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Mental Health Professionals & Insurance Companies

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By Michael Birnkrant

Recent legislative changes affecting mental health insurance coverage coming about due to The Mental Health Parity and Addiction Equity Act (2008) and the Patient Protection and Affordable Care Act (ACA, 2010) will result in more people than ever having access to mental health treatment, especially those who can’t afford out of pocket treatment.

Michael Birnkrant
                 Michael Birnkrant, M.A.

All good things can have a cost, though, which brings me to thinking about what it means to have a metaphorical third in the room. Today, the most commonly encountered third party involved in mental health treatment is the insurance company. As more people seek mental health treatment through their health insurance plans, it is a good time to slow down and have a dialogue about how these changes will affect the work.

How ethical and accurate is it to diagnose a patient on the first visit—which is required if the therapist wants to get paid right away? What will it mean to keep patient records electronically (a requirement of ACA for all providers by 2017)? I read almost daily about breaches in security and identity theft (see the recent attack of 2/4/15 on over one million Anthem/ Blue Cross Blue Shield customers). When a third party is paying, how much can they dictate the duration and type of the treatment? Currently, that is an issue for many who feel it is impossible to disclose to a client the duration of a course of treatment before it starts—even though that is included in some insurance company agreements with providers and in some fields’ ethical codes.

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U.S. Ambivalence about Torture: An Analysis of Post-9/11 Films

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By Dr. Stephen Soldz

BGSP graduate Dr. Jean Rahbar has just published a paper in the online film journal Jump Cut that was based on her dissertation research in BGSP’s doctoral program on Psychoanalysis, Society , and Culture. She investigated post-911 American Iraq war films in which torture by Americans or their allies is depicted in order to  gain insight into the ambivalence of American audiences toward torture.

We asked Dr. Rahbar to write a brief description of her research:

I began my research project examining the nature of American ambivalence about torture in 2011. What I learned was that Americans were able to metabolize their guilt surrounding the topic of American involvement in torture through a third individual who passively participates in the torture while he/she simultaneously objects to the human rights violations occurring before him/her. On the one hand, we are a pro human rights country, while on the other, horrific acts of abuse have occurred and continue to occur by American hands. This led me to wonder how torture, specifically torture in post 9/11 Iraq War Films, would be portrayed on screen and if I could gain any insight into the nature of American ambivalence about the topic.

Through the persistent nature of a third American individual whom I call the “observer,” Americans watchers can maintain their disgust in regards to human rights violations, while passively participating in it and reaping the benefits of torture (i.e. garner supposed information that could potentially save lives).

This third position also allowed for a number of psychoanalytic mechanisms to be employed, affording Americans the privilege of being freedom loving individuals who can deny their own aggression while gaining any of the supposed benefits that come with torturing another individual.

Her complete paper, U.S. Ambivalence about Torture: An Analysis of Post-9/11 Films, can be read here.

American Sniper

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When asked to write an entry on the BGSP blog site about the film American Sniper memories of my time in the service, unexpectedly, came back to me.  I recalled the moment I was handed my M1 rifle and how the drill instructor shouted a chant we all had to repeat.  “This is my rifle this is my gun, one is for killing the other for fun” and then the Rifleman’s Creed.

This is my rifle. There are many like it, but this one is mine.

My rifle is my best friend. It is my life. I must master it as I must master my life.

My rifle, without me, is useless. Without my rifle, I am useless. I must fire my rifle true. I must shoot straighter than my enemy who is trying to kill me. I must shoot him before he shoots me. I will…

My rifle and I know that what counts in war are not the rounds we fire, the noise of neither our burst, nor the smoke we make. We know that it is the hits that count. We will hit…

My rifle is human, even as I, because it is my life. Thus, I will learn it as a brother. I will learn its weaknesses, its strength, its parts, its accessories, its sights and its barrel. I will keep my rifle clean and ready, even as I am clean and ready. We will become part of each other. We will…

Before God, I swear this creed. My rifle and I are the defenders of my country. We are the masters of our enemy. We are the saviors of my life.

So be it, until victory is America’s and there is no enemy, but peace!

That creed, a powerful prayer-like chant is one of the first experiences a young marine has and it is followed by many such injunctions and testaments to a new way of life. Yet, no matter how many others follow the rifleman’s creed, the rifle gets embedded into one like nothing else.

In the Marine Corps, no matter what eventual MOS (military occupation specialty) you draw, at heart you are a rifleman.  On the sands of Iwo Jima during the Second World War, a veteran of that invasion told me that his duty as a supply sergeant made no difference as Japanese fighters attacked; he was called to be part of a defensive effort that had him firing his rifle all through the night till the attack was repelled.

In boot camp, once you are issued your rifle it goes everywhere with you and cannot be more than 12 inches from where you sleep.  Sometimes, if you messed up in training, those 12 inches would disappear and it became your bunkmate.

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BiRDMAN or THE UNEXPECTED ViRTUE OF iGNORANCE

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Once in a while a film comes along that seems as interesting and layered as a psychoanalytic dialogue.  Birdman is such a one.  From the many Hollywood and Broadway in- jokes, through the Raymond Carver story serving as the play within the play, all the way back through Greek mythology to classical Buddhism, abundant points of symbolic reference serve to deepen and enrich the meaning.  Ironies and ambiguities draw us in further and unanswerable questions inspire.  Finally a complex and beautiful pattern appears.  At least, that is the way it is in my viewing, and this is a film that grants an unexpected degree of authorship to its viewers.

Birdman fully rewards Freud’s method of dream analysis.  We are presented with a wealth of disguised wishes in conflict,  and although they start as our hero’s desires, they blink in and out of view in the other characters, shoot into the wider culture, and eventually light up the viewers’ struggles as well.  (As evidence of this I take the unprecedented number of passionate  post-film conversations in the seats and the lobbies and the bathrooms each time and in each location where I saw the film.) The much-noted camera work (by Emmanuel Lubezki), rendered as if in a single uninterrupted take, feels like free association, taking us seamlessly into the mind of the driven, let’s say virtigiphilic hero, his belligerent Birdman alter ego, the characters from the Carver story whom he directs and plays on stage, and the parts of himself we see echoed in the other people in the film such as his actors, his crew, his loyal friend, his recently rehabbed daughter and his forbearing ex-wife.  Taken as a whole, it widens from a small look at the impulses toward both flight and fall of an individual actor who could easily be called narcissistic, manic depressive, suicidal, perhaps delusional, through a nuanced examination of the nature of Love and its close cousin, Art, all the way to riffs on Reality and hints at Enlightenment.

As in many psychoanalyses, the symbol set and inter-texts are introduced at the very beginning.  Before anything else, we see a quote from Raymond Carver (from A New Path to the Waterfall):

And did you get what you wanted from this life even so?”

“I did”.

“And what did you want?”

“To call myself beloved, to feel myself beloved on the earth.”

The letters appear first as separate points, gradually coming together to form words, like stars in a constellation.

Next, although it takes a while to realize it, we are met with images signaling the subtext of the myth of Icarus:  A ball of light soaring and falling from high in the sky and below it something ambiguous, drowned in the receded sea.  Next we see our hero, Riggan Thompson (played brilliantly by Michael Keaton),  in his underwear, in lotus position, levitating slightly, looking out the window of his dressing room and being addressed by the growling voice of his former role as Birdman, a movie superhero he is trying ever to rise above.   What makes this funny is the fact that Keaton himself left behind his famous role in the Batman movie series, declining, as his fictional character does here, to do further episodes despite the assurance of further fame. His path serves now as a kind of “reality pre-quel” to the film, especially given his many recent awards and pending nominations. (Indeed, a synopsis of the situation might now go like this:  An old actor becomes newly famous for playing a superhero becoming a real actor after famously declining to continue to be famous for playing a superhero.)

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Talking Helps: An Evidence-Based Approach to Psychoanalytic Counseling

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By Dr. William Sharp

Psychoanalysis is the talking cure and talking helps!  Yet, we analysts are not always good at talking about our work so that those interested can learn some basics about it, especially if you compare all the textbooks and ‘how to’s’ out there for approaches like Dialectical Behavior Therapy (DBT) and Cognitive Behavior Therapy (CBT), that make their way into undergraduate and graduate classrooms. SKM_554e15011616030

I found that many of my students at Northeastern University and Wheelock College knew the basics of applied behavioral analysis, a manualized treatment with clear protocols, but loved to hear about psychodynamic cases and to get ideas from me on how to work with cases that other types of approaches were not successful with.

Ten years of presentations on the topic and two years of writing led to a preliminary copy of something teachers can use to introduce basic psychoanalytic concepts and their application in clinical settings, my new book Talking Helps: An Evidenced Based Approach to Psychoanalytic Counseling (2015, Cognella Publishing).

When I started writing this text, I realized it was a near impossible task. I suspect many will feel that such a textbook is not appropriate and will not catch the essence of psychoanalysis.  And to them I say, please write others!  I believe a proliferation in the area of accessible texts will only help the field.   The more discussion we participate in, the better we will be able to define ourselves and strengthen psychoanalysis. I overcame my resistances on how to write this book by talking to people and realizing that it does not need to be perfect or contain everything. It can’t. Learning to be an analyst or psychoanalytically-informed counselor is largely experiential, but there are things I present here that can help start people thinking about their work in the helping professions by returning to its start in talk. Read the rest of this entry »

Narcissism and Technology: Symptom, Cause, or Carry On?

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By Dr. William Sharp

There is debate about the impact of technology- is it a help or a hindrance?  Is it impacting human development?  Is it making us narcissistic?  On one side, Jean Twenge writes in Generation Me, that there is a rise in narcissism on most measures used (see Time Magazine, 5/20/13). On the other side is human development textbook author Jeffrey Arnett who writes that there is no significant rise in narcissism — every older generation has said that of the younger generation — and saying so only causes insult and injury.   I would like to view the debate through a psychoanalytic lens.  Specifically, I would like to argue that technology is not inherently bad, but rather, as Sherry Turkle puts it in her book Alone Together (2010), humans are not strong enough to resist its pull.

Dr. William Sharp
Dr. William Sharp

We learn to wait our turns, listen, talk, share time, cooperate and negotiate through play.  Without these skills, life in any group — family, friend, or work — would be difficult.  Growing up, we used to be in a neighborhood and therefore were forced to play stick ball when we wanted to play freeze tag, in the hopes that next time, we would be able to have it our way.  Today, much of game time has gone online in massively multiplayer online games. In these scenarios, if your team isn’t interested in storming the castle when you want to, you can search globally for a team that does want to work on your schedule.  And, if that doesn’t work, you can switch the game to play against a ‘bot’ (robot, that is, playing against the computer who graciously always wants to do things on your schedule).   So, given the choice to not learn basic social skills, would humans choose the easy way out?   That is what Freud would predict.  And I think that is what we see viewing the impact of technology through a psychoanalytic lens. Read the rest of this entry »

The Multiple Threats of Drone Warfare

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By Dr. Stephen Soldz

Recently I participated in American Psychological Association (APA) annual conference and in associated meetings of Psychologists for Social Responsibility (PsySR) and the APA’s Peace Psychology Division. The latter two organizations jointly conducted a miniconvention on the psychology and ethics of the US government’s program of targeted killing using unmanned drones.

Dr. Stephen Soldz
Dr. Stephen Soldz

The miniconvention began with my chairing a prerelease screening of a new documentary entitled Drone, accompanied by commentary by counterintelligence officer Lieutenant Colonel Douglas Pryer, author of a widely cited article critical of the US drone program: “The Rise Of The Machines: Why Increasingly ‘Perfect’ Machines Help Perpetuate Our Wars And Endanger Our Nations,” in the journal Military Review. LTC Pryer expressed concerns about the directions the military was being led through its endorsement of the use of drones as a major aspect of contemporary warfare. In his writing Pryer has called for the US military to take the lead for declaring drones to be malum in se weapons – evil in themselves – and thus banned by international law.

The rest of the miniconvention included two Presidential Discussion panels of the Peace Psychology division at APA and a discussion session sponsored by PsySR. Panelists focused on a number of aspects of the drone phenomena.

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