Episode 81 Transcript

Grant: My guest today is Brent Robbins, who's a professor of psychology at Point Park University here in Pittsburgh. He's the director of the Psy.D. Clinical Psychology Program and one of the developers of their Community Psychology program. So he's also an important leader in the world of humanistic psychology. He's been a critic of the DSM and is interested in the idea of scapegoating in psychology, among a number of other topics. He's also a good friend of mine, a good friend of the Beatrice Institute. So I'm really excited to bring Brent on today.

Welcome to the podcast, Brent.

Brent: Well, thank you Grant. It's a pleasure to be here. Thanks for inviting me.

Grant: Yeah. So I'm going to start off with a story. So when our son was around three or four, maybe five, he had this explosive temper, right? He had a very hard time regulating his emotions. And my wife and I were pretty scared and we weren't quite sure what to do. We discussed for a long time about looking for some help, went back and forth about what to do, about maybe getting some professional help. But we were sort of arguing about it, or at least talking very passionately about it. And I remember myself saying, in a very exasperated way, “I don't want to get our boy within a hundred miles of a child psychiatrist.”

I'm interested in your response to that feeling that I had in reference to my own son.

Brent: Yeah. Well, before I speak as a professor of clinical psychology, I'll speak as a father and say that I went through a very similar experience with both of my sons and that right around that age, that's a very difficult age. And we flirted with the idea of taking them to psychotherapy or – not so much to psychiatry for reasons I'll explain. And ultimately we decided we didn't want to do that, although we did do family therapy at one point, and that was very helpful.

But in terms of going to see a psychiatrist, speaking more from a professional perspective: Yeah, I mean, I think there is a reluctance to go see a psychiatrist has some merit for a number of different reasons.

One is back in the 1950s, 1952, Hans Eysenk did a classic study where he found that most people who have a diagnosable condition end up going through spontaneous remission. They sort of recover on their own. And he actually used that as an argument that spontaneous remission was actually superior to the outcomes of psychotherapy.

Now we've gotten a lot better with experimentation on psychotherapy, and we do randomized controlled studies, and psychotherapy, through meta-analysis, has been found to be effective for most people. But a lot of people spontaneously recover from whatever it is they're struggling with.

When you take your child or if you go to a psychiatrist, most psychiatrists in my experience are good people who have very good intentions, who really know what they're doing in many respects. But what concerns me about psychiatry is the pressures that are put on many of the good people who are doing psychiatry from a socioeconomic perspective.

The pharmaceutical industry, managed care: there's a lot of pressures on psychiatrists that almost mandate, in order to do treatment, to medicate clients, to give them a diagnosis and to medicate. And I think sometimes, whether you go to a general physician or a psychiatrist, there's a need to or desire to want to help, to intervene, to help with the client's distress. And often the first line of treatment, whether you go to a GP or a physician who's a psychiatrist, you're going to get some kind of medication, a diagnosis and a medication because that's how they get reimbursed. And usually in the treatment guidelines, medications are the first line of treatment. And sometimes medications are needed, but in some cases I think there are pressures to medicate when there may be other possible options prior to consideration of medication.

So that's a concern that I have because all medications have side effects, and you have to weigh the costs and benefits of taking that medication. And so that's a big concern of mine, especially with the influence of the pharmaceutical industry within psychiatry and how it, obviously, influences the training that psychiatrists get. There's even textbooks within medical schools that are ghost written by the pharmaceutical industry. So there's a lot of influence. And so as a result of that, I think well-intentioned psychiatrists who are really intent on helping their patients can begin to be influenced by those pharmaceutical interests in ways that I think can be problematic.

Grant: All right. Thanks so much. So happy ending of the story is that my son, over time, he's been able to regulate his emotions better, maybe through the love of his family, but it didn't require any professional intervention. I think Taekwondo actually had a big part in that. But, so a long story short, we didn't need to go to psychiatrists or psychologists anyway.

But speaking of emotions, what are emotions and where do they come from?

Brent: Wow. That's a great question. It's a difficult question because there's not a consensus on what emotions are, believe it or not. Within emotion science and psychology, depending on who you ask, you'll get very different answers to that. In fact, that's one of the things that attracts me to the study of emotion is that it's such a complex phenomena. It really draws upon all areas of psychology in a way. You have to look at emotions from my perspective in a more holistic way.

But I'll give you my answer to that question, which is: the emotions are an evaluation of one's situation in light of one's goals. And the term for that is appraisal, right? So it's an appraisal of one's situation. So it's an evaluation of how you're doing in terms of your projects and your relationships and the way that…

So that involves cognition, usually implicit, not necessarily, what we usually think of as thinking. But it's an implicit, felt sense of the meaning of a situation. It's embodied in the sense that there's this felt sense that corresponds to it. And I think the felt sense that goes along with the evaluation of the situation has to do with the action tendencies that come along with that.

So emotions have tendencies towards certain actions. When I'm afraid, my tendency is to retreat; when I'm angry, my tendency is towards aggression. If I'm happy, my tendency is to be engaged and absorbed in this situation. So there's different action tendencies to correspond to different emotions, and our body is preparing itself for those actions. Even if ultimately we don't take action, we can inhibit those action tendencies. But our bodies are preparing for taking action.

And that feeling of our body's preparedness for action is an important component of emotion. That's what people mostly associate with emotions, why we call them feelings, right? Because there's a certain perturbance that's happening on a deep bodily level, which, Eugene Gendlin, who's a psychotherapist, talks about as a felt sense.

Grant: So we know that a lot of our students, particularly undergraduates, are tremendously anxious. Is there a sense in which we can understand anxiety as our soul or our psyche or our body getting our mind's attention towards things of worthy value, and in that case, transform anxiety into something positive as opposed to something negative?

Brent: Yeah, absolutely. In fact, I was, to just give you a little anecdote, we just got finished with final exams at Point Park and I was walking into one of my undergraduate classes and they just looked terrified. There was clearly a lot of anxiety. It was a challenging test. It's a difficult test. And I looked at them and I could see that they were very anxious. And I said, “I see there's a lot of anxiety in the room.” I said, “That's good, because that shows that you respect the test, right? That you care about the exam.” Because if you didn't care, you wouldn't feel anxious, right?

The problem of course, is when anxiety becomes so extreme that it begins to interfere with our performance. But if you care about some outcome, if you're invested in something and you don't feel some anxiety, you probably don't care. Right? So anxiety is an indication of our care, of our concern for a person or a project that matters to us.

And so, I think that when you see somebody with anxiety disorders or with panic disorder, the fundamental problem is not that they have anxiety; it's the person's relationship to their anxiety.

Panic disorder is, I think, a very clear indication of what I'm trying to say in that it's not anxiety that's the problem in a person who has panic disorder; it's their fear of their anxiety. So a person becomes preoccupied with bodily signs of their anxiety because they're worried about having another panic attack. And that amplifies the anxiety because they're paying attention to the bodily cues. It's almost like sticking a microphone up to a speaker, like that when any sign of anxiety leads them to have more anxiety and that leads them to be more vigilant about signs of anxiety. And it just keeps amplifying until it becomes a panic attack.

And so, yeah, and even in the case of what we might call “generalized anxiety,” which is part of the hallmark of general anxiety, is it's free floating. It doesn't seem to be about anything in particular. It's not like a phobia where you're afraid of something in particular, but often when we operate in psychotherapy and you begin to work with somebody who has general anxiety, eventually a person begins to discover there's something at the root of that anxiety, something that's being avoided, that needs to be attended to.

So whether somebody's dealing with a panic attack or generalized anxiety, I think a good way to think about it is that that anxiety is your friend. It's telling you something that you need to listen to. And if you tune into the anxiety in a contemplative, meditative kind of way, give yourself some silence and opportunity to listen in to that anxiety, oftentimes it can transform it into an insight.

Grant: Yeah, in fact, I've struggled with anxiety my whole life and it was almost a cognitive realization that every morning I woke up and there was a panic. And I began to think of it as really the Holy Spirit waking me up and saying, “You have work to do.” And I was able to make that cognitive switch now. Not to say that it's totally gone away. I've been able to sort of re-understand it in a way that's actually been helpful, is it doesn't give me fear, but it tells me to wake up and it's time to get to mission, right.

Brent: Yeah. Yeah. I mean, I was very influenced by – I went to Duquesne University and they're big in phenomenology, right, in their psychology program. And so my first year we had to read Being and Time, which is quite a tome, which is very difficult book by Heidegger, the German phenomenologist. But that really shaped how I think about anxiety because he has quite a brilliant description of anxiety in that book where he talks about anxiety as an authentic attunement, or an authentic mood, that turns us toward an appreciation or a revelation of being is what he talks about. Our being in the world gets revealed in anxiety in a way that it normally doesn't. Because, he said, the world becomes uncanny. Right? Things become strange. We begin to ask questions that we normally wouldn't ask when we're sort of absorbed in our everyday activities in a kind of busy way.

And I think what you're describing is it tunes us into the ontological, which from a Christian perspective is the divine right? Is the source of being. So anxiety can be understood literally as an attunement to a kind of call from being itself to the divine. And if we tune into it that way, then we can really begin to see it as a blessing, as something that calls us into some claim on us for the day or for our lives.

And I find that to be true. In fact, Heidegger says that if we stay attuned to anxiety rather than fleeing from it, then it transforms into what he calls unshakable joy in this revelation of being, right? A gratitude for our existence and the opportunity to claim our possibilities as our own, right? So understood within the spiritual life, that makes a lot of sense, right? That we come to appreciate, “Well, what's at stake in anxiety is my existence. The very meaning of my existence, what I'm about, what I'm claimed to do and be. And if I claim that, if I take up that claim, then that really becomes an opportunity to find the meaning and purpose of my life.”

And once you are directed in that way, once you have a sense of mission, then you get this wind into your back, right? There's a kind of energy that comes with that. We could understand in the Christian sense as the Holy Spirit moving us, the direction of our mission, enabling us to, and empowering us to accomplish it.

But sometimes we have to go through those periods. We have to go through the desert experience to get to the joy.

Grant: So given your definition of emotions, how would you characterize auditory hallucinations or voice hearing? Is that a form of emotion or is that some other phenomenon? How would you understand those within the context of emotion?

Brent: Yeah. Well, there's some really good research coming out of the UK by a guy named Richard Bentall. And if you're interested in schizophrenia, I strongly recommend looking at his work. It's quite brilliant. But in Bentall's work, he understands schizophrenia… He, based on lots of empirical evidence – this is not just speculation – he has really good empirical evidence that points in the direction that for two things that people with psychosis, their symptoms of psychosis, including voices, seem to be rooted in histories of trauma. And so in that way, they're very similar to those kinds of symptoms overlap and are very similar to states of dissociation.

Both dissociation and auditorial hallucinations are problems of ipseity in phenomenology. We use the word “ipseity” to talk about the sense that my experience is my own. You know, there's my coffee cup over there. That's my experience of the coffee cup, but I can recognize that other people might have a different perspective and a different experience of the same coffee cup. So I have a sense that my experience is mine and certain aspects of my experience, or a recognition that other people have a different perspective. Well, with problems of ipseity or disturbances of the self, there's a problem there. And oftentimes those problems are rooted in trauma, first of all.

And then second, the other thing that Bentall found is that schizophrenia and other forms of psychosis, as well as dissociation, can be understood as a form of coping with extreme anxiety, right? He makes the argument that schizophrenia is actually an anxiety disorder.

Grant: Oh, interesting.

Brent: And that, so, yes, it is connected to moods and basically what's happening in the case of an auditory hallucination, a very simple way to understand it is this issue of ipseity, that there's some… It's okay if I use some technical vocabulary for this podcast, right?

Grant: Our listeners have Google; they can look it up.

Brent: Yeah. So, in British psychoanalytic theory, they talk about the interjection of an object, right? So when we're young, our relationships become a part of our internal psyche, right? And we all know this because you have that voice of your mother or your father that comes out when you're doing something that you shouldn't be doing, and you think, “Oh, mom wouldn't like this,” and you can hear mom's voice coming.

So that would be an interjected object. That person in your life becomes sort of a part of your psyche. But typically, if you're not psychotic, you recognize that’s your psyche. It's not an alien voice within you, right? You have some control over that voice, right? You don't see it as sort of external to you, independent of you.

Whereas when somebody hears voices, oftentimes the person who has those voices could even trace back that voice to a particular person in their life. Maybe it was a bully at school, or… Oftentimes the voice is identifiable. It might take them a little while to make that connection, say, in the process of therapy. But typically, if you look at the kind of work that's being done by the Hearing Voices Network, people can trace those voices back to trauma and to particular objects or people that they've interjected.

And so in other words, when somebody has a trauma and there's some problematic agent who was sort of part of that trauma, then they can become part of the internal world of the person with psychosis. But instead of being integrated into their identity, it remains an alienated aspect of the self. It's like a part of the self that it experiences outside of the self.

And so a lot of what we do in therapy is to try to help the person to gain control over the voice. The goal isn't even necessarily to get rid of the voice. It's really being able to live with the voice and to make sense of it so that it becomes more of a meaningful part of their psyche rather than something that's intrusive and that they don't have control over.

Grant: So one thing I really appreciate about your work, and actually one of the funnest things about doing this podcast is being able to read all the work of my friends and colleagues. One thing that I really appreciate about your work was how philosophical it was and theoretically grounded.

Brent: Thank you.

Grant: What is the dominant theory of the person that guides standard psychiatric practice? Because you talk a lot about personalism. So what's the dominant theory of the person that guides just standard psychiatric practice in the United States?

Brent: Yeah. Well, I mean, in some ways part of the problem with a lot of psychiatry and psychology is they don't really think very deeply about what does it mean to be a person. So sometimes it's just an absence of thought with regard to those questions. But when you don't think about that stuff very deeply, what ends up sort of becoming the default position is a kind of reductive materialism. That essentially the person is epiphenomenal, right? The person isn't really real. It's a byproduct of neurochemicals and biomechanical processes in the brain and the nervous system. And ultimately, what's going on in the brain and nervous system and living organisms is ultimately reducible to chemistry and then ultimately to principles of physics, right?

So reductionism tends to be deflationary, right? And if you really think it all the way through, then there's really no difference between a human being and a rock. You know what I mean? Ontologically, everything is just a mechanism, a thing. And I think that's the default position of medicine and a lot of psychology, even a lot of psychology which is supposed to be interested in the psyche, but ultimately, because…

Behaviorism, I think, is a really extreme example of this, where Skinner wrote a book called Beyond Freedom and Dignity, where – I mean, that says it all right? That basically there is no person. He calls that “explanatory fiction.” It's unnecessary to explain human behavior. And if all you have is human behavior, then human beings are simply mechanisms responding to contingencies, causal contingencies outside of themselves, and therefore we have no freedom. And therefore, this idea that humans have a special kind of dignity, for Skinner, is a sort of antiquated idea we need to get over.

Grant: Right. So do you find that your students are increasingly less likely to be interested in theory and just want the facts and techniques?

Brent: That's a good question. I think it depends on the student. I think Point Park is kind of unusual in that we kind of advertise ourselves as being very philosophical. And so we tend to attract students that are interested in theory. But even in that case, when students just want to get their license, you know what I mean? Like they just want to go and get their license. We have some students that, you know, they pay good lip service to that when they're doing the interviews, but when they get to the program, you realize they're really not that interested in that.

In general, I think it's part of the American pragmatist in us that we want to just get to the, “Okay, tell me what to do. Tell me how to do therapy.” And part of what students don't understand is that you really can't be a good therapist if all you're doing is thinking in terms of techniques. Because techniques are saturated with all kinds of presuppositions about that. That if you're going to be a critical thinker, and if you're going to be ethical in your practice, you need to understand how your techniques are, all the assumptions that go into the use of those techniques and whether they make sense and whether they're coherent, if you're using them along with other techniques.

And, so if you don't have theory, if you're not being driven by theory, you're not going to be a good therapist, you're going to be clumsy, you're just going to offer sort of a mixed bag of tools that don't make much sense together. And I think that's the way a lot of people practice. They call themselves eclectic, but it's just throwing techniques at people in a way that I think can sometimes be more damaging than helpful.

Grant: Right. So I'm going to turn a little bit towards the framework that you work from. So you talked a lot about being a humanistic psychologist, particularly driven by personalism. So thinking back to our conversation about people with schizophrenia, what is the goal for people with schizophrenia within a humanistic or personal psychology?

And how would you know that you've done well by your client? And maybe juxtapose that against the standard, maybe “eclectic” approach or just standard psychiatry or psychology. How would this humanistic psychology help you understand and have different goals for someone suffering from schizophrenia?

Brent: Yeah, I mean, I'll start with talking more generally than just about schizophrenia, and I'll come back to talking about schizophrenia. But I would say that, from my perspective, and there's a range of perspectives within the humanistic approach. But I think my approach captures the essence of it in many ways, even though you might find varieties of perspectives. If you look at conventional psychiatry and conventional psychology, they operate according to what is called the medical model, right?

What is the medical model? Well, you presume that if somebody has a certain collection of symptoms, there's some underlying disease. And the ultimate goal is to – I mean, at least in psychology and psychiatry, because often we don't know what the underlying disease is, all we know is what the symptoms are – So the tendency is then once you identify the symptoms, is to eliminate the symptoms. So if somebody has anxiety, the goal is to reduce the anxiety. If somebody is depressed, the goal is to reduce the symptoms of depression. So they should be sad less often, right?

What I see as a real danger in that mindset is, if you think about it, the whole goal is to sort of reduce aspects of a person's existence, to eradicate certain functions in a way that often doesn't consider it in a more holistic way to think about, “Well, when is anxiety adaptive and when is it not adaptive?” Right? Maybe it's not so much maybe about getting rid of the anxiety as much as learning how to relate to your anxiety in a way that's adaptive and helpful so the person can flourish. So, from a humanistic perspective, it's more strength-based. It's more focused on expanding a person's possibilities rather than eliminating certain possibilities. So rather than reducing things, you're looking to expand a person's range of possibilities. That, I think, is the fundamental difference.

So with somebody with psychoses such as schizophrenia, the goal, it may not be getting rid of your voices, right? It may be learning how to live with voices in a way that is meaningful, right? So that's where I think there's a big difference.

And I would say in the case of schizophrenia, what I would look for in work with schizophrenia is whether we're moving in the direction where a person has a sense of meaning, that they have a sense of insight into their symptoms and also instead of seeing their suffering as simply meaningless or absurd, that there's something redemptive in the process of suffering.

One of the things that we find in people that are flourishing, people that are… Often some of the people who are highest in wellbeing are people who went through a lot of adversity, but they tell a “redemptive narrative,” is the term, right? That they found a way to overcome that adversity in a way that their adversity is intrinsic to who they are as a person.

And so I would say to somebody with schizophrenia, “You're never going to be able to not have a life that isn't marked by adversity indifference, but that can be the very thing that is part of your redemptive story,” right? And so, to me, meaning and redemption would be a very important part of what I'd want to see in the outcome of schizophrenia.

Also, engagement. So a lot what we see with a lot of psychosis is a kind of hyper reflexivity, a preoccupation with one's thoughts and with one's voice is in a way that the person can't engage with people or with projects that would otherwise matter to them. So to me, a sign of health is that a person is reengaging. They're able to engage in projects that matter to them, into relationships. And so that would be a positive outcome.

And then the third thing I would say is just a person's recognition of their dignity, a sense of blessedness in their lives, a sense of the sacred in their lives, I think, would be an important outcome.

Grant: So another really interesting thing about your work, as I was reading through the papers that you sent me, was the extent to which you put mental health… You contextualize it within culture, economics, and power. So I want to explore that a little bit.

So my first question is: are SSRIs the key to keeping the workers in our knowledge economy from revolting against the emptiness of bullshit jobs?

Brent: Well, of course the first thing that comes to mind there is Huxley's Brave New World, right? The…

Grant: Soma.

Brent: Yeah, Soma. And I think there's something to that. Yeah. I mean, there's a couple thinkers that have influenced me in thinking about this. One is Aldous Huxley.

Another one is Erich Fromm. Eric Fromm, he talks about social pathology, right? In other words, what's normative within a society can be pathological. In what sense? Well, in that even if everybody in a society sort of accepts something as the norm, even if a certain behavior or disposition or a set of values is even socially rewarded and esteemed within a culture, it can be fundamentally destructive at its core. I mean, the easy target is the Nazis. But you could look at any society really, and probably find certain norms that are destructive.

And so I think one of the problems with, one of the concerns is that if you miss that, if you're not thinking about the social dimension, the way things that are normative can be pathological, then people can be sick. You can make people that are sick, and then when those people get sick, they go to a psychiatrist or they go to their GP or they go to a psychologist and they get a diagnosis.

And usually when you get a diagnosis, the implication is that there's something wrong with you. There's some malfunction within your internal mechanisms, whether that's your biology or your cognition or your emotions. There's something wrong with you. It's an internal problem.

And sometimes that's the case. I mean, sometimes there are biological causes of psychopathology and sometimes there are purely psychological issues. But a lot of times people are suffering because they're working within dysfunctional systems that are exploitative.

Bullshit jobs being a good example. You know, when people are being exploited, oftentimes people don't even have insight into that. They might not have any other experience of being employed in other settings. They might not realize they're being asked to do things that are detrimental to their health and wellbeing. And so if they start to feel sick mentally or physically and they go to the doctor, they might not even be linking those two things together, right? Working in unhealthy working conditions and their mental health.

So the problem is that in that case psychiatry, by sort of medicating the problem, ironically can collude with a dysfunctional system by helping somebody adjust to the dysfunction rather than coming to an awareness of a need for change. Like maybe what you need is not antidepressants. Maybe what you need is a union. You need to unionize.

Grant: Yeah. So if you were talking to one of your colleagues who's just sort of a standard psychologist or psychiatrist, and you said that their mode of practice, particularly the use of SSRIs was in service to multinational corporations, particularly exploitive capitalism. Would – blank stares? What would the response be?

Brent: Well, I can tell you firsthand, because I've had that experience.

Grant: Okay.

Brent: I've gone to APA and said that, and I've been doing that for a long time. In fact, when I was in grad school at Duquesne, I was a graduate student and, thank goodness it was my second experience at APA. Because I had a very good experience the first time I gave a presentation. I got a lot of applause and people liked it. Second time I came around, I talked more on this subject and, I'm not kidding you, like, about a third of the people in the middle of my talk got up and walked out.

Grant: Oh wow.

Brent: So, and I was like a second-year grad student at that point. So I was like, “My career is over at this point.”

Grant: Right.

Brent: Fortunately it wasn't. What I found is that over time there's been a shift especially within the last ten years where people are more attuned to this argument that I'm making. And more recently when I had a panel – this is about three or four years ago – I gave a similar kind of presentation along with a panel of other people. And was a group of young people that came up and said, “This is the best thing I've heard at APA. Why isn't everybody talking about this?” So there's a shift that's sort of happening there, I think.

But yeah, I would say most people don't like it. I've had a hard time – you probably won't be surprised that my work claiming that diagnosis can function as a scapegoat mechanism, it's not easy to get published.

Grant: Right. Exactly.

Brent: It's difficult to get it through the peer-review process.

Grant: And to your point, I've actually found, I make this argument from time to time in my Health Policy and Human Flourishing class about SSRIs, and how in many ways potentially the use of SSRIs is distracting you from a bigger meta problem that you need to deal with.

I've actually found that a certain proportion of the class gets very angry because I think they've sort of internalized that the SSRI is the only thing that allows them to function. And that may or may not be true.

But then I found an equally passionate group that that was in their heart and they didn't know how to express it because all the messages they're getting is “we don't want to stigmatize mental illness” and that sort of thing. But when I say it out loud, they realize that, “Oh, that's been exactly my experience and when I've been able to get myself off of these, I realize that there's this stuff that it was hidden. And once that I could deal with what was hidden, then it turned me towards flourishing,” right?

Brent: Yeah. Yeah. I mean, I had the same experience in my classes when there's a certain group of students who, it seems like they're very closely identified with their diagnosis, very central to their identity, whatever that might be: depression, attention deficit. They've gotten a diagnosis probably very early in life, and it's become very central to who they are as a person. And then part of that is “Because I'm this kind of person, I take this medication and by taking this medication, I'm caring for myself. I'm loving myself by taking this medication.” And that's been their experience.

And first of all, I don't doubt the authenticity and genuineness of that experience and if that's working for somebody and that gets them out of bed and allows them to function, more power to them. I'm not after those people to try to undermine their… If that's working for them. Good. I'm happy.

But I think that part of the danger there is that I worry that there could be a false consciousness, right, that can come along with that. Not in everybody's case, but maybe in some cases, somebody's been socialized to believe that and they've never really been exposed to another perspective.

And what I find often is when you introduce another perspective on some level, people recognize, “Oh, this is maybe a valid perspective that I haven't considered before.” And there's two ways that people can react to that. One, as you described, they can go, “Oh, you're giving words to something I've always kind of felt, but I never really thought of.” And then that opens up a new world to them, a new way of thinking.

And there's another way that people can react, which is defensively. And they get angry and they feel that you're personally insulting them. I've had some students write pretty scathing evaluations at the end of class, because I've simply raised these kinds of questions or had a reading that raised these sort of questions.

I've become more skilled in addressing those students in a way that I think they can hear me without feeling that they’re being discarded or discounted. But at the same time, like, “Hey, yeah, there's different perspectives on this and let's have a conversation about it. We don't all have to agree.” I have to sort of preface things with that remark for people to feel like I'm not going to stigmatize them or exclude them from or see them as sort of lesser-than, because they don't necessarily agree with a particular perspective that I'm espousing.

Grant: Yeah. This is kind of a personal question, but how do you emotionally respond to those student evaluations? It's taken me some time to – and I'm still sort of going through this process of accepting those sorts of student evaluations and maybe it being a sign of my ability to speak well, but they sting, don't they? They sting.

Brent: Oh yeah, they do. Yeah. Well, I mean, yes, I'm sure that anybody who teaches could relate to this. Negative teaching evaluations, you have always have an ambivalent relationship to, because you want the negative feedback to make your teaching better. But, they can be a boat of ego, and often students, they're not necessarily artful in the way that they mount their criticism. It can be very personal in the way that the person attacks, and wounding. So it can be pretty painful sometimes to read those when it's a personal attack.

So I try to look beyond the personal aspects and try to get to, “Okay, what can I learn from this comment to improve my teaching?” and not focus so much on the personal attack stuff.

And also I've learned that sometimes criticisms are really compliments, right? That sometimes the things that the students are criticizing me for, I think, “Okay, well I'm glad that disturbed them in some way because now they're thinking about something that they weren't open to. They're reacting defensively, but in time they might come around, you know?”

So I don’t necessarily… every time a student writes a negative comment, I change my class as a result of it. Sometimes if there's a negative comment, I actually see it as sort of a compliment. “Okay. I kind of ruffled this person's feathers a little bit, but that's good because they're thinking now about something that they weren't thinking about before.”

Grant: Right. Yeah. So I'm going to turn a little bit to this idea of scapegoating. You brought that up and I thought your arguments here were very compelling. So in what ways are the “mentally ill” sending us prophetic messages about the state of our sixth society? If so, what does that mean for practice?

Brent: Yeah. So, well, like I talked about in relationship to alienating work conditions, exploitative work conditions, you can sort of generalize that to any kind of social condition where people suffer as a result of that.

Now, I'm very influenced by René Girard in the way I conceptualize scapegoating. I'm also drawing from other people. Ernest Becker, in his book, Denial of Death. And Erich Fromm, who I mentioned earlier in the conversation. I’m kind of trying to integrate a number of different theories.

But Girard is really sort of the backbone of the scapegoat theory. And so what I think is really interesting about Girard, which shifted my whole way of seeing things, is that for him, the scapegoat is not somebody – usually when we think of somebody who's stigmatized or scapegoated, we think about them as somebody who's different, right? Somebody who's other than the norm. But actually what Girard says is what makes the scapegoat a target for scapegoating is not that they're other. If they were radically other, they wouldn't be a threat to the system. Because we would just say, “Oh, they're not one of us.” Right? What makes the person a threat to the system is that they take the logic of the system to its extreme, logical conclusion in a way that exposes the vulnerability of the system to dissolution, to chaos. And it undermines the legitimacy of the whole symbolic system.

And once you start seeing things that way, it was amazing. I just changed my whole perspective on things. So, and he wrote a book – not a book, he wrote an article on eating disorders, actually, which, that one was really important because I saw how he was thinking. And then we began to apply that to other diagnostic categories like substance abuse and even in the case of psychosis.

But eating disorders, that's really easy to see, right? You have a norm, right? That you could think of the thin ideal, right? The sort of objectifying of women in the culture, the pornographic culture that we live in. And then certain women take that ideal to its logical conclusion, right? They master their ability to be thin to such an extent that it becomes a life-threatening disorder.

And once we see the consequences of that, then it calls the whole symbolic system into order, right? Like the proper thing to do would be saying, “What kind of messages are we sending to young girls that they would think that this is the right way to behave, right?” That this would actually lead to flourishing. That would mean we would have to look at ourselves and see how we're contributing to that. We'd have to look at the way we portray images of women in the media. We'd have to look at the whole pornography industry and so on and so forth.

But typically, what we do is we see eating disorders as a disorder that's located within the person rather than within the social system that produces the person. And once you understand that principle, then you can apply it to really any diagnostic category. And it seems to work in many respects.

Grant: Right. So if we understand mental illness in this sort of scapegoating manner of sort of a manifestation of a sick society, do we run the risk of removing agency from individuals? And does that have some implication for when you're doing sort of interpersonal therapy and counseling?

Brent: Yeah. Well I think there is a way that this sort of scapegoating theory could be used in a way that does not appreciate or value a person's agency. It could be presented in a way that's disempowering rather than empowering for people. So I think there's always a danger anytime you're looking at the sociological dimension of…

Just like we talked about, biological reductionism, you can get a kind of sociological reduction, reductionism, everything gets reduced to social categories. And so we always have to be cautious of the both sides of that error, right?

Or a psychologism, right? That's another kind of reductionism, that the person is always, in some sense, it's all of those, we're biological, we're sociological, we're psychological, and we're also more than any of those, right? There's an excess in the person that's not reducible to any kind of theoretical system at the same time. And part of what's irreducible to any particular system is our capacity for agency, that we do have an ability to transcend our social moment.

And we can see many examples of that. And those are the people we tend to celebrate as a culture. Well, usually at first we don't celebrate them. Usually we crucify them and then we celebrate them later. First we crucify them, then we celebrate them. That's part of the scapegoating function, right?

But I think, yeah, so I would say that it's very important when we're talking about scapegoating and a scapegoating theory and we're looking at issues around stigma not to engage in that kind of reductionism. At the same time, experience is that people find it very empowering, right? Because if I start to realize, “Wait a minute, there's not something irredeemably wrong with me, right? My symptoms make sense within a larger social context.” And then you, essentially what you do is you empower the person to orient themselves in a different way within those social situations so that they can find a way to live, right? And people have power to change their circumstances to some extent. Some people more than others. Like I said, if you're being exploited at work and you lack insight into that, and you think your problem is depression and so you take a pill, but maybe what you really needed was to unionize or maybe just get another job, that's not exploitative.

I think there's often ways that we can improve our situation. Not always, but I think most of the time people can't – once they realize, “Oh, this situation is making me sick,” then that insight is transformative and empowering of the person's agency to work toward change, and that gives people hope, and hope is healing.

Grant: Yeah. So you mentioned the word “stigma.” As I was reading your work, I was really wrestling with your treatment of stigma, and I wrestle with the question of stigma quite a bit.

So in many ways human culture, and Philip Rieff sort of talks about culture this way, it really can be collapsed into a process by which we say “no” to some things and say “yes” to other things that we think are pro-social, right?

So in what ways is stigma an important tool for culture to sort of keep order outside of the power of the state? In other words, don't we need some kind of stigma to make our lives together work? So I guess another way to say, isn't stigma a good thing from time to time or doesn't have a good social function?

Brent: Yeah, it's a good question. It's a difficult, provocative question, and I've – let me think about that.

Grant: So let me give you an example I give to my students to sort of trigger what you're thinking is If I'm at dinner, we're at dinner with the McDermotts and the Sanchezes, and you pull out a crack pipe and you start smoking crack at the dinner table, don't you think it would be like a good thing for us to be like, “Brent, that's odd,” and we stigmatize that behavior at the dinner table, right? So, I mean, that's a silly example, but to a certain extent, doesn't that seem right? That there are certain behaviors that are stigmatized in a good way because it's both good for you, it's good for our community, and we just say, “Sorry. No, we don't need the police to keep you from smoking crack. We're just going to tell you that that's not appropriate within our social context.”

Brent: Okay. So I think the tricky part here is there's a certain ambiguity around the way the word “stigma” can be used.

Grant: Right.

Brent: So in my work, I tend to conceptualize dignity and stigma as being sort of diametrically opposed, right? I think, in an interesting way, you can link stigma to the concept of scapegoating in Girard in that literally, we talk about the stigmata as being the mark of the crucifixion on the hands of Christ. So stigma has a very powerful symbolic connection to scapegoating and persecution of the innocent and all those kind of things. So when I hear the word stigma, I tend to think it's a mark on the person. It's not necessarily about behavior, right? It's that it's a shame that is seen as “you are a bad person right now.”

I think that if I, if I was amongst my friends and I pulled out a crack pipe, I don't think they would stigmatize me in the way I just described it, right? I think they would love me, they care about me, and they're like, “What are you doing, Brent? This is not good for you.”

The problem with, I think, stigma and the way I defined it as being the opposite of dignity is I think we tend to give up on people that we stigmatize in that sense, right? We don't really see them as redeemable or valuable. We just see them as sort of less than human and discard them, or persecute them, or exclude them or exterminate them, right? So stigma in that sense is something that I see as just fundamentally unethical from a personalist perspective.

But here's the thing we often forget when we're talking about stigma and being concerned about other people, is stigma research is often concerned about the dignity of the person. And when we think about the dignity of the person, the first thing everybody thinks about is rights. You know, people have rights. And that's true. Dignity is the foundation for human rights. Really, the concept of dignity is the origin of the Bill of Rights in the U.S. Constitution. The United Nations’ Declaration of Human Rights, right, the preamble says that these are founded on the concept. It doesn't define human dignity or outline the anthropology and metaphysics that it's founded on, but it's there, in the preamble.

So rights are important, but what people forget is what alongside rights comes responsibilities. Part of our dignity – we can live beneath our dignity, right? In the sense that if I go around… I'm a father I have, I'm responsible for this graduate program that all my students are counting on. You know, we’ve got to keep APA accreditation, I have responsibilities. I have a wife, and I need to make sure that I'm holding up my end of the deal in terms of being able to pay the rent, and – well, we own a house, so pay the mortgage. So if I'm going around using a crack pipe, if I'm going to, hey, I'm going to go around doing crack, that's extraordinarily irresponsible, right? So in that respect, I'm failing to live up to my obligation and I'm living beneath my dignity. I'm not living up to my potential. And in a certain sense, that's a personal assault on my own dignity.

So if I'm engaging in behaviors that are harmful to me, in a certain sense it's a kind of self-hatred. It's a self-stigmatizing. It's a failure to appreciate my own dignity and live up to my full potential.

So that, in that sense, that's how I would frame it. So in a way, it's a kind of self-stigmatizing, when people are harming themselves and the loving and charitable thing to do is to intervene and help people to…

In Man’s Search For Meaning by Viktor Frankl, there's a passage in there that actually my wife and I had read at our wedding, where he describes love and it's a wonderful definition of love where he says that loving, and it's a kind of agapic love that he's describing. It's not necessarily romantic love or friendship. It's a love you can have for your enemies or for colleagues that you don't like or somebody who is engaging in behavior that's harmful to themselves or other people.

He says to love somebody is to see the potential in that other person and to help the person to actualize that potential, right, to work, and in a way that's not self-serving. So I'm not trying to help you actualize its potential because it's somehow going to benefit me. I'm not trying to bring something out in you because it's somehow going to serve me. I'm purely interested in your wellbeing for your own sake. That's love.

And so if I allow somebody to go around harming themselves, and I fail to intervene, that kind of indifference is a kind of callousness that's really the opposite of love. So, I see when you recognize the dignity of others, then you want to do everything you can to help that person to flourish.

Grant: So it seems to me that you're differentiating the stigma of a person, of an individual person, versus the stigma that we hold socially around particular behaviors, right?

Brent: Right.

Grant: And so, I see the sort of the apotheosis, is the word I'm looking for, of this sort of reflex sort of…

In San Francisco – I was there recently – and there's a sense in which we don't want to stigmatize mental illness, we don't want to stigmatize drug use. And then you go to the Tenderloin and it seems to be the epitome of this sort of sense in which we don't want to stigmatize this behavior, but there's a certain cruelty that seems to be existing in the streets of San Francisco when there's this confusion between stigmatizing the person versus stigmatizing the behavior.

Brent: Yes. Yeah, I agree. I think it goes back to that issue of rights and responsibilities. In the tradition, there's always a balance between justice and mercy, right? That in our attempt to emulate… We're made in the dying image, but we always fall short. And God is infinitely just and infinitely merciful. We tend to, in our own finite, sinful way, fail to reconcile that paradox. And so I think we always tend to fall on one side or the other. We tend to overemphasize justice or we overemphasize mercy. And I think it, in this sense, sometimes when we overemphasize mercy at the expense of justice, we focus on rights without talking about obligation and responsibility. And sometimes people are harsh and unmerciful in their emphasis on people's obligations and responsibilities.

You know, we can't forget, I’m, as a Catholic, that there's a preferential option for the poor and the vulnerable. So, the Church recognizes that we have to care for the poor and vulnerable. Christ says they're always going to be with us, as tragic as that is. And so mercy has to be operative, but at the same time, what does it mean to be merciful? Mercy doesn't mean not holding people accountable to their responsibilities. That the merciful, charitable thing to do is to recognize in the other person their full potential, their full humanity, and to do whatever you can to help them to be a virtuous person.

Grant: Right. So I want to discuss a little bit the idea of social justice within the world of behavioral health. So you use this word quite a bit in your work. And it's interesting, as I was preparing these questions, an article came across my email from the Free Press, which is the Substack run by Bari Weiss that was very, very critical of this idea of social justice within psychiatry and psychology, particularly this idea of what they refer to as “critical social justice.”

So when you use the term “social justice,” what do you mean? And is that different from the way your colleagues might use that word “social justice”?

Brent: Yeah, I mean, in some ways it… Let me tell you a story that was part of my story of me returning to the Church. It was sort of one of those things that got me oriented back in the direction of the Church.

It was like a Facebook group my colleagues – so my colleagues in society for humanistic psychology… Wonderful people, really wonderful, caring people. Brilliant, theoretically, sophisticated group. So people that I respected and admired. And we had a conference and I was hosting the conference. It was hosted at Point Park here in Pittsburgh. So the national conference came here. And I had a speaker, his name's Nathaniel Granger, an African American psychologist, who was very influenced by Martin Luther King, and he gave just a fantastic presentation on King's “I Have a Dream Speech” as part of the keynote. And so as a part of all that, we had a conversation about this issue of dignity. And then it sort of carried over on a listserv – or not a listserv, but on those Facebook groups where you can have conversations? So it was one of those Facebook groups and that was sort of how we would stay connected between these conferences usually.

And so we're having a conversation in the wake of this fantastic conference and this wonderful keynote. And I raised this question to my colleagues. I said, “What if the Nazis had won? What if the fascists had taken over? And anybody who really tried to make a claim for the intrinsic dignity of the person, for human rights, were simply eliminated?” So there's just the only people who left are people that say that there's some people who are deserving of life and there's other people who aren't. Right?

Grant: Right.

Brent: And the Holocaust just becomes a kind of everyday thing. It's just something everyone's come to accept. I said, “Let's imagine that world. There's nobody left to object to Hitler.” So I asked the question, “Does dignity still exist? If the idea of human dignity has been so suppressed that nobody ever remembers it, does it still exist?” And they all said “no.” So I was actually pretty taken back that people said “No, dignity wouldn't exist.” So then I went to my students, I went to my class. I raised the same question, and they said the same thing.

And so what I realized is they saw the concept of dignity as a socially contingent, right? That it was simply a social invention. It was just simply a mandate of the state, right? It's not something that is intrinsic to the person to such an extent that humanity itself would resist any attempt to suppress it because it's contrary to reality, right, to metaphysics and to our anthropology.

And that was when I realized, yeah, the social constructionism that I had sort of bought into was a problem. That's when I realized, “Yeah, no, I don't believe that.” And I was like, “So where does dignity come from?” And that's when I realized like, “Well, it comes from God because we're made in the image of God.” And that's when I was like, “Okay, maybe I ought to take this Church thing a little more seriously.” It was a wakeup call, you know?

So that's one of the things I think is a big difference, is I think that a lot of people who might call themselves “operating from social justice,” I think they see social justice as simply state-mandated ethics, and they don't see it as operating from some kind of metaphysical and anthropological ground. It's not, based in natural law. It's simply social convention.

And so, well, if that's all it is, if it's just a social convention, then well, to hell with it, right? Because if it's a social convention, then it's probably just whoever the elite is in power at the time gets to define whatever the good is. And that's never going to be in the best interest of those who are outside of power, right? Unless there's something objective about morality, then what good is it?

So I think that's the fundamental difference. And that's something that I really push with my colleagues: where is the grounding for your concept of dignity? And that's why I've introduced personalism as a way of mounting that argument. And as you can imagine, there's a resistance to that line of argument.

That's the probably simplest answer to your question. Yeah.

Grant: So the critique that was raised in this Free Press article that I shared with you is that when a lot of times people talk about critical social justice, what ends up happening is individuals’ experience gets collapsed into identity categories, right? Their experience is totally understood as their identity as black or gay. And it seemed to me that that would run counter to the idea of personalism, right?

Do you think, is that an important re-understanding of social justice that runs counter to the way that you understand social justice? Or do you think the free press piece is a mischaracterization of your colleagues in terms of how they understand social justice?

Brent: Well, I mean, I think there's a couple different responses to that issue. I think I could… Couple things I could say about that.

One is my experience with most of my colleagues is I think most people who are smart, who are really thinking carefully about what they're doing, do not buy into a kind of essentialism based on social identity. They recognize the fluidity of social categories that they change over time and over history. I mean, our racial categories: people who understand history go back and read texts in the Middle Ages, go back and read texts in the class of Greek. Nobody talks about race. It doesn't exist until the 17th century really. It's invented as a rationalization for chattel slavery, right? These social groups.

So, if African light-skinned people who are considered African-American in the United States are considered white in Latin America, right? Like, I mean, I'm not sure about this, Obama is fairly light-skinned black. Barack Obama, would he – I'm not sure – would he be considered black in Brazil or would they see him as white?

Grant: This is actually very relevant. I just got back from Argentina and we have a student who was biracial and someone actually said to her, “You're not black.” And she actually found that very offensive. But this person was actually trying to be complimentary, that “You would not be stigmatized in Argentina.” But again, because so much for identity, it's important for her that she is black, she found that very offensive.

Brent: Yeah, exactly. So gender categories, I mean, yeah, I mean, race in particular I think is very obviously a social convention that changes from time to time. And, so to essentialize people based on those categories is, I think, just to be ignorant of history and the facts of sociology.

But it's also unethical in the sense that when you see some, oh, you belong to a particular social category, therefore there's something the same you share something in common with all these people who are within that social category. I mean, that's the very definition of prejudice. I mean like I thought we were trying to get, the irony is that there seem to be some people who are trying to battle prejudice using the very tool, using the very conceptual tools in the basis for prejudice, which I find very paradoxical and ironic and counterproductive.

But I think the more sophisticated of my colleagues, I don't think fall into that trap; they don't fall into that thing. But I think there's a way that this gets in the way that these things get institutionalized legally. And that, or maybe in certain bureaucracies that it gets dumbed down and it becomes this kind of essentialism that, and I think some, there is some training in psychotherapy, for example, that says that, “Well, if you're working with an African-American client or you're working with somebody who's gay, then your job is to learn about that category so that you can work appropriately with this person.” And the danger there is, again, that's almost by definition introducing a kind of prejudice into the relationship, right? You go, “Oh, well I know about because I read this book, now I know about people that are gay, and now I'm going to come and work with this person.” And now you're not paying attention to what's distinctive about that person, right, what's irreplaceable and non-fungible.

To me, personalism is there's a number of qualities of personhood, and one of this is the irreplaceability and uniqueness of the person. And when you think, “Oh, I know who this person is, because they belong to these social categories,” Emmanuel Levinas, in “Totality and Infinity,” he would call that totalization. You totalize the person. “Oh, I know what you are: you're that kind of person.”

And if that's what social justice is, then social justice has become a kind of monstrosity. If social justice is about being open to the stranger, if it's about hospitality, if it's about love, then more power to it. But if it's about, “Oh, now we understand who people are because we understand their” –  no matter how much you want to get into intersectionality too. If we reduce people to their identities, whether intersectional identities or identities, then I think we're going down a dangerous path.

Grant: Yeah. So you bring up a really interesting point that I've been trying to flesh out, and I think you put words to it, is that, if you want to use the word “wokeness” or how it is sort of talked about publicly, I think the critique of the academy from an institutional perspective is probably right, that that’s sort of overtaken sort of the institutional structures of the university. So this idea of wokeness, right? But actually, within the intellectual lives of our colleagues, it's much more complicated than that.

Brent: Right.

Grant: I think that that's something that the general public doesn't totally appreciate.

Brent: Right. There's a lot of colleagues that I have who are good friends of mine, who I think people – or maybe, heck, people might label me with wokeness. I don't know. Depending on how they would use that category, I think some people would maybe put that label on me because of some of my lines of argument – But I can think of other people who would sort of fit that. Somebody would hear them talk, say, “Oh, this person's woke.” But I've worked with that person for a long time, and they have a very subtle, sophisticated way of talking. And when I hear the way wokeness is talked about in mass culture in the… I feel like that's a straw man. There's sort of straw man versions of those arguments.

But the danger of that is because people are listening to the mass media that has such an influence that it's beginning to influence a whole generation I think are starting to identify as so-called “woke” or sometimes buying the straw or… it's a weird thing. It's like the straw man is becoming a reality because it's almost like being socially constructed by mass media,

Grant: Yeah.

Brent: I think that's a dangerous thing.

Grant: Yeah, I think that's exactly right. And actually Abigail Favale, who I interviewed before, talked about this interesting way in which relatively, well, reductionistic, but otherwise sophisticated theory sort of enters Tumblr and then came out of something new and weird that sort of transfigured that academic argument, which was a wrong argument and it is theoretically wrong, but was more the theoretically sophisticated than what came out of Tumblr. And I think there might be something going on there, which is kind of interesting.

So I know we're coming up on time, so I have one more question for you. Is joy a hedonic or eudaimonic form of wellbeing?

Brent: Well, I would argue it's both. That, well, it depends on whether we're talking about state. If we're talking about the state of joy, as an emotional state, something that's transitory, momentary, then it's purely hedonic. But if we're talking about a joyful disposition, what I call the joyful life, the joyful life, I define as a – and this is based on my qualitative research – as really a consummation of flourishing that includes a hedonic component, eudaimonic and a kairotic component, which I'll explain.

So I think the hedonic, the pleasure of joy is a byproduct of the other two. So it's not something you're aiming for. What you're aiming for is a virtuous life. That's the eudaimonic.

And you're also, kairotic is a sense of life as being blessed, right? Which usually corresponds with a sense of awe, wonder, gratitude, those kinds of things. And Paul Wong has written some really good stuff on this. He talks about people that have eudaimonic wellbeing and a kairotic sense of wellbeing and are oriented to that, that's what they're looking for, he calls that a meaning orientation of wellbeing, as opposed to a happiness orientation.

So I see joy as a fulfillment of that meaning orientation, which as a byproduct of that comes a kind of hedonic wellbeing. Right? Yeah.

Grant: Well, Brent, that is the final question. I had a sneaking suspicion that this was going to be a really fun conversation and my suspicions were correct. So thanks so much for coming on. I'm looking forward to talking more about these things over drinks at the writer's group. So thanks so much.

Brent: Good. Well, thanks. It's been a pleasure. It was a lot of fun too. I had a good time.

Grant: Awesome. All right. Take

Brent: Take care, Grant. Bye-bye.