Re-Run: Therapy Culture

Among one of the small stories that I remember hearing, or reading after the monster tsunami that struck South-East Asia on the day after Christmas several years ago was the one about the clouds of mental-health professionals, breathlessly hurrying in to offer grief and trauma counseling to the understandably traumatized survivors – only to discover that – well, most of them were getting along fine. And if not fine, at least reasonably OK, Yes, they were grieving, they were traumatized by all sorts of losses, their lives and livelihoods, their communities and their families had been brutally ripped apart, but a large number of the survivors seemed inclined to be rather stoic about it all. They seemed to be more interested in pulling up their socks, metaphorically speaking, and getting on with it. It appeared that, according to the story, their culture and religion predisposed them to a mind-set that said: the incomprehensible does indeed happen, wheel of life, turn of fate and all that, and when it happens, pull up your socks and get on with it.

The peripatetic grief counselors seemed a little at a loss, that their services were in so little demand in the face of (to them) such obvious need. I was also left wondering if wall-to-wall counseling was somewhat akin to taking a ton of over-the-counter remedies for a case of the flu or a cold. In most cases, you’re gonna get over it, anyway.

When my parents lost their house, lock stock and contents in the Paradise Mountain/Valley Center fire in 2003, my daughter Blondie and I were monitoring the whole situation from a distance. This was the house that my parents had built together, after owning the land for nearly twenty-five years previously. It had everything in it that I remember growing up with, from the spiky Danish Moderne teak dining room set, to a complete run of American Heritage magazines from the days when it was in hard-cover and without advertisements, and every shred of mementoes and furniture inherited from our grandparents and Great-Aunt Nan – everything that had not been diverted to my sister Pip, my brothers and I. My parents were left with two vehicles, the clothes they stood up in, their pets, and a small number of things my mother put into her pockets when she did a final sweep through the house as the fire roared up the hill, or that the firemen grabbed off the walls when the heat of it began exploding the windows inwards.

They were rocked – for about a day. And then they borrowed a camper, and moved right back onto their hill, and began planning to rebuild the house. As my mother philosophically explained many times to us, their friends, and those members of the disaster-relief community offering counseling and therapy, she and my father had gotten off rather lucky in comparison to others. They were retired, and did not have to rebuild a business, they had escaped the fire with their pets and themselves physically unscathed, and they were completely insured. All they had lost were things. And one more thing: they had lived in fire country for many years, and always in the back of their mind was this very possibility. They knew the risks and accepted them willingly. The odds caught up with them at last – but they pulled up their socks and got on with it.

I own to being quite proud of my parents for being so stoical about the whole thing – really, it harks back to my current obsession, the 19th Century. For researching Adelsverein, I read a lot of memoirs, and accounts of fairly shattering events, and yet the people writing them afterwards seem remarkably un-traumatized and quite grounded, following upon events that by twentieth-century mental health practice would have justified a life-time valium prescription and a couple of decades of survivor-support meetings. As I told Mom and Dad about Carl Becker, one of my leading characters and a survivor of the infamous Goliad Massacre, “Today, he’d be in therapy for post-traumatic stress – but he’s a Victorian, so he’s only a little haunted.”

I have to admit to a sneaking affection for the Victorians; at once terribly sentimental and operatic in their emotions, but at the same time fully aware that bad things could and indeed happen fairly often. Husbands buried wives with depressing frequency, wives burying husbands ditto, and parents burying small children and vice versa; accidents of industry, transportation and war occurred with similarly discouraging frequency. Victorian death rituals are infamous for what we considered, during the enlightened century just past, to be terribly over-wrought, self-indulgent and – well, just too morbid. But I do wonder, if maybe they might have been better able to cope, and were able to function after catastrophic tragedies, knowing that the possibility of such experiences was always out there. Sure, there were people back then who were entirely shattered by various traumatic experiences, and self-medication with a variety of interesting substances was not a recent invention — opiate addiction positively soared among injured Civil War veterans — but still and all, one does wonder.

21 thoughts on “Re-Run: Therapy Culture”

  1. It’s amazing how much you can accomplish in a crunch by Just Getting On With It.

    I don’t claim to be particularly level headed, insensitive to pain, or immune to dithering and procrastination. But I’ve noticed an odd reaction I have in emergency situations, especially life or serious injury threatening situations: my emotions mostly turn off while I’m handling the emergency. Once the immediate emergency is over they all come back with full force and I experience the full reaction – but I’m still alive and largely intact today thanks to it.

    I can’t claim any moral high ground because of this – indeed, it may be hereditary (my mother, who worked as an ER nurse for many years, has the same reaction). And it doesn’t apply in ordinary situations – my wife, who doesn’t have my emergency reaction, is much more organized and practical on a day to day basis.

    But the lesson I get from this is that giving in to emotions is often (usually?) a luxury. If you’re wealthy enough that absolute survival isn’t at stake (or if you genuinely don’t care about survival), you can afford to indulge your emotions, trot them out with therapists, and display them ad infinitum.

    If you’re living a barely subsistence existence, and sitting around indulging your grief means that you and any surviving family members may starve to death . . . well, amazingly enough people Get On With It. Their grief is just as strong, but giving in to it instead of soldiering on only ensures MORE grief. Life in general – not just brief emergencies – requires them to keep their focus on day to day living.

    Even in our society, very few of the working poor (as opposed to the entitlement class) indulge in endless therapy. It’s the Woody Allens of the world – wealthy, narcissistic, and self-obsessed – who have the money, time, and pampered angst to indulge in years of therapy that somehow never cures them of their ills. Or even gives them enough self-awareness to realize how fatuous they appear.

  2. I’ve often wondered also if it’s the expections of those around you, which also aids or retards mental recovery after a shattering event. If everyone around you is expecting you to come apart in little-tiny grief-stricken pieces, encouraging you to do so, enabling you … why then, it’s likely that you will perform to expectations. If you are expected to be stoic – to grieve for a short and acknowleged period of time and then get on with it – maybe you do bounce back with few long-term emotional side-effects.

    My parents weren’t at a subsistance level, and yet they bounced back quite readily. English victims of the various Blitzes weren’t completely subsistence-level, and I have read many accounts of survivors stoically getting on with it … there was an elderly gentlemen I knew from the church we attended once, who had served in the Western front trenches in WWI and as a ARP warden in London during the Blitz. I assume from what he said of those experiences that he experienced and witnessed some horrific events – yet he was quite a level-headed and well-adjusted person, not a walking bundle of PTS symptoms. Is it cultural, economic, emotional, that some of us are better fitted to survive emotionally?

  3. Part of it is the victimology environment – always wondered just what these “counselors” are supposed to do – nobody ever puts such events “behind them” but you just have to deal with it and keep going.

  4. This last year or so for me has been very difficult on many levels – it has taken away a lot of my blogging time (#firstworldproblems). I have pushed a lot of things aside and done what you say in this post – just getting on with it – nose to the grindstone, moving forward inch by damned inch, dragging my wife and family with me.

    But I remain happy through it all, and look at these challenges as character builders.

    I am not sure if it takes a certain type of mindset, or a certain type of upbringing, or maybe it is my Midwestern values (yes, I believe in such a thing). But I feel that many others are not as “hard” as I am and tend to mope around a bit more when faced with difficulty and/or adversity.

  5. I’ve thought about this. A friend is tough – she looks at a situation, at herself, and subsumes her ego in action. She’s faced down cancer more than once. And she prepares: she’s a sharp shooter, active on the critical response team, teaches felons “life skills,” and looks for solutions as an administrator before problems hit. She’d be brisk but a comfort in a crisis. She would say her religion has given her that steel – but it is also her character; many have her beliefs but few her strength. Of course, a captivity narrator believes the painful episode – a child dying in her arms, friend stripped and burned to death on a pyre – are but challenges set by a loving God to test her steel. Fatalism may work, but this confidence helps.

    Dan: I’d say a service business exerts discipline. Instead of navel gazing, I found myself overnight standing at the counter and greeting customers with something approaching good cheer and listening to workers with something approaching empathy. It seemed a good way to avoid depression, certainly better than therapy. And business is a roller coaster; that’s a byproduct of capitalism – except the track isn’t circular and seen but mysterious and endless. Bureaucracies (public or private) encourage a belief stasis is good. It’s not. And remembering it isn’t helps meet other surprises.

    By the way, to me Midwestern values meant, probably more than anything else, perseverance accompanied by irony. I still hear it in my brother’s laughs. As my business began, my employees and I would regularly look at each other and recite – “In this best of all possible worlds”; daily we’d tear off the sheet from a calendar with Murphy’s Law axioms. My customers might not have relished the irony, but it kept us going. And they were often encouraged to build their characters, given the wonderful luck of carrying a skid of paper up some steep stairs. And maybe it did.

  6. Not all therapy is bad. Some of it may be quite helpful. Different measures help different people. Some people don’t need therapy, others do. What I think is bad is the overemphasis on formal therapy that follows when too many people become therapists and are given too much power and money, by the state and in some cases private institutions. Therapists become arrogant and intrusive. The worst become job-justifying hacks or power-hungry apparatchiks. Therapeutic institutions, driven by classic public-choice incentives, discover ever-expanding needs for their services. Maybe the best that can be done is to cut institutional budgets so that the supply of therapeutic services becomes more responsive to customer demand than to bureaucratic expansionism.

  7. A different kind of group therapy – takes a combat vet to help a combat vet

    A story of soldiers and – Marines all wounded in Iraq or Afghanistan – taking a week long 380 mile cycling trip though the Ardenees – site of the Battle of the Bulge – with 3 generations of soldiers

  8. I think Jonathan is correct. Kind of like the old saying that when you’re a hammer, everything looks like a nail. Our society suffers from the same thing apropos lawyers…..we have too many of them, and so we now have much more litigation, over things many of us believe absurd.

  9. By the way, I long ago heard (and this may be an old wives’ tale) that ministers were better marriage counselors than psychologists with advanced degrees. The reason was that one group saw a stronger marriage as the goal and the other more liberated individuals. Which is not to say that I haven’t known of people helped by therapy at moments where an outside voice (and listener) weren’t very important at arriving at resolution.

  10. I am pretty suspicious of psychologists (my daughter-in-law is a psychology professor) having watched the whole “recovered memory” thing and seen a friend, who went to a therapist for help with her alcoholism, become convinced her father molested her as a child. She told me that none of her siblings believed her. I caught up with her a few years later and the whole thing had sort of vanished.

    Medical students, the majority now female, are being indoctrinated into the therapy culture. Some of it is OK, they are getting coaching in the handling of a dying patient and I think hospice has been a real improvement in medicine. However, I am not in the mainstream of current dogma and my teaching is probably not considered up to date. They know I’m a former surgeon and I am probably given some allowance for that. I usually get one of my six students interested in surgery each year. Yesterday, waiting for the shuttle bus back to the train station, one of my former students from 12 years ago, came up to me to talk. He is now faculty and told me he still has a copy of the draft manuscript I gave the kids when I was writing my history of medicine. We chatted about how surgery has changed. He is a plastic surgeon who does big cases and burns, not the cosmetic sort, many of whom have sketchy training these days.

    Small group teaching, which USC pioneered 50 years ago, is a great chance to really get to know students over a year or two. Yesterday afternoon, I had two workshops to conduct for first year students who are now learning the rudiments of physical exam. The psychology is handled by somebody else, as far as I am concerned I am chiefly concerned with competence, a worry as class sizes increase and basics like anatomy and microbiology get reduced.

  11. The best way to control people is to make them feel weak and powerless. Telling people they should be emotional fragile and fall apart in the face of any traumatic event is a good way to make people feel weak and helpless. Creating an ethos in which everyone is expected to coddle the traumatized indefinitely simply reinforces the weakening by becoming a passive means of influencing others.

    The many casual insults and degradations of the powerful elites towards the majority of the population in all pre-industrial cultures were highly functional means of oppression and control by reminding individuals over and over again that they were overpowered.

    In our notionally egalitarian culture, that will not work so instead elites evolved mechanisms that eat away at people’s sense of power from below. Instead of knocking people down, they just wait for them to trip and then make a big deal of it. At the same time, they constantly remind them that other parts of the population are always out to get them and only the elites can protect them.

    People are constantly told they are weak, helpless and alone. In desperation they turn to the elites to protect them. Nobody planned this, it just evolved because elite actions that encourage weakness and dependency were rewarded with more power thus creating a feedback loop. The end result is that almost everything in our society, especially the education system, has become a mechanism for making individuals isolated and ineffectual. People are taught to conflate the empowerment of elites with their own power while in reality, the elites are stealing power for their own benefit.

    Hopefully, having to face external competition will save us. Being challenged by tough, no nonsense people, even economically will toughen and strengthen us individually and collectively.

  12. Had a friend who was a svc mgr to an MB dealership – and he said some of the nuttiest people that would come through were the shrinks

    Personally while I think there are some good ones, most are like pimps in that they will never tell a patient they are “good to do” – always something next week to talk about (and pay for). They create a dependency.

    Of course there are the exceptions.

    So to the point of the “therapy culture” I am a bit cynical – it is almost like parasites looking for hosts.

    That’s why – I think – there is so much hostility to “Dr Laura” (who is a licensed psychologist) – she puts a lot of responsibility on the patient saying “the only one who can help you – is you” – I miss her AM radio show – she went to satellite.

    But in the span of literally minutes – after hearing the caller – she could tell him exactly why has been happening in the caller’s life – and why they have reacted the way they have. She gives them the reason for the way they feel as they do. It is up to the caller to see the reason and slowly adjust.

    That is what is missing from the overwhelming majority in the profession –

  13. “Dr Laura” (who is a licensed psychologist) ”

    She is actually a PhD in physiology, not psychology. I liked her early on but she got a bit off the reservation, like her fixation with circumcision. I don’t really care about it one way or the other but she got Dean Edell, a good radio doc and an MD ophthalmologist, kicked off the radio because he is anti-circumcision. He is outspoken but he is right on on every medical subject I’ve heard him talk about. She got his contract with EIB, the syndicater of Rush Limbaugh, cancelled.

  14. I hadn’t heard about Laura and Dean Edell. Pity, I enjoyed his show. I used to listen to Laura too. She was good at smacking down attention seekers who needed it, but I didn’t like the way she browbeat many of the hapless schlubs who were dumb enough to call in for advice. They didn’t realize that she was an entertainer and they were the entertainment.

    If you need a therapist you should hire one and pay him yourself. That way, you know he’s working for you.

  15. Didn’t know that about Dean Edell Mike –

    Jonathan – valid criticisms – she would browbeat some – but usually those who were looking for sympathy – I bought her book “10 Stupid Things Men Do To Mess Up Their Lives” – am going down the checklist – “Yep “Yep” Nope…..” ;-)

    A friend – long time Angeleno – said she got her start with a call in to a legendary radio guy at – KFWB? – Bill Balance? – she was a call in and ended up getting on the radio.

    Then too if I had a problem worth possibly a shrink’s consultation (and then I would say “shop carefully”) I think the last thing I would do would be to call a radio show with millions listening –

    Always remember one – ‘Jerry” – got his girl friend pregnant – left her for 18 years – “Jerry” wanted to come back to “his daughter’s” life and attend her HS graduation – Laura called him a jerk – And she refers to such men not as fathers but sperm donors – which they are –

    What I do like about her is her emphasis on helping yourself and not opting for “victim-hood” – but I would say her treatment of Dean Edell seems like vindictiveness.

  16. “a legendary radio guy at – KFWB? – Bill Balance? – she was a call in and ended up getting on the radio. ”

    I believe that is the guy she ended up sleeping with. He is kind of a jerk. He put some nude photos of her on the internet a few years ago. She wasn’t married when she had her affair with him.

    The house I bought in Lake Arrowhead was her weekend home in the past. There were still some of her books around. I didn’t buy it from her. She had sold it to buy another one on the lake. Then, when she became an enemy of gays, they would take the lake cruise so they could harass her family. She sold that house and now races a sailboat. She has done pretty well with it, too.

  17. BTW Sgt I am just starting the first book of your trilogy and enjoying it – wonder if some independent film maker would be interesting in making a movie – Texas film Commission?

    I’ll bet none of your characters would ask for a grief counselor ;-)

  18. Bill, my daughter and I both think it would make a better TV miniseries than a single movie! I can only wish that something along those lines may come from it. But it would be fantastic to film in all on location in the Hill Country, or in places close to where the events described actually happened.

    Grief counselor … not to put you off or anything, but the need for one occurs in Book Two. And in Three…

    Daughter and I just got back from a long road trip, up to Fredericksburg by the back roads. Much more fun, and even a bit shorter than by the main road. Pictorial evidence to follow.

  19. Sgt – the back roads are always nicer! And Texas abounds in them – called “farm Roads” (FM) aren’t they?

    Let’s hope the right person tied with the industry sees your books. Publishing a good movie can be made outside the Hollywood studio establishment and for a lot less money. Maybe you could be the next Larry McMurtry with your own Lonesome Dove.

    Grief Counselors – about 10 years ago I went through some real bad stuff. That’s where I formed my opinion on shrinks.

    Came to the conclusion it is mainly just having someone to talk to.

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