Hugh Polk on Psychiatry and Social Therapy
On the future of mental health
Posted Mar 28, 2016
The following interview is part of a “future of mental health” interview series that will be running for 100+ days. This series presents different points of view about what helps a person in distress. I’ve aimed to be ecumenical and included many points of view different from my own. I hope you enjoy it. As with every service and resource in the mental health field, please do your due diligence. If you’d like to learn more about these philosophies, services, and organizations mentioned, follow the links provided.
Interview with Hugh Polk
EM: You are both a psychiatrist and a social therapist. How do those two connect?
HP: Psychiatry and social therapy bear a “family resemblance” to one another: they’re both efforts to help people who are in emotional pain. But there are some fundamental differences between them: 1) psychiatry treats the individual, while social therapy treats the group; 2) psychiatry is truth-referential, while social therapy is performatory; 3) psychiatry relies on a received compendium of diagnostic categories and labels (aka the DSM), while social therapy is improvisational; 4) psychiatry seeks to uncover the hidden meaning of the language that patients use, while social therapy seeks to create, collaboratively, new emotional language and new meanings; 5) psychiatry concerns itself with adaptation, adjustment, the changing of particular things, while social therapy relates to every person as a “revolutionary” with the uniquely human capacity to change everything; 6) the psychiatrist is an authority figure, whose knowledge, training, and credentials give him/her privileged access to what is “really” going on beneath the surface of everyday living and speaking, while the social therapist is something like a community organizer who supports the group to engage in the improvisational, continuously emergent activity of building the group – an activity that produces development.
For the past 35 years, my home base has been our network of social therapy centers in New York City. Even when I’ve worked in traditional psychiatric settings, I’ve tried to “import” the social therapeutic approach into my practice. Some years ago I was the unit chief in a psychiatric hospital, where I startled some of my colleagues by running rounds with all the patients in a group rather than individually. When I couldn’t be at work one day, the head psychiatrist ran my rounds for me – with everyone on the ward in a group. The next day he told me that he’d never seen patients relate to one another so well, relationally, encouraging and challenging each other to grow. Did his experience have an impact on hospital practice? No. The institution of psychiatry is a hard nut to crack.
EM: You focus on health and growth rather than on illness and symptom control. How do you do that?
HP: The most remarkable, and ordinary, example of development is young children learning to speak. From the very beginning, adults and older children relate to babies as being “a head taller than they are,” responding to their babbling not by ignoring or correcting their pronunciation and grammar but by talking back to them. In other words, we relate to very young children as members of the speaking community – inexperienced, but members nevertheless – and they participate with us in playing improvisational language games. Testing, evaluating, and making judgments simply don’t come into it. Before we know it (in much less time than it takes to get an undergraduate degree in psychology!), that babbling baby is speaking – naming things, asking questions, expressing wants and needs, making jokes and singing songs. That’s development!
Social therapy groups are environments in which we play emotive language games for grownups. People speak – usually, but not necessarily – about what’s troubling them. Other members of the group respond by asking questions. They’re not just any sort of questions … we’re not trying to discern “pathology,” or to come up with a diagnosis – an explanation of why someone feels the way that he/she feels – and we’re not trying to solve the problem. Indeed, we’re not looking for answers at all! The asking of questions in the social therapeutic environment is a philosophical activity in which we’re attempting to “deconstruct” the assumptions that underlie emotive language. What does it mean, for example, when someone says, “I’m depressed”? Is depression a thing that’s located somewhere within the individual? Is it the private possession of the person who “has” it? Or is it, perhaps, something that we do rather than something that we have? Could we, the group, do “your” depression, or “mine,” as a group? It turns out that the collective asking of such questions is developmental.
EM: You are on the faculty of the East Side Institute for Group and Short Term Psychotherapy. What sort of work gets done there and what sort of work do you do there?
HP: The East Side Institute is an international training and research center for bringing the social therapeutic approach out to people around the world – mental health and other helping professionals, inner city youngsters, corporate managers and executives, community organizers, teachers, and everyone else who is looking for new tools to open up emotional and social possibilities for their clients, their families, their communities, their employees, and/or their students.
Members of the Institute staff teach classes and conduct workshops on line and at our center in New York City. In addition to teaching classes, I’m responsible for supervising social therapy trainees. We regularly make presentations at conferences of mental health and education practitioners both in the United States and abroad, and we conduct intensive trainings for psychologists and educators wherever in the world we’re invited to do so. Every two years we host a conference, “Performing the World,” which brings together some 500 mental health practitioners, social workers, and community organizers who have made performance a centerpiece of their work. Together with you and many other colleagues, we are active in the effort to broaden and deepen the dialogue on psychiatric diagnosis that is currently taking place around the world. As part of that effort, my colleagues and I regularly spend time out on the streets of New York City asking passers-by to take a moment to tell us their opinions on the subject; we want to ensure that the voices of ordinary people are included in the conversation. After all, it’s not enough just to critique the DSMs—following Vygotsky, we have to create a new psychology.
EM: What are your thoughts on the current, dominant paradigm of diagnosing and treating mental disorders and the use of so-called psychiatric medication to treat mental disorders in children, teens and adults?
HP: Given what I’ve said so far, you won’t be surprised to learn that I’m not a fan of the paradigm, and that I strongly disagree – on scientific and ethical grounds – with the wholesale diagnosing, labeling and drugging of millions of people.
While I have great respect for the courageous work that Peter Breggin and others have done to expose the lasting harm caused by the “psychiatry-industrial complex” in its relentless drive to pathologize – and monetize – everything from grief to inattention, I am not reflexively anti-medication. I take aspirin when I have a headache and I take antibiotics when I have an infection, so it would be hypocrisy for me to say that other people shouldn’t ever take drugs under any circumstances. If someone is so paralyzed by emotional pain that they’re unable to participate in the hard work of development, I’m willing to prescribe psychotropic medication that can help them to come back to it. As I see it, taking medication isn’t an alternative to or a substitute for the work of development; it has to be part of a therapeutic package – otherwise, it usually ends up doing more harm than good. I’m strongly of the opinion that development, rather than any pill, is the cure for emotional pain.
EM: If you had a loved one in emotional or mental distress, what would you suggest that he or she do or try?
HP: Start developing again! How? 1. Be giving to other people – regardless of how much you may be hurting, or how little you may feel you have to give. 2. Do new things – walk home a different way, eat something you’ve never eaten before, have a different kind of conversation with someone you talk to every day, talk to someone you’ve just met – in short, start improvising your life. 3. Ask for help – from your friends, your family, a member of the clergy, a therapist – and be open to letting the other person give you what they have to give. 4. If you go to therapy, do it with the attitude that this is YOUR therapy; let the therapist know, week in and week out, how the therapy is going for you. Therapy works best when it’s a collaboration between the therapist and the person seeking help. 5. Keep putting one foot in front of the other … you’ll be surprised to find that you actually get somewhere new that way.
Hugh Polk, MD, is a psychiatrist and social therapist practicing in New York City. He is based at the Social Therapy Group where he runs weekly social therapy groups, and sees patients for short-term individual therapy and couples and family therapy. He has worked closely for 35 years with the late Fred Newman, the founder of social therapy, Lois Holzman, Newman's clinical collaborator and Christine LaCerva, the director of the STG to develop and advance social therapy. He is an organizer for new approaches to helping people with their emotional difficulties. He has also worked at community mental health centers all over New York City. Hugh Polk can be reached at www.socialtherapygroup.com and by email at firstname.lastname@example.org and by phone at 646-239-8426.
Eric Maisel, Ph.D., is the author of 40+ books, among them The Future of Mental Health, Rethinking Depression, Mastering Creative Anxiety, Life Purpose Boot Camp and The Van Gogh Blues. Write Dr. Maisel at email@example.com, visit him at http://www.ericmaisel.com, and learn more about the future of mental health movement at http://www.thefutureofmentalhealth.com
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