The Truth About the Patient/Therapist Mind Game
Nick Williams, Contributor
There is something particularly odious – in my view – about the way in which we in the West approach what (until very recently) used to be called ‘mental illness’. We may use a slightly different terminology now, preferring to talk in terms of ‘conditions’ rather than ‘illness’, but our approach is still the same. There is something very unpleasant – toxic even – in our attitude, and this unpleasantness, I think, stems from our fundamental lack of respect towards the experiences of the people we, as mental health professions, are dealing with.
In a nutshell, we’re arrogant; we’re arrogant because we are so convinced that our ‘neat and tidy’ rational way of looking at the world – which we did not arrive at ourselves but rather passively absorbed from the cultural milieu (in a ‘default’ way that requires no effort on our part) – is the right way that we can’t even come close to empathizing with other, often very different, perceptions of reality. This is precisely where our unconscious arrogance lies therefore – it lies in the fact that we (by some special virtue of our own) know what the right way to view reality is. The great philosophers of the past may not have known what the right way to look at reality is, but somehow we do…
Not everyone is guilty of this unconscious disrespect of course. The point we are making is that the ‘disrespect’ is systematic – it’s built into whole structure of things and so it’s always going to set the tone. It’s always going to be the dominant influence. Disrespect is always systematic where there is an inbuilt ‘power differential’, when one group of people have more power given to them by society than another, and this is exactly the state of affairs in psychiatry, or in the mental health industries in general.
A crude but nevertheless very effective way of determining whether a power differential exists between the professionals whose job it is to work with people suffering from mental health conditions and the people themselves is to ask the question ‘Who is the most successful in society’s terms, a consultant psychiatrist or clinical psychologist (for example) or a psychiatric patient? We’re not supposed to ask this question, of course. It is very politically incorrect suggest that patients might be granted lower social status in the basis of the fact that they are patients (i.e. on the basis that they are not, in most cases, highly qualified professionals but are, rather, sufferers of a mental health condition); it is politically incorrect to suggest it but that doesn’t mean that it is true. We all know that it is true…
We don’t want to admit that the actual patients themselves may not have the same social status as the healthcare professionals who are trained to treat them but at the same time we all know very well that this is the case. Society operates purely on the basis of status and prestige, whether we want to admit it or not. Society operates on the basis of the power gradient that exists between those of high status and those of low, and it would be foolish in the extreme to pretend otherwise. Society isn’t a ‘free’ kind of an affair; it’s coercive, in other words. It’s based on following rules….
When you as a patient look across the desk at the mental health professional who is dealing with you it is evidently the case that you are looking at someone who has more power than you; this isn’t just power in terms of how we usually understand ‘social status’, it is power in the sense of ‘Which one of us has the authority to say what the proper way to see the world is?’ Power is a basic part of all human interactions – every time we interact with someone we are involved in a struggle (whether we are conscious of it or not). We are involved in the struggle to see who has the power to define the ‘consensus reality’ that is to be negotiated in the interaction. This contest can be very subtle, or it can be very unsubtle indeed! When we are involved in an argument, for example, then this is an unsubtle example of ‘the struggle to see who can define reality’! Our current way of understanding mental health conditions is a perfect illustration of ‘something that has been defined by the powerful’ – when depression (just to give one example) is defined as ‘a mechanical malfunction of the brain’ then this is ‘disrespect’, this is ‘an abuse of power’.
There are times when human interactions are not based on power, it is true, but my point is that they are comparatively rare. Interactions that are not based on power are interactions that are based on love, and love – as we all know – is not usually part of the equation! All interactions that are based on the roles we are playing, or the social personas that we are acting out, or on the unquestionable rules that exist in the social game, are predicated upon power. All games full stop are predicated upon the use of power, and we’re all playing games of one sort or another almost all of the time, whether we realize it or not. To not play a game is to be ‘totally honest’, and how often can we afford to be totally honest in a human interaction? When we see our therapist or our psychiatrist or our psychologist the chances are very much that we’re playing a game here too. We’re playing ‘the patient / therapist game’, as Ram Dass says in the following passage:
“Then I was a therapist and so many hours a week I had somebody sitting on the other side of the desk, and he was playing patient, I was playing doctor I would run thru my list of theories as he would run through his list of symptoms and we’d compare them and match them up and, you know, it wasn’t enough. It didn’t quite gel. It was as if psychology had a reason to be as defensive as it was.” ~Ram Dass
The patient / therapist game is a very comforting and familiar one to be sure, but that doesn’t mean that it’s therapeutic! Whilst a good old-fashioned power hierarchy has everything to do with the way we organize social groups (in baboons as much as humans) it has nothing to do with therapy. Therapy isn’t an exercise in power-play, it isn’t an exercise in ‘doing what you’re told’ (or ‘doing what you’re expected to do’). A power gradient between two people (or two groups of people) equals disrespect. The use of power IS disrespect! That’s the whole point – what the use of power comes down to is ‘My way of looking at the world is more valid than your way’. ‘Might is right’, would be another way of putting this. According to Friedrich Nietzsche, what we call truth is simply ‘an interpretation’ and the one who has the most power is – naturally enough – the one whose interpretation passes into law! This is why Nietzsche talks about ‘the impossibility of truth’ –
Against [empiricism], which halts at [observable] phenomena—‘There are only facts’—I would say, no, facts is precisely what there is not, only interpretations. We cannot establish any fact ‘in itself’: perhaps it is folly to want to do such a thing.
‘Everything is subjective [for example, a figment of your reasoning mind],’ you say; but even this is interpretation. The ‘subject’ is not something given, it is something added and invented … [Is] it necessary to posit an interpreter behind the interpretation? …
In so far as the word ‘knowledge’ has any meaning, the world is … interpretable, otherwise it has no meaning behind it, but countless meanings—‘Perspectivism’. ~Friedrich Nietzsche
Those who have the power have the right to say what is true and what is not true. It is not just that the powerful ‘decide upon the agenda’, the powerful decide on what game we should be playing (or to put this another way, the powerful decide what reality should consist of, what it is and what it isn’t). Inasmuch as society is a power hierarchy therefore, it is the top of the hierarchy that tells us what reality is, and we don’t get to question it. We don’t even know that our perceptions of reality have been defined for us! So if we’re in this situation of not being aware that our perceptions of reality have been defined for us (because we’re ‘socially adapted’) then it is inevitably the case that we will impose the very same assumptions we have passively absorbed upon everyone else we meet, without realizing that we are doing this.
This is of course a very important thing to be aware of, but when we’re talking about therapy, it becomes even more critical, even more poignant. Being unconsciously socially conditioned means that we are incapable of engaging in ‘honest human interaction’ – the only type of honest human interaction is after all that interaction which takes place without an assumed context, and because we can’t SEE our assumed context, that just isn’t possible. We’re not aware that we’re seeing the world via the lens of our social conditioning and this (as we’ve just said) means that we’re imposing that conditioning on everyone we meet, without knowing that we’re doing it. We’ve been set up as virally-infected ‘zombie-units’ whose job it is to unconsciously propagate the ‘officially approved view or interpretation of reality’ whilst imagining the whole time that we are acting as independent agents!
This situation is good from the POV of ‘perpetuating the socialized view of reality’, but not good from the POV of anything that might properly be called ‘therapy’! ‘Therapy’ and ‘brainwashing’ aren’t supposed to be the same thing, after all, and yet we confuse the two all the time… If we’re working in the field of mental health therefore, then the only way we can AVOID imposing our unexamined assumptions on everyone we meet is by taking the trouble to ‘examine’ them (and thereby examine ourselves). This isn’t what happens though – instead of becoming less programmed when we get trained as therapists or doctors or psychologists we get more programmed; instead of becoming more broad-minded we become narrower, as is always the way with specialization.
About the Author
Nick Williams – I work as an occupational therapist in acute psychiatry in the West of Ireland, and have done for the last 25 yrs. Before training to be an occupational therapist I graduated from the University of Kent with a degree in Health Education and Natural Science, and before that I was unemployed in South London for 15 years. The part of my current work that I enjoy the most is running a community creative writing group and a number of mindfulness groups. I am a keen blogger on the topic of ‘alternative approaches to mental health’ because I believe that the conventional approach in psychiatry does not respect the healing process that is always going on in us and simply tries to return people to a ‘standardized’ form of mental health. I feel that a lot of the chronic mental distress in the modern world comes from the artificial constraints that society puts on our consciousness and are not due to a type of ‘illness process’, as psychiatry suggests. I also give talks and run workshops on ‘nonduality and mental health’. Please visit my blog Negative Therapy and intrinsicspace.me.