part 1)
Posted originally on December 18, 2002 on Duncan Double’s Critical Psychiatry message board (now largely defunct due to spam); this portion brought to you courtesy of the Wayback Machine, www.WaybackMachine.org
words and ideas from _The Radical Therapist_, produced by Jerome Agel, 1971
(edited to bring more notice to certain parts, with comments in “[ ]“)
[editor's note: Obviously, this author engages in a few techniques of manipulation, while calling attention to the manipulations of the status quo. Notably, his manipulations fall quite in line with the manipulations of what was called the "New Left"--heavily influenced by ideologically-challenged Communism-- of this era, such as opportunistically hyping one's imagination against fat or monetarily rich people. Still, I find much importance in this text compared to everything else I recall reading, and expect that you will also. The copyright has long since ended, so do post it around the world!!!!]
chapter “On Training Therapists”, by Michael Glenn p.8-15
intro:
Michael Glenn is on *The Radical Therapist* Minot [Iowa?] staff. While much of what follows describes a psychiatrist’s experience, it is also true of other “professional” therapists’ training. The suggestions at the end speak to all therapists.
The psychiatrist in training is embedded in a medically oriented matrix with a closed-guild tradition, whose model is master and apprentice. He is assumed to be inexperienced and naive, a stumbling creature whose every step must be watched and checked. The model of supervision approximates that of therapist/patient, and the supervision constantly resorts to unbeatable ploys, like commenting on the trainees psychological hang-ups. Mathemeticians, businessmen, [fine] artists, actors, teachers, historians: all are acknowledged to have some sense of the world and of their place in it by the time they are thirty: yet the therapist in training is encouraged to see himself as grossly inadequate, ill informed, and bumbling.
The professionalism of the medical model, with it aura and mystique, permeates psychiatric training. One is constantly mystified and perplexed. The completion of training allows the now-professional psychiatrist to begin mystifying others, even though he usually has no idea how he does it. He seems to become mature, capable, and a member of the guild in good standing the moment the diploma enters his hand.
Its model makes psychiatry invincible. Attempts to change are readily discredited as psychopathology, delayed adolescence, and acting out. The trainer rarely encounters the trainee as another person, a brother or sister. Training is marked by psychological put-down, intimidation, and guilt-invoking techniques. Its graduates then repeat their experience with their clients. Such a dehumanizing, destructive system must be changed.
Szasz, Laing, and others have shown how psychotherapy dehumanizes both patient and therapist. Goffman has shown this in asylums. The same is true for therapist training, which effects the professional annihilation of trainees by incorporating them into a corrupting structure, which they must accept to succeed.
They must play the game correctly. But learning to play the game correctly often ties them to its rules for life. It is a Medean shirt which cannot easily be removed once it is put on.
(see all parts, specifically parts 2, 3, and 4 here: http://theicarusproject.net/forums/viewtopic.php?p=67168&highlight=#67168 ; other portions include: “Professional mystification and the psychiatrist’s role”, and “therapy and politics”)
Part 2:
Professional mystification and the psychiatrist’s role
Psychiatrists, being physicians, have endured years [more than 4, that's for sure--ed] of psychological brainwashing called education. They have learned that, to be able to make an exorbitant income, they must assume a social mask of Responsibility and Omniscient Doctor. They are our society’s shamans, though lacking in the latter’s sense of true drama.
[ed: as well as lacking an individual spirit--ed]
Medical training has certain values:
1) It lets the young psychiatrist see the system as it really is;
2) It helps him learn to act decisively in emergencies;
3) It gives him experience with ultimate, profound situations;
4) It provides him with a range of human experience–albeit as observer–usually forbidden others not in the guild;
5) It gives him status in the system.
In return, however, medical training tyrannizes the young psychiatrist in several ways:
1) It foists an image of the physician on him;
2) It keeps him an observer, not a participant;
3) It makes him seem/feel infallible;
4) It inculcates in him values of sacrifice and responsibility, while at the same time insisting he owes himself all the luxury he can later obtain, thus encouraging him to accept materialistic values as the true measure of his worth;
5) It estranges him from others.
Medical training supports the conventional values in this society: the status quo, traditional sex roles, the search for profit. The physician becomes a petit entrepreneur. He has to behave the correct way. He becomes a defender of [established notions of] the church, the family, the community, the nation. His role today is a far cry from what it was in the 19th century, when pysicians were often, as skeptics and scientists, in the vanguard of social change.
[Over and over again, we see this pattern: starting out "radically" to *reform* superficial parts of a system or school of belief, and ending up strengthening systematically unaccountable power--ed]
Now, comfortable and fat, they challenge little and accept much. They hand on to what they’ve got.
[ed: This in itself should not be viewed to be as bad as the situtions which allow them to become alienated from the rest of us. And while all may have a hand in responsibility in this area, we can see that the ways in which institutions like this run have the crucial keys. So, to make an institution accountable and thus valid, these situations would have to be dealt with seriously.]
In addition, medicine is mystifying. Doctors have kept their numbers down. They conceal facts from patients. They hide behind the garb of their professionalism, as if they posess arcane secrets. The public** goes along with them and attributes all kinds of knowledge and power to them which they do not possess. Use of drugs, treatment of illness, prognosis of common maladies: all these are kept as secrets for the medical professional only. Mystification augments their status. But, based on a lie–that only they are capable of holding the secrets–it makes the “profession” ever paranoid, ever watchful, ever more secretive. Of course physicians resent pressure “from below” to demystify.
[**editor's NOTE: any generalization of a mass of people called "the public" needs to be qualified by breaking down exactly what is happening when "the public" is said to come, or actually comes into action. "The public", after all, is not a monolithic entity; yet, in a culture oriented to manipulation, this can appear so in that "the public" is first and foremost manipulated and "led" by influence professionals and others who know how to hype or otherwise mal-inform masses of people. Notably, their/our perceptions of "reality" are often notably superficial and hysterical, and quite unthreatening to the underlying and long-term interests of elites.]
The doctor’s morality is conventional: thus oppressive. [ed: in the context of a severely alienated society] Physicians act to heal and patch up: not to challenge the fabric of the system which sustains them. Psychiatrists, at the top of the “mental health” heap, may indulge in liberal [read: superficial--ed] causes without fear, especially in liberal university or town setting; but they run into trouble if they become politically concerned beyond that. (I can cite five known instances of therapists being dismissed after becoming involved in community politics.)
Part 3:
The psychiatrist in training learns to treasure his elite identity, to pull rank on “ancillary” and “paraprofessional” personnel. His lengthy training lets him charge higher fees in private practice. He is a ubiquitous authority, assured prestige if he only behaves right.
The same is true of other therapist professionals. Each pecks on those beneath him; and all peck on the clients. Mystification of their skill maintains their invincibility.
Who needs medical training?
What is the rationale for psychiatrists–or any therapists–being physicians? How relevant is medical training?
Four years of medical school [after 4 years of regular school--ed] followed by an internship give the young psychiatrist the following: months of anatomy and biochemistry, hisology, pathology, urology, surgery, cardiology. But he receives NO sociology, psychology, anthropology, politics, or notions of human interaction. To be a physician, he endures all kinds of special training, which he only forgets later. Indeed, he has to unlearn his taught bias later on.
If the medical model is really important, all therapists could receive training in it. Certainly notions of public health, emergency care, and common maladies are useful to everyone who works with people. But the bulk of medical school’s professionalism, formality, and specialization is irrelevant to the therapist’s work.
The usual arguments for psychiatrists having to be physicians–thus distinguishing them from psychologists, nurses, social workers, etc.–are rationalizations for historical accident and caste priviledge. Emotional difficulty was defined by physicians as a medical illness: thus it had to be treated by a physician specialist in emotional illness. The medical model makes psychiatry oppressive: people are defined as “patients;” they are told they have “diseases;” they are locked up, shocked, socially denigrated, and ostracized because they are “sick.” The psychiatrist becomes society’s cop.
Do people with problems in living really have an “illness”?
The medical model makes psychiatrists a healthy elite. It makes the patients an oppressed class. Other therapies too, insofar as they participate in the one-up, one-down relationship, join psychiatry as oppressive.
The issue of prescribing drugs is a red herring. Because only physicians can prescribe the drugs needed to treat emotional “illness,” they maintain a monopoly on their role. This issue is so contaminated with drug-company commercialism [hype--ed], “diagnostics,” [mystified language--ed] and mystifying guild elitism that any sensible discussion of it is impossible [and thus a key device for keeping non-professionals out--ed]. The simple fact is, if drug use is important, most people can learn about it in a rather brief time.
Others argue that psychiatrists need medical training to “catch” brain tumors and other “organic” diseases which might masquerade as depression, conversion reactions, etc. [More likely, tho, they need the immersion time/"training" to better integrate into the mystifying language, techniques, and professional culture!--ed] The argument is weak. If such training is important for a therapist to have, it can be taught most therapists in a rather brief time. It doesn’t take five years of medical training to recognize organic disease.
Medical school is about 80 percent a waste of time for the young psychiatrist. It should be scrapped.
Repression of trainees
In most psychiatric training centers, the residents, young adults, are powerless. Their curriculum is not theirs to make; their routine is set up for them to follow. “Others wiser than they” determine what they shall and shall not do. Resident advisory councils are false fronts.
[ed's note: "resident" itself is an interesting psychological manipulation]
The ideal therapist in training is intelligent and afraid: indecisive and obsessional, he can be made to feel inadequate and guilty with ease. Over and over again, in my own training, administrators and supervisors would push residents down, dismissing their grievances as adolescent psychopathology, criticizing their efforts at assuming responsibility for their own education. The amazing thing is how readily the residents accepted this image of themselves.*** They got themselves into therapy. They forswore social activism to uncover the “causes” of their rebelliousness within themselves. A more thorough job of mystification and brainwashing was never achieved!
[***editor's note: the "well educated" mindset would call this yet another truism for the *stupidity* of people; and such looks reasonable as long as no contexts are allowed! Contexts including family pressure to institutionally "achieve" despite injustices, etc.]
Here, at random, are some incidents from my own experience:
1) An activist resident who organized the community against the university’s “mental health center”–an imperialistic fraud–was fired for “clinical incompetence.” The other residents refused [or feared too much?--ed] to create a stir to defend him.
2) The director of the emergency room service decided that third-year residents would have to see every patient the first-year resident saw. This rule had not been observed for years. Rather than discuss the situation, the director insisted his will would be followed. Residents’ arguments could not move him. Yet the residents would not consider a strike or collective action [certainly still quite an alien technique to their often conservative up-bringings--ed] to dramatize their opposition. Their attitude was: Why make waves; we’ll soon be out.
3) A resident rotating through a state hospital criticized its program to its director. The latter complained to a supervisor, and the resident was severely upbraided [huh??--ed] for “unprofessional behavior.”
4) A paper written about the state hospital system was bottled up by the administration and refused imprimatur. [say what?--ed]
5) An anonymous letter circulated among the supervisory staff which demanded higher salaries for residents and threatened to call the press unless its demand was met was angrily denounced by several of the staff at a residents’ meeting. The unknown author–it was unclear to the residents if any of their number had ever written it–was called “seriously disturbed” and told to get himself into therapy. The issue of salaries was not discussed, except when the director advised any resident who wanted more money that he could go elsewhere. The anger and fear of the staff was incredible.
6) The grapevine in the program proclaimed that, so long as a resident didn’t rock the boat, he could leave the program and make $40,000 a year [in 1971 that was a lot--ed]. Most of the residents swallowed the bait. What earthly incentive could they then have for challenging they system!
Our program emphasized one-to-one treatment, psychoanalytic insight, and hospital care. Family and group work was almost nonexistent; and the “community program” existed in a vacuum, whose instructors never discussed what was going on in the actual community outside but instead prepared the residents for administrative posts.
It was frightening how few residents saw any value in opposing a system which they all agreed was oppressing them. Their attitude was to wait until they were out and on top themselves. Their salvation, in other words, lay in their future capacity to bilk, brainwash, co-opt and alienate others [re: getting 'on top'--ed]. They preserved the illusion that, so long as they disagreed inwardly, they could go along with the outward demand and still preserve their integrity.
Part 4:
Unless training programs are changed, therapists will continue to serve their own interests, not that of the people [at large]. They will be men of good will in an oppressive structure.
Therapy and politics
Therapists are politically naive. They come through a professional education which gives them little understanding of social and political issues. Psychiatrists probably suffer the most through their long isolation in medical school, where they remove themselves from their society and give themselves the illusion they are gods. They are ignorant of their place in society; they are ignorant of what is going on in the real world; they are victims of a narrow horizon.
Many therapists go into debt to complete training. Making money to them is important. Staying within the system they can rise out of debt and become affluent in a matter of years. It is no wonder that they guard their possessions jealously and are angry at those who “impatiently” press for change.
The life-style of the therapist–certainly the psychiatrist–proclaims his place in the status quo. He lives comfortably off in the suburbs, or in a town house. His children are in private school. He has a maid to free his wife. He owns color TV sets [still a big deal in 1971--ed], cars, boats, land in the country, stereos, tailor-made clothes, season opera tickets, a fine portfolio of stocks; and takes vacations around the world. HOW CAN HE EVER BE AN INSTRUMENT OF CHANGE, THEN? He owes allegiance to the system in which he prospers.
Thus it is that he becomes an oppressor, an enemy of the people. While he eats high off the hog, others starve****. Even when he is “liberal” he rarely risks his security for his ideas. Within the present system, it seems, he has no choice. That is why the system must change.
[****Do you note the rhetorical devices here? Such people are oppressors, yet they are oppressed themselves, and if conscious manipulators of the Left or Right, or wherever, were to openly promote examination of the CONTEXTS of these situations, they would more likely come to conclusions which can bring us all TOGETHER to solve these challenges, more than these same old division techniques ever do. Certainly such people are part of the problem, but further alienating them cannot help!--ed]
Therapy is not a branch of medicine, nor is it a social science
Therapy is a discipline in its own right, dealing with human feelings and human relationships in a human society. It was a historical accident that therapy became incorporated under its various disciplines.
If we accept this, it then becomes clear how unfortunate and divisive are the distinctions between the various therapy fields. For some therapists to have medical training and others social work training and others experimental psychology training, etc., means that the field of therapy is being partitioned like Poland in the 18th century. Therapy debands its own institutions, its own training programs, its own practice. The therapy fields belong together, brothers and sisters under one roof.
Current training prepares young therapists for roles which already exist in the system: institutional roles, private practice roles, research and teaching roles. But they don’t prepare them for reexamining and challenging the system itself.
The young therapist may see this, but he isn’t sure how to deal with it. Staying clean has its advantages. Going outside the system [--getting "dirty"--ed] is a hardship. Only a few will take the risk, and they can be easily isolated.
New training programs are needed if any change is to occur.
Alternative training programs
[partially given here]
Alternative institutions have risen dramatically in recent years. Spurred on by [Paul?] Goodman and others, free universities, free clinics, and new life-styles have emerged. [Theodore] Roszak documents the movements strength. Berke presents its rationale. Domhoff underscores its political importance.
Rather than confront the present system head on and be massacred by its flunkies, many today are working “to let grass push throught the cracks in the concrete”*****: putting energies into new forms and new ways and letting the system collapse of its own dead weight. Some attempts have already been begun. Others will soon arise and solidify. The following is a sketch of what they will involved:
1) Training will not divide people into categories such as “psychiatrist” and “social worker.” All people in the program will be therapists. They will be trained as such. Further skills can be obtained elsewhere.
2) Training will be open to all people, not made a class privilege. (…)
3) Training will be funded by local communities.
4) Training will be demystified and deprofessionalized. …Therapists will be workers in their community, like any other worker. Their skills are needed for the common good. But their skills will not make them a “professional” elite.
5) Training programs will be interdisciplinary, dealing with psychology and politics, [etcetera]…
6) The model of training will change from hierarchical, obsessional, master/pupil interaction to a more open, popular, democratic form. All whose ideas and insights are valid will be heard. Age itself will carry no guarantee of wisdom.
7) New techniques will be evaluated openly, without fear of change. Therapy training centers will be like free universities, not trade schools. Free inquiry and dissent will be encouraged, not put down as “pathology.” Therapists will become politically involved in the overall struggle against oppression.
8) The number of therapists trained will increase…
9) Incomes for practicing therapists will be appropriate for their work. No one will grow wealthy from the people’s suffering.
10) Modes of collective practice and communal living will be tried, in the belief that the therapist’s life-style strongly affects his work. Therapists will not live aloof from their clients, distanced by class and interest, elite oppressors helping only from “above.” They will be part of their community.
11) Therapy will be available to all, not sold to those who can afford it like fried chicken or any other commodity. It will be geared to the needs of communities [as studied and developed by the new boss, same as the old boss yet a little more "morally upright" and "valid"/"appropriate" than the earlier vanguardists, no doubt--ed].
Let us push ahead, toward a radical therapy.
[So much for "radical"...--ed]
[*****Grass, notably, not those pesky, free-flowing WEEDS. Metaphorically translated: yet another reform-minded strengthening of the existing framework. Just the idea that, in 1971, EVEN BEFORE knowledge came out about the f.b.i.'s illegal *Counter Intelligence Program* against all articulate dissent, articulate "leaders"/vanguardists were convinced that reform could be the "only" way. And, in their confined imagination of the "war" that would have to become, this makes sense; yet they were in no way oriented, as the manipulation against "the oppressor" shows, to truly demystifying and liberating "the People"...--ed]
=====
my comments from 2002:
In light of this 1970s era viewpoint which was supposed to bring indepth change, we might begin asking questions about just how effective some of the ideas were, and compare them with today’s ideas for reforms.
Take the following ideas:
Training should be open to all people, and not only for those of the right class (2).
Local community funding would make a difference(3) (do charities like the u.s.a.’s United Way qualify as a “local” funder?)
The interdisciplinary orientation of therapeutic training (5)–have changes, if any, made a difference?
Number of therapists trained (8)
Therapy available to all (11)
Did I miss any in your estimation?
