The Social Healer
Presented August 10, 2006 in a Symposium on
Empathy and the Creative Spirit: Toward Individual and Social Healing
At the APA Annual Meeting, New Orleans, Louisiana
by
Mitch Hall and Marc Pilisuk
Abstract
Psychologists are invited to address the social causes of the emotional disturbances they treat in their clinical practices. Such social factors as inequality, injustice, poverty, exploitation, isolation, and child abuse and neglect are viewed as traumatic causes, on an epidemic scale, of psychological problems. Unless psychologists work creatively as social healers in the realm of primary prevention, we will be relatively ineffective in reducing human suffering and enhancing health and happiness. The legacy of the pioneering preventive psychologist George W. Albee is remembered. The rationale is given for approaching emotional healing through the building of supportive relationships and interpersonal networks. Examples of creative social initiatives are given, as is the relevance of attachment research to social healing.
The Social Healer
Empathy and creativity are two fundamental aspects of the work that psychologists do in assisting people who have been traumatized. Empathy involves the ability to listen compassionately, accurately, and deeply to another person and to reflect back one’s understanding of that person’s experiences, perceptions, feelings, and needs in a way that helps the person. Creativity, in the psychotherapeutic context, involves nurturing the client’s initiatives to mobilize human and material resources to create positive change.
Every child or adult whom we assist is a cause for joy. Yet we tend to do little as psychologists to address the social epidemics that are creating so many victims. We may even contribute to their perpetuation by treating social ills as if they were merely individual problems.
This paper offers illustrations of social healing that go beyond the assistance to individuals who have been traumatized and that apply empathy and creativity to making this a world in which fewer people are psychologically maimed or made to suffer. If we can make such programs part of the everyday life of psychologists, then the profession will come closer to its mission.
Remembering George W. Albee’s Work for Social Healing
While this paper was in preparation, news (Washington Post, 2006) came of the death on July 8, 2006 of George W. Albee, a distinguished psychologist who was a pioneering proponent of social healing. A past president of the American Psychological Association and the author of dozens of books and hundreds of papers, Albee was an early advocate of preventive psychology. Throughout his career, he maintained the following:
Social evils like racism, sexism, ageism, unemployment, child abuse—indeed every condition in which inequalities of power prevail and exploitation results—are responsible for far more psychopathology than twisted molecules; that mental and emotional disorders are too prevalent for any society to provide sufficient practitioners to treat the afflicted; and that consequently the most effective and humane way to reduce human suffering is through primary prevention (University of Vermont Department of Psychology, 2006).
Regarding the pathogenic effects of poverty, Albee cited the research reported in Unhealthy Societies (Wilkinson, 1997) that found the following:
A society that has a narrower gap between the rich and poor has better health, significantly longer life expectancy, better mental health, fewer people in prison…In those countries with the widest gaps, you have the worst health and shortest life expectancy. Poverty is one of the major causes of mental and emotional problems (Lifelines, 1999, p. 2).
One can only speculate that the increasing gap between rich and poor, both within the United States and globally, was a grave concern for Albee in his last years. It is indeed a tragic predictor of an epidemic of emotional disorders, as well as material distress, that
by 1995, 1 percent of the American population owned 47 percent of the nation’s wealth; by 1998, the 400 richest individuals in the world had as much wealth as the bottom half of the world’s population (more than 3 billion people) (Berman, 2006, p. 14).
Furthermore, according to a U.N. report of 2003, about one-sixth of the people in the world were then living in slums, and trends made it likely that within 30 years one-third of the earth’s population would become impoverished slum dwellers (Berman, p. 63). As Albee understood it, the poor represent the group at highest risk for psychological problems. Therefore, he enjoined psychologists to be involved in social action to reduce, and ultimately, to eliminate poverty. This is a daunting challenge in an era of neoliberal economics and politics when huge multinational corporations--backed by U.S. military supremacy and the policies of the WTO, the World Bank, the IMF, and NAFTA--have free reign to maximize their profits at the expense of the earth and most of its people.
Regarding the noxious effects of child abuse and neglect, Albee affirmed the following:
If every child born was a wanted child we would significantly reduce the rate of mental and emotional disorders in the next generation…I think that if children sense in their bones that they are wanted, loved, and appreciated, they develop a great internal self-confidence that resists all kinds of stress (University of Vermont, 1996, p. 3).
Albee marshaled empirical data in support of his views on this, as on other subjects. The validity of Albee’s position on the importance to emotional health of having been a wanted child has been supported by large-scale, longitudinal studies conducted in Finland, Sweden, and the Czech Republic, with findings of decreased sociability and, in one study, higher risk for schizophrenia for individuals whose mothers had not wanted the pregnancy or the birth of the child (Odent, 1999, pp. 39-41). Traumatologists, attachment researchers, and neurobiologists have been contributing their ongoing research findings to the discussion of the effects of child abuse to which Albee contributed so richly. For example, van der Kolk (2003) cited the findings of a study involving approximately 10,000 medical patients. According to this study,
persons with histories of being seriously maltreated as a child showed a 4 to 12 times greater risk of developing alcoholism, depression, and drug abuse, attempting suicide, a 2 to 4 times greater risk of smoking, having at least 50 sex partners, acquiring sexually transmitted disease, a 1.4 to 1.6 times greater risk for physical inactivity and obesity, and a 1.6 to 2.9 times greater risk for ischemic heart disease, cancer, chronic lung disease, skeletal fractures, hepatitis, diabetes, and liver disease (van der Kolk, p. 168).
Albee was a proponent for the adoption of the U.N. Convention on the Rights of the Child, seeing it as an important primary prevention initiative. Sadly, two countries have not to date signed the convention, and they are Somalia and the United States. The good news, of course, is that all other countries on earth have ratified the convention in principle, and this is an indicator of a willingness of at least some policy makers to put it into practice. Seventeen nations, primarily in northern and western Europe, have taken a step beyond the convention by legally banning all corporal punishment of children (Global Initiative to End All Corporal Punishment of Children, 2006). It is regrettable that the American Psychological Association (APA) has not yet acted on a petition, written by one of us (Hall), signed by hundreds of psychologists, and presented on July 8, 2003 to Robert J. Sternberg, who was APA president, by Parents and Teachers against Violence in Education, requesting that the APA issue a resolution against all corporal punishment of children. The comparable professional association of American pediatricians has already made such a proclamation. The APA’s acting on this initiative would be a modest effort toward social healing through a resolute stand against this form of violence against children, which has even resulted, in the most egregious instances, in deaths.
Child abuse and neglect are, alas, highly prevalent in our country. On an annual basis,
“in the United States alone, at least 5 million children are either victims of or witnesses to physical abuse, domestic violence or community violence—all while they are bathed in the powerful images of television, which over-represent violent acts and over-value the power of violence as a solution to conflict” (Perry, 1997).
Psychologists need to be involved in primary prevention initiatives to reduce such horrifying levels of trauma to children through exposure to and the infliction of violence. Unfortunately, most psychologist are called upon to help at the levels of either secondary prevention, when mild symptoms of disorder are already present, or tertiary prevention, when significant damage has already been done and the goal is to prevent further damage and to contribute to whatever healing is possible. In a later section of this paper, some primary prevention initiatives on behalf of children will be discussed.
For 17 years, Albee directed the Vermont Conference on Primary Prevention. His colleague Lynne Bond on the University of Vermont psychology faculty said that the conference’s goal was to address the question “How do we structure our world to prevent the development of vulnerable people?” (Washington Post,2006).
In the perspective of many indigenous cultures, George W. Albee has now become one of our spiritual ancestors, and it is appropriate, in the context of a paper on The Social Healer, that we honor his life and work with heartfelt thanks for his important legacy. In the scientific perspective of psychology, it is equally important that we heed his call for us to be creative ourselves in our initiatives for the primary prevention of human suffering.
Interdependence
In discussing the theme of social healing, we may benefit from reflecting on the fact that humanity has evolved as part of an intricately designed planetary system, in which all parts, living and mineral, are interconnected and dependent upon one another. Other members of our species form a particularly important part of these connections. Through most of human history, individuals survived within groups of between 15 and 150 people linked by kinship, but also economically, socially, and spiritually connected, within a particular geographic niche where they found sustenance. Conscious thought, as a late arrival in evolutionary history, has taken note, in varied cosmologies, of this interdependence. However, the gift of thought has come with a great deal of flexibility in what we choose to include in the conscious worlds that we construct.
In several indigenous cultures, the interconnections of all that exists present a paradigm of thought that frames the meanings of life in daily actions. Likewise, the Buddhist concept of anatta, or no self, deconstructs the notion of a separate, independent person and posits, rather, that we are impermanent, changing, relational beings (Gier, 1995).
In most of Western medicine and psychology, the assumption has been made that the person is a distinct and separable object of study. Our efforts to understand the human being and to predict human behavior have focused largely upon attributes considered to be parts of the individual psyche. This has been true despite powerful evidence to show how interdependent we are with our ecology (Bronfenbrenner, 1977) our attachments (Bowlby, 1969) and our relationships (Belenky et al., 1986).
The dominant, individual-centered approach fails to take cognizance of the degree to which people are, in fact, interdependent, with fluid personal boundaries. Physiologically, we are, throughout all the stages of the life cycle from conception to old age, open-loop systems, unconsciously and mutually regulating and being regulated by the somatic systems of those people with whom we are in close relationships. These systems include “hormone levels, cardiovascular function, sleep rhythms, immune function, and more” (Lewis, Amini, & Lannon, 2000, p. 85). This process of interpersonal influence has been called limbic regulation because it occurs at the level of the limbic brain. Research on humans, primates, and other mammals, has demonstrated that physical touch is one of the essential mediators of such regulation (Harlow & Harlow, 1962; Montagu, 1971 & 1978; Prescott, 1975). When such touch is nurturing and occurs in the context of a close, emotionally supportive relationship, from the time we are babies onward, we tend to thrive.
A full understanding of an individual depends upon an appreciation of the nature, and of the degree, of that person’s connections with a broader sustaining ecology
and, in particular, with other people. When an individual’s health breaks down, there has often been a prior rift in the ties needed to sustain the person. One cannot view health holistically while ignoring the major factors that tear people from the interpersonal network. We understand health rather poorly without knowing the particular place and the people that give meaning to human lives.
When an individual suffers discomforting symptoms, it is possible to examine the source of the internal infection, the bodily organ working defectively, or the deeply embedded anxieties--all to be found within the person. This approach is extremely important for establishing a diagnosis and for prescribing a specific treatment. But if we follow the oft-cited admonition of Dr. William Osler, it may be more important to ask what kind of patient has the illness rather than what kind of illness has the patient (cited in Cassell, 1976). When we do, we find some remarkable similarities among patients experiencing the widest variety of physical and behavioral pathologies. Those who show one or more of a great variety of maladies, or who die prematurely, are more likely to have weaknesses in the web of supportive ties that represents their network. Those who might otherwise not be considered to be lacking in network ties typically move into the group with a high risk of breakdown, in some form, following a loss or disruption of their networks (Pilisuk and Parks, 1986; Seeman, 1996; Sagan, 1988; Achterberg, 1998). The form of the breakdown may vary from auto accidents to depression or suicide attempts, from hypertension or cardiovascular disease to digestive of respiratory problems, and the timing of the breakdown may be immediate or longer term, as in post-traumatic stress disorder (Pilisuk, Boylin, & Acredelo. 1987).
The importance of integration into a social network was noted in Durkheim’s classic study showing that suicide rates were higher among persons who were not married and who were not linked well to a church or community (Durkheim,1897/1997). The relevance of social ties to mental health was subsequently noted (Ware, 1956). Tolsdorf (1976) documented the weak and fragmented networks of psychotic patients. Now many studies confirm that people better integrated into a social network live longer (Berkman, 1995: Sagan, 1988) and are less susceptible to infectious diseases (Cohen, Doyle et al., 1997). They are more likely to survive a heart attack (Seeman, 1996) and to avoid a recurrence of cancer (Helgeson, Cohen, & Fritz, 1998). These effects appear even when controlling for risks associated with smoking, blood pressure, and obesity (House, Landis, & Umberson, 1988) and, therefore, highlight the importance of understanding and assessing social networks. The health-promoting or illness-preventing effects of special ties have been documented in work with monkeys, goats, mice and chickens (Pilisuk & Parks, 1986). Gradually, research in psychoneuroimmunology has provided evidence from controlled studies linking social support to health by documenting the particular changes within the immune system to be found when individuals are subjected to high stress without the buffering support of a strong interpersonal network (Kiecolt-Glaser et al., 1986)). This research is now quite extensive (Glaser & Kiecolt-Glaser, 1994) and has been related to a theory of what some have described as the fundamental power of love in the healing process (Green & Shellenberger, 1996; Lewis, Amini, & Lannon, 2000).
There is, however, a competing view for which some evidence has accumulated. It states that, while support may be helpful to mitigate the effects of stress, individuals become most vulnerable to some form of breakdown when they no longer have a sense of control over the challenges that they must meet through life (Syme, 1989). This thesis appears, at first glance, to take us back to the individual as the object of study. In other words, disempowered individuals are more likely to break down under the stressors confronting them. However, under closer scrutiny, we see that empowerment is a social process and not a personal bootstrap operation.
Within the fields of community organizing and community development, empowerment has referred to two phenomena. First, the term relates to the ability of poor and disenfranchised people to discover that they do have voices, and, second, it shows a process by which people are enabled to use their voices collectively to address their conditions. The latter is particularly important since it reminds us that power is a concept that takes its meaning in relation to how it is distributed. Those who lack power do so because some other people or forces have more power. Where one party gains power, others lose it.
Recent research about the health benefits of altruistic activism demonstrates that working for the good of the planet and of other human beings is good for the health of participants in pro-social action. This research is consonant with both the social integration view and the personal empowerment view of human health, as discussed above. Drury (2003) and associates conducted in-depth interviews of 40 activists from diverse backgrounds who had been involved in over 160 collective actions, including protests against war and environmental damage. The research revealed that the participants derived from their activist involvements long-lasting feelings of wellbeing and reductions of stress, anxiety, depression, and pain. A key to the benefits, according to the research, was the sense of unity, mutual support, and collective identity that the activists experienced from joining others in pursuit of the common good. Decades ago, Sorokin’s research (1963) had reached similar findings about the health benefits of creative altruism. It is important, however, to do what is possible to prevent and treat burnout, also known as compassion fatigue, which can mitigate these advantages.
In one study, three of the commonly used predictors of health status, i.e., social support, locus of control, and life stress, were used with a sample of older adults. All variables showed association with the reported presence of actual symptoms of illness. But, for the men in the sample, an increased sense of control and a larger network of friends distinguished males who were able to see themselves as healthy despite the presence of symptoms (Pilisuk et al., 1993). U. S. males are more intensively socialized to obtain mastery. When their control and their networks are in place, they are more likely to discount the importance of their symptoms, which helps to explain lower rates of medical care utilization among men. But for those who cannot sustain an image of control and support, such as those whose life has been marked by chronic unemployment, the low sense of control is internalized as failure and contributes to a decline in one’s image of healthfulness. This decline is even more rapid than the identifiable physical disorders and symptoms that ensue. The communities we label as at risk are filled with adults who see few options for giving in meaningful ways to a network they will need for their wellbeing. These adults oblige young people to seek their support from others who, like themselves, have been cut off from the supportive connections of a broader community. It is perhaps only a small jump from such studies to the conclusion that health-promotion is not only about the provision of treatment services or even preventive services. Health is promoted when communities use their voice to make known their health concerns and to act upon them (Wallack, 2005; Wallerstein & Bernstein, 1988).
If we are to conceive of the professional task as one directed in a fundamental way toward reweaving the web of relationships, three considerations should prove useful.
1) Networks, including both their strengths and the rifts and gaps within them, can be assessed and diagnosed.
2) The client for services can be redefined to include the context of a healing network.
3) The relationship of the professional is to a client who is no longer an ailing individual but an inadequately functioning set of relationships and resources.
The plotting of the web of exchange tunes us to look at individuals both as recipients of activities generated by others and as generators of activity as well. Precise networks of who is connected to whom can be plotted. The overall plot has a distinctive size and structure --densely or loosely interconnected, hierarchical or equally accessible to all, closed to specific groups or open to outsiders. The linkages can be described according to what flows between people--material help, companionship, or emotional sharing.
Functional or interactive qualities describe the relationship of pairs of individuals in a network. In this, we are looking not at the form of the web but at the qualities of the links. We examine such qualities as frequency of contact and friendship duration. In addition, the mode of contact describes the way individuals communicate, such as directly in face-to-face interactions or via telephone or email. Intimacy refers to how an individual describes the closeness of a relationship. Multiplicity refers to the number of different exchanges (emotional support, physical help, social contact, or money) that can occur between two individuals. Symmetry (Barnes, 1969) refers to the degree of mutuality or reciprocity in any relationship. Functional stability describes changes in the way in which the network is used over time. Surely ties may be strong or weak, intimate or formal, and reciprocal or unilateral. They may reflect single or multiple role relationships and may be hierarchically ordered in accord with power relationships. The links may be a source of companionship, emotional support or instrumental assistance (Pilisuk and Parks, 1986). Various scales and measures select aspects of the network of greatest interest to particular assessments. Some of the most important aspects of a network for health include elements of multiplex relationships (many types of exchange) and opportunities for reciprocation (Pilisuk & Wong, 2002). These are more often found in close or intimate networks and are considered critical in mitigating the trauma and subsequent breakdowns in health that are associated with grief or loss. However, the strength or weakness of ties emerges when clients need to “network” in order to find new resources to move on to a new job, a new living situation, or primary relationship (Granovetter, 1973). The more extended network can help the professional in the tasks of re-building building family networks, locating and strengthening the work of natural helpers, resolving disputes, building coalitions, humanizing places of work, and linking people facing similar challenges to one another.
These concepts may be viewed as central to the tasks of counseling and psychotherapy. Feminist theory places relationships at the center of human development and examines how disconnections occur and how therapy may be seen as an effort to deepen relationships. Miller and Stiver (1997) apply the principles to the cultivation of healing relationships in families and in therapy. But just as individual family members cannot be fully helped without attention to their dysfunctional families, families cannot be adequately helped without attention to the pathology of their communities, and communities suffer from the pressures of a global economy that must also be addressed (Weissbourd & Kagan, 1989). While professionals have an obligation to address larger policy issues, they also have a major role in facilitating the actions of local communities. Many of the practical interventions are grouped under the concept of capacity mapping and capacity building (McKnight & Kreitzman, 2005; Gutierrez & Lewis, 2005)
One question frequently raised is whether people who have been challenged deeply by years of isolation and alcoholism, by serious psychoses, by the learned helplessness of life in a ghetto or in a refugee camp, can truly be full partners in the restoration of their social networks, their neighborhoods, or communities. A number of studies note that schizophrenics treated in the developed nations as flawed individuals requiring pharmacological interventions show remarkably high rates of reintegration into normal roles in less-developed countries where they receive no drugs but are expected to return to normal roles within a caring community (Irwin 2004a and 2004b; Vedantum, 2005).
One project addressed another group of unlikely candidates for transformative efforts, the health of elderly residents in single-room-occupancy hotels in San Francisco’s Tenderloin district. The population includes a large percentage of old people displaced by the closing of mental hospitals. Many are socially isolated, afraid of mugging if they leave their rooms, and afraid of asking their landlords to deal with broken appliances and toilets, infested cabinets, unsafe and unclean stairwells. They share their surroundings with mentally and physically disabled younger people, recent immigrants, and the homeless in a section with high crime rates and three-hundred-times-greater population density than the rest of the city. The Tenderloin Senior Outreach Project (TSOP) began modestly with one-on-one conversations to address the serious isolation of aged and ill residents of one deteriorated single room occupancy hotel. It evolved into a coalition of tenants' organizations in 20 hotels. Twelve years later they were able to claim safer and better housing, merchant "safe houses" for protection against muggers, better nutrition, active social involvement, shopping chaperones, political activity on behalf of local immigrant groups (Cambodian and Vietnamese), access to the press and to the mayor's office, and regular training for and participation in political advocacy on issues from the local to the global (Minkler, 2005).
Redefining the Client
Viewing the embedding connections of people, we are able to shed the image of the client as an ailing person. Instead, we find a web of exchanges that punish some people, isolate others, and fail to provide sustenance to meet the physical and emotional needs of many. The client is no longer an abused or unfortunate victim but part of a threadbare social fabric that must be rewoven.
How does the Healthcare Professional infuse love and social connection? Love, or integration into a network of caring and reciprocal expectations, may be nurtured. It cannot be prescribed as if it were a particular pill or an added activity to be included on a checklist. The healthcare professional can, however, apply knowledge of its importance in several ways. At the client level, this involves a great deal of active search for the existing familial or community network and a willingness to work outside of the comfort zones of office or agency (Cohen et al., 2000). For example, PsycHealth, Ltd., a managed behavioral health care organization that serves low-income patients in the Chicago and Evanston area, has found that its home-based, psychotherapeutic intervention program has significantly reduced inpatient readmissions rates (Johns et al., 2006). Additionally, “wraparound” treatment programs for delinquent youth develop comprehensive support networks in the home, school, and community to give the young people the social connections that can help them to thrive (National Wraparound Initiative, 2006).
To the extent that health or behavioral problems were created and sustained by social dislocation, the remedies must include social re-integration. For the professional to make full use of the beneficial aspects of reciprocity and of multiplex or complex relationships, s/he needs to be sensitively aware of what networks are already in place and also what the clients have to give.
At the professional level, the context of helping may be critical. The remedies dispensed now add yoga, meditation, behavioral training exercises, and herbal remedies to the drugs and surgeries heretofore dispensed. But an important aspect of the individual-focused medical model persists among the providers of these complementary modalities of holistic treatment. The professional as a lone practitioner, overworked and disconnected from other practitioners, presents a poor role model for the client. It is a model of work that places the healer at increased risk of breakdown.
The cost to the natural helper may be even greater. Natural helpers play a large and often unseen role. As the population ages and life expectancy increases, the number of caregivers needed grows dramatically, and family members provide most care for the frail elderly. The situation of the typical primary caregiver exemplifies the burden entailed in taking on this responsibility. She (women far outnumber men in this role) spends an average of six hours and 28 minutes per day assisting with medication, personal hygiene, household chores, transportation, and shopping. The amount of instrumental assistance in care provision can be great. Forty-six percent of the caregivers are required to help the disabled person get in and out of bed. This can pose a tremendous problem to many caregivers who are themselves older people, and whose physical strength is seriously tapped in providing this instrumental assistance. A very high prevalence among caregivers of certain emotional consequences--notably depression, anger, and chronic fatigue--has been well documented When a spouse or parent becomes highly dependent, an inevitable change occurs in the family. The questions before the caregiver include: Is my relative in pain? Can I handle this situation physically? Am I doing enough? What does one do about incontinence, or passivity, or asocial behavior? An experience of grief over the loss of ability and of a relationship as it has been known often occurs. This grief differs from loss through death. Death is final and brings with it a closure to a relationship. Loss here is open-ended (Parks & Pilisuk, 1991). The point of the caregiver illustration is that natural helpers need the professionals and the society they represent to enable them to reduce the physical and financial burdens in order to permit family members to do what they do best, i.e., to provide love and companionship.
The egocentric view of personal health takes society off the hook. It also removes the hook that we professionals sorely need to be effective. Too often we stand helpless to address the rifts in a fabric torn by people being downsized at work, displaced by development or by long-term illness or disability, or caught in the destitution of deprivation. The rift in a supportive network may be from the disruptions of war, removing the soldier from home and family, killing some, permanently disabling others, disrupting family expectations for being a partner or a parent, and creating another generation of people bearing the symptoms of PTSD and unable to fulfill the promise of their attachments. In its wake are the displaced and uprooted refugees, mostly children, left without parents, or shelter or potable water.
Some poor communities, particularly some communities of color, have literally survived by the strength of their informal ties (Malson, 1983: Stack, 1974). But survival with a high level of suffering is more the norm. Poverty, defined both as a lack of critical resources and as a source of cultural adaptations to lives of struggle, also contributes to rifts in the supportive web that sustains health (Belle, 1983). Those who are poor are believed to be responsible for their lack of success. To be poor is not only to lack material things but also to experience the scorn of others and the often-internalized scorn of oneself. It is to see one’s circumstance as an incurable consequence of fate.
In Freire’s Pedagogy of the Oppressed (1990), the steps are laid out for how to teach by asking questions and by listening. As poor and illiterate peasants learn the signs and labels for common items they gradually come to realize that these symbols are constructions that were created by other people. Alternative constructions can be created to fit their own experience and the experience of their family, tribe, or village. Such constructions permit a perceptual world in which caring relationships are more securely in place.
Other projects elsewhere in the world have built community gardens on the rooftops of tenement houses, brought street theatre and free clinics to migrant farm workers, or mobilized communities to action against toxic wastes that were contaminating their wells. The best of these have gone on to organize larger constituencies of people more concerned with caring for humans than with expanding corporate markets. The best of these also share the joy, the creativity, the sense of closeness to the human community and the political will to stand up to those whose economic and political power have deprived communities of their health-generating connections and resources. Concepts of love, trust, kindness, caring, sharing, giving, receiving, influencing, teaching, belonging, and relating are important parts of the human condition that can only be studied, nurtured or appreciated by examining and enhancing each individual’s connections to others.
Attachment Research—Its Relevance to Social Healing
Attachment theory and research (Cassidy & Shaver, 1999) provide an important frame of reference for understanding the early childhood origins of our capacity for interpersonal connection and, hence, for contributing to social healing. According to attachment theorists, beginning with Bowlby (1969/1982), we are born with an innate, biologically determined attachment behavioral system that motivates us to seek proximity to specific people who will provide a safe haven from dangers and a safe base from which we can depart and to which we can return for our explorations of the wider world.
Under normal circumstances, the first attachment figure in the earliest stages of life is the mother. Our internal working models, as Bowlby phrased the concept, of self and others are implicitly established in the circuits of the limbic brain in the earliest periods of life, based on the quality of care we have received from our primary attachment figures. These models are implicit, unconscious, relatively persistent, and can only be changed through later, sustained attachment relationships, as in psychotherapy (Schore, 2003a), romantic relationships (Lewis, Amini, & Lannon, 2000), mentoring relationships, and friendships.
The caregiving behavioral system is complementary to the attachment behavioral system. To the extent that our own needs for secure attachment have not been met, our capacity to provide caregiving will be limited. The more securely attached we are, the more we thrive in all dimensions of our lives and the more inclined we are to help others thrive. The more abused, neglected, traumatized, marginalized, disempowered, unconnected, and violated we are, the less well we thrive and the less well we will be able to care for others.
Four primary attachment patterns have been observed through research: secure, anxious, avoidant, and disorganized. Secure attachment results from warm, consistent, nurturing, responsive, contingent, nonviolent parenting. The anxious and avoidant styles are organized adaptations to two styles of less-than-optimal, but not severely traumatizing, parenting. The anxious attachment style results from inconsistent--at times supportive and at other times intrusive or emotionally unavailable--parenting. Anxiously attached individuals have hyper-activated attachment behavioral systems and tend to be emotionally expressive in order to attract the attention and responsiveness from a caregiver. The avoidant style results from unresponsive, neglectful parenting. Avoidant individuals have de-activated attachment behavioral systems and tend to be dismissive of feelings. The disorganized style results from parenting that is extremely traumatizing, abusive, and/or neglectful. The disorganized style is associated with the most severe emotional disturbances and violent behaviors (Schore, 2003b). Unhealed early relational trauma, abuse, and neglect may lead to (1) insecure attachment, either anxious, avoidant, or disorganized; (2) greater risk for impaired physical, cognitive, and emotional functioning; (3) reduced capacity for healthy intimacy and relationship; and (4) lower levels of compassionate feelings and altruistic behavior.
In recent research, Mikulincer and Shaver (2005) found that “compassionate feelings and values, as well as responsive, altruistic behaviors, are promoted by both dispositional and experimentally induced attachment security” (p. 34). They affirmed that
“these studies and the theoretical ideas that generated them provide guidelines for enhancing compassion and altruism in the real world” (p. 34). In another research report, Gillath, Shaver, and Mikulincer (2005) reported similar findings to the effect that “being secure with respect to attachment—either dispositionally secure or momentarily secure because of experimental interventions—is associated with empathy and willingness to help others” (p.122).
One of the significant implications of this attachment research is that psychologists can play a role in furthering social healing by teaching parents how to raise securely attached children. Recently published books, (Gerhardt, 2004; Grille, 2005; Siegel & Hartzell, 2003; Sunderland, 2006) represent the efforts of psychologists who are cognizant of the findings of attachment research and of complementary neurobiological research to educate parents about the kind of childrearing that will help their children to thrive and to relate to others in empathic ways, thereby enhancing social health as well.
Beyond writing books and working with their clients, psychologists may also contribute to social healing by promoting parenting centers, informed by relevant attachment research. Two examples of such parenting centers follow.
In Boulder, Colorado, the physician Robert McFarland established, and has sustained for over two decades, community parenting centers (deMause, 2002; Linden & McFarland , 1993; McFarland & Fanton, 1997) with the goal of teaching parents of newborn babies how to raise their children in caring, nonviolent ways. The services of these centers include home visits, discussion groups, classes on baby massage, assistance to single parents, and more. Statistics from the records of local social service agencies, hospitals, and the police “show a substantial decrease in child abuse reports” (deMause, 2002, p. 432). McFarland calculated that the modest financial costs of the parenting centers are much lower than the expenses that the community would later incur as a result of child abuse. Becker (2001), as cited in deMause, estimated that “the cost to society of career criminal behavior, drug use, and high-school dropouts for a single youth is $1.7 to $2.3 million” (deMause, p. 432). McFarland sees child abuse and neglect as root causes of individual suffering, war, and social violence. He has proposed that parenting centers for “every community on earth can be supported by a small ‘children’s tax’ of one-tenth of one percent in the sales tax” (deMause, p. 432).
In an inner-city community of Los Angeles, Ruth Beaglehole directs the Center for Non-violent Education and Parenting (CNVEP). Like McFarland, she believes there are strong connections between how children are raised and the overall health of a society. Beaglehole is originally from New Zealand. After several years of working as a nursery school teacher, a childcare center director, and a parent educator, she founded the CNVEP in 2000. The center serves approximately 3,000 parents a year, with a staff of 17, including nine full-time parent educators, one part-time educator, four child care providers, an administrator, a development director, and a part-time office assistant. The services that the CNVEP offers, in both Spanish and English, include parenting classes; bi-monthly days of dialogue on building safe havens for children, peaceful communities, and a world of peace and justice; individualized family support; training and workshops in nonviolent philosophy and research; childcare; a resource center with books, pamphlets, and curricular materials; teacher training; public speaking, and more. Parenting classes are offered at the center itself and at about 25 other community-based organizations per year. These organizations include public schools and shelters from domestic violence. Participating parents come from working class and middle class backgrounds. One parent wrote about how her study of nonviolent parenting has been positively transforming her life. This mother said she learned how to appreciate conflicts with her children, which are inevitable, as opportunities to recognize their needs and to reflect on “the words we use, the use of silence, what our bodies convey, expressing in the language of feelings and needs, understanding limits and boundaries, what we value and why, a never ending font of moments for connection” (Beaglehole, personal communication, July 18, 2006). Furthermore, the mother, after two years of CNVEP involvement, was seeking to start a discussion group with other parents about nonviolent parenting. This is an excellent example of social healing with regard to childrearing and the shift from an old paradigm of parenting, based on punishment and control, to a new paradigm, based on nurturance and the kind of nonviolent connection and attentiveness that promote secure attachment.
The Internet is being used as a tool for social healing as well. In the case of the prevention of child abuse and neglect, for example, organizations such as Parents and Teachers against Violence in Education (PTAVE) (www.nospank.net), the Alliance for Transforming the Lives of Children (aTLC) (www.aTLC.org), and the National Organization of Circumcision Information Resource Centers (NOCIRC) (www.nocirc.org) are making information available, with regard to their respective missions, and entering into supportive dialogue and social actions with people around the country and the world.
PTAVE’s director, Jordan Riak, has assembled a vast amount of documentation on the issue of corporal punishment (CP) and has been a leading campaigner for the abolition of CP from the schools, as well as the homes, of America. He wrote the legislation that banned CP from the public schools of California and has led campaigns to that end in other states. CP is still practiced in the schools in 22 states ( HYPERLINK "http://www.nospank.net" Center for Effective Discipline, 2006), and African American children are two-and-a-half times more likely than white children to be “paddled,” as these school-based beatings are euphemistically called.
The Alliance for Transforming the Lives of Children (aTLC) advocates an approach to parenting that its founders believe supports the secure attachment of children and, thereby, can prevent untold future suffering for both individuals and society. One of the aTLC founders, John W. Travis, M.D., has been credited with being the founder of the wellness movement in modern American medicine. He was the first M. D. to open, in 1975 in Mill Valley, California, a center dedicated to promoting wellness rather than to treating illness. The Wellness Workbook (Travis & Ryan, 2004) was published to offer readers access to the wellness work pioneered at the center. Travis subsequently came to the conclusion that even wellness interventions with adults were too late because of the damage previously done at the beginnings of life due of insecure attachment. Therefore, he networked with likeminded professionals and co-founded the aTLC, which focuses on primary prevention. The Alliance consists of over 100 Affiliates, including PTAVE and NOCIRC.
NOCIRC is directed by Marilyn Milos, a registered nurse who became alarmed during her nursing education when she witnessed the trauma suffered by infant boys who are gratuitously subjected to routine penile circumcision. Milos educates others about this issue through her web site, publications, videos, NOCIRC-sponsored conferences, court appearances on behalf of families whose babies have suffered adverse effects from circumcision, and classes. A slogan that she uses brings out the implications of this issue for her: “circumcision—where sex and violence first meet.” Milos’s campaign against routine male circumcision as a ritual of genital mutilation is another example of primary prevention. While Riak, Travis, and Milos are not themselves psychologists, they draw upon the research of psychologists to support their well-informed activism.
Further Implications of Attachment Security for Social Healing
Numerous studies support the social and political, as well as psychological, significance of promoting attachment security for children as a pivotal social healing intervention, to be considered along with others, such as eliminating poverty, racism, sexism, and homophobia. Milburn and Conrad (1996), two social psychologists, presented experimental and clinical evidence to support their contention that “many of our political attitudes, particularly those we feel strongly about, have their source in childhood” (p. 69). Punitive political attitudes, including a tendency to favor war as an instrument of national policy and capital punishment, were found to be correlated with punitive upbringings and to serve as venues through which people, especially males who have not benefited from psychotherapy, displace their childhood anger onto political issues. A side benefit of psychotherapy for males raised punitively was found to be a reduction in punitive political attitudes. Therefore, it can be argued that each person who benefits from psychotherapy is likely to address social and political issues in a potentially more compassionate way. Thus, individual psychotherapy, as secondary or tertiary prevention, serves to promote social healing, at least on a small scale, client by client. Furthermore, parents who benefit from psychotherapy are less likely to act (unconsciously) in ways that result in disorganized attachment in their offspring due the parents’ unresolved traumas that are nonverbally transmitted even by non-maltreating parents (Hesse, Main, Yost Abrams, & Rifkin in Solomon & Siegel, 2003).
Compelling evidence for the relevance of secure attachment to social healing and primary prevention is found in the work of Samuel and Pearl Oliner (1988), two sociologists, who wanted to understand the motivations of gentiles who had risked their own lives by becoming rescuers of Jews during the Nazi holocaust. Forty years after the end of this genocidal period in European history, they conducted and interpreted, both qualitatively and quantitatively, in-depth interviews of 700 persons who had lived in Nazi-occupied Europe. The subjects of the research included 406 rescuers of Jews, 126 non-rescuers, and 150 survivors. What motivated the rescuers? The Oliners identified three primary sources of their altruistic motivation: “heightened empathy for people in pain, internalized norms of social groups to whom they were strongly attached, and for a small minority, it was a question of loyalty to overriding autonomous principles rooted in justice and caring” (1988, p. 249). Many of the most important features distinguishing rescuers from non-rescuers related to how they had been raised. The rescuers were raised with “close family relationships in which parents model caring behavior and communicate caring values” (p. 249). Discipline in these families was described as “lenient” and “almost imperceptible” to the children. In order to help the children to distinguish right from wrong, the parents communicated with the children, provided lots of reasoning and explanations of “why behaviors are inappropriate, often with reference to the consequences for others” (p. 249). Physical punishment was rarely, if ever, used in the rescuers’ families of origin, and, if used, was never gratuitous or a means for the parents to act out their own frustrations and aggression. “Parents set high standards they expected their children to meet, particularly with regard to caring for others…in a spirit of generosity, without concern for external rewards or reciprocity” (p. 249). The parents’ own behavior was congruent with these standards. In other words, the parents were good and consistent role models. They did not shame the children. They pointed to failures as valuable learning experiences, rather than as evidence of character defects in the children. This kind of childrearing provided security to the children who later became rescuers, a strong sense of family attachment, and an internalized sense of self-worth. Out of such families of origin the rescuers of Jews in Nazi Europe emerged. Having been cared for with loving-kindness, they learned to extend such care to others, even to stigmatized strangers.
By contrast, the bystanders whom the Oliners studied had weak family attachments throughout their lives. In their childhoods, parental “discipline relies heavily on physical punishment, …often routine and gratuitous” (1988, p. 251). The parents engaged in little reasoning and explaining. “Family values center on the self and social conventions; relationships with others are guarded and generally viewed as commodity exchanges. Stereotypes regarding outsiders are common” (p. 251). The non-rescuing bystanders tended to be insecure and suspicious of others. They had limited information and limited social skills, and also encountered little diversity in their lives because they avoided interactions with people from different backgrounds. Similarly, Miller (1983) and deMause (2002; 2006) documented that harsh, violent, traumatic upbringings were, too often, the norm for the generation of Germans and Austrians that became the perpetrators and bystanders of the Nazi holocaust. The Oliners’ research, along with that of Miller and deMause, validates the importance for primary prevention and social healing of promoting attachment security through caring, nonviolent childrearing.
School Interventions
Another locus for preventive psychological interventions and social healing is the social institution of the school. For example, the psychologist Cowen and associates found that first-grade children were able to identify their classmates who were most at risk (Cowen, 1995; Cowen et al., 1996; Cowen et al., 1998). Adult volunteers then befriended and mentored the at-risk children in relationships that were sustained over time. This program of secondary prevention was instituted with positive results in hundreds of schools around the country.
Levin (2003) developed a well-regarded, psychologically informed approach for teachers to build peaceable classrooms to provide safe havens and teach emotional coping skills to young children living in violent times and circumstances. The Australian psychologist Grille (2005) reported on classroom-based projects that are based on attachment theory. In such projects, emotionally available teachers provide a secure emotional base, which helps at-risk children with disruptive tendencies to feel safe and to relate more sociably. The International Democratic Education Conference, with representatives from about 25 countries,
agreed that Article 26 (2) of the International Declaration of Children’s Rights, which is directed toward freedom, tolerance and understanding, constitutes a working framework for the day-to-day practice in democratic learning environments. In a nutshell, this means that students are given a vote over curricular and administrative decisions that affect their lives (Grille, p. 381).
Democratic schools, in countries as far different from each other as Japan and Israel, have been found to reduce the incidence of bullying, prejudice, distrust, and violence. Such innovations contribute at the level of the school toward social healing.
Summary Review
A premise of this paper is that psychologists need to become more involved in primary prevention with regard to the social causes of mental and emotional disorders. The paper has explored many facets of social healing.
First, the life’s work of the recently deceased psychologist George Albee was reviewed in tribute to his pioneering contributions to social healing. Then, evidence of the interdependence of human beings upon one another for physical and emotional wellbeing was reviewed. In view of this evidence, the individual-centered approach of most of Western psychology and medicine was critiqued as being inadequate and as inadvertently contributing to the problems of human suffering as much as helping to solve them. The social integration theory of health was documented and was reconciled with the personal locus of control theory of health. Research on the health benefits of altruistic activism on behalf of ecological balance, human rights, and peace was cited.
The primary professional task for psychologists was posited metaphorically as being a reweaving of the tattered web of interpersonal relationships. Principles were given for mapping relationship networks.
Evidence was cited in support of the assertion that even seriously challenged people benefit when their relationship networks are renewed. One successful project occurred among elderly residents in single-room-occupancy hotels in San Francisco’s Tenderloin district.
The psychologist’s client was redefined as being the threadbare social network rather than the emotionally ailing individual. Examples were given of a psychotherapeutic home intervention program and a support system for troubled adolescents. The issue of compassion fatigue, for professionals as well as for natural helpers, was addressed, along with suggestions for approaches to reducing the risks of this syndrome.
The challenge of being poor was highlighted, and the resourcefulness of those who are poor but who manage to cope and survive through nurturing networks was celebrated. Freire’s pedagogy of the oppressed was noted as a popular education initiative that empowers previously illiterate people and helps them to discover their capacity for interpreting and changing their social, political, and economic contexts. Several other examples of social healing were also noted.
The relevance of attachment research to social healing was then discussed. Fundamentals of attachment theory were reviewed. Attachment security was found through research to be a predictor of a higher likelihood of compassionate feelings, empathy, and altruistic actions. Those with insecure attachment status have greater difficulty activating their caregiver behavioral systems. Recent publications of psychologists to educate parents about the findings of attachment research and neurobiology were cited as an initiative to contribute to primary prevention and social healing. Two exemplary centers dedicated to educating parents in the ways of nonviolent, nurturing childrearing and to promoting secure attachment were described. Following this, three children’s advocacy organizations, with similar missions all related to reducing harm to children and increasing attachment security, were reviewed, and their use of the Internet as a networking tool was cited.
Further evidence of the relevance to social healing of nonviolent parenting was given with reference to research on the connections between punitive upbringings and punitive political attitudes as contrasted with the connections between nonviolent upbringings and altruistic actions. The Oliners’ (1988) compelling and historically important research on attachment security in nonviolently raised adults who had been rescuers of Jews during the Nazi holocaust was reviewed.
In the last section, social healing interventions in schools were discussed. Only some of the many possible initiatives in which psychologists could engage for primary prevention and social healing were covered in this paper. It is hoped that readers will find inspiration to identify their own ways of acting, in concert with others, to heal society and thereby to prevent the emotional and mental disorders that psychologists are professionally dedicated to healing.
Concluding Remarks
The challenges to social healing that are before us are daunting. Whereas we have seen that supportive interpersonal networks are essential for physical and emotional health, some indicators show that the web of human connection is further unraveling in our society. Parents, on the average, are spending significantly less time with their children now than they did three decades ago (Berman, 2006, p. 18). The press recently gave wide coverage to a sociological survey that found that most adults can talk about serious personal issues with only two other people, and that “one-quarter have no close confidants at all” (Fountain, New York Times, July 2, 2006, p. 12). One reason for Americans’ spending less time with friends, family, and children is that, by 2000, the average American couple were working seven weeks more per year than they had worked three decades earlier (Berman, p. 18). From 1973 to 1994, “tens of thousands of community groups disappeared,” and “one-third of our social infrastructure vanished” (Berman, p. 45). Whereas in 1964, 77 percent of adults who were “interviewed said that most people could be trusted,” “by 1993, 63 percent stated that most people couldn’t be trusted” (Berman, p. 45). These trends, along with the widening gap between rich and poor, denote a breakdown of sustaining social connections and predict increases of emotional disturbances, as well as physical maladies.
While the poor are most at risk for psychological disturbances, those among the affluent who focus on material success as a measure of their human fulfillment also fare poorly in terms of emotional health. Kohn (1999) reported on studies that found the following: “Those who aspired to affluence also had more transient relationships, watched more television and were more likely to use cigarettes, alcohol and other drugs than were those who placed less emphasis on extrinsic goals” (Kohn, p. F7). Such people showed high levels of anxiety and depression. Eighteen-year-olds with a primary focus on financial success were likely to have been raised by cold, controlling mothers who were not nurturing. Evidently, attachment insecurity is one of the roots of the notorious materialism of U.S. culture.
As psychologists who understand the primary importance of warm, nurturing, supportive human relationships at all stages of the life cycle, we have a responsibility to find ways to make the findings of our research about the sources of human health and happiness more widely known and influential. We also need to move more and more into the active arena of primary prevention. It is this inconvenient truth that is George W. Albee’s legacy to us. If we are to live up to the promise of our compassionate, professional calling to heal suffering humans, we need to find practical, empathic, and creative ways to achieve social, in addition to individual, healing.
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