"A Plea from the Public Square"

by  Flora E. Lazar, Ph.D., L.S.W

4th December 2016

Early last summer, my son called to tell me to drop everything and go online. Tickets for the Chicago run of "Hamilton" beginning in November were going on sale in just a few minutes, and, if I wasn't logged into the Ticketmaster site promptly, I would likely miss my best opportunity to participate in the cultural phenomenon that the show had become. I homed in on three distant Tuesdays, days I thought would be less desirable and thus easier to secure if I had to click quickly. To my great delight, the strategy worked and I rather effortlessly secured four seats. As the presidential campaign began to wind down, the reason for my success became clear: Without realizing it, the date I picked, November 8, was election night. How ironic it turned out to have been that night to watch some of the great debates about our country's founding values unfold in music and dance, while those very values were under assault at the ballot box.

Not 24 hours later, I would get my first glimpse of how the election results were playing out clinically. And so it has been, almost without relief, since that day. I am no stranger to addressing the needs of traditionally vulnerable populations. Before becoming a psychotherapist, I had devoted most of my career to public policy and advocacy, mostly for children and families involved in the public human services systems. I had intentionally selected social work among the therapeutic professions because of its explicit attention to the social surround.

But nothing could have prepared me for the depth and pervasiveness of this intrusion into my clinical work. To be sure, most of the patients I see at a large urban practice specializing in LGBTQ and multi-cultural work identify with groups that have historically been marginalized. In the six months I have worked with most of my patients, I don't recall ever talking with them about politics. Whether because of their immigration status, gender identity, or sexual orientation, the election immeasurably ratcheted up their feelings of vulnerability.

How to experience this moment with them was not at all clear to me as an early career clinician, so I was relieved to see the self psychology community respond so quickly to this clinical challenge by offering an online forum in which we could discuss our reactions to the election. I was especially heartened to discover that I was not the only psychotherapist for whom the sudden confrontation with a new political reality appeared to represent a clinical game-changer, a seeming violation of some of the most sacred principles of practice I had learned in my early training. I took comfort in discovering that I was not alone in struggling to get my bearings in a setting where remaining value-neutral now seemed untenable. And as a lifelong activist, I was encouraged to see at least an initial burst of energy from some members of the self psychological community to join in petition campaigns. It has been some time since I have seen so many petitions off social media.

Absent from the reaction, however, was what I see as our most potent tool, our collective voice. What actions could the organized self psychological community as a community take, and what collective responsibility does it have to raise its collective voice in the public square not just in the wake of the election, but more broadly as a source of expertise on human emotions and human behavior? How can we expect to help our patients address feelings such as self-loathing and insecurity if we do not collectively make our voice heard on the impact of the devaluing and threatening rhetoric of the campaign. . As one of my patients put it tearfully the morning after Election Day: "I struggle enough with internalized homophobia, so how can I help myself when it is now suddenly permissible."

To be sure, it takes hard work to maintain a sense of community when discussing potentially divisive issues. Members of the IAPSP don't all agree on every issue and we don't all vote similarly. But in the name of cohesiveness - and sometimes in the name of protecting the organization's non-profit status - we may not be taking the full measure of our responsibility to use what we know about from our theory, our research, and our clinical practice to help shape a society where our patients can enjoy the same safety outside the consulting room that we try to provide inside. While there are some issues, such as the Israel-Palestine question, where we may never succeed at finding common ground, I believe there are others, such as the mental health needs of veterans or the needs of children exposed to community violence, where I am convinced we can and must step into the public debate with a shared voice informed by work.

Here is a small example of the kind of action that people of different political philosophies can undertake in pursuit of such a common goal: I began my career in the non-profit world leading an anti-bullying organization founded by Peter Yarrow, one of the progressive left's most reliable voices. Our board comprised not just some of the Democratic Party's most reliable "bundlers," but also the head of the conservative Ohio Business Roundtable. Furthermore, we were funded by State Farm Insurance, whose CEO, Ed Rust, reliably served as an advisor to most Republican administrations since the 1990s. Notwithstanding these fundamental differences, we could all agree on one basic thing: an education system free of bullying was a basic human right and essential to any educational success children might enjoy.

There are numerous ways we can revitalize the place of psychoanalysis in the public square and in the public mind. Not the least is one we are already engaged in: - writing. We write for journals, I presume, ultimately for the benefit of our patients. If we have learned anything from our clinical work since the election, it is that we also need to write for a broader audience. Taking a position on important issues that affect emotional well-being is as important as theory development. Other organizations, notably the American Psychoanalytic Association, actively encourage members to use their professional stature to inform the public about issues that ultimately find their way into the consulting room. The APsaA has not shied away from writing position papers in the name of the entire organization. In the last two years alone, the association has issued position papers on a wide range of issues, including refugee resettlement, human trafficking, racial profiling, and campus sexual violence, among others. Few efforts can speak more compellingly to the continued relevance of psychoanalysis in contemporary society.

Acting as a force for social change is not a new role for psychoanalysis. It is just relatively new in the United States. As historian Elizabeth Danto has persuasively shown, many of the pioneering German and Austrian analysts, including Freud and his daughter, were actively involved in the pursuit of a social justice agenda whose first incarnation was a series of free outpatient mental health clinics in Vienna and Berlin. At a 1918 international conference, Freud told his colleagues that the poor had as much right to mental health care as they had to life saving surgery. It is time for us as a community to recover that agenda.

In one of "Hamilton's" most stirring songs, "Hurricane," which would not be too strong a term for last month's election, the eponymous main character sings about the transformative power of writing. "I wrote my way out of hell," he sings, going on to add:

"I wrote about the Constitution and defended it well.
And in the face of ignorance and resistance, I wrote financial systems into existence.
And when my prayers to God were met with indifference,
I picked up a pen, I wrote my own deliverance."

The great chronicler of the American propensity for association, Alexis de Tocqueville, observed during his famous 1831 trip to the United States that "in democratic peoples ... all citizens are independent and weak; they can do almost nothing by themselves ... If men who live in democratic countries had neither the right nor the taste to unite in political goals, their independence would run great risk." From this, he concluded that "In democratic countries, the science of association is the mother science; the progress of all the others depends on the progress of that one."

Or as "Hamilton's" protagonist reminds us, "When you got skin in the game, you stay in the game. But you don't get a win unless you play in the game."

Flora Lazar, Ph.D., M.A. has spent most of her professional life at the intersection of human services, research, and public policy. She is a graduate of the University of Chicago's School of Social Service Administration and works at Live Oak, a multi-disciplinary group of psychotherapists from all theoretical orientations, all engaged in trauma-informed, LGBTQ affirmative, multi-systemic, and multicultural practice. She is a student-at-large at the Chicago Institute for Psychoanalysis. An historian by training, Dr. Lazar is currently working on a revision of her doctoral dissertation on the development of the empirical tradition and the role of the university in American psychoanalysis. She contributed to the writing and editing of Infant and Childhood Depression: Developmental Factors (John Wiley & Sons) and Infant Depression: Paradigms and Paradoxes (Springer Science & Business Media).

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