Therapists and Political Agendas
by Garry Cooper, LCSW
Gee, John, sometimes you have such a dim view of mental health professionals, I’d think that you would want them out making political speeches rather than spending their time practicing incompetent therapy.
Seriously, in the example of the man—apparently bipolar—who was murdered at the airport, you’re being as unfair to therapists as the therapists were to the federal marshals. You’re taking comments from a listserv of therapists, and listservs are notoriously places where people let their hair down and dash all kinds of emotional and often poorly reasoned emails. Heck, I’ve probably done it myself. Therapists and movie stars have as much right as anyone else to broadcast their political and social opinions.
Of course it’s nonsense, especially given today’s weapons that can inflict mortal wounds even without direct hits on vital body parts, to ask that law enforcement officials shoot someone in the arm instead of in the head or heart in emergency situations. I myself wouldn’t condemn the marshals, despite the fact that the man’s wife was apparently yelling that he had a mental disorder and hadn’t been taking his meds. They did what they’ve been trained to do. The problem goes deeper here: we’ve become so fear-crazed and reactionary about terrorists that we want our law enforcement officials trained to kill in situations of potential danger. The fault lies not in the marshals but in ourselves—or in those in power who know very well that if they can keep everyone scared to death they can get away with any power grab they want to pull off. But let me issue a disclaimer here: I’m voicing these opinions not as a therapist but as a socially and politically aware citizen (a species, I’m afraid disappearing as quickly as the polar bears). I’ve even set up a blog to do this at http://whirlednewstonight.blogspot.com .
But your example of PTSD brings up a more important point about therapists’ views. When they use their credentials and supposed expertise to comment or postulate as therapists, then there are different obligations incumbent upon them. Fortunately, PTSD’s day as the diagnosis du jour seems to be declining. Our field, I’m afraid, is particularly prone to these diagnoses du jour, and eventually, when we and the rest of the world acquire enough perspective, we usually end up looking foolish. We’ve had recovered memory, anger and grief management, childhood bipolar disorder, dissociative disorder (popularly known as multiple personality disorder), and some would add AD/HD to the list. None of these are totally made up conditions; it’s just that therapists often hop on bandwagons and end up mis- and over-diagnosing them (and, paradoxically, missing the relatively few genuine cases).
Does PTSD exist? Absolutely. Interestingly, it doesn’t seem highly correlated with the severity of the trauma. Something like under 20% of people exposed to trauma go on to develop PTSD. It seems correlated to things like a person’s pre-existing cognitive patterns, perhaps a familial propensity to mood disorders, and exposure to previous traumas. In one of the more interesting findings, it’s now believed that crisis intervention teams who descend upon the scene of a trauma and start counseling everyone around, actually increase the number of people who will develop PTSD. It’s thought that by offering help too soon to people who won’t ever need it, they interfere with people’s natural resilience and coping mechanisms. To their credit, disaster relief organizations and crisis response teams have stopped charging in like the cavalry and have begun offering lower-key onsite counseling. I hope most therapists have gotten the message.
Is it tacky and ill-advised to use our professional expertise to further our political views? That’s a tough knot to untangle, and I think we have to make the same difficult judgments that we make when we’re in session: doing some deep thinking to make sure that we’re clear about the difference between our clinical judgment and our personal passions. Therapists have something in common with other human beings: we are prone to making judgments based upon emotions and then finding logical reasons after the fact to justify those judgments. I think the war in Iraq is so wrong for so many reasons; in fact, I think it’s criminal and that the people responsible for it ought to be held criminally responsible. I also know that PTSD is a horrible disorder and that by our armed forces’ own estimate, the rate of PTSD is higher than in the first Gulf War or in Afghanistan. But it would be disingenuous for me to use PTSD to argue against the war, just as it would be wrong of me to set myself up as a hired gun expert witness to find PTSD in everyone who’s suing because they’ve been in some kind of accident. If we’re going to use our professional expertise as a basis for making political or social points, then we ought to carefully explicate the connection between our expertise and our agenda, backing up what we say with research and/or good anecdotal evidence.
Garry Cooper, LCSW is a therapist and writing coach in private practice. His “Clinician’s Digest” column for the national magazine Psychotherapy Networker, covers the latest news and research in mental health and psychotherapy. He can be contacted at garry@psychjourney.com Visit his blog.
Read a counter-point by Dr. John Riolo.
