Psychiatry and the Obstacles to Human Growth



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Psychiatry and the Obstacles to Human Growth

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WE hold these Truths to be self-evident, that all Men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the Pursuit of Happiness.



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With these words, the Declaration of Independence of the original 13 colonies of America, a nation to be, launched a challenge in the face of the values of the colonial Empire of Great Britain. Not only life, but liberty and the pursuit of happiness were claimed as inalienable rights for the citizens of this America-to-be.

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Through good times and bad, this nation has grown, raising the standard of living of its citizens and carrying our values abroad to inspire literally billions of world citizens. There is much to be proud of here: security from foreign wars, protection under our laws from the injustice of arbitrary government, economic opportunity for most, and political equality.



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At the same time, after 200 years of history, there are signs of hardening of our national arteries. Modern American society is profoundly isolating, intensely individualistic, competitive, and insecure. The United States is classified as a "guilt-based" culture--one in which the individual is constantly pressured to conform economically, religiously and socially to beliefs and behaviors condoned by the majority. Failure to "measure up" or conform creates feelings of guilt, shame and self-alienation on a massive scale among those who feel they do not fit this paradigm.

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We also have some of the most serious health care problems in the industrialized West. We have more people in prison per capita than any other Western nation. We have a very high incidence of mental and emotional illness. Our rates of murder, violence against other persons, and crime rank among the highest. Homelessness is a national scandal, with many of those living on our streets suffering from untreated mental illness because we don't provide universal health care. Poverty stands at 14 percent of our population, with 40 percent of those in poverty being children. Marital failures are epidemic, with divorce rates exceeding 50 percent.



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Nevertheless, as Americans we grow up in this climate and, knowing no other environment, consider it "normal." We even idealize it as "the best" in the world, pointing proudly at the standard of living most enjoy and the freedoms we have compared with much of the rest of the world.

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America is a society in which work provides the primary avenue for self-fulfillment. We seek realization of our potential through our work, whether it is in the marketplace or in the home. Our 'Protestant ethic" idealizes work and scathingly judges laziness and sloth as morally reprehensible. So we go to work with high expectations and with much to prove: that we are responsible, competent, dedicated to our employers' interests, willing to grow and assume greater responsibility, and resilient enough to deal with the inevitable conflict of working with other employees. The marketplace for jobs is, for most of us, life's testing ground for our wills and our ambitions, where we are challenged to make reality surrender to our dreams and our needs--to earn what we need and want. Work life in America is, in this sense, a battleground where we strive to succeed, to exceed others, to gain wealth, power, recognition, and security.



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The problem is that, in this competitive economy, we are never secure for long, never satisfied with what we have achieved, and never wealthy enough to feel safe. No matter what we do, or have done, we are not able to rest or relax into who we are and live in the present; no sooner do were fight our way to one victory that we feel that we must battle on to the next plateau of achievement, wealth, and security. We find ourselves constantly in a restless quest to "become" something other than we are now--to get more.

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Then, sooner or later, everyone's fortunes turn downward. We "top out." Or we find ourselves in an impossible job situation. Then our concern turns to holding on to what we've got. Now we worry that we might lose our jobs, our marriages, our lives, our security. When we are not "winning", we are "losing." There is no rest. There are only the quick and the dead.



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Our restless striving and struggling to hold on to what we've gained arises from fear. We miss that fact sometimes, because we distract ourselves with so much activity or clutter in our lives that we lose sight of what drives us. But at bottom, fear keeps us from ever being satisfied and present in our lives. Fear makes us stay in a job when we should go. Fear keeps us compromising our dreams and our integrity.

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Our sense of "self" rests upon our individual success in 'running this gauntlet' through school and work life to retirement. Our sense of worth and value teeters on the outcome of our test of wills. Failure to run that gauntlet successfully--to wrench what we demand from life, from others and the environment--results in a collapse of our self-respect, self-worth, self-confidence, our ability to hold our heads up in the community and before our families, and our sense of adequacy at coping with Reality.



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But the work of the past century in psychotherapy suggests that this need not be the outcome of our lives at all. Work by many psychiatrists since Sigmund Freud began his work nearly a century ago suggests that the damage began in childhood in the way we were parented, and then reinforced by societal values and a ruthlessly competitive economy. This work to understand our minds and emotions suggests that mental and emotional health may be achieved only by not allowing our society's social, religious, and economic values to control our choices about work and family life. It may well be that "liberty" is not to be found within the values of American economic, political, social and religious systems at all, but rather outside those belief systems, within our own selves.

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In this paper, the work of a number of prominent psychotherapists are reviewed to understand their views of the non-biological sources of neuroses and psychosis, the consequences of neuroses for our lives, and the connection between these distorted viewpoints of self and life with our social environment.



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Sigmund Freud and "Guilty Man"

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Sigmund Freud, popularly known as the 'Father of Psychiatry', perceived man as caught between the biological drives of sex and ambition. Building upon the theories of classical liberal economists and political scientists such as John Locke, John Stuart Mill, Thomas Hobbes, Adam Smith and others, Freud hypothesized that man's psychic needs derived from his biological nature. Therefore, he argued that under our 'social contract', Man surrenders his individual liberty only in order to protect himself from the violence of others; man is essentially an animal, potentially violent, and self-interested. When a man surrenders his liberty to be and do what he pleases to participate in the in the marketplace or work place, he expects to be protected from the violent intentions of others and enabled to meet his biologically based needs.



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The marketplace and work place, Freud maintained, was not only a hostile place; it was a truly terrible environment unlikely to meet most men needs. So as a man goes out into the marketplace or work place to satisfy his needs, he inevitably encounters failure and frustration of his needs. As a result, every man must inevitably experience rage at himself and at others for his inability to meet his needs. Every man inevitably learns to hate himself for giving himself away to get what he needs from others.

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According to Freud, man seeks satisfaction of his needs from his base of biological instincts; the result is the stimulation of his lust (greed and desire to possess) and anger-- each drive working in opposing directions--the one demanding pleasure and satisfaction for oneself and the other blaming others for the failure to get one's needs met. The two drives are ultimately uncontrollable and incompatible, resulting in painful feelings of guilt (that he would seek to overpower others).



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As infants, both of the drives are self-reinforcing. Both emotions are initially reinforce one another then, resulting in self-love and the identification of others (e.g. mother father) as 'extensions' of one's self. But as maturation proceeds and the growing child encounters frustration of his needs, these drives have to be turned out towards others, resulting in the loss of self-love and increasing self-hatred. The growing child realizes that he must do for others instead of himself, and this causes him to deny his own needs to get approval from others. This denial of self generates self-hatred, which soon becomes projected outward towards others and society. Modern man thus becomes haunted by self-hatred projected onto others, which becomes hatred towards and violence against others.

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In Freud's theory, Man suffers from his inability to get his needs met but is controlled by guilt and self-judgment. He is also held in place by society's moral codes, its rules and laws, and his fear of annihilation by society's power. He is unable to escape his fate and unable to meet his needs. This intolerable situation, which Freud saw as terrible for us all, is a fact of life because reality is essentially heartless.



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Freud felt that the young must surrender to this reality as they mature and adjust to living in this unfeeling reality. The price of that surrender and anger at others, however, is the self-inflicted violence of guilt and hostility to life itself. Thus, the guilt which is socially required for individual survival threatens the survival it is meant to insure.

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Freud was justifiably famous for his recognition of man's unconscious, conscience, and instincts; and for his recognition of the importance of man's dreams as revealing man's unfulfilled wishes. Dream interpretation formed a major part of the therapy patients received from him. He was perhaps the first to recognize that patients must be helped to bring the rage and fear experienced helplessly during childhood into conscious awareness to heal and free them from neurotic or psychotic behavior. Nearly all neurotic behavior, Freud believed, could be traced back to sexual fixations upon one's opposite sex parent. Once aware of the causes of his neurotic fixation, the patient could integrate the new knowledge into daily living and live a more acceptable life within the hostile world man has created for himself.



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Alfred Adler and Individual Psychology

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Alfred Adler was a collaborating colleague of Freud's, but broke with Freud over his insistence upon sexual fixations as the cause of all neurosis. Adler felt that preoccupation with gaining power over others was more important as a symptom of adult neurosis than infantile sexual frustrations. However, Adler is also misunderstood today because he never gave "power seeking" the central role in his thinking that much of psychiatry believes.



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Adler's central preoccupation was with the mental health of children. His view was that a person's "life style" was formed during the first three or four years of childhood. During this period, parental behavior shaped a child's outlook so profoundly, and sometimes so disastrously, that the child makes mistakes in understanding life. These mistaken perceptions or viewpoints about life, once formed, are very difficult to change once they are in place.

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One of Adler's contributions was the discovery that a child's order of birth within a family is generally a very powerful indicator of his neuroses, the formation of neuroses, and the character traits he adopts. First children are the "only child" and the center of parental attention until the second child is born. The birth of a second child "dethrones" the first born and leads to their belief that they have lost the love of their parents to their younger sibling. The first born subsequently becomes very power oriented, concerned about authority and responsibility issues in order to win back the love through achievement they believe they've lost. They also are very resentful of their younger sibling.



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Second born children, unlike first born, are never alone and always feel they are competing with their older, more powerful sibling. These children try to overtake their older brother or sister and are driven to outperform them. Should the first born "win the race" to parental love, second born children may give up the battle, become neurotic, and feel overwhelmed by life's problems. Or they may become a rebel, act out constantly, and hold all authority in contempt.

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Last born are the last in the nest, and are often spoiled or pampered by parents. Last born children may shoot forward into success in life, or be so shaped by childhood pampering that they become dependent and expect others to care for them. These latter children may experience a feeling of helplessness as they enter adulthood and become a 'failure' in everything they do.



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Parental punishment of a young child can cause the child to adopt the view that the world is a hostile environment where she is punished for thoughts, feelings or deeds others disapprove of. This view of the world can be a frightening event, causing the individual to live in constant fear of life as she grows in adulthood.

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Adler was also the therapist who coined the phrase "inferiority complex'--a neurotic condition characterized by being unable to solve life's problems. However, Adler recognized that feeling inferior was also a fundamental consequence of being human.



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Babies, small children are dependent on the help of adults. Their wishes meet resistance from parents and caretakers forcing the little ones to give in. The experience of weakness and powerlessness awakens a feeling of inferiority, activating him to strive upward. If this normal upward striving is prevented through faulty upbringing, then this inferiority feeling may deepen and lead to an inferiority complex, which prevents him from successfully solving life's problems. 

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The feeling of inferiority stems from three sources, according to Adler: (1) physical weaknesses, (2) spoiling of a child, and (3) neglect and abuse of a child. Physical weaknesses, handicaps, vision or hearing problems etc make a child feel inadequate for dealing with their world and cause a feeling of helplessness to deal with threats to well being or self esteem



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Spoiling stems from a mother's over-protectiveness of her child; in spoiling her children, she fails to help the child find contact with the world around it and to teach it how to cooperate to get its needs met from others. Spoiled children, Adler, argues, seldom develop the social skills they need to get along with others and develop close relationships. They have been taught dependent behavior, which many are then unable to outgrow. Such children may later constantly avoid responsibility, be unable to make critical life decisions, and be unable to care for themselves throughout their lives. They often make passive and unreliable employees when asked to support themselves economically.

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Abused children experience continuous humiliation because their parents hated, did not like, or ridiculed them as infants and small children.



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These children may psychically withdraw from life, feeling the hostility of the world and the absence of love. Others may attempt to compensate for their childhood humiliation by adopting personas of cleverness, wit, being funny, agreeableness, being charming, and even sweetness. Witness Dicken's character in Oliver Twist called the Artful Dodger as an example. But underneath, they cannot escape their vision of the world as a harsh place nor their own feeling of being hated and unlovable.

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Superiority complexes, Adler pointed out, are simply another form of the inferiority complex, in which the neurotic acts supercilious, vane, competitive, arrogant, snobbish, boastful, domineering, and hypercritical of others. They often exhibit intense emotions of anger, a desire for revenge, a claim of superior knowledge or ability, and hyper enthusiasm to cover their feelings of inferiority.



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Whether these feelings of inferiority manifest as inferiority or superiority complexes, such people seek power over others to reassure themselves that they are superior to others. However, he noted that achievement of power "never satisfies such a person that they can never be satisfied with what they have achieved. They constantly must prove anew that they are superior to others and can never rest. This is a neurotic behavior.

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Treatment of troubled children was Adler's major preoccupation during his career. He observed that:



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Every human being strives towards a goal. . .As soon as one discovers the goal a human being has set himself, one can explain his actions. This method, which Adler called the 'final method', is the opposite of the method of observation which inquires after the reason for a behavior, the 'causal method.'

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Adler viewed each individual as a unique personality, unlike any other. He therefore had no interest in personality categories such as those developed by Jung and others. Treatment of psychic disturbances had to proceed by understanding the unity of the personality and the mistaken perceptions the child adopted during very young childhood.



Adler believed that dreams were not interpreted symbolically, but should be understood as a means whereby the psyche created "moods" or feelings to help the patient break his rational justifications of his perceptual mistakes. In treatment, accepting the patient's reasoning about how the world is seldom helps the patient, because it holds him in his suffering state.

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Like Freud, Adler believed that young people must be helped to adjust to living within society--not to turn their backs on society's values and ways. He insisted that a human being could not be assessed apart from her environment and social context. Unlike the Liberal Political Economy thinkers of his age such as Sigmund Freud, Thomas Hobbes, John Stuart Mill, or Adam Smith, it was unthinkable to him to consider mankind's natural state as being outside of society; mankind, he would say, does not enter into a social contract with others to protect himself from the violence of others, but because he is a social animal.



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In Adler's treatment regime, the analyst would work to understand the goals underlying the patient's life, review the childhood experiences of the patient, and then reveal the mistakes in perception made by the child in childhood. Once the patient accepts that his point of view is mistaken, he can adjust to a more normal life.

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Recent work by James Hillman has raised the reputation of Adler in the initial triumphirite of Freud, Adler and Jung. Hillman argues that Adler was misinterpreted much of the time, largely because of a pedantic writing style from which poetic metaphor was misinterpreted literally.



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Both Freud and Jung based their systems upon shaman-like visions, which led them to an explanatory structure with self-developmental goals, such as the movement of neurosis into consciousness, individuation, and wholeness.

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Adler was doing something different. He based his psychology upon clinical research. He was a phenomenologist who wanted to understand consciousness from within itself and without appeal to concepts outside of it. Whereas Freud and Jung, learning from their inner visions and psychic experiences, pretended to be objective and scientific, reasoning how we should live and what life should mean, Adler remained subjective and hermeneutic.



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Within consciousness, Adler recognized that much that passes for truth is simply a fabrication or fiction. It is ‘made up or plagiarized.’ So to him unconsciousness was simply that we are unclear that what we believe is fiction. Becoming conscious means being clear about the fantasies driving our thinking and behavior.

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When we ask therefore “What does the soul want?”, Adler would answer that it asks to become aware of its fantasies! Normal people, Adler would argue, will accept guiding principles and goals as metaphorical information. The neurotic, on the other hand, ascribes “absolute truth” to the metaphor. So for Adler, what makes for madness is literalism! When religion, for example, is interpreted as poetics or metaphor, it provides “as if” guidelines which can be used pragmatically to guide behavior. But when the metaphor is taken, literally, as “the Word” or “the Truth”, it leads into madness. To be sane, we must recognize our beliefs as fictions, and see through our hypotheses about Reality as fantasies.



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Being sane then means learning to live in a Universe of ambiguities, uncertainties, unknowing. To some minds, this ambiguity of truth is untenable, unbearable…and so they move towards dogma or fanatical belief, using authorities, references, experts, holy books, logic, social values, belief systems, ideology, tradition etc in an attempt to make the right choices in life. But there is no “making the right choices” if the hypothesis driving our choices are a fiction.

For most of us, the ego will strive to decide the right answer anyway, because to make the “wrong choice” leaves one feeling inferior; to make the “correct choice” leaves one feeling superior. Ego flees from the unbearable feeling of inferiority or the unbearable tension of ambiguity.

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To Adler, Mankind’s inability to accept the ambiguity of life, goodness, rightness leads to madness. In the end, we choose to kill one another to defend the “correctness” of our point of view.



The best that psychiatry can do is to lead us all out of our core beliefs, into acceptance that psychologically we must accept feeling unwell about ourselves to be well. We must accept our “ordinariness” rather than our “superiority.” We must accept our equality rather than our belief that we are better than others. Our perceived inferiorities may not be literally true, but we feel them nevertheless. We can choose to see our lives as a tragic-comedy if we like, with ourselves as the “leading actor.” What matters is surrendering to the idea that Mankind is an imperfect being in an incomprehensible Universe. Being free of perfection or of being right, we are free.

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The impetus to resolve the problem of inferiority is the individual’s path of growth in life and is, in Adler’s terms, its soul purposes. The urgent need to escape from the feeling of inferiority creates neurosis. Of course, it is the ego itself which defends the psyche against this feeling, pushes the psyche into unconsciousness of it, and chooses to grasp the belief systems which it associates with “rightness”, “correctness”, “perfection”, “goodness.” So Adler would say the ego can never lead one out of unconsciousness.



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The primary cause of the damage from these fictions is what Adler calls the masculine impetus: the need to win, to come out on top, to compete! In any issue defined by a duality—such as good and bad, right and wrong, high and low--where both poles are fictions, the whole idea of winning is a fiction! So is the idea of losing. Instead, winning is the acceptance of the ambiguity of existence, the absence of information about winning or losing, right or wrong—because all existence can only be grasped metaphorically and never literally.

What then drives us to seek the higher, the best, the perfect? Adler thought this was an innate drive in humanity—a fantasy of the spirit, so to speak—lodged in a limiting and imperfect shell (the body). We desire or need a path towards perfection to feel well about ourselves. We feel a need to be right! So our inferiorities, or weaknesses, create a path to rigidity acceptance of some code of honor, integrity, goodness. These needs to “be right” or “get better” are ego goals. But the Path is a fiction if the inferiority is a fiction and if the duality of lesser and greater, lower and higher, are fictions.

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