and flow of psychological theories are as constant as the tides. But is it any accident that Seligman’s call for prevention and positive thinking — which are much quicker and cheaper than in-depth therapies — coincides with the greatest economic crisis the discipline of psychology has ever faced? Even if many psychologists won’t accept Seligman’s message, it’s interesting to note that most managed care companies would probably eagerly endorse it.
With the rise of managed care, fewer therapists can count on insurance companies to make their services affordable to patients. Psychotropic drugs like Prozac and Zoloft have also undermined psychology’s corner on the market of less-than-crazy clients: In 1997, there were 10 million prescriptions for Prozac and 65 million prescriptions for antidepressants.
And psychology has other sources of competition, too. When Seligman called for psychologists to “nurture” those things “that make life worth living” in his opening address, it all sounded oddly familiar. We were in San Francisco, after all, a seething nest of body-based therapies, shamanic workshops, self-help programs and Eastern spirituality. And while psychologists have been diagnosing the worried well with psychiatric labels, New Age practitioners have bypassed the techno-medical jargon and promised the world on a lollipop. Happiness, wealth, creativity, enlightenment, sensual pleasure and communication with our inner children, the dead and even household pets are among the highly touted benefits of these ingenious new therapies. Such approaches also tend to be cheaper and often stress the importance of prevention over crisis intervention, an approach to health that Western medicine has only grudgingly begun to adopt.
Now these New Age therapies are increasingly encroaching on the most hallowed part of a psychologist’s turf — the face-to-face encounter between the psychologist and client. Philosophers, yoga teachers and meditation gurus have begun to borrow this therapeutic forum and to make money from it. The January/February 1997 issue of the Utne Reader was devoted to new therapies. Recently I’ve watched several friends replace traditional therapists with Buddhist monks or massage therapists or unconventional career counselors.
Faced with the triple challenge of managed care, pharmaceuticals and new alternatives to traditional shrinkage, Seligman’s vision may prove not only to be a rosy one, but a shrewd one as well.
The brave new world of managed care has already forced many therapists to change their approach to their careers. “Like most psychologists, I had actively and eagerly allowed myself to be seduced [by insurance reimbursement],” says Dana C. Ackley, author of “Breaking Free of Managed Care.” When managed care came to his town, Roanoke, Va., he responded first with denial, then depression. Then, after an unsuccessful attempt to fight it politically, he set about to transform the very nature of his practice and move away from the medical model in literal as well as conceptual terms. Now he says that 90 percent of his patients choose to pay out of pocket for his services — once they understand just how the confidentiality and control of their therapy will be affected if they don’t.
“Third-party reimbursement has some very serious problems,” he says. “For one thing, most therapists don’t use the medical model of psychiatric illness in the practice itself. It’s generally a poor model for the work we do. But in the end, therapists have to refer to the Diagnostic Statistical Manual and choose a diagnosis from there. Because that’s how they get paid.”
Ackley asserts that while psychology’s collaboration with the medical establishment has given psychologists a free ride, it’s also scared away many potential clients. “The more you move outside of the medical model, the more receptive people are. Many people who would benefit from therapy don’t want the stigma of mental illness on their records.”
He believes those teaching at current graduate programs are gradually working themselves out of a job. “Soon the field as we know it is going to be extinct — especially since managed care prefers lower-priced master’s degrees.” He wishes these programs would begin to help their students learn how to market themselves and position their practices in the real world. “Some of our colleagues are comfortable in managed care, and that’s fine, I don’t begrudge them that. But what troubles me sometimes is that I feel like the guy from Plato’s allegory of the cave — when I say there’s this beautiful world out there, they answer, yeah right.”
In his keynote address at the APA conference, Daniel Goleman, author of “Emotional Intelligence,” sounded a similar note of optimism and took it one step further, encouraging psychologists to find new markets for their work in schools and corporations. A good many panels were devoted to such career changes — among them were five symposia on dealing with managed care, two workshops on becoming a business coach and a continuing education workshop on alternative medicine. A panel “Opening the Door to New Markets — What, Where and How!” promised papers with can-do advice like “Prosperity for Independent Practitioners: It Can Happen!” and “Psychotherapy Outreach for New Markets: How to Make it Happen.” There were even a few panels on how to get out of psychology altogether. One that I sat in on offered the most depressing spectacle of the conference by far. Steve Swavely, a pale man with slicked-back hair, recounted his transformation from a psychologist into a successful financial advisor, listing all the ways he had put his psychodynamic training to use in his new career: good people skills, assessment skills, understanding the needs of others. While he exhorted the audience to “keep an open mind,” they stared back — eyes glazed as baked hams.
Peter Kramer, the “Listening to Prozac” author, agrees that there are serious financial reasons for psychology to reinvent itself. “Social workers are cheaper and psychiatrists can prescribe drugs and there are a lot of talented psychologists who are extremely underused,” he says. But he’s especially wary of psychologists breaking with the medical model and refashioning themselves as experts of positivity. “You enter into very murky territory,” he says. “How can they have a special standing on the good life?” All in all, he wishes that psychologists could keep working as they do: “There is plenty of mental illness out there — it’s extraordinarily undertreated. I would prefer that the health system reinvent itself rather than psychologists feeling they must reinvent themselves.”
Last week a psychologist friend and I argued about the value of long-term therapy. Drawing from his seven years of training, four years in psychoanalysis and three years in private practice, he spoke of its complexity, intimacy and depth. I argued that it was a socially acceptable cult. My basis? Years of watching mentally healthy friends pour money down a drain to talk about their feelings ad nauseam. Some friends definitely emerged sweeter and more stable (possibly due to natural maturation). A few became therapy addicts who lost friends and alienated people with their inane psychobabble. But most came out the same wonderful, flawed people they’d gone in.
But these observations of mine are meaningless. I can’t judge the subjective texture of their happiness any more than they can decide that my chipper demeanor — maintained by a cognitive/behaviorist diet of optimism, exercise and masochistic attempts to be creative — is a pathetic imitation of their hard-earned contentment.
It all comes down to the struggle between depth and surface. How do we imagine the psyche’s playground? Is it a shallow sandbox or a Gaudi-esque jungle gym? For Freud, it was a place of such deep, impenetrable space, the individual needed a box of conceptual keys, a trained locksmith and years of jiggering to open the doors and glimpse its terrifying beauty.
Peter Kramer’s “aesthestic” distaste for cognitive theories issues from this appreciation for the artistic complexity of our souls. Cognitive and behaviorist theorists like Seligman take people’s desires and testimonies at face value. In investing in the truth of surfaces, they address psychological problems in order to solve them, not savor them. In “What You Can Change and What You Can’t,” Seligman invokes the image of psychic depth as a way of explaining why certain characteristics are relatively easy to change while others — the deeper ones — resist all forms of therapeutic intervention.
Seligman’s notion that different afflictions are best treated with therapies aimed at different stratospheres of the psyche suggests there’s a way out of the debate altogether. Who knows, someday therapists may be trained to tailor their work according to the kind of happiness you are seeking — whether it’s the sublime, inward contentment of “Middlemarch’s” Dorothea Brooke or the rabid glee of a Nike spokesperson screaming, “Just Do It!” Or maybe we’ll learn to identify our needs at a certain gradient of psychic depth and receive custom-designed therapy from a variety of methodologies. But of course, that’s what’s already happening in the offices of thoughtful therapists across the country.
At a panel called “Spiritual Intelligence,” I got a glimpse of one version of that new future, where scientific research and ideals of spiritual growth collide in a psychology of wisdom for the masses. In his paper “Art and Science of Wisdom,” Roger N. Walsh, a Ph.D. and M.D. from the University of California at Irvine, outlined the psychological characteristics of wise people. Frances Vaughan, a Ph.D. from Mill Valley, Calif., listed the “well-mapped set of technologies” leading to wisdom in seven psychological steps. Such formulations may sound cheesy and pre-fab, but they didn’t after five days of listening to academic psychological jargon. Maybe they are the first baby steps of a science of the soul that integrates its various rivalries and sets about looking for the truth.
Speaking last, Michael Mahoney, from the University of North Texas, offered the best argument I had heard yet for psychology to transcend its medical trappings. “This is the most complex profession in the world,” he said. “Every aspect of your personal life feeds your work. Life is inconceivably precious; death is certain … and psychotherapy can be both a spiritual practice and a service.”
Carol Lloyd is currently at work on a book about the gentrification wars in San Francisco's Mission District.More Carol Lloyd.
Niagara Falls, U.S./Canada
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