Hermeneutic Approaches to Interpretive Research: Dissertations in a Different Key 9780367690441, 9780367686895, 9781003140177

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HERMENEUTIC APPROACHES TO INTERPRETIVE RESEARCH

This unique and insightful book brings together a collection of impactful essays written by former psychology doctoral students, which feature hermeneutics as a method of qualitative inquiry. Philip Cushman brings together eleven chapters in which his former students describe their hermeneutic dissertations—how they chose their topics, their approach to research, what they discovered, what it was like emotionally for them, and how the process has inf luenced them in the years since completion. The contributors explore important contemporary issues like social justice, identity, gender inequality, and the political consequences of psychological theories and offer fresh, critical perspectives rooted in lived experiences. This book showcases the value and importance of hermeneutics, both as a philosophy, and as an orientation for conducting research that aids in critical, culturally respectful, interdisciplinary approaches. This is illuminating reading for graduate students and scholars curious about the hermeneutic approach to research, particularly those engaged in fields like theoretical psychology, clinical psychology, psychotherapy, mental health, cultural history, and social work. Ph ilip Cushman is a retired psychotherapist and a retired core faculty member of doctoral programs in psychology at the California School of Professional Psychology (Alameda) and most recently at Antioch University Seattle, Washington. His latest book is Travels With the Self: Interpreting Psychology as Cultural History.

Advances in Theoretical and Philosophical Psychology Series Editor Brent D. Slife Brigham Young University Editorial Board Scott Churchill University of Dallas

Jeffrey Reber West Georgia University

Blaine Fowers University of Miami

Frank Richardson University of Texas

Mark Freeman College of Holy Cross

Kate Slaney Simon Fraser University

James Lamiell Georgetown University

Jeff Sugarman Simon Fraser University

Jack Martin Simon Fraser University

Thomas Teo York University

Mary Beth Morrissey Fordham University

Nancy K. Dess A Multidisciplinary Approach to Embodiment: Understanding Human Being Jack Martin From Scientific Psychology to the Study of Persons: A Psychologist’s Memoir James T. Lamiell and Kathleen L. Slaney Problematic Research Practices and Inertia in Scientific Psychology: History, Sources, and Recommended Solutions Robert K. Beshara Critical Psychology Praxis: Psychosocial Non-Alignment to Modernity/Coloniality Martin Dege and Irene Strasser Global Pandemics and Epistemic Crises in Psychology: A Socio-Philosophical Approach Robert C. Bishop Hermeneutic Dialogue and Shaping the Landscape of Theoretical and Philosophical Psychology: The Work of Frank Richardson For more information about this series, please visit: www.routledge.com/ psychology/series/TPP

Advances in Theoretical and Philosophical Psychology Series Foreword Brent D. Slife, Editor

Psychologists need to face the facts. Their commitment to empiricism for answering disciplinary questions does not prevent pivotal questions from arising that cannot be evaluated exclusively through empirical methods, hence the title of this series: Advances in Theoretical and Philosophical Psychology. For example, moral questions such as “What is the nature of a good life?” are crucial to psychotherapists but are not answerable through empirical methods alone. And what of the methods themselves? Many have worried that our current psychological means of investigation are not adequate for fully understanding the person (e.g., Schiff, 2019). How do we address this concern through empirical methods without running headlong into the dilemma of methods investigating themselves? Such questions are in some sense philosophical, to be sure, but the discipline of psychology cannot advance even its own empirical agenda without addressing questions like these in defensible ways. How then should the discipline of psychology deal with such distinctly theoretical questions? We could leave the answers exclusively to professional philosophers, but this option would mean that the conceptual foundations of the discipline, including the conceptual framework of empiricism itself, are left to scholars who are outside the discipline. As undoubtedly helpful as philosophers are and will be, this situation would mean that the people doing the actual psychological work, psychologists themselves, are divorced from the people who formulate and re-formulate the conceptual foundations of that work. This division of labor would not seem to serve the long-term viability of the discipline. Instead, the founders of psychology—thinkers such as Wundt, Freud, and James—recognized the importance of psychologists in formulating their own foundations. These parents of psychology not only did their own theorizing, in cooperation with many other disciplines, but also realized the significance of psychologists continuously re-examining these theories and philosophies. This re-examination process allowed for the people most directly involved in and knowledgeable about the discipline to be the ones to decide whether changes were needed and how such changes would be best implemented. This book series is dedicated to that task, the examining and re-examining of psychology’s foundations.

References Schiff, B. (2019). Situating qualitative methods in psychological science. London: Routledge.

HERMENEUTIC APPROACHES TO INTERPRETIVE RESEARCH Dissertations in a Different Key

Edited by Philip Cushman

First published 2022 by Routledge 605 Third Avenue, New York, NY 10158 and by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN Routledge is an imprint of the Taylor & Francis Group, an informa business © 2022 selection and editorial matter, Philip Cushman; individual chapters, the contributors The right of Philip Cushman to be identified as the author of the editorial material, and of the authors for their individual chapters, has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging-in-Publication Data Names: Cushman, Philip, editor. Title: Hermeneutic approaches to interpretive research : dissertations in a different key / edited by Philip Cushman. Description: Abingdon, Oxon ; New York, NY : Routledge, 2022. | Series: Advances in theoretical and philosophical psychology | Includes bibliographical references and index. Identifiers: LCCN 2021014458 (print) | LCCN 2021014459 (ebook) | ISBN 9780367690441 (hardback) | ISBN 9780367686895 (paperback) | ISBN 9781003140177 (ebook) Subjects: LCSH: Psychology—Qualitative research. | Hermeneutics. Classification: LCC BF76.6.H47 H468 2022 (print) | LCC BF76.6.H47 (ebook) | DDC 150.19—dc23 LC record available at https://lccn.loc.gov/2021014458 LC ebook record available at https://lccn.loc.gov/2021014459 ISBN: 978-0-367-69044-1 (hbk) ISBN: 978-0-367-68689-5 (pbk) ISBN: 978-1-003-14017-7 (ebk) DOI: 10.4324/9781003140177 Typeset in Bembo by Apex CoVantage, LLC

To Edward E. Sampson, teacher, inspiration, and dear friend Jack Mitchell, first supervisor Margaret T. Singer, mentor and teacher Hilde Burton, long-time consultant And to my dear former students and to students everywhere

CONTENTS

About the Contributors 1 Hermeneutics and the Blooming of Mavericks: An Introduction Philip Cushman

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PART I

Critiques of Texts and Practices 2 Interpreting the Political Meaning of Manualized Trauma Treatment: A Hermeneutic Exploration of Battlemind and the Warrior Cult Sarah Peregrine Lord 3 Psychotherapy and the Embodiment of Neuronal Identity Ari Natinsky 4 Emerging Into a World of Understanding: A Hermeneutic Exploration of Perinatal Mood Disorders and Clinical Practice Kathleen M. Pape 5 A Hermeneutic Analysis of Trauma Diagnoses Julianne Ludlam

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Contents

6 Feelings of Enlightenment: Emotion-Focused Therapy’s Scientific Cloaking of Enlightenment Values Alex A. Gomez

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PART II

Philosophical Explorations 7 Living Truth Between Traditions: A Hermeneutic Integration of Moral Perception and Mutual Recognition Maxim A. Livshetz 8 The Psychological Dissertation and the Voice of the Therapist: From the Indivisible Self to the Land of Intersubjectivity Daniel Masler

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PART III

Applying Hermeneutic Theory to Psychological Practices

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9 Encountering Questions About Being Human: Toward Improving Training Practices for End-of-Life Care Susana Lauraine McCune

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10 Psychotherapy, Hermeneutics, and Relationality: Certainty Is a Dangerous Commodity Scott Perna

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11 Heidegger, Homelessness, and the Adopted Self: An Application of a Hermeneutic Methodology to an Essentially Hermeneutic Psychological Phenomenon William Scott Abbott

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12 Are We Woke Yet? Hermeneutics and the Politics of 21st-Century Social Justice MiNa Chung

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Index

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ABOUT THE CONTRIBUTORS

William Scott Abbott, PsyD, is a licensed clinical psychologist in private practice in New Haven, Connecticut, where he enjoys assisting adolescents and young adults in working to define their authentic voice and vocation and address the turbulence of this phase of life. An undergraduate degree in philosophy allowed Scott to bring the interpretive perspective into his graduate psychology studies at the California School of Professional Psychology. Combining the disciplines, he completed a qualitative dissertation in 1999 under Dr. Cushman’s guidance utilizing ontological hermeneutics. Scott is also a registered yoga teacher and values mindfulness practice both personally and in its application to therapy. MiNa Chung, PhD, is a licensed clinical psychologist in Providence, Rhode

Island, who divides her time among clinical practice, consultation, and research. In her clinical practice and consultation, she specializes in the treatment of complex relational trauma, personality assessment, and professional career development. In her current research, she is investigating the moral, philosophical, and psychological dimensions of identity politics, intersectionality, and ideological possession. Philip Cushman, PhD, is a retired psychotherapist and retired core faculty member of doctoral programs in psychology at the California School of Professional Psychology (Alameda) and most recently at Antioch University Seattle. He has been a member of APA divisions 24, 26, 29, and 39, Psychologists for Social Responsibility, and the Washington State Religious Campaign Against Torture. He has published articles in professional journals such as American Psychologist, Psychoanalytic Dialogues, Contemporary Psychoanalysis, and Journal of Theoretical and Philosophical Psychology and two books, Constructing the

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Self, Constructing America: A cultural history of psychotherapy and Travels With the Self: Interpreting Psychology as Cultural History. Alex A. Gomez, PsyD, is a Licensed Mental Health Counselor and has a private practice in Bellevue, Washington. He graduated with his PsyD in 2018 from Antioch University Seattle and his M.A. in Clinical Psychology in 2006 from the Michigan School of Professional Psychology (MiSPP) in Detroit, Michigan. Dr. Gomez is a member of and social media manager for the Center for Object Relations (COR) in Seattle. He has enjoyed hosting psychoanalytic movie nights for COR as a member and MiSPP as a student. Dr. Gomez is passionate about combining sociopolitical, hermeneutic, and relational psychoanalytic frameworks to his therapeutic practice with individual adults. Maxim A. Livshetz, PsyD, practices clinical psychology in Lynwood, Washington, usually at the crossroad of depression and chronic pain. While his therapy style is strewn with all the apparent materialism of well-packaged mindfulness, he finds a wealth of information in looking for what opens up through the countertransference f low of information that hermeneutics phenomenologically exposes as “prejudice.” His patients are just as likely to spend their sessions taking a stroll or turning their pain behaviors into an improvised dance as they are falling back into the relational currents and analytic depths of the old chair. Sarah Peregrine “Grin” Lord, PsyD, ABPP, is a board-certified clinical psy-

chologist who goes by part of her middle name. She has worked for the University of Washington and Harborview Medical Center as a therapist, supervisor, and trainer in trauma interventions. She is the founder, director, and lead therapist of the Center for Relational and Family Therapy (CRAFT), Bellevue, Washington, and teaches and supervises at Seattle University, University of Washington, and Antioch University Seattle. She has published over 20 peerreviewed research publications and training tools for new therapists. Her interests include the intersections of technology and psychology, the evolution of empathy, and the social meanings of trauma. Julianne Ludlam, PhD, obtained a bachelor’s degree in psychology from Grinnell College, a master’s degree from Harvard University, and a doctorate in clinical psychology from Alliant International University. She trained at California Pacific Medical Center’s outpatient mental health clinic, San Francisco County Jail’s psychiatric services unit, and a community mental health center in San Francisco’s Tenderloin neighborhood. After teaching undergraduate psychology at the University of Missouri, she moved to Raleigh, North Carolina, and currently conducts forensic and psychological evaluations at KKJ Forensic & Psychological Services. Dr. Ludlam’s clinical interests have centered

About the Contributors

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around the topic of trauma and trauma-related disorders, and her study of the topic continually informs her work. Daniel Masler, PsyD, MLIS, is a clinical psychologist in private practice in

Woodinville, Washington. He works with children, teens, adults, and families. Previously an investigative journalist, librarian, and magazine editor, he has written widely on social justice and environmental issues, along with two short documentaries. Susana Lauraine McCune, PsyD, has a deep concern for compassionate clinical care that is driven by the patient’s voice and preservation of dignity, which was born from her personal experiences and previous work with vulnerable individuals including homeless women, hospice and in-patient psychiatric patients, and dementia patients. Her concern is further deepened by her ongoing recovery from a traumatic brain injury. She hopes to broaden the aperture of research, aid in reforming healthcare worldwide, continue to support hermeneutic theses and dissertations, and teach specialized courses that return compassion and commitment to the patient in research and clinical care. Ari Natinsky, PsyD, earned his doctorate in clinical psychology from Antioch

University Seattle. He completed postdoctoral work in psychological and neuropsychological assessment at a private practice in Seattle and then completed his fellowship at a trauma-focused community mental health clinic in West Chicago, where he currently serves as a lead clinician and supervisor. His interests involve contemporary psychoanalysis and the theoretical–philosophical division of professional psychology. His current clinical practice includes theoretically integrative psychodynamic therapy, court-ordered psychological treatment for family court cases, and dyadic parent–child treatment for early childhood trauma, all centered on the accessibility of services for patients in underserved communities. Kathleen M. Pape, PsyD, is a university lecturer, licensed clinical psychologist, and supervisor in private practice in Seattle, Washington. She received her M.A. from Seattle University’s Master of Arts in Existential-Phenomenological Psychology and her Doctor of Psychology from Antioch University Seattle. She completed her doctoral clinical training at the Fremont Community Therapy Project, founded by Laura S. Brown, Ph.D., to provide feminist, culturally competent, trauma-informed services to low-income individuals. Her career includes working in community mental health centers, partial hospitalization facilities, and group practices. Her research interests include hermeneutic philosophy, feminist maternal theory, perinatal mood and anxiety disorders, trauma theory, and adult sibling bereavement.

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Scott Perna, PsyD, is a clinical psychologist with a private practice in San

Francisco. He is currently a post-seminar candidate in psychoanalysis at the Psychoanalytic Institute of Northern California. His current interests include the impact of Whiteness on the therapeutic encounter as well as the ref lection of neoliberalism in psychotherapeutic and psychoanalytic structures and practices.

1 HERMENEUTICS AND THE BLOOMING OF MAVERICKS An Introduction Philip Cushman

You won’t see many books like this, written by former psychology doctoral students who completed intellectually complex qualitative dissertations about highly unusual historical and political topics about their field. For this book, eleven of my former students wrote a chapter each about their hermeneutic dissertations; they recount how they chose their particular topics, what methods they used to do their research, what they discovered, what they made of what they found, and how the process affected them intellectually, professionally, and emotionally. They are all practicing psychotherapists, card-carrying professional psychologists—yet they took it upon themselves to carry through on a demanding, intellectually rigorous, painfully honest critique of their chosen field and one of their cherished theories or practices. They weathered skepticism if not reproach from other professors, worries from administrators, confusion from their peers, and no doubt some complaints from their significant others about the amount of time and intensity such projects demand. And yet they persevered. They chose a topic that they thought was an important one for the field and were determined to frame it in a hermeneutic perspective that had come to mean a great deal to them. Their results were intriguing, pointing the way to crucial reforms in American psychology and the country as a whole. Working with them was not always easy (I’m sure they would say the same about working with me), but it was most rewarding and meaningful. I think that living through the process of a hermeneutic research project helped us all become better therapists and teachers, better friends, and better people. For my part, I came to enjoy them and know them well. In fact, for their insightfulness, their courage, their tenacity, and their good-heartedness, I have come to care deeply for them. Teaching hermeneutically has been for me a source of pride and much joy. DOI: 10.4324/9781003140177-1

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The Story Behind the Beginning In 1988, Ed Sampson handed me a reprint of his recently published American Psychologist article, “The Debate on Individualism: Indigenous Psychologies of the Individual and Their Role in Personal and Societal Functioning” (Sampson, 1988). It was an article that over time came to mean a great deal to me, one that among other things inspired me to write and seek publication for my first American Psychologist article “Why the Self Is Empty” (Cushman, 1990) and to teach in a lovingly subversive way—some fruits of which you can see in this book. Ed and I first met in 1981, when I began a Ph.D. program in psychology. Ed became a teacher of mine, then a friend, and years later a dear friend. When Ed gave me the 1988 reprint, he and his wife Marya were about to set off on a trip to China, which was one of the early American trips allowed after the thaw in East–West relations. At the top of the first page (with apologies to Chairman Mao, who in 1956 announced a new “cultural revolution” in China by the slogan “Let a Hundred Flowers Blossom”), Ed wrote “May a Thousand Mavericks Bloom” and signed his name with a f lourish. The inscription was at once a funny and deeply meaningful gesture. To this day, I still have that reprint. We didn’t talk about it then, but I think we both knew what it meant. Ed was an intellectual revolutionary, which is perhaps a strange turn of phrase to use about someone who taught and at times was a dean in university psychology departments throughout his working life. In my opinion, his written work constituted one of the great intellectual and political challenges to the discipline of psychology in the second half of the 20th century. His 1977 article “Psychology and the American Ideal” (Sampson, 1977) shook mainstream psychology to its core, as did his 1978 article “Scientific Paradigms and Social Values: Wanted—A Scientific Revolution” (Sampson, 1978). And I believe his 1981 American Psychologist article “Cognitive Psychology as Ideology” (Sampson, 1981) was one of the most brilliant—and politically relevant—critiques of post-World War II American psychology yet written. He was a masterful professor and an effortlessly charismatic personality; what he taught was profoundly challenging both intellectually and politically to graduate students in the process of entering the field and no doubt especially to their professors. I’ve often heard students and faculty colleagues ask “you want us to criticize the profession we are working so hard to join (or advance) in? Why in the world would we want to do that?” For Ed, that question was never a problem: he was morally committed to exactly that way of being a psychologist. I could not have realized at the time how important to my teaching Ed’s ideas would become and how meaningful and generative teaching would be for me. Nor could I have allowed myself to imagine how wonderful my own students would turn out to be. And I could not have begun to dream that someday all of us together could produce something as insightful and touching as this book, written by the mavericks Ed inspired but sadly did not live to meet. In retrospect,

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I now realize this book is the embodiment of Ed’s injunction to me. Many mavericks have bloomed because of the profound inf luence of my teacher and friend. I hope this book will encourage and assist the development of mavericks yet to come. God knows we need you. We need people committed to both the discipline of psychology and simultaneously the critique of psychology. We need graduate students who can do the rigorous intellectual work and summon the integrity and courage to undertake dissertations like the ones described in the following chapters. Although Ed did not use the term to describe his work, I think what Ed wrote could be described today as studies in a cultural history of psychology. By adding Hans-Georg Gadamer’s philosophical hermeneutics to Ed’s critical vision, I have come to realize that cultural history is what I have written and taught to my students. It is important to bring Gadamer’s hermeneutics into this conversation although Ed never evinced a great deal of interest in that. I think in part that is because Ed was always quite leery of direct talk about the moral realm— something understandable given the intellectual atmosphere in which he was educated and some of the hypocritical moralism he encountered in his personal history. But through the help of my hermeneutic friends, I came to realize the foundational importance of the hermeneutic emphasis on moral understandings. It is that vision that allows hermeneutics to avoid an extreme relativism and exercise the capacity not only to critique but also to generate ideas about potential solutions to the social problems of our time and place—to build as well as take apart. That, in fact, is one of the major differences between hermeneutics and postmodernism, the other major stream of the intellectual movement called the Interpretive Turn in the humanities and social sciences (see, e.g., Hiley, Bohman, & Shusterman, 1991). I hope in the chapters that follow you will notice the influence of hermeneutics as well as postmodern critique—of Gadamer as well as Sampson—in the work of my former students. It is the confluence of the two together that makes the mavericks who create the magic. But please do not think that such a combination makes for a simple or easy research project. In fact, just the opposite, as the authors in this book will eagerly tell you. Then again, no one ever said that completing a dissertation would be easy. Inspiring, yes. Even occasionally brilliant, yes. But never easy.

Why the Dreaded A.B.D. So let’s be honest. Doctoral dissertations are just plain difficult to complete. There are reasons why the final degree that some graduate psychology students achieve is the dreaded A.B.D. (All But Dissertation) degree, because they never finish it. It’s frightening but true: dissertations are hard to start and even harder to finish. If you’re a psychology student just now starting to face the task, or if you’ve been trying to start but really haven’t been able to get going, or if you

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are a professor whose students are having trouble structuring their research or beginning to write their proposal, it is important to understand why students have trouble jumping in and/or finishing. Because of the way psychology programs now structure doctoral programs, by the time students have completed most or all of their courses, to one degree or another they often have had their imagination and initiative attenuated. If students get as far as entering the dissertation phase, they’ve done pretty well in the required courses. But it turns out that’s part of the problem. Required courses, especially those in American Psychological Association (APA) accredited programs or programs trying to become APA accredited, are now usually highly structured. There are many rules and procedures, strict requirements, much memorization, and sadly, increasingly little room for student reflection, initiative, imagination, and creativity. One of the unacknowledged effects of electronic syllabi, required articles or chapters posted online, and electronic grids for the demonstration of competencies is that graduate student learning in psychology has become highly structured and controlled. One of the consequences of control is that initiative and especially imagination get squeezed out of students. After two or three years of teachers and administrators taking responsibility for what students learn and severely limiting how they demonstrate what they have learned, students tend to develop ingrained habits, and then a way of being, that is passive, less curious, more compliant, and performance-oriented. By the time doctoral students have learned how to get high grades, they have been enculturated into ways of learning and a professional identity that tend to discourage them from developing or pursuing their own interdisciplinary intellectual interests and connecting their political commitments to their professional practices. This is especially true when those interests—and/or the means of pursuing those interests—might diverge from the content, method, or disciplinary political implications preferred in (or required by) their particular department or program. The ability of students to stay curious and creative is seriously dampened by the spoken and unspoken rules that control their learning experiences and ultimately their professional futures. It becomes increasingly difficult to recapture their intellectual curiosity or remember their initial research interests and their passions about the field. Their lives become one long instrumental exercise in getting along without making waves. And in the process, somewhere along the way, their love of learning lessens. So when it becomes time for students to structure their own research, to choose what they want to devote the next few years to, to know how to narrow a topic to a doable and yet meaningful size, and to identify and shape the best approach for studying it, some are pretty much at a loss. It has been years since they let their imaginations and commitments guide them, and often those muscles have weakened. Of course, most mainstream doctoral programs are aware of the problem of A.B.D. students. Increasingly, mainstream psychology programs are dedicated to what is called scientism—that is, the belief that the application of a physical science method is the only preferred way to find the truth about all human

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problems or questions, including what is sometimes referred to in moral philosophy (with apologies to Tocqueville) as habits of the heart. Because of the mainstream allegiance to scientism and due to the anxiety (and distain) usually produced in faculty members when a student deviates from that ideology, often a faculty member’s solution to the problem of confused and f loundering students is to guide them into restrictive, previously determined (sometimes boring) topics and rigid, quantitative methods. In other words, the cause becomes the supposed cure. Then, the very instructional style and the content that dampened the intellectual curiosity and initiative of students to begin with is then offered to them in order to save them (and their program) from a fate worse than death, the A.B.D. label. And so, year after year, cohort after cohort, mainstream psychology tends to turn out doctoral research that is uninteresting, disappointing, or at best a disguised ref lection of common sense. Implicitly, we teach our students that professionalism means following orders, but then after requiring that they complete an ongoing, complex research project that requires the exercise of imagination, agency, and creativity in structuring their own learning experience, we are dismayed when they fail. It is ironic, is it not, that we are shocked that they have not mastered skills that we have removed from their curriculum and after we have in a multitude of ways dissuaded or prevented them from learning in a creative and student-centered manner. I do not mean that faculty members are deliberately setting out to destroy their students’ intellectual curiosity or freedom—not at all. Teachers are by and large good-hearted folks who want the best for their students. They as much as their students are victims of the convergence of political and economic forces that have resulted in psychology’s current situation. They are squeezed on the one side by the ever-tightening university budgets that cause them to be significantly overworked and forced to comply with granting institutions that increasingly ref lect neoliberal, instrumental, and procedural worldviews. On the other side, they are motivated by the idealistic motives that moved them to enter the field in the first place. Exacerbating this conf lict is the increasing political conservatism in the country that includes an unquestioned valorization of unregulated capitalism, superficial patriotism, and unwavering militarism. These forces make honest, forthright critique unpopular, if not downright dangerous. Among other symptoms of this squeeze is the pressure to be evermore hyperconcrete, procedural, and behavioral in both research and practice. Therapists, for example, must present themselves as experts in various specialties and practitioners of well-known diagnostic and intervention techniques. The field of academic psychology has gotten intensely mechanistic—faculty must either comply or be replaced. And as time goes by, fewer and fewer teachers are around who can remember a different intellectual world, one of moral alternatives, more f lexibility, a more reasonable workload, and less economic pressure.

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So the problem is a systemic problem, an overdetermined product of many forces that are entrenched through a network of interlocking procedures (see Cushman, 2019, pp. 240–247) that, seemingly benign individually, become pernicious when viewed in their entirety. Faculty are as much victims as students are—in fact, in some ways more so, because they are forced to be purveyors and enforcers of the very theories and procedures they and their students are being controlled by. Fortunately, and much to their credit, our doctoral students somehow have survived in our highly structured environment with at least some of their curiosity and energy still intact, or at least slumbering but still able to be awakened. Most of our students usually enter our field with passion, commitment, and hope. And despite our best attempts at forcing upon them the proceduralism, surveillance techniques, and soulless academic competencies that are now the backbone of doctoral studies (see, e.g., Kaslow et al., 2007), still it turns out they have some curiosity and intellectual integrity left. With half a chance, they will learn to draw upon that wellspring of energy, but we have to give them that chance. How? In a better world, instead of forcing students into a learning style of compliance, memorization, and true believership, we could give them a chance by helping them, course by course, learn about the limitations of and alternatives to scientism. By doing so, we would encourage them to develop their own interests and research projects, learn about alternative research processes, and especially craft their own questions. But even if the curriculum cannot provide the encouragement and guidance to think creatively, still students are capable of transcending a strictly scientistic research approach, if only they can be given a chance to find their own path and the means to pursue it. Some professors—for instance, those who are members of Division 24 of APA (Theoretical and Philosophical Psychology)—have found ways of doing so by encouraging students to learn about what is called ontological or philosophical hermeneutics and seriously consider using a hermeneutic perspective in their research. I know that for students who have studied little or no philosophy, hermeneutics sounds intimidating. But really, its foundational ideas are fairly straightforward and in fact somewhat intuitive, once one gets a sense of some of the strange words or phrases that hermeneuticists use. Most of my dissertation students, for instance, who previously had never been exposed to hermeneutics before taking basic doctoral-level psychology courses that used a hermeneutic framework, caught on pretty quickly. For many, it just seemed like common sense although the language did take some getting used to. Over the years, I have chaired many dissertations. Most of those have been brave attempts to think critically about the field of psychology: critique famous theories, historically situate popular practices, creatively interpret psychological ideas in relation to the cultural history of their time and place, or learn more about the unintended sociopolitical results or consequences of a particular

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practice or theory. This book is a collection of chapters offered to readers with the hope that the topics, contents, and processes utilized by these researchers will encourage others to pursue their own interests and queries. They might go on to raise new, important questions, to see connections between the current political terrain and the theories and practices of our field, and to develop new understandings about an issue, event, or institution. It is really not so difficult for students to choose and narrow a topic and to figure out the best way to pursue it, once they are given the freedom to think in a less scientistic manner, to identify their own concerns and questions, and to pursue topics about which they feel passionately and perspectives to which they are deeply committed. In the following section, I describe a few hermeneutic ideas that students can draw upon in order to better recognize and then think about and research the issues that enchant, puzzle, or anger them. And then readers will have the opportunity to learn in more detail how a few former students pursued their interests and learned and wrote about some fascinating subjects. I admire their work and hope it will give you an idea of what topics and types of research are possible if you can let yourself pursue the interests close to your heart.

Hermeneutic Concepts Philosophy has gone through many changes in the centuries of the intellectual work that prepared the ground for 21st-century hermeneutics (e.g., Palmer, 1969; Richardson, Fowers, & Guignon, 1999). Although historians of hermeneutics usually date the beginnings of hermeneutics with Christian scholarship on the Hebrew and Christian Bibles, recent Jewish scholars have recognized the last 2,000 years of rabbinic interpretation of the Hebrew Bible, called Midrash, to be a product of hermeneutic processes (Fishbane, 1993; Stern, 1996; Cushman, 2007). In general, we can say that ontological or philosophical hermeneutics—as differentiated from methodological hermeneutics (see Messer, Sass, & Woolfolk, 1988)—is a 20th-century philosophical movement initially based on the work of Martin Heidegger (e.g., 1962, 1977). He argued that culture and historical contexts constitute humans, and he explored the omnipresence of, and difficulties that inhere in, interpretative processes. In the last quarter of the 20th century and the beginning of the 21st century in the United States, there was also much interest in the work of Hans-Georg Gadamer (e.g., 1989), especially through what might be whimsically referred to as the North American psychological interpretation of hermeneutics. This interpretation, following especially the work of Charles Taylor (e.g., 1988, 1989) and Richard Bernstein (1983, 1991), emphasizes the crucial importance of recognizing how historical traditions, which are inescapably moral traditions, constitute the predominant way of being—that is, the self—of a particular era or culture.

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Hermeneuticists of the North American movement believe that this emphasis on moral traditions is an important concept that distinguishes hermeneutics from some relativistic postmodern theories, the other stream in the intellectual tradition referred to as “the Interpretive Turn” (Hiley, Bohman, & Shusterman, 1991). Gadamer developed an extended argument that explained why the physical science method of research must not be the sole determinant of truth in the human sciences. This is an idea especially important to psychology’s involvement in current disputes over quantitative outcomes studies, evidencebased treatments, and the corporate control of mental health practices, which in turn have many political and economic consequences. Hermeneutic ideas moved my students to focus on the everyday context of whatever or whomever one is studying. This is because humans exist within and are constituted by a certain historical and moral context. This approach focuses on situating one’s object of study within that context. Studying humans by abstracting them from their cultural context and claiming to observe them in a dispassionate, putatively objective manner in the psychological laboratory is more akin to removing a fish from water than picking up a rock from its resting place (see Cushman, 2013). The claim to bracket off all pre-judgments, thereby putatively achieving objectivity and discovering the universal laws of human being, is what the mainstream psychological research tradition usually has used since its inception as a modern-era science in order to legitimate its practices. But studying people in a scientistic way doesn’t “bracket off ” a researcher’s pre-judgments so much as disguises them. Hermeneuticists believe that it is a wrong-headed approach that more often than not causes psychology to unknowingly support the political status quo and ironically sometimes has a hand in reproducing the very ills it is responsible for healing. Hermeneutic researchers, therefore, make no claims to objectivity or the discovery of universal laws. Instead, many of them state their own pre-judgments directly, discuss their research findings as creative interpretations grounded in careful, fair, honest, and deliberative—not objective—processes, try to consider all challenges to those interpretations, if necessary modify their interpretations accordingly, and attempt to get a sense of the implicit moral understandings of particular psychological theories and their political consequences. Individuals, cultural products, intellectual artifacts, and their social context form a dialogical, interpenetrating unit; by studying one, the researcher inevitably studies the others. The following are some basic concepts that inform an extended interpretation of hermeneutics that I have used in my research in psychology, adapted from an earlier, briefer version I published in 1995 (Cushman, 1995, pp. 17–20, under fair use guidelines): 1.

Humans do not have a basic, fundamental, pure human nature that is transhistorical and transcultural. We are incomplete and therefore unable to

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adequately function unless we are embedded in a specific cultural matrix composed of language, symbols, moral understandings, rituals, rules, origin myths, explanatory stories, songs, and customs. Of course, we are also biological, embodied beings and thus subject to biochemical forces and events far beyond our ability to fully comprehend. But ultimately it is not possible to separate our biochemistry from the social world in which we are embedded. It is impossible to separate the biochemical from the social because the cultural matrix allows humans to function by explaining and interpreting the world, helping us focus our attention on or ignore certain aspects of our environment and personal experiences, opening up or closing off possibilities for us, and encouraging us to and dissuading us from thinking and acting in certain ways. Culture constitutes individuals through the social practices of everyday life, which are shaped by what hermeneuticists call “inescapable” moral understandings. Those social practices shape and form in foundational ways how we conceive of the world and our place within it. The material objects humans create, the ideas and moral convictions we hold, and the actions we take are shaped in foundational ways by the social framework in which we have been raised. They are cultural artifacts. Even a preponderance of data or scientistic theorizing cannot separate our interpretations or anything else we produce from its cultural and historical context. These cultural artifacts are not only the ref lection or expression of an era. They are the immediate stuff of daily life, thereby shaping and molding our community’s generalized reality orientation, intellectual and moral understandings, and political and material arrangements in subtle and unseen ways. Owing to the dual nature of artifacts (that they both ref lect and reproduce their era), one task of hermeneutic research is to develop understandings about the contextual meanings and functions of a culture’s artifacts. Because cultural artifacts express aspects of the society from which they are created, they also tend to reinforce and reproduce the constellations of power, wealth, and inf luence that dominate in that society. Artifacts are not benign, apolitical coincidences, they are part of subtle and effective social activities and narratives that keep human communities functioning in specific moral and political ways. Some hermeneutic researchers focus on describing and explaining how the predominant ways of being of a specific society— such as the bounded, masterful self of modern-era Western society— are communicated to the individuals who are born and raised in it. Humans do not make decisions—about what is worthwhile in life, how to comport ourselves, and what goals are preferable to strive for—by a

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disembodied, unemotional use of acontextual, scientific objectivity. Instead, a certain way of being, a type of self, is produced by a particular society, and the shape of that self greatly inf luences the everyday interpretations that humans must make continually in daily life. We are profoundly dependent on the broad cultural understandings and material arrangements of the society into which we are thrown at birth. In this respect, the interpretations one develops about one’s experiences are of crucial importance in determining who one is and how one acts in the world. There is no Enlightenmentera view from nowhere, and starting in earliest childhood, we do not learn by being little Enlightenment-like scientists. Instead, we learn by engaging with our environment, long before we know it is an environment. Human knowledge and human experience are always perspectival. The role that the predominant configuration of the self plays in the reinforcement and reproduction of its particular era, serving whichever forces and groups benefit from that configuration, should be considered a prominent subject for social sciences like psychology. Questions that would be generated from that perspective could lead to an examination of how the current configuration of the self constitutes individuals who unconsciously live in and comply with the cultural framework that ref lects the current visions of the good, the power relations of race, gender, sexual orientation, and class, and the absences and desires that fuel consumer behavior. Such understandings can lead us to better practices, and better practices can lead to better ways of structuring our society, always in a continuing search for the good.

What Hermeneutic Research Might Look Like In the following chapters, the authors describe their doctoral dissertations in order to illustrate some of the ways hermeneutics can be utilized in order to address specific theoretical and practice-oriented questions, controversies, challenges, and diagnoses in psychology. I think you will find them to be intriguing, in fact remarkable, treatments of some of the most important issues of our time. The chapters are divided into three thematic sections. Part I is titled “Critique of Texts and Practices” and is composed of five chapters. Part II, composed of two chapters, is titled “Philosophical Explorations.” Part III is titled “Applying Hermeneutic Theory to Psychological Practices” and is composed of four chapters. These chapters demonstrate why the modern-era insistence on the distinctions among psychological science, moral understandings, history, and politics are mistaken, and how those distinctions further current arrangements of power and wealth. These chapters show what historically minded, relational, hermeneutic research projects in psychology can contribute to resisting harmful aspects of the political status quo. I hope that readers who are students will be inspired

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to seriously consider learning about and drawing from hermeneutics in your dissertation research and that those of you who are professors will be encouraged to help your students give it a try. It is not easy work, but it is worthwhile and surprisingly gratifying, as you will see from the following chapters. In Chapter 2, “Interpreting the Political Meaning of Manualized Trauma Treatment: A Hermeneutic Exploration of Battlemind and the Warrior Cult,” Sarah Peregrine Lord describes her dissertation and applies her findings to contemporary US society. In her dissertation, she drew out political and moral meanings of the trauma industry through a detailed textual interpretation of three evidence-supported treatment manuals. In the process, she came to realize the political effects of cognitivism in psychology, how trauma theory privileges scientism, and how contemporary US society—in its extreme reliance on instrumentalism, technicism, and neoliberalism— creates what she terms a warrior cult. In this chapter, she explains that the treatment manuals take for granted, ref lect, and reproduce the highly competitive, militaristic society of the United States and teach patients to ignore the social causes of daily political suffering. This situation valorizes a military-style state of mind and an extreme form of self-contained individualism. It thereby reinforces the political status quo that has a hand in causing some of the damage and abuse trauma treatments claim to attenuate. In Chapter 3, “Psychotherapy and the Embodiment of Neuronal Identity,” Ari Natinsky describes his dissertation, which was a textual analysis of an extremely popular and inf luential book about the integration of neuroscience and psychotherapy. Implications about the possible cultural and political effects of psychotherapy’s budding neuronal identity were explored critically. In Chapter 3, Natinsky applies those findings to current issues in the field of psychology and to US society in general. Among his many conclusions, Natinsky argues that the author’s ahistorical perspective serves to def lect critical thought about the sociohistorical context in which brain-based psychology resides. This produces a scientized and reductionistic vision of therapy that dismisses subjectivity, agency, and morality— a combination of dangerous absences. In Chapter 4, “Emerging Into a World of Understanding: A Hermeneutic Exploration of Perinatal Mood Disorders and Clinical Practice,” Kathleen M. Pape describes her dissertation, which initiates a feminist, hermeneutic interpretation of one of the more well-known, popular, and taken-for-granted diagnoses of our time, perinatal mood and anxiety disorders. She does so by examining three books on the subject; in a careful reading, she focused on how they describe the challenges and struggles of birthing and mothering, and how clinicians understand their patients, themselves, their practices, and their roles. By historically contextualizing the suffering and confusion of mothers and the theorizing and treatment practices of their doctors, Pape identifies several themes running through the material. The mother’s suffering is reduced to a medicalized, internal, universal disorder, and her well-being is deemed important to the degree that

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she serves others. In this chapter, Pape argues that the texts she studied reinforce current political arrangements of gender and power. She also reflects on how the hermeneutic processes she used affect her current clinical work. Julianne Ludlam describes her dissertation findings and her dissertation experiences in Chapter 5, “A Hermeneutic Analysis of Trauma Diagnoses.” Her dissertation was a historical examination of trauma diagnoses as cultural artifacts, artifacts that ref lect and reveal aspects of what it was like to be a person in a particular time and place. Her ambitious study examined texts in modern-era Western society from the earliest recorded psychiatric diagnoses to the most current, that is, from the Civil War’s “soldier’s heart” to contemporary posttraumatic stress disorder (PTSD). In all, fourteen texts from four different historical eras were examined and interpreted. Alex A. Gomez’s dissertation critiqued an inf luential humanistic book about psychotherapy theory and technique, and in Chapter 6, he describes his findings in “Feelings of Enlightenment: Emotion-Focused Therapy’s Scientific Cloaking of Enlightenment Values.” The theory in question, Gomez argued, turns out to be saturated with Enlightenment assumptions and values even though disguised in scientific and objectivist frameworks, thus perpetuating a one-sided emphasis on individual minds and devaluing the importance of sociopolitical forces. The result is a therapy theory that claims a scientific warrant and encourages clients to rely on the individualistic ideology that, ironically, has a strong hand in creating the very suffering the theory is responsible for healing. In Chapter 7, Maxim A. Livshetz writes “Living Truth Between Traditions: A Hermeneutic Integration of Moral Perception and Mutual Recognition.” This is a poetic, Gadamerian-inspired exploration of the philosophical meanings and moral dimensions of intimacy and commitment. He interprets Jessica Benjamin’s famous book The Bonds of Love (1988), best known for her discussion of developmental processes that make possible the capacity for intimacy, with an eye to its implied moral constituents. Similarly, Livshetz explores Blaine Fowers’ Aristotelian-inspired book, Virtue and Psychology (2005), with an eye to its implied developmental constituents. In other words, Livshetz makes explicit the moral in a developmental theory and the psychological in a philosophical theory. In Chapter 8, “The Psychological Dissertation and the Voice of the Therapist: From the Indivisible Self to the Land of Intersubjectivity,” Daniel Masler describes his dissertation, which is a comprehensive examination of the internationally acclaimed relational psychoanalyst Donnel B. Stern’s oeuvre (e.g., 1997, 2010, 2015). In this chapter, Masler investigates Stern’s philosophical assumptions and situates Stern’s work historically. By doing so, he draws out some of the meanings and enigmas present in Stern’s concepts of dissociation, enactment, unformulated experience, multiple self-states, and self-ref lection. Masler shows how Stern’s work embodies that most quintessential of psychoanalytic qualities: it both ref lects and resists the contemporary sociopolitical terrain. Masler also writes extensively about the effects that writing his dissertation has had on his practices as a psychotherapist.

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In her dissertation, Worlds of Connection: A Hermeneutic Formulation of the Interdisciplinary Relational Model of Care (2014), Susana Lauraine McCune formulated, discussed, and demonstrated a new model for advanced medical care planning. Her Chapter 9 in this book is titled “Encountering Questions About Being Human: Toward Improving Training Practices for End-of-Life Care.” McCune draws especially from hermeneutics and relational psychoanalysis in order to conceptualize and carry out an improved clinical approach to patients who, for reasons of grave illness or old age, need to utilize advanced medical directives and advanced care planning and yet are not allowed to do so by their caregivers. McCune has crafted changes in training curricula in order to help doctors, nurses, therapists, and social workers become better at staying helpful, courageous, and related to their patients during their struggles with death and dying. In Chapter 10, “Psychotherapy, Hermeneutics, and Relationality: Certainty Is a Dangerous Commodity,” Scott Perna describes his dissertation that was a study of how hysteria had been described and explained by male doctors and compared them to fictional writings by female writers of the same era. Also, he describes how the concerns he articulated in the dissertation have inf luenced him in his current practice as a psychoanalytic psychologist not only with female clients but also with clients of different sexual orientations, cultural backgrounds, and racial identities. William Scott Abbott in Chapter 11 writes “Heidegger, Homelessness, and the Adopted Self: An Application of a Hermeneutic Methodology to an Essentially Hermeneutic Psychological Phenomenon.” He describes how in his dissertation he applied hermeneutic ideas (and his own experiences as an adopted adolescent), such as the concept of “at-home-ness,” to a client population that embodies the absence of “at-home-ness”—adolescents who were adopted at or soon after birth. By conducting semi-structured interviews, he found that therapists tend to psychologize the struggles of adoptees by conceiving of those struggles as forms of pathology and locating them in the psychological interior of the adopted person. This act causes therapists to overlook the adoptee’s inevitable confrontation with the historically constituted nature of identity, social practices, and personal relationships. Abbott was able to look for the broader cultural, historical, and moral implications of the adoptees’ experiences. And then he was able to apply his findings to psychotherapy with adoptees, thereby deepen their—and hopefully, their therapists’—understandings of struggles with identity, belonging, and what it means to be human. In Chapter 12, “Are We Woke Yet? Hermeneutics and the Politics of 21st Century Social Justice,” MiNa Chung describes her dissertation, which was a friendly philosophical critique of multiculturalism and applies it to current political struggles in the United States. By drawing on her years as a multicultural counselor, multicultural teacher, and multicultural administrator, she found that some forms of relativistic postmodernism, when used as a philosophical foundation for multiculturalism, inf luence multicultural policy to gravitate toward unfortunate positions and political roles. One of those positions is a

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philosophical incoherence that can result in authoritarianism, censorship, and a kind of contemporary surveillance and policing that is found in some forms of “wokeness.” She argues that this leads to a political dead end with a potential for divisiveness and violence that runs counter to a more hermeneutic, relationally informed, and ultimately more progressive and effective, multiculturalism.

What the Struggles of Dissertation Students Tell Us About Our Profession and Our World Once my students completed their dissertations and their work became known in the community, they started to hear variations of the following theme from other students: “What? You wrote a dissertation about that? Seriously? And you did it how? Are graduate students allowed to do that?” I’ve heard that a lot over the years. Students from mainstream schools are shocked and attracted by the research topics my students chose and the methods they used. It is as if they believe my students have done something slightly shady, illegal, perhaps immoral, but also intriguing. Why are they so surprised? What is it about the current conceptualizations of psychological research— in fact, about the discipline of psychology as a whole— that have led to such a rigid, limited vision of what constitutes permissible topics and methods? Now, I don’t want you to get the wrong idea: it is not as if my students had really bizarre ideas about the what or how of psychological research. My students explored the philosophical merits and political meanings of psychotherapy theories, conducted interviews about contemporary social or political topics such as racism or sexism, and examined cultural phenomena such as novels or films or dramatic programs on television. But, mainstream students say, “how can you study those topics in an objective way? Sure, they could be studied in a humanities department, but this is psychology. How can I study those topics without using evidence-based practices? This isn’t anthropology or sociology, you know, this is real science!” And then sometimes, they say the saddest thing of all; if we are alone or at least not in a big crowd, they might take the risk of telling the truth. In a quiet, wistful way, they say It was that kind of topic that I really wanted to learn about when I entered the department. I wanted to study something interesting and important for my dissertation, and I wanted to study it in a creative way. So, I might ask, why don’t you, now that you have a chance? Well, you know how it is in psychology: We have certain standards, we have to be careful, we have scientific methods that ensure our objectivity. There are only certain ways of researching a topic that are acceptable, and they really restrict what we can do. If a topic can’t be studied by using those methods, it probably lacks reliability or validity, so you have to find

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a new topic, or you have to study it in a much more . . . ah, limited way. That’s all there is to it. And where do these rules come from? Who decides what is a proper psychological topic and what isn’t? Isn’t that covered by APA rules and regulations in some way? I don’t know. I do know my school is getting nervous about an upcoming accreditation visit; faculty members are busy counting things and compiling statistics about the program, the curriculum is getting tweaked again in order to fit better with APA requirements, the administration is getting nervous about how many students couldn’t finish their dissertations, and it’s making sure that we leave an electronic trail of everything we do and how we do it. I don’t know how APA inf luences the topics and methods of dissertations, but it sure feels like it does. [Pause] . . . Maybe the changes instituted before an accreditation visit—like new required courses inserted and electives deleted—inf luence all of us, but in subtle, hard to tell ways. In its haste to submit to the ever-increasing pressures of corporate healthcare and governmental regulations to reduce psychotherapy practices to items measured by hyperconcrete outcomes or items on a consumer-like survey, mainstream psychology has narrowed its paradigm to an increasingly rigid scientism. The beginnings of theoretical pluralism and interdisciplinarity in the 1960s and 1970s have been consigned to the shadows, and in their place is a vision of theory and practice that primarily recognizes only one or two broad philosophical understandings of proper method. That vision is based on a decontextual, instrumental technicism that is philosophically wrong-headed; as a result, technicism is easily conscripted into the pursuit of social conformity, money, and inf luence. By limiting themselves to a scientistic framework, mainstream psychologists become increasingly less able to conceive of and carry out research about topics and issues in an in-depth, interdisciplinary, historically contextual manner and therefore have difficulty utilizing critique in psychology to further any sort of broad, non-token progressive politics. It becomes difficult for faculty to even notice the negative political effects of ever-constricting surveillance systems inspired by accreditation processes that rely on a framework of what is called academic competencies and recognize how that system has affected them and their students. Sadly, the profession is now filled with folks who have willingly, sometimes self-righteously, welcomed a panoptic existence. They are the worse for it, of course, as is the public they claim to serve. Do you think I’m exaggerating? If you are yourself a teacher, just talk with your students, I mean really talk with and listen to them. If you are yourself a student, really listen to your classmates—you will find you are not the only one secretly unsure and unhappy. But in all likelihood, this could well be the last generation of students who are quietly demoralized, self-blaming, and some secretly in despair. I fear the interlocking procedures of scientism (Cushman, 2019, pp.  240–247)

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are tightening, and soon everyone involved—administration, faculty, staff, and recently admitted students—will be so enculturated and self-selected into the one truth of scientism that there will be no one left to question it. Faculty will be so overworked and worried about job security that they will have neither the time nor inclination nor increasingly the training to think critically about the unquestioned philosophical and political frame, rules, and regulations under which they labor. The administration will watch carefully to spot adjunct faculty members who resist the party line and will have no reluctance in replacing them with one of several desperate adjuncts waiting for a chance. And the students, fresh out of undergrad psychology programs that are structured by doctrinaire behavioral and cognitivist frameworks, will not know any alternative. Increasingly, incoming doctoral students are younger, less experienced, and intellectually one-dimensional psychology majors, which means that they are rarely exposed to the arts, humanities, or less scientistic aspects of social sciences such as sociology or anthropology. As a result, students will not know what they are missing or why they feel vaguely disappointed or unfulfilled. They will not know how to question widely and how to think deeply. They will have difficulty knowing what they feel curious about and what they might like to study or research or critique. They will have to turn to narrow, politically regressive psychology theories for intellectual and spiritual guidance, and they will end up feeling unfulfilled, with a nagging sense that those theories might be more damaging than helpful. Predictably, they will learn to keep their mouths—and then their minds—shut. Eventually, they will come to blame themselves when, in their more despairing moments, they experience doubts or unusual wishes and accuse themselves of being undisciplined or not appropriately scientific. That is how institutional forces subtly attack dissent, one person and one cohort at a time. This is why it is crucial that students learn how to critically examine psychological theories by thinking historically, politically, and morally about our profession. As teachers, we should not be ashamed about helping them learn how to do so. We should be proud to recognize the limits of our knowledge and take on the sad wisdom and potential creativity that a more hermeneutically oriented vision of human beings can develop. As you will see from the chapters that follow, there is much that can be gained from realizing our cultural and historical situatedness and the vital importance of honoring, challenging, and being creative with the moral understandings we were thrown into at birth. As practitioners of the North American psychological interpretation of hermeneutics have said for many years now: “Our nature or being as humans is not just something we find, . . . nor is it something we just make, . . .; instead, it is what we make of what we find” (Richardson et al., 1999, p. 212). Similarly, what is of vital importance in our search for knowledge is what we make of what we find. Our hard-won understandings are always incomplete and uncertain, but they matter to us—and they are enough (Richardson et al., 1999, p. 18). We are interpretive beings.

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Hermeneutics helps us notice how fragile our understandings are, and yet how resilient they are, if only we can face up to their fragility and especially their historical situatedness. Our job as humans, exemplified by the chapters that follow, is to know well the historical traditions we were thrown into at birth and the professional traditions we are enculturated into, to study and respect those traditions, to let them be challenged—really challenged—by encounters with those who were thrown or initiated into different traditions, and thereby when appropriate to shift our traditions in ways that are influenced by the best aspects of their traditions. Our job is to know where we stand and critique where we stand and be able to tolerate shifting our location a bit, when we are open to and then affected by different perspectives. That is a tall order. But it has always been the fate of humans, when we are lucky, to experience those occasional moments of enlightened change—and in our multicultural world of today, we have the opportunity to be lucky indeed. Hermeneutic dissertations can help us navigate that path. It is a good path—not easy, but good. Students, know that in the authors of the following chapters, you have like-minded colleagues who might be able to help you along the way. They could help you, and hopefully someday you will return the favor by nurturing your own colleagues and students. And when being open to new and different colleagues, you might stumble upon other mavericks who are also quietly looking for like-minded souls. I wish you good fortune in your hermeneutic adventures. May they be filled with many meaningful, helpful, emotionally touching moments in the years to come, as mine have been.

References Benjamin, J. (1988). The bonds of love: Psychoanalysis, feminism, and the problem of domination. New York: Pantheon Books. Bernstein, R. J. (1983). Beyond objectivism and relativism: Science, hermeneutics, and practice. Philadelphia, PA: University of Pennsylvania Press. Bernstein, R. J. (1991). The new constellation: The ethical-political horizons of modernity/ postmodernity. Cambridge, MA: MIT Press. Cushman, P. (1990). Why the self is empty: Toward a historically situated psychology. American Psychologist, 45, 599–611. Cushman, P. (1995). Constructing the self, constructing America: A cultural history of psychotherapy. New York: Da Capo. Cushman, P. (2007). A burning world, an absent God: Midrash, hermeneutics, and relational psychoanalysis. Contemporary Psychoanalysis, 43, 47–88. Cushman, P. (2013). Because the rock will not read the article: A discussion of Jeremy Safran’s critique of Irwin Z. Hoffman’s “Doublethinking our way to ‘scientific’ legitimacy”. Psychoanalytic Dialogues, 23, 211–224. Cushman, P. (2019). Travels with the self: Interpreting psychology as cultural history. New York: Routledge. Fishbane, E. (Ed.). (1993). The midrashic imagination: Jewish exegesis, thought, and history. Albany, NY: State University of New York Press.

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Fowers, B. J. (2005). Virtue and psychology: Pursuing excellence in ordinary practices. Washington, DC: American Psychology Association. Gadamer, H.-G. (1989). Truth and method (D. Marshall & J. Weinsheimer, Trans.). New York: Crossroads (Original work published 1960). Heidegger, M. (1962). Being and time ( J. Macquarrie & E. Robinson, Trans.). New York: Crossroads (Original work published 1927). Heidegger, M. (1977). The question concerning technology and other essays (W. Lovitt, Trans.). New York: Harper & Row. Hiley, D. R., Bohman, J. G., & Shusterman, R. (Eds.). (1991). The interpretive turn: Philosophy, science, culture. Ithaca, NY: Cornell University Press. Kaslow, N. J., Rubin, N. J., Bebeau, M. J., Leigh, W., Lictenberg, J. W., Nelson, P.  D.,  .  .  . & Smith, I. L. (2007). Guiding principles and recommendations for the assessment of competence. Professional Psychology: Research and Practice, 38(5), 441– 451. https://doi.org/10.1037-7028.38.5.441 McCune, S. L. (2014). Worlds of connection: A hermeneutic formulation of the Interdisciplinary Relational Model of Care [Doctoral dissertation], Antioch University Seattle. Retrieved from Ohiolink http://rave.ohiolink.edu/etdc/view?acc_num=antioch1404395833 Messer, S., Sass, L., & Woolfolk, R. (Eds.). (1988). Hermeneutics and psychological theory: Interpretive perspectives on personality, psychotherapy, and psychopathology. New Brunswick, NJ: Rutgers University Press. Palmer, R. (1969). Hermeneutics. Evanston, IL: Northwestern University Press. Richardson, F. C., Fowers, B. J., & Guignon, C. (1999). Re-envisioning psychology: Moral dimensions of theory and practice. San Francisco, CA: Jossey-Bass. Sampson, E. E. (1977). Psychology and the American ideal. Journal of Personality and Social Psychology, 32, 309–320. Sampson, E. E. (1978). Scientific paradigms and social values: Wanted—A scientific revolution. Journal of Personality and Social Psychology, 36, 1332–1343. Sampson, E. E. (1981). Cognitive psychology as ideology. American Psychologist, 36, 730–743. Sampson, E. E. (1988). The debate on individualism: Indigenous psychologies of the individual and their role in personal and societal functioning. American Psychologist, 43, 15–22. Stern, D. (1996). Midrash and theory. Evanston, IL: Northwestern University Press. Stern, D. B. (1997). Unformulated experience. Hillsdale, NJ: The Analytic Press. Stern, D. B. (2010). Partners in thought. New York: Routledge. Stern, D. B. (2015). Relational freedom. New York: Routledge. Taylor, C. (1988). The moral topography of the self. In S. B. Messer, L. A. Sass, & R. L. Woolfolk (Eds.), Hermeneutics and psychological theory: Interpretative perspectives on personality, psychotherapy, and psychopathology (pp.  298–320). New Brunswick, NJ: Rutgers University Press. Taylor, C. (1989). Sources of the self: The making of the modern identity. Cambridge, MA: Harvard University Press.

PART I

Critiques of Texts and Practices

2 INTERPRETING THE POLITICAL MEANING OF MANUALIZED TRAUMA TREATMENT A Hermeneutic Exploration of Battlemind and the Warrior Cult Sarah Peregrine Lord We live in a traumatized society. The act of continually reading disturbing news stories for hours has become a part of our everyday life to the extent that we coined a word for it in 2020: “Doomscrolling” (Merriam-Webster, 2020). When not reading the news, average Americans relax by watching entertainment that centers on disaster, war, and violence. The most-watched TV shows of 2020 included Grey’s Anatomy, a series about life in a level 1 trauma center, followed by Criminal Minds, NCIS, and Ozark, all of which are American crime dramas (Gutosky, 2021). Even in entertainment not specifically focused on crime or disaster, the protagonists describe themselves as suffering from posttraumatic stress disorder (PTSD), including Katniss in the Hunger Games, Tony Stark in Iron Man 3, Arabella Essiedu in I May Destroy You, Nicholas Brody in Homeland, Terry Bellef leur in True Blood, Dr. Stanley Keyworth from The West Wing, June Osborne in The Handmaid’s Tale, Starbuck in Battlestar Galactica, the imprisoned women in Orange Is the New Black, the shell-shocked valet in Downton Abbey, and the list goes on. The obsession with trauma has been increasing over the last twenty years. The word “trauma” was cited in the UK newspapers less than 500 times a year in the early 1990s, and ten years later, it was cited over 5500 times (Furedi, 2004, p.  4).1 An international Google trends analysis revealed that the relative interest on a scale for the search term “PTSD” had risen 81% from 2004 to 2020 (Google.com). Today, there are even websites selling PTSD branded “swag” like stickers that say “PTSD isn’t just for veterans” and shirts that read “PTSD is my reality” and “traumatized” (Redbubble.com). This trauma-culture  obsession reveals that to identify as traumatized is a marketable, readily understood, and relatable way of being human. Although trauma is both troubling and vital to individuals and society, it is not enough to simply realize that trauma abounds in the social world. DOI: 10.4324/9781003140177-3

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Through working on my dissertation, I understood that US society needs psychologists, historians, counselors, and the like to interpret trauma—what it means and stands for, and the many political meanings, especially discomforting or dangerous political meanings, it contains.2 Two of the consequences of either avoiding or being incapable of interpreting the rise of trauma culture are fetishizing it or dissociating from its harmful consequences. At worst, therapists perpetuate and re-create what is violent and traumatizing in our world by taking it for granted and interpreting it only in decontextualized and instrumental ways. My dissertation’s purpose was to interpret the social world that gives rise to and maintains distinctions such as victims, survivors, warriors, perpetrators, and rescuers. It is a world where PTSD and traumatic stress are not obscure, decontextualized psychiatric terms but part of the common vernacular—where each individual is understood to engage in an internal mental war to dominate or erase their trauma and suffering. One of my primary hopes in conducting my dissertation was that therapists would discover alternative, perhaps previously unformulated insights about how we think and act in this traumatized world. Second, I hoped it would encourage therapists to open themselves to the possibility of becoming politically and socially active in the therapy room and beyond. By demonstrating how therapists can contextualize and thereby questioning their daily practices in trauma society, I hoped that this work could contribute in some small way to breaking the traumatic enactments that we witness daily.

Methods for Interpreting Trauma Treatment Manuals as Paradigmatic Cultural Objects In my dissertation, I examined how trauma culture is embodied and perpetuated, as counterintuitive as it seems, in psychological trauma treatments. I did this by engaging in a qualitative textual interpretation of three widely utilized trauma treatment manuals from contemporary psychotherapeutic practice. I chose to analyze treatment manuals in particular because they have become such an integral component of today’s psychotherapy. All wellestablished evidence-supported psychotherapeutic treatments for trauma disorders involve the therapist learning from and continuing to retain fidelity to a trauma treatment manual (Bisson & Andrew, 2007; DoD, 2010; Foa, Keane, & Friedman, 2000; Foa, Keane, Friedman, & Cohen, 2008; Forbes et  al., 2010; Rosen et al., 2004; WHO, 2013). How therapy is being conceived, trained, practiced, and exported across the world is now primarily determined by manuals. The manuals I selected for interpretation were as follows: 1.

Cohen, Mannarino, and Deblinger’s (2006) trauma-focused cognitive behavioral therapy (TF-CBT) manual: Treating trauma and traumatic grief in children and adolescents.

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2. 3.

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Francine Shapiro’s (2001) EMDR manual: Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures. The US military’s Battlemind Debriefing and Training series (Battlemind; WRAIR, 2006a, 2006b, 2006c, 2008a, 2008b) and their associated supplementary texts.

These manuals were widely disseminated, represented a range of psychotherapeutic approaches, and were designed for use with a child, adult, and military patient populations, respectively. Studying the manuals’ messages and thinking about the world that gave rise to them were imperative given their increasing utilization and the continued cultural obsession with trauma in the United States and internationally since the 1980s. Restoring the historicity and context to trauma-treatment manuals in the study was important so these texts could be seen as products of a specific time, political interest, industry, and culture rather than as communicating ahistorical, transcultural truths about healing. Thus, I engaged in a hermeneutic interpretation of the texts. This process is described in the hermeneutic literature by Anthony Stigliano (1989), Victoria Leonard (1993), Michelle McCoy Barrett (2000), and Jeff Chang (2010). These scholars have drawn from the theoretical background of philosophical hermeneutics and from disciplines such as nursing that use hermeneutic methods in research (cf. Patricia Benner and Karen Plager). My interpretation proceeded from Gadamerian hermeneutic philosophy (Gadamer, 2004) and a comprehensive literature review on the history of trauma treatments in mental health fields (see Lord, 2014, Appendix A for review).

Areas of Hermeneutic Inquiry Hermeneutic philosophers ask questions like: How it is that humans understand? (cf. Kant, Schleiermacher), What is the most objective way to understand human life and everyday practice? (cf. Dilthey, 1978), How is being? (cf. Heidegger, 1996), and What kind of world, including personal, social, and cultural histories, would allow for questions about meaning-making to exist in the first place? (cf. Gadamer, 2004). For me, it was learning about the concept of “falling out of everydayness” from Heidegger (1996) that pushed me to examine these manuals, these therapists, and myself as a trauma therapist—as an enacting artifact of trauma culture. Like Marcel Duchamp’s ready-made art, I began by asking questions that provoked a falling out and allowed trauma culture to look both absurd and uniquely bespoke for this moment in time. In my dissertation, I followed Gadamerian lines of inquiry. I attempted to move beyond positivist and ontic questions about trauma such as “How does trauma change our brains?” and “What symptoms indicate moderate PTSD?” Instead, I examined the human traditions and practices that allow these questions to be asked in the first place.

24 Sarah Peregrine Lord

I explored the cultural messages about traumatization, suffering, victimhood, and healing embedded in trauma treatment manuals and discussed their moral, cultural, and political implications. I began with questions like: • • •

•

• • •

In what kind of social world do “trauma treatment manuals” exist? In what kind of social world do these manuals work? And what does “work” mean? What does it tell us about the concept and social function of trauma when a manual-based treatment can claim to heal any trauma, from child abuse to genocide? What does the particular form of trauma we experience today, as it is represented in evidence-supported trauma treatment manuals, tell us about this historical moment? What understandings of the good do trauma treatment manuals implicitly and unintentionally ref lect and prescribe? How do members of society, especially therapists and patients, define themselves in trauma and act in a trauma-based society? How is human being defined in a trauma-based society?

I also asked several additional specific research questions that explored the historical context and moral judgments about traumatic responses described in the texts (see Appendix B, Lord, 2014). As a trained and practiced therapist living in a trauma-based society, I, of course, brought my pre-judgments about trauma culture to my interpretation, which I identified and questioned. I was strongly inf luenced by cultural understandings and by enacting consumption of trauma culture given the traditions and social world I live in and unknowingly embody. But embarking on this dissertation was the beginning of questioning that world. Gadamer (2004) believed that by becoming aware or “foregrounding” the assumptions that we are conscious of, the interpreter might be freer to listen to a text’s background traditions in a way that allows for its meaning to be heard despite the interpreter’s personal history and traditions. Interpreting trauma hermeneutically required tolerating ambiguity and allowing time to develop interpretations that were uncomfortable or complex (i.e., interpretations that stand at the edge of the clearing, as Gadamer might have said). It required acknowledging our dependence on others, living with anxiety caused by not being able to erase trauma, and questioning agency during the trauma—all things that trauma culture does not consider to be aspects of good values and, therefore, does not encourage. Finally, it required the ability to conceptualize therapeutic practices that, at times, opposed mainstream American understandings of what is good. Before beginning the interpretation of the treatment manuals, I wrote a chapter on “foregrounding” where I reviewed my experience as a trainee trauma therapist; this is now separately published (Lord, 2021).

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Reckoning with the moral frame during my research was particularly difficult because, as a student therapist, I was trained to adhere to the very manuals I was questioning. Even now, writing this chapter as a psychologist many years later, it is still difficult to question what I learned and the identity of a “trauma therapist.” The practices of being a trauma therapist still feel right to me and fit with my expectations of healing. Yet, today, with more therapists than we’ve ever had before to heal our traumatized world, it remains vitally important to question our responsibility in perpetuating the problems we purport to cure.

Trauma Treatment Manuals as Paradigmatic Objects of Contemporary Culture One of my first conclusions was the importance of understanding the manuals themselves as paradigmatic objects of contemporary culture. A paradigmatic object comes to create a societal space in which some of the most fundamental meanings and activities of the society come into being (e.g., the Acropolis for ancient Greece; Dreyfus & Wakefield, 1988; Heidegger, 1977). It is quintessential to the culture because it articulates the boundaries of what it is to be human. I suggested that trauma treatment manuals were a response to significant political and moral questions. One that did not encourage an opening and laying out of what we, as a society and a profession, have taken for granted; nor an opportunity to ref lect on and think about this traumatizing world. Instead, the manuals implied that a good way to be human in the contemporary society is to respond to the questions that being traumatized raises with a preformulated set of rules. Rules that encourage a return to normalcy through individualized “work on oneself ” and erasure or containment of the trauma contained therein. Rules that some like Sugarman (2015) and Layton (2010) have suggested perpetuate a neoliberal status quo.3 The manuals may also reframe social and moral problems in ways that can be resolved only through a lucrative industry of healthcare and private companies.

Primary Interpretation: The Discovery of the Warrior Cult The primary interpretation I developed when thinking of trauma treatment manuals as a paradigmatic object was that the manuals ref lected and created a warrior-cult society. This interpretation first emerged for me during the textual analysis of Battlemind. But when studying the other two manuals—Treating Trauma and Traumatic Grief in Children and Adolescents; and Eye Movement Desensitization and Reprocessing (EMDR)—I realized that despite differences, they also displayed common characteristics with Battlemind. Foremost among the similarities was that they ref lected society as a battlefield and successful patients like warrior soldiers.

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I described the warrior cult as a way of being that contemporary US society creates and idealizes. It is one in which people easily assume the identity of trauma survivor: an enterprising, functional, and fiercely individual member of a warrior cult. In the warrior cult society, to think or to talk about social causes and public solutions to daily political suffering is thought to be either nongermane, cowardly, or dangerous. Individuals are seen as free from all dependencies and social ties, overcoming personal and public adversity by arming or fortifying their brains and replacing thoughts in their computer-like minds. My primary interpretation demonstrates a central concept in hermeneutic cultural studies: cultural artifacts such as psychotherapy practices fit the larger society like a key fits its lock. In the highly competitive and violent society of the United States, poverty, racism, misogyny, and homophobia abound. Everyday life takes on the experience of a war and personal survival that seems to require the discipline skills of a trained soldier. In my dissertation, I explored this overriding theme through the interpretation of each manual. Also, I reviewed the broad structure of cults, their indoctrination processes, and their relationship to coming of age ceremonies (Lord, 2014, pp. 119–128). In this chapter, however, I discuss specific examples of the warrior cult in only one treatment manual: Battlemind.

Context of Battlemind The Battlemind debriefing and training series was created as an early intervention for PTSD, depression, and sleep problems in US and UK service members returning from Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND), which are commonly referred to as the Post-9/11 Wars in Afghanistan and Iraq. Between 480,000 and 507,000 people died, including both civilians and combatants, in Iraq and Afghanistan as a result of the violent conf lict (Crawford, 2018). At the time my dissertation was published, 6,750 US service members ( Jean-Louis, Linch, Fetterhoff, & Hadar, 2014) and 447 UK service members (Ministry of Defence, United Kingdom, 2014) had died in Iraq or Afghanistan. Approximately 40% of service member deaths were from improvised explosive devices (IEDs) (P. W. Singer, 2012). The veracity and amount of evidence of the initial reasons to enter war, like weapons of mass destruction, have been disproven by post hoc evidence and analyses ( Johnson, 2006; Mayer, 2009; Ricks, 2006). The primary controversies surrounding the US invasion of Iraq and Afghanistan in OEF/OIF/OED have included but are not limited to instigation of the war on false pretenses for the US economic benefit (Maddow, 2014; Ricks, 2006), the legality of the war (British Broadcasting Corporation [BBC], 2004), human and financial cost of war (Project, 2014; Crawford, 2018), lack of transparency and government control with the use of private-sector military (Avant & Sigelman, 2010;

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Carafano, 2008), torture and degradation of prisoners of war (e.g., Abu Ghraib; Zimbardo, 2007), and the use of off-shore prisons like Guantanamo Bay. Within the field of US psychology, there was much controversy about the American Psychological Association not taking a stance on torture in OEF/ OIF and psychologists’ participation in torture during the war (Allen, Keller, Reisner, & Iacopino, 2009; Lott, 2007; Soldz, 2008). It is beyond this chapter’s scope to review these controversies, but further information can be located in the citations provided earlier. The series was developed at the Walter Reed Army Institute of Research (WRAIR) in 2007 and instituted in the US Army Combat Operational Stress Control course from 2007 to 2013 as a part of required pre-deployment Comprehensive Solider Fitness Training (Adler, Castro, & McGurk, 2009). As a part of the National Defense Authorization Act, all US Army service members were required to attend all phases of the Battlemind series and then complete a routine mental health assessment (Department of Defense, 2010). Groups receiving any component of Battlemind in any size group reported significantly fewer symptoms of posttraumatic stress, depression, and sleep problems than those who received standard post-deployment stress education (Adler, Bliese, McGurk, Hoge, & Castro, 2009). The symptom reduction occurred regardless of the level of combat exposure. In 2013, Battlemind was enhanced and replaced by a resiliency training series (Reivich, Seligman, & McBride, 2011).

Presentation of OEF/OIF/OED in Battlemind The experience of the OEF/OIF/OED wars was characterized in Battlemind training as urban warfare carried out by organized terrorist groups who had limited resources (e.g., no airstrikes, primarily using IEDs; WRAIR, 2008a, 2008b). The Battlemind pre-deployment skills training for leaders (WRAIR, 2008a) and warriors (WRAIR, 2008b) prepared soldiers for the deployment environment and war through a set of slides entitled “a profile of the hostile forces,” which included a description of what soldiers may see, hear, smell, feel, and think when in combat. The training began with the trainer reading from the manual script, “What’s deployment like?” A slide of both a woman in a niqab and a child holding an AK-47 was presented, while the script directed the trainer to remind the soldiers that “the enemy is not going to fight fair. He is going to hide behind women and children, in churches and among civilians. Further, the enemy will not follow the laws of land warfare” (WRAIR, 2008a, p. 8). The trainer script continued, “What will you see?” A note instructing the trainer read, “Ideally the new guys should hear it from the ones that deployed before. This part of the brief should be interactive. Avoid turning this into a cultural brief . . . focus on the sensory overload” (WRAIR, 2008a, p. 12). The trainer then was instructed to show images of war while narrating what the soldiers will see, “extreme

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poverty, decay, garbage and feces, people on rooftops, gawkers ‘just looking,’ rubbled [sic] structures, incoming/outgoing fire, raging infernos—your vehicle on fire, wounded/killed friends and enemies” (WRAIR, 2008a, p.  13). The “what you will hear” slides showed women and children begging and screaming next to pictures of an explosion. The trainer was instructed to say, “You may hear: explosions, gunfire, ricochets and near misses, cries of wounded, pleas of help or mercy, wailing of mourners, shouts of rage and taunts, and multiple commands” (WRAIR, 2008a, p. 15). The implications of these slides and the taken-for-granted messages about human being in trauma culture that are ref lected in the training will be discussed later; however, I have presented the content here to demonstrate how a solider might first learn about the war, deployment environment, and culture they are about to enter.

Context of the Authors The phrase “Battlemind” was credited by the authors to have been coined by General Crosbie Saint when he was the Commanding General of the US Army Europe in the 1980s. He defined it as “A warrior’s inner strength to face adversity, fear, and hardship during combat with confidence and resolution. It is the will to persevere and win” (WRAIR, 2006c). There was minimal information provided about the background of the two clinical psychologists who authored Battlemind, Dr. Adler and Lieutenant Colonel (LTC) Castro. LTC Castro appears to be primarily responsible for the drafting of scripts that were intended to be read by trainers during the skills training PowerPoint presentations. Adler’s research focus was a brief intervention for trauma in the military, and she was the first author of the primary manual for the debriefing component (Adler, Castro, & McGurk, 2007).

Treatment Goals, Structure, and Principles The overarching goal of the Battlemind series was to provide systematic early intervention in the military to prevent PTSD, depression, and sleep problems following deployment (Adler, Bliese et al., 2009). The intervention was designed in three parts: (1) a pre-deployment skills-based program called Battlemind (WRAIR, 2008a, 2008b), (2) small group psychological in-theatre4 stress debriefings (Adler et al., 2007), and (3) a post-deployment stress education (WRAIR, 2005, 2006b, 2006c, 2007). The training series was designed to be delivered in PowerPoint presentations. The goals of the pre-deployment skills training as described by the manual were to: 1.

Prepare warriors mentally for the rigors of combat and other military deployments.

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2. 3. 4.

29

Assist warriors in their transition back home. Prepare warriors with the skills to assist their battle-buddy during deployment as well as to transition back home. Prepare warriors to possibly deploy again in support of all types of military operations including additional combat tours.

The goals of the in-theatre debriefings (Adler et al., 2007; Adler, Castro et al., 2009) were to: 1. 2. 3.

Support military personnel in their transition back to duty after a significant in-theatre incident. Reduce the overall mental health symptoms for the unit. Acknowledge combat events among unit members, discuss common reactions, and review actions that can be taken to facilitate the transition back to duty. The goals of the post-deployment stress training were to:

1. 2.

“Reset the soldier’s Battlemind” (Castro et al., 2006, p. 17). Adapting Battlemind skills so that they can be “just as effective at home as they were in combat” (WRAIR, 2006b, p. 2).

The goals here are so procedural that it is difficult to digest or resist the Orwellian doublethink contained in this training. They invoke an aspirational process of fortification and cleansing of the mind and avoid any mention of preparation for killing and death or coping with the moral pain of enacting and witnessing war. This obfuscation of reality through language was a repeated theme in this manual.

Battlemind’s Presentation of Trauma In Battlemind, the word trauma was notably absent. PTSD and other traumarelated symptoms were referred to as Battlemind injuries, war stress injuries, or combat stress reactions. Reference to PTSD was limited and was only mentioned twice: once in the leaders’ training in the context of debriefing (WRAIR, 2008a, p. 35) and once at the end of the training in a unit on alcohol abuse and traumatic brain injury (WRAIR, 2008a, p.  51). Overall, there was an emphasis on describing all reactions to war as normal survival instincts rather than a mental disorder, “Reactions that are sometimes called PTSD can help warriors survive in combat” (WRAIR, 2008a, p.  51). The leaders were informed that they should expect these reactions: Combat operational stress reactions are expected. Combat stress reactions are not a sign of weakness. Why look at mental health injuries as

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a weakness? If Soldiers deal with their combat stress reaction, they can come back to work. Treating your Soldiers who have combat stress reactions just like you would any other injured Soldier is not just something that supports the mission, it’s the right thing to do. (WRAIR, 2008a, p. 49) Leaders were also told that the psychic impact of war needs to be understood like a physical injury: “Mental health injuries need to be treated like all other battlefield injuries” (WRAIR, 2008a, p. 57). In Battlemind, the word trauma was not universalized to encompass all potential traumatic experiences. Events that would otherwise be considered to lead to PTSD were mentioned by name and described as part of the day-to-day deployment life. These events included combat, military operations, warfare, wounding, catastrophic vehicle kill, cleaning-up of human remains, missing warriors, and IED explosions.

Battlemind Creates the Warrior Cult Overall, the Battlemind training texts contained many elements of thought reform that have been previously identified by Lifton (1989) and others (e.g., Cushman, 1986, 1995; Hochman, 1990; West, 1993; Singer & Lalich, 1995) as part of a cult or restrictive organization thought-reform techniques. One aspect of thought reform is a concept that Lifton called “loading the language” where a new language often including “thought-terminating clichés” serves to create intellectual confusion, maintain group cohesiveness, and keep outsiders from making meaningful contact or engagement with the group. Several thought-terminating clichés that were employed in Battlemind are included here in Table 2.1. This table reproduces the cliché from the training, how it was defined, the taken-for-granted assumptions about human being that are represented in the cliché and potential thoughts or questions quashed by the cliché. The aim of the pre-deployment Battlemind training was similar to that described by Lifton (1989): to indoctrinate the soldiers into the warrior cult and the ethic of killing without second-guessing one’s actions. The indoctrination processes contained in Battlemind (and also utilized in other aspects of the Army’s Basic Training) break down the identities and commitments of the recruits in order to reinvent them as violent soldiers or warriors, in the vernacular of the military. The aim of the post-deployment training was to deprogram or alter the dysfunctional Battlemind so veterans can integrate into society happily and ignore or eliminate guilt and confusion that they are likely to experience post-deployment (symptoms that are similar to those experienced after leaving a cult [Cushman, 1989; West, 1993).

Table 2.1 Interpretations of Battlemind’s Thought Terminating Clichés

Cliché

“Steel your Battlemind” (WRAIR, 2008b, p. 26)

Quote of Trainer Script Surrounding One Utilization of Cliché (Citation); Meaning

Potential Thoughts the Cliché Terminates

• Problems in the social world can be guarded against or prevented through fortifying the mental world.

• This experience can’t be overcome mentally. • This will be horrific and incomprehensible. • I shouldn’t or can’t do this.

• The mind is like a computer that can be programmed and deprogrammed. • Suffering caused by war and violence can be overcome with mental skill.

• It will be difficult to adjust back home. • I don’t think my problems can be fixed.

• We are free because of war and the sacrifices of soldiers. • Killing is a necessary evil to ensure safety.

All of the thoughts listed in the “What you will think during deployment” slide (WRAIR, 2008a, p. 19), such as: • No one will notice the sacrifices I have made. • I’ve wasted my life here. • There doesn’t seem to be a point to this.

31

(Continued)

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“Maintain your mental toughness, meet challenges head on, be confident, take calculated risks and maintain positive thinking during times of adversity and challenge” (WRAIR, 2008b, p. 30); Don’t let war affect you. “Reset your Battlemind” Reset the soldier’s Battlemind “so they can (Adler et al., 2007, be just as effective at home as they were p. 23; Castro et al., in combat” (WRAIR, 2006b, p. 2); 2006, p. 17) Reset your mind and you won’t have problems. “Freedom isn’t free” “You’ve made the sacrifices. Most (WRAIR, 2006b, Americans won’t make that sacrifice. So p. 30) be proud of your service” (WRAIR, 2006a, p. 34); Your suffering was for the greater good and safety of society.

Taken-for-Granted Assumption About Human Being

Cliché

Quote of Trainer Script Surrounding One Utilization of Cliché (Citation); Meaning

Taken-for-Granted Assumption About Human Being

Potential Thoughts the Cliché Terminates

“Drive on” (WRAIR, 2006b, 2008a, p. 20)

“Don’t allow your survival guilt to destroy you. Your buddy would want you to drive on. . . . If you could have gone back to the day before your buddy died and [asked], ‘What if you died? Would you want me to drive on?’ He’d say yes . . . Remember the fallen and live a life worthy of their sacrifices” (WRAIR, 2006b); Don’t allow yourself to feel guilty. “Most places where you’ll be back home, you don’t have to make an immediate decision this is the time to turn to your buddy and get an azimuth check” (WRAIR, 2008a, p. 13); Stop and check the map before you act. “It’s easy to say in hindsight to secondguess your decision or the decisions of others. With the info you had at the time, would you make the same decision? Probably yes. . . . If you’re feeling so much grief that you can’t be happy or appreciate life then you may need to go get help” (WRAIR, 2006a, pp. 36–37); If you aren’t happy postdeployment something could be wrong.

• It is not good to think critically about the morality behind decisions. • Veterans who died in war just want you to be happy.

• • • • • •

• Problems in life have concrete answers. • Your buddy has the solution to problems.

• This can’t be figured out with my buddy. • This problem doesn’t have a map. • I don’t know how to think about this. • I don’t think I made the right decision. • Something was wrong here. • I am sad about what I did/what I have participated in.

“Azimuth Check” or “Buddy Check”

“No second-guessing” (WRAIR, 2006a, pp. 36–37).

• If you could go back in time you would do the same thing again. • Thinking can lead to unhappiness. • Thinking is a form of uncertainty.

This was wrong. I am devastated. I did something wrong. The war was wrong. I need to mourn my friend. I am angry.

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Table 2.1 (Continued)

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Interpretation of the Warrior Cult Battlemind actually contributes to, if not creates trauma by preparing the soldiers to accept the skills, ethics, and values of what I have referred to as the warrior cult. The second training would not be necessary if not for the first training. Thus, the pre- and post-training exemplify how iatrogenic traumatic illness can be created. First, the training principles are instituted as a way of being (i.e., “arming the Battlemind”), and then, the veterans’ continued participation in this way of being is reinterpreted as a set of pathological symptoms (i.e., PTSD or Battlemind that is not adapted to the home zone). Once framed as symptoms, the soldier’s experience is subject to the clinical gaze (cf.  Foucault) of cognitive reframing, thought replacement, and dissociative strategies; these strategies are contained in Battlemind debriefings as well as in CBT and EMDR treatments that veterans may be referred to post-deployment (after completing the D.D. Form 2900). The consequences of extending the clinical gaze to this iatrogenic set of trauma symptoms result in the erasure of veteran’s experience in war and the moral questions that these experiences pose to our society. Furthermore, the consequences of war are separated from the veteran’s personhood and re-conceptualized as something to be managed, contained, and monitored. One of the primary stated goals of the Battlemind training is to prepare soldiers for re-deployment—not just integration home. Thus, if soldiers develop dependency on their group, adhere to the training, and report problems only within their group, there is a higher likelihood of the soldier being interested in or capable of re-deployment. In short, the post-deployment training ensures that the soldiers are interested in re-deployment in order to retain group cohesion and avoid questioning their responsibility or feel moral pain (cf. Marin, 1981) in such a way that they might leave the group or take action against the military or contribute to political discussions about their experiences in the war. What is perhaps most telling about the US military psychologists’ awareness of the damage that Battlemind can cause, including the use of thoughtreform techniques, is the explicit need to reset the soldier’s orientation in the post-deployment training. The post-deployment training acknowledges that the beliefs and behaviors that the military instills under the banner of surviving war are highly dysfunctional outside of group membership and deployment. Thus, the Battlemind training itself adds significantly to what is traumatizing about participating in war—the training that prepares soldiers to learn and accept an ethic of killing in the warrior class with no recourse for thinking or discussing this ethic. The training ignores the political context that causes the suffering and suggests that traumatic symptoms are an anomalous (pathogenic) occurrence or personal failure. Previous studies that have identified cult-like features of psychological interventions have questioned the role of psychologists in these types of

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therapies, their responsibility to prevent harm, and whether such training should be even considered a form of psychotherapy (e.g., Cushman, 1986, 1989). As Marin (1981) pointed out in the Vietnam War, the psychiatrists’ role was perversely to keep soldiers in the mood for killing. For Battlemind, a similar interpretation could be suggested: the pre-deployment training were designed by psychologists to mentally insulate soldiers from feeling the debilitating effects of war and questioning their role in participation. Ironically, Marin described these two qualities as being primarily responsible for healing PTSD among Vietnam vets. The post-deployment trainings were designed to ensure that soldiers go to therapy rather than funnel their suffering into alternative forms of coping such as self- or societal-destruction or even anti-war activism. Arkin and Dobrofsky (1978), West (1993), and others have identified symptoms of leaving a cult similar to those represented in the DSM-IV and V PTSD diagnostic criteria. What is particularly unsettling about many military-based trauma psychotherapy treatments is how the moral imperative to heal can be transformed into an exercise in repeating and prolonging the trauma of war and denial of its social consequences. Therapists participate in and are partially responsible for arranging the social world in this way. When therapists create and participate in treatments like Battlemind that localize the consequences of war in the individual, as a disorder like PTSD or a mental injury, they do a disservice to veterans by contributing to the government’s and public’s avoidance of responsibility for the consequences of war and the society to which they return. While understanding how to respond to war (and in particular to OEF/OIF) is complex, the lack of social context for trauma disorders presented in Battlemind helps to retain the delusion that psychotherapy treatments—rather than efforts to resist war or present the social causes of war—are preventing trauma. How psychologists come to participate in such traumatizing treatments (and perhaps the indoctrination they also receive in training) is an essential area of future study. After my analysis, I was left with many questions, such as: Are soldiers experiencing PTSD symptoms from having undergone these treatments before entering war as well as from the acts of war themselves? In other words, is the trauma of war made worse and more traumatizing by having been indoctrinated to accept the ethics of war, cut ties to all support and families, and submit oneself to milieu control? Given the limited focus on the narrative assessment of PTSD symptoms (e.g., utilization of two-item PTSD screeners), it would be impossible to discern from the military’s assessments of PTSD if the symptoms soldiers are experiencing are due to participation in military operations and war or also due to feeling betrayed by their government, indoctrinated into killing, and frustrated by the lack of ability or space to

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discuss any reactions to war outside of those provided in narrow PTSD assessments (cf. Young, 1995). How is Battlemind a good way to respond to or prevent suffering through war? We must find a place for ref lection in the midst of the terror of war and ask ourselves as a field: How has healing and helping come to take this shape? How has helping others come to be expressed through a PowerPoint training that teaches thought replacement? Is Battlemind a good way to respond to or to prevent suffering and war? When considering the historical evolution of trauma treatments in the military since the Vietnam War, one can notice how the technologies identified in the Battlemind exemplars (e.g., assessments and forms) have continued to evolve to an alarming level of efficient proceduralism. Compare, for instance, Young’s (1995) description of inpatient psychoanalytic treatment with in-depth clinical interviews at the Veteran’s Administration (VA) to the contemporary utilization of a two-item PTSD screener (Lang & Stein, 2005). These technologies have assisted in insulating psychologists from sociopolitical ref lection and the kind of moral questions we should be asking about the industry of trauma healing; they have distanced not only the therapists but also the society from facing what veterans actually experience and feel. The unarticulated and dissociated form of political and social suffering that we are participating in is further repressed and denied when training like Battlemind locate this suffering in the form of an individualized, internal disorder. This leads to the unquestioned belief that the disorder can be adjusted only through thought-replacement techniques practiced in therapy offices’ confines and their concomitant procedural forms. Yet this type of therapy is seen as somehow helpful and good. From my perspective, the ultimate irony of Battlemind treatment is that it is a pre-deployment training that claims to prevent PTSD, but the training itself is part of the trauma. In Battlemind, the prevention of war occurs in the mind, not in reality. The strong cognitivist ideology in Battlemind—if we arm the soldier’s mind for the battle we can protect them from the trauma of war—has reached a delusional level such that killing and death are somehow acceptable as long as the consequences for the perpetrators can be mentally controlled for. This is not a unique phenomenon to Battlemind training. The country continues to spend millions of dollars in funding the VA and the Department of Defense to develop PTSD preventive treatments (Basu, 2013; Baum, 2012) as if one day we can find the science to erase the experience of war by manipulating the mental life of soldiers. This is also ref lected in the recent surge in research to identify biomarkers of PTSD (Baum, 2012; Lehner & Yehuda, 2014), psychotropic medicines like propranolol that prevent the formation of memory and psychic pain during the war to prevent PTSD symptoms post-trauma (Fletcher,

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Creamer, & Forbes, 2010; Pitman & Delahanty, 2007). At the time I first published my dissertation, a 70-million-dollar grant was awarded to DARPA to study the implantation of electrodes in soldiers’ brains so clinicians may monitor and stimulate the brain in combat to prevent PTSD (Hamilton, 2014). This is an example of one of the key themes I observed across all manuals: the political uses of cognitivist ideology. The treatment manuals predicated therapy on assumptions such as: you can change the world by changing your mind, when you change your mind, you change your brain, your brain and mind can protect you from trauma, and if you have inner safety, you are safe, and thus the world is safe. These cognitivist assumptions create confusion between shifts in individual subjectivity and shifts in the social world, which can ultimately result in no change to the status quo of existing political problems and arrangements of power and domination. When cognitivist ideology prevails in psychology, people accept—in fact strive for—changes in their subjective experience instead of changes in their material reality, thus allowing existing arrangements of power and domination to continue (Sampson, 1981). In this sense, evidence-based trauma treatments perform cognitivist ideology in the guise of healing and thus serve to maintain the political status quo. By shifting the way we perceive the world, we overlook the need to change it and turn to each other and to sociopolitical structures to make meaning of and address social problems. The interpretation of this theme was inspired by the work of Sampson (1981), who described how cognitivist ideology has led to a disturbing shift within psychology, wherein humanity is defined by “mental events, mental activities, mental operations, mental organization and mental transformations that are of greater importance than the events, activities, operations, organization or transformation of the external world” (p. 733). Within the cognitivist approach, mental events are placed within the landscape of the putatively interior self. And as Sampson foresaw, in a world in which cognitive psychology is dominant, the necessity to change the material arrangements of the social world does not come to light. For a field that prizes rationality so deeply, psychology’s acceptance of the existence of preventive PTSD treatments in the military ref lects such a skewed logic that perhaps it can best be understood as a form of dissociation or denial from the immense suffering that war brings and the ways psychological techniques assist in that suffering. To retain the belief that conducting these trainings is actually preventing rather than contributing to trauma, one would have to ascribe to the ethic of the executioner (cf. Camus, 1946) and believe that war is unavoidable or necessary and can be mitigated only in the mental and not the social world. What would make therapists and recruits alike attracted to Battlemind in this historical moment? In other words, why are we choosing the prevention of war and suffering through evidence-based trauma treatments that resemble cult indoctrination processes? Numerous authors believe that cults and totalitarianism emerge when traditional values and structures of a society are weakened

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and when there is a period of historical dislocation in which there is a breakdown in human meaning and culture (Appel, 1983; Cushman, 1986; Hochman, 1990; Lifton, 1989, 2002; Singer & Lalich, 1995). Societal concern about cults was prominent in the late 1970s and beginning of the 1980s (the Post-Vietnam era), since then, interest in and discussion of cults have waned.5 Hence, many of the articles about indoctrination and cults I previously reviewed are dated pre-1990. As concern with cults waned, obsession with PTSD and trauma has risen. It appears as if the societal focus has shifted away from trying to dismantle the restrictive and authoritarian structures that indoctrinate persons and instead unquestioningly accepting their existence and trying to cope with their consequences. Several scholars have interpreted trauma symptoms as a reaction to the decline of the public realm, societal isolation, and cultural degeneration (Furedi, 2004; Hillman & Ventura, 1992; Layton, 2010; Szasz, 1974). Patrick Bracken (2002) in Trauma: Culture, Meaning and Philosophy wrote that trauma is a cultural trope that expresses the concerns and fears of our time. While describing a wealth of different ways, Western science has shaped trauma discourse, Bracken asked a similar question to one at the core of my research: Why have we become so focused on trauma since the 1990s? He wondered if the cultural shift away from spiritual and moral ways of understanding the self has left modern society with no narrative from which to understand our lives. Perhaps the dogma of trauma treatments has become a way that we are able to live with and encounter the coming to terms with the fragility or vulnerability of the self in the postmodern world (like Sass’s 1992 perspective on psychosis)—a way that we have come to live in order to preclude facing an explicit sociopolitical critique. Bracken asked: Is trauma a culturally specific, Western narrative that has emerged in the wake of the loss of spiritual, moral, and other traditions of meaning-making? While trauma may be the way we understand what it is to be human in the contemporary world, the particular attraction to a procedural expression of life at this moment may ref lect the growing uncertainty and fear of living in this particular world—of a helplessness and perpetual search for answers from experts and science rather than from within the local community, moral traditions, social relationships, and through dialogue with one another.

Discussion: Trauma Manuals Meet Dissociated Therapists All the trauma treatment manuals I studied are not passive documents; they are both a prescriptive authority and a ref lection of daily social practices that therapists and patients live out. When we engage with these texts, we are changed by them. Thus, when new therapist trainees are assigned to read these manuals, this has an impact on how trainees talk about the world, conduct their practice, and conceptualize trauma and healing—the manual assists in constituting the boundaries of our cultural clearing as practicing psychologists.

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Membership in the warrior cult is aspirational and commonsensical given the current arrangements of the social world; however, therapists play a significant role in indoctrinating and promoting this way of being through the practices of healing the traumatized self. As I realized in my research of all three manuals, therapists can contribute to indoctrinating their patients into the warrior cult by following evidence-based manualized trauma treatments that suggest particular ways that humans should be good trauma survivors. The TF-CBT child patient must erase the trauma and act age appropriately, the EMDR patients must repair their self-image until all positive cognitions are completely true, and the Battlemind warrior must drive on and repress moral pain. In my dissertation, I discussed several ideas about how being human in a trauma-based society has come to take the shape of responding to political problems and traumatic suffering by complying with manualized treatments and colluding with the warrior cult. What should be of particular concern to therapists is the way that manual-based practice perpetuates the social problems and traumatic symptoms that these trauma treatments purport to treat. What is unsettling about the consequences of practicing manual-based trauma therapies is how therapists’ moral imperative to heal can be transformed into exercises that repeat and prolong trauma. Beyond the specialized field of trauma therapy, the field of clinical psychology has shifted away from attempting to change our world and the social causes of suffering except in a token manner. Several clinicians and scholars have described the consequences of mainstream psychology’s disinterest in political action (see, e.g., Bracken & Thomas, 1999; Fine, 2012; Hillman & Ventura, 1992; Hoffman, 2009). The profession shows little interest in resisting neoliberal demands through community development or the dismantling of authoritative structures that indoctrinate persons (Binkley, 2011; Cushman, 2015; Cushman & Gilford, 2000; Layton, 2004, 2013). Instead, it promotes the use of manualized trauma therapies that focus on coping with the consequences of living in a traumatized world in an internal, asocial, and isolated way—a way that ultimately benefits managed care corporations over the public welfare. Thus, clinicians from all areas and specialties within psychology are in the difficult position of struggling to practice morally and with integrity while also attempting to comply with the demands of an increasingly scientistic, apolitical, and profit-driven field. A final remaining question is: How can clinicians resist reproducing the social world that creates traumatic suffering?

Reception of My Dissertation in the Psychological Community To explore this question, I’d like to start with what happened when I presented my dissertation to my immediate psychological community. When I presented the proposal for this study to colleagues at my school, some of the

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initial feedback I received was a concern that thinking about trauma-culture and the world that produces and sustains trauma treatment manuals was too broad of a topic. Indeed, my dissertation spanned a wide breadth of literature— from understanding what constitutes a child to US complacency with the war in Iraq. While I sacrificed depth and nuance to identify broader patterns, I approached the study of trauma culture with an awareness that critically thinking about trauma is somehow overwhelming to the field and would likely be difficult for me to conceptualize. What I found truly interesting about my colleagues’ concern as I embarked on my dissertation was the urgency with which they discouraged me from approaching this question because of its overwhelming scope; yet, in everyday practice, it is not overwhelming to them that trauma treatment manuals exist in the first place. How can there be a book that prescribes a universal treatment for all forms of human suffering known as trauma? Utilizing a manual that purports to provide a solution to all human experiences of trauma was somehow less problematic for my colleagues than thinking about the world that produces that manual. The concern that was directed at my study might be best directed at all trauma treatment manuals and the world that produces them. We should all be concerned about why the field does not ask historical, political, and moral questions and speculate about the treatments that therapists produce and practice. In the case of evidence-based manuals, I think the field should be suspicious of treatments that are seen as formulaic, acultural, or universal solutions to all types of human suffering. Some of other reactions I found noteworthy while writing my dissertation included those from those who are engaged in federally funded quantitative research (e.g., persons conducting randomized control trials funded by NIMH R01 grants). Many of them were perplexed by my topic. They stated things like, “Oh, so your writing kind of like a book-type of a dissertation, like a philosophy one.” Some of them critiqued the inclusion of only three manuals, particularly of the inclusion of Battlemind (e.g., How could I possibly compare two trauma treatments to preventive intervention and debriefing?). Others asked questions about what was the practical value of my study. How would I judge the quality of these treatments? As a result of my study, could I make a recommendation about the best treatment? In general, most people I encountered in psychology had some discomfort with this topic but couldn’t seem to describe what their discomfort was, other than to talk about problems with the scope of the topic and the interpretive methodology. Many practicing therapists I talked to about the topic seemed to understand the idea of trauma culture. Some of them shared their experiences of losing patients because the patients wanted to find a therapist who was a “trauma specialist.” Others talked about a cultural divide at conferences in which trauma therapists saw themselves as wearing a badge of unique sensitivity to patient problems. Some, who I characterize as EMDR evangelists, seemed pleased to

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hear that a CBT approach was included in the study, but then they were also disappointed that I included EMDR as well. They (perhaps jokingly) wondered if my inclusion of both EMDR and CBT in the same study meant that I just “hated all therapy”—as if thinking critically about EMDR was somehow problematic or destructive but critiquing CBT was not. With laypersons to whom I talked about the topic, the mention of the word trauma instantly invoked a sense that I was doing something important. Without hearing much at all about the study, they said things like how thankful they were that I was “looking out for veterans” or “saving abused children.” I couldn’t help noticing the privilege of being a psychologist in training, and the deference these people were paying to me as an expert. Their deference came with the automatic assumption that all my endeavors must be ultimately helpful as a future psychologist—especially because I was writing about trauma.

Returning to the Question: How Can Clinicians Resist Reproducing the Social World That Creates Traumatic Suffering? The answer to this question is difficult but possible to discuss. To think or talk about trauma in nuanced and complex ways takes time and responsibility for clinicians and their community. Despite being embedded in a traumatized culture and warrior cult, I argued in my dissertation that patients and therapists are not naïve drones or empty vessels that perform or absorb restrictive practices and therapeutic rules. While we may live out many of the problematic practices described in this study, many clinicians and patients feel uncomfortable participating in such practices. From my experiences in training and the review of the literature, it is apparent that many clinicians and scholars have resisted traumatic ways of being by thinking critically and historically about trauma, by questioning our field (see, e.g., Brave Heart, 2003; Clancy, 2009; Cushman, 1995, 2019; Farrell, 1998; Fassin & Rechtman, 2009; Foucault, 1973; Haaken, 1995; Layton, 2010; Rose, 2006; Tolleson, 2009; Young, 1995) and by refusing to participate in practices that they see as amoral or colonial (see, e.g., Altman, 2010; Bracken, Giller, & Summerfield, 1995; Fine, 2012; Gone, 2009; Leary, 2005; Smith, 1999; Szasz, 1974). One thing I have learned from these clinicians is that the world cannot always be understood in instrumental ways, with problems and solutions that are readily available and easy to come by. Despite there being no ready answers, something I learned that might contribute to clinicians who are struggling with these issues is to first acknowledge that as trainee therapists in our increasingly procedure-focused and apolitical field, we may unavoidably enact and participate in traumatic ways of being (Layton, 2006; Stern, 2003, 2010). In acknowledging our participation, it is important that we find

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compassion for each other and ourselves when attempting to think, talk about, and resist traumatic ways of being (Cushman, personal communication, May 27, 2014). It may also require the ability to engage in therapeutic practices that oppose mainstream American understandings of the good and resist problematic aspects of trauma culture (e.g., acknowledging dependence on others, learning to live with anxiety caused by not being able to erase trauma, taking responsibility for mistakes). Beyond acknowledgment, we can strive to become politically and socially active as therapists in the therapy room and beyond (Altman, 2010; Botticelli, 2004; Cushman, 1995, 2020; Layton, 2020; Tolleson, 2009). To the students reading my chapter. My first hope for this study was to break a traumatic enactment by thinking differently about trauma, but I wouldn’t have been able to do so without continual dialogue about these important social and political problems with my colleagues and mentors—most notably Drs. Philip Cushman, Lynne Layton, and Jennifer Tolleson. I would encourage student clinicians, perhaps while feeling angry, unsure, or afraid, to continue the process of political and social interpretation in dialogue with others as a way to resist and change our traumatic world. Second, following what Philip Cushman taught me, I would suggest questioning that which feels easy, good, or privileged while undergoing training in psychological treatment. Imagine what is being left out, who is being left out, and what is unsaid in traumatic healing. Invite the questions, thoughts, feelings, reactions, and people that are on the margins into the dialogue and interpretation. Interpreting big or taken-for-granted topics and questions can be done, and it’s done best with others. Hopefully, this chapter provides you some suggestions about a structure to do so in your own dissertation and a colleague to reach out to, should you ever need to interpret and resist.

Notes 1. To place these statistics historically, I conducted the majority of the research grounding for this chapter in 2012–2013 as part of my dissertation, Ways of Being in Trauma-Based Society: Discovering the Politics and Moral Culture of the Trauma Industry Through Hermeneutic Interpretation of Evidence-Supported PTSD Treatment Manuals (Lord, 2014). 2. I use the word political in the broad sense of the ideas and processes that govern the social world, not in the narrow sense of political offices or policies that govern the state. 3. Williamson (1990) defined neoliberalism as moving control of the economy from the public sector and government to the private sector and corporations. Neoliberal theory supports free-market capitalism where the private market determines value rather than a collective group, publicly elected government, or regulatory oversight system. In neoliberal culture, responsibility for social well-being has been removed by the state and replaced with private resources or not replaced at all (Fine & McClelland, 2007). 4. Even the use of the phrase “in theatre” to describe being on the killing fields is an example of a “thought-terminating cliché” (Lifton, 1973), which cannot go unnoticed here. I will explain these cliches in more detail shortly.

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5. Note that I wrote my dissertation before the Trump presidency, forced separation of migrant families, open-carry takeover of government buildings by white supremacists, loss of hundreds of thousands of lives to COVID-19, and the intrepid rise of the Black Lives Matter movement. In 2014, I wrote about a traumatized society inclined to a cult-like way of being. At that time, the concept of a “warrior cult society” was considered by some readers to be something like 1970s hyperbole, and it was more comfortable to frame these events in the vernacular of trauma. In 2020–2021, speaking of cults is, again, a mainstream understanding of our contemporary social world as we see a shift back to active dissent, protesting, and resistance.

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Reivich, K. J., Seligman, M. E., & McBride, S. (2011). Master resilience training in the U.S. Army. The American Psychologist, 66(1), 25–34. Ricks, T. E. (2006). Fiasco: The American military adventure in Iraq. New York: Penguin. Rose, N. S. (2006). Disorders without borders? The expanding scope of psychiatric practice. Biosocieties, 1(4), 465–484. Rosen, C. S., Chow, H. C., Finney, J. F., Greenbaum, M. A., Moos, R. H., Sheikh, J. I., & Yesavage, J. A. (2004). V.A. practice patterns and practice guidelines for treating posttraumatic stress disorder. Journal of Traumatic Stress, 17(3), 213–222. Sampson, E. E. (1981). Cognitive psychology as ideology. American Psychologist, 36, 730–743. Sass, L. A. (1992). Madness and modernism: Insanity in the light of modern art, literature, and thought. New York: Basic Books. Shapiro, F. (2001). Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures. New York: Guilford. Singer, P. W. (2012). The evolution of improvised explosive devices (IEDs). Armed Forces Journal. Retrieved from http://www.brookings.edu/research/articles/2012/02/ improvised-explosive-devices-singer Singer, M. T., & Lalich, J. (1995). Cults in our midst. New York: Jossey-Bass. Smith, L. T. (1999). Decolonizing methodologies: Research and indigenous peoples. London, England: Zed Books. Soldz, S. (2008). Healers or interrogators: Psychology and the United States torture regime. Psychoanalytic Dialogues, 18(5), 592–613. Stern, D. B. (2003). The fusion of horizons: Dissociation, enactment, and understanding. Psychoanalytic Dialogues, 13(6), 843–873. Stern, D. B. (2010). Partners in thought: Working with unformulated experience, dissociation, and enactment (Vol. 12). New York: Routledge. Stigliano, A. (1989). Hermeneutical practice. Saybrook Review, 7(2), 47–69. Sugarman, J. (2015). Neoliberalism and psychological ethics. Journal of Theoretical and Philosophical Psychology, 35(2), 103. Szasz, T. (1974). The myth of mental illness: Foundations of a theory of personal conduct. New York: Harper and Row. Tolleson, J. (2009). Saving the world one patient at a time: Psychoanalysis and social critique. Psychotherapy & Politics International, 7(3), 190–205. https://doi.org/10.1002/ ppi.200 Walter Reed Army Institute of Research (WRAIR). (2005). Post-deployment health reassessment (PDHRA): Clinician training. Washington, DC: Walter Reed Army Institute of Research, U.S. Army Medical Research and Materiel Command. Walter Reed Army Institute of Research (WRAIR). (2006a). Battlemind training I. Washington, DC: Walter Reed Army Institute of Research, U.S. Army Medical Research and Materiel Command. Walter Reed Army Institute of Research (WRAIR). (2006b). Battlemind training II: Continuing the transition home. Washington, DC: Walter Reed Army Institute of Research, U.S. Army Medical Research and Materiel Command. Walter Reed Army Institute of Research (WRAIR). (2006c). PDHRA Battlemind training: Continuing the transition home. Washington, DC: Walter Reed Army Institute of Research, U.S. Army Medical Research and Materiel Command. Walter Reed Army Institute of Research (WRAIR). (2007). Spouse Battlemind training: Helping you and your family transition from deployments. Retrieved from http://purl. access.gpo.gov/GPO/LPS100942

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3 PSYCHOTHERAPY AND THE EMBODIMENT OF NEURONAL IDENTITY Ari Natinsky

For my doctoral dissertation, I completed a hermeneutic study of what I refer to as brain-based psychotherapy. That is, the segment of psychology literature focused on describing therapy theories and practices alongside or in terms of brain functioning. A variety of books and journal articles in our field over the past two to three decades have placed descriptions of human psychology alongside purportedly relevant findings from cognitive neuroscience. For my research, I critically examined a well-known book that I found to be representative of this increasingly popular trend: Louis Cozolino’s (2010) The Neuroscience of Psychotherapy: Healing the Social Brain. I outlined the primary content, rhetorical strategies, and recurring themes in the book, critiqued these elements, and examined ways in which they are representative of the wider cultural and historical context in which the text emerged. The purpose of this research was to uncover the understanding of the self or what it means to be human according to the discourses and clinical practices in a brain-based therapy text. The results of my textual analysis were striking. I argued that Cozolino’s book and the broader movement it exemplifies may ultimately be damaging to the credibility and sustainability of professional psychology. With this study, I intended to encourage a more prevalent discussion about the potential consequences of widely embracing neuroscience for our profession and Western culture generally. In this chapter, I discuss my personal experiences during the dissertation process, provide an overview of my research and highlights from my findings, and ref lect on the challenging yet ultimately invaluable experience of writing a theoretical–philosophical dissertation. DOI: 10.4324/9781003140177-4

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Preliminary Research Process I completed my doctorate in clinical psychology at Antioch University Seattle, where I was a student of Dr. Philip Cushman in his history of psychology and adult lifespan development courses. Dr. Cushman designed these courses to be alternatives to typical graduate-level learning. Readings in contemporary social theory and theoretical–philosophical psychology guided thoughtful discussions about psychological theory and practice. Students learned to interpret the developments in our field as inseparable from the broader social, political, and economic arrangements of the era in which these phenomena emerge. Unfortunately, it is rare for graduate schools in psychology to recognize the importance of this kind of careful sociohistorical analysis. The absence of critical thinking in clinical training programs relates directly to practitioners’ susceptibility to embracing pseudoscientific trends and questionable research. Too many therapy practices actively prevent the kind of understanding and insight that is necessary for well-being, thereby exacerbating the underlying causes of patients’ difficulties. Dr. Cushman encouraged me to draw from my undergraduate studies in philosophy to inform my clinical training and coursework. Eventually, I recognized the opportunity to complete a dissertation that would allow me to spend several years focused on thought-provoking readings and to develop a professional identity rooted in the theoretical–philosophical branch of psychology. As I thought about possible dissertation topics, I remembered two graduate courses that included neuroscience-informed psychotherapy books among the required readings. I recalled that the books were received as well regarded, although I also remembered several criticisms of them that classmates raised. These brief instances show that students are often eager for alternative viewpoints that are easily overlooked when the focus is on managing overwhelming workloads and adhering to typical measures of competency. Through preliminary research informed by philosophical hermeneutics, I recognized that the effort to integrate psychotherapy with neuroscience has shown itself to be widely captivating, even though fundamental assumptions about its truthfulness and relevance had rarely been questioned.

Dissertation Summary Background There are a number of ways in which authors have attempted to fuse psychotherapy with cognitive neuroscience (i.e., the branch of neuroscience that uses brain imaging to identify neurological correlates of individual experiences that have traditionally been discussed as social or psychological concepts). For

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example, since the 1990s, some therapy outcome studies have included brain imaging in order to identify neurological processes involved in participants’ effective symptom reduction (e.g., Farrow et al., 2005; Paquette et al., 2003). Other authors have combined long-standing psychological theories with an array of neuroscientific findings in order to create hybrid paradigms. For example, the field of “neuropsychoanalysis” associated with author Alan Schore takes one of psychology’s traditional models and relocates it in brain functioning (see Schore, 2012). Other authors have used neuroscience as a vehicle to integrate a variety of psychotherapy practices. For example, Daniel Siegel (2007, 2010), who has referred to his paradigm as “interpersonal neurobiology,” has used neuroscience to broadly integrate concepts from attachment theory, physiological and social bases of individual development, psychopathology, and psychological treatment. Across psychological literature, the significance of neuroscience for the mental health profession has been praised with an unusual degree of zealousness and urgency. For example, according to Kay (2009), neuroimaging studies comparing the effects of psychotherapy to psychiatric medication “portend a time when it may be possible to use imaging for the differential treatment of disorders, and they begin to illustrate the helpfulness of psychotherapy” (p. 135). Philosophical hermeneutics (e.g., Gadamer, 1975) emerged during the 20th century as a challenge to the foundational assumptions of modern era thinking. By viewing the study of human experience as inseparable from the broader world that humans inhabit, hermeneuticists reject the idea of a deeply interiorized, intrapsychic individual that exists separately from their broader context and social relationships (Kirschner & Martin, 2010). Hermeneutics views humans as actively experiencing the world by interpreting and assigning meaning to it (Wachterhauser, 1994; Woolfolk, Sass, & Messer, 1988). In psychology, 20th-century critical theory has been applied, for example, through qualitative methods of analyzing research participants’ reporting of their lived experience, rather than testing hypotheses with standardized empirical data. In psychotherapy, postmodern and hermeneutic philosophy has inf luenced treatment approaches including feminist, multicultural, humanistic-existential, and interpersonal or relational theories (Frie & Coburn, 2011). Critical scholars in psychology have applied philosophical hermeneutics to examine how therapy theories unknowingly reinforce problematic understandings of psychological difficulties and change because of the underlying aspects of personhood they often reinforce (Cushman, 1995; Richardson & Bishop, 2004). Often our models of human functioning, relationships, and treatment perpetuate a highly individualistic way of life that disregards social and cultural aspects of psychology. The valorizing of empirical research, adopted from the scientific method which studies the physical world, has been problematic for psychology generally and often reinforced by psychotherapy discourse. Psychology’s long-standing desire to be viewed as a

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physical science has also resulted in attaching itself to various discourses from physical sciences in order to present psychological concepts as material or physical understandings of behavior and psychological experience. Psychology has often continued to esteem those trends even after they have been dismissed by the scientific disciplines that popularized them (Uttal, 2007; Tallis, 2004). The appeal of a brain-based therapy emerges at the historical crossroads among the intense popularity of neuroscience, the significance of biomedicine in Western culture, and psychology’s perceived need to somehow reconcile contentious differences within our vast field. These include questions of legitimacy between empirical and experiential research methods, a lack of standardization for treatment practices and measures of efficacy, and the need to adhere to managed care guidelines that control payments for services we provide. However, embracing neuroscience as an infallible solution for psychology’s problems necessarily requires an acceptance of its problematic aspects, which have been largely unacknowledged in our field. In my dissertation, I reviewed the works of scholars who have shown that neuroscience is firmly rooted in biomedical sciences. The biomedical self, as articulated by Rose (2007), is an interpretation of contemporary life in the West greatly interested in disease prevention and health optimization at the genetic and molecular level. The reverence for this view of individuals as physical entities concerned with altering and enhancing life through biomedical interventions has been increasingly essential to understandings of self hood in the West during the last century. Scholars such as Brenninkmeijer (2010) and Ortega and Vidal (2007) have observed the proliferation of markets for self-help products promising personal enhancement through improving brain functioning and health. As Pitts-Taylor (2010) noted, countless authors have found neuroscience appealing because it allegedly provides evidence that individuals are inf luenced by their broader context by charting measurable changes in the brain resulting from changes in the environment. Unfortunately, this biomedical view of self is firmly rooted in neoliberal thinking that prioritizes individual gain above cultural context or equitable social policy. Other authors have insightfully critiqued both the scientific validity of mind–brain reductionism and the sociological consequences of a widespread discourse that intentionally or unintentionally dismisses consciousness, subjective experience, and the choice of language ref lective of neurobiological reductionism inserted into everyday language (Bennett & Hacker, 2003; Brothers, 2001; Tallis, 2004). I used my dissertation to connect critical theorists in psychology with scholars outside our field whose cultural examinations of cognitive neuroscience are highly relevant for understanding the implications of brain-based therapy because they have analyzed the inf luence of biomedical and brain science on the understanding of the self.

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Research Methods and Highlights of Results I identified Louis Cozolino’s (2010) The Neuroscience of Psychotherapy: Healing the Social Brain as a popular and prototypical brain-based psychotherapy text that incorporates a wide variety of psychology–neuroscience research in a way that is noticeably accessible for readers. My methodology consisted of detailed analyses of passages I found to exemplify the primary content, rhetorical strategies, and recurring themes in the text. For the primary content, I first summarized passages in which Cozolino addressed the history of psychotherapy, the history of his brain-based psychotherapy theory, and examples of established psychotherapy theories. Second, I detailed the tenets of Cozolino’s psychotherapy theory, which included statements in which he discussed the definition of therapy and its purpose; reasons that patients seek therapy; the definition and etiology of psychopathology; the existence and definitions of self and mind; the relationships between self, mind, and brain; neurobiological and psychological mechanisms of effective psychotherapy; descriptions of how therapists should provide therapy; and indicators of successful therapy outcomes. Third, I summarized Cozolino’s use of therapy case vignettes and discussed in detail two that I found to be exemplars of his portrayal of patient care. For identifying and gathering examples of rhetorical strategies in Cozolino’s text, I familiarized myself with literary devices I identified in the Oxford Dictionary of Literary Terms ( Baldick, 2008) that I thought might be relevant. Ultimately, the categories of grammatical strategies that I identified included diction (i.e., word choice or sentence structure), ambiguity, analogy, metaphor, and personification. In my third data collection section, I outlined and discussed primary themes and subthemes that I found to recur throughout Cozolino’s text. The primary themes I identified included evolution as a central organizing principle; synonymity and convergence between areas of study or types of human relationships; the brain as a controller of human experience and psychology; the therapeutic correction to the distortions of brain functioning; neurobiological explanations for all human experience; integration; and the progression of neuroscience.

Examples of My Analysis of Primary Content in Cozolino’s (2010) Text My Results chapter was lengthy and beyond the scope of this chapter to review in depth. Due to space restrictions in this book, the majority of the Results chapter could not be included. Here, I provide a brief overview of several findings that readers might find helpful for conducting critical historical research using a text as the primary source of information to analyze.

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Cozolino’s Understanding of the History of Psychotherapy Cozolino (2010) provided a relatively brief description of the origins of psychotherapy. He argued that Freud’s original intention was to create a neurological theory of human development and behavior. However, at that time, modern neuroimaging technology had not yet been invented, so Freud was forced to write a discourse filled with allusions to literature, philosophy, and other shared discourses. Cozolino explains that his book represents the realization of Freud’s original purpose of psychotherapy, which is its unification with the field of neurology now that neuroimaging exists. In other words, he depicts psychological theories that have been significant for Western culture over the past century as antiquated placeholders for understanding human beings through neuroscientific discourse. Psychologists (e.g., Orange, 2003) have elsewhere already rejected this historical revision of Freud’s abandonment of neurological reductionism in psychology. I further explained how Cozolino’s (2010) understanding of therapy’s emergence is an origin myth. His view is an oversimplified and narrow claim that removes contemporary psychology from the broader history of 20thcentury Western culture. Cozolino’s use of this origin myth is significant. Throughout his book, it justifies his endeavor of describing psychotherapy discourse as a neurological intervention. From this view, the purpose of therapy becomes a neurological intervention, with its major paradigms reimagined simply as everyday ways of explaining relevant neural processes. The problems for which all clients seek therapy treatment are described as neurobiological problems regardless of whether they are conceptualized as serious mental health problems or general life issues. This is also used to create the appearance of inevitability with regard to psychology being subsumed by neuroscience in order to revise therapy theories or provide proof of effectiveness. Simultaneously, this origin myth serves as a vehicle for promoting a widespread view of the self as identical to, or interchangeable with, the human brain. Cozolino’s (2010) reductionistic view is challenged by scholars outside of psychology who have raised the inherent contradiction of using brain science to prove the origins of human consciousness or to justify psychological theories. That is, brain science can only be interpreted through the lens of what humans already believe or want to confirm about themselves (Bennett & Hacker, 2003). Brain science cannot confirm or deny the existence or accuracy of psychological concepts because those concepts exist as everyday shared social understandings about human beings, not from physical processes that may correlate with them (Bennett & Hacker, 2003; Brothers, 2001). Cozolino’s (2010) historical misrepresentation is used to justify a future in which psychology serves as a vehicle for broadly replacing everyday language about the self with neuroscientific jargon that reduces human beings to individual brain functioning. As Brothers (2001) cautioned, such a move would eliminate the language

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people have to criticize it and with it dismiss the ability to think critically and attribute human difficulties to broad inequity and other social arrangements rather than individual neurobiological failings.

Cozolino’s Uses of the Concepts of Self and Mind I examined and categorized every passage in which Cozolino (2010) used the terms self and mind, which included statements in which he used them together, separately, and alongside or independently of descriptions of brain functioning. I found that Cozolino (2010) used the term mind in only a few passages. He primarily used it when describing how concepts that have traditionally fallen within the domain of psychology have unknowingly been descriptions of neurological functioning. Both the limited number of times the term mind appears and how it is used were strategies to portray psychological discourse as somehow rendered outdated by recent advancements in brain science. This perpetuated the assumption of neuroscience as the true method for understanding human psychology, while preparing readers to dismiss traditional psychological concepts that have been essential to how individuals discuss and think about themselves and other people in everyday language. When not used alongside descriptions of the brain, Cozolino (2010) used the concept of self in several ways. He was inf luenced by D. W. Winnicott’s view of a true self as the individual who has developed the capacity for independence and self-ref lection. He explained that a false self, conversely, is characterized by pathological dependence on others; the true self is described as formed in childhood during periods of calmness and being alone. Cozolino also described the self as formed through narrative or what he called “stories about the self,” which in turn serves to facilitate affect regulation. He additionally described the concept of self as closely connected to humans’ capacity for imagination. With these latter views, he seemed to endorse a relativistic idea of personhood as comprised by how an individual thinks about who or what they are. In other words, with these various understandings of self hood, Cozolino endorsed social theory from both the modern era and postmodern thought. He depicted them all as verified by recent discoveries about human brain functioning. Cozolino (2010) primarily used the term self alongside descriptions of brain functioning, thereby portraying the brain as the source of human psychological experience. For example, his view of well-being is a function of the true self, which is a reflection of the extent to which an individual has achieved neural integration. Neural integration is also said to facilitate the experience of an embodied self. Elsewhere in his book he argued that distinct aspects of the self are localized in the left and right hemispheres of the brain and that the parietal lobes of the brain are probably essential in generating the experience of self. He also argued that psychological problems (or “problems of the self”) result from the brain’s capacity for imagination and therefore incorrectly interpreting the world and social interactions.

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Cozolino’s assorted uses of the concept of self are scattered throughout his lengthy book and primarily depict an interchangeability between self and brain. The primary understanding of human being in his text is that personhood is interchangeable with brain functioning. According to Cozolino, the brain largely acts outside of conscious awareness to construct reality and control individual emotions, thinking, and behavior. However, individuals can alter the brain to develop or expand agency or self-directedness, selfawareness, and self-control through human activity insofar as it increases neural integration. Psychotherapy is included as one of those activities, but since the definition of personal growth or psychological integration is inextricable from what he calls neural integration, Cozolino implicitly relinquishes psychology’s unique significance in Western culture’s broad understandings of personal well-being, illness, and change. The study of the self was reimagined as the study of the brain, but his claims supported a variety of positions about human subjectivity, agency, and biological determinism. The result is an eclectic assortment of conf licting theories that are portrayed as options for interpreting the reality that the brain constructs for us. Whether these positions are better interpreted as relevant because of sociohistorical and psychological factors, rather than somehow understandable through brain science, is never considered.

Examples of My Analysis of Rhetorical Strategies in Cozolino’s (2010) Text I analyzed a number of rhetorical strategies that Cozolino frequently used to integrate the fields of psychology and neuroscience (and therefore human experience and neurological functioning generally) through phrasing or word choice rather than coherent scientific or philosophical arguments.

Speculative Language I identified passages in which Cozolino’s (2010) diction or word choice included speculation, or strategically alternated between speculation and certainty, with regard to the fusion between human psychology and brain functioning. I found this to be significant for a text that was purported to establish psychotherapy’s place within neurological sciences. For example, in the following passage connecting early interpersonal context, brain development, and psychological functioning, Cozolino places a sentence containing a conjecture before a sentence that would typically represent a firmly committed argument: The early interpersonal environment may be imprinted in the human brain by shaping the child’s neural networks and establishing the

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biochemical set points in circuitry dedicated to memory, emotion, safety, and survival. Later, these structures and processes come to serve as the infrastructure for social and intellectual skills, affect regulation, and the sense of self. (p. 10, emphasis mine) Later, he hedged as he summarized his mapping of the hallmark psychological concept of defense mechanisms onto the brain: Given that we use our internal expressions as implicit models for how we understand others, it could be that what Freud called the defense mechanism of projection is actually a simple byproduct of how our brains interweave our automatic theories of others’ minds with understandings of ourselves. (p. 314, emphasis mine) This attention to diction and word choice is important because scholars (e.g., Brothers, 2001; Moreira & Palladino, 2005; Novas, 2006) have cautioned that the use of speculative language in these kinds of popular adaptations of neuroscience indicate that authors are appealing to a general sense of hopefulness or optimism that brain science will eventually discover otherwise unknowable mind–brain relationships. This optimism about what neuroscience will do, rather than what it actually is capable of doing, is an aspect of what Rose (2007) described as the biomedical self. This type of rhetoric keeps readers attached to the idea that such correlates will eventually be located with further research, while completely overlooking how the fields of psychology and neuroscience have distinctly different purposes, methods, and meanings. In other words, such an outcome is not scientifically possible because its premise is illogical ( Bennett & Hacker, 2003). In a brain-based therapy book, speculative language implies that it is not plausible to fully combine the fields of psychology and neuroscience. However, Cozolino (2010) never acknowledged the possible implications for professional therapy if it comes to be closely aligned with a scientific endeavor that ultimately becomes a trend that passes out of favor.

Rewriting or Explaining One Field of Study From the Perspective of Another Field In another example of diction, I examined how Cozolino (2010) casually portrayed one academic discipline or area of study as easily explained by another field of study. This served to equate various epistemologies or ways of knowing and then subsume them under the higher-level field of neuroscience. The following are two examples of this: Remember, from the perspective of neuroscience, psychotherapists are in the brain-rebuilding business. (p. 33)

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From the standpoint of neurobiology, most of Freud’s work addressed the discontinuities and dissociations between networks of conscious and unconscious processing. Freud focused on the role of overwhelming emotion as the cause of unintegrated neural processing. (p. 33) These passages exemplified how grammar was substituted for actual evidence for the feasibility of combining these differing understandings of human life.

Metaphor Metaphor (a comparison between objects or concepts that is subtle since it does not use the words “like” or “as”) was one commonly used figure of speech in Cozolino’s (2010) book. In a psychology–neuroscience integration text, metaphors served to re-appropriate psychological concepts as descriptions of brain functioning, albeit unbeknown to readers. One category I discussed was Cozolino’s use of infrastructure terms when portraying the relationship between brain development and a person’s environment: A therapist attempts to restructure neural architecture in the service of more adaptive behavior, cognition, and emotion. (p. 9) The neural architecture of the brain comes to embody the environment that shapes it. You could also think of our neural architecture as a tangible expression of our learning history. (p. 19) Cozolino (2010) also used metaphors to compare human development to the brain: During the first 2 years of life, the right hemisphere has a growth spurt. (p. 95) In contrast to the amygdala, the hippocampus is a late bloomer, continuing to mature into early adulthood. (p. 231) In the first example of his use of metaphor, Cozolino (2010) was able to depict intangible or nonphysical understandings of human experience (which are central to psychotherapy theories) as having been made tangible through corresponding workings of the physical brain. In the second category of metaphor, he humanized the brain, describing it as possessing traits typically ascribed to people. In this way, he depicted the brain as the source of human development,

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mapping cultural ways of discussing human development onto the physical organ generally associated with individual identity.

Discussion I concluded from my textual analysis of Cozolino’s (2010) book that the project of a brain-based psychotherapy necessarily requires a misguiding depiction of the history and the purpose of psychotherapy, combined with numerous grammatical devices portraying human psychology as easily reducible to individual neurology. These appeared to substitute for scientifically and philosophically tenable arguments for subsuming psychotherapy under the field of neuroscience. In other words, relevant scientific evidence or substantive logic, which might attempt to explain how human experience and brain functioning could actually be synonymous, were absent. I found instead an unreasonable reappropriation of psychotherapy as a vehicle to promote more widely the idea that the self is equal to the brain. This positioning of personhood as alterable and knowable through brain imaging fits more with what Rose (2007) critically identified as the biomedical self. This is a materialist view that is incapable of resolving questions about the relationship between mental and physical aspects of human being, or the origins of human consciousness. Because the mind–brain or psychotherapy–neuroscience synonymity is depicted largely by rhetoric, uncovering the fallibility of such an equation raises questions about why this endeavor is important, and whether it is actually interesting, since it does not withstand close scrutiny. Further, my research raised the question of what the eventual consequences might be for the viability and reputation of psychology if this problematic use of popular neuroscience eventually goes out of fashion. I argued that ignoring this issue will ultimately result in a setback to our profession’s credibility, even if many fans of this literature cannot immediately see past the initial allure of neuroscience-based professional psychology. The self in Cozolino’s (2010) book is depicted simply as a product of brain functioning. It follows that by learning about brain science, an individual can be assured that they are capable of agency, personal change, and psychological well-being. In other words, believing a certain interpretation of brain science becomes a requirement for the understandings of human behavior and experience that people have traditionally valued. The use of brain science to establish and verify physical (and therefore alterable) origins of human experience thus reveals itself as a surprisingly relativistic effort. What is overlooked by this incoherent mapping of self onto the brain is a careful examination of the psychological processes required to believe and accept this literature. Cozolino never permits readers to consider, however, the question of why professional psychology needs to align itself with the impossible goal of cognitive neuroscience’s material reductionism.

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Even when Cozolino (2010) makes token appeals to contemporary ideas about social and decentralized self hood, mapping these concepts onto the brain is inherently dismissive of them. This effort reduces the ability of psychology to facilitate a discourse on these issues that is rooted in shared social, cultural, and historical understandings of the self. The fascination with this f lawed neuroscience–psychotherapy integration is likely to distract psychologists from thinking meaningfully about both human experience and how to actually strengthen the viability of our field. That is why 20th-century movements in philosophy such as hermeneutics, rather than brain science, are better suited to address questions about the self and the relationship between physical and nonphysical aspects of human experience. Cozolino’s book and similar efforts ultimately reduce, rather than enhance, critical thinking, subjectivity, and personal empowerment. With a narrow vision of a materialized and decontextualized human being, Cozolino dismisses the language of the social. It were well for psychologists and psychotherapists to keep in mind that contemporary social theories such as philosophical hermeneutics already provide a solution to the so-called mind–body problem by assuming that individuals are whole entities. That is, it is understood with our everyday language that to be a person is to exist as a combined mental and physical being, embedded within a sociohistorical context, and understood through a culture’s shared language. The use of brain imaging to establish how mental experience and physical processes are connected requires an assumption of the very mind–body split it seeks to transcend. Rather than challenging the problems of modern era scientism, equating therapy theories with neuroscientific jargon perpetuates a highly technical approach to understanding human experience, illness, and change. This is further evidence for why our profession should focus on contextual, relational practices, rather than simply acquiescing our unique epistemological domain to neuroscience. Brain-based therapies subtlety dismiss psychotherapy while proclaiming themselves as the key to empowering and promoting our field. Part of the appeal of a brain-based therapy text for psychology students and clinicians is its portrayal of neuroscience as providing a link between the wide array of treatment and assessment duties that psychologists perform. Some of our work closely involves measuring and treating the emotional and cognitive effects of medical conditions; often, our practices are better understood to be applied philosophy. Many students and clinicians are unable to explain how clinical work and research areas that span from cognitive science to theoreticalphilosophical psychology are related. I found that Cozolino’s text relies on exploiting this vulnerability for many readers. However, this problem is not insurmountable. The basic knowledge of psychology’s epistemological domain is a key part of reclaiming and preserving the integrity of our field. Basic assumptions of brain-based therapy collapse easily upon any close scrutiny of its claims and rhetoric.

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Personal Reflections Since Completing the Dissertation Drawing from my interests and experience in psychodynamic psychotherapy, as well as psychological and neuropsychological testing and assessment, my dissertation helped me understand how the practice of psychology across these areas is united in understanding individual experience to be knowable socially, within a shared interpersonal context. My goal has been to strengthen the epistemological domains of psychological treatment and assessment by challenging scientized and decontextualized claims about the history and purpose of our field or the reducibility of human experience to brain functioning. Readers may also have noticed that as a hermeneutic researcher, I did not attempt to deny the inf luence of my personal experiences and knowledge before I started the dissertation. Such efforts would contradict the premise of individuals being inextricable from their broader context or personal biases. As I read my final Discussion chapter, I realized that after over four years of being immersed in the research and writing process, I had returned to many of my original thoughts and predictions about the topic. This was not simply a case of having “found what I was looking for.” Rather, I identified many of my initial ideas as having reemerged after the lengthy process of analyzing and situating the primary material I had selected to critique. In other words, I recognized in my writing the hermeneutic tacking back and forth between the phenomenon being examined and the larger historical frame, and also between the researcher’s experiences and the document that is being created. My conclusions emerged from the process itself as if they brought themselves into existence. The hermeneutic process is lengthy and at times difficult, and it takes on a life of its own. I did not realize this until I saw it in what I had created. This experience is unknowable in empirical research. Dr. Cushman told his dissertation students from the outset to expect something like this, to live in the emergent process rather than try to race toward its end. This was difficult amidst the pressures of graduate school. The topic of my dissertation and its methodology will become central to my research and writing throughout my career. A dissertation of this nature may require more time, uncertainty, and personal investment than quantitative or other common mainstream research projects. However, the benefits of this work are likely to be more significant personally, professionally, and in their contribution to psychology. The theoretical–philosophical dissertation is undertaken in order to become a serious scholar and better clinician. I highly recommend it.

References Baldick, C. (2008). Oxford dictionary of literary terms (3rd ed.). New York: Oxford University Press.

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Bennett, M. R., & Hacker, P. M. S. (2003). Philosophical foundations of neuroscience. Malden, MA: Blackwell. Brenninkmeijer, J. (2010). Taking care of one’s brain: How manipulating the brain changes people’s selves. History of the Human Sciences, 23, 107–126. https://doi. org/10.1177/0952695109352824 Brothers, L. (2001). Mistaken identity: The mind-brain problem reconsidered. Albany: State University of New York Press. Cozolino, L. J. (2010). The neuroscience of psychotherapy: Healing the social brain (2nd ed.). New York: W.W. Norton. Cushman, P. (1995). Constructing the self, constructing America: A cultural history of psychotherapy. Cambridge, MA: Da Capo Press. Farrow, T. F. D., Hunter, M. D., Wilkinson, I. D., Gouneea, C., Fawbert, D., Smith, R., . . . Woodruff, P. W. R. (2005). Quantifiable change in functional brain response to empathic and forgivability judgments with resolution of posttraumatic stress disorder. Psychiatry Research-Neuroimaging, 140, 45–53. https://doi.org/10.1016/j. pscychresns.2005.05.012 Frie, R., & Coburn, W. J. (2011). Introduction: Experience in context. In R. Frie & W. J. Coburn (Eds.), Persons in context: The challenge of individuality in theory and practice (pp. xv–xxx). New York: Routledge. Gadamer, H.-G. (1975). Truth and method (2nd ed., revised, J. Weinsheimer & D. G. Marshal, Trans.). New York: Continuum. Kay, J. (2009). Combining psychodynamic psychotherapy with medication. In G. O. Gabbard (Ed.), Textbook of psychotherapeutic treatments (pp. 133–161). Arlington, VA: American Psychiatric. Kirschner, S. R., & Martin, J. (2010). The sociocultural turn in psychology: A contextual emergence of mind and self. New York: Columbia University Press. Moreira, T., & Palladino, P. (2005). Between truth and hope: On Parkinson’s disease, neurotransplantation and the production of the “self ”. History of the Human Sciences, 18, 55–82. https://doi.org/10.1177/0952695105059306 Novas, C. (2006). The political economy of hope: Patients’ organizations, science and biovalue. BioSocieties, 1, 289–305. https://doi.org/10.1017/S1745855206003024 Orange, D. (2003). Antidotes and alternatives: Perspectival realism and the new reductions. Psychoanalytic Psychology, 20, 472–486. https://doi.org/10.1037/0736-9735.20.3.472 Ortega, F., & Vidal, F. (2007). Mapping the cerebral subject in contemporary culture. RECIIS: Electronic Journal of Communication, Information & Innovation in Health, 1, 255–259. https://doi.org/10.3395/reciis.v1i2.90en Paquette, V., Levesque, J., Mensour, B., Leroux, J.-M., Beaudoin, G., Bourgouin, P., & Beauregard, M. (2003). Change the mind and you change the brain: Effects of cognitive-behavioral therapy on the neural correlates of spider phobia. NeuroImage, 18, 401–409. https://doi.org/10.1016/S1053-8119(02)00030-7 Pitts-Taylor, V. (2010). The plastic brain: Neoliberalism and the neuronal self. Health, 14, 635–652. https://doi.org/10.1177/1363459309360796 Richardson, F. C., & Bishop, R. (2004). Practices, power, and cultural ideals. Journal of Theoretical and Philosophical Psychology, 24(2), 179–195. Rose, N. (2007). The politics of life itself. Princeton, NJ: Princeton University Press. Schore, A. N. (2012). The science of the art of psychotherapy. New York: W.W. Norton. Siegel, D. J. (2007). The mindful brain: Reflection and attunement in the cultivation of wellbeing. New York: W.W. Norton.

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Siegel, D. J. (2010). Mindsight: The new science of personal transformation. New York: Bantam Books. Tallis, R. (2004). Why the mind is not a computer: A pocket lexicon of neuromythology. Charlottesville, VA: Imprint Academic. Uttal, W. R. (2007). The immeasurable mind: The real science of psychology. Amherst, NY: Prometheus Books. Wachterhauser, B. R. (1994). Introduction: Is there truth after interpretation? In B. R. Wachterhauser (Ed.), Hermeneutics and truth (pp. 1–24). Evanston, IL: Northwestern University Press. Woolfolk, R. L., Sass, L. A., & Messer, S. B. (1988). Introduction to hermeneutics. In S. B. Messer, L. A. Sass, & R. L. Woolfolk (Eds.), Hermeneutics and psychological theory: Interpretive perspectives on personality, psychotherapy, and psychopathology (pp. 2–26). New Brunswick, NJ: Rutgers University Press.

4 EMERGING INTO A WORLD OF UNDERSTANDING A Hermeneutic Exploration of Perinatal Mood Disorders and Clinical Practice Kathleen M. Pape

A doctoral dissertation is the culmination of learning, training, research, and professionalization for a graduate student in psychology. It is the final task in preparing the student to move into the world of professional practice. In clinical psychology that involves sitting with another being who is in pain, distressed, or disoriented, the perceived wisdom is that the accumulated knowledge expressed in a dissertation is what is required to practice psychology well. However, the experience of writing a hermeneutic dissertation showed me that, in contrast to simply accumulating knowledge, increasing my capacity for paying close attention to, and working toward understanding, a text or a person can be more fruitful and ref lective of human experience. In my doctoral dissertation (Pape, 2014), Mothering and the Functional Self: A Hermeneutic Exploration of Texts on Perinatal Mood and Anxiety Disorders, I considered the varied cultural and historical contexts from which struggling mothers, and the clinicians who encounter them, draw their meanings. The substantial increase in the published research into perinatal mood disorders, and the clinical practices derived from that research, demanded a closer examination of what was taken for granted as knowledge or belief about mothers and clinicians within the field of perinatal mental health. In particular, I came to realize that the lack of historical context in perinatal research created gaps in psychological understanding that could create misunderstandings and reinforce systems of oppression. By conducting a textual interpretation of three books written about perinatal mental health, especially of how those texts described the challenges and struggles of birthing and mothering, I developed understandings of how clinicians respond to those issues and in the process understand themselves, their practices, and their sociocultural roles. With those understandings, I considered the shape of the current social terrain that highlights the experiences of DOI: 10.4324/9781003140177-5

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birthing women and the clinicians who treat them. The question that framed my exploration was, “What kind of world would bring these texts to light?” Mothering can be difficult, and mothering in post-9/11 North America seemed particularly fraught with fears, worries, tensions, and challenges. These difficulties included intense societal expectations that mothers must meet (Hays, 1996; Maushart, 2003; Slaughter, 2012) while managing political, social, and economic insecurity (Clawson, 2014; Kennedy, Charlesworth, & Chen, 2004; Vandenbeld Giles, 2014). The struggles that mothers experienced during this era, and the way those struggles were understood in the field of psychology, led me to focus my dissertation on contemporary texts of perinatal mood and anxiety disorders (PMADs).

Background Perinatal mood and anxiety disorders (PMADs) are defined as “a mood disorder (for instance, depression) or anxiety disorder (e.g., panic) beginning during pregnancy or during the first year postpartum” (Bennett & Indman, 2010, p.  146). PMADs denote the umbrella term encompassing six principal disorders—depression, obsessive-compulsive disorder, panic disorder, psychosis, post-traumatic stress disorder (PTSD), and Bipolar I and II—that may occur around pregnancy, birth, and up to one year after birth (Bennett & Indman, 2010). In the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the specifier, “with peripartum onset” may be applied to major depressive and/or manic episodes, as well as “postpartum onset” during brief psychotic episodes (APA, 2013). For the purposes of my dissertation, I used the term perinatal mood and anxiety disorders (PMADs) to describe the general understandings of the struggles experienced by mothers discussed in the books on perinatal mental health. However, when an author referred specifically to one disorder, I used that term (e.g., Shields’s postpartum depression [PPD]). PMADs are often attributed to hormonal changes that affect brain chemistry during or following pregnancy (Bennett & Indman, 2010) as well as psychosocial factors such as family history, stressors, lack of social or familial support, and sexual abuse (Misri & Joe, 2008). Studies estimated that approximately 7.14–32.26% of pregnant women and mothers experience symptoms of major or minor depression, anxiety, or serious mental illness prior to giving birth or in the first year postpartum (Bauman et al., 2018; Beck, 2001; Doe et al., 2017; Gavin et al., 2005; McKee et al., 2020; O’Hara & Swain, 1996). Reported prevalence rates for PMADs varied depending on factors such as age, geographic location, experience of intimate partner violence before or during pregnancy, and infant survival (Bauman et al., 2018); socio-economic status, ethnic identification, and immigration status (Doe et al., 2017); as well as whether the birth was preterm (McKee et al., 2020). The profound difference

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in the prevalence of PMADS, particularly depending on social factors, indicated that the perceived universality of maternal experience was unwarranted. My dissertation was a textual interpretation of three books written about perinatal mood and anxiety disorders (PMADs) for three different yet overlapping audiences. One book was written specifically for healthcare practitioners: Susan Dowd Stone and Alexis E. Menken’s (Eds.) (2008) Perinatal and Postpartum Mood Disorders: Perspective and Treatment Guide for the Health Care Practitioner. The second book was written for clinicians as well as for a general audience: Shoshanna Bennett and Pec Indman’s (2010) Beyond the Blues: Understanding and Treating Prenatal and Postpartum Depression & Anxiety. The third book was written primarily for a general audience: Brooke Shields’s (2005) memoir Down Came the Rain: My Journey Through Postpartum Depression. The authors of the three books approached the subject of PMADs from the perspectives of psychology, nursing, healthcare, social advocacy, and personal experience. By using a hermeneutic approach, I explored how the challenges and struggles of birthing and mothering were described within these three books. In-depth examination of the texts, individually and together, indicated repeated, similar descriptions of mothering and of clinicians’ responses to mothers who struggle. I then organized these descriptions into themes and supported them with examples from the texts.

Themes There were five shared themes that emerged from the exploration of the three texts: maternal suffering is overlooked and perinatal mood and anxiety disorders are undertreated; suffering is reduced to a medicalized disease located within the mother necessitating an individualist response; the mother is an object whose well-being serves others; perinatal mood and anxiety disorders are universal across time and culture; and the clinician is a rational, concerned expert who brings order to the disordered.

Maternal Suffering Is Overlooked, and Perinatal Mood and Anxiety Disorders Are Undertreated All three texts (Stone & Menken, 2008; Bennett & Indman, 2010; Shields, 2005) explicitly stated that there was a need to increase awareness of the struggles that mothers experienced—that perinatal mood and anxiety disorders had been overlooked and undertreated. In fact, the purpose of each book was to make known more broadly these difficulties and to guide clinicians and mothers in the treatment of perinatal mood disorders. All three books included a section at the end that listed resources—organizations, websites, and publications—that a mother or clinician could access as needed to address a perinatal mood or anxiety disorder. The reader was encouraged to use them,

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and if the reader was a clinician, she was encouraged to have those resources available to distribute to mothers in need.

Suffering Is Reduced to a Medicalized Disease Located Within the Mother Necessitating an Individualist Response In all three books, the mother’s suffering was addressed as a medical disorder in need of professional treatment. Of the 27 total authors included in the three books, 25 of them recommended medication and psychotherapy as the primary treatments, or responses, for mothers who were struggling. Whenever social or interpersonal issues were addressed, it was primarily related to the experiences of the partners of mothers. When discussing mothers, medical terminology such as “symptoms” or “diagnosis” were primarily used. This conveyed the idea that the mother’s suffering was located within the mother herself, not within her circumstances or environment. The emphasis on treating or curing the mother reinforced the value of individualism and precluded a full understanding of the mother, her relationships to others, or her sociopolitical situation. The most glaring examples of the preference given to medical disorders over human experience were found in the titles of two of the books: Stone and Menken’s (2008) Perinatal and Postpartum Mood Disorders: Perspective and Treatment Guide for the Health Care Practitioner and Bennett and Indman’s (2010) Beyond the Blues: Understanding and Treating Prenatal and Postpartum Depression and Anxiety. The mother is never mentioned as a subject in these titles. The disorders, and the healthcare practitioners who treat these disorders, are the foci of the books, not the complex women who present with their own unique stories of struggles, losses, disorientation, and challenges. Notably, none of the authors advocated for societal structural changes (e.g., parental leave, universal childcare) except to have mothers screened for disease and increase their access to medical treatment. It was surprising to me how much focus was placed on the internal workings of the individual mother in the writings on PMADs. Surprising because mothering is at minimum a relational vocation, and on a larger scale a societal vocation. As the feminist legal scholar Martha Fineman (2013) pointed out, “(H) aving and caring for dependent children are society-preserving tasks, essential to the future of society and all of its institutions” (para 4). That view, however, may also explain the impetus for perinatal clinicians to push so hard for treatment— the recognition that if a mother–child bond is disrupted, eventually the whole of society will feel it. The unspoken, or unacknowledged, recognition of the implications of childbearing and childrearing reinforces the tendency to control mothers—through legislation or coercion—and reinforces the idea of the clinician as an all-knowing expert and the mother as dependent on the expert. The potential for the disempowerment of mothers is why a sociohistorical perspective on PMADs is so important for our understanding of these struggles.

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The Mother Is an Object Whose Well-Being Serves Others There was an emphasis in all three of the books on the mother being the crucial member of a newly expanded family whose well-being had profound effects on those around her. It was repeatedly emphasized that the mother’s vital role in the family was primarily the inf luence she had on her children’s well-being. This advanced the argument for her treatment. If she was suffering, she needed medical treatment to better fulfill her role of caring for others, not necessarily for her own well-being. In Stone and Menken’s (2008) Perinatal and Postpartum Mood Disorders, threequarters of the first section (three of the four chapters of Part I) focused on the effects of maternal mental health on those around the mother, particularly her children. Bennett and Indman (2010) also began their section entitled “Consequences of Untreated Mood Disorders” by describing its effects on the struggling mother’s children, not on the woman diagnosed with the mood disorder. This emphasis presented an image of the mother not as a person or a subject in her own right, much less a complex individual forming a unique relationship with her child, but rather as important only for the care she provides her child.

Perinatal Mood and Anxiety Disorders Are Universal Across Time and Culture Perinatal mood and anxiety disorders were considered by the authors to be universal, even though PMADs are a Western conceptualization of illness and disease (Stone & Menken, 2008, p.  212; Bennett & Indman, 2010, pp. 67, 82; Shields, 2005, p.  220). The authors encouraged clinicians to become aware of cultural differences in mothers, but only so that clinicians could more effectively utilize Western conceptualizations and treatments of disease on those from diverse backgrounds. The benefits and risks of clinicians treating a nonWestern mother for a Western-conceived mental illness were never questioned. In addition, there was no mention of the contexts from which mothers develop and form their mothering practices. This conveyed a generality and timelessness—it is the same everywhere and always has been—to the experience of perinatal mood and anxiety disorders, rather than an understanding of how certain contexts call for certain responses from mothers. This absence of context and the timelessness and universality it conveyed would not have occurred with a hermeneutic perspective.

The Clinician Is a Rational, Concerned Expert Who Brings Order to the Disordered Perhaps the most insidiously dangerous theme the books presented was the idea that the clinician is a rational, concerned expert who brings order to the

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disordered. In one way or another, the authors of the texts were presented as authoritative experts in perinatal health, people whose opinions and ideas were worth considering. This perspective ascribed power to these authors to define what are good and right ways to be a mother and, by extension, what are good and right ways to be human. The authors of the texts also described clinicians as advocates and guides for women. They performed this role by being rational and scientific experts who detected and diagnosed mental and emotional disorders and knew the appropriate treatment for the mother. They privileged knowledge over understanding by viewing the detection of symptoms, awareness of risk factors, and access to treatment methods as more important than the careful listening to and understanding of a mother’s experience. Clinicians were expected to notice a mother’s presentation and use it to diagnose her quickly and accurately with a mood disorder and to facilitate her treatment. Universal screening tools were relied on to inform clinicians of what mothers may not have been willing to share with a clinician. Guilt, shame, denial, and lack of knowledge were identified as reasons that a mother would be hesitant to disclose her struggles. However, further investigation of the complexities or ambiguities of these experiences was not encouraged (Klempner, 2008, p. 102; Lofrumento, 2008, p. 189). Bennett and Indman (2010) expressed a belief that the clinician was inf luential enough that the clinician’s “matter-offact tone” (p. 82) regarding a mother’s struggles and PMAD diagnosis would be enough to reassure a mother and open her to receiving this assessment as objective and non-judgmental and then to willingly follow through with treatment. All three texts presented a belief that mothers who were suffering were emotionally disordered and in need of treatment to restore order in themselves and to their lives. The clinician was viewed as the expert who brings order to the disordered mother. The disordered mother was a mother who did not feel like herself, could not function properly in her role as mother, and who required professional assistance. It was expressed by the authors that the administration of a treatment and the establishment of order would result in the mother feeling familiar to herself again and able to perform her maternal role.

The Functional Self The themes that emerged brought to light taken-for-granted beliefs and conveyed meanings about struggles in mothering, clinicians’ responses to them. This included clinicians’ understandings of themselves, their practices, and their sociocultural roles. I interpreted the meanings conveyed in the texts as being constitutive of the social world and historical time in which they were relevant. The texts pointed to the practices and social roles that mothers and clinicians were expected to adopt and enact. I came to realize that those practices and roles ref lected understandings of the good in the era in which they emerged— that is, the particular understandings about how to be properly human within

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that culture. I described how the current social terrain brings to light these experiences and ascribes value to what could be called a way of being. I called this way of being a functional self. The functional self is ref lected both in the demand that the mother seamlessly transition into her role of mothering her child without disruption, confusion, or hesitation, and in the way that clinicians understand their role, which is to respond to mothers knowledgeably, effectively, and actively lest they fail in their response to mothers. The functional self is recognized by its activity. The self of this era does not exhibit functioning in contemplation or by wondering about and questioning that which she is called to do. Rather, she functions by performing her role(s), by doing. The functional self does not respond with confusion, or by accepting that humans cannot be fully comprehended. Further, fully understanding the person is not necessary so long as failures in functioning can be fixed. What those failures or gaps in doing may indicate or mean or what purpose they may serve to the person or the clinician, are not considered important. To not act with alacrity is considered a failure. Psychology’s recent infatuation with instrumental processes (e.g., an overreliance on manualized treatments, empirically-supported treatments, and quantitative research methods) has reinforced systems of power and oppression in which the clinician, or expert, tells the client or the patient what her problem is and how to best manage it. Though lip service is given to client-centered ideals in contemporary mainstream psychotherapy, the real emphasis is closer to the clinician’s knowledge base and system of beliefs. An oft-repeated statement at a Postpartum Support International conference depicts this power imbalance: “Most women don’t know what they have until we diagnose them” (B. Meyer, personal communication, September 16, 2011) and shows how naming and defining an experience allows clinicians to exert power. It should be noted that the authors of the three texts did not see their practices as exercising power, or if they did, they thought of it as in service to the women for whom they care.

A Fusion of Horizons A hermeneutic exploration of the experience of PMADs approaches the subject from a different perspective. It acknowledges that I, the researcher, have a perspective—a reality that is often missing, or tried to be controlled for, in other styles of research. In addition, the understandings that arise from a hermeneutic analysis come to light as a result of the process of encountering, reading, and reviewing the text. To borrow Stern’s (2013) term, the ideas emerge from the text and come into being as I encounter the texts in an attempt at a good-faith dialogue. Though I am the researcher, I am not the expert. I am on equal footing with the text, learning and being transformed by it, even as my interpretation of the text reaches out to the author’s words and hopefully develops a mutual understanding. In opening myself to the text, I am also willing to understand the world that informs these authors and allows their

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ideas to come to light, a world that I share with them, which allows me to better understand their ideas. I am looking not for the change agent, or essential variable, I am seeking what Gadamer (1960/2004) described as a “fusion of horizons” (p. 306).

Clinical Implications Throughout my doctoral studies, I maintained my private psychotherapy practice as a licensed mental health counselor. Interestingly, focusing my dissertation on the careful interpretation of texts seemed to deepen the quality of my clinical work. My development as a hermeneuticist was crucial not only in finding my voice as a scholar but also in supporting my skills as a clinician. In my research, I learned to use interpretation to understand what was problematic with what I was reading, and why. In addition, Gadamer’s (1960/2004) philosophical hermeneutics provided a way for me to talk about ideas in a moral and ethical way. It provided a way to dialogue with the text and to come to some understanding not only of the text but also of the era in which we find ourselves. Then, my further understanding of our era helped me to listen and better understand the text. Jim Risser, a professor of philosophy at Seattle University who teaches a hermeneutics course in the MA in Psychology program, begins his exploration of hermeneutics and psychology with two questions: “Who sits in front of me?” and “How can I understand him or her?” (personal communication, 2016). Both of these questions avoid the presumption so often present in psychotherapy—believing that the clinician knows the patient because of their presentation and that clinicians understand patients because of their symptoms (i.e., they can diagnose them and place them in a psychological context). This applies whether the diagnosis is confirmed or ruled out. The assumption is that in finding the right diagnosis, one will know and understand the patient. This is not to say that the act of diagnosing is of itself necessarily the problem. Rather, it is when diagnoses become the primary way of understanding another that the complexities, ambiguities, and humanness of the person sitting across from the clinician may be lost. As my dissertation proceeded, I noticed a stronger sense of hearing what my clients were saying, or trying to say, or in some cases avoiding saying. The careful practice that I had developed in exploring texts on PMADs was equally useful when my clients and their understandings of themselves and their situations became like a text to be explored. The work of textual exploration nurtured skills of perception, listening, and interpreting, and in the end seemed to be an excellent way to prepare me to do the complex work of being with humans in their confusion and pain. This was similar to Stern’s (2013) description of psychotherapy as an emergent process featuring activities such as “the deployment of curiosity, an active attitude of openness to whatever I can notice about

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the patient, myself, and what’s transpiring between us” (p.  105). That kind of engagement calls for a hermeneutic method. “Hermeneutic ref lection,” he explained, “takes precedence over any kind of methodology” (p. 114).

Clinical Meetings and Openings Approaching psychotherapy as an “emergent process” (Stern, 2013, p.  105) seems diametrically different from approaching psychotherapy with a rigid treatment plan based primarily on empirically-supported treatment methods. Treatment plans and treatment methods presuppose a knowledge of what any unique client is experiencing. It assumes that the client’s struggles are the problem, rather than, for instance, an indicator of something right about the client, who may be responding to problematic situations—whether interpersonal, social, or political. As one of my clients put it, “(A) plan is what you need when you have a problem, and I guess it was helpful to not automatically think of myself as a problem.” Heidegger (1927/2010) described humans as living in a cultural clearing in which certain things can be known or understood. We act on our world, as well as our world acting on us. Therefore, the task of therapy becomes less about fixing my client’s problem behaviors and instead of bringing into the light the ways in which my clients have acted on their world and shaped their world, even as it has shaped them. This allows them to see opportunities for choices they had assumed they did not have. This deepened sense of curiosity and listening to my clients was not an automatic outcome of my doctoral training. At the beginning of my work on my dissertation, it seemed particularly difficult to return to a sense of curiosity and wonder in my work with clients after having been immersed for several years in a didactic and regimented form of study such as a clinical psychology program. It proved hard to think historically and philosophically after so many years of thinking reductively and technically. During the time in which I was working on my dissertation, I was also struck by what seemed to be an enormous gulf between a historical and a philosophical way of thinking about being human and the way mainstream psychology portrays humans—as mechanistic and predictable. Yet, at the same time, how refreshing it was to open myself to exploration about a topic which I had been interested in for a long time. There were many moments when I reflected on the truth that as difficult as it was to write a dissertation, it would have been doubly difficult to write one about which I held little passion— provided that completing it didn’t kill my spirit. I’m sure this would have been my course of action if needed. The doctoral candidate’s perceived desire to just write anything and get out resonated with me as I spilled into my eighth year in the program. It proved to be a conundrum that I had to negotiate—how to produce an original work when I had been so restricted and dominated during my years in the program. Doing the diligent work of a hermeneutic dissertation—exploring,

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questioning, confronting—helped me to understand enough of what I was reading to articulate it, critique it, and tolerate potentially displeasing others.

The Clinician’s Perspective Working with clients from different backgrounds demands that I call into question my own long-held assumptions about the world. As Cushman (2005) stated, “If their world brings them to light in the way they are, what kind of world is it that brings me to light in the way I am?” (p. 408). This historically and socially located ref lection often demands that I not take-for-granted certain benefits and privileges that have enabled my life to be a certain way and that are not available to some of my clients. As Jon Briere stated, “the only difference is that you were luckier than they were” (personal communication, 2012). In letting go of my assumptions and making a good faith effort to understand the world that forms my clients, as well as the world that forms me, I can better see how what first appears as problematic is often times ingenious, sophisticated, and frankly effective for my client’s survival and well-being. This kind of understanding requires a loosening of position and belief or at the very least, a letting go of the idea that one is always right. Though as psychotherapists we often believe that we are open to our clients, I would propose that we are trained to hold our positions of knowledge and authority. The professionalization of students and interns constantly demands that they are knowledgeable and competent. This makes it very difficult to sit with not knowing or to have our worldview shifted by the person sitting across from us. To be fair, we are professionals, and we are expected to be competent in our professional practices. However, I believe that good clinical work also requires authentic dialogue, which requires a tolerance for openness to new ways of viewing the world—to be comfortable with not knowing. This became clearer to me while working on my dissertation. As my research and writing proceeded, I noticed a new pacing to my encounters with my clients. I was more open to understanding their views of their world, more patient with seeing from a different perspective, and less apt to panic when I felt these flashes of new understanding that seemed to transform how I had previously known or conceptualized my client. I think the task of interpreting texts encouraged these traits in me.

Being Comfortable With Not Knowing During some of the time that I was working on my dissertation (and interestingly, a majority of the time that I was not working on my dissertation), I was plagued by a low-level tension and worry that what I was doing was illegitimate—that I was doing psychological research incorrectly. I wasn’t bracketing out presuppositions. On the contrary, in my foregrounding section, I was including them. I wasn’t controlling for variables—selectively isolating them and then picking them out of the research to make it simpler and

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cleaner. I was doing just the opposite. I was searching for more complexity, allowing new understandings to emerge. At one point, I remember confessing to my dissertation chair, “I feel like I am just making stuff up!” When he responded in the affirmative and congratulated me on doing so, I was both relieved and apprehensive. What had I gotten myself into? I came to realize, as with most creative endeavors, the path this project took could not have been known before I started. Importantly, the same can be said for psychotherapy. That path, of course, is similar to what motherhood is like. New mothers may make many preparations, but they can never be prepared fully for the unique child who comes into the world, or the ever-emerging relationship they form with their child over the course of their lives. I want to describe an incident from mothering my young child that served as an epiphany for me not only in understanding my child but also in understanding Heidegger’s (1927/2010) and Gadamer’s (1960/2004) hermeneutics. Like most kids, my son went through regular periods of particularly frustrating behavior when he was around two or three years old. One day when I was cleaning off the kitchen table, I noticed the usual detritus of lost food particles, along with something sticky on the f loor, under his chair. I lowered to my knees and started picking up bits of food and wiping up whatever was stuck to the f loor. Then, I reached up to finish wiping the table. Likely, out of fatigue, I just stayed on my knees to wipe the rest of the table. As I was doing so, I realized that the view that I had at that moment, barely seeing to the far end of the table, was how my son encountered our table at every meal. I was struck by the different perspective. There was plenty that I could view from there, but a lot that I could not—for example, the angle of any cups or glasses that may have liquid in them. No wonder I was wiping up so much sticky stuff off the f loor! And no wonder he was often frustrated or difficult at the table for reasons that, from my perspective a foot or so higher, seemed inexplicable. I had gained some idea of the perspective and the world in which he lived.

Conclusion Professional psychologists, and the organizations that represent them, have been pushing for psychology to become a STEM (Science, Technology, Engineering, and Math) discipline for over a decade now (APA Presidential Task Force on Evidence-based Practice, 2006). They want psychology to be viewed more as a physical science than a social science. The danger in viewing psychology this way lies in its over-reliance and near-infatuation with scientism and empiricism. As a profession, a discipline, and a practice, psychology can lack imagination. Change funneled through the mill of functionality prevents us from conceiving of a world that is any different than the one we grasp right in front of us. We fail to perceive the complex ways in which we make sense of the strangeness of being human—the unpredictability, yet inevitability, of our mortality. We cling

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to our empirically-supported, manualized, value-laden techniques, and in doing so suffocate what needs to be born in us and in our clients. Not only does this creative deficit mean that as clinicians we cannot imagine the different ways of being human for the person sitting across from us, we also are impeded in creating ways of living differently that may be more satisfying to our clients and to us. How could we possibly believe that we could make anyone’s life better without the imagination to see our lives in a completely new way? It seems that some of our best moments—as mothers, as parents, as therapists, and as researchers—come in quiet, surprising encounters of meeting the world of another being and doing the hard and sometimes disorienting work of coming to some understanding of their experiences. These moments cannot be predicted or forced. In fact, they require a kind of loosening and openness that an over-reliance on formulaic techniques precludes. When we have these moments of surprise and understanding, it is helpful to notice the conditions that might allow them to happen again. In addition, we must cherish these moments as an encounter of one’s world with another’s that broaden our own world and ignite it with wonder and curiosity.

References American Psychiatric Association (APA) (2006). Evidence-based practice in psychology. American Psychologist, 61(4), 271–285. https://doi.org/10.1037/0003-066X.61.4.271 American Psychiatric Association (APA) (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: APA. https://doi.org/10.1176/appi.books. 9780890425596 Bauman, B. L., Ko, J. Y., Cox, S., D’Angelo, D. V., Warner, L., Folger, S., . . . & Barfield, W. D. (2018). Vital signs: Postpartum depressive symptoms and provider discussions about perinatal depression—United States, 2018. MMWR Morbidity and Mortality Weekly Report, 69(19), 575–581. https://doi.org/10.15585/mmwr.mm6919a2 Beck, C. T. (2001). Predictors of postpartum depression: An update. Nursing Research, 50(5), 275–285. Bennett, S., & Indman, P. (2010). Beyond the blues: Understanding and treating prenatal and postpartum depression & anxiety. San Jose, CA: Moodswings Press. Clawson, L. (2014, January 15). House Republican: More babies equals more jobs, so let’s ban Abortion. Daily Kos. Retrieved from www.dailykos.com/story/2014/ 01/15/1269897/-House-Republican-More-babies-equals-more-jobs-so-let-s-banabortion Cushman, P. (2005). Between arrogance and a dead-end: Psychoanalysis and the Heidegger-Foucault dilemma. Contemporary Psychoanalysis, 41(3), 399–417. Doe, S., LoBue, S., Hamaoui, A., Rezai, S., Henderson, C., & Mercado, R. (2017). Prevalence and predictors of positive screening for postpartum depression in minority parturients in the South Bronx. Archives of Women’s Mental Health, 20(2), 291– 295. https://doi.org/10.1007/s00737-016-0695-4 Fineman, M. (2013, December). Having a child is nothing like deciding to buy a Porsche. The Guardian. Retrieved from www.theguardian.com/commentisfree/2013/dec/01/ harvard-professor-maternity-coverage-children-porsche

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Gadamer, H.-G. (2004). Truth and method ( J. Weinsheimer & D. G. Marshall, Trans., 2nd ed.). New York: Continuum (Original work published 1960). Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005). Perinatal depression: A systematic review of prevalence and incidence. Obstetrics And Gynecology, 106(5), 1071–1083. Hays, S. (1996). The cultural contradictions of motherhood. New Haven, CT: Yale University Press. Heidegger, M. (2010). Being and time ( J. Stambaugh, Trans.). Albany, New York: State University of New York Press (Original work published 1927). Kennedy, C., Charlesworth, A., & Chen, J.-L. (2004). Disaster at a distance: Impact of 9.11.01 televised news coverage on mothers’ and children’s health. Journal of Pediatric Nursing, 19(5), 329–339. Klempner, L. G. (2008). Diagnosis and screening of perinatal mood disorders. In S. D. Stone & A. E. Menken (Eds.), Perinatal and postpartum mood disorders: Perspectives and treatment guide for the health care practitioner (pp. 87–106). New York: Springer. Lofrumento, M. A. (2008). The pediatrician’s role in identifying postpartum mood disorders. In S. D. Stone & A. E. Menken (Eds.), Perinatal and postpartum mood disorders: Perspectives and treatment guide for the health care practitioner (pp. 183–201). New York: Springer. Maushart, S. (2003). Wifework: What marriage really means for women. London, England: Bloomsbury. McKee, K., Admon, L. K., Winkelman, T. N. A., Muzik, M., Hall, S., Dalton, V. K., & Zivin, K. (2020). Perinatal mood and anxiety disorders, serious mental illness, and delivery-related health outcomes, United States, 2006–2015. BMC Women’s Health, 20(1), 1–7. https://doi.org/10.1186/s12905-020-00996-6 Misri, S., & Joe, K. (2008). Perinatal mood disorders: An introduction. In S. D. Stone & A. E. Menken (Eds.), Perinatal and postpartum mood disorders: Perspectives and treatment guide for the health care practitioner (pp. 65–83). New York: Springer. O’Hara, M. W., & Swain, A. M. (1996). Rates and risk of postpartum depression—A meta-analysis. International Review of Psychiatry, 8(1), 37–54. Pape, K. M. (2014). Mothering and the functional self: A hermeneutic exploration of texts on perinatal mood and anxiety disorders [Doctoral dissertation], Antioch University Seattle. ProQuest Dissertations & Theses A&I (Publication No. 3680501). Shields, B. (2005). Down came the rain: My journey through postpartum depression. New York: Hyperion. Slaughter, A.-M. (2012, July/August). Why women still can’t have it all. The Atlantic Monthly, 310(1), 84–102. Stern, D. (2013). Psychotherapy is an emergent process: In favor of acknowledging hermeneutics and against the privileging of systemic empirical research. Psychoanalytic Dialogues, 23(1), 102–115. https://doi.org/10.1080/10481885.2013.754277 Stone, S. D., & Menken, A. E. (Eds.). (2008). Perinatal and postpartum mood disorders: Perspectives and treatment guide for the health care practitioner. New York: Springer. Vandenbeld Giles, M. (2014). Introduction: An alternative mother-centered economic paradigm. In M. Vandenbeld Giles (Ed.), Mothering in the age of neoliberalism (pp. 1–30). Bradford, CA: Demeter Press.

5 A HERMENEUTIC ANALYSIS OF TRAUMA DIAGNOSES Julianne Ludlam

When considering my dissertation topic, I wandered slowly through the stacks in our school’s library. I was interested in posttraumatic stress disorder (PTSD), a beast of a topic. A researcher’s job, I knew, was to narrow the focus, find a small but useful niche, and contribute some tiny piece to a larger and evergrowing body of work. Real research, as I had learned as a student and an assistant, was measured in small steps. Real research was also supposed to be unemotional and objective—as unbiased as possible—and I was determined to embark upon my own study with every bit of mind-clearing objectivity that a good researcher could muster. As a believer in the scientific method, I dutifully set out to find my small, answerable research question, logically and methodically. I sat in row after row in our library for hours, reading books on the topic and scanning piles of journals and special editions of journals. After weeks of reading in the library, I was increasingly intrigued by my topic, but also frustrated. Small questions did not capture the ideas that fleetingly ran through my mind, and my (rather emotional) concerns about trauma diagnosis and treatment occasionally fluttered in the spaces on the shelves. Why and how had PTSD become so popular, even being dubbed “the disorder of the 1990s” (Marsella, Friedman, Gerrity, & Scurfield, 1996)? Why did clinicians, patients, and families alike seem to view PTSD as “an acceptable face of mental illness,” preferring it over other diagnoses (O’Brien, 1998, p. 3)? Why did our culture seem fascinated with trauma, devising innumerable studies on PTSD, creating television shows and movies with trauma as a theme, and constantly covering traumatic events, both small and large, in the media? And finally, despite this apparent fascination with trauma, why were rape victims and war veterans still consistently struggling to receive the most basic care and help for such a potentially disabling condition? The quiet library stacks were calming, but they seemed to hold few answers to these questions. DOI: 10.4324/9781003140177-6

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Studies with the standard “suggestions for future research” instructed me to choose something tame, such as measure validation, specific techniques, or brain scans. I was unsatisfied, but I was determined to find something that sparked my interest and reached, just a little, toward my unmanageably big ideas. On the final day of this library exercise, I wandered to the dissertation section, filled with (mostly thin) volumes of students past. Here, I thought, I would see how others had tamed their beasts! Dissertations on PTSD tested manualized, short-term treatments, examined co-morbidity, and investigated risk factors. These were important, but few seemed substantial enough to me, as the findings were both limited and unsurprising. Effect sizes for treatments were small or patients dropped out, co-morbidity should be considered, and risk factors were many (and often involved past trauma). These were indeed tame, as well as manageable, but they did not speak to my interests. I began to think of my ideas as unscientific and uselessly broad, and I resolved to settle. One study is a small step, I reminded myself, and that is simply how research works. Shutting out my rustling concerns and questions, I jotted down some ideas and tried to move forward. And then, I learned there were other ways of thinking about research.

My Process: From Rigidly Quantitative to Fascinatingly Qualitative My experiences with traditional research, while mentally stimulating in certain ways, were perhaps too mundane and familiar to me when I was considering my dissertation topic. Assisting with survey design and implementation, analyzing results, and writing up quantitative research studies had been my past—six years of working in research centers and then later conducting statistical analysis as a freelance consultant. I loved the methodological puzzle of deciding which statistical analysis to run for the questions others wanted to ask. Follow this simple f low chart, I would tell clients or fellow students (those who cared to know the details of their own analyses). If your answer falls on a continuum, like a score, choose a t-test or analysis of variance (ANOVA) (or even a MANOVA, for very complicated designs). If your answer falls into categories, like yes/no, try the chi-square test, or the variations on that arm of the chart. Simply rinse and repeat for multiple questions. Most research questions required little more complex than these analyses. Even for more complicated analyses, there is always an answer in statistics; it is a series of decisions, informed by one’s well-stated, laser-focused research question. Follow the rules, meet statistical assumptions, and interpret quantitative findings cautiously. These are simple steps, leading to the standard write-up. But feminist psychology, postmodern philosophy, and hermeneutic thought engaged me in a way that traditional research had not. The deep, thoughtprovoking writings and questions led to eye-opening, meaningful ideas, ideas that impacted my emotions and behaviors. The level of engagement within

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these writings seemed similar to that being taught to us concurrently as psychotherapists-in-training, so perhaps it both ref lected and resounded with my clinical training. Gadamer, Heidegger, Foucault—these made for difficult reading, but they led me to newer authors, like Lynne Layton and Rachel Hare-Mustin, whose work spoke to me about the intersections between philosophy and psychotherapy. The writings of Philip Cushman, the editor of this volume and my dissertation chair, showed me the surprising ways that psychology and psychotherapy were historically and politically situated, and opened up to me the realm of hermeneutic investigation. However, although hermeneutics fascinated me, I initially had no belief that it could be effectively applied to “real” research. Like many, I still held a general disdain for soft, qualitative, or interpretive research. It was only after many dialogues and discussions that I realized that my topic—how PTSD and trauma were seen and treated in Western culture—was essentially a qualitative, hermeneutically-based question. With this new, complex method of inquiry opened up to me, I could see the fuzzy boundaries of my dissertation taking shape. I was excited but also quite uncertain. Unlike the process outlined in my favorite quantitative f low charts, hermeneutic research was time consuming and slow. It was likely especially slow for me—someone previously reluctant to interpret beyond the numbers and with little background in history or politics. At the same time, the hermeneutic process was completely fascinating. I had embarked on a historical exploration of trauma, and this required finding and carefully reading primary source documents dating back to the early 1800s. The library research and reading were delightful; the writing was difficult. I felt like an explorer not outfitted for the journey, plodding along with no scales or tools for tracking. Thankfully, others were there along the way—my tireless chair, my supportive committee, and a kind and generous group of fellow student-explorers. They helped me traverse the landscapes of hermeneutic thought, even when I stumbled blindly. Ultimately, I hoped to understand how PTSD could be considered as an artifact of past and present-day Western cultures, or, in other words, what our beliefs about trauma said about us, as human beings, in different eras. I tried to immerse myself in the events, words, and diagnoses of each era, in the hopes of grasping how trauma was seen through different eyes in different times. My lack of knowledge regarding history led me to read several textbooks (and then critiques of textbooks), so that I could understand the context in which each of my primary source documents emerged. Throughout, I tried to base claims on substantial evidence—not quantitative evidence, but evidence found in repeated words and themes within each source document. Often, I relied on readers, like my chair and fellow students, to help me broaden my knowledge of history and hermeneutics and develop clear, well-reasoned conclusions. In the end, I felt as though I had a firmer grasp on the historical development of trauma-related diagnoses and their inf luence on our present era, and I thought

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I had succeeded in illuminating some of the advantages and disadvantages of the diagnosis of PTSD. Whether this is a fitting interpretation, I cannot say for sure. I leave that for a reader’s critical examination.

Findings: Hypothesis and Themes In my dissertation, I explored the hypothesis that the diagnosis of PTSD, as conceptualized in the present era, captured an essential idea or feeling in Western culture. This hypothesis suggested that our ideas about trauma could potentially ref lect something about us as human beings—that the diagnosis of PTSD might be able to tell us something about the “self,” or what it means to be human at a particular time and in a particular place. This hypothesis was based on the idea that clinical literature can be considered a cultural artifact, both ref lecting and essentially reinforcing the existing social framework (Cushman, 1995; Logan, 1987). Essentially, I set out to examine the historical, cultural, and political interactions between concepts of trauma and Western society. I explored trauma-related conditions from four different historical eras, and unsurprisingly, our beliefs about trauma have indeed depended upon the cultural and historical context in which they appeared. I described and analyzed the emergence of conditions such as “soldier’s heart” (Da Costa, 1874), “railway spine” (Erichsen, 1882), and hysteria (Charcot, 1887; Freud, 1896/1962; Janet, 1907), to shell shock (Myers, 1915; Mott, 1919), traumatic neurosis (Freud, 1915/1966; Kardiner, 1941), and finally PTSD (Herman, 1992a; Horowitz, 1999). I analyzed conceptualizations of trauma from the earliest recorded diagnosis to the most current information available in the late-20th century. Fourteen specific texts were chosen to represent one of the four eras examined; each was considered “seminal” or highly inf luential in its particular time period. In other words, texts were selected based on the importance accorded to the author, and the work by medical, academic, and mental health groups, and an argument was made regarding the inclusion of each. For example, one text selected to represent the Victorian Era was On Concussion of the Spine by John E. Erichsen (1882). In his time, Erichsen was an important and wellknown figure in medicine. He has been referred to as one of the first to scientifically describe trauma as a cause of psychological problems, specifically in his conceptualization of “concussion of the spine,” colloquially known as “railway spine” (Weisæth & Eitinger, 1991, p.  1; Brown, 1995, p.  502). Erichsen was an English surgeon, a professor emeritus of clinical surgery at the University College Hospital in London and a former president of the Royal College of Surgeons of England as well as the Royal Medical and Chirurgical Society. His early lectures on the topic, entitled On Railway and Other Injuries of the Nervous System, were published first in London in 1866 and then re-published in the United States (Weisæth & Eitinger, 1991). These lectures were said to be “very inf luential” in the late 1800s and to have “had much inf luence on

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contemporary medico-legal thinking” (Trimble, 1981, p.  9). Brown (1995) reported that the “growing frequency and importance of railway litigation” that accompanied the expansion of railroads and increase in passenger rail travel during the late 19th century made Erichsen’s work quite well known in public and legal spheres (p. 502). In 1882, Erichsen added eight new lectures to his original series on railway injuries and then published On Concussion of the Spine: Nervous Shock and Other Obscure Injuries of the Nervous System in Their Clinical and Medico-Legal Aspects in 1882; historians and trauma researchers considered this text highly inf luential (Trimble, 1981, p.  9; Figley, 1985, p.  8; Brown, 1995). Given that “railway spine” was one of the earliest conceptualizations of a trauma-related condition and that it was well known in the medical and legal systems as well as in the public, Erickson’s final, comprehensive text was selected for the analysis. Similar reasons were compiled for each text chosen. Each era was represented by a variable number of texts due to varying available conceptualizations, and as many texts as possible were included. Four authors and a total of six individual texts represented the Victorian Era; aside from Erichsen, works from Jacob M. Da Costa (1874), Sigmund Freud (1896/1962) and Jean M. Charcot (1887) were chosen due to their inf luence on the study of trauma. Four authors were selected to represent the era of World War I: Pierre Janet (1907), Frederick Mott (1919), Charles S. Myers (1915), and Freud (1915/1966). These authors were linked with the conditions of hysteria, shell shock, and traumatic neurosis, respectively. The era encompassing World War II and the Vietnam War was represented by two authors, Abram Kardiner, whose comprehensive treatise on traumatic neuroses of war has been said to have “essentially defined PTSD for the remainder of the 20th century” (van der Kolk, McFarlane, & Weisaeth, 1996, p.  57), and Robert J. Lifton, a researcher long associated with the acceptance of PTSD in psychiatric nomenclature (Herman, 1992b). For the late 20th century, two authors were again selected: Judith Lewis Herman and Mardi J. Horowitz, contemporary “giants” in the study of trauma. Although the number of texts selected was large for this type of qualitative study, Benner (1994) and others have suggested that multiple texts from a variety of sources are helpful and desirable to more reliably observe meanings and patterns. At this point, I feel I must stop to warn you, dear reader and potential hermeneutic investigator, that my dissertation was long—a full 709 pages, with references. This was not my simple quantitative write-up; it was a labor of perseverance and a struggling with ideas and approaches that were unfamiliar. And while I encourage you to read the entire work, of course, I shall skip to page 661 for you and summarize the concluding themes of this interpretive, hermeneutic investigation. Some resulting themes were more surprising than others. For example, most trauma theories and treatments demonstrated a lack of appreciation for differences among individuals; while troubling, this theme seemed unsurprising to me. A few theories, those of Robert J. Lifton (1973) and Judith Lewis Herman

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(1992a), considered the importance of gender and developed social critiques related to the particular experiences of women, but considerations of ethnicity were effectively absent. Another recurring theme involved the association between trauma and a transformation of personal identity. The idea that trauma has an impact on one’s identity was raised by half of the fourteen texts, again, perhaps not surprisingly, as many trauma survivors themselves describe transformations or changes in their sense of self or identity. However, only Lifton (1973) examined this idea critically and politically, describing the self of veterans to be unstable and fragmented, with a capacity for change. More surprisingly, another theme involved the absence of emotional suffering in almost all texts. Most authors tended to ignore, discount, or trivialize emotional suffering; even in more recent texts, emotions were considered as byproducts of cognitions or hindrances to cognitive processing. Lifton (1973) appeared to consider only certain emotions (rage and guilt; fear and terror) in any depth. Only Herman (1992a) described a full range of potential emotional reactions to trauma, placing importance on many different emotional experiences, from terror to rage to grief, in both her conceptualization and treatment. Other themes, particularly when considered together, were disturbing and led to conclusions regarding trauma and power. Perhaps most troubling to me was that sufferers of trauma did not tend to receive help, relief, or even compassion from theories and treatments, but that those in power tended to experience multiple benefits, consistently in every era. In twelve out of fourteen texts, there was a disturbing absence of actual help for sufferers of trauma; “help” was defined as both tangible and intangible benefits for sufferers, from compensation or respectful treatment to improvement in symptoms, relationships, or behaviors. Most authors at least stated that helping patients was a goal, but I looked for evidence of said “help” in transcripts, descriptions of outcomes, and case examples. Past theories, like those of Charcot (1887) or Janet (1907) placed little to no importance on treatment or help for patients; problems related to trauma were considered incurable, and emphasis was placed predominantly on observation. Wartime theories, such as those of Da Costa (1874), Myers (1915), and Mott (1919), emphasized brief treatments that returned soldiers to battle and effectively precluded military discharge or compensation. Some theories (Freud, 1896/1962; Freud, 1915/1966; Horowitz, 1999) described treatments, but offered no evidence or examples of patient improvement or relief. Only Lifton (1973) and Herman (1992a) demonstrated evidence of improvements, benefits, and changes for patients due to treatments or interventions. Consistent benefits, however, were afforded to groups and institutions in power in every era. Soldiers were returned to battle and workers returned to employment as rapidly as possible; patients were observed and symptoms were classified; all while reactions to trauma were trivialized, disparaged, or ignored. Treatment was restricted, soldiers were not released from service, and sufferers were not compensated. Thus, psychological and psychiatric theories supported

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existing arrangements, particularly those arrangements that benefitted the military, industry, and the scientific establishments—those arrangements that met stated or unstated military, capitalistic, and individualistic goals. This theme occurred practically without exception, and my conclusion was that trauma theories have both supported and perpetuated existing power imbalances and potentially oppressive practices, rather than questioning or changing practices in order to help those in need. Even Lifton’s “rap groups,” meetings of veterans that did challenge political problems with the Vietnam War and criticized existing, ineffective psychiatric practices, were eventually subsumed under the Veterans’ Administration, leaving many political issues unquestioned and therapeutic problems unaddressed. The political or social circumstances that caused trauma were unchanged by these trauma theories and treatments. Given the lack of clear help for trauma sufferers, it was important to examine where and when help did occur; this search led to a conclusion regarding political or contextual awareness in the trauma theories and texts. Fundamentally, it appeared from this analysis that the degree of political awareness evident within the theory was directly related to the level of help that sufferers received. For example, Lifton (1973) stated unequivocally that the veterans’ problems were a clear result of the circumstances and unique experiences associated with the Vietnam War and with characteristics of US culture. He argued that anger, disconnection, and “caricatured maleness” led to the severity of their symptoms in many cases. Lifton’s writings showed ample evidence that the veterans who considered these political and social causes with him in the rap groups experienced increased insight, improved relationships, and symptom reduction. Similarly, Herman (1992a) utilized a feminist model to examine issues of power, relatedness, and emotion, and she directly addressed the domination of women in abusive relationships and the responsibility of society for traumas. Herman (1992a) also argued that political and social forces have changed the study and the treatment of trauma over history. And, like Lifton, Herman’s text provided substantial documentation of patient improvement in emotions, intimate relationships, and behaviors. The degree of help that trauma sufferers received also seemed linked to a related factor—the sharing of experiences and a sense of connection within the political or social realm. Lifton (1973) and Herman (1992a) were unique in that both recommended some form of political activity as part of their recommended treatments. While such activity could involve simply gathering in groups to discuss shared experiences, survivors of trauma also met to seek justice or to work toward political/social change. Group therapy and shared experiences were key parts of treatment for these authors, and again, substantial evidence was provided that these groups or gatherings resulted in clear help, symptom reduction, and various improvements. Political activities seemed to provide a unique opportunity for sharing experiences with others and set against the backdrop of the individualistic, disconnected Western lifestyle described by several authors

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and historians (Bauman, 2005; Cushman, 1995; Lears, 1983), and I suggested that such group treatment or activity (whether recognized as political) may offer a sense of community and belonging in a society that tends to offer mostly shallow, inauthentic connections to others. In other words, groups that are formed around shared experiences such as trauma may offer deep connections that are difficult to find in everyday, Western culture. Given that my initial interest in the topic of trauma was related to its cultural popularity, I attempted to explore some ways that trauma and identity might be intertwined, at least in the beginning of the 21st century. Although many texts linked trauma to changes in personal identity, one research goal was to consider what the conceptualizations of trauma could suggest about the self in Western society—in other words, how ideas about trauma may ref lect ways of being in Western culture. One interpretation was based on the assumption that individuals in Western culture are engaged in constant, sometimes frantic efforts to develop a sense of identity, or that individuals may struggle with developing a sense of self in a modern, consumer-oriented society with a preference for interchangeable, disposable identities. These ideas are described in the theories of the empty self (Cushman, 1990), a self focused on consuming products, services, or drugs in order to find and form an identity, as well as the more recent multiple self (Cushman & Gilford, 1999), a self focused on selecting and discarding aspects of identities in order to form a new identity. Similarly, Bauman (2005) suggested that individuals may continually search for an “identity badge or token needed to bring their selves up to date” (p. 34). On the basis of this assumption, I suggested that the identity of trauma victim might either fill an empty self temporarily or might offer an aspect of a multiple identity. When a diagnosis is used to explain all problems or experiences, this may be a modern attempt to define oneself. Theories of trauma may be complicit in this dynamic, offering a scripted route to a new identity or a simple explanation for life struggles. For example, Horowitz’s trauma theory stated that a traumatic experience is discrepant with a person’s previously held beliefs (or schemata) and that such a discrepancy should be resolved and the traumatic memory stored, with the individual returning to “ordinary” (p. 5). However, such a treatment approach offers a mechanistic, simplistic path for recovery; perhaps previous beliefs should be questioned and changed and the meaning of the traumatic event for the individual’s sense of self should be considered in depth. A mechanistic approach fits well within a managed care environment, which values efficiency but offers limited, superficial help for patients (Cushman & Gilford, 2000). Mechanistic approaches to treating trauma—those that reduce PTSD to problems in cognitive or brain processing and view the disorder as treatable with short-term techniques and medications—may offer some immediate relief but do not allow for any exploration of the sociopolitical causes of suffering or the sociopolitical arrangements that may support continued traumatic circumstances.

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Clearly, there were limitations to this study, as with any study. A hermeneutic study makes connections and interpretations that “are never fixed or certain, always tentative and partial” (Bracken, 2002, p.  206). Although the texts selected were considered special and important works, I might have chosen other texts, or more texts, as historical sources. My study did not examine lesser-known works with potentially less traditional approaches to treatment, such as Summerfield’s (2004) examination of trauma in international refugees. Attempts were made to support all claims and interpretations with ample evidence from the texts and from quality sources, but others may find fault, reasonably, with any of these.

Looking Back: Reflections on a Hermeneutic Dissertation Although it is difficult to summarize the impacts of my dissertation process, there are a few thoughts that have come to me when writing this chapter. To preface, I have not made a career in the treatment of trauma. I have not continued to conduct research, either quantitatively or qualitatively. Instead, I became a teaching faculty member at a large public university. This was a career path I had not planned, but my career path changed dramatically after having children. When I decided to return to work, I wanted a part-time job that allowed me ample time with my family. When someone suggested teaching an undergraduate class, I took the opportunity, thinking it might be a “foot in the door” to a clinical or research career. But once I stood in front of my first class of 434 students, I was hooked. (First scared, then hooked.) I had not realized I loved teaching! Sharing my love of psychology was joyously fun. Students were bright and hilarious and maddening and delightful—sometimes all of these at the same time. Because hermeneutics changed the way I thought about research, it also changed the way I taught about it. I remain a lover of the scientific method, but I gained a different perspective on some of its f laws, limitations, and vulnerabilities. My students learned in depth about the scientific method (from me and from others—it is, of course, standard undergraduate fare); I emphasized it as one very important way of trying to know about things. But I also acknowledged that the traditional research of science is but one way of learning about the world and that it is f lawed. I taught my students that traditional research may be f lawed in all the ways that are covered in textbooks, of course—problems such as experimenter expectancies or confirmation bias—but I also introduced the idea that research of any kind may be potentially f lawed in a more opaque, contextual sense, that it is vulnerable to political, social forces. To illustrate this in small ways, I provided students with critiques of ongoing research. Students were particularly surprised, for example, by the work of Irving Kirsch on antidepressants (e.g., Kirsch et al., 2008) and Gary Greenberg (2013) on psychiatric diagnosis. While I taught that the scientific method is extremely valuable,

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I wanted my students to realize that science is subject to biases and larger social and political forces that may impair our ability to see problems clearly and to act in the world around us. Many authors and researchers have critiqued the current model of traditional scientific research, describing its f laws and failures. Bauerlein, Gad-el-Hak, Grody, McKelvey, and Trimble (2010) decried the “avalanche of low-quality research” due to young researchers being trained on a publishing treadmill and suggested that the current research model results in researchers who become “cynical about the higher ideals of the pursuit of knowledge” (para. 14). Rajasekaran (2012) also lamented the “treadmill of the numbers game” and noted that fraud, plagiarism, and retractions have become far more common due to low-quality research (p. 7). Aschwanden (2015) authored a comprehensive analysis of the many ways that science appears “broken,” including the practice of p-hacking, fabrication of data, perverse incentives to publish, and absent self-correction of errors. In addition, many researchers have been disturbed by the recent inability to replicate landmark studies, some long assumed to be fundamental to psychology (Open Science Collaboration, 2015). Aschwanden (2015) concluded that science is not broken, but that we need to reduce our expectations of it. Science is difficult, requires more careful attention to details, and is only “our best approximation of the truth” (part 3, para. 2). Science is also “low-yield,” uncertainty is inherent, and biases are rampant (part 3, para. 5). We must respect the failures of science and try to examine the biases that create them. Above all, we must remember that “Human fallibilities send the scientific process hurtling in fits, starts and misdirections instead of in a straight line from question to truth” (part 3, para. 12). Aschwanden’s (2015) conclusions are quite reasonable and sane, and yet I wonder why alternative approaches to understanding, such as hermeneutic interpretation, are not considered valuable in research, particularly when they may address some of the broadest and most inf luential of human fallibilities. Why not add and value investigations that involve in-depth considerations of political, historical, and social forces, since those may be the very forces that might illuminate our biases and provide new ways of thinking about and addressing problems? Given that hermeneutic investigations have biases just as traditional research does and that these are often addressed more directly in hermeneutics, this more qualitative, interpretive approach seems to add depth and meaning to an increasingly superficial field. Hermeneutic investigation may also help us to realize when traditional science is failing us; I would contend that is the case for PTSD and trauma diagnoses. Recent data have indicated that PTSD continues to have low treatment efficacy rates coupled with high dropout rates and that the disorder varies greatly among individuals (Hendriks, De Kleine, & Van Minnen, 2015). Given the recent scandal of negligence within the Veterans’ Health Administration, treatment for trauma sufferers does not show signs that it is improving despite

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continued research (Griffin, 2014). Still, sufferers struggle to receive adequate help for trauma conditions, and the powerful institution remains effectively unchanged (Philipps, 2015). The conclusions I came to in my dissertation seem to continue to apply. Soldiers are returned for multiple tours of duty despite research demonstrating the increased risk associated with the practice (Xue et  al., 2015); rape kits are absent and/or not processed so that perpetrators are not brought to justice (Spohn, 2016). The political and social forces associated with continued and increased trauma remain unquestioned. My dissertation led me to many understandings, realizations, and questions— not only about trauma diagnoses but also about research and science more generally. It left me with the belief that there are many paths to knowledge and with the compass-like idea that I will try to follow a path that is paved with both evidence and meaning. Both evidence and meaning may be found by the scientific method, of course, but even its most avid supporters acknowledge that meaning is also frequently obscured in science despite our best efforts. Hermeneutic investigations offer a potential alternative, since they can also provide a form of evidence as well as deep, reasoned meanings. If we acknowledge that research will not create a single, straight path from questions to answers, why not support many paths?

References Aschwanden, C. (2015, August 19). Science isn’t broken. Retrieved from https://fivethirty eight.com/features/science-isnt-broken/ Bauerlein, M., Gad-el-Hak, M., Grody, W., McKelvey, B., & Trimble, S. W. (2010, June 13). We must stop the avalanche of low-quality research. The Chronicle of Higher Education. Retrieved from http://chronicle.com/article/We-Must-Stop-theAvalanche-of/65890/ Bauman, Z. (2005). Liquid life. Cambridge: Polity Press. Benner, P. (Ed.). (1994). Interpretive phenomenology: Embodiment, caring, and ethics in health and illness. Thousand Oaks, CA: Sage Publications. Bracken, P. (2002). Trauma: Culture, meaning and philosophy. Philadelphia, PA: Whurr Publishers. Brown, E. M. (1995). Post-traumatic stress disorder and shell shock: Social section. In G. E. Berrios & R. Porter (Eds.), A history of clinical psychiatry. New York: New York University Press. Charcot, J. M. (1887). Lectures on the illnesses of the nervous system, delivered at La Salpetriere (G. Sigerson, Trans.). Philadelphia, PA: Lea. Cushman, P. (1990). Why the self is empty: Toward a historically situated psychology. American Psychologist, 45, 599–611. Cushman, P. (1995). Constructing the self, constructing America: A cultural history of psychotherapy. Reading, MA: Addison-Wesley Publishing Company, Inc. Cushman, P., & Gilford, P. (1999). From emptiness to multiplicity: The self at the year 2000. Psychohistory Review, 27, 15–31. Da Costa, J. M. (1874). On strain and overaction of the heart (Smithsonian Miscellaneous Collections, 279, the Toner Lectures, Lecture III). Washington, DC: Smithsonian Institution.

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Erichsen, J. E. (1882). On concussion of the spine: Nervous shock and other obscure injuries of the nervous system in their clinical and medico-legal aspects. New York: Birmingham. Figley, C. R. (Ed.). (1985). Trauma and its wake: The study and treatment of post-traumatic stress disorder (Vol. I). Washington, DC: Brunner/Mazel, Inc. Freud, S. (1962). The aetiology of hysteria. In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 3, pp. 189–221). London: Hogarth Press (Original work published 1896). Freud, S. (1966). Fixation to traumas—The unconscious. In J. Strachey (Ed. & Trans.), Introductory lectures on psychoanalysis (pp.  338–353). New York: W.W. Norton & Company (Original work published 1915). Greenberg, G. (2013). The book of woe: The DSM and the unmaking of psychiatry. New York: Blue Rider Press. Griffin, R. J., Acting Inspector General. (2014, May 28). Interim report: Review of patient wait times, scheduling practices, and alleged patient deaths at the Phoenix Health Care System. Washington, DC: VA Office of Inspector General, Veterans Health Administration, Dept. of Veterans Affairs. 14-02603-178. Hendriks, G. J., De Kleine, R., & Van Minnen, A. (2015). Optimizing the efficacy of exposure in PTSD treatment. European Journal of Psychotraumatology, 6. https://doi. org/10.3402/ejpt.v6.27628 Herman, J. L. (1992a). Trauma and recovery: The aftermath of violence—from domestic abuse to political terror. New York: Basic Books. Herman, J. L. (1992b). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 3(1), 377–391. Horowitz, M. J. (Ed.). (1999). Essential papers on posttraumatic stress disorder. New York: New York University Press. Janet, P. (1907). Lecture I: The problem of hysteria. In P. Janet,  The major symptoms of hysteria (pp. 1–21). New York: Macmillan Publishing. Kardiner, A. (1941). The traumatic neuroses of war. In F. Dunbar (Ed.), Psychosomatic medicine monographs (Vol. II–III). Menasha, WI: The George Banta Publishing Company. Kirsch, I., Deacon, B. J., Huedo-Medina, T. B., Scoboria, A., Moore, T. J., & Johnson, B. T. (2008). Initial severity and antidepressant benefits: A meta-analysis of data submitted to the Food and Drug Administration. PLoS Medicine, 5(2), e45. Lears, T. J. J. (1983). From salvation to self-realization: Advertising and the therapeutic roots of the consumer culture. In R. W. Fox & T. J. J. Lears (Eds.), The culture of consumption. New York: Pantheon Books. Lifton, R. J. (1973). Home from the war—Vietnam veterans: Neither victims nor executioners. New York: Simon & Schuster. Logan, R. (1987). Historical change in prevailing sense of self. In K. Yardley & T. Honess (Eds.), Self and identity: Psychosocial perspectives (pp. 13–26). Chichester: Wiley. Marsella, A. J., Friedman, M. J., Gerrity, E. T., & Scurfield, R. M. (Eds.). (1996). Ethnocultural aspects of posttraumatic stress disorder: Issues, research, and clinical applications. Washington, DC: American Psychological Association. Mott, F. W. (1919). War neuroses and shell shock. London: Oxford University Press. Myers, C. S. (1915). A contribution to the study of shell shock. Lancet, 1, 316–320. O’Brien, L. S. (1998). Traumatic events and mental health. Cambridge: Cambridge University Press. Open Science Collaboration. (2015). Estimating the reproducibility of psychological science. Science, 349(6251), aac4716.

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Philipps, D. (2015, April 22). Few people lost jobs with V.A. in scandal. The New York Times. ISSN 0362–4331 Rajasekaran, S. (2012). Publish to f lourish: Is it corrupting science? Bone & Joint 360, 1(4), 5–7. Spohn, C. (2016). Untested sexual assault kits: A national dilemma. Criminology & Public Policy, 15, 551–554. Summerfield, D. (2004). Cross-cultural perspectives on the medicalization of human suffering. In G. M. Rosen (Ed.), Posttraumatic stress disorder: Issues and controversies (pp. 233–246). Chichester, West Sussex: John Wiley & Sons, Ltd. Trimble, M. R. (1981). Post-traumatic neurosis: From railway spine to the whiplash. Chichester: John Wiley & Sons. van der Kolk, B. A., McFarlane, A. C., & Weisaeth, L. (Eds.). (1996). Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York: The Guilford Press. Weisæth, L., & Eitinger, L. (1991). Research on PTSD and other post-traumatic reactions: European literature. PTSD Research Quarterly, 2(2), 1–7. Xue, C., Ge, Y., Tang, B., Liu, Y., Kang, P., Wang, M., & Zhang, L. (2015). A metaanalysis of risk factors for combat-related PTSD among military personnel and veterans. PLoS ONE, 10(3), e0120270.

6 FEELINGS OF ENLIGHTENMENT Emotion-Focused Therapy’s Scientific Cloaking of Enlightenment Values1 Alex A. Gomez

In 2005, I attended a master’s degree program in clinical psychology with a specific focus on humanistic psychology because I was enamored with its theory. It’s insistence on removing barriers to one’s innate authentic self just felt right! Ideas about realizing potential were compelling and exciting. Ideas about how external impositions impede one’s innate authenticity resonated. It set the scene for me to be the kind of therapist I envisioned being; a caring and nurturing type, helping others to feel special, cared for, and free. A theory like emotionfocused therapy (EFT), pioneered by Leslie Greenberg (2015), appears to be a required evolution of humanistic theory, in order to bring humanistic concepts into the age of evidence-based treatments. However, I was also critical of mainstream cultural ideologies. Inf luenced by Erich Fromm (1941/1994), I developed language for my sense that American individualism encapsulated toxic and contradictory ideals. It was not until a history of psychology course, and then a series of hermeneutic psychology and research courses, that I realized this type of scrutiny could and should also be applied to the theories of psychotherapy, including those taught in the training programs I attended and was attending. My dissertation was a ref lection on my own clinical journey from a humanistic therapist to a therapist that embraced relational and hermeneutic concepts. I decided to critique a current humanistic theory, embedded with current evidence-based perspectives. Greenberg (2015) labeled EFT a “neo-humanistic” therapy. Ultimately, this critical interpretation of implicit assumptions, which were camouf laged within Greenberg’s EFT, was a critical and transformative ref lection of my own foundational implicit theoretical assumptions and their development throughout my training. I felt some sadness in challenging my idealistic vision of humanistic psychotherapy, yet I was motivated to take on this project for several reasons and DOI: 10.4324/9781003140177-7

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I have enjoyed the impact on my perspective and clinical practice. I saw the grip of evidence-based treatments that conceptualize humans as self-contained, acontextual machines with either functional or dysfunctional equipment as narrowing psychotherapists’ view of human struggle. Also, by the time I began this study, I already began embracing contextual theories of psychotherapy. However, hermeneutics does not necessarily advocate for throwing the baby out with the bathwater. In the end, the therapist that I am becoming is the integration and synthesis of all of my knowledge, training, practice, and being. I still find myself providing nurturing, person-centered care, while also helping my patients to see their struggles in the light of family, relationships, culture, history, and ideologies.

Values In my dissertation, I used a hermeneutic approach to historically situate Greenberg’s Emotion-Focused Therapy: Coaching Clients to Work Through Their Feelings (EFT). I interpreted Greenberg’s EFT (Greenberg, 2015) by drawing on the framework of Charles Taylor’s (1989) perspective on Enlightenment era philosophy and its impact on modern self hood, although several other cultural– historical theorists were relied on as well. Within this framework, I found that EFT obscured assumptions, values, and ideologies that stemmed from the Enlightenment era—particularly those advanced by Descartes, Locke, Kant, Rousseau—by using evidence-based, neuroscientific, and neohumanistic frameworks. According to Greenberg, emotions are meant to guide people to adaptive and productive actions and choices that promote overall well-being. Greenberg perceives emotions as evolutionary, universal, and action-mobilizing mental messages about the needs of the person that are generated from the limbic system. Emotions inform individuals of their innate adaptive tendencies toward growth. Learning to express and interpret emotions leads one to grow properly, be adaptive, and be healthy. The neutral and strategic EFT therapist instrumentalizes interpersonal behaviors such as empathy, genuineness, and collaboration in an effort to help clients undergo a nine-step therapeutic process resulting in the full realization, regulation, and adaptive use of their emotions. In my dissertation, I followed a commonly used social science approach by introducing the topic of research, stating the problem, describing the study, proposing questions to guide my research, and explaining the theoretical framework used. I also described my own path from humanistic clinical foundations to the adoption of relational and hermeneutic principles. Next, I reviewed the importance and the scope of sociocultural and hermeneutic examinations of implicit assumptions in mainstream theories, introduced Greenberg’s EFT text, and reviewed the EFT research. The literature review found that proponents of this theory (e.g., Auszra, Greenberg, & Herrmann, 2013; Sutherland, Peräkylä, & Elliott, 2014; Ribeiro et al., 2014) claimed to use objective scientific

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measures and were predominantly focused on outcomes, theory building, and methods testing. Their studies did not include ref lections on moral values or assumptions around which their theories were built. This absence indicated a gap in the literature that my study could address. I then described how I had gone about interpreting EFT hermeneutically, and finally, I presented my interpretation of Greenberg’s text. Greenberg’s depiction of emotion as a messenger of inner truths that generate from within self-insulated individuals then require instrumental rational management for their realization. In other words, I came to realize that EFT, despite its claim to be a purely objective scientific process, is among other things a ref lection of the prominent ideologies, values, and moral assumptions of the Enlightenment era. In this chapter, I suggest some of the broader consequences of unacknowledged and unarticulated assumptions in EFT and mainstream psychological theories beyond EFT. Greenberg’s EFT theory is compelling and proposes a creative approach to managing personal struggles in a Western individualistic society. It has not been my intent to discredit his theory or to undermine the salience of his theory; however, I would frame EFT differently. I believe Greenberg’s EFT can be effective at providing clients with a way to navigate a sociocultural system of individualistic values and expectations. In fact, as a therapist, there are many proposed interactions in his text that I employ quite naturally with my patients. On the one hand, this is likely due to my training in humanistic and integrative therapies; on the other hand, this is because the ideals that shaped EFT are part of the cultural clearing in which mine and my patients’ ideals have been shaped. But is helping people to uncritically adapt more f luidly to their social norms, rather than to recognize and challenge these norms, the best our practice has to offer? Despite the way EFT seems to fit my patients and myself so well, I also question this fit and wonder why it feels so natural to me. What I find unsettling about EFT is the one-sided emphasis on individual subjective experience and mental mechanisms and its claim to a universal, scientifically objective truth. I hold the unexamined Western values in this therapy to a critical light.

My Hermeneutic Process A hermeneutic approach to research (see, e.g., Gadamer, 1989; Richardson, Fowers, & Guignon, 1999; Stigliano, 1989) allows interpretation of psychological and social phenomena from a contextual, sociopolitical perspective. Hermeneutics has the potential to reveal inf luential relativistic or era- and context-specific values that are hidden within what we commonly accept as universal facts. But they are putative facts that people accept without even thinking about or questioning them. An uncomfortable example might be the way that Nazi Germany attempted to scientifically legitimize the inferiority of Jews. The scientific method applied to human and social phenomena can be used to legitimize what are already commonly held beliefs or, in many instances, the beliefs of those in power. These kinds of distortions have

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commonly been used throughout history for political purposes that have had drastic consequences. An initial step to hermeneutic research is for researchers to examine their own values and pre-judgments. Hermeneutics seemed like a perfect fit for me because of the deconstructionist frame of reference I adopted as early as high school, when I became curious about and began to question conformity. This led me to enthusiastically studying research, theory, and concepts about the intersection of sociology and psychology throughout my academic career, particularly critiques of individualism, capitalism, and Western culture. Predictably, I became wary of the manualized approaches and parochial conceptualizations of pathology and treatment, such as those found in so many of the mainstreamed psychotherapies identified by acronyms that I was forced to digest throughout grad school. I came into this dissertation with the belief that so much of what was accepted as established facts in the field of psychotherapy were only offering a limited, and impoverished, view of human existence and struggle. In addition, I am enamored with the creativity and acknowledgment of mystery in human life contained in analytic, interpersonal, and relational approaches to therapy. They are enlivening and fit my experience of life, and often those of my patients, because some contemporary versions of these theories make less attempts to distort human experience with abstract concepts and emphasize the co-constitutive nature of the therapeutic dyad. I have found hermeneutics to be a thrilling way to perceive the humanity behind our vain attempts to reduce life to objectively comprehensible and predictable formulas. Aspects of hermeneutics seemed apparent to me when embarking on my dissertation, yet I f loundered for some time to truly grasp a way to apply it. Through my initial readings and recommendations from my chair, Philip Cushman, I was eventually redirected to Sources of the Self by Charles Taylor (1989). It was after taking a deeper dive into this text that ways of applying hermeneutics to my topic slowly began to make sense. However, at the outset of my research, it was almost as if I believed by reading back and forth between Greenberg’s text and other sociocultural critiques that ideas would magically spring to mind. By the time you reach the end of this chapter, you might understand this kind of thinking to be a product of the kind of Enlightenmentera thinking I had set out to critique! Fortunately, over time, I came to realize that the process is a bit more involved than that, particularly involving the perspectives of the researcher’s critiques and/or historical perspectives more directly to the reading of the text being interpreted. For example, many answers (for lack of a better term) came directly from Taylor’s book or so it seemed. But I came to realize it was my interpretation of Taylor applied to Greenberg that fueled my critique. The experience of it felt much like having a conversation with Taylor about Greenberg, or as Louis Sass (1988, p. 250) and Dr. Cushman (1995, p. 23) put it, reading over the shoulder of Taylor, or whichever author I was drawing from at the time.

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When I began, I did not realize I would be situating EFT historically within Enlightenment philosophy or drawing so heavily from Taylor. The process before embracing Taylor felt like a searching or wandering. By having absorbed Taylor’s ideas, I could see how an EFT concept fit within an Enlightenment frame of reference. For example, Greenberg’s concept of emotion schemes echoed Kant’s creation of internal structures. Greenberg drew from scientific research to present emotion schemes nearly as some sort of factual structure in the brain. Yet, it was clear such ideas emerged during the Enlightenment period, which saw the transition from a medieval perspective of humans as players in a larger cosmic picture, to an Enlightenment framework of humans as unique, decontextual, and self-contained sources of knowledge and purpose. I continued to apply Taylor and other writers to Greenberg’s EFT text in this fashion. Many of the additional readings served to reinforce my interpretations, and I then developed themes based on my interpretations. Many times, I moved in a circular fashion between the texts, learning which ones to keep and which ones to let go, and eventually themes began to surface and solidify. I retained and developed the interpretations or themes that had strong textual support. From there, I concluded that particular EFT concepts promulgate Enlightenment-era ideas, while at the same time disguising those values as scientific truths. The themes are (1) The Reduction and Reification of Emotion as a Basic Building Block of the Mind; (2) The Emotional Brain and Interiorized Emotion; (3) Emotion Scheme and the World Inside Our Brain; (4) Immunity from Cultural Inf luence; (5) Emotion Transformation as a Return to Grace; (6) Internal Guide and the Voice of Nature; and (7) Uniting the Expressivist and Instrumental Stance. Due to limitations of space, I do not reproduce here the specific textual examples that moved me to create those themes. Instead, in what follows, I interpret the themes, hoping to convey their cumulative and larger meanings for therapists and for the society as a whole.

Emotion as Inner Truth and Its Rational Realization In this study, Greenberg’s EFT was interpreted predominantly with the help of Taylor’s perspective of Enlightenment-era philosophy and its impact on modern self hood as well as many other writers. Within this framework, I came to realize that EFT enshrouds assumptions, values, and ideologies that stemmed from the Enlightenment era—particularly those advanced by Descartes, Kant, Rousseau—within an evidence-based, neuroscientific, and neohumanistic framework.

Mind–Body Split Drawing from Sampson’s (1981) critique of cognitivist theory, EFT’s conceptualization of emotion as a basic building block of the mind and as an

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integral component of a psychological structure was interpreted as an example of mainstream cognitive psychotherapy theory’s reification and universalization of internal psychological structures and units. These structures and units were thought to be separate from and in control of the material world and in fact produced the individual’s reality. This cognitivist vision was a product of the Cartesian mind–body dualism and Kant’s transcendental ego, concepts that ref lect individualist and subjectivist ideas. Writers such as Sampson (1981), Cushman (1991), Richardson et al. (1999), and Taylor (1989) argued that reinforcing subjectivist and individualist ideologies have the effect of putatively relieving one from being beholden to the will of others and external authority while bolstering personal agency. Hence, they ref lect the values of personal freedom, self-determination, unique thinking abilities of the individual, and the importance of subjective experience. Concealing these values within a scientific framework justifies an approach to psychology that gets taken seriously by the academic and medical communities, because it can explain what goes wrong in people with a putative scientific certainty (Gergen, 2015; Sarason, 1981). However, an overemphasis on abstracted and internalized psychological concepts has resulted in an exaggerated belief in the powers of individual will and the extent of self-responsibility while deemphasizing, in fact nearly excluding, discussions of values and the way that political systems, power imbalances, and relational dynamics can contribute to ways of life that are oppressive and undesirable.

Structures in the Mind as Sources of Truth and Goodness Taylor (1989) contended that a defining consequence of Enlightenment philosophy was locating sources of the good, such as moral guidance and a sense of identity, within the individual. Hermeneuticists and like-minded critics of mainstream psychotherapy argued that mainstream theories of psychotherapy are embedded with Enlightenment-era values that exalt the interior of individuals. Similar to how Descartes located certainty within the mind and exalted the mind’s dominion over the world of objects (including the body), Greenberg located emotions and emotional processing, which he portrayed as the primary source of good inside the brain, and one’s ability to use other mental resources, such as instrumental rationality, as the vehicle for gaining dominion over one’s life and the ability to adapt to the world. And all this was justified by the use of a scientific warrant. Greenberg’s more specific construct of Emotion Schemes exemplified how subjectivist and individualist reductions and a form of Kant’s structuralism are entrenched within cognitive therapy (Burston & Frie, 2006; Sampson, 1981; Taylor, 1989). An Emotion Scheme represents a constellation of memories, sensations, cognitions, perceptions, and feelings that activate simultaneously when associative stimuli are perceived (Greenberg, 2015, p.  48). A Scheme’s

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precognitive and non-transparent nature and its description as a mediator between the material world and the internal world likened the construct to Kant’s mental structures, or transcendental ego (Kant, 1781/1999). Unlike Kant, Greenberg privileged emotions over reason as a source of identity and moral guidance; however, Greenberg’s insistence on the necessity of reason to make the best use of emotion aligned him with Kant and with some rationalists from the Enlightenment era. Also, like Kant, Greenberg insisted that employing rational control resulted in a type of freedom by living in accordance with what one was intended to be. Locating sources of the good inside the individual, such as within the brain or the type of internal constructs put forth by Greenberg, ref lected Christianinf luenced Western philosophy, particularly Rousseau’s (1762/1979) theory that one gets turned away from inner truth by the morally inferior external material world. Taylor described this type of theory as embedded in what Christianity refers to as “The Fall” in the Hebrew Bible’s Book of Genesis.2 Likewise, Taylor postulated that hidden in the narrative of Western philosophers resides a return to grace. Taylor credited Rousseau for locating the source of grace inside of individuals, attributable to their inner nature. Greenberg portrayed what he called “low road” emotions as internal, pure, human responses and were meant to guide one to adaptive decisions that get distorted by bad learning, culture, and social experience. “High road” emotions were depicted as “cognitively derived and culturally inf luenced” (Greenberg, 2015, p.  55). Greenberg argued that being guided by one’s head over one’s heart disconnects one from some sort of Rousseauian truth, albeit in more contemporary terms, much like Maslow’s concept of the actualizing tendency (Buss, 1979). EFT treatment helps individuals unearth the truths from within, Greenberg maintained, which become distorted by culture and relationships and concealed by other layers of emotions.

Reliability of the Inner Voices and Internal Structures In this way, EFT structural formulations such as the Emotion Scheme or “low road” emotions affirm concepts such as the necessity and uncontested nature of human agency, centralize subjective experience, and perpetuate individualistic and subjectivist values. They do so by training patients to orient their attention to their private interior experience for direction and for the ability to regulate, or master, their own emotions through this type of ref lection. However, the continual orienting of the patients’ attention to their emotions also delivers a powerful message about what matters in life, which has the effect of diminishing the significance of the social world, political systems, and external events. Ironically, Greenberg’s portrayal of emotions as innate guides has the effect of navigating clients toward socially acceptable behavior. And yet, the innate internal guidance system is portrayed as being derailed or distorted by outside

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forces. While he did not directly discount the role of culture and relationships in the shaping and regulating of emotion, his emphasis on internal structures downplayed the significance of meaning-embedded situations and undercut the social values that dictate which emotions are most acceptable/desirable in society. This way of thinking that interiorizes moral sources and formulates a gap between one’s mind and social context while minimizing the inf luence of the social world while reinforcing the values of personal freedom and autonomy also consequently increases the perception of personal responsibility. The concept of a “low road,” pure state of emotion, and a “high road,” distorted level of emotion, is not new (it is common Enlightenment-era faire, save for Greenberg’s use of objective science to support those claims). So, paradoxically, at the same time that Greenberg’s theory extolls the power of interior feelings as independent of and the shaper of the external world, his theory is a ref lection of the social narratives and moral understandings of the external world. In addition to freedom and autonomy, the Western importance put on the uniqueness of self, depth of personal identity, and confidence in the credibility of subjective experience are perpetuated in Greenberg’s EFT. These values, rooted in the philosophy of Rousseau (1762/1979) and later Expressivists in general, were ref lected in the techniques and concepts of Greenberg’s “Arriving Phase” of treatment. This phase employs techniques that focus clients on their internal experience in order to guide them in accessing, accepting, verbalizing, and expressing their emotions. This strategy of inward searching to find adaptive feelings and to give them form through expression Greenberg compared to Rousseau’s inward search to hear the voice of nature and to formulate this inner discovery. The strategy also embodied Rousseau’s diminishing of the material world. Sass (1988) noted that the exaltation of subjective experience and the “essential quality of innerness” in humanistic psychology, which appeared to me as a fundamental inf luence on EFT, is rooted in the Romantic philosophy that followed Rousseau (1762/1979, p.  227). In EFT, the justification for its therapeutic processes is biologically based, and what is discovered within the individual is thought to be the individual’s greatest moral truth. Again, the centralizing of subjective experience to the exclusion of the sociocultural realm implies that inner reality provides the most reliable data about human existence, while ignoring the impact of external sources of pain or comfort.

Active Agents Not Social Victims The centralizing of subjective experience to the near exclusion of the sociocultural realm implies that inner reality provides the most reliable data about human existence, while minimizing, or disregarding the impact of external sources of pain, comfort, and moral understandings. The location of problems inside of abstract psychological structures within the individual, the exaltation of subjective experience, the reinforcing of personal agency, and the diminishing of the sociopolitical world result in an enormous degree of perceived and

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expected personal responsibility. One has not only the power to make one’s life the way one desires but also moral obligations become a matter of individual insight and any problems that one experiences are framed as deficiencies of the individual. Greenberg’s adoption and construal of emotional intelligence as an ability indicative of healthy psychological functioning, especially the dimensions of agency and regulation, ref lect efforts originating in the Enlightenment era to combine values from the contradictory positions of Rationalism/Kantianism and Expressivism/Rousseauism. The emphasis on being an active agent and taking responsibility for one’s emotions, and the claim that holding external situations accountable for these emotions is being passive, ref lected the values of self-determination, selfcontrol, and rational instrumentalism brought forth by the likes of Descartes, Kant, and Locke. These philosophers believed the highest good for individuals was for them to construct their own singular realities, thus the blaming of anything outside of the self puts one in the devalued position of being a passive victim. Greenberg’s conceptualization of a healthy adaptive person portrayed a decontextualized, isolated, emotional-rational agent who can instrumentally control, not just his emotions but his life, as part of a process of resetting his emotions back to their natural state. Several writers (e.g., Ryan, 1971; Sampson, 1981) consider this stance to be an example of blaming the victim.

EFT and the Philosophical Conundrum Overall, the unref lected implicit values of EFT including freedom, autonomy, uniqueness of inner experience, self-expression, depth of personal identity, and certitude of subjective experience exemplified an attempt to combine two strands of Enlightenment philosophy, which Taylor (1989) argued should be incompatible based on their contradictions. However, attempts to combine the philosophies of Kant and Rousseau have continued among inf luential institutions from the Enlightenment through contemporary times. I concluded that Greenberg’s EFT ref lected a similar effort. On the one hand, Greenberg’s neohumanistic theory was found to be embedded within the Rousseauan, Expressivist, and Romantic emphasis on innerness and uniqueness and implicitly harbored the values of freedom and individualism. On the other hand, Greenberg’s EFT also ref lected the type of instrumental rationalism and individual agency that was prized by Kant, as well as Rationalists like Descartes and Locke—which paradoxically ref lect values that humanistic psychology had initially pitted itself against. These values ref lect the terrain of contemporary Western society and what Greenberg does is provide individuals with one particular way of navigating one of its primary contradictions by making a better individualist of the individual. By looking at EFT hermeneutically, the problems with these contradictions become apparent. By tuning in to one’s emotions, one is supposed to realize how one should be living. The freedom of constructing a narrative to capture

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these realizations seemed a way to get a handle on this reality that emanated from within the individual. Taking orders from a putatively automatic and natural evolutionary structure, Greenberg explained, does not provide the individual with true autonomy and freedom. These emotional instructions meet rationality in the development of emotional intelligence (EI), particularly in how one regulates one’s emotions and takes responsibility for one’s own feelings and life. However, these rational maneuvers are not included as ways to pursue one’s own preferred ends, but rather to conform one to the forces of adaptivity. The f lexibility must lie in meeting one’s needs in a preferred way or employing EI in the variety of settings in which one chooses to be. However, the overall implication is that being adaptive requires one to be who one truly is, as indicated by the depths of one’s emotional interior. Unfortunately, the belief in being what one was supposedly intended to be does nothing to address differing circumstances that we are all brought into and the different advantages or disadvantages that impact individuals and groups of people throughout their lives. Nor does it question the assumption that some omnipotent design or designer has determined individual essences.

Consequences of Unacknowledged Implicit Values in Psychotherapy Critical psychologists (e.g., Cushman, 1995, 2019; Richardson et al., 1999; Smedslund, 2009) have argued that there are significant consequences to mainstream psychological theories that take their scientific frameworks for granted and do not ref lect more deeply on the assumptions implicit in their theories. Obliviousness to values embedded in one’s theory also will prevent one from understanding how treatments address local and contemporary ills, rather than simply expressing universal and timeless conditions. My dissertation found that a mainstream theory such as EFT unknowingly reinforces and perpetuates current values and the current configuration of the self, which preclude contemplation about how the field of psychotherapy itself contributes to the ills it is responsible for treating. Like the theories brought under hermeneutic examination that were referred to throughout my dissertation, EFT reinforces values of contemporary Western society more than it reveals universal facts about the human mind. Borrowing from Smedslund’s (2009) concept of repetition, while a theory like EFT is determining which emotions are adaptive and maladaptive, and using science to support this claim, in current American society, there are already emotions that are considered good and bad, and expectations about how good emotions should be expressed. These are often the emotions reinforced by EFT, and EFT guides one to express them in a socially acceptable way. However, Greenberg did not acknowledge these emotions as socially desirable or acceptable (with the exception of how they are expressed), but rather that they are scientifically proven superior emotions.

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In EFT, its scientific framework conceals its underlying values. This mode of transmitting values while denying doing so is regarded by Smedslund (2009) as repetition or translation of the language most commonly used for a specific culture of a specific era. For example, Western society typically judges unchecked emotions as bad; when EFT maintains that ref lecting on one’s emotions is scientifically supported, it is reiterating a value that already exists in society. If something sounds familiar about a theory and its premises, if it seems reasonable and correct, it could be that the theory is basically a conceptual translation of common values. Similarly, the belief that repressing emotions can cause psychopathology is a fairly commonly held folk belief often reiterated in the Freudian psychoanalysis (Davis, 2004). Moreover, the idea that one can be guided by what is inside of the self has survived for centuries and has become a strong ideological force in Western society. Greenberg’s description of emotion as a scientifically derived inner guide, then, ref lects the long-held modern-era cultural values of prizing inner experience, unique identity, the good of attuning to one’s inner nature, individual autonomy, and self-control. Westerners already believe in being self-guided and self-responsible. The idea that emotion is the internal guide ref lects a centuries-old scientific cultural project of trying to justify an emphasis on inner experience and autonomy as a factually supported endeavor separate from its socially derived moral dimension. The consequences of this kind of repetition have been argued clearly by the authors mentioned earlier. The overemphasis on one’s individual abilities to draw from inner sources to derive moral guidance, to overcome obstacles, to become what one wants to be, to control one’s self, and to take responsibility for one’s circumstances devalues and disregards the ways the sociopolitical sphere shapes individuals and contributes to their suffering, as well as how individuals can draw from communal sources and moral traditions to find guidance, care, and meaning. One consequence of EFT’s attempt to combine romanticism and rationalism is the shaping or fortifying of problematic contemporary configurations of self that are based on questionable and implicit societal values and ideologies. Cushman’s (1990, 1995) construal of the post-World War II configuration of the self, “the empty self,” suggested that emptiness and its resulting consumerism were heavily integrated with political and economic goals. The Enlightenment project of freeing individuals from external commitments began to leave people isolated and disconnected with a sense of emptiness. But rather than scrutinize how social conditions and values might be contributing to their experience, they were encouraged to fill the emptiness with consumer goods or experiential trends, including psychotherapy, due to ingrained beliefs that selffulfillment is important and a matter of self-responsibility. This inward focus combined with minimizing the social and political spheres can leave individuals to wallow in their own groundlessness while shaping them into a politically docile and compliant population who contribute to the economy through consumer activities aimed at filling the empty self. According to Richardson and

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Zeddies (2001), the modern age is defined by a moral ideal that individuals are self-contained, autonomous, and free from the binds of the past and of obligations to others. However, the break from social ties, traditions, and purposes beyond self-realization leave individuals at risk of being severely alienated and emotionally isolated. Fromm (1941/1994) argued similarly that the freedom Americans experienced was isolating and directionless, prompting individuals to desperately and, at times, blindly conform to groups, ideologies, or movements that were anything from meaningless to dangerous. When the dominant configuration of self is perpetuated, so are the individual and societal problems that are associated with it. Reinforcing the self-contained and self-controlled individual diminishes the inf luences of culture and contributes to people feeling impotent about political engagement and losing what is valuable about traditions. Hermeneuticists describe tradition as a guide that imbues people with knowledge and can orient people with a sense of moral purpose. The loss of community and tradition contributes to the empty self as major losses that need to be replaced by consumer goods, but these losses can also encourage individual conformity to the harmful or questionable values of various institutions or organizations such as dehumanizing political sects or manipulative cults. In my therapy practice, I see teens and young adults conform to groups that have introduced these patients to harmful behaviors that over time devolve into poor coping habits that typically involve activities centered on avoidance and self-soothing. Fromm (1941/1994) believed conformity compromised individual integrity and genuine social bonds. But beyond that, Westerners also experience an absence of guidelines for living that are both pertinent to thriving in the local context and help to confront the vagaries of human life experienced in that locality. In EFT, these external guidelines are replaced with a certain use of individual emotions and rationality. Placing the entirety of deciding how to live a life on the shoulders of an individual can be too overwhelming. In return, one’s individual need for some sense of direction can, paradoxically, make one vulnerable to questionable sources of authority. It can also make individuals feel at the whim of their political circumstances, hence accepting the political status quo while loathing their individual sense of powerlessness. EFT certainly ref lects the human need for direction, but places that direction solely within the individual and gives the individual nowhere else to look as they continue to struggle. Other consequences of this sociopolitical constellation include reinforcing selfishness and reinforcing the devaluing and instrumental views of others and promoting civil apathy. According to Bellah, Madsen, Sullivan, Swidler, and Tipton (1996), in the face of social injustices and harmful practices, there is a temptation for people in Western society to disengage from the broader society. Civic consciousness, or the idea that we belong to a society and are responsible

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for shaping it, has weakened. When adopted by the governing and business elite, the lack of the sense of social obligation along with the moral encouragement for individual achievement creates self-serving, self-motivated people of inf luence, who earn their success at the expense of others and do not consider what happens to others a matter of their concern. Simultaneously, Westerners, especially Americans, exhibit a tendency to resist moral commitments and define relationships instrumentally (Bellah et al., 1996; Richardson et al., 1999). So, what are the consequences of a theory that focuses individuals on their emotions for information about what is wrong with themselves and how to live their lives and promotes their rational ability to manage these emotions productively? EFT equates reality with one’s internal life, so that the external world is rarely perceived as a significant problem, except as a medium with the potential to interfere with one’s access to one’s interior self. It constitutes one’s perception of one’s self as entirely responsible for healing psychological anguish, rather than suggesting interpersonal or relational strategies. In fact, EFT promotes interventions such as two-chair or empty chair techniques, where the patient works to process emotions through the solo activity of talking to themselves as both a version of themselves and a prominent other with whom they have an unarticulated conf lict (Greenberg, 2015, p. 132), or the individual patient is conceptualized into parts and conversation is prompted between the self ’s parts (Greenberg, 2015, p.  127). It seemed I was hearing that resolution could occur independently within the self, and others were not necessary. In these interventions, the therapist seems more like a referee between the imagined others or selves. The therapist’s impact on the client and on the therapy is understated, and the interpersonal field (see, e.g., Stern, 2010) remains an untapped source of understanding clients’ conf lict. Without scrutinizing the impact of individualist ideology or any ideologies on psychological functioning, Greenberg cannot understand how these ideologies helped to create the suffering of his clients, yet he treats these ills by conceiving of acontextual treatment plans and strengthening self-contained individualistic qualities. He demonstrates an implicit belief that EFT restores individuals back to their natural state. Greenberg’s self-absorbed individual cannot consider if political or social structures are in need of change or critique the values his or her society hold dear. The transformation will be conceived of solely at the individual level, while maintaining the social and political status quo.

Feeling Enlightened My dissertation research had an immediate impact on my thinking and psychotherapy practices, and a lasting impact on my life as well. The result has been a kind of “bilingual” hearing of psychopathology. Human problems are filtered through both mainstream theoretical interpretations and contextual, sociocultural interpretations. This grants me the f lexibility to focus beyond solely

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the interior experience of the individual by situating the individual’s problems within ubiquitous and implicitly accepted systems of beliefs, practices, and expectations. Sometimes it makes sense to focus on a patient’s emotional experience and help them increase agency exactly because we live in a society that requires a coherent sense of self and autonomy. However, many problems can also be perceived as conf licts between the patient’s way of being and the most dominant standards of society. The irony is that adapting to American culture’s most prominent ideals of autonomy and freedom should result in an increase in individual freedom. Yet it is the identifying and historically situating of these ideals and their impacts on the individual that free the individual to truly examine their life and the moral traditions that have constituted them and thus make decisions about the values to which they might then choose to subscribe. A hermeneutic approach has been extremely helpful to me in thinking issues through an intersectional (Crenshaw, 1989) lens that includes conf licts between a first-generation immigrant’s culture of origin and American culture or conf licts experienced by women in male-dominated workplaces. Sometimes, not only is it unnecessary to pathologize a patient but also it could be harmful. Patients might feel less shame by understanding their struggles as resulting from contextual conf licts rather than a broken brain and are more able to focus on an active solution toward change that can be beneficial to both self and society. Sometimes pathologizing a problem acontextually only convinces patients that they are the problem and that the solution is to conform to and comply with ideals such as self-contained individualism, toxic masculinity, or gender discrimination. My patients often seem to feel agentic and enlivened by understanding their struggles within a sociopolitical context. My hermeneutic research also reinforced the incorporation of relational psychoanalytic ideas into my way of providing therapy. The contexts of both the patient and therapist’s lives bear on the developing relationship and the therapeutic work. The burgeoning context from this developing relationship ref lects not only the worlds of both but also the way the meeting of these worlds has a hand in co-constituting a new world. This is, essentially, the hermeneutic circle applied and embraced within therapy. Although Greenberg (2015) emphasized the therapeutic relationship, I found his construal to embody at least one confusing contradiction. He depicted the relationship as co-constructive but also described the therapist’s role as non-imposing and neutral. I am not sure how a neutral person contributes to the world between two people. I believe this contradiction deserves further attention in future research in order to understand how historical and cultural beliefs about humans inform contemporary and mainstream beliefs about therapeutic relationships. Overall, my dissertation has helped me think more expansively as a therapist, one who can practice creatively and truly collaboratively through the coconstitutive nature of the therapeutic relationship, and one who will continue to grow through the questioning of narrow and commonly accepted standards within the field and society in general. I encourage those who feel disillusioned

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by limiting and listless quantitative methods, and those who are passionate about the intersection of philosophy, critical thinking, politics, psychology, and culture to consider a life-changing hermeneutic study. Indeed, in important ways, my hermeneutic dissertation and my ongoing work as a hermeneutic, relational therapist have had a hand in changing my life for the better. It is not easy looking behind the veil, but it is enriching to see psychology as a part of life rather than some abstract measure of normalcy.

Notes 1. Aspects of this chapter are taken from Gomez’s dissertation (2018) in accordance with American Psychological Association Style 7 guidelines. 2. Jewish tradition does not interpret the Garden of Eden story in this way (see, e.g., Fromm, 1966 for a vastly different interpretation).

References Auszra, L., Greenberg, L. S., & Herrmann, I. (2013). Client emotional productivity— optimal client in-session emotional processing in experiential therapy. Psychotherapy Research, 23(6), 732–746. https://doi.org/10.1080/10503307.2013.816882 Bellah, R. N., Madsen, R., Sullivan, W. M., Swidler, A., & Tipton, S. M. (1996). Habits of the heart: Individualism and commitment in American life (updated paperback ed.). Berkeley, CA: University of California Press. Burston, D., & Frie, R. (2006). Psychotherapy as a human science. Pittsburgh, PA: Duquesne University Press. Buss, A. R. (1979). Humanistic psychology as liberal ideology: The socio-historical roots of Maslow’s theory of self-actualization. Journal of Humanistic Psychology, 19(3), 43–55. https://doi.org/10.1177/002216787901900309 Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrine, feminist theory, and antiracist politics. University of Chicago Legal Forum, 1989(1), 139–167. Retrieved from https://chicago unbound.uchicago.edu/uclf/vol1989/iss1/8 Cushman, P. (1990). Why the self is empty: Toward a historically situation psychology. American Psychologist, 5(5), 599–611. https://doi.org/10.1037/0003-066X.45.5.599 Cushman, P. (1991). Ideology obscured: Political uses of the self in Daniel Stern’s infant. American Psychologist, 46(3), 206–219. Cushman, P. (1995). Constructing the self, constructing America: A cultural history of psychotherapy. Cambridge, MA: Perseus Publishing. Cushman, P. (2019). Travels with the self: Interpreting psychology as cultural history. New York: Routledge. Davis, D. R. (2004). Gregory. In L. Richard (Ed.), The Oxford companion to the mind (2nd ed., p. 803). Oxford: Oxford University Press. Fromm, E. (1966). You shall be as Gods: A radical interpretation of the Old Testament and its tradition. New York: Henry Holt. Fromm, E. (1994). Escape from freedom. New York: Henry Holt & Company, LLC (Original work published in 1941). Gadamer, H.-G. (1989). Truth and method (J. Weinsheimer  & D. G. Marshall, Trans.). New York: Continuum (Original work published in 1960).

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Gergen, K. J. (2015). Culturally inclusive psychology from a constructionist standpoint. Journal for the Theory of Social Behaviour, 45(1), 95–107. https://doi.org/10.1111/ jtsb.12059 Gomez, A. A. (2018). Feelings of enlightenment: A hermeneutic interpretation of latent enlightenment assumptions in Greenberg’s emotion-focused therapy [Doctoral dissertation], Antioch University Seattle. Retrieved from https://aura.antioch.edu/etds/434 Greenberg, L. S. (2015). Emotion-focused therapy: Coaching clients to work through their feelings (2nd ed.). Washington, DC: American Psychological Association. Kant, I. (1999). Critique of pure reason (P. Guyer & A. Wood, Trans.). Cambridge: Cambridge University Press (Original work published in 1781). Ribeiro, A. P., Mendes, I., Stiles, W. B., Angus, L., Sousa, I., & Gonçalves, M. M. (2014). Ambivalence in emotion-focused therapy for depression: The maintenance of problematically dominant self-narratives. Psychotherapy Research, 24(6), 702–710. https://doi.org/10.1080/10503307.2013.879620 Richardson, F. C., Fowers, B. J., & Guignon, C. B. (1999). Re-envisioning psychology: Moral dimensions of theory and practice. San Francisco, CA: Jossey-Bass Publishers. Richardson, F. C., & Zeddies, T. (2001). Individualism and modern psychotherapy. In B. Slife, R. Williams, & S. Barlow (Eds.), Critical issues in psychotherapy: Translating new ideas into practice (pp. 147–165). Thousand Oaks, CA: Sage Publications, Inc. Rousseau, J.-J. (1979). Emile or on education (A. Bloom, Trans.). New York: Basic Books (Original work published in 1762). Ryan, W. (1971). Blaming the victim. New York: Vintage. Sampson, E. E. (1981). Cognitive psychology as ideology. American Psychologist, 36, 730–743. Sarason, S. B. (1981). An asocial psychology and a misdirected clinical psychology. American Psychologist, 36(8), 827–836. https://doi.org/10.1037/0003-066X.36.8.827 Sass, L. A. (1988). Humanism, hermeneutics, and the concept of the human subject. In S. B. Messer, L. A. Sass, & R. L. Woolfolk (Eds.), Hermeneutics and psychological theory: Interpretive perspectives on personality, psychotherapy, and psychopathology (pp. 223–227). New York: Rutgers University Press. Smedslund, J. (2009). The mismatch between current research methods and the nature of psychological phenomena: What researchers must learn from practitioners. Theory & Psychology, 19(6), 778–794. https://doi.org/10.1177/0959354309345648 Stern, D. B. (2010). Partners in thought: Working with unformulated experience, dissociation, and enactment. New York: Routledge. Stigliano, A. (1989). Hermeneutical practice. Saybrook Review, 7, 47–69. Sutherland, O., Peräkylä, A., & Elliott, R. (2014). Conversation analysis of the twochair self- soothing task in emotion-focused therapy. Psychotherapy Research, 24(6), 738–751. https://doi.org/10.1080/10503307.2014.885146 Taylor, C. (1989). Sources of the self: The making of the modern identity. Cambridge, MA: Harvard University Press.

PART II

Philosophical Explorations

7 LIVING TRUTH BETWEEN TRADITIONS A Hermeneutic Integration of Moral Perception and Mutual Recognition Maxim A. Livshetz

My dissertation set f light over a vast terrain of knowledge, and while the distance of time frees me to question whether it really arrived at any of its destinations, I do believe it succeeded in exemplifying the hermeneutic virtue of bringing different traditions into dialogue. Dialogue done well is an interpenetration between lived truth and truth longing for life, expressing some vital essence burrowed between two subjectivities sharing a horizon. In the hermeneutic tradition, dialogue begins with the laying bare of prejudices on each side and exposing them to mutual questioning until the shared ground between interlocutors begins to form as if on its own accord. The freedom to question depends on the difference between my world of meanings and the interlocutor’s. Nonetheless, the space this process of mutual question and answer carves out has the merit of accommodating both of our subjectivities for the duration of our engagement with the topic and the process of dialogue. Meanwhile, all manner of discoveries unfolds between us. Likewise, comparably rich traditions of scholarship will resist a wholistic integration in an effort to maintain their own discrete integrity. Yet find a meaningful meeting place between them, and you open the possibility of a complete meeting. In a fusion of horizons, a tradition does not change its identity, but its identity expands and deepens in various ways from having to harmonize its practices with its evolving self-understanding that is quickened in these exchanges. Therefore, in presenting what made my dissertation rich to me, I will expand on a nodal point within the dissertation where the tradition of virtue ethics comes to bear on the applications we derive from the relational psychoanalytic concept of mutual recognition. The intention of the effort is to offer a f lavor of how traditions in dialogue DOI: 10.4324/9781003140177-9

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speak to and inform each other in the way we learn from each other during good conversation, but a process that is not present in scientific ways of thinking, a way of deriving at truth validated by the hermeneutic understanding of dialogue.

A Few Words About My Dissertation Relevant to This Chapter A central question in my dissertation was: Does moral understanding occur on a procedural level? This question is prefigured in the broader hermeneutic situation in which something the other says comes to change my understanding: new understandings open into the awareness of new choices. Conversely, the question expressed a core belief that all understanding of value to psychological life is either explicitly or implicitly moral. Therefore, in approaching moral understanding as a psychological phenomenon, it was necessary to anticipate the critique based on our cultural associations between morality and cognitive rigidity by relying on Gadamer’s exposition of the anti-dogmatism that lies at the heart of moral reasoning. Further relying on Gadamer, I used his description of dialogue in Truth and Method (2006) to provide a phenomenological description of what is involved in a contextualized understanding of a conversation partner’s point of view, naturally including her needs and circumstances, in mind. Contextualized understanding invariably places the needs of others front and center and carries the implicit imperative to act on what has been comprehended. After all, if understanding is a dispelling of an ignorance, it is also the amelioration of suffering and thus cannot persist as an internal event within a conversation. At a minimum, an understanding of another, at any degree of specificity, is an inherently ref lective event, as some expression of what is understood is a necessity of sustaining the connection that moves a dialogue along. Therefore, the very act of understanding, occurring as an interactive event, is already the activity of healing—a moral act. Those of us who work in some area of psychological healing know full well the relief our clients feel when they feel understood by us in places where they suffer. Therefore, another prejudice informing my choice of subject matter was that moral understanding is closer to the demands of life than a merely insightful one. Insight, after all, helps me understand something, while moral understanding is actionable in service of the other. If fact, understanding itself is an act of giving what all expression implicitly and sometimes explicitly seeks—to be understood. In this way, all understanding begins with the point of curiosity that extends along a spiraling trajectory that terminates the fulfillment of the other’s need, and a complete understanding, thereby, has inherent clinical value. My dissertation (2013), titled Deliberation and Mutual Recognition in Intimate and Committed

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Love was an immersion in just such a point of curiosity and understanding. Practically speaking, however, how does one glimpse another’s experience with both a useful and relatively self less accuracy? More interestingly, how does one come to feel toward another in such a way that interest is sustained until such understanding approaches its fully moral dimension? Blaine Fowers’ (2005) intellectually rigorous synthesis of Aristotelian ethics and psychological life in Virtue and Psychology: Pursuing Excellence in Ordinary Practices addresses this affective component by tying it to the integration of emotion and virtue in the course of character development. By learning good values from one’s parents, caregivers, friends, and community, we practice what is good, and it shapes our identity through a love of the good that is a natural part of virtuous action. Jessica Benjamin’s (1988) Bonds of Love—a modern classic of relational analytic thinking—explicitly describes the development of the affective component of moral understanding. Through the process of attunement and mutual recognition, she shows the way in which the desire for pleasure makes a dialectic journey along a developmental trajectory to catch up to the desire for the other’s pleasure and thereby attain a horizon of goodness. The superficial challenge of the fact that these authors dealt with different topics did not obscure the natural meeting place between two essential concepts in their work: Fowers’ moral perception and Benjamin’s mutual recognition. In my own reading of the two works, it was obvious that these two concepts addressed overlapping domains of experience. Nonetheless, to appreciate the value of allowing them to inform each other, we might first consider how easily these two concepts might validly be viewed through the lens of difference. Fowers extolls character and virtue, foregrounding not only their inherent worth in human life but also their psychological indispensability. He is aware of the essential quality of feeling in moral reasoning but sees it as a by-product of a practiced concern with moral responses to situations and interactions. Benjamin, on the other hand, presents an implicit and even latent morality in the emotional dynamics of relational experience, even when the goal is personal satisfaction and pleasure. In her work, a vast developmental narrative, beginning with these perfectly selfish motivations, culminates in an expression of passionate mutual recognition as the epitome of their fulfillment. While, for Fowers, pleasure and satisfaction operate best as byproducts of wholehearted virtuous action, Benjamin distills the good-old pleasure principle into a consideration of the other’s needs. Fowers skillfully subverts the value of pleasure and satisfaction to moral concerns, while Benjamin draws out their moral potential—distinct tasks that complement each other. Driven primarily by personal pleasure, we are numbed to the other’s experience and needs; meanwhile abstracting the needs of the other from our own desires dries up the vitality of our response to him. While it is intuitive that these positions should overlap in a “fusion of horizons,” the f leshing out of how presents us with a task that

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is bound from the outset to express a valuable phenomenology that reveals the continuity between pleasure, personal satisfaction, and moral understanding and moral action—even if that action is as small as the spontaneous look of compassion, which we all know can be like distilled nectar in a moment of deprivation. In this chapter, I will f lesh out this fusion of horizons without even attempting to present any of the intellectual legwork of the dissertation, which will hopefully make for more engaging reading! After some personal ref lections, I will offer brief summaries of each author’s work in order to set the stage for expressing an integrative perspective that emerged from what they spoke to each other in my inquiry. It will hopefully be apparent that mutual recognition and moral perception are mutually enriching ways of looking at seemingly disparate domains of human life. From a broader scope, I hope to express a key hermeneutic concern—the pursuit of living truth in the meeting places between traditions, between readers and texts, and between partners in a conversation. And a more hidden intention will be to demonstrate the interpretive process involved in all these interactions—an even subtler relationship between a mind and its all-too-effervescent contents.

Some Personal Reflections As I write this, it has been nearly seven years since I heard Philip Cushman utter the blessed, fateful words: “Congratulations, Dr. Livshetz” spoken by a man I will always reverently and fondly think of in the grand old German honorific “Dissertation Father.” He meant to be a rabbi and became a psychological historian, while I was an immigrant boy slated to become a cliché’ of a Jewish lawyer, making money and my parents proud, only to end up coerced into being a painfully ahistorical psychologist by the doctoral program I entered. However, Phil loves history, as do I, and the aspect of hermeneutics that captured my attention was its phenomenology of how a simple process of question and answer could produce new truth, arising from the precise art with which an inquiry is conducted. Then and now, my passion lies with a primarily philosophical understanding that includes an awareness of history, but specifically as the transformative agent from dialectic to speculative thought as the driving process of dialogue. Working with Phil made the conf lict between an ahistorical and a historical vision obvious, and for that reason, it was a tough dissertation. Nonetheless, it taught me how to live and breathe in a process of inquiry that guides the way I learn from my clients about what they need. Rather than delve too closely into method, I would like to share something about motivation, process, and meaning. I chose to write a hermeneutic dissertation because I loved the way Phil taught. He introduced me to Gadamer’s Truth and Method, which must be one of the best things anyone ever wrote about conversation. At that time, about thirteen years ago, I was beginning

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to grow numb against a psychological training quite decontextualized from its own tradition, often unaware of the logical fragility of its many taken-forgranted assumptions, unaware of the values it prescribes behind a mask of moral neutrality. The reason I went into psychology—a curiosity about the rhythms and deep architecture of the mind—was slowly becoming obscured by mechanism. Evidence-based manualized practices for validly discerned diagnoses displaced an understanding of the suffering underlying the designation, or what could humanly touch it in a way either person could feel. Even as I appreciated the management of symptoms, the processes I was taught to heal with numbed my passion to discern the roots of human pain. And then there was Phil—a man who rejected all of it while rejecting none of the people. That was magic, and it was nothing in comparison to the way he taught. It was Midrash. He taught us to think and talk to each other about the work ahead in such a way that let us practice in his classes a way of thinking and being that would ripple into the work to come. I cannot think of a better way to express the value an educator in our field could give his student. I had several classes with Phil, but it was the first of them that exposed me to hermeneutic thought, and I just thought it was the way thinking worked. It was useful and adequate to apply in an interactive moment. Psychotherapy is an art, but it is not entirely a game, and if it is, the stakes are rather high so we should get good at it. My dissertation process prepared me to at least know how to learn on the job and to learn from my patients. In writing a little bit about what the process of writing this dissertation was like, I would like to share some of my appreciation for Gadamer’s hermeneutics as a kind of theoretical orientation, but I ask the reader to consider how doing so actually obscures the full respect and feeling I have for the context in which I learned it. That context is of being Phil’s student, talking to him through these ideas so that I could trust my understanding, hearing from him how they worked with his clients, seeing him apply them in dialogue with me and my classmates. It was both a course of study and an apprenticeship. Furthermore, as I write about this dissertation, I intend to obscure none of the pain it brought me. Passion is a good word for the process because it expresses a suffering pleasure, and I began it with great inspiration. My project was driven by a desire to understand what makes human relationships good and beautiful rather than restoring people to something called “function.” One of the advantages of hermeneutic philosophy is that it provides a description of an excellent conversation. Blaine Fowers’ work, furthermore, inspired me because it provided a scope for interpreting human life in terms of its excellence as distinct from its functioning. This scope was a relief from a prevailing, insurance-dominated vision of the field that relegates the work of healing to some mechanistic restoration. The works of Gadamer and Fowers opened for me horizons of understanding human emotional pain within a fuller context of good relationships and good

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lives. However, psychology is essentially a work of feeling. Gadamer’s description of dialogue was a cognitive enterprise, while Fowers’ horizon was primarily a moral one. In getting the big picture, I needed to situate both in a view of corresponding affective dynamics. For this, I settled on Jessica Benjamin, and particularly her comprehensive description of the unfolding of this emotional exchange as an epic journey from infant to mother to lover and beloved. Take the three together, and while infinite details were missing, I finally had a vision of full scope in a way that made both logical and intuitive sense. Even the process of settling on these three authors was not simple. For instance—small side note: I probably spent more time reading the philosophy of Emmanuel Levinas while I discerned the way forward, often thinking I would organize my project around it. It was painful to let that go, to say the least. I mean, we are talking about months and eventually a couple of years of life for this whole thing, in which I was not there fully for my wife and daughter. In many ways, the dissertation contributed to the eventual dissolution of my marriage. These are not cheap lessons, and I encourage people writing such a dissertation to be more limited in their scope. But it was how it was for me, and I embrace even the pain of remembering the late nights and the exhaustion, as well as the thrill of a world intellectually unfolding. Nor do I want to feign full acceptance when the truth is, I carry some pain from the process. I disagreed, for example, that I had to contextualize this project in a historical analysis of the institution of marriage, and till this day, I feel that it was not an effort worth the time and remaining emotional reserves that it cost me. This is difficult to admit in a work such as this, which tries to foreground what is best while sticking to truth before method. And yet I recall so much joy. As I read and wrote, I felt like I was truly participating in tradition—learning about the nature of being a person and showing up for another in a way that inspired me about the work I would do. I would stay up late nights in a perpetual state of wonderment. I would write myself into corners and claw my way out, cutting out pages that felt intensely compelling to write. I would read and when I felt too full of what I read, then I wrote. As I wrote, I thought of what else I should read and how this relates to me personally. My views on things changed along the way. I found new questions and wondered what the clinical work looked like through the lens of what I was reading. As I began seeing clients in my internship, I developed new ways to interrogate the subject matter and found answers that the reading provided echoing in sessions with clients. It was a living process of learning. The connection between Blaine Fowers’ work and Gadamer’s philosophy was an explicit one, as Fowers wrote about hermeneutics and Aristotle, and his whole body of work is a kind of hermeneutic exchange between psychology and virtue ethics in various spheres of life. It is impressive. However, in working and thinking clinically, even as I read Fowers’ and others’ adaptation of hermeneutic philosophy to clinical work (e.g., Donnel Stern, Frank Richardson),

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I felt that the missing piece had to do with my prejudice about the primacy of the non-verbal in healing exchanges. Reading about dialogue in great depth, and how it ref lected a moral dimension of psychological work, I felt a profound need to ground this understanding in what happens between faces: an exchange of feelings that is a dialogic process. I felt psychotherapy as a lived practice was a feeling art. I found this prejudice confirmed in my clinical practicums and in most conversations that meant something in my life. In what I read about the application of hermeneutics to the field, nowhere did I find fully expressed an understanding of how the capacity to perceive these feelings accurately develops. What’s more, it was apparent to me that to integrate hermeneutic thought into the field of psychology, we had to articulate how its process comports with a vision of human development that articulates the development of this affective capacity. Relational psychoanalysis provided these answers, but nowhere was the process better and more narratively articulated than in Bonds of Love by Jessica Benjamin. All of the prejudices and questions that my prior study brought to the surface were laid bare in an experience of ecstasy when I read that book. While reading it with hermeneutics in mind, I saw it as nothing less than a parallel text that described both process and development of the capacity to enact that hermeneutic process on an affective level, paralleling what I found so profoundly expressed on a cognitive level. In real terms, all that remained as far as the actual process was to show how Benjamin’s work provides an emotional mirror to the moral and cognitive picture painted by Gadamer and Fowers. Meanwhile, I had to foreground the fact that Benjamin was interpreting human life itself in emotional terms, while Gadamer and Fowers were essentially moral interpretations, enacted in deliberative and dialogic ways. The elegant bridge—the fusion of horizons—occurred in the fact that the phenomenology of affective exchange Benjamin presented was expressed in alignment with hermeneutic principles and was susceptible to interpretation as its own form of dialogue! In my mind, these pieces fit so intuitively that when the prejudices of seeing life in affective terms versus in moral terms were laid bare, the fundamental compatibility between them were exposed. The remainder of the work was simply to show a way in which they fit.

Fowers and Moral Reasoning For Blaine Fowers (2005), a focal point for the moral component of human personality lies in the character virtue of practical wisdom. He divided this cultivated trait into three basic abilities: moral perception, deliberation, and reasoned choice (p. 117). Of these, moral perception is probably the capacity closest to a psychological property: it just happens, as if by itself, and the other abilities depend on it. Furthermore, deliberation and reasoned choice are largely within one’s control and operate in a structured pattern that can be learned and then

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practiced at will. Without moral perception, however, they will be misapplied because the capacity to see the situation clearly is a prerequisite for the application of moral reasoning to that very situation. Thereby, moral perception puts together the spontaneity of a receptive consciousness with the intentionality of a conscientious actor, expressing an attribute of maturity accomplished through experience. Fowers described moral perception as “an ability to comprehend the essential features of the situation” (p. 118). However, he also described it as an “ethical sensibility that highlights what is at stake in a given situation for the goods that one seeks” (p. 118). These seem like basically the same descriptions, but they foreground different aspects of the phenomenon: a kind of spontaneous comprehension on the one hand and more of an unformulated sensory responsiveness on the other hand. Therefore, an ethical sensibility operating on its own accord is a particularly interesting and useful component of moral perception because it proposes an unconscious moral process that operates autonomously on its way to the surface where processing can occur. And it may just be that an ethical sensibility operates simultaneously to the comprehensive process, but somehow underneath it, in a manner of speaking, and I find this to be a thrilling possibility that singlehandedly plants the seed for an undogmatic morality by undoing the contrivance of action dependent wholly on a deliberative process. In other words, an ethical sensibility would allow morality to coincide with spontaneity while retaining a cognitive f lexibility that could adapt to changes. Fowers added another layer of detail to ethical sensibility, attributing to it a capacity to recognize the presence of situational features of moral significance before they take discernable form in a subject’s mind (p. 194), and he considered this to be developmental: “Human beings learn about what is worthwhile or worthless, appropriate or ill-fitting, admirable, or deplorable in our socialization” (p.  195). Should this be so, once cultivated, the moral sense functions implicitly and spontaneously and is, therefore, adequate to the nature of ethical challenges that arrive unannounced. This adequacy is a function of the blending of developmental experience with one’s core—character—so that the way in which one responds naturally tends toward goodness. As such, ethical sense guides us through the social terrain of our lives, like a correct opinion we have yet to articulate to ourselves, protecting us from the burden of deliberating on every significant daily happening. Often, we just know what the right thing is, and this is quite important because moral responses must come in real time. Often, a delay in response is harmful. When someone whose trust we start to gain looks tentatively at us for a return of affection, hesitation can convey ambivalence and the moment turns to rejection. Likewise, when a child runs into the street busy with car traffic, there is no time to think at all. Thus, it is no small thing that before deliberative comprehension, there is already something between a reaction and a response

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that is accurate in its own way. This sensibility is a feeling, such as when we say: “this doesn’t feel right,” or the converse. While rightness and wrongness depend on judgment, that judgment and feelings typically coincide is a matter that naturally nourishes the curiosity of what it means to think and act morally. In turn, importantly, Fowers stated that “this implicit moral ethical sense may not always offer adequate guidance” (2005, p. 195). He suggested that situations in which this ethical sense is inadequate are first distinguishable by the sheer sense that something is amiss. We return to the consideration again that a key aspect of moral perception is attention to one’s feelings and intuitions. A nagging feeling or disquiet is often a sign that our ordinary moral sense has led us astray or neglected some important question. When we experience this, it is necessary to review the facts of the situation and sort through what it is that we have misconstrued or missed (p. 195). And yet, it seems to me that the very sense of something amiss represents a continuity in the operation of ethical sensibility precisely as feeling, seamlessly reversing direction from accord to discord, to alert us that a course of action is falling out of step with its intent. The good in thought and deed, after all, is less a monolith than a skillful dance with the complexity of the situation that place moral demands on us, and it is this complexity that seems to demand an ethical sensibility to be present and operational to guide our appraisals in time—dancing in rhythm with circumstances’ unfolding. Fowers confirms this dimension of ethical sensibility by explicitly drawing out the role of emotions in moral perception: “Emotions highlight the ethically salient features of a situation” (2005, p. 121). This is a distinctly hermeneutic idea: novel features of experiences catch the mind, disrupt a prejudice, cause a person to fall out of “everydayness,” and elicit a response, but this combination of cognitions is illuminated into awareness by a single feeling of either accord or of discord. Fowers’ earlier link of experience with the thwarting of expectations reinforces this observation. He adds that “right readings of situations are often possible only when we have certain feelings, whether those emotions are compassion, anger, love, or revulsion” (Fowers, 2005, p.  121). These feelings are familiar, possibly universal, but the unbidden way in which they arise highlights novel elements of experience. This is the fuller meaning and the connecting link between what Fowers would regard as the limit of ethical sensibility with my more expansive interpretation of its operation, wherein an element of surprise is always at play. Feelings, by their nature, are responses to what is partially unexpected, even in the context of agreement. While, for instance, we might be in a stable state of consonance with an interpretation of a situation as we act within it, we never expect fully to be delighted by a turn of events—if we expected it with certainty, then a delightful turn of events would lose its power to delight. Therefore, whether in accord or discord, the ethical sensibility represents a continuity of emotional contact with what it experiences as salient features.

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If we follow this logic, it becomes apparent that an emotion carries with it an essential quality of all experience and is essential to moral perception. Emotions are embodied moral understandings and therefore lead to rehearsed ways of experiencing situations: there is something so familiar about them that they are easy to take for granted. At the same time, they are what responds to unexpected changes. Like Gadamer’s Erfahrung—a condensed phenomenology of the essence of all experience—an emotional response involves the harmonization of experiential novelty and familiarity, without subsuming one in the other. Therefore, the emotional component of moral sense lies at the nodal point of intersection between experiential and moral life.

Mutual Recognition as the Affective Basis for Deliberation and Dialogue What constitutes emotional life? Benjamin’s (1988) theory of mutual recognition provides a valuable narrative of the way emotional life develops in such a way that it is already implicitly moral, particularly in her major text Bonds of Love (1988). This seminal work in intersubjective theory provides a compelling model for the way patterns of emotional response developmentally attain ethical sensibility. In it, she formulated psychological development in terms of the mediation of the dynamics of domination and submission. Recently, she has written about the moral implication of this same theory in terms of “the third,” which she described as the intersubjective, moral, and/or shared third (e.g., Benjamin, 2009). This third is a way of speaking of intersubjective space and abiding within it is a function of what Benjamin regarded as good psychological development. It is an abstract idea that speaks to a capacity to dwell within both self and other experiences. As such, the third corresponds to the way an emotion integrates the familiar with the novel by the mediation of self and other(ness). However, it seems that there is something more directly moral about formulating psychological health in terms of the non-verbal mediation of the forces of domination and submission. It ref lects the values of fairness and equity. A way to appreciate the advantage of understanding the development of emotional awareness through this lens of power dynamic is to recognize in it an echo of Aristotelian ethical logic. Aristotle (2011) saw fairness as proportion in the distribution of a society’s resources. The goods one possesses, all things being proportional, ref lect one’s character and standing in a society (see discussion above). Because social power is measurable by resources, such as esteem, wealth, political power, etc., issues of fairness relate to issues of power. It would follow that in the best of cases, the power one has is proportional to one’s merit, in which case such a person has exactly the amount of power that maximizes his ability to contribute to society—for an abundance of virtue, to

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Aristotle, would always imply a concern with the good of others. For Aristotle, the consideration of others was a defining component of any quality worth calling a virtue. Conversely, abuses of power involve domination and submission, the context of every inequity. Because Aristotle saw graspingness as the opposite of fairness, he made a persuasive argument that all unfairness corresponded to the desire to have more goods than one’s virtue merits. When we exercise power, in whatever form we have it, to dominate others for personal gain, we suffer deficits in our character. Submission, in turn, involves a failure to resist such an abuse of power, even when resistance is both just and reasonably possible (see Livshetz, 2013, pp. 81–84, for elaboration). Therefore, Benjamin’s conceptualization of psychological well-being in terms of the capacity to mediate the forces of domination and submission in relationships implies a moral concern that echoes the values that are expressed in Aristotle’s Nicomachean Ethics (2011). However, by conceptualizing domination and submission in terms of psychological characteristics that make up a human being, Benjamin (1988) introduced a new level of complexity to the Aristotelian framework that informs Fowers’ conception of moral perception. If domination and submission are not only activities but also implicitly operating attitudes, then the balancing of these forces involves implicit processes as much as explicit ones. Fowers’ description of ethical sensibility, his conceptualization of the faculty depends on messages from family and culture, and the assumption I make in reading it is that these messages tend toward the explicit communication of values through shared meaningful activities, dialogue, etc. However, emotions take shape as a receptive matrix determining the positive/negative, good/bad, and painful/pleasurable nature of an experience; they must first develop preverbally in the exchanges between mother/father/caregiver and infant. There must be a relationship between how the capacity to feel attunes us to the possibilities for the enjoyment of life and how those feelings attain a moral dimension that is somehow genuine, expressing an epitome of enjoyment. Morality may involve restraint for a time but must yield a greater fulfillment that can be felt. This way it sustains itself and breeds the old love of the good for nothing but its goodness. Benjamin’s work renders this an intellectually palpable process.

Affective Morality, Moral Relationality In Bonds ( Benjamin, 1988), the necessary and sufficient affective components of human thriving seem to be attunement and mutual recognition. My reading is that mutual recognition is simply attunement geometrically expanding out of emotional harmonization between faces engaged in a play of an emotion into the dialogic and erotic spheres. She begins by describing attunement

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as the preverbal version of mutual recognition that perseveres into adulthood (pp.  13–15). It is a non-verbal language and rhythm present already in the earliest parent–infant interactions, and though relatively simple, it grows in complexity quite rapidly. Throughout her account, the language of gesture, facial expression, and movement attain a linguistic meaningfulness of its own (pp.  11–51). For example, Benjamin describes the emergence of the sense of agency in the recognition of the infant’s actions by the parent in which the sense of “I am, I do” is ref lected through the parent’s facial expression, attention, and affective encouragement as “You are, you have done” (p. 21). She describes these experiences as symbolic, but to the degree that the description is accurate, it is destined to coalesce into a linguistic form. And yet, as a process, and an experience that develops and functions at implicit levels of awareness, attunement, and mutual recognition are experiential to the point that their reduction to a conscious process would interfere with their f luent functioning. If ethical sensibility emerges from attunement and co-emerges with mutual recognition, it is relational and responsive in its essence. Conversely, to formulate psychological health as Benjamin (1988) does ref lects a concern with fairness and equity. Even Gadamer (2006) felt that these affective processes bind us to each other. Benjamin shows that they only do so when their operation is the affective component of equity—the experiential balancing of domination and submission, where love binds without shackling.

The Development of Attunement In Bonds of Love, Benjamin (1988) combined evidence from parent–infant observation studies, psychoanalytic theory, and the philosophy of intersubjectivity to elucidate the relational essence of infant development. Her view of development may be summarized as the pathway from attunement between the parent and the child to mutual recognition between adult partners in erotic play. These prefigure dialogic engagement and provide the emotional basis for understanding its subtext. In attunement, there is a dance of facial expressions beginning early on, wherein the parent imitates to regulate and adds new expressions to stimulate and exhilarate, while the infant gradually learns to reciprocate in increasingly detailed ways. As part of the process of unfolding attunement, a sense of safety is carried over from the parent’s proven capacity to share in feeling with the infant and f lows over into the very environment and the objects that constitute it. There is a sense of being recognized by the environment, and a reciprocal attitude of faith, trust, and love toward the world. From the safety of this transitional space, the infant also recognizes that the actual parent who approaches is also free to move away.

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Then, as the drama of destruction and survival is performed repeatedly, the infant begins to learn that emotional distance is not the same as abandonment. By setting an emotional boundary, the parent also marks the limits of the space within which the infant’s exploration is safe. In this space, the infant finds the freedom to express himself spontaneously. Winnicott called such expressions “spontaneous gestures,” which are both bids for play and expressions of the experience of play through non-verbal channels (Mitchell & Black, 1995, p. 126). Adding more layers to this description, Benjamin (1988) located between separation and reunion an experience Winnicott called “being alone in the presence of the other” (Benjamin, 1988, p. 42). It is a process that occurs when the parent is close, but not interacting with the infant. With this breadth of experience emerging for the child, the original imitation and stimulation game of attunement evolve into a complex dance. There is a coordination of expression, the honoring of each other’s need for space when overstimulated, the sense of connection even when at a distance, and the longedfor reunion. Most importantly, the infant now brings something from his own world into the communication and can stimulate the parent with his own unexpected expressions once removed from the imperative to convey a physical need. Then, as the repeated survival of the parent in the rapprochement developmental phase becomes a reliable dimension of the relationship, it allows the child to continue to experience the missing of the other as desire, wish, and longing. As such, its gratification can be both delayed and savored. The presence of desire in the parent–child interaction is perhaps most clearly delineated in the distinction Benjamin (1988) drew between being with the parent and being regulated by the parent. Being the parent occurs in a space that accommodates each partner’s assertion in the dance of attunement so that the regulation by the parent of the interaction transitions into a mutual co-creation (Benjamin, 1988, pp. 45–48). For my clinical work as well as my research, this development has tremendous significance. For the infant, assertion begins to include spontaneous gestures that originate subjectively and are not simply the response to the stimulus provided by the parent in the face to face. Furthermore, unlike in the earliest stages of infancy, the expression of spontaneous gestures aims at the parent’s recognition of his experience that goes beyond the need to have his emotions regulated. The purpose of these, in large measure, is to receive recognition by the parent of the child as now a separate person. When regulating the child’s emotion, the parent mostly mirrors the child and holds him both physically and emotionally. In contrast, when the parent and child are alone, but with each other, the holding environment of the transitional space is also a space in which the infant begins to experience himself in his agency. The emotional dance of attunement can take on the features of assertion and recognition by each partner in the dyad, which Benjamin described as “mutual recognition” (1988, pp. 53–54). In such an interaction, the emotional needs of both partners find both expression and fulfillment.

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The Erotic Fusion of Horizons Aside from the obvious differences, there is also an important difference between the attunement that hopefully is present from birth and adult erotic attunement. The difference is full awareness of the separateness of the other— an awareness that is not accessible in the parent–child relationship in the same way (Benjamin, 1988, p. 181). Children depend on their parents for emotional regulation, affirmation, and boundaries even through much of their teens. This dependence creates a natural and valuable limit to the amount of recognition children can offer their parents. Survival, throughout childhood and the teen years, involves a restoration of hierarchy in which the child benefits by reembracing a nurturing and fair parental authority where borders within which the child can freely roam are established, tested, reshaped, and reaffirmed. Benjamin’s (1988) solution to the domination/submission dialectic, which is also a limit, begins to imagine a complete mutuality. While the survival of the teen parallels the survival of a love partner who occupies a submissive position, the survival of the latter takes on at least some of the dominant position (Benjamin, 1988, pp. 68–74). The teen’s Oedipal survival marks a restoration of hierarchy but renders the boundaries of that hierarchy f luid and negotiable. The survival of the adult masochist, however, undermines the hierarchical structure altogether because mutual recognition in adulthood cannot depend primarily on the honoring of a boundary. In the erotic situation, the possibility for full mutual recognition depends on the unraveling of hierarchical relations through the sharing of passion (Benjamin, 1988, pp. 73–74). Survival, in this case, is a mutual process that relies on the assertion from the masochistic position and on recognition from the sadistic position (pp. 68–74). Therefore, the limit-setting reverses position in a complete way, wherein possibilities for the equal sharing of power emerge. Furthermore, she does not seem to suggest that most or any real relationships are made up of pure masochists and sadists, but that partners typically occupy these positions at different times, to a variable extent. Her key point seems to be that these positions need to become f luidly interchangeable for mutual recognition to operate without falling into stereotyped enactments that choke out shared affection. If the transitional experience proper to good child development were simply transferred into the erotic space between lovers, it would inevitably result in the splitting of positions of power between the partners. The overwhelming intensity of the erotic space would lead one to identify with the parental and the other with the child’s position. Within erotic space, these manifest as dominance and submission because the fullness of the erotic experience depends on the f luidity of these positions. This f luidity, in turn, is based on a capacity to hold sadism and masochism in an internal dialectic dance. When the positions are rigid, they result in a split power structure that externalizes an

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overwhelmingly tense moment in the internal dance, like a snapshot of positions of power within it that then defines the whole actual relationship. In the parent–child relationship, the parent offers the possibility of holding and being held simultaneously, but with the caveat that the parent is doing more of the holding. An erotic embrace captures mutuality and reciprocity of holding and being held all at once, wherein pleasure comes to serve an equalizing function. Even as caress and caressed change places, the pleasure of being held is shared in the holding and in the changing of positions. The mutual blurring of bodies and emotions accomplished by passion transforms transitional space into a kind of inner space as desire meets a fulfillment that also feeds desire. Such desire is irreducible to either impulse or spontaneous gesture. Rather, erotic desire moves the subject from a position of being held to the position of being held by her own holding. This inner space, capable of receiving the full array of sensation and emotion at play in passion, unites the fantasied, internalized, and felt other with the f lesh and breath of the lover. The sensory wealth of the erotic blurring of boundaries shimmers in Benjamin’s observation that, in an embrace, pleasure is not localized genitally, but spread throughout the entire body. In it, passion and tenderness are possible at once: When the sexual self is represented by the sensual capacities of the whole body, when the totality of space between, within, and outside our bodies become the site of pleasure, then desire escapes the borders of the imperial phallus and resides on the shores of endless worlds. (1988, p. 130) At the shores of these endless worlds, desire escapes only to be immersed, without a hope of return, into the mystery of contact between separate beings.

The Interdependence of Mutual Recognition, Moral Perception, and Desire: An Integration Benjamin’s (1988) account provides a theoretical foundation for the full range and power of the affective processes at play in moral perception. It also provides valuable insights for how moral perceptions operate on a psychological level. Nonetheless, there is an important difference in that moral perception depends less on the desire for the other than on another kind of desire—a desire for the good. In mutual recognition, these two appear to be inextricably intertwined. Goodness itself, however, is only implied in mutual recognition, which resurfaces the question of the process through which desire for the other becomes a desire for the good. In interpreting Benjamin’s (1988) description of desire, I foregrounded the dialectic process by which desire for the other experientially approaches the

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desire for the good: the desire for the other transforms into a desire for mutual recognition while remaining a desire for the other. Mutual recognition, in turn, is inherently desirable because its meaning is infused with the pleasure of an embrace—both physical and emotional. If the desire for the other becomes the desire to recognize the other, then one’s perception of the other will include a sensitivity to what is good for the other. There is no way to recognize the other without an awareness of the other’s needs, carried in the assertion at implicit and sometimes explicit levels of communication. To recognize is to respond in a way that is equal to the need an assertion carries without submitting to coercion. As Levinas wisely taught us, to recognize the other is to recognize a hunger (1969, p. 73), a need of some kind. However, the dialectic dimension of mutual recognition—involving the overlapping processes of destruction and survival, assertion, and recognition—is particularly suited to recognizing what the other is hungry for because it makes a habit of attending to the other’s emotional state. When one fully embodies desire, the object of desire is intimacy because its depth is not finite, perhaps because we can engage intellectually and emotionally in simultaneous, rhythmic, and harmonious ways. By pursuing intimacy in a relationship, we find that the desire to fulfill the needs of the other expresses the desire for the other. Desiring for one’s own pleasure and desiring to fulfill the beloved’s desire and needs naturally are entangled in the singular experiences known as moments, sometimes extended, of love. This is a balanced perceptual structure, neither sacrificing personal needs nor trespassing boundaries. There is harmony in thinking of human contact in this way, and when extended to dialogue, it carries with it the sensibility necessary to guide body and mind in the way it engages with a topic. From such a standpoint, Benjamin’s (1988) mutual recognition is a description of one kind of human activity that helps develop moral perception. This reading further implies the possibility of formulating mutual recognition as a shared, constitutive goal in relationships: just as one acts as a good friend to accomplish the goal of friendship, one can practice recognizing others in order to accomplish mutual recognition. For Fowers (2005), this is how character development happens: one practices the virtue to transform the activity into a character trait so that over time the subjective distance between doer and act, between thought and word diminishes. An intimate relationship is an excellent context for such a practice because in it partners can experience their desire for each other and their desire for what is good for the other in a unity of wanting that can fuel commitment. Thus, by thinking of mutual recognition as a moral practice, Fowers increases the power of the concept. On a basic level, learning to think of each other first can become a basis of goodness. This was certainly true of Aristotle, discernable even in the earlier discussion of some of the underpinnings of morality in Aristotle’s ethics. If fairness and equity show up in society as the charitable but fair distribution of

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resources, a consistent application of these values would require self-interest to always be guided by the constant awareness of those who stand to be affected by one’s choices. It is infinitely delightful that when we add mutual recognition to the recipe, an awareness of the other prior to intentionality—a fundamental receptivity—comes to correspond to what we might most desire as biologically social beings. This kind of love does involve restraint of some of the desires we feel on a momentary basis, but the restraint is itself fulfilling and consonant with the life determine for ourselves when our deep wishes and precious values attain a union. Commitment, as the protective dimension of love, involves a restraint fully infused by that very love. In fact, the restraint itself can be a pleasurable experience of giving space to inhabit a fulfilling separateness—space that can later open back onto the beloved in another embrace. Furthermore, such an approach to loving intimate relationships can, in fact, open into a broader alliance to the good in a person’s actions and choices simply because fulfillment comes from putting others first. The Aristotelian notion of character is that it develops in the social context of one’s parents and environment. This will always include a combination of verbal and non-verbal learning as what parents, family, and friends will convey is always either accentuated or undercut nonverbally and non-conceptually. The affective tone of the message, often more impactful than the contents, transmits the sense of the meaning. When I think of the others who will be impacted by my actions, the consequences they will feel impacts me at least as much as the positive emotions I will feel from getting a desirable outcome that depends on their suffering. Moral choices operate on levels of feeling or thinking driven primarily by feeling. When these feelings naturally go along with what is good, there is less struggle in times of moral choice. In this way, the child gradually learns that every good is a social good because it comes from others, and its practice always depends on keeping others in mind. And it only helps, as Benjamin also helps us see, that we might enjoy ourselves along the way to virtuous character. It is a much better narrative than the outdated morality of simple-minded self-denial in the name of some ideal, which so often just makes for poor company. This same argument, seen from the moral side of the equation, rests on remembering that practical wisdom involves reasoned choice simply because in Aristotle’s own formulation reasoned choice involves desire: “Aristotle further emphasized the combined roles of reason and desire by defining choice as ‘desiderative reason or ratiocinative desire’” (Fowers, 2005, p. 126). This means that a good choice is reasoned (deliberated) in a way that fulfills one’s desire in a situation. Alternatively, it is a choice of what one really wants most because what one wants becomes consistent with what one also understands is best. This latter description is closer to the formulation of a good choice that emerges from a moral analysis of Benjamin’s (1988) work, because her theory begins with desire. The former description, on the other hand, is closer to how

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Fowers (2005) would have framed it, because his framework depends more closely on a clear understanding of the good in one’s own life. While the two formulations share similar motivations, they have different implications for how one experiences a moral choice. One begins with thinking and the other begins with wanting. Benjamin’s understanding enriches Fowers’ because it confronts us with the need to understand desire itself in such a way that it emerges as desire for the good. Her version of the desire for the good, in the form of mutual recognition, is energized by a sexual vitality that incorporates the whole body. In Freudian terms, she introduces a libidinal dimension to morality and character, which is hardly an aside: Benjamin allows us to see the desire for the good in affective terms. Bringing her together with Fowers, we see that the solution to elements of desire that are destructive to our most meaningful and most loving relationships does not lie in sublimation. Rather, it lies in the characterological integration of desire with the desire for the good. It may even be in our nature to do just that.1 Moreover, when we begin to understand mutual recognition with more ethical sensibility than an exclusively psychological description allows, we begin to see that desire has its own inherent logic and nobility. In the context of a good-enough psychological and characterological developmental process, desire becomes an embodied movement toward recognizing the other, toward being recognized, toward coming to exist through each other. It is a movement toward genuineness, agency, and subjectivity. At its utmost, it is a movement toward the discovery of one’s potential as a moral being in the nakedness of one’s experiential connection to the world and others in it. Then, just as a parent can inspirit a little child’s environment, so a beloved can ennoble one’s life.

Concluding Remarks and Dialogic Processes I hope this reading helps to convey the f lavor of how a mind moves interpretively. We have a philosophy for it in Gadamer’s elegant hermeneutics, but I think it is also something intuitive. Therefore, as a complement to some of the more academically focused chapters in this book, I chose to present the more impressionistic, but still intellectually rigorous example of movement in harmony with and between texts. While I do not regard my dissertation as an elegant form of writing, ref lecting upon it calls to mind so much elegance in the process of coming to understand these things. It is a process that organized itself, and I find it echoed these days more and more in every therapy hour, where it lives and breathes now as healing work. People in our field often talk about compassion fatigue and I have felt years of it, but my work today is becoming increasingly sustaining, and consistently so. In fact, when I am fatigued, it is because the way of thinking and experiencing my work with people that were prefigured above all by

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the dissertation process reveals to me not any excesses but the limitations of my compassionate understanding. I used to get tired from trying to express my understandings of people and hear them in ways they find useful, but as time goes by, I simply learn to be more present, my understanding grows over time, and in it, my compassion f lows more freely, nourishing both the patient and me. The dissertation wounded me, but it helped me bridge the gap between a therapist and a healer, allowing grace to f low through my work and even my life in ways difficult to imagine without having gone through it. Therefore, I encourage any reader to consider the profound benefits of embracing their dissertation as a kind of shamanic death that takes its shape in accordance with each student’s destiny and propensity. We embrace loss even ahead of starting because healing happens where our scars touch wounds needing care.

Note 1. While this assertion follows from Benjamin’s developmental progression, it is profoundly enhanced by Fowers’ more recent work integrating evolutionary biology with Aristotelian ethics (Fowers, 2015).

References Aristotle. (2011). Nicomachean ethics (D. Ross, Trans.). Victoria, Canada: Hourigan. Benjamin, J. (1988). The Bonds of love. New York: Pantheon Books. Benjamin, J. (2009). A relational psychoanalysis perspective on the necessity of acknowledging failure in order to restore the facilitating and containing features of the intersubjective relationship (the shared third). International Journal of Psychoanalysis, 90, 441–450. https://doi.org/10.1111/j.1745-8315.2009.00163.x Fowers, B. J. (2005). Virtue and psychology: Pursuing excellence in ordinary practices. Washington, DC: American Psychological Association. Fowers, B. J. (2015). The evolution of ethics: Human sociality and the emergence of ethical mindedness. New York: Palgrave Macmillian. Gadamer, H. G. (2006). Truth and method (2nd rev. ed., J. Weinsheimer & G. Marshall, Trans.). London, England: Continuum (Original work published in 1960). Levinas, E. (1969). Totality and Infinity (A. Lingis, Trans.). Pittsburgh, PA: Duquesne University Press. Livshetz, M. A. (2013). Deliberation and mutual recognition in intimate and committed love [Doctoral dissertation], Antioch University Seattle. Available from Ohiolink. Mitchell, S. A., & Black, M. J. (1995). Freud and beyond: A history of modern psychoanalytic thought. New York: Basic Books.

8 THE PSYCHOLOGICAL DISSERTATION AND THE VOICE OF THE THERAPIST From the Indivisible Self to the Land of Intersubjectivity Daniel Masler Psychology as a discipline is an effort to understand human states of mind, human relationships, and human actions. Apprehension in this social science is determined to begin at the very level of the subject. At its heart is talk therapy. My aim as a doctoral student in clinical psychology was, then, to write a dissertation that would contribute to the ongoing theory in a way that could engender meaningful discussions in the future. I wanted to inform myself as a psychotherapist and hopefully to invigorate others treating patients who were struggling with the issues and pain that naturally arise from living in a society that is increasingly confused about its own values, its future, its potential avenues of happiness, and even its mass survival. These very broad objectives would lead me down an unexpected path, to write a dissertation on interpersonal relational psychoanalysis, The Self of the Field and the Work of Donnel Stern (Masler, 2014). I was particularly drawn to Stern’s writings. They offered a rarely cohesive theory that suggested ways of thinking, which might lead psychology out of the hole it had dug for itself for almost two centuries by submitting to a notion of the individual self as a categorically set-off entity that must be studied objectively. In this longheld conception, the individual is seen as a unit that is somehow hermetically separate—and therefore entirely susceptible to rational comprehension, almost an atomic particle—and therefore necessarily outside of the world in which this very self has been constituted. Stern described the problem inherent in psychology’s truth claim to objectivity as a problem of privileging one kind of interpretation—a type of language—over another: “But if the truth is the outcome of the grasp of being in language, there cannot be a superior way to accomplish it, because one cannot escape being part of the event one wants to capture.” (Stern, 1991, p. 63). Over a century earlier, Nietzsche also asked, DOI: 10.4324/9781003140177-10

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“Might not an illusion lurk in the highest interpretation of the word ‘objectivity’?” (1874/1957, p. 37). On the other hand, the interpersonal approach has suggested at least since the 1930s (Sullivan, 1938) that we can understand people and their problems only by including the context in which these emerge. Relational psychoanalysis presents a further dimension of critical thinking about how we understand race, class, gender, sexual orientation, politics, identity, and even the environment; it demands a constant questioning about the effects of power, both conscious and unconscious, and the experiences of both patient and therapist as they interact. My aspiration in writing the present chapter is to support others struggling in the psychology profession and those writing dissertations, to help locate themselves in the field, in order to find where they fit in, and to make better sense of their own experiences. We are witnessing a shift, from seeing psychology something best theorized along the lines of statistical values and traditional or even just-posited universal laws, toward a broader notion of language as making us what we are. This shift offers the idea that we have different ways of being that are available to us (Gadamer, 1975/2004). If we are indeed linguistic creatures and are sedimented in language, then our engagements with texts at the level of the dissertation transforms us even in unknown ways. Later, in this chapter, I describe the path my dissertation provided me, of working through various issues raised when one considers intersubjectivity as an essential part of the practice of psychotherapy.

Is Meaning Made or Could It Emerge? I chose to investigate how conceptions of the self appeared in Donnel Stern’s prolific and original works. As I read his published works, I was confronted with various enigmas that appeared at times contextual and at others deeply within Stern’s theory itself. The first enigma was how a theory such as Stern’s, based on ideas such as creative or compassionate curiosity, spontaneity, or the “unbidden,” as central to progress in psychotherapy (2003, 2012b, 2015) could appear within the context of our modern realm of healthcare. I wanted to locate Stern’s work as social practice as well as a theory, at a time in history when health itself was a highly charged concept. Healthcare had become a trillion dollar business, possibly the major national political issue in the United States, and the focus of enormous personal concern to Americans (Pew Research Center, 2019). It had overf lowed from a course of helping people lead sound lives to matters of ethical and economic and even identity survival (Crawford, 1994, 2006). How, then, could a theory of such intimate connection as Stern’s serve, at the level of the social, a notion of patient health? What assumptions on either side might be at work here? Stern also made the striking assertion that “the era of psychic geography is dead” (2010, p. 3). His own conception of a self in psychology was, however,

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not to be found in his writings expressed in any direct way. A second enigma therefore was in Stern’s alternative conception as to what a self would be in his interpersonal relational psychoanalysis. Did his idea of the self as being possibly “multiple” ref lect (perhaps by happenstance) an internet-charged, highly consumerist idea of the entrepreneurial individual of the 21st century—the experience of oneself as being many and no one at the same time? Did his concept propose a rejection of the belief that there exists some mysterious “material” in the unconscious of each of us? Was Stern’s refutation of unconscious “contents” leading to a very different way of conceptualizing psychic life and hence of doing psychotherapy? The last enigma came to me as I wrote on the above two. I wanted to know about coming to moral understandings in psychotherapy (see also Cushman, 2016; Fowers, 2012). What was the relationship between moral questions as these arose and the deeply psychoanalytic tenet that our interpretations, our conversations, our very formulations of patients’ stories, are to be as free as possible—carried out in a spirit of caring openness to whatever is said, expressed, felt, or thought during a session (Freud, Strachey, & Richards, 1920/1991)? Stern’s writings have consistently edged toward helping patients to live better by their own estimations and in relation to others. Did that mean that his theory was in fact morally active? If so, wouldn’t a position on moral understanding end up contrary to the psychoanalytic attention to exploring untenable emotions, that is, the immoral, possibly horrific sides of ourselves? How can we remain aesthetically and clinically open to whatever comes our way while also holding to what in life is worthwhile and good?

Experience Meets Understanding Early on I found it impossible to separate the very personal impressions of being in therapy (as counselor or patient) from the best ways to theorize about that lived experience. Psychological theory it seemed should apply to life, even beyond the consulting room. Furthermore, I have consistently found it impossible to extract the practice and the reflecting on psychological theory from the cultural and historical milieus in which all of these activities have long taken place. American psychology, for example, is distinctly American (Cushman, 1995), wherever it exports. Traditional, or what is now mainstream Western psychology, with claims to essentialist concepts (Hiley, Bohman, & Shusterman, 1991; Stern, 2003) holds a contradictory position, even among the social sciences, due to its condition of studying the human mind with the mind, that is, the requirement that an investigator must be immersed in her own object of study. Objectivity means standing outside of one’s topic of study and being seen as untouched by it. Objectivity, in fact, is the carte blanche for using a technique or a technology in psychology. Technique connotes a proven and reliable method in medicine, an intervening cause that will produce a desired outcome, a process thought to

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exist outside of the uncertainties of mutual subjectivity or the uncertainty of the interpersonal field—often supposed to transcend even culture. As a beginning therapist, I often found myself on the one hand being taught to use professionalized language and to deploy techniques, while on the other hand I also found myself attempting to help patients respond to the “incomplete .  .  . and coarsening effect” of instrumentalism “on personal and social life” (Richardson & Manglos, 2012, p.  188)—that is, on their own lives. This was salient as I observed how linear, instrumental actions were enforced as ideals, in juxtaposition to the actual living conditions of my poorer patients and in contrast to the ethos of many who tended to think divergently. Suggesting reliable life strategies of the kinds often found books or talks in popular psychology to someone who was indigent sometimes appeared like arguing questions of free will with a person who had been shackled to a wall. There seemed to be a highly political, and even a business element that remained unelaborated in the application of psychological method as such. Often, technique seemed to render connection into a syllogistic interaction that translated everything into a language no one really spoke, even when this was ostensibly for the patient’s own good. A psychological or automated operation of this sort is the imposition of a form, the enactment of a control function. It demands from patient and clinician a series of actions or procedures that are meant to affect or shape life. Even when deployed for putatively existential purposes, technique invokes a predetermined, generally sanctioned proceduralism. Reading Stern’s writings, contrarily, one hears a surprising openness on the part of both patient and psychotherapist to be able to deconstruct what is occurring in session. There is a constant questioning: Is there another way of thinking about this? Is there another way to be in psychotherapy? My own interests went toward a social thinking that resisted the adherence to privileging logo-centric, especially scientifically licensed thought. While I found, and still find scientific rigor in psychology to be a frequently useful thing, at least when used in small doses, I was also curious about the effects of the Western European, and later American, roots of rationalism (Cushman, 1995; James, 1912/2010). It seemed to me that if psychology were to remain open to the enormous varieties of human experience, then it should be carried out while the practitioner was engaged in diverse and sundry ways of thinking about experience, and in a struggle to remain as open as possible to this plenitude of experience—both one’s own and that of others. Much of Stern’s work, in fact, argues against assuming that we can know the other in therapy to the degree to which we often imagine ourselves knowing (2003). It points to important moments, Stern’s “mutual enactments” (Stern, passim; see especially 2003 and 2015), when the therapist’s own understandings are under threat by what is emerging in the relational field. Surprisingly, in Stern’s observations partnering and working through, these very difficulties can be the most productive times in a psychotherapy, though they may

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temporarily give rise to what in outcome research would likely be deemed undesirable qualities, especially in the therapist: confusion, anxiety, selfquestioning, frustration or anger on either side, and even states of mind that (e.g., Racker, 1968; Searles, 1959; Winnicott, 1949) themselves are categorically pathological. What looks bad on an insurance form, on a marketing survey, or when measured by corporate algorithms of health might actually be the process of fundamental interpersonal change, that is, signs of a productive struggling with entrenched aspects of the patient’s own history and life circumstances. In Stern’s theory, such emotional chaos is frequently the way to a “creative disorder” (2003, p. 65), and it frequently involves the psychotherapist’s confusion about how best to proceed. Contrarily, in today’s practice, we are often taught to abhor the marks of uncertainty—odd for such uncertain times.

Making Sense of One’s Own Writing As a dissertation student, I believed that it was important to initiate a study that would further engage me in the struggles of everyday psychotherapy practice. I wanted to engage in research that would motivate a rigorous questioning of my own knowledge. I also wanted to develop my own voice as a psychotherapist through the work of the dissertation. These were difficult goals to reach. I had studied Latin American, Spanish, and French literature, in addition to philosophy. Years before starting formal psychological training, I had worked with refugees, as an activist, as an investigative journalist, and as a youth-librarian and then an academic librarian. In addition to various strains of North American culture, I was also intimate with the literature, language, common philosophies, and culture of Japan. I was also an older-than-average doctoral psychology student. It was a tall order to find material that would last the rigors of being fit into the dissertation structure and that would also continue to whet my appetite for a language that could speak to me and that might hopefully lead me to engaging future readers. There were the difficulties imposed on the working student simply to fulfill the nearly endless requirements of becoming an accredited doctor of psychology and carrying on even vaguely with a life. I was also faced with my own, somewhat stoical, and possibly ingrained aesthetic demands from the start. In choosing my dissertation, given the need for ref lection that seemed to have been built into the nature of psychology and into my own life experiences, it was increasingly important to me that I undertake a project that made sense—if not common sense then on a deeper level, something that seemed it might hold some tenacious significance to it. If this was an aesthetic condition, it also transcended being a simple wish on my part. The container, the text, would need to have at least a chance of containing some of its own meaning. Stern and others have written on the problems of making meaning in psychotherapy. He has juxtaposed intellectualization as characterization versus

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authentic intellectual activity. To go beyond mere intellectualization, Stern wrote, thought needs to be “deeply infused with” and even depends upon “feeling.” Most undergraduate textbooks, for example, are exercises in intellectualization, which is probably why it can be so mind-numbing to read them. But the significant original work the textbooks are written to convey, no matter whether that work is literature or physics, was almost always done with the deepest kind of feeling. (2018, p. 55) He might as well have been writing about many graduate-level textbooks, in which pinched snippets of theory are scattered throughout, in order to provide an endless feast of samples of theoretical thought, with minimal attention to the social contexts, constructs, or concerns of the thinkers from whom these ideas arose. Like so many YouTube videos, theory was endlessly provided by schema after schema, with no sense of entering any theoretical architecture, as can be done from reading original works. For Stern, however, in order to discourse on something meaningfully, we do not just indite our subjects of enquiry, we feel our way into them. The very warm tone in Stern’s language and his attention to the aesthetic experience of creating also give his writing a thoughtful f luidity. I found in these writings references ranging from jazz greats to abstract expressionists to Ovid and symbolist poets Stephen Mallarmé and especially Paul Valèrie and his poetry about the aesthetics of poetry; and from Flannery O’Connor to living artists such as Christo and Cindy Sherman. While many psychological writings employ literary or artistic citations as a way to supply a truism with a rhetorical, pithy afterthought, for Stern on the other hand, the experiences of scientists, artists, musicians, and writers are often tendered as part of the construction of the theory itself, as a way to help spell out and bring it into further reaches of understanding. He turned to artists in the general sense, as experts in creating, taking their words to tell us a great deal about unconscious process and its unimagined creative potential. This theory proposes not simply a liberal plea for celebrating the struggling world of the arts, but rather it comes from an assumption that without an aesthetic connection we risk missing enormously important experience and knowledge that are fundamental to psychology (Stern, 2010, 2018), and, I would add, to all of the social sciences. While accepting and striving toward a greater artistic comprehension can be based in life’s more playful sphere, there is a seriousness here that puts art in its various manifestations at the level of bedrock. I felt an affinity for Stern’s serious playfulness, his attention to words, and at the same time for his clinical and theoretical rigor. I found in these writings an embodied language and also the work of a psychologist struggling to transcend the limits of much of what was passing in psychological discourse as given, as

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well as his own givens. The question had long shadowed me as well: Could there be an alternative way of conceiving of the therapeutic encounter from what I was being shown? I discovered this concern ref lected in Stern’s seminal article (1990). It was a piece entitled “Courting Surprise: Unbidden Perceptions in Clinical Practice.” There was a profound care for language present in Stern’s chapters that could bear many a re-reading. I also saw there similar attention to the effects of what the psychologist does and how we understand the mind. Within “Courting Surprise” is one of Stern’s tenets: that the psychoanalyst’s own thinking arises from the interpersonal field, and that grasping for a set of internalized scripts or preconceptions is a probable death knell for therapeutic growth. Rather, for Stern, “in a careful analytic inquiry, what is learned must come unbidden” (1990, p. 457). This made sense from my own observations as both a writer and a psychotherapist. Movement appeared to occur in therapy toward immediate or long-term relief for the patient when at least one of us, usually both of us, could begin to see things very differently from how we had seen them before. My experience had been similar in other endeavors, as well, whether it was in teaching, putting together an issue of a monthly magazine, or in a meeting about a screenplay. Important things took place in a time in which everyone there was present, and they happened within a unique conf luence of historical micro-currents in which we were located, that was both impossible without each of us, and was beyond any one of us. An alternative way of approaching questions of knowledge more generally is to be found in hermeneutic thought (Gadamer, 1975/2004; Heidegger, 1927/2010), a philosophy that supposes that any human being can only exist in a certain time or a place (and temporarily so!)—and therefore that our understandings can be better or worse, but that they are necessarily impermanent and incomplete. Although this can seem to be a loss for the infinite claims made since the beginning of the Enlightenment about universal facets of human nature, along with a subsequent confidence that is fueled by more codified or medicalized forms of psychological practice, there is a relief to be found here. There is a certain comfort in the corollary that our understandings can, with work, be adequate, that our knowledge can arrive at, or can be a good enough fit for the situation at hand (Gadamer, 1975/2004; Richardson, Fowers, & Guignon, 1999). In other words, understanding happens in the present, it requires our understandings of the past, and perspectives can change. From this way of thinking, knowledge, interpretation, and our access to truth involve an ongoing, temporal, and effortful process. This of course is in tune with psychoanalytic theory and method, in which process is attended to over content (Mitchell & Black, 1995). Thinking relationally, the focus is not so much on what the therapist tells the patient as on what the therapist can say with the patient and the patient with the therapist.

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In this kind of a philosophy, we can only perceive from one place at a time. However, we are not required always to think from any single fixed position or perspective (Gadamer, 1975/2004). Perspective is merely part of being human. Indeed, changing our previous understandings, arriving at a different perspective, may be the essence of much of human conversation (whether that is with each other, as in psychotherapy, or with a work of art, a scientific understanding, or a text in the very general sense). So, if understanding requires a truly open dialogue, there is also inevitably political change. Sooner or later, understanding the other means “getting beyond oneself.” Dialogue, the hearing of each other with an openness to be changed ourselves (Buber, 1970; Gadamer, 1975/2004), is the way to authentic understandings, even when apprehension focused on what we hold to be most private or personal comes about. We gain new context in opening our own opinions up for discussion and change (Cushman, 2019; Stern, 2003). For Stern, the location of such change is the interpersonal field. Cushman (2007), likewise, has written on psychology as a type of Midrash (the Jewish tradition of commenting, critiquing, and discussing texts in which the comments themselves may remain ambiguous). That is, psychology is a commentary on commentary, about life. Coburn has gone so far as to maintain that intersubjectivity is necessary for any type of experiencing at all (Coburn, 2002). This would suggest that dialogue is a way for experience to enter unknown territory (Gadamer, 1975/2004). In Coburn’s terms, the action for change in psychotherapy comes about in a “playing with meaning that reverberates across multiple experiential worlds” (p. 11). Stern more recently wrote on the analyst as a critic who helps to bring out the art of the patient’s life stories (2018). I would say, rather, that the therapist often acts like a lyricist who sits with the patient-composer, in order, together, to bring words to the music of the patient’s life. When the psychological point of departure is grounded in subjectivity as a necessary condition of being human (and if we see this condition as something that cannot be transcended), our oneiric lives, photographs and films, novels, songs, stories, doodles, off-hand remarks, sculptures, graffiti, and scribblings— the worked products of our imaginations—take on new importance (e.g., Ferro, 2006; Meltzer & Williams, 2008). This becomes particularly significant in a hyper-mechanized society where the products of the imagination or even of our private worlds are on an industrial scale being commoditized, appropriated, sanctioned, or banished back to the shadows cast by speed and unknowing—anything but worked through (see Zuboff, 2019). Furthermore, our mental lives can suffer under, or they can defy much of the reification dictated by an established and even, occasionally coercive psychology. Indeed, in group therapy, the actual objectives likely deviate greatly from the best laid instrumentalist plans of therapists or patients alike; some hold that where a group therapy goes will necessarily be far from the plans of any member

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of the group, psychoanalyst included (Bion, 1961). Likewise, in any course of therapy, the patient’s most fundamental issues can turn out to have been merely the gloss of an unformulated (Stern, 2003, 2018) experience, narratives that will easily range far from the patient’s original “presenting problem” (Panajian, 2017). This is not to say that the tribulations the patient describes in initiating a course of therapy are an error or a trick. Nor is the point that the patient’s hopes and objectives are to be shoved aside (Smith, 2009). In Stern’s works, it is that the problem at hand has become a problem precisely because important aspects of life cannot be spoken out or thought of. We need experience in order to change ourselves in any fundamental way. And we need each other for this. Where mutual experience leads is often a mystery. Sullivan (Sullivan, 1953/1997) and later Stern (Stern, 2003) maintained that disassociation is the norm (i.e., a way to achieve everyday understanding from the immensity of possible interpretations contained in the world). It follows that an important part of the therapist’s role lies in helping the patient to talk about aspects of life that are intense enough to warrant non-recognition. Usually, the interpersonal relational psychoanalyst therefore neither drives nor entices the conversation into avoided or overlooked areas. There is, rather, a searching along with the patient to find the right words for what has previously remained unthought and therefore unspoken, for what calls to be spoken. These are not necessarily scripts awaiting revelation (Gadamer, 1975/2004); rather, in Stern’s thought, they are potentials to be realized interpersonally. Therapy is a partnership in understanding the patient’s own life story (Stern, 2010, 2018). This kind of searching requires a more contextualized openness than most researched or institutionalized approaches. Smith has written that [T]he openness that allows the particulars to appear begins to take on a value of its own as that which helps one not to be too entangled in any particulars. This openness is not brought about by some technical intervention. It is enacted in the doing of therapy that invites the client to join me in enacting it himself. (Smith, 2009, p. 41) Often the analyst achieves this by doing the same, working to spell out her own thoughts or feelings that have hitherto remained unverbalized (Stern, 2010). The engagement will travel a great distance from the purported solution at the focus of intake. In Stern’s conception, time and sufficient interpersonal relaxation bring, outside of our control, certain moments of surprise all around (2010, 2015). Psychotherapy then requires that something different emerge from the interpersonal field of the analytic relationship (Stern, 1990, 2010): “[T]he original, to be a real contribution, must arise from an intention so much a piece with living that it is outside the bounds of ref lection or control” (Stern, 1990, p. 455). The change sought here appears to be something

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that can come about only from a space that would necessarily remain invisible from the lenses of technicism or ideology. There is a striving toward a thinking that resists a language that is externally dictated, mechanically programmed, or pre-ordained. We remain on the lookout for when objectification in any relationship sets in and mutual subjectivity is undermined ( Benjamin, 1988). There are political, relational, feminist, egalitarian, and humanistic reasons for doing this. There is also a hope for something new. Stern’s theory is rare in that it presents this activity in the most proximal moments of therapeutic interaction. This is Stern’s notion of important understandings that arrive unpredictably under certain conditions, but which appear only unbidden. For Stern, even ref lecting in psychotherapy is not a matter of analytic determination. “I believe we do not and cannot control ref lection, not where it matters clinically. These things come upon us” (Stern, 2010, p. 162).

The Empty Tool Chest In Stern’s work, drawing from Gadamer’s hermeneutic and from constructivist ideas, the most important change takes place between a highly contextual, social surround, and the interactions of patient and therapist in session. Indeed, all meaning might be thought of as occurring in such a place. In other words, therapeutic change is generally seen as a fundamentally mutual endeavor, one in which agency is often relegated to the “analytic third” (Ogden, 1994) or the “interpersonal field” (Stern, 2003) via mutual unconscious activities of which anybody has but the most occasional and f leeting grasp. Here, interpersonal does not signify simply holding a magnifying glass to the patient’s most important patterns of relating or relationships. It means, instead, thinking together about the interplay of the session. Stern’s second book was meaningfully titled Partners in Thought (2010). In his conceptualization, doing therapy is not to make something happen but rather, together, to enter into a particular type of a caring relationship based on an agreement to focus on the patient’s most pressing concerns, even if aspects of the relationship may at times be warded off (held beyond elaboration) by either side. In Stern’s thinking, dissociation remains the norm, because keeping some parts off of the field of perception is essential to our being able to understand other aspects of it. The project of the therapist, then, is often to enact a search of affective life, to find where the conversation is hesitant or even unable for a time, to think out, that is, to verbalize potentially important meanings. For Stern, this involves a consistently “compassionate curiosity” (Stern, 2015) on the analyst’s part, and eventually, one hopes, a rigorous, mutual curiosity about the patient’s problems in living. In my own readings, Stern was leading me to see therapeutic work not as a way to plan ourselves into a hard and fast mental cure, but rather as a struggle on

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the edge of both patient’s and therapist’s personalities (see Ehrenberg, 1992), geared to the asking the most important questions (Gadamer, 1975/2007 ) at any given moment. I wrote in the dissertation: Such an apprenticeship to curiosity demands a ceaseless struggle for the freedom to question not only the psychoanalyst’s own personal structuring of experience that affects countertransference (as developed from relational patterns with early caregivers), but to question cultural assumptions regarding race, socioeconomic status, genders, sexual orientation, and Foucault’s moving target of productive power and its relation to truth. (Masler, 2014, p. 159) Once seen from a hermeneutic, relational analytic perspective, there may be no other way to do psychotherapy at a significant level of change. For Stern, for example, the therapist cannot really possess a “tool chest” but must instead rely on her own experience (2010), the embodiment of one’s training and professional knowledge, along with one’s own personality (2003). Stern stressed the importance of having the ability to engage with appreciation (2018), care, and with a deep curiosity about the most difficult aspects of the patient’s life and the most difficult moments invoked in the therapy. Training can be seen not as training so much as the experience gleaned in study and learning, something that will be called upon in new ways. The resultant uncertainty is not a given simply for the sake of an abstract ideal of creativity. From a hermeneutic point of view, we are “constituted” (Gadamer, 1975/2004) by language. As Stern explained it: What sometimes saves us, and now and then makes new meaning possible, is that culture is not monolithic. Each of us is an intersection of many cultural and linguistic traditions (see Cushman, 1995). The value of uncertainty is not an abstract principle. Uncertainty is good because its maintenance allows multiple traditions to contribute to unexpected ways to the formulation of the unformulated. (2003, p. 28) The dissertating student is likewise caught in a f lux of cultural traditions and a highly fraught interpersonal field; these create an extreme level of complexity for the scholar in the midst of not only traditions but also ongoing conf licts. It also means that the student inevitably has her own voice and traditions to draw from, which will be both unlike and like those of her committee, peers, or institution. The student is put into a position that, from the hermeneutic point of view, should be imbued with the language of the discipline, while, from a relational point of view, it will hopefully offer a certain rebellion to that tradition up to the present. Dissertations with theses that do not emerge deeply changed once the student has engaged in a searching dialogue with the subject

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(and hopefully with mentors as well) are generally sterile. Without experience, where do we find authentic ref lection?

Questioning the Sphinx If there has long been a monad of psychological study, particularly in the United States, it is, again, the individual self. When I began my doctoral studies, I was often struck while reading psychological textbooks by the honor that seemed to be conferred upon human beings whenever there appeared the word individual. It seemed to award respect for the person’s inherent and legalized freedom under the US Constitution that is deeply embedded within the ethos of the United States. Such usage seemed to hold that we could label, hypothesize about, or delineate the individual but we could not transgress any personal limits, whatever these might be. Despite all our psychological conjectures, the individual would, it seemed, remain intact, available to a certain freedom by virtue of that person’s unique separateness. It is an odd stricture, given what has been done, especially to marginalized individuals, in the name of Western psychology throughout its history. While texts registered vast and deep generalizations about types of people in character, diagnosis, or social situations, and frequently in universalists terms, they contradictorily seemed to evoke an almost existential aspiration for change or for the revelation of something radically different from the original case presented. In their being applied to such a conception of the “individual,” the categories of diagnostics seemed to be open to endless observation that appeared to be free of judgments or power. In reading Foucault (1965/1988, 1975/1995), I would discover the makings of the shell game involved in ways we tend to constitute and record individuality in the Western society. But at my first readings, the bounded, self-contained individual (Baumeister, 1987; Cushman, 1990; Sampson, 1977, 1988; Susman, 1973; Taylor, 1988) emerged cloaked in a language that was confined to a distinctly American understanding of both privacy and freedom. The individual could be described but, it seemed, could never be open to an exacting vision of constituent history and the world. It further put the patient subject in a bind merely by being talked about (i.e., “written up”). By being ahistorical, the individual seemed to be free to choose for the better (if not for one’s lack of willpower and clarity), while it also remained an essentialist psychic entity worthy in any form of our respect. That free, individual, fundamental subject of the American psychological project came to resemble most closely an Augustinian soul—a part of the self wholly set off from the rest of the human being or the tainted world. Further study, seemingly endless readings, and long discussions led me to doubt this basis of much of psychological research and application. Eventually, the linguistic delineation of the self stopped at this seemingly sacrosanct barrier beyond which the texts seemed to be encouraging us not to imagine or think. Contrarily, what was opaque slowly emerged for me as available for

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questioning. I would eventually include an examination of the diagnostic gloss in my own dissertation. This may sound simple at the outset. However, one of the greatest challenges was the formulation of impossible questions, those that seemed to have no answers. The acceptance of uncertainty is a first step to sensing its presence, and the next is to begin to formulate at least the potential location or contours of what we are missing. Another kind of change occurs with hermeneutic inquiry. The common American psychological notion of the self, and the different professional subdialects used to constitute it, was suddenly amenable to an examination as a cultural artifact that could find its place in geographical and historical context. Early in my dissertation, I wrote: Often appearing as a single unit of study, the self has been at the heart of Western psychological inquiry since at least the 1940s (Cushman, 1990). At that time, psychological study gained momentum by attaching to the energy and resources of a growing U.S. economic and cultural dominance. Much of U.S. mainstream culture with its roots in the Enlightenment could be said to have come out of notions of a single, bounded, masterful, or “self-contained” individual (Baumeister, 1987; Cushman, 1990; Sampson, 1977, 1988; Susman, 1973; Taylor, 1988), from rules thought to frame practices as diverse as economic exchange, to architecture, to social explanations of the world. The emphasis on a Cartesian self, reshaped with the substance of a rugged individualism inherent in European expansionism, was given all the more impetus by a psychology that thrived on American soil (Cushman, 1995). Individualism received a further thrust from the industrialization and consumerism of the U.S., in particular during the second half of the 20th Century. (Masler, 2014, p. 1) Problems at this core of psychological thinking eventually led me to what Stern would term an enactment. Stern used enactment to describe a closed period of being mutually stuck in therapy that is only to be broken open by some change in the dialogue. In researching and writing about enactments, I oddly found myself in one. In this case, it was my own; it was located in my lived engagement with the dissertation material itself. Embedded in our psychological culture, on the one side, there was this seemingly correct way of characterizing the person as an irreducible basic concept, a unit available to technological manipulation being at the same time an individual particle beyond which one might not question. Then, there was my constantly intuited and felt experience that the session was far more than just two individuals in a battle against some stripe of pathology. From my first appointment as a counselor, it was clear that my being with the patient involved far more going on than could be summarized even in a

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month’s worth of case conceptualization. Our ways of being together took on impossible shifts that could not possibly be accurately charted in any form of analysis, let alone progress notes; the data went beyond report or representation. I was writing about psychotherapy and experiencing it. But there was a disruption between the ways the practice was conventionally portrayed and lived experience. I would feel groggy when thinking about this contradiction, listless, and out of sorts. It was when I identified the contradiction, and realized what was at stake in it, that the enactment evaporated, just like Stern predicted. By one’s merely erasing the once impermeable lines that surrounded what it meant to be a person, this individual self, this element of psychological understanding surfaced as a f luid entity, one subject to varying conceptions, indeed, configurations. According to Cushman (1995; see also Sampson, 1988), for example, the self ends up being constituted in different ways at different times in our culture, and these ways of being a self have profound effects on life in general. This is not simply a categorical banishing of thoughts about individualism. It is, rather, a profoundly serious critique of many of the consequences of seeing ourselves as bounded off from one another. Among other effects, such a wrapping of individuality frequently leads to the pursuit of one side of a number of binaries: liberty versus community need, satisfaction versus deprivation, consumption versus relinquishment, political versus private, monolithic production versus customized choice, living as we want to versus engaging for the group, and so on. One can look, for example, at America’s choking, run-down highways, endlessly spreading suburbs, shuttered office spaces, explosions of people without homes onto the edges of freeways, entropy in access to healthcare, too-big-to fail corporate prisons, lower- and middle-class debt, teen and elderly suicide, epidemics of depression and drugs, spent resources for anxiety, mesmerism with IT, pervasive subjugation of women, systemic discrimination, isolation, white cultural hostility to minorities, urgent consumerism, violence at home and school, and even wars abroad—and one can see the effects of a bounded, self-contained individual all around. Certainly, the refusal to wear a protective mask in public is seen by those who do so as an assertion of oneself as both free and beyond the reach of others—despite the epidemiological evidence otherwise. In envisioning this self as something that is inevitably isolated, forced to triumph entrepreneurially on one’s own (Binkley, 2011a; Layton, 2010), and immersed in the sea of mutual, self-interested biology, has psychology been limiting itself to an accidental replication of anomie, alienation, and subtle but pervasive forms of constraint (Barthes, 1957/1988; Foucault, 1975/1995, 1965/1988)? If we are practicing psychology in a society that is suffering from particularly neoliberal ailments (Binkley, 2011b; Sugarman, 2015), are we doing so in

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a way that actually addresses the public or even the most personal sufferings? Are psychologists themselves able to act beyond prescriptions that constrain our patients to a hyper-driven, painfully accelerated life devoid of the kind of mutual ref lection that allows for greater possibilities for meaning and freedom of thought? These became essential questions within the original queries of my dissertation. Could even alternative theorizing, such as Stern’s, still be inadvertently re-drafting this same self that was seen at its best when privileged and successful in conformity with the neoliberal values of American society? Was the self that emerged from Stern’s work also bounded, or might it be something different? And was Stern’s work itself helped or, on the other hand, stilted by the rationalism of the medico-empirical world of healthcare, and concomitant notions of health, in which Stern as a psychologist, psychotherapist, psychoanalyst, and university teacher inevitably practiced? Or was it rather, offering a way doing psychotherapy that suggested a greater freedom in how we imagine and are in our relationships with one another?

The Chalice of Modernism “A gain in meaning is a perfectly justifiable ground for going beyond the limits of direct experience” (Freud, 1915/1989, p.  573). With that short sentence, Freud may have given away the very modernist thrust of his own project. One way that Freud surpassed his own empirical thinking was indeed by attending to the irrational, accepting it at face value in the words of patients (e.g., in working with association and resistance) and in including counter-transference as an element of treatment (Freud et al., 1920/1991). It was only when I had written over half of my dissertation that I realized that it had taken the form of a series of concentric circles inward. At the outset was a general placement of Stern and his work into the realm of today’s healthcare in the United States, the contextual world in which he practiced. In fact, I found that Stern’s hermeneutic thinking, with its stress on spontaneity, working in dialogue, and attending to multiple perspectives, formed a type of resistance to the medicalization and the preference of an expert therapist’s rational technology over the purported chaos of the patient’s psychological struggles. Stern’s writing holds a consistent sense of humility and balance throughout. In researching the notion of the self in America, I saw that one problem with the bounded, individual self as psychology has long portrayed it was its reliance on a conception of interiority. Interiority is a product of the European modern era (Heller, Sosna, & Wellbery, 1986) that appears to have taken root and f lourished in a particularly historical American sense of interior space that is both Romantic and pertains to the myth of the frontier (e.g., Turner, 1893/1986) during US expansion westward starting in the 18th century. Stern to this day,

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however, maintains the significance of theorizing about some kind of a private interior (2018), presenting a philosophical contradiction to his hermeneutic stance that we are, à la Gadamer, constituted or constructed by something very much beyond each one of us by language. On the one hand, Stern holds that we are constantly being re-created through language. On the other hand, he suggests the importance of an interior, a very private form of experience, that can have its origins in the nonverbal, the pre-ref lected. Therapy, for Stern, is about the newness that can arise from the interplay of both types of experience, the represented and the un-represented. It seems to me that this kind of an emergent newness could only have been created in a white American culture, with an established exaltation of progress, inventiveness, ingenuity, non-traditional creation, rebellion, and mythologies built on the concept of self-reliance and expansion to (supposedly) new and open spaces. As I joked during my dissertation defense, it is unlikely that our patients would commit to treatment if therapists offered to change them into precise replicas of their mothers or fathers. As psychotherapists we proffer to our patients something new. That said, in a time of disappearing traditional cultures, aging societies, pandemics, and drastic climatological change, shouldn’t the clinical thrust toward a necessary newness of experience also be put into question? Are there different orders of newness? It may be that Americans hold to one that is jingled in online consumerist temptations, and perhaps another that is somehow epiphanic? How would we authenticate between the two? The third circle brought me to a discussion of Stern’s notions of multiplicity. Cushman has critically discussed a more recent conceptualization of the self as multiple (Cushman, 2011; Cushman & Gilford, 1999), and Bromberg has written about the self as just that (Bromberg, 1996) a way of discussing a rich sense of variation of experience but also of suggesting that a person can switch around internal selves. My examination of Stern’s texts to date has him at times holding to an idea that self-states are multiple and occasionally referring to these as actual selves (Stern, 2018). This question remains, to my mind, one that is regularly avoided, perhaps because of the race of technology upon our ways of not just experiencing but of entering into discussions about experience itself. It could be that our interpretations about the self remain contradictory largely because our ways of living are also contradictory. That is not to release the obligation of further questioning of either one; it is only perhaps a momentary description of our unrequited confusion. I believe this is a point that needs to be pursued, because it challenges our relationships not just with each other but with the very planet on which we (temporarily at least) live. Like the enormous production of newness, we may find that our ability quickly to change the channels on our identities or on the experiential self is frequently limited, possibly an illusion, a frantically minted new form of defense, perhaps—even one from which we might

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suddenly awaken. Certainly, our love of speed, ready-made solutions, and instant gratification have caused problems both in psychotherapy (Laplanche, 1997) and in society in general. In how many sessions have at least therapists who treat youth recently participated, in which emotional matters are adamantly described, but limited to the mental terrain of the latest video game, and based upon the strengths or weaknesses of a given, digital avatar? The previous power of cinema has long been giving way to computerized video that purports to be as present and interactive as an ideal mother, and therefore eternally new. Much digital entertainment provides illusory good-enough, intimate relationships made of psychological and mechanical as-if ’s; they are, in fact, capitalistically behaviorally motivated scenarios (Zuboff, 2019) projected over a fabric of surveillance and social control. As a psychotherapist, questions brought up in the dissertation continue to appear in my sessions. Occasionally, I find, I must ask myself: Am I simply (or unwittingly) driving a given conversation toward whatever seems new? Is this helpful? Is my own notion of what changes in therapy leading to my own notions of what would be the good in my patient’s life, or is it the patient’s own thinking that is allowing something different to emerge (Stern, 2010)? Multiplicity could be a way to a different, unforeseen perspective. Multiplicity could just as well be a gloss for merely a fascination with what is perceived as the newest, the best, and the brightest, psychology’s latest aesthetic enticement, the patient’s (or the clinician’s, or society’s) most recent manifestation of accelerated confusion. Psychotherapy as a search for meaning parallels the searching that is intrinsic in a good dissertation. A dissertation that involves what we might call “subtler languages” (I borrow the term from Taylor, 1989), even if it takes up its traditional literary form (Introduction, Statement of the Problem, Methodology, Findings, Discussion, Limitations, References, and so on). It sets the student against the subject of study, institutional constraints, a disciplinary tradition, the personalities of her committee, and the student’s knowledge of her own experience. The challenge for the writer of a dissertation, to my mind, is next to arrive at a modernist stance, in which material can be both generative and helpful, to speak at times in a subtler language. I think that this is akin to Taylor’s description of artistic and literary works that began to be published around the time of the Symbolist poets. For Taylor (1989), a product of “creative imagination” is a creation that “as revelation . . . at the same time defines and completes what it makes manifest” (p. 419). There can be an epiphanic quality to such writing, in that it opens up or discloses, while it also poses questions. More than delving into answering the research “gap,” that is, simply filling in or withdrawing information under a dichotomous utilitarian gaze, it delves, as in a good psychotherapy, into what is not being said by both the researcher and the researched (in so far as these two can

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be told apart). I cannot imagine such a process of research being much different from the creative processes described by Stern and Taylor, one that offers a high level of unpredictability and one that is open to the surprise of the unbidden. Stern’s writings, then, have given me a certain spontaneous and ref lective freedom in my therapeutic work. In understanding that what I say could be any of a contained myriad of unformulated meanings, I am better able to help patients find a certain satisfaction in life with its impossible timing and natural imperfections. In engaging with Stern’s ideas about mutuality, I am often better able to speak with patients about our own surprising interactions. In seeing enactment as an inevitable fact of life in therapy (and in general living), I am frequently able to join with patients to find out what on either side remains unformulated.

The Music of Uncertainty My own voice has changed through my inquiry into Stern’s texts via a hermeneutic approach, not in that I have necessarily adopted another way of speaking. Rather, it is in the very openness to my own ways of being in therapy that have been encouraged by both writing and grappling with this thought, an availability to the unspoken that was instilled in the theory itself. Once again, far from a facile attitude, this involves a constant searching and awareness of the therapist’s own experience, history, training, foibles, theoretical know-how, predilections, and so on. Certainly, writing the dissertation brought about a certain intimacy with Stern’s ideas and even the notes of his own experience over years as a psychoanalyst. More importantly for me, however, has been the ability to accept new spaces opening up in sessions, times of the mutually unknown that are inevitable within any psychotherapy worth its salt. These can be very difficult moments on both sides, and they are easily eschewed. As Congresswoman Alexandria Ocasio-Cortez said in an animated video on the Green New Deal, “We can be whatever we have the courage to see” (2019). The curiosity to envision our worlds and ourselves differently can be essential not only for a therapeutic advance but also for political progress. I now find myself able to follow difficult threads in the therapeutic work, or to sense when I cannot see them—the places of potential, mutual dissociation, which can ultimately be the richest veins for finding where a patient has, or sometimes I have, been almost ritually obstructed in life. One seeks to map out and re-draw what is often the most intolerable emotional territory, while listening all along to the voice of the patient, who is the real arbiter of the truth of her own experience (Stern, 2003). Similar to looking at an abstract painting or hearing an unusual piece of music, for example, one finds oneself attending to the spaces in-between. This is more than simply recognizing interpersonal patterns and later seeking to describe them with the patient’s help; this kind of interaction entails, rather, the kind of courageous curiosity of which Stern has

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written, one that is also practiced in writing on a very difficult subject in which even the most important questions are not immediately clear. Stern’s work on enactments and spontaneity in particular suggests a different sense of timing in psychotherapy, one that is not known at any given session’s outset. Riding through enactments, allowing for well-timed expressions of spontaneity, looking for the f lashes of unpredictability, tolerating the twists and turns of relationships, and allowing for that strange thing imagination into the requisite form of the academic dissertation is no easy task. It is excellent formation, however, if we are to find a meaningful language to talk psychologically and to find our way through the generative uncertainty of psychotherapy, among other things, in this world over which psychology holds some inf luence.

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Turner, F. J. (1893/1986). The significance of the frontier in American history. In M. Ridge (Ed.), Frederick Jackson Turner: Wisconsin’s historian of the frontier (pp.  1–19). Madison, WI: State Historical Society of Wisconsin. Winnicott, D. W. (1949). Hate in the counter-transference. International Journal of Psycho-Analysis, 30, 69–74. Zuboff, S. (2019). The age of surveillance capitalism: The fight for a human future at the new frontier of power. New York: Hachette Book Group.

PART III

Applying Hermeneutic Theory to Psychological Practices

9 ENCOUNTERING QUESTIONS ABOUT BEING HUMAN Toward Improving Training Practices for End-of-Life Care Susana Lauraine McCune

I write this a year too early, a year too late, and at the precipice. It is a year too early—because I am intending this project as occupational therapy. My neurologist, who was treating me for traumatic brain and spinal injuries I sustained in 2016, told me occupational therapy would be the most important part of my recovery. “But,” he emphasized, “I won’t write a prescription for a referral to occupational therapy for at least five years. Remember, you are running a marathon.” The doctor spoke little, and each word has been proven true. I am not yet to year five. I am a year too early. A year too late—because I started working on this chapter in 2015, before I was injured, and then later, I surely thought my recovery would be sufficient to enable me to finish a book chapter in five years. But not so. Due to the extent of my injuries, cognitive and physical limitations make the translation of ideas into words through digital and paper media painful and difficult. At the precipice—of our pre- and post-COVID worlds. I write this in December of 2020. In both my dissertation and now in this chapter, I am calling for compassionate care given within the clinical relationship. What will be the shape of healthcare relationships that will survive the isolation, social and personal distancing, digital life, and personal protective equipment? How are healthcare and psychological care transforming? What will become of our historical concepts of, and—for myself a yearning for—old-fashioned clinical and personal relationships? Phil is making this chapter possible by extending to me understanding, patience, and compassion, and the editing and writing of my thoughts in a coherent, cogent form. So, you will read here my thinking presented through Phil’s understanding of me, made possible by over a dozen years of his mentorship and our thinking hermeneutically together. My thinking and questioning are refined, ordered, expanded, and presented in a logical order so it will be DOI: 10.4324/9781003140177-12

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understandable to those outside my head. It is now spun into something understandable from my despair and hope—and, I must admit, from my rage. In part, my hope comes from the gratitude I feel for those who have provided compassionate care for me, care that helped me survive and recover abilities thought by some to be lost forever, which made it possible for me to write this chapter. It is difficult to be right and not righteous. Sadly, over ten years ago, I sounded a call for changes in the ways we talk about, and don’t talk about, aging and end of life, and how we give care. I now find myself deep in the belly of the beast, reliant on medical “care” during COVID, as I attempt to write, shall we say, more “academically.” We still have opportunities to make the changes this dissertation identified as needed. They are needed now more than ever. With that, the hermeneutic exploration continues, because the spiral of inquiry is never ending. Death came to me very early; it has been one of my most important teachers. My youngest brother, eighteen months at that time, died in my arms as our mother drove us to the doctor’s office. I was five years old. We lived in the high country outside Durango—life was hard there. I was twelve when my stepfather was diagnosed and increasingly disabled from cancer; my mother then had to financially support the family, and I had to be his main caregiver. He died three years later. At around that same time, my beloved Grandmother died. As an adult, I became my mother’s authorized Durable Power of Attorney for Health Care (DPOA-HC). She suffered from a degenerative nerve disease and severe dementia for fifteen years before she died. I advocated for her to receive hospice care during the last six months of her life, but due to the doctor’s refusal to sign and other systemic blockades, I failed. During her final three months of life, her doctor refused her wishes as stated in her advanced directives, and when I once again pointed out to him her end-of-life stipulations and objected to how he was disregarding them, he screamed at me: “You are murdering your mother!” Not long after her death, I became a hospice volunteer, and then a hospice employee. At the same time, I entered a doctoral program in clinical psychology. One of the many questions propelling me into psychology was what caused professional caregivers of all kinds—physicians, nurses, psychologists, counselors, social workers—to think and act in ways that ultimately avoided or rejected the end-of-life arrangements of their dying patients. After many years of research, I came to realize that their training and, at times legal constraints and financial considerations, could limit opportunities for professional caregivers to really listen to their patients and respectfully carry out their wishes. Due to the lack of self-ref lective skills, clinicians could not recognize the ways in which their own death anxieties, value judgments, prejudices, and preconceptions inf luenced their clinical relationships and clinical care decisions. There have been many reports of physicians and administrators disregarding patients’ wishes for the care they desired as they died. In so doing, healthcare systems failed patients and their loved ones, as well as front-line professional caregivers. Take, for instance, the experiences of my hospice patient who in this

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chapter I refer to as Sam. His long-time life partner had suffered from a severe illness for several years and received hospice care. Hospice’s compassionate care helped him, and after his partner’s death, Sam donated a generous sum to the hospice. Sadly, not long after that Sam himself was diagnosed with a painful form of cancer. Sam was a kind and thoughtful person and sought relief from his suffering by the Death With Dignity bill that had been debated in the state capital and was finally passed into law in November 2008. Sam clearly asked for the relief this law offered, but his requests were repeatedly turned down by the agency. I watched as Sam’s torment and the agency’s professional and legal dilemmas created severe ethical conf licts for those treating him. It was excruciating for all involved. Tragically, Sam did not receive the forms of care and relief he requested, and the resulting conf licts brought much physical and emotional pain to him and heartache to the healthcare workers involved. Sam died in March 2009. One colleague, a longtime and respected hospice nurse, was emotionally torn apart by the conf lict and finally had to be hospitalized. I myself became dedicated to changing the system and was moved to become a psychologist in order to do so. During my course of study, I decided to research and write a dissertation about how these mistaken practices, arrogant positions, and ethical conf licts came about, and what the profession could do to change them.

Exploring Human Being In formulating my dissertation, I chose to explore essential questions about being human, especially questions about dying while in the care of current healthcare systems. Specifically, I decided to explore patient–clinician communication about advance care planning for end-of-life care. The resulting dissertation was titled Worlds of Connection: A Hermeneutic Formulation of the Interdisciplinary Relational Model of Care (McCune, 2014). I had faced ethical dilemmas surrounding these questions, both personally and professionally. Many experiences, similar to those associated with my mother’s care or Sam’s care, caused various professional and organizational conf licts that evoked complex ethical dilemmas. Despite patient’s advance documentation of, and their verbally expressed desires for, end-of-life care through what is now known as advance care planning, often requests were not honored by professional caregivers, and my patients’ requests were not honored by the organization I worked for. These ethical dilemmas galvanized my determination to take on for my dissertation the topic of patient–client communication about advanced planning for medical care. Through the dissertation proposal process, I came to realize that quantitative research has inf luenced formulations of theory, which have inf luenced training, which has inf luenced clinical practices, which have led to some of these dilemmas. Through these realizations, I also discovered I was passionate about broadening the paradigm of favored dissertation methods. I hoped that

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with my dissertation, I could contribute to changing and improving end-of-life care, and I believed more than collecting and analyzing quantitative data were required to understand how humans in relationship can communicate about questions of being, caring, and dying.

Broadening the Aperture of Psychological Research As a psychology doctoral student, I was subject to the speeding bullet train of APA doctoral-level accreditation, which is propelling a continually narrowing, objectivist view of psychological research. Such a constricted view of research narrows the scope of training and depth of clinical practice. An objectivist frame excludes findings from an array of established qualitative and philosophically-grounded traditions as well as contributions from emerging state-of-the art research techniques. Understandings yielded from a more inclusive array of interdisciplinary research approaches can elicit more meaningful questions and provide more contextual interpretations about questions of human being. Although currently undervalued, qualitative research can allow researchers to delve into the complexities of living in ways that cannot adequately be explored or measured through proceduralized, quantitative methods (cf. Cushman, 2013; Hoffman, 2009; Stern, 2013; Walls, 2012). I realized that incorporating alternative research approaches could provide findings that could improve training programs for professional caregivers and ultimately improve practices of clinical care. Undertaking a hermeneutic dissertation was my way of broadening the aperture of acceptable psychological research by exploring questions of dying—one of the essential questions of humanity. Formulating and conducting a hermeneutic dissertation was my way of resisting the temptation of succumbing to pressure from the prevailing paradigm—pressure to conduct a dissertation within a scientistic model.1

Humanity and Autobiography in a Dissertation And I wanted to go a step further, I wanted to reintroduce the concept of humanity—the researcher’s humanity, in this case, my humanity—into the dissertation process, so I advocated for the power of autobiography to inform my research. Many in the academy do not think autobiographical perspectives belong in dissertations, and thus I heard: “You can’t do that” many times over. I disagreed, and I was fortunate to have found faculty support to proceed in a more humane manner. I wanted to include autobiography because I felt strongly that we needed a counternarrative to objectivity. Researchers dedicated to the mainstream paradigm frequently deny the inf luence of assumptions hidden within their research. In the scientistic view, the researcher is to remain apart, emotionally

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uninvolved, and the research is undertaken in order to produce results that are putatively objective (e.g., Cushman, 2019; Richardson, Fowers, & Guignon, 1999; Slife & Williams, 1995). In my view, and the view of others (Bernstein, 1983; MacIntyre, 1995; Stern, 1991), objectivity is impossible for humans to achieve. From a hermeneutic perspective, this is because researchers have embodied moral understandings and unknowingly but inevitably make epistemological assumptions and knowledge claims (e.g., Cushman, 1995; Gadamer, 1989; Heidegger, 1962; Hoffman, 2009; Richardson et al., 1999; Stern, 2013). These judgments and assumptions inf luence the researchers and therefore inf luence the research, even though in mainstream psychology, the assumptions usually remain unacknowledged. In the scientistic view, the researcher is to “bracket off ” all pre-judgments, and by the proper use of physical science method, the research will produce results that are objective. However, all research is formulated, conducted, and analyzed by humans. Therefore, although typically unrecognized, autobiography and its accompanying moral and political meanings inf luence all research. The scientistic research approach is akin to a psychotherapist conducting therapy without exploring transference-countertransference dynamics. It can be viewed as equivalent to therapists who disavow their responsibilities by failing to acknowledge the presence of autobiography in inf luencing the therapy they offer. In my opinion, the willful disregard of such significant personal inf luences on clinical and research practices borders on the unethical. Therefore, in the context of my research, with careful and critical selfref lection, I incorporated autobiography. I brought my struggles, born of personal and professional ethical dilemmas surrounding end-of-life care and dying, to bear on my dissertation. The ethical dilemmas evoked in caring for patients during the end of life were in fact the questions that motivated my dissertation plans from its inception.

Dissertation as Political Resistance My choice to undertake a hermeneutic dissertation was a quiet act of political resistance. With sadness, I note that philosophically-grounded theoretical, clinical, and research courses—requiring thoughtful examination rather than mindless memorization—are disappearing from doctoral programs. They are increasingly difficult, if not impossible, to find—in curricula of APA accredited programs. They have been replaced with procedural, instrumental courses, as schools are shaping curricula to meet current APA requirements. While in school, I was drawn to philosophically based existential, humanistic, and depth traditions. I discovered hermeneutics as both a research approach and a clinical approach. I benefited from exposure to these ways of reaching a deeper understanding of complex human experience, undertaking meaningful research, and embodying sensitive clinical practices. I also studied relational

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psychoanalysis, which became the primary clinical theory for my dissertation, and ontological hermeneutics, which then profoundly informed my research approach. Sadly, existential, humanistic, relational, and hermeneutic courses are now rarely available in the curriculum at my alma mater. My dissertation illustrated how changes in the curricula of medicine, psychology, counseling, and nursing could shift the way caregivers initiate and develop discussions about end-of-life decisions. I set out to formulate a model of care that could be used across disciplines in professional caregiver training programs, a model that could translate into, and hopefully improve, clinical practice. As a result of my attempt to draw from relational theory, philosophy (especially hermeneutics), and critical studies, my dissertation became a protest against the omission of philosophical and relational courses from training programs for clinical psychologists, and from training programs for all caregiving professionals. It was also a protest against a mainstream movement that tends to invalidate qualitative and philosophically oriented research methods. In my view, these omissions have led to a paucity of more meaningful approaches to psychological research, professional caregiver training, and clinical practices. Hermeneutic engagement allowed me to emphasize the humane truths of interaction between patients and clinicians when communicating about endof-life care. Incorporating my personal and professional experiences and historical studies allowed me to further contextualize the problem. The resulting hermeneutic dissertation project examined dynamics that have inf luenced prevailing theory, questioned resulting practices, and offered a new theoretical model for patient–clinician communication about advance care planning for end-of-life care.

Hermeneutic Research In contrast to other hermeneutic traditions, ontological hermeneutics (cf. Messer, Sass, & Woolfolk, 1988) makes a point of not using a priori, step-bystep methods. As Stigliano wrote: “Hermeneutics is not a ‘methodology’ in the sense that experimental research is” (1989, p. 47). Instead, hermeneutics focuses on the processes of exploration. I have come to call this approach “the no-method method.” If there were a prescribed method for ontological hermeneutics, it would comprise engaging in processes of interpretation to attain understanding. These processes use concepts such as dialogue, fusion of horizons, and the hermeneutic circle. They emphasize engagement and exploration, creativity, and intuitiveness. And I believe that they result in a more meaningful interpretation of contextual circumstances, in which further ref lection can develop deeper understandings and more meaningful expressions of human experience. Hermeneutists understand that any effort to interpret and reach understanding “will always be partial and incomplete” (Christopher, Richardson, & Christopher, 2000,

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p. 18; Richardson et al., 1999). Processes of interpretation and understanding are everchanging and never ending. They evolve through a “circularity” that is “built into life” itself and is thereby ref lected in or “built into all inquiry” ( Richardson et al., 1999, p. 207).

Hermeneutic Practice I settled on an ontological hermeneutic approach because my research and my experiences had shown me that such an approach could elicit better understandings of current practices and reveal deeper meanings and human truths of communicating about end-of-life care. I sought to discover the cultural distinctions (see Stigliano, 1989) that have made possible current communication practices about advance care planning, made possible a disregard for the patient’s stated desired care. I consulted scholarly and professional practice-based health services literature, along with juridical, legislative, policy, and philosophical texts that informed models of care. I made interpretations of literature and artifacts and deeply explored my experiences, those of others, and those of our patients through iterative processes of critical ref lection and synthesis. I did so intending to allow an ontology of clinical engagement to emerge when quality-of-life and death are the stuff that forms the elusive structures that, although hidden, support visible reality. As Stigliano (1989) observed, “What one has at the end of a hermeneutical study is a body of distinctions which make a given practice or network of practices possible” (Stigliano, 1989, p. 65). I used recursive processes, the hermeneutic tacking back and forth in which the whole is understood through understanding the parts and the parts understood through understanding the whole (Gadamer, 1989). Recursive inquiry led me to ask: How could ignoring patients’ advance directives have become so common in clinical practice, and how can the inf luences that have led to this clinical practice be stopped or guided in ways to create a better living and dying experience for patients. The processes of researching and writing through an interpretative approach exposed deficient clinical practices as an effect of a movement within human sciences research and caregiver training away from a respect for relationship and philosophical considerations of truth, knowledge, being, and ethics. As Stigliano noted, “the distinctions we use are not merely theoretical categories, but an ontology—a determination of what things there are in the world” (Stigliano, 1989, p.  62). Engaging in the processes of hermeneutic study made it possible for me to identify tacit and explicit phenomena, conditions, and practices of patient–clinician communication. A hermeneutic approach allowed me to engage in processes of interpretation that historically and culturally situate mainstream medical and hospice practices and then creatively formulate responses and alternatives. Hermeneutics yielded something impossible to assemble from quantitative data. Through

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an interdisciplinary perspective, I looked behind the surface in order to get a sense of the cultural background that brought to light current end-of-life care practices. Doing so enabled me to make meaning of the ways history, juridical policy, legal movements and laws, economics, politics, and education inf luence the clinical care of dying patients.

Hermeneutically Situating Models of Care Through this contextualization, I realized that I needed to understand how models of care taught in clinical training programs perpetuated clinical practices of care that justify professional caregivers disregard for their patients’ desired care. I felt it necessary to consider the models of care that have brought us to this point in time and the current standard of care. I started with the bio-psychosocial-spiritual model that was used by the hospice team of which I was a member when caring for my patient Sam. This exploration led me to the branch of philosophy known as ethics. I discovered that, contrary to models of care currently advocated in the literature, many caregivers with whom I had interacted were providing care from a paternalistic model. In this model, the clinician is thought to be the expert, and communication and decision-making are largely one way, with the clinical expert issuing medical care directives. The professional literature advocates against this model. Yet this model is still widely, if unconsciously, used despite a substantial body of literature demonstrating that many patients do not respond favorably to a paternalistic style (Cooper & Buckner, 2013; E. J. Emanuel & Emanuel, 1992; Phillips, 1987; K. V. Smith, 2005; Roter, 2000). For instance, by studying the history of models of end-of-life care, I came to realize much of what passes for the teaching of ethics has been reduced to finding cautious ways of avoiding punishment from the courts and professional associations. Similarly, a taken-for-granted reliance on the ideology of selfcontained individualism (see Cushman, 1990; Sampson, 1988) has been uncritically but subtly used to justify paternalistic models of care. I asked how could caregivers provide care based on models that have been shown to be undesirable and problematic. This led me to turn my focus to the literature about clinical training programs, especially those for physicians and nurses who, in the current multidisciplinary paradigm, drive the care provided by interdisciplinary teams. I realized I needed to understand how professional caregivers were being trained. By doing so four new thoughts emerged. One, I came to understand ethics in a moral philosophical sense and how three ethical principles—paternalism, autonomy, and beneficence—frequently form the basis for clinicians’ view of their duty in the relationship between patient and clinician, and the position from which care is delivered. Two, yet throughout the country, philosophy, relational theory, and phenomenology are being eliminated from curricula in training programs for psychologists and for other healthcare providers.

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Three, clinicians, especially physicians, report they do not receive enough training in communicating with their patients, especially about end of life, dying, and death. They also do not receive training in basic aspects of clinical relationships, such as self-ref lection, relationality, transference-countertransference dynamics, and compassion. Four, the lack of training in crucial fields of study has created gaps that have led to weaknesses in clinical practice. This was ref lected in Sam’s case because clinical caregivers were unable to change the case paradigm, and administrators were unable to respond with compassion to the patient’s desires because they could not critically ref lect on their own death anxieties and religious doctrines. Such training may have stopped administrators from putting undue priority on concerns for remuneration and organizational convenience.

Hermeneutics in Practice: Formulating a New Model of Care Through a hermeneutic approach, I developed a conceptual description and explanation of the phenomenon of end-of-life care practices and offered a response (McCune, 2014). I formulated a new model of care, the Interdisciplinary Relational Model of Care (the IRMOC). The IRMOC was then applied to communication about advance directives and advance care planning in the patient–clinician relationship.

Initial Findings Professional caregivers get little training in philosophy, ethics, self-ref lection, communication skills, and in how to engage in relationships with compassion, especially about the most essential of human experiences: end-of-life care, dying, and death. In my dissertation, I applied hermeneutic concepts such as the belief that • •

Human experience is interpretive. It is the basis of all caring relationships. Humans can be conscious or unconscious of their interpretive processes and how these interpretations result in judgments, decisions, and actions that affect others, especially in the case of healthcare workers and patients.

With these understandings as a foundation, the IRMOC encouraged those in caring professions to: • •

Recognize that the caregiver brings all of who they are to the caregiving relationship. Recognize the importance and impact of their presence, words, actions, prejudices, and anxieties in caregiving relationships.

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• • • •

Extend kindness and compassion regardless of the patient’s condition, circumstances, or presentation. Understand that one can never fully know the satisfactions and suffering of a patient. Attend to communication with thoughtful listening and responding. Communicate about values and desires in order to select treatments that sustain and enhance the patient’s quality of life and well-being.

The IRMOC urged professionals in caring professions to understand their interpretive prejudices and how those prejudices inf luence the specific care they give. Since my dissertation, I have expanded on those points, and in the following section, I lay out some of those ideas.

Recent Findings In Truth and Method, Gadamer (1989) argued that in the human sciences truth cannot be found exclusively or even primarily through physical science method. I came to realize that respect, dignity, compassion, thoughtful listening, and communication within the treatment relationship—not protocols and profits— must be placed at the center of engagement. To repeat, the main task of my dissertation was to better understand the disjunction between how patients want to arrange their healthcare when they are severely ill and dying, what their doctors and nurses are capable of hearing, and what degree of authority they are willing to grant patients in determining their end-of-life arrangements. Often the seeds of this disjunction occur, followed by disastrous results, before the onset of medical troubles or at least the onset of lifethreatening events. And of course, the 2020–2021 Coronavirus, which brings layers of new issues, only makes the disjunction more immediate and serious. Studying this disjunction in detail produces a stark realization: to an alarming degree, healthcare workers—especially doctors—are unable to listen respectfully to their patients, help patients identify and explore their fears, and then tolerate discussions about how patients want their lives to end. There are, of course, reasons why healthcare professionals are avoidant about engaging in discussions with patients about death and dying, even beyond the historical discomfort most Americans have with that topic. The difficulty caregivers have with that kind of engagement (no doubt attributable in part to their own unacknowledged death fears and anxieties) causes untold frustration and needless suffering. Patients end up feeling resentful and betrayed, and doctors end up feeling impatient and fearful, and at times ineffective and like a failure. What can be done to address this problem? Through developing the IRMOC in my dissertation and now writing this chapter, I have a suggestion: the curricula in medical schools, nursing programs, and graduate psychology, counseling, and social work programs must do a better job of training students to become more effective and compassionate communicators. This will

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necessitate students learning how to tolerate their own death anxieties, professional uncertainties, legal worries, and everyday common powerlessness. That, in turn, will necessitate a slowing down of the high-speed, sometimes frantic pace of the memorization and manualization in graduate schools, their emphasis on procedural practices, and objectivist thinking, especially medical school and psychology doctoral programs. Will a revised curriculum be able to help with these topics, especially in today’s neoliberal social terrain, where professionals acutely feel the pressure to present themselves as infallible experts? Of course, restructuring can help with this difficult challenge. But administrators and instructors will have to face the problems associated with death and dying and respond to them with courage and creativity. One idea I have developed to meet that gap in training is a series of courses that address the aforementioned emotional/psychological conf licts and deficits in healthcare workers and aid in the development and honing of their clinical, interpersonal skills. This could attenuate the iatrogenic suffering witnessed in hospitals and hospice units throughout the country. The first course in this proposed series is an introduction to a politically contextualized history of medicine, psychology, counseling, and social work in the United States. Students can learn to historically situate healthcare practices and think critically, thereby developing some humility about their chosen profession and some of the professional practices once presented as a scientific fact but in retrospect better understood as severely limited or even damaging medically, psychologically, and politically. The second course is an introduction to hermeneutic philosophy and relational theory. Students can learn about the importance of an interpretive way of life and its interpersonal extension, relationality. In the process, students can develop a deeper respect and compassion for others, an ability to engage in Gadamerian dialogue, a more involved understanding of their own personal limitations and strengths, take advantage of opportunities that come with selfref lection practices, and better face some of the difficulties that come with intimate personal relating, such as transference-countertransference dynamics. The third course in the series focuses specifically on aging and end-of-life care. Students delve into problems and prospects of growing old and facing the end of life. Students learn to consider the intersections of culture, race, class, gender, sexual orientation, socioeconomic status, and education, and their impacts during aging and the end of life. The consequences of varying perspectives on attitudes toward, and delivery of care for, the elderly and the effects of inequities on aging, end of life, and dying will be examined. This course is designed to provide an enriching experience that brings together real-world experience and scholarly work, along with exploration through creativity, media, and culture. Students develop skills in critical inquiry, communication, creativity, self-ref lective practices, and social justice considerations during end-of-life care. The purpose of these learning experiences is for students to identify, understand, and critique the ways

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honesty, compassion, and the awareness of transference-countertransference dynamics can facilitate healing in clinical settings. Self-ref lection and historical consciousness are used to increase student’s awareness of personallyheld perspectives inf luencing their views of cultural, social, economic, and political inf luences on clinical relationships. By doing so, students develop an awareness of power and privilege in the clinical relationship and the ability to admit interpersonal mistakes. The fourth course in the series is an opportunity to integrate and put into practice the understandings and skills introduced in the first three courses, especially related to aging and end-of-life care. Through readings, group discussion, and role–playing exercises, students have the opportunity to practice the relational skills and gain the personal courage that are required to help their patients face end-of-life issues, elucidate their particular fears and wishes, and develop a plan that meets their individual needs and preferences. Throughout the first three courses, and especially in this fourth course, a confrontation with one’s own mortality, uncertainty, and powerlessness must be developed in order for healthcare workers to allow for patients the interpersonal space to put into words their struggles with mortality, their fears of suffering and death, their sorrow, loss, and grief. Through each of these courses, students learn how to learn, and by doing so become models for their patients. Of course, this series of courses is not a panacea—how could it be for existential problems that ultimately have no solutions? But the series is a start at addressing the serious disjunctions between patients and healthcare workers that they have experienced and researchers have noted in the professional literature. Hopefully, if nothing more, knowledge and experiences gained during these courses will be a resource for students in internship placements that they will be able to draw from as they grow and develop professionally and personally in the many years after graduation. Clinical training could be improved if programs stopped pushing students to the point that they must numb-out to survive their training programs and graduate. Maybe then clinicians would stop expecting (and encouraging) their patients to numb-out. Instead, we could start teaching students how to care for themselves by incorporating self-ref lection and self-compassion as components in professional development. Our training programs could support students in conceptualizing their work as participating in relationships that are containers for human engagement in which healing occurs. To do this, we need to help students understand that their experiences, emotions, beliefs, opinions, judgments, and values cannot be ignored during clinical work. Who they are and how they feel cannot be checked, like pieces of luggage, at the door to the treatment room. The care clinicians give will become more compassionate if we help students and clinicians learn to recognize, understand, and use these aspects of their self in their clinical relationships.

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In Hindsight Developing and carrying out a hermeneutic dissertation were my way of sustaining my sanity, retaining my moral integrity, healing from traumatizing experiences, nurturing my soul, and fighting the system. The act of engaging in a hermeneutic project helped me survive feeling as if I were dying a slow death from 1,000 cuts administered by increasingly constricted education and healthcare systems. It challenged and cultivated my scholarship and critical thinking skills. It allowed me to channel my frustration with the current state of psychological and medical training and their respective evidence-based clinical practices into an academic product that would be an unconventional contribution to the literature, a contribution that encourages new ways of more meaningfully researching and compassionately practicing. I hope I have accomplished some degree of those lofty goals. It was a difficult, life-changing, and gratifying experience, one for which I will be forever grateful. Another result of this study is that hermeneutic inquiry has become a way of life for me. Hermeneutic processes help me bring a spirit of curious inquiry to all areas of life. Especially when I am at an emotional tipping point, remembering to remain curiously inquisitive helps me in self-ref lection, relationship, clinical work, research, communicating about life and death, and at times, to simply get through the day. I remind myself that the hermeneutic spiral of inquiry continually brings possibilities for new interpretations that deepen understanding and expand meaning—this process is never ending.

Note 1. Scientism is the belief that only a physical science model can accurately determine the truths about humans.

References Bernstein, R. (1983). Beyond objectivism and relativism: Science, hermeneutics, and praxis. Philadelphia, PA: University of Pennsylvania Press. Christopher, J. C., Richardson, F., & Christopher, S. (2000). Philosophical hermeneutics: A metatheory to transcend dualism and individualism in Western psychology. Paper presented at the International Congress of the International Association for CrossCultural Psychologists, Warsaw, Poland. Cooper, G., & Buckner, E. (2013). Elders’ impressions of ethical-legal issues in healthcare. Online Journal of Health Ethics, 2, 3. Retrieved from http://aquila.usm.edu/ ojhe/vol2/iss2/3 Cushman, P. (1990). Why the self is empty: Toward a historically situated psychology. American Psychologist, 45, 599–611. Cushman, P. (1995). Constructing the self, constructing America: A cultural history of psychotherapy. New York: Da Capo Press.

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Cushman, P. (2013). Because the rock will not read the article: A discussion of Jeremy D. Safran’s critique of Irwin Z. Hoffman’s “Doublethinking our way to ‘scientific’ legitimacy.” Psychoanalytic Dialogues, 23, 211–224. Cushman, P. (2019). Travels with the self: Interpreting psychology as cultural history. New York: Routledge. Emanuel, E. J., & Emanuel, L. L. (1992). Four models of the physician patient relationship. Journal of the American Medical Association, 267, 2221–2226. Gadamer, H.-G. (1989). Truth and method (D. Marshall & J. Weinsheimer, Trans.). New York: Crossroads. (Original work published 1960). Heidegger, M. (1962). Being and time ( J. Macquarrie & E. Robinson, Trans.). New York: Crossroads (Original work published 1927). Hoffman, I. Z. (2009). Doublethinking our way to “scientific” legitimacy: The desiccation of human experience. Journal of the American Psychoanalytic Association, 57, 1043–1069. MacIntyre, A. (1995). How psychology makes itself true—or false. In S. Koch & D. E. Leary (Eds.), A century of psychology as science (pp. 897–903). Washington, DC: American Psychological Association. McCune, S. L. (2014). Worlds of connection: A hermeneutic formulation of the Interdisciplinary Relational Model of Care [Doctoral dissertation, Antioch University Seattle]. Retrieved from Ohiolink http://rave.ohiolink.edu/etdc/view?acc_num=antioch1404395833. Messer, S. B., Sass, L. A., & Woolfolk, R. L. (1988). Hermeneutics and psychological theory: Interpretive perspectives on personality, psychotherapy, and psychopathology. New Brunswick, NJ: Rutgers University Press. Phillips, L. R. (1987). Respect basic human rights. Journal of Gerontological Nursing, 13, 36–39. ISSN: 0098-9134. Richardson, F. C., Fowers, B. J., & Guignon, C. B. (1999). Re-envisioning psychology: Moral dimensions of theory and practice (pp. 199–236). San Francisco, CA: Jossey-Bass. Roter, D. (2000). The enduring and evolving nature of the patient-physician relationship. Patient Education and Counseling, 39, 5–15. https://doi.org/1090b1013e31823 ebe31822e Sampson, E. E. (1988). The debate on individualism: Indigenous psychologies of the individual and their role in personal and societal functioning. American Psychologist, 43, 15–22. Slife, B. D., & Williams, R. N. (1995). What’s behind the research? Discovering hidden assumptions in the behavioral sciences. Thousand Oaks, CA: Sage. Smith, K. V. (2005). Ethical issues related to health care: The older adult’s perspective. Journal of Gerontological Nursing, 31, 32–39. Stern, D. B. (1991). A philosophy for the embedded analyst: Gadamer’s hermeneutics and the social paradigm of psychoanalysis. Contemporary Psychoanalysis, 27, 51–80. Stern, D. B. (2013). Psychotherapy is an emergent process: In favor of acknowledging hermeneutics and against the privileging of systematic empirical research. Psychoanalytic Dialogues, 23, 102–115. Stigliano, A. (1989). Hermeneutical practice. Saybrook Review, 7, 47–69. Walls, G. (2012). Is systematic quantitative research scientifically rigorous? Methodological and statistical considerations. Journal of the American Psychoanalytic Association, 60, 145–152.

10 PSYCHOTHERAPY, HERMENEUTICS, AND RELATIONALITY Certainty Is a Dangerous Commodity Scott Perna

Almost twenty years ago, I wrote a dissertation titled “The Function and Diagnosis of Hysteria in Nineteenth Century Fiction and Medical Texts” (Perna, 2002). It interpreted the function and diagnosis of hysteria in 19th-century fiction and medical texts. It analyzed 19th-century, pre-Freudian medical texts about hysteria, written by male doctors, and compared them to fictional writings by women. Through this process, I examined and critiqued the moral and political assumptions that have existed, and continue to exist, between doctor and patient, male and female, and mental illness and mental health within a psychological/psychiatric framework. By using feminist literary criticism and historical accounts of 19th-century medical practices, I analyzed three male doctors’ texts detailing the different pre-Freudian treatments of hysteria. I compared these texts to two novels and one short story written by women, which portrayed hysterical episodes in the course of their narratives. In comparing the medical texts with the women’s fiction, I analyzed how the gender of the respective authors, and the assumptions about gender imbedded in the texts, inf luenced how each respective author approached the understanding of hysterical phenomena. In each case, the women writers were able to contextualize the thoughts, feelings, and behavior in a wider social context, while the male doctors essentialized hysteria as a product of being female. This dissertation, it turns out, was a protest, a very personal protest, against the kinds of banal language used in psychological discourse and the kinds of automatic thinking that often replaces real thought in clinical psychology. The subject chosen for a dissertation is inevitably a deeply personal one for the author. This was no exception for me, though the personal significance of this subject wasn’t truly apparent to me until I was finished writing and I could examine with some distance what I had written. DOI: 10.4324/9781003140177-13

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What became apparent in the planning and writing of my dissertation was a profound anger and rebelliousness at the world I grew up in: Ronald Reagan’s America with its paean to the post-World War II (WWII) suburban spread and its conservative values. Those values included stability, defined by rigid hierarchical definitions of sexual orientations and gender roles; freedom, defined by individual and property rights, and the cult-like belief in the “wisdom” of the marketplace to solve every problem; the denigration of leftist collective action; the unexamined assumption of White supremacy; and the most conservative readings of religion with their fundamentalist, definitive, hard-line visions of right and wrong and what constituted holiness. To grow up in such a confining environment as a young gay person is to be confronted with all these largely unspoken assumptions about what it means to be a healthy human being. If one does belong to a marginalized group (or, at least, if one has thoughts and feelings that conf lict with the dominant ideology), one might be led to start to question why these assumptions? Why are human beings thought to be constituted this way? How and why is this thought to be good, moral, right? Which, if one follows the logic of this questioning, leads to wondering who gets to say what’s right and moral? This kind of inquiry questions the structures of power and privilege that benefit from these ideologies. As a young gay teen, I sought help secretly from psychological texts to try to understand my “condition.” What I found was a bewildering array of attitudes masquerading as science. (If one wants to see an illustration of the social and ideological basis of psychological diagnosis, one only need to look to December 15, 1973, when homosexuality was suddenly and magically proclaimed no longer to be a psychiatric illness.) This experience of alienation from the dominant culture left its own mark, a trace of distance, a knee-jerk reaction against believing in any ideology. My skepticism, which was more emotional in nature than intellectual, needed some kind of structure, a way of thinking that generated a more coherent critique. In choosing to study clinical psychology, I was confronted by categories of symptoms that seemingly described discrete disorders. But in practice, in treating patients, I discovered that the presenting symptoms rarely corresponded so clearly with the categories they were supposed to ref lect. And treatment strategies always unquestioningly assumed models of mental health. It was these experiences cumulatively that led me to thinking about psychology from a hermeneutic perspective. Questioning psychological assumptions around what constitutes a contemporary self and those ideas and practices that blindly support current ideologies of what makes us human led me back to where I started: a critique of the individualistic, free market loving, antifeminist, racist, and homophobic world I grew up in. The rigid categories of what’s right and wrong in human nature, structured by the political world we live in, are ref lected in psychology’s goals, however unthinkingly. This need for categorization on all those different levels, and through all those different factors, is a resistance, a defense, against the need to think through one’s experience, to confront the world with the innocence of

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questions. Packaging the world into neat, tidy, essentialized categories provides a comforting, predictable mental space, an experience already structured so that only certain kinds of thoughts and certain kinds of interpretations are encouraged. If psychology is to have any significance to it at all, it has to question constantly and consistently its own premises and biases. In my dissertation, I spoke to a particular set of biases around gender in psychiatric diagnosis. But one could critique a nearly limitless number of possible biases and assumptions in psychology. Looking at the politics of psychology only interests me in so far as it pertains to the clinical relationship between doctor and patient, so the rest of this chapter will focus on how I think about the psychotherapy hour.

Psychology and Race Those biases and assumptions shift and change with cultural changes. When I wrote my dissertation, I was examining Victorian culture through a late 20thcentury feminist lens. This was a very privileged undertaking, because I had in front of me decades of feminist work which reshaped understandings of gender. It’s always easier to look at the past and interpret what was wrong than to examine the present era one is living in. I’m writing this now in June 2020, during the COVID-19 pandemic, the Trump administration, and the resurgence of Black Lives Matter as a political force. Since Trump’s 2016 electoral college victory, and perhaps because of it, certain cultural assumptions have been upended and reinterpreted. The MeToo movement is an excellent example of this: a spontaneous uprising in which the terms of conduct between men and women have been re-written and re-interpreted. The current movement against police brutality headed by Black Lives Matter, in which White people have suddenly become conscious of the daily trauma of walking around Black in America, is another instance of a kind of apres-coup. (Apres-coup is a psychoanalytic term denoting a particular type of re-interpretation: when a certain emotional maturity is achieved, one re-interprets previous experience based on this new emotional knowledge; the previous experience then acquires a completely different emotional and cognitive meaning.1 One can apply this to the White response to Black oppression in the current socio-political climate.) If psychology is to last as a discipline, it has to take into account how mainstream psychology’s ideal of mental health is mired in whatever current sociopolitical ideas of mental health are circulating. My dissertation amply illustrated this. As cultural changes happen, psychology tends to follow, but often without examining the biases and prejudices that structure its interpretation of human nature. This seems so self-evident to me that it wouldn’t merit comment except for a cursory glance at psychological research or what (on a much lower level) passes for psychology on any bookstore bookshelf. Often, the books are catalogued according to categories like “self-esteem,” “personal transformation,” “happiness,” “motivational,” and “stress management.” Why are these particular categories so consumable? Why, in our culture with every need satisfied at

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our fingertips, do we need books on how to feel happy? Why are we under so much stress? Why do we need our person transformed? And transformed into what? The road to answering these questions leads to further questions about the structures our culture rests on. I’m a White therapist. A long-term Black patient sits across from me. We’ve come to an impasse. He calls it “a gap.” I will never really deeply understand his experience, what it’s like walking around being Black in the world. I’ve been structured by Whiteness: what is generally called “privilege” today is really an amalgam of defenses like disavowal, projection, splitting, and projective identification. His Blackness has been the screen on which Whiteness has projected its fantasies and fears. We are racialized.

The Inescapability of Politics At the moment he points to the difference in our situations, I have a range of actions I can take: I can interpret this impasse at the internal unconscious level, that is, he’s using this as a defense against any intimacy between us because of his unconscious conf licts. I can confront him on the cognitive level by pointing out that he is using race to stereotype both of us and thereby reducing us to the level of caricature. I can talk about my awareness of my own privilege and how much I can sympathize with his plight, how my own experience of oppression allows me to be empathic. All three of these interventions would be misguided—if not downright racist. The larger point is the inescapability of politics in the clinical encounter. This patient is pointing to a truth too often ignored in clinical writings: we are both products of a history greater than our individual, or even familial, histories. In the aforementioned example, the patient rightly sees our difference as both inescapable and a product of history and a legacy neither of us created. Still, it plays out in the here-and-now of our relationship. In thinking about this situation, there are myriad levels on which this relationship is enacted: from what might called the political, in which a White man in a position of authority is questioning a Black man; to the professional in which one man is asking for help from another; to the social in which two men are speaking intimately to one another; to the psychotherapeutic in which a transference/ countertransference relationship is being worked out. From each different vantage point, this single relationship takes on a different cast. But then what could one say is true about this relationship? Clinicians are trained usually to look at a patient’s presenting symptoms and her/his personal history and extrapolate a diagnosis and treatment plan from that. In some modes of treatment, there are even manuals that take the patient and clinician step by step through the treatment process. The structures of understanding a patient are often very limited by clinical thought and language. Clinical language itself often accrues value judgments from the general culture; this is, one reason “manic-depressive” was renamed “bipolar.” But it’s now common

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to hear someone described derogatorily as “bipolar.” So, in even trying to describe someone through the lingo of psychology, one faces a cascade of embedded cultural meanings and judgments for two reasons. One reason is the anxiety raised by the notion of mental disorders and the definitions of mental health, with the judgments that result from this anxiety—to be deemed mentally ill is to have one’s judgment questioned and mostly invalidated. The other is that language itself, by definition, is social. There is no such thing as a “private language.” Language doesn’t belong to anyone; it belongs to everyone. Language is one of the venues through which history is enacted. Language is also the means by which psychotherapy is enacted. With the Black patient/White therapist example, the focus on history and how it impacts the therapeutic relationship seems obvious: the field has been teaching multiculturalism for many years now. Therapists have been discussing the impact of privilege on the therapeutic relationship with minority clients in numerous articles and workshops. But the questions that arise in these discussions should inform every psychotherapeutic relationship. Psychotherapy is, at its best, an intensely private affair. It is unlike any other kind of relationship, though it evokes all kinds of other relationships. The essence of psychotherapy is paradoxical: it is private and public, intimate and professional, close and distant, a real relationship, and an imagined one. It is also embedded in a particular historical moment, a moment that requires psychotherapy as a needed corrective.

Psychotherapy and the Present Political Moment Why psychotherapy right now? What is it in our culture that requires this particular configuration of relationships? Psychotherapy is a relatively young idea and, in its simplicity, a radical one: the curative property is the act of listening intently to the patient. Every school of psychotherapy begins with the act of listening, though what you are listening for shifts and changes with each theory. This is where morality and politics are enacted: what the therapist is listening for is structured by his/her understanding of mental health and mental illness. In other words, the therapist’s listening is formed by cultural understandings of what constitutes health. A therapist’s listening relies on interpretation, an interpretation framed by his/her education and experience, all shaped by the surrounding culture. Listening and interpretation are the working gears of the therapeutic relationship. But there’s more to it than that: the therapist and patient are also inf luenced by the relationship’s transference and countertransference thoughts and feelings. Neither participant is coming into the therapeutic relationship without the ghosts of past relationships haunting the endeavor. The psychotherapeutic relationship then is saturated with many layers of different assumptions, both cultural and intrapsychic. When a patient arrives for the first appointment, there are already fantasies of what the relationship can provide on both sides. These are personal fantasies, clearly, but, as the saying goes, the

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personal is the political: fantasies of cure and relief from mental distress are all bound up in what we expect from our culture’s norms of health and well-being. It’s a common phenomenon at some point in every treatment for therapists to experience their patients, whether overtly or covertly, as demanding that they act as perfect parental figures and provide answers that will resolve all the patients’ anxieties. This kind of transference is extremely powerful and can be used to illustrate two points: on the intrapsychic level, it indicates the necessary disappointment and mourning everyone goes through that there are no perfect parents; on a cultural level, it expresses how much anxiety is uncontained by a culture devoted to individualism and competition and operates through precarity. If on the second point, I appear to be chewing more than I bit off, let me state here that the significance of psychotherapy in our age—its seeming necessity and the hope, dread, and hatred it arouses in response to its necessity—lies directly on our culture’s inability to alleviate a general sense of anxiety, depression, hopelessness, envy, and dread. These terrible feelings relate to our society’s valorization of competition, individualism, and greed. In a culture where the marketplace becomes the arbiter of all things good, and those good things come from competing and winning, the worth of any person becomes bound up in economics: one goes to school, not necessarily to be educated, but to get a good job; one works hard, not necessarily to take pride in one’s work, but so that one can afford housing, food, and, in the United States at least, healthcare. To become homeless or hungry or ill is a moral failing in this atmosphere and serves as warning to everyone else that disaster is a possibility at any moment. No one is really safe. Psychotherapy promises, rightly or wrongly, to be able to alleviate these anxieties first by labeling them and domesticating them with a DSM diagnosis (thereby signaling to everyone that these symptoms are serious); then by treating them with talk therapy or medication or both. Psychotherapists provide a cultural site where one can bring all of one’s existential dread and hopelessness and be soothed and comforted by a warm maternal embrace. This might sound too harsh. Most psychotherapists, I suspect, are out to do good, to help people find some solace in life. I’m writing not about specific therapists but therapy’s location in our culture. It’s an antidote, but one that doesn’t really affect the general social structure. On the contrary, psychotherapy is very much interwoven in our free market system. Without insurance, many if not most people couldn’t afford to see a therapist for any reasonable amount of time. My concern is with how individual therapists think about this situation in any particular individual treatment, which bridges the political and moral with the clinical, in any particular individual treatment. Between the Black patient and White therapist, there’s a historical and political reality that can’t be ignored, must be acknowledged, and addressed. But how about between patients and therapists of similar cultural backgrounds? How does one begin to address the larger societal concerns in the course of treatment? How does one approach the treatment of these anxieties and depressions while respecting the

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patient’s autonomy? It is, after all, the patient who should be able to speak to what’s on his or her mind without the therapist hijacking the session. These are large questions for psychotherapists to face. They point not only to the immediate political reality (e.g., the lies and hate that lead to Trump and his ilk) but also to the larger system in play that allows for the extreme inequities and the resulting societal angst. It seems to me at least that treating mental illness in the session as if it were just a product of individual upbringing neglects other, wider systems at play in anyone’s particular struggles. In any session, then, the therapist should be able to pay attention to the following: the therapist’s feelings about the patient, including those feelings aroused by class conf lict (e.g., envy at the patient’s success); the patient’s feelings toward the therapist, which include the various manifestations of the transference, but also those feelings aroused by perceptions of the therapist’s success or failure; how the patient’s feelings of anxiety or depression might mirror larger cultural responses to a political and economic system that relies on precarity; how the patient’s feelings may ref lect the racialization endemic in US culture; how the patient’s feelings may ref lect the pressure of gendered stereotypes or the pressure of a hierarchy of acceptable sexualities. The list isn’t exhaustive. And, clearly, one can’t keep all the different factors in mind at once.

The Value of Uncertainty But it is incumbent on an ethical therapist to keep in mind that there are all sorts of dimensions to an individual treatment and that a good treatment will keep looking at those dimensions from different angles. Most often, a good treatment won’t provide answers so much as provide better ways of asking the questions. Real psychotherapy doesn’t make people happy; real psychotherapy helps people suffer better and with more clarity. The process of reading for my dissertation, then writing it, elucidated for me just how language, in very complicated ways, shapes our understanding and perceptions of the human condition. The understandings of human behavior, thoughts, and feelings are particularly prone to being molded by language, which always both shapes and ref lects our cultural surroundings. In doing this research, I have attended much more closely to the use of language with patients and with other clinicians. Too often, the language of psychology becomes stilted and concrete, losing any resonance in describing mental suffering, with unexamined assumptions about patients being acted out in rigid diagnostic categorizations that can leave out any real questions of what truly constitutes mental illness. In my dissertation, the reading of the male doctors located mental illness within women struggling with their femininity and their “true” place in the world. From the women authors, mental illness appears to be more of a struggle of the individual against societal constraints. In other words, by shifting focus, meanings shift dramatically. From writing my dissertation, I became

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much clearer about the need to keep any phenomena that appears in my office open to different points of view, different interpretations. This can only result in an attitude of openness to experience and interpretation and a resultant position of humility—one can’t, and doesn’t, know everything, a truism that is too often forgotten in a sea of experts. For the record, when my Black patient made mention of “the gap” between us, I did not ask about specific experiences with others or make interpretations about his childhood or bemoan those moments when I felt oppressed. I sat with the uncomfortableness, a kind of resigned despair, that our culture’s racialization had created a canyon between us. I did not make it about anything other than what it was. I’m White and I’ll never know what it’s like to walk around Black. Further, my Whiteness needed to be acknowledged as something I do, a way I act (however unconsciously) in the world. In a moment like this, it is not only that therapists must think about how patients are situated in the larger social matrix but therapists must also recognize how they themselves participate in it as well, a knowledge that can be both painful and alienating. As psychotherapists, we consciously want to do good in the world. It is an uncomfortable, estranging sensation to realize how one participates in this system without realizing it. There are moments when we realize we are caught up in our own stereotyped thinking and are left feeling defenseless and embarrassed. Those moments are times when we have the opportunity to begin to think something new, to examine ourselves and our situation, and to have new perspectives. The hermeneuticist Hans-Georg Gadamer (1989) called this process “dialogue.” Real education is painful and frightening. For our profession to grow, we must continually put ourselves in those positions of discomfort so that we can help our patients develop a more nuanced, more complex, more enlivening view of themselves and their situations.

Note 1. For a good take on how apres-coup relates to the #MeToo movement, see “Using Psychoanalysis to Understand #MeToo memories” by Avgi Saketopoulou in the New York Review of Books (2018).

References Gadamer, H.-G. (1989). Truth and method (D. Marshall & J. Weinsheimer, Trans.). New York: Crossroads (Original work published in 1960). Perna, S. (2002). The function and diagnosis of hysteria in nineteenth century fiction and medical texts [Doctoral dissertation, California School of Professional Psychology]. Saketopoulou, A. (2018, October 11). Using psychoanalysis to understand #MeToo memories. New York Review of Books.

11 HEIDEGGER, HOMELESSNESS, AND THE ADOPTED SELF An Application of a Hermeneutic Methodology to an Essentially Hermeneutic Psychological Phenomenon William Scott Abbott

In 1999, I completed a dissertation titled When There’s No Place Like Home: Heidegger, Hermeneutics, and the Narratives of Adopted Adolescents (Abbott, 1999). The dissertation drew from eleven semi-structured, face-to-face interviews with adolescents who had been adopted in infancy. I used hermeneutic interpretive categories (Benner, 1994) such as thematic analysis, exemplars, and paradigmatic cases to organize and describe the narrative data.

Conceptual Origins: The Intersection of the Personal and the Professional My path to undertaking a qualitative study and writing a dissertation based on hermeneutic and postmodern philosophy had its origins in perhaps the least objective and scientific realm possible—specific, personal experience with the psychological issue I purported, first as a counselor and then as a graduate student, to examine. As a person adopted in infancy, I grappled with this experience throughout a troubled adolescence full of misdeeds, rebellious teenage behavior, psychological treatment, and family conf lict. Adopted by a wealthy and ostensibly ideal family, I was afforded every advantage one could hope for, including the best private schools, the best psychiatric and medical treatment, and anything else deemed advantageous by my concerned and generous parents. And yet I did not succeed, until later in young adulthood, at arriving at a working and positive sense of self hood, a notion of my purpose or place in the world, and a reasonably stable feeling of belonging in body, in my family, and in my environment in general. I was assisted in this achievement by some wise counselors who took a different approach to my pervasive sense of rootlessness DOI: 10.4324/9781003140177-14

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and, to borrow a phrase from Martin Heidegger, the feeling of having been jolted “out of everydayness” by the awareness that I was, at least in part, not who I had been told I was. Instead of dismissing my sense of existential dislocation as merely a putative universal aspect of adolescence, or reducing it to an innate psychiatric symptom such as a failure of attachment, my new counselors took it seriously. They encouraged a philosophical inquiry into the nature of how one becomes a self, emphasizing the socio-cultural, political, familial, moral, and personal narratives, practices, and prescriptions in which we are immersed from birth and that form the many interconnected layers of personhood. In earlier and more standard treatment I had received, my well-meaning psychologists attempted to apply a medical/clinical methodology to my situation, seeing signs of illness and treating symptoms in a reductionistic fashion without much reference to even the most basic level of broader systemic investigation such as the self/family interface—let alone its philosophical or politics dimensions. They were interested in uncovering largely internal psychological and neurological malfunctions and in finding a way to coerce my behavior and emotions back into normal parameters. On the contrary, as an adolescent steeped in the idealism of the 1960s and the concern for authenticity of existential philosophers such as Simone De Beauvoir and Albert Camus, I was interested in (and angry about) the moral, philosophical, and political superficiality of my wealthy, homogenous, and success-driven suburban environment. The signifiers of illness they identified had, for me, very different meanings—they were forms of protest, inarticulate questions about identity, and expressions of existential concern and confusion. Of course, the emotional distress and behavioral problems they observed can also be interpreted as symptoms of psychiatric conditions that we understand as depression or anxiety, or given my adoption, as attachment difficulties of some kind. However, their interpretation using these categories was too limited and ultimately unproductive for me—it rang hollow even to my as yet uneducated adolescent ears—and it certainly did not resolve the emotional or behavioral problems I was experiencing. It left something vital out of the equation which, as it turned out, had a lot to do with my lived experience of feeling “out of everydayness” and with the subsequent narrative, I had developed about my condition. Having experienced this early adoption-related personal dysfunction and struggle, and having encountered wise and broadly educated counselors capable of helping me get back on track, I pursued a combined degree in philosophy and psychology at Earlham College in Indiana. Earlham’s Quaker origins and campus culture made it a perfect environment for combining the study of psychology as a science with modern interpretive philosophical understandings such as phenomenology, the hermeneutics of Martin Heidegger and HansGeorg Gadamer, and the study of the modern self by way of such seminal

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thinkers as Charles Taylor. The Quaker meeting itself was a study in interpretive practice: one spoke while others listened and made their own interpretations of the meaning and value of what was shared. No central doctrinal authority or pre-determined set of allegedly universal concepts determined the course of spiritual development in the meeting house. In the interest of keeping faith with the hermeneutic practice of deconstructing one’s own historical and cultural prejudices, I would add that in addition to this Quaker inf luence, Earlham in the early 1980s was a progressive and liberal environment where students were beginning to explore concepts that are now in common parlance such as gender f luidity and intersectionality. These forces, though in their early stages to some degree, were inf luential in my approach to the undergraduate study of psychology and led me to question, right off the bat, many of the theories and conceits encountered in the standard canon. Notions of universal stages of development, ideas about the moral development of persons (boys of course), and theories of what constituted proper or adequate attachment seemed to me to be missing a consideration of important parts of the phenomenon they sought to describe. Having established a baseline education in psychology combined with an introduction to deconstructive philosophies, ontological hermeneutics, and critical theory, I decided the next step would be to undertake direct clinical work with troubled adolescent clients and adoptees and see what insights could be gleaned from their experience. Thus, I spent the next 6 years as a counselor at a therapeutic residential program geared toward deeply troubled adolescents who had been unsuccessfully (for the most part) treated by traditional outpatient providers. I discovered that an unusually high percentage of them were adopted, and after consulting the literature discovered this preponderance was also true in many treatment programs and therapy clinics nationally. Indeed, it has been shown that adoptees, and in particular adoptees currently struggling with adolescence, are overrepresented in clinical and treatment settings given the relatively low incidence of adoption in the general population (Brodzinsky, 1990; Cohen, Coyne, & Duvall, 1993; LeVine & Sallee, 1990; Verrier, 1993; Weiss, 1985; Wierzbicki, 1993). Following this practical experience and my ongoing concern with adoption issues, I enrolled in the California School of Professional Psychology intending to continue pursuing a better understanding of the adoption experience through the graduate-level study of philosophical psychology and more advanced clinical training. I was very fortunate to land, on my first day, in Philip Cushman’s History and Systems class, where the history of psychology and its practices were being vigorously deconstructed, historically and culturally situated, and generally critiqued for its scientism and reification of self-contained individualism (Baumeister, 1987; Cushman, 1990, 1995; Sampson, 1988). The importance of meeting Philip Cushman, the continuation of a hermeneutic approach to studying psychological practice, and of joining his ongoing

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hermeneutic cluster (dissertation support group) cannot be overstated in identifying the factors that led me to choose a qualitative method for the dissertation. I had an initial intuition in that first class that a method of understanding human being based largely on the notion that the self is a cultural construct— an interpretive “product” as it were—rooted in important and powerfully held local traditions and practices would be a fitting method for studying an adoptee’s construction of their sense of self.

Theoretical Framework At the time I started this dissertation in 1994, clinical approaches to the treatment of distressed adopted persons had been concerned with attachment, the formation of a self-concept and identity, and with adoptee’s often troubling sense of loss and/or of not “belonging” to the adoptive family. A number of researchers and clinicians working with adopted children from this theoretical perspective noted the similarity of themes that tended to arise (Brodzinsky, Radice, Huffman, & Merkler, 1987; Deeg, 1991; Groze, 1992; Hartman, 1991). Some of the typical issues discussed along developmental or psychodynamic lines included identity problems, difficulties in attachment and trust, and the adoptee’s comparatively lower sense of self-worth. It was less common for researchers or clinicians to employ a more philosophical or globally existential framework in studying adoption, or in treating adoptees, although several authors (Lifton, 1990; Partridge, 1991) raised issues that pointed in that direction. For example, Lifton (1990) described what could be construed as a more philosophical constellation of themes in adopted persons, which she labeled rootlessness, implying a diffuse and pervasive sense of unconnectedness that the adoptees seemed to experience. In this concept, I began to see a bridge to the ontological hermeneutics that would form the foundation for my study; that is, that the adoptee may often have a disturbing sense that they do not quite “belong” or are not “at home” even in the press of close friends and family. After a very long process of reading existing adoption literature, attachment theory, and studies using the aligned behavioral treatment approaches to distressed adolescents, I became convinced that a more explicitly hermeneutic investigation of what adoptees actually report would reveal more of the above. In addition, I hoped it would reveal hidden dimensions of the adoption experience significant enough to guide a more comprehensive interventional strategy than I had seen currently employed in the field. The philosophy behind ontological hermeneutics is dense, fantastically difficult to read, and challenging to apply to psychological topics even if one has formal training in it. It is beyond the scope of this chapter to recreate the entire theoretical framework for my dissertation and so I will instead offer a brief overview to show some of the thinking that directed my research questions

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and how the study subjects and their discourse were approached. To anyone contemplating a dissertation utilizing Heidegger, Gadamer, Taylor, Cushman, Sass, Wakefield, Dreyfus, or similar scholars, I advise developing a mindset somewhat divergent from the typical frame of reference or manner of thinking about psychological studies. It will likely take longer, involve more writing, be more difficult to explain to other psychologists, and its conclusions will be messier and require a great deal of ongoing explication. Its outcome may not be as immediately useful as statistical clinical data, but it will likely be—my prejudice—more interesting overall. So, in what proved to be a deep dive into the 20th-century hermeneutic philosophy of Heidegger and Gadamer, concepts surfaced that I believe proved useful in undertaking a study of adoption from an interpretive and phenomenological point of view. Woolfolk, Sass, and Messer (1988) called Heidegger’s analysis of Dasein, or our human being-in-the-world, the “first expression of ontological hermeneutics” (p. 12) in that Heidegger posited that hermeneutics was not one of a variety of methods by which we arrive at understanding. Heidegger asserts instead that the fundamental condition of Being is hermeneutic in nature; in effect, hermeneutics is “constitutive of human being” (Woolfolk et al., 1988, p.  12). As Heidegger (1927/1962) argued; “The phenomenology of Dasein is a hermeneutic in the primordial signification of this word” where phenomenology is understood to be “the science of the Being of entitiesontology” (p. 62). Thus, both our actual ontology as human beings and our ontological analysis of the human condition is hermeneutic. We are constituted by the hermeneutic process and therefore must study what we are via a hermeneutic methodology. To look at this another way, from the point of view of ontological hermeneutics (see Gadamer, 1960/1989 or Heidegger, 1927/1962), we are all engaged in the constant and inescapable process of defining, being constituted by, rebelling against, and living out aspects of the cultural and historical context into which we are thrust at birth. According to hermeneuticists such as Heidegger (1927/1962), Gadamer (1960/1989), Taylor (1989), and Sass (1988), our way of being human takes shape and acquires coherence within the ever-shifting horizons defined by our living out the epoch-specific and local intersecting traditions, political practices, and values which make up the landscape within which we find ourselves. What Heidegger (1927/1962) has described as an immersion in “everydayness,” or a historical embeddedness in social and family systems, becomes a problem for adoptees by virtue of the fact of their adoption and subsequently by their perception that they sometimes do not “fit” in their families. Standard psychological categories and terms such as attachment, individuation, object constancy, boundaries, and self-esteem may prevent us from drawing on the insights embodied in the daily lives of adopted persons in order to more fully understand their human experience. These categories can serve to

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reduce the meaning of distress in the adoptee’s experience to various developmental and familial failures and thus obscure the possibility that adopted persons may be struggling with more profound and universal issues than those suggested by what are arguably more reductionist psychological theories. Without entirely discounting these concepts and the classic psychological notions of how one becomes a self, I thought that a hermeneutic interpretation of the narratives of adopted persons might offer a more comprehensive metaphor for understanding how someone becomes (and is constantly becoming) who they are. That is, people who have had the experience of being adopted may, by virtue of a sense of alienation and insecurity in regard to taken-forgranted aspects of ordinary reality, have unarticulated knowledge about the socially constructed nature and historicity of the human condition. This unformulated knowing may also arise because the adoptee is unable to unproblematically accept the way of being into which they are “thrown” at random and thus must learn how to practice a kind of primitive hermeneutic or interpretive process in order to develop a stable and effective personal narrative and sense of historical groundedness. Thus, in contradiction to an exclusively psychologized point of view, adoption can also be interpreted as a philosophical problem. In short, adoptees find profound existential questions in the same ground in which other persons find certainties or at most issues of a more concrete psychological nature. In general terms, from my own experience, clinical work, and to a lesser degree from the literature on adoption issues, it was clear that many adopted adolescents experienced greater difficulties in weathering the vicissitudes of growing up than do their non-adopted peers. I hypothesized that adoption, in a sense, seems to “rip the veil” off the fiction that one’s experience of life, the meaning of being, and the nature of one’s relation to other persons (even family) is given and unproblematic. In doing so, adoption presents itself as an emblematic experience of hermeneutic living. Adoption highlights the ongoing, indispensable processes that constitute human being: the necessity of having to interpret, deconstruct, and then reconstitute the taken-for-granted web of cultural meanings, values, and foundational assumptions in which we are embedded. By reifying and universalizing human development and subsequently psychologizing the problem of adoption and locating its meaning intrapsychically within the adopted person, psychologists overlook the adopted person’s inevitable experiential confrontation with the historically constructed nature of identity, social practices, and personal relationships. From a more broadly contextualized and interpretive perspective, attachment-issue or developmentalstage approaches fall short of addressing some of the more philosophically interesting and clinically useful issues—such as the experience of a lack of athomeness and a sense of alienation and insecurity in regard to taken-for-granted aspects of ordinary reality—that were reported by many adoptees in my clinical

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experience. My dissertation explored these existential and hermeneutic issues by examining narratives of adopted adolescents and utilized these issues as a frame of reference for generating new insights for treatment approaches for adolescent adoptees. Furthermore, an adoptee’s problem of not feeling “at home” or of being adrift in regard to identity, place, and purpose is compounded by the fact that many of their non-adopted peers or siblings do not perceive their families or everyday experience as disquieting in the same way. However, it seemed to me at the time (and does more so today) that that this perception of unconnectedness or rootlessness may be becoming more congruent with ordinary experience in our historical era as our sense of community erodes and the divisiveness within our isolated nuclear families and larger political tribes increases. Hermeneuticists such as Gadamer (1960/1989), Heidegger (1927/1962), and Taylor (1989) argued that human being is grounded and formed by the beliefs, practices, and institutions within which we exist. As dominant cultural definitions and constructions of who we are as a nation politically, ethically, and racially begin to unravel, we may better appreciate the anxiety with which the adoptee ordinarily contends. Conversely, we may find some of the experiences with which adoptees’ struggle, and the solutions adoptees develop, to be of use to the non-adopted general population in meeting the challenges posed by the continued erosion and conf lict within our traditions.

Description of the Study In this study, I conducted individual face-to-face interviews in order to examine the discourse of 11 adolescents who had been adopted in infancy, seven of whom were currently receiving psychotherapy or residential treatment for diverse social, emotional, and behavioral problems. The other four participants were likewise adopted, but had not had any significant therapeutic treatment. By using an interpretive hermeneutic process, their discourse was examined to determine common themes in their descriptions of the problems they faced and to explicate the lived structure (Benner, 1994) of the relationship between adoption and psychological difficulties and the coping strategies they have generated and used. The study also explored the connections between the perceptions, values, and self-descriptions of these adopted teenagers and aspects of our current psychological understandings of the self, and what, if anything, adoptees can tell us about human being in general. The study also used the interview data to make recommendations for therapeutic interventions with these adopted teenagers and their families. Specifically, I sought to construct, through an interpretive dialogue with the adopted participants, a plausible reading of the meaning of some of the psychological problems frequently experienced by adopted teenagers. This is a reading

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or interpretation that takes into account both the adopted person’s alienation and estrangement (when expressed) from social and hence individual reality, and the interaction of this phenomenon with aspects of our dominant culture’s current understanding of what it is to be human, have a self, and belong to a family and a society. On the basis of the hypothesis that adopted individuals may have some unformulated philosophical insight into what Heidegger, among others, called the “interpretive” nature of human being, I sought to make explicit these possible aspects of adoption and the perspective on the nature of human being embodied in the lived understandings, problems, and practices of these particular subjects. I attempted to develop a possible way of conceiving of an “ontology of adoption” set against the larger cultural background of notions of self hood, identity, autonomy, and agency; what Charles Taylor has referred to as a culture’s shared intersubjective understandings about human being and our practices that form the social matrix within which individuals live and act (Taylor, 1985, p. 34). This method differs radically from the tenets of standard quantitative research and is based largely on Martin Heidegger’s understanding of Being/ human being, and on Gadamer’s exegesis of the process by which we pursue understanding in general. That this method is appropriate to the psychological inquiry has been well established. Taylor (1985), for example, contended that A being who exists only in self-interpretation cannot be understood absolutely; and one who can only be understood against the background of distinctions of worth cannot be captured by a scientific language that essentially aspires to neutrality. Our personhood cannot be treated scientifically in exactly the same way we approach our organic being. What it is to possess a liver or a heart is something I can define quite independently of the space of questions in which I exist for myself, but not what it is to have a self or a be a person. (pp. 3–4) Thus, the human sciences must have as their goal meanings and the lived understandings of individuals-in-context; a project that can only be rendered intelligible via the interpretations of persons who, like everyone else, are embedded in a particular social and historical context. Furthermore, it is an assumption of this study that our understandings of world and self are not derived in a realm of privatized subjectivity from an a priori set of principles or consciously held beliefs that can be exhaustively and objectively spelled out by studying the isolated subject. Our self-interpretations have a more public and, paradoxically, a more concealed origin as Sass (1988) makes clear: For the ontological hermeneuticists, then, human beings are constituted by their self-interpretations; but, for the most part, these interpretations

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are not unique, freely chosen, or consciously recognized, since they are deeply embedded in the public and determining facts of language, culture, and history, and are so pervasive as to be nearly invisible. (p. 248) It is within this temporal field of horizontally situated and pre-ontological understandings that our fundamental human activity of self-interpretation both is made possible and in which it finds its limits. Any attempt therefore to quantify the data of human experience along the lines of objective, atemporal, and universally binding laws or mechanisms will fail to apprehend our constitutive historical and cultural background. That is, in attempting to free such understanding from all the contaminating biases and contingencies inherent in our mode of being-in-the-world, an objectifying reason will overlook both its own historically grounded prejudices and the genetic conditions that give rise to any particular form of human activity. These conditions are, of course, irreducible elements of the historical and cultural horizon that form the framework within which experience can have any meaning whatsoever. Because these hermeneutic notions were the working assumptions of this study, it was essential to use a method that was able to tentatively elucidate the adopted participants’ self-interpretations, my interpretive framework, and the horizon of publicly shared understandings in which these interpretations are always embedded. Leonard (1994) referred to the multifaceted task facing a situated hermeneutic understanding when she echoed Taylor by noting that “because persons are fundamentally self-interpreting beings for whom things have a significance, understanding human action always involves an interpretation, by the researcher, of the interpretations being made by those persons being studied” (p. 55). Or, as Clifford Geertz elegantly pointed out, our interpretations are like “looking over the shoulder of the other at the text he himself is reading” (quoted in Sass, 1988, p. 250). Although a hermeneutic or interpretive method appears well suited for investigating psychologically complex phenomena, it has a number of limitations. Foremost among these are the problems of evaluating results as truthclaims and of determining the generalizability of interpretations derived from the interviews. Qualitative data such as interview transcripts can be used to generate multiple and perhaps contradictory interpretations. Fully resolving the epistemological issues involved in this problem was well beyond the scope of this study. However, researchers such as Patricia Benner, Donald Polkinghorne, Karen Plager, and Victoria Leonard have developed a method for organizing interpretive data in a meaningful and rigorous fashion. The specific steps I used to organize and interpret the interview data were explicated and defended in my study’s data analysis section (Abbott, 1999). Given these arguments (and many others for which there is no room here), I decided to utilize a hermeneutic methodology to study these important

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psychological issues. I determined that the purpose of this study was to investigate adopted adolescents’ understandings of the nature and etiology of the emotional and interpersonal problems from which they often suffer, and to generate insights about the ontology of adoption and its illumination of the constructed nature of human being.

Summary and Discussion of the Results So, to return to the world of normal language and practical inquiry here, I was interested in three things in the study, both conditioned by my own experience as a troubled adolescent adoptee and by my immersion in a hermeneutic approach to psychology as a discipline and clinical activity. I wanted to find out whether adoptee’s narratives ref lected a hermeneutic-like understanding of the processes of growing up, self-defining, and their tendency to resist or rebel against aspects of those processes that seemed inconsistent with their felt experience and nascent insight into the constructed nature of the self; to examine what role adoption had played in this process; and to see whether a hermeneutic frame of reference for a project of this nature could yield some valuable insights and perhaps hints for clinical practice going forward. Six female and five male adopted adolescents were recruited through contacts with therapists and programs (this was the therapy group) or as volunteers identified by standard research advertisements or word of mouth (the non-therapy group) and were interviewed using the semi-structured interview schedule designed to elicit responses and generate dialogue about the perceptions of the adopted adolescents of their life-world and experiences and to identify the inf luence and effects of adoption on their concept of self, behavior, relationships, and problems. All of the participants were from middle or middle-toupper income families, all had been adopted in infancy and had remained with the same family since that time, and all were in school grades 9–12. All of the participants appeared bright and reasonably well educated relative to their ages, and all appeared to come from generally stable family backgrounds, though three participants reported having experienced disruptions or family problems (divorce, physical abuse) not related to adoption. Seven of the participants were White and had been adopted by White families. One participant was of Mexican and European descent and had been adopted by a White family. One participant identified as being of Native-American and (he believed) African-American descent and had also been adopted by a White family. One participant was of Korean and White descent and had been adopted by a couple in which the mother was a Japanese-born American citizen and the father was born in the United States and was White. Finally, one participant’s adoptive father had been born in El Salvador, but raised in the United States. In the briefest of summaries, it was found that many of the themes did show up in the adolescent’s discussion of their lives and difficulties—or lack

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thereof—although as expected the degree to which the more troubling themes occurred was greater in the group that had required treatment. Many of the participants in both groups appeared to have had what I interpreted as genuine ontological or philosophical insights about the human condition as described by Heidegger and Gadamer; insights that were both critical to the adoptee’s self-understanding and troubling for them—all of them actually, albeit to different degrees. The interviews were organized around four thematic research propositions, which for reasons of brevity, are condensed into three and brief ly described and illustrated in this chapter. The first was that adopted persons, and adolescents in particular, may have a sense of not-at-homeness, rootlessness, or not-belonging, which, to varying degrees, was disturbing to them and related to some aspect of their adoption. Several participants made comments such as: Adoption was kind of feeling unwanted by anybody. Being alone is like. . . . I don’t know. If you, like, feel alone you always think you’re always going to be alone, or something. Well, like . . . not being accepted is almost the same as like, not . . . like being alone, you know? If you’re not accepted, like, nobody is there. So, it was always like a big issue for me to, like, be accepted. Another participant described it as: “Yeah. It’s a big hole. It’s like . . . I’m not even really existing.” Asked how she felt in her current living situation, she responded, “Well, it’s not home, I know that. I have no idea where it is; I have no idea who she is. Nothing. I guess it’s just kind of a fear . . . of . . . being anywhere.” A second proposition was that the adoptees had an experience of being jarred out of everydayness or of falling out of everydayness. This proposition suggested that an experience related to aspects of adoption led the participants to question certain social and intrafamilial assumptions about who they were, how (and indeed whether) they fit or belonged in their family, how one becomes who one is as a person, and general aspects of ordinary reality such as the solidity of parental and sibling ties. The clearest example of this theme was offered by one of the participants who been in treatment who said: And then also at about the age of seven my mom came out and told me that I was adopted. And that was just kind of a shock to me and ever since them I’ve just been like, “I want to meet my real mom, I want to meet my real mom.” I mean, then I got really . . . that’s when my depression started ’cause the whole adoption just totally shocked me and . . . changed my life the whole way through. Because I’m still wondering who my real family is.

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In a very poignant example of how this jarring moment of being told about adoption felt, another participant stated: I was being driven to Sunday school and I don’t remember. . . . I remember the street, the time of year, everything. You know? It was fall. All the leaves were brown on [my] street. It’s very long and we’re driving along. You know, I don’t know how we got into the conversation, but we did. And, like, my mom told me she was adopted. And I was like, oh really? It was, like, okay. You know? And then I remember just, like . . . like, it’s not crystal clear, but I think I remember, like, well, am I adopted? Am I adopted? Because it was just like . . . I knew I wasn’t, but I just wanted to make sure. But then my mom, like completely came out well, yeah, you are. And, you know, I was like . . . and finally, you know, I was just crying and crying and crying in the car. Participants reported experiences that could be interpreted as falling out of everydayness, and therefore, many had been presented with an unusual dilemma in that at an early age the adoptee developed a sense of alienation, distance, and estrangement from some of the more basic aspects of reality, such as familial relationships. Given this, it appeared they felt an unusual urgency attached to the generally human need to begin to practice a rudimentary kind of interpretive process or story making to address a sense of insecurity in basic connections, a sense of not being wanted, and an apprehension that things in “my family are not what they seem to be,” to quote one participant. This young man went on to say: To me it means like a couple different things. Like, it means. . . . it means maybe one, like my parents . . . my biological parents somewhere down the line thought that, like, I’d be in a better place if I was with . . . you know, another family. With another family I’d be in a better place. And then you always have the f lip side of that, of, you know, maybe they just didn’t want me. So that’s how that was. . . . You’re affected, you know, self-esteem and my security for myself. The third proposition was that adoptees would have a narrative that linked their adoption situation to the psychological and behavioral troubles they had experienced. In a number of cases, participants did indeed connect the experience of uncertainty introduced by adoption to their psychiatric and experiential struggles. In an archetypical example, one participant noted disciplinary problems he had in middle school: As I think about it now, now when I think back on maybe why I did that stuff . . . why I was put up for adoption and it kind of makes me think,

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like what was wrong with me? And so that was kind of like an important issue. I mean . . . I mean, maybe they thought I was important and maybe they didn’t—that’s why they got rid of me. I mean, like, when you’re adopted and you start growing up and you actually care whether you’re adopted or not, like, you . . . all that stuff starts running through your mind, you know? What were they thinking, what were they like? Did they like me, did they not like me? As with any hermeneutic study, the results were complex and required interpretation, critical self-ref lection on my initial assumptions and personal situatedness or positionality in regard to the topic, considerations of contradictions to the proposed themes, and in general a careful reading of the extensive discourse produced in these long interviews. As we know from multiple hermeneutic thinkers and researchers, interpretive results are never considered brute facts but rather are tentative and partial aspects of whatever is being studied. In this case, also the interviews produced moments of dialogic self/researcher produced interpretive truths that give meaningful clues as to ways of understanding and thus further engaging with the adolescent adoptee. Everydayness, our immersion in the nearly invisible fabric of our ordinary, taken-for-granted contextual world, has important consequences for understanding the phenomenon of adoption. We are, as Heidegger said, “thrown projection”; that is, our projection or constitution of self through language, social practice, and self-examination takes place within a context of shared understandings about what is meaningful and real into which we were thrown at birth. Also, prior to actively interpreting self and world, we “understand ourselves in a self-evident way in the family, society, and state in which we live” (Gadamer, 1960/1989, p. 276). It is in this last aspect of the interpretive activity of human beings that adoptees appear to experience significant disruptions. This self-evident understanding to which Gadamer referred functions as a kind of frame of reference, a lens for understanding, or even as a necessary prejudice that makes any and all subsequent understandings possible. Adoption, it appears from many of the interviews, can create fissures or ambiguities in this frame of reference that, in important ways, preclude the development of more refined, concrete, and satisfactory answers to adoptees’ questions about themselves, about how and in fact whether they belong in their family, and about how to engage in and feel confident about intimate relationships. Adoptees, in many cases, cannot unproblematically accept and make use of the practices, beliefs, and answers provided by the adoptive family (their ordinary, immediate context) because they feel themselves to be somewhat at odds or not quite “meshed” with this context. Thus, the adoptee remains to a degree open to some of the vast possibilities of undisclosed being; both the process of self-determination and deciding how to engage with the world around them

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remain, to some degree, in a state of fundamental ambiguity. As one participant put it: Yeah, out of it, that’s how I felt for a long time. I was like resentful because I wasn’t quote—unquote normal. You know? When you’re that age there is something normal but when you grow up adopted you realize that normal is like what society accepts. But normal is not always good and abnormal is not always bad. So, there is no real normal. A hermeneutic approach to the discourse and experience of adopted adolescents allows us to avoid the tendency in clinical practice to apply, a priori, reified concepts drawn from putatively universal conceptions of identity development, appropriate familial attachment (or attachment in general), and to avoid pathologizing genuine adolescent insight as psychiatric symptoms—although the suffering many adoptees endure is as poignant regardless of how we interpret it. Nonetheless, a better and more situated understanding of it may prevent us from making it worse through iatrogenic prescriptions about how one ought to perceive the self and existence in general. One example of this problem I encountered in my graduate training that stands in sharp contradiction to the process of hermeneutic understanding I hoped to engender in my study concerns Erik Erikson’s classic theory of developmental stages and its ramifications, and in particular the stage in which the main developmental task is thought to be separation and individuation, especially from one’s parents. Although this notion is now perhaps somewhat dated and has certainly evolved, it can still serve as a valid example of a decontextualized and universal theory that was broadly applied to understanding identity formation. Erikson’s contention that this task is essential for children/adolescents and is part of a series of stages thought to be both necessary and universal is still generally axiomatic in mainstream psychological and popular culture. However, the adoptee’s experience is often already defined by separation and a forced “cutoff ” from at least one essential part of their lives—their history and connection with their biological parents. In such a case, prescribing further separation as the preferred method of establishing one’s individuality seems at best counterintuitive and at worst an iatrogenic intervention that would serve to further discredit adoptees’ ontological insights. This idea is in part predicated on the notion—again perhaps a bit more dated than it was in 1995 when I began this study—that the proper modern self is one that is strictly bounded, masterful, and largely independent of the cultural traditions and practices, which form the context in which it develops (Taylor, 1985, 1989). Such a notion of the self would rely on a secure and independent internal representation or blueprint for its definition and have no need of an interpretive engagement with its broader context, or an historical investigation to give it clarity, stability, or a sense of belonging. If applied to the experience

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of many adoptees, it would suggest to them that they could, and in fact should, unproblematically accept and incorporate the aspects of their ordinary reality they find uncertain or in need of questioning. It is likely that this would be disturbing to the adoptee in that it both denies the importance of their early uneasiness regarding being and pathologizes their sense of distance and estrangement. It does this by becoming embodied through the speech, practices, and healing technologies of various elements of a society in what Foucault has called the process of exercising “the power of the positive,” that is, by defining and prescribing a proper mode of being a person and engaging in one’s life-world. The origins and conditional nature of such prescriptions becomes obscured and forms part of the taken-for-granted horizon that informs the beliefs and practices of members of that culture. These practices and beliefs are then reified and elevated to the status of universal explanatory principles. One specific result of this process for adoptees has been the tendency of mainstream psychological approaches, based on the concept of individualism described earlier, to locate the origins of their feelings of alienation and insecurity in an internal character deficit rather than entertaining the notion that these feelings or thoughts may represent valid ontological insights. This is an example of the unreflective application of aspects of the cultural clearing through the use of healing technologies such as those employed by therapists, and one that would be hurtful to many adoptees by being dismissive of important aspects of their actual experience. Many practitioners also subscribe to the philosophical assumption and psychological prescription that there is a true human self that can be found, uncovered, and distinguished from the various false forms of self, which it may have been induced to assume—a foundational tenet in the psychoanalytic theories of, for example, Donald Winnicott, Karen Horney, and Heinz Kohut. Creating an environment in which the therapeutic client can discover this true self is considered, from this perspective, to be an essential goal of treatment. Combined with aforementioned aspects of our cultural clearing that support and promote such a perspective, these ideas may have a profound impact on the adoptee. Specifically, they may serve to fuel an often desperate striving in the adoptee to “uncover,” “find,” or otherwise unearth his or her true self, rather than affirming and normalizing their disquieting intuition that one’s true self is neither essentially true nor uniquely individualized, fixed, and enduring, but rather a collaborative social entity constructed over time. Again, this could be seen as a notion that pathologizes the adoptee’s early sense of alienation and insecurity in regard to taken-for-granted aspects of self, family, and the world in general, and the anxiety that often accompanies it. In other words, the adoptee’s intuitions and anxiety will tend to be viewed as individualized psychological symptoms rather than as potentially valuable and plausible interpretations of the human condition from a hermeneutic point of view. Undertaking a hermeneutic dissertation presented some significant challenges and also had a number of positive outcomes for me. The challenges were

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largely related to the difficulty of stepping outside the confines of straightforward psychological theory to incorporate complex postmodern and hermeneutic philosophical notions into a study, the massive amount of verbal data generated by long interviews (1,500 transcribed pages!), and the need to carefully interpret and defend results that were tentative, interpretative narratives rather than the usual statistical datapoints. Since completing the dissertation, I have embarked on a career as a clinical psychologist focused on providing therapy rather than continuing to do research, so the positives have largely shown up in my direct work with adolescents and their families. Pursuing a contextualized, historically and culturally situated, and nuanced interpretive understanding of any important topic or phenomena has enormous benefits, in my opinion, in the personal, the political, the intellectual, and the moral realms. This project and my experience with my astute peers in the hermeneutic cluster chaired by Cushman had a significant impact on the way that I conceive of and engage in therapy with adolescents and young adults, adopted or otherwise. It has allowed me an understanding of the process as an engagement in a form of inquiry incorporating and taking place at a junction of intersecting traditions, beliefs, moral understandings, psychological theories, and the conf luence of both therapist and client’s experience of self, of each other, and the world around us. Rather than trying to pretend to a kind of scientific neutrality in which the therapist applies evidence-based healing technologies to disparate symptoms of localized and intrapsychic dysfunction contained largely within the patient, I see my work in therapy as an engaged dialogue between a concerned, attentive adult aware of the contingent and situated nature of their interpretations, and a young person struggling with intersecting narratives of self hood, the meaning and origins of their suffering, cultural, political, and racial concerns, and questions about how to cohere and move forward into a more preferred (by them) way of being. Thus, perhaps the most important outcome for me in learning to think about and work with clients and their issues hermeneutically has been the ability to create a space for authentic dialogue to occur within the tangled, messy, historically and culturally enmeshed—but also fascinating and richly complex context brought to the clinical hour by both parties. The argument that framed this study was, in general, that the experience of confronting, questioning, and therefore interpreting ordinary and usually taken-for-granted realities is anxiety producing and problematic for many adoptees. Standing out, or having fallen out of everydayness can, as Heidegger and other thinkers have shown, create a deep existential uneasiness. For a number of the participants, this uneasiness appeared linked to later psychological turmoil and behavioral problems. If adoptees have an early sense of alienation and insecurity about foundational aspects of their ordinary experience and about Being in general, then they will by necessity need to become skilled at tolerating and working with the existential ambiguity (and anxiety) this implies—Heidegger’s “undisclosed possibilities for Dasein.”

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This is a tall order to say the least, but nonetheless one that the therapeutic milieu is uniquely well-suited to fill, particularly if this ambiguity is recognized for what it (in part) is and is not reduced to merely intra-psychic deficits or characterological f laws or issues. It is also, and perhaps more fundamentally, a philosophical issue that needs to be addressed philosophically, that is, as part of the adolescents’ larger concerns about the world, the meaning of life, their personal ideals, and their ultimate mode of being-in-the-world. In order to address these existential concerns philosophically, the adoptees need to develop a strong interpretive faculty, one that will allow them to embrace rather than f lee from this ambiguity and to bring to it definitions and concrete modes of engagement that begin to address the anguished dilemmas they have recounted in this and other studies. The relatively unformulated knowledge they have about the constructed nature of human realities could, if made explicit for them and stripped of some of its anxiety, translate into a sense of tremendous freedom and personal efficacy for the troubled adoptee. They have difficult and sometimes painful questions to be sure, such as “who am I, and am I wanted, important, or capable of contributing good things to others?” Particularly for the adoptees in this study who were experiencing distress, these were still largely unanswered questions. I made an argument in my study that adoptee’s behavioral symptoms can be seen as a way of struggling for answers in a kind of undirected and anxiety-producing hermeneutic quandary. In the many years of clinical practice following my graduate work, I have seen this dynamic play out many times, and I have witnessed these adolescents and young adults all too often generating negative answers to these questions of identity and self-worth. However, interpretations and narratives are f lexible tools, and so just as I hoped, it has been possible to help them develop a proactive and stronger faculty for addressing the fundamental ambiguity of life (and of course adoption) in general, and specifically to achieve a method for creating healthier and more self-affirming answers.

References Abbott, W. S. (1999). When there’s no place like home: Heidegger, Hermeneutics, and the Narratives of Adopted Adolescents [Doctoral dissertation, California School of Professional Psychology]. ProQuest Dissertations & Theses Global (Publication No. 9945868). Baumeister, R. F. (1987). How the self became a problem: A psychological review of historical research. Journal of Personality and Social Psychology, 52(1), 163–176. Benner, P. (1994). The tradition and skill of interpretive phenomenology in studying health, illness, and caring practices. In P. Benner (Ed.), Interpretive phenomenology: Embodiment, caring, and ethics in health and illness (pp. 99–127). Thousand Oaks, CA: Sage Publications. Brodzinsky, D. M., Radice, C., Huffman, L., & Merkler, K. (1987). Prevalence of clinically significant symptomatology in a nonclinical sample of adopted and nonadopted children. Journal of Clinical Child Psychology, 16(4), 350–356.

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Brodzinsky, D. M., & Schechter, M. D. (1990). A stress and coping model of adoption adjustment. In D. M. Brodzinsky (Ed.), The psychology of adoption (pp. 3–24). Oxford: Oxford University Press. Cohen, N. J., Coyne, J., & Duvall, J. (1993). Adopted and biological children in the clinic: Family, parental and child characteristics. Journal of Child Psychology & Psychiatry & Allied Disciplines, 34(4), 545–562. Cushman, P. (1990). Why the self is empty. American Psychologist, 45(5), 599–611. Cushman, P. (1995). Constructing the self, constructing America: A cultural history of psychotherapy. New York, NY: Hachette. Deeg, C. F. (1991). On the adoptee’s search for identity. Psychoanalysis and Psychotherapy, 9(2), 128–133. Gadamer, H.-G. (1989). Truth and method ( J. Weinsheimer & D. G. Marshall, Trans., 2nd ed.). New York, NY: Continuum (Original work published in 1960). Groze, V. (1992). Adoption, attachment and self-concept. Child and Adolescent Social Work Journal, 9(2), 169–191. Hartman, A. (1991). Every clinical social worker is in post-adoption practice. Journal of Independent Social Work, 5(3/4), 149–163. Heidegger, M. (1962). Being and time ( J. Macquarrie & E. Robinson, Trans.). New York, NY: Harper Collins (Original work published 1927). Leonard, V. W. (1994). A Heideggerian phenomenological perspective on the concept of person. In P. Benner (Ed.), Interpretive phenomenology: Embodiment, caring, and ethics in health and illness (pp. 43–63). Thousand Oaks, CA: Sage Publications. LeVine, E. S., & Sallee, A. L. (1990). Critical phases among adoptees and their families: Implications for therapy. Child and Adolescent Social Work, 7(3), 217–232. Lifton, B. J. (1990). The formation of the adopted self. Psychotherapy in Private Practice, 8(3), 85–91. Partridge, P. C. (1991). The particular challenges of being adopted. Smith College Studies in Social Work, 61(2), 197–208. Sampson, E. E. (1988). The debate on individualism. American Psychologist, 43(1), 15–22. Sass, L. A. (1988). Humanism, hermeneutics, and the concept of the human subject. In S. B. Messer, L. A. Sass, & R. L. Woolfolk (Eds.), Hermeneutics and psychological theory: Interpretive perspectives on personality, psychotherapy, and psychopathology (pp. 222– 271). New Brunswick, NJ: Rutgers University Press. Taylor, C. (1985). Philosophy and the human sciences: Philosophical papers 2. Cambridge: Cambridge University Press. Taylor, C. (1989). Sources of the self: The making of modern identity. Cambridge, MA: Harvard University Press. Verrier, N. N. (1993). The primal wound: Understanding the adopted child. Southlake, TX: Gateway Press. Weiss, A. (1985). Symptomatology of adopted and nonadopted adolescents in a psychiatric hospital. Adolescence, 20(80), 763–774. Wierzbicki, M. (1993). Psychological adjustment of adoptees: A meta-analysis. Journal of Clinical Child Psychology, 22(4), 447–454. Woolfolk, R. L., Sass, L. A., & Messer, S. B. (1988). Introduction to hermeneutics. In S. B. Messer, L. A. Sass, & R. L. Woolfolk (Eds.), Hermeneutics and psychological theory: Interpretive perspectives on personality, psychotherapy, and psychopathology (pp. 2–26). New Brunswick, NJ: Rutgers University Press.

12 ARE WE WOKE YET? HERMENEUTICS AND THE POLITICS OF 21ST-CENTURY SOCIAL JUSTICE MiNa Chung

My aim in this chapter is twofold. First, I provide an overview of my dissertation on the philosophical frameworks of multicultural psychology and how this research led me down a number of professional pathways, from private practice to academia, in which hard lessons were learned. Second, drawing from these hard lessons and returning to the discoveries I made in my dissertation, I attempt to make sense of the ideological contradictions and inconsistencies that seem to be plaguing today’s social justice movement. Recognizing that this second part is a huge undertaking, I offer some early thoughts and possible alternatives with the hope that they can contribute to an ongoing critical dialogue on the merits and drawbacks of the 21st-century social justice movement for the purposes of making it better—which we must do if American democracy is to survive the consequences of trending toward hyperpolarization and fascism. By combining these two aims, I hope to illustrate the ways in which my dissertation—both in subject matter and process of inquiry—has played a central role in my own professional, intellectual, and personal growth.

What My Dissertation Revealed At the beginning of graduate school, I held some certainty that I would specialize in the areas of multicultural psychology. As a Korean born, Korean American woman growing up in middle America in a bilingual household and dealing with racial and gender discrimination, along with resource scarcity, surely a concentration in multicultural psychology would offer a clinical framework for understanding my experiences, as well as those who are culturally different from me. And as a well-established discipline, I believed that multicultural psychology could bring into sharper focus and articulation DOI: 10.4324/9781003140177-15

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the complex interplay of identity, race, class, gender and sexuality, and the psychological impact of oppression and discrimination. Since I’ve never been one to accept things at face value, it is no surprise to me that, as I learned about multicultural psychology’s theories, philosophical frameworks, and practices, I noticed numerous contradictions and inconsistencies that could render the discipline’s principles and aims incoherent. This troubled me as I believed that multicultural psychology had, and continues to have, much to offer. So, it seemed that understanding the problems and finding alternative frameworks to reconcile the contradictions and inconsistencies would help strengthen the discipline. This led me to pursing a hermeneutic dissertation on multicultural psychology’s philosophical foundations. Beginning with the broadest questions, I began my research by simply asking: (1) What is multicultural psychology? (2) How does one practice it? What seemed at first a straightforward inquiry involving theory and praxis soon revealed a number of fundamentally contradicting and inconsistent principles that rendered its objectives incoherent. The first question I posed pointed to hermeneutic theory and philosophy. That is, what are the principles and aims that constitute the overarching values of multicultural psychology, and how do these values shape and inf luence how one perceives the world and interacts in it. Ever since the establishment of the Board of Ethnic Minority Affairs in 1980 by the American Psychological Association, which is now the Office of Ethnic Minority Affairs (OEMA), multicultural scholars have published widely in the areas of theory and research related to diversity and working with diverse populations. Two seminal texts on multicultural psychology and counseling include Counseling the Culturally Diverse (Sue, Sue, Neville, & Smith, 2019), now in its 8th edition and Multicultural Counseling Competencies (Sue et  al., 1998). Here, scholars articulated the philosophical frameworks that should guide multicultural psychology’s theory and practice. Simply put, these include postmodernism, social constructionism, and cultural relativism (Sue et al., 1998). Subsequently, these philosophical frameworks, over time, have formed the bedrock of the entire discipline of multiculturalism. Virtually all scholarly work is predicated on the assumptions that, within a pluralistic society, truths and realities are socially constructed and culturally relative (Chung, 2005). Within this framework, multicultural scholars have argued that certain hegemonic ideologies, namely, white supremacy, hetero-patriarchy, and capitalism, have served to systematically oppress individuals and communities whose identities are positioned outside of dominant culture (e.g., Furumoto, 1998; Hardiman, 1982; Lee, 1997; McConahay, 1986; McRae & Johnson, 1991; Mio & Iwamasa, 1993; Pedersen, 1988; Ponterotto, 1996; Ridley, Mendoza, & Hill, 2001; Sue et al., 1982; Sue, Arredondo, & McDavis, 1992; Sue et al., 1998; Sue, Sue, Neville, & Smith, 2019; Wrenn, 1962). As a result of unchecked biases and prejudicial views of straight white male researchers and scholars, who have

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produced psychological theories and clinical treatments that have harmed and oppressed marginalized populations, ethnocentric monoculturalism has been identified as the primary culprit of oppression in psychology (Sue et al., 1998). Sue and his colleagues do not explicitly name the target identity responsible for oppression—that is, who is doing the oppressing. However, it is fair to assume that since ethnocentric monoculturalism is defined as a hegemonic practice indicative of Western European-American worldviews, the primary culprits of oppression are straight, White men, who create and disseminate mainstream psychotherapy theories. Because straight White men have dominated the mental health profession, Sue and his colleagues have characterized them as “unenlightened . . . hostile, antagonistic, and guilty of cultural oppression” (p. xi). From this vantage point, Sue and his colleagues developed 34 specific counseling competencies as a measure to combat ethnocentric monoculturalism. Upon first glance, the aspirational values of multicultural counseling competencies seem to hold some promise in addressing unexamined biases in the mental health profession, as well as in research and scholarship. That is, by encouraging an orientation toward self-awareness, awareness of others, and aligning one’s actions and values in accordance with the competencies, mental health professionals can work toward combating and eradicating ethnocentric monoculturalism; and in so doing, promote pluralism, inclusion, equity, equality, and justice in all spheres of the mental health field including research, scholarship and professional practice. For those, like me, who value viewpoint diversity and hold strong commitments to social justice, the multicultural counseling competencies seemed pertinent. However, a closer examination of the competencies revealed numerous inconsistencies and contradictions. Although presented as aspirational, these competencies are anything but. Instead, these competencies articulate clear ontological claims regarding what constitutes a good clinician; and with further extrapolation, what constitutes the good. In short, a good clinician is one who becomes multiculturally competent, which also assumes that they have adopted the philosophical tenets that guide the competencies. This also implies that a clinician who decides not to become multiculturally competent—whether by willful refusal or ignorance—would be casted as a “bad clinician” and one who is complicit to ethnocentric monoculturalism. According to Sue et al. (1992), the failure to become multiculturally competent is viewed as unethical, and a refusal is tantamount to a violation of human rights. This moral position reveals a significant contradiction. The ontological assertion, that what constitutes a good human is a multiculturally competent one, is in direct violation of the principles that frame postmodernism and cultural relativism. Broadly speaking, these philosophical frameworks necessarily espouse the multiplicity of truths and realities, as well as cautioning against the imposition of cultural values and beliefs. From this vantage point, disagreements about multicultural counseling theories and competencies are not only

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permitted discourse but they should also be treated as equally valid. Yet that hasn’t been the case. It seemed pertinent to find alternative frameworks to help lessen the contradictions and inconsistencies found in multicultural psychology’s principles and aims. I turned my attention to philosophical hermeneutics as a possible solution.

A Hermeneutic Critique With the help of important hermeneutic thinkers (e.g., Bernstein, 1983; Cushman, 1995, 2000, 2001; Fowers & Richardson, 1996; Fox & Prilleltensky, 1997; Gadamer, 1976, 1989; Heidegger, 1962; Richardson, Fowers, & Guignon, 1999; Richardson & Fowers, 1998; Slife, Reber, & Richardson, 2005; Taylor, 1989, 1992; Webster, 1997; Yanchar & Slife, 1997), I was able to pull together a type of moral topography of multicultural psychology’s theories and practices and, in the process, highlight the problems multiculturalism faces when its moral claims and ontological presuppositions are in contradiction with its philosophical commitments. Beyond identifying the problems, however, I also saw that a hermeneutic lens could offer multicultural psychology possible solutions to the traps and dead ends often evident in postmodernism and cultural relativism (Chung, 2005). In particular, Gadamer’s (1976, 1989) philosophical hermeneutics seemed to offer a possible way through the entanglements of multicultural psychology’s philosophical contradictions and inconsistencies. Gadamer (1976) expanded on Heidegger’s (1962) presuppositions on phenomenology by turning his attention to what he called dialogue. For Heidegger, language and discourse are not merely linguistic structures and tools for communicating or delivering information. Instead, discourse itself—the information that is being delivered—and language as its primary tool sheds light on the often taken-for-granted ways of being-in-the-world. Discourse, then, reveals moral frameworks and moral claims. In agreement, Gadamer viewed discourse as embodied truths that illuminate moral frameworks. However, Gadamer also contended that moral frameworks can only be known genuinely and sincerely through dialogue; something he referred to as “genuine conversation.” As such, dialogue is a central feature of Gadamer’s philosophical hermeneutics. Dialogical encounter makes possible new understandings about the social context of the two interlocutors, which creates the conditions for illuminating the embodied truths of oneself and the other, thereby arriving at an agreement of understanding about the embodied truths and, possibly, an agreement of new understandings. For Gadamer, an agreement of understanding is not about emerging as the dialogical winner, but rather a hashing out of ideas and opinions for the sake of moving ever closer to a genuine conversation that, by coming to shared understandings, can transform viewpoints. In my dissertation, I argued that a hermeneutical dialogue may prove to be useful in untangling the contradictions and inconsistencies found in

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multicultural psychology’s principles and aims. I also argued that dialogue may enable, more than just critical discourse, conditions for important revisions for the purposes of strengthening multicultural psychology. In other words, the purpose of critically examining multicultural psychology’s philosophical frameworks is not to rip it to shreds and discard the discipline. But rather to engage in honest dialogue that includes, for instance, critically examining the merits and drawbacks of postmodernism and cultural relativism and exploring alternative frameworks that may be better suited to support its purpose and mission. For Gadamer, prejudice or “pre-judgments” not only constitute our being but also serve as the enabling condition for dialogical understanding. That is, our pre-judgments (i.e., prejudices) make us who we are and, as a result, they are inescapable. So, an honest dialogue necessarily involves a backand-forth interface with pre-judgments—mine, yours, and theirs. Dialogue, carried out in good faith, is a condition for shifting pre-judgments, but first, they need to be identified, respected, and historically situated. Fowers and Richardson (1996) attempted such a dialogue in their paper published in American Psychologist. Here, these authors focused their attention on the political and philosophical frameworks of multiculturalism. They examined several moral claims, including multiculturalism’s ideals of human equality, cultural authenticity, and relieving human suffering. What Fowers and Richardson intended as an invitation to dialogue was changed by multiculturalists into harsh attacks against them, which quickly put a kabash on future dialogue. As I argued in my dissertation, what seemed the most salient about these attacks is that Fowers and Richardson were casted as ethnocentric monoculturalist. Yet for Sue and his colleagues, they seem to ignore that a concept like ethnocentric monoculturalism is, itself, a product of a set of prejudices; and in effect, their multicultural competency objectives seek to eliminate prejudice (ethnocentric monoculturalism) with prejudice (multicultural competency). And in so doing, multiculturalists seemed to suggest that not all prejudices are wrong and bad—a position with which hermeneuticists would agree. The question is how we go about determining a good prejudice from a bad prejudice. Multiculturalists could well do this, if not for their postmodern prejudice against prejudice. Unfortunately, when they cannot do so, they fall back on a stance that centers on the experiences of minoritized groups. These groups, then, set the moral standard for what kinds of prejudices should be promoted and what prejudices should be condemned and eliminated. Sadly, very few prominent instances of discourse, debate, or dialogue have surfaced ever since Fowers and Richardson’s paper and the acrimonious responses they received between the time period of 1996–1998. One way to understand why any such conversations about the merits and drawbacks of multicultural psychology have been silenced over the past twenty years is that scholars who offer their critiques may fear being marked as oppressive obstructionists, that is, racists. The vitriol following Fowers and Richardson’s paper

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likely discouraged other scholars in the field from offering their ref lections for fear of being tagged as racist, a term that carries with it enormous consequences to one’s personal and professional reputation. And this likely discouraged even more scholars from offering their critiques and ideas about multiculturalism’s conceptualizations on gender and sexuality for fear of being branded as sexist, homophobic, or transphobic. Fear, silence, and silencing have left the discipline of multicultural psychology and multicultural competency unchallenged. But what has happened in our discipline is not unique to what is happening across many academic disciplines within the social sciences, as well as what is happening within our broader society. When it comes to matters of oppression, especially concerning race, we are left paralyzed when it comes to engaging in honest and sincere dialogue.

Building a Moral Topography in Private Practice After completing my dissertation and transitioning into professional life, I set out to effect social justice by applying hermeneutics in my private practice in order to create conditions for genuine dialogue. I held faith that hermeneutics would serve as the antidote to dialogical paralysis. While I relied on relational psychoanalytic traditions and attachment theory to situate and understand my patients’ intrapsychic suffering, I also drew from critical race theory and feminist theory in order to situate their suffering within a broader cultural, historical, and political context. In essence, I viewed my work as a process that involved co-building a moral topography, which was constituted by a collection of experiences that have informed my patient’s understanding of what it means to be human and what constitutes the good life. This moral mapping included the inf luences of local relationships, as well as broader cultural practices, norms, and narratives. For my patients of color, in particular, developing a moral topography necessarily centralized race and racism as key factors in understanding their identity formation, their experiences, and the intergenerational transmission of internalized oppression. In fact, while the lives and experiences of my patients of color were widely varied, a common thread involved the challenges and psychic toll of navigating life as a racialized other. For many years, in the intimate space of my psychotherapy office, I bore witness to countless stories of how racism wreaked havoc on my patient’s self-worth, self-value, and self-efficacy. Not only did I “get it,” I also understood it because I, too, have experienced the damage and hurt of being a racialized other.

Back to the University The more I witnessed, the stronger I felt in redirecting my professional focus to transforming systems rather than individuals. To this end, I left my private practice and returned to higher education. In this setting, I served in a hybrid role as an educator and administrator overseeing a cultural center that allowed

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me to teach, consult, supervise and advise students, staff, and faculty across Student Affairs and Academic Affairs. I had a seat at many different tables that involved matters of teaching and learning, recruitment and retention, and student success particularly in the areas of diversity and inclusion. In this role, it became immediately apparent how the university was ill-equipped to have honest conversations about race and racism on campus. Given my research in multiculturalism and hermeneutics, I believed I could help ease the dialogical gridlock and bring about positive and mutually beneficial changes. However, this optimism was short-lived. A typical response to racial incidents on campus was to prescribe cultural competency training and implicit-bias training, which I was often called upon to facilitate. In light of my dissertation research on multicultural competency, I held serious reservations about the utility of this type of diversity training. I held the position that diversity training needed to be problematized as it made little impact on authentic change, and instead, tended to spur divisiveness between those who challenge its aims and those who believe it should be a university mandate. In effect, it set up a false and damaging binary marking those who challenge diversity workshops as oppressors (racist, sexist, transphobic, etc.) and those who support it as social justice warriors. It seemed obvious to me that a necessary prerequisite to systemic changes involved a cultural shift in values. I believed that as a university community, we needed to first understand what the central problems were beyond the surface sentiments around systemic racism. I pushed for engagement in critically examining campus narratives around diversity, equity, inclusion, privilege, and intersectionality. I suspected that disagreements and misunderstandings around these concepts were at the heart of what was causing university turmoil. It was not self-evident for me at the time, but I had become more and more entrenched with identity politics in problematic and contradictory ways. Overtime, I found myself wrapped tightly around the axle of social justice double standards and authoritarianism. And as a result, I began to champion certain practices and beliefs that were counter to my own values. For instance, I found myself engaged in countless debates in support of viewpoint diversity, inclusion, and free speech, while simultaneously rebuking those who did not share my perspectives. Not only was I in the crossfires of a cultural and ideological battle on campus, I was also drowning in my own contradictions and inconsistencies. It became clear to me that my growing ideological rigidity made me more susceptible to the same kind of incoherent logic and f laws I was critiquing in my dissertation. It was time for a reset. I left academia, and this time, I knew I would not return again.

Moral Shapeshifting and Identity Politics Leaving my position provided me with some important lessons and insights. Academia, as an institution privileged with the power and responsibility of

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producing and disseminating knowledge, has played a key role in affecting the trajectory of the 21st-century social justice movement. In light of how inf luential this movement has been on re-shaping cultural narratives and ideologies, it is crucial to examine the philosophical and theoretical frameworks undergirding this movement to understand why the principles of equality are being compromised and why, as a society, we seem to be moving in the direction of moral absolutism and authoritarianism. Similar to the process I took with my dissertation in addressing the problems with multicultural psychology, a critical examination of the social justice movement may help to illuminate, and therefore alleviate or avoid, the traps that are resulting in incoherent logic and contradictions. An important place to begin is on the topic of moral shapeshifting and identity politics, which are central features of the social justice movement. By the time Trump was elected, the social justice movement successfully implemented a powerful moral narrative around matters of oppression, infiltrating several spheres of inf luence, including media, corporations, secondary and higher education, and state and federal government. This moral narrative became the prevailing cultural counter-narrative, which included dismantling and eradicating systems and structures that perpetuate and maintain power and privilege. Here, group identities were situated along hierarchies of historical and/or generational inheritance of power and privilege. According to Bell (2010), individual lives are experienced based on the location of their identity along the hierarchy. Identities at the top of the hierarchy possess the most privilege and power and, therefore, are oppressive. Subsequently, identities at the bottom have the least amount of power and privilege and are, thus, believed to be oppressed identities. Simply put, the hierarchy represents a moral configuration of identities that are classified as good or bad based on the amount of power and privilege they possess. As such, one of the moral aims in social justice involves redistributing power and privilege so that all identities are equally and equitably comparable. Social philosopher Eric Hoffer warned against the corporatization of social movements. He is popularly quoted as saying: “Every great cause begins as a movement, becomes a business, and eventually degenerates into a racket” (Hoffer, 1967). Twenty-first-century social justice has indeed become a business, and members of this business are anointed with the honorary badge of wokeness, from the everyday warriors who operate like managers, to the vocal leaders who control the woke narratives like CEOs. This badge signifies possessing an enlightened and inalienable truth about oppression. Within this business, social justice warriors believe they hold moral authority in their fight against identitybased oppression. Doxing, which is an extreme form of internet censure, has become a common tactic to publicly expose, shame, bully, and silence viewpoints that differ from, or challenge any precepts of the social justice doctrine. An outgrowth of doxing is “cancel culture.” It’s a practice whereby individuals (and businesses) are indicted and boycotted for “oppressive behavior.” Doxing

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and cancelling aside, mainstream news media, independent news media, social media platforms, and academic publications have all jumped on the bandwagon to police, enforce and disseminate social justice ideologies. The proliferation of social justice publications within these outlets has also affected language and discourse. New terminologies and concepts have emerged, as well as redefining old ones. Terms such as intersectionality, microaggression, ableism, alloism, cisgenderism, transgender, transphobia, lookism, and sizeism are among the few that have been added to the social justice vernacular. Other major terms such as racism, sexism, classism, White supremacy, patriarchy, capitalism, and privilege have been redefined. In light of these new and redefined terms, social justice warriors use wokeness as a metric to determine if one is an “ally” (i.e., a co-conspirator or comrade) and, therefore, trustworthy and on the right side of justice. As such, to be woke means to be in agreement with the social justice discourse. Wokeness also means that one must be an active participant in dismantling and eradicating oppression. Maajid Nawaz, co-founder of Quilliam, a British counter-extremism think tank, coined the term “regressive left” to describe the dogmatic politics of social justice warriors, marked by two contradictory and inconsistent practices: authoritarianism and cultural and moral relativism (Rubin, 2015). Nawaz argued that the regressive left promotes multiculturalism and inclusion with the pretext that all cultures hold equal value while centering marginalized cultures and insisting on the adoption of the social justice master narratives generated by the oppressed. In this context, there is an inherent contradiction that involves imposing the narratives of the oppressed while promoting diversity and inclusion. Likewise, groups whose identities have experienced the most oppression hold the privilege of imposing their narratives. One of the problems here is that the needle on the moral good, alongside constant redefinition of terms and concepts, continues to shift amongst the regressive left.

White Woman’s Tears This type of moral shapeshifting is endemic within social justice circles. As an example, the concept of White women’s tears made its way to academic research, mainstream media and popular culture (e.g., Accapadi, 2007; Hamad, 2018, 2019; Zohore, 2019; Spanierman, Beard, & Todd, 2012; Slap Bang, 2019; Eddo-Lodge, n.d.; Jarrell, 2008; Donnella, 2018; Wong, 2019; DiAngelo, 2019; Meltzer, 2019; Donsky, 2019; Leontiades, 2018). Here, White women have been accused of weaponizing their tears as a strategy to control conversations on race issues by perpetuating the damsel in distress trope. According to Hamad (2019), this trope signifies “an infantilized woman whose purity and innocence is both inherent and sanctified, leading to her perceived reliance on men.” And since women are subject to rely on men, the damsel uses distress signals, that is, crying, to exercise her limited power. Hamad also applied a racialized lens

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to this trope by noting the horrific lynching of Emmett Till in 1955 after he was accused of whistling at a young White woman. Hamad argued that when White women “invoke the damsel,” their crying resurrects a “bloody history” of racism. Hamad further pointed out that “white women are not only aware of their privileged status in society but use it surreptitiously to manipulate and dominate people of color, only to resort to the damsel in distress archetype of White female innocence and victimhood when challenged.” As such, White women’s tears are viewed as a racist act. They are weaponized to silence the experiences of people of color, especially when they feel discomfort and guilt around their White privilege. This perspective is broadly shared within the social justice movement particularly by people of color and “woke” White women. Not only is it permissible to police and condemn White women’s tears but also a zero-tolerance position is often enthusiastically encouraged. This is because condemning White women’s tears also means condemning racism.

When Women of Color Cry An important watershed moment that prompted me to re-evaluate my moral framework around social justice and revisit my dissertation research involved an encounter with a tearful White woman. Intellectually, I understand the racialized interpretations of White women’s tears and have often participated in diversity workshops in which self-identified progressive White feminists derailed conversations with their effusive emotions around guilt, shame, or denial. However, as a psychotherapist and, generally speaking, an empathetic person, I often felt split between my agitation with how conversations on race got derailed by White women and my impulse to help soothe their distress and bear witness to their suffering. Several years ago, I attended a workshop on colorism through the National Conference on Race and Ethnicity (NCORE). This was a three-hour experiential workshop intended to explore the impact of colorism—the practice of discriminating individuals based on skin color. Roughly fifty attendees, all women, sat in a large circle and represented diverse racial and ethnic backgrounds as well as skin tones. One of the facilitators posed a broad question to the group: Have you been impacted by colorism? Most attendees nodded in confirmation and a dark-skinned Black woman raised her hand to share her story. I felt a knot in my throat as I listened to the ways in which she navigated bullying as a dark-skinned woman within her own family as well as the broader community. The pain in her story was palpable in the room, and I noticed several women tearing up. As she wrapped up her story, she stood up from her chair and chaos quickly ensued. Pointing her finger toward my direction, she shouted out, “I don’t need your fucking pity.” Confused and trying to assess whether that comment was directed toward me, I quickly realized that she was chastising the White woman who was seated next to me who appeared to be

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shedding tears well before being called out. She seemed to realize this at the same time and asked, “are you talking about me?” From there, she received a verbal shellacking about how her White tears were not welcomed in the space and how White women shouldn’t have even been invited into this workshop because they don’t experience racism and colorism and, instead, they are the racists and the colorists. The more the White woman was verbally pummeled, the more she sobbed, which exacerbated the Black woman’s vitriol and reinforced her claims that the White woman was derailing the workshop with her tears. Instinctively, I placed a gentle hand on the White woman’s back as she whispered to herself, “What did I do?” My immediate thought was nothing; she did nothing wrong. She, like many of the other women in the room, was affected by the Black woman’s story, and in tears, expressed empathy and compassion toward another person’s suffering. The facilitators were panicked and tried desperately to de-escalate the situation and finally called for a time-out. During the break, I noticed immediately that a large group of attendees encircled the Black woman on one side of the room, consoling her as she was crying; on the other side of the room, the White woman stood against the wall alone, and it was clear that she was made a pariah. I understood why she was being neglected. Any attempts to comfort her would signal complicity to White supremacy. In that moment, I felt torn between a desire to align with the Black woman to affirm my commitment to social justice while simultaneously recognizing my moral conviction that the Black woman mishandled the situation and unfairly criticized and ostracized the White woman. Knowing the potential social consequences and risks of consoling the White woman who was accused of being a racist, I knew it would be immoral for me to turn my back on her. So, I approached her and offered support. Once the group reconvened, the facilitators attempted to engage attendees in an open dialogue, which quickly devolved into a color war; or more accurately, those with darker skin complexion were insistent that the workshop could not resume until all the White women and women of color with lighter complexion were excused from the workshop because colorism and racism did not affect them. The workshop was completely derailed, and attendees could not recover from the chaos sparked by the Black woman. Left with no choice, the facilitators ended the workshop early and without resolution. In this example, it was clear that the Black woman’s tears derailed the workshop. Also clear was that the White woman’s tears were not racist nor being weaponized to silence the Black woman. The most salient ideological framework that surfaced in this workshop involved identity politics. Individuals with light and fair-skinned complexions were criticized for their White and White-passing privilege. And because of their light skin privilege—both people of color and White people—they are allowed and able to participate more freely within the dominant White culture. Provided that dominant White culture is defined as oppressive, the intertwined

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nature of skin tone and race means that all light-skinned individuals are inherently racist, regardless if the light-skinned individual is a person of color. This justified the call for excluding all light-skinned individuals in the workshop. Yet this call was deeply problematic as it revealed a dangerous double-standard with regard to core social justice principles, as well as major f laws in the philosophical and moral frameworks that support their cause. Simply put, how do social justice proponents and activists reconcile calls for exclusion when one of their prominent tenets involves promoting inclusion? Moreover, how will they reconcile their position on White women’s tears when the tears come from a Black woman? For instance, would it be appropriate to say that the Black woman’s distress during the workshop was racist; that she knowingly weaponized her emotions and tears to attack and accuse a White woman for being racist simply because she was White? In this case, who was the damsel in distress and who was behaving in a racist manner? Furthermore, can light-skinned people of color be racist since their fair skin offers some of the advantages of White privilege? What about mixed-race and multi-ethnic individuals who appear White-passing or have no visible detection of Whiteness? Can they be racist? In light of the double-standards often visible within the 21st-century social justice and the regressive left, it seems that there are certain cases in which it is acceptable to use tears as a cudgel for social justice, as well as permitting certain behaviors classified as oppressive when applied to the dominant culture. For instance, Senator Jeff Flake of Arizona was confronted by two women, Maria Gallagher and Ana Maria Archila, who pleaded with him to delay the Senate vote in nominating Brett Kavanaugh to the Supreme Court Justice, in order to allow more time for the FBI to investigate the sexual assault charges brought against him (Malveaux & Stracqualursi, 2018). During this confrontation, which was caught on video and immediately went viral, Gallagher, a White woman who was overwrought with uncontrolled emotions, was seen yelling at Senator Flake, insisting he meets her demands. Archila, a Latina woman, was also seen forcefully yelling at the Senator, pointing at him numerous times while standing a few inches away from him. Gallagher and Archila were successful in using intimidation and emotional hostility to sway the Senator’s vote in favor of delaying the hearing to nominate Kavanaugh. What is striking in this situation is that despite Gallagher’s unrestrained display of emotions, which can be characterized as her invoking the damsel in distress, there was zero-mention or public discourse on Gallagher appearing to weaponize her tears. Also striking was a lack of discourse on what can be perceived as Archila’s threatening physical behavior against the Senator, assuming that if she were a Latino male accosting and trapping a White female Senator in an elevator, this would spark national attention. Instead, these women were featured in Harper’s BAZAAR and praised for their courage to speak out: “Outspoken and unconventional, these brazen women are beacons of change who refuse to

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conform, inspiring people around the world to fight for what they believe in” (Flemming, 2018). What this seems to suggest is that if the damsel in distress trope is invoked, then White women’s tears are acceptable so long as their weaponization of tears is used to promote a social justice agenda. Moreover, it is fair to assume that it is acceptable for women of color to intimidate and behave in belligerent fashion, especially toward a White male when their mission is to challenge violence against women. One way to explain why these women were hailed as role models and courageous warriors of the oppressed rests in the philosophical frameworks that shape the cultural narrative on social justice. Rooted in critical race theory and intersectional feminist theory, Sensoy and DiAngelo (2012) argued that oppression necessarily involves institutional control and ideological domination. Prejudice and discrimination are important facets of oppression; however, they contend that oppression exists only when these two facets are combined with institutional power, and oppressed identities lack this type of power. These authors situate “isms” solely within this framework, resulting in the stance that minoritized people can be prejudiced about or discriminate against others, but they cannot be an “ists” because they lack institutionalized power. Not only is this viewpoint wholly and unproblematically adopted by social justice warriors but it is also foundational in academia among the social sciences and liberal arts ( Lynn & Dixson, 2013). From this vantage point, it can be easily argued that the Black woman in the colorism workshop was not racist and her attack on the White woman was justified given the legacy of slavery and anti-Blackness. Moreover, the social justice framework precludes Gallagher and Archila from being challenged as sexist, for invoking the damsel and using physical force to intimidate and corner Senator Flake in the elevator, because of their marginalized gender identity. What this ultimately means is that the social justice movement’s redefinition of oppression permits oppressive behaviors so long as it is used to disrupt and dismantle dominant White culture. In effect, the 21st-century social justice disguises itself as a noble movement to promote inclusion, diversity, equity, and equality; but in practice, it condones authoritarianism, as well as psychological violence against those who disagree or challenge their framework. What was once viewed as a counter-narrative, the ascension of today’s social justice movement and principles are now the dominant cultural narrative. If this evaluation of a realignment of power is accurate, are we then to believe that, for instance, forms of verbal racial bullying are permissible (perhaps even good, when in the cause of social justice)?

Fusion of Horizons Without correction or challenge, there is a danger that the moral shapeshifting and identity politics in the 21st-century social justice movement could lead to

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a damaging quest for moral absolutism and purity. It seems that the arguments I made in my dissertation may continue to have relevance in the case of today’s ideological battles. That is, Gadamer’s (1975, 1976) philosophical hermeneutics may offer some solutions to the problems with the social justice movement. For Gadamer, how we come to understand the present necessarily includes an understanding of the past. And when we engage in a Gadamerian “genuine conversation” or dialogue in good faith, we create a hermeneutical situation that makes it possible to experience a moment of what Gadamer called the “fusion of horizons.” The concept of “horizon” suggests itself because it expresses the superior breadth of vision that the person who is trying to understand must have. To acquire a horizon means that one learns to look beyond what is close at hand—not in order to look away from it but to see it better, within a larger whole and in truer proportion. (Gadamer, 1975, p. 305) Here, Gadamer is not suggesting that “to see it better” means to discover a fixed or essential truth. But rather, seeing it better suggests an active process of understanding the context of “pre-judgments” or prejudice. For Gadamer, prejudice is inescapable. It is situated in the historical horizon, and it is only through dialogue, which reveals aspects of the historical horizon, that we can contextualize prejudice and thereby understand them—theirs and ours—more clearly. So, in a hermeneutical dialogue, the perspective of the other is not solely attributed to that individual as if they exist in a vacuum; instead, the other’s perspective becomes known upon understanding the broader context of that perspective. As the other’s context becomes more understandable, one can experience a truer understanding of the other, and crucially that process can then lead to a truer understanding of one’s own prejudices. This becomes a search for humble understanding, not a demand for purity. Dialogue, then, enables a discovery of the good prejudices as well as the bad ones in both dialogical partners. Further, this back-and-forth exchange of horizons help to create conditions for new understandings; and this enables new possibilities for establishing shared and shifted horizons that can lead to change and transformation.

Postmodernism and Critical Race Theory From the vantage point of hermeneutics, one of the problems that seem to undermine the social justice movement involves the adoption of critical race theory’s (CRT’s) presuppositions on the roots of oppression. And while critical race studies do not represent a unified school of thought, CRT and, subsequently, the social justice movement, are usually unified in their commitment to postmodernism.

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A central theoretical premise of CRT involves the stance that racism is not an aberrant practice; instead, it is an ordinary, everyday practice that is normalized in every sphere of inf luence from the individual to broader systems and structures of society. As such, CRT conceptualizes the fabric of North American traditions, beliefs, and values as inherently racist and White supremacist. Nikole Hannah-Jones (2019), the creator of the 1619 Project of the New York Times, asserted not only that America is inherently racist but also that the birth of this nation is undisputedly predicated on White supremacy. Critical race scholars have argued that, as a collective, Whites have exercised their dominance by imposing their ideologies on non-Whites, resulting in historical and institutionalized racism and oppression (Delgado & Stefancic, 2001). From this perspective, White individuals, even those who have not engaged in racist behavior, are presupposed to be inherently racist. They have benefited from, and inherited the legacy of, White supremacy and the privileges that accompany that. And because Whites possess hegemonic power, their racism is invisible to them, which manifests as “internalized dominance” and implicit biases ( DiAngelo, 2012). Thus, CRT’s framework of White supremacy suggests a moral binary consisting of the oppressed versus the oppressor. The oppressors are exclusively White and inherently racist. As an outgrowth of CRT, it is evident that the social justice movement defines Whiteness and racism as synonymous. The call to eradicate racism is also a call to eradicate Whiteness. Whiteness represents an evil that must be tamed into submission; and taming Whiteness is the only way to achieve “collective liberation.” Chris Crass, an educator and a social justice author, noted that to build a new America we must center the “other America” (2013, 2015). White anti-racism has now become a prominent feature in the social justice movement and a thriving business next to Black Lives Matter (BLM). Notable scholars and authors include Robin DiAngelo (2012, 2018), Tim Wise (2005), Shakti Butler (2006), Ijeoma Oluo (2018), Ibram X. Kendi (2019). Online resources have virtually exploded, from YouTube videos to blogs, as well as community organizations such as Standing Up for Racial Justice (SURJ), which has local chapters across the nation. It is not hyperbolic to say that all of the racial justice information (e.g., books, articles, videos, organizations, and activism) that has emerged from the social justice movement is galvanized around CRT’s definition of racism and conceptualizations of White supremacy. In addition, CRT situates White supremacy within the framework of social constructionism (Ladson-Billings, 2013). Rejecting biological explanations of race, CRT posits that race is a social construction stemming from the desire to categorize hierarchical group differences in order to maintain White supremacy. As such, the concept of race, itself, is not a “real” thing per se; however, the social construction of it (the values and beliefs that are established), and how it is practiced, has had a real sociopolitical impact. Moreover, scholars of CRT posit that oppression is intersectional and understand that individuals hold multiple

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socially constructed identities so that experiences of oppression affect those multiple identities. As such, CRT also adopts the concept of intersectionality— a concept coined by Kimberle Crenshaw (1991)—which aims to locate specific social group identities—for example, race, class, gender, and sexuality—along the axis of privileged and oppressed to determine how the combination of one or more of these identities produce unique experiences of oppression (LadsonBillings, 2013). Much like race, other identities such as gender, class, ability, age, religion, and sexuality are conceptualized as products of socially constructed ideas and values, which inf luence one’s experience of privilege and/or oppression. Intersectionality, then, brings to light other hegemonic ideologies that serve to oppress non-dominant identities in similar ways that White supremacy oppresses people of color. As such, hetero-cis-patriarchy and capitalism are hegemonic ideologies that must be critically examined to understand the full nature of oppression. Hetero-cis-patriarchy involves the value impositions and dominance of straightness, biological categorization of sex, and male superiority. In short, hetero-cis-patriarchy ref lects straight-male dominance. Capitalism, then, ref lects wealth superiority. Ideologically, capitalism is viewed as an abhorrent machine often controlled by straight White males, who must exploit others for personal gain. These three hegemonic ideologies are central pillars in CRT. In practice, the social justice movement has adopted these pillars and treats them in ways that might be called the holy trinity of oppression. So sacrosanct are these ideologies that the mere challenge of them sparks outcries of heresy and condemnation. And given that much of our public discourse exists on social media, social justice warriors and devotees of the holy trinity are armed and ready to dox and “cancel” dissenters. CRT’s adoption of social constructionism is rooted within the larger framework of postmodern theory, Foucault (1970,1975) and Rorty (1991) in particular. The central tenet of postmodern theory is the rejection of an absolute truth, especially universal claims of truth derived from scientific inquiry that presupposes objectivity. In postmodern discourse, truths are considered relative; they are social constructions that constitute subjective realities, values, beliefs, traditions, and practices that are shaped culturally, politically, and historically. Given the subjective nature of socially constructed truths, they are, in essence, all valid and hold equal value. To not view truths as such and to lay judgments that place higher value on one truth over another means that it leaves one vulnerable to absolutism. The by-product of absolutism can result in the gross misuse of power leading to violence, oppression, and the disintegration of the individual and society (Foucault, 1975). The social justice movement believes that White supremacy, hetero-cis-patriarchy, and capitalism are interwoven by-products of White, Western absolutism; and this belief justifies their call to action in dismantling the holy trinity of oppression.

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It makes sense why critical race scholars and social justice activists have adopted postmodern theory as its central framework. This framework is paramount in grounding their argument that individuals of non-dominant social identities have been systematically oppressed as a result of White supremacy, hetero-cis-patriarchy, and capitalism. CRT utilizes postmodern discourse to reject the truth claims of these ideologies, asserting that because truths are socially constructed, and thereby subjective and relative, Western cultural superiority should and must be repudiated and eliminated. After all, the holy trinity of oppression is couched as representing absolute truth and exercising absolute power, which directly excludes the subjective truths and realities of marginalized identities. CRT argues that systematic and institutionalized exclusion, racial or otherwise, has led to generational harm; and one way in which harm can be eliminated is by de-centering the ideologies of the oppressors and centering the discourse of the oppressed, In other words, by transforming the counter-narrative into the metanarrative. Postmodernism enables 21st-century social justice to take this stance, but not without significant problems. By adopting postmodernism as CRT’s central school of thought, we can see that CRT is vulnerable to ideological contradictions and inconsistencies. Hicks (2018) asserted that “in order to equalize the power imbalance, explicit and forthright double-standards are absolutely and unapologetically called for by the postmodern left” (p. 238). Hicks noted that postmodern discourse necessarily produces contradictions and double standards because it argues for a subjectivist and relativist vision while also taking an unyielding stance on dogmatic absolutism. For instance, social justice activists contend that truth and values are subjective and relative, and that all cultures and identities are equally deserving of respect; however, they also promulgate moral claims—and often presented as indisputable truths—that White, wealthy, heterosexual males are destructive and bad. Following Hicks’ argument, if social justice activists were committed to subjectivity and relativism, then we would see more diversity both in viewpoints and across the political spectrum within this movement. However, this is not the case, as the social justice movement along with postmodernism are situated squarely on the political left; and as Hicks discerned, “relativism and absolutism coexist in postmodernism, but the contradictions between them simply do not matter psychologically to those who hold them” (p. 185). I contend that postmodernism leads to an inevitable dead-end, especially when applied to matters of multiculturalism and social justice. Returning to my example of White women’s tears, CRT scholars and activists have unified around the belief that White women’s tears are racist. This indictment, then, justifies actions that disrupt the tears (e.g., the Black woman yelling at the White woman during the NCORE workshop). The danger of slipping into absolutism involves irreconcilable contradictions when postmodernism is the primary philosophical framework. So, while the White woman at the workshop was

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admonished for her tears, Maria Gallagher, a White woman, was hailed as a hero when she cornered Senator Jeff Flake in the elevator. What this seems to suggest, and what might be uncomfortable to admit, is that the social justice movement relies heavily on a type of dogmatic absolutism, and when put into practice, dogmatic absolutism manifests as authoritarianism. Moreover, it seems that when their absolutism is challenged, they slip into social constructionism and relativism to bolster the validity of their stances. Not only is this circularity self-defeating, it renders the social justice movement and its causes philosophically incoherent. They think that the only way to achieve the goals of the social justice movement—eradicating all forms of oppression—is to adopt, without question, the movement’s ideologies. In effect, society can be transformed according to the vision of the social justice movement. It would require pledging an allegiance to the belief that America, from root to branch, is racist, sexist, classist, homophobic, and transphobic: all White people, all men, all straight people, all cis people, and all wealthy people are oppressors. To not agree with this is a moral sin and a failing of character; and even those who agree that identity-based discrimination and prejudice exits, but do not condemn all Whites as advised by the social justice movement, they too, are defined as oppressors who must be defeated. Idris Elba’s viral tweet on June 2, 2020, in support of the protests, riots, and looting that have swept the nation following the death of George Floyd captures the spirit of some aspects of the social justice movement: “This ain’t a movie/ain’t calling cut/we cutting the throat of the old system/so if you ain’t with us/then you better run. New breed.” One common message shared amongst the protestors and its destructive fringe involves an end to dialogue. They are fed up with “talking” and now they want action. But action cannot take place without dialogue. So, it seems here that the action being called for involves unquestioningly meeting all the demands of the social justice movement. A push toward a “new breed” or a new “other America” is a dangerous proposition. This may appear transformative, and in the literal sense, it is. It is transformative with respect to replacing one hegemonic power with another; but even with this “new breed,” oppression will still exist, as will imbalances of power—it will just be the identity of the oppressed that will be different. How, then, will the leaders of this “new breed” govern with respect to policies and laws? Will authoritarianism and the brutal exercise of power continue but just with different perpetrators and victims, or will the contradictions of the movement become obvious and needed changes occur?

Conclusion At this critical junction in history, plagued with civil and political unrest, Gadamerian dialogue, more than ever, is crucial. From the vantage point of

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philosophical hermeneutics, the full horizon of the 21st-century social justice movement needs to be examined and understood. This can happen whether in direct conversation with another or through an engagement with texts, including scholarly literature and media sources. A hermeneutical dialogue can shed light on the moral commitments that are so precious to this movement, and understanding these moral commitments is crucial to deepening the quality and honesty of dialogue. When those moments of a fusion of horizons occur, the possibilities for change and meaningful transformation are expanded. The fusion enables important questions about context to be addressed and explored, as well as respect for all dialogic partners to be honored. For instance, using a hermeneutic rather than a postmodern framework allows for important questions to be asked: What are the values and aims of the social justice movement? Can systemic and institutionalized oppression be eradicated while the movement’s values be honored? If so, how will the movement attack White supremacy, hetero-cis-patriarchy, and capitalism? How effective will this attack be? Who will suffer as a result? If it turns out that those with “privileged identities” suffer under the new world order, how will the movement attend to this suffering, and can the movement learn from that suffering? Will the suffering of the formerly “privileged” matter? If the social justice movement were to achieve its goals, what would society look like and how would it be governed? What would be the consequences for those who challenge the movement? What are the merits and drawbacks of grounding the social justice movement in postmodern theory and discourse? When contradictions and inconsistencies are identified, how will they be reconciled? Would the movement be willing to forego certain theoretical and philosophical presuppositions if they continue to produce contradictions and double-standards? Questions like these can set the stage for more honest and courageous dialogue. It requires one to wrestle with one’s own moral commitments, continually place them into question in relation to those of others, and practice humility when determining what values can be preserved and what should be abandoned. Since my departure from higher education, and as social justice extremism has risen during Trump’s presidency, I have revisited my dissertation research in order to understand how the 21st-century social justice movement has become untenable. Perhaps more than ever, I am committed to Gadamerian dialogue, and returning to my dissertation has reminded me of this commitment. It has helped me to understand why I became mired in contradictions and how to make my way through the entanglements. The problems I examined with regard to multicultural psychology in my dissertation echo the same problems we are facing as a nation. That is, how do we contend with ideological differences, and how can we better determine what is the good and how to apply it properly? And when the counter-narrative becomes the metanarrative in problematic ways, how do we challenge this without resorting to rigid authoritarianism, identity politics, ideological extremism, and moral purity? I am all the

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more profoundly indebted to Phillip Cushman, who helped me to understand that a dissertation is not exclusively an academic requirement needed to earn a diploma. Instead, a dissertation in psychology serves as a map and a guide to understanding and developing solutions to some of the most vexing problems in society. Writing a dissertation is a rigorous and soulful endeavor that can have lifelong affects, especially when the subject of research holds personal significance for the researcher. Simply put, the questions that are asked in a dissertation must be meaningful for the researcher in order to make proper meaning. Although it was difficult, I am most grateful for being afforded the opportunity to engage in it. I’m not sure I could have found my way out of the contradictions in which I found myself had I not had my dissertation as a map.

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INDEX

Note: Page numbers in bold indicate a table on the corresponding page. Page numbers followed by “n” indicate a note. 21st-century social justice movement 208–210; colorism 200–203; dogmatic absolutism 208; fusion of horizons 203–204; language and discourse 199; moral shapeshifting and identity politics 197–199; postmodernism 207–208; racialized interpretations of White women’s tears 200–203; White women’s tears concept 199–200; see also critical race theory (CRT) Abbott, W. S. 13 absolutism 198, 206–208 academic competencies 15 Adler, A. B. 28 adopted adolescents see adoption adoptees 179, 183–186, 189 adoption: adopted persons 183; challenges 187–188; described 183; issues 178; notion of the self 186–187; ontological hermeneutics 176–177; ontology 180; personal and professional intersection 173–176; psychological categories 177–178; psychological problems experienced by teenagers 179–180; self-interpretations 181; situation 184–185; study description 179–182; study result summary and discussion 182–189; theoretical framework 176–179; see also adoptees

All But Dissertation (A.B.D.) 3 –7 American Psychological Association (APA) 4, 6, 15 American Psychologist 2 , 195 anxiety 169–171 apres-coup, term 167 Archila, A. M. 202, 203 Aristotle 116, 117, 122, 123 Arkin, W. 34 Arriving Phase of treatment 96 Aschwanden, C. 85 attunement: described 117–118; development 118–119 autobiography 154–155 bad clinician 193 Barrett, M. M. 23 Battlemind Debriefing and Training series 23; authors context 28; context 25–32; defined 28; goals 28–29; OEF/ OIF/OED presentation 27–28; predeployment training 30; PTSD 26, 29–30; thought-terminating clichés 30, 31–32; trauma presentation 29–30; trauma symptoms 37; treatment goals, structure, and principles 28–29; warrior cult 30 battlemind injuries 29 Battlestar Galactica 21 Bauerlein, M. 85

Index

Bauman, Z. 83 being human 177, 180; see also end-of-life care Bell, L. A. 198 Bellah, R. N. 100 Bellef leur, T. 21 Benjamin, J. 12, 109, 112, 113, 116–123 Benner, P. 80, 181 Bennett, S. 65– 68 Bernstein, R. 7 Beyond the Blues: Understanding and Treating Prenatal and Postpartum Depression and Anxiety 65, 66 biomedical sciences 51 bipolar 168–169 Black people 167–170, 172, 200–203 Black Lives Matter (BLM) 42, 167, 205 Bonds of Love, The 12, 109, 113, 116, 117 Bracken, P. 37 brain-based therapy 51, 59 brain science 53 Brenninkmeijer, J. 51 Briere, J. 72 Brody, N. 21 Bromberg, P. M. 141 Brothers, L. 53 Butler, S. 205 cancel culture 198 capitalism 192, 206 Castro, C. A. 28 Chang, J. 23 Charcot, J. M. 80, 81 children see adoption; parent-child relationship chi-square test 77 Christo 131 Chung, M.N. 13 class 206 clinical implications 70–71; being comfortable with not knowing 72–73; clinician’s perspective 72; meetings and openings 71–72 clinical language 168–169 clinical training 162 clinicians 67– 68, 72, 168 Coburn, W. J. 133 cognitive neuroscience 49 Cohen, J. A. 22 collective liberation 205 colorism 200–203 combat stress reactions 29–30 commitment 123 compassionate curiosity 135

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Comprehensive Solider Fitness Training 27 concept of self 54–55 concussion of the spine see railway spine Coronavirus 160, 167 Counseling the Culturally Diverse 192 Courting Surprise: Unbidden Perceptions in Clinical Practice 132 COVID-19 pandemic 160, 167 Cozolino, L. J. 48, 52–59; brain-based therapy 59; brain functioning 58; metaphor 57–58; mind–body problem 59; primary content analysis examples 52–55; psychotherapy history 53–54; rewriting or explaining one field of study from perspective of another field 56–57; rhetorical strategies analysis 55–58; self and mind concept 54–55; social and decentralized self hood 59; speculative language 55–56 Crass, C. 205 creative disorder 130 Crenshaw, K. 206 Criminal Minds 21 critical race theory (CRT) 204; intersectionality 206; oppression 205–206; racism 205; social constructionism 206; White supremacy 205–206; White women’s tears 207–208 cultural artifacts 9, 26, 79 culture 9 Cushman, P. 41, 49, 60, 72, 78, 92, 94, 99, 110, 111, 133, 139, 141, 175, 177, 188, 210 Da Costa, J. M. 81 Dasein 177, 188 Death With Dignity 153 Deblinger, E. 22 deliberation 113 Deliberation and Mutual Recognition in Intimate and Committed Love 108–109 desire: described 121–122; good choice 123–124; intimacy 122; reasoned choice 123 Diagnostic and Statistical Manual of Mental Disorders (DSM-5) 64 dialogue 133, 172, 194, 204 DiAngelo, R. 203, 205 disassociation 134 discourse 179, 186, 194–195, 199; postmodern 206, 207; psychological 54, 131–132, 165

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discrimination 203 dissertations 3 –7; autobiography 154–155; feeling enlightened 101–103; humanity 154–155; political resistance 155–156; psychological community 38– 40; psychotherapy 49– 60; students struggles 14–17; trauma diagnoses 84– 86; see also psychological dissertation and therapist voice Dobrofsky, L. R. 34 dogmatic absolutism 208 Doomscrolling, term 21 Down Came the Rain: My Journey Through Postpartum Depression 65 Downton Abbey 21 doxing 198–199 Dreyfus, H. L. 177 Duchamp, M. 23 Elba, I. 208 emotional intelligence (EI) 98 emotion-focused therapy (EFT) 89–91; active agents not social victims 96–97; hermeneutic process 91–93; mind–body split 93–94; philosophical conundrum, and 97–98; reliability of inner voices and internal structures 95–96; repetition 98–99; romanticism and rationalism 99–100; structures in mind as sources of truth and goodness 94–95; unacknowledged implicit value consequences in psychotherapy 98–101; values 98–101 Emotion-Focused Therapy: Coaching Clients to Work Through Their Feelings 90 emotions 90, 117; feeling enlightened 101–103; moral perception 115–116; see also emotion focused therapy (EFT) Emotion Schemes 93, 94 empty chair technique 101 empty self 99 enactment 138, 144 end-of-life care: autobiography 153–154; hermeneutic practice 157–158; hermeneutic research 156–157; hindsight 163; humanity 153–154; IRMOC 159–162; political resistance 155–156; psychological research 154; questions about 153–154 enlightenment, feelings of 89–90; dissertation research 101–103; emotion as inner truth and rational realization 93–97; hermeneutic process 91–93; unacknowledged implicit values in

psychotherapy 98–101; values 90–91; see also emotion focused therapy (EFT) Erfahrung, term 116 Erichsen, J. E. 79, 80 Erikson, E. 186 Essiedu, A. 21 ethical sensibility 114–115, 118 ethnocentric monoculturalism 193 everydayness 23, 115, 174, 177, 183, 184, 185, 188 Eye movement desensitization and reprocessing (EMDR) manual 23, 25, 40– 41 face-to-face interviews 179 facial expression 118 faculty 5 – 6, 16 false self 54 feelings 115; see also emotions; enlightenment, feelings of Fineman, M. 66 Flake, J. 202, 203, 208 Floyd, G. 208 foregrounding 72 Foucault, M. 78, 137, 187, 206 Fowers, B. J. 12, 109, 111–116, 122, 124, 195; see also moral perception fragility 17 Freud, S. 53, 56, 57, 80, 140 Fromm, E. 89, 100 functional self 68– 69 Function and Diagnosis of Hysteria in Nineteenth Century Fiction and Medical Texts, The 165 fusion of horizons 109–110, 203–204 Gadamer, H.-G. 3, 7, 8, 23, 24, 70, 73, 78, 108, 110–113, 116, 118, 124, 135, 141, 160, 172, 177, 179, 180, 183, 185, 194, 204 Gad-el-Hak, M. 85 Gallagher, M. 202, 203, 208 “gap” 142–143, 168 Geertz, C. 181 gender 206 Gomez, A. A. 12 good clinician 193 goodness 94–95, 121 Greenberg, G. 84 Greenberg, L. S. 89, 90, 92–99, 101, 102 Grey’s Anatomy 21 Grody, W. 85 group therapy 133–134

Index

Hamad, R. 199, 200 Handmaid’s Tale, The 21 Hannah-Jones, N. 205 Hare-Mustin, R. 78 healing 108 healthcare workers 160, 162 Hebrew Bible 7 Heidegger, M. 7, 23, 71, 73, 78, 177, 179, 180, 183, 185, 188, 194 Herman, J. L. 80– 82 hermeneuticists 8, 94, 100, 177, 179 hermeneutics 1–3; A.B.D. 3 –7; concepts 7–10; described 156; EFT 91–93; hindsight 163; ideas 8; inquiry 163; inquiry areas 23–25; interpretative concepts 8 –10; literature 23; models of care 158–159; new model of care 159–162; ontological 176–177, 180–181; practice 157–158; psychotherapy, relationality, and 165–172; research 10–14, 156–157; researchers 8; trauma diagnoses 76– 86 hetero-cis-patriarchy 206, 207, 209 Hicks, S. R. C. 207 “high road” emotions 95, 96 Hoffer, E. 198 holy trinity of oppression 206 Homeland 21 Horney, K. 187 Horowitz, M. J. 80, 83 hospice care 152–153 humanity 36, 154–155 humans 8 –10 human sciences 180 Hunger Games 21 hysteria 79, 80 identity of trauma victim 83 identity politics 197–199, 201–202 I May Destroy You 21 Indman, P. 65, 66– 68 infant see parent-infant interactions injuries 29–30 Interdisciplinary Relational Model of Care (IRMOC): aging and end-of-life care 161–162; disjunction patients and healthcare workers 160; hermeneutic philosophy and relational theory 161; historically situate healthcare 161; initial findings 159–160; recent findings 160–162 interiority 140 interpersonal field 135

217

interpersonal neurobiology 50 Interpretive Turn 3, 8 in-theatre debriefings 29, 41n4 intimacy 122 Iron Man 3 21 Janet, P. 80, 81 Kant, I. 90, 93–95, 97 Kardiner, A. 80 Kavanaugh, B. 202 Kay, J. 50 Kendi, I. X. 205 Keyworth, K. 21 Kirsch, I. 84 Kohut, H. 187 language 55–56, 169, 171, 194; see also clinical language language of gesture 118 Layton, L. 25, 41, 78 Leonard, V. W. 23, 181 Levinas, E. 112, 122 Lifton, B. J. 176 Lifton, R. J. 30, 80– 82 living truth between traditions: attunement development 118–119; dissertation 108–113, 124–125; erotic fusion of horizons 120–121; interdependence of mutual recognition, moral perception, and desire 121–124; moral reasoning 113–116; mutual recognition 116–117 Livshetz, M. A. 12 loading the language concept 30 Lord, S. P. 11 “low road” emotions 95, 96 Ludlam, J. 12 Madsen, R. 100 Mallarmé, S. 131 manic-depressive 168 Mannarino, A. P. 22 Marin, P. 34 Masler, D. 12 maternal suffering 65– 66 mavericks 2 –3 McCune, S. L. 13 McKelvey, B. 85 Menken, A. E. 65– 67 mental health injuries 30 Messer, S. B. 177 MeToo movement 167 Midrash 7, 111, 133

218

Index

military 34–37; see also Battlemind Debriefing and Training series; soldiers mind–body dualism 94 mind–body problem 59 modern age 100 modernism: creative imagination 142–143; digital entertainment 142; experience 141–142; interiority 140–141; multiplicity 142; mutuality 143; notion of the self 140; notions of multiplicity 141 morality 117–118; action 110; reasoning 113–116; relationality 117–118; shapeshifting 197–199; topography in private practice 196 moral perception 113–114, 121–124; described 114; emotions in 115–116; ethical sensibility 114–115, 117 moral understanding: fusion of horizons 109–110; insight 108; moral action 110; pleasure and satisfaction 109; psychological healing 108 Mothering and the Functional Self: A Hermeneutic Exploration of Texts on Perinatal Mood and Anxiety Disorders 63 mother/mothering 68– 69; see also perinatal mood and anxiety disorders (PMADs) Mott, F. W. 80, 81 Multicultural Counseling Competencies 192 multiculturalism 195, 199 multiculturalists 195 multicultural psychology 191–192; counseling competencies 193; dialogue 195–196; disciplines 196; hegemonic ideologies 192; hermeneutic critique 194–196; language and discourse 194; merits and drawbacks 195–196; political and philosophical frameworks 195; pre-judgments 195 multiple self 83, 128, 141 mutual curiosity 135 mutual enactments 129 mutual recognition 121–124; graspingness 117; social power 116–117; third, the 116 Myers, C. S. 80, 81 nagging feeling or disquiet 115 Natinsky, A. 11 National Conference on Race and Ethnicity (NCORE) 200 National Defense Authorization Act 27

Nawaz, M. 199 NCIS 21 neo-humanistic therapy see emotion focused therapy (EFT) neoliberalism 41n3 neural integration 54 neurological intervention 53 neuropsychoanalysis 50 neuroscience of psychotherapy 11, 48; biomedical sciences 51; cognitive neuroscience 49; dissertation 49– 60; philosophical hermeneutics 50–51; preliminary research process 49; research methods and results 52; see also Cozolino, L. J. Neuroscience of Psychotherapy: Healing the Social Brain, The 48, 52 “new breed” 208 Nicomachean Ethics 117 Nietzsche, F. 126 “no-method method” 156 North American movement 8 not-at-homeness 183 not-belonging 183 objectivity 128 Ocasio-Cortez, A. 143 occupational therapy 151 O’Connor, F. 131 Oedipal survival 120 oeuvre 12 Office of Ethnic Minority Affairs (OEMA) 192 Oluo, I. 205 On Concussion of the Spine: Nervous Shock and Other Obscure Injuries of the Nervous System in Their Clinical and MedicoLegal Aspects 79, 80 On Railway and Other Injuries of the Nervous System 79 ontological hermeneutics 6, 7, 176–177 ontology of adoption 180 Operation Enduring Freedom (OEF) 26–28 Operation Iraqi Freedom (OIF) 26–28 Operation New Dawn (OND) 26 Orange Is the New Black 21 Ortega, F. 51 Osborne, J. 21 Ozark 21 Pape, K. M. 11 parent-child relationship: erotic space 120–121; teen survival 120

Index

parent-infant interactions: emotional dance of attunement 119; sense of safety 118 Partners in Thought 135 patient-clinician communication 153, 156, 157; see also Interdisciplinary Relational Model of Care (IRMOC) patients 162; see also Interdisciplinary Relational Model of Care (IRMOC) Perinatal and Postpartum Mood Disorders: Perspective and Treatment Guide for the Health Care Practitioner 65– 67 perinatal mood and anxiety disorders (PMADs): clinician who brings order to disordered 67– 68; defined 64; fusion of horizons 69–70; maternal suffering and 65– 66; mother is an object whose well-being serves others 67; mother’s suffering reduced to medicalized disease within an individualist response 66; universal across time and culture 67 Perna, S. 13 personal identity 81, 83, 96, 97 philosophical hermeneutics 6, 7 physical injury 30 Pitts-Taylor, V. 51 Plager, K. 181 politics: identity 197–199; inescapability of 168–169 Polkinghorne, D. 181 post-9/11 wars in Afghanistan and Iraq 26 post-deployment stress training 29 postmodernism 3, 204–208 posttraumatic stress disorder (PTSD) 21, 76–77, 79, 85; see also Battlemind Debriefing and Training series pre-deployment Battlemind training 30, 35 pre-deployment skills-based program see Battlemind Debriefing and Training series pre-Freudian treatments of hysteria 165 pre-judgments 195, 204 prejudice see pre-judgments privilege 168 problems of the self 54 professional caregivers 152, 159–160 professors 2 , 6, 11 psychological community 38– 40 psychological dissertation and therapist voice 126–127; aesthetic experience 131; bringing out patient’s life stories 133; dialogue 133; disassociation 134; empty tool chest 135–137; enactment 138; experience meets

219

understanding 128–135; group therapy 133–134; individualism 139; individual self 139; instrumental actions 129; interpersonal approach 127; modernism 140–143; movement 132; neoliberal ailments 139–140; objectivity 128; perspective 133; self 138; social thinking 129; technique 129; uncertainty 143–144; see also Stern’s theory psychology 73–74, 126, 167–168; see also psychological dissertation and therapist voice; psychotherapy psychotherapists 59, 72, 141, 170–172 psychotherapy 111, 113, 169; hermeneutics, and relationality 165–172; moral understandings 128; present political moment and 169–171; promises 170; psychotherapeutic relationship 169–170; unacknowledged implicit value consequences 98–101; see also clinical implications; neuroscience of psychotherapy; perinatal mood and anxiety disorders (PMADs); psychological dissertation; Stern’s theory psychotherapy–neuroscience synonymity 58 qualitative data 181 race/racism 167–168, 197; racism described 205; White women’s tears 199–203; see also critical race theory (CRT) railway spine 79, 80 Rajasekaran, S. 85 rap groups 82 Reagan, R. 166 reasoned choice 113 recursive processes 157 regressive left 199 relationality 117–118, 165–172 religion 206 repetition concept 98–99 Richardson, F. C. 94, 99, 195 Risser, J. 70 rootlessness, term 176, 183 Rorty, R. 206 Rose, N. 51, 56, 58 Rousseau, J.-J. 90, 93, 95–97 Saint, C. 28 Sampson, E. E. 2 , 3, 36, 93, 94

220

Index

Sass, L. A. 92, 96, 177, 180 Schore, A. N. 50 science 85 scientism 4 – 6, 11, 15–16, 29, 73, 163n1 self 54–55 self-interpretations 181 Sensoy, O. 203 sexuality 206 Shapiro, F. 23 shell shock 79, 80 Sherman, C. 131 Shields, B. 65 Siegel, D. 50 Smedslund, J. 98, 99 Smith, K. 134 social group identities 206 social justice movement see 21st-century social justice movement social power 116–117 soldiers 81– 82, 86; post-deployment training 33–34; pre-deployment training 34; PTSD 34–35; re-deployment 33; see also Battlemind Debriefing and Training series soldier’s heart 79 Sources of the Self 92 spontaneous gestures 119, 121 Standing Up for Racial Justice (SURJ) 205 Stark, T. 21 Stern, D. B. 12, 69, 70, 126–144; alternative conception 128; compassionate curiosity 135; cultural and linguistic traditions 136; curiosity 135–136; disassociation 134; dissociation 135; emotional chaos 130; era of psychic geography is dead 127–128; ideas in psychotherapy 127; language 131–132; moral understandings 128; mutual enactments 129; uncertainty 143–144; see also modernism Stigliano, A. 23, 156, 157 Stone, S. D. 65– 67 stories about the self 54 students 5, 7, 16, 160–162, 197; dissertation 14–17; doctoral 4, 6, 16; psychology 3 – 4 Sue, D. W. 193, 195 Sugarman, J. 25 Sullivan, H. S. 134 Sullivan, W. M. 100 Summerfield, D. 84 survival 120 Swidler, A. 100

Taylor, C. 7, 90, 92–95, 97, 142, 177, 179, 180 teachers 5, 15 teenagers/teens 120, 179 therapists 37–38, 169; see also psychological dissertation and therapist voice third, the, concept 116 thought-terminating clichés 30, 31–32 thrown projection 185 Till, E. 200 Tipton, S. M. 100 Tolleson, J. 41 training 136; Battlemind 30; clinical 162; post-deployment stress 29; predeployment skills 28–29; programs 162 transcendental ego 94 trauma: clinicians resistance 40– 41; described 21–22; dissertation in psychological community 38– 40; foregrounding 24–25; hermeneutic inquiry 23–25; interpret 21–22; primary interpretation 25–26; treatment manuals 22–23, 25; see also Battlemind Debriefing and Training series; trauma diagnoses Trauma: Culture, Meaning and Philosophy 37 trauma diagnoses 76–77; hermeneutic dissertation 84– 86; hypothesis and themes 79– 84; process: from quantitative to qualitative 77–79 trauma-focused cognitive behavioral therapy (TF-CBT) manual 22 traumatic neurosis 79, 80 trauma treatment manual: dissociated therapists 37–38; interpretation manuals 22–23; paradigmatic cultural objects, as 22–23; paradigmatic objects of contemporary culture, as 25 Treating trauma and traumatic grief in children and adolescents 22, 25 Trimble, S. W. 85 True Blood 21 true self 54 Trump, D. 167, 198, 209 Truth and Method 108, 110, 160 two-chair technique 101 uncertainty 143–144, 171–172 Valèrie, P. 131 value: EFT 90–91; uncertainty 171–172 Veteran’s Administration (VA) 35, 82

Index

Victorian Era 79, 80 Vidal, F. 51 Vietnam War 34, 35, 80, 82 Virtue and Psychology: Pursuing Excellence in Ordinary Practices 12, 109 Wakefield, J. 177 Walter Reed Army Institute of Research (WRAIR) 27 warrior cult 25–26, 30, 33–37, 42n5 war stress injuries 29 wartime theories 81 Western culture 53, 55, 78, 79, 83, 92 West, L. J. 34 West Wing, The 21 When There’s No Place Like Home: Heidegger, Hermeneutics, and the Narratives of Adopted Adolescents 173

221

White 39, 141, 167–170, 172, 182, 193, 199–203, 205, 208 White anti-racism 205 White culture 201–202 White supremacy 192 White women’s tears, concept of 199–203 Winnicott, D. W. 54, 119, 187 Wise, T. 205 wokeness 199 Woolfolk, R. L. 177 Worlds of Connection: A Hermeneutic Formulation of the Interdisciplinary Relational Model of Care 13, 153 World War II 80 Young, A. 35 Zeddies, T. 100