It isn’t neurotic at all to be concerned about climate change, or the loss of the natural world, or the rapid erosion of public institutions that used to guarantee a basic standard of political stability. In fact, being concerned about these huge trends is an important part of living together in the real world, and a therapeutic culture of atomized individualism can prevent the public from getting together to improve things. Yet this, too, is a delicate balance to be struck and maintained, because we don’t pay our therapists to sway us into their favorite world-saving projects. Treatment should remain focused on the patient’s individual well-being, and include bigger public issues only insofar as the patient is already struggling with them.
Read MoreHoarding occurs on a spectrum of severity. It can be a light nuisance, a serious problem that impinges on one’s life-possibilities, or a severe mental affliction with potentially dire implications for physical health. It’s a distorted version of some natural and necessary mental functions. In the deeply ancient world, long before civilization, people generally kept only what they could carry. Evolutionary psychology of this sort can easily jump to mistaken conclusions, but it seems likely that somewhere along the line it became adaptive to try and hang onto stuff that might be useful later on. A temperament that disposed people to a more retentive attitude became partly heritable—despite the fact that it could also cause trouble...
Read MoreWe often want to help people with their regrets, by telling them: “If you could have done any better, you would have. The reason you didn’t, is that you were constrained by your trauma background, your history.” They reply that this is a slippery slope; that if they allow themselves the solace of explaining their bad choices by invoking their past history, they might recklessly let themselves off the hook for all kinds of error—laziness, impulsivity, greed—in the present and the future. But it is not a slippery slope, so long as we locate the determinism in the past, where it belongs, and the freedom in the present, where we need it.
Read MoreIf I am stuck in the bitterness of feeling screwed-over, I may be living inside the misconception that any progress I dare to make would be a betrayal of the wounded child inside me. Adults boycott their own lives, they flounder and self-sabotage and procrastinate, because of a beautiful, bittersweet, tragic loyalty to their own grievances from long, long ago. The unwritten law of such a life is: If I go ahead and start building my own life for myself, it will mean that I approve of all the wrongs that were done to me in the past.
Read MoreCompliance and defiance typically have been the poles between which the patient has been running back and forth for years, inside a family system which is stuck in that pattern. His compliance seems to be movement forward into adulthood, so long as most of what he complies with happens to be good advice, and reasonable rules, from exasperated elders who may well love him. But compliance is never really as good as it looks, because it's not autonomous, so it is not sustainable; it builds resentment that comes out sooner or later. His defiance appears to be much worse, of course, because it's often full of hostility, self-destructive, anti-social, risky, and debilitating. Part of the reason this pattern is so terribly stable and hard to break up, is that the family's response to the young addict's defiance is usually a call for a return to compliance, this time a new-and-improved compliance that will last. That never works, because even if he does produce a good lengthy chunk of compliance, it's still mere compliance. The solution is, in most such cases, to bring in a therapist whose client is not the family, but the patient himself. That way, the patient can continue doing the only two things he knows how to do, but in a whole new way which will permit him to learn new skills: he defies the family, and complies with the therapist in a private, collaborative search for what the patient really wants from life.
Read More