Objective:
Unlearn deficit indoctrination that breeds labeling.
Pivot toward strengths thinking.
A “normal” person is the sort of person that
might be designed by a committee. Each person
puts in a pretty color and it comes out gray.
—Alan Sherman
Close your eyes. Picture the word psychology. What comes to mind? A brain? Diagnosis? A couch? Sigmund Freud? Your therapist’s I know you’re feeding me a line of bullshit glance? Inkblots?
If inkblots danced across your mind, that’s because they are the most known mainstream images associated with psychology. Swiss psychologist Hermann Rorschach, a bit of a Brad Pitt lookalike, made them famous in 1921.
Rorschach was into klecksography, the art of making images from inkblots. He wasn’t just artsy or obsessed with the sensory experience of making them, but he was trying to test his theory, one that was in lockstep with the main juxtaposition of psychology: that something’s wrong with you and needs to be fixed.
He thought that if he analyzed how his patients recognized patterns, it would reveal whether they were mentally stable. He hadn’t exactly accounted for his own subjectivity or its inconsistency in predicting behavior. He didn’t factor in social context, or the countless other variables that affect perception. And he never got the chance to tease it out properly.
Rorschach died at the age of thirty-seven, while his test methods were still immature. But the domino had already been tipped. His sticky idea spread, and then some. You can see why something as intriguing as the inkblot test had such a run. And it’s not dead yet. Even nearly a century later—despite scientific evidence deeming the test unreliable and invalid—psychologists and websites still use them.
Like the popular inkblot test, the something’s wrong with you position has stood the test of time. When an entire field is built on this premise, some time is needed to wash away the imprint. Since beliefs become behaviors, we need to start scrubbing the ink off our collective consciousness. Where’s Mr. Clean when you need him?
You’d think we’d have magically erased it away by now. We certainly have the tools to do so. Between breaking news in brain science and all the data we have on social context, it seems like we’d have retired old diagnostic and treatment methods by now.
We’ve done so in medicine. In 1992 and then again in 2002, I had my ACL repaired. The second surgery went a lot smoother that the first. Smaller scars, less invasive, better recovery time. When your surgeon fixes New England Patriots and Boston Celtics players, you know you’re in good hands. Mine had all the latest tools to get me back to my eclectic adventures. When we default to outdated methods of framing human behavior, not factoring in all we now know about brain science and social context, it’s as absurd as me saying to my surgeon, “Oh, you wanna use that same technique from back in the ’90s? Sure, put away your arthroscope, dust off your old scalpel, and get to work. I don’t mind triple the recovery time and a massive scar.”
That we’re using old-school sit-on-the-couch-and-tell-me-your-problems methods in behavioral science realms, even though we have new learning that could revolutionize our lives, is one of our great modern shames. You’d think those old couches would be out on the curb by now, but they’re heavy to move.
The misinformation spills into our communities, schools, and homes—places where we need the best of brain science to inform us. We label, shun, stigmatize, and imprison people because of it. Our classrooms, therapy rooms, boardrooms, and living rooms are stuck in the 1950s. Blame and shame techniques from yesteryear have been proven to do more harm than good, but they live on as go-to tactics for too many teachers, therapists, leaders, and parents.
We have data that should have flipped Freud and his couch over long ago.1 But we’re hard-to-budge couch potatoes, binge watching old episodes of Freud and His Bros telling us how pathological we are. Who gets to decide what normal is?
Flip the Couch
After the first few weeks of my clinical training, I wasn’t only ready to flip the couch. I wanted to flip off my supervisor, Mary. Right from the outset, I noticed a lot of contradictions.
When you take master’s in social work (MSW) classes, there’s a lot of hype about a strengths-based perspective. It’s ethical, evidence-based, and humane. Three for three. Sold.
Then, when you start clinical rounds, that perspective goes missing. There’s something about how those mental health diagnostic examinations are worded. They fish for everything but something’s-right-with-you clues. Besides the one token strengths question tacked on at the end, everything else was hard-core what’s-a-matter-fa-you material.
I needed a 1-800-strengths finder hotline to help me out. “If you’d like people to understand they are wired for change, press 1. If you believe they can turn their challenges into momentum, press 2. If you worry people are blinded by their problems and stigmatized by their labels instead of appreciating their awesomeness, press 3. If you wish society would realize that the problem is the problem, not the person, press 4. If you think shaming people sucks, press 5. And for all of the above?
Of course, there was no hotline. Mary’s only available options were, “If you think people will never change, press 1. If you think people are lazy, crazy, and stupid, press 2. If you think every minute of every session should be spent talking about negative stuff, press 3. If you think people are 100 percent to blame for everything that happens to them, and deserve exactly what they get, because they just love being victims, press 4. If you like to rub people’s noses in their own shit, press 5.”
Mary was the ultimate people hater, which wouldn’t matter as much if she were an accountant. But here she was, in a field dedicated to helping people, hating on everybody like they were spotted puppies and she was Cruella de Vil.
You’ve seen it before: the screaming teacher who seems to despise kids or the obese doctor who smokes and won’t exercise. It’s confusing, right? C’mon, didn’t you read What Color Is Your Parachute? Life is full of strange contradictions like this. I was running out of options, but I knew I wasn’t going to accept Mary’s abysmal way of treating people.
Sometimes you gotta take matters into your own rebel-with-a-cause hands. I’d been reading about solutions-focused, strength-based techniques, so I decided to try my own experiment.
Besides asking, “How long has your depression lasted?” or “How many panic attacks have you experienced?” or “How long has your husband driven you batshit crazy?” I decided to get creative. I started asking things like, “What’s going well in your life?” “What lights you up?” “When things went off the rails, what got you back on track again?” “You know your name is ‘John,’ not ‘bipolar,’ right?”
You’d think my patients would have loved my underground intervention. At first, they seemed a little spooked. Many of them had seen a lot of different therapists, but I was the first to ask them these types of questions. It took them a little time to warm up to what they saw as a radically different form of treatment, but the approach was working.
Once my patients made a conscious effort to stop defaulting to their self-loathing recitations, everything changed. The sparkle in their eyes returned. The shame hangover lessened. They were finally free from beating themselves up.
I didn’t know at that early point in my training how religiously I would cling to the strengths-based approach beyond my clinical work. It became my go-to within my own therapy process, parenting, teaching, workout strategies, and even dreaded postelection Thanksgiving dinners when the only temporary tension-breaker is pumpkin pie.
Bake Your Strengths
It wasn’t just the intake forms, my crusty supervisor, or my tentative patients that were having trouble shifting. It’s taken over a century to get our teeth around a different approach.
A strengths-based perspective, a social work practice theory founded by Bertha Capen Reynolds in the early 1900s, warned against the traditional psychoanalytic approach. She asserted that people are resourceful and resilient, not broken and helpless. Today, Reynolds is seen as a hero in the field, but back then she wasn’t exactly the hit of the party. You can imagine just how likely people were apt to listen to her ideas at a time when women didn’t have basic rights, like voting.
Years later, in 1999, when then president of the American Psychological Association, Dr. Martin Seligman, pointed to the merits of strengths-based thinking, people were warming up to the idea. He warned that “the most important thing that we learned was that psychology is half-baked. We’ve baked the part about mental illness, about repair damage. The other side’s unbaked, the side of strength, the side of what we’re good at.”
The baking metaphor was sticky. He probably could have gotten carried away with it if he wanted, since the cousin theory to a strengths-based perspective is known as Person In Environment (PIE), which is worth Googling. Luckily, Seligman wasn’t that cheesy and instead created his own acronym, PERMA, standing for Positive emotions, Engagement, positive Relationships, Meaning, and Accomplishment. Seligman’s work emphasizes that we can no longer accept half-baked information—that we are capable of better methods.
Seligman has been named the father of positive psychology, which, like professional social work, holds central the belief that change occurs when we come out of the gate looking for what’s working well, versus what’s not. The starting point frames the entire change effort. He says that the goal of positive psychology isn’t just to increase human happiness, but to promote eudaimonia, or human flourishing.
This perspective is not rainbows and butterflies, and it doesn’t try to shove life into a childhood story template with a perfect arc and happy ending. Baking our strengths doesn’t mean we won’t experience pain or difficulty. It helps us work toward a more holistic approach to understanding ourselves and one another.
Another positive psychologist, University of Michigan’s Barbara Frederickson, is working hard to help people warm up to the idea of getting their strengths into the oven. In her broaden-and-build theory of positive emotions, she explains how negative emotions narrow thought-action repertoires that trigger fight-or-flight behaviors. Positive emotions, on the other hand, help broaden these repertoires, thus spurring on novel thought and action.
Frederickson’s research has manifested an important discovery: deficit doesn’t have to be our natural default. We can widen our attention and cognition. Frederickson says this expansion helps us initiate upward spirals.
Baking strengths can be messy and tedious work. Many of us hadn’t even set foot into the kitchen until well into our adult lives. We might not think we have the equipment to get us started, or that our efforts will measure up, given our challenges.
But once we get going, we realize that our minds are capable of generating upward momentum, and things start to gel. Frederickson’s theory repudiates conventional downward-spiral, something’s-wrong mind-sets, and gets us asking the kinds of questions that spur on new thinking and behavior.
Save Your Normal
Dr. Allen Frances has worked hard to get us moving in a new direction. After holding prestigious chairperson roles at Duke University’s School of Medicine and the Diagnostic and Statistical Manual (DSM-IV) task force, he blew the whistle on psychiatry. After years as an insider, he called malarkey on what he calls “diagnostic inflation,” or the tendency to gather any hints of struggle into a full-blown diagnosis.
After some successful online stalking on my part, Dr. Frances agreed to a phone interview with me. He started by telling me that when his wife died, he felt sad—but it wasn’t “major depressive disorder”; it was a natural response to losing her. He explained that using an exclusively biological paradigm without scientific justification is bad practice. To his point, a study published by the American Psychological Association reported that only one-third of patients receiving antidepressants were engaging in evidence-based interventions such as cognitive behavioral therapy.
This matter is delicate and complicated. It’s not that medicine is the enemy. Medicine can be an effective and lifesaving tool in treating mental health issues. Throwing the baby out with the bathwater would be foolish. But when it’s the only approach being used without factoring in psychosocial components, we’re at risk of medicalizing normal. Frances is concerned that growing practices to categorize human emotions as automatic grounds for diagnosis could be distracting us from helping people who need it most.
Frances emphasized that we need accountability and more grounded, ethical policies to mitigate overprescribing, and to help us get the comprehensive help we need. A 2015 Centers for Disease Control and Prevention report revealed that of the 2.8 billion drugs ordered, antidepressants were in the most frequently prescribed category. Ethical leaders need to take a stand and not let the voices of integrity get drowned out by those with their own interests in mind.
As with his book Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life, Frances told me that “overtreatment” of the “worried well” was becoming out of control. Not only are we erring when we flag emotions like sadness, anxiety, and grief as inevitable signs of mental illness, but drug companies and physicians are making some serious funds off these framings.
Big Pharma, which has been called “America’s New Mafia,” pumps out a lot of commercials reminding us just how sick we are—$3 billion worth, to be exact. The catchy prelude plays. Cartoon Mom enters the scene. She looks a little gloomy. The announcer says she has “hard-to-treat depression.” Oh, she must need Abilify.
Viewer: What about those side effects? They seem intense.
Big Pharma: What’s a little drooling, a few extra pounds, dizziness, paralyzed jaw, constipation, or risk of death to deal with anyway? Plus, it can work as fast as two weeks. You can trust us.
Viewer: Will it work?
Big Pharma: Don’t worry about the studies from the doctors we couldn’t pay off to suppress their findings. Sure, they’ve shown placebos 80 percent as effective as the most popularly prescribed medicines—Prozac, Paxil, Zoloft, Celexa, Serzone, and Effexor—but none have come out against Abilify. Oh, that muffled sound coming from my trunk? Definitely not a whistleblowing doctor. It’s just my stash of Abilify mugs, pens, T-shirts, and donuts to try to win a few more docs over.
Viewer: Are there other options?
Big Pharma: Lifestyle medicine—getting proper sleep, nutrition, and exercise—or evidence-based cognitive behavioral treatment have a lot of research to back them up, but you should talk to doctors we spend $1.4 billion on to verify our claims. They’re totally impartial and have no conflicts of interest.
Viewer: Hasn’t Abilify always been used to treat psychosis?
Big Pharma: Yes, that’s always been the case, but we found some doctors who could vouch for it, plus with this new “hard-to-treat depression” that seems to be the case for so many women, one of our fastest-growing customers. . . . I mean patient groups, why not give it a try?
Viewer: Do these commercials run across the world? Is all the medicine healthy for us?
Big Pharma: Only the United States and New Zealand are lucky enough to get this kind of information regularly presented to them. Seventy percent of Americans are on prescriptive drugs, and the United States has worse health outcomes than other industrialized countries, but don’t worry. Just keep on kissing our ring and we’ll have your back. Did we mention we have pills for bad backs, too?
This all seems like a scene from The Fugitive Meets The Godfather, except Harrison Ford and Al Pacino are nowhere in sight. Commercials aren’t the only problem. Drug companies have a lot of power. Big Pharma has cast a wide net for experts and patients alike.
Years ago, when I was working in a psychiatric practice, we had regular visits from drug reps equipped with donuts and every kind of office supply branded with their logo for our clinical team. They also had plenty of drug samples to get our patients on their merry way. It always seemed a little suspect to me, and you’d think they would’ve at least picked a healthier snack for a team of doctors, but stranger things have happened.
I once had a go-round with Drug Rep Guy, as we not-so-creatively referred to him. At the time, Depakote was the rising-star med for bipolar disorder, and he was determined to sell it to our clinic. I had some beefs with it, mainly because a lot of my patients were gaining weight right before my eyes.
The effects from the honey-glazed donuts he’d swooned us with had worn off, so I started drilling him with questions. Drug Rep Guy insisted that the drug didn’t cause weight gain, even though the evidence showed otherwise.
I brought up the studies I’d read and the patient examples, but his eyes were glazing over. He kept repeating his script: While the drug hasn’t been proven to cause weight gain, it does cause an increase in appetite, and special cravings for chocolate and fatty food. Oh, alright, now it makes total sense to me. Increased cravings for Hershey’s and Awesome Blossoms have zero relationship to weight gain. Sometimes I get caught up in semantics. Thank you for this important clarification.
With the pharmaceutical industry in bed with some academic physicians, the resulting conflicts of interest bring hard-core consequences. Dr. Marcia Angell, the former editor-in-chief of the New England Journal of Medicine, has had plenty of her own go-rounds with Big Pharma, so much so that she warns not to “rely on the judgment of trusted physicians or authoritative medical guidelines.” Now what?
In the meantime, we need evidenced-based treatment solutions that do more than push pills. A 2012 World Health Organization report calls depression a “global crisis,” estimating its effect on 350 million people worldwide. Cartoon Mom has a lot of friends.
What if there’s a backstory to Cartoon Mom’s and Friends’ hard-to-treat depression? Could it be that she’s exhausted from her eighteen-plus-hour days, and then the perpetual game of musical beds with her kids by night? What if she can barely sneak in thirty minutes of walking during the intermission of her son’s soccer game while she answers the ridiculous amounts of email she left behind to dash there?
Could being upset reflect a natural response to the fact she’d arrived to the game late, greeted by Good Mom who showed up fifteen minutes early with Pinterest cupcakes for all the kids, telling her that she’d literally just missed her son’s first goal of the season? What if she’s like most parents who wrestle with constant guilt that they’re not spending enough time with their children,2 even though today’s parents spend more time with their kids than previous generations?
What if Cartoon Mom is tired of being vilified for her choices? What if she just needs to stop being a fembot for five minutes and grab some fresh air and solitude? Maybe she just needs one Saturday morning of uninterrupted sleep, or for someone to stop thinking her life is so easy just because she “has it all”?
Might Cartoon Mom’s hard-to-treat, atypical depression shift if her creepy boss started listening to her ideas instead of looking at her ass? What if she just needs the robotic smiles and good-for-you pats to stop when she tells someone she’s a high-powered lawyer, as if she’s a special-case, token successful woman? What if she’s sick of everyone telling her husband how great he is because he so graciously shares the responsibilities everyone thinks were hers to begin with? She’s soooo lucky. He babysits their own kids. He even grocery shops.
What if we’re looking at the inkblot all wrong? What if hard-to-treat Cartoon Mom or any of her anxious and depressed friends aren’t the ones with the problem? What if the interpretation of symptoms is skipping over the part about hard-to-treat social ills? What if the data we’re basing everything on are flawed, not her?
And what if Cartoon Mom and her friends could see the bigger picture—that while clinically significant mental health issues are serious, sometimes we need to turn off the commercials to save normal and get us off the couch once and for all.3
Psychology has at least gotten us awake and out of bed, but we can no longer stay glued to our couches. We’ve got to flip them over, to find out what else is underneath. In our global twenty-first century, we need to save normal. There is no good reason to be held hostage by Big Pharma, or in pseudoscience inkblot and WEIRD modes. We can think bigger and broader, using the best of evidence-based brain science and a strengths-based perspective to move us upward.