Wednesday, April 27, 2005

What A Concept !

Believe me, this kind of thing really irks me, too. It gives Psychiatry and Psychiatrists a bad name. It seems that more and more "therapy" offered to the public by so-called "professionals" simply has as its goal the creation of a new subclass of victims.

Once you create the new subclass (e.g., women abused by their female bosses; upset parents whose kids are out of control; students who get bad grades (oh, the trauma!) by mean teachers; political parties that lose an election; Albino farmers with sensitive skin) you can milk it for all it is worth, to gain sympathy and understanding from all--and, of course, some sort of recompense for your suffering. Victimhood Rules! You are not alone! Your suffering was CAUSED by SOMEONE or SOMETHING! YOU ARE NOT TO BLAME! IT'S SOMEONE ELSE'S FAULT.

The key point [and probably the main attraction] to such victimhood therapeutics is that YOU don't have t change. It's not YOUR fault! Blame is carefully placed on external factors and the goal is to find a way to make those external factors change! Taking a pill. Or, passing a law is always a good idea, if you can get a large number of people to buy into your victimhood. Even better if you can file a lawsuit! Then you can be a rich victim.

I hear it over and over again. It's. Not. My. Fault! I will accept that they feel that way and even empathize. I even believe that there are physiological correlates in many cases. But part of my job is to help them to see that often (not always--but often) they actually have quite a bit of control over what happens to them in the world. That they have made some CHOICES that have led to the situation they are in. Now they are in a position to make some NEW CHOICES--if they really want to change things.

There are a lot of people who are truly at the mercy of forces outside their control. Children, for example. People caught up in natural disasters or accidents. Those who have severe biological vulnerabilities. But even in those cases, people can make some different choices.

The unhappy reality is that most members of the victimhood clubs only feel that they cannot control events. Typically, they can make important changes in their life that would alter their circumstances, but for various reasons have chosen not to.

It is a poor therapist indeed, who, having empathized with the feelings of helplessness on the part of their patient--never helps them to take responsibility for their behaviors. This is one of the problems with "pop" psychology. Besides oversimplifying the underlying psychological theories and rendering them rather meaningless; they often stop at the "feeling" stage (it is OK to have these feelings) and neglect the next--and equally, if not more important phase of therapy (YOU are responsible for your own life. YOU are the one who must take steps to change things).

People generally don't have much control about what they feel--emotions are fundamental physiology. BUT THEY DO HAVE CONTROL OVER HOW THEY BEHAVE. This is called Personal Responsibility.

I urge you to read this post on RESPONSIBILITY from ShrinkWrapped.

As I have pointed out to patients on many occasions: When you do not know why you behave the way you do, or feel the way you feel, you can not change anything. It is only once you understand why you are feeling the way you feel and why you do the things you do, that you have the choice of changing the behavior that causes you, and others, grief. In brief, the goal of psychoanalysis is to enlarge the area of mental life, feelings and behavior, that a person can take conscious responsibility for.

ShrinkWrapped is speaking as a psychoanalyst (a special type of psychotherapist), but all psychotherapy has a similar goal. Psychoanalysis works to change the deeper character structures and hence behavior. It is very intense and often goes on for a long period of time. But even psychoanalysis doesn't always work. One professor I remember during training, who was himself a psychoanalyst used to say, "Sometimes when you take a schmuck and analyze him, all you'll get is a well-analyzed schmuck."

Remember that old joke? How many psychiatrists does it take to change a lightbulb? Just one. But the lightbulb really has to want to change. Like all good humor, it hints at a fundamental truth that isn't ofen acknowledged.

Psychotherapy is a two-way street. No matter how brilliant the therapist, the person in therapy basically has to want to change.

All effective psychotherapy has the goal of changing behavior. And works by helping people --who want to change and take control of their lives --learn to take responsibility for their thoughts, feelings and behaviors.

What a concept.

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