Washington has been called "Shrink City, U.S.A.," and with good reason. More practitioners per capita can be found here than anywhere else in the country.
But even here we find growing disenchantment with the traditional "talking cure" for emotional problems. One reason is a big difference between today's practitioners and the pioneers of Freud's time. This, coupled with changes in the problems, has resulted in an ironic situation: Troubled people today are often not helped at all, or they may even be more disturbed after treatment than before.
There are, of course, sensitive and skilled practitioners who do help disturbed people. But we mental-health practitioners--whether psychologists, psychiatrists or clinical social workers--often just don't know what we are dealing with when people seek our help. Our own characters, values, ambitions and life experiences render many of us ill-equipped to either understand our patients' troubles or know what would help them. We have become comfort-seeking careerists whose prime interest is too often simply using our trade to make a fairly lucrative and easy living.
Contemporaries of Freud--despite his recent bad press--had a more radical spirit of seeking the truth about attitudes and relationships. Freud, in fact, said that analysis is based on a love of the truth--reality--and that it precludes any kind of sham, deception or illusion.
Such truth might be a deep desire to remain a protected and secure baby, or a desire to destroy one's father. Or a devotion to greed, to power or to cheating and using people.
The early analysts were pioneers, adventurous enough to explore the uncharted terrain of human character and unconscious passions, and courageous enough to risk their careers by calling attention to the effects of repressed sexuality. Their aim was to reduce suffering and help the person develop more love, reason and independence.
But something happened. You don't hear practitioners talk of passions, values or truths anymore. It's considered irrelevant to "coping" or "adjusting" better.
People who now become analysts and therapists are apt to be cautious careerists, uncritical supporters of adjustment to conventional values and norms. They will spend years ferreting out tiny truths, mostly about childhood, whether or not they are relevant to current problems. They especially avoid analyzing the situations and values their patients have adapted to at work and in their love ralationships.
Also, the pioneer analysts were much more well-read in literature, history and culture. Freud's writings are filled with references from Shakespeare, Goethe and other greats in literature, drama and mythology. He used their themes, plots and character portrayals to help illuminate and understand the motives and moral dilemmas underlying his patients' emotional problems.
Today's practitioners, however, are primarily unread technicians, ignorant of the relevance of literary, philosophical, religious, cultural and socio-economic history of our civilizations, all of which profoundly influence how and why we think and behave as we do, including our accepted views about what is "normal" or "disturbed."
Although there are more than 250 psychotherapies now on the marketplace, the profession no longer attracts the numbers it used to, nor the sharpest, most imaginative or creative minds. Only 4 percent of medical school graduates now choose to enter psychiatry.
As technically oriented careerists, today's practitioners share in, rather than critique, the social norms, values and anxieties of our times. They uncritically accept outward success, functioning without complaint and conventional values like power-seeking as mentally healthy. Most are trained to assume that all conflicts originate in childhood. They don't understand that normal adjustment often results in repressed feelings of self-betrayal, self-criticism and the desire to be more free and alive. The price of overadaptation to our bureaucratized and careerist society can be a fear of strong emotion, depression, anxiety, chronic indecisiveness, physical complaints and escapism through drugs, alcohol and hi-tech gadgets.
This "negative side" of success is an increasing source of emotional problems for normal people who have traded off and compromised too much of themselves to move to the top. What we define as "normal" is adaptive, but not necessarily sane from the standpoint of what is humanly fulfilling or rational.
Most practitioners have had little, if any, experience with life in the outside world, particularly with the politics and pressures of work in a large corporation or bureaucracy. So they are unable--from the isolation of their offices--to differentiate between those problems based on a neurotic personality and those of a bad situation.
It is not uncommon to hear some practitioners joke cynically about how this patient paid for the new Mercedes or sailboat; that patient, the skiing trip to Zermatt. As careerists who are uncritical and uninterested in analyzing their own values--and can therefore rationalize self-indulgence, greed or admiration of power lust--many have become examples of the people they should be trying to help.
Practitioners have been quoted as saying that power lust is healthy. But this is nothing new. Conquistadors, dictators and sadists have always felt energized by power. What is missing today is an analysis of power--how people obtain it, and at what cost to themselves and others. Lovers of power and domination are often driven by pathological grandiosity, by desires to conquer and destroy the "enemy" and by extreme self-aggrandizement, none of which may be visible on the surface if adaptive to their work and goal of "success."
Because many therapists secretly admire and vicariously enjoy their patients' power lust, they are incapable of analyzing it. Instead, they equate power with mental health, yet label it a "heroin high," "anti-depressant," "aphrodisiac"--even though they report seeing patients burn out or become unable to function after the loss of power.
Increasing numbers of people are enticed by new competitors in the therapeutic marketplace: short-term quasi-therapies like est, assertive- ness training, burnout avoidance, stress management and other post-counterculture, "new age" experiences.
The quasi-therapies are understandably appealing, especially to trapped, bored and passive urbanite careerists who are turned off by traditional practitioners, but want some glimmer of hope that change is possible. Unfortunately, most of these alternative therapies are mystifying gimmicks and bags of tricks; the mental-health version of supply-side economics. They teach how to become more self-centered and exploitative; how to "get yours" before the bomb drops or the economy collapses.
The traditional route is not much better. Treatment can drag on for years while the patient continues to be troubled and the therapist continues to collect the fee.
Why is this? Psychoanalyst and Harvard researcher Michael Maccoby, who has studied corporate and government managers in his widely read books The Gamesman and The Leader, describes what he calls the "cover story" and the "hidden plot" of many modern careerists. The cover story is our conscious explanation of our behavior and motives. Beneath it--unconscious or semi-conscious--lies a hidden plot, like in a Shakespearean drama.
Therapist and patient often collude to tinker with the cover story, making it smoother here, more persuasive there. But both avoid exposing and confronting the hidden plot if it is too frightening for either of them to face. Treatment then amounts to verbal Rolaids--something to quell inner distress--without having to change anything.
For all of Freud's shortcomings and human failings, he was insistent about exposing the hidden plot. Exposure of the truth, he said, is something like what happens in a fairy tale when the power of evil spirits is broken as soon as you can tell them their name.
Here in the 1980s and beyond, computerized technology is rapidly changing the fabric of our personal and working lives while creating both new stresses and new routes to success. Too much adaptation, compromise and trade-offs lay the foundation for new emotional problems. The therapist has a special responsibility not just to understand this, but also to create an atmosphere of truth-seeking, courage to face the irrational and painful, and willingness to analyze the values and costs of social adjustment as they affect the quality of life in our times.