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Welcome to Unraveling. This is a podcast that sees the world through the lens of mental health. I'm Mary Wilson, a journalist.
And I'm Curt White, a social worker and psychotherapist.
Well, Curt, we've had quite a few episodes now sort of exploring the biological markers of mental health. And today, we have something different, a very special roundtable that's shifting our focus more to the social forces that shape our inner lives, including political identity.
Yes. We were talking about this, all of these episodes, about things like epigenetics and diagnosis. And I think we're missing something here. The way that we exist in the social world and the way that that affects us and our ideas about who we are and how we come together, how we see ourselves as individuals and part of groups, how we advocate for change in the world. And what does that have to do with mental health, with psychology, with this enterprise?
Because I think we all feel like it does, that that's one of the underpinnings of this whole unraveling endeavor is that there's some relationship between the social world and the intrapersonal and interpersonal worlds. And that we ought to be able to say something meaningful about that, about ourselves, our, you know, maybe what could be called our ideals, our politics even, this sort of struggle between us of what's ideal, what's pragmatic, where where are we going, and and how do how do we live in relationship with each other.
So we've brought together a very interesting panel of people who have spent years maybe considering how political identity shapes our sense of self, our relationships, and our mental health.
Yes. Three wonderful clinicians with very different backgrounds. I'll let them introduce themselves. Sarah, maybe you first.
I'm Sarah Turbo. I use she, her pronouns. I am a clinical social worker. I work here at the retreat, and I also am a community organizer. And I'm also the chair of the Brattleboro retreats diversity, equity, and inclusion committee.
I'm Jeff Kane. I'm a physician in addiction medicine by way of internal medicine, an individual and group therapist. And I have a major interest in the community aspects of health as well as clinical aspects of health.
My name is Nnamdi Pole. I'm a clinical psychologist, a professor of psychology at Smith. Right around 2008 when I started working at Smith College, I had the opportunity to start working as an adjunct in a school for social work, which began to shift my consciousness and and lead me to question the role of politics and other things, in the realm of mental health.
And our topic today is politics. So maybe we just start with the word itself because it seems to have different meaning today, more about polarization perhaps than policy. And Sarah, why don't we start with you, with your background as a community organizer and an activist? What does politics mean to you in your eyes?
Yeah. I mean, I think politics in the broadest possible sense means anything that has to do with how people are impacted by and interact in public life. So that's a very, very broad definition. In the clinical sense, how are the things that are happening in the world, the policy decisions that are being made impacting the people that we see in our clinical settings, our patients? So things like recent cuts to SNAP, for example, how are those impacting patients?
How does the national conversation and legislation and political action around trans rights, for example, impact the mental health of folks in our community who are trans or patients who are trans. Thinking about how politics shows up in a clinical space, that's how I that's how I think about it.
I love Sarah's definition. What comes to mind for me first is people's political affiliation, maybe is one of the things. So politics in part means kinda what what should the two major parties you're you you affiliate with, and then people sort of stereotypes, assumptions, and probably in some ways, you know, accurate guesses about what might go along with with your beliefs, your values. I came to this and had to grapple with it and its role in mental health as an African American person in our society and then African American professional in the wake of the Black Lives Matter movement. So there's this, like, movement that's happening, a socio I call it political movement that was happening out in the world.
And the question was how much should that be a factor in in in in the clinical work, but also in the training of clinicians, you know, working with diverse clientele, clientele of color, black, indigenous. Like, all sorts of conversations were sort of happening in society. And the decision I have as a professor, but also as a clinician, I've I was asked in this time period to come in and work with many community mental health agencies in predominantly white areas of New England, grappling with actual clinical cases where race and racism were alive issues. And I've been doing this for many, many years. And so, you know, like it or not, the the the sociopolitical movement, was having impact in the clinical world, and and I was drawn into it and and personally interested and invested in it.
I see it affecting everyone. And it's sort of a term for, as Sarah said, how we act in our relationships with others in communities, you know, neighborhood, to national, international. And in my work in addiction medicine, a lot of the effort has been to help people wake up to the reality that there's more to who they are and why they do the things they do than what meets their own mind, the whole issue of the unconscious and implicit bias. And all the various identities that any one of us carry have probably unconscious and conscious representation. And the political is so polarized that does or does not affect therapists in their relationships with people who are being buffeted by these things outside.
I was saying this to Mary yesterday. So we were talking about getting together today that I'd disappointed if Plato's Republic didn't come up at least once. You know? But I thought, well, I probably will have to bring it up, I guess. Right?
That's how that goes. But, you know, there's that little passage at the beginning that sort of frames the whole discussion about what kind of government do you have, actually, where they're coming back from essentially like a like a festival party gathering, and someone comes up from behind and wants to stop Socrates and bring them back to see some more of the party that isn't over yet. They've left too soon. And they say, well, you know, we order you to wait. Well, what if I don't want to wait?
Well, you see there's more of us than there are of you. So what choice do you have? Well, what if we persuade you not to? And what if we don't listen? Right?
That's the discussion that precedes this very famous tome about how do we live together and march in the same direction or something? Is it might makes right? Is it something else? You know, can we sort of subsume enough of our will to a general larger purpose that we can function together, but not so much of it that we've created a lack of justice, which is the sort of key theme of that work for for ourselves, for others. And but how would we know? Right?
That makes it sound like it's all about the control of others as opposed to the understanding and, I know, comradeship with others.
I mean, I think part of what it also has to do with is less government, but power dynamics. Who has power? Who doesn't have power? Who is able to make decisions that impact their lives? Who are making decisions that impact other people's lives that exists, you know, politically, whether that's has to do with government or doesn't have to do with government at all.
I see my role in both therapy and in organizing as being somebody who's interested in agency. People to have agency over their own lives and over the the circumstances of their lives and to be able to come into a greater sense and a greater actuality of agency. If you don't have political power, it's very difficult to make any kind of impact on the policies or the circumstances of your life. And it also has to do with what agency do you have even around your own behaviors, your own relationships, your own day to day life.
Sarah, it sounds like agency for you has people looking out for their own interests and also not disregarding the interests of other people at the same time.
No. Absolutely. I think agency also for the people that they care about and love, or even agency in society as a whole. But unfortunately, I mean, I think in the ideal, politics is not a zero sum game, meaning that everybody can win. Everybody can get something out of it. But right now in our current politics, given the power dynamics, oftentimes, is a zero sum game where somebody wins and somebody loses.
How did the feelings of maybe powerlessness or empowerment around politics affect mental health?
This is less in my clinical experience, but in my experience in organizing, watching people be involved politically, how empowered they feel and how like, you can even, like, affectively watch them come into a sense of power and strength of being somebody who can take action with other people to change the circumstances of their life. I was doing organizing housing organizing in Brooklyn, a number of years ago, and there was a public housing project where there was one building that had, you know, lights that were out all the time, and the elevator was broken, and the security cameras were broken. And then there was another building that had such a bad rat problem that after 04:00 in the afternoon, all of the residents would close themselves in their apartments because the rats would just be running rampant in the hallways. And we had organized a group of residents from these buildings, from this public housing project, to go down to the building manager's office and demand a meeting. And it's like 15 people.
They cram into this little room, and there's bulletproof glass, and they demand to speak to the the building manager. And this receptionist like runs and goes talks to the building manager. The building manager comes out and was like, yes. Yes. Let's have a meeting.
And they get out there scheduling books, they put a meeting on the schedule. And there was this one woman from the building with the rats who said, you know, I've been trying every single way that I could possibly think of to get that man's attention. I've called 411. I've called NYCHA, the New York Housing Authority. I've tried to catch him, like wave him down when he's in his little golf cart riding around the housing project.
I've come down here during business hours. Nothing has gotten that guy's attention. It wasn't until I showed up here with another with a group of people and demanded a meeting that he actually agreed to a meeting. Affectively, her whole body changed. And you could just see how she, in that moment, understood something really different about how can I go about making change in my life that's like materially important to my life?
Right? You can if we're talking about mental health, you can imagine how shutting yourself in your apartment when there are rats running around, not great for your mental health, but also not great for your physical health or any other part of your well-being. And she all of a sudden was in a position to be able to make some change around that. There's no way that that doesn't impact somebody's sense of agency and self respect and dignity.
I I think I add to that. As I was talking about this and and the word agency came up and empowerment came up, you know, reminds me that in in my own clinical training, which initially was psychodynamic, you know, kind of Freudian based, and then later cognitive and behavioral, and that, you know, I kind of amassed a set of tools I could use when I was working with clients in distress. And I think that for me, once I started to I guess the first time I remember being aware of hearing about feminist psychology, which kind of said that, you know, you needed to also have in that toolkit the ability sometimes to introduce your clients to empowerment, to do consciousness raising about the fact that what their that that the depression or the anxiety that that your client might be suffering. In this case, women, you know, in the nineteen seventies when these therapies were created, that that part was going on is not depression, but rather oppression. And that if that's the case, spending time, you know, exploring your psychodynamics and your cognitive distortions, it it may not be the most helpful thing.
And for therapists who only work in that way, they might be complicit in kind of just reinforcing a kind of sense of social inequities. So being able to sometimes help your clients see agency, see that what's happening to them and their feelings and what's going on with them psychologically is not strictly psychological, but actually social, and might have a social remedy is is is really important. And, again, I wanna underscore again, not having that, you run the risk of of just reinforcing some of the ills in society and being being being complicit and and being somebody who is kind of just adding to the sense of oppression, and you're kinda helping people to tolerate something that maybe is kind of intolerable, like rats running around in your hallway.
The social remedy is it's sort of Sarah described agency together, which is different from just solo agency.
So social collective action might might be a political movement. It might be being attached to a political movement, but it might mean, you know, talking about politics, bringing political things into the clinical space. But actually, doctor Kane, I'm curious to know what whether whether you would agree with that. Like, do do you see that collective agency you keep naming? Is that is that political to you? Is that or not? Or does it not need to be?
That's a tough one. I think because political these days refers to sort of a dichotomous split in communities that's often adversarial and disrespectful to one another. I grew up in a day where I was happy to be not involved in politics because there were representatives who were elected, who sort of thought a lot and worked things out. That doesn't seem to be the case anymore.
It's interesting. I think, you know, doctor Kane, you and I have had this conversation offline in a couple of different in a couple of different ways as well or elsewhere, but sort of the role of anger in in political work. Right? Because when I'm thinking about what NAMDI is saying, the way that that actually plays out for me, for example, if I'm confronted with a patient who is feeling really hopeless and really self hating, like their self hate is being bumped up by hatred in our society. Right?
I'm thinking specifically about a number of LGBTQ clients that I've had over the last number of years. Right? Part of the way that I externalize that, you are not the problem. The problem is the problem, which is a very, like, narrative therapy way of thinking about it. Right?
Is to say, in part, there are people who want you to feel that way. They are counting on you feeling hopeless and wanting to go back into the closet, and to not be out, and to not be strong and public. And they are hoping that you will do that by making life impossible for you. And that actually stirs up anger. And my hope is that that's angered outwards as opposed to anger inwards.
Like, that's a clinical intervention that I'm making. And it is also adversarial. It is saying there are people out there who you should be angry at instead of being angry at yourself. So and I I think that that, you know, isn't a very civility minded or a depolarization minded intervention. I'm curious how you might think about that, doctor Kane.
It's a challenge, and I don't presume to have the answers to it. The analogy I think of is self defense. There are martial arts that seek to neutralize the aggression of an oncoming attacker. And their ideal is, you know, nobody gets hurt. Everybody goes home to dinner.
Yet there are situations where people are subject to aggression. Even lethal means of defending oneself are to me ethically and practically and morally sound. One of the things I've said for years about domestic violence is with a trace of anger, the wrong people get hurt. I have some fairly clear ideas when it comes to self defense, where to cross the line from assertiveness to aggression in the political sphere, and that may mean yelling. I don't know if it means, you know, mutual attack, but I'm not so clear about that.
I think as in self defense, there may be a place for it where, as you describe, somebody is out to make someone feel bad and take a lower profile. Well, that's not fair.
It's an interesting problem because it becomes very practical quite quickly, I think. Right? As therapists and helping professionals, we're supposed to actually do something, I think, right? I mean, someone shows up, and I guess the sort of ideal thing would be that we find out what kind of problem they have, and then we use our learning to help them with that kind of problem in a way that they don't have it anymore. But it's not that simple.
I mean, I think it's, you know, that sort of model assumes a kind of detachment from reality. Right? If one person's from social reality. If one person's depressed, they're depressed, or so it would seem. But if everyone in a community is depressed, you know, or if more people are than you think really ought to be, then something's in the water, something's going on.
Right? And so you get things like I remember a study where they found a Native American community where, because of some changing circumstances, the community got a fair bit more money in a hurry. And they studied the rates of things like childhood mental health problems that you would think are kind of like almost objectively measured, you know, using standardized measures before and after this. And they found actually that the mental health went way down when the standard of living went way up, right? I mean, in a way it's obvious.
It's so obvious we shouldn't even mention it. But like it's, I think, our pretense toward objectivity in this field that like there is such a thing as a diagnosis that goes bump in the night, you know, that's out there sort of lurking, you know. It might be a fundamental misunderstanding of a person in their lived reality and the knowledge that we might need to help them with the problem. It's maybe an incorrect framing.
I'll ask Nambe a question. When differences appear between therapist and client, how does that affect the therapeutic alliance, the connection or lack thereof?
Right. That's a that's a that's a good and important question. One of the truisms in psychotherapy research is is among our better predictors of good outcome is a good therapeutic alliance characterized by an emotional bond, a sense of agreement between the therapist and client on the goals of therapy and the tasks that are required to achieve those goals. And so it would seem to be quite a threat to one of the essential ingredients for success to have difference rear its head certainly in certain in certain forms. If that difference arises in such a way that it disrupts the bond, so it's harder to feel close to the you know, they don't feel as close to each other, or they have, like, a radical different view on what is a good outcome and how to get there.
So I I definitely think it's something that professionals should look out for. But I think my my own view is I think we we sometimes are too timid about about that, because we also have tools about what to do with with ruptures, how to repair them. And sometimes repairing ruptures actually not only strengthens the relationship, but is a is is a hugely transformative agent. You know? So I I think that the novice says, well, I I better make sure that I never do anything to raise differences between us because that client might not ever come back.
But I would hope that the the more sophisticated we get in our work, we we we start to think about how might we introduce and raise these kinds of issues. And I'll just give one example of this, because as I mentioned, I'm a African American psychologist and have spent a lot of time teaching on race and racism. And one of my regular lessons is teaching white therapists how to bring up the topic of racial difference with clients of color. Again, white people in The United States for a long time on average have been taught that taught to be color blind, essentially, that it's impolite to bring up racial difference, and that is only gonna make people feel othered for many of the reasons that Sarah has beautifully spoken about. So so but and yet, I think we've gotten the feedback from lots of clients of color that to pretend that you don't notice the racial difference actually does some harm.
So, yes, you might succeed in having the person feel like they're just a person, but you also might be raising questions in their mind about how sophisticated is the white therapist about race and racial differences and so on. So so it's it's about equipping the clinician about how to bravely enter the space of of raising differences, working with those differences, and providing a therapeutic experience around the discussion and negotiation. It's harder work, but it's kind of what we get paid for.
One of the things that makes me think of is in that work, the importance of the therapist knowing their place. The problem with differences in identity, whether it's color educational level, it's when people feel superior to someone else. And if the conversation across racial lines or socioeconomic lines or whatever is one of mutual respect, with the burden maybe being more on the therapist to provide that. It can be quite fruitful. Humanity should be there in the room.
So, yes, it's I think it's important when we have these areas of difference to be aware that kinda what position of relative power you have. Right? It matters in kinda how you negotiate it. So the average white therapist raising the issue of a racial difference with, a black client, you know, shouldn't problematize that difference by saying, oh, you know, we're we're kind of we're different, and what are we gonna do about that? Because to your point, doctor Kane, the white person sort of holds a certain degree of privilege in that situation, and the more powerful person has to kind of take on the burden of the struggle of the difference, essentially, to help make that rather than make it like highlighting it and diminishing the other person.
Right? So I think you're right. It's it's one of the many tricks we have to use professionally to try to figure how do we successfully negotiate these differences. And it might even come up with political affiliation. That might be another taboo difference that we might have to bring up from time to time and figure out how do we talk about that and preserve the relationship. You know?
I mean, I I think to go back to doctor Kane, you know, it all depends. Right? And I think you're when you're talking about the therapeutic relationship, the primary responsibility is to think about what's appropriate for this particular dyadic relationship. In terms of neutrality, I mean, Kurt, you you were asking kind of what do we do about neutrality? There are certain patients for whom they're experiencing sociopolitical or sociocultural, socioeconomic stressors.
And I think my job in that moment is to be social worker and to connect them to resources. For others, it's to, like, genuinely share frustration, anger, disappointment, grief, fear with them and be with them in those feelings. For some, it's actually to encourage them to take some sort of collective action. For others, it's to not talk about these things in such a overt way, and like to not be disclosive. You know, I'm I'm pretty disclosive about my politics with patients for whom I think that that is of benefit to be able to show and demonstrate, hey, I really am with you in this moment of fear, grief, uncertainty, whatever that is.
One of the things that I'm pretty self disclosive about is that I'm Jewish. Right? That comes up fairly early on in a therapeutic relationship. And I've had people ask me about my views about Israel or assume views about Israel. And the conversation then becomes so interesting.
What's important to you about knowing my views about Israel? Let's talk about what would it mean if we did share the same politics? What would it mean if we didn't share the same politics? Why is that important? What does that mean to you?
And I think that that actually is a way of exploring the relationship in the here and now, which is something that we might do in any other kind of here and now moment. Right? Where somebody asks, oh, are you a parent? Why does it feel important to you that I'm a parent? Tell me what you imagine I may or may not be able to relate to you about that given that I'm a parent or not a parent.
Right? Like, it doesn't have to be something that's controversial. When it comes to Israel politics, it's quite controversial, and I'm very uninterested in getting into my own Israel politics in a therapy conversation with somebody. But it can be useful to the relationship. I think the question is, like, when is there clearly not overlap or when somebody says something that's offensive?
I think that that becomes or, you know, really not aligned with my own politics. And I I think it really depends. But and this has not happened to me before, but I think about what I might do if if it did come up, if somebody used, for example, a word that I found very offensive. I think going to what what Nnamdi was saying about the rupture and repair of saying, wow, you know, that that word that you just used really landed with me in a challenging way. Like that word hurts me.
Like, can we talk about that, and what's going on in this particular moment? Tell me more about why you decided to use that word, or where you learned that or what what's that about for you? What does it mean for us to be in disagreement about that? Right? So I think there are lots of different ways of bringing the self into this space that can be clinically appropriate. It's not a one size fits all solution.
I'd love to hear more about navigating that tension that you mentioned of being a human being yourself, a citizen, and a mental health professional, especially when those roles can clash.
Making decisions about disclosing, not disclosing, discussing, not discussing, I think I I try to discipline myself to to prioritize as number one, the welfare of the client, what's in the client's interest. So I again, in Sarah's example, it was like, I see a path where this disclosure would benefit this person. I normally wouldn't disclose on this, but I'm gonna do it here because this client would benefit. As again, a quick quick anecdote, I'm thinking about a student I worked with who was a gay white man working with a black adolescent girl who was struggling with her sexual orientation and about coming out as a lesbian. And he his question was, you know, should I tell her I'm a gay man?
And what he saw was an opportunity to bond on their common gay identity while what was obvious was their dip their racial and gender differences. And so he took that path and to the to the benefit of the therapy. Right? So so that's a great example. But then I think what Sarah got to at the very end, I think, is one something I'd love to hear from other panelists about too is the, you know, when you find that your client's political views are offensive to you as a therapist and kind of how one negotiates.
That may be among the most controversial kinds of things we can find ourselves in and and one of the places we might struggle the most. When I'm in that situation, I almost always need to take some kind of pause. I don't trust any immediate reaction I might have in terms of in terms of the intervention because it has probably hurt me. It's wounded me. It's made it's disoriented me, not knocking off my game.
And what I wanna do is respond in a way that is first and foremost for the benefit of the client. And so I I usually need some space and time to figure that out, and then some response might come down the road about that. The human being in me has has now supplanted the therapist in me.
I I I wanna quickly join you in the need for a pause. There are times when there's something about a individual client in a group or one on one that ticks me off. And usually not a superficial characteristics. It's something about how they're living, maybe taking advantage of others or mistreating themselves. And I will sometimes sit and listen until I find something that rubs me the right way.
The person may have marginalized others, taken advantage of others, but has a loving relationship with a pet or something. So I'll wait till I warm up with a pet and then get into more of a conversation. There have been times where something sparked me so noticeably that right away I felt compelled to assert my position. And as soon as it became about me, it ruptured the relationship. There, recall
a couple
of instances where there was no repair. I mean, the person signed out that day or the next day. And had I simply reflected what I heard rather than reacted to what I heard, things might have gone very differently.
I remember I had a client a number of years or a few years ago who had a lot of what we might call cognitive distortions. Right? He was making a lot doing a lot of mind reading of other people, almost to the degree of paranoia, but maybe not quite. And it sort of met up with a like feeling that women were out to get him. And it was this very challenging set of conversations to have because it really felt almost like in Sully.
Right? This like really kind of creepy, like anti woman narrative that he had. And this was a short term treatment that I was doing with him. And I ended up not addressing that part, but only addressing the cognitive distortions part. And like there I think there's also a way of even using like really basic like CBT.
What's the you know, you you think that this woman in your life is out to get you. What's the evidence for that? Like, can you defend that that's actually the case? Is there some other explanation? Is there something else that might be going on, which is more about being able to hold different possibilities?
And, you know, my part of my underlying motivation is also then to disrupt maybe the politics that that leads him to. Right? But in the moment, it was more about this particular almost delusion that he was having. So I think there's also a way of doing it without addressing the political piece as well sometimes. What does it mean to treat the politics?
Is that even appropriate? Or are you treating the underlying mental health challenges in the hopes that the politics will move in a particular direction? But is it ethically okay for us to hope that somebody's politics will move in a certain direction, I think is a whole additional question. And I feel very ambivalent about that.
I think that for us as mental as mental health professionals, it will be helpful at this stage, in this moment, to get clearer and clearer about the kinds of things that are totally fair game for us to be intervening about, and not let some of those things get named as political things that are off limits. Though, like you, Sarah, I would share I I would find myself uncomfortable if I was really clear that my goal in intervening was merely to prevent somebody from voting a particular way to get them to change their party affiliation. That's not what I wanna be in the business of. I think the lane that we wanna be in is what where do we have, you know, pretty solid clinical or empirical evidence that this behavior is maladaptive, harmful? You know, again, if you are a podiatrist and you know that your client that your patient is a smoker, I mean, you know, it's not I mean, are you allowed to comment on the hey.
We we know what smoking does to people. So I guess my point is to the degree that we see behaviors and have concerns about the way someone is behaving, and we are the the the behavioral health professional, the mental health professional, I think we we now are at greater risk at being bystanders, letting things go by because we think, oh, those things are political things. We better not mess with that. So when I come back to your comment, Jeff, I see you emphasizing some more fundamental principles like community, like, you know, you you you kinda elevate the conversation. And I also hear in your comments, Jeff, a reluctance to do anything that's divisive.
Do anything that kind of divides us. I I totally get that. I think we are so polarized. So part of the solution is for us to kind of find those common principle those principles about, like, you know, how we treat other people and try to lean into those things more as professionals and feeling more comfortable with intervening in those areas, stopping short of having the ambition of, you know, what that means for down the road who you vote for. I mean, that's that's not that's not our business necessarily, but but the other stuff might be.
More more of our business than we currently let it be.
I'm mostly in agreement. I think it's a time of aggressive action toward others. Like, there's a shooter in the room. Intervention is the name of the game as far as I'm concerned. I would wanna be able to do something.
If the timing is different, however, if the shooter is now incarcerated and I have a clinical contact with that person, or if someone is at risk for becoming an aggressor, I think there's more room to work. I think I'm cultured to or buy into or identify with the sort of humanistic psychology approach, which is built into motivational interviewing, and that within the individual, there's some caring space so that in exploring the person's values and behavior, whether it's voting behavior or affiliative behavior with some group that takes advantage of others, just to explore with reflective statements what they think about what they're doing, and develop some dissonance within. That is entirely within how I would see my role. I might not preach to someone who doesn't wanna talk about the health effects of smoking, but I'll inquire about their grandchildren.
So how does what we're talking about today differ from maybe how each of you were trained? Did this come up at all in school? Did you learn about all of this? So I'll just
say, I mean, I went to graduate school to be a clinical social worker, to learn clinical social work as an organizer. My goal was to be able to bring the tools and orientations of therapy into organizing and vice versa. So really sit exactly at the intersection of this conversation. I started graduate school in the 2020, which was the summer of the George Floyd, protest and first summer of COVID. And so there was a lot, a lot, a lot of stuff going on politically, and it was a huge part of our training and education.
However, I will say that there was a lot around the stuff that Namdi mentioned. Right? How do you bring in the difference between yourself and your client into the therapy room? How do we address those kinds of questions around race or different identity? There was a lot of pushback from my classmates, however, about the idea that clinicians may have a responsibility to be involved systemically.
The idea was that a lot of people saw that there were systemic reasons that their patients were maybe showing up in front of them, but their job was solely to care for the person in front of them, not to make an intervention higher upstream, which is something I feel really strongly about to the contrary. So it was a part of my training, but not necessarily in such a, what does this now mean for politics?
Yeah. Okay. I'll go next. I did my training in the nineteen nineties in the San Francisco Bay Area. That's when I would go completed my doctoral training.
And I sort of mentioned that because, know, that the the cold war was over, The US seemed to be out of out of ground war, the business of ground wars. And it was a time, a really heady time around what technology was gonna bring us. The Internet was being born, and I was in school down the street. Some of my roommates were computer science majors who were kinda creating, you know, Yahoo and all this stuff. So that was the setting in which I got my my doctoral education, and again, in a very liberal part of the country.
But my interest I went into it, as I say, thinking initially about psychiatry and then settling on clinical psychology and very much interested in learning how to intervene with the individual. I I wanted to help people to make changes in their behavior, and I got quite enamored with trauma in particular because I was working under the idea of like, well, you know, a person's going along living a normal life, and then they have a terrible day. Something awful happens to them, and they they don't recognize themselves. And it's my job to help them get back to who they used to be. You know?
So that was kind of the model that I was trained in, working with individuals to overcome adversities and to kinda get back to normal. And so very focused on the individual. And I was and though I am a a black psychologist with some knowledge about how to deal with, you know, race and racism, but not not the way the social workers taught me how to think about it, I guess, is what I would say. And and and it seemed to me also and maybe this is even I'll add one more thing. Because I think when I made the shift from being a thinking about medical school to shifting to to the PhD, I remember this moment where I realized I needed to stop thinking of my the people I served as patients and thinking of them as clients.
And one of the things that meant was letting them lead. So if they were my patients, then I was the expert who was gonna find their illness, and they would just listen to what I had to say about how to how to get better. But as my clients, I was gonna be, you know, like a lawyer works for a client or something like this. I'm gonna, you know, be an agent of the person who hires me. So so, I mean, that was my initial thinking about it.
And and why that matters to our conversation today is that, you know, my client the idea that I would impose my political views on the client. You know? It might have been much more comfortable if I were an MD who was routinely invading all sorts of things, but it was an uncomfortable feeling as a PhD who thought that, like, well, you know, who am I? Like, if I'm a lawyer working for a serial killer, you know, my job is just to an advocate for my client, essentially. So it's been interesting trying to think about where where do I do I and should I be an expert who says, hey.
These behaviors are harmful. They're bad. Whether you like them or not, I'm gonna I'm gonna intervene in some way to to raise your consciousness or to help you to see that this is unhealthy, and and that's my role. So I think that's part of the the struggle I feel about how I how how this conversation pulls on what is my appropriate role as a as a practitioner.
I studied biology and medicine and public health, graduated from medical school in 1971. And the biological thing carried forth into the community thing in terms of thinking in terms of ecology and how everything affects everything else. And other than an orientation toward ecology, I'm not sure there was much else that's relevant to this conversation. Though in college, I worked as a volunteer in housing problems in Dorchester. Later on, I worked in the hill section of New Haven and the South Bronx, and much later on an Indian reservation.
So, Nambi, your characterization of patients as people talked down to, I wish I could take back some of the lectures and instruction I've given over the years, but much more recently heard a then president of the American Medical Association referred to patient physician relationships, finally putting the patient first. And I think in much of my work, I've endeavored to do that and try to do more listening than talking.
I'll I'll weigh in on that too. I was a student once. I was just a kid that liked to read books. That's what I was, I think. I and and so I mean, I studied literature, and I wondered how stories were organized and what sense people made of their own lives and saw the intersection of the stories as we live them and the stories as we write them and the struggle of the poets to understand the nature of the soul and motivation and the struggle of psychology and mental health fundamentally, I think is the same struggle.
Stand by it. Maybe we ask too much of the psychotherapy to explain things and we let the poets off the hook a little too easily. I think we need to champion the other side of this if we really want to understand what puts people together. And I think there's a sort of best version of psychoanalytic ideas that sort of speaks to that and has a kind of a radical curiosity about why things are the way that they are. And yet there's some interesting ironies in that, I suppose.
I was taught by folks who were, in many cases, Jewish and not that far away from the Holocaust, either in their own experience, their family's experience, or their teachers' experience. And yet they were often looking almost exclusively for individual level motivations to human suffering in an almost you know, we could we could only explain it, you know, I I think as a kind of defensively myopic view of the world, you know, and that sort of lived alongside this radical curiosity. And I think I've sort of spent much of my career trying to untangle those things. I think there are times when it's just a terrible mistake to look for an individual problem underneath something that where really only a social explanation will do, you know, and sort of wisdom of what's called liberation psychology. Some readings of these things are in my syllabi these days, you know, to sort of say, like, actually, we to be able to look at things, you know, yes, with curiosity, but what's the meaning of it to an individual, but also where does this come from?
Why are we navigating this, at all in this way on someone else's terms?
And I and I think kind of, Kurt, just to link what you're saying to something that Nambi said before, it's like thinking about the therapist is actually having an important political educate role in political education. Right? Which is to if somebody themselves is not necessarily aware of this whatever it is being outside of themselves, but being something that has to do with systems, to be able to point that out and kind of agitate around that, I actually see as a huge part of our role.
In Jeff's comments, he talked about ecology, and I thought in in bed I think your background, Jeff, includes public health. Is that true as well? Yeah. So so one thing I'm curious about is is a natural extension of this is whether we in the mental health world, you know, should have should be contributing more to the public health conversation. So, again, I'm thinking about in the nineties, one of things that sort of happened was there was this movement about smoking, coming back to smoking again in public.
And I remember, you know, the restaurants and bars changing their practices because of research on secondhand smoke, and there was a kind of way in which policy began to get shifted in part for the pub the good of public medical health. And I guess I'm curious about an analogy about public mental health essentially, and whether we as a profession should be not only doing the kind of education that Sarah's advocating on a one to one basis with our individual clients, But do we owe something to society at large? Should we be speaking up more about the things that we as a profession have understanding are harmful, and we see the harms played out? You know? And should we be engaged?
And so that I mean, it's it's the next level up of political engagement, not not just, you know, with the people who sign up for us, but but the but actually in some other way, should we be should we be speaking? So I I'm curious about what people think about that. Is there should we have more of a role than we currently have?
Yeah. Can I give you a megaphone? I I I think the evidence of adverse effects of marginalization, including economic marginalization, is huge. With my orientation, I look to start to draw attention to it maybe in the late seventies, early 1980s. I'm not sure anyone listened. There probably needed to be more voices saying it. And that's what Sarah's asking for and and you're asking for.
I mean, I will see, Namda, your should we and raise it to it's our ethical obligation as mental health care providers to be involved politically. I I really very strongly feel this. There are more than enough issues to go around. You can choose one that is most important to you. But especially right now, I mean, we're even talking about public benefits, SNAP, Medicaid, Medicare.
These are things that are impacting so so so so so many of our patients or clients. You know, at the retreat, we really believe that gender affirming care is suicide prevention. And at a fundamental level, ultimately, it doesn't really matter what our politics are. On a fundamental level, the the role of a mental health care institution is to keep people from dying by suicide. And so when we're talking about raising our voices for the importance of gender affirming care, practicing gender affirming care alongside other health care institutions in Vermont, again, we're not just talking about having a political perspective or it's a value that we have because it's nice to have, but because we see it as fundamental to the work that we're doing and to being able to serve the people that we're serving.
And and I would say we should, as mental health professionals, never cede our authority to speak on that topic. You know? So right? And so we should always hold on to the if the topic is suicide prevention, yeah, we we we should be at the table having that conversation, and we shouldn't be disallowed if it happens to be a topic that's controversial or has you know, how we talk about it and all the other things we can that that's up for discussion. But that we talk about it should never be, you know, in question.
Yeah. And coming from my own field as a journalist when I was out on the streets as a reporter, there was a certain time when it became almost scary to be out asking people questions because there would be people driving by in cars and shouting fake news and almost being a bit threatening to people in the press. People started to struggle with their mental health in in the journalism field because of this. And so I can see how, you know, if I was going to be looking for a therapist that I would it would cross my mind if they are coming from the same political background as me and how that would kind of color our relationship.
Yeah. I think, Mary, you're also bringing up the great point of like, you know, we've talked a lot about people who are particularly marginalized in our society. And there are peep you know, there's sort of people who are less marginalized in our society who I think are still very impacted by what's going on politically. Right? I work with a lot of health care workers.
I work with a lot of teachers. Right? And there are people who are like, this is so stressful and so people feeling under threat professionally. Right? We didn't even touch upon that, and I think that's really important as well.
Yeah. You know, one of my mentors, Ya'an Agassarian, more recent mentors in my professional life, Chia, would talk about that one of the main things, one of the main tasks of being human was to discriminate and integrate differences. And how do we do that without totally, destroying each other, actually, right, or separating, so that would be the other risk, separating so that we can never talk to each other at all. It does seem to me that both things are a higher risk. I feel them to be a higher risk in the political sphere, in the world, the global sphere maybe, than I used to feel them.
And that might have to do with my privilege. I was protected from feeling that. People in many parts of the world with certain identities may have felt it more than I do, but I'm getting a taste of it now. And I do think that therapists have some knowledge about how to do these things, even though we're not great at it. And I think the other part that I just want to say is that I think we can if we can know what we know about it, if we can be confident in it, if we can test it out using the methods that we use, clinical and research methods, then we might be able to help a little bit for others to do this hard thing, which is to sort of understand that others in the world are different than we are and that this is really hard sometimes, felt at a level identity that feels unresolvable and locked.
And yet it isn't unresolvable, I think. But you know? And so that's the other role of therapy, I just think, didn't really come up as much. But I do think that's a helpful thing.
And the process that therapists use may help a close associate of your mentor in group psychotherapy, Scott Rutan, has described how if he pulls together a group that have major differences in their identities, over time they come to see how much alike they are one another. And if he pulls together a group that have very similar identities, over time, they discriminate how different they are from one another. And the group therapy process tends to produce that.
I really love that. So a lot of this leads me to being grateful that we had this conversation today and to feel like because I think one of the things that one of the characteristics of the polarized times we live in is that I think it has led people to silence as a solution, you know, be in silos, not to talk. And I think, you know, we in the therapy world have always valued talking. You know, Jeff has just laid out some of the way some of the processes that can unfold in talking in groups, talking in groups that are put together around differences or similarities. But I I think we should bravely go into this space and have more conversations like the one we're having today, at least in the beginning with each other as professionals.
I think I think this is I wanna echo what Kurt said. It's very hard. And I think that we gotta we have to know what we know. We gotta be able to see the the the the blind spots, the minefields, because there's so many ways we can get into trouble and do this badly to the detriment of our profession and the people we serve. And yet, I think the solution that of of, like, let's stay away from this, that that I think does harm and will prevent what Kurt the vision that both Kurt and Jeff laid out, which is that if we can move in this direction, there's this opportunity to be to contribute to to a better society in which we live.
We might be able to offer people around us something they don't already have now to get out of the the stuck place that a lot of us feel we're in.
To add a political note to this, least of all where the threat is coming from is, like, professionally in terms of our our government. Right. I like, I think there's also it's like, it's it's dangerous in terms of our reputation. It's dangerous in terms of our professional relationships. It's dangerous in terms of or tricky in terms of our professional ethics and our treatment goals for the people that we're working with.
But also we're in a moment where sticking your neck out in that kind of way can really cause problems for you and the organizations that you belong to. And I think that that's actually like a really important piece to it. So even having the conversations if we disagree in itself is an act of political resistance, which is a little meta and a little complicated.
I enjoy the the call for more communication, for more conversations, and I'm finding more and more, if I say the word talking, I think for a moment and think I really mean listening.
Well said.
Well, thank you so much to everyone for taking part in that conversation. Nnamdi, Sarah, and Jeff, we really appreciate, getting you all together in the same virtual room so we could hear each one of your valuable perspectives.
Thank you.
Thanks for having us.
Thank you.
And thank you, listeners, for joining us today and being a part of this conversation. As always, we want to hear what you have to say about this topic. Feel free to send us an email or voice memo to our email address at unravel, U N R A V E L, brattlebororetreat dot org. Link in the show notes. Or leave us a voice message at 802 That's 802 And we'll hear from you soon, I hope.
Unraveling is brought to you by Brattleboro Retreat. Our producers at Charts and Leisure are Andrew Abkin, Hans Beuteau, and Jason Oberholzer.
And you can find us on social media by searching Bratteboro Retreat. Bratteboro Retreat is committed to exploring diverse perspectives on mental health. While we invite hosts and guests to share their insights, the views expressed are their own and do not necessarily reflect the policies or positions of the hospital or its staff.