Being both a patient and a therapist gifted me

Written By: Psychotherapist- Sara Mishly
Translated By: Farah Baghdadi
Being both a patient and a therapist gifted me with understanding and appreciating self-awareness in a holistic way. I have always believed that self-awareness liberates us from forces we are unaware of that lurk in our mind. It allows us to make authentic decisions, revives us with the full range of emotions, and allows us to connect with others with honesty and courage. There are few pleasures in this life that can compare to the pleasure of an “aha-moment”, even when it is painful sometimes. Lately, however, I have been troubled by new questions: do self-awareness and mental health have any benefits beyond helping patients and their families throughout their life journeys? Would there be an accumulated benefit to the whole society if we all become the best versions of ourselves? If yes, how would this eutopic world look like? And why aren’t we nearly there yet? If not, then isn’t it time for the people who are rarely seen in therapy at their own will, to finally be in therapy? Would that change the equation? When will dictators, politicians, corruptors, narcissists, abusers, and their like ever be patients? When did therapy become about helping us function in systems that our symptoms revolted against? In this article, I would like to expand on a controversial topic that has been gaining more attention lately: self-awareness and social responsibility.

Psychotherapist- Sara Mishly

To contextualize things a little bit, this article is written during the outbreak of the Covid-19 pandemic, the murder of George Floyd, and the Lebanese revolution against the political corruption and sectarianism. I know there are many other things happening in the world in addition to, and in between, those three, but they are the ones occupying my mind right now. Although those three catastrophes might seem irrelevant, if we look closely, we will find more similarities than differences. They are similar in revealing the social injustices, the power imbalance, the crime of silence against wrongdoing, and the irreversible destruction caused by greed and misused wealth and status. While it is not an easy time to live in, everything is challenging us to consider a “post pandemic era”, but what would it look like?
The reader can fairly question, how is any of the above relevant to mental health and self-awareness? I am a strong believer that we cannot understand the individual without understanding the societies surrounding them and the messages that were internalized as unquestioned facts. Similarly, we cannot “treat” societies without understanding and promoting the healing journey of the individuals who compose the society. Segregating social and clinical psychology carries the risk of over-pathologizing the individual, as though there is something about the person that is keeping them in their misery. This perspective gives no regard to social injustices and rigidity that make upward social mobility, with all its privileges, unattainable to many for no fault of their own. At the same time, excessive focus on social obstacles makes therapy impersonal, with the risk of reducing people to predetermined objects instead of understanding how they actually overcome those obstacles and thrive. Psychological insight and resilience is a hidden gem somewhere between those two. Since clinical psychologists are many times the only witnesses of the direct effects of social and political constructs on mental health, then they have inherently signed up to be social activists, otherwise, whose side are they on?
If we join the analytic eyes of social and clinical psychologists, then maybe we can start asking the right questions. Why did the efforts to bring down dictatorships sometimes yield, against all expectations and bloodshed, to the succession of worse dictatorships? What internal dynamics make some people find safety in electing power-hungry leaders? What object relations are activated when we think we are more important and entitled than others, or the opposite, unworthy of love, rights, or respect than others, preserving the eternal tension between freedom and oppression? What kind of people do we need to be in order to participate in full democracy?
I do not claim to have answers to my own questions. However, if I landed on one consistent realization, it is that mental health and self-awareness can no longer be treated as a privilege for the intellectuals or a reflective moment during summer vacations, but as a social responsibility. We owe it ourselves and to the world to delve into ourselves, know who we are, and make a decision about the kind of people we want to be on this Earth. It has been consistently established in the literature and across different theories that the way we think of and relate to ourselves plays a major role in the way we relate to others and to the world. At the same time, the way we relate to ourselves is shaped by our earliest interactions and direct environments, through which we develop as humans. Most of our adult emotions, thoughts, and decisions are influenced by unconscious knowledge, defense mechanisms, and a complex constellation of emotions. Yes, nothing is as simple as it seems. While we are not always directly aware of these forces, every campaign that identifies us as their target population is very much aware of them. For example, it is no longer a secret that election and political campaigns target our fear and anger and project them on a dissimilar other, highlight our differences rather than our similarities, and talk about “the other” in “groups” rather than individuals, only then to introduce the candidate as the rescuer in this fantasy, or wars and weapons as the only refuge. Marketing campaigns target our deepest insecurities, appealing to the layers of shame and inadequacies inside us, only then to promise to restore us through their products, to make us smarter through a triumph purchase during sales, and to grant us instant happiness with a faster delivery. Now, imagine the ripple effects of every time each one of us makes a decision without recognizing those psychological blind spots.
Can we dare to reflect on how different the world could be if many of the unconscious material became conscious to us? How would violence and discrimination in all their shapes and forms sustain themselves if we are no longer threatened by a dissimilar other? How secure and resilient do we need to be psychologically and emotionally in order to relate to someone else’s humanity? How differently would we draw the world map if we learned more about our own relational boundaries before enforcing them through military and division? What kind of consumers would we be if we can own and hold our insecurities, buy what we need, and use the right elements to our intrapsychic world?
This is where the relationship between self-awareness and social responsibility becomes complex. Freedom is all about allowing ourselves and others to engage in self-creation. Self-creation requires inquisitive self-awareness. Self-awareness entails tolerating the extreme forces within us and understanding how powerful yet limiting they can be. It is about being humble enough to admit our flaws, wounds, limitations, and prejudices and wise enough to make a decision to grow and celebrate our resilience. If we want a better world, we need to be better people, and to be better people, we need to realize that we are capable of being bad and wrong. Silence is sometimes enough to make us perpetrators. If we want our rights granted, we need not be threatened by other people’s rights. Connecting with our and others’ humanity might give us a chance to be free from oppression, violence, and discrimination which thrive on division and demonizing others.
However, to think that things are that simple or one-directional is plain naive. Most of us are ordinary people who are simply trying our best, but we are in no position of power to change the world. Policies and regulations are required to empower the disempowered, redistribute wealth, and make mental health services accessible to all people. Self-awareness and social responsibility need to be more cultivated into our families, religious institutions, educational curriculums, and legal policies, and need to receive equal attention to public health. I do not claim that the path to self-awareness is limited to psychotherapy. Psychotherapy is relatively new in history. Civilizations rose and fell without it. Psychotherapy is one route among infinite others for those who decide to embark on this journey.
Furthermore, mental health should not only benefit the privileged, and no one should be above the possibility of psychological pathologies, clinical assessments, and interventions, especially those in power. Therapy is not about making us feel better about ourselves, but about holding us as reliable narrators of our stories, breaking unhealthy patterns, and promoting change. To give a simple example, many times I have seen employees from the same company in therapy burdened by an anxious, obsessive, or narcissist manager or by a greedy system. It makes me wonder, how many people need to suffer for the cause to be identified and addressed? And how economical is it to have all employees in therapy to learn stress management skills when the major stressor is not willing to change and not held responsible? I have to emphasize that having the mental health lens is not to justify or minimize any human or legal violations, and definitely not to be used as a tool for stigmatization and discrimination. Simply, in psychoanalysis, psychologists are required to be in therapy to make sure they are capable of caring for their patients. In aviation, pilots are evaluated on how they handle stress during testing their flying skills, and are provided with mental health interventions if needed. In an ideal world, there simply need to be policies that enforce mental health services on those in power (any position of power no matter how simple or great), just as much as education, experience, and training are treated as requirements.
Additionally, psychologists should also play a more active role in participating in social activism and drafting social policies. Every time a clinician feels a patient’s helplessness due to social factors is an alert signal for them to advocate for a cause. Finally, as Judith Herman beautifully states “Advances in the field occur only when they are supported by a political movement powerful enough to legitimate an alliance between investigators and patients and to counteract the ordinary processes of silencing and denial”.


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