The Politics of Greed, Fear, and Hate

There are no simple solutions to the problems of mental disorders and addictions. Although all mental health disciplines require that practitioners adhere to and practice the value of informed consent—giving clients as much information as they need to give their informed consent to treatment—few seem to practice it. Giving clients a one- or two-page sheet of information about the pros and cons of mental health treatment in general, or even an estimate of how many sessions the client may need is not the same as telling the client the truth about what we know about treatment for their particular mental disorder, or that of their loved one. I know from experience that few therapists give their clients the actual, bottom-line facts about how long treatment will take, how effective it will be, and how much it will cost. Most treatable mental disorders take over two years to treat in such a way that the client experiences a significant change in real-world function and their subjective experience of the changes. This is costly, often more costly than companies want to pay. And many people forget to check their lifetime limits of insurance coverage: there’s only so much insurance money available.

addictions

And then there are the mental disorders that are not much treatable, with a poor prognosis, and which are nearly entirely dependent on the client’s desire and ability to maintain a treatment protocol. Substance abuse disorders (addictions) are a case in point. Notoriously resistant to treatment and with poor overall long-term outcomes, we lose more money on addiction-related illness than on any other mental disorder in the United States. The costs of treated and untreated addictions are astronomical. And treatment centers and individual practitioners rarely seem to tell the family members footing the bill, or the addicts themselves, the facts about outcome studies.

The only solution that has ever worked long-term with addiction, in fact, is free: the 12-Step programs such as Alcoholics Anonymous, Narcotics Anonymous, Overeaters Anonymous, etc. Some years ago, an APA meta-analysis of all the addiction outcome research ever done bore this out. Researchers found that just about anything worked when a person wanted help, and that 12-Step recovery was more effective than individual therapy for addictions. Self-help, reading books, talking to friends or family, and having a relationship with God all helped more than having a therapist. But what therapist in his or her right fiscal mind is going to tell the client this fact?

Even so, the relapse rate among addicts of all kinds is high. As many as 90% cannot stay clean and sober for more than 12 months at a time, and nearly every addict eventually relapses. The relapse and failure rates for the majority of chronic mental disorders for which treatment even exists are abysmal and always have been. Actor Carroll O’Connor, whose son committed suicde after years of drug addiction, once said, “Get between your kid and drugs, any way you can, if you want to save the kid’s life.” I cannot agree more, for those who get lost in addiction often are lost for a lifetime. And then they die; that’s what happens with addictions.

My point is that there are no known cures for addiction. Those who disparage 12-Step programs for always calling addicts “recovering” and never fully “recovered” lack adequate empirical information about how addictions work, and what they do to people. There is no cure. A person simply learns to live always as an addict in recovery, in the process of working to stay sober. The addict must always stay vigilant, and there’s no insurance on earth that can pay for this type of vigilance.

The state of psychotherapy

As James Hillman and Michael Ventura point out, “We’ve Had a Hundred Years of Psychotherapy and the World’s Getting Worse.”  Psychiatry and psychology are among the most notorious failures as healing professions; we do not heal as much as we teach people how to get by. Given that, I suppose that it only makes sense to combine national emergency help for failed mortgage companies and other financial institutions with help for mental health consumers. The problem that I see is that often times the most vulnerable people, the ones most in need of hope, are sold a bill of goods by the folks who are ultimately going to benefit by the sale. Insurance companies can drop their mental health and addiction plans altogether if they do it to an entire class of people, say, all their plan members working in XYZ market or in XYZ demographic, and there is nothing in the new law to prevent it. The new law does not mandate mental health or addiction coverage. It merely tells mid- to large-size businesses that if they cover mental illness or addiction at all, they have to be fair about it. And small businesses—those with fewer than 50 employees—do not have to provide equity at all.

Ultimately, it is the mental health practitioners who will benefit most from the passage of this bill. It is they who will be lining their pockets, whether their clients improve or not, whether their clients ultimately die from the disorder or not. This is true for the cancer patient as much as it is true for the alcoholic, the crack addict, or the autistic child: practitioners are paid whether they succeed or not, and even when there is little chance of their efforts succeeding.

How different the professions are from the trades. Professionals cannot guarantee success, but must be paid anyway, while tradesmen must guarantee success or they will not be paid. Do we admire, respect, and pay professionals so much more because we admire this clever and educated ruse? Sometimes I think so. And I smile at our naivete.

the zen cure

One reason I left practice was that I saw, after some years, that therapists tended to have similar outcomes regardless of their training, preparation and dedication, and research confirmed this. For the easy-to-treat problems that plague the majority of Americans, any kind of therapist is about as effective as the next kind; any kind of therapy is about as effective as the next. Most types of therapy being applied by most types of therapists work most of the time for the run-of-the-mill problems being treated most of the time. The Consumer Reports research with former APA President Martin Seligman identified the common mental health problems that plague our society as general anxiety, panic, phobia, depression, low mood, alcohol or drugs, grief, weight, eating disorders, and problems with the marriage, sex, children, family, work, or stress. Successful, long-lasting  treatment of the more difficult and serious mental disorders, such as schizophrenia, bipolar disorder, borderline personality disorder, persistent substance abuse, and most others, continues to be the Holy Grail of psychotherapy.

Zen master Thich Nhat Hanh says that the reason people need therapists is that they have nobody to listen to them at home. He believes that all illnesses of the mind and soul arise from the lack of compassion, relatedness, and community. In my favorite book of his, True Love, he writes:

The other suffers as long as he is in need of someone to listen to him; and you—you are the person who can do it. If someone has to have recourse to a psychotherapist, it is because no one in his house can listen. A psychotherapist should be able to sit there and really listen, but I know therapists who have suffered too much and do not truly have the ability to listen to their clients.

So if we love someone, we should train in being able to listen. By listening with calm and understanding, we can erase the suffering of another person. An hour spent in this way can already relieve a great deal of another person’s pain.

The funny thing about Thich Nhat Hanh’s beliefs is that research bears them out. After about two years of getting any sort of therapist to listen to them, people with our most commonly-reported mental disorders mostly tend to improve. But I question why we are going to therapists when we could be making friends instead. Why are we paying someone $120 an hour to listen to us, when we might get free help? Has our society become so isolated that we no longer have friends with the time or ability to listen to us? Have we out-sourced the blessings of friendship to paid professionals, much as we out-source our parenting to paid babysitters, nannies, and other child-care workers?

Clients who want to get better, get better. Those who do not want to improve do not. The most effective treatment for any addiction is given by a community of addicts, not by a lone therapist or treatment center. People forced into treatment of any kind rarely improve substantially. The information necessary to help people heal is freely available. Being loved and having friends is healing. These are some of the things I learned as a therapist, and learning them are part of what influenced me to retire from that work. So, when I read about this new law that promises help for our ever-increasing mental illnesses, I know that only true love provides true help, and I know that our society and world are so sick with greed, fear, and hatred that we are not likely to be able to truly love others enough that we can really help them. We can barely help ourselves. We are in deep trouble, and it’s a trouble that cannot be legislated away.

The politics of greed, fear, and hate

The political climate in the U.S. and what it has brought out in people are clear evidence of just how greedy, fearful, and hateful we are as a people. Blaming fingers are pointed everywhere. Just a few days ago I received emails from two different Democrat friends who blame Republicans for ruining our country. They know that I’m a registered Republican; I wonder if they remember this when they cast their wide net of blame? On the other side of the fence are the people I know who are Republican, who can be heard as we wait outside the school to pick up our children, blaming ”those tax-and-spend Democrats,” the ones whose majority in Congress have strapped us with more taxes (never mind that we elected a Republican president). Democrats blame Republicans and “their Republican president;” Republicans blame Democrats and “their Democratic congress.” But as Pogo said, “We have seen the enemy, and he is us.”

Because we don’t want to see the truth about ourselves, we remain blind about the source of our disproportionate irritation.  Often, what most aggravates us about others, we first reject and resist in ourselves. The hatred being thrown out there onto the “other party” is probably first and foremost our fear of our own shadowy parts that we refuse to admit into consciousness. Conservatives who hate the philosophy of letting the poor suck the life out of the able probably fear helplessness more than anything else. Liberals who hate the philosophy of rugged individualism and pulling yourself up by the bootstraps represented by conservatives reject the parts of themselves that might take personal responsibility. Everyone wants everyone else to do something; everyone wants someone else to blame.

I have an odd view of current events: I believe we reap what we sow, and we get what we unconsciously reject, but which is needed to heal us. Our next president will be the man we need, but not necessarily the one we want. And he won’t be able to change much more than anyone else who came before him changed. They’re all in Washington together and they’re not helping us, and we’re blaming them. This is the story we tell ourselves.

Doing my part

But we’re not helping us, either. I wonder just how much debt every American complaining about the bailout bill carries individually? How much in credit card balances? How many car loans? How much in mortgage debt? How many Americans tell their children to go to college on federal school loans rather than working their way through school the old-fashioned way, and then look the other way when their kids default on their student loans? How many parents were unwilling to help their kids when they needed help and might have benefitted by it, and let other taxpayers foot the bill for the kid they foisted on society? How many said, “It’s not my fault!” and refused to look into the way they raised their kids, the adult decisions they made that affected their kids, and their lack of familial charity, and then blamed others?

It’s easy to swipe that credit card and easy to take a swipe at a fellow American, a person who is our brother or sister. It’s much more difficult to live lives of personal responsibility, accountability, and true compassion and love. It’s easier to blame others than to ask, “What might I have done that contributed to this failure? What can I do about it now?”

My invitation this week is to ask everyone to think back over the past week, and take a “searching and fearless moral inventory” of all the blaming words that have come out of your mouth, or rolled around inside your mind and heart. Think of all the finger-pointing you’ve done. And then recall any projections, and send some love the way of those people you reviled and blamed. They are probably as sincere and well-intentioned as you about their own beliefs. They are probably no stupider than you are, regardless of what you think. Look into yourself for the characteristics you despise in them. Look closely. You’ll find them in yourself, too, and you’ll be inspired to be more compassionate and forgiving, I’m sure.

The way of love

One of my oldest and dearest friends is a staunch Democrat. In over 25 years of friendship we have never shared political or religious beliefs. But we have worked shoulder-to-shoulder for the same right causes, and we have changed the face of American child welfare in permanent, lasting ways. We have accomplished the same goals by the same means with very different political and religious philosophies driving us. We rely on love, good will, hope, and respect as the underpinnings of our friendship and the way we live. If love and respect can work for us for over 25 years, through thick and thin, I know it can work on a large scale. So, please, friends, as the economy and politics and other things heat up, let’s calm ourselves. Let’s extend more kindness and love. Let’s remember all the hard things we’ve lived through and recall that they didn’t last. Let’s recall how blessed we are, and let’s be liberal with our praise and hope. Remember that the politician you hate is someone’s father, husband, wife, sister, mother, son. That person is loved by God just as dearly as you and your candidate.

And remember that nobody else is ruining the world but you and I. Instead of ruining it, let’s love on each other and spread some peace. Being loving and peaceful won’t require anyone to change their vote, and it will most certainly change the atmosphere of hatred and fear permeating our country right now. Love is the right thing to be. Let’s get out there and be love. Let’s represent our values through the kindest and most compassionate behavior. Let’s smile more and remember that hope sustains.

For further reading:

• Mental Health: A Report of the Surgeon General
• “Characteristics of Empirically Supported Treatments,” Journal of Psychotherapy Practice and Research
• Characteristics of Proven Psychotherapies
• The Empirically-Validated Treatments Movement: A Practitioner Perspective
• The Effectiveness of Psychotherapy: The Consumer Reports Study
• “Bailout,” Third Eve
• “Help for the Mentally Ill?” Third Eve