Finding a Place to Stand

A Systems Psychodynamic Approach to Citizenship

Shapiro, Edward R.

• Publisher: Phoenix Publishing House
• Year: 2019
• Print ISBN: 9781912691333
• eBook ISBN: 9781912691340
• Topic: Psicologia
• Subtopic: Psicoanalisi

What stands between us and authoritarianism seems increasingly fragile. Democratic practices are under attack by foreign intrusion into elections; voter suppression restricts citizen participation. Nations are turning to autocratic leaders in the face of rapid social change. Democratic values and open society can only be preserved if citizens can discover and claim their voices. We access society through our organisations, yet the collective voices and irrationalities of these organisations do not currently offer clear pathways for individuals to locate themselves. How can we move through the mounting chaos of our social systems, through our multiple roles in groups and institutions, to find a voice that matters? What kind of perspective will allow institutional leaders to facilitate the discovery of active citizenship and support engagement? This book draws on psychodynamic systems thinking to offer a new understanding of the journey from being an individual to joining society as a citizen. With detailed stories, the steps – and the conscious and unconscious linkages – from being a family member, to entering outside groups, to taking up and making sense of institutional roles, illuminate the process of claiming the citizen role. With the help of leaders who recognise and utilise the dynamics of social systems, there may be hope for us as citizens to use our institutional experiences to discover a place to stand.

Part I

Joining

Becoming a participating citizen and having a public voice requires an ability to discover connections between people through shared membership. Joining a group exposes us to group dynamics, the management of irrationality, and the discovery of larger social connections. Taking our role-related experience seriously and trying to make sense of it is an initial step toward social interpretation and the development of a citizen voice.

We (most of us) begin life as members of a family organization; we take up a role in relation to the family’s developmental task. In this section of the book, I focus on a way of listening to others, the unconscious elements of the joining process, the transition from family membership to group membership, the relationship of organizational role to the organization’s mission, and the ways in which groups and organizations can begin to contain intense emotions and use them in the service of their tasks.

In Chapter Four, I offer a case study where my efforts to take seriously my experience in an assigned organizational role began to make sense of an organization’s collective functioning. The case demonstrates how learning to negotiate with others a shared understanding of a group’s process can contribute to the possibility of speaking on its behalf, a central aspect of effective citizenship.

Chapter One

How Are They Right?

Citizenship is not just a legal status. It defines a membership role in a group with a social task and purpose. Becoming a member and developing a representative voice requires a joining process that has a developmental history. We learn the role of member from the beginning in our family; membership is our birthright. We learn the structure of rules, values, and roles that encompass family membership. The psychological boundary that begins to shape each of us as unique individuals has its origins there. As we join groups outside of the family and get invested in identifying with the other people, we relax that individual boundary. This process begins a transformation from “me as an individual” toward “me as a member” and begins to allow me to see other people not as “the other” but as “one of us.” Once outside of the family, peer group dynamics of inclusion and exclusion further shape our sense of ourselves. We choose and are chosen to be a member for reasons that initially are beyond our grasp. But we learn from this process and, increasingly, we take charge of our decisions to join.

Joining a group requires the capacity to identify with the group’s task and link our ideas to what others are saying. Affirming the other’s perspective and searching creatively for a larger context that links differing views are initial steps toward membership. To do that, we must first consider “How are they right,” that is, what aspect of what they are saying fits with my experience? I will present three stories about joining, each describing an individual’s discovery of a bridging connection that offered an opportunity for overcoming isolation by revealing a shared and larger context.

Philadelphia

The first story is a small example of joining. It comes from a visit my colleagues and I made to a reception in Philadelphia for the Austen Riggs Center, where we met with a group of clinicians to talk about our work. A number of senior clinicians attended this gathering because of a wish to hear more about Riggs and think through the implications of our work with treatment-resistant patients for their practices. As with many clinicians who work with difficult cases in outpatient treatment, these doctors were grateful for Riggs’ survival in the managed-care climate, which was limiting the financial resources available for treatment. Riggs had a long tradition of commitment to an intensive psychotherapeutic approach that seemed increasingly to be facing external institutional attacks on its survival. The meeting was organized both to support these outside clinicians who worked psychodynamically with severely troubled patients and to add them to Riggs’ referral base.

After receiving a brief presentation of the institution and an outline of our clinical approach, people began describing their practices and the struggles they were having with hard-to-treat patients. After several had spoken, a very senior clinician said, “I’ve always thought my practice was stimulating until a year ago when I had an epiphany.” He then described how he was sitting at a dinner party and, looking across the table, he saw a spoon begin to curl up in front of him. He then saw other items in the room begin to move by themselves, some out through the door to the outside garden. He detailed his unfolding excitement about people’s ability to do miraculous things if they only believed, describing how one person could levitate a heavier person with just two fingers under the arms if they believed deeply enough!

People in the room were hushed and tense as he elaborated this. My colleagues and I were stunned, thinking about how to manage this unexpected and seemingly irrational presentation in the context of this elegant and clinically focused reception. Some of the clinicians, trying to be supportive and contain their skepticism and concern, spoke of their knowledge about parapsychology and experiments with mind control of inanimate objects. Their comments spurred the speaker on to more extravagant descriptions about the power of belief. The discussion was being shaped in an unpredicted way that appeared to be taking us far away from the problems of treatment-resistant patients. Finally, I intervened: “I know just what you mean about the power of belief,” I said. “Many clinicians have told me that they just could not believe that any institution devoted to psychodynamic treatment could survive in this healthcare world.” This oblique but task-related comment brought relieved laughter from the group, and the discussion easily turned back to the shared focus around treatment.

As I thought about this later, I wondered if this elderly man’s comments were stimulated by his anxiety about his own survival. I realized that his taking up a seemingly irrational role, presenting divergent comments about the power of belief, could potentially be understood as connected to the group’s anxiety about our evening’s theme. In this context, my effort to link his comments to the survival of Riggs allowed the group to place our shared anxiety in perspective, rejoin the issue under discussion, and strengthen the boundary around the group, bringing the elderly clinician back into a more rational and task-related conversation.

This is a simple story about bringing in a shared context to reintegrate an isolating and isolated group member. But the question it raised for me is about what it takes to listen respectfully to the most manifestly irrational and seemingly off-base comment so as to discern how it might be right and connected. It would have been easy to listen to this man’s comments as nonsensical and disregard them and, by extension, him. But that kind of judgmental and disrespectful listening would inevitably have furthered his isolation and heightened our anxiety, while reassuring us that at least we weren’t irrational. Finding a way to join a shared context was difficult but not impossible (Carr & E. R. Shapiro, 1989).

The piano

My second story is a bit more complex. It occurred at the Austen Riggs Center when I was coming in as the new medical director and CEO. Riggs is a completely open setting that offers a spectrum of care for treatment-resistant patients. In an effort to maximally authorize patients’ competence, the center authorizes the patients’ complete freedom to come and go, with no restrictions or privilege systems. In addition to intensive psychotherapy, psychopharmacology, and family work, patients participate in an active therapeutic community where, through elected office, they govern themselves and participate in the management of the center’s community life.

In negotiating the details of the medical director’s residence, I had inquired of the administration about a piano. Prior to my arrival, the retiring medical director had decided with the trustees that the patients were not using all of their five pianos and that one of them could easily be relocated into the medical director’s home for social events. During the transition, the hospital community was in some disarray around the management of resources. Consequently, no effective discussion about the piano was carried out with the patients or with me prior to my arrival.

As a result, the patients greeted me with outrage that I had “stolen” their piano. Even though they were not using the piano, they were adamant that it “belonged” to them. In their experience, I was the CEO with all my perks, and they were the abused victims of forceful power. As I saw it, some sort of negotiation had occurred before I arrived, and they were reacting to it in a way I could not grasp; I felt equally victimized and righteous.

So, the patients and I met—forty of them and me. We attempted to negotiate a shared reality with frustrations on all sides. The discussion focused on power—who controlled the pianos, the patients or the medical director? There was no possibility of neutral ground. On the face of it, the question seemed perplexing since pianos were a resource of the institution and I was in charge of resources. To take up the authority of my role required me to link available resources to the institution’s task. At this moment, however, asserting that role in the face of the patients’ concerns would have been simply a power operation since I could not discover with them the shared task that the resources needed to join. Without understanding what we were involved in, I could not act; we were stuck. I tried to listen to how they were right but could not find the appropriate context.

But then one patient spoke movingly of the terrible sense of helplessness she had felt when the piano was arbitrarily moved without her consent. Though she did not play the piano and knew that other patients didn’t use it, she felt strongly that something terribly important had been taken away. From the perspective of the treatment context at Riggs, this made sense. The patients were willingly participating in a clinical situation where, as citizens of a therapeutic community, they had autonomy over their treatment. When the piano was taken from them without their input, they were feeling as though the institution had seemingly betrayed their trust and by extension compromised the negotiated task of restoring them to health. Even though this perspective was understandable, it was not opening a solution. The patients’ passion and the language of helplessness, however, suddenly seemed to open up a larger context beyond the institution.

With a barely perceptible shift, we suddenly found ourselves talking about money, insurance, third-party payers, and managed care. The patients had entered the hospital and begun their engagement in treatment when suddenly, without their participation, their financial resources were arbitrarily and irrevocably ripped away. The piano suddenly became less important as we discovered a larger context for this discussion. We were talking about the task of treatment and the resources for providing it. I could join them, not by projecting negative images about power into managed-care companies, but by working with them on the feelings of helplessness and vulnerability they had about the encroachments of reality and limited resources; these were feelings I also had in my leadership role. In fact, some of these feelings had contributed to my anxious wish to provide a formal space in my home to bring in outsiders and raise money for the hospital.

When we returned to the piano, the patients and I discovered that we could negotiate a process for its review, discussion, and decision. In the context of the shared treatment task, we had uncovered through our various roles a mutual experience of relative helplessness in the face of limited resources. Perhaps one of the functions of a discovered shared context is to provide a resting place that allows a beginning integration of what might initially seem to be competing experiences. The patients were regressively experiencing a repetition of unempathic, arbitrary power; I was in a similar regression of feeling misunderstood by them. In this mutual experience of empathic failure, both sides felt hurt, abused, and unable to learn from each other. Our discovery of the shared task allowed us all to recognize our connections as members of this institution, recover from the mutual regression, and join in an interpretation of a shared reality that we were all grappling with from different roles in a community that we all cared about.

But how could I be sure that my interest in the metaphor of limited resources and the apparently shared context of the third-party payers was not simply self-serving and designed to allow me to mask my own arbitrariness and facilitate my keeping the piano? The patients and I together represented a system in enormous flux, both inside and outside of the hospital. It may have been too much to expect to hold onto a shared context long enough to negotiate a meaningful picture of the significance of the piano without the rest of the system. Though I did keep the piano in my home and arranged to have the pianos in the patient community retuned and reconditioned, we did not revisit this issue after that powerful discussion.

But the evidence that we had found at least the beginnings of a real negotiation came five months later. The patients left me a Christmas stocking on my office door. Inside the stocking were two offerings: a lump of coal and a beautiful, tiny wooden piano, with a tag that said, “This one’s on us!”

The bus ride

My third story comes from a British conference I attended. Tom, a social worker of West Indian descent and a member of an Anglican church, reported the following: “I was on a bus during the firemen’s strike and a group of black teenagers began harassing the white bus driver. None of the other passengers, who were all white, moved or intervened in any way. As the teenagers’ harassment grew in intensity, I thought with some irritation and anxiety, ‘Why do I have to do this?’ Finally, I got up and spoke to the kids about the current tensions in the environment and the dangers of their behavior and asked them to knock it off, which they did. I did not like the role I was in.”

The firemen’s strike took place in London and had evoked significant social anxiety, opening vulnerability and dependency and stimulating anger and blame between segments of the population. Emergency crews were threatened during the brief strike; tensions were running high and these were reflected on the bus. Tom’s response concisely conveys many of the dilemmas of joining raised by the two earlier stories, but this time the solution is not asserted (as I did in the first story) or discovered (as the patients and I did together in the second). Here the solution is almost forced upon Tom by a complex set of internal and external pressures. The dynamics of the total event move us beyond the small group to consider immersion in the multiple subgroupings of our larger society.

In this event, Tom initially found himself alone. Then he felt himself, almost against his will, in a role. He felt pulled in ways he couldn’t fully articulate or discern into a risky engagement with others and with a task that transcended his personal needs. Tom asked himself, poignantly, “Why do I have to do this?” which raises a number of questions. Who says he “has to”? Are the pressures he experiences coming from his personal psychology or from the social surround? What internalized group is he joining, why, and through what process? And, for whom is he responding? Tom’s question, “Why do I have to do this?” can be translated as: “What groups and roles do I represent?” Answer: black man, father, social worker, church member, British citizen. And, from that range of identities, “What do I feel moved to do in this particular group and why?”

Tom’s second comment is similarly puzzling. He says, “I did not like the role I was in.” What is the nature of this role, and does he mean that this role does not feel like a part of him? How can such a thing happen?

The more we become aware that our experience of ourselves is affected by others, not just in our families but in the larger contexts in which we live, the less sure we seem to be about where our individual experience begins and ends. Each individual may choose a role (making it feel like part of the self), but alternatively he may find himself in a role as a consequence of factors beyond his grasp (unconscious family dynamics, nonverbal interpersonal pressures, hidden ethnic or social identifications), making it feel somewhat alien. Tom’s story begins to raise the central question of this book: What are the steps toward taking up the role of active citizen?

These are dilemmas for all of us. We are each embedded in many groups—many more than we realize. Their tasks and meanings are in our minds if we search for them. Facing conflict with another, we might be able to allow ourselves to wonder which groups might link the differing perspectives we are hearing and feeling. And we might consider negotiating this shared membership with others in order to discover a way out of disconnection and impasse.

There are limitations to this method of exploration. If I am in a dialogue with someone who threatens me physically, can I attempt to find a larger context that joins us without being naïve? Physical danger inevitably limits negotiation. Tom said “back off” to the adolescents at some personal risk. He set a limit and contained their aggression, a precondition for exploration and discovery.

* * *

I’ve offered three stories. The first, a simple social example, is about taking up a leadership role in order to claim a shared space for a divergent colleague; the second concerns an individual and a group discovering their shared institu...

Table of contents

• Cover Page
• Half title
• Full title
• Copyright
• Dedication
• How are they right?
• Contents
• Permissions
• Acknowledgments
• About the author
• Foreword
• Part I: Joining
• Part II: Leadership and the Self-reflective Institution
• Part III: A Citizen in Society
• Conclusion
• References
• Index