Privileging Individuality: The Psychotherapists’ Sacred Duty

(Bolstered by Soren Kirkegaard’s lament that “ours is a paltry age because it lacks passion,” Dr. Alan Karbelnig writes this regular column to provoke thoughtful reaction from his SGVPA colleagues. He has been a member of SGVPA since 1988, served as its president in the early 1990s, and chaired its Ethics Committee for 15 years. Alan is a Training and Supervising psychoanalyst at the New Center for Psychoanalysis and the Newport Psychoanalytic Institute. He practices psychoanalytic psychotherapy and forensic psychology in South Pasadena.)

If you view psychological conditions as distinct “disease” entities, then you likely appreciate the existence of cognitive behavioral psychotherapists. They develop skill in categorizing aspects of human experience that comport with DSM IV disorders. They identify empirically validated mechanisms for treating such psychiatric entities. They research and publish studies on the effectiveness of their interventions. But even the most conservative cognitive behaviorists would not consider their approaches to be holistic, to involve the “whole person.” Instead, although they might use kinder words, they treat their patients like some variation of machines that, after some thought-adjustments, can be returned tranquilly to society.

Psychodynamic practitioners, in contrast, listen to the persons who consult them as whole beings, as sentient subjects. They realize that, whereas persons might seek help for “erectile dysfunction,” psychotherapy sessions may uncover more global relational difficulties. They understand that, whereas other persons might present with “depression,” the therapy encounters might reveal a profound disinterest in their life work, or previously unknown conflicts with their family or friends. Similarly, they might help persons with “anxiety disorders” discover that their nervousness betrays an insufficient sense of identity, meaning, or emotional security. All of these underlying subjective themes can become altered through the structured interpersonal process called psychoanalytic psychotherapy.

Despite their various inter-school conflicts, these psychodynamic practitioners share a focus on individuality. To one extent or another, they find guidance in the pursuit of what psychoanalyst and philosopher Jacques Lacan called the subject (who the person really is) rather than the ego (who the person thinks he or she is). This search for the subject is nothing less than a sacred duty, particularly in view of contemporary society’s near-destruction of individuality.

This threat to distinct personhood becomes readily evident when watching late night television. As you have likely witnessed yourself, television commercials pawn medications for every “ailment” – physical, mental, or cultural. They display actors showing a range of emotion, from sadness to nervousness to excitement to exhaustion; they then name these as depression, anxiety, mania, or fatigue; they then suggest that your doctor can provide you with the Lexapro, Xanax, Lamictal or Provigil to eliminate these “disorders.”

The process of naming various mental states, and even identifying them as abnormal, begins in earliest childhood. We are inculcated into the mythology of our families – regardless of our true natures. If the family values education and we struggle academically, then we are sent to tutors, offered special remedial materials, and shuffled off to private schools. If mild, compliant behavior is sought, and we are intense by nature, then we are referred for special education, or perhaps given psychoactive substances to modulate our passions.

Once we leave the family home, we become immersed in a more intensive, all-encompassing propaganda program. The mass media encourages the atrophy of all critical thinking abilities. We are barraged with information defining our experiences. We are told what bodily smells are bad, what behaviors are problematic, and what habits are self-destructive. These mass informational campaigns severely damage individuals’ capacity for finding themselves.

In contrast, psychodynamic psychotherapists focus more broadly on the search for individuals’ desires, feelings, thoughts, attitudes, memories, and dreams. They help the individuals who seek their assistance to find the meanings contained therein. As such, these practitioners will always be ill-equipped to target “diagnostically regulated groups.” They will always fit poorly into the evidence based medicine model. Their work towards the liberation of human individuality – ironically just like individuality itself – will never be subject to neat packaging comparable to “the little blue pill.” While the clarion calls for scientifically-based approaches dominate the popular discourse, these professionals will quietly continue to pursue meaning and individuality – features of the human experience that defy categorization and therefore measurement.