One troubling aspect of psychotherapy is its focus on symptoms, rather that causes. Depression and related conditions, for example, consume 9 different DSM categories and more than 30 subcategories. And while many clients are chemically prone to depression – so that symptom alleviation is, in fact, a key issue – the great majority are dealing with non-organic issues as well.
Symptom relief is, without question, an urgent goal. But the growing tendency is to stop there; to see psychotropic medications and cognitive/behavioral interventions, not as important tactics in a larger fight, but as ends in themselves.
Today, more than 90% of psychiatrists – the most educated and highly compensated clinicians – prescribe drugs and do nothing more. In addition, more and more “talk based” clinicians have adopted short-term approaches to therapy, driven by insurance companies’ demands for “measurable” success toward “concrete” goals.
The reason for this trend is, to me, self-evident. The mental health establishment, like every other industry of any size and persistence, is not interested in pursuing problems to their root causes. Why? Because so many of the real culprits, lurking behind our emotional issues, are the unexamined values that keep us locked into our roles as compliant workers and consumers. Implicitly recognizing this reality, the mainstream culture – with its genius for self-perpetuation – will financially starve and marginalize healing strategies that seriously challenge its central outlooks and beliefs.
Salvatore Menuchin’s career is an object lesson in this phenomenon. His systems approach to family therapy was widely recognized and became a generative force in the profession. But his later work – applying these same ideas to larger social structures – was mostly ignored. Why? Because it challenged our mainstream ways of operating.
In this Reflection, I deal with one of the root, non-organic causes of so much of our psychic dysfunction: Perfectionism. This mindset – an almost impossible to resist byproduct of our obsession with competition, dominance and control – is one of the more obvious causes, not just of depression, but also of our epidemic of anxiety, shame, and self-judgment.
Notwithstanding this reality, perfectionism is not a condition that is dealt with in the DSM. Indeed, the culture’s ability to deflect attention from the real drivers of our pain is exemplified by this remarkable fact: Far from being seen as a problem, perfectionism – dressed up in more acceptable language – is widely seen as a positive value, to be celebrated and encouraged.
This rhetoric is so pervasive that we scarcely notice, and rarely comment on, its perversity.
For me, the archetypal example is the culture’s constant reminder that “we can do anything we want, if we just try hard enough.” What is so chilling about this pervasive cultural rallying cry is this: It studiously omits the aphorism’s inescapable second clause: “And if you don’t accomplish your goals, there is something wrong with you.”
This statement is, of course demonstrably false. The odds of a poor African American child going to an Ivy League college, after 12 years at a ghetto based public school, are astronomically small. Similarly, if you work in a dying industry or seek a job in a saturated market, you may not find any work at all let alone the position of your dreams.
Notwithstanding the mainstream culture’s perfectionist rhetoric – exemplified by this phrase – the primary reason for these and most other “failures” is not a lack of effort. To the contrary,
- The game is fixed. Those with money and connections have a long head start; and
- It is arbitrary. Determined or not, we will fail if – for whatever reason, good or bad – you get on the wrong side of the boss; and,
- Like it or not, we are all limited by our human frailties.
What is interesting is that we know all this. And yet, at a personal level, utterly fail to follow through on its implications.
For most of us – when it comes to our situation – there are no excuses. Falling short, my automatic response is that “I” am the problem. Pointing to external causes feels wimpy and shameful. I need to “man up,” take responsibility, redouble my efforts to do better the next time. Never mind:
- That there were massive lay offs (I, somehow, should be the exception); or
- That I was sick – or distracted by my child’s crisis at school; or
- That I am not, and never will be, a good pubic speaker.
None of these things matter. My presentation should have been crisp, tight, and compelling.
It is as though we walk around with a measuring stick in our heads, remorselessly assessing our value, judging any outcome that doesn’t approach 100% as a failure. And in this unforgiving landscape, “wins” – for most of us – become fleeting visits to an all but impossible to attain mountaintop; moments of surcease in a larger system in which losing is the norm.
Thus, for example, I vividly remember a friend’s powerful feelings of failure when, as one of four finalists for a position sought by over 300 applicants; she failed to get the job. And, too, the client’s intense feelings of shame because his boss – a man he didn’t like or respect – told him he wasn’t measuring up.
These sorts of deeply engrained, automatic responses breed a wide variety of psychically discouraging mindsets:
- Ashamed of our failure, we isolate.
- Reflexively judging and doubting ourselves, we become cautious, indecisive, and defensive.
- Unable to shake the sense than we are “defective, “less than,” “a fraud,” we stop trying, content to go through the motions.
Thus, while the mainstream rhetoric is about achieving great things, our perfectionist mindsets actually move most of us in the opposite direction, with chilling effectiveness. This outcome is wonderfully effective – if the goal is to create a pandemic of spirit-sapping mindsets, a result that – not coincidentally – deeply discourages efforts to challenge and change our current, mainstream ways of operating.
Note, importantly, that our obsession with individual perfection deeply obscures the systemic factors that contribute to what ails us – reinforcing our status quo ways of operating in this way as well.
Thus, millions of people, financially leveled by the economic downturn that occurred after the 2008 housing and financial meltdown, took second jobs and economized to a point of real pain. And yet, remarkably, there was no perceptible movement to reform our patently corrupt financial system. Similarly, a handful of “bad actors” were prosecuted for torturing prisoners in Iraq while the policies they carried out, and the people who created them, were ignored.
The implicit message in each of these examples? Bad policies and malevolent systems don’t matter. “Good” people should just know what the right thing to do is – and have the will to do it.
Because perfectionism is a byproduct of the culture’s deeply engrained, win/lose values system, programs such as Radical Decency – that seek to systematically implement more humane ways of operating – are the most strategically viable response. These comprehensive, values-based strategies are the strong medicine we need to deal with this virulent cultural disease.
As we re-orient our energy toward the consuming task of being decent in all that we do, perfectionism will increasingly be seen as an unwanted distraction; an attention and energy draining habit of mind that diverts us from our more ennobling goal. With time, it will wither and recede.
Getting from “here” to “there” is, however, an enormous challenge. Being creatures of habit, there is no easy way to wean our selves from our perfectionist mindsets. But while the work is hard, the pay-offs are, potentially, life changing. While it is a long shot, to be sure, it is – as I see it – the most realistic path toward creating a more nourishing lives and meaningfully contributing to a more decent and humane world.