IN THIS ISSUE
By Miraj U. Desai, MA, and Nate Koser, MA
Humanistic revolutions: the case of Sangath and India
Miraj U. Desai, MA, Fordham University
There is a humanistic revolution happening, and it's happening worlds away. This revolution—focused on humane values, social justice, and sound research—is taking place in India under the leadership of Sangath, a mental health NGO based in Goa. Guided by the philosophy of “People's health in people's hands,” Sangath has focused on bringing culturally sensitive health care to the people of India, where resources are scarce but the problems often immense.
With the understanding that the Western model of specialized care is simply unfeasible in a place like India with relatively few specialists and a population of over 1 billion, Sangath's team has argued for a radically different model of care. Specifically, they have advanced the idea that the developing world needs effective, community-based programs, staffed in part by non-expert members of society. The role of the practitioner becomes that of the mentor, and the role of the researcher becomes that of the psychologist-anthropologist-epidemiologist-phenomenologist (among other things). The scientist-practitioners’ energies are focused on skills-training, capacity-building, creating partnerships, empowering those in need, and employing the most sophisticated methodologies available for program evaluation—all hallmarks of a 21st century humanistic praxis. In other words, the person comes first.
Key phrases in this movement are task-shifting and scaling-up. Task-shifting is quite literally shifting the task of care beyond specialists to everyday members of society; scaling-up is increasing the availability of effective care to match overall need. Far from simple hypotheses, task-shifting has proven effective for addressing everything from HIV/AIDS to depression. Finally, Sangath has even gone “beyond evidence” to argue quite persuasively about the moral case for addressing all forms of human suffering, not just the physical kind. Whether they are of mind, body, soul, or spirit, suffering is suffering is suffering.
Over the last 2 years, I have had the opportunity and privilege of working with Sangath on a project investigating the phenomenology and epidemiology of autism spectrum disorders (ASD) in India. I remain humbled by the parents who let me into their lives, and had the honor of presenting the story of one such mother at this year’s APA convention in San Diego. In brief, her journey entailed directly facing uncertainty and conflicts regarding her child's difficulties, while also transcending these struggles through care, duty, and hope. Her child’s future remains indeterminate, but the mother is committed to broadening the child's life horizons as far as possible, using all available resources. The mother’s journey is far from over, as she continues to advocate for an improved social security system in India for special needs children and greater sensitivity to the challenges facing such families.
When I presented the poster to my colleagues in India, they specifically focused in on how just one narrative can tell so much about the lives of these families. This is important in the developing world where resources are scarce but an in-depth understanding of a few participants can go a long way. My colleagues also rightfully cautioned that cases like this mother’s, while valiant, do not necessarily represent many families, who either lack or refuse basic care for their family. Overall, the challenges facing the developing world are complex, highlighting the need for continued human scientific research and practice.
Correspondingly, there is much in the humanistic psychology community that can aid this process: a long history of empowerment-based practice dating back to pioneers like Rogers; a focus on empathic immersion in the lives of persons; methodological diversity, including phenomenology, hermeneutics, and narrative; cross-cultural and transpersonal studies; and, finally, a strong commitment to social justice.
In sum, to those committed to a global, reflective, and modest humanistic vision, one message is clear: Time to lend an ear and, if asked, lend a hand.
For more information regarding the work of Sangath or the autism project, please do not hesitate to visit Sangath's website at http://www.sangath.com or contact me at email@example.com.
On human encounter
Nate Koser, MA, Saybrook University, Horizons Counseling and Consultation, Eastern Mennonite University
What is the nature of human beings that two persons can communicate, can grasp each other as beings, have genuine concern with the welfare and fulfillment of the other, and experience some genuine trust. (May, 1983, p. 19-20)
Each and every man is at the same time separate from his fellows and related to them. Such separateness and relatedness are mutually necessary postulates. Personal relatedness can exist only between beings who are separate but who are not isolates. (Laing, 1969, p. 26)
It is time for our session. We had met numerous times before and I had gained some loose semblance of knowledge about her past, her relationships, and her current concerns; although, it was never quite clear what “it” was that she had come to process. I had begun to get a relative clinical picture and a vague sense about who this person is, but because her messages are often cryptic and enigmatic, I have to rest on the foundation of the experience itself. As May (1958) articulated, “when we seek to know a person, the knowledge about him must be subordinated to the overarching fact of his actual existence” (p. 38) -- immediately and contextually. This is where we begin.
She comes into the room, sits down on the couch, and begins to settle into her seat. She glances up at me and pauses. I wait. I notice the slow, silent spread of redness wipe up and over her barely visible chest, her neck and throat, and eventually her taunt, frozen face. Her eyes widen behind her glasses and she directs them to the shadowed corner of the room. My presence needs to be averted. I get the message. She seems terrified and shaken. She is frozen yet on the edge of explosion.
I feel myself becoming more focused. The world around me begins to melt away. My thoughts dissipate and my attention sharpens. My stomach tightens, and then goes loose. My breath begins to slow. The heaviness of the room weighs on my shoulders, and the poignancy of the moment becomes a palpable presence. Her eyes turn and meet mine. For a moment we stare at one another. The silence becomes thick and pulsing.
She tries to speak and I can see the corners of her mouth begin to drop. Her tongue darts and presses against her cheek, her eyes widen further and shoot up to the ceiling -- she begins to quiver. I can feel that she is on the edge of something. I can feel that she wants to engage, but is being swallowed up. She looks back at me in her frozen terror. This is our kairos. It is time.
The Therapeutic Moment
I can not let this moment escape us. We -- being “human, all too human” (Nietzsche, 1996, p. 5) -- may try to ignore it, deaden it, and turn away. Working from an existential perspective, I know that these moments present tremendous opportunities for therapeutic movement. They are pregnant with the deeper reaches of human experience, and it is into such realms that the existential therapist helps the client journey. These moments are subtle, evocative, and daunting. Such instances are easily lost -- they are easily neglected. However, in them lie the most intimate struggles. It is here that we rub up against the concerns we all must face.
I lean forward, gaze toward her intently, and give a slow nod. I reflect that I notice she is struggling. She seems to stagger back. She becomes chocked up, bites her lip, and puts her hand to her chest. She presses: “It’s right there. I feel like I am going to lose it. I feel like I want to run away.” The chaos has emerged. Again, I let her know that I am there and that this is important. With my entire presence I try to show her that this is what we are to deal with. I ask her to stay with this experience.
Moments such as these, hinge on the therapeutic relationship. She has come to the edge, and as Nietzsche (2005) opined: “not the height: the precipice is terrible” (P. 123)! In her eyes I can read the question of whether I would be willing to venture further. Will I be there? Can she trust me? I know her past will lead her to answer in the negative, and it is this past we have to navigate. Her past may suffocate her.
I feel the silent, non-verbal questions hanging in mid air. I realize again -- as Mendelowitz (2006) had, citing Kafka -- that: “The road from appearance to reality is often very hard and long, and many people make only very poor travelers. We must forgive them when they stagger against us as if against a brick wall” (p. 390). This will be our Dantean decent; these, the questions requiring an answer.
It would seem that any psychotherapy/therapist claiming to be existential must attend to the profound implications of human-to-human relationships. This is the foundation upon which the therapy is built -- perhaps even life itself, and our realities (Buber, 1970). It is this very meeting between human beings that creates the space for transformative growth. This human meeting creates the “holy void” (May, 1981, p. 182) in which I and Thou may find kinship.
Along with the journey into the inner depths of struggle, in psychotherapy we seem always already engaged in (re)negotiating this intimate human exchange. Before any technicalities and systemic protocols, May (1983) urged us to recognize that “in the therapeutic hour a total relationship is going on between two people” (p. 21) -- a total, raw experience, from which we create all our theoretical abstractions.
Now, in this shuddering moment, I see that not only is the client peering into her abyss, but together we have come also against her relational past. Here “participating always involves risk” (May, 1983, p. 20). At this moment we stand at the edge of that fateful circle of life, and “if [she] at that moment sees to [her] horror how in these limits logic coils around itself and finally bites its own tail – then the new form of knowledge breaks through, tragic knowledge” (Nietzsche, 2000, p. 84). This being knowledge we so often keep in hiding -- knowledge showing a “profound respect for the human being and a devotion to his rights and destiny” (May, 1953, p. 51).
This new opportunity becomes a tangled knot of the past, present, and future; fears, desires, and expectations. This is “being against the possibility of nonbeing” (May, 1983, p. 18). This is an interweaving, which if new growth is to occur, must be in some ways untied. As Laing (1969) suggested:
The art of understanding those aspects of an individual’s being which we can observe, as expressive of his mode of being-in-the-world, requires us to relate his actions to his way of experiencing the situation he is in with us. Similarly it is in terms of his present that we have to understand his past, and not exclusively the other way around. (p. 32; italics added)
In rapt, anxious waiting, she glances back up at me. I mirror back that there seems to be something terrifying her; something she feels impossible to engage, now, in this moment. We turn back to the immediate dynamic of our encounter. She says pointedly in return: “I don’t want to go there. I don’t want to show you how I am really feeling. It is disgusting, stupid, and worthless. I am not worth your time. I should just get over it myself.” With this she alludes to her pain; yet, she also shows me a sense of her experience with relationships. How will this encounter be different?
She shows me that hers has been a life plagued with painful, alienating human exchanges. This is the suffering voice of exile searching for dwelling and companionship. However, I hear the somewhat subtle whisper of “primary ontological insecurity” (Laing, 1969, p. 39) -- a reminder that “the ontologically insecure person is preoccupied with preserving rather than gratifying” (Laing, 1969, p. 42). Her ambivalent reaching is a means of communication from an insecure, yet still-secure impenetrability -- one needing an echo. Here she “dreads relatedness as such…because [her] uncertainty about the stability of [her] autonomy lays [her] open to the dread lest in any relationship [she] will lose [her] autonomy and identity” (Laing, 1969, p. 44).
With whatever concerns are present for her at this moment -- whatever terrifies her, impinges upon her, and creates such a poignant response -- reminiscences have also bubbled up to cloud the waters of our immediate encounter. It seems as May (1983) had intimated: “transference is to be understood as the distortion of encounter” (p. 19). This moment has become one in which both the present and the past have become illuminated -- time is now Janus faced and more explicitly unified. I see her breathe as if to speak; she stops short.
From an existential perspective, I am aware that the client and I have stumbled upon her personal turmoil, primary concerns and protective maneuvers, and the unique form into which her encounters with others have coalesced. We have come upon the unique tapestry of her existential situation. We are in her unique realm of life; a realm I may only broach and draw near. As Emerson (1990) -- speaking perhaps metaphorically of the Other -- reminded us:
At the gates of the forest, the surprised man of the world is forced to leave his city estimates of great and small, wise and foolish. The knapsack of custom falls off his back with the first step he makes into these precincts. Here is sanctity which shames our religions, and reality which discredits our heroes. Here we find nature to be the circumstance which dwarfs every other circumstance, and judges like a god all men that come to her. (p. 311)
Technical knowledge seems to pale in comparison to the phenomenological moment of our encounter. Such a moment we will both have to cultivate and groom -- a moment like this one. And as May (1958) stated: “any therapist is existential to the extent that, with all his technical training and his knowledge of transference and dynamisms, he is still able to relate to the [client] as ‘one existence communicating with another’” (p. 81).
In order to provide the space necessary for growth and possible therapeutic transformation, the client and I will have to continually recognize these processes. We will have to hold to these profound, subtle moments of depth, and to the struggle of attending to them through our relationship. We must intimate this rise-and-fall and back-and-forth -- the ebb-and-flow of communion. We must both adhere to a potent level of examination, openness, and engagement. Here, “the primary question is how the person relates to his freedom to express potentialities” (May, 1958, p. 79).
Her hands -- clasped and wringing each other -- are thrust into her lap. Tears come and form, but hang tightly. Again she leads us: “If I open all this up, if I go there, it will wreck my life. I know I have to, but once I do it will take so much work to get through. This is just too much.” Again we circle round. Again, she at once opines the pain and ambivalently asks for movement, but in this I feel she is speaking more about the strength of my commitment. I offer up my recognition of her fear, of her ambivalence, and reflect my awareness of her suspicion that I may abandon her. How, but through action can I assure her?
She hears me, but clings ever more to the edge. She speaks always with intuitive precision away from the issue at hand. With each of my reflections of the process and each attempt to deepen, the angst becomes more alive and present. With each offering to enter further into her immediate situation, our encounter, and her concerns, she seems to feel the tenuousness; the potency of her expectation that her pain will fall on deaf or dismissive ears.
I am holding nothing back in my responses. I do not hide my own pain in this moment. My sorrow for her and her position is as visible as is felt. I allow her to see that I take her very seriously, and that I care. Yet, I do not harangue. I do not actively attempt to change her mind. Here I am human -- I to Thou.
Working from this position, I bring my humanity into contact with her, and I trust that our encounter with each other will be that catalytic vehicle by which she can transcend her protective constriction. I unapologetically show her my presence and acknowledgement of her pain. I do so for her to engage further -- to prepare the space to engender authentic becoming (May, 1958, 1983; Laing, 1969).
From an existential position, her terror of encounter alongside the desire for further growth is of primary importance. Rank (1932) and Becker (1973) were troubadours of this tension. This will be a dynamic that will need constant monitoring. As May (1958) articulated, this “therapy will attempt to ‘analyze out’ the ways of behaving which destroy presence” (p. 84) - an attempt to foster and deepen meaningful encounter with self, others, and the world.
The session continues. She begins to speak again and now her narrative turns to guilt, self-loathing, and emptiness: “I just want to disappear…not to be seen. I am no good. I really hate what I have had to become to get by. I am a disappointment.” From both within and without, I hear in her admonition the guilt engendered by self-sacrifice and perceived failure to both self and those unknown, haunting others. I feel her pining. As with the anxiety, the guilt seems ontological. May (1983) emphasized that “the condition of the individual when confronted with the issue of fulfilling his potentialities is anxiety…when the person denies these potentialities, fails to fulfill them, his condition is guilt” (p. 112). Perhaps this is where this woman finds herself.
I emphasize the loathing, guilt, and devastation -- I do not turn, but heighten and illuminate. She hears my reflection and seems to touch these feelings in the moment. The anxiety and guilt come together and they overflow her conscious margins. She begins to cry and she does not pull away from the tears. She remains present. I lean forward as if to present myself and our encounter as an opportunity in which she will no longer need to disown her honest and authentically felt experience. Again, I mirror back her pain.
Here, the words of Laing (1967) spring up and it strikes me that “if we are stripped of experience, we are stripped of our deeds; and if our deeds are, so to speak, taken out of our hands like toys from the hands of children, we are bereft of our humanity” (p. 29). And as with May (1958), I conceive existential therapy “[as] concerned with something…fundamental, namely, helping the person experience his existence” (May, 1958, p. 86).
This is a process of unfolding, which begins in the encounter where “the world of this particular [client] must be grasped from the inside, be known and seen so far as possible from the angle of the one who exists in it” (May, 1983, p. 117). And an existential approach is one, which targets experiencing and subjectivity as the cornerstone of a more authentic and meaningful life.
The content of her pain is still latent; yet, with each step further, with each of my reflections and motions inward, the process deepens and becomes more potent. For now, the content does not seem as important. We are doing different work -- a different sort of dance. She tells me: “I have to work things out on my own, inside; away from others. They don’t want to know what’s going on in here. It would hurt them; scare them…even I would hate to hear what I have to say.” I continue to respond to her feelings that she is toxic, and that what is inside is dangerous. I show her that I am interested, and that I am as present now as when she began.
She stares at me. Her wide eyes peer across the room and pierce through the space between us. I feel I am being examined. Her face is red, her lips quivering, and her cheeks glisten from tears in the dim light of the room. I gaze back in silent witness. I feel our unspoken connection.
She speaks almost whisperingly: “I feel somehow that there is hope. Not that this will in any way be easy, but maybe there is something to look forward to. I guess this is just how it is; how it has to be.” A still-small light perhaps brought out through our meeting -- an honesty wrought out of his experience. Perhaps there is hope. Regardless, I, with Emerson (1990) find myself saying in both conclusion and welcoming:
But every insight from this realm of thought is felt as initial, and promises a sequel. I do not make it; I arrive there, and behold what was there already. I make! O no! I clap my hands in infantine joy and amazement, before the first opening to me of this august magnificence, old with the love and homage of innumerable ages, young with the life of life, the sunbright Mecca of the desert. (p. 255)
Becker, E. (1973). The denial of death. New York, NY: Free Press.
Buber, M. (1970). I and thou. (W. Kaufmann, Trans.). New York: Charles Scribner. (Original work published 1937)
Emerson, R. W. (1990). Essays: First and second series. New York, NY: Literary Classics of the United States.
Laing, R. D. (1967). The politics of experience. New York, NY: Pantheon Books.
Laing, R. R. (1969). The divided self: An existential study in sanity and madness. New York, NY: Penguin.
May, R. (1953). Man’s search for himself. New York, NY: Norton.
May, R. (1958). Contributions of existential psychotherapy. In R. May, E. Angel, & H. F. Ellenberger (Eds.), Existence (pp. 37-91). New York, NY: Basic Books.
May, R. (1981). Freedom and destiny. New York, NY: Norton.
May, R. (1983). The discovery of being. New York, NY: Norton.
Mendelowitz, E. (2006). Meditations on Oedipus: Becker’s Kafka and Nietzsche’s metamorphoses. The Journal of Humanistic Psychology, 46, 385-431.
Nietzsche, F. (1996). Human, all too human (R. J. Hollingdale Trans.). New York, NY: Cambridge University.
Nietzsche, F. (2000). The birth of tragedy (D. Smith, Trans.). New York, NY: Oxford University Press.
Nietzsche, F. (2005). Thus spoke Zarathustra (C. Martin, Trans.). New York, NY: Barnes & Noble.
Rank, O. (1932). Art and artist: Creative urge and personality development. New York, NY: Norton.
On Sam Cooke's "8 Bars of Soul"
Miraj U. Desai, M.A., Fordham University
Legendary soul singer Sam Cooke was one asked to describe, that is, to hum “8 bars of what soul represents.” His response is embodied in a beautiful gift, a simple humming from the depths of his soul. It’s only a few seconds long, without any words, and can be found as the last track of his greatest hits collection Portrait of a Legend. When I hear it, I am taken back to the sound of ancient Hindu mantras I remember listening to as a child. But I often wonder--what is Cooke’s humming doing in those mere 8 bars?
To me, his voice soothes. But going deeper, what is he soothing? It seems to soothe what Buddhist teacher Pema Chodron describes as the vulnerability at the root of all humans. Underneath our presence in the world, our desires, our joys, our afflictions, our pain, our suffering, there remains an embodied vulnerability, inherent since birth.
On the one hand, this vulnerability allows us to remain open to the world for nourishment and connection. On the other, this vulnerability can scare us or make us sad. There is pain in heartbreak. There is sadness in loss and death, realizing that the good times can’t last forever. These events have a way of reminding us of that vulnerability.
But the soul, the heart of sadness, the vulnerability is ultimately not to be avoided or feared—it is to be respected, to be loved and enjoyed. Chodron offers that we can simply make friends with this vulnerability, not lash out in spite of it, but rather give it space.
Coming full circle, it takes something like Sam Cooke’s voice, the resonance of pure sound without words, arising from the depths of soul, to help feed our own, and simply, give us space to be.
For further listening and reading:
- Sam Cooke - Cooke, S. (2003). Portrait of a legend: 1951-1964 [CD]. New York: ABKCO Music & Records, Inc.
- Pema Chodron - Chodron, P. (1994). Start where you are: A guide to compassionate living. Boston: Shambhala