Talk Is Not Enough, Part II

THE OPEN MIND
Host: Richard D. Heffner
Guest: Willard Gaylin
Title: “Talk Is Not Enough”, Part II
VTR: 4/13/00

I’m Richard Heffner, your host on The Open Mind. And this is the second of two new programs with Dr. Willard Gaylin, Clinical Professor of Psychiatry at Columbia’s College of Physicians and Surgeons and Co-founder of The Hastings Center, the preeminent institute for the study of ethical issues in the life sciences.

Now, we began last time to discuss Dr. Gaylin’s newest book “Talk Is Not Enough, How Psychotherapy Really Works” and I’d like to pick up now where we left off and, Dr. Gaylin I wanted to go to a quote from you and from the book, on page 272, you write … and I have to ask you what precisely you mean about this, “the heart of the psychoanalyst is with freedom even while his discoveries constantly challenge autonomy”. What did you mean?

GAYLIN: [Laughter] Well, it’s very, very hard to take a developmental point of view and almost all therapists, even non-psychoanalytic therapists take a developmental point of view. What do I mean by a developmental point of view? It means that the present is somehow or other a product of the past.

HEFFNER: This happened, so that happens now.

GAYLIN: That’s right. The child is the father of the man. “I didn’t do this of my own free will” becomes the off-shoot of that, “I did it because my Daddy treated me this way, my mother treated me this way”. If you were going to say that this piece of behavior, if you’re just going to be logical, and you say, “this piece of behavior,”, let’s say it’s anti-social behavior, it’s an interesting one to go into … was because I was neglected, I had a Dickens type of childhood, I was Black, I was deprived, I felt like an outcast, etc. and therefore, that’s why I did it. In a sense if those were all of the determinants, then it means you had no choice but to do that. So psychoanalytic theory and almost all psychotherapeutic theory began to sound deterministic. And it did lead to some outrageous defenses in the criminal justice system. You couldn’t do this, there was “air of rage,” You remember that one. And then there was all kinds of ethnic deprivations and you can’t blame him because “look where he came from and look what he did”. Now the answer, the logical thing is “what you mean you can blame him ‘look where he came from and look what he …’ you know if you had come from that environment … somebody could say, “hey didn’t a lot of people come from that environment, who became good solid citizens?”. Yes, but this guy came from that environment, therefore you can’t blame him and he’s not culpable. He’s not culpable because … well in that case I better watch out for everyone who came from that environment, if they’re uncontrollable. So what you have is a theory that drives you to psychic determinism, the whole idea that we’re the products of our past and to nibble away at free will. At the same time most therapists will say, “logic or no logic, I just know (and you have to say) that my patient can say ‘no’, he can change”. Now the problem with the just say no kind of thing … you don’t need therapy, just say no … is it’s patently absurd. Would we all be svelte, wouldn’t we all be doing all of our exercises. Would we all be doing macho things. Would we all be eating veggies and fruits and grains and never go into that lamb chop. We can’t say no. Or we don’t choose to say no. So you can’t just say just those things. What you can do is say, “Look, he is … he has the baggage of the past with him”. And I guess one of the best definitions of a neurosis that I can think of is it’s an individual who cannot learn from experience because he doesn’t perceive the real world (one of the great discoveries of Freud). He doesn’t perceive … he perceives his image of the real world. So what we try to do in therapy … so he can’t learn by experience because … “ah, I know, you trust them and they cheat you”, to use my example about paranoia, which is an easy one. You have to show him that he is imposing these distortions on the real world. And then he will be able to learn from the experience of the real world. Then he will be able to exercise will. So even though we say, “listen, you are the way you are because of Daddy, Mommy, siblings, the culture, everything like that”, we’re stuck with saying, “but stop doing it”. Now we don’t do it in that blunt a way. We find ways of making what you’re doing … we show you how terribly self-destructive, it is, how fruitless it is, how little it serves your purposes and your desires. But we must eventually say to you “stop doing that, engage people in a different way”.

HEFFNER: But if you haven’t had the luxury or person A or B or C hasn’t had the luxury of having a therapist say “stop seeing yourself and the world in this way”, then what becomes with the question of individual responsibility. That’s still, I know what has plagued you in so many of the books that you have written, this question of determinism, and the question of responsibility and free will.

GAYLIN: Yes.

HEFFNER: How do you work with that, Will?

GAYLIN: Well, it’s, it’s a tension and it’s a balance. I do believe in will. And I end the book with chapters on “the will”. I’m worried about that because I don’t want people … I remember the old days, and we’re trapped in the politics of therapy, too, where … you remember Patton slapping the soldier across the face because he was just a ninny and coward … what do you mean. I remember the old days where all of emotional disorders were seen as a matter of weak-willed people who simply couldn’t take control of themselves. So I don’t like to encourage that. And, indeed, we slipped into … in protection against that into the opposite extreme. Now what I’m saying is, we won that battle. Most people do recognize the fact that our past determines the present and the present determines the future and it’s a real problem. Most people now accept that we are, ironically, in this day when we’re all sniffing our nose at Freud, at least all the intellectuals in the cutting edge magazines that used to just, oh, bog down in, in reverence to him. The fact is that we are all speaking Freudian language without knowing it like the character in Moliere who is delighted to discover that he was speaking prose all his life. We’re all Freudians. We know we don’t want our kids to do this because we don’t want to color the way they are. Everyone is a developmentalist these days, “If my child doesn’t have this experience, will it move there”. In this time now, I feel it’s safer to redress the imbalance in the other direction and say, “hey, there still is a place for will”. I do believe in a limited individual, but essentially a free individual.

HEFFNER: Of course, when you say “now” I think back to the book on Bonnie Garland and your indignation, your enormous indignation, as expressed there, at the effort to remove responsibility, within the legal system …

GAYLIN: Yes, because there I made the point that even were it true, if we wanted … an analyst can get away with pretending that there’s no free will, you change the conditions and now the patient will be manipulated in a certain thing. But society has to operate with a code of responsibility. And when I wrote the Bonnie Garland book, that was the time when everyone was finding exculpating excuses for almost everything. So I wanted to say we mustn’t give up for social reasons, even if we were … even if we were correct that we are automatons, which I don’t believe, we must give it up because of social order … a democratic social, particularly demands the concept of voluntariness, autonomy and accepting responsibility for when you’re naughty.

HEFFNER: It’s, it’s so interesting that it was the success of your profession that brought about this problem. Because you say, and you say so very well “within the therapeutic situation, with the psychoanalytic situation you’re going to use the understanding that we are not our own masters initially.

GAYLIN: Yes.

HEFFNER: … that we are the product. But outside of that situation, outside of your office, you have real trouble …

GAYLIN: Exactly.

HEFFNER: … when the Freudian ideas, psychological ideas are widespread.

GAYLIN: I think the best way for some whose just getting into these ideas and, and to keep it as non-theoretical as possible, is the problem of the medical model. In the old days if you did certain things you were just irresponsible and a bad citizen. We began to talk about mental illness of all sorts as an illness. Now when you say something is an illness … you know, what a simple … a simple example let’s say is masturbation. In the old days, the early nineteenth century, masturbation was onanism and it was a sin against God. Masturbation then gradually became not a sin against God, but in the early Freudian days, “immature” … the last thing you want to be to a Freudian … “immature”. “This is pre-Oedipal … masturbation … he hasn’t grown out of that stage.” Then masturbation became an ordinary activity which presumably you give up in adult life when you had the opportunity for regular relationships. Then with the Feminist Movement, masturbation became the most elegant … because it frees you of the necessity of having a male consort of some sort or other.

When you change the frame of reference, you change everything. So when I see a horrible, and to a lay person disgusting pussy rash, I don’t say, “oh get away from me, you’re just an obnoxious person”. I recognize “oh, that must be a strep infection. If the color of the pus is that way, that must be a staph infection. If it’s doing this, etc.” and I see that patient as non-culpable. That’s what the medical model means … “I am not responsible, I am to be sympathized with for it”. And this was the way we handled the horrible coughing which offended all of us … the rashes, the smelly ulcers on one’s leg. You didn’t blame the patient he was the victim of it, and you were compassionate. And that was a wonderful introduction to a psychotherapeutic world. On the other hand you see just where I’m going.

HEFFNER: MmmHmm.

GAYLIN: This means, “listen, if it’s just a sickness, you’re no longer more responsible for your thievery, for your wife beating, for your … for the abuse of your children then you are for your cough, or your pneumonia”. And that was the direction we were beginning to move..

HEFFNER: Will, you say “that was”. Certainly we’re caught up in that right now.

GAYLIN: Well …

HEFFNER: … to a faretheewell.

GAYLIN: Like most dilemmas like this, it’s going to be battled and battled and battled, and the tide will go in one direction or another. I think we were perilously close … that’s why I wrote the Bonnie Garland book when I did … perilously close to giving up responsibility and more and more of that was coming into the law. And if not the actual law itself, as practiced, the sociology and philosophy law. I think there is a greater sense of personal responsibility. We are human being, we have to consider that we … this was the lesson of Adam and Eve. You know, things were swell in that garden … what did you want … food was good, service was great … every animal in there was to your servant … God created you to have master dominion over … God simply said, “just don’t do this one thing, please. Don’t get knowledge.” Knowledge being another word for freedom. And you know what, Adam and Eve to their glory gave birth to the … because I don’t think those people in the garden were human beings, they were something elegant, something like little seraphifim or something. Once they bit into that apple, and they got freedom and knowledge, God pushed them out, but he never cursed them for it. Said, “okay, this is what you’re going to be”. And indeed Adam after first whining and wriggling around, says okay we’ll start a whole new group of human creatures. He renames his wife, we’ll be the father and mother of something which is free. And that’s the defining … that’s been since Genesis, through Kant, through all of the philosophers, the defining distinction between man and the most intelligent animal, the chimpanzee. The chimpanzee is going to do what it’s doing, it will still be picking it’s teeth with whatever that little thorn is that it uses for centuries. The human being will not only change the thorn, he’ll make it out of plastic, he’ll invent a polymer. He will conceive a world outside of his experience. Freedom essentially defines the glory of our species. So we can’t allow the psychoanalytic theoretians to rob us of our greatest pride.

HEFFNER: But your colleague, your late colleague, Eric Fromm pointed out that we have made a history of … humankind of escaping from freedom because freedom and responsibility are so perilous, they’re so difficult, they’re so hard to deal with and we make every effort we can escape from freedom

GAYLIN: Well this was … this book, Escape from Freedom was essentially influenced by the totalitarian era …

HEFFNER: Sure.

GAYLIN: In which the Communists and the Nazis had the same party line, essentially “you don’t need freedom”. It goes back way before that. You read that wonderful section in the Brothers Karamozoff, the Inquisitor …

HEFFNER: The Grand Inquisitor …

GAYLIN: The Grand Inquisitor … you remember, Christ comes back and he is shunned, “you’ve caused enough trouble now, with your giving … your emphasis on freedom and love. Get out of here”.

HEFFNER: Well, Will, taking those two, or taking the Grand Inquisitor alone, are you sanguine about the way you find humankind today in regard to freedom and responsibility.

GAYLIN: You know I’ve never been sanguine about anything. On the other hand I remember once you’re saying to me, “are you still an optimist”. This was years ago.

HEFFNER: MmmHmm.

GAYLIN: And it’s a fatal curse I have that I am an optimist. But it’s becoming more and more difficult. I worry about it. I worry about a culture which diminished freedom autonomy. There was enormous emphasis on rights … most of them wonderful … civil rights, the right to health, but without any proportional concern about responsibility. The thing I think that kept me honest … we keep saying that the therapy … psychotherapy and psychoanalysis in theory led you to a determinism. But the thing that kept me honest, was that I was in a service profession with people who were miserable, and unhappy. And I was not about to say to them, “hey fella, you’re the way you are because your Mom and Dad were just nasty to you, or seductive to you, or this. And what are we going to do? Live your life with that”. I was going to say to them, “you do not have to be strangled … now, you understand I don’t make speeches like I’m talking to you to my patient. They think of me as a quiet fellow who sits there and listens to them. [Laughter] But the message I was sending to them, “you are a free person who can shape his future, you can shape you life. You are not a victim, you are not a victim of the past”. So the irony, while I was part of this stream of determinism, exculpability, “don’t worry about it, it’s not your responsibility” in one sense. My job … my day to day job of taking miserable, unhappy, unproductive, frightened people and giving them a richer life and hope demanded that I stay on that optimistic life. We can change it. If I can change my patients, maybe I can the world.

HEFFNER: Talking about change, Will, we’ve known each other for a lot of decades now, and we’ve talked to each other at this table for many, many years. What’s changed with Gaylin over these years?

GAYLIN: What’s changed with Gaylin? Ah, well I’d have never written this book thirty years ago.

HEFFNER: You said you would not have …

GAYLIN: Never, never …

HEFFNER: You did not … but …

GAYLIN: No. And people say, isn’t it strange, shouldn’t the first book you’ve written be about psychotherapy? Why didn’t I write it then? It … this book exposes me a great deal … I tell a lot about my personal life. I would not have done that as a younger man. I was protective of my patients and I still am, but I have enough history that I can go back thirty years for the case studies. I never once, if you remember my other books, used case studies, even though they’re so attractive, I went into literature as a substitute, because I felt I wasn’t sure about the ethicality. Here, it’s gone far enough and I have enough conglomerate so I can squish together a few cases and make something real. And you can’t use literature, you have to go … if I’m talking about therapy … So how have I changed? Even though I look exactly the same as I did thirty years ago …

HEFFNER: True, true … absolutely …

GAYLIN: [Laughter]
HEFFNER: … Will, not a day older.

GAYLIN: I’ve aged. Certain things I’ve always believed. I can remember my saying that with anything I’ve done, the glory of raising children and the glory of continuity and the glory of relationships with family has always transcended writing almost anything else. I think as one gets older one recognizes a limited future. I don’t mean … as a matter of fact I do mean there’s no future. There’s a long present, but there’s no future. Meaning that I could now recast myself … let’s say the way with the Hastings Center where I decided I was going to spend more time starting an institution than I was with my patients, or writing or anything like that. I see now an end-point, which I never saw when I was young. I was just as arrogant as anyone else. I was going to live forever. Ironically, I don’t think it’s changed my passions. I don’t think it’s changed my priorities. I always loved family, loved people. It may have changed my activities, I can’t play as hard a game of tennis, I can’t do this. But how am I different from thirty years ago? I don’t think much different. The same optimist, optimism persists. It may make my angrier. Because I’m so frustrated.

HEFFNER: Oh, you were so angry at the time …

GAYLIN: [Laughter]

HEFFNER: … of Bonnie Garland and when you wrote the book about Rage.

GAYLIN: Well, there you go. So maybe in a sense I haven’t changed at all. I’m encouraged. I see dramatic differences. But the world is certainly better off since the dissolution of the Cold War. If you asked me then to look at Africa and the countries … the undeveloped countries … that’s horrible …

HEFFNER: No.

GAYLIN: … and there can’t be any hope. But I look at our society, I see us in a struggle. I see people beginning to move back to an aristitlian point of view. It was only the intellectuals … you, you sit here and talk to the smartest people and you’re smart and you deal with brilliant people all the time. So the intellectuals have their fads and their moods and their Left Wing and their all …I mean when I was in college and you were in college, weren’t all your teachers Marxists?

HEFFNER: Sure.

GAYLIN: It was hard to find one who wasn’t. So you went along with the Marxism for a short period of time. But you grew up before the intellectuals did. My teachers were still Marxists after a time, I said, “what are those people thinking?” The people who life an ordinary life, never bought the psychic determinism that much. Some of the political opportunists did. But the people always recognized … they said to their children, “you’ve got a responsibility”. They said that to them. They didn’t say “don’t’. You’ve got to go out and learn a living. You’ve got to do well in school. There was always acceptance, I think, in the average person’s mind of individual responsibility. And sure we’re having conflicts … new cultures … Hispanic groups coming in, questioning the kind of culture we have. I don’t know. I don’t have a negative feeling about our time. I feel that there’s still great disparities, but I feel we have our eye, on what, on the ball. We know what the problems are. Now maybe that’s that sneaky malignant optimism of mine. And maybe because I just have to feel that way. I can’t feel that the evolution that has come that is just going to lead to some kind of disaster. It would just be intolerable.

HEFFNER: What did you do here with my friend B. F. Skinner? He’s, he’s what …one of the enemy here?

GAYLIN: You know, I never thought so …

HEFFNER: Good.

GAYLIN: I knew Fred Skinner and when he was an older man. This was the most self-confident, assured human being. He knew all of the answers. I was at Yale with him and can’t remember what those fellowships were called, in which a whole group of scholars, every one of us was opposed to him. Fred Skinner is a behaviorist, which in many ways is the opposite of a dynamic therapist. He didn’t believe in an unconscious, but still, essentially he believed that the present was capite to the past. He also believed it was all conditioning, but once you were conditioned this way, so he believed you had to be unconditioned …

HEFFNER: Right.

GAYLIN: I think he was an extraordinary scholar and in certain populations … damaged children, children with learning, severe learning problems … institutionalized people … he had some profound things to say. I hope that in the book … I want to relieve the tensions … I grew up with these groups, these advocates, all of which … you know it came right out of the Marxism of the thirties and forties, I think. That you not only, if you weren’t on my side, you were a fool, you were a fascist, you were an idiot. The fact is the human being is so complicated and so complex that you can take … if you take an authentic cut, you’re going to have a different view that you’re going to touch most of the elements of humanity. So I think the idea that oh, the only good person is a Freudian, or the only good person is a Jungian, or the only person is a Rogerian, or a Sullivanian is foolish. We are all approaching the human being, we’re simply organizing the data in a different structure. There are people who are foolish. I mean if some tells you that all of your life is determined by your passage to Iraq through the birth canal and it all happened just like that … that’s trivial. That’s too superficial to do justice to this wonderful thing that is a human being. But I think we’ve learned a certain tolerance, we’re talking to … does that mean there still aren’t despotic, arrogant people around. Of course there are But I think the group … the psychotherapeutic community has changed dramatically.
HEFFNER: Talking about change … in a minute and a half that we have left, when I first knew about the book, “Talk Is Not Enough”, I wondered if it was a book about psychopharmacology. And it’s not.

GAYLIN: Funny that you should say that. I hate the title … it was imposed on my by the publisher because I said it’s going to be misread. That “Talk Is Not Enough” sounds like an anti-psychotherapy book. I’m a passionate defender of psychotherapy. I’m not opposed to drugs. As I said, they facilitate psychotherapy. And most of my friends who are good psychopharmacologist know that whether there’s a psychopharmacological change that produces depression, still that depression has caused adjustment problems that have to be corrected and they want psychotherapy. I didn’t like the title at all, because just as you said, I thought it might be misunderstood. What I think my publisher, to do her justice, had in mind was that she wanted to say that insight and knowledge is not enough and talk is not enough. So we wanted to say talk, insight and knowledge … so she looked for something quite catchy. I actually wanted to call it what the subtitle is “How Psychotherapy Really Works”. That’s what this book is about. Or I had another one. I had one called “Deconstructing Psychotherapy” because now that Woody Allen has used that term, everyone knows what that means. With a sub-title “How it Works, When It Works and Why Sometimes It Doesn’t Work”.

HEFFNER: Will Gaylin I’m so glad you were here today and I must say to you I like the title “Talk Is Not Enough”, but I think it needed a colon and then ACT in much larger words. And my action is to thank you again for joining me on The Open Mind.

GAYLIN: Well, it’s always a pleasure, Dick.

HEFFNER: And thanks, too, to you in the audience. I hope you join us again next time. If you would like a transcript of today’s program, please send four dollars in check or money order to: The Open Mind, P. O. Box 7977, F.D.R. Station, New York, New York 10150

Meanwhile, as an old friend used to say, “Good night and good luck”.

N.B. Every effort has been made to ensure the accuracy of this transcript. It may not, however, be a verbatim copy of the program.

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