Andrew Hartz is a practicing clinical psychologist and the founder of the Open Therapy Institute. Andrew and Inez discuss how woke ideology is encouraging therapists to violate their professional obligations to patients and making them unable to work with the majority of Americans. Andrew also parries some of Inez’s objections to therapy as a concept, and the two discuss what negative psychological tendencies are encouraged by the culture.
TRANSCRIPT
Inez Stepman:
Welcome to High Noon where we talk about controversial subjects with interesting people. And my guest this week is Andrew Hartz. Andrew is a practicing clinical psychologist and the founder of the Open Therapy Institute, which we’ll discuss. He was formerly a professor in the clinical psychology doctoral program at Long Island University. And the way that I found out about him other than secret parties in New York, is that he has published articles with outlets like the Wall Street Journal and the Federalist detailing some of his worries about the influence of woke ideology on his profession. I thought it’d be really interesting to talk to him about that and some other objections I’m sure longtime listeners have heard from me about his profession as a whole. So he’s so agreeable. He has agreed to come on and hear those objections. So welcome Andrew to High Noon.
Andrew Hartz:
Thanks for having me.
Inez Stepman:
So I want to start out just with how you got concerned about ideological influence as a professional. Was there a particular episode or moment where you realized this isn’t just people’s political perspective or something that is outside of the profession but might actually impact their work as professionals?
Andrew Hartz:
Yeah. I mean, I started my PhD program I think in 2013. And at that time, virtually there was very little politics in clinical psychology, and I think it wasn’t that long ago, but there was pretty much a consensus that a therapist inserting politics into a therapy session was bad care, unethical. I think that was a pretty broad consensus. And that started to change in 2014 and 2015, and then faster change in 2016 and 2017, and then it just kept escalating. And I think it got to the point where the culture in the field of being open and talking about wide range of feelings and wide range of thoughts, things started to feel more stifled. People started to seem like they’re walking on eggshells. The whole tone of the field changed, and politics went from being something that rarely came up to weekly trainings on social justice topics that were often very aggressively delivered. Dialogue was not open. Agreement was essentially demanded. They were often full of hostility. It was just a dramatic change over the time I started my program to the time I ended it.
Inez Stepman:
You think you’ve written a lot about this concept or spoken about this concept of splitting, which apparently, I would have no idea other than listening to you, but that is a key concept in a wide variety of both interpreting different pathologies in psychology and then different psychological approaches within therapy, different clinical approaches. Can you maybe lay out your argument about that and how you see that conflict coming into the actual practice of clinical psychology as opposed to… I could see it being sort of theoretical if you’re talking about societies, but then when you have somebody in a room and it’s just you and them, like they express a certain thought. If you’re a therapist observes you as a bad person, I feel like you… really, then, feel like you must be a terrible person at your core.
Andrew Hartz:
Or you just give up on therapy and… Splitting is probably the most important concept in clinical psychology that people don’t know about. It’s almost a hundred years old. It pervades the field. It’s a dominant concept from psychiatric inpatient units to private practice psychotherapy. It’s central to dialectical behavioral therapy, which is one of the most common therapies. It’s central to psychoanalysis. It enforces couples therapy and families therapy and the treatment of addictions. It’s everywhere. It is a central, central idea to numerous evidence-based therapies.
So a lot of people have never heard of it who aren’t in the mental health field, but it’s an incredibly powerful idea. And essentially it says thinking in all or nothing terms about things comes easily to people, and tolerating a mix of pros and cons and mixed feelings about people is hard and it’s uncomfortable. And so this applies to how people feel about themselves, how they feel about other people in their lives, how they feel about groups of people, how they feel about issues. So there’s a kind of magnetism almost that pulls people to want to view people in all or nothing terms. And so an example of this might be with depression.
A lot of people that are depressed think that everything about themselves is bad, everything about their future is bad, everything about the world is bad, and it’s all hopeless and nothing’s good. And if you talk to somebody who’s depressed and you try to say, “Hey, but there’s some bright spots. You have some strength,” something like that. Often they hate it. It feels invalidating and threatening and uncomfortable, and they almost resist it. So that’s kind of counterintuitive because you’d think people would want to feel positive things about themselves as opposed to negative things, but it’s actually, in the short term, easier in a psychological sense to be depressed and view everything as bad than to tolerate that there’s a mix of good and bad in your life and in the world. So splitting is this sense of framing everything in all or nothing terms related to an issue or relationship for yourself. And it comes out in all kinds of different ways, and it ends up being a really central part of a lot of psychotherapies.
Inez Stepman:
Immediately, I have a nonpolitical question, which is, how do you maintain a sense of moral clarity without splitting?
Andrew Hartz:
Give me an example.
Inez Stepman:
I would think it would be very difficult to maintain, not impossible but difficult to maintain, for example, the need for retributive justice if you are incapable of sort of splitting people as wholly bad. And I know that… I guess I’m relating it to the problem of evil. And I also think, by the way, that it’s of course a simplistic way to view anyone. I mean, one of the earliest moral lessons I can remember learning from my family is… Which, by the way, my family is half polish, half Jewish, suffered under both Nazis and communists. So in my family, the point is no sympathy in this direction.
But I just remember being a kid and going to some museum and doing… I was six or seven years old, and I was putting the thumbs down on one of Hitler’s speeches where all these people are very excited about this speech and I’m just simplistically saying like, “Boo, boo.” And my dad got mad at me and he was like, “All of those people thought it was great, and you have to understand that you could also be that person.” And even Hitler is not… You have to be able to understand why this is appealing to people or you’re not actually confronting the problem of evil in the world. But it does seem like what you’re talking about, splitting, is a natural human instinct to try to divide the world into things that are dangerous or evil and things that aren’t. Obviously it can be simplistic in doing that, but you don’t want people who are incapable. Not just along with their moral nuance, they become incapable, for example, punishing evil or fighting things that are bad because they’re too concerned about always considering the good pieces of that person or that action.
Andrew Hartz:
And people have to use their judgments. I mean, it’s not like, “Oh, sexually abusing children has some positive thing or something.” I mean, I don’t think there’s anything positive in that. And I think there’s lots of issues that you could think of where it’s like, “Yeah, murder isn’t good.” I don’t think we need to sit around and think about the benefits of murder or something. And there are other issues like that.
So some of it is judgment, some of it is how you frame it. If you’re saying, “Is the holocaust bad?” I think that’s a pretty easy, “Yes, it is.” But if you’re thinking about… You could frame complex moral issues in sorts of like, “Why did it happen and what were the complex social factors that contributed to it? Maybe there’s more to flush out there.” But in therapy, that’s almost never what’s at issue. It’s like this person who had a spade of bad life events thinks that they’re irredeemably bad, even though they’re a normal person. Or in narcissists, do the opposite and think that they can’t tolerate acknowledging weaknesses in themselves. And so I think most of what’s actually happening in therapy and a lot of the splitting that you see is not at all about those issues.
Inez Stepman:
Okay. How do you see that splitting tendency that I assume we all have… If you have certain pathologies, you might be more prone to it, but that seems to me like a pretty basic human instinct or construct in how we think. How is an excess of that or a bad version of that applied in our politics now? Or how do you see it?
Andrew Hartz:
I see it in two ways. I guess two main ways. The first is, I think that most institutions of American civil society have become political. They’ve been politicized. That includes mental health. I think it includes a lot of other areas of society, and they frame political issues in all or nothing terms. They only make comments in support of one side and against another and on a wide range of political issues. And I think that’s very dysregulating for everybody in society. If it’s a school or a university or a media outlet, it breeds lots of anger, lots of conflict, lots of mistrust because people know that most controversial issues involve risks and benefits and pros and cons and they affect different values differently. And so it’s very dysregulating when leadership at civil society organizations frame issue after issue in all or nothing terms. They only say good about one side and bad about the other.
In education in particular, I think that can lead… If you get through K-12, you get through college, you get through graduate school, and you’ve only heard arguments on one side of the spectrum and you’ve never heard the other side of the dialectic, you’ve never heard that or you’ve never been taught that as having any legitimacy. It’s not just that you have a really distorted view of what’s happening and these issues, but that you can become emotionally dysregulated where you can’t even tolerate having conversations about these issues that acknowledge pros and cons because it’s unbearable.
And so I think that can really pull all of society to have these conflict-ridden enactments where we’re not capable… There’s a difference between a conversation where I say, “I have really strong views on this. I think my side has lots of benefits. It’s got some costs, but it’s worth it. This is the better path.” And the other person says, “Well, I think mine has a lot more benefits than costs and I view mine.” That’s one type of conversation. Another one is, “Mine is all good, no bad. And you’re evil if you disagree with it.” And I think what we’ve seen in the public discourse is it going more towards that second model and away towards the first one. People are losing their capacity to have discussions that talk about strengths and weaknesses.
There’s another key where splitting manifests that I can go right into that now, which is a little bit different and I think maybe more radical. But I think people are more likely to split when issues get really emotionally charged because the intensity of the emotions is difficult and it’s hard to think clearly. And so people gravitate towards these simple all or nothing framings. And I think it happens especially with identity politics where they only say bad things about one group and they only say good things about another group, and they can’t tolerate anything that deviates from that.
And I think that this happens with men versus women sometimes, I think it happens with white versus people of color sometimes, I think it happens with LGBT versus heteronormative sometimes, where people only say good things about one group and they might really idealize that group in really grandiose terms. They never talk about a negative trait, trend or dynamic in that group. They can’t tolerate it. They think that’s unacceptable. The other group, they attack and criticize sometimes viciously; they’re oppressors, they’re privileged, they’re weak, ignorant, immoral, whatever, and they think that saying that those groups have any strengths is totally unacceptable. So I think that’s another really common form of splitting that has to do with identity politics and framing groups of people in all or nothing terms.
Inez Stepman:
What happens when even the… I assume you called your group the Open Therapy Institute because you want people who are coming in to a therapist to be able to say various strengths. For example, if they were in race or in sex-based differences or something, to be able to say, “I think white men do X really well.”
Andrew Hartz:
Right.
Inez Stepman:
And to have the ability to say something like that in therapy and not to be engaged immediately in a political struggle session. Or in more the course of life, just saying, for example, “This coworker did this thing.” I think the example you used at one point was somebody coming to therapy and has some resentment around the fact that his colleague had been promoted over him and suspects that affirmative action was at play because the colleague is Black and the person going to therapy is white.
I guess your objection here is that the therapists that are being turned out by the academy now are not able to even provide a space in which to talk about that with somebody, even if they disagree with it. And even if they push back by saying, “Are you sure that this is the issue, blah, blah, blah?” But you’re saying something more intense than that, which is that they’re immediately hostile and can’t hold in their head like a sympathetic feeling to their patient with this splitting idea of nobody could say or do these things without being ultimately evil, or what?
Andrew Hartz:
I think the splitting is interacting with mental health in complex ways, and we could try to flesh out what some of those are. My concerns around that are a little bit separate from why we wanted to found the Open Therapy Institute. I mean, yes. I don’t want to overstate the case, but there are really atrocious therapy practices that are spreading where people are saying, “Hey, if the patient says something that you think is racist, you got to confront that and make the therapy about that. You have to insert race into every session. You have to insert gender ideology into every session. If you’re a couple’s therapist, you have to treat through a feminist lens.” There’s stuff like that that is happening. And I think a lot of people are having bad experiences and there are a lot of therapists who are like, “I’m not going to work with a Republican. I would never treat a Trump voter,” or things like that.
So there are bad practices, but my bigger concern with the field is that there’s so much bias in the education system and in the mental health field in particular that even therapists who are like, “Oh, I would never attack my patient for their view,” that doesn’t mean that they’re clinically competent or skilled to work with patients who have diverse viewpoints that they understand. For example, what the experience of self-censorship is like, or what the experience of being ostracized or punished for your views is like, or what types of masculinity issues men might struggle with, or what a victim of anti-white hate might experience, or what somebody who has orthodox religious views might encounter in a variety of places in their life. I think they might, in a lot of those places, just have lots of blind spots or be uncomfortable or not want to be supportive or avoid it or be mis-attuned.
So I think the bigger concern is that there’s huge chunks of the country, lots of different populations of people that would come into therapy where they don’t know where to find a clinically competent therapist who could understand them and work with their issue. And there’s really nowhere for them to look. There aren’t lots of clinics that are specializing in these issues. There’s really nowhere for them to go. So we wanted there to be a place for people with those issues to be able to find an attuned therapist, and we wanted to start to offer trainings for therapists to deal with those issues.
Inez Stepman:
So it’s kind of like a therapy for the canceled in a sense?
Andrew Hartz:
But if you think about it another way, I mean, a large majority of the country has at least one unorthodox opinion. Most people have at least one thing where they don’t agree 100% with the stated orthodoxy. And so therapists need to have some fluency with what those experiences are, and if they’re uncomfortable or hostile or avoidant or oblivious, they’re not going to be able to provide effective therapy to those people.
Inez Stepman:
Yeah, I guess I think of this as kind of similar to what’s happening in the legal field. But there, there’s just this hard check because there’s nine people in black robes at the end of the day, and I’m very curious what will happen because the law schools aren’t producing. Forget for a moment about all of the other consequences of having this cultural revolution within the legal profession. They’re not producing people who can competently argue in front of an originalist court because they simply have no familiarity, it’s a blind spot in their legal training. Kind of like what you’re saying, they have no familiarity with even how to swim in those waters. So in a sense, it’s kind of shooting yourself in the foot because the majority of the court now is either textualist or originalist. You need to be able to make those arguments if you want to win your cases. But in this case, there’s not really that backstop of people with power. A lot of the people that you’re talking about don’t have that kind of, forget about legal, even the kind of cultural power to be a backstop.
So what do you think is actually happening to folks who might have an issue and want to go talk to a therapist? Are they just leaving therapy altogether or are they simply having a sort of gap therapy where you just try to completely excise a large part of your life and focus on something else? What do you think is happening with those folks? I think about, for example, the parents of detransitioners. There’s so many of those stories where they couldn’t find a therapist who wouldn’t affirm, and obviously these are young, often women, with… They have a host of issues and they’re having a tough time in their teenage years for a variety of reasons, and they’re just not able to find somebody who is not going to affirm even in various religious networks or whatever. It’s just so much part of the best practices now that there’s no space for that.
Andrew Hartz:
Well, the APA actually says that for kids who are questioning their gender identity, you should have therapy to discuss it. That’s actually the official standard. But there’s also a lot of fear in the field that is saying that… I think a lot of therapists are worried that if they push back or challenge or really do a tough exploration with a kid, that they’re going to get accused of being transphobic or they’re going to get sued or they’re going to get attacked. And it’s hard to know, and there’s plenty of clinics that are just doing rubber stamp stuff.
But to your earlier question, I do think a lot of people with unorthodox views have given up on the field. They don’t like it, they don’t trust them, they don’t think they’re going to find somebody who respects their worldview or their values or could really be helpful to them in that. And I think there’s a lot of people who self-censor in therapy, and they go in and they’re like, “Well, I’m just not going to talk about that part of my life.” What they’re missing is that having an important part of your life that you’re just self-censoring through your therapy actually can be pretty disruptive to the process and to getting the type of change that people want out of it. And some people will just take a stab in the dark, and if you see enough repeat therapists, maybe you’ll get one who you can work with. But it’s like there’s no listing, it’s hard to find. In a lot of places, it’s like there’s virtually no one who is listed who advertises themselves as skilled with any of those issues.
Inez Stepman:
Is part of your ultimate goal then to provide a kind of directory or certification or something that can indicate to people… I feel funny saying this, but this is a safe space, right-
Andrew Hartz:
Yeah.
Inez Stepman:
… for people who are not marked at least completely in lockstep with the sort of cultural left-wing views of the therapy profession at large, at least on average?
Andrew Hartz:
It’s about openness. It’s about being open to people who have a wide range of views. It’s not like you have to be conservative on every issue. I don’t think that would be good therapy either. I mean, in therapy people have to have the ability to explore irrational and contradictory thoughts and feelings in a kind of unfiltered way. I think the process really depends on that. And so that’s what we want, just people who are open and committed to being open and signaling openness wherever that is.
Yeah, I mean, I do think that we’re definitely talking about doing a certification. I would love to have a certificate that we offer to therapists who could signal that they’re invested in being open. I don’t know about an online directory. I think the bigger issue is developing those trainings to therapists. And on a lot of these issues that we’re talking about, the clinical literature is thin to nothing. I mean, where you’re thinking… One of the people involved in the institute has written about men who have been falsely accused of sexual misconduct. That’s an experience that a lot of people have. But where’s the literature on it? Where’s the specialists on it? Where are the papers on it? What do we need to know about working with that population? And I think a lot of these issues are going to continue to be overlooked by most of academia. So hopefully we can start to develop a literature, start to develop trainings, develop a certificate, and get more and more skilled therapists to work with these populations out there.
Inez Stepman:
Yeah. I was talking to somebody whose son went through that and she ended up founding a group, and then the percentage of falsely accused men just in that sort of whatever group to share experiences who had attempted suicide. And many of them, because they’re men, actually succeeded in their attempts. Isn’t that true that women attempt it more often, but men follow through more often?
Andrew Hartz:
Yeah.
Inez Stepman:
So unfortunately, there was a high number of suicides even in that small group. And then the number of attempted suicides, it was high. So it really did seem like a population that desperately needed some way to process it, what had happened to them, because in a lot of cases, it did destroy their lives. I mean, even if they won in court, it just completely derailed them and their lives.
Andrew Hartz:
And you look online and you find a therapist who looks skilled and you don’t know that they’re coming from the feminist orientation and they have a me too perspective on things, and that can manifest later in the treatment. And even just understanding with that population, I don’t know hard literature on it, but I would guess that men in that experience have a high percentage of sexual dysfunctions or deep distrust of relationships, in addition to stigma, isolation. I think that there’s just a lot of different issues there that are worth understanding better so that therapists can do better work with them. And that’s just one among really dozens of groups that are basically entirely overlooked by the field.
Inez Stepman:
Yeah, it’s interesting to me that you’re almost using a lot of the leftist framework almost to talk about we have these underserved populations who don’t have the same access or level of comfort with this service. So now I can get into some of my objections to the entire thing and you can parry them and tell me.
Andrew Hartz:
Okay, I’ll try my best.
Inez Stepman:
I’ve always been unconvinced from watching from the outside. I’ve never done therapy but have had lots of friends who did it. I have never quite been convinced that spending a lot of mental energy thinking about your emotions or even your impulses or motivations is actually a happiness producing activity. I mean, I could see it being helpful in sort of a limited way if you really don’t understand where your motivations are coming from, but it seems like spending too much time thinking about it actually produces the opposite effect in a lot of people where they end up just endlessly obsessing over characteristics of theirs or why they did this thing or that thing, and it paralyzes them or it makes them unhappy and it doesn’t seem like it moves forward. So I guess one cheer for repression would be, how do you answer the… Is it always bad to just repress and move forward with your life?
Andrew Hartz:
No, there’s a lot of literature and clinical psychology about the high costs of rumination and excessive rumination, and I absolutely agree that excessive rumination is not health producing. There are people who get problems from totally avoiding issues, too, that they need to deal with. So I’d say there’s a spectrum, but definitely totally avoiding problems and excessively ruminating I think can both get people stuck.
Inez Stepman:
So on that kind of balance, there’s this perception that the generations over time have become more psychologically fragile. And the answer usually back is, well, past generations were repressing a lot of us and it came out in different ways, and so now we don’t repress it anymore and therefore we’re better off. The sort of stereotypical example is, “Grandpa doesn’t talk about the war.” And so is it your perception that we are getting more fragile over time, as in somebody born in 2000 is on average more mentally fragile than somebody who was born in 1980 or 1960 or 1920?
Andrew Hartz:
Are people becoming more fragile? Yeah, I don’t know of good… This is the place where I don’t know of good empirical literature on it, and there probably is stuff. But that fits with my perception that younger people, especially right now, seem to be more fragile than past generations. Yes.
Inez Stepman:
I mean, do you have any speculation as to why that is? If we are going to therapy more than we would have in the past on a whole… And I’m not even making the argument that these are cause out that are causal mechanisms. Maybe it goes the other way, like we’re going to therapy more because we are unable to handle things and feel overwhelmed by life more. But why do you think that that might be? And I understand that you’re speculating, and I’m not going to hold you to a literature review of why you think that is, but why is it that, for example, somebody born in the year 2000 seems much more often unable to deal with the basic bumps and sideways elements of life? From the small, dealing with being overwhelmed at work, to the large like… I’m thinking here and now of my own generation in the middle of millennials.
We obviously don’t confront death in the same common part of life way that people in 1820 do simply because… I mean, fortunately for all of us, medical advancements have made it so that we just…. The person who confronts death from age five on the regular becomes the unlucky one rather than the norm of the human experience. The difference between, for example, somebody born in 1985 and somebody born in 2000… Medical science hasn’t changed that much in 15 years in terms of infant mortality or anything else. So the bigger conditions of life seem, at least in some important ways, equal, and yet there does seem to be this observable gap where people younger are seem unable to deal with any of the bruises of life.
Andrew Hartz:
Well, you said something at the beginning of this that I might want go back to, which was, you were saying that maybe you haven’t seen a lot of evidence among your friends that therapy is making people happier. And I’ll just say, this is my own personal view, just speaking as an individual. I don’t really see the goal of psychotherapy as to make people happy. And you might actually, of all the schools of therapy, the one that you might be more interested in is called ACT or ACT Therapy. Have you ever heard of this?
Inez Stepman:
No.
Andrew Hartz:
It stands for acceptance and commitment therapy, and it’s actually pretty similar to a lot of Freud’s ideas about emotions. And this is it in a nutshell. The human nervous system is built to feel all of the emotions: pleasure, pain, joy, sorrow, pride, shame, happy, sad, anxiety, anger, desire, fatigue, stress. Those are all built in to our neurobiology. So they’re going to come and go throughout our life. And people get stuck, I think, and get developmental illness a lot of times when they don’t let things come when they need to come and let them go when they need to go. And rumination might be a way that someone gets really stuck on a feeling and not able to kind of let it go, but it’s time to let it go. But what happens a lot of times is people pick all those little emotions that they don’t want to feel. They don’t want to feel anger, they don’t want to feel anxiety, they don’t want to feel stress or fatigue or sadness, and so they pathologize it as, “I need therapy to take away that range of the emotional spectrum for me.”
And I don’t think the goal of therapy is to take that away and make people feel happiness all the time or something like that. It’s more about restoring balance and having the capacity to feel the range of human feelings and let them go. And most of the time, little things shouldn’t cause huge emotional disruptions. Big things will. You get divorced, you have this traumatic loss, or there are things that do hurt you can expect an emotional reaction to. And then there’s a lot of things that… You got cut off in traffic or something, and it shouldn’t derail most people most of the time. So I think of therapy for the most part along those lines. It’s not a pathway to enlightenment, and it’s not a pathway to feeling happiness all the time, it’s just kind of restoring balance for people who are thrown off one way or another.
Inez Stepman:
I think maybe I was inaccurate when I was… Not even inaccurate, just flippant about the happiness thing. In fact, one of my larger objections, and I think you’re addressing this to some extent is that I think the therapeutic concept or culture sometimes pathologizes human suffering in a way that I think is a little bit dystopian even to imagine. And it causes people, I think, sometimes to talk to each other even in a way that is holding at distance, actual connection with other human beings. So the best example… Or even can be manipulative. This is more of an example of the latter, but I don’t know if you saw the Jonah Hill text that blew up and stuff. I don’t know if you saw that.
Andrew Hartz:
A little bit.
Inez Stepman:
I don’t know if it was below your line, but his ex-girlfriend released text messages and she called it emotional abuse. And it was obviously, in my view, not abusive, but it was the opposite. It was sort of manipulative and sideways in using all this language about setting boundaries and very therapeutic language of how to basically say, well… But I can’t imagine someone in the heat of a moment arguing with their significant other, arguing with a girlfriend or a boyfriend or a husband or a wife, and speaking in this detached, regulated way. It seems a little inhuman to me and actually a barrier to connection. Sometimes people need to yell at each other, sometimes they need to… You know what I mean?
Andrew Hartz:
Yeah.
Inez Stepman:
They need to directly communicate. Even if that’s hurtful or painful or whatever, they need to directly communicate. And in those moments, sometimes people say things that they regret, they don’t believe. That’s obviously true, but even that itself is part of… I don’t know, how much of the human experience are we now pathologizing if people yelling at each other or suffering a great loss or all of these things are things to be sort of regulated and correctly processed. And I mean, is there a correct way to process the understanding that you’re going to die one day? Is there a healthy way to process that or should you rage against it? These don’t seem to me to have obvious normative answers, even in terms of what you’re aiming for.
Andrew Hartz:
I hear you. Is there a question?
Inez Stepman:
These are just my objections.
Andrew Hartz:
No, no, no. I want to respond, but what should I respond to?
Inez Stepman:
So okay, let’s go with the first idea about pathologizing certain intense human emotions, whether it’s suffering or anger. Obviously, and I’m acknowledging there are people who have issues. Some small percentage of people are unable to deal at all with anger or suffering in a way. If you’re unable to function in life because you’re so angry at small things, obviously that’s a type of pathological behavior. And I’m using pathological as a sort of neutral word, meaning being in a slice of human behavior that’s in the minority and a small minority and has specific characteristics that have specific negative outcomes. But often the way that people talk about what they learned in therapy, it’s how to process what I see as inevitable suffering in life, for example. It seems almost philosophical, like they’re replacing having an answer either from a philosophical perspective or a theological perspective with, “Well, this is how I regulate my emotions about it.”
Andrew Hartz:
Well, yeah. So in the DSM, which is the list of psychiatric diagnoses that we use, most disorders are characterized by impairment in functioning or extremely high levels of distress. They’re both pretty subjective, those are pretty vague, but it’s kind of like if it causes a lot of distress, it might be a mental disorder. If it causes a serious impairment in function, it might be a mental disorder. That’s tends to be how they’re categorized. This is the system that we have in place for how people get help around these issues. And I do think people have tried to get help around these types of issues for thousands of years. They might’ve gone to the ashram or they climbed the mountain to see the guru or a monk or a priest or whatever, or just somebody. I think there’s always been a desire for help around the types of things that people suffer with.
The question for me is… This is the system we have now. And I was actually thinking about a job before I settled on becoming a therapist. I was like, “Well, maybe I should have a religious job,” and I talked to a bunch of different people. One of them was a rabbi, and he said, “If somebody comes to me and they’re depressed or they have panic attacks or something, I send them to a therapist. I do weddings and funerals and bar mitzvahs, and if somebody wants help with those things, I send them to a therapist.” I was like, “Well, I actually wanted to help people with that stuff, and that was part of why I went into this field as opposed to the other one.”
But the question is, is it helpful? Let’s go back to… I’m using the depression example a lot, but somebody’s depressed and they’re saying, “Well, what’s the point? Sure. I don’t like my life right now. I’m sad a lot of times. I don’t have a lot of energy. Why do I need to go to somebody and spill my guts and tell them I’m sad, and then they’re just going to stare at me and then tell me to come back the next week and do the same thing? What a waste.” But you often don’t know where it’s going to go, and sometimes…
I hear what you’re saying about just excessive nasal gazing and ruminating on how bad everything is and just spinning your wheels and feeling worse and worse and worse. I hear you. But sometimes you unpack it and you’re like, “Oh, I’m depressed in part because I’m not even aware of how self-critical I am, and I’m attacking myself in all of these ways that I don’t even believe, just reflexively. I’m saying I’m stupid. I fucked up. People don’t like me. Nobody’s going to want to date me,” or whatever it is that they’re saying. “And I don’t even believe that stuff, but I’m tormenting myself with it. Now that I’m aware of that process, I don’t have to buy into it as much.”
Maybe that doesn’t cure the depression entirely, but it’s an insight that could help. And there are lots of little things like that that can help a little bit. And it doesn’t mean you’re never going to feel sad, it doesn’t mean you’re never going to be self-critical, it’s not a solution to everything, and it’s not necessary for everybody in society to go through this. But for a lot of people who are depressed, things like that can make things a little bit easier. And does that mean it’s a disease and it’s medical, or are there better social structure… I mean, I don’t know, but I think it can be helpful.
Inez Stepman:
So to the extent, I agree with what you’re saying. It’s remarkable to me the story about the split between the rabbi, what the rabbi does, what you do. To me, the purpose of religion such that it is to provide answers to those questions. Now they may not be satisfying to everyone. They have never been satisfying to me, but it seems like a lot of this is coming from… So I guess what I’m asking you, is the relationship between your metaphysical commitments, let’s call it… The modern term would be worldview. Your normative metaphysical commitments and the kind of anguish that you might feel on the backend. And we know this is true at least in some cases because even on the superficial political level that we were talking about before, we know that left-leaning young women self-report the most. And there might be a little problem there too, but self-report the most mental illness, whereas older conservative men report the least of it in some of those surveys.
So in other words, ours at least some percentage. Obviously, schizophrenia is not downstream of worldview, at least to some extent. I mean, I guess you could put Nietzsche in the middle. But even something like that, I mean, you could stipulate that Nietzsche went insane and Dostoevsky did not, because they took different answers. They answered the same questions differently, and one set of answers allowed someone to live a sane life. Not a happy one, but a sane one, and the other set of answers didn’t. It was just not compatible with living in a sane way. But let’s stipulate that the sum percentage of easily identifiable mental illness is genetic, is physiological. But it seems like another big chunk of it to me seems actually quite connected to normative worldview commitments that that person has about what exists, who am I? Is there a God? Is there a good? And those questions seem to me not the best answered. How is therapy going to answer those questions for somebody?
Andrew Hartz:
Like about is there a God?
Inez Stepman:
I feel like that’s part of… Some of these questions, like you even said it, why am I depressed? Why am I self-critical? Well, I don’t know about that particular example actually, I don’t have a connection to that one. But what if somebody is depressed because they feel that their life is meaningless? Well, that’s a question that requires all kinds of antecedents and commitments in different directions. One answer to why is life not meaningless might be like, “Because God made you, and every creature God makes has a purpose.” Another answer might be a nihilistic answer that says, “Actually, yeah, you’re correct. It’s not a pathology. You are correctly interpreting the world around you. Yes, you are meaningless and you’re going to have to either find or not a reason to persist after that.” But all of these questions seem to me to be philosophical. I don’t understand how a medical construct can actually answer those kinds of questions. But maybe those are not the questions that people come to therapy with, I don’t know, but that’s what I would think that these are the things that make people depressed, anxious, whatever.
Andrew Hartz:
I love talking about those questions with patients. They don’t happen so often. They come up sometimes, but when I talk to them about it, I’m not answering those questions for them. I’m not telling them, “Yes, there is a God and that’s why you have a meaningful life and I’ll see you next week.” I would never do that. But you also don’t know… Often with some of these questions, there’s an emotional side angle to it that maybe is helpful to explore, maybe it’s not. But their feelings about death have to do with ultimate loneliness in the universe, for example. Let’s say this is something that they’re thinking about death, we’re all fundamentally alone. And then you find out that they were adopted, and they have this feeling that they’ve carried with them of being abandoned. There might be a connection between those two things. But my job isn’t to answer any of that, but I can facilitate a dialogue about it. And sometimes those philosophical answers really do cut deep to emotional stuff that’s really salient. Yeah.
Inez Stepman:
So I’m going to ask you a question. One of the most obvious connections that people have made… And I think in the 70s, people like Tom Wolfe, writer, Christopher Lasch, and then now I think all in resurgence, Philip Rieff. What’s your definition of narcissism, and do you think that that’s the greatest psychological ill of our current age? Or do you think it’s something else or none of the above?
Andrew Hartz:
Okay. Really interesting question. I think if you ask a hundred therapists what narcissism is, you’ll get 200 answers. It’s not a well-defined construct. There is a narcissistic personality disorder in the DSM. You can look up what the criteria for it is. So it’s a hard thing to talk about because people use that term to refer to a wide constellation of things. I mean, some people will use it in as loose of a way as it’s just concerns related to selfhood. You want yourself to hang together and to have a reasonably functionally positive view of the self, to be able to function and to be coherent to an extent. And maybe that whole constellation of self-related functions are all narcissistic concerns in some sense or another. And for other people, it’s this pathological need to be grandiose and self-important at all times in ways that hurts other people. And those are just so far apart that it’s hard to talk about.
I don’t like pigeonholing people by their character trait and saying, “You’re a narcissist. You’re a depressive. You’re a histrionic. You’re this or that.” I don’t think about people in those terms. I want to know what’s the issue and what’s happening. Somebody who maybe you could say the therapy is focused on narcissism, but their issue is they have trouble tolerating that they make mistakes or have shortcomings, or they have trouble empathizing with other people, or they have trouble admitting when they’re wrong, or whatever it is. It could be a number… Or they have trouble sharing, you could think of all types of things. So then that’s the issue, and I don’t feel a strong need to label them a narcissist or not. I think as a therapist, once you kind of pigeonhole somebody that way, it kind of becomes hard to see them for the unique individual things that they’re struggling with, which is more important to me.
Inez Stepman:
Then let me rephrase. What characteristics that become problems for people do you think are the sort of ills of art, age? In other words… Because yes, everybody’s an individual, but we all interact in a society that has certain cultural influences on us, certain encouragement. So one obvious example I would say is, and this is not a psychological DSM sort of example. But I would say that, for example, women’s sometimes selfish behavior in relationships is very much lauded by society now in a way that wasn’t true 30 or 40 years ago. And correspondingly sort of stereotypically male selfishness, like banging your secretary are very much not tolerated. I’m not saying one is better than the other, but one is very much tolerated and put up in lights and sort of you-go-girl, and the other expression of a selfishness that is male is very much socially ostracized. What ills do you think are popular ones in the current cultural mix that we live in? Or what do you see as encouraged traits that maybe are causing difficulties for people that might land them in your office?
Andrew Hartz:
Yeah, okay. This is something I’ve been thinking about for a while, and I’ve talked about it some, but I’m concerned about people being too focused on the external and not enough aware of the internal. Both in the sense of constantly having external stimulation and not having time… like kids not having time for free play, kids not having time to daydream, unstructured play, fantasy, reflection, unstructured environments. And I think there is a component to it that I think is spiritual of having room for the internal and the subtle as opposed to a kind of focus on external stimulation.
And I think what you might be getting at and maybe this is what you’re thinking of as narcissism if… I think there’s a preoccupation with self-image, with the image and the way that you’re perceived by others, almost like an over-identification with the image that you’re presenting to others and how that’s perceived by others. And it’s almost like, that’s me, is the person in the photos on Instagram is me. And there’s almost like an alienation from the sense that who we are one might say is actually this ineffable perceiving, living, subjective being that changes and has contradictory desires and multiplicity and isn’t entirely coherent. And it’s like we’re maybe becoming alienated from that side of ourselves as we’re kind of becoming more over-identified with self-image and anxious about the self-image and anxious about how this is perceived by people. And I do think all of those are themes.
Inez Stepman:
Yeah, it’s interesting. Maybe that drives the constant… I could see that very quickly becoming tyrannical, both in the personal relations and in politics. On the personal level, I could see… If you have that desperate need to be defined by the way that people reflect back at you, who you are, you could demand that all your friends or your partner or whatever, needs to reflect that back to you, and you can become tyrannical in demanding it. But even more so on the societal level, if all this talk about erasure as though if somebody doesn’t agree that biological sex is mutable, for example, to give one example. You don’t exist. You don’t exist, because I always think that’s a very revealing phrase on the part of trans activists. It’s like trans people exist. “Well, I’m not denying that you exist. I’m denying that if you’re biologically a man that you’re a woman. That’s what I’m denying. I’m not denying that you exist and you have these feelings.”
The framing of it is, “You don’t think I exist,” which is a very strange and revealing way to put it. And I think that’s kind of what you’re getting at.
Andrew Hartz:
Yeah.
Inez Stepman:
Or related to that somehow.
Andrew Hartz:
Yes. Well, when we talk about identity, identity politics, or what is identity and what are the features of identity that mean the most, they’re usually the most superficial external things, these crude group categories. It’s actually very far from what we really are. And there’s almost this kind of… It’s a mis-identification really of like, “I’m the image, I am the image,” as opposed to which we’re not. The image is we’re actually something, we’re living beings that change and are distinct from that. But yeah, it does seem like there’s more of a preoccupation with that, at the same time, that there’s a losing of a connection to the… And I think people are looking for these identity categories and group categories to climb onto and to say, “I’m that thing over there.” It’s the other way around.
Inez Stepman:
And I’m going to have to think about that one for a while. But since I’ve taken up an hour of your time, I’m going to let you go. So if you want to interact more with Andrew’s work, you can check out the Open Therapy Institute and his pieces for the Federalist, for Wall Street Journal, for some other outlets as well. I don’t think you’re on Twitter, which is probably a healthy sign for a therapist.
Andrew Hartz:
I’m not.
Inez Stepman:
But thank you so much, Andrew Hartz for coming on High Noon and sharing this hour.
Andrew Hartz:
Thanks so much.
Inez Stepman:
And thank you to our listeners. High Noon with Inez Stepman is a production of the Independent Women’s Forum. As always, you can send comments and questions to [email protected]. Please help us out by hitting the subscribe button and leaving us a comment or review on Apple Podcast, Acast, Google Play, YouTube, or iwf.org. Be brave and we’ll see you next time on High Noon.
