A THERAPY WITHOUT PREVIOUS CRITERIA OF NORMALITY
CARLOS AVILA-PIZZUTO
Where does this text come from?
It occurred to me that I wanted to write about doing therapy
(psychotherapy) without prior criteria or imposition of normality after the
workshop that Carlotta Ehrenzeller facilitated at the IIPE Mexico 2022
(Conference of the International Institute for Peace Education) “What does this
have to do with me? decoloniality? A workshop towards decolonial thought and
being.” I went to the workshop because I declared myself ignorant of the
subject and wanted to explore things about peace education that I did not know.
In the reflections that emerged in the workshop, I found that coloniality today[8]
has to do with looking at the world from a perspective with a vanishing point
located in the northern and western hemisphere of the planet, which considers
itself universal and therefore so worthy of being imposed on other visions of
the world; It would be something like this: “if something does not look the way
it does in Europe or North America, it is because it is not right.”
At the end of the workshop, we were asked for a final intention and I said:
"I want to continue looking for a way to do therapy without criteria of
normality." In a conversation with the facilitator after the closing, she
asked me something about this therapy without criteria of normality and added,
what would it be like with serious disorders such as schizophrenia? I
automatically responded with an idea that has been with me for a few years
about "madness", an idea inspired by proposals in the antipsychiatry
of R. D. Laing and taken up by the existential therapist Ernesto Spinelli, in
which it is stated that the "madman" is not "crazy" because
of the content of his psychic world but because he expects that content to be
understood by others without creating adequate bridges to communicate. In the
story “Lifting a veil”[9] by Spinelli, a
man has a revelation, a veil is lifted, and clarity arrives… He sees a hidden
truth, but no one else sees it and he desperately tries to make everyone see
what he sees… People call him crazy. Yaqui A. Martínez-Robles, representative
of Mexican existential therapy, says that the difference between the “crazy”
and the genius is in the others. How do people describe him, as a genius or as
a madman? Giles, Spinelli's character was described as crazy. What difference
was there between Giles who saw the world with different eyes and, for example,
Einstein who also had a revelation? Spinelli would propose that the scientist
framed his revelation in mathematical terms understandable to his peers.
Carlotta listened, then she said yes, it was clear to Einstein's peers, but
he still used a language foreign to the understanding of others who did not
know Western science. Surely, E=mc2 sounds like complete madness to
those who do not know what variables are represented, and even so, to those
people who do not understand it, the idea of Einstein's genius has been
imposed on us without understanding what he is talking about. This leads me to
want to dig deeper into these ideas.
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| Carlotta Ehrenzeller |
Are the ideas of psychological normality
universal or imposed?
I use grief as an example,
seen from the ideas of abnormality and normality determined by the American
Psychological Association (APA).
As a parenthesis, talking
about APA leads me to a question: Why in Mexico should we stick to the APA
criteria? Is it because of the Monroe Doctrine[10]?
Does the American refer to the United States or the American continent?
The APA diagnostic criteria
are considered in the context of the United States (perhaps specifically to a
part of the United States[11]) and
consider the needs of insurers, employers, and pharmaceutical companies in a
context other than that Mexico's and other countries. The
APA DSM diagnostic manual states that grief goes through stages of accepting a
loss, allowing the pain of loss, adapting to a new reality, and establishing
new bonds, and that a person should go through these stages in no more than a
year or else it is considered to require medical attention[12].
Isn't that a psychiatrization of a complex existential experience that must be
understood as unique in each context? A psychiatrization of everyday life? A
medicalization of life as Ivan Illich[13] suggests.
Let's understand the
economic implications: A year of discomfort is acceptable, a couple of days of
incapacity for work due to a death in the family is acceptable. But is a person
in mourning acceptable in economic terms, which would mean distraction,
sadness, mood swings, demotivation, work absences? Not in this economic model
that depends on growth! In addition, if we consider it natural that the person
suffered a loss, that leaves that person far from being able to receive medical
and psychological care within an insurance scheme for medical expenses. If the
idea of abnormal grief is accepted, the patient will be able to access psychiatric
and therapeutic care. But that does not apply in Mexico, in Mexico in general
it is a matter of life or death to continue working despite everything and
insurance does not cover therapy, so what is the use of making grief
pathological? Sometimes, it is used to pressure people who are suffering to
stop suffering as soon as possible. Why the rush to stop suffering? How is it
that we assume that happiness is the normal state of people even when the
context is adverse? Is that another idea originating in the north-western
context? Is this idea that it is normal to be happy behind considering
depression as something abnormal?
Let's see, if a person has
suffered a significant loss, in a context where instead of affection for their
loss they receive a demand to be well, to continue with their goals, to be
grateful for life, to remember only the good, to let go of the past... I
suppose that this person to be accepted in his social and work circle must push
herself or himself until running the risk of being exhausted[14].
Could not depression be the way that the organism has, to avoid the absolute
wear of that person? Wouldn't it be better to approach human suffering as a
sign that there is much room for improvement as a culture?
What would a therapy be like without previous
criteria of normality?
Therapy has many challenges,
here I will address one: the ideas of normality and abnormality are freely
shared on social networks, blogs, video blogs and podcasts and without regard
to the contexts in which these ideas are generated.
People from indigenous
communities judge themselves with criteria of self-esteem, dependency,
codependency, happiness and mental health originating from different cultures
with different resources; young people come to my office diagnosing their
partners as narcissists and themselves as excessively empathic because of
something they read or heard on a podcast; executive personnel of transnational
companies come to consultation diagnosed by human resources as lacking
leadership traits, lacking proactivity, with incompetence to communicate and
lack of commitment; women with partners who have beaten them arrive complaining
about their lack of self-esteem, their hysteria, their codependency... There
are also those who wonder why they attract violent people, those who are not
happy because they are surrounded by negative people, those who cannot vibrate
high… Many criteria of normality and abnormality that overwhelm, that make us
look at ourselves with mistrust, that make us demand an impossible and
exhausting perfection.
As therapists (and teachers), perhaps, if we
pause our judgment of what is normal and what we should consider abnormal
according to research institutions in other contexts, we could become creators
of bridges between the experience of each other, we could change the question:
How do I get rid of abnormal grief or depression (or whatever)? For the
questions: How has this suffering been built? What has your body had to put up with?
What have you had to do to belong and receive acceptance from your social
group? What judgments do you make of yourself for feeling this way, where did
you learn to judge yourself this way? What do you seek to achieve with your
life? And how is that search affected by that loss? What left when that person
left? How much security do you find in your social context? What beliefs of
yours are at risk because of what happened? What economic challenges do you
face from that loss? What social gaps does this experience leave? What was left
pending? In addition, we need to ask ourselves methodological questions
together with the person requesting therapy, such as: How can we build a
space-time of peace between us so that you can express your complexity, your inconsistency,
your emotions, your desires, your doubts, your uncertainties?, how can we
create a space-time for the tender care of our sufferings?; and perhaps, what
ideas of what should be are incompatible with what is being in this
space-time?... This therapy would not seek to cure, it would seek to respect
the experience of those who request it.
I am often asked, Isn't respecting the
experience as it manifests itself a bit mediocre? Shouldn't we strive to be
better? My first reaction is to ask myself where the ideas of mediocrity and
effort come from, but in order not to answer questions with questions, I would
say that nothing is the same when a person is accompanied to experience the
complexity of their experience without judgment, without imposition and without
demand. The person would enter for a time a space that is not governed by the
rules of culture, which provides a different look and an opportunity to seek
well-being that is glimpsed from a meeting of willing beings, from a
conversation, from a dance of ideas and feelings, instead of an idea of
well-being manufactured in the marketing department of a company based in the
north-west of our planet.
[8] I understand that other times, other empires
have considered themselves possessors of a universal knowledge that must be
imposed and have not always been placed in the North and the West.
[9] Spinelli, 2015
[10] “America for the Americans”, which although it
is presented as an anti-colonial statement towards Europeans, has been used to
justify an imperial position on the continent.
[11] Bias in psychological and social research by
using an excessive sample of Westerners from rich industrialized countries in
democratic societies is called WEIRD population. But we must also consider that
research subjects in the United States tend to belong to the most educated and
urban sector.
[12]
Mayo Clinic, 2017
[13]
Illich, 1975
[14]
Garson, 2022
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