My reasoning

Today I was talking to one of the gentlemen I meet with regularly.  We were examining how anxious he still gets when he talks to a woman with whom he might want to begin a relationship.  He is in his mid-thirties, and still single. This anxiety has limited him badly.

We discussed how he had been a poor kid in a rich town, with parents who were awkward, often embarrassing, and always discouraging.  He could see how this has planted a strong reaction in him that he is not allowed to approach an attractive accomplished woman, even though he has grown to be an attractive, accomplished man.  It isn't the woman that makes him anxious.  He feels that someone else, some unnamed authority, with suddenly sweep in and and pull him out of the picture, telling him that he is not good enough and should not be doing this.

I mention this here because of what I have been talking about for the last week, that it is important to have someone like me, someone who is a bit out of step, who questions, who is not completely comfortable with the way things are run, to be your therapist. My reasoning is that, despite all my education, and all the research on internal intra-psychic factors, despite all the claims of biology, brain chemistry, genetics and psycho-neurological explanations, I feel that a great deal of the actual causes of what is called psychopathology are cultural.

Many of the people I treat are those who, for many reasons, sometimes gross and sometimes subtle, do not fit it well with the general flow of their surrounding culture.  They may have a different body-type, a different learning style, a different sexual preference, a different energy level, a unique reaction to stress or anger, or just be more sensitive than most people.  Usually, if these people have families that are accepting, or a circle of friends, or even one caring teacher, they can do very well.  But when the culture around someone becomes uncomfortable with someone, that person will often become even more uncomfortable being themselves.  This can lead to them acting in a way that others will consider odd, or even "crazy."

I think it can be a very powerful tool in treatment to be aware of what it is like to want to resist the pressure of conformity and societal norms.  It can be very validating to a person who feels as if he or she is an outcast, that they can still be OK, or even better than that, that they are strong.

I am familiar with several therapists who, because of their own nature, take the opposite stance.  They feel that part of treatment should be helping people learn to fit in, and to get along, and follow the rules and expectations of their culture.  Currently, there is a great deal of pressure from insurance companies that send out treatment guidelines, and in psychiatry, to see the goal of treatment as getting people to be calm, reasonable and pleasant.

I can understand that approach, but I don't agree with it.  In truth, I don't think it works; I don't even think it can work.  It can even cause a lot of harm to try and help someone to be what they don't want to be, and in many cases, can't be.