Politicization of Psychology

This one is just a start...

Politics has become an all-consuming topic, and in many cases, for good reason. Most of us are acutely aware of how politics impacts our lives, experience anxiety and distress over how the changes in our politics will affect our lives, and have been getting an effective crash course in the minutiae of how our branches of government operate. If you are reading this and thinking, “I’m not sure I’m really that deep in the weeds with politics,” take my quick quiz to get the Anxiously Waiting Clinical Politico-Obsessional (CPO) score (all severity ranges below have been completely made up by me). Ok, here goes:

1. When you watch the news and a member of Congress is interviewed, do you have a favorite one?

   1. No

   2. Yes

   3. I don’t understand the question. I hate them all.

   4. Yes, but there’s a tie for two or more.

2. How many elected officials do you recognize immediately by voice?

   1. 1-2

   2. 3-5

   3. 6-10

   4. 11 or more

3. For #2, how many are not one of your elected officials?

   1. none

   2. less than 3

   3. less than 6 but more than 3

   4. none of them are my elected officials

4. When I watch political shows, I

   1. play a game with my partner in which we correct the guests about their civic knowledge.

   2. secretly dream of being on the show instead of the elected officials.

   3. mutter to myself that the Dunning-Kruger effect fails to account for people who simply lack the curiosity and cognitive functioning to get to the point of self-doubt that comes with expertise.

   4. email the guests with book recommendations so they can be better informed in the future.

Scoring: a=1 point, b=2 points, c=3 points, d=4 points.

CPO Scores of 4-5 mean that you are an emotionally well-adjusted person…or terminally uninformed and are the reason for all our country’s ills. You choose which.

With CPO scores of 6-8, you’re staying informed and possibly dreaming occasionally of being a combination sports announcer/political analyst. In short, someone who thinks they know stuff and everyone else nods in agreement, but if you could read their thought bubble, you’d be deeply offended.

If you scored 9 or higher on the CPO scale, I’m terribly sorry to inform you that you desperately need professional help. Frustratingly, there are no known treatments, either. Maybe brainspotting will help (see this article). There are other promising quack treatments, or maybe this will be a golden opportunity to develop one yourself! Full disclosure, my wife and I would attain the top score, and the questions were formulated based on discussions she and I have had numerous times. In fact, the scaling is insufficient to really capture the severity of our Clinical Politico-Obsessions.

You might be thinking, “What an odd way to build community by inserting a quiz whose sole purpose is to set up gratuitous insults.” Look, you subscribed, and as such, you’d better be hardy. I’m confident you’ll get over it. If not, check into brainspotting once again.

Ok, a serious note now. If you are politically engaged, you will surely appreciate that politics has infused much of our lives. Political processes have also seeped into many professions, including psychology and mental health. To give a sense of my personal view on this, one that has empirical backing, consider this blurb, which is the portion devoted to the topic on my faculty webpage:

“Social and political movements have consequences in the treatment room. In the past several years, these political movements have led to increasing numbers of practitioners engaging in political activism in patient-facing settings. While the intention of these political gestures may be grounded in the practitioner’s particular political ideology and thus assumed by them to be in the interest of the general public, it can also be alienating to patients and lead to poorer outcomes, patient frustration, and treatment dropout. Among practitioners, these political movements among colleagues can lead to an unwillingness to speak up when policies may have identifiable harms to minoritized groups.”

Most mental health professionals are, at the very least, politically knowledgeable (probably scoring 6-8 on my untested and almost certainly invalid CPO test). Anecdotally, those whom I know personally are far more than casually aware of political issues and would likely score higher on my little quiz. Further, research has demonstrated that most mental health professionals tilt leftward on the political spectrum (see Redding, 2023). Add to this mix that recent treatment conceptualizations suggest that clinicians engage in activism (Comas-Diaz & Rivera, 2020), and you can see where this is all headed.

This will get complicated pretty quickly, and in order to cover this properly, I’ll break this up into portions for future posts. For the time being, the main issue that I want to highlight is that activism in one’s personal life is very different from introducing it as a component of treatment. It is also very different from a client reporting anxiety or distress about the political climate. These distinctions are essential to keep in mind. If you are engaged in political activism in your personal life, that is great, and you may derive emotional benefits from doing so. If you are a mental health practitioner and you introduce activism in the treatment you provide, you are employing a specific contemporary approach that is primarily conceptual in nature at this point. And if you are receiving treatment and your practitioner begins to encourage activism as a functional component of your care, you may want to ask about the degree to which there is clear support for doing so and what the specific connections are to your therapy. For this entry, we will focus only on political activism by and among mental health practitioners. A future entry will cover the role of activism within treatment.

Politics Among Mental Health Practitioners

As noted earlier, mental health professionals tend to be more liberal than the general public. Considering the nature of political discourse in the US, this roughly translates to some divisions within the profession when attitudes and values vary for some specific hot-button topics. Consider just one example: support for free-market capitalism. There are no reliable survey data on how widely mental health professionals support or reject free market capitalistic systems (known broadly as neoliberalism). However, there are some rough indicators that suggest a schism between what is said versus how people operate. If you were to peruse various networks of mental health professionals, the social ills of neoliberalism are extensively discussed. There are unquestionably problems related to systemic racial inequities in neoliberalism (discussed in Ahlberg et al., 2019), and reforms are desperately needed. However, in direct tension with the general rejection of neoliberalism is another recurrent theme in these networks - how to make more money, with various target annual income rates, and how to set session fees, as practitioners rightly view their work as a commodity. This tension does not appear terribly controversial, and yet it can spark intense debate among practitioners. Accordingly, you can surmise that ‘hotter’ political topics generate far more intense discourse among practitioners, even among people who are generally on the same side of the political spectrum.

The vitriol among mental health professionals can be as bad as that found on general political social media sites. There is a dominant mental health approach designed to persuade individuals to engage in therapeutic change called Motivational Interviewing. In the influential text on this topic (Miller & Rollnick, 2023), the following topics are listed in the table of contents: engaging, encouraging, planning, supporting, teaching persistence, and learning from conversations. You know what isn’t in there? Repeatedly telling people they’re a piece of shit as a way to get them to change their mind when it comes to political topics. And yet, this is not uncommon discourse among mental health professionals in their social media networks.

Unlike political rancor that emerges in the general population, when it occurs among professionals, power dynamics come into play. These are not as straightforward as simply more senior members of the profession dominating people earlier in their careers, although that certainly does occur. It also takes the form of those with the perceived moral high ground intimidating those with countervailing views. Allow me to share a specific illustration. In late 2023, a political protest broke out at a conference I was attending. This protest was yoked to a series of social media posts by one of the invited speakers at the same conference. I’m deliberately omitting the nature of the protest, as that will be part of a future post. Readers familiar with contemporary global politics can readily guess what was happening.

Following this conference, I was personally distressed by the insertion of politics into the professional organization, a shift that was, I believed, at the expense of science. I began to organize colleagues who would form a group to push back on this politicization. The majority of the people I contacted were senior members of the profession, all people who had secure positions. In short, they faced little to no professional risk in pushing back on this issue. Out of around ninety colleagues that I approached, almost half declined to join, not because of disagreement, but due to fear of reprisal.

Let that last part sink in deeply…over forty senior members of the profession, all of whom were on the same side of the political spectrum, declined to speak out due to fear of professional consequences. I’ve been digesting this experience for well over a year, and I am still amazed and horrified by the implications. Whether it is explicit or assumed, there is a serious illiberalism coursing through the mental health professions.

What Happens When Professionals Fear Open Discourse?

Every profession benefits from the free flow of ideas among its members. If the profession is based on some scientific concepts, like the mental health professions - ok, if you read my recent pseudoscience piece, you are likely laughing now - then this includes potentially controversial ideas. If the willingness of even the most senior members is compromised, then we know that the chilling effect on open dialogue is likely quite widespread. It is particularly ironic as members of the mental health professions have all undergone extensive training in interpersonal engagement; speak with clients who themselves may express a range of highly distressing experiences and hold myriad social and political views; and our task as clinicians is to engage non-judgmentally in order to provide care.

Zoom in on that last one: “…and our task as clinicians is to engage non-judgmentally in order to provide care.” Is that truly our task? I always believed that was so, for the duration of my thirty-plus-year career. It is also part of almost every introductory graduate course in clinical interviewing, and is part of many treatment movements (i.e., mindfulness; motivational interviewing). Nevertheless, the point I just raised is currently under sharp dispute. This is my little ‘teaser.’ Can mental health practitioners reject clients on the basis solely of their political beliefs? Can they discriminate against colleagues for disagreeing on political issues even if they are on the same side of the political aisle? And does mental health training prepare professionals to engage in political activism in the treatment room? On that note, I’ll leave you anxiously waiting…see what I did there? Ok, I promise that kind of nerdiness will be rare.

Before I leave you altogether today, I want to make a concluding remark. What I’ve highlighted is that if we are all political animals, it is challenging for those of us who are also mental health practitioners to check that at the door. And the profession has not yet worked out how to best resolve this challenge while simultaneously diving headlong into explicitly incorporating politics into treatment. The stress points are evident in the kinds of discourse that take place among professionals, and there is a deep well of additional topics that are not even discussed due to concerns that they are too controversial. But we will go there.

References

Ahlberg, B.M., Hamed, S., Thapar-Björkert, S., & Bradby, H. (2019). Invisibility of racism in the global neoliberal era: Implications for researching racism in healthcare. Frontiers in Sociology, 4, 61.

Comas-Diaz, L., & Rivera, E.T. (2020). Liberation psychology: Theory, method, practice, and social justice. Washington, DC: American Psychological Association Press.

Miller, W.R., & Rollnick, S. (2023). Motivational interviewing (4th edition). New York: Guilford.

Redding, R.E. (2023). Psychologists’ Politics. In: Frisby, C.L., Redding, R.E., O'Donohue, W.T., Lilienfeld, S.O. (eds) Ideological and Political Bias in Psychology. Springer, Cham. https://doi.org/10.1007/978-3-031-29148-7_4