healing the mind lifts society in seen and unseen ways
The way we think is fascinating on so many levels and especially when it comes to rearranging how we process the world around us. It gives the word ‘association’ a different priority, too, where below the radar, our hopes and fears align with often random events.
The COGNITIVE-BEHAVIOURAL model of mental health sees maladaptive thinking and behaviour from the merged perspective of thoughts, emotions and actions and in the process, appears to adopt the classical and operant conditioning models of behaviour. This is clear in its treatment of OCD, Obsessive-compulsive Disorder: a debilitating condition with intrusive thoughts and time-consuming compensatory behaviour that affects millions of people worldwide. In fact, in 1997, some 50-million people in a global population of 6-billion were said to have it.
That’s a significant number also reflected in a research article: ‘Epidemiology of Obsessive-Compulsive Disorder: A World View’. It was published in the Journal of Clinical Psychiatry in 1997 with the figure adapting to: ‘The worldwide prevalence of Obsessive-compulsive Disorder (OCD) is approximately 2% of the general population.’ The real figure may have been more or less and while the only up-to-date figure sourced is 1.1% – 1.8% globally, for 2014, it suggests the disorder has decreased in prevalence over 17-years. In that year, the global population was 7.2 billion, meaning between 80 and 130-million people had it. Yet, the difficult nature of the condition with its disturbing thought patterns often of a sexual, religious, violent and or traumatic nature can prevent people from seeking help.
As mentioned, it seems to function on the classical (Stimulus-response) and operant (Behavioural-reward) conditioning models of behaviour: meaning, the stimulus of an irrational OCD trigger leads to fear-based behaviour in the compulsions – as in the classical process and where you can’t help it. Equally, avoiding irrational triggers as fear-based OCD behaviour then leads to the reward of not being alarmed into fear-based compulsions – regarding the operant process as you help yourself, to avoid interim stress. However, this is stressful, too, and the eventuality of meeting with a trigger takes you back into the classical cycle. This is how it felt for me, at least, as I struggled with the condition from the age of 9 until 38, when I had cognitive-behavioural therapy, targeting my irrational behaviour.
Thankfully, that salvation had been devised by Aaron Beck, an American psychiatrist, who in 1967 developed a theory that would later become cognitive-behavioural therapy, or CBT. Initially, looking to cement the fundamentals of psychoanalysis, he found himself facing the opposite with with work indicating that long-standing internal narratives carried greater weight than self-directed anger, in areas like depression. So, his ideas evolved and in an interview at the Beck Institute, in 2018, and with his daughter, Dr Judith Beck, he discussed some of the influential people, who had guided his thinking. In the end, he was certainly as influential as Freud, and his understanding of the relationships that we form with ourselves reflected insight into the way we view the world, too:
‘Although these domains appear to be remote from each other, the themes underlying anger and hatred in close relationships appear to be similar to those manifested by antagonistic groups and nations. The overreactions of friends, associates and marital partners to presumed wrongs and offenses are paralleled by the hostile responses of people in confrontation with members of different religious, ethnic or racial groups.’
It’s true and in practise, CBT offers a management system for dealing with faulty perceptions and terrible disorders, like OCD. So, within its set-up are tools like ‘The Vicious Cycle of OCD’ driving terms such as: ‘Beliefs about thoughts’; ‘Feelings’; ‘Behavioural cognition’; ‘Compulsive behaviour’ and ‘Accommodation and feelings’: that are in turn gateways to understanding yourself. The ‘Risk-coping’ graphs, then remind you that the relationship between anxiety and time is fraught with pitfalls, while ‘Theory A and Theory B’ introduce you to the OCD reality check. ‘Thought-Action Fusion,’ meanwhile, outlines the folly of creating equivalency between thinking thoughts and acting on them, and ‘Tolerating Uncertainty’ is exactly what it says, on the tin.
So, behavioural psychology took various forms, and initially it began with the experimental work of people like Ivan Pavlov (classical conditioning), Edward Thorndike, J.B Watson and B.F Skinner (operant conditioning). From there and as a school of thought: behaviourism stood in direct opposition to psychoanalysis where concepts of the unconscious mind and repressed activity were ignored, let alone more esoteric ideas like the archetypes.
Next, the HUMANISTIC-EXISTENTIAL model approaches therapy with a view to helping people take direct responsibility for healing, while sharing a great deal in common with the recovery model of mental health, too. The former offers different types of therapy from Gestalt (helping you to identify your emotions and feelings), and Carl Rogers’ Client-centred work (that involves active listening and acknowledgement), to the existential (which looks at free will and the quest for meaning). The recovery model, meanwhile, suggests that whilst a person may be in freefall regarding agency over their thinking and life, it‘s still possible for them to regain power over themselves while at the same time not entirely eliminating their troubles.
Certainly, humanism as a philosophy can be found as early as the 14th Century, and it’s spread influenced the development of critical thinking where divine authority had long ruled and with churches of all persuasions, resisting it. In terms of therapy, it evolved during the mid-20th Century with the publication of Abraham Maslow’s ‘Motivation and Personality’, in 1954. It was a seminal work in which ideas about human empowerment took hold and a therapeutic approach was born. In a 1998 study, published in Advanced Personality, J.C Watson and L.S Greenberg wrote:
‘The emphasis on people as self-reflective agents refers to people’s capacity for choice and self-determination, as well as their ability to represent experience symbolically and to reflect on and evaluate that experience in terms of higher order values and goals.’
Still, a decade before that, Maslow announced himself on the psychogenic stage with his 1943 paper ‘A Theory of Human Motivation’. In it, he presented the now famous ‘Hierarchy of Needs’, which has gone on to influence psychology, sociology and social work; business, philosophy and more. A stark criticism, however, is that he based his research solely on educated, caucasian males whose life experiences were non-transferable. Also, the order of needs has been questioned, too, with some suggesting that people pursue the different levels, arbitrarily. Whilst this is, of course, true; the fact remains that physiological requirements come well before personal development. The environment determines this emphatically because where you live matters, to the hierarchy. Yet, more generalised critiques of the humanistic approach suggest an absence of social mediators.
‘The critiques of humanistic theories in a cross-cultural context present some of the limitations of these approaches. As stated before, humanistic approaches can be excessively individualistic and minimize the influence of social factors. For example, a common critique of gestalt therapy is that clients may have cultural or social inhibitions related to confronting relatives/important people in their life, even in imagination.’
As with everything in life and analysis, opinions are diverse and the RECOVERY model is no different. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) admits that no one interpretation of ‘recovery’ exists, which can make it hard to pinpoint exactly what it is a person seeks, in terms of goal orientation. In a way this underscores the ethos of the recovery model, in so far as it isn’t a one-size-fits-all structure. Fortunately, there are lights on the runway, so to speak, and ideas around identity, optimism, social togetherness, agency and existential meaning are common to most definitions. With this in mind, in a study called ‘Recovery: An International Perspective’ the impact of the model across the globe serves to highlight the evolution of therapy, since the time of Freud.
‘The term ‘recovery’ has become increasingly visible in mental-health services. A focus on recovery is advocated as the guiding principle for mental-health policy in many English-speaking countries: Australia (Australian Health Minister, 2003) England (Department of Health, 2001), Ireland (Mental Health Commission, 2005) New Zealand (Mental Health Commission, 1998) and the United States (New Freedom Commission on Mental Health, 2005).’
Maybe, the reason for this lies in the way studies show how an autonomous approach to personal healing, offers benefits beyond a particular model. So, what are termed ‘stakeholder perspectives’, as in: the service provision agenda; the social domain; power and control; hope and optimism as well as risk and responsibility, ensure elements of agency as far as a client or patient is concerned. Clearly, these humanistic goals are in line with existential aims, too, meaning some overlap is to be expected.
Even so, a good definition in separating the two areas is found in chapter 6 of the book ‘Brief Interventions and Brief Therapies for Substance Abuse’. The second paragraph begins:
‘Whereas the key words for humanistic therapy are acceptance and growth, the major themes of existential therapy are client responsibility and freedom.’
These are interchangeable terms, it seems, but then finally and somewhat lesser known perhaps is the EXISTENTIAL model of mental health, sitting on top of the philosophy itself. In his 2003 book ‘Existential therapies’: a professor of counselling psychology at the University of Roehampton, Mick Cooper, wrote:
‘At the most general level, existential therapy can be defined as ‘a form of therapeutic practice that is based, primarily or wholly, on the assumptions associated with the existential school of thought’ (Cooper, Vos & Craig, 2011)’
Existentialism. It’s a title some advocates avoid at all costs and to underline the point, Albert Camus pulled no punches in declaring: ‘I am not an existentialist!’ in a 1945 interview with the French magazine, Les Nouvelles Littéraires. His contemporary philosopher, Martin Heidegger said as much, too, when he also denied being one. It seems their reluctance to not only be labelled but to not pin themselves down either, lines up with a humanistic sense of flexibility. That latitude sits in contrast to Aristotle’s essentialism, which as a product of its time defined the ‘essence’ of any being as unchanging. On the one hand, it seems true in terms of our biological drives – and the first level of Maslow’s hierarchy of needs, whilst on the other, it falls down where internal narratives and personal growth are concerned. Dictionary.com, puts it another way:
‘Philosophy; one of a number of related doctrines which hold that there are necessary properties of things, that these are logically prior to the existence of the individuals which instantiate them, and that their classification depends upon their satisfaction of sets of necessary conditions.’
This definition is important because the post-second world war growth of existentialism uses the reverse idea of ‘existence precedes essence’: a phrase coined by the French philosopher, Jean Paul Sartre and presented in a 1945 lecture called, ‘Existentialism is a Humanism’. It reinforces the central theme of Viktor Frankl’s work which is to say that in searching for and discovering a meaning to life: we fulfil not only a sense of purpose – we also regulate Sartre’s ‘tension’ that we feel over the inevitability of responsibility, pain, loss and death.
‘Existentialists forward a novel conception of the self not as a substance or thing with some pre-given nature (or ‘essence’), but as a situated activity or way of being whereby we are always in the process of making or creating who we are, as our life unfolds. This means our essence is not given in advance; we are contingently thrown into existence and are burdened with the task of creating ourselves through our choices and actions.’
In putting all of this into a framework of existential therapy, a natural process unfolds in which trying to analyse the human condition leads to introspection of the deepest kind and from which, it’s impossible to escape the relativity of suffering. This, allows, no, it pushes us to engage with the four central ideas behind the therapy – death, meaninglessness, isolation and freedom which are things we may wrestle with every other week. Either way, the weight of these matters can bear down hard as people try and adjust to the changes within and around them.
In fact, our eternal search for meaning took on new angles as Viktor Frankl watched from the confines of a concentration camp while the human spirit plunged to depths rarely matched, in the course of human history. So, the need to find something within as schemas processed not only an indescribable suffering but also evidence that others were capable of such depravity, demanded unique ways of thinking. As a result, in observing the way his fellow prisoners approached each and every day, he was able to discern differences in coping that aligned with certain attitudes.
So, after the war and new found freedom, he went on to finish the theory he’d developed in 1938 and before conflict had broken out, which then led to him presenting ‘Logotherapy’ as a form of psychological analysis. The three principles of this approach are: Freedom of will (the agency of thought); Will to meaning (the search for meaning) and Meaning of life (the acceptance of responsibility). These are all to be found in existential therapy sessions, too, where a therapist may respond to a client’s concerns in ways that guide him or her, towards a sense of accountability.
So, in this and other traditions, the various models of mental health continue to serve an array of people across the planet.
People for whom, life has taken a turn for the worse in one way or another and whose usual cognitive functioning has gone awry. From Cade, Horney, Engels and Ainsworth to Freud, Bowlby, Beck, Maslow, Frankl and a host of others, the degree of disruption and finding a way back drives us to further our knowledge in the hope that one day, it’ll all feel easier. Of course, being human means our strains and struggles will never go away but maybe greater understanding in the importance of mental life, will allow us to pay heed before inflicting strife.
For those who try and help, a calling may come from different places where for some it’s a need and perhaps others, a desire. An attempt to rewrite a script from the past to allow healing not suffering whilst changing the present, again and again. Yet, curiosity, too, can drive a hard bargain as it pushes the incumbent to question the mind. It’s true: who, what, why, where and when may face off the how, the which and its time to move on. Either way, we’re lucky some choose to qualify in that life, and we’re luckier still if the resources are there to support the questions, the care and the solutions.
‘Everything that irritates us about others, can lead us to an understanding of ourselves.’
Carl Jung
Existence, agency and luck are a holier trinity than some of the experiences they’ll conceive.
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