Paradoxical Therapy and Politics

Vitezslav Vylicil/AdobeStock

PSYCHIATRIC VIEWS ON THE DAILY NEWS

“There’s a lullaby for suffering

And a paradox to blame. . .”

-Leonard Cohen, lyric from “You Want It Darker

There is a kind of psychotherapy called paradoxical psychotherapy. Perhaps counterintuitively, it encourages patients to face their fears. It is sometimes tried with such issues as undue fears, family miscommunications, insomnia, and eating disorders. It seems to help some individuals think about their problems from a different perspective.

Perhaps that is the approach being tried by the upcoming Presidential administration. So many of the Cabinet nominations seem to be based on ultimate loyalty rather than professional expertise. One related to our field is the nomination of a Kennedy, Robert F. Kennedy, Jr, for Secretary of Health and Human Services, startling even some establishment Republicans. He has a history of doubting the value of vaccines and even science, viewpoints which ordinarily might disqualify a candidate for this job.

Paradoxical therapy does have many drawbacks, though, which might suggest why it has had limited popularity. It can make situations worse. It can seem absurd.

Yet, whether intentional or not, many of the recommended nominations, if paradoxical, could backfire. Maybe that is what is intended. Rile up the opposition so that they will be relieved if some are replaced that are slightly more qualified. Or is it part of a revenge process following humiliation?

Or take climate change. The annual global summit, called COP29, is being held in another oil-rich country, Azerbaijan. This paradox, the location not seeming to fit the solution, as well as our election results, seems to be stimulating a shift from opposition negotiation to implementing action.

Since we in psychiatry have some expertise in paradoxical therapy, we should also consider doing what is not expected, which might be to monitor how these nominations are doing and, if approved, producing.

If this column itself seems absurd, just don’t read it! Whoops. Likely you already have. Or have we come to a stage where paradox is normal process, just like alternative facts are deemed the truth? If so, will need reality therapy.

Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.