Rev. Dr. Glenn A. Robitaille on moving from object to subject

Love as a Clinical Variable

“Every case of psychotherapy, to a greater or lesser extent, is a problem of the failure to love. Sometimes the problem is in focus; sometimes it is a covert contributor to other problems, but at core, it is always there. Those who can plant and tend love may have pain in life, but not the kind of pain that draws a person towards psychotherapy… Failure to love is always a religious problem. It always has roots in the answer to the question: What is the nature of the universe in which I dwell?” [1] [emphasis added]

Paul R. Fleishman, The Spirit Within

I like Paul Fleishman as a modern philosopher. In fact, more of my fodder for writing has come from the above book than from any other modern work. The central idea in this quote, however, gave me pause. Is it not bad enough that suffering people must seek the assistance of others to help them navigate the “white waters” of difficulty without the selfishness label being added to their struggles? “Every case of psychotherapy is a consequence of failing to love?”

Fleishman is correct in arguing that having problems is human and becoming mired in a quagmire as a result of those problems is more of a choice. Not all people become thoroughly self-centered when they are suffering, but it is common. And a lot of those thusly mired are often so fixed on themselves that they lose interest in the needs of others. It is one of the challenges of working with the suffering. So perhaps it is often true, or much of the time, but in every case?

Centuries ago the Greek philosopher, Aristotle, wrote of the “golden mean” in his Nichomachean Ethics.[2] His thesis was that truth is rarely, if ever, found in the extremes. Human beings tend to become polarized in extremities more often than anyone wants to admit, but the very fact of disagreement is often a good indicator that things are rarely clear cut enough to warrant the qualifier “always.” For instance, it isn’t the core message of Christianity or Islam or Atheism that most non-adherents object to when religious ideas are discussed, but the exclusivity of their claims. As soon as you move from the Kierkegaardian “both/and” to the “either/or,” discussion is severely challenged, or becomes defensive.[3] In the context of this question, if every case of psychotherapy is a consequence of failing to love, then that is that. Suffering people simply need to get over themselves, stop being so self-centered and move on with life. End of discussion.

It could just as erroneously be argued that every case of psychotherapy is, to a greater or lesser extent, a problem of the failure to be loved. Some personality disorders can have their root in a perception of being unloved and failing to receive the kind of nurturance necessary to developing a healthy sense of self, but that is certainly not the only cause. As many school age children have found, being loved by family does not necessarily mitigate all of the consequences of incessant bullying. Emotional dysfunction can arrive in a variety of ways, of which failing to be loved is one.

The subject of perception is important when it comes to looking at love and its many implications on mental health. Where feeling loved is concerned, perception is everything. Parents can love their children more than life itself, but if the child does not believe it, the love of the parent has little psychological benefit to the child. It is this fact that has led to the idea of finding the “love languages” of those we love to ensure the arrow of our intent actually hits the heart of the matter in them. Call it a dance, an exploration, or whatever, but love only germinates in a culture of knowing and being known. Sometimes we rush to the facts at the expense of due diligence. In all human interactions, perceptions must be addressed before truth can be found. The well traveled axiom, “People don’t care how much you know until they know how much you care” is as true in a hospital setting as it is anywhere else.

In the regimented, clinical and (sometimes) sterile environment of a psychiatric hospital, cultivating love sounds a tad sentimental. The perception could exist that it is not even on the radar. We are accustomed to treating symptoms and managing behavior, and often clinicians find little time to do much else. Fiscal pressures, patient resistance, and the sheer enormity of the problems we often encounter make it difficult to be as client-centered in our praxis as we desire to be in our ideals. If an optimum methodology for interacting with patients exists, it probably lies somewhere between “Patch Adams” and “Dr. Geoffrey House.” Yes, we are treating human beings, and yes, we are treating diseases and disorders. And yes, it is probably necessary at times that treatment lean more heavily toward the disease than the person, as traditional allopathic methodology has suggested. But should that be the ideal in a mental health setting?

Clearly, both failure to sense love and failure to communicate love are clinical variables. Human well-being could be conditional upon this quality above all others, as poets and philosophers have long asserted. A person’s capacity to receive and express love is likely the single best predictor of resiliency, and resiliency is likely the single greatest predictor of recovery. How do we then, as health care professionals, make it an appropriate ingredient in client and patient assessment and care?

It perhaps begins with taking sentimentality out of the equation. The early Greeks had a word for the kind of love that makes good process in a health care setting. While Classical Greek had a variety of words to describe the various aspects of love, it is the agape definition that could prove helpful for our work. Agape has little to do with affection or passion, or how we feel about another person. It is more about volition. Agape affirms the significance of the other and the value we place on others’ needs and desires. As a counselor and therapist for over twenty years, I have learned that a sense of being valued is critical to the therapeutic process. Unless positive transference is developed, people do not develop the kind of trust essential to their recovery. Inherent in positive transference are such qualities as respect, honesty, appropriate boundaries, and clear communication. It is not about others getting that “warm, fuzzy” feeling; it is about their believing that we “get” them, and that they matter.

When we care for others with agape, we listen with our eyes as well as our ears; we provide what is needed rather than what is deserved; and we use power only as a last resort and when it is truly in the best interest of the patient. In the process, our patients get the message that they are seen, and that the outcome of their treatment makes a difference to us.

In a clinical setting, the catalyst that most often triggers a sense of being valued is curiosity. People know when others are interested in them and when they are not. People do not feel valued when dispassionate clinicians set bones, apply ointment, or collect information. The movement from object to subject comes when those setting the bones, applying the ointment and collecting the information communicate interest in how the injury was incurred, or how it feels to have that injury. Whether one specializes in physical, emotional or spiritual assessment and care, it is this sense of wanting to know the person behind the problem that creates the awareness of being valued. Such an approach requires intention and attendance to the person we are seeing, as well as a willingness to set aside the easy categories and pigeon holes that we are tempted to utilize for the sake of economy. A lot of disorders and treatment strategies have similarities, but only my disorder is my disorder, or injury, or life-challenge. The greater sense a patient or client has that we understand this, the greater the connection to the healing strategies offered there will be.

There are no formulas available that make the application of agape an easy thing, but its outcome is dependent on taking our patients’ need to be valued seriously. Some who receive this kind of care actually feel affection. But whether or not they do, a good first step toward the kind of emotional health that leads to meaningful relationships is a belief we can be worth something to someone. Our manner of relating either contributes or detracts from that belief.

Cultivating worth is a clinical matter and looks an awful lot like loving. Kumbaya!

Footnotes:

[1] Fleischman, Paul, The Healing Spirit, New York: Paragon House, 1990.
[2] Aristotle, Thomson, J.A.K. ed., The Ethics of Aristotle: Nichomachean Ethics, New York: Penguin Books.
[3] Kierkegaard, Soren, Erimata, Victor, ed., Either/Or: A Fragment of Life, New York: Penguin Books.

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