Conversations with Practitioners: On the Verge of a Nervous Breakdown

February 20, 2016


I am Christine LaCerva, director of the Social Therapy Group, a community group therapy center in Fort Greene, Brooklyn, and in Manhattan. I am also the director of clinical training at the East Side Institute, an international training and research center. I have been practicing social therapy for 34 years.

This evening I will be talking about being a therapist and how I practice therapy – what the process is like for me in working with people who are in serious emotional distress. Therapists don’t get much of an opportunity to talk about that. Then there is the question of how to talk about that? What drives the therapy? I want to talk to you about my search for method as a social therapist – searching for how to go around and about creating environments for emotional development. It’s a performance, if you will, of not knowing not coming up with answers – in favor of the activity of exploration with my patients and colleagues.

Let me tell you how I think about “practitioners.” When I say practitioners, I mean everyone who is here tonight. The fact is we are all practitioners. We all are engaged knowingly or unknowingly in creating environments where we can grow emotionally (or not). As human beings we are active choice makers. We have the unique characteristic of being both over-determined by the existing culture and culture-makers. This includes the makers of the conceptual frameworks that inform how we think about things and how we feel. At the same time we have the capacity to create new things, new ways of thinking that have not existed before.

So tonight I would like us to take a look (outside of the medical model) at how we as human beings are inherently social and cultural and what follows from that therapeutically. We are going to be taking a look at methodology – how we go about doing therapy.

For starters, let’s take a look at the broader historical context we are in, since we are not doing therapy in a vacuum.

We are living in a postmodern, rapidly destabilizing world: terrorism, rising poverty, racism in everyone’s backyard, global warming, increased violence, a failing political system. Millions of people around the globe are questioning what is to be done in a world that’s spinning out of control. At the Social Therapy Group and its sister organization the East Side Institute, we are arrogant enough to say we have an answer: developmental activity. We create environments where people can develop who they are, where they can go beyond themselves, deepen their capabilities, deepen their humanity and be powerful in how they live their lives.

As a social therapist, I have trained in a postmodern methodology that challenges the assumptions and biases of how we know how to help people grow. Social therapy has as its centerpiece the activity of development – i.e., qualitative growth that changes the totality of who and how we are as human beings.

I was trained by Dr. Fred Newman, a philosopher, political activist and the founder of social therapy. He taught me and many others to explore the impact of the institution of psychology on how we see, how we feel, how we relate to emotional pain and, most importantly, what we think there is to do about it. I am passionate about this work – as I am sure many of you are in what you do. And I do get somewhat riled up about things. I love provocations to the standing order of how therapy is practiced.

First and foremost, social therapy is not on the spectrum of traditional psychological approaches. It is a revolutionary, philosophical, alternative to psychology. It is a group therapy – where people learn from each other and have to work to reinitiate their creativity in how they are living their lives.

You might be thinking what does this have to do with being On the Verge of a Nervous Breakdown? I think it has everything to do with it.

Let’s start with the therapist’s job. The therapist is typically understood as the person who will provide preventative care and help the client avoid the shame, confusion, panicked obsessions/depressions or anxieties that are often part and parcel of a breakdown.

If I asked how many people in the room have had a nervous breakdown more than likely no one would raise their hand. It is viewed as shameful, scary and private – no one needs to know.

What if it turns out that patients and sometimes therapists need to fall apart?

At the moment I have a number of people in my practice, both men and women, who are breaking down. They become obsessed with the past and what caused them to be how they are. They are anxiety-ridden, unmoored and erratic in how they live their lives. They can’t sleep. They are eating too much or not eating at all. Often they don’t tell others how bad they are feeling. By contrast, some are mesmerized by how they feel, and that’s all they talk about.

In choosing this topic for tonight’s event, I am interested in how we talk about breakdowns. Consider the phrase: on the verge of a breakdown. What exactly is a verge? I think the language we use to talk about things has an enormous impact on our experience of what something is. So I looked it up. It has to do with coming to the realization that you are about to experience an utter collapse, uncontrollable weeping, near-death and falling apart at the seams. Something really not so good is about to happen. How frightening is that?

It’s a phrase that’s emblematic of how our culture looks upon emotional pain – it’s a focus on the individual-in-distress for whom something very bad is about to happen.

I am not saying there isn’t something to the diagnostic characterizations (that person’s on the verge…) or other diagnostic descriptors of presumed psychiatric disorders, but the diagnostics leave out a central aspect of who human beings are. We have the capacity to organize and reorganize how we live our lives and how we do our emotionality. The descriptors leave out how we actually grow and develop.

A major influence on the methodology of social therapy is the Soviet psychologist Lev Vygostky, who lived in the 1920s and 30s. He had a particular view of how human beings grow and develop. For example, we relate to infants ahead of where they are developmentally speaking. We speak to infants as if they understand what we are saying. They don’t. Yet we relate to them as if they do. In Vygotsky’s language, we are relating to them both as who they are and who they are becoming, and that activity is what allows them to become speakers! This is very important therapeutically speaking – i.e., being-and-becoming – as a dialectical unity of growth and development.

The relevance of Vygotsky’s discoveries, for me as a social therapist, is all about helping patients consider the unimagined, unthought and unspoken. It is about creating possibility that currently is not there.

I practice a group therapy for the reason that it enhances who we are as social/cultural/relational beings. It opens the door for collective development. It’s not just particular individuals that grow in social therapy – it’s the group, including the therapist. In fact, I would say that it’s the group’s growth that produces the individual’s development. And in the case of emotional crisis, people can learn from each other how to be in pain.

People “on the verge” can feel quite vulnerable and at the same time have the capacity to work with others to decide how they are going to go through this moment in their lives.

How we experience breaking down is organized by a culture of fear, panic and disability – it derives from an over-medicalized world view, which says, “There is something wrong with you. You need a psychiatric diagnosis; you need to be hospitalized and drugged.”

Is it possible that there are other ways to organize this crisis moment for people? I believe so. And people are successfully doing it. The Family Care Foundation in Scandinavia (and Carina Hakansoon), the Open Dialogue, Fountain House, Parachute, and the Respite Garden here in Brooklyn are but a few who have successfully created alternatives to the medical model.

Social therapy is provocation to the traditional notions of psychology. So I have some provocations for you regarding nervous breakdowns.

1.     If you are going to have a breakdown, have one with your friends. Have a breakdown get together. And no, I am not kidding. Talk with each other about how to organize what is going on into a new form of life. Relate to this as something we are doing together. Let it become “our breakdown.” When you are in pain you often think it is only you who is in it – but that isn’t true. Our friends and loved ones go through something when we are in emotional turmoil. Find new ways to socialize emotional pain and learn new ways of being in pain with others – let yourself be upset with others.

2.  Learn to be philosophical. Stop asking questions that have store-bought answers. Try some hard hitting philosophical ones. Invite your friends to play this philosophy game with you. Ask big questions about little things. For example, where do I want to locate myself in this chaotic moment? Am I willing to lead and direct a new performance of my relational life even though I do not know how to do it? Can I still be giving to people even though I am in great distress? Am I willing to be impacted on by the people in my life? How did I come to base what I do on how I feel?

3.  Create new emotions! When we are deeply upset and feeling fragile we often have limited emotional responses. Anger, anger and more anger is the norm – sometimes anxiety –which more often than not is anger in disguise. What I love about social therapy groups is that sometimes when we are working to create new forms of life, new emotionality emerges from that activity. Some patients say “I feel confused. I am not sure what I am feeling.” That sounds good to me. A patient recently said, “I am close to 30 people in my group. How can this be? But I am. We don’t know that much about each other; so how is being so close possible?”

These are my recommendations for my patients. For therapists it means letting ourselves fully feel the pain and conflictedness of what is happening with our patients. And for ourselves – let’s have that we don’t know what to say or do. We can be confused or frightened; we go slowly; we go fast; we’re not sure of the next move. There are times for me that being sure makes me less alive, less available, and ultimately less responsive. We have to be willing to lead the activity of breaking down into the developmental activity of breaking through. It’s grabbing the opportunity for both patients and therapist to be less alienated, more emotionally expressive, more intimate.