Should you operate upon your clients as objects, you risk reducing them to less than human. Following the culture of appropriation and mastery your clients become a kind of extension of yourself, of your ego. In the appropriation and objectification mode, your clients’ well-being and success in treatment reflect well upon you. You “did” something to them, you made them well. You acted upon them and can take the credit for successful therapy or treatment. Conversely, if your clients flounder or regress, that reflects poorly on you. On this side of things the culture of appropriation and mastery says that you are not doing enough. You are not exerting enough influence, technique or therapeutic force. What anxiety this can breed for some clinicians! DBT offers a framework and tools for a treatment that allows clients to retain their full humanity. Through the practice of mindfulness, you can learn to cultivate a fuller presence to the moments of your life, and even with your clients and your work with them. This presence potentiates an encounter between two irreducible human beings, meeting professionally, of course, and meeting humanly. The dialectical framework, which embraces contradictions and gives you a way of seeing that life is pregnant with creative tensions, allows for your discovery of your limits and possibilities, gives you a way of seeing the dynamic nature of reality that is anything but sitting still; shows you that your identity grows from relationship with others, including those you help, that you are an irreducible human being encountering other irreducible human beings who exert influence upon you, even as you exert your own upon them. Even without clinical contrivance.
I began to see that the stronger a therapy emphasized feelings, self-esteem, and self-confidence, the more dependent the therapist was upon his providing for the patient ongoing, unconditional, positive regard. The more self-esteem was the end, the more the means, in the form of the patient’s efforts, had to appear blameless in the face of failure. In this paradigm, accuracy and comparison must continually be sacrificed to acceptance and compassion; which often results in the escalation of bizarre behavior and bizarre diagnoses.The bizarre behavior results from us taking credit for everything that is positive and assigning blame elsewhere for anything negative. Because of this skewed positive-feedback loop between our judged actions and our beliefs, we systematically become more and more adapted to ourselves, our feelings, and our inaccurate solitary thinking; and less and less adapted to the environment that we share with our fellows. The resultant behavior, such as crying, depression, displays of temper, high-risk behavior, or romantic ventures, or abandonment of personal responsibilities, which seem either compulsory, necessary, or intelligent to us, will begin to appear more and more irrational to others.The bizarre diagnoses occur because, in some cases, if a ‘cause disease’ (excuse from blame) does not exist, it has to be 'discovered’ (invented). Psychiatry has expanded its diagnoses of mental disease every year to include 'illnesses’ like kleptomania and frotteurism [now frotteuristic disorder in the DSM-V]. (Do you know what frotteurism is? It is a mental disorder that causes people, usually men, to surreptitiously fondle women’s breasts or genitals in crowded situations such as elevators and subways.)The problem with the escalation of these kinds of diagnoses is that either we can become so adapted to our thinking and feelings instead of our environment that we will become dissociated from the whole idea that we have a problem at all; or at least, the more we become blameless, the more we become helpless in the face of our problems, thinking our problems need to be 'fixed’ by outside help before we can move forward on our own.For 2,000 years of Western culture our problems existed in the human power struggle constantly being waged between our principles and our primal impulses. In the last fifty years we have unprincipled ourselves and become what I call 'psychologized.’ Now the power struggle is between the 'expert’ and the 'disorder.’ Since the rise of psychiatry and psychology as the moral compass, we don’t talk about moral imperatives anymore, we talk about coping mechanisms. We are not living our lives by principles so much as we are living our lives by mental health diagnoses. This is not working because it very subtly undermines our solid sense of self.
The physical shape of Mollies paralyses and contortions fit the pattern of late-nineteenth-century hysteria as well — in particular the phases of "grand hysteria" described by Jean-Martin Charcot, a French physician who became world-famous in the 1870s and 1880s for his studies of hysterics...""The hooplike spasm Mollie experienced sounds uncannily like what Charcot considered the ultimate grand movement, the arc de de cercle (also called arc-en-ciel), in which the patient arched her back, balancing on her heels and the top of her head...""One of his star patients, known to her audiences only as Louise, was a specialist in the arc de cercle — and had a background and hysterical manifestations quite similar to Mollie's. A small-town girl who made her way to Paris in her teens, Louise had had a disrupted childhood, replete with abandonment and sexual abuse.She entered Salpetriere in 1875, where while under Charcot's care she experienced partial paralysis and complete loss of sensation over the right side of her body, as well as a decrease in hearing, smell, taste, and vision. She had frequent violent, dramatic hysterical fits, alternating with hallucinations and trancelike phases during which she would "see" her mother and other people she knew standing before her (this symptom would manifest itself in Mollie). Although critics, at the time and since, have decried the sometime circus atmosphere of Charcot's lectures, and claimed that he, inadvertently or not, trained his patients how to be hysterical, he remains a key figure in understanding nineteenth-century hysteria.
Kraus asks the question of Freudian analysis: What would be enough? At what point would talking about one’s problems for x hours a week, be sufficient to bring one to a state of “normalcy”?The genius of Freudianism, Kraus writes, is not the creation of a cure, but of a disease—the universal, if intermittent, human sentiment that “something is not right,” elaborated into a state whose parameters, definitions, and prescriptions are controlled by a self-selecting group of “experts,” who can never be proved wrong.It was said that the genius of the Listerine campaign was attributable to the creation not of mouthwash, but of halitosis. Kraus indicts Freud for the creation of the nondisease of dissatisfaction. (See also the famous “malaise” of Jimmy Carter, which, like Oscar Wilde’s Pea Soup Fogs, didn’t exist ’til someone began describing it.) To consider a general dissatisfaction with one’s life, or with life in general as a political rather than a personal, moral problem, is to exercise or invite manipulation. The fortune teller, the “life coach,” the Spiritual Advisor, these earn their living from applying nonspecific, nonspecifiable “remedies” to nonspecifiable discomforts.The sufferers of such, in medicine, are called “the worried well,” and provide the bulk of income and consume the bulk of time of most physicians. It was the genius of the Obama campaign to exploit them politically. The antecedent of his campaign has been called Roosevelt’s New Deal, but it could, more accurately, be identified as The Music Man.