Therapeutic Change for Self and Society*

Beth Roy (©2007)

270 Prospect Ave, San Francisco, CA 94110
Tel 415 695 8119, Email: broy at igc dot org


Another world is not only possible, she is on her way. On a quiet day, I can hear her breathing.

                                             - Arundhati Roy

In 1973 I arrived in California and discovered that a good friend had become a lay psychotherapist, working with a group called Bay Area Radical Psychiatry. I was doubtful. A socialist and passionate critic of therapy, I believed most individual distress grew out of oppressive social conditions. To treat the individual, I was convinced, was to become distracted from the real deal: transforming society. Young and passionate, I scoffed at the possibility that therapy could be anything more than a band aid on a seriously bloody wound.

At the same time, I respected the views of my friend. Becky Jenkins was a red diaper baby (the child of left-wing activists) someone whose commitment to social justice I knew to be consistent and thoughtful. “Just come see the work,” she cajoled, and I could think of no convincing reason to decline. So I sat in on a group session she conducted….and I was moved, fascinated, engaged. I can’t say I was an immediate convert, but a door opened a few inches, and I continued to observe the work, listening with a more thoughtful ear. Increasingly, I came to see possibilities for bringing together personal and political change, bridging a dichotomy that had always before tilted me in an activist and anti-therapy direction.

I also needed a job. A single mom who had lived outside the US for many years, I lacked the essentials – a credit card, a history of employment, a clear career path. Still, I was resisting taking on work out of sync with my values. So I agreed to join the collective of Radical Psychiatrists practicing in the San Francisco Bay Area.

Thirty plus years later, I am still practicing. Mostly I do group therapy and conflict resolution, the two most direct outgrowths of the social theory that is the basis of the work. But some individual therapy has crept in over the years, as well as some couple counseling and family work, although in an atypical form. I also train and supervise therapists. I view all of it as political activity; indeed, I believe all therapy is political, no matter how it views itself. In the case of Radical Psychiatry, the politics are explicit, openly stated in the theoretical underpinnings, deeply imbedded in the practice.

In the Spirit of the Times

On Tuesday, Wednesday, and Thursday evenings groups of six to eight people convene in my office. We call them problem-solving groups, not therapy, in an effort to get away from a medical mindset for the work we do. I lead both women’s groups and a gender-mixed group. Based on a model of cooperation, each member sets her or his own goals for the work. Time is shared through an explicit process created by each group of people to suit their sensibilities. Members take turns talking about whatever is on their minds that night. While I actively guide the work, intervening in ways particular to my role as leader, members interact intently, making observations, giving feedback, sharing their own life experience, registering feelings, asking questions, growing relationships, nurturing, supporting, critiquing, all within a framework of respectful speech and self-determination. Groups are the heart of the practice, for reasons both pragmatic and theoretical.

Radical Psychiatry began in collectivity. It was the beginning of the 1970’s. Movements for social change were thick in the air: civil rights, free speech, anti-war, lifestyle change, gay liberation, feminism. Berkeley and San Francisco were flooded with young people, drawn from towns all over the country by stories of flower-child utopia in the Bay Area. They crashed in cheap “pads”, smoked pot on the streets, experimented with free sex – and some of them fell apart both physically and emotionally. Far away from home, confronting unfamiliar realities of poverty, unskilled in recognizing or solving the social problems that come along with revolutionary new personal behavior, they fell ill with malaise ranging from unattended respiratory infections to unheard of sexual diseases. Right along with the open and welcoming love fest the flower children so progressively proposed, many people also encountered conventional jealousies, conflicts, competitiveness, unrequited love, proscribed anger, and, most surprising of all, loneliness and a sense of inadequacy.

The Berkeley Free Clinic formed to address physical problems, and a loose-knit group of progressive therapists came forward to address the emotional ones. Radical Psychiatry eventually evolved from this latter group. This part of the story is hearsay for me. It predated my return to the country. The version I carry in my mind is that a group of people formed to create a new approach to psychological work built in the spirit of the times on the foundation of a social theory. Hogie Wyckoff, a student at the University of California at Berkeley, brought new understandings of Marxism joined with her passionate feminism; Claude Steiner his years of experience leading Transactional Analysis groups; Bob Schwebel a critique of his graduate studies in psychology and an interest in designing non-competitive games; Joy Marcus her talents as a poet; Becky Jenkins her roots in the political left and the arts. There were contributors who came from Quaker backgrounds and Catholic and Jewish ones, from experiences in many of the social movements of the times, from wealthy families and poor ones, from every part of the country. Racial diversity was lacking; typical of the ghettoized times, the new movement was largely white. Some originators were psychologists, others social workers; most had no professional training and eagerly embraced new means of developing skills based on an apprenticeship model. Bonded by a common desire to be of service in some way that reflected the radical spirit of the times, the founders set to work to articulate the principles of a political psychology, and to live those principles in the process as they constituted themselves a collective.

The first and perhaps most productive commitment of the group was to be realistic as well as idealistic. Working collectively meant exercising a will to challenge power in all its forms; but having articulated a desire for cooperation, the group quickly found that they did not in fact know how to do it. Instead, they recognized how deeply schooled they were in practices of competitiveness, just like the people they sought to serve, just like most Americans. To be cooperative required both a theory of cooperation and a way to embody it in practice.

From the beginning, then, practical needs combined with ideology to shape a theoretical agenda resting on three legs: a social-constructionist description of psychology, a visionary procedure for cooperation, and a realistic understanding of power.

Where Society and Psyche Intersect

Radical Psychiatry theory begins with the simplest of premises: people are good. We do the best we can under the conditions we are given. Those conditions are social in nature, and because severely stressed for most of us, they stress and distort human experience. The first step, therefore, is to name the material conditions in which emotional and interpersonal life is lived.

Operationally, that set of ideas runs counter to imbedded assumptions of more conventional therapies. We resist explanatory notions of pathology, of addictive or self-destructive behavior, or of biochemical flaws, believing that, in their cultural and professional popularity, they overshadow a view from a more political and material angle. If people act peculiarly, if they are hostile or depressed or anxious, we postulate that there are describable reasons for those behaviors. Starting with an understanding of alienation, we study the ways social dynamics become deeply imbedded in individual psyches and lead to feelings, ideas, and behaviors that limit a sense of what is possible, sometimes causing people to act against their own best interests in a manner that may seem irrational but, seen in a larger context, is not. Instead, such behaviors, and the feelings that intertwine them, are products of oppression and its internalization.

It is in the interrelationship of material facts and internalized oppression that the work of “therapy” lies. I put quotation marks around the word because it suggests a process of healing when in fact I’m talking about a process of change. Language is a boundary, a fence walling off alternative ways of thinking. None of us is nor ever has been a psychiatrist, in the professional sense of the word. But in the early days of our work, we reclaimed “psychiatry”, noting that the Greek meaning translates into “soul healing”, a practice, we insisted, that is everybody’s business. In that sense, the process of group is not about sick psyches; it is about injured spirits.

Alienation and Change, Social and Personal

We equate human distress with alienation, and we attribute alienation to an interactive combination of three factors: oppression, mystification, and isolation.

First, oppression is a fundamental experience of all but a very few individuals living in hierarchical societies. Oppression is coercion in its many forms, evident and opaque, physical and subtle, that induce or force us to accept less than fully human lives: disassociated work, unhappy relationships, absent communities, conflict-ridden families, and other familiar features of the times.

Given that the human will is strong, and strongly leans toward well-being, why do we comply with oppression? We would be less likely to submit if we knew we were being oppressed. But, especially in modern capitalist societies, oppression is mystified, the second element making for alienation. We are told lies about the prevailing social conditions. Through popular culture, interpersonal transactions, legend and myth, we are told that we live in the best of all possible systems, that we are free individuals and have free choice, that the best succeed and the inadequate fail. If we are unhappy, therefore, it is our own fault, the product of some moral inadequacies: laziness perhaps, or stupidity or some other unredeemable flaw. Material oppression thus becomes internalized in moral terms, and the network of ideas form an ideology so deeply learned as to become unquestioned, transmuted into invisible assumptions.

This approach to understanding the interaction of society and psyche has been elaborated by numbers of twentieth century scholar-activists. Franz Fanon (1963) described its political course in the framework of colonialism, while Phyllis Chesler (1989) analyzed women’s relationship to psychiatry in terms of internalized oppression. Perhaps the most compelling exploration, because it focuses on cultural dynamics of mystification in an attempt to conceptualize and create counter-culture as a revolutionary act, is the work of Antonio Gramsci (1979). We are immersed in a sea of ideas and practices that, taken together, form the boundaries within which we can question social reality, indeed within which we can think. The work of social change, and by extension of personal change, is involved with an ability to think outside that frame. “I don’t know who discovered water,” some clever person said, “but I’m pretty sure it wasn’t a fish.” Much of the work of Radical Psychiatry is aimed at naming those assumptions about self and society that limit the possibilities for action, and then quite literally rethinking them, transforming them into a redefinition of the possible.

The route to accomplishing that process is honest interaction. Isolation is the third condition necessary to the perpetuation of alienation. There are many ways to think about the functional impact of isolation, how it is enacted and what it accomplishes. We can start with the role of shame (Scheff, 1990). A key element in constructing any social order, shame holds the whip that keeps individuals within the fence of acceptable behavior. While every society produces some version of shame, each society does so differently: that which is shameful here is no big deal somewhere else. In modern America, the effective values, those standards the violation of which cause the cheek to burn and the voice to falter, are different for people in different social locations – gender, class, race, and so on – but they all tend to cluster around individualism. The ultimate judgments on an individual’s character are about autonomy, independence, effectiveness, success. At least, those are the measuring sticks for men. Women’s standards have grown closer to men’s as gendered economic roles have begun to converge, but they still involve what were once complementary measures such as an ability to put others’ needs before ones own, to nurture and bolster rather than assert and initiate. Now women still find these relational injunctions deeply settled within their sense of self-worth, but they are in conflict with the more masculine commands that fuel competitive success in the capitalist world of work: to be able to stand alone in the world, to look out for oneself, and so on.

Thus oppression, mystification, and isolation interact to produce the distressed and disempowered individual whom conventional psychiatry sees as pathological. If human distress is actually a form of alienation, then the work of therapy becomes a project of changing the conditions that alienate. The early Radical Psychiatry theorists captured that agenda in two formulae:

Alienation = Oppression + Mystification + Isolation

Contact    +     Awareness    + Action    => Change (Liberation?)

The first step toward “soul healing” is to bring people together. Many of the social movements of the day were vividly demonstrating how powerful a force the telling of life stories could be. Women’s consciousness-raising groups were an explicit model, as was with Eric Berne’s work with groups. The simple act of people gathering in small batches to talk honestly about their lives was the core organizing form for the burgeoning women’s liberation movement. Meanwhile, the black power movement challenged ideas as fundamental as beauty; “black is beautiful” had a galvanizing impact on African American people’s sense of self-worth, raising to consciousness the inhibiting force of standards of beauty for all people.

The second step in the process is thus a potential outgrowth of the first, to construct a different understanding of life and oneself in society. I say “potential” because we all have had experiences of being in groups that compound alienation rather than relieving it. Groups as we usually find them are a powerful force for oppression. Families, our first group experience, often both enforce roles on every member and mystify the oppressive nature of those roles through a moral discourse grounded in cultures of secrecy. Families talk about privacy when actually they promote shame by imposing silence, a self-protective construct in a competitive and judgmental world. Classrooms, that familiar childhood exposure to groups, institutionalize more subtle familial lessons about competition; we are endlessly, explicitly judged and ranked against our classmates. Job sites capitalize on the pedagogy of competitiveness, adding the major incentive of insecurity: if we don’t stack up well, we suffer unemployment. Meanwhile, friendship groups and communities created for recreation and social support, instead reproduce secrecy and competition, the only rules of interaction we know. How many times people “learn it on the grapevine”, experiencing the shame of being the last to know that which has been whispered elsewhere first.

The Cooperation Theory

No wonder then that so many people shy away from groups. Simple contact has the potential to be as oppressive as it can be libratory. The early Radical Psychiatry collective lived that problem even as they tried working consensually to create the new practice. A major element of the work was clearly to unlearn one way of relating to others, and in its stead learn to cooperate. One of the earliest projects was, therefore, to identify the basic components of cooperation, to create a theory that might guide practice. What the collective came up with was pretty simple: a commitment to honesty and to respectful, non-coercive interaction. These precepts were captured in the form of a cooperation contract consisting of three agreements:

Š                                          No secrets or lies

Š                                          No power plays

Š                                          No self-sacrifice

Seemingly obvious, in the real world these rules test core questions about relationships. They require two crucial pre-conditions: a reasonable approximation of equal power and a shared will toward equal rights. Failing these conditions, simple acts of honesty can be high risk business. I’ve noted how destructive secrets can be in families and communities. But secrecy has a function: where there is a danger of coercion, through force or judgment, it is wise to use information strategically. Information, as has been well demonstrated in the modern communications era, is power, a tool both for those in positions of superiority and of suppression. Withholding information can be a means for imposing ones will on others or for self-protection. In either case, it precludes cooperation.

To dramatize the importance of information, we call secrets “lies of omission.” Keeping secrets is not generally seen as a “bad thing”, while telling lies is. But we contend that secrets are every bit as destructive when people are striving to conduct relationships cooperatively. Withholding information is, in fact, a power play.

A power play is defined as any act designed to get another person to do something he or she would not otherwise choose to do. In subtle or overt form, it is coercion. To agree to eliminate power plays is to sign on for negotiation, persuasion, consensus.

The third rule, no self-sacrifice, is in some ways the most difficult to enact. Giving up ones rights and interests is also, in a more convoluted way, an act of coercion, a secret decision to withhold information and produce an outcome that might well be different if everyone were involved in the process. We look at the phenomenon in terms of a concept taken from Transactional Analysis, the Rescue (or Drama) Triangle. Rescue is similar to co-dependency, but with a crucial difference that makes it a more useful tool for analyzing power. It describes three roles: Rescuer, Victim, and, its distinguishing feature, Persecutor. To Rescue is to do more than your share of the work around some transaction, or to do something you really don’t want to do – two variations on a theme of self-sacrifice. Rescue often takes the form of an implicit and unchallenged division of labor. A prototypic example grounded in gender dynamics is given us by common ways heterosexual couples find themselves handling life’s work. Same-sex couples may experience seemingly-similar dynamics, but with crucial and illustrative differences (Rabenold, 1988). Similarly, while the couple I describe are white and working class, their story may well ring familiar to people of many other social identities.

Simon is a skilled carpenter; he spends his weekends and evenings renovating the basement of the house he owns with Wendy. They desperately need more space now that they have two small kids, and, what with mortgage payments and repaying the loan Wendy’s parents gave them for the down payment, they couldn’t possibly afford to pay for labor. At first, Simon liked the creative challenge, but the pleasure has long since worn thin and all he wants is to be done.

Meanwhile Wendy is left with a lot more childcare than she really wants to do, in addition to her part-time job selling at the department store. She’s a dedicated mom, but all the work of getting kids up and out in the morning, bathed and settled at night, is draining her. She tries to talk with Simon about it, without a lot of success. He sees her complaints as criticism, “attack” is his word, and, in truth, feels helpless to do anything about it anyway.

Simon Rescues by tending to physical space, Wendy by taking charge of both the domestic and emotional environments. He fixes things, she takes care of the household and relationships. Each of them has become Victimized by their Rescue, suffering losses and pain. But each also falls into the Rescue role because she or he sees the other as a Victim. Wendy couldn’t possibly learn to wield a hammer, could she? And Simon is hopeless around the struggles and maneuvers of breakfast and bedtime. But both parents have long since become burned out, and they take their fatigue and depletion out on each other. They Persecute, Wendy by indignant nagging, Simon by refusing to talk and eventually turning his bottled up emotional energy into outbursts of angry shouting. Wendy feels martyred, Simon beleaguered. Each is both right and wrong.

Wendy has no constructive way to voice her feelings, and they come out as anger at Simon, especially when he insists he’s working harder than she is. She falls into the competitive pattern of trying to top his sense of oppression. Moreover, she senses that the work she does is not visible as work to him. After all, he remembers his mother’s doing all that without complaining. Isn’t it just part of life? Whereas Simon’s own work in the basement yields very tangible results on a daily basis.

But Simon too feels helpless. He can’t see a way to get off the treadmill of working eight-to-five as a non-union carpenter and then coming home to more work. He feels responsible for supporting his family, knowing that his manual skills earn more money than Wendy could possibly command. But he also experiences an endless series of demands on him, with little enough encouragement to meet them and far too little appreciation for what he does.

Each looks to the other to solve the pressing problems, each knowing at some level the impossibility of that quest. They have some friends and relatives to whom they occasionally complain, but nowhere on the social horizon does anything promise to deliver the effective help they need and deserve. In this respect, they are actual victims of an unkind social system, of class and of the nuclear family, as well as psychological Victims insofar as they have come to a false conviction that the problems lie in their own and the other’s inadequacies, and the remedies lie beyond their powers.


This example is typical of a gendered division of labor, still very common in today’s heterosexual relationships when both women and men work for wages but men on average earn more money and women still do more than fifty percent of domestic labor (Hochschild, 1989). It is also prototypical of Rescue as a power dynamic. A social structure that results in scarcity (in this case, of money and labor) combines with a limited vision of alternatives (neither Wendy nor Simon can look up from the task-at-hand long enough to have a creative idea) and a poverty of interconnection with others (the failure of community is a core cause of their problems and, at the same time, deprives them of the awareness that their problems are not unique to them, not about their own failings as individuals but socially induced) to produce a set of ingrained roles that are functional but highly distressing as well. Neither has an apparent source of power to take control over her or his life.

Power is a problematic concept. It dons so many costumes that it is difficult to identify, elusive to name. One handicap is that we tend to think of power as a thing, as something to possess (Birkhoff, 2000). Moreover, people struggling to be cooperative most often think of it as a bad thing and, in consequence, shy away from naming it or dealing with it directly.

I find it more useful to think about power as a process, operating on many levels, a dynamic between and among people, multi-layered and ever-shifting. There are five arenas (at least) in which power is transacted: internal, interactional, organizational, cultural, structural. Like any schema, this one is less than exhaustive, carving complex reality up into discrete categories. Like many schemas, this one also has analytic usefulness, but we need to remember that power is operating on all these levels simultaneously, the various arenas interacting in such a way as to mutually construct each other continuously.

Starting with the most external, structural power accrues from institutional arrangements, the inevitable context within which all human experience is lived. Wendy and Simon exist within several defining social structures: the nuclear family, urban life bereft of meaningful communities, institutions of work based on wage labor, political policies that fail to provide adequate child-rearing support, and so on. These structures remain largely invisible to them; they take them for granted, deeply obscured as they are by the cultural hegemony within which they swim.

Problems that result from negotiating these structures are compounded by cultural practices. Most obviously, gender shapes Wendy and Simon’s experience. They fall into roles for which they have been securely socialized. The structures of their own families of origin mediated socially-inscribed gender identities and practices, shaping Simon for instrumentality, Wendy for relationship. Lessons in gender solidify into character structures, metaphorically and literally embodied, and enacted in the form of silent agreements: I’ll do this, you do that, even if neither of us likes it. In the process, power is distributed, and because of structural inequities, the distribution is rarely equal. Wendy’s lack of economic power disadvantages her in a world without assured support more severely than Simon’s lack of emotional prowess.

Gendered cultural arrangements interact with other social identities – race, ethnicity, sexual orientations, disability, generation, and so on – to parse power relations in complex ways. Children of immigrants, for instance, very often struggle with tensions between American standards of individualism and a strong sense of responsibility to their elders, especially when racial discrimination is at play. When to break free of parents and when loyally to advocate for them and for the larger community can be conflicting choices. Young people, perhaps confronting their own barriers to well-being in a racist society, are keenly aware of the even greater hurdles confronting the first generation who may lack English language skills as well as cultural knowledge needed to negotiate new systems.

Similarly, gender relations among people of color can be severely strained by the different forms of racism men and women face. African American women speak of having to choose between their own dissatisfactions in relationships with Black men and the greater condemnation heaped on the latter by white society. Can the women afford to be critical and risk colluding with a whole array of damaging stereotypes of Black men?

Many of these quandaries manifest organizationally, showing up most evidently in the dealings of people of color with institutions, both state and civil. In the aftermath of the police killing of Amadou Diallo in New York, a social worker in the Bronx near where the young African immigrant was shot talked with me about her experience with police intervention in domestic violence in her community. She was part of a campaign to encourage women to dial 9-1-1. But when they did, police several times in quick succession shot and killed the offending men. “We wanted our men restrained, not dead,” she said. Women stopped calling the police, leaving them with less power to protect themselves, less power to insist their men learn non-violent ways, less help from the larger community. Decisions about how to take power, where its limits lie, are thus informed and enforced by particular social experiences.

Organizational power relations are most clearly identified in workplace and civil institutions, such as schools and churches. Hierarchies in these settings tend to be both overt – named in the form of titles and offices – and covert. Who speaks first and often in meetings, who gets the coffee, how it is decided that one person will travel to a conference while another of apparently equal rank stays back to finish the office work: all these unspoken roles and responsibilities transact power in ways both intricate and, most often, mystified.

The family, too, is an organization in which parallel power dynamics are acted out, interlacing age and gender to form compelling lessons in hierarchy. Parents order children around; older siblings dominate younger ones through “play”; brothers rough-house with sisters and overwhelm them frequently; and on and on. Meanwhile, Rescue dynamics – children who decide to cause parents no trouble because they can see how overwhelmed they are, or how drunk; parents who wear themselves out keeping a neat house or paying the mortgage, and then tyrannize everyone to pick up the crumbs or turn out the lights – form counter-currents of power, parsing domination and submission in different ways at different moments.

Simultaneously, racialized lessons in power are also being taught, explicitly through language, implicitly through very fundamental transactions. In her book Black Looks: Race and Representation, bell hooks  (1992)describes “The Oppositional Gaze”. “I remember being punished as a child for staring,” she writes, “for those hard intense direct looks children would give grown-ups, looks that were seen as confrontational, as gestures of resistance, challenges to authority.” She goes on to note the contradiction and locate it historically:

Yet, when punished, the child is told by parents, ‘Look at me when I talk to you.’ Only, the child is afraid to look. Afraid to look, but fascinated by the gaze. There is power in looking.

Amazed the first time I read in history classes that white slave-owners (men, women, and children) punished enslaved black people for looking, I wondered how this traumatic relationship to the gaze had informed black parenting and black spectatorship. (p. 115)

What seems at first glance to be a transaction negotiating generational power – the gaze can flow from parent to child, but not the other way – is in addition a piece of the construction of race relations, continued through time. That it is a product of trauma gives it weight and substance. That it teaches something about current realities of oppression and danger gives the lesson immediacy and function. Direct looks in public spaces can be dangerous for black adults as well, subject to interpretation in a racialized climate as confrontational, and consequently violently punished.

White children learn thoroughly implicit lessons about their racial identity as well. The very absence of mention of whiteness communicates the expectation that their experiences are the norm, that which is to be expected without note. My own parents were courageous integrationists in a southern city during Jim Crow. I very clearly understood lessons in justice. But at the same time I witnessed the prevalence of black domestic labor and the rarity of black professional people in our community. I witnessed my father’s assumption that he could lift a telephone and be heard by the mayor or the chief of police when trouble was afoot, and I knew his access was a function of his race, gender and class. Brave and outspoken as she was, my mother never made the same bold kinds of phone calls. By association and contrast, through emulation and opposition, I formed my own relationship to those social attributes and to the power dynamics they constructed.

Culture and social location commonly intermingle, manifested as power struggles in all kinds of relationships, in ways sometimes banal and often troubling. Krista and Wanda keep bumping up against an all-too-familiar impasse in their year-old lesbian relationship. From Wanda’s perspective, Krista suddenly vanishes at some point in a disagreement. Krista describes her mode as “being easy in the front and in the back going my own way.” She chooses that round-about route when she feels over-powered, which she does regularly during negotiations, or what she experiences as fights, because Wanda is skillfully verbal, acutely self-knowing. Both women are white, close in age, and probably equally in love with each other. But Krista’s methodology was forged in Germany, in a family that never talked about themselves or their relationships and that imposed very strong expectations of a very conventional, heterosexual sort on their daughter. Early on, she learned silence was a potent means of self-protection and a cover for going her own way. Wanda, meanwhile, grew up with a single mom who talked openly and elaborately with her only child. When she found herself in a lesbian community where “process” was valued, she excelled.

Another example: culture and social structure shape parental expectations, sometimes spoken, sometimes implied, which in turn shape children’s strategies for taking power. My father was the child of immigrants from Eastern Europe. Working on the lower East Side of Manhattan in sweatshops, his parents looked to their first-born son as the economic hope of the family. He became a doctor. From time to time, people asked him when he’d decided on a medical career, and he always replied, “As soon as I was old enough to understand what my mother was telling me.” Heavily shaped by culture, often dictated by the requirements of negotiating disadvantaged social locations or protecting privileged ones, instructions to children are communicated through the most nuanced of interactions: a parent’s raised eyebrow, a derisive comment about a neighbor overheard in the elevator, praise heaped on someone else’s son or daughter. Like my father, some children never consider the possibility of disobeying. Others rebel, choosing paths as divergent from their given road-maps as they can possibly find. Only later may they realize that their direction was nonetheless set by their parents values, just in reverse, through opposition.

Strategies for survival and well-being track children into adulthood. They both offer strengths and simultaneously trap people in behaviors they wish to change. Eduardo works hard to support his family, following the example set by his father in a rural setting in El Salvador. But unlike the village men Eduardo emulates, he lacks the shared responsibility of a farming community as well as the ready companionship of an extended family. Needing the relief and support those structures provided his father, Eduardo escapes responsibility Friday nights by drinking heavily and gambling with his male friends. But his wife Alejandra shares his isolation; no close-at-hand community of women help her with domestic chores, brush her hair during the hot afternoon break, share gossip and laughter over the evening cooking. She, too, works for wages all day and then comes home to a “second shift.” Eduardo cannot see clearly all that she does, but he nonetheless knows it’s overload and he sympathizes with her. She rages at him for his Friday-night disappearing act, angry that he’s not home to help and even more that he loses significant sums of money. He regularly promises to reform, but come Friday night he’s ready to burst with fatigue and disquiet and knows no other way to care for himself. Lacking language to say all that to Alejandra, he simply does not go home after work on Friday.

Wendy’s most powerful tool is language; she can talk Simon to a standstill. But Simon literally disarms her by refusing the conversation she seeks to impose. When he sets his mouth, refuses to meet her eyes, turns back to his hammer and nails, he exercises power effectively: he forces Wendy to abandon verbal processes, and she knows of no alternative. On the other hand, when Wendy insists Simon wash the dishes after dinner and then follows in his path wiping up crumbs and splotches he’s overlooked, she is wielding her greater housekeeping skills in a moral battle. Power transactions are infinitely creative, ranging from the most subtle (a cast of the eyes) to the most overt (a throw of the fist).

Violence is, of course, the ultimate power play. For that reason, any work on building cooperative relationships depends on the absence of any threat of violence. Men resort to violence as a form of dominance often paradoxically borne of the sensation of powerlessness. It is not a sign of evil, nor even sometimes of entitlement. It is what men are trained to do – use the physical body – as their means to take control over an unwieldy environment. Its consequence, though, is to re-enforce relations of privilege and disadvantage that are systemically constructed. Domestic violence negates the possibility of doing any constructive cooperative work, until a clear and realistic commitment to non-violence has been made. The work we know how to do is grounded in a framework that values equality of power as a pragmatic good: relationships work badly when people live in fear. All our work is premised on the possibility of conscious change, and that includes the reality that men who batter can learn alternatives. Innovative work has been done by groups of men helping batterers reform, based in principles of group support and the premise that using physical force is a choice that can be changed.

Finally, power operates internally. We all accrue beliefs about what we can and cannot do, where we have permission to act, when we have agency to effect change. If Wendy has secretly formed the belief that she is not smart enough to support herself and her children without Simon, she is more likely to resist doing those things that might in fact help her acquire the skills she needs to negotiate the world of money. If Simon believes he is inadequate to form nurturing relationships with his children, he is more likely to fade away from the troubled moments of the day and choose play times to be with them instead. Each is dependant on the other for what she or he perceives to be an inadequacy in herself or himself. Without the necessity of taking on those tasks, each is deprived of the experiences that would form an ability to perform.

Internalized Oppression: “The Pig”

The theory of internalized oppression is at the heart of Radical Psychiatry practice. A great deal of what happens in “therapy” is about naming and challenging this pervasive set of attitudes. In the early days of Radical Psychiatry, as anti-war and black-power movements raged in the streets, the collective nicknamed internalized oppression “The Pig”. It is the internalized cop that keeps us in our socially-prescribed place. The name has advantages and disadvantages. It is punchy, usable both as verb (“I Pig myself as much as others”) and noun (“My Pig says I should….”) It lends itself to therapeutic metaphor; we can name the Pig, reveal the Pig, fight the Pig, unlearn the Pig. It suggests that the struggle is about something external that nonetheless has great power to enforce rules of the most intimate sort. But it is itself Pig, a slur on police officers – not to mention on pigs. Yet it remains a piece of solidified history, difficult to relinquish however much it may breed discomfort. Because it is an extant therapeutic form, and because cognitive dissonance can be a constructive experience, helping to heighten consciousness, I will continue to use the disquieting nomenclature here – as I do in my practice, with explanation and apology, and an open invitation to “rename the Pig.”[1]

The Pig is an ideological construct that is learned through articulated messages, interpersonal interaction, and cultural hegemony. I’ve already written about how Wendy and Simon’s assumed models of gender are reinforced by the interactions between them and with their children. Clearly, those stereotypes of gendered behavior are compounded with great frequency by media and other cultural forms. A few years ago, some students of mine did a visual research project on gender and racial messages contained in advertising images. They found that the majority of male models in shiny magazines were posed face-forward, chin up, photographed in some action. Women, on the other hand, rarely faced the camera, usually lounged passively, often with downcast eyes. Most of the female models were white, all showing great expanses of bare flesh. The rare woman of African or Asian heritage usually posed in some sort of “exotic” attire. All the white men were fully clothed; the only African-American male model they found was also the only example of near-nude male cheesecake. Imagistic symbolism changes over time, sometimes quite rapidly. Today male flesh has become a good deal more prevalent, and boldness in women has been redefined as sexy.

Messages about who we are and how we are supposed to behave take two forms: injunctions and attributions. Injunctions tell us how to behave (“Be strong; don’t cry”; “Be sweet; don’t be angry”). Attributions tells us what’s wrong with us if we disobey: “You’re a sissy!”; “My, you’re selfish!” Gendered messages suit us for heterosexuality. They find their way, of course, into same-sex relationships, but they ideally fit people for the sort of relationship that Wendy and Simon illustrate, constructing a coercive interdependency that adds iron to marriage vows.[2]

Injunctions and attributions support the construction of all sorts of social hierarchies. Intelligence and diligence are two fundamental categories of internalized oppression. The many interactions children of color encounter in school, for instance, in which they are signaled that their intelligence is suspect because their cultural expression falls outside a white teacher’s expectations, or their assumptions about life clash with a standardized curriculum, construct power-diminishing responses –  self-doubt, for instance, or rebelliousness – that undercuts the attainment of skills for survival in white-dominated society (Bourgois, 1995). The examples can be multiplied endlessly.

The Pig may make complex accusations of inadequacy or wrong-doing, but in western capitalist society they tend to boil down to seven categories: stupid, lazy, crazy, sick, ugly, bad. When all these beliefs about oneself exist simultaneously, people are frequently suicidal; the seventh message is “deserves to die”.

Because these messages are learned, they can be unlearned. It is a defining characteristic of the Pig that it is false. It’s very grammatical structure gives rise to its internal impossibility: it is categorical and abstract. When Wendy has trouble keeping track of her bank balance, the voice of the Pig echoes in her mind saying she is stupid. But it excludes from her consciousness evidence of her brilliance in knowing what her children need, indeed what they feel and think. It discounts the intelligence needed to multi-task in the ways she does as a matter of course. It ignores the fact that she was never taught how to balance a checkbook, nor that she lost her confidence in her math abilities at the age of eleven when the message became palpable that girl math whizzes were not attractive.

Power in general, and internalized oppression in particular, are processes we negotiate. We are not passive objects waiting to be molded into solid shapes that can never be undone. In fact, the genesis of the Pig often lies in a very particular sort of negotiation. As children, we realize very soon where the limits to our power lie, and we construct strategies for dealing with the ensuing problems. In the midst of parental conflict, for example, some children opt to make themselves invisible, others to make a distracting fuss; still others try to mediate. To each of these strategies is attached certain conclusions: “I’m not strong enough to make a difference.” “I fall apart when trouble hits.” “The fate of the world depends on my intervention.” The first becomes embodied as a sense of futility, the second as a sense of fragility, the third as a sense of over-burdened responsibility. Each of these premises is tested in other venues, becoming refined or reinforced. These conclusions, once useful, later become counter-productive when altered conditions call for different more self-affirming strategies and skills.

It is fundamental to the practice of Radical Psychiatry that very deeply ingrained beliefs and behaviors can be altered, that the processes of negotiation by which they were formed continue throughout life, giving hope both for personal and for social change.

Problem-Solving Group

It is to promote and support such change that Radical Psychiatry practice assumes the form of problem-solving groups. Group is itself a small example of social change, bringing together community support, skill learning, and a very intentional process of unlearning powerlessness while experiencing conscious forms of power-sharing, to challenge both internal and external barriers to well-being.

From start to finish, power is negotiated between group leaders and group members. Fees, for instance, are kept as low as feasible. (We continue to contend, rhetorically, that no one should have to pay for “therapy”; it should be a readily-accessible form of community support.) Many of us use a sliding scale, inviting clients to set their own fees within a range that, in my case, has grown ever wider over the years, as I’ve raised the top but not the bottom.

Not everything about group is negotiable: the basic structure is a given – how long group lasts (mine are two-and-a-half hours long), how many people belong (six or seven), who joins when a place opens up (although I certainly take into consideration needs for particular representation to provide support for particular current members). I’m happy, though, to talk through the reasoning behind these choices, and on occasion I’ve been persuaded to expand or contract the length, to add more or fewer people. Transparency and flexibility both serve the purpose of keeping me true to an intention to use the power of leadership humanely and openly.

On the other hand, the content of people’s work is very much their own, including their judgment of what they need to change about their lives and when they’re ready to leave the group. (We do not insist on elaborate “termination” processes, trusting that few people turn away from a good and helpful thing as long as it continues to be useful.)

“Work” in group takes many forms – problem-solving, expressing emotion, role-playing, sorting out in-the-room feelings and relationships, and more. A typical exchange may look something like this:

Trina (a newcomer to group): I am so scattered, I drive myself crazy! I am just so dumb I  can’t keep track of where I’m supposed to be and what I’m supposed to have with me. I showed up for my big presentation at work without the transparencies I was supposed to show, and now I’m really afraid I’m going to get fired.

Sylvia (an older group member): Wow, is it ever hard for me to imagine you as “dumb”! I remember your  talking a couple of weeks ago about how much you had to handle as the child of immigrants: keeping track of all sorts of paperwork, translating for your parents, getting yourself and your siblings to school. You got bad grades because you were exhausted by all that, but you were clearly not stupid then and you’re certainly not now! I’ve been knocked out by the great feedback you give us in group!

Beth (the group leader): It makes real sense that you’d feel overwhelmed and at some point check out, Trina, just as Sylvia said. Your Pig says you’re stupid, but that was the way you were defined at school, which was clearly both racist and class biased. Also, maybe it was a pretty smart strategy – at least back then – to decide  you were stupid. Given how much people depended on you, maybe it gave you a little protection. But now that view of yourself is clearly demeaning and getting in your way.

When Trina came into group, she told us she wanted to improve her self-esteem. The first act in group is to define the immediate goal of the work, what is inaccurately called a contract.[3] It is a simple positive statement that serves several purposes: It puts the client in charge of her own work, guarding against diagnosis. Trina knows more about her problems and needs than I do. Labeling her is not helpful to either of us, although renaming her problems may be. Often, the only characterizations available to people are laced with Pig: “I’m in trouble at work because I’m so slow to learn how to do things,” or, “I can’t make a relationship work because I’m so angry.”

Second, the contract is a tool for accomplishing whatever it is Trina chooses to work toward. It should be something Trina can remember in a moment of choice, an idea that helps her choose a new way of being. Third, the contract is a yardstick. If group is not helping her make recognizable change in fairly short order, then something is wrong and she is encouraged to challenge the process. The presumption is that the problem lies in our way of working together, not in her diagnosable pathology.

On the other hand, the contract is frequently a product of discussion in the group. “Self-esteem”, for example, is rarely a useful way of framing a contract; it puts too great an onus on the client, distracting from a more interactive materialist understanding.

“What’s wrong with your self-esteem?” I asked Trina that first group. “What exactly is the problem?”

“Well, I lose my nerve when I have to do something hard at work. And I end up feeling bad about myself in relationships and somehow or other mess them up.”

Trina presented two problems, joined together by an analytic leap she’d made. Wondering whether that leap was influenced by her Pig, I asked her to give us some examples. Getting the details of the story almost always leads to a more refined statement of the problem.

“I thought I was on top of my part in the new project. I worked and worked and worked on it, and I actually got a pretty good evaluation. But then my closest co-worker complained to our supervisor that I was slowing her down by being too meticulous. I felt terrible. I guess I’m just too slow; it does take me forever to sort through what I’m supposed to do.”

“Seems to me,” said Sylvia, “that your work is more about handling competition than it is about self-esteem.” As we talked more, it appeared that Trina was actually doing fine in terms of work-skills, but that she was facing a competitive dynamic fueled in part by the bad economy we were in and her co-worker’s consequent insecurities.

Trina was still not convinced, though, that she wasn’t at fault. So she went on to describe some of the interactions with her lover. “I just can’t keep my mouth shut. Matt’s a nice person, but he drives me nuts sometimes. We were at a party, and I could see my friend Shana couldn’t get a word in edgewise. Matt just went on and on, telling some boring story. I knew Shana was getting upset. So I just blurted out that he should stop dominating the conversation, that I wanted to hear what was up with Shana.

“I could see he was hurt. Afterward, he said I was rude and arrogant, and that those qualities were not attractive in a woman. I felt terrible! I didn’t mean to upset him. But I do that sort of thing all the time. What’s wrong with me?!” Group members agreed that she could use some better skills for speaking her mind. But they pointed out that Matt had “Pigged” her back, and that he’d hit a very vulnerable spot by using a very sexist accusation. No wonder her self-esteem was shaken..

I ventured a suggestion, tying together both stories. “Maybe the common thread between work and relationship problems is that you blame yourself instead of figuring out what the problem is. How about starting with a contract to nurture yourself in the face of trouble? To do that, I think you’ll have to find ways to understand what’s going on in a more self-forgiving way, and in turn that self-nurturing can create a positive climate in which you can learn some interpersonal skills – like telling Matt how you’re feeling rather than speaking to him judgmentally.”

Identifying a unifying theme in a list of problems to be solved is one approach. Another might be to ask Trina to choose a starting place, either work or love, for instance, with the expectation that whatever dynamics they have in common will emerge no matter where she starts.

Once her contract had been defined, Trina came to group to talk about whatever was most compelling for her in the moment. If the topics on her mind did not relate to the contract she made, we explored the possibility that the contract needed altering, not her emotional selection of material to present.

As group members form relationships and give feedback to each other, the group leader plays several roles. She provides safety by helping people learn to talk honestly without judgment. In this aspect of her work, she is both teacher and facilitator. She gives people tools with which to describe more and more vividly and constructively what they experience. In particular, she teaches approaches to fighting the Pig and provides a powerful force in implementing them.

Fighting the Pig

The theory of internalized oppression posits three forms in which Pig messages appear: as emotions, as body sensations, and as ideas. More often than not, we first become aware of them in their most non-verbal forms. We feel fear or anxiety, depression or unrelieved sadness. We hold pain in the stomach, or tense the jaw against expressions of grief, the shoulders against anger. The first step in group, therefore, is to acknowledge the feelings and identify them with words.

The second step is to analyze what exactly the Pig says, to boil it down to its most essential and, therefore, most forceful statement. “I am not good with numbers and often lose track of time” may become “I’m stupid!” “Why are you always so emotional? Can’t you just be sensible for a change?” are rhetorical questions masking a conclusion: “I am crazy.” Each of these statements is associated with some form of political dynamic. “Stupid”, for instance, is often a class-defining accusation. The definitions of smart that most afflict us derive from the skills of those at the top of the social hierarchy: scientists, lawyers, executives. These are the people who are trained to think in linear, abstract terms. They also are most commonly white and male, even after decades of progress around professional demography. But intelligence actually takes many forms: intuitive, creative, holistic, and so on (Gardner, 1983; Belenky, 1986).

Similarly “ugly” is often a gender message. Beauty matters for women, socialized to take very seriously the assessing gaze of men. Classically, men choose love objects, women wait. Here again, the rule is outdated; the Sixties liberated women’s activism in the pursuit of love, and change has marched steadily on from there. But the feelings accompanying even such newer transactions still track the old gender order. Men’s aesthetic, socially infected beyond their recognition, far more often determines their choice of partners than does women’s. Men judge others and women judge themselves by appearance, not always and absolutely but in great preponderance. While their own appearance may matter to straight men, gay men report a far more compelling preoccupation with their looks, as they, like straight women, respond to narrow standards of physical desirability reflected in the judging gaze of potential male partners. Meanwhile, lesbians may be more protected from “looks-ism” but still don’t always escape it’s touch. Women attracted to women may still be painfully conscious of appearance as a factor in appeal, sometimes with the added problem of uncertainty about how to initiate romance without replicating gendered dynamics of aggression.

That Pig is an ideology fitting people to particular social locations, and capturing them there, is evident in the area of racial identity. All three of these messages – stupid, crazy, and ugly – lie at the heart of stereotypes that beset African American people, for instance. Combined with accusations of laziness, the form a quadruple phalanx driving racism to the most personal levels. Black rage is judged by the white community to be crazed. Black beauty is still distorted by white ideals of fairness, slenderness, and straight hair.  Black smarts are overlooked by white teachers, submerged in perceptions of unruliness or the impermissibility of African-American forms of speech. Disadvantage is then blamed on the victim, who is accused of laziness, of failing to work hard enough to succeed. Political and cultural movements seek to defend against these onslaughts, with significant success. But in the context of institutional discrimination, the very necessity to resist constitutes oppression.

Other people of color suffer other assaults on self – Asian women become invisible behind presumptions of the exotic, Latino men are stereotyped as erotic and not seen as formidable in all the other respects they may be. All stereotypes are a form of Pig, by definition: they are generalizations that distort a dimensional reality and oppress options for power of those who are targeted. (As well, I might add, of those who target, although that’s a story for another day.) All resonate within structural systems of inequality that turn the struggle against them into a dire battle.

Super heavy assaults of Pig sometimes result in suicidality. Like violence toward others, suicide is also a choice. For some people in extreme despair, suicide may appear as the only relief possible. The idea that the only power left is the power to end life is, in our view, the ultimate victory of the Pig. As long as it appears to be an option, it is very hard to do the work of uncovering and contesting all the other messages of powerlessness that have been learned along the way, and to rebuild a life that truly makes for well-being. So we ask people to choose life, and to make a contract with the group to rule out suicide. On the other side of that contract is a commitment by the group, and especially by the group leader, to be available to help fight the despair at any time it becomes suicidally intense. For me as group leader, that commitment is serious. I give people my cell phone number and promise I’ll talk to them night or day, if the need is there. Often, the act of making a contract to stay alive is a turning point and the need for emergency intervention never arises. But when it does, to make the critical phone call is such an act of trust, an exercise of essential human power, that the work moves forward steadily from there.

Depression in general, such a common complaint in modern America, we see not as illness but as an expression of alienation. When large segments of a population suffer the same affliction, there is reason to suspect some common social genesis. In fact, I’ve come to believe that we collapse a multitude of emotional experiences under the diagnosis of depression. Grief, anger in the context of a sense of powerlessness, immobilizing confusion, and so many other similar experiences are pathologized and medicated. But each of those experiences is, to me, an expression of problems that can be understood and addressed in reality. Isolation from others, as I’ve said, disempowers people, depriving us of the human connection that makes for the power to make change happen. Why not feel depressed if you feel you cannot change that which is dehumanizing? On the other hand, once we’ve managed to connect with others we stand a far better chance of identifying causes for distress, both external problems and internalized oppression. With that awareness and support, it is possible to begin a process of making changes, step by step. Action in and of itself relieves depression, defeating the Pig messages of powerlessness, and especially the false notion that the cause lies somewhere inside the individual.

Once the Pig is identified and boiled down to its essentials, the next task is to construct strategies for unlearning it and replacing it with a true sense of self. Approaches vary from one person to another, but there are two commonalties. First is the power of exposure in a group. Once spoken, the effectiveness of the Pig message often diminishes. Moreover, it quickly becomes clear that other people’s Pigs lie. If Betsy’s belief that she is ugly and stupid is so palpably false, it’s hard for Annie to maintain that her Pig, and her Pig alone, tells the truth. Interaction with others is thus a powerful, perhaps an essential, element in making change.

The second force for challenging Pig is “strokes”. A stroke is any unit of positive interaction, something once again we borrowed (from Transactional Analysis) and then theorized in political terms. We speak of a stroke economy,[4] a constructed scarcity of compliments, affection, encouragement that drives us to try harder, feel less secure, act more competitively – in general, to consent to an individualistic society. We are severely trained in the western world to curtail strokes. We’re taught not to give them (lest we’re thought to be sexually aggressive or trying to get something manipulatively for ourselves), not to accept them (lest we’re seen as conceited), not to request them (lest we’re seen as needy), not to reject them (lest we contradict some imbedded injunction, such as “You’re so sweet!”), and, most of all, not to stroke ourselves (lest we induce unacceptable degrees of competitiveness from others.) Breaking these rules is radical business, a powerful force against internalized oppression and a serious means of opening channels to positive connection.

Strokes help to keep relationships in group clear, but so too do other forms of emotional dialogue that enable us to work through conflict. Conflict inevitably arises. We do not see conflict as a deflection from the work; it is its essence. Change happens through conflict, properly conducted. So one aspect of group is teaching people to be in conflict respectfully and productively. These practices (which I won’t detail here but are elaborated by Claude Steiner in Achieving Emotional Literacy) are also at the heart of the second form in which much of our work takes place.

Conflict Resolution

Finding ways to address conflict started, as I’ve said, at the very beginning of Radical Psychiatry, at first as a self-help tool for handling conflicts within the collective. Incorporating elements of labor mediation, notions seeping into the American discourse from neighborhood mediation in China, and whatever tools from Transactional Analysis looked promising, the early members constructed a clearly-formulated procedure for intervention.

The process of mediation begins with contracts, the participants articulating their goals for the work. They then are helped to clear the air, telling the stories of their grievances through the use of emotionally-oriented statements: “I-statements” in current conflict resolution jargon; “held feelings” in common Radical Psychiatry jargon. Participants take turns saying the things that upset them, without judgment, and also without discussion or argument. The premise here is that what we feel matters. It is an anti-pathology premise: nobody is crazy, we all feel what we feel for a reason and the feelings must be spoken if change is to happen. At length, once all the subjective experiences have been voiced, the mediator offers direct feedback. The mediator presents a likely story or analysis of how the various subjective experiences fit together, and then invites the participants to craft revisions until they agree on an understanding of what’s going on between them.

At this point, the participants say what they’d like to change, encouraged to imagine an ideal outcome. Where there are differences in the visions, the mediator guides the participants through a negotiation. We work from a theory of negotiation: start with 100% of what you want, lest compromise deprive you of more than you can tolerate giving up. Then look for new solutions that stand to satisfy all the interests expressed. If none can be found (and here’s a place where the mediator can be helpful, offering imagination and the accumulated knowledge of other people’s successful solutions), then begin to trade compromises. In the end, whatever new terms are set up need to be tested in reality. An onerous agreement is a fragile one. Agreements need to be subject to revision, just so long as that act is not unilateral. If it doesn’t work, in other words, renegotiate, don’t renege.

Mediation quickly spread from practitioners to consumers. We began mediating other people’s interpersonal conflicts as well as our own. Because the individuals who came to therapy were commonly also involved in other communities, often working in social change organizations and institutions of a progressive sort, we began to be asked to mediate larger groups of people. Over the years, we’ve worked with a great array of cultural, social service, educational, and political groups, as well as with families (it’s a dynamite form to use with teenagers; they excel in the dialogue and get important support to renegotiate power with parents) and other social groupings.

The structure I’ve outlined here is a starting place. As with most things in life, flexibility is necessary. The classic forms are culturally biased. They privilege a certain degree of comfort with verbal expressions of emotion, with face-to-face confrontation, and with an acceptance of direction in manners of speaking. Working in multicultural settings, I often present the structures and tools as possibilities not necessities, inviting participants to share the work of constructing a culturally-appropriate dialogue that fulfills the essential principles of respectful and honest communication in the service of collaborative settlements.

Mediation always involves rearranging power in some form. That process is clearest when generational differences are at issue, but it is true also in organizations. A large part of the work there is sorting out the institutional roots of seemingly interpersonal conflicts. Often two people in what are defined as personality struggles are actually playing out unarticulated problems of hierarchy and role function. By combining attention to individual and transactional power issues with such questions of structure, mediation in organizations crosses the lines between therapy and organizational development. It binds together understandings of power and of emotion with dignity and effectiveness.

The model is simple to state, easy to teach, but it contains some parts that draw on considerable skill. Establishing enough rapport with upset people to be able to guide the discourse in constructive directions is itself an example of the respectful use of power. Formulating an analysis requires a point of view and keen perceptions of transactions as they are described and enacted in the room, skills that come with lots of practice.

Finally, advocacy is a necessary part of addressing power imbalances. Neutrality is not a value in a Radical Psychiatry mediation. When I mediate, I find it easy to feel sympathy with people on all sides of a power divide. Nobody is bad, even though the need for change may be unequally distributed. The job of the mediator is to persuade those with more power to see where their own interests join with their subordinates’ in recasting roles and relationships, as well as teaching leaders the difference between the cooperative use of power and its hierarchical abuse.

This last comment suggests the ways in which mediation is not a universally applicable form. It presupposes a will to equality, of rights as well as power. It requires, in other words, that conditions for cooperation exist, for mediation is by definition a cooperative process. Many social change organizations today seek to construct humane hierarchies, eschewing the time and energy demands of consensus for more efficient modes of decision-making. That endeavor is worthy but difficult. It requires a willingness for transparency on the part of the leadership, and for acceptance of the limitations of participation on the part of all others. Leaders must be able to say, Here I’m inviting input but I’ll make the decision, and, There you have a real say; we’ll come to a decision together.

Paranoia: the Value of Intuition

There is one other tool we use in mediation and elsewhere in our practice that is unusual and unusually helpful. It is a technique for checking out assumptions, in the variety of forms they take. Provocatively, in line with our challenge to traditional psychiatry, we named this class of events “Paranoia”, and we reframed paranoia as something positive rather than pathological.

The theory is that human communication takes forms beyond the verbal. We perceive the most subtle of signs – the lift of an eyebrow, the quick dart of an eye, the tensing of a shoulder – and we make meaning, interpreting the significance in the context of a framework of things known, feared, suspected, anticipated, and so on. We create a story to fill in blanks, making sense of that which goes unsaid. In this sense, Paranoia is “heightened awareness”, a slogan we coined long ago and which has since, in light of subsequent political events, become a good deal less radical than it seemed at the time. Such meaning-making draws on accurate perceptions; people are not crazy, therefore what we pick up is always based on something real. But the explanations we create can also contain inaccuracies. In essence, we’re making a good guess about what another human being is thinking or feeling, but we cannot really know without honest witness from the person involved.

The approach we propose is that people pose their Paranoias directly, running out the story they imagine to be true while implicitly understanding they may not be altogether correct. We sometimes call these stories “Paranoid Fantasies”, rhetoric intended to encourage elaboration of assumptions and concerns. The partner to this transaction is then urged to tell the truth, first identifying what is true about the offered version, then correcting any distortions. We urge that particular order of things because we know that people have a strong tendency to defend their perceptions, only giving them up when they’ve gotten essential validation for the kernel of truth they’ve intuited. To contest the offered version is to invite an argument. But, like a muscle spasm, the tendency toward defensiveness relaxes in light of an adequate validation.

Paranoia is in a sense a litmus test for power. The more insecure we feel, the more risks we in fact face, the more paranoid we become. Keen intuition is a survival skill. Like a dog sniffing out the subtlest smells of food and foe, we use our non-verbal perceptiveness with more or less alacrity depending on how serious the consequences of missing something important are likely to be. Paranoia also increases with distance. The less we know directly, the more we need to pick up intuitively. It is a dynamic that therefore characterizes race relations in America: the social distance between people of different communities combined with perceptions of danger and disadvantage promote heightened alertness to nuances and symbols. Often the stories we construct on both sides of a racial divide are simultaneously both accurate and amiss, the distorted part fed by stereotypes and fears. But while Paranoia operates on both sides of the racial divide, there are important differences in its forms and consequences. Members of a dominant group have more power to harm than those in subordinated categories, who are continuously dealing with systemic racism already. Moreover, people of color and others consigned to marginalized social locations classically do more than their share of the work of divining the meanings of mainstream behavior, both because they are more at risk and also because the lives of those in the mainstream are more apparent, over-represented as they are in popular culture.

Implications for Social Justice

The theory of Paranoia as heightened awareness is one of several ways that Radical Psychiatry can contribute to social justice work. Combined with an analysis of power, it is a tool for understanding commonly divisive dynamics among people of different identities, whether class-based, racial, gendered, generational, or along some other lines.[5]

The conflict resolution work is an instrument for creating greater unity across boundaries that commonly divide social justice activists. From the very beginning, we’ve declined to mediate across structural power inequities. We do not work in corporations or in prisons, unless some very particular conditions are negotiated. (They sometimes are in corporations, haven’t so far been in prisons.) But we have helped many, many progressive organizations learn and grow stronger from otherwise destructive conflicts in their ranks. Mediation in this context is not simply a service to help people avoid damage. It is an opportunity to teach tools and skills for conducting human interaction in a way that models the world so many of us wish to create, where power is transacted humanely, relationships matter as much as outcomes, and emotions are both honored and honorably expressed.

Finally, the work in groups helps to build communities of support well beyond the persons of the group members themselves. The road to the changes people seek – relief from overwork, the enactment of functional love relationships, finding meaningful careers, having voice in political decisions in the wider world – more often than not traverses a terrain of caring communities. Two single moms may make a child-rearing cooperative that benefits six other families as well as their own. Trina may introduce into her workplace concepts of loving support, lobbying for more praise and less secrecy, and in the process extending notions of cooperation to a wider groups of people. Simon and Wendy could start a co-housing project, where they join with other families, elderly people, young singles, to share the chores of life and build a society of friendliness and fun.

Overall, Radical Psychiatry’s approach challenges a psychiatric hegemony that heavily supports the construction of consent to oppressive social structures. If dissatisfactions are diagnosable, if the sources of discontent reside wholly within the individual psyche, then inclinations toward social critique are undermined. The very structure of most therapeutic intervention supports individualist assumptions. One “doctor” and one “patient” in a room alone, however comforting the dialogue may be to both people involved, nonetheless teeters on the brink of replicating the sort of power inequities that may have injured people in the first place. Moreover, the therapeutic relationship, curtained in confidentiality, promotes isolation in a society heavily oriented toward dyads. Clearly, it would be unsafe and unwise for therapists to share information about their clients haphazardly. But when we accept rigid rules of confidentiality uncritically, we are in danger of colluding with judgments, unfortunately so widespread in the greater society, about their distress. Where is the line between hiding the illness of a patient and tacitly agreeing that the world would condemn the patient’s plight? In the end, patients may feel ill and alone, and therapists may be deprived of both accountability and support that would flow from a more open dialogue. Here is another argument for group therapy: when the work of an individual with a group leader is witnessed by several other people, there is less risk of power abuse by the therapist. For many years, one criterion for calling oneself a Radical Psychiatrist was that the therapist meet regularly with a peer support collective where the details of practice were disclosed and discussed. We had little use for credentials as a means to maintain quality, feeling that they glorified professionalism and stood to disorient clients’ own assessments of the effectiveness of the therapy. (Doesn’t that row of diplomas and certificates on the wall suggest the fault lies not with the “expert” therapist but with the client who persists in not “getting better”?) Instead, at the same time that we encouraged clients to maintain critical evaluation of their experience, we relied on knowing each others work in an on-going way in great detail. If a collective member’s work was questionable, it was questioned, immediately and constructively, not to punish but to help.

Better protection and better learning derive from more openness, in an environment where everyone involved is committed to respectful treatment of each other and of all clients. Similarly, group members promise not to talk lightly about each other’s work. But we also acknowledge that there is a lot of learning that goes on in the course of ones peers’ work, and to prohibit discussion of that learning with intimates outside the group would be counter-productive. If someone wants a particularly stringent vow of confidentiality about a particular story, that is honored. But in general we counsel people to use information responsibly and to protect their fellow members from judgment (the Pig lives in the wider community, although these issues tend to broaden the challenge to its dominance). Moreover, group work sometimes leads to the weaving of networks of interaction. People refer their friends and family members. People make new friends, and sometimes family members. These interconnections are positive, but they also require care and cooperation, and we teach and support adequate agreements about how to handle information.

If the object of the exercise is to heal illness, then one doctor/one patient makes sense. But if the objective is to change conditions of isolation and internalized judgment, to heal social injuries to the souls of healthy human beings by building positive relationships in ever-widening circles, then a very different structure is called for.

But What About….?

What of mental illness, then? Do we seriously suppose there is no such thing? In our heyday, we provocatively declared just that. Along with R.D. Laing and Wilhelm Reich, we saw those phenomena generally labeled mental illness as an outgrowth of familial and social dynamics. We resisted the new genetic explanations for just-about-everything.

Today, after thirty years of practice, I would qualify that stance, in this specific way: I do believe there exist conditions that lie beyond the reach of cognition. I can’t say I’m convinced by any of the explanations for those conditions. Western thought strongly inclines toward separating mind and body, and then recombining them in one-directional, mechanical ways. First science says it’s all in the mind, then it’s all in the genes. I believe that emotional life has the power to alter the material body. We secrete chemicals when upset (Taylor, Klein, Lewis, Gurung, & Updegraff, 2000). Our emotional lives influence how we eat, sleep, exercise, interact with others, all of which involve biochemical processes. Indeed, there is no thought or emotion that is not composed of chemical interaction. So the mind-body connection is multi-directional: mind reacts to chemistry, chemistry to mind, and both are housed in a mechanical body that tenses and relaxes, grows habits of rigidity and learns new forms of flexibility, provides pleasure and pain, throughout life.

Mental illness, then, is something I believe to affect a very, very small number of people. We don’t really know how many, in part because the designation so easily becomes the metaphor for describing – and the program for treating – a vast array of normal human phenomena. Pathologies as widespread as depression and anxiety, for instance, are far better understood in terms of their social functions, and as symptoms of widespread social dysfunction.

Another place we run afoul of conventional wisdom is in our approach to treating substance abuse. First, we do not accept at face value the easy application of the common labels of addict and alcoholic. We ask people to recount the problems associated with their substance use. Do they suffer physical damage? Are their relationships with other people negatively affected? Is their use of the substance out of their control? Having decided to have two drinks, for instance, do they find themselves downing the fifth? These are the most prevalent problems people encounter, and they are reasons to change things.

Commonly, we ask people to stop using for a year, during which time they work in group on whatever problems interfere with their ability to make a clear and controlled choice about how they want to relate to substances. At the end of a year of sobriety, most people can form a healthy relationship to at least some types of substances. Some people may choose abstinence, realizing that the work involved in maintaining a problem-free way of drinking or smoking involves a use of energies they’d rather invest elsewhere. The act of choosing, however, counters stigmatized identities adhering to those who see themselves as suffering a disease or an addictive personality.

There are exceptions, of course. Some drugs are sufficiently addictive on a chemical level that their use is hard to justify. Others, like alcohol or marijuana, can be habit-forming on a psychological level even if not usually on a biochemical one. There are, however, a very small number of people who do seem to have something akin to an allergic reaction to alcohol. A sip of something alcoholic triggers profound alterations, in body odor, behavior, emotion, and in an ability to drink in moderation. Total abstinence is a wise choice for these folks. But their experience is not widely generalizable.

The Current State of the Art

After its promising beginnings, Radical Psychiatry ran into all the familiar troubles. At first, there were a dozen collectives meeting together, offering 24-hour drop-in groups free to anyone who needed them, acquiring a building in Berkeley, running strong. Soon, however, theoretical controversies developed. Was it possible to heal souls without first changing the social system? Were we reproducing a hierarchy in our own midst? Who got to decide how the Radical Psychiatry Center should be used? Eventually, splits happened and within a few years the group reduced to a handful of people.

That handful, however, continued meeting for two decades, developing the work, teaching, publishing a quarterly journal (first called Issues in Radical Therapy, and later Issues in Cooperation and Power), holding an annual four-day event that was half teaching institute, half eclectic conference – and more than half celebration of a growing, national network. All of these activities served to construct an institutional presence for the Bay Area Radical Psychiatry collective (affectionately known as BARP). As newcomers came into the picture and learned the work, they brought new energy and ideas. But some also expressed resentment that we held too much power. We thought they were right, experiencing the other side of their criticism in the form of our own fatigue and overblown sense of responsibility. So we gave away the journal to a group in Colorado and the Institute to a group in San Francisco. We disbanded our institutional form and dubbed ourselves an informal support network, renamed GOOF (for Group of Old Friends). Despite our facetiousness, we were serious in wanting to experiment with avoiding the calcification of power that accrues when organizations exist over a long time. If the theory and practice we promoted had value, we imagined, it would survive. If it failed, well then perhaps that was right, too.

After many years during which we supported and fought with each other, worked through differences in power and bumped up against differences of opinion, we finally disbanded the collective in 1990 (although the collective had resumed more formal shape for a few years before then.) The times had changed; living and working in alternative ways had become harder to sustain. Many of us had taken jobs in agencies, and we were hard-pressed for time, not to mention the patience it takes to work consensually. We decided to give it up, each of us taking our form of the work into whatever new and continuing endeavors we embraced.

Today, a handful of people lead formal Radical Psychiatry groups, but many more incorporate principles of the work into a wide variety of practices. Conflict resolution approaches have been widely influenced by our model of mediation. Radical Psychiatry concepts have made their way into diverse realms, from union organizing to pedagogy, from “diversity work” to arts organizations, and much more.

We still sometimes train people in both group work and, in my case more consistently, in conflict resolution. Students have taken the work in many different directions – starting practices in small towns, integrating it into bodywork modalities, using it in political organizing, and more. Claude Steiner continues to write and teach skills of emotional literacy. My work as a scholar and writer is deeply informed by my experiences in Radical Psychiatry.

Years ago, a conference was convened in the mid-west on the subject of combining therapy and politics. I remember a woman who stood up toward the end and said, “I’ve been struggling alone in my work for years and I never knew until now that there were others doing the same. I have a name for what I do now: Radical Therapist.” She was working very much in isolation, in an African-American community in a southern state. What was inspiring about what she said was the realization that good ideas arise in different places when the time is right, in varied forms, but speaking to the same need and vision.

Today, I believe the time is again right. I see whole new movements of people delving into the connections between social justice and psychotherapy. How encouraging that is, not only for the state of a profession, but for the state of the world. If we truly join the political and the personal, as the women’s movement proposed, if we work to liberate the human heart from its burden of alienation, then we cannot continue to countenance oppression of any people, anywhere. And that is very good news, indeed.



Belenky, M. F., Clinchy, B. M., Goldberger, N. R., & Tarule, J. M. (1986). Women’s ways of knowing. New York: Basic Books.

Birkhoff, J. (2000). Mediators’ perspectives on power: a window into a profession? Fairfax, VA: unpublished dissertation, George Mason University.

Chesler, P. (1989). Women and madness. New York: Harcourt, Brace, Jovanovich.

Fanon, F. (1963). The wretched of the earth. New York: Grove Press.

Gardner, H. (1983). Frames of mind: the theory of multiple intelligences. New York: Basic Books.

Gramsci, A. (1979). Selections from the prison notebooks. New York: International Publishers.

Rabenold, D. (1988). Love and rescue in lesbian relationships. In Radical Psychiatry: the second decade. San Francisco: Bay Area Radical Therapy Collective.

Roy, B. (2002). For white people, on how to listen when race is the subject. In The journal of intergroup relations, XXIX, 3, 3-15.

Roy, B., and Steiner, C. (Eds.). (1988).Radical Psychiatry: the second decade. San Francisco: Bay Area Radical Therapy Collective.

Scheff, T. Microsociology (1990) (University of Chicago Press, Chicago,

Steiner, C. (1969) A warm fuzzy tale. http://www.emotional-literacy.com/fuzzy.htm

Steiner, C. (Ed.). (1975). Readings in Radical Psychiatry. New York: Grove Press.

Steiner, C. (1981). The other side of power. New York: Grove Press.

Steiner, C. (2001). Achieving emotional literacy. New York: Trafalgar Square.

Taylor, S. E., Klein, L.C., Lewis, B. P., Gruenewald, T. L., Gurung, R. A. R., & Updegraff, J. A. (2000). Female responses to stress: tend and befriend, not fight or flight. In Psychological review, 107(3), 41-429.

Wyckoff, H. (1976). Love, therapy, and politics. New York: Grove Press.

Wyckoff, H. (1977). Solving women’s problems. New York: Grove Press.


* Published in Advancing Social Justice Through Clinical Practice, ed. by Etiony Aldarondo (Lawrence Erlbaum Associates, 2007)

[1] Other nomenclature I’ve heard people use is The Critic, The Demon, the Voice of Internalized Oppression. Roberto Vargas, a colleague who created approaches to therapy and to organizational development suited to Chicano communities, uses the term “El No”, a phrase I like a lot. Navajos use a concept called “nayee”, which refers to anything that stands in the way of a good life.

[2] As times change, paradoxically, that rigidity also induces fractures; today’s heterosexual relationships often embody enormous tensions between new ideals of equality, emotional intimacy, friendship, and sexuality on the one hand, and the actual capacities men and women bring with them to fulfill those expectations. The structure of relationship has failed to change as rapidly as the ideals, with the end result of disappointment, anger, and, eventually, grief.

[3] Much of the jargon of Radical Psychiatry is taken from commercial dealings, a peculiar contradiction with the value basis of the work. Some of that usage reflects the historic influence of Transactional Analysis. I look forward to a future project to reform the descriptive vocabulary.

[4] a term coined by Claude Steiner (1969).

[5] I’ve elaborated this aspect of the work in “For White People, on How to Listen When Race is the Subject” (Roy, 2002).