Treatment 20of 20Mental 20Illness 20and 20Antisocial 20Behavior 20 20The 20Evolution 20of 20a 20Disaster 20and 20a 20New 20Paradigm 20for 20a 20Way 20Out by XEG0oRPc

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									        Treatment of Mental Illness and Antisocial Behavior -
       the Evolution of a Disaster and a New Paradigm for a Way Out
                                 by Edwin L. Young, PhD


      II. http:// UNDER CONSTRUCTION 4-3 revision moving B.
  Objectification of Man http:// UNDER CONSTRUCTION 4-3 revision
      moving B. The Evolution of Mental Health Treatment and the
                            Objectification of Man
           A Historical, Systems-Structures-Processes Approach
                     Objectification of Man PAGE 32

      CAN THERE BE A PARADIGM SHIFT IN PSYCHOTHERAPY 1

                     Designing Programs that are Reoriented
                away from a medical 'Illness and Cure Model'
              and from a justice 'Crime and Punishment Model'
            and toward a 'Maturity and Structural Change Model'.

       Thesis: the thesis of the proposal is that all of the various traditional forms of
treatment of psychological problems have had goals that have fallen far short of the
mark and that the Natural Systems approach can overcome these deficiencies. The
thesis has six parts.
       First, typically these unmet goals include treatment meant to result in enduring
improvement with respect to the following problems for which people enter treatment, or
are referred to treatment:
           1. Destructiveness to self and other
           2. Illegal or Behaviors harmful to society
           3. Psychosis
           4. Disorders that are supposedly caused by brain chemistry imbalance
           5. Emotional distress
           6. Psychologically related health problems
           7. Behavioral and communication ineffectiveness
           8. Relationship dysfunctions
           9. Immaturity
           10. Deficiencies in ego mastery or coping skills
       Second, there are alternatives to these traditional approaches to these problems
that are based on a revised perspective on humans, society, and the relations between
humans and their social environment.
       Third, as a result of this revised perspective, a wide range of both old and new
concepts and techniques can be integrated in new configurations of modes of delivering
treatment that are especially designed to address goals for all of the problems listed
above.
       Fourth, this proposal presents a new method of analysis of the full range of
causal factors of these problems from this holistic perspective.

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      Fifth, use of this method of analysis can yield a wide range of new systems and
devices to be used in designing these news modes of treatment.
      Sixth, quantitative performance indicators will demonstrate the increased and
enduring effectiveness of this new approach.
      This new approach is called the Natural Systems approach.
________________________________________

        I.     What Good Is Psychotherapy?
             A. My Personal Experience as a Client and as a Therapist in
                Private Practice
        Being seventy-four years old and a retired psychotherapist, if I were
suddenly transformed into a fifty-year old me, would I want to practice
psychotherapy again? Yes! I liked it. I enjoyed doing it and I enjoyed my clients.
I liked listening. I found my clients fascinating, all of them. Obnoxious or
charming, brilliant or stupid, richly articulate or practically mute, powerful or
nobodies, accommodating or intransigent, deceptive, manipulative, transparent,
rude, babbling crazies, planet X psychotics, whatever, each in their own way were
intriguing. Clients with all kinds of problems from amnesiacs to steely cold serial
killers; from sycophantic homosexuals to brutal white Aryan nation militants;
from prostitutes to sex addicted priests; from multiple personalities to
compulsive personalities; from anxiety and panic disorders to bullies; from
sarcastic feminists to hard core misogynists, whatever, they were all fascinating
and each an intriguing and compelling puzzle. For me it was a matter of “What‟s
not to like?” because it was virtually a first rate „personality‟ museum, the kind
you could stay mesmerized in all day. Moreover, my heart went out to all, truly
all, of them.
        So, why do I knock it? Many of you have heard the put-downs of
psychotherapy – head shrinking - more than you cared to, I am sure! So now let
me say what „I‟ feel is good about it. First, I, myself, was a client for many years
and loved going to my therapy sessions, gut wrenching though many of them
were. I started „shrinking‟ at age nineteen when I was a sophomore at UT and
went off and on for probably a cumulative of nearly twenty years from start to
when it ended at around age fifty-one. I always felt like it was helping even
though I maintained the same self-defeating patterns and miserable symptoms up
until around age forty-five. I usually felt good after a session. I gained incredible
insights and had heart-wrenching catharses during almost all sessions. I felt I
learned a tremendous amount about „me‟; about why I was the way I was; and
about what made me „tick‟. All of this wonderful stuff happened and nevertheless
I maintained the same self-defeating patterns and most of the miserable
symptoms. Much too late I learned that there is placebo affect in psychotherapy
as well as with medications. In the old days, we called it the „Mask of Sanity‟ and
both clients and therapists were equally likely to be taken in by it. I did not realize
it until much later but there was a „disconnect‟, a gap larger than from here to the
moon, between the wonderful stuff in therapy and perpetual negative stuff in daily

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life. It was not until many years later that I saw the reality and the therapy
session juxtaposed for a reality check, for a realistic comparison. However,
again, I would, if I were back in my younger days, do it again because it was kind
of like my anchor during those tormented years.
        After years of working with my own clients, I eventually concluded that the
comfort and the small benefits supplied by the sessions did not offset the lack of
change in behavior or symptoms. Consequently, early on, I began to try things,
to branch out and experiment sometimes with modest additions and sometimes
with innovations that some might consider bizarre. I studied, in situ, the living
process going on in my clients and between my clients and me. I also used
questionnaires to track, quantitatively, the effects of therapy for sometimes up to
five years after termination of therapy. Sometimes conventional therapy paid off
with respect to some of their problems and sometimes the unconventional
techniques paid off as well. Since I did not sample therapists at large, I cannot
generalize on the basis on my practice alone.


         B. Some Positive Outcomes Did Come from Individual
            Psychotherapy


      Here are some of what I think were positive outcomes. On
issues like major life choices such as choosing or changing an
occupation or engaging in an education program, therapy seemed to
make the process more objective, lend confidence to their decisions,
and even add a little more belief in their decision-making ability.
However, I am not sure that those benefits carried over to future,
similar choices. Immediate difficulties with people like intimate
partners or work supervisors seemed to be helped by using problem-
solving techniques. When they gained insight into them, some of
these insights seemed to make clients more comfortable with
themselves, at least with respect to scary or annoying misgivings
they had about themselves. If the therapy was of long duration, the
quality of the therapeutic relationship seemed to make clients
gradually more self-accepting and to increase their self-esteem or
sense of self worth. Some clients with anxiety reactions and panic
attacks seemed, or at least reported, to get some relief from these
symptoms.

     One unusual outcome that seemed to be enduring was with
respect to psychosomatic or somatic-psychic symptoms. For
instance, a woman with repeated surgeries for endometriosis was
deemed by her doctor as not in need of a forthcoming surgery and
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pronounced her symptom free. This result was still in effect many
years after therapy. A man with high blood pressure for which he was
taking medication was relieved of that symptom and his doctor took
him off the medication. In part, the technique that accounted for
these changes involved the use of hypnosis. In addition, hypnosis, in
combination with insight-talking therapy, seemed to help clients with
early sexual and/or physical abuse to recover the related memories
and be relieved of problems with the sex act with their current
partners. Some phobias also were overcome using similar
techniques. Many more symptom types were relieved as well.


     C. A Program in a Closed Institution Suggests Ways to
Overcome the Weaknesses of Psychotherapy

       I have often noted the positive aspects and outcomes cited
above yet I have cited the problems with psychotherapy as well. If
psychotherapy, whether with conventional or unconventional
techniques, seemed to be effective, then why do I keep harping on the
shortcomings of psychotherapy? Because, once having seen
alternatives that were more effective, I began to pursue them and,
naturally, parallel to that endeavor, seriously to question traditional
psychotherapy. The aspects questioned or reasons for questioning
are twofold. Let me dispense with the first of the reasons quickly at
the outset. Most of the above-cited reduction in symptoms using
psychotherapy also disappeared when using, in a closed institution, a
Natural System‟s structured program called “Stars and Stripes”. The
institution referred to was a juvenile correctional facility for boys who
had committed serious felonies and who had been repeat offenders.
They had an average age of fifteen and a range from thirteen up to
seventeen. Before “Stars and Stripes”, the facility was much like a
strictly controlled, medium security, adult prison.
       Under the prison-like system, these youths were constantly
aggressively acting out and escaping. Over seventy percent of the
population was on psychotropic medications prescribed by the
institution‟s psychiatrist. Once the “Stars and Stripes” program was
fully implemented, almost all of the youths were taken off
psychotropic medications. Prior to this program, a few of the youths,
possibly ten percent, were provided with individual counseling. After
implementing the new program, a few continued to receive traditional,
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one hour per week, counseling in order to appear to comply with
professionally recommended county policy.
      After implementation of “Stars and Stripes”, the institution
changed from a cauldron of constant violence, escapes, property
destruction, and a wide variety of neurotic symptoms to being more
like a well-disciplined, model school, with healthy, respectful youths.
The residents became more mature and their school achievement
soared. Instead of being alienated, the youths positively identified
with the institution. The benefits of this Natural Systems program
accrued to almost all of the residents (inmates). Furthermore, the
benefits endured in post release, when they were free in their home
community. These benefits occurred in spite of the fact that less that
ten percent had received individual counseling. Prior to this program,
individual counseling had made no observable changes in behaviors.
For me, this was reason enough to question traditional
psychotherapy. These questions, however, relentlessly persisted in
nagging me. Why was individual psychotherapy less effective than
the Natural Systems‟ program, which was successfully applied
simultaneously to an entire population without the use of
psychotropic medications and with ninety percent receiving no
counseling? What was missing in individual therapy? Seeing the
comparative ineffectiveness, what was its significance? What was
this trying to tell me? On the other hand, an even more profound
question was what were the causes of such massive effectiveness?
      In almost all cases of mentally ill patients, behavior disorders,
and convicted criminals, a stock answer with respect to their cause
was that these problems were due to a biological, or genetic,
predisposition to a chemical imbalance in the brain. To the contrary,
however, if, when all but five percent of the entire population of the
institution‟s youth were taken off psychotropic medications, the youth
began behaving normally, then one had to question psychiatry‟s
assumptions about imbalance in brain chemistry or neurotransmitters
being „the cause‟ of their varied types of abnormal and antisocial
behavior. Of course, it is doubtful that psychotropic medications
were the cause of the troublesome behaviors, since these behaviors
were present long before being administered the medications.
Assumptions that pre-program negative behavior was „associated
with‟ or caused by brain chemistry imbalance, namely
neurotransmitters, seem false. Obviously, symptoms were only
modestly ameliorated when on the medications since the institution
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had been churning with pathological and violent behavior. Neither
should the positive changes exhibited with the new program be
attributed to the withdrawal of the medication. After all, they had
been given the psychotropic medication to calm them and reduce
their unmanageable behavior and that had not worked.
       The simplest and most reasonable hypothesis should be that it
was the change in the structure of the institution, namely the way the
“Stars and Stripes” program was designed, which was the cause of
the change to positive behavior. By inference, it might seem to be a
reasonable hypothesis that the program could have corrected the
youths‟ brain chemistry imbalance, or neurotransmitters. It could
have been something about the structure of the program and the
behaviors and feelings it elicited that was simultaneously bringing
their neurotransmitters back into balance. On the other hand, it is
just as reasonable to assume that brain chemistry is either irrelevant
or a mere transitory phenomenon related to arrest and incarceration.
It is possible that brain chemistry can change or adapt to factors in
the structure of their world be it in their natural home environment or
the way the institution is structured.
       It has always seemed strange to me that when discussing the
cause of delinquency or criminal behavior the structures of the social
environment are rarely considered and quickly dismissed. In the
popular Leonard Bernstein musical, “Westside Story” film (1961), the
social structure causation theory is even ridiculed. In the middle of
the twentieth century Robert Merton, a renowned American
Sociologist, made a good case for some prominent aspects of the
structure of society being the cause but his theory never gained much
of a following. Social Theory and Social Structure (1949; rev. ed.
1968) One of his theories that gained influence was that of what he
referred to as „Anomie‟. He saw anomie as a major cause of social
deviance but he also emphasized the threat of punishment as the only
viable way to control rebellion and crime and delinquency. He was
primarily a social theorist. Consequently, in spite of several other
popular structural ideas such as the influence of role models, he
never provided an effective method for analyzing structure or altering
structure. Structure easily bowed to the ideas of causation with more
popular appeal, such as genetic predisposition and Merton‟s idea of
breakdown of the family in a society with increasing „normlessness‟.
       The “Stars and Stripes” phenomenon, however, revives the
concept of structure, especially levels of social structure, as the
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primary causal factor in both delinquency and the reform of
delinquents. The first question regarding the cause of the
transformation of the youth in the correctional institution was
answered, quite inescapably, with the observation that the structural
design of the “Stars and Stripes program” had to be the cause of
dramatic, positive changes in the entire population of the institution.
Obviously, psychotropic medications were not the cause. More
important to the thesis of this manuscript, however, is the
observation that traditional psychotherapy does not get such
astounding results while the institution‟s program did. How many
therapists and how many hours of therapy would it take to get results
of this magnitude, if ever? Would results be as enduring for when
using either approach? Finally, what is the reason that
psychotherapy „does not‟ result in such a dramatic difference? This
is a vitally important question.
      Pursuing these questions, I found the following additional likely
answers. Aside from the enormous gain when using a Natural
System‟s program in a closed, structured institution, a comparison
yields a second and by far more significant reason for
psychotherapy‟s failure. Through my analysis, I came to believe that
when traditional therapeutic modalities are compared to the Natural
Systems approach in this structured environment, the traditional
therapeutic modalities exhibited a wide range of drawbacks. For
instance, with psychotherapy, behavioral patterns rarely changed but,
when they did, it was usually only after many sessions over a long
period. Negative behavioral patterns typically resurface later on.
Furthermore, while clients often reported feeling better after each
session and, particularly, after the extended period of therapy had
ended, the actual maturity of behavior patterns had not increased and
the breadth and level of sophistication of ego-mastery skills seldom
grew or had only slightly improved. Why was this?
      I suspected that another reason for this lack of behavior change
when using psychotherapy was because, outside of the therapy hour,
everyday life continues to exert its influence for the remaining six
days and twenty-three hours. After that one therapy hour, the
constant pull of influences from their home and work environments to
get a person to exhibit their previous standard, ineffective, self-
defeating behavioral patterns is relentless. The force of their natural
environment exerts a powerful pull to get the patients‟ behavior to
return to its status quo Families persist in keeping a „designated‟
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problem person in their problem role within the family role system.
The expectations and pressures to maintain the status quo behavior
that exist in work relations, peer relations, relations with significant
others, and so on, persist. Try as hard as the client may, these mostly
unwitting external pressures in the non-institutional, open social
environment tend to mercilessly and tyrannically maintain the client‟s
same old ineffectual, problem behavior patterns. Not only is their
environment unwittingly maintaining these negative behaviors, but
also the „maintainers‟ exert their negative influence in spite of the fact
that they are simultaneously vocally disapproving of those same
behaviors and urging them to „get well‟, „shape up‟, and „take your
meds!‟. Who could charge these ostensible well-wishers with being
to blame for the failure of the patient‟s therapy?
       The “Stars and Stripes” program was able to avoid all of these
weaknesses examined above. The challenge now is to find the
courage to consider that psychotherapy is in need of a Paradigm
Shift.



             The Duplex Pyramids Model of Natural Systems
                       External Structures and Systems



                 Intentionality                    Processes



                       Internal Structures and Processes
                                http://dredyoung.com
                        http://TheNaturalSystemsInstitute.org




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      III.   Natural Systems, and its Duplex Pyramid model and
             Intentionality Model, suggests an alternative form
             of psychotherapy

     A. Describing the Duplex Pyramid model‟s top and bottom
pyramids, time, and the integrating Intentionality model:

     Natural Systems is an approach that includes the Duplex
Pyramid model. It also includes the Intentionality model that makes it
possible for the human being to interact with the external world and
integrate the internal and external structures represented by the
Duplex Pyramid. The Duplex Pyramid is one pyramid stacked on top
of another one.

                            TABLE I.
       BELOW IS A GRAPHIC REPRESENTATION OF THE DUPLEX
      PYRAMID MODEL WITH THE TEMPORAL DIMENSION AND
                  INTENTIONALITY INCLUDED




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           NATURAL SYSTEMS‟ SCHEMA PERSPECTIVES USING THE DUPLEX PYRAMIDS

                                                Encompassing Environments
                                                  Institution or Organization
                                                    Settings within Institution
             INTENTIONAL PROCESSES

                                                            Situations
                                                            Formal Roles

                                                               Dyadic
                                     PAST                                      FUTURE
                                                             Interaction

                                                            Informal Roles
                                                           And Relationships

                                                    Physical/Verbal Behavior
                                                              Cognition
                                                           Emotion/Feelings
                                                              Perception
                                            Life History     Genetics     Brain Chemistry




      1. Introducing and Defining the Top and Bottom Pyramids

      The top pyramid, as you can see, is inverted. Each pyramid is
divided into sections called levels. The top pyramid represents the
external world. Its levels are arranged in terms of their scope. The
topmost level of the top pyramid represents the largest scope but that
can be defined according to your purpose. In this case, the topmost
level represents the encompassing environment, which in this case is
the social environment. The next level represents an institution or
organization but could also represent a community or whatever meets
your purpose. The next lower level represents settings in an
institution such an educational or training class. The next level
represents situations that occur in that particular setting. The next, or
lowest, level represents the formal roles in the setting such as teacher
and student.
      The bottom pyramid represents a person‟s internal world. It has
levels arranged according to structures inside the person. The
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bottom most level represents what is deepest and most inaccessible
in person such as their life history and its secrets, for example.
Moving up, the next level represents perception. The next up
represents emotions and feelings. Next, there is cognition. The next
level near the top represents physical and verbal behavior. Finally,
there is a level called informal roles and relationships. In the very
center is what I refer to as the fulcrum of the pyramids, dyadic
interaction.
      will introduce you to understanding how to use the Duplex
Pyramids and will illustrate how to change and adapt your mental
processes to take in the scope of both Pyramids, examine each level
of each Pyramid, and then bring the whole, both Pyramids, into a
unified perspective. When one is working on any concept related to
humans and human society, this Duplex Pyramid approach can help
gain a more comprehensive and more detailed perspective.

For the reader to keep all of the levels of both pyramids in mind is a
daunting task. It is even more difficult when one is trying to apply it later.
Accomplishing this takes a very long time with much practice. Adding the
temporal dimension makes the model more realistic and dynamic but even
more complicated and intimidating. Add to that another critical component
to be presented later on, “The Intentionality Model”, and mastering this
system becomes formidable. “The Intentionality Model” reveals the
dynamism of humanity‟s real life way of interacting with their world. The
world with which people are interacting and the manner of interacting with it
is mostly mental and not immediately perceived. This world consists of
levels of the aforementioned internal and external structures. Putting all of
these factors together in one holistic system increases that complication
even further. Yet, this is the true nature of human existence. This Natural
Systems is a way of presenting the world that is not fragmented, contrary to
what is customary. Most people prefer to be presented with models and
systems that are simpler and less multidimensional. Fragments of the
world are easier to learn and comprehend. The problem with that is that
humans and human societies are by nature highly complex, highly
multidimensional and in flux with all of these factors continuously
accelerating in our modern, techno, global world. Our world is holistic and
we try to integrate its complex and forever fluctuating collision with our
senses. Our modern, fragmented systems just make this task virtually
impossible.


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      I am hoping, however, to provide, with these integrated models,
something like a roadmap or a set of integrated roadmaps to facilitate
the mental process of understanding the whole individual/society
welter, while at the same time facilitating the development of a new
form of therapeutic practice that integrates and addresses that whole
in a synergistic, effective way. This project is dedicated to that end.


      2. Introducing and defining and explaining the levels of structure
of the bottom pyramid

      As noted, I have given Natural Systems a logo called the Duplex
Pyramid model. It consists of two pyramids with one on top of the
other. The top is an inverted pyramid representing the external
structures and systems while the bottom pyramid represents the
internal structures and processes. Both the top and bottom pyramids
are arranged with levels ascending and descending in width from the
center out. The center designates dyadic interaction, which is
observable to an outsider but also has a parallel aspect that is
available only to the awareness of the individual, like the two sides of
a coin. This is also meant to indicate that all social interaction has as
its primary focus, solely, the interaction between two people. In other
words, if you are in a group, when you engage in interaction, you only
focus on one person at a time. If you are addressing a group, you
may focus on one person, the entire group, or neither. You may
address a group and yet be solely focused on what you are saying
and not on a person or persons. When you focus on one person in a
group, the rest are peripheral. The interaction is with the one. The
others may be an audience, but still peripheral to the dyadic
interaction. Most modalities of psychotherapy are explicitly designed
as dyadic interaction, therapist and client. This also is true of
couples, family, as well as group therapy. The focus is one person at
a time.
      The levels of external structures and systems shape the
personalities of people. External structures have varying degrees of
direct influence on the internal structures and processes, or the
personality of the person. For the purposes of this paper I have
categorized the top pyramid‟s external structures, starting with the
topmost, as the encompassing environment; institutions,
organizations, or community; settings within the institution,
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organization, or community; situations within settings; and formal
roles. Dyadic interaction is the fulcrum between the upper and lower
pyramids. The lower pyramid includes the internal structures and
processes to be discussed in the next section. The Duplex Pyramid
Model also has a temporal dimension. The temporal dimension is
represented in the graph below by the bi-directional arrow in the
center, between the two pyramids. This takes into consideration the
degrees of distance that both the past and future have from the
present. Later on, after thoroughly addressing the lower pyramid, I
will be able to show what the levels of structure of the upper pyramid
are influencing in the lower pyramid.
      In the lower pyramid, at the levels below the central dyadic
interaction, there are internal structures that are arranged in order the
degree to which they are immediately observable, the ease with which
they are can be observed or studied, and their directness of
connection to the external world. These internal levels of structures,
with the exception of physical and verbal behavior, are only
observable indirectly through psychological experiments or self-
report. The further down these levels one goes, the less easily
observable (or rather the less easily detectable) they are through
these indirect means.
      For convenience, I have elected to give a brief label to each level
of the bottom pyramid in the following descending order. The first
level is informal roles and relationships. The second level is physical
and verbal behavior, which, while observable, are difficult to study
since words and acts have no significance without reference to
indirect studies of their complex networks of meaning. The third level
is cognition or thinking and imagining. The fourth level is emotion
and feelings. The fifth level is perception. Finally, the sixth level is
the person‟s life history. As you can see, each level seems to have
some conceptual overlap with the others. They are, nevertheless,
differentiated or demarcated from each other in order to illustrate how
different modalities have developed to focus on their special level.
      On the other hand, if one starts at the lowest level of the bottom
pyramid and works up to the fulcrum dyadic interaction, it is possible
to view the ascending levels from a different perspective. From this
perspective, we move from the factors that have both the most
pervasive influence over dyadic interaction and yet are the least
specifically determinative of, or have the least direct effect, on
immediate dyadic interaction.
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       For instance, life history and genetics are the least determinative
and have the least direct effect on dyadic interaction. Next, since the
relations between what one actually perceives, and the way one
actually perceives, the acts of the dyad‟s other and how one comes to
act toward that other are often quite out of kilter with one another. Of
course, the other cannot directly perceive these inconsistencies. On
the other hand, emotions and feelings can be suppressed and their
meaning can be disguised. Nevertheless, emotions are usually
visibly observable while their import remains difficult to infer.
Interestingly enough, it is even possible for a person to disguise from
themselves what their true perceptions are and what their true
feelings or first feelings are. Cognition, or what one is thinking, has a
somewhat more direct effect on one‟s actual verbal and/or physical
behavior. Nevertheless, humans are notorious for the pretending,
scheming, manipulating, and craftiness of their behavior. People
seldom want the other to know exactly what their thoughts are. Of
course, this is both a reflection of the disconnection between thought
and act but also their direct connection.
       Cognition is immediately affected by and effects dyadic
interaction. It is a two-way street. Thinking about what to say and
how to act becomes increasingly swift as one grows from childhood
into adulthood. Even children are somewhat swift but less adept at
disguising their true thoughts from adults. Yet, somehow, perhaps
through extensive repetition over the years, human minds develop
somewhat stereotyped patterns or habits of thought and
consequently of behavior that often make their interaction oddly
ineffective or maladaptive with respect to the other‟s behavior in the
interaction. It often said that a person acted without thinking. In fact,
it is more likely that the two are bound together as a reflex.
       In isolation from a dyad, people often rehearse for the upcoming
interaction. Some may even repeat deprecatory or conceited self-talk
referring to themselves and deprecatory or flattering self-talk directed
to the other. For some these rehearsals are repeated somewhat like a
mantra. They may have the same mantra-like repetitions in reference
to the other. They may rehearse positive and negative talk strategies
for the upcoming interaction as well. They usually develop, during
their rehearsal, several versions of this solitary talk. Their repertoire
of references to self and other expands as they move into adulthood.
While they carry on this mental dialogue between themselves and the
other, when they are actually face to face with the other, nothing from
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their rehearsal is likely to be used. Nevertheless, many would feel
lost and vulnerable without it.
      Cognition, therefore, is more determinative and has a more
direct effect on physical and verbal behavior and the eventual dyadic
interaction than do the lower level structures of the bottom pyramid.
At the next higher level, Physical and verbal behaviors are in an
immediate reciprocal relation with informal roles and relationships.
Physical and verbal behaviors certainly do not completely determine
the enactment of an informal role when engaged in dyadic interaction.
All of the successive lower levels make their own contribution.
Nevertheless, the behaviors enacted through an informal role are the
direct cues to and from the participants in the dyad for each
successive act or word. Acts and words require interpretation and
can be misinterpreted, yet they are the essence of the immediate
interaction. The behavior or communication of each can quickly
change directions simply on a subtle inflection of the voice or nuance
of meaning.
      I assume that nothing gets through to the lower level structures
except through some form of personal dyadic interaction. As an
aside, it is notorious that the impersonal reading of self-help books is
ineffectual in achieving their stated purpose. As we descend the
levels of the bottom pyramid, the influence over successively lower
levels diminishes. However, referring back to the temporal dimension
of the Duplex Model, if a consistent structure of the external world
permits a perpetual, long-term, and well-designed influence on all
dyadic interactions, eventually the influence begins to shape, by
successive levels, the whole person. Old patterns of each level are
supplanted and new patterns become incorporated. If this goes on
long enough, even the highly indirect but pervasive influence of the
lowest level, life history, is permanently, significantly altered. The
levels all become highly resistant to alteration.
      The final principle here is that the uppermost levels change the
most and the most rapidly. The lowest levels change the least and
the most slowly. Therapy aimed at dyadic interaction can make rapid
but ephemeral changes. Therapy aimed at the lowest level takes by
far the longest time. Yet, if a person lived in a social vacuum, therapy
aimed at this level might eventually result in persistent changes in
dyadic interaction. Unfortunately, it, namely psychoanalysis, does
not take place in a vacuum with respect to the social environment.
The perpetual bombardment of one‟s relatively and typically
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unchanging social environment tends to undo the work of such
depth-oriented therapies and this reinstates ante therapy status quo
behavior. On the other hand, the more surface-oriented therapies are
not able to have lasting effects on the lowest, more indirect, yet more
pervasively, more enduring lower levels. I envision that the Natural
Systems modality will be able to overcome this dilemma.
       It is interesting to me that each modality did primarily develop in
order to address a specific level of the bottom pyramid. As such, they
each brought significant insights that were level-specific to the
general field of psychotherapy. As each modality gained prominence,
their insufficiency eventually would become apparent and another
modality arose to remedy the insufficiency by focusing on another
specific and usually higher level in the pyramid. In and of themselves
all of the modalities only address and represent one major aspect or
internal, structural level of human beings. Taken all together,
however, they seem to me to form this pyramid of mutually
influencing internal structures. Therefore, all of the levels taken as a
whole seem to be a reasonable representation of all of the structures
that constitute the human being. The Natural Systems modality is
meant to address all of these levels using an integrated approach.



      3. Features of psychotherapeutic modalities are selectively
related to the separate levels of the bottom Pyramid

      These aforementioned levels of the lower Pyramid can also be
seen as arranged in a descending order that relates to typologies of
modalities of psychotherapy that tend to focus primarily on that level.
      The upper most level relates to roles and relationships and the
corresponding type of therapy involves role analysis, role-playing,
psychodrama, and role structuring with dyadic interaction,
transactional analysis, and cognitively restructuring roles and
relationships. The focus is not on formal roles such as you would
find in corporations, agencies, or organizations. These roles are a
part of job descriptions that are very narrowly prescribed. This is why
one rarely sees non-conformist, deviant, or symptom-behaviors of
mental illness when a person is performing a formal role on the job.
      In this context, however, I am referring to informal roles that
occur in open society. Roles of husband and wife; parent and child;
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roles in peer groups; roles in social clubs; informal gatherings after
work are all examples of informal roles that have no or very loose
prescriptions for behavior. The psychotherapeutic modalities
mentioned at the beginning of this section are all designed to treat
informal role related psychological problems. For example, these
therapies could involve analyzing and altering the way clients
communicate or talk to one another. In its simplest form,
transactional analysis will point out how two people can each assume
various combinations of one of three primary roles: parent, adult, and
child. Therapists sometimes instruct clients to speak to one another
as though they inhabit a different role vis-à-vis the „other‟, for
example, husbands and wives may be asked to switch roles. A
husband could be taking the role of parent and the wife taking the role
of child and so on for their several permutations. Once clients
understand the point of view of the other‟s role, it is possible to begin
attempting to alter the client‟s own style of relating and
communicating. Therapists suggest ways for clients to alter their
communication patterns with each other. To follow the instructions,
each client must rely on their own inner resources to try to enact what
the therapist is suggesting. They also have to imagine and enact
what they feel to be their significant other‟s, peer‟s, parent or child‟s,
for example, styles of relating.
       Communication therapy such as that used by Virginia Satir fits
into this category as it is also concerned with the way people in
relationships communicate with one another. The clients do the inner
work of imagining and preparing to assume the role and then move
into the interplay of dyadic interaction. The therapist gives feedback
or analysis of defects in the communication pattern and they cycle
through until they have a mutually satisfactory style interpersonal
communication. The concepts of family of origin techniques, family
systems, and family styles are often used in the therapy in these
contexts, especially when working with the extended family.
       Descending to the next level, this structure involves both
physical and verbal behavior, yet here they are dealt with
independently of roles and relationships. Therapies such as these
may use positive reinforcement as is found in behavior modification
to train a client to act or speak in a certain way. The therapist may
provide the source material and may use coaching or modeling to
illustrate the suggested ways of behaving and speaking.
Desensitization is a technique that is typically for the individual client
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and may be used to reduce anxious, fearful, and avoidance behavior.
Behavior is the focus and variations in stimuli and types of
reinforcement are used to alter behavior. The justification for using
these techniques is that these emotions are painful to the client and
they inhibit and thwart effective behavioral responses. Traumas and
traumatic life conditions are typically the initiators of these painful
emotions. War, natural disasters, and accidents account for many
panic, fear, and anxiety reactions. Extremely embarrassing incidents
are also a common cause. The most widely used modality,
Psychiatry, also deals with physical or overt behavior. Its assumption
is that a chemical imbalance in the brain is the primary cause of
psychoses and personality and behavior disorders. We could call
Psychiatry a brain-chemistry manipulation modality as its principal
and almost exclusive treatment is the use of psychotropic
medications.
      At the next lower level, there are the more sophisticated,
cognitively oriented therapies that are used with the individual client.
A sample of these is reality therapy, rational emotive therapy,
cognitive restructuring, problem solving, values clarification,
journalizing, and guidance and life-decision counseling. Life
conditions can prevent normal development and growth in maturity
and discourage or prevent the acquisition of ego mastery skills. If a
person grows up with life conditions that are disadvantaged, harsh or
dangerous, involve racial prejudice, or when tragedies like the death
of a parent or divorce have occurred, the person‟s personality can
become malformed. These cognitively oriented therapies have been
designed to deal with such personality disorders or immaturity. They
may focus on how to intellectually can gain insight and alter various
aspects of such problems. Therapists help them become more aware
of and alter problems such as the following: their self-concept and
identity problems; their self-defeating patterns; their negative self-
talk; and deal with relationship problems and make more well-
informed life choices.
      At the next level near the bottom of the pyramid, we have Gestalt
therapy that is also for the individual client. It is especially designed
to work with the way perception has been distorted by lessons from
parents and the culture. Gestalt therapists suggest that, as the child
begins to develop, its primitive, direct perceptions are transformed
into socially sanctioned but unrealistic interpretations. Gestalt
therapists focus on how such distorted perceptions determine the
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way the client interacts with the world. They work with clients to help
them get back to objective perception that is uncontaminated by
these imposed interpretations. They especially attempt to help them
get in touch with their true, unadulterated perceptions, sensations,
and feelings toward the world versus their false interpretations. The
Gestalt theory of phenomenology attempts to present and to put into
obvious contrast with objective reality, its subjective perception, or
interpretation, of reality. This new realism attempts to help the client
get at objective reality and thus cast out the demons of subjective
interpretations that are full of illusions, delusions, and nightmarish
views of the world. The intent of this therapy is to bring the client to
this point of perceiving realistically and authentically, free of neurotic
conflicts. While Gestalt therapy does focus on how the social
environment influenced the development of the distorted perceptions,
it is still primarily focused on the person and „how‟, or the processes
by which, the person is engages in the act of perception, rather than
on the „what‟ of the perception, namely the external environment. It
must be noted that this „how‟ of perceiving is considered in isolation
from all of the other processes of intentionality, which are essential to
Natural Systems.
       At the final and lowest level of the bottom pyramid, we have
psychoanalytically oriented psychodynamic psychotherapy that
focuses on the individual client and deals largely with clients‟ life
histories. The expanse of the psychoanalytic model is deeper and
broader than most of the other modalities. The mental arena of
psychoanalysis includes time, mainly past time, with the focus being
on the individual‟s life history. The focus of this model is principally
inside the person and on the dynamics of the person.
       Freud, the founder of psychoanalysis, began his career as a
medical doctor. In medicine, doctors made a diagnosis and
prescribed a prescription with detailed instructions that another
doctor or, even in some cases, a nurse could follow. This is
somewhat like an algorithm. Medicine had „disease‟ taxonomy. Each
label in their diagnostic taxonomy has its preferred treatment. Each
illness in the taxonomy also includes an etiology, which was an
explanation or description of the cause and the course or stages the
disease will follow. This is the essence of the medical model.
       After discovering conversion reactions in which psychological
rather than physical causes were attributed to certain illnesses,
Freud‟s version of medicine turned toward a wholly new direction.
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This led to the new discipline of „psycho‟ „analysis‟. This new
discipline evolved into a focus on client‟s non-medical complaints
and a search for causes inside the person, in their psyche. Etiology
became factors in the person‟s life history, particularly their early
childhood development and their relations with family members.
Freud focused inside the person and toward the person‟s past. The
dynamics of the patient‟s illness were also to be found in primitive
desires in the person. These had their origin in the physical nature of
the person, that is to say, their biological drives. From this point on, a
new taxonomy developed. This became a taxonomy of psychological,
or mental, illnesses. Etiology in this new discipline was a
combination of life history plus family dynamics plus biological
drives. Initially biological drive that was the most important was the
sex drive. Working from this combination, Freud formed a tripartite
division of the personality consisting of the id, ego, and superego,
which were in conflict with one another. He also constructed a
structure of the mind that consisted of the conscious, pre-conscious,
and unconscious. Freud created an additional kind of taxonomy,
called defense mechanisms, to describe how people dealt with
conflicts between the parts of his tripartite model of the mind.
      In the relatively calm social environment of pre-war Austria,
there was no need to focus outside the person and their social
environment. Right before World War II, when the country became
turbulent due to the threat of Nazism, he came to America where the
social environment was calm and stable. He died the next year, 1938.
By this time, his system of psychoanalysis was virtually complete.
For a considerable period thereafter, Freud‟s psychoanalysis was a
virtually unchallenged, highly popular, and highly revered new
treatment discipline. Of course, classical psychoanalysis was quickly
recognized as something only the rich could afford. In its classical
form, a patient would see their analyst for an hour five times a week at
a charge higher than other modalities. In addition, in classical
analysis, the technique consisted of the analyst listening, with little of
no input, to the patient for the entire hour. He had his patients recline
on a couch and encouraged them to speak freely about themselves.
As an aside, reclining on a couch is much like being in bed for a
night‟s sleep. In this situation, with no influence from the pressures
of daily life, thoughts, fears, fantasies kept at bay during the day
begin to surface. Again, this was another stroke of Freud‟s genius. It


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seems odd that he followers abandoned this technique so quickly
after the master died.
       In spite of the hallowed status the Freudian system, there was
one challenger. This came from a close associate whom he had
mentored and in whom he had seen much promise, named Jung.
Jung had tried to refocus therapy toward the influences of the
external world. He was particularly interested in bringing concepts
related to culture into psychoanalysis. Another challenger was Adler
who tried to shift the focus toward the future and away from being
primarily on the past and on the achievement motive rather than the
sex drive. He presented humans as goal-oriented. However, no
challenges within the discipline of psychoanalysis were persuasive
enough to cause a swerve away from the course that the huge
momentum of Freud‟s psychoanalysis had gained. A more affordable
and practical version of psychoanalysis sprang up in the form of
psychodynamic psychotherapy. Initially, this related modality used
Freud‟s theory of personality but the technique was more interactive
and was limited to one hour per week, which made it more affordable.
These varieties of psychotherapeutic modalities suffer from the same
intractable problems of all individually oriented therapies mentioned
above.
       As was mentioned above, Psychiatry is associated with and
belongs with the second level on the pyramid. This is due to its focus
on overt behavior and employing a brain-chemistry manipulation
modality that alters neurotransmitters. Psychiatry eventually
assumed the legacy of the Freudian tradition. It vastly expanded the
taxonomy of psychological illnesses found in the regularly updated
DSM, manual of diagnostic criteria. The majority of categories in this
taxonomy are diagnosed by collecting direct or chronological
observations of overt behavior, reliable self-report, or reports coming
from family or institutional staff.
       Psychiatry found the search for Freud‟s kind of etiology too
illusive and explanations of illnesses derived from Freud‟s theory of
drives and conflicts within the tripartite self to be inefficient.
Psychiatry‟s taxonomy became codified descriptions of behavioral
patterns. Their diagnosis came to be based on objectively observed
behavior rather than illusive concepts of the inner world. Their
etiologies relied less on life history. Even life histories were reduced
and codified to aid in gauging the severity of the illness. Their
explanations switched from Freud‟s conflicts between id, ego, and
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superego to the more scientifically demonstrable disturbances in
brain chemistry and endocrine glands and their hormone secretions.
As behavioral descriptions that fit within taxonomic labels were
studied in relation to physiological patterns, medical research was
finding correlations between these labels and types of disturbances
in the persons‟ physiology, particularly brain chemistry.
      Corresponding in time and collaborating with psychiatry,
psychopharmacology was beginning to find chemicals, tranquilizers,
which could quickly ameliorate the condition or disturbance in brain
chemistry and the accompanying symptomatic behaviors as well.
Psychiatry and psychopharmacology were able to demonstrate quick
and easy cures simply by giving the patient a pill. Their focus
primarily became restricted to the person‟s observable behavioral
patterns with corresponding imbalances in brain chemistry.
Psychiatry became the hero of the modern world. Symptoms that
developed because of pathological influences in the external
structures of the changing modern world could quickly be diminished
so that people could adapt to them. People could be made to adapt to
the rapidly evolving disorder and stresses of modern culture. They
were, therefore, were less of a problem to their employers.
      One additional intractable problem that is attached to psychiatry
and that is only remotely related to those mentioned above was the
fact that giving a person a diagnostic label that entailed a select
aggregate of behavioral patterns, or traits, subsumed under it did not
guarantee that they would be constant and immutable. A person
could change from situation to situation and time to time. A simple
example is that a person who killed someone would typically be given
a diagnostic label like antisocial personality. If a person went to war
and killed someone on behalf of their government, were they an
antisocial personality? In this situation, they were usually referred to
as decorated heroes. Many veterans, on the contrary, experienced
this as an overwhelming cognitive dissonance accompanied by
persistent guilt, depression, and alienation. The government had to
proclaim the murderous deeds of warfare as morally legitimate but to
many veterans, the deed was the same regardless of the situation.
For many veterans, the attempt by authorities thusly to assuage their
guilt only seemed like hypocrisy and added to their despair and
alienation. Psychopharmacology merely turned most of them into
harmless zombies for life, as, underneath their prescribed
psychotropic medication, their condition typically remained
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intransigent. However, of course, they could not be labeled antisocial
personality nor described as suffering from moral angst and
indignation. That would be politically incorrect. This zombie-like
condition, however, remained true regardless of how they were
treated.
      Another example of a labeled mental illness being situation-
specific would be that of a person who is chronically anxious. They
are given a diagnosis of chronic anxiety reaction. It is as though the
person „is‟ the label or what the label describes, now and forever
more. Yet, a wife living with a chronically threatening husband
should be chronically anxious while with him but could very likely
eventually stop being anxious after she leaves him and enters a safe,
secure, supportive circumstance or set of relationships.
      Once again, this suggests that the structure of the environment
accounts for the lion‟s share as the cause of so-called mental
illnesses.
      Meanwhile, psychopharmacological pills began to be doled out
ever so freely by the psychiatric profession and yet they were not
proving to be effective in resolving the moral dilemmas, effects of
pathological social structures, or social and economic injustices that
are rife in our nation‟s pell-mell rush into social chaos. In fact, the
marketing practices of the mind pill industry are now so pervasive,
powerful, and mesmerizing that they dupe even highly intelligent
consumers. These unfortunate and unwitting people suffer from
painful emotions and socially unwelcome symptoms. These pills
numb their senses and dumb down their faculties sufficiently to meet
the daily demands of work and family. Yet these vulnerable, easy
human targets are paying the price of psychologically never working
through the underlying causes of their misery. One cannot deal with
painful emotions and their roots if emotions are drugged into
oblivion. They are cheated out of the chance of developing ego
mastery skills for coping with the past unfinished-business and
psychological traumas, as well as life‟s future challenges. We all are
paying dearly for having a blind eye turned toward these malignant
external structures of our national and medical culture.
      The final contrast, therefore, is with this medical model mode of
treatment used by the vast majority of psychiatrists. Today that
treatment consists almost entirely of the following the following
steps. The psychiatrist conducts an initial brief, structured, thorough
and professionally recommended interview. From the results of this
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interview, the psychiatrist notes the range of symptoms presented by
the patient. He compares those with the symptoms related to
symptoms listed under diagnostic categories in their DSM manual.
He assigns the patient one or more diagnostic labels. Based on his
diagnosis, he selects from the medications that are supposed to treat
that particular form of mental illness. He prescribes one or more of
the medications that are recommended as the approved treatment.
He then has the patient follow up every few weeks or months to check
their progress in improvement or reduction of symptoms, and to see
if changes in their medication need to be made.
      Psychiatrists infer from information gathered from the patient
and possibly other reliable sources what their illness most likely is.
They view the patient as „having that illness‟, that is to say, the illness
is located „in‟ the individual. Also, in a sense, this could be
interpreted as implying that the „label‟ that indexes the patient‟s
collection of symptoms is „the cause‟ of their illnesses or that the
label indicates that the illness is an „entity‟ located in the person and
a cause of the overt behavior. Even if they do not intend to do this,
the patient and the public at large tend to treat the label as though it
were an entity and the cause. Of course, this is circular logic. If
argued in a court of law that the a person committed an illegal act
because they had, or were, the type of mental illness implied by the
label, the judge would not allow that to be considered in the jury‟s
deliberations on the basis of the claim‟s circular logic.

      The search for an explanatory cause of the symptoms,
nevertheless, stops. If asked in a more probing manner what the
cause is, they might suggest something like a chemical imbalance.
No one knows exactly what is „meant‟ by chemical imbalance. If the
diagnosis and prescription entail chemical imbalance, there is often
reference to a specific (or some) neurotransmitter. This would lead
one to assume that the offending neurotransmitter or the
configuration of neurotransmitters is a permanent condition. In fact,
researchers studying neurotransmitters have isolated over one
hundred of them. In addition, their research clearly demonstrates that
neurotransmitters are in continuous flux. The configuration of
neurotransmitters is constantly changing and the major cause of the
flux is the person‟s response to their environment. This tendency to
tag one or two neurotransmitters as the cause seems more like a
shorthand way of covering a multitude of generally, informally
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accepted but unverified assumptions. The role of the environment,
being unobserved and inaccessible to the psychiatrist, is not given its
due in this treatment process. Environmental causes, diagrammed in
the top pyramid of the “Duplex Pyramid Model” are not considered in
either the diagnosis or treatment. This disconnection tends to
perpetuate both the illness and the myth of chemical imbalance as
„the‟ causal factor.
      At this point, the all-important question of effectiveness of this
type of treatment arises. What happens when a person is given a
psychiatric diagnostic label and treated with psychotropic
medications? Let us dispose of a most conspicuous criticism. In a
majority of cases, once a person has been given a label, they are
assumed to „be‟ that diagnosis and therefore to have that illness for
the rest of their lives. Therefore, they must remain on a psychotropic
medication for life. The implications for the person‟s life in the
present, on the other hand, are more subtle and illusive. The
devastating affects of being given a mental illness label must be
addressed.
      What is in a name? For friends and relatives, this person
suddenly „becomes‟ the stigmatizing psychiatric label. Psychiatric
labels are generally frightening to people. They no longer know what
to expect but sense that they should expect something embarrassing
or even dangerous. If experiences from past associations with the
labeled person did not include behavior they should have been wary
of, now that past is discounted or revised with the worst of
intimations. Friends and relatives now treat that person in a guarded
manner. The slightest sign of some unexpected or peculiar behavior
is met with the well-known shuttering inhale of breath that a rash
breach of decorum brings. After a certain number of „aghast‟
reactions, the patient‟s identity becomes colored as though they were
a pariah and they tend to be avoided and excluded.
      What are the implications for the patient (person) to having a
psychiatric label that eventually transforms their identity and causes
these shunning reactions? Some may become inhibited around
others. Some may feel despair over being forever treated with
caution and even avoided. Some may become resentful and blame
others for their so-called or assumed condition. Some may flaunt
their label as though it makes them special in some way. For others
the concept of self-fulfilling prophecy may come into play. Some may
simply give up and say to themselves that if they have the name
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(label) they might as well have the game. Some could feel relieved
that they no longer have to probe or be probed with myriads of
homespun theories of causation. It may also be easier simply to
conform to the perverse and defeatist expectations of relatives and
friends and put on exhibitions of insanity and perplexing behavior for
them. The main and most crippling result is that having their problem
solved by proxy due to the „label being the cause‟, and therefore any
genuine quest to explore themselves or to look for ways to become
healed is aborted. Self-understanding, self-development, personal
growth, attempts to restructure their lives, and just plain hope are
foreclosed. Furthermore, attempts by friends and relatives to help
them overcome their problem and find alternatives that might lead
them out of the psychological prison psychiatry has put them in
cease with a bitter but final sense of resignation. Who will listen to
them as a mere fellow human being rather than a „stigmatized label‟?
      Therefore, in what ways do psychiatric treatments shape or
influence personality and behavior? The conclusion must be that
psychiatric treatment, at best, smothers any further self-knowledge
and stunts psychological growth. It makes the person forever
dependent upon the psychiatrist and the psychotropic medication
prescribed. It does not matter if improvement means only a reduction
in symptoms. When their condition seems to worsen, do they
question the treatment or the psychiatrist? No, because the
psychiatrist is supposed to be the ultimate authority and it would be
foolish to question such an awesome expert. Their hope that
someone might listen to them as they would any other human is
dashed. Their belief in their own ego, their longing to fulfill their
dreams, their willingness to take the risk of adventuring, their
independent existence as a human being is dead. These very results
of psychiatry are haled as a miracle of modern medicine by the
shallow media.
      Coming to the rescue of this psychological doom is an amazing
finding that emerged when an innovative program was introduced
into a juvenile delinquent correctional institution. As I noted at the
beginning, juvenile delinquents who had been given psychotropic
medications for chemical imbalance in the brain showed minimal
change in behavior. When the structure of the institutional
environment became more positive and supportive and positive,
responsible behavior was approved and rewarded, these youths


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exhibited no abnormal symptoms indicative of disturbed brain
chemistry. They no longer needed psychotropic medication.
       Obviously, a person‟s personality is not as static as a diagnostic
label would suggest. Furthermore, a search for causal explanations
that focuses solely on the person‟s behavioral patterns, on their past,
or on their inner dynamics is far too narrow. The structure of one‟s
social environment provides a far better explanation and prediction of
the status of one‟s mental health than a psychiatrist‟s diagnosis of
the individual.
       In summation, this section on the features of psychotherapeutic
modalities that are selectively related to the separate levels of the
lower Pyramid revealed many deficiencies. I conclude that each of
these modalities fall short of their goals. This is because they each
focus too narrowly on one level of the person‟s inner structures.
They exclude the relevance of the other levels of structure within the
person as well as the external levels of structure that also have major
impacts on the person‟s personality and treatment outcome.
Understanding a person requires a multidimensional mental arena.
Finding a successful treatment requires a multidimensional focus.
       It is hard simultaneously to focus on the inner person and their
external world, on their own past and future, and on the past and
future of their culture. It is even more difficult simultaneously to try to
correctly guess or determine the mutual influences of factors in the
structures of the external world and the processes of the internal
world. If you are trained to focus one way, it is hard to adopt a
different type of focus. If you are trained to focus in a unidirectional
way and at one or only a few dimensions, it is hard to adopt a multi-
directional, multi-dimensional focus. The era of the one-dimensional,
unidirectional modalities, plus the medical model and its offshoots,
has proven to be unequal to the challenge of dealing with the
problems of individuals in this exceedingly complex, exceedingly
fluid, and disturbed modern external world.
       While all of these therapies cited above offer something of value
to clients, each modality in and of itself retains intractable problems.
However, each of these more individually oriented therapies do
contain some insights and techniques that are of unquestionable
value. There are, nevertheless, four serious, intractable problems
with them all. First, as was discussed above, psychotherapy is
conducted in the cloistered one-hour session, while the majority of
influence on the client is in the rest of the seven, twenty-four hour,
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days. Second, the inner intentional processes are addressed only
accidentally, if at all. Third, practice of new, more mature behaviors
or ego mastery skills does not become a significant part of these
therapies. Fourth, and finally, while these therapies address specific
precipitating situations or incidents, they do not address the
powerful, indirect influences from the levels of external structures.
External structures are the primary cause of immediate behavior.
Internal structures, or rather intentional processes, are the secondary
cause of immediate behavior. Autochthonous intentional processes
are the tertiary cause of immediate behavior. Autochthonous, in this
case, means that the cause of an act was mainly something
originating in the person with minimal stimuli and instigators from the
immediate environment, for example something creative, novel, or
original. This is least reliable of all to be attributed to the person as
the cause of their behavior. Nevertheless, however, behavior is most
likely and easily to be linked to a person‟s intentions. Typically,
common sense and folk psychology is most likely to attribute the
cause of action to be autochthonous due to a belief in free will.
Hence we have the tendency to neglect External structures as
significant causal factors worthy of consideration in explaining
behavior or when making a diagnosis or prescribing a treatment.


      4. There is a temporal dimension to the Duplex Pyramid Model
and it can be used to describe intractable problems with
psychotherapy that are related to altering longitudinal behavioral
schemes

      There are categories of behavior that could be called
longitudinal patterns. They are similar to a series of related
behavioral skits that might recur throughout a movie drama. In a
movie, such longitudinal patterns that might unfold over months or
years in real life are compressed into two hours, making it much
easier to grasp the concept. In real life, some such patterns could be
related to a person‟s long-term objective or even life‟s goal. The acts
or skits required to realize the objective are sequentially strung out in
segments or phases over time. This is often seen when a character in
a movie is a clever manipulator, enacting each different, brief skit as
part of a longer devious scheme. Each skit at each stage could be
enacted with a different person, but they are essentially either a
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variation of the same skit or different skits designed to reach the
same end. On the other hand, each variation of the same skit could
be repeatedly enacted with only one or a few people, for example one
or a few family members. The skit may be slated to appear only when
the time is ripe for that version of the skit or scene. Imagine, for
example, a teenage trying to manipulate both parents. For one
instance of their scheme, they have a skit that is designed to play one
parent off against the other in hopes of getting their way. For a
second instance, they could alternate their skit between parents. Yet,
the goal of the scheme could be roughly the same in each instance.
Very sharp parents may be able to figure out that they are both being
played. Cognitively, detecting such patterns is a task that is next to
unattainable in the one hour a week sessions of psychotherapy. Yet,
it is easy to see that absent an addressing of this tricky pattern in the
therapy hour, little progress will be made with respect to relations
with parents or with respect to detecting and altering manipulation
schemes.
       As noted, these longitudinal patterns are even more difficult to
detect in real life. To deal with this sort of thing in traditional
psychotherapy is nearly impossible. The obvious reason for this is
that the client tends to focus on each skit or bit of behavior
separately, without reference to its role in the longer sequence. From
another point of view, it is extremely unlikely that the client will see
the whole pattern with its inclusion of both parties in the dyadic
interaction. How often do you have a client describe interpersonal
interaction from the viewpoint of the other party? The therapist might
point this out, but does the client listen or buy it? Therefore, with
respect to this category of behavior, it is next to impossible for the
client, much less the therapist, to call up, during any one session,
each longitudinal instance that unfolds scene by scene, stage-by-
stage, perspective versus perspective, over a much longer period, as
for example, months or even more. Is it not of a far more serious
consequence that such patterns are very unlikely to be amenable not
just to detection but to change when played out in the natural
environment over long periods?
       It is necessary to find a way to review each instance as a part of
an entire longitudinal behavioral pattern. It is necessary for the client
to grasp the unconscious function, goal, and covert significance of
this scheme. The therapeutic purpose of doing that would be to
compare repetitive or devolving instances across the longitudinal
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path, grasp how they dovetail toward a dénouement or climax,
imagine alternative criteria for fulfillment, imagine alternative patterns
and their mutual effects in dyads, and practice, implement, and
maintain these more positive alternatives. This is what solid progress
would mean.
       On the other hand, these longitudinal patterns are more readily
detected and dealt with in the closed institution. Paradoxically, it is
unnecessary and even counterproductive to do so if the institution
has a program like “Stars and Stripes”. The reason for this is that the
Natural Systems program in the closed institution is designed to
facilitate acquisition of positive ego mastery skills and foster personal
growth and maturity. As this takes place, the need for such
longitudinal schemes is supplanted by the more mature coping and
ego mastery skills.
       If one enters into and gets a realistic perspective on the
longitudinal concept, whether it be an isolated scenario within or an
entire longitudinal pattern, it is easy to see that this is beyond the
capacity of clients in hour-a-week sessions. It is impossible for them
to focus on each and all of the relevant problematical instances of
such patterns as they occur in the midst of the fast flow of life in open
society. Nevertheless, doing this is crucial to long-term success in
therapy. To assist in solving this problem, a chronology of
experiences, insights, feedback from other participants, and practice
can be recorded throughout the course of the Group. In the open,
natural, social environment, participants in a Natural Systems Group
can use various techniques to record their progress over the life of
the group. These techniques create a chronological record of a
participant‟s events, actions, insights, exercises, practice, and
progress that unfold in concert both within the Group and in their
daily life over the course of treatment and even afterwards if they so
wish.


       5. The Intentionality Model: Introducing that part of the Natural
Systems approach that integrates the top and bottom pyramids and
the temporal or longitudinal perspective
A few early psychoanalysts had discussed the „will‟. However,
intentionality, as a set of sequential processes each of which could be
addressed with specific techniques, has never been addressed. The
separate, descending, levels of the bottom pyramid were shown to be
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related to corresponding psychotherapeutic modalities. The Intentionality
Model and its processes will be elaborated later in this document. For now,
I will simply point out the powerful role of the Intentionality Model in the
Natural Systems‟ therapeutic approach. Each of the separate processes of
intentionality can be treated using collection of tailored therapeutic
techniques. Another important feature of the intentionality processes is that
their methods of treatment can come largely from aspects of the top
pyramid. This feature will also be discussed in detail later in this document.
Looked at from inside the Intentionality Model out, its processes serve to
store and integrate the inner and outer observations our world. Looked at
from the outside in, the intentionality processes can be seen to be
influenced by aspects of the levels of the external world. Those aspects of
the external world can be redesigned to have a therapeutic effect on the
intentionality processes. The most powerful characteristic of the
therapeutic approach that Natural Systems uses with intentionality
processes is that it does not have to be oriented to treat illnesses,
disorders, or psychological illnesses. Rather, this approach is oriented to
designing structures that elicit growth in traits we associate with increased
levels of maturity. In other words, this is a positive psychology.


     B. The Evolution of Mental Health Treatment and the
Objectification of Man

III. The Evolution of Mental Health Treatment and the Objectification of Man
           A Historical, Systems-Structures-Processes Approach
                                List of Contents
1.    THE EVOLUTION OF THE TREATMENT OF MENTAL ILLNESS FROM THE DAWN OF
HISTORY     33
2.    THE ANCIENT TRENDS MEET A DEAD END 34
3.    A DOOR TO A PROMISING NEW APPROACH TO TREATMENT CLOSES       35
4.   FROM MEDIEVAL TIMES TO EARLY AMERICA, THE MENTALLY ILL TENDED TO BE
DEMONIZED 35
5.    THE MODERN PARADOX: BAD PERSON OR BAD STRUCTURE?       36
6.    STAR CROSSED HISTORICAL AND AHISTORICAL APPROACHES     36
7.    WESTERN OBJECTIFICATION OF PATIENTS IN THE TREATMENT OF EMOTIONAL
DISTURBANCE      37
8.    PSYCHIATRY CREATES A HANDBOOK WITH A TAXONOMY OF MENTAL ILLNESSES
      37


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9.    THE RISE OF PSYCHIATRY AND THE RISE AND FALL OF PSYCHOTHERAPY          39
10.   PSYCHIATRY‟S ROAD FROM ASCENDANCE TO PREEMINENCE       39
11.   CARL ROGERS BUCKS THE OBJECTIFICATION TREND      41
12.    HUMANE ROGERS OPPOSES OBJECTIFICATION BUT STAYS IN THE CULT OF THE
INDIVIDUAL 42
13.   WHAT IS REQUIRED TO OVERCOME THE CULT OF THE INDIVIDUAL      43
14.   THE PERSON BECOMES THE LABEL :: THE LABEL BECOMES THE PERSON           44
15.   THE CULT OF THE INDIVIDUAL IS REINFORCED WITH DIAGNOSTIC LABELING      44
16.   MENTAL HEALTH SUFFERS A HOSTILE TAKEOVER BY THE CORPORATE MENTALITY
      44
17.  PHARMACY, INSURANCE, AND NOW JUSTICE SYSTEM REINFORCE PSYCHIATRY‟S
PREEMINENCE      45
18.   PSYCHOTHERAPISTS PLAY-FOLLOW-THE-LEADER WITH PSYCHIATRISTS             48
19.   PSYCHIATRY GETS PHYSICAL AND PSYCHOTHERAPISTS TRY TO TAG ALONG         48
20.  EVOLUTION OF MENTAL CARE DURING THE SECOND HALF OF THE TWENTIETH
CENTURY   49
21.   ERAS OF MENTAL HEALTH CULTURE FROM THE PERSPECTIVE INSURANCE
REIMBURSEMENTS 52
22.  QUESTIONING THE 'PERSON AS OBJECT' IN AMERICA‟S NEW MENTAL HEALTH CARE
SYSTEM     58
23.   STIGMATIZING BECOMES FASHIONABLE IN TV ADS AND SWEEPS ACROSS AMERICA
      59
24.   NAME CALLING REINFORCES PRESSURE FOR CONFORMITY VERSUS TOLERANCE
      61
25.   THE MODERN ZEITGEIST OF „SIGNS‟ 62
26.   WHAT IS CHEMICAL IMBALANCE IN THE BRAIN ANYWAY? 62
27.   MODERN LIFE STYLES CREATE A GENERATION ADDICTED TO PILL POPPING        63
28.   FROM PILL POPPING TO PILL HOPPING    63
29.   PSYCHIATRY‟S MODERN PATERNALISTIC POSTURE        63
30.   ON THERAPY AND BEING A PATIENT UNDER THE NEW LORDS OF THE MIND         64
31.   THE PUBLIC HAS UNWITTINGLY ABDICATED ITS AUTONOMY      65
32.  HOW THE MEDIA KEEPS THE MEDICAL-INDUSTRIAL-COMPLEX WHEELS WELL
GREASED   66
33.   A CULTURAL ANTHROPOLOGIST ASKS, “WHO IS REALLY SICK HERE??” 66
34.   HOW CAN THE CONCEPT OF STRUCTURE PLAY A ROLE IN MENTAL HEALTH?         68
35.  THE DIALECTICAL TENSION BETWEEN SOCIAL STRUCTURES AND INDIVIDUAL
FREEDOM    69
36.  A NEW PROPOSED GOAL WOULD BE FACILITATING MATURATION VERSUS CURE
SYMPTOMS 69
37.   PRESCRIBING ALTERNATIVE METHODS TO RECOVERY FROM OUR CULTURAL
SICKNESS   69


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38.  WAYS OF RELATING IN TYPES OF ROLES AND RELATIONSHIPS IN THE NEW MENTAL
HEALTH SYSTEM   69
39.    TO REVERSE THE OBJECTIFICATION OF MAN: RESPECT THEIR TOTAL INNER PERSON,
LIFE HISTORY, LIFE CIRCUMSTANCES, AND INTENTIONS 69
40.    ALL OF THIS BEING SAID, WHAT DO WE DO NOW? 69


      1. The Evolution of the Treatment of Mental Illness from the Dawn of History

        Over many millennia, modern humans, with the help of languages, gradually
developed civilizations. Sometime after people in Western Civilization began to write, a
few began to record histories. Eventually they began to philosophize and record their
philosophies. Among other things, they philosophized about the origin and nature of
their external world. After the introduction of numbers, perhaps over five millennia ago,
they eventually began to quantify. Quantification assisted with trade and commerce,
building, and defense, and eventually with government for tax and census purposes.
The use of words eventually led to trying to name persons‟ positions in a tribe or
community and to trying to describe one another and, finally much later, there were
even attempts to develop taxonomies of types of people. The pairing of quantification
with construction, commerce, and all of the other externally observable aspects of the
world was extremely successful. Their observations of the physical world led to, or
improved, suppositions about cause and effect relations. Physical causes began to
replace supernatural causes, at least among the intellectual elite.               Since the
supernatural had been assumed to cause effects in the physical world, it was natural to
assume that it caused bizarre, disapproved, behaviors. Religious rituals had been used
to try to exorcize the evil spirits, which they presumed to be the cause of those bizarre,
disapproved, behaviors. It was natural for intellectuals to begin searching for physical
causes of and cures for what they felt were bizarre behaviors, whether demons were
involved or not. Trepanning, primitive surgery on the brain, in use for millennia, had
begun to be used as a physical cure for bizarre behaviors caused by demonic spirits. It
was supposed that trepanning might release the demons from the brain. Within some
groups of people during these ancient days, their religious leaders had even
recommended beating the person to drive out the evil spirits. Early on, the Greeks
began to reject the notion that demonic spirits caused mental illness. They developed
rudimentary taxonomies of mental illnesses and prescribed the application of external
treatments such as dieting, rest, exercise, and the like. In a quantum intellectual leap,
but without totally rejecting earlier notions, Plato, circa fourth century B.C., put forth the
idea that childhood experiences shaped adult behaviors and this hinted at a new form of
causation,                               psychosocial                              causation.

                         2. The Ancient Trends Meet a Dead End

       Note the sequential trend of this long drawn out historical evolution with respect
to the cause and treatment of bizarre and disapproved behavior. The earliest attempts
both to understand and to treat bizarre people initially focused on:
       a) supernatural causes and treatments
       b) supernatural causes with physical

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       c) objects having supernatural powers as treatments
       d) a combination supernatural causes and physical treatments
       e) a more sophisticated physical treatment that involved the use of trepanning to
           either fix the brain or release evil spirits
       f) much later, the next development was the creation of rudimentary taxonomies
           bizarre and incomprehensible people and the use of more benign physical
           treatments that did not involve the supernatural
       g) Finally, Plato sought understanding or explanation of bizarre and disapproved
           behavior in a causal relation between childhood experiences and adult
           behavior.
The latter somehow did not spark a movement to develop a new discipline designed to
explore what kinds of early childhood experiences produced bizarre adult behavior. The
Greeks of his day, unfortunately, were not inspired to explore how negative early
conditions could be replaced with positive ones.


            3. A Door To A Promising New Approach To Treatment Closes

        The focus during Plato‟s period of history was on the person. Plato‟s novel
explanation was a tiny „crack in the door‟ could have led to explanations of bizarre
behavior oriented toward aspects of external structures of the social world. Taking this
perspective might have provided clues as to what the primary causal influences might
be. Certainly the dramatist‟s plays during these centuries were alive with powerful
illustrations of how early childhood experiences influenced adult behavior. This
tendency could have opened the „crack in the door‟. It did not.

    4. From Medieval Times to Early America, the Mentally Ill tended to be Demonized

        In Medieval times, the mentally ill were regarded as possessed by the devil or
evil spirits. Their nonconformist acts could often be regarded as sin. The treatment
was to pray for them and preach at them at first. If that did not work, they might be
subjected to exorcism or even burned at the stake. In the early days of America, the
mentally ill, or sinners, might be regarded as possessed by evil spirits or the devil. They
could be regarded a witches and put on trial and even hanged. Exorcism might be tried
or they might be shunned, ostracized, cast out of town. Later, particularly before the
Civil War, bizarre behavior at religious revivals was often regarded as being possessed
by the Holy Spirit. At other times, they could be treated by the ritual of „laying on of
hands‟. In the latter part of the 19th century, hospitals for the insane were built,
especially in cases where families needed to be relieved the burden of caring for them.
There was an attempt to treat them humanely, provide moral instruction, and teach
them a trade. These Asylums took care to treat them with respect and to avoid
restraints or physically abusive treatment. Innovative forms of medical treatment were
tried to no avail. Eventually these Asylums became overcrowded and degenerated into
mere custodial care. Then, at the end of the 19th and beginning of the 20th centuries,
medical doctors were evolving into psychiatrists. Europeans began to make close
careful observations and developed rudimentary classification systems. They also

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began studying autopsies of the brain to try to determine if brain abnormalities or
lesions might be the cause of mental illness. Again, these efforts met with little success.
Mesmer and his star pupil Freud began the first truly psychological approaches to
treating the mentally ill. Freud‟s incredibly astute observations of his patients‟ discourse
during hourly sessions, five days a week led to his theory of psychoanalysis extensively
described in his many books. These books had great appeal to the medical community
and even non-medical intellectuals. His works eventually led to the initial rise to
prominence of psychiatry. Different schools of psychiatry evolved. The difficulty of
practicing psychoanalysis in mental hospitals led to their being replaced with more
physical, less labor intensive methods like using drugs, electroconvulsive therapy,
insulin-induced comas, and surgery such as lobotomies. Drugs only gained popularity
after World War II. From then up to the 1950s the drugs of choice were sedatives. By
1952, psychiatry had a fairly elaborate manual for the classification of mental illnesses.
On the heels of the rise of psychiatry, social work entered the picture in order to assist
psychiatrists in the documentation of case histories but, most importantly, for the
management of patients.

                5. The Modern Paradox: Bad Person or Bad Structure?

        To this day, the paradox remains that while mental health professionals explore
life or social histories to understand the patients they classify (classify now equals an
elaborate taxonomy of mental illnesses or diseases), they, nevertheless, treat „patients‟
as though the locus of the illness is in the person‟s personality. Life histories are
perused and then set aside. Usually a life history includes a description of the patient‟s
parents and extended family; their ethnicity; whether there were divorces; remarriages;
serious physical or mental illnesses, deaths; substance abuse; incarcerations; degree of
poverty; and whether the family had been on welfare. Also included were descriptions
of the general life conditions or environment, for example the types of neighborhoods, in
which the patient grew up. It may also include the schools the patient‟s had been
enrolled in and problems with school, agencies that had been involved with the patient,
and their work history. Oddly, for the psychiatrist‟s diagnosis and prescribed treatment,
the person is virtually ahistorical, as though existing in a psychosocial vacuum. The
patient is treated as though problem lies not in the past but in the way the person, the
patient, is at present. The present pattern of behavior is the problem and nothing else
need be considered. The cause of the problem is the person, that is to it say resides
inside the person. Bizarre acts are considered generated by something within or
intrinsic to the person and influences of external structural factors are subtracted out.
With this way of framing the question of cause, the alternative explanations intrinsic to
the person are narrowed to a defect in the brain, with a genetic version of the „bad
seed‟, or some intrinsic proclivity to act in their particular bizarre, disturbing manner. In
other words, they either have an „illness‟ or there is something wrong in their
personality. Vestiges of the medieval days and Puritan America have merely evolved
into the person with behavior that is discomforting to others, essentially, having a „bad‟
personality, or being diseased. Bad structure and bad history simply do not enter into
the equation.



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                6.    Star Crossed Historical and Ahistorical Approaches

         Contemporary mental health professionals, particularly psychiatrists, typically
treat patients as though the mental illness is due to an imbalance in brain chemistry. An
imbalance in brain chemistry is cited as the physical, inner cause of the pathological
behavior. Yet, paradoxically, they use life histories as a kind of backup source of
validation of their judgment, perhaps as a form of professional insurance, if you will.
Initially, their modus operandi, therefore, is simultaneously historical and ahistorical.
The historical part, however, somehow surreptitiously slips behind a shroud, never to be
invoked again. The historical aspect certainly will be unlikely to be invoked as
explanatory when called to testify as an expert witness in a court of law. Consequently,
that early Platonic tiny „crack in the door‟ that could have opened the way to exploration
of current external structures and early life conditions or experiences as the primary
causes of mental illness or behavioral aberrations has remained just that, a once tiny
„crack in the door‟ that has remained tightly closed. Those contemporary iconoclastic
protagonists who would open the door to exploring life histories, social influences, and
current external structures as plausible explanations and guides to effective treatments
continue to bang their heads to no avail against that ancient „door‟.




   7.   Western Objectification of Patients in the Treatment of Emotional Disturbance

        The tendency to regard mental illnesses as having physical causes entails
looking at humans who exhibit unusual and disturbing behavior as objects. Early
Western Civilization, that so successfully looked „objectively‟ at their physical world, also
looked in the same way at their fellow humans, yet, I sadly suspect, misunderstanding
them. They looked at physical objects, things, and saw ways to invent and transform
matter and nature into irrigation ditches, crops, swords and projectiles, wheels, maps,
coins, arches and towers, and the like. It is impossible to empathize with persons when
taking this „objective‟ perspective. When focusing on the physical aspects, such as
behavioral patterns, samples of blood, or PET scans, in order to explain and attempt to
heal emotional disturbance, understanding how the person feels and sees their world is
irrelevant. The psychiatrists‟ mentally deranged fellow humans intransigently resist this
impersonal approach to helping them. Nevertheless, because of the logic of social
roles, those in the role of healer are automatically considered experts and authorities
into whose hands the patients must yield their trust. Patients have always had to submit
to being treated as objects when involved in this stratified role structure. Humans have
a strange capacity simultaneously to inwardly resist and outwardly submit to an
authority‟s dominance with respect to diagnosis and treatment.

        8.   Psychiatry Creates a Handbook with a Taxonomy of Mental Illnesses

       Following in those early traditions, psychiatry‟s contemporary taxonomy of mental
illnesses helps lend credibility and expert status to this „objectification‟ aspect of their

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endeavor. Around the beginning of the twentieth century, psychiatrists had begun to
create a rudimentary taxonomy with about twelve diagnostic labels. They appeared to
allow the psychiatrist to look, seemingly objectively, for patterns of behavior that fit the
criteria for some diagnostic label in the taxonomy that they think might apply in this
case. Add to this the fact that pharmaceutical medications have been developed
specifically for particular labels in the diagnostic handbook. That is to say, in psychiatric
parlance, if you have such and such label of mental illness, you need such and such
medication as the treatment. Psychiatry, insurance companies, and the pharmaceutical
industry have to have a uniform standard of determining whether treatment is
appropriate and justified for the type of illness and whether the fees for reimbursement
justifiable and reasonable. To accomplish this uniformity the psychiatrists are required
to assign the patient a label taken from the taxonomy of mental illnesses in the
American Psychiatric Association‟s “Diagnostic and Statistical Manual of Mental
Disorders” (First Edition 1952). This diagnostic manual has grown from 60 types of
mental illness in 1952 to 374 diagnostic codes by the year 2000. As the maladies
multiplied, so did the psychiatrists‟ patient loads. The patient is given a particular label
because he or she seems to fit some of the patterns listed as the criteria under a
diagnostic category. The patterns subsumed under the label, which are the criteria for
ascribing the label, are now assumed to be the actual characteristics and patterns of the
individual. Now the patient „becomes‟ that label and that assessment is solidified when
the appropriate kind of treatment is chosen and the matching psychotropic medication is
prescribed. Since these uniform standards unanimously are agreed upon by the giant
three industries, an air of unquestionable authority and legitimacy has formed.
        So how did this classification system come about? As mentioned above, this
was a gradual process with the psychoanalysts being the progenitors. However, to
create the taxonomy for their diagnostic manual, psychiatrists formed a group of
esteemed colleagues from the American Psychiatric Association. These leaders came
together and laid out their collective knowledge of mental illnesses. They first agreed
on a uniform terminology. Next, they honed from their observations of patients those
whom they felt had similar patterns that could fit the various diagnostic labels. Next,
they further refined the characteristics of each type of mental illness into what they felt
would turn out to be universally acceptable to their fellow psychiatrists and called these
characteristics, or patterns, the criteria for assigning each diagnosis. Over time, they
organized the types into major categories and subcategories and these names rapidly
began to be used until almost all of their fellow psychiatrists were familiar with them.
Finally, major categories and subcategories were given a numbering system to be used
as codes, similar to physical illnesses. The codes came to be submitted to the
insurance companies for reimbursement. The diagnosis, code submission, and
reimbursement process became standard and routine and paved the way for
psychiatrists eventually to branch out into private practice.
        A major problem with this taxonomy was that it was not quantified or validated.
Since each psychiatrist made their observations of a small sample of their patient‟s
behavioral patterns, how could they be sure that this sample was representative of the
full range patient‟s behavior and not just an aberration? Actually, in most cases the
psychiatrist relied upon the patient‟s self-report in the interview. Occasionally their
diagnosis was based on anecdotes provided by family members. There was no way to

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validate these informal reports. In addition, in spite of the attempt at precision in
developing criteria for assigning labels, one could never be sure as to whether what
they were observing and concluded matched what the framers intended.
        To correct this problem of ambiguity, many studies using „validated‟
psychological measurement instruments were designed to test the degree of
correspondence between the psychiatrists‟ diagnosis and scores on the measurement
instrument. Unfortunately, these studies were seldom well designed and rarely resulted
in a statistically significant outcome. In spite of and because of the persisting ambiguity
problem, clinical psychologists became occasional handmaidens to psychiatrists by
backing up their diagnoses with these objective measurements of validated clinical
personality assessment instruments. This was a very loose procedure but soon the two
groups began to develop a common language and consensus so that they usually
approximately made a match. In an attempt to gain credibility, there were also a few
experiments designed to hypothesize how a person with a specific diagnosis would
behave in an experimental condition. The experimenters must guess what conditions or
situations might evoke their symptomatic behavior. If their hypothesized behavioral
reaction occurred in this condition, they would conclude, erroneously, I feel, that their
diagnosis was validated. These, too, seldom provided support for the taxonomy and the
psychiatrist‟s methods of making their diagnoses. A fatal flaw with such experiments is
that the experimental condition is probably not even close to the kinds of situations that
evoke the patient‟s characteristic symptomatic behavior. In the end, psychiatrists had to
settle for trusting their individual judgment and hope others, particularly insurance
companies, did as well. It revealing statistic late in the twentieth century was the way
the frequencies of diagnoses clustered demographically. The number of diagnostic
labels assigned in one region in relation to the population of that region differed widely
when looked at across regions. This suggested that assigned diagnoses were more a
function of consensus among the psychiatrists within a region than accurate parings
between diagnostic criteria and the actual characteristics of their patients. Also
revealing is the way, in the latter part of the twentieth century, frequencies of diagnoses
varied precisely with changes in the diagnoses for which Managed Care organizations
were granting reimbursement.

           9. The Rise of Psychiatry and the Rise and Fall of Psychotherapy

        Psychiatry had succeeded in becoming dominant among the mental health
professionals, helped greatly by the American Psychiatric Association‟s DSM-III-R
Manual for diagnostic classification and the widespread use of psychotropic
medications. Due to the higher cost of seeing a psychiatrist, insurance began to favor
non-medical therapists such as social workers, clinical psychologists, and psychological
counselors. The founding fathers of mental health treatment, the psychoanalysts, and
their progeny, the psychotherapists, began to recede from prominence and popularity in
the public mind. Psychiatry, seeing this shift to non-medical therapists as a threat,
seized the opportunity that psychotropic drugs, coupled with their Manual‟s diagnostic
codes, offered. Being the only one that could prescribe medications, psychotherapists
had to become subordinate to psychiatry and receded from prominence. Psychiatry‟s
rising success had been like an earthquake of history, which transformed the entire

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mental health landscape. Therapy was leaving behind the tradition of sitting with
patients or clients for an hour or more a week sometimes for years while patiently
listening to them. Psychotherapists had had their heyday of empathically listening to
their clients talk out their personal and interpersonal conflicts, resolve their self doubts,
gain insight into their defenses, confront their inner demons, ventilate suppressed
feelings, experience catharsis, and abreact old traumas. Because of these dramatic
changes, psychotherapists made efforts to ally themselves with this breed of healers
that was dominating the landscape. Psychotherapists too shifted to using rapid
diagnosis. Next, they attempted to gain the legal privilege of committing patients to
psychiatric hospitals and prescribing medications. Their efforts were in vain. They
began a tragic journey into near obsolescence. Their numbers as private practitioners
gradually declined. Their decimation, however, was to come later.

                10. Psychiatry‟s Road from Ascendance to Preeminence

        It is important to examine the foundations of this new and dominant mental health
professional. In the beginning, psychiatrists, with intuition as their main tool, primarily
worked in state mental hospitals, which in effect were giant warehouses for society‟s
outcasts. Psychiatrists were aided by the fact that their ancestors, the psychoanalysts
had written a plethora of books on patients with unique abnormal symptoms and
patients whose personalities and symptoms were common. Paranoia, anxiety, phobias,
social withdrawal, compulsions, impulsivity, depression, mania, psychosomatic
illnesses, conversion reactions, physical disorders caused by psychological factors,
various types of psychoses, suicidal tendencies, identity confusion, amnesias, and a
variety of other personality disorders had been exhaustively written about. There were
major differences as to the etiology and dynamics of these types but there was
consensus about the existence of the types. Psychiatrists were now widely employed in
state mental hospitals, adult prisons, and juvenile institutions. By the 1950‟s, they had
developed rudimentary techniques such as structured interviews for quickly identifying
or diagnosing the familiar types of patients. They were successful in using clinical
psychologists‟ personality tests and social workers‟ life histories to back up their
diagnoses. They had become „an establishment‟.
        Parallel to the evolution of psychiatry, the pharmaceutical companies had had
early success with a few tranquilizers. These tranquilizers reduced symptoms,
particularly in psychotics. Selecting the appropriate tranquilizers for the different types
of psychotic patients was difficult and was more an art than a science. Initially this was
not too difficult since diagnoses had not yet multiplied and there were as yet only a few
tranquilizers. One of the most often prescribed of the patients‟ medications was called
Thorazine and this usually resulted in a calmness that made patients much easier to
manage. A major problem was that the medications often caused severe and
sometimes painful or immobilizing side effects. Yet there was exhilaration from their
success and psychiatry and the psychotropic drug industry developed an immediate
affinity. In those early days, this great excitement in both groups gave them confidence
to branch out. This motivated the psychiatrists to build private psychiatric hospitals.
These new hospitals were used mainly by the rich who had family members with bizarre



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and embarrassing behaviors. Insurance companies began to write policies for care of
the mentally ill in these private psychiatric hospitals. It was a profitable relationship.
        Since a rudimentary diagnostic manual was in use, it could be codified and the
code submitted to the insurance agency just as physicians did when filing for
reimbursement for treatment of physical diseases. This made the practice of psychiatry
as legitimate and professional as the rest of the medical professions.
        As the numbers of psychiatrists graduating from psychiatry departments of
medical schools rapidly increased, positions with state mental hospitals were no longer
an option and therefore most newly graduated psychiatrists went into private practice.
The public was accustomed to the hour a week talk therapy in vogue for psychoanalysts
and psychiatrists. Therefore, in the late 1950s and through the 1960‟s, this new breed
of psychiatrists offered one from among the many the popular psychotherapeutic
modalities to their patients. However, having been schooled in how to assess
presenting symptoms and quickly diagnose, they supplemented their therapy with
prescriptions for psychotropic medications. For the most part, their patients came from
wealthy families. When the lower upper class and upper middle class caught on to what
their wealthier acquaintances were doing, many of them sought treatment as a mark of
social status. Along with this trend came a sharing of their experiences in therapy with
one another and it was natural to share the medication their psychiatrist „had them on‟.
        At this juncture, psychotherapy and counseling were common in universities and
community mental health clinics. Psychotherapy had found a way to share, to some
extent, the aura cast by psychiatry. Psychotherapists, also, began to move into private
practice and eventually reimbursement by insurance companies was routine for them as
well. Holding themselves out as being nearly on a par with psychiatrists, they asked for
comparable reimbursement. To receive reimbursement, they too had to include
psychiatric diagnostic codes in their forms for reimbursement.                      Clients of
psychotherapists usually knew what diagnostic label they had been given. They shared
their labels as well as the names of their prescribing psychiatrist and their medications
as though these gave them some exotic form of status.
        Psychiatric diagnosis and prescription was a rapidly growing social movement.
The language of diagnostic labels and psychotropic medications became a common
language in the culture. By the 1970‟s the majority of Americans were familiar with a
wide range of labels and medications. The inherent fuzziness of the process of
diagnosis, the process of assigning labels with their subsumed criteria and matching
these with appropriate medications ceased to be a concern. The mindset of psychiatry
was now ingrained in our culture and accepted as „reality‟. If one‟s psychiatrist said it, it
was bound to be true. However, new problems with insurance companies‟ policies,
costs to corporate America, and cost of prescriptions, federal health programs, and
percentage of the Gross National Product spent on healthcare all combined to
challenge and undermine psychiatry‟s preeminence. In addition, an awareness of
widespread off-the-cuff labeling just to make sure they were reimbursed and the way
labels varied arbitrarily and chimerically across doctors, regions, years, and with
whatever were in vogue and reimbursable at the moment became glaringly in evidence.
Noticing these trends throughout America‟s institutions meant that harsh changes were
just over the horizon.



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                              11. Carl Rogers Bucks the Objectification Trend

        Bucking the objectification trend was the psychotherapist Carl Rogers who came
to fame in the late fifties. Rogers took no life histories; did not use psychological
assessments; did not rely on medications; made no prescriptions of any kind for
treatment; refused to use the label „patient‟ and used the word „client‟ instead; did not
diagnose and give clients a diagnostic label; did not regard clients as having an „illness‟;
did not assume an expert posture in relation to his clients; and instead of any form of
structured psychotherapeutic modality he used what he called a non-directive,
empathetic approach to his clients. His was the only type of therapy that posed a real
alternative in this rapidly expanding movement to professionalize the treatment „mental
illnesses. Beginning in the fifties and reaching its peak of popularity in the sixties, it was
doomed to fade as the numbers of certified psychiatrists burgeoned. With the success
of certified psychiatrists, psychotherapists pushed for their own certification. Rogers
sternly warned that this would spell the end for quality psychotherapy and respect for
and humane treatment of clients. In other words, he was sounding the alarm against
what he saw as the inevitable „objectification‟ of man. His colleagues in the
psychotherapy field did not (or would not) see the danger of objectification implicit in his
warning.
        Rogers had had also encouraged all those who wanted to be psychotherapists to
undergo psychotherapy as clients themselves. He could foresee how certification would
cause psychotherapy programs in graduate schools to create required courses that
bright persons with unhealthy personalities, unsuited for the role of therapist, could
easily pass. Such programs would not have to require candidates to undergo therapy.
This would lead to candidates passing all required courses and being certified without
working through their own personal problems. This had occurred in psychiatry when it
created the requirements and exams to become Board Certified Psychiatrist. Any
medical doctor who had fulfilled all of the requirements but had not passed the Board
could still be and hold himself out to be a psychiatrist. Unfortunately, neither Board
certified nor non-Board certified psychiatrists had to undergo therapy. Later this would
repeat itself for Clinical Social Workers and Licensed Professional Counselors, as well
as Clinical Psychologists. In addition, without this experiential aspect, they could
graduate without having a feeling for what it is like to be a client. Certification without
undergoing psychotherapy, he felt, would lead to a dominant, stratified, impersonal role
relationship vis-à-vis the client. Because of his certified expertise, the professional
could claim to have superior knowledge of the client‟s problems. These professionals
would be likely to feel free to exert control over their clients‟ lives.
        For Rogers, no one should have a license to direct another‟s life and usurp their
will or self-determination. For Rogers, no one could know better what the client was
feeling than clients themselves. The certified therapist could feel they had the
credentials that authorized them to analyze, assess, and examine the client just as one
does a bug in a laboratory. Treating clients as objects could lead to all sorts of
legitimized abuse of clients. Rogers sensed, or rather foresaw, that this would lead to
sinister consequences for clients. Furthermore, he sensed sinister consequences for all
humans if, and wherever, the objectification-subordination trend became dominant.

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History is full of cases that would support his fears. Empathy makes regarding the
person as an object impossible.

   12. Humane Rogers Opposes Objectification but Stays In the Cult of the Individual

       Rogers focused on the client‟s feelings. In addition to the catena of things in the
paragraph above that he resisted was attention to external structures and systems as
causal factors in emotional disturbance. Naturally, that omission also entailed that one
not use the redesign of structures to overcome emotional and behavioral disordered
and to promote positive personal growth. However, he did address and write on the
topic of management of organizations to promote empathy, mutual regard, and personal
growth. This document was virtually ignored even by devoted Rogerians. While this
document was concerned with organizational climate and a new philosophy of
administration, it mainly focused on the individual person. Before the total triumph of
objectivistic psychiatry, several renowned psychoanalysts, for example Harry Stack
Sullivan, had begun to emphasize the „structure‟ of the therapist-patient relationship.
This movement was also short-lived. Subsequently, there was period during which
those who engaged in research of psychotherapy modalities and the psychotherapist-
client relationship. They found that the quality of the relationship was the greatest
determinant of success with clients. They enumerated certain critical qualities exhibited
by successful therapists. This endeavor, seemingly having exhausted its run of
valuable and undisputed findings, subsided into books on the history of psychology.
The corner of psychiatrists‟ objectivism and quick and easy pharmaceutical cures had
been rounded and won the day. Sadly, Rogers did not see that empathy could and
should include both an attempt to understand how a person perceived and reacted to
the conditions and structures of the life in which they were imbedded. Conceptualizing
how social structures could be redesigned and conditions could be created to foster
positive, mature growth was far beyond Rogers‟ field of vision.

              13.   What is Required to Overcome the Cult of the Individual

         Both empathy for the individual and understanding of the structures in which their
life is imbedded are necessary to overcome the cult of the individual. Why is this so
difficult? Here is the problem with which we are faced. First, clients are limited to what
they have experienced just like everyone else. Second, Rogers‟ non-directive, feeling
oriented therapy, therefore, entailed the critical limitation of not addressing external
structures encompassing individuals. Clients may lack awareness of what behaviors
are causing them problems; lack knowledge of behavioral possibilities; lack knowledge
of the consequences of types of interpersonal interactions or scenarios; and lack
knowledge of the way different factors in structures shape behavioral and emotional
reactions or feelings. If this is the case, then solely empathically focusing on the client‟s
feelings limits their possibilities for acquiring new understandings of their world, new ego
mastery skills to deal with their external structures, higher levels of maturity related to
the many domains of their life, and increased personal growth for a full life in their world.
         From a different perspective, just as the theory of psychoanalysis was difficult to
master, it seemed that Rogers‟ unique approach of empathic listening was difficult to

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master.      Psychiatrists‟ prescribing psychotropic medications circumvented these
difficulties. If Rogers‟ clients did not improve, the fault must lie with the therapist or his
technique. If the psychiatrists‟ patients‟ symptoms did not subside, the fault lay in the
medication and that could easily be changed. In the case of both types of therapy, the
focus was on removing or reducing the problems „inside‟ their patients or clients. Their
focus, therefore, was on the individual exclusive of the structures of their world that
might be producing their problems. Supposedly, community psychiatry was designed to
deal with such external structures. However, with the medical-prescriptive mentality of
psychiatrists, and all other mental health professionals for that matter, these structures
did not have to be addressed. None of the extant types of therapy found it necessary to
assist their patients in understanding those structures and their impact or in finding
ways to cope successfully with them. The cult of the individual was the status quo and
remains so today. This was true of all modalities that came before and is true of all that
came after them. The cult of the individual has yet to be overcome. i

         14.   The Person Becomes the Label :: the Label Becomes the Person

       These labels have even come to be regarded as not just a correct assessment of
patterns or symptoms. Now a label is regarded as the „cause‟ of the pattern of
behavior. The experts refer to the person (patient) by their label. For example, the
patient is diagnosed as a Sociopath or Paranoid Personality, for example, and then he
is discussed and referred to in terms such as “the Sociopath” or “Paranoid Personality”.
The person or patient‟s actual patterns are now virtually discarded since it is much
easier to deal with the label as shorthand for its subsumed defined patterns. It is much
easier to adopt this shorthand convention of referring to patients using their label rather
than their name and their unique patterns. When this convention is in use, the
possibility that there is not, or very likely may not be, an isomorphic relation between the
patient‟s actual, daily behaviors and the label or criteria of the label is overlooked.
Furthermore, there is a hidden assumption that all persons with that label are the same.
Consequently, the individual‟s patterns and even the defining patterns under the label
are as good as discarded or eliminated from the conversation and only the label is dealt
with. A person „has become‟ a label. In the next stage, the person not only „is‟ the label
but now the label is treated as the „cause‟ of whatever referring behavior is under
scrutiny.     Precipitating conditions, circumstances, and structures are completely
excluded from awareness. The collected life histories are stuck in the patients‟ file and
forgotten as possible causal factors. Life histories and external factors are treated as
superfluous and exempt from consideration. The cult of the person has triumphed!

                 15. The Cult of the Individual Is Reinforced With Diagnostic Labeling

       Under the reign of this objectification zeitgeist, the structures and systems that I
regard as the ultimate causal factors in what are generally regarded as emotional,
mental, and behavior disorders are never brought into consideration. Of course, this
structuralist perspective would have been irrelevant in psychiatric cases, especially
once a diagnosis has been made. Now, is some strange contortion of reason, the
patient (person) „is‟ the label and, furthermore, the label „is‟ the cause. For example, if a

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person committed the act, once having been given the diagnostic label, the label is used
as the explanation for the behavior. If he has that label, he has to have the patterns of
behavior, has to be the kind of person who would commit that kind of act. Initially, he
only has to have been reported to act that way in at least one instance to get that label.
It does not matter that an instance does not constitute an observed, recurring pattern. If
he has that label, he has to be the kind of person that would commit that act. No other
causal explanation of the behavior need be sought, is required, nor is welcome. A
quaint form of circular logic; is it not! For example, the defense attorney will argue that
the accused committed the crime due to being a‟ ------ „ (substitute here a label from the
psychiatric taxonomy). In such cases, the defense attorney often will argue that, having
his particular diagnosis, „he did it because he was off of his medication‟.

       16.   Mental Health Suffers a Hostile Takeover by the Corporate Mentality

        Ironically, we have an incipience of a cultural illness here. With the increasingly
vast numbers of professional people involved in some direct way to a mental health
industry that is increasingly generating new categories of mental illness and increasing
percentages of the population to fill their categories, psychiatry itself is now subject to
the ascription or diagnosis as a malignant cultural illness. Three interdependent
industries are perpetuating the myth of mental illness and multiplying the numbers of
patients who fill their coffers. These perpetrators responsible for this contagious cultural
disease are the mental health professionals, the pharmaceutical companies that supply
medicines that supposedly cure almost all entries in the psychiatric diagnostic
handbook, and, in the background, the insurance companies that reimburse them.
Together their triumvirate represents such a huge percentage of the US Gross National
Product that Federal that legislators dare not ignore it. For the same reason they dare
not deny the suggestions from their lobbyists for legislation that benefits them. While
members of this medical-industrial triumvirate jockey with each other for their share, or
more, of the financial pie, they keep a well-maintained and well-coordinated front for
their mutual success and benefit. Beneath them are the disconnected, unsuspecting
flock of patients who annually pay huge sums that are distributed among the big three.
Patients have no lobby, other than frail, ineffectual ones like the AARP for the elderly, to
vie against the overwhelming influence of the big three and their newest member that is
Managed Care. The people do have a voice, albeit a small one, when the Democratic
Party, the party supposedly of the people, is in power. When this happens, the big
three, or four, bring out their full arsenal to prevent losing their advantage. In 1993, at
the beginning of the Clinton administration, Hilary Clinton waged war with them, or
rather their pawns in the legislature, to change all of that with universal health care and
parity for mental illness. She fought a valiant battle but lost. Vice President Gore‟s wife
Tipper, and Congressman Wellstone continued to lobby the American people for mental
health insurance coverage and parity through the media, but to no avail.



17. Pharmacy, Insurance, and Now Justice System Reinforce Psychiatry‟s Preeminence



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        In the case of both the diagnosis and the treatment, the person has become an
„it‟. You need not try to understand the possible role of external structures, or even
internal psychological processes. All that matters is that the psychiatrist gleans from
self-reports, arrest records, or family anecdotes some patterns of behavior that match
the criteria for one or more of the diagnostic labels. The label for this „object‟ is nailed!
Now all you have to do is to determine where to commit him, what chemicals to inject in
him, and to which program to assign him. If the „prospective‟ patient refuses to be
committed voluntarily to a psychiatric hospital, the recourse for the family and/or the
psychiatrist is to turn to a Justice of the Peace and get him to declare the person a
danger to himself or others and/or declare the person non compos mentis. It is all an
objective manipulation of an object.
        Strangely, the paradox mentioned above remains intransigent. The paradox
remains because while mental health professionals explore life social histories to
understand the patients they classify they nevertheless treat „patients‟ as though the
locus of the illness is in the person‟s personality. They act as though the illness is not in
the history or structure of a person‟s like. Rather, the illness is inside the person, minus
influences of external structural factors and history.
        Currently, if the person is mentally ill:
        a) There is something physically wrong
        b) The physical cause surely has to be in the brain
        c) The problem or cause in the brain is an imbalance in brain chemistry
        d) An imbalance in brain chemistry requires a psychotropic medication
       e) Being prescribed a psychotropic medication is sufficient evidence to insurance
           companies that person has a mental illness and requires outpatient psychiatric
           treatment and/or hospitalization;
       f) Treatment by psychiatrists and their auxiliary therapists requires reimbursement
          by the insurance companies
       g) Psychotropic medication prescribed for treatment is to be paid for by the
          insurance companies.
The result is a scaffolding of agreement concerning the nature of mental illness upon
which a mammoth structure of collaboration between pharmaceutical, insurance,
medical, and mental health industries is built.
        This scaffolding contains, yet conceals, the age-old paradox of the mixture of the
historical and ahistorical. This fallacy must not be challenged and exposed or the
scaffolding and edifice will collapse. Joining the pharmaceutical, insurance, medical,
and mental health industries, justice system enters the picture and helps to validate the
mental health-industrial complex by disallowing a defendant‟s past as an explanation or
excuse for their crime.ii The justice system further abets the mental health-industrial
complex by disallowing the use of a psychiatric diagnosis as an explanation or excuse
for a crime. The only exceptions are:
          a) If the defendant is a case of extreme mental retardation
          b) If the defendant clearly does not know the difference between right and
          wrong
          c) If the defendant is so obviously psychotic, that they cannot act in their
          defense and they cannot be held accountable for their actionsiii



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         An unintended consequence of all of this is that when authorities, families, or
enough people regard someone‟s behavior as too bizarre, non-conformist, or disturbing,
they are stigmatized as either criminal or crazy. It might be that they are not mentally ill.
It might be that the structure of their world is a more than sufficient explanation for their
bizarre behavior and offense. It might be that their life history, holistically considered, is
a legitimate excuse. However, if the person is excluded from the normal conversational
give and take, this evidence will not be considered. In this case, they are treated as
though they are deaf, like a piece of furniture, an „object‟, an „it‟. Their exclusion from
the conversation also prevents the history side of the history versus a-history paradox
from seeping in.
         If defendants are either too vocal and articulate in their opposition to the
judgments of the court or insufficiently vocal and articulate, a pronouncement of non-
compos mentis can be made and this discredits their opinion. One or the other is
almost always the case, consequently defendants are discouraged from acting in their
own defense, and their attorney speaks for them. Since one of the criteria for
participating in a trial is that, the defendant understands the meaning and significance of
what is said in the proceedings. A ruing against non-compos mentis means that, in a
legal sense, the defendant does understand. This is prima facie rather absurd since
almost no one, other than the lawyers, understands what is being said or what is
transpiring. As this is the usual case, it is inevitable that the defendant be treated as an
object or „it‟, whether or not non-compos mentis. The result of these legal conventions
is that people appearing before the court on charges of committing a crime are
extremely rarely found not guilty by reason of insanity (NGRI) or guilty but mentally ill
(GBMI). The GBMI cases are typically placed in hospitals for the criminally insane for
unusually long stays.
         Sociopathy does not qualify for the insanity defense. People found guilty of
crimes, therefore, rarely are placed in psychiatric facilities. Psychiatrists are relieved of
the obligation to treat criminals in private practice or psychiatric hospitals. They treat
criminals only when they are employed by a prison and the prison pays for their
services. Very few are employed by prisons and their function is mainly to prevent
liability and as window dressing for the prison‟s „humane‟ image. If insurance
companies had to reimburse for the psychiatric treatment criminals, they would go broke
over night. If it were easier to try cases based on an insanity plea, the courts would be
so clogged that either they would have to cease functioning or their budgets would have
to be dramatically increased. On the other hand, in the contemporary world, the
majority of prison inmates do receive psychotropic medications. Of course, the
pharmaceutical companies benefit from this while insurance is spared outlays for this
enormous expense.
         Who picks up the tab for all of this? It is paid for by federal, state, county, and
municipal governments. In other words, the taxpayers pay for the prison and jail
expenses. Psychiatry is spared the unpleasant burden of treating those with obnoxious
diagnoses that lead to prison like sociopathy, anti-social personalities, substance
abuses, and those prone to aggression. The insurance companies are spared a huge
expense, and the pharmaceuticals get a bonanza. Ironically, receiving psychotropic
medications should qualify for a diagnosis of mental illness and yet these inmates got to
prison because they could not claim mental illness as a defense. Conveniently failing to

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notice such inconsistencies, these symbiotic parties trudge along with an arrangement
that works to the benefit of them all excepting the people. Even though less that one
percent plea insanity, these insanity laws have become an airtight mechanism to keep
this arrangement between these symbioses intact. Moreover, let us not forget how
Nixon‟s crime agenda added to burgeoning prisons and thus vastly increasing these
expenses to taxpayers.
       There may not be a conspiracy here. It seems as though their various positions
evolved as a natural consequence of each of them acting in the best interests of their
own industry. What are excluded from the dialogue are people for whom they exist,
namely the patients. Ironically, what is in the best interest of each industry involved is
extremely detrimental to the patients they proclaim they are helping. Psychiatry may be
the direct link to the patient, but they are all enormously benefited from the „symbioses‟
within and between their systems.
       Several things that are of benefit to the parties in these symbioses and to the
detriment of both the patient/criminal and the public have been examined here.

            18. Psychotherapists Play-Follow-the-Leader with Psychiatrists

        I have neglected, so far, a prior and eventually parallel development in the
broadening, modern, mental health movement.              Psychotherapy, beginning with
psychoanalysis, began in the early part of the twentieth century. Over about seventy-
five years, it unfolded as consecutive differentiations of modalities that were not related
to physical medicine and the diagnostic taxonomy of psychiatry that originated in1951.
Usually psychiatrists met their clients in their offices for a once-a-week, hour-long
talking session. Likewise, most of these evolving modalities of psychotherapy
structured their manner of treatment to meet clients in the therapist‟s office for a one-
hour per week individual interview. Each modality had its unique philosophy of how to
conduct these interviews. They tended not follow the psychiatric pattern of focusing on
brain chemistry or prescribing psychotropic medications. They had their own style of
dialogue with clients. They each focused on mainly on one particular aspect of their
clients‟ personalities. Eventually, they evolved to include small groups of clients in
group therapy and then broadened to include clients and their families in family therapy.
A few therapists even expanded the length of sessions to several hours and some even
designed weekend retreats when treating groups, couples, and families. Nevertheless,
eventually psychotherapists increasingly modeled themselves after and allied with
psychiatrists who, in the second half of the century, had triumphed in the arena of public
opinion.


         19. Psychiatry Gets Biological and Psychotherapists Try to Tag Along

       What set psychiatry apart from their progenitor, psychotherapy or
psychoanalysis, was their focus on the physical nature of the client. Psychiatry
assumed that clients‟ mental, emotional, and behavioral problems were symptoms of an
underlying sickness. This sickness came to be seen as being a result of an imbalance
in brain chemistry. Being allied with the medical community, it was natural for

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psychiatry to adopt their style of diagnosing and prescribing. Therefore, they developed
a taxonomy of mental illnesses, to phrase it more appropriately, sicknesses. Psychiatry
outstripped psychotherapy as the dominant mode of treating people with bizarre,
disturbing behavior. The public soon attributed an aura of ultimate, expert authority to
them. Psychotherapists reacted to the dominance of psychiatry by trying to become
mini-psychiatrists. Consequently, psychotherapy adapted to the situation and adopted
the psychiatrists‟ taxonomy, hoping to share in their aura of authority. Finally,
psychotherapists began to develop sub-modalities or variations of treatment tailored to
diagnostic categories. Mental illnesses such as anorexia, depression, panic, phobias,
withdrawal, addictions, and many others began to have designer treatments. Many
psychotherapists formed alliances or even partnerships with psychiatrists as the expert,
controller, and authenticator of the treatment. The psychiatrist had control of
prescribing and dispensing the crucial element of therapy, which was the psychotropic
medication. Psychotherapists had to go along with this development in order to insure
reimbursement from insurance companies.              Consequently, a splinter group of
psychotherapists began a movement to establish a lobby to gain the legal right to
prescribe medications, to commit patients involuntarily to psychiatric hospitals and along
with it to gain the status of having equal authority with psychiatrists in the mental health
world. Their efforts failed. Psychiatrist‟s sole control over prescribing medications was
the coup de grace. Psychotherapy capitulated and accepted being their fate of being
dependent upon and subservient to psychiatry. Thus began the long history of
contorted interactions between psychotherapy, psychiatry, and insurance companies.

    20.   Evolution of Mental Care During the Second Half of the Twentieth Century

        In 1951, I had my first real experience with a mental hospital as I was walking
past one in Austin, Texas, where I was attending the University of Texas as a freshman.
Three years prior, when in high school, I saw the movie “Snake Pit” (1948) with all of its
scariness and eeriness causing me to fear insane people and Insane Asylums. I recall
that in my first year at the university I often walked on the sidewalk along a high wire
fence that kept patients from running away from the Austin State Mental Hospital. One
day as I was walking past the mental hospital, a man was leaning against the fence and
watching the cars go by. I stopped to say hello and he made an interesting comment.
He said, in a pleasant but ironic tone, that if people like him were in the majority, he
would be on the outside and people like me would be in this hospital and behind the
fence. I never forgot what he said. The next year I took a job as an attendant in the
hospital and got to know the patients. From then on, I was hooked on working with
mental patients, the mentally retarded, prison inmates, incarcerated juvenile
delinquents, and the disadvantaged.
        In the History of the mental health movement, initially the states funded large
state mental hospitals. People who did not fit in, whose behavior was a nuisance or
burden were simply dropped off at the state mental hospital. In the first part of the
twentieth century, these patients were subjected to some gruesome treatment, even
horrifying treatments. Many of these state hospitals had populations of over three
thousand and were gruesome warehouses. They were very costly to states. Gradually
they began to institute care that was more humane.

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        In the fifties, they recruited elderly doctors who were regarded as psychiatrists.
Many of the staff believed insanity was genetically caused. A movie called “The Bad
Seed” (1956) seemed to validate this hopeless belief. By the sixties, these hospitals
were staffed with young psychiatrists who were trained in the new mode of diagnosis
and who used the new (1952) American Psychiatric Association‟s Manual. While most
of them had a psychoanalytic background, there was little chance of practicing that in
these human corrals. They each had hundreds of patients. These patients were a
mystery even to the professional staff. The psychiatrists were trained in the use of the
new tranquilizers. They used electric shock therapy and insulin therapy and prescribed
a variety of tranquilizers. These hospitals also hired a few clinical psychologists to
administered paper and pencil psychological tests and projective tests to a small
percentage of entering patients with seemingly good prognoses, and assigned them a
diagnosis.
        The wards in the hospitals were run by head nurses. Psychiatrist spent only a
few hours a week on the wards. Most of the patients just hung out in halls and sitting
rooms all day. Over time, the state introduced rudimentary occupational, educational,
and art programs. Eventually, they established internships for graduate students and
psychiatric residents. They were to provide more personal contact with as many
patients as they as possible. This was also limited due the fact that there were such
large populations. These primitive hospitals remained warehouses throughout the fifties
but in the sixties, they had begun to be more humane and to incorporate the more
modern, advanced treatment techniques. Maintaining these hospitals was a large
financial burden on the states.
        When private psychiatric hospitals slowly emerged in the late fifties and early
sixties, they were meant primarily to serve the rich. They took away a very small portion
of the financial burden state mental hospitals had put on the state‟s budget. The 1957
movie “The Three Faces of Eve” glamorized psychiatric treatment. People bought into
idea of the awesome power of psychiatrists presented in this movie. Their almost
magical ability to cure Eve‟s multiple personality, a serious but dramatic psychosis, was
very appealing to the naïve and gullible generation of the fifties and sixties. These
factors both symbolized the growing trend toward seeing a psychiatrist and promoted
private psychiatric practice and hospitals. This trend generalized into a humanizing
movement and support for and hopes for the success of the emerging social programs
and early tranquilizers. A romantic movie about two teenagers in a private psychiatric
hospital (“David and Lisa”, 1962) further added to this glamorization and belief in
psychiatry and private psychiatric hospitals.
        During the Johnson era (1963-1969) of the Great Society more and more of the
down and out and outcast members of society were brought under this umbrella.
Johnson ordered the creation of commissions to study how to reform these human
services and make them more successful and humane. All over the nation, huge
numbers of people were hired to carry out these reforms. The costs for these reformed
human services programs and institutions grew very large. With the initial success of
the mental health-industrial complex, the justice system picked up the treatment drift
and began implementing rehabilitation programs in adult prisons and, to some extent,
juvenile delinquent facilities. Psychiatry‟s origins in psychoanalytic movement had
proven to be increasingly awkward. Psychoanalysis was absolutely useless in these

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times of huge caseloads. The initial successes of B.F. Skinner‟s Behaviorism and of
behavior modification and token economies, gave them a legitimate way to transition
out of the psychoanalytic model. Now since they had had their APA Diagnostic Manual
since 1952, they were prepared to justify making diagnoses based on „behavioral‟
observations. They could also easily install makeshift reward systems with a pretext
that it was shaping behavior. In fact, they had found a way to make management of
large populations of patients much easier. This behavior shaping movement also
influenced educational programs, occupational training, and, the big-ticket item,
psychological rehabilitation or treatment in the form of reward systems supplemented
with medication. By the early 80s, behavior therapy had proved either too labor
intensive or simply too narrow and modest in its behavioral results. Psychological
rehabilitation also entailed the excessive cost of hiring many psychiatrists,
psychologists, social workers, educators, and other technicians. Psychiatrists, of
course, eventually met this cost problem by importing the new fad of prescribing
psychotropic medications. These had at first had been aimed primarily at making
patients and inmates more manageable. Eventually, however, hope began arising that
these new medications would cure or at least dramatically ameliorate their symptoms.
This caused many mental health professionals and even politicians of this era to feel
that these new humane treatment trends were imperative. However, the expense
burgeoned with the increase of these programs in mental hospitals and prisons. This,
coupled with the expense of many other social programs leftover from the Johnson era
such as the model cities‟ poverty programs, made cost a major concern once again.
Now we had a situation in which to provide humane treatment to these vast numbers of
welfare recipients, other wards of the state and of state institutions and programs, state
budgets and federal matching funds were escalating out of site. By the late seventies,
these costs had also combined with the cost of the Viet Nam war and became such a
burden that something had to give. Aside from these considerations, from the late 50s
up to the early 80s, hospital populations steadily and dramatically declined due to cost.
          During the Nixon (1969-1974) era, crime was dramatically increasing, prisons
were filling up, prison rehabilitation expenses were escalating and state, and federal
budgets were continuing to skyrocket. Nixon had inherited a war and a big federal
budget. The federal budget was strained to the bursting. Nixon saw that one of the
ways to avoid a fiscal crisis was to cut the Johnson era programs and cut their
exorbitant costs along with them. Nixon secretly commissioned a nationwide study of
institutional and community rehabilitation programs (Martinson‟s National Evaluation of
Rehabilitation Programs, 1970). The results of this massive study were that no
rehabilitation programs were successful.          Consequently, these programs were
considered a huge waste of money and they began to be shut down by, 1973, all over
the nation. The new miracle psychotropic medications helped make this transition
easier. At the same time, movies such as “Asylum” (a ghoulish film that takes place in a
ghoulish psychiatric hospital) in 1972 and “One Flew over the Cuckoo's Nest” (a movie
that turns a psychiatric hospital into the personification of sadism) in 1975 were
beginning to sour the public on the once romantic psychiatric treatment and institutions.
There began to be a return to deinstitutionalization and officials settled for mere
management of patients.         This aided the new commitment to cost reduction.
“Clockwork Orange”, 1971, added another angle to the shift toward „managing‟ mental

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patients and prison inmates, and away from the new treatment fads. With treatments
such as the grossly inhumane use of behavior modification, particularly aversive
treatment, treatment and treatment institutions lost their allure. Behavior modification
was out but using behavioral observations to make diagnoses remained. In fact,
psychotropic drugs did modify, or rather mollify, behavior much more quickly and easily.
Why? If the drugs turned patients into tranquil, manageable zombies, their behavior
was changed. Treatment with drugs, therefore, was deemed successful. The growing
disillusionment over poor results from the labor-intensive behavior modification meant
there was a safe rationale for ending that practice and moving exclusively to
medications. “Clockwork Orange” had given the impression that the psychiatrists and
hospital and prison staff administering these institutions were evolving into
Machiavellian-like characters. They had to get this albatross off their necks. At the
same time, all of this bad press aided the Nixon agenda to end rehabilitation. Certainly,
the pharmaceutical industry was pleased with this sea change.
        These and many other factors of his day made it possible for Nixon to easily
switch to an appealing political stance with a constructive ambiance of getting tough on
crime, such as convicting people for less serious crimes and extending the lengths of
their sentences. The rationale or justification was that this would result in an eventual
drop in the crime rate and along with that a reduction in the cost of community social
programs. In fact, many people who had been committed to mental hospitals were now
sentenced to the much less expensive prisons and jails. The anticipated result of crime
reduction, however, did occur a few years later, only to rise again several years after
that. Over time, however, it became obvious to Nixon that something had to be done
because costs of these Johnsonian humane services were still too high.
        During the late sixties, a small movement to place recovering mental hospital
patients in Community Mental Health Centers had begun. Many felt that the new
success of psychotropic medications now made this feasible. However, with the coming
of the Nixon stringency era, this movement was transformed into a way dramatically to
decrease the expense of mental hospitals whose populations were still much too large.
Commissioners of state human services agencies began a massive, orchestrated
phasing out of state mental hospitals and phasing in of community treatment facilities.
What this trend eventually led to, however, was actually dumping mental hospital
patients on the street. Huge numbers of them became what we now call „the homeless‟.
Veteran‟s mental hospitals followed suit and many of these mentally ill or drug addicted
veterans also became what we now call the homeless. Eventually, this mass of
homeless people sleeping in the doorways of major businesses and churches was
considered blight to city councils to and county commissions. Their only recourse
seemed to be putting these forgotten, sick people in jails, especially during harsh
weather. This could never work and finally there was a revolving door of the mentally ill,
veterans, and ex-convicts homeless in and out of the county jails. However, many of
the homeless committed petty crimes to survive or maintain their drug habit and these
were convicted and sent to prison, thus overcrowding prisons even more.iv

  21. Eras of Mental Health Culture from the Perspective Insurance Reimbursements




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       At the beginning of these massive transitions, in the pre-Nixon era, 1965, the
nation had Medicare. Eventually Medicare began covering mental health treatment for
many who were not impoverished and homeless but were too poor to afford expensive
private psychiatric treatment. This was Stage 1 in the history of Medicare and
insurance coverage of treatment of the mentally ill. This was a new kind of movement
toward humane mental health care. This became a minor bonanza for psychiatrists,
psychologists, and social workers. At the same time, insurance companies had
developed policies, aided by corporations, which included mental health riders on their
health insurance policies. In the beginning, insurance companies‟ policies allowed
unlimited therapy sessions and were not concerned when psychotherapists and clinical
social workers were seeing patients without psychiatric oversight and without
psychotropic medication. However, many of these professionals were prone to see
patients for exceedingly long periods, some even for years. The ranks of these
professionals naturally swelled, becoming a problem for insurance companies. The led
to Stage 2 and was a huge reversal in policy. In the mid-eighties, the insurance
companies made a complete turn about, began restraining the duration of sessions, and
instead wrote policies for treatment in psychiatric hospitals. Insurance companies were
not concerned at the time since there were legal and medical limits on who qualified for
commitment to psychiatric hospitals.
       With this change in insurance policies, treatment professionals like schools of
fish, began to refer patients to psychiatric hospitals. Interestingly, Carter a deeply
committed humanitarian was in office from 1977-1981. Early in Carter‟s administration
the movie, “I Never Promised You a Rose Garden” (1977) came out, signaling a re-
emergence of humane mental health care. This movie portrayed psychiatric hospitals
as places where painfully disturbed people could go and find a nurturing environment,
be genuinely helped, and eventually return home and live happily ever after. Since only
psychiatrists could commit patients to a psychiatric hospital, psychologists and clinical
social workers allied themselves with psychiatrists. Under the auspices and supervision
of psychiatrists, psychologists and social workers could see in-patients. Psychiatric
hospital administrators encouraged psychiatrists commit their patients, diagnose, and
prescribe psychotropic medications. Hospitals also hired psychologists, and social
workers to have sessions with them in the hospital. In addition, some psychologists
administered psychological tests and social workers worked up social histories to
backup the psychiatric functions. Fees for inpatient sessions were lower than for
outpatient, but administrators encouraged them to have many patients and therapy
sessions. Now all of these mental health professionals began to make a good deal of
money working with patients in these new psychiatric hospitals. Hospitals took a high
percentage of what insurance paid for the sessions. Initially, therefore, hospitals also
found this to be a bonanza. In addition, many policies were written to allow extended
stays in psychiatric hospitals, some even allowed for as long as a year. The hospital
administrators started a push actually to recruit patients. They found ways to concoct
diagnoses that they knew insurance companies would accept.                  To increase
reimbursements and bilk insurance companies, they created a wide range of diversified
inpatient treatment programs.
       Hospitals and professionals both now had a gravy train. These abuses of
Medicare and insurance largesse led to Stage 3 in the evolving history. While these

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abuses were raging out of control, a series of movies depicting disillusionment with
psychiatry, psychotherapy, and psychiatric hospitals. First, there was “Endless Love”
with a love obsessed youth being sent to a hospital and returning just as dangerous as
he was before. Then there was “Frances” (1982) that depicted how a mother drove her
daughter crazy, had her committed to a psychiatric hospital where she was eventually
lobotomized. She spent the rest of her life as a complacent human vegetable. There
followed “Lovesick” (1983); and “Nobody‟s Child” (1986), all showing the dark side of
therapy and psychiatric hospitals. This trend reversed temporarily with “Another
Woman” showing the benefits of outpatient psychotherapy and “Clean and Sober” that
showed how outpatient drug treatment could succeed, both in (1988). In 1990, the
movie “Awakenings” first showed the dramatic success of psychiatric medication but
ended with a gravely disappointing failure. These movies of the 80s up to 1990 were
paralleling the intense conflict unfolding with mental health systems. It should not have
come as a surprise to hospitals and mental health professionals that serious negative
consequences were in the offing for them. Nevertheless, they were caught off guard
and much to dismay of hospital administrators, this abuse soon met with extreme
reprisals. Around 1992, hospitals were investigated for fraud, the federal government
spread their search across the nation, and the outcome was that many hospitals were
shut down and their multi-billion dollar parent companies were fined billions of dollars.
Some hospital administrators were even sentenced to prison. Overnight, a few
psychiatrists actually relocated to foreign countries that had no mutual extradition
treaties. Ironically, also in 1992 a movie called “Whispers in the Dark” was playing. It
was an extremely sinister, intricate, murder mystery depicting psychoanalysts in deadly
romantic involvements with clients and each other. The movie industry was reflecting
disillusionment with psychiatry just as psychiatric hospitals were beginning to be shut
down. “Mr. Jones” (1993), on the other hand, was showing the sincerity and expertise
of psychiatrists and the desperate need that patients like Jones, a manic-depressive,
had for their services. It was like a last ditch cultural plea hoping to hold off the end of
the grand and lucrative hospital era.
        However, backing up a bit to before the fall of the hospitals, therapists had
caught on to the hospital‟s brilliant scheme of taking advantage of insurance companies
during the 1980s. They quickly transformed traditional modalities into of diagnosis-
specific treatment techniques. These evolved into glamorous treatment packages.
They began tailoring these packages for outpatient therapy. Insurance companies
would see these packages as far less expensive than inpatient treatment and bought
into the scheme. To succeed with this they had to sell their outpatient clients and
insurance companies on this new wave of therapy. They convinced outpatient clients
by reifying diagnostic labels and finding ways to make as many as possible fit within the
package‟s label. They designed ways for regimenting and freezing the treatment
procedures. This way they could apply the same formula to all with the paired
diagnosis. They then had to impose diagnoses uniformly, as if they were templates, to
any patient with characteristics that could be squeezed into the diagnosis. Each
individual client‟s unique characteristics had to be pruned or dismissed as unimportant
to go unnoticed by the insurance companies. These packages were presented as being
so good that they would work for even for outliers who might question the
appropriateness of including them under the label. An example of this kind of in-patient

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package was shown in the movie “The End of Innocence” (1990) in which a patient with
an addiction to prescription drugs and with horrific family conflicts was cured by
abreacting her rage. It was as though this movie was crying out against the oncoming
dismantling of the prize achievements of this era in mental health treatment: „hold on‟
these new programs are worth keeping. A package with a diagnosis specific treatment
had to have an elaborate set of technique procedures that would all appear to be
necessary to cure anyone with that diagnosis. However, when a diagnosis was tied to a
treatment specialty, the treatment procedures had to be implemented almost as though
they were algorithms to avoid having to waste time reinventing with each staging. It
also had to have an air of legitimacy and sophisticated expertise. Therapists quickly
learned to be expert at marketing and advertising the packages. These novel and
elaborate packages seemed to inspire awe in potential clients and the new wave
became such a rage that soon clients with minimally disturbing symptoms wanted to
„get in the game‟ as though it were a new fashion statement. Being less costly,
insurance companies got on the bandwagon as well.
        As Stage 3 was abruptly unfolding, Stage 4 was slowly emerging. The 1981-
1992 Reagan-Bush administrations were oriented toward conservative, cultural
conformity and rugged individualism. Department heads, taking their cue from the
administrations orientation, reacted to the way psychiatric hospitals and treatment
professionals were taking advantage of their benefactors and nudged along the Justice
Department and Health and Human Services to stem the runaway expenditures in this
area.
        Stage 4 came in the wake of this reaction against the abuses of the mental
health system provided a solution. It involved a novel way of cost cutting called
Managed Care.         After gradually was being formed during the Reagan-Bush
administrations, Managed Care organizations were inaugurated around 1990, about a
year before the federal crackdown began. Managed care is a generic term for various
health care payment systems that attempt to contain costs by controlling who and what
qualified for service and the type and level of services provided. Health maintenance
organization (HMO) is a term that is often used synonymously with managed care, but
HMOs are actually a particular type of managed care organization. Managed Care
companies had been well prepared in advance, infiltrating mental health communities
like insurgents canvassing for hits. They methodically and resolutely made their push to
create a pervasive bureaucracy and campaign strategy with aim the toward cost cutting.
         Managed Care was to be a gatekeeper between the insurance companies and
hospitals and professionals. As they began, Managed Care representatives invaded
hospitals and set strict requirements on who could be admitted, how long they could
stay, and what kinds of treatment they could receive. They set restrictions on which
patients of private practitioners would qualify for reimbursement. Cleverly, they started
selecting some professionals to act like a clearinghouse for which patients would qualify
and decided which therapist would see the patient. In every case, patients had to be
seeing a psychiatrist for diagnosis and prescribing psychotropic medication. Therapists
soon found that their reimbursement was reduced by fifty to twenty-five percent. The
number of sessions was typically restricted to six per patient. Under these conditions,
many psychotherapists simply left their private practice of psychotherapy. Those
remaining in the Managed Care programs were offered training classes in short term

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treatment methods. Other professionals turned to only seeing patients who pay out of
their own pockets. This, of course, meant that their practice would be limited to well-off
clients.
        The highlights of this Stage 4 thrust involved a radically new therapeutic
approach dominated by Managed Care in which the therapist and patient were to set
goals for their therapy and submit these for approval to the insurance companies. Of
course, this flew in this face of ninety years of massive experience and study of the
therapeutic process. Those ninety years had unanimously concluded that clients or
patients came to therapy with a presenting complaint but the real reason for coming to
therapy did not surface until many weeks or months of sessions. Typically, when the
client finally realized what they had really come for it was a complete surprise to them.
Therapists were also required to document thoroughly what transpired in each session.
This too was a farce, as therapists never know what their clients are really working on
any more than clients do. The therapeutic process is riddled with defenses and
unconscious agendas. Setting circumscribed, definitive goals and recording therapists‟
impressions or even verbatim notes is like advertising, the show is to impress and
persuade and not to disclose the facts or realistic advantages or necessity. The
paperwork required for reimbursement was so excessive that for every hour with a
patient, thirty minutes to an hour had to be spent filling out insurance forms. The
therapists were required to focus on visible changes in behavior and determine if these
were consistent with the treatment goals. In other words, psychotherapy had actually
become a coercive process. The psychiatrists had been accustomed to seeing
inpatients for about fifteen minutes just to confirm their need for continued treatment
and renew or alter prescriptions. The work of the psychiatrist had become, once again,
a means of both social control and cost reduction. This continued with their outpatients
after the clamp down on hospitalizations. Managed Care found therapists and
psychiatrists who would agree to these terms. Some psychiatrists were expert at
herding large numbers of patients each day. Eventually, Managed Care realized that it
was very cost efficient to have a few psychiatrists who would see an exorbitant number
of outpatients solely for checking on how their patients‟ medications were working. To
prevent seeming like they were merely a cost cutting scam Managed Care companies
quickly developed a battle plan to have credible professionals available all over the
nation touting the superiority and efficacy of short-term therapy techniques and were
able to tie they to each profession‟s annual requirements to maintain their accreditation.
It was a masterful and highly successful battle plan.
        Insurance companies and many corporations were very pleased with this new
development. For the mass of people with mental illness, this became a psychological
form of the Great Depression. Another grand era in psychotherapy subsided into books
on the history of psychology. Ironically, that grand era of genuine psychotherapy that
focused solely of what was good for the client and let the client decide when to
terminate their therapy was now only a faint memory. It was now a forgotten legacy
even though it is still glamorized or spoofed in movies and TV shows as though it still
exists.
        There is another unfortunate set of ironies to this story. The professionals have
had to capitulate to Managed Care. Reimbursements to providers were reduced by
twenty-five to fifty percent. At the same time, the annual national cost for health care

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has risen by at least twenty-five percent. Not surprisingly, with the takeover of the
health industry by Managed Care, the quality of care given to those with mental
illnesses and to patients with physical illnesses as well has been degraded by at least
twenty-five percent. Some corporations, especially those who were self-insured, opted
out of the Medicare-insurance scheme of Managed Care. They saw a way to avoid
these topsy-turvy financial outcomes of Managed Care and instead invented Employee
Assistance Programs (EAPs). Some of these new EAPs avoided siphoning off money
meant for psychological services that were then directed into the contorted, pseudo-
medical, mangled Managed Care organizations that were headed by profit driven health
care bureaucrats who had no legitimate background to be controlling medical decisions.
Instead, EAPs made it possible for psychotherapists and clinical social workers to treat
without being under the supervision of psychiatrists. This also had the advantage of
obviating the necessity for medically prescribed psychotropic drugs. Other EAPs
eventually returned to the Managed Care model and became gatekeepers for cost
cutting.
        Why has therapy been degraded? Managed Care officials (bureaucrats), who
had trainers, supervisors, and administrators of psychotherapists under their jurisdiction,
now had to steer them toward short-term therapy techniques. Instead of helping
psychotherapists work through issues in their own personalities that might get in the
way of helping clients to deal with those same kinds of issues, they had to focus on
quick fix gimmicks. Instead of helping them overcome factors in them that were
impeding their clients‟ ability to grapple with their deeper, often suppressed or repressed
conflicts, they had to teach them how to keep clients on track toward resolving pseudo
goals agreed to before the therapy even began. Keeping in mind that presenting
complaints are seldom the real problems, keeping them on track actually sabotages the
chance to reach the real problems. Instead of teaching psychotherapists more
advanced techniques that might improve their effectiveness so as to create conditions
promoting client transparency and growth toward authenticity, they had to guide them
toward structuring the process to keep clients oriented toward the initial agreed upon set
of goals. Instead of helping psychotherapists gain deeper insight into client dynamics,
they had to teach them how to shore up clients‟ defenses. Supervisors and
administrators had to forego helping psychotherapists understand how to wait for the
appropriate moment to help clients gain flexible skills to cope with and react to their
critical life situations and conditions spontaneously and intuitively, with trust in
themselves, rather trying to obsessively plan rigid advance strategies. Instead, they
had to teach them how to train clients to adopt simple, canned, behaviors that were
oriented to their specified treatment goals. They had to forego helping facilitate
psychotherapist‟s mastery skills for managing the clients‟ therapy to optimize their
potential.
        By the early nineties, physicians, psychiatrists, psychotherapists, and patients all
had lost control over their mental and physical health. The people and legislators of the
early 21st century decry this development, but no one dares look back into the root
cause, which is the callousness and greed of the medical-industrial complex. The
power of lobbyists for the medical-industrial complex is rich and strong that legislators
are forced to back off form considering how to provide mentally disturbed persons with



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humane treatment The subjugation of mental health care to commercialism was
complete. It had virtually destroyed genuine mental health care.v
         Ironically, at first, the era saw this decline and disintegration and attacked mental
health care. For a the next decade, a rash of movies came out depicting mental health
professionals, programs, hospitals, and even medication as not only as failure but also
as superfluous and somewhat ridiculous. A good relationship with a healthy friend is all
you need to be set free from your inner hell. The rest is a hoax, bad joke, recipe for
disaster, torture chamber, or a further descent into your private hell. For example,
“Another Woman” (1988); “The Young Poisoner‟s Handbook” (1995); “A Couch in New
York” (1996); “As Good as it Gets” (1997); “Analyze This” (1999) and “Analyze That”
(2002); “Girl Interrupted” (1999); “28 Days” (2000); “Requiem for a Dream” (2000);
“Flowers for Algernon” (1968; 2000); “Prozac Nation” (2001); “Pollock” 2001; “Sylvia”
2003; “Intimate Strangers” (2004); “The Aviator” (2005); “Tom and Viv” (2005); and “The
Treatment” (2006) all slammed mental health professionals and care in one way or
another.
         Eventually, however, Managed care became the kicking post and a new rash of
TV and radio shows like “Infinite Mind” and movies came out that virtually vivisected
insurance companies and Managed Care for the way they usurped the authority of the
medical professionals and withheld authorization for necessary treatment. These
attacks, while dramatic, have been ineffectual. Commercialism has continued to reign
during the second Bush‟s administration (2000-present). Objectification of the individual
is fait accompli and now it has been joined by the objectification of the American people
as a whole!vi

22.    Questioning the 'Person as Object' in America‟s New Mental Health Care System

        Objectification of persons means persons are related to as though they were
objects. An object is looked at on its surface. An object is looked at in isolation from its
surrounding structures. An object is looked at a-historically. I have been making the
case that mental health care, while still taking case histories, treats the person as
though in isolation from their history, as though in a time vacuum. I have been making
the case that mental health care diagnoses and treats the persons „supposed‟
behavioral patterns. I have been making the case that mental health care treats the
person as a biological entity, as an „it‟ whose disordered behavioral patterns are the
result of a biological defect or imbalance. I have been making the case that a person‟s
diagnosis and treatment is conducted as though „it‟ acts independent of its surrounding
structures. An object can be regarded in terms of its physical context such as an object
in water, exposed to air pollutants, temperature, and the like. In other words, the
immediate physical context can be taken into consideration. However, with regard to
persons, if, and when, surrounding structures are taken into consideration, they are
restricted to interactions in close personal relationships such as parent-child, spouses,
extended families, and peers or authorities with whom they have significant, influential,
and continuing relationships. The impact of general cultural factors, sociological factors,
social institutions that shape lives such as education, religious and social affiliations,
recreational resources, the legal system, medicine, the economic systems, media, the



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Zeitgeist of a decade or two, in summary the life topography of the person, are
disregarded or discounted.
        In addition, if, and when, regarding a person, their multiplicity of inner
psychological structures and intentional processes are disregarded or discounted, they
have been transformed into a physical object. When workers are regarded as
commodities or patients are regarded as consumers, they can be manipulated like
objects without regard to their status as a person, for example, as one would regard a
loved one, whether spouse, child, or close friend, for example. The military, for
example, is expert in regarding military persons as objects. In a similar way, let us say
a car salesperson has a goal of selling a customer a car. He or she has to learn to
disregard the inner feeling and economic circumstance of the customer. He or she
must try to sell a car, regardless of the impact on the customer‟s life, and keep his or
her focus on meeting their quota for car sales for the month. The person is now an
object to be manipulated and treated without regard to their welfare or regard for what is
in their best interest. Our culture is suffused with language that objectifies persons. For
example, politicians have constituents and they use Madison Avenue, mathematically
sophisticated, techniques of marketing and advertising to get their constituent‟s votes.
A person who steals or assaults is a criminal and therefore becomes somewhat like a
different species from the rest of us. The medical-industrial complex has come to
regard persons, that is to say patients, and prospective patients, in just this way, as an
object or collection of objects. This is so tragically true with respect to mental health
care. In opposition to this trend, the Natural Systems‟ Duplex Pyramids Model takes
into consideration the whole person, the totality of their inner world, the totality of their
social environment, and with respect to their history and the history of their culture.
Natural Systems is a de-objectification of the person.


   23.    Stigmatizing Becomes Fashionable In TV Ads and Sweeps Across America

        New varieties of Puritanism and new „Scarlet Letters‟ are evolving all the time.
After the success of psychiatry a tsunami of new ways to judge people appeared.
Labeling had always been a part of the American cultural landscape. The varieties of
new ways to stigmatize new began to increase. Now there were not only religious and
moralistic ways to judge people, but new clinical deviations could be used to stigmatize.
Stigmatizing people by their political leanings or affiliations had been in vogue for a long
time, taking a surge during the Joe McCarthy Era (1945-1960) by labeling persons a
communist, red, pinko, or leftist, and so on to defame them. McCarthyism had the
effect of making those involved in social reform and progressivism, such as social
workers and others in the helping professions and Hollywood back off and restrain or
curtail their efforts. This was a period of the rise of the importance of television in
American life. The McCarthy era is an excellent illustration of the power of stigmatizing,
especially when movements like McCarthyism are able to saturate the airways.
        Television made it possible for populace to learn new language conventions for
character assassination, defaming, discounting, denigrating, ostracizing, encouraging
prejudice, putting down rivals, ridiculing, getting revenge, and so on. With the growing
familiarity with psychiatric diagnostic labels and the art of diagnosing, people began to

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say, “That is a sign of. . . “, followed by a diagnostic label. An amazing range of
“signs” indicating that something was wrong with you began to „catch on‟. Such fads
have always seeped in and out of language currency, but before television, this usually
took considerable time. However, modern media made it possible for the entire country
to stay hip with the psychiatric jargon.
        Prior to the contemporary scene, if people thought you had sinned, that made
you an evil person. The reaction when a person was called evil was for them to be
shunned, purged or cast out of a group, or excommunicated from a religious
organization. For some people, if you exhibited one moral peccadillo, that could be
taken as a „sign‟ that you are through and through an immoral or a bad person and must
be censured. If you said things that were considered self-righteous, or you judged
others behaviors based on your own morals, some would say you were a „holier than
thou‟, a fanatic, or zealot. In some periods of US history, if a family put a US flag in their
yard they might be regarded by some as a right-winger, ultra-conservative, chauvinist or
jingoist. If you were known to have favored legislative reform, you might be called an
activist. In the 1960s, if you uttered statements about what a woman‟s role should be,
this would very likely be considered an insult by women. A negative insinuation against
a womanly characteristic could result you being regarded as a sexist. From the sixties
on, if you uttered a racially tinged word or epithet, you would be labeled a racist or a
bigot. If one openly shows some form of indiscrete behavior or improper manners, it
may be taken to be a sign that you are lower class and polite „society‟ should shun you.
Even in the present, if you broadcast a disagreement with the political majority then you
may become anathema to them. Deviate too far to the left and perhaps you may be
labeled a liberal, socialist, communist or communist sympathizer, or too far to the right
and be labeled a fascist, or Nazi, say some things and you are unpatriotic and other
things and you are a right-winger.
        Labeling and casting aspersions has become a favorite game for some people.
Impugning a person by pointing out that an utterance or mannerism is a sign of
something worse, something wicked that is hidden from view, is a vicious, insidious
game. With the popularity of psychiatric labels, there came a sub-rosa movement that
has progressed from diagnosing observable patterns to taking certain behaviors as a
„sign‟ of some underlying, unobservable, awful disorder. For example, if a person
exhibits a certain kind of hand gesture, they may be labeled gay, queer, or homosexual.
As each new stigma becomes au courant, those who exhibit its signs are fair game for
psychological bullies. Among teens, physical bullying is often condoned by the
authorities if the victim has been labeled, even if the label is based on a „sign‟ and is
completely inappropriate.
        This cultural trend of stigmatizing was a harbinger for the current perverse
misuse of psychiatric diagnosis. Ironically, this trend has been unwittingly seized upon
by other professions, as well as psychiatrists, as an opportunity to broaden the
coverage of behaviors that could fall under a label in the psychiatric taxonomy. To an
ever greater extent, modestly odd behaviors, or „signs‟, are now being diagnosed as
psychiatric illnesses. Most of these merely irritating or odd behaviors were easily
tolerated in earlier times. This is a windfall for psychiatrists as the more behaviors that
can be included under diagnostic categories, the more patients, the more drugs
dispensed, the more money for the psychiatrists and pharmaceutical companies. When

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administrators in the educational, welfare, mental health, and justice „industries‟ find out
what behaviors many parents and family members do not like, they tend to give them
psychiatric labels. Find out what behaviors teachers do not like in their students and
give these behaviors psychiatric labels. Find out what behaviors staff in organizations
do not like and give them psychiatric labels. Once you are given a label you have (must
have) the game. That is to say, if some authority gives you a psychiatric label, then it is
assumed that you have the corresponding illness. If you have that illness, you must be
treated by a psychiatrist and prescribed psychotropic medications. This is a self-
fulfilling prophecy has begun to operate extremely effectively.
         Once a person is labeled, a cycle through stages begins. First, if you have the
„name‟ then you must have the game. If you have the game, then you are the
stigmatized. Once stigmatized, it is assumed you are, or more less permanently have,
the associated illness. If you are stigmatized you must be set apart in some way, put in
a special program, treated in a special way that implies some kind of inner inferiority. If
you have that special kind of ostracism, „            the program‟, then, of course, you must
be medicated. If when you receive the special treatment, including the medication, you
do not exhibit the „signs‟ ,           this is taken to mean that the treatment worked, but
unfortunately, also, it means that you „indelibly, unalterably,            have‟ the illness
and must stay in the program to prevent a resurgence of the symptoms, „signs‟. This is
a powerful, self-perpetuating, vicious cycle. This is an unconscious pattern. It has
become a part of the fabric of our national language, our of perceiving people, our way
handling the targeted people, a part of our belief system, and now a second nature,
knee jerk reaction. No alternative makes sense, and those who suggest alternatives
and considered not just to be flat out wrong but virtually idiots. This vicious cycle is,
itself, the true illness – an illness of our culture.

      24.    Name Calling Reinforces Pressure For Conformity Versus Tolerance

        Those whom one perceives as eccentric and unintelligible are not necessarily
insane. From extreme conformity out of fear of being labeled as communist, or one of
its wide range of synonyms, in the fifties, the pendulum swung far to the left.
Paradoxically, in the sixties extreme liberalism was also accompanied by name-calling.
The NOW movement and the feminists, the anti-racism, the fad of dressing down,
sexual liberation and encouragement of experimental life styles all attacked
stereotyping. Gender, race, and class were attacked as barriers that closed avenues to
educational and occupational opportunities. Yet, at the same time, the movements of
this era were facilitated by labeling and name-calling those who showed signs of
preserving traditional roles and identities. Whether it was McCarthyism or liberalism,
both used labeling and name-calling to pressure others to conform. Name-calling and
labeling was effective in reinforcing pressure people toward conformity or tolerance.
The same tool could be used to reinforce rigid social standards or to encourage
freedom of expression the right to be different. This was nothing new. Even in isolated,
rural towns, this was a means of choice for exerting social pressure. Interestingly, this
era of tolerance extended to the mentally ill. This meant that the movers and shakers
were encouraging the population to revamp its perception of the mentally ill. One
renowned psychiatrist wrote a highly popular book entitled “The Myth of Mental Illness”.

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Sixties‟ people were encouraged to be more accepting and tolerant of those exhibiting
what had formerly regarded as psychotic. This new attitude toward psychological
deviance helped pave the way for the community mental health movement. There was
a parallel movement to redefine criminals as having a social disease and to establish
halfway houses to facilitate their reintegration in to society.
        While psychiatry was now able to have a thriving private practice outside of state
mental institutions and private psychiatric hospitals had begun to thrive, the treatment of
the criminal element took another and problematic course. Psychiatry‟s diagnostic
handbook typically labeled those with criminal records as sociopathic, psychopathic,
anti-social, aggressive, and unsocialized. These types were generally considered
incorrigible and therefore bad risks from a cost-benefits point of view. In addition, when
persons with a criminal record received these diagnoses, they were generally
considered too dangerous to be seen in private practice or to be committed to private
psychiatric hospitals. Managed Care and insurance companies complied with this drift
and discouraged their inclusion as mental patients. Drug addicts were covered since
theirs was considered an illness but they proved even more unmanageable and
resistant to treatment than criminals did. Programs sprang up everywhere to deal with
drug addicts but had little success. Prisons created faux treatment programs for drug
addicts so as not to appear absurdly inhumane. Psychiatrists and other mental health
professionals did see a few criminals and the addicted when they were placed on
probation and the terms of their probation required entering therapy. Therapists tended
not to welcome them as patients. Drug addicted probationers wound up being sent to
prison and entering a prison revolving door. The Nixon era‟s crackdown on crime soon
included drug addicts and prisons, which were now rapidly becoming overcrowded with
criminals, began to be filled to overflowing with drug addicts. Nixon‟s cost reduction
agenda of „being tough on crime‟ had backfired. Nevertheless, psychiatry was spared
the drain on their practice of having to deal with criminals and drug addicts unless they
were in prison or psychiatric hospitals. Likewise, insurance companies were spared a
cost-ineffective obligation. The sixties era of tolerance had wound down to a rather
harsh ending for the deviants, wretched, and unwanted of society. A new era of name-
calling, labeling, rejection, exclusion, neglect, insensitivity, intolerance, and cruelty had
ascended to cultural dominance.
        ADHD, ADD, (escalated 700% in last 30 years) and related syndromes are
excellent examples of dealing with unwanted demands from fellow human beings, in
this case mostly children and youth, by using name-calling (In professional parlance it is
called diagnosing.), medicating, and in too many cases segregating them in special
classes. Just briefly, let us look at this so-called problem of inattentiveness and hyper-
activity from the point of view of evolutionary psychology. Parent teacher social skills.
Wilting ego mastery skills. Validating results. Devotion to the diagnosis and Ritalin.
Spreading of a new cultural beliefs system and common language. Conspiracy of
pharma, FDA, research, and psychiatry and unwitting collaboration of schools and PTA,
local physicians, administrators, etc.
        Schools and ADHD. It only seems right to help the labeled by medicating. It
seems to work so well. To consider going back and ceasing to give medication to solve
the problem seems idiotic to caregivers who once had to deal with the troublemakers.
Damage to kids. Boon to pharma and psychi. Eventual lawsuits. vii

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                                    25. The Modern Zeitgeist Of „Signs‟

          Got it now - got it for life. One swallow does not        a sign does not
make signified patterns
        Starting to look at oneself for signs of some deeper malady      seeing signs of
others or reading about them and imagining that one might have the malady because
on sees something similar in oneself having seen it one begins to act that way or
simulate having that disorder. Humans are high suggestible.
        What the sociology of „signs‟ has evolved into. From a sign of a mental disease
to a sign of a chemical imbalance.


                          26. What Is Chemical Imbalance in the Brain Anyway?

       When a prescribed medication fails??
       If psychotherapy had not bought into the hoax of diagnosis and its complement of
prescribing meds, they might have used their brilliance to find an alternative approach to
treatment. Rogers had resisted all of these trends that led to the supremacy of
psychiatry.
       CHEMICAL                  IMBALANCE                      AND                 PILLS

                 27. Modern Life Styles Create a Generation Addicted To Pill Popping

        By waging an advertising war Decades ago, with the aid of a ceaseless
bombardment of ads about disorders and meds in the television media, the big three
slowly achieved a total and invincible cultural coup. The people were taken in and no
one noticed how they and the culture gradually had been transformed. Their invincibility
can also be attributed to tradition of the country doctor and the implicit faith people had
long ago developed with their doctors. Finally, the culture that evolved in the second
half of the twentieth century was mobile, fast-paced, and stressful. While the bond and
trust with one‟s family doctor faded, this belief in his authority endured and even was
transferred to pharmaceutical ads. Dual career families became the norm. People
lacked the calm leisure to work things out with one another and be understanding of and
tolerant with one another‟s problems. The era of frozen dinners and fast food
restaurants had arrived. Appliances now had push buttons and remotes could even be
set to go off at appointed times. America had become the quick and easy culture.
When offered a pill to stop every little pain and uncomfortable emotion, they took it.

                                 28. From Pill Popping to Pill Hopping

       Since they had not loss the childlike faith in the well-meaning authority of their
doctor, they believed that if some authority said it would work, they wanted it and took it.
Even if did not really work, the belief caused powerful, albeit ephemeral, placebo
effects. If the benefits did not last, or if there were negative side effects, one simply got
a new prescription to quickly deal with the problem. They had no time to take note and

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raise efficacy questions. They just simply and quickly succumbed to the next fad. No
one wanted to hear that real, effective, enduring results had to come from psychological
therapy that took a lot of time, emotional discomfort, and effort. What is more, who
wanted to deal with the possibility of being stigmatized as mentally ill or of being too
weak to cope with their problems independently?


                              29. Psychiatry‟s Modern Paternalistic Posture

        The people‟s trust in the country doctor‟s expertise and their belief that their
doctor had a genuine, special interest in their welfare is a legacy that has transferred to
modern „commercialized‟ doctors and the wholly interrelated health care industrial
complex. In this earlier paternalism, there was a sense that the family doctor was
actually, to a degree, a part of each family under their care, somewhat like the country
pastor. These professions were nurturing, personal, non-authoritarian, and non-
legalistic, always respecting the autonomy of their patients or congregation members.
Since they were in small communities, everyone had a history with one another that
provided a basis for this trust. There were no pressures from interdependent corporate
groups like insurance and pharmaceutical companies. As these commercial, profit
driven, corporate conglomerates emerged and the medical professions split into
specialties, the close personal bonds that patients had with one, well-known country
doctor shaded into a sterile, technical, officious, impersonal, business-medical-person
style that processed patients through assembly lines where billing forms and
documentation of treatments were more important than the person being treated.
        The control of the patients‟ health destiny had shifted to corporate policies. Now,
the doctor mechanically examines, diagnoses, prescribes, and dictates notes as
patients who had been waiting sometimes for hours are formally routed, room to room,
in and out in a few minutes. Patients do as the doctor says without question. After all,
the doctor‟s choices are restricted to treatments and medications dictated by insurance
companies‟ bureaucratic gatekeepers who are ordered to keep costs at a minimum.
Who can question when the doctor‟s choices are dictated by distant, invariant
algorithms. This is medical care by proxy. The medical profession has had to abdicate
autonomy in exercising their expertise to distant bureaucrats and accounting-
dominated, impersonal algorithms. Furthermore, what is relevant for this topic is that
the industry-wide transformation into impersonal commercialism has even extended to
psychiatry where the non-linear person‟s personality and personal needs should be
preeminent. Furthermore, the impersonal, authoritarian paternalism, in the same
manner, infected non-medical psychotherapists since reimbursement for their services
required both a psychiatric diagnosis, which in turn required some kind of supervision by
or affiliation with a psychiatrist, and approval by insurance companies‟ bureaucratic
gatekeepers and corporate, mercenary, mechanistic policies.
        The old paternalistic posture of psychiatrists remains, in a sense. Yet, in a
sinister way, their paternalism is now possessed by mercenary, mechanistic, corporate
accounting mentality. This accounting mentality has taken control but asserts itself in a
deceptively caring manner that is nevertheless authoritative and admitting no leeway for



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interjections of the patients worries or wishes. This has become a most insidious form
of the new psychiatric paternalistic control over the patient.

                  30. On Therapy and Being a Patient Under the New Lords of the Mind

         Within the therapeutic relationship during the „hour‟ of therapy, the client (patient)
was still defined as sick and dependent and the therapist was still defined as the expert
healer. This vertical structure of the therapy relationship unwittingly had the effect of
maintaining the client‟s identity as a „sick‟ person. The expert, if a psychotherapist, was
to heal the sick person‟s symptoms in collaboration with his dominant medical
counterpart, the psychiatrist. It was now assumed that when the symptoms were
ameliorated and the client‟s behavior was no longer seriously bizarre, disturbing, or
disordered, „the therapist‟ could conclude the therapy. However, in fact, when the
managed care bureaucrat dictated that the allocated number of sessions was up, the
therapy was over. With most modalities and in most cases, reduction of symptoms was
the goal. The „nominal goal‟ was supposedly arrived at through consensus between
therapist and patient. In fact, the therapist was forced to orchestrate, scrumptiously, the
consensus over the goal. Once the nominal goal achieved, the „patient‟ was considered
to be in remission. This, due to the new structure of the relationship, had to be
determined by the therapist. Thus, the vertical status remained.
         On the one hand, here was an expert who knew all about the client and who
must be deferred to regardless of the patient‟s feelings and whether symptoms returned
or new ones developed and then, on the other hand, there was the patient, the person
designated as in remission, modified, ameliorated, or the recovered „sick‟ person. In
other words, the patient was like a second-class citizen, not to be trusted with his own
life, and never considered as an equal or self-determinant vis-à-vis the expert in the
decision-making process. This is akin to the treatment of slaves; ethnic groups
regarded as inferior; children; or even sub-humans. The patient is now a „thing‟ that has
to be managed and that could be disposed of at the discretion of the master expert
class or race.
         Woe be under to unfortunate soul that fell into this category of mentally „ill‟
patient. Like criminals who, when convicted, lose their citizen‟s rights, a person being
diagnosed as mentally ill has their autonomy forfeited, virtually, their human rights are
written off. This expert decision transforms the person and thereafter has an almost
mysterious sticking power, like an embossed identity, a contagious disease, or a
supernatural stigma, which, when somehow someone is exposed to it, it could not be
rubbed or cast off. Like the effect of being in the presence of a leper, the formerly
„normal‟ human, an equal among humans, might be vulnerable to having the stigma rub
off, or transferred onto them and shunned for life.
         The tragedy is that all of this psychological interplay takes place on a subliminal
level and therefore is immune from ever being consciously addressed.


                    31. The Public Has Unwittingly Abdicated Its Autonomy




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       A completely new class of humans has evolved, sociologically, which is
somehow psychologically an underling and has to be managed and repaired as one
would one‟s car. A whole, contemporary, population of humans has somehow
descended into a subordinate, dependent, inferior status vis-à-vis the mental health
professionals and their corporate masters. This population is no longer completely in
charge of its own destiny. Gradually and surreptitiously, the populace has been
redefined. Now, since their problems are not in their intrinsic personality, it is in their
genes, or their brain chemistry. All unwanted causal bases for mental illness have been
excluded, all bases are covered, and the people are none the wiser.
       The lay population seldom looks to life history, life conditions, or external
structures for causal explanations of their misfortunate psychological conditions. If,
along with those factors, their individual personalities are excluded then the people
would turn to the new mysterious, secret domain over which no one but the psychiatrists
have access. Within this secret domain they could be unchallenged if they claimed that
the fault of mere, ordinary humans‟ predicaments lay not in their disordered selves, or
lack of capacity for self-determination or self-direction, but rather in their „brain
chemistry‟ over which they have no control. According to our new world of expert
authorities, media oracles, and institutional overlords, imbalanced brain chemistry is the
exclusive domain of the lords of personhood and sanity, namely the psychiatrists.
Faced with this formidable assemblage of seers, what ordinary human would presume
to rely on their own meager judgment. They seem to assume that it is better to
decommission this ego mastery skill and defer to new lords of the mind. Of course, this
is also true of so many other domains of modern life that is it easy to concede this one
as well.
       “Listen, accept, obey, and do not question or search out answers on one‟s own”
seems to be the motto of modern man.


  32. How The Media Keeps The Medical-Industrial-Complex Wheels Well Greased


                33. A Cultural Anthropologist Asks, “Who Is Really Sick Here??”

        A comprehensive structure and systems: Pharma, corps, legislat, managed care,
prof, justice, factory mass production model, persons =numbers, force of media,
insurance, belief in bureaucracy, belief in cost/benefits analysis, structuralism-
management by objectives-participatory management
        Limitations of philosophy of man, one size fits all, faulty psychology, myopic
psychotherapy, using career insecurity to blackmail, exploitation of lack of organization
of MH consumers and professionals. Academic assimilation of business culture.
        See history of management philosophy does efficiency entail effectiveness?
Does the personal touch matter? For money, effectiveness or for well-being and life
quality of persons.
        Modern management in the complex of Insurance-Managed Care-Professional
providers-and client/consumer.



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        During the bonanza days of psychiatric hospitals, they became very big business.
Giant corporations sprang up and built new psychiatric hospitals wherever they could,
as fast as they could. They set management systems built on a marketing model. This
was highly successful in bringing in new patients and many patients meant billing
insurance company‟s increasingly large sums. This had been made possible because
of the rewriting of the mental health clauses that were changed to permit costly long
stays in psychiatric hospitals rather than pay the swelling ranks of mental health
professionals. Unlimited visits to private practitioners had taken the burden off the
states for their state mental hospitals, which had been overflowing. Insurance
companies had not had to worry about how to manage the costs of treating physical
illnesses. The latter had remained steady with only a gradual increase over the years.
However, this mental health cost bubble caused them to rethink their management
philosophy. Their solution was to create a mid-level organization to exert cost controls
over the mental health sector. Physical medicine costs were beginning to escalate,
however, so they applied the managed care approach to it also.
        Insurance companies abandoned their loose management of providers and
switched to a cost accounting management model. By injecting managed care between
the insurance companies and the providers, they restructured not only the
reimbursement policies and procedures but also restructured the doctor-patient
relationship. Managed care employees were usually not medical or mental health
professionals. They were more like bureaucrats. In their role of bureaucrat, they were
responsible for keeping costs at a minimum. To do this, as was mentioned above in
section 21, they became gatekeepers. They were responsible for reviewing requests to
treat patients and weed out prospective patients whom they thought did not meet their
criteria. They were to keep the number of sessions to a minimum. They required
providers to submit huge numbers of forms and reports. They made providers develop,
with the patient, goals for the therapy, to record progress toward the goals, and to
record the degree of success when the allotted number of sessions had been met. The
bureaucrats also kept records of their evaluation of provider‟s performance. Providers
with „good‟ performance records were rewarded with more referrals and vice versa.
        Under this cost accounting management system, the locus of control shifted
away from both the provider and the client. Previously, providers were like consumers
of a retail product. Insurance companies had to „sell‟ their goods to the consumer and,
as any good salesperson; they had to court and persuade the consumer. Clients were
consumers of a service, the provider‟s service. The providers had to hone their
therapeutic skills for their clients. In a sense, therapists were like small business
owners in which they were their own boss and their own evaluator of their performance.
Their criteria for the evaluation were whether the client felt they had resolved their issue
and were ready to terminate. Their most important skill was empathy. The client
determined the course of therapy. Consequently, the locus of control lay with both the
therapist and the client, but primarily with the client. From the onset of managed care
on, the therapist/client, relationship underwent a radical restructuring. The changes
were insidious. Most therapists felt but did not understand what was happening to
them. They were stuck in between the needs and self-determination of their clients and
the requirements put upon them by managed care. In effect, therapists had to become
manipulators par excellence in this dual role.

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       There was another irksome and costly annoyance. Managed care bureaucrats
exercised an unacknowledged prerogative of refusing to reimburse, often without prior
notification. However, worse than this, they scaled down the amount of the
reimbursements. Many providers went from $150.00 an hour to $25.00 an hour. This,
plus the other repugnant impositions, drove many therapists out of business. Of course,
this did not displease managed care. In fact, these bureaucrats were typically advised
by their superiors, and ultimately of course, the insurance companies they were serving,
that those who had the best cost control records would be rewarded with a bonus.
       War seems to require a nameless, faceless enemy.
form (structure) follows function in the biological world (Ernest Cassirer) until culture
arrives and then function (human behavior and personality) follows form (structure as in
the institutions, roles, etc. of culture) this is important for understanding the relation
between managed care, providers, and clients
       The new language of mental health and the cultural zeitgeist as a part of the
structures and systems of modern MH
       1971. Cultures as systems: Toward a critique of historical reason, Bucknell
Review, XXII:151-161. Ludwig von Bertalanffy (1901--1972)
his General Systems Theory

           34. How Can the Concept of Structure Play a Role In Mental Health?

        Teaching participants to identify and use the eight systems of structures of their
organizations. Questioning and suggesting to orgs they and their children belong to.
To understand family structures and fragmented-blended families and extended families
and Neighborhoods. Questioning public high school organization, school boards, and
violence programs.
        The psychology I present there is very different from conventional psychology.
When I first began to see things differently, back in the middle 1960s, I realized that I
had to make a paradigm shift from psychology I had been taught. I eventually came to
see it as like a Copernican revolution in which the earth was no longer the center of the
universe. Copernicus saw the Sun as the center. Of course, now we know that the sun
is only the center of our Galaxy. Likewise, I began to reverse my perception and see
that a person-centric psychology was a disastrous mistake. I replaced that model with a
structure-centric psychology because it became obvious to me that when external or
social structures are changed, the person changes.
        Upon reflecting on my own practice and that of others over the years, I saw that
attempts to change the person, especially if they were „mentally ill‟ or criminal offenders,
and the like, had only short-term effects if they had any. Sometimes, the results of
therapy with individual clients, whether in or out of an institution, were even negative.
This was particularly true of inmates in prisons or juvenile correctional institutions. On
the other hand, when I made constructive changes in the structures and programs of
mental or correctional institutions, the results were dramatic and enduring in a very
positive way.
        Treating people outside of these types of institutions did not work so well with the
structure-centric model. I reasoned that I was applying the traditional model of the
therapist treating an individual (or group as in group therapy or family therapy) and

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      therefore this approach could not address the negative factors in the structure of their
      home and home community environment. In 1968, I had directed a community
      development project with the focus on a group of about sixteen habitually impoverished
      individuals. However, I was able to enlist the involvement of many agencies and
      institutions in the project and I, therefore, made sweeping changes in the structure of
      their social environment. Once again, enduring and dramatically positive effects were
      achieved. I now believe that, if a change agent understands people in terms of a
      structure-centric model and if that person is given the freedom to be able to design
      structures and programs to elicit positive, mature behaviors, then they will achieve
      enduring, dramatically positive, changes in the individual persons involved in the
      program.
                      If you have the time to study my web sites and all of its sub webs, you will
      see this philosophy spelled out in great detail. The “Stars and Stripes” site is the best
      example of the successful application of this approach to an institution. I am currently
      working on a way to apply this model to people with a wide range of issues and
      problems outside of institutional environments.
            35. The Dialectical Tension Between Social Structures and Individual Freedom
      Hegel and Marx spoke of the dialectic of history. Hesse‟s Beneath the Wheel and
      Kafka‟s The Penal Colony illustrate the dominance of external structures. Management
      philosophy (Peter) of the 60s put emphasis on the individual. This was followed by
      tough-minded management of the 80s and 90s. Mental health had its swings during
      these decades: 1900-1930; 1930-40; 1940-50; 1950-60, etc. Managed care arose in
      the early 90s. In a sense, the Duplex Pyramids Model represents a Dialectical tension
      be
              could be trained to use, in a more elaborate sense of course, the figure-ground
      reversal technique. By bringing into play the Duplex Pyramid Model, with its detailed
      methods of analysis of the levels of both pyramids and their interaction, or mutual
      influences, such groups could systematically and methodically work through to designs
      that do, in fact, include both the top and bottom pyramids in a mutually facilitating
      manner.

      36.    A New Proposed Goal Would Be Facilitating Maturation Versus Cure Symptoms
                          Designing Programs that are Reoriented
                       away from a medical 'Illness and Cure Model'
                     and from a justice 'Crime and Punishment Model'
                    and toward a 'Maturity and Structural Change Model'

             37. Prescribing Alternative Methods to Recover from Our Cultural Sickness

38.   Ways of Relating in Types of Roles and Relationships in the New Mental Health System

                         39. To Reverse the Objectification of Man: Respect their Total Inner
                                 Person, Life History, Life Circumstances, and Intentions

                                   This means no discounting and no imposing.


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                       40. All of this being said, what do we do now?
      .



      C. Critiquing current individual treatment modalities and
institutional programs

       1. Traditional psychotherapeutic modalities do have aspects that
relate positively to their counterpart levels in the bottom pyramid of
the Duplex Pyramid Model
       a. Dyadic Role-relationship therapies
       Transactional analysis has its paradigm of how people relate to
 each other. One person can assume one of three root positions or
 roles: Parent, Adult, or Child. The other person can also assume
 any one of the three. As for instance, if a person takes the role of
 Parent, the other can assume a Parent, Adult, or child role. With
 each combination, the dynamics of the relationship will change
 considerably. Each of the three root roles can have different styles.
 For instance, one could have a punitive parent style and the other a
 rebellious child style. This combination would likely be stuck in
 endless conflict. If the punitive parent switches to acting like a
 rebellious child, the rebellious child will sometimes switch to acting
 like the punitive parent. The ideal is for two people to both assume
 the adult role. Their relationship will likely be one of equality,
 fairness, reciprocity, rationality, mutual respect, support, and
 facilitation of each other‟s goals. Of course, if a grown up is a
 parent with a child, assuming the adult role with the child would
 have inherent unrealistic expectations. However, when the adult
 takes into consideration that the child will be operating at a child‟s
 level of emotional, moral, social, and mental development and
 adapts their communication with the child in a manner appropriate
 for the child‟s level of development, the child will gradually grow
 more rational, fair, responsible, and respectful with the adult. This
 development will, as mentioned occur gradually. If the parent‟s
 expectations do not get ahead of where the child is, the child will
 not only mature but also have an accompanying self-esteem,
 confidence, and pride in their expressions of increasingly more
 mature and adult-like responsibility.


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       When the staff in an institution learns to assume the adult role
illustrated above, their client population will also begin to relate and
an increasingly more mature way, just as did the child example cited
above. The client population will tend to bond more easily with the
staff and to take them as role models to emulate.
       Likewise, in the Natural Systems groups in the „Open Society‟,
there could be opportunities to adopt this adult-adult model.
Members, of course, will be interacting and discussing their personal
concerns, ideas from lessons, plans, and progress related to projects,
and the like. As they do so, one of their functions will be facilitate
each other‟s growth in acquiring ego mastery skills and maturity. An
important example of these skills will be relating to each other on an
adult-adult basis.

      b. Role-playing variations and especially Psychodrama:

      Psychodrama, usually a group technique, and role-playing
therapies are designed to help clients understand their roles and the
roles of others in their network of close relationships by dramatizing
and switching roles and simulating role interactions. Through these
mini-scenarios, clients can also learn new and more effective ways to
interact with others. Role-playing is also used in sessions with just
the individual client and the therapist enacting roles somewhat as is
done in psychodrama. The problem with this technique is the same
as with all modalities used with the individual client. That problem, as
was noted in the beginning, concerns the one-hour a week. Through
out the rest of the week, the insights gained in the sessions fade and
the pressures coming from so many other interactions during the
week cause a regression to their status quo ante. Most of these role
relations are informal and constantly requiring adaptations to all of
the various persons with whom they interact in all of the various
settings and situations. However, the main handicap is the fact that
there is neither the time nor opportunity to learn a wide range of role
behaviors or to incorporate their changed role and role behaviors into
their identity vis-à-vis their full range of relationships nor to integrate
these changes into their self-concept.
      Nevertheless, the concept roles and role behaviors is a vital part
of the Natural Systems institutional program. In the case of Stars and
Stripes, the youth are given formal roles to enact and they have to
learn to adapt their behavior to these roles. As they move up in rank,
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their roles not only change but also demand more responsibility, skill,
and maturity. Since they hold each of their roles for several weeks,
their peers and staff begin to identify their roles for each rank. This
role enactment becomes, therefore, a part of their identity and
eventually it is incorporated into their self-concept. Since the ranks
of the program are graduated in a manner similar to the
developmental stages from childhood through late adolescence, their
identity is also assumed to be becoming increasingly mature. As they
move through the ranks and levels of maturity, they are developing
ego mastery skills in the areas of person maturity, interpersonal
maturity, social maturity or maturity in identifying with the institution
and serving to maintain and enhance the quality of community life.
Assuming formal roles in the context of the institution‟s program is a
powerful way for the youth to incorporate maturity and ego mastery
skills that they are proud of and that will help with the test of time.
Regression to status quo ante behavior becomes much less likely
with this approach.
      Natural Systems groups in the “Open Society” can also benefit
from this technique. Members can be assigned formal roles for
conducting various tasks or presentations. They can be provided
constructive feedback from fellow members to assist them in
improving their leadership skills while the members providing the
feedback can do the same with each other. As they enact their formal
roles as leader and audience, they acquire these new skills and styles
that then become incorporated into their behavioral repertoire and
their identity and self-concepts as well. The informal roles they
attempt to assume and the group attempts to assign to them can also
be detected, shared, and discussed to give each insights into their
unconscious tendencies in informal role assumption and their
preferred informal roles. This feedback and these insights can then
be viewed as choices to be evaluated from among alternative informal
roles. Engaging in this activity is highly personal. It will require
acquisition of sensitivity and non-judgmental communication styles.
      The employment of formal roles and evaluation of skills and
styles in both formal and informal roles should be a powerful part of
the Natural Systems groups.

    c. Communication therapies and Virginia Satir and family
systems:


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       Natural Systems groups can benefit from the great contribution
made by family systems therapists and communication therapists.
Previous modalities had focused on having people talk out their
conflicts or act them out in groups. Psychodrama with groups was
eventually adapted to Psychodrama with families. What family
systems and communication modalities did was to shift the focus on
„the way‟ people or families talked and „the way‟ families developed a
system of roles and relationships which was revealed in „the way
people or families talked differently to each other depending on their
role in the system„.
      This turned the previous focus upside down. Instead of
inferring roles by listening to the way members talked to each other
and then dealing with the pathology in the role system, the focus
became dealing with the communication pathology. This does not
involve an inference or a construct. This is what is immediately
apparent. Clients could hear a therapist or another client say, for
example, „You are not listening to me. You are talking down to me.
You are side stepping the issue. You are not revealing yourself. You
are not giving that person an equal chance to talk.‟ This is immediate.
The therapist could take the spoken words, or the manner of shutting
a person out, or the angry and hostile manner of speaking, and such,
and focus on them. Then the therapist could turn it around to,
without pejorative diagnosis, labeling, or being judgmental, directly
retrain the communication pattern.
      Clients could see for themselves that, when they talked
differently, they got different results. When they listened differently,
they got different results. These results changed the quality of the
relationship and this became rewarding and satisfying to the clients.
Changing the communication pattern did not involve invading their
private personality that tends to make clients uneasy and defensive
and lends toward defining their identity in a negative way. Yet, when
the communication pattern changed in a therapeutic way, the clients
began to be more transparent and empathetic. They did not
defensively have to maintain their public personality. Therefore, they
had less reason to be defensive and guarded against being accused
of such things as deceptiveness, of being manipulative, or self-
righteous, and the like. The labyrinthine paths taken by former
modalities to get at the underlying cause was short-circuited. The
immediate small successes could be self-reinforcing.


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      In a somewhat similar manner, Natural Systems groups can
engage in mutual assessments of one another‟s transparency and
empathy, assist one another in finding more effective communication
skills, and mutually support and verbally reward with other for
practicing these skills. They can do this as a part of tasks that
likewise circumvent those labyrinthine paths and pejorative labeling
of former modalities as well. They can do this in a positive and
objective way that merely says, “Lets try this alternative and see if it
helps.” A neutral member can take the assessed information and
their immediate observations and actually coach, for example, pairs
that are trying to improve their communication skills. Their success
instantly can be given recognition and encouragement to persist, just
as a coach does.
      Only one that includes learning to communicate and change role
relations within the „family system‟.

      d. Psychiatry and psychopharmacology:

      In collaboration, these two have provided significant insights
into normal and abnormal brain chemistry. It is helpful to know, or
suspect, that a certain type of treatment, whether psychological
therapy or psychotropic medication, has restored the brain to a
balanced chemistry, or healthy pattern of neurotransmitter
interaction. On the other hand, if after taking psychotropic
medications, a patient reports inner comfort, exhibits self-enhancing
behavior, and appropriate social skills, it adds little to state that there
may no longer be a brain chemistry imbalance. Alternative
explanations are just as justifiable in the absence of empirical
evidence or demonstrated cause and effect relations. If after
withdrawal of psychotropic medications a person is symptom free,
the same argument applies.
      Consider, for example, that if first there were unhealthy
symptoms, then a patient entered an institution and psychotropic
medications were administrated and the symptoms were not reduced,
and then a treatment program was introduced and at the same time
the medications were withdrawn and then the symptoms disappeared,
would the best explanation be that the program was the causal agent?
Could we assume that initially negative external environmental
conditions induced an imbalance in brain chemistry and then
subsequently positive environmental conditions influenced a balance
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in brain chemistry? How could faulty brain chemistry be the best
explanation as the cause of the symptoms or their reduction?
Nevertheless, it would be interesting if an unbiased research
organization could test brain chemistry before and after a program
like “Stars and Stripes” or a Natural Systems group in the Open
Society.
      Nevertheless, finding correlations between neurotransmitters
and symptoms can be helpful. If studies can show that
configurations of neurotransmitters seem to fit with changes in the
structure of the external environment and/or a person‟s life
conditions, this can be helpful. Likewise, a determination of
configurations of neurotransmitters that seems to correspond with a
person‟s symptoms could be helpful. If such results demonstrate or
suggest that brain chemistry or neurotransmitters are sensitive to and
closely related to shifts in the person‟s external world, this suggests
that there is more than a mind-body connection but also there is a
mind-body-external world connection. In other words, a holistic
philosophy of mind-environment could lead to an entirely new
direction in treatment, namely one that begins to emphasize the
importance of external structures in mental health.

      e. Behavior modification:

       Behavior modification is based on learning theory and
particularly on reinforcement theory. It uses positive reinforcement
or rewards and negative reinforcement or the withholding of rewards.
It uses punishment. Reward and punishment can come in an
immense variety from words; to physical sensations; food; tokens;
ceremonies; or whatever the inventiveness of the therapist can
devise. Reinforcement can be scheduled to come at fixed or varied
times and to come consistently or intermittently.
       There are two principal problems or concerns with behavior
modification. 1) That a very small response set is treated in isolation
from the rest of the person and their social environment. 2) That it is
administered either impersonally and mechanically or without taking
into account the nature of the relationship between the client and
therapist and without regard for whether or what kind of a bond exists
between them. In other words, it is mechanical, impersonal, without
regard for the whole person, and the reinforcement is administered in
a non-bonded relationship.
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      Nevertheless, the idea of reinforcement can be used in a positive
and effective way. First, the mechanical aspect must be discarded.
Then reinforcement through personal recognition within a bonded
relationship will be appreciated and the behavior is not likely to be
faked. When it is truly deserved and not used to manipulate it can be
very meaningful to the client. With this approach, the reinforced
pattern or achievement will tend to be incorporated on an enduring
basis. It is especially meaningful and effective if it is meant as an
acknowledgement of positive, community related achievement from
both the therapist or a staff member and the person‟s peers. With this
kind of approach, the reinforcement aspect of behavior modification
can be adapted to Natural Systems groups. In this regard, the
reinforcement aspect of behavior modification can make a significant
contribution to the Natural Systems approach in the Open Society as
well as in juvenile correctional institutions.
      In behavior modification, verbal behavior is a subset of behavior
that is to be modified and is not a means through which a client may
gain insight. Insight is disregarded. The isolated unit of verbal or
physical behavior is the focus of the treatment without regards to
anything else. It is virtually the opposite of a holistic approach.
      In some juvenile correctional institutions token economies (a
form of behavior modification adapted for institutions) have been
used. In each case it has not worked. The residents not only do not
change in a positive way, but they become more expert in their
negative behaviors. They learn to bully, cheat, manipulate, lie, and
feign improvement. Since it is an impersonal form of treatment, the
residents come to understand that it is being used to control them
and that those administering the program do not care for them as
persons. The response to being not cared for as a person is that they
do not care for the others or themselves. Without care, the ostensive
objectives of the program are not incorporated. Even if they do
manage to conform and modify their behavior, the change is for
appearances sake and is short-lived.
      Contrariwise, in the “Stars and Stripes” program, teaching and
training those in a rank below to rise to your rank instills the content
being taught in the teacher, but it also instills the helping or teaching
behavior. Those being trained to attain the next higher rank are
rewarded when the goal is achieved. Parallel with that, the behaviors
engaged in to reach that rank do not merely involved learning
content. It is mainly behavior, repeated actions, that was rewarded.
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When the learned behavior is enacted intentionally, consistently, and
repeatedly, it is far more likely to become incorporated. The person
has to choose and set a long-term goal to reach the rank and follow
through with the appropriate behavior. Attaining the rank under
these conditions reinforces both setting long-term goals and the
persistence necessary in working to reach that goal. The attained
rank is a reward but it also entails greater responsibility and more
advanced pro-social roles.
      Contrary to behavior modification, a reward in “Stars and
Stripes” is redefined. Reward now signifies gaining a desire to being
identified as more mature, responsible, and entrusted with a more
responsible pro-social role. Rewards in this context are for not just
used as positive incentives and influences on those of lower ranks.
They mean that the more advanced rank entails responsibility for
maintaining a positive community. The reward entails a positive
membership in a group of one‟s peers. Furthermore, it entails
identification with the institution as a whole. The reward is more than
a higher rank. It imbues the youth with a new identity that entails
respect and implies the capability and trustworthiness of the youth.
      Even though being quite different from the traditional behavior
modification modality, it can still be considered a form of behavior
modification because it relies on reinforcement theory. It is, on the
other hand, far different from traditional behavior modification
because it is implicitly reinforcing in the youth a broader perspective
on the world. Understanding it on an experiential rather tha a
conceptual level, it nevertheless includes the full range of levels of
the top pyramid‟s external structures. It is simultaneously reinforcing
alteration of all of the internal structures. That is to say, it reinforces
aspects of dyadic interaction; developing healthy relationships; roles
and the ability to change and adapt to different kinds of roles;
physical and verbal behavior patterns; ways of communicating; ways
of thinking and learning to think before one acts; identifying emotions
and feelings and expressing feelings effectively; perceiving reality or
what a person is really like versus projection; and understanding and
re-construing one‟s life history. All of this means that this form of
reinforcement includes attaining a higher level of the ego mastery
skills.
      Finally, when successful by attaining the highest rank, it means
that the youth has reached a higher level of maturity and therefore
regression is far less likely. The reward is multifaceted and comes
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from their peers, the staff, and the community as a whole. The reward
for attaining each rank is presented in a ceremony before the whole
community that, thereby, is acknowledging the youth‟s advance in
responsibility and status and at the same time, the community is
demonstrating appreciation for the youth‟s rise to greater
responsibility in and for the community.
       In other words, this form of behavior modification is no longer a
part of the cult of individualism. The whole reformulation of it makes
it an integral part of the whole, the community, and virtually a part of
the larger social structure. However, in this system, at each higher
level of rank, there is an increase in the youth‟s competence at each
of the levels of the internal structures and processes. These are all
evolving in the youth as they move up through the stages of maturity.
In this way, becoming more mature means that all of the components
of the self and the youth‟s schemata of the institution and social
world are simultaneously involved and integrated by the maturation of
the essential integrating processes of intentionality. Behavior
modification is taken from a focus on extremely isolated units of
behavior to the whole human being in its whole environment. It is
transformed into a holistic approach. The concept of reinforcement is
a vital component of the Natural Systems approach to treatment.

     f. Cognitively oriented therapies such as cognitive
restructuring, problem solving, and reality therapy:

      Cognitive restructuring is one of the newer modalities. In
cognitive restructuring, there is an attempt to identify the client‟s self-
defeating thoughts, negative self-talk and irrational beliefs. The
tendency to set unrealistic or unachievable goals is an example of
thinking that involves a vicious cycle. Many people hold irrational
worldviews or schemata of the world that produces depression or
anxiety. Most people are not aware of the fact that this kind of
thinking is stress producing. The therapist tries to help the client
learn to recognize and change these unhealthy thoughts and attitudes
so that they can reduce stress and the physical symptoms related to
it. Unhealthy thinking tends to produce negative emotions, such as
anxiety, fear, sadness, frustration, anger, or guilt. These negative
emotions can in turn result in physical problems, such as headaches
or fatigue, or behavior problems, such as irritability with friends or
addictions. You first learn to identify your own cycle of thoughts,

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emotions, physical symptoms, and behavior. Then you learn to
change your thinking, irrational beliefs, faulty world schemata,
tendencies to misperceive others as threats and changing these
patterns into more realistic and positive ones can reduce stress,
improve your relationships, and benefit your health. Cognitive
restructuring can be combined with other techniques, such as
relaxation response therapy, healthy diet and exercise, breathing
exercises, meditation, visual imagery, and yoga. In other words, this
modality espouses a holistic philosophy.

      Since youth in a correctional institution are typically hostile to
attempts to use counseling with them or get them to recognize their
faulty thinking, cognitive restructuring as an individual therapy
modality is virtually useless. However, it is clear that the negative
structure of their thoughts and beliefs is a major contributor to their
behavior and emotional disorders, particularly their delinquent
behavior. Instead using employing a therapy modality, the
institution‟s program is designed to bring about an identification with
and bond with the staff, the institution, their peers, and ultimately
bring about a redefinition of the world, society, and representatives of
society‟s agency such a police. This indirect approach results in a
pervasive change in their thinking and beliefs that is simultaneously
associated with their behavior and feelings.

      Reality therapy and goal orientation only therapy involving goal
setting but therapist is dominant and interactive in the goal setting
and enforcing rule of “no excuses” Reality therapy also involves
Identity concept in that goals set also involve a change in identity
and/or self concept

      My assumption is that there is a value inherent in cognitive
restructuring but that this can be accomplished more effectively
through indirect means. This same approach can be adapted to the
Natural Systems groups. By designing the group so that group
members engage in cooperative tasks for the sake of the rest of the
group, they will come to bond and identify with each other. For
example, a few of them at a time could prepare and present a lesson.
If they chose to do one on the nature of an agency or corporation that
is taking a beating in the press one of their goals could how structure
rather than administrators or staff was the problem. Alternatively,

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they could present something on the causes of stress, delinquency,
poverty, or homelessness, or the like. In this case, they could be
charged with trying to show how the structural factors are influencing
these social and personal problems rather than some defect or ill will
inherent in the person. All in one project, they bond with each other,
come to understand each other better, identify with the group, take
ownership of the purpose and conduct of the group, and begin to
alter their beliefs about the world their ways of thinking, and their
worldview.

      While the modality, cognitive restructuring, has the same
intractable problems mentioned at the outset, it is still possible to see
the potential value of some of its underlying philosophy that can
contribute to Natural Systems groups.

      g. Rogers Client-Centered, psychodynamic, and feeling
 oriented therapies:

          From Rogerian non-directive, psychodynamic, and analytical
 therapies, Natural Systems takes training staff group leaders and
 support team surrogate parents to be accepting, non-judgmental, and
 empathetic so that the youth come to feel free to express their true
 emotions, learn to verbalize them so that they are transformed into
 more refined expressions of feelings - - while being related to with
 non-judgmental empathy from staff and staff surrogate parents in
 support teams the youth model and learn to be empathic and non-
 judgmental                         iin allmostt allll ttherapiies tthere iis an obviious or
                                       n a mos a herap es here s an obv ous or
iimplliiciitt sttrattiiffiied rellattiionshiip,, and one up tto one down rellattiionshiip
  mp c s ra ed re a onsh p and one up o one down re a onsh p
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doiing tto or ffor ratther tthan a muttuall,, pariitty,, equalliitty,, same llevell
 do ng o or or ra her han a mu ua par y equa y same eve
rellattiionshiip even iiff clliientt iis encouraged tto diirectt ttheiir own ttherapy iin
 re a onsh p even c en s encouraged o d rec he r own herapy n
ttheiir own way and ttiime -- tthatt iis as iin Rogeriian non--diirecttiive – whiich
  he r own way and me ha s as n Roger an non d rec ve – wh ch
encourages ttheiir openiing up ttheiir priivatte person -- PARADOX
 encourages he r open ng up he r pr va e person                                PARADOX
Rogeriian ffeelliing oriientted and owniing ffeelliings and psychodynamiic
 Roger an ee ng or en ed and own ng ee ngs and psychodynam c
gaiiniing iinsiightt iintto repressed and suppressed priivatte person and
 ga n ng ns gh n o repressed and suppressed pr va e person and
iintto whatt lliies beneatth deffenses and publliic personalliitty PARADOX off
  n o wha es benea h de enses and pub c persona y PARADOX o
ttransparency,, autthenttiiciitty,, empatthy versus
  ransparency au hen c y empa hy versus                                  off confformiing tto
                                                                         o con orm ng o
rolle prescriipttiions assumiing a publliic persona assumiing tthe iidenttiitty
 ro e prescr p ons assum ng a pub c persona assum ng he den y
enttaiilled iin tthe fformall rolle iin order tto llearn and tto iincorporatte ego
 en a ed n he orma ro e n order o earn and o ncorpora e ego
masttery skiilllls ffor tthe devellopmentt off tthe ttraiitts off iincreased llevells off
 mas ery sk s or he deve opmen o he ra s o ncreased eve s o

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matturiitty enacttiing and practtiiciing tthe behaviiors off tthe rolle „„jjob
 ma ur y enac ng and prac c ng he behav ors o he ro e ob
descriipttiion‟‟ versus autthenttiic behaviior and sponttaneiitty autthenttiic sellff
 descr p on versus au hen c behav or and spon ane y au hen c se
percepttiion and ttransparentt sellff revellattiion versus adopttiing tthe goalls
 percep on and ransparen se reve a on versus adop ng he goa s
off tthe fformall rolle and confformiing tto tthe ttraiitts off tthe rolle assumiing
 o he orma ro e and con orm ng o he ra s o he ro e assum ng
tthe sttrattiiffiied – one up – one down – rellattiionshiip off hiigher ranked
  he s ra ed – one up – one down – re a onsh p o h gher ranked
youtth ttraiiniing,, tteachiing,, and hellpiing tthe llower ranked youtth and
 you h ra n ng each ng and he p ng he ower ranked you h and
siimullttaneouslly llearniing tto rellatte as equalls and llearniing tto cooperatte
 s mu aneous y earn ng o re a e as equa s and earn ng o coopera e
as equalls --peer tto peer – adulltt tto adulltt as iin ttransacttiionall anallysiis
 as equa s peer o peer – adu o adu as n ransac ona ana ys s
        avoiidiing tthe rolle off reward--er and reiinfforce--er off tthe otther‟‟s
        avo d ng he ro e o reward er and re n orce er o he o her s
behaviior as iin Rogeriian non--diirecttiive ttherapy versus assumiing as iin
 behav or as n Roger an non d rec ve herapy versus assum ng as n
tthe adopttiion off tthe reiinfforcementt rolle rellattiionshiip off tthe fformall rolle
  he adop on o he re n orcemen ro e re a onsh p o he orma ro e
systtem Natural Systems groups
 sys em

       h. Gestalt therapy:


      From Gestalt therapy, Natural Systems in the institution
achieves its emphasis on learning to differentiate between their
mistaken perception and interpretation of the world and objective
reality through the corrective feedback provided by both staff and
peers. Eventually they learn self-correction and to be brutally honest
both with respect to their misperceptions of themselves, their
misperceptions of the „others‟, of the institution, and the world.
Natural Systems groups.

       i. Psychoanalysis:

            When psychoanalysis laid out the theory of the role of
parents in the development of the child‟s personality, it generated
much controversy. This, in turn, generated much research in
psychology, sociology, and child development. Such extensive
questioning and research contributed to developments in
psychotherapy. Of particular importance were the efforts that led to
family systems theory and therapy. Margaret Mead‟s cross-cultural
studies opened the way to explorations of alternatives to Freud‟s
ideas about the nature of the family. Family systems theory explored
role-systems in the family. It proponents demonstrated how members
of a family, especially children, were unconsciously assigned roles.
The experts in family systems gained insights into how parents‟
motives in assigning roles were sometimes pathological.
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Consequently, the child who assumed these assigned roles
developed pathological behavior and interaction patterns with parents
and even with peers and other adult authorities.
            Using the combination of Freudian family concepts and
concepts from family systems, Natural Systems saw that building a
way to have two positive parent surrogates placed in roles in which
they could maintain a close, positive, supportive relationship with a
youth. In this role they could encourage the youth to use their own
judgment, set their own goals, self-evaluate consequences, and learn
to be self-corrective so that they could progress through
developmental stages in their growth toward increased maturity.
            “Stars and Stripes” also emphasized ways to alter the
youth‟s interaction with their family of origin, or biological family. The
youth‟s were taught how to use negotiation and mediation skills
within their family. They taught to understand how their families‟
unconsciously assigned them negation roles and how to resist this.
Further, they were instructed to expect a two-week honeymoon period
upon return home. After returning home, pressure to return to ante-
incarceration status quo behavior and to their assigned role in the
family system will start to build. Knowledge of this pattern serves as
a kind of inoculation against caving in to this post honeymoon
pressure.
      Building on Freud‟s concept of transference as a natural
phenomena that occurs in a close, bonded relationship with a caring
and accepting adult and his concept of the superego as an
introjections of a child‟s parents, Natural Systems uses a similar
concept of the Implicit Other. Even with severely antisocial and
emotionally disturbed youths and adults, if the required type and
quality of bond forms with the staff or therapist, original negative
parents can be supplanted. If this relationship persists over a
sufficient length of time, the adult authority as parent surrogate can
become incorporated, supplanting the original parents as Implicit
Others. Over time, this close relationship can result in the adult
becoming a role model whom the client or youth attempts to emulate.
The client or youth will seek their approval by trying to become as
much like them as possible. If this pattern of interaction is
successful, the supplanting Implicit Others will stand the test of time
and function somewhat like a subliminal voice guiding choices and
behavior and serving as a perpetual unconscious positive reinforcer.
The introjections of staff surrogate parents as their new implicit
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parents also serves as a powerful inoculation against the negative
family systems‟ pressure.
      These Implicit Others also assist in the formation of a new
Secondary Implicit Other, or implicit peer reference group, guiding
selection of new friends and assumption of new informal roles with
possible subsequent new peer groups. This is one place where the
concept of longitudinal patterns mentioned at the beginning comes
into play. These concepts, originally based on the Freudian model,
hopefully, can also prove useful in the Natural Systems groups in the
“Open Society”.

j. In summation:
      In contrast to the criticisms offered above, each of these
modalities has their own contribution to make to the new Natural
Systems group therapy. For example, the concept of transference in
psychoanalysis means that the child introjected their parents and
when in therapy they initially project their introjected parent images
onto the therapist. The therapist is non-judgmental and accepting as
the client expresses their conflicts and confesses their guilt.
Eventually the client perceives the difference between their parents
and the therapist. The client replaces their introjected parents by
introjecting the therapist and takes the therapist‟s attitude toward
himself. Thereby, they are learning to live with self-acceptance. In
The Natural Systems‟ “Stars and Stripes” program the staff, while not
doing psychotherapy, took a similar non-judgmental and accepting
attitude toward the youths. The youths eventually introjected the staff
as implicit parents and unconsciously took this non-judgmental and
accepting attitude toward their selves. DDDDDDDDD
            Psychoanalysis looks to the vague, hidden human drives
while Natural Systems looks to publicly detectable external structures
in the culture that shape and create drives. Psychoanalysis and most
modalities are essentially amoral and unconcerned with levels of
maturity. Their aim is to eliminate or reduce painful emotions and
alter malfunctioning patterns in internal structures and processes
such as, for example, perception, communication, behavioral habits,
or faulty strategies for relating to others. Ego mastery skills become
involved in traditional therapies when underdeveloped and ineffective
ones must be replaced. Ego mastery skills are also addressed in
Natural Systems since they are required increase maturity and to

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make a mature person‟s character more successful. The approach is
far different. Traditional modalities focus on or work exclusively with
the individual client through their preferred level of internal structure.
Natural Systems can work with large numbers of persons and focuses
on designing structures that can elicit more skillful and mature
behavior. A Natural Systems program can be designed to work with
any or all of the internal structures as well as any or all of the inner
intentional processes.
       When considering the problems with and contributions from the
major individual or group treatment modalities, Existential therapy
purposely was left out. Existential therapy was not considered in
those discussions of modalities because it is the only one that
addresses meaning, significance rather than one of the internal
structures. Also, in contrast to the others, Existential therapy
addresses the person‟s ethical nature in relation to their mental health
and maturity issues. In a sense, Existential therapy has more in
common with a critical aspect of Natural Systems. They both relate to
the man/world Gestalt and they both assist the client in coming to
grips with the human condition and learning ways to creatively cope
with it. Existential therapy looks at this in terms of humans‟ needs to
have meaning in their lives and to live a life that has significance.
       Natural Systems approaches this concern differently, however,
in that while the focus is on how to cope with and alter their external
world, it is assumed that when the person acquires the ego mastery
skill and maturity to do this, they will have a sense of community and
collaboration with others in an attempt to reshape their world so that
it becomes a mutually supportive, mutually facilitating community. It
is assumed that this will give each person a sense of purpose,
significance, and meaning. When they sense their world is at cross-
purposes with this, their sense of purpose, significance, and meaning
will come from a commitment to correct this and reshape their world.
They will not be focused on the defects and symptoms of their fellow
humans, but rather on the structures that are their cause.
       Someone could assert that „the reason‟ why “Stars and Stripes”
works is because the youths are given a sense of control or actually a
sizable degree of control. There is no doubt that control, which is
fostered by the program‟s design, is a causal factor. However, that
conclusion would overlook two of the most significant causal factors.
First, the program‟s design has to include many structural factors, all
of which are integrated by the principle that all of those structural
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factors are carefully designed to evoke growth in all of the youth‟s
internal structures and each and all of their processes of
intentionality. Second, and this where the underlying philosophy of
Existential therapy comes into play, is an aspect of the program that
transcends the mere sense of control by evoking a sense of purpose,
meaning, and a sense of positive identification with a large whole,
namely the quality of life of the community within the institution. The
concept of control or self-determination is a neutral concept that does
not include the person gaining meaning, significance within the
whole, and a higher purpose, a purpose beyond mere self-interest or
self-enhancement. When the arrives, through difficult growth and
self-correction, as well as constructive feedback from others, at the
level of that sense of personal meaning, significance within the whole,
and the higher purpose of responsibility and commitment to the
quality of community life, they have transcended mere ego mastery
skills.
       Ego mastery skills are crucial, but they are more like tools or
means to ends. The level of maturity that entails those attributes of
meaning, significance, and purpose signifies transcendence, which
is, I understand as the goal of Existential therapy. In the case of
“Stars and Stripes”, this is achieved without therapy, which also often
is the way it is reached in the “Open Society”. Ordinarily, however,
the clients of Existential therapists are people of high intelligence, a
high level of skills, and are generally quite successful in life, yet have
a haunting sense of despair and the meaninglessness of life. Yet,
when a person reaches this level of maturity and transcendence while
in Existential therapy, then, what we call pathological symptomology
simply disappears from awareness. This is why Existential therapists
claim that a person‟s illness somehow disappears after they have the
moment of epiphany of seeing a meaning, significance, and purpose
for their lives. Interestingly, goal orientation and execution is
centered in the left front orbital cortex and is associated with a sense
of well being and even improved physical health. This is what
Existential therapy is all about, that is assisting clients in gaining a
sense of purpose and becoming goal oriented. Happily, those far less
advantaged can also be given the opportunity to experience that
same sort of epiphany and transcendence to a higher, more fulfilling
level of existence when exposed to a Natural Systems treatment
program, whether in an institution or in the “Open Society”.


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      PARADOX cited above (20 and 27) also involves inclusion of all
levels of structures of both Duplex Pyramids.
      see the reference to “S & S” program description in the
“Essential Features of Stars and Stripes”.


       2. Natural Systems and Psychiatric Categories and Treatment
                           Approaches Contrasted
Reinterpreting Psychiatric diagnostic categories and treatments so as
to reflect the man/world Gestalt and supplant the cult of the
individual.

              Natural Systems and Psychiatric Categories
Below is a list of problems, personality types, or behavioral patterns
for which society uses psychiatry, governmental human services, or
agencies to ameliorate, control, or contain. These problems are
typically easily observable. They may, or may not, be seen as
problems to the individuals having them. Contributing causal factors
for them can usually be found in the levels of structures and systems.
However, society, its institutions, and helping or controlling
professions tend to see the locus of the problem in the individual and
tend to exclude consideration of external factors as the cause.
There is a special set of problem behaviors that are harmful to others
but are treated differently. Society tends to take a laissez faire
approach toward this special set. The difference between the special
set and the non-special set appears to be that the special set are
committed by persons of high socio-economic status, heads of
corporations, or high level governmental officials. The non-special
set tends to be committed by or characteristic of the poor and
powerless.
In the Natural Systems approach, all of these problems are regarded
as being caused by factors in the levels of external structures and
systems that do, in fact, evidence themselves as problems within the
person‟s internal structures and processes. The problems within the
person that involved processes are primarily the processes of
intentionality
      When these problems are treated in an institution with a
program like “Stars and Stripes”, there is no diagnosis or
psychological assessment. The individuals are not given any
psychiatric or other types of labels of mental illness or disorder.
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There is no prescription of treatment for any of the institutionalized
individuals. No psychotropic medications are prescribed or
administered. There is not even any use of any psychotherapeutic
modalities.
       The structure of the institution, the structure of the “Stars and
Stripes” program, is the treatment. It is uniformly applied to all.
Since the „symptoms‟, or the behavioral or emotional problems
gradually disappear and the person behaves normally, or
appropriately, one must assume that the cause and treatment is
structural. Since these institutional residents gradually increase their
ego mastery and social skills and grow in maturity, it is assumed that
the way the structure is designed elicits this growth in the individuals.
It is the growth in each of the hidden, inner, intentional processes
which constitutes the evidential growth in ego and social mastery
skills and maturity.
       There was coercion, manipulation, or bribery, and there was no
psychological intervention or treatment directed, specifically or
overtly, at any of the inner, intentional process. In spite of that, the
observable problems such as rage, impulsivity, ADHD, depression,
and all of the rest in the right column disappeared.
       The question of great concern here is can such changes, or
improvements, be achieved in the non-institutional, „Open Society‟?
It is impossible to restructure the „Open Society‟ so as to be similar to
that of the institution. Given this assumption, or rather fact, could
there be a way to structure a program in the „Open Society‟ that could
have something approaching the kind of positive impact achieved
inside the institution?
       The labels in green below are emotional problems but have
negative consequences for either others, the individual, or both. They
are typically diagnosed and treated by psychiatry as the individual‟s
problem without reference to structural causes. The locus of the
problem is in the person. The prescribed treatment primarily will be
the administration of psychotropic medications.
The problems listed below in red and some of those in green are
frequently seen in juvenile correctional institutions. They are found in
adult prisons and in psychiatric hospitals as well. These are also
problems are frequently found in the general population of the „Open
Society‟.
       The labels in red are primarily behavioral problems that have
negative consequences primarily for others. They too are typically
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diagnosed and treated by psychiatry as the individual‟s problem
without reference to structural causes. Their locus is also seen to be
in the person. The prescribed treatment for these will also be the
administration of psychotropic medications.
      Individuals having some of these problems will assert that their
cause comes from the actions of other people, situations, or life
conditions. Some of these problems, especially the painful emotions,
will sometimes be attributed to themselves.



a. Destructiveness to self and other:
Rage Antisocial Behavior Dangerous Aggression Suicidal behavior
Destructiveness is typical in prisons and to a lesser extent in
psychiatric hospitals. Actually, many psychiatric labels have the
potential for destructiveness. In the past, anger and rage were not
even listed in the DSM Index, and neither was aggression.
Aggressive behavior is mentioned in reference to Conduct Disorders.
Antisocial was touched upon very slightly and mainly in reference to
criminal behavior. Suicide or suicidal behavior is more frequent in
psychiatric hospitals than anywhere else. Suicide was not mentioned
in the early DSM. Why would being a danger to others of self not be
considered a mental, emotional, or behavioral disorder?
Interestingly, to be involuntarily committed to a psychiatric hospital,
someone had to certify that the patient was a danger to themselves or
others. So, why was there no entry under any label in the DSM for
destructiveness to self or other? Dangerous people seemed to be
avoided like the plague by psychiatry. Could this inconsistency be
due to the desire to avoid liability, because psychotropic medications
either had little effect on these two significant problems or
occasionally seemed to precipitate them? Destructiveness to others
and criminal behavior was left to the Departments of Correction.
Oddly, the psychology and psychiatry departments in adult and
juvenile corrections have gone to great lengths to provide
psychological testing and psychiatric diagnosis to inmates. Even
stranger, neither correctional institutions nor psychiatric hospitals
have been equipped to treat or deal with the dangerous people other
than by extreme sedation, solitary confinement, or by putting them in
manacles. Treatment and rehabilitation programs in adult and
juvenile correctional institutions have long been known to be titular.
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The use of psychotropic medications in these institutions did not
make the inmates or inmate population as a whole any less
dangerous, either to others or themselves. Genuine attempts to treat
always failed because you cannot enforce therapy and therapy at the
hands of extremely oppressive staff is like an oxymoron.
Contrariwise, my own programs in both adult and juvenile
correctional institutions was more successful than any type of
treatment modality or program precisely because it restructured the
organization and transformed the staff from being oppressive to
being supportive. In other words, the transformation of the
environment was effective with dangerous people even in the
absence of therapy or psychotropic medications.
   There is such a thing as Social Psychiatry, yet strangely it is
seldom heard from and when it is heard from through the media the
impression is of a meek, insignificant, impotent voice. The social
problems it is called upon to address have to do with extreme
examples of violent acts of youth, typically in gangs or small groups
attacking other youth and occasionally attacking the homeless;
parental physical abuse of children; occasional instances of extreme
discipline measures by teachers; and police brutality; abuse of the
elderly, particularly in homes (private and public) for the aged; In the
case of parental abuse or extreme neglect, the state provides Child
Protective Services and treatment is a very low priority. Orphaned
and abused children are typically housed in group homes or foster
homes which are notorious for their poor and inhumane care of these
children. Why is the influence of Social Psychiatry so conspicuously
absence in this huge arena of misfortune and inhumane treatment?
Why is Social Psychiatry‟s influence so pitiful with respect to the
severe and chronic problems of physical and emotional violence in
the public schools? Why is there their influence missing in regard to
breeding ground of bullies, sociopathic behavior, sanctioned violence
within high school athletics? My suspicion is that School Boards and
community leaders, particularly wealthy and influential
businesspersons encourage Social Psychiatry to stay out of it.
  There are societal problems that virtually facilitate or even create
violence, inhumane treatment, neglect, exploitation. Leaders in the
world of commerce perpetrate these social atrocities. Such problems
are in evidence in governmental policies formulated through the
collaboration of leaders in business and industry and politicians.
Examples are below subsistence wages and substandard benefits
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and other forms of legitimate care of full time employees and part
time and unprotected workers. If a powerful parent abuses, neglects,
or exploits their children, if a fully capable adult commits economic
crimes like fraud, scams, not honoring economic obligations, passing
bad checks, the various social systems like the justice systems are
called upon to see that justice is done and punishment exacted.
When these categories of abuse, neglect, or exploitation are
perpetrated on a large scale upon the poor and powerless by
corporations, causing a domino effect of additional individual and
social problems, who stands ready to convict and punish them, and
what is Social Psychiatry‟s role in this arena? The media plays to the
public‟s lust for reports over which they can moan, “Ain‟t it awful!”
Broadcasting these human catastrophes is a virtual cash cow for the
media corporations. Nevertheless, when they hear about America
corporations exploiting children as laborers in their factories in
horrible conditions, the only consequence is temporary bad publicity,
which spin-doctors quickly dissipate. Is this not antisocial,
sociopathic, and criminal behavior on a grand scale? Small-scale
crime and you do the „time‟, large-scale crime and you buy off the
„time‟ while your stock climbs! Is not apparent, after all, that human
services are there to serve the wishes and economic interests of the
elite? Is not apparent that the justice system is in bed with the rich
and powerful? Is not apparent that the very idea of „social justice‟
suffers extreme disfavor in our society? They used to say „you
cannot fight City Hall‟. Now you can say „you cannot fight the global
corporations‟ and now they own City Hall as well. Are not media
commentators who expose our society‟s tendency to blame the victim
ridiculed and lefties, socialists, even communists? If neither
politicians, agency heads, the media, business leaders, nor religious
leaders are willing to, have the strength of character to, provide
oversight to those perpetrating such ubiquitous causes of mental
illness, crime, and poverty in our society and call the economically
and politically powerful to accounting for their version of white collar,
legislatively sanctioned inhumane treatment of their less fortunate
fellow human beings, who will provide this oversight and extract
retribution commensurate with their misdeeds? Where are the
experts who can clearly explain to the public the nature of our „social
pathology‟ and its consequences „for everyone‟ and for our future? It
seems that Social Psychiatry has definitely abdicated this role and


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instead assumed the role of caretaker of the victimized by this social
disease when it is profitable to do so.

    b. Sexual Aggression:
Sexual Offenses as Illegal or Behaviors harmful to society.
    As mentioned above, behaviors designated as criminal offenses
are treated as criminal cases to be handled through criminal courts
and penal institutions. They receive scant treatment in the DSM and
are almost exclusively consigned to incarceration. Sexual
aggression, such as child molestation, rape, prostitution, and the like
are likewise handled through the justice system. Adults having sex
with minors is probably one of the most under reported offenses. Its
incidence is, as reported, highly biased toward males. In fact, if it
were possible to gain reliable statistics, the incidence of sex with
minors is probably more frequent among adult females but the nature
of our culture makes reporting in these cases unlikely. The only
difference in treatment of “sex offenders” is that they often are
compelled to participate in treatment programs in penal institutions.
It should be no surprise that these programs are notorious for their
failure rates but, nonetheless, continue to be provided and funded by
the state.
    Sex addicts, on the other hand, are treated in the private sector by
both psychiatrists, using psychotropic medications, and
psychologists, using modalities of choice. Who should define what
sexual addiction is? It should be no surprise that failure rates in
these settings are also notoriously high. After all, who are sex
addicts harming? Where does this appellation come from? I suspect
that its source is spouses whose husbands or wives are chronically
unfaithful. Some have a compulsion for engaging in sex acts in
public even though, or perhaps because, it is a crime.
       Offenders, when caught, which is probably very rare, are
typically told to put on the brakes and move on. If arrested, they are
usually given probation with the stipulation that they enter therapy.
This criminalizing reaction from authorities is odd seeing that risky,
public sex is so glamorized in the media. I suspect that if the
„culprits‟ can find a way to be more circumspect, they will continue to
pursue the risky, intensely erotic, mildly illegal, public sex. Many
women and men find sex in public places to be the ultimate form of
eroticism. Furthermore, what is their incentive to reduce their
frequency or manner of engaging in this kind of sex? Why all the fuss
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about it anyway? In the past such peccadilloes were always
successfully handled by a verbal reproach and order to cool it and
move on. This peculiar modern phenomenon is signaling that a very
important transformation is taking place in our society. Could it be
that the way sex offenses are handled represents our contemporary
obsession with and tendency toward litigiousness? The legal
profession now seizes upon so many conflicts that were once
handled by the parties themselves along with the help of friends, the
clergy, or others in their community. Could it be that lawyers have a
great deal to gain by inflaming these issues?
       Could it be that along with our mobility and other alienating
aspects of contemporary industrialized culture, others, even
neighbors, are looked upon with suspicion and we can no longer
make a personal connection with fellow human beings. We have lost
the ability, the ego mastery skills, to deal with ordinary, everyday
interpersonal interaction. Our knee jerk reaction is, “Sue the bastard.
Or, just call the police and let them handle it.” The legal profession is
happy to oblige and profit from our loss of interpersonal skills. Could
it be, also, that politicians have found this cultural condition and
these petty kinds of issues easy to exploit during their campaigns,
just as „getting tough on crime‟ has been for over a century? Could it
be that taking a rational approach to this issue, just as is the case
with narcotics, is a sure way to lose an election?
       What I am doing here in making a very brief analysis of the roles
of structures and systems, of which historical developments are a
part. I am putting the spotlight on this one issue of sexual offenses
(to use the example from above), in order to expose how the
professions and agencies are getting increasingly involved in our
lives. They are dealing with these issues in ever more futile, costly,
and counterproductive ways. Yet, at the same time that they are
making these problems worse, they are also making the population
weaker. Do we make the effort, do we dare, to ask the question “What
it is about the structure of our culture that is creating and shaping
these problems?” Do we question whether the cost of our ineffectual
approaches may be far greater and far worse than the behaviors
themselves, anyway? This illustrates the fact that these questions
are difficult to ask and examine because, while most crimes are
odious, sex offenses are taboo and clever men know that they tread
this ground only at risk of grave peril to themselves. We have,
consequently, reached a new and most unfortunate status quo.
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  The most important question, however, is, given the point we have
reached in this negative spiral of our culture, what can the Natural
Systems approach do to make the best of a bad situation and design
a program that can deal effectively with this problem?

    c. Psychosis:
       Psychosis in the most general sense is a disconnection between
what is going on outside the head and what is going on in the head.
People who are diagnosed as psychotic are seldom dangerous or
harmful to others. For the most part they a nuisance to others,
disrupting business or requiring that extra effort be exerted to
manage them. Their behavior in inexplicable and therefore frustrating
and communicating with them or getting them to cooperate is usually
impossible. Regardless of what the cause is, this disconnection with
the world outside of themselves is the most essential feature of
psychosis. There are many kinds of psychosis. Nevertheless, one
does not need to know the kind in order to recognize it when you see
it. Similarly, the bizarre behaviors and verbal expressions still lead
back to the essential disconnection, at least from the point of view of
the rest of society and the helping professionals. „Normal people‟
who interact with psychotics find that some say things that are
incomprehensible and some do things that are incomprehensible,
irrational, outlandish, and even scary. „Normal people‟ find them
useless and frustrating to deal with. In a sense, they seem
unpredictable but that may due to infrequent encounters with them.
For those who have frequent interaction with them, they begin to be
very predictable even while remaining incomprehensible.
       From among all of the bizarre behaviors and expressions, some
are seem related and typically are grouped together and placed under
one of the Psychotic psychiatric DSM diagnostic classifications.
Psychotherapists who try to treat them or merely to interact with them
are soon ready to relinquish them to psychiatrists who prescribe
medications based on the diagnosis and pattern of symptoms. I am
oversimplifying here because the essential point has nothing to do
with the etiology or symptomatology.
       Let me enter a caveat at this point. There most probably is a
small percentage of cases of psychosis that are biologically based.
Autopsies on deceased psychotics have demonstrated that did in fact
have malformed brain architecture. These account for a small
percentage of the total diagnosed as psychotic. Recently a research
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study using the autopsies of psychotics has shown abnormal
neurotransmitter behavior in regions of the brain. This study had a
very small sample. However, the real problem is the question of
which came first, the chicken or the egg? Given the small percentage
of biologically based psychoses, that leaves open the question of
how to explain and treat the remaining large percentage.
      In order to deal with the inquiries from nonprofessionals, or
laymen, concerning explanations for the psychotic disorder,
psychiatrists use the shorthand statement, “It is due to an imbalance
in brain chemistry”. The use of this brief diagnostic explanation
makes it easy to transition to informing concerned parties, or laymen,
such as parents, relatives, or committing judicial authorities that the
prescribed treatment will consist mainly of psychotropic medications
designed to correct this imbalance and reduce symptoms. Quite
often the concerned parties are informed that the patient will most
likely have to take the medication for the rest of their lives.
Nevertheless, since such medications either do not work or work in
undesirable ways such as negative side effects, the prescribed
medication is frequently changed and sometimes new medications
are added to counteract negative reactions. Often the patients report
that the medication is so disagreeable that they want to stop taking it.
They and concerned parties are warned that the consequences of
getting off the medications could be disastrous. Sometimes
psychotherapy is recommended as an adjunct to the medication.
      The research literature is full of conclusions that the best
formula for treatment of psychosis is a combination of psychotherapy
and medication. The recommended psychotherapy du jour seems to
be the cognitive-behavioral modality since most other modalities
researched has shown poor results. The results of this combination
are cited as being salutary in spite of the fact that the studies typically
have short follow up periods and are usually severely flawed and
even what is called favorable is often below fifty-percent with a very
generous description of what is favorable.
      A question that is not asked but that seems crucial to me is
whether some preceding factors caused the imbalance in brain
chemistry. Was the imbalance in brain chemistry there all along and
just waiting until some internal schedule set it off? If that were the
case, then there should be extensive research to find this internal
alarm clock. There is not. For over sixty years the psychiatric
profession and the pharmaceutical companies have been doing
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extensive research both to determine the exact nature of the
imbalance in brain chemistry, such as which neurotransmitters were
either in excess or deficient and/or which regions of the brain or over
or underactive. The pharmaceutical companies have searched for
psychotropic medications that will block or enhance the behavior of
these neurotransmitters or brain regions. During these years of
search for chemical causes and chemical cures there have been an
enormous number of Eureka experiences.
      Repeatedly, these „so-called‟ efficacious treatments have been
discredited and replaced by newer ones „discovered‟ and then
marketed by the pharmaceutical industries. On each of these
occasions, the psychiatrists begin to use the psychotropic
medications du jour. Similarly, the psychotherapeutic profession has
cycled through one modality, or combination of modality and
medication, in tandem with their symbiotically superior relatives, the
psychiatrists. Through all of this, repeatedly coming to my mind
decade after decade is the aforementioned question, „that is not
asked‟, but, nevertheless, seems crucial, is whether some preceding
non-physiological factors caused the imbalance in brain chemistry.
Of course, what I am thinking of regarding the preceding causative
factors relates to factors in levels of structures and systems that
could be precipitating the psychosis.
      Why has this question not been asked? Why have the same old
approaches been used in spite of their pitiful rates of success? The
answer lies partly because there is no well-known and esteemed
group of experts available to do the questioning. The most plausible
explanation concerns „vested interests‟. Psychiatrists and the
medical profession in general (all M. D.‟s can legally prescribe
psychotropic medications) in collaboration with the pharmaceutical
industry represent two of the largest, wealthiest, and politically most
powerful groups in the country. They have a huge interest in
perpetuating the status quo. They have captured the trust of the
entire population. They have convinced them all, even to the point of
virtually mesmerizing them, of their ultimate authority as mental
health experts. Their word is like the law or god. They have the funds
and lobbyists to influence US legislators. They seldom have more
than minuscule, ineffectual, competition from detractors.
      With the wealth of these powerhouses, they are able to saturate
television with highly appealing ads that successfully bate the
populace to find reasons to see their doctor and ask for the latest
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cure for even the most trifling worries about themselves. These
companies are like the hawkers of old peddling fake panaceas yet
with their acts carried to unbelievable heights of bedazzling
showmanship. They are convincingly presented as our lifesavers.
Who would dare take a chance on questioning such awesomely
educated and revered authorities in whose hands their lives are
dependent? Sometimes I suspect they even have mesmerized
themselves so that they are no longer capable of questioning their
compromised research methods and counterfeit „scientific belief
system‟. They are no longer capable of considering alternatives.
      Now we shall turn to the central issue to be considered with
reference to psychosis. From the Natural Systems point of view, if
psychiatrists or psychologists take a blanket approach to all patients
exhibiting behavior and expressions that are typically classified as
psychotic, they are making the mistake of devotion to an obsolete
treatment paradigm. While some few exhibiting such symptoms may
have a genetically caused defect in brain architecture or brain
chemistry, the assumption that all have this sort of defect is a grave
error and injustice. There is high probability that many of such
people have the potential to behave in a manner sufficiently normal
so that they can join naturally into any activity with their fellow
humans and interact appropriately and well without the aid of
medication.
      The problem preventing mental health professionals from
exploring this possibility has been due to the dominance of the
„medical model paradigm‟. The psychiatric profession has tried no
other alternative or paradigm. Natural Systems does provide such an
alternative. In fact in my experience, going back to the latter sixties,
very many of those exhibiting psychotic behaviors or symptoms have
resumed behavior closely approximating what we call normal when in
a Natural Systems‟ type of program in an institution for several
months without psychotropic medications. I am referring here not to
the “Stars and Stripes” program mentioned near the beginning, but to
other instances where the patients were male and female adults.
When the program in these institutions changed so that they
embodied the concepts and principles of Natural Systems, these
adults resumed normal and pro-social behaviors rather quickly.
These results occurred while they were not on medications and were
not in psychotherapy. Reiterating, the philosophy and approach of
Natural Systems assumes that the root or locus of the problem is not
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inside the individual but rather lies in the manner in which their
institutional or social environment is structured.
      Outside of the institution, in the “Open Society”, Naturally
Systems faces its greatest challenge. The problem here is that, if
there are structural factors that are precipitating or causing
psychosis, how does one go about detecting them. If it took finding
the point of origin for a person becoming psychotic, it would be a
hopeless task, neither the psychotic individual nor their parents or
others overseeing them would be able to answer that accurately.
Furthermore, if you tried to find out what the parents might have done
to bring this on, you would only find them pleading ignorance, and
insisting that they did all the right things. They would be adamant
that they did nothing to bring about these bizarre symptoms.
Fortunately, it is not necessary to determine a point of origin or the
causative forces. Ironically, this ahistorical approach is similar to the
psychiatric approach. Psychiatry may look into the etiology but it is
mainly concerned with gaining an accurate depiction of the pattern of
symptoms. However, a rough index of the point of origin, whether it
began in childhood or adulthood is important to diagnosis.
Determining whether there was in recent precipitating event such as
something to cause posttraumatic stress reaction is also important.
For Natural Systems, detecting causal or precipitating factors is
irrelevant. Classifying the pattern of symptoms is irrelevant. As was
mentioned in the beginning of this section, a person who is
disconnected from the outside world is hard to miss. For Natural
Systems, the concern is how to relate to disconnected people whose
behavior and verbal expressions are too bizarre for comprehension.
      How to relate to psychotics, therefore, is the central issue for
Natural Systems. I have to go on my own past experience to address
this issue. In the late fifties, I had the good fortune to be working in
State Mental Hospital while studying psychology. I was working with
psychotics in the position of Attendant. I was given great liberty by
the professional staff and was able to spend most of my time caring
for and talking with patients. I had already had minimal training in
counseling but the nature of my duties made counseling impossible.
Very often I was confronted with patients who were hallucinating;
were delusional; uncommunicative or uncooperative; babbling
incoherently; engaging in repetitive; ritualistic like behavior; catatonic
behavior; lassitude; explosive episodes; extremely manipulative
behavior; childlike behavior; extremes of emotionality like crying,
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laughing, or giddiness; fabricated stories; highly unrealistic promises
or predictions, and so on. I was very curious and listened to them
and interacted with them in personal way. I eventually found myself
entering into the world as they saw it. I even did this if a patient was
hallucinating. I would talk with them as though what they were
experiencing was real to me also. A funny thing happened when I did
this. Eventually they would break out of their hallucination and begin
to talk directly to me about it. We would engage in a serious
conversation about it. From that time on, I found that they would talk
with me and they were not talking about a hallucination but about
their everyday concerns or even about their past. It was as though
they had developed a normal friendship.
        One man was hallucinating about being attacked when he was
walking with me on an errand. At one point, he was even threatening
me but I continued to talk with him about the imagined threat as
though it were real. I entered into the drama with him. He came out of
it and began talking with me about a terrifying event that happened to
him in his native country. He seemed very relieved after that. He
eventually became friendly with me. Overtime, the hallucinations
diminished and then disappeared.
        In another case, a psychotic who had been standing rigidly in
the same spot for years, not saying a word, with a somewhat (to me
anyway) saturnine smile. I walked past him several times every day
and each and every time I would smile, say hi, and say his name.
After a few months of this, I was suddenly surprised to hear him say
hi back. After this happened for a few days, I stopped and talked
briefly with him and he conversed with me. Eventually he stopped
standing rigidly all day in the same spot and mingled about the ward
the same as everyone else.
        I had numerous experiences like this. I finally arrived at the
conclusion that the way these patients were treated was the
immediate cause of their psychotic behavior. The explanation could
be found in the structure of the relationships between staff and
patients. The symptoms were unique to each patient and most
probably had something to do with earlier life experiences. However,
the fact that I treated them differently, in a friendly way as though they
were persons like me and equal in human dignity to me, resulted in
their dropping their symptomatic behavior. After that period in my
life, I worked in other psychiatric facilities and adult and juvenile
penal institutions and always found that treating them as though they
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were persons like me and equal in human dignity to me almost always
resulted in their assuming normal, friendly relations with me.
       After consistently seeing this style of doctor-patient relation, I
wondered, “Could it be that the psychiatric profession acts so
superior, so clinical, so cold and distant, that it actually freezes the
patient within their defensive symptoms? Could it be that the
psychiatrists are so much like insensitive veterinarians treating a
„supposedly‟ feeling-less, disposable, subhuman animal, that their
patients must disconnect and exhibit bizarre behavior as a defense to
keep from interacting with these Nazi-like professionals?”
       As the years rolled on, and my official position rose to being
director of treatment or other similar positions, I expanded this
principal of humane treatment and attributing the cause to external
structures rather than something inherent and unalterable in the
individual, I began to include more and more of the natural features
that I found so helpful.
       I thought I had discovered a principle that these psychotics were
disconnected because others were disconnected from them. It took a
while to re-establish a connection with them but it did not take overly
long and was certainly worth the time and patience. After a long
career in this field, I codified all of the features of this approach into
what I now call Natural Systems, the essence of which was to treat
each person as though they were persons like me, equal in human
dignity to me, and deserving of equal respect. While the simple act of
treating them like any other human being is not sufficient to develop
their ego mastery skills and develop a level of maturity sufficient for
successfully handling life‟s challenges and forming fulfilling, intimate
interpersonal relations, it is definitely essential and a very good place
to start.
       Healthy role system. Goal orientation.

   d. Substance Abuse:
      Substance abuse is by far the most difficult human problem to
treat. Psychotics account for a small percentage of the population
while addicts and substance abusers in general constitute a very
large percentage of the population. Psychotics are difficult but for the
most part, they are easy to keep track of and control, regardless of
the lack of efficacy of the treatment they receive. Drug addicts, on the
other hand, run away, steal, lie, cheat, renege on appointments, have
a revolving door in jails and rehabilitation centers, pretend,
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manipulate, and constantly offer sincere intentions for recovery which
they abandon in due time. A therapist can watch them bite the hand
that feeds them and slowly degenerate in health until even the most
caring relatives have to cast them out.
      On the other hand, treatment professionals and officials have
made matters worse. They set up new centers and treatment
programs or support traditional ones but for the most part they rely
on knowledge laid out long before them or on new research that is a
mere extension of the same. There have been variations and
innovations but these do not venture far outside the ruts of tradition.
The innovators, of course, do not see it that way. They offer new,
high hopes. They display statistics verifying their success rates. Yet,
out of sight and absent from print are the dirty truths of their dismal
failures, such as their soft criteria for success, their biased methods
for collecting outcome data, and their carefully selected client
populations, decade after decade.
      Judges have no viable choices and therefore sentence addicts
to prisons that have nominal drug treatment programs. In reality,
such programs are not only a complete farce; they are like secret little
markets at the crossroads of the massive drug dealer industry. While
in prison, addicts seldom go without drugs for more than a few days.
Visitors and even officers and staff are often guilty of being suppliers
on the sly. The judges have to defend themselves by saying that they
rely on whatever trusted psychiatric professionals and prison officials
say about these programs. Without evidence or information to the
contrary and without alternatives, they will keep sending drug
offenders to these sham programs and keep despairing over seeing
them repeatedly back in their courts. The courts, therefore, become
swamped with these cases. Therefore, from among the genuine
candidates for prison that come before judges, a large percentage
must be placed on probation. Probation for an addict is the kiss of
death as for as any hope of abstinence or recovery is concerned.
      Another farce is making one of the terms of probation
attendance at support groups for addicts such as AA or NA. These
are ideal places where to meet fellow addicts, commiserate, and
seduce each other to get high after the meeting, exchange drug
shoptalk and experiences, and trade information about suppliers or
dealers and their going rates for drugs.
      The tragedy is that while rehabilitation and treatment centers are
holding out hope if addicts will just muster enough „will power‟,
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medical research is contradicting this false hope. Medical research
has convincingly demonstrated over and over again that once a
person is addicted, a human body that goes a short time without their
drug „fix‟ begins a physiological chain reaction that completely
overwhelms and decommissions rational thought and the best of
good intentions or will power.
      Fortunately, as far back as the late fifties the medical
professional proclaimed, not entirely opportunistically but also kindly
and realistically, alcoholism to be and illness. Lately they have made
the same pronouncement with respect to narcotics. Much to my
dismay, by illness they meant medical-physiological illness having
nothing to do with absence of will power. They did not see these
addictions as a societal illness or as having external, structural
causes. Over the years, their attempt to extend this perspective to
drug addiction has met with even less success as far as altering the
way addicts are perceived and treated. As an illness, it is clear why
therapeutic programs or interventions are impotent. None of the
medications has been found to work when the craving inside the
brain takes over. It is similar in intensity to having gone without water
or food for a very long time. They get desperate and will do almost
anything to get their drug or alcohol and in order to get relief from the
miserably painful feelings of craving. The brain chemistry of
addiction overrides all forms of treatment.
      Addiction is accompanied by a psychological component that is
almost as powerful as is the physiological, namely a perpetual feeling
of desperation. Being alone or feeling lonely and feeling empty, lost,
vulnerable, abandoned, unreal, and disconnected from any human
help, addicts descend into a terrifying, highly primitive, nightmarish
sense of desperation. Combined with the agonizingly gnawing of the
craving coming from their brain chemistry, panic sets in and they
begin a frenzied quest for their narcotic without regard for
consequences.
      Once again, as with psychosis and many other ailments, the
pharmaceutical industry finds a way to profit from this human
tragedy. The human tragedy for the addict and their family and
friends and the enormous cost to society is a powerful motivator to
keep trying to find a pharmaceutical cure. Over the last sixty or more
years I have heard of one medication after another that is supposed to
work wonders in curing addicts. One after another, these discoveries
are eventually tossed in the refuse can of chemical history.
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Psychiatrists and physicians faithfully take the bait offered by the
pharmaceutical companies and faithfully prescribe the amazing new
medical discovery only to find their hopes dashed once again. What
alternative do they have? A recent research discovery may shed light
on why the medical approach has such daunting odds against it. This
new finding has determined that psychological stimuli can trigger the
same chemical chain reaction that going without the drug for a period
does.
      Let us more deeply examine why treatments fail. In the case of
substance abuse in its many forms, in contrast to most purely
psychological disorders, looking into its etiology may be helpful.
Etiology of each individual case, however, is not what is important.
Instead, we need to examine etiology in the abstract. We have already
briefly reviewed the treatment and control programs such as the
pharmaceutical, psychiatric, and judicial and penal factors. Now, we
need to turn our attention to differentiating etiological factors that are
obvious and have received nearly all of the attention such as the
genetic; physiological; psychological; education; social and familial;
gender related; ethnic; occupational; socio-economic; demographic;
legal or laws related to substance use; history and tradition; and
societal factors from certain other structural factors that have been
left out of the search for causes and treatments. Ubiquitous
structural factors such as media, marketing, sales, politics,
predominant forms of recreation, language conventions, widely held
belief systems about addiction in the culture, and even the role of
religion have an unaddressed influence on inducing and maintaining
the various addictions. These factors can be seen as structured in
levels each having a shaping influence on the level below them but
also as forming components of systems that work together to
perpetuate alcohol, illegal narcotic, and medically prescribed narcotic
addictions. It is not that
      Research in genetics has come up with several interesting
findings. It has been found that certain persons are born with a gene
that allows them to drink more with less intoxicating effects than
others, metabolize alcohol better, and be free from hangovers. This
would of course make such persons vulnerable to becoming
alcoholics. Oriental people tend to be highly allergic to alcohol while
Native Indians are highly susceptible to alcoholism. Cultural aspects
of ethnic groups probably part a big part with respect to the
individual‟s propensities. Once they begin to drink at parties or with
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friends and find that they have few side effects, drinking should be
more to continue. When partying has this effect, consumption should
even increase. Not having knowledge of the negative effects that
alcohol can have on their health, there is little else to prevent them
from drinking for the rest of their lives. Unfortunately, medical
science has shown that alcohol does damage to the brain, liver, and
the kidneys, and due to its tendency to reduce eating healthy food,
vitamin depletion occurs and they become vulnerable to disease and
aging. Many of these harmful effects are irreversible. It is also well
know now that as health degenerates, a person must drink even more
in order to get drunk. This is a particularly nasty vicious cycle.
      When a person drinks, the immediate physiological effects on
the brain are behavioral. Becoming drunk decommissions the higher
intellectual functions and removes inhibitions so that a person can
say and do things that would otherwise be suppressed as socially
unacceptable and even offensive. They may be acting in a way that
they think is funny while others see it as silly and boorish. They can
become melancholy, vulgar, hostile, grandiose, sexually aggressive,
intrusive and even intruding on complete strangers or strangely
enough do so with police, or become withdrawn, and all taken to such
extremes that they make others very uncomfortable and repulsed.
Often they will vomit in front of everyone and even on people. They
can also begin to lose their equilibrium and timing so that they
stumble and fall, fall on others, break things, blurred vision along with
loss of control of their body can cause them to drive dangerously,
lose their way home, or fall asleep is strange places. Many who get
this intoxicated will a poor or no memory of all of the things they did.
Because of all of this, they may wind up retaining as friends only
those who have the same drinking habits as they.
      The drug addict tends to run a course similar to that of the
alcoholic but the pattern will vary somewhat depending on the class
of narcotic they use. Addicts and alcoholics usually eventually learn
to be deceptive with disapproving friends, spouses, family,
employers, therapists, some members of their support group, and
with other close associates. These are people who are typically,
uncomfortable, tense, anxious, or miserable. Nevertheless, they want
approval and acceptance. What they find, however, is just the
reverse. While people may be superficially friendly, there is a lack of
genuine closeness and the spontaneity, authenticity, and
transparency common to close friends. This increases the feeling of
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loneliness in substance abusers. It also produces suppressed
resentment that may show itself through sarcasm or may not come
out until they are high or drunk.
      Certain types of speed can rot teeth, damage the heart, kill brain
cells, and when taken long enough will result in dangerous paranoia.
Speed users often find that they cannot concentrate or are dull
without their drug but when they are on it, they are unbearably
hyperactive and though attentive tend to talk too much, to make
miscues, or make rash and impulsive decisions. Yet they feel they
cannot perform without the drug. Psychological
      Education about drugs and alcohol is typically inappropriate to
the learner. The lessons may be attended to but they do not have any
effect as far as changing behavior is concerned.
      Social peer pressure to do it, developmentally vulnerable teens,
and family rejection or enabling or longsuffering and then ousting;
roles in families and implicit parents have a contributing role.
      Gender related –men may have different precipitating factors.
      Ethnic aside from genetic predisposition, ethnic groups
combined with other factors may increase the probability of
substance abuse
      Occupational status, security, and the kind of occupation for
example traveling salesmen, corporate representatives, public
relations, professional sports and entertainers,
      Socio-Economic
      Demographic
      Legal or laws related to substance use
      History and tradition
      Societal


      Learning the role of learning theory.
      The pull of the structure of a person‟s life topology.
      Counterintuitive things to avoid; addicts as friends. Involvement
of family. Ignoring identifiable places and times of vulnerability. Lack
of opportunity for habituation to alternatives.
      What is needed:
      Long term inst. And well struc long enough to overcome
separation pain. New implicit others. Each process of intentionality.
New secondary peers and roles. Natural Systems prog. No return to
home and friends and job. Establishing a completely new life
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topology.

   e. Disorders of mood that are „supposedly‟ caused by brain
      chemistry imbalance:
      Aside from psychosis, there are a number of other disorders
that are viewed by many professionals as apparently unrelated to
what is going on outside the person, that is to say they are unrelated
to environmental or life conditions and situations or any of the levels
of external structures and systems. These mood conditions do not
seem to be directed toward anyone or blamed on anyone. They are
nevertheless disliked by or frustrating to others. Of course, these
conditions are unpleasant to persons having them. These people
often do, however, express disaffection with life conditions, others, or
the requirements or demands of others. They do not know the „why‟.
They cannot point to anything specific outside of themselves as „the‟
cause. Therefore, it must be them, something wrong with them. A
few of these are examined below.
ADHD, Attention Deficit Hyperactivity Disorder, has become famous,
or rather notorious, in last forty years. Irritability, tension,
restlessness,
      Depression
      Mood Swings
      Despair (sense of meaninglessness)
      Boredom
      Numbness or automaton like behavior

   f. Emotional distress:

Phobias – fears accompanying a sense of suspicious of dangerous
intentions of others
Chronic Anxiety
Panic
Other than the mood swings from depression to elation, there are
some intense emotions that are examined below that are less
prominent but equally disturbing to the people having them. To them,
the locus or cause of the emotion is typically inside of them and
others heartily agree. Moreover, the way they show themselves in
observable behavior is usually disturbing to others, especially those
who try to help. Still, both others and they themselves tend to treat
the problem as though it is independent of or unrelated to relations
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with the outside world. This is true even though they may point to
some present, or possibly becoming present, external stimulus as the
cause for these unpleasant feelings. Outsiders would say they are
reacting to something unreal or extremely improbable and try to
convince the sufferer of the irrationality of their feeling. The
professional sees the symptom and the sufferer feels the unpleasant
feelings, yet neither sees nor understands the powerful causal forces
in structures and systems. Likewise, neither sees the powerful forces
of some internal structure or intentional process. Especially, neither
sees how whatever is in the external structures and systems are
integrally related to whatever internal structure or processes may be
involved as the combination erupts into what they can see and sense.
They both choose the option of dealing with the immediate. The
sufferer just wants to be rid of awful feelings and the professional just
wants to change something in the person, something in their
personality or in their brain chemistry. The ultimate unseen cause is
left unaddressed. A sufferer may try to talk it out and be encouraged
to search for causes in past experiences. They can usually identify
some such experience but this serves to mislead both professional
and client. This is point where the entire field of psychologically and
medically oriented mental health professionals gets stuck and never
takes the leap to explore the non-immediate but truly causal unseen
structural factors in integral dynamic combination with unseen
internal structures and processes. The old saying, “You can‟t get
there from here.” certainly applies to this situation. For instance, with
respect inner processes, neither the client nor professional will ever
identify the role of negative implicit others, as a part of intentional
processes, that are immediately determining the symptoms and
enduringly perpetuating their negative influence regardless of
devoted efforts within the current treatment paradigm. They cannot
get there from here (the current paradigm). Unfortunately, the
contemporary culture or zeitgeist and treatment paradigm are of a
piece, woven together in the same tapestry. For example the
prominence in our culture of a belief in competition, status, the
struggle for upward mobility, and the acquisition the approved
material indicators, from cars, to perfume, to seats in bleachers, to
grades, to invitations and so on, all fit neatly together with social
comparison and feelings of success, acceptance, and status or
rejection, failure, neglect, and exclusion. Built into our belief system
so that we do not see their pathological effects, their cause of painful
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symptoms or sociopathic discrimination and exploitation, they are
like the air we breathe, a reality we do not question as possible
candidates as monstrous, ubiquitous causal agents. We say „ain‟t it
awful‟ when a politician becomes corrupt but we do not understand
that they live within a vicious adversarial systems where the need to
win overrides all other values. The means, however sinister, „have to‟
be justified by the end, everybody does it or else they lose. You have
to have the in „jeans‟. You „have to‟ get the latest face lift. You „have
to‟ be whistled at and at the same time pretend you are annoyed. You
have to dive off the diving board even if you are terrified, or be
ridiculed. But the terror comes from having to be a reckless risk taker
without proper preparation. You see, these themes run through our
entire culture and are the ultimate causal agents, wrenching our guts
and driving us nuts, while we attempt in vain to deal with the
immediate symptom or problem. It is the art of depicting their
corruption as heroic and virtuous that must be mastered. You either
master this art or you lose, you are „out‟. One outcome is that
Americans put mountainous pressure on their children to succeed at
any cost and look like choirboys at the same time. These mostly
caring parents do not understand what they are doing and especially
do not understand why. Great profits can be made from those who
can be made to play this game. This is a part of the system that is
also a powerful inducement to perpetuate the system. Ironically, both
adults and their children are victims of the system. Nevertheless, the
unquestioned system gets away with blaming the victim.




   g. Psychologically related health problems:
Psychogenic health problems such as sleep disorders, ulcers,
headaches = physical health problems whose etiology cannot be
traced to viruses, bacteria, cancer, material trauma or poison, aging,
or genetic defect.


  h. Behavior or communication that is unacceptable, inappropriate,
     or ineffective:
Unsocialized behavior


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Impulsivity


    i. Relationship dysfunctions:
Shyness
Manipulative behavior
Oppositional Defiant
These problems cannot be attributed to a serious psychiatric
diagnosis or physical illness. Problems that relate to deficient or
erroneous life lessons, lack of knowledge of how successfully to
engage in relationships, imitating poor models, having been poorly
life coached or educated to manners or social obligations. These
patterns stand out as especially underdeveloped and inappropriate
social or interpersonal skills.


   3. Tables 1 and 2 below compare traditional individual therapy
      modalities as treatments for emotional and behavioral disorders
      There are certain kinds of emotional and behavioral disorders
that occur with greater frequency in the general population. These
disorders are listed in Tables 1 and 2 below. The discussion about
the contribution of major level-specific modalities to Natural Systems
did not go into their efficacy with these specific disorders. Seven
emotional disorders and nine behavioral disorders are covered. Both
behavioral and emotional disorders are a function of the levels of
external structures. Any or all of the levels of internal structures can
be involved to some degree in any of these disorders. I have
described the problems with all of these modalities. However, I did
not specify whether there were types of disorders with which they
might be effective. It seems in order now to examine this question
and make comparisons of their relative effectiveness with these two
sets of disorders.
                                 TABLE 1
      Which of the individual treatment modalities in the left column
below will eliminate or ameliorate the EMOTIONAL DISORDERS in the
top row? Insert a 1 in the row across from a modality if it is very likely
to be successful; 2 for modest of brief success; 3 very unlikely to be
successful. Enter 1 for likely Success; 2 for Minimal; and 3 for
unlikely Success; 4 for likely Worsening.


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                                    Disorders




                                                                            Posttrauma
                                                     Depression




                                                                            tic stress
                                           Shyness
                                 Phobias




                                                                  Chronic
                                                                  Anxiety


                                                                            Swings
                                                                            Mood
                                                                  Rage
               Modality:
               Family            3         2          2           3   2     2    3
               systems
               Psychotropic      3         2          4           2   4     2    4
               medications
               Behavior          2         3          3           3   2     4    4
               modification
               Cognitive         3         2          3           3   2     3    3
               restructuring
               Reality           4         4          4           4   2     3    4
               therapy
               Guidance          4         4          4           4   4     4    4
               counseling
               Client-           2         2          2           3   2     3    3
               Centered
               Gestalt           3         2          3           3   2     3    2
               therapy
               Psycho-           3         2          3           3   3     3    4
               analysis



                                TABLE 2
      Which of the individual treatment modalities in the left column
below will eliminate or ameliorate the BEHAVIOR DISORDERS in the
top row? Insert a 1 in the row across from a modality if it is very likely
to be successful; 2 for modest of brief success; 3 very unlikely to be
successful. Enter 1 for likely Success; 2 for Minimal; and 3 for
unlikely Success; 4 for likely Worsening




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       Modality:




                             Manipulativ
                             Unsocialize




                             Aggression
                             Narcissism
                             Achieveme
                             Opposition


                             aggressive


                             Impulsiven




                             immaturity
                             Anti-social




                             Centricity
                             al Defiant




                             Sexual
                             Under
                      ADHD




                             Ego
                             ess
                             nt




                             d



                             e
    Family
    systems
    Psychotropic
    medications
    Behavior
    modification
    Cognitive
    restructuring
    Reality
    therapy
    Guidance
    counseling
    Client-
    Centered
    Gestalt
    therapy
    Psycho-
    analysis

            a. Life Topology considerations for clients in individual
               treatment

            b. Special Focus Support Groups for clients during and
               after individual treatment


   4. Tables 3 and 4 below compare models of institutional correction
      and treatment programs for emotional and behavioral disorders

                                TABLE 3.
      For the Institutional Programs in the left column, which will be
effective with these EMOTIONAL DISORDERS? Insert a 1 in the ROW

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across from a program if it is very likely to be successful; 2 for
modest or brief success; 3 very unlikely to be successful. Enter 1 for
likely Success; 2 for Minimal; and 3 for unlikely Success; 4 for likely
Worsening
             Institutional




                                                     Depression
             Correctional-




                                                                            traumatic
             treatment




                                           Shyness
                                 Phobias




                                                                  Chronic
                                                                  Anxiety



                                                                            Swings
             programs:




                                                                            stress
                                                                            Mood

                                                                            Post-
                                                                  Rage
        1.     Traditional -
                Punitive
        2.     Boot Camp
        3.     Token
                Economy
        4.     Point System
        5.     Positive Peer
               Group
        6.     Wilderness
        7.     Treatment
                Community
        8.     Stars and
                Stripes




                                TABLE 4.
For the institutional programs in the left column below, indicate which
  will eliminate or ameliorate the BEHAVIOR DISORDERS in the top
  row? Enter 1 for likely Success; 2 for Minimal; and 3 for unlikely
                    Success; 4 for likely Worsening

                                     BEHAVIOR DISORDERS




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        Institutional




                                                 Impulsiveness




                                                                                Ego Centricity
                                 Achievement



                                 Unsocialized
                                 Oppositional




                                                                 Manipulative
        Correctional-




                                 Aggressive




                                                                                Narcissism


                                                                                aggression
                                                                                Immaturity
                                 Anti-social
        treatment
        programs:




                                 Defiant




                                                                                Sexual
                                 Under
                          ADHD
        Traditional-
        Punitive
        Boot Camp
        Token
        Economy
        Point
        System
        Positive
        Peer Group
        Wilderness
        Treatment
        Community
        Stars and
        Stripes

            a. Topology considerations for clients post
               institutionalization


      b. Special Focus Layman Support Groups
           Alcohol Anonymous
           Narcotics
           Suicide
           Sex Addiction



     IV.    Examining the top pyramid‟s levels of external
            structures and systems
     The top, inverted, pyramid is concerned with how external structures
shape personality. Each of the levels of the bottom pyramid can be influenced,
to varying degrees, by levels of the top pyramid, selectively and either

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 negatively or therapeutically. Ascending by level of structure from the bottom
 of the top pyramid up, the influence on personality, of each successive level is
 decreasingly observable. Beginning with the topmost level, we have what I call
 encompassing environments. You may choose your perspective, depending on
 what you wish to analyze. For instance, you may want to analyze how the
 American culture as a whole shapes the character and personality of American
 individuals, relationships, or families. You could begin with the nation as a
 whole and then designate your next lower level structure to be a community or
 organization. You could analyze how being a member of an ethnic group
 influences personality tendencies, how these influenced tendencies vary with
 the group, or which aspects of the personality are influences in what ways. For
 example, how identity is generally influenced or how does skin color result in
 mistakenly attributing ethnic stereotypes. On the other hand, you may want to
 analyze how a corporation, social organization, institution, community, and so
 on, influences personality. What aspects of these encompassing structures
 influence certain tendencies of its members? You may start with an
 arrangement of one set of categories occupying the successive levels and later
 change categories to get a different perspective. This is merely an analytical
 device to assist in gaining the most productive perspective.
       Off and on, I have been interested in how the media affects life styles,
interests, values, etc., or how socio-economic status influences language, or how
technology has influenced gender behavior and relations. I have also tried to
track how the influence of these global structures has changed through periods
of history. The value of using this model is that, once you choose a category for
a level, you can then select each the categories for each successive level of
structure and then analyze their mutual influences. One of my main concerns has
been how the structures of correctional and mental institutions influence the
personalities, behavior, and especially the intentional processes, of their wards.
       I have been observing, studying, and experimenting with the structural side
of this Duplex Model equation in institutions for almost fifty years. After all these
years, my question is this. What are the differential effects of approaching
institutions from the perspective of external structures in relation to intentional
processes versus external structures in relation to internal structures? One
perspective involves grasping the nature of the institution and the way it is
organized and how that affects the client population. I began to examine the
structures and systems in the institution. I noticed that changing structures
changed the way staff acted but also changed the way the client population
behaved. How did these changes in structure shape the behavior of employees
and the client population?
       The structure of the institution is mediated through the staff. However,
positive results came from such unexpected aspects of the structure as simply
rearranging where the offices of staff were located. Residents had anxieties over
uncertainty about visitations, release dates, being granted privileges, whether
they could see the nurse, and the like. With continuous access to their
caseworkers, these anxieties disappeared, pestering the caseworkers for
information ended, and the build up mutual hostility ended. Engaging all staff in

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participatory management with the top management had similar effects with
respect to uncertainty, anxiety, paranoia, and mutual hostility. Each level of
structure within the institution have many such aspects than can be redesigned
to have positive rather than negative effects on the dyadic interaction between
staff and staff, staff and residents, and between residents. When these structural
aspects changed and dyadic interaction changed, then communication and
behavioral acting out problems receded. The way they reasoned about their
situations, planned for and anticipated their future, and explained or resolved
conflicts became more rational. There was far less projection of evil intentions
and blaming. Their feelings mellowed and became more positive. Staff and
management perceived each other more positively as was true for residents and
staff perceptions of each other and residents‟ perceptions of each other. If the
reader will recall some passages at the beginning of this text, psychiatrists
stopped giving residents psychotropic medications because they assumed their
brain chemistry had become balanced. So, you see, each level of structure of the
bottom pyramid was affected when factors in the levels of structure in the top
pyramid were redesigned.
       Another vital perspective involves how to redesign the structure of the
institution so that it has positive effects on the intentional processes of the staff
and residents. This topic will be addressed in sections C., D., and E below.


A. Descending Levels of External Structures and Systems in
Institutions

      1. GLOBAL, ENCOMPASSING STRUCTURES
        Understand Influences of, gain different perspectives on,
            master, and their temporal aspects
        Police and the loss of community living skills
        Law and justice
        Rapid turnover neighborhoods and depersonalized relations
            and litigiousness
        Technology and home items
        Mass education with unit progress and competition, winners
            and losers, and identity and self-concept
        Institutions for the casualties of modernity
        Corporations and special interest social organizations as the
            new community; non-personal internet communities
        Housing developments, urban segregation, and blaming the
            victim
        Corporations, capitalism, corporate law,
        Media and marketing; marketing and money purveyors versus
            home economy

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       Media and the behavior of governing bodies – co-opting the
          spotlight; disaster addiction; sound bytes and
          unaccountability
       The church versus the media: Who is the authority now?
       Sports, competition, violence, and communication of values
       Im-personalization of warfare
       Heroes, models, celebrities, and media idols
       Computers and impersonal-personal communication
       Chemical products and home items, kitchens, hygiene and
          cosmetics and fashion, chemistry and sex
       Music and movies
       News and conversation topics
       Geographical mobility, demography is destiny
       Transportation mobility
       Food franchises and diet
       Weltanschauungen in relation to Zeitgeist


      2. INSTITUTIONS, AND THEIR STRUCTURE AND SYSTEMS


    3. SETTINGS IN THE ORGANIZATION OR INSTITUTION,
INFORMAL GROUPS IN THE INSTITUTION


     4. SITUATIONS IN SETTING IN THE ORGANIZATION,
INSTITUTION, FAMILY, AND PEER GROUPS

Problems developing new situation-specific behavioral templates and
practicing


      5. Formal ROLES IN SETTINGS

Problems learning to alter roles and identities and the inner
restrictions they impose SECTION X

    B. Descending Levels of External Structures and Systems in the
Open Society
     Life Topology: Where Did You Go Today?

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      Minds are accustomed to reverting to their current, accumulated
repertoire as their life typology seldom encounters situations so
novel that they cannot be assimilated to their reliable, left brain
oriented, stock of schemata and schemes. Temporary, minor
adjustments, if they have to be made, are categorized as exceptions
not likely to be encountered again. They are shelved as not essential
for retention and the principle of disuse means that they soon will be
forgotten. Life typologies are shaped and trimmed for the familiar,
reliable, efficient, minimally demanding, and routine and as such
rarely require the invocation of the novelty handling, new learning
oriented right brain. The mind prefers the familiar world and second
nature responses of a stagnant life typology. Disruptive, demanding,
and uncertain new-learning types of situations and tasks are
inherently aversive and ulikely to be voluntarily sought out,
       Old haunts, well-trodden trails, and well-established boundaries
          do not require being „mentally seen‟. Familiar yet unexplored
          locations of your community cease being „mentally seen‟;
          they rely on an automaton mentality. Intentional mentality is
          decommissioned.
       Routes and Roles about Town
       FORMAL CIVIC AND SOCIAL ORGANIZATIONS AND INFORMAL
          GROUPS IN THE OPEN SOCIETY
       Systems, Settings, and Situations in Schools
       Communities and their organization
       Neighborhoods and their parameters: Open; Personal;
          Organized; Rewarding; and Productive
          Police and Courts
       State and County human and health services
       Business, corporations, and business organizations
       Labor organizations
       Social organizations
       Churches
       Sports and recreational organizations
       Public Entertainment
       Home Entertainment
       Communications: public and private
       Public Schools in the Open Society
       School Extracurricular activities
       Homes, Family and Extended Family


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      1.   Illustrations, using the concepts of Settings and Situations,
of the psychology of the effects of External Structures on Internal
Structures and Processes in the Open Society

      There is, of course, an exchange involved in dyadic interaction,
our fulcrum concept. However, each party to a dyad is a recipient of
input from the external levels of structures. Everyone in a population
is theoretically a potential party to a dyad. At the lower levels of
external structures, their differential impact on each member of a
dyad potentially can be observed. Typically, the members („A‟ and
„B‟) of a dyad are focused on each other but in their subconscious
minds, the nature of the potential influences of their different external
structures is taken into account by each. Let us take an example of a
dyad engaged in a debate in a church with some church members
present. Let us say that A is a member of the church and B is a
member of a very different kind of church or religion. What transpires
in the debate will be influenced by their different external structures.
If they were in another, neutral, location, the content and style of
debate of both A and B the might be very different.
      Consider another example of the influence of structure over
dyadic interaction. A husband (Bill) and wife (Sue) go to be with their
respective extended families during a holiday. They arrive at Sue‟s
family first. After settling in and seated all together in the living room,
family members ask Sue and Bill how things have been going for
them. Naturally, Sue speaks of first and recites a list, diplomatically
but with insinuations that could be better if Bill would have done so
and so and if he had not done such and such. Bill makes a few
grumbles and sheepishly tries to take for himself but that does not go
so well. While meekly trying to defend himself, Sue‟s younger
brother, a swaggering, mans-man and ex athlete enters and listens for
a moment and then aggressively starts to run interference for Bill.
Sue politely suggests that they must move on, as they are due to be
at the home of Bill‟s family. They and the whole family settle in and
are seated in the living room and family members ask Bill and Sue
how things have been going for them. Naturally, Bill speaks up and
seizes the opportunity to get back at Sue for her performance at her
family‟s home. Bill proceeds to ask the women seemingly innocuous
questions about how they would do a number of things that the
women usually handle. Sensing the opportunity to both show off and
put Sue down, they give copious advice that is quite different what
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they know about the way Sue has been doing things. Sue cowers
under the onslaught and glares at Bill out of the corner of her eyes.
During the subtle savagery, Bill‟s older sister, a confirmed feminist,
comes and catching the drift of the conversation launches a tirade
against Bill for his male chauvinism. Sue gloats. When Bill suggests
that it is time to go, Sue perks up and states that she is enjoying Bill‟s
family and feels would be rude to leave so soon. What we can learn
from this vignette seems obvious. Conversational style shifts
dramatically as the composition of the group shifts back and forth in
being weighted in favor of Sue and Bill. Entry of allies causes sudden
changes in conversational style.
       Extended families and their homes are Settings with Formal
Roles of traditional positions in the family such as parent,
grandparent, sibling, and so on. These Settings and Formal Roles
make it possible for informal family roles to be shaped and family
systems to arise. When in an informal role, the person knows what
others expect of them and what they can, in this case, get away with.
New additions such as a husband or wife are typically at the mercy of
a family when their informal role in the family system initially being
carved out. This power of these alliances and the vulnerability of the
newcomer can lead to either spouse exploiting it to get revenge or
increase leverage and bargaining power in their relationship. It only
takes minimal interpersonal skills for people to grasp the nature of
situations that eventuate and quickly invoke their ploys.
       I use the word „structure‟ rather religion in the first example to
emphasize the abstractness of the Natural Systems approach. One
can substitute many things under the abstract concept of structure.
The influencing factor could be religion, politics, race, rank,
neighborhood, academic subject or class, winner or loser in a
contest, and so on. Typically, people in a dyad are in a „place‟. The
place could be in a supermarket, church, stadium, factory, street, and
so on. The abstract word I use for place is „Setting‟. A Setting is
where the dyad interaction is transpiring. Of course, the setting could
be in two different places as for example when using a cell phone or
video conferencing. Settings have constituent parts or aspects. For
example, a classroom setting could be on the lawn of a campus or in
a room in a building with a chalkboard, desks, chairs, windows,
teacher(s), student(s), video or audio equipment, computers, and so
on. The constituents of a Setting are also a part of the external
structure and will have an influence over the dyadic interaction. The
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purpose for being in the Setting is a constituent. Many things are
possible constituents.
      Within a stable Setting and constituents, one would expect
Situations would arise that will shift the topic and nature of the dyadic
interaction. Situations are highly transitory and variable. Situation,
therefore, is another abstract structural concept under which there
can be an almost infinite number of types of situations. However, a
relatively stable Setting will usually be host to only a few types of
situations. Most of the other possible situations in the universe of
possibilities would never arise in a given, stable Setting. If the street
were the Setting under consideration, the range of possibilities can
expand vastly. Depending on the type of neighborhood, for instance,
the range of situations could expand or contract. For most of us, this
is just common sense.
      Consider two types of dyads, a therapist and client and a
romantic pair, and a solitary person, a monad, who is at home, in bed,
and about to go to sleep. What do these have in common? These are
all contexts in which people will confide their secret longings or fears.
Their private person will surface. If the therapist is very empathetic
and nonjudgmental, most clients eventually will confide things that
they have kept hidden from everyone. As for the romantic pair, on
some enchanted evening, they see each other across a crowded
room, as the song goes, and have an immediate attraction. They
make contact. They try to impress each other and find common
interests to share. They begin to meet for dates. They touch and feel
an excitement and electricity. Eventually they may wind up in bed
and having sex. They tell each other how wonderful the sex was and
how comfortable they feel with each other. Both are maximally
accepting of everything said and done by each other. What do they
have in common with the therapist-client dyad? They begin to reveal
their secret longings and fears; they may even recount details of their
sexual histories, and the things they say to each other, as with a
therapist, they would never say to anyone else.
      Now consider the monad about to go to sleep. At this point, as
they are sinking into a sleepy reverie and the hubbub of the world is
passing away, this same private self with its secret longings and fears
begins to surface and drift dreamlike and sometimes fitfully through
their head just before falling to sleep.
      Here we have three different Settings between which we
normally would see no connection. Using this method of abstract
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analysis, we can ferret out the common factor, which is the fading
away of the pressures of their world along with a waning of fear of
being judged. In the two cases of dyads, even though another person
is present, it is as though nothing exists but the two of them, the
world has been shut out. Similarly, in the case of the monad, this
special kind of Setting permits the same kind of neutral, world
dissolving, situation in which private, authentic issues and concerns
can resurface from their subconscious.
      If the monad were an incarcerated person after lights out, and a
warm and empathetic staff comes and quietly sits by their side on
their bunk bed to comfort them, oftentimes these same kinds of
issues concealed in their private self will begin to surface just as with
the client, lovers, or safe at home in one‟s own bed.
      It is possible to create these conditions and this kind of situation
in other types of Settings. This is one of the hallmarks of effective
therapy, regardless of modality. Remarkably, these conditions were
created in the juvenile institution cited above. The question remains
as to whether these conditions can be created with a Natural Systems
therapy group in the „Open Society‟ and without resorting to one of
the traditional treatment modalities or combining some of them in a
contrived eclectic approach. This is one of the essential challenges
for the new Natural Systems group approach. This issue will be
addressed in full when the description of the Natural Systems group
approach begins below.
      It is important to note that, while the quality of acceptance is a
major key to success in any type of traditional modality, it alone is not
sufficient to meet the goals stated in the Thesis at the beginning of
this document.
      Group therapy and psycho-educational groups do not create
these special therapeutic conditions. These conditions are most
likely to be created when using modalities that address emotions and
feelings, perception, and life history, in other words the lower levels
of the bottom pyramid. Psychiatry is an exception here because it
addresses brain chemistry. Few psychiatrists address emotions and
feelings, perception, and life history. Psychodrama, while addressing
depth factors, revolves around the therapist providing scripts and
metaphorical behaviors to induce clients to act out the deeper aspect
of family relationships and past traumas. This method, however,
does not create the conditions that allow clients to have that sense
that the world has faded, it is only the two of them, therapist and
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client, with the therapist offering empathy and a non-judgmental
attitude along with the uninterrupted personal space and undistracted
time within which the secret, private self can resurface.
      Ironically, the therapeutic approach that resulted in the greatest
increases in maturity and ego mastery skills and the most enduring
change was the Natural Systems institutional program. Yet it did not
create these special therapeutic conditions. It did provide conditions
that were close to being non-judgmental. It definitely did not involve
a therapist being in control of the interaction in order to intervene,
induce abreaction or resurfacing of past traumas, and overcome
clients‟ defenses against revealing their private, secret selves, as is
the case with some Group therapies and Psychodrama. On the other
hand, it did attempt to provide and accepting atmosphere and
empathic relationships with at least two staff as non-judgmental
parent surrogates and all staff being non-invasive coaches especially
with respect to interpersonal relations and maturity. This approach is
uniquely suited to work with adolescents since they are typically
resistant to counseling, direct guidance, and exploration of their life
history and past psychological traumas. Adolescents, in contrast to
adults, are urgently focused on dealing with immediate interpersonal
conflicts and are future oriented in the sense of learning how to
become adults. They are readily open to non-judgmental coaching
and copying or emulating mature, respect models. All of their internal
levels of structure and intentional processes are constantly in a flux
of experimentation in order to find ways to survive in interpersonal
situations, avoid ridicule, and demonstrate the superior coping or ego
mastery skills of adults, which they tend to refer to as being „cool‟. It
is this nature of adolescence makes the Natural Systems institutional
program so successful.
      Once again, it is sophistication in understanding the role of
structure, as in the Duplex Pyramid model along with its processes of
intentionality and their integrating role, which provides the most
effective tools for designing a successful therapeutic model,
especially in the case of adolescents. Moreover, once again, the
major challenge for Natural Systems group therapy is how to adapt
these concepts and tools to the task of therapeutic work with adults.

2. An example of a high level organization that has the broad
authority to alter the way the entire field of mental health treatment


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transforms the work of all mental health professionals with their
clients, regardless of their chosen treatment modality.
      Managed Care is an example of the highest level of
encompassing structure within the realm of a specific type of
occupation and institution.



V. How the Intentional Model is related to and integrates both
pyramids of the Duplex Pyramid model and its temporal
dimension

       Finally, while clients in or out of an institution can be trained for behavior
change through behavior modification, role-playing, psychodrama, and the like,
the problems described above still remain. However, and more to the point, the
situations or stimuli that clients face in the rapidly and forever changing everyday
open society are so vast and variegated that no psychotherapy client could
maintain a battery of ready-to-use, situation-specific, behavioral templates, or
repertoire, to select from. Expecting clients, in the flux of daily life, to review and
choose which would be the better or more effective behavioral strategies is
unrealistic. Even more daunting is the challenge of reviewing and selecting the
more mature inner, intentional, processes to invoke prior to enacting the related
behavioral patterns. That expectation borders on absurdity. It takes reserving
time and calmness in order to step back and choose and revise inner processes
and then to act on this choice with the most wise and appropriate behavioral
strategy. The demands of the day do not permit the luxury to go through entire
arrays of complex processes and then apply them appropriately, Johnny-on-the-
spot. Overwhelmed, as most people surely must be, if they were to try to do this,
they are bound to surrender and simply react instinctually, unconsciously, and
with minimal variations from their ingrained inner processes and behavioral
habits.


     A. The following are simplified and followed by complete
descriptions of the intentional processes:

                    Perceiving the world (immediate experience)

                    Learning what is perceived which includes the quality
                    of accompanying sensations

                    Incorporating or dis-incorporating the sensation

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                  Seeing where, when, and how to act in relation to the
                  immediate experience

                  Forming expectations of what should happen
                  because of the action

                  Acting, guiding, and correcting the action

                  Storing the outcome, as an expansion of knowledge
                  of the world since we tend to expect a repetition of
                  similar situations

      These are all separate, sequential, intentional processes. They
are incrementally shaped and continuously transformed. They each
become more complex with additional experience and as one ages.
They are all relevant to the vast storehouse of psychological concepts
we eventually apply to our self and to others. They underlie all
psychological problems and all psychological attributes. Solely
dealing with psychological attributes and stated psychological
problems means that we are only dealing with the surface. The
underlying intentional processes remain essentially unchanged and
continue to determine behavior and quality of life. Changes are
temporary because behavior tends to be brought back into the status
quo of the behavioral repertoire. This regression is because the
underlying intentional processes have not been addressed.
      The first intractable problem was dealing with longitudinal
behavioral patterns. The second intractable problem with traditional
psychotherapy, therefore, concerns dealing with these inner,
intentional processes. Can you imagine one of your clients just
sitting there while you try to lead them through an examination of all
of the hidden processes that go through their head when they
confront a salient situation? Can you image them enduring being
coached to change any or all of these inner processes? I think not.
Clients come to get things off their chest and resolve problems as
they surface, willy-nilly, in that hour. They expect to go away feeling
better and they expect to go away prepared for a new life free of such
problems. Those expectations are in marked contrast to the
hypothetical, labored therapeutic process I just described.


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      Often the problems or feelings they unloaded in the session may
seem to them to have been resolved. Nevertheless, we find that same
problem focus or issue may resurface periodically. Clients are often
driven by a need to unload the troubling thoughts and feelings of the
day, or sometimes those from the night before, or even their dreams.
They want someone to listen patiently, warmly, empathetically, and
especially non-judgmentally as they tell their story. Sometimes the
troublesome issue unfolds in bits or aspects. These may be
examined in one session and then other snippets may surface be
examined in later sessions until finally a precipitating causal event is
recalled, disclosed, and ventilated, often with intense emotion. This
latter stage is sometimes called catharsis. When they have arrived at
a resolving and satisfying insight or understanding of the event or
issue, they move on. There may even be additional discussion of how
to cope with such situations in the future. Therapists sometimes
contribute their thoughts on coping strategies. Nevertheless, it is
rare that the coping skills related to how to deal with the initiating
event or subsequent similar situations are practiced in the session. It
is even rarer for the client to practice enacting such coping skills
outside of therapy. When the situation subsequently arises outside of
the session, the same old behavioral patterns are the ones most likely
to be played out.
      Notice that when these emotional self-disclosures take place in
the interview, those rapidly cycling intentional processes referred to
above are not addressed. Now, here is the crux of the matter. This is
what I consider one of the most serious flaws in traditional
psychotherapy. The necessary coping skills require and entail a
restructuring of each of those intentional processes, the final stage of
which is behavior, or, as it is referred to in the model, Adventuring.
Each of the sequential intentional processes plays an integral part in
the complete act that culminates in observable behavior. Not only are
these elements or processes not addressed but the crucial stage of
practicing new behavioral patterns is generally not a part of the
therapy session. They are not included as a simulation in the
session. There is no rehearsal to prepare for a real life setting in the
home environment. At home, one tends to focus on the activity or
situation at hand and the recommendations from therapy just do not
come to mind. Even inside of a closed institution with a Natural
Systems program, it is very difficult to engage in „practicing‟ coping
skills in vitro for the troublesome situations. However, the features of
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this program are designed to elicit the optimal inner processes
repeatedly with recognition when successful. The structure of the
program makes it is possible to deal with the inner intentional
processes underlying behavioral acts or longitudinal patterns without
directly focusing on them. These intentional processes are going on
implicitly and continuously. They are exquisitely sensitive to the
social environment. With a correctly designed program, each
intentional process is being shaped to enhance maturity and increase
ego mastery skills for twenty-four hours of each of the seven days a
week.


      1. Below, there is the complete graphic model of intentionality
       This model was designed to reveal the steps or stages through which each
of the intentional processes cycle. They are cycling very rapidly and
continuously through the mind. As a person goes through developmental stages
over the years, these processes change from being very simple to being
extremely elaborate. They constantly interact with the external world. The
personality also becomes more complex. Each level of the internal structures
becomes more complex. These intentional processes are exquisitely sensitive to
the external world but they are also exquisitely sensitive to their internal world.
Part of their external world consists of other persons like themselves. Each
person becomes aware of the others as having a personality and of their
interacting with the world with similar components of the self. Each person has
an implicit psychology of what others are like. They infer that others are to
varying degrees reacting to and interacting with the world in ways similar to their
own. Each person subconsciously senses that others are also similarly,
exquisitely sensitive to their world yet each in their own unique way. Each
person learns to talk about the machinations and dynamics of people‟s inner
worlds. Most significantly, each person is integrating their reactions to levels of
their external world with the structures on their internal world. To give a simple
example, most people are aware of their being a government. They infer that the
government has some degree of awareness of what citizens or their constituents‟
lives are like. They suppose that government officials perceive the conditions in
their state, think about these conditions and what to do about them, have feelings
about what they see and preferences, values, or tastes related to their state, its
people, their activities, and their life conditions. Based on this information, they
envision plans to deal with conditions in their state, they act on some plans,
evaluate consequences, and revise plans, and so forth. In other words, people
are integrating their external world and internal world through the processes of
intentionality. This graph below illustrated how these intentional processes
operate to integrate the external and internal worlds.




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     a. INTENTIONALITY MODEL
The Duplex Pyramids‟ External and Internal Structures are implicitly represented
in memory as a part of the Intentionality Model.

                                           External
                                           Structures


                                           Internal
                                           Structures




b. Flow Chart of Intentional Processes that Integrate the Duplex Pyramids




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2. Defining and explaining the intentional processes and the way they
cycle through the mind.

Addressing how each of the processes of the Intentionality model
works to overcome these problems, facilitates maturation, and
increases ego mastery skills

                         INTENTIONALITY MODEL

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LABELS         PROCESS DEFINITIONS COMPONENTS ADDRESSED BY
PROGRAM

Levels of   External                 These exist prior to the person but when the
External    Environmental            persons enter any Setting they must quickly
Structur    Contexts                 accommodate to it. Different contexts and
es in the   Settings within them     settings affect people differently. Their
world       and the Setting‟s        internal structures and processes are
            constraints              affected or challenged. Learning how to
            Situations faced and     adapt or cope is life‟s great challenge.
            anticipated within       Adapting or coping can mean employing or
            the Setting. Each        learning the skill to change one or more
            instance of              levels of external structure or change one
            encounter with           or some internal structures of and in their
            these contexts will      self. People make these adaptations using
            eventually be            their intentional processes. Typically, some
            incorporated by          of their intentional processes have not
            persons as               optimally developed to master the
            representations.         adaptation or coping task of every context
            That is to say they      and setting, including all of the levels of
            will store them in       external structures they meet. The
            memory as a              intentional processes cycle quickly,
            dynamic, unified         continuously revising until a sufficient level
            Gestalt of the           of mastery has been reached. From the
            schemata of the          perspective outside the person, those who
            external context and     can must learn how to restructure the
            the schemes              salient aspects of the most relevant levels
            appropriate to it.       of the external structures. The
                                     restructuring person has the formidable
                                     task of initially understanding which
                                     aspects of the external structures must and
                                     will optimally address which internal
                                     structures. Second, they must understand
                                     how to optimally evoke and develop or
                                     reshape which ones of the other person‟s
                                     intentional processes. Based on this
                                     understanding, the restructuring person, or
                                     reformer, must plan, design, and then
                                     implement the restructuring plan. An


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                                optimal design will facilitate not just the
                                other‟s adaptation but the growth of the ego
                                mastery skills and maturity.
Percepti People always          One important ego mastery skill is learning
on,       perceive a Context    to differentiate between what one expected
Receptio and begin to receive to see or projected onto the setting and
n,        this perception in    what is the present reality. Gestalt therapy
and       their unique way      sees this as one of its major functions.
Retrieval and then retrieve     However, one does not have to use the
          their relevant stored Gestalt modality to facilitate a person‟s
          Gestalt of memories acquisition of this ego mastery skill. The
          of prior schemata     principal involved in this facilitation may
          and schemes that      merely be similar to that used in Gestalt
          occurred in that      therapy.
          context and setting.
Internal  People construct an
Represe Internal
n-tation  Representation of
of the    the Context and
External retrieve their
world by Schemata
Schemat concerning how this
a         context operates
          and which aspects
          of settings and
          social „Sets‟ are
          expected and which
          appropriate
          schemes of other
          people are expected
          to be enacted.
          Typically, what
          actually occurs is to
          varying degrees
          different from what
          was anticipated.




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          Person‟s typically
Accommodation
          first try to assimilate
Assimilation or

          the actual context to
          their Schemata and
          if not successful,
          they accommodate
          by altering their
          Schemata
          When person‟s have
related Behavioral




          settled on the
          Schemata for the
Schemata and




          Setting, they invoke
memories of




          memory patterns of
Storage of



Schemes




          the relevant
          behavioral Schemes
          they may enact as
          Situations arise
Levels of As the activities and
Assess- functions of the
ment of   Setting unfold,
the       person‟s begin to
perceive assess how this
d         instantiated Setting
external is consistent with its
world     larger
and the   encompassing
expected external
behavior environmental
          context; they
          assess how or
          whether this Setting
          is consistent with
          what they would
          expect for its type;
          they assess the
          various aspects of
          the Setting such as
          its time of
          occurrence, those

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            holding leadership
            roles and the
            appropriateness of
            their behavior.
            Concomitant with
            these assessments
            of the external
            factors, they also
            assess their
            sensations such as
            temperature,
            lighting, sounds,
            comfort of
            accommodations,
            how proximate and
            invasive or
            permissive are the
            others in the setting,
            the agenda or
            scheduled activities,
            the presence and
            nature of
            supervision or
            evaluation, the
            degree of freedom
            of access and
            departure, the
            presence or nature
            of consequences,
            the characteristics
            of those present and
            their estimate of
            how others feel
            about them and they
            feel about others,
            and finally they
            assess what all this
            implies about their
            personality, identity,

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          their comfort with
          assigned or
          possibly chosen
          roles and how these
          factors make them
          feel about
          themselves.
Individua As they are rapidly
-tion in  going through all of
accord    these complex-
with      multi-level
hedonic assessments, they
sense-    are registering the
tions     degree of
and       pleasantness
feeling   versus
reaction unpleasantness
s         they experience
          with each
The       Because of these               Psychoanalytic defense mechanisms
Hedonic combined                         should be contrasted with Incorporation
tone      assessments and                States. Incorporation states as different
associat their hedonic                   from psychoanalytic defense
ed with   quality, they nearly           mechanisms. Incorporation is dealing
external instantaneously                 with the outside conflicts and defense
stimuli   route aspects of the           mechanisms is dealing with inner
or        Setting and the                forbidden drives and conflicting
objects   situations that                tendencies.
directs   eventuate into
the       states that classify
objects   them as alien to
to be     them integral to
stored in them. In many
the       cases the assign
various   them to a tentative
states of state in which they
Incorpor reserve judgment
a-tion    for after more
and       familiarity. In many

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Disincor cases, they assign
p-oration them to a class that
          requires pretending
          likely or disliking or
          to pretending they
          are integral to their
          self or alien. The
          states to which
          aspects are
          assigned may be
          allowed to be
          obvious to others or
          their behavior may
          be designed to
          disguise their true
          relation to these
          aspects or true
          involvement with
          them. These
          assignments will
          become an essential
          part of how they
          intend to act in the
          immediate and for
          the duration of their
          presence in the
          Setting.
Envision Having made the
-ing what assignments
action to indicated above and
take      grasped the nature
begins.   of the Setting,
Envision persons will begin
-ing      to envision their
tends to immediate actions
include   but also couch
the       these intended
Environ- actions so as to be
mental    consistent with their

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Condi-       life outside of or
tions        beyond this Setting.
within       They quickly
which        envision whether
actions      how they act now
will take    will fit in with what
place        others in the next
and the      Setting of further
time         into the future will
con-         expect of them or
straints     what the
or           consequences will
possibili-   be for them at some
ties for     future date with
the          some significant
actions.     other or others.
Action       They quickly
strategie    estimate how they
s are        might successfully
consi-       rationalize any
dered.       inconsistent
Envision     behavior. They
-ing also    must work out a
takes        sketchy, tentative
perspec-     strategy of how they
tives on     will justify having
the          adopted seemingly
impact       inconsistent roles or
tentative    identities. All the
strategie    while, they have
s will       their omnipresent
have on      implicit parents or
Levels of    surrogate parents
External     lurking in their
Structur     preconscious or
es.          subconscious mind
Tentative    and judging their
intention    actions so that they
s to act     also have to try to

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are         avoid a sense of
subcon-     violation of
sciously    expectations or
monitore    betrayal to them of
d by        the kind of person
one‟s       these implicit
Implicit    parents want them
others.     to be. Summing up,
Envision    instant by instant
-ing        these processes are
must        rapidly cycling
involve a   through their minds
Time        and they are
Perspec-    typically making
tive        split or
            instantaneous
            decisions about
            how they will act
            now and they their
            goals for varying
            distances into the
            future will be.

Criteria
for
Fulfillme
nt
Foresha- Another important
dowing    aspect of this
          envisioning process
          is an interstice-
          process of
          imagining what the
          experience will be
          like once the act is
          completed or
          achieved.
          People often
          imagine based on

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            their current or past
            state of relation to
            the envisioned act
            or goal. If they have
            foreshowed a
            paradise of
            fulfillment and
            reality does not turn
            out that way, there
            can be a profound
            experience of „let-
            down‟. Depending
            on the nature of the
            foreshadowing and
            its basis in reality,
            the end experience
            can be an extreme
            sense of fulfillment
            or extreme
            disillusionment and
            despair.
Deciding
Goal
Setting
Adventur Instantly on the
-ing     heels of these
Timing   amazingly complex
Tempora  mental
l Experi-machinations, they
ence     have to act. Of
         course, on some
         occasions their
Emotion ambivalence will
al By-   result in inhibition
Products of any act or
         freezing. However,
         as they begin to act
         and as they are in
         the midst of action,

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            discords between
            the above factors
            may cause they
            body to become
            tense or to act
            awkwardly or
            hesitantly, this
            make cause their
            timing to be off.
            Those who have no
            such discord will
            act with smooth
            integration of their
            acts with the flow of
            acts of the others in
            the Setting. Their
            degree of accord
            and involvement
            versus discord and
            hesitancy or
            inhibition will affect
            their temporal
            experience. Time
            may seem to drag in
            one case and in
            another they will be
            oblivious to time.
            With the prospect of
            negative
            consequences when
            they are ambivalent
            and hesitant and not
            performing well, as
            the deadline or end
            approaches time
            may seem to be
            fleeting to fast but
            when in accord and
            performing well,

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             their obliviousness
             to time may also
             make it seem life
             like it is flying but
             on retrospect, the
             experience of being
             „in the zone‟ may
             make it seem like
             their enactment was
             an eternity. In these
             different modes of
             enactment, the
             accompanying
             emotions can be
             either extremely
             painful and negative
             or exhilarating and
             ecstatic. In the one
             case there is a
             desire to forever
             avoid a repeat of
             that situation and in
             the other there is a
             desire to do it over
             and over again.
Body                                 Body experience and its relation to
Experi-                              sexuality. The body has sexual sensations
ence.                                and feelings. External stimulation typically
Example                              evokes arousal of sexual sensations and
s:                                   feelings. These are powerfully pleasant. It
sexuality                            is the manner and circumstances that
;                                    initially shapes sexual behavior patterns.
in                                   The social structure initially guides it ><
action;                              ><><><><><By the time a person is acting
ineffectiv                           on sexual urges and/or arousing stimuli,
e action;                            they had previous had some form of sexual
failure;                             sensation or stimulation of varying degrees
success                              of pleasure or pain that occurred in a
                                     situation and setting in the context of

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                                     persons, significant or otherwise, with
                                     varying degrees of positive or negative
                                     beliefs that have been communicated and
                                     who were prone toward approval or
                                     disapproval with concomitant
                                     consequences. All of these conditions,
                                     taken together, results in assigning the
                                     sexual experience and acts to one of the
                                     inner states of incorporation. Therefore,
                                     each person‟s proclivity to engage in the
                                     range of possible presented sexual
                                     opportunities will be unique. They will
                                     conform to the cultural practices of which
                                     they have knowledge or they will secretly
                                     evade detection and give outlet to their
                                     unique proclivities. The degree of
                                     strictness or restraint, or their opposite, of
                                     present, impinging structure will determine
                                     their likelihood of engaging in forbidden or
                                     taboo practices. The implication of this
                                     complicated state of affairs is that each
                                     individual‟s sexual desires will be
                                     expressed in a manner that will have such a
                                     wide range that their sexual motivation
                                     cannot be assigned to any unified theory of
                                     sexual motivation. Some forms of sexual
                                     expression will seem normal to some
                                     people, bizarre to some, repugnant and
                                     perverted to some, pathological to some,
                                     and even criminal to some. There is no
                                     concept of a normal or natural form of
                                     sexual expression that applies universally.
                                     In conclusion, there can be no universal
                                     theory of sexual motivation and there be no
                                     universal form or forms of sexual
                                     expression. These aspects of the sexuality
                                     are relative to cultures, subcultures,
                                     communities, institutions, settings, and
                                     situatiolns. Each configuration of these

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                                     levels of external structures is not only
                                     unique but also exist as the mere accidental
                                     and arbitrary evolution and history of every
                                     culture‟s manner of sexual expression.
Disenga
g-ing,
Mirroring
,
Re-
Envision
-ing,
Altering
Criteria
for
Fulfillme
nt
Revising
Strategy,
Re-
engagin
g
Complet-
ing
success-
fully or
Failing
Exiting
the
Intention
al Cycle

Storing
aspects
of the
Cycle‟s
Experi-
ence
with

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Schemat
a and
Schemes
Repeatin
g the
cycle
Achievin
g
Mastery
and
Storing
Transce     Mastery and              Transcendence means more than moving to
nd-ing      progressive              a higher level of skill mastery. It entails a
levels of   transcendence with       more mature perspective, vision, ethical
mastery     respect of each of       man/world responsibility. Maturity involves
by          the ego mastery          an expansion of the arena of the mind. It
creating    skills involved in       means a higher level of development in
a more      levels of maturity       character. It means an increase in depth
effective   mean endurance of        and breadth of one‟s character. It means
intention   progress in the face     moving beyond acceptance and empathy to
al cycle    of the challenges to     care. It means moving beyond
entailing   be met in the Open       transparency to authenticity, and from
increase    Society.                 authenticity to oneness with humanity and
d                                    earth.
maturity
of all of
the
intention
al
processe
s and
Storing


      3. Restructuring the intentional processes of a client population
requires restructuring the levels of external structures so that they
target levels of internal structures while providing for a continual
longitudinal influence that elicit optimal maturity of each of the


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intentional processes.


       Examples.
       Since I am claiming that restructuring intentional processes is
crucial for therapy to be successful in an enduring and
comprehensive way, we must get a deeper understanding of them.
Let us back up and consider how these inner intentional processes
begin as the person‟s life begins. They develop slowly and they
develop in a way that is adapted to their life situation. As these
processes begin to evolve, they are incorporated without awareness
and usually with little or no competition from alternative versions of
them. Therefore, such things as one‟s view of their world, their home,
their caretakers, what they eat, how they are fed, and so on become
ingrained perceptions as their sole reality, almost like stereotypes,
and in fact, one could call them prejudices even those this term is
reserved for a special meaning. Life as it is lived in different
environments seems strange and is not incorporated, rather is
incorporated as „not my world‟. As a child grows and explores its
world, their view of it becomes more complex but always limited to
what is available. Knowledge of the world, what people expect, and
how to behave becomes ingrained but these are also accompanied
with experiences that involve feelings, some negative and some
positive. The child, or person, soon becomes aware of their
emotions, feelings, and sensations of pleasure and pain. As this
happens, they are instructed by their caretakers and peers about how
they are to relate to these experiences.
       Without knowing it, they are being taught not just how to relate
to feelings and sensations but whether to relate to them at all.
Informally, the people in their world are also teaching them what to
believe about what is good or bad, what one can or must do, and what
one cannot or must not do. This is a crucial stage of life. Things that
initially are pleasant may be described as unpleasant and to be
avoided. Things that initially are unpleasant or painful may be
described as necessary and pleasant. The taste of a food may initially
be repugnant but described as great, as something „everybody likes‟
and „everybody does‟. The world of real sensations and feelings are
being transformed with no, or at least fleeting, awareness. Later in
life, the person will insist that they really like something that is
unpleasant and really do not like something that is pleasant. This is
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an acculturation that everyone goes through and everyone forgets.
These distortions of initial experience, being unconscious, are not
brought up in the therapy session. They do not present themselves
as a problem to the person. These distortions have become reality,
unquestionable reality.
       I have been describing how a few of the inner intentional
processes are acquired and how they have become a non-conscious
part of the person‟s life. These very processes typically, without
awareness, have become aspects of the structure of the person‟s
world that could be having extremely destructive effects on their well-
being. Clients are not going to bring these up in an interview. There
are healthy alternatives to them but the person is either not aware of
them or discounts them out of hand. The concept of free will and
choice is often discussed in our culture but usually ends without
clarification and then dismissed as irrelevant. However, what I am
offering here is a different slant on the free will concept. A person is
not free to choose an alternative if they do not know it exists or if, for
some other reason, it remains unavailable to them. Traditional
psychotherapy was not designed to deal with this condition. The
Natural Systems Group, on the other hand, is designed to make these
alternatives available so that they become a part of the possible
alternatives from which one can choose.
       For a familiar example, parents may unwittingly be training their
children to distort their experience. Eventually the children learn to
do the distorting to their own selves, totally without awareness of
what they are doing. They are, of course, totally unaware that there
might be alternatives from which to choose. Usually parents do this
to their children naively and with the very best of intentions.
Consequently, parents do not raise such issues in therapy. They do
not come up in therapy because parents do not perceive them.
Parents certainly do not perceive this as a part of their child rearing
problems. If this issue does happen to be brought up by parents and
the therapist perceives that it falls in this category and chooses to
describe alternative approaches to the parent, the parent will not
accommodate their concepts to the new information about unwittingly
training the child to distort their experience. Rather, they will
somehow assimilate it to what they already do or already know and to
their current practices. It may seem, to the therapist, as if they have
understood and accepted what was offered. Unfortunately, the
therapist only discovers later on that this was not the case since the
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problem tends to be brought up repeatedly. The parents will use
stock phrases like „we tried your suggestion but our child resists‟ or
that „our child is just too stubborn‟ or some such explanation that
may seem perfectly plausible to them. They expectantly look to you
for some new miraculous suggestion.
      In the Natural Systems Group, on the other hand, the
participants can express these same concerns and puzzlements but
here there are two advantages. One, they have the concepts before
them to readily refer to in presentation form. Two, they can stimulate
one another to look at things differently, to re-examine the interaction
with their children, and to make a fresh attempt to experiment with
new things. In this context, when parents finally do show positive
results, fellow participants can give each other recognition and
positively reinforce each other for their progress.
      Dealing with the underlying intentional processes is precisely
one of the major purposes of Natural Systems Groups.


     B. How the role of Intentionality integrates the levels of both the
upper and lower pyramids figures in developing a Natural Systems
group therapy within the Open Society

      It should be noted here that I have taken what I feel to be the
most productive concepts from these other modalities and put them
to use in the Natural Systems approach. Before progressing to a
description of the upper pyramid‟s structures and systems, I must
make it clear that the intentionality model is in a sense separate from
the Duplex Pyramid model. The intentional processes of the
Intentionality Model are not a part of these modalities nor their
features. I have also reiterated that they are not a part of the levels of
structures and processes in the lower pyramid. From my point of
view, the upper and lower pyramids mutually influence each other yet
the process by which they do so is the heretofore un-researched
inner, intentional processes. The intentional processes reveal how
these structures and processes operate, or rather, what the details
are of the workings that the mind goes through to accomplish these
mutual influences. As was mentioned toward the beginning, if
behavioral patterns are changed because of therapy but the
intentional processes that must be gone through to make those


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behavioral pattern changes are not changed, then the therapeutic
changes will not persist.
       Behavior can change because some person, like a professional
induced, recommended, or demanded they change. For the change to
endure, the person‟s own intentional processes must have voluntarily
become involved. When these processes are voluntarily invoked, ego
mastery skills are being acquired. The person not only takes and
feels ownership but these processes and skills become second
nature, which is to say they become an unconscious, automatically
produced pattern appropriate to the invoking situation. The levels of
the lower, internal pyramid are involved in the change, brought into
play as and when needed by the intentional processes. Any one of
the intentional processes can invoke or use any of the structures of
the levels of the lower pyramid. Traditional psychology has
researched each level thoroughly but not the underlying intentional
processes that brought about the outcomes of its research
hypothesis and design. Intentional processes have been the
proverbial „black box‟. Modalities, similarly, have focused on one or
another level of the lower pyramid but left the exploration of the
„black box‟ out of the equation or made assumptions about its
contribution. This policy of holding implied, unverified assumptions
about the „why‟, the „black box‟, behind the process and outcome of
their modality is what has created the chasm between clinical
psychology and psychotherapy and experimental psychology. The
one, experimental, has called the other soft, speculative, armchair,
unscientific, unproven, and subject to the bias of the therapists. The
other, clinical, has called experimental inhuman, cold, impractical,
inapplicable, too objective, and out of touch with the real world living
of life.
       The intentional processes are like a fulcrum. They are like the
secret machinations behind the magician‟s magic. There is no magic
without these secret machinations. They are also the force that
makes the mutual influences between the two pyramids possible and
melds their new configuration. The intentional processes are
exquisitely sensitive to their world. Nevertheless, they can be, and
have been, scientifically researched. This research has demonstrated
that it is highly relevant to both experimental and clinical psychology.
Research on the intentional processes has brought these two worlds
together. It has also brought the Duplex Pyramids together in a
unified world. The word world in this instance means both the
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external structures and systems and the internal structures and
processes. The clients need not know in any conceptual or cognitive
manner to what they are being exquisitely sensitive. They need not
„know‟ what a feeling is to be sensitive to it, nor what a perception is
to be using it, and certainly not what intentional processes are for
them to be organizing and administering their interaction with the
world. People need not „know‟ or have a present awareness of the
people in a room or where the doors are located, but if there is some
subtle change in what is transpiring in the room that might involve
people or doors, they are instantly sensitive to and responsive to
them. Their intentional processes make this responsiveness
possible. That being said, for most people, the powerful and
ubiquitous forces shaping the structures and processes of the lower
pyramid are the external structures and systems. It is these to which
the intentional processes are so sensitive. External structures are
continuously affecting and influencing the internal structures and the
intentional processes use and organize them for instantaneous and
usually appropriate responses. The intentional processes are
continuously integrating these influences, that is to say, the
influencing external structures and the influenced internal structures.
This entire interaction is the amazingly complex, unifying entity we
call „mind‟.
      Clients must ultimately come to recognize and understand, in a
primitive, immediate, and elementary way, both the external and
internal factors and forces. They must ultimately gain conscious
control over these forces. Each acquisition of successful new
patterns of processes is an increase in ego mastery skills on the way
toward a higher level of maturity. I say they must do this because it is
that recognition and that accomplishment that increasingly will lead
to them to true personal freedom. With each increment of
accomplishment, the individual‟s freedom to choose the kind of life
they will live is expanded. Prior to this radical transformation, all
humans are mere puppets of cultural and biological determinism. The
more they are aware of these factors and forces, the more possible
true freedom becomes, degree by degree.


     1. Intentionality, the Duplex Pyramids, and overcoming the
formerly intractable problems of the temporal or longitudinal


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dimension


      2. Intractable problems with identifying and altering inner,
mental, intentional processes and the way they are related to the
client‟s external world

      Invisibly underlying behavioral acts occurring in everyday life
situations, there are an exceedingly large number of inner, mental,
intentional processes cycling through millisecond by millisecond. No
human can be aware of all of these intentional processes as they
occur. Being aware of even one would be difficult and probably is
very rare. Being aware of your many, or any, inner processes at the
very same time that you are producing the intended behavioral or
speech acts is not possible. With intense concentration and
persistence, a psychologically aware person can backtrack and detect
subtle processes or aspects of the mental processes that led to an
utterance or act. The act is supposed to realize the intent of the
intentional processes. The intent is analogous to the goal and, in
some sense, you must be aware of that. Yet, the processes that
culminate in the intent are non-conscious. The motivation behind the
intent could be either conscious or subconscious. Imagining what
you intend is conscious, but how you do the imagining is not.
Analogously, when we act, we are not aware of the bodily functions
and physiology that make possible and produce the act. Our focus is
on, and our awareness is of, the external world with which we
interact. We do not know how we perceive the external world. We do
not know the nature of our worldview, yet it is exerting a powerful
influence over our choices. Similarly, you cannot, at least not
without great awkwardness, speak and listen to your voice at the
same time or act and focus your attention on how the act is produced
at the same time. In fact, you do not know how speech or behavior is
produced. However clients can and typically or often do focus on
what they do or do not want to say „before‟ speaking.
      We can recall past events and we can feel feelings or emotions
that are in some sense related to the initial event, but we do not know
how we do this. People are seldom aware of how some past events
affect their choices and function to direct, impel, or inhibit their acts
and lives. Nevertheless, clients tend to spend a great deal of time
talking about recent events that have troubled them or more distant
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memories that are related or may been their cause. Occasionally,
clients may become occupied with recovering a memory of an event
from their distant past, yet with little or no understanding of how it
relates to their life today. Some therapists refer to this influence from
the past as „Unfinished Business‟.
      Not unexpectedly, very few people are motivated to explore their
covert or non-conscious intentional processes, nor would they know
how if they did want to. The science of psychology proclaimed, long
ago, that experiments designed to get at inner processes, particularly
by using introspection, are too subjective and unreliable and must be
dispensed with in favor of more objective scientific methods. Yet, if,
as I said at the beginning, these hidden intentional processes are the
engine propelling all behavior all of the time, it behooves us to
question the history of psychology and take a second look at them, at
their importance in perpetuating negative behavior and symptoms,
and to look for possible ways to address them in therapy.
      Contrary to this tradition of ignoring inner processes, I have
spent the last forty years trying to track and describe these
intentional processes. It is now possible to design experiments to
infer the unobservable from the observable in psychology just like in
physics, astrophysics, and psycholinguistics, to name a few. In the
late 80s, I conducted a broad scale experiment that conformed to the
canons of scientific experiments and that was designed to
demonstrate what these processes are and how they behave. Using a
different but complementary tactic, I took an applied research
approach in the early 90s. The program was “Stars and Stripes”.
This project demonstrated rather astounding success. The
quantitative part was institutional performance indicators. Since the
late 60s, I designed programs with features that were supposed to
influence, or correct, inner processes of delinquents in correctional
institutions, patients committed to psychiatric hospitals, adult prison
inmates, and my clients in private practice. Through the years, the
most success I have had has been with institutionalized populations.
Unfortunately, the least success has been with my clients in
individual psychotherapy. In the first paragraphs of this manuscript, I
noted the institutional successes but also expressed my serious
doubts and questions regarding the efficacy and practicality of
individual psychotherapy. These doubts include using Natural
Systems concepts in my individual psychotherapy practice.


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       As I intend to address what I feel could be a viable alternative, I
will first describe what I feel to be some of the “problems in
identifying and altering inner, mental, intentional processes and how
these are related to the client‟s external world” when using traditional
individual psychotherapeutic modalities, but also traditional group
therapy modalities.


     3. Natural Systems integrates intentionality, the Duplex
Pyramids, and the temporal dimension and opens the way to
innovation in treatment in the Open Society


      4. Finding a replacement for traditional psychotherapies that can
deal successfully with all of their intractable problems


     VI.    Prospects for a More Efficacious Alternative to
            Traditional Psychotherapy
   A. An example of success in a closed institution using the natural
      systems‟ topics described above

      In a Natural Systems-type, well designed, structured program or
institution, clients can be coached to check themselves and alter their
behavior to react more maturely to presented situations. Programs
are designed to evoke these situations as „generic situations‟ that
make it much more likely to foster transference to relatively similar
types of situations in „the free‟. This in itself is helpful. However, a
situation-response paradigm is similar to the stimulus-response
paradigm alluded to earlier and which was pointed out to be too
„rapidly and forever changing everyday world‟ and therefore making
the discrimination of situation types and matching response selection
too complex and chancy. What is needed for transfer of learning to
„the free‟ is something more identified with the people themselves,
something that provides more continuity within the flux of reality in
„the free‟. The concept of „role‟, so popular in sociology, seems to be
the ideal vehicle for this purpose. Roles can, or rather must, have
role-specific behaviors. Wherever and whenever the role is called for,
the battery of associated behaviors, a much smaller universe than the

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random flux of possible but unpredictable situations becomes readily
available for the client to draw from. If they learn the role well, the
transfer of role-specific behaviors has a much greater probability of
transfer to new environments in „the free‟.
       However, there are several problems with the role learning
technique. Institutionally fashioned roles are shaped by institutional
staff in and for institutional settings. In „the free‟, as was alluded to
earlier, roles are assigned by multiple groups of people such as
families, peers, work relations, intimate relations, relations I social
and recreational organizations, etc. There are formal and informal
role structures in such groups. These roles also have role specific
behaviors. People occupying roles within the formal and informal
role structures within such groups interface role to role with
expectations that the role they interface with moment by moment will
respond in the expected way. If these expectations are not met, there
can pressures brought to bear to restore conformity and quite harsh
psychologically negative consequences for lack of compliance.
Institutionally shaped roles, however wholesome and positive they
are, will bend to such pressures in „free‟.
       How can the client be inoculated against caving in to such
pressures from the many groups that have their own needs for
conformity to role prescriptions? First, if role shaping in the
institution is integrated with a complex of factors one of which is as
an overarching role structure that includes a hierarchy of roles
through which the client must progress and includes the criteria for
progression as well. The criteria are increasingly mature behavior.
Therefore, there is a strong incentive to become more mature. At the
same time, he lives with a small number of youths, all of whom are
trying to become more mature. The program structure requires them
to help each other attain this goal. They bond with each other and
become a mutually supportive, mutually facilitative, positive peer
group. His peers also have to learn to be realistic and objective and
to assess each other‟s readiness to ascend to higher ranks
accurately. The youths become aware of each other‟s progress in
attaining the characteristics of more mature behavior. They assess
not just whether more mature behavior is exhibited, but also whether
it is being genuinely incorporated. Each of them is becoming aware
of the fact that the control over their attainment of the more mature
behavior primarily rests with themselves but is also interdependent
with the rest of the group. They come to know that all of these factors
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are involved and required to reach the next level in the progression
within the hierarchical role structure.
      That aspect of „more control‟ means that he can be the one to
choose which behaviors to exhibit. More importantly, he becomes
aware of the fact that he can control the kind of consequences that go
along with his choices and behavior. He can now discriminate
situational demands and decide whether to succumb to the negative
pressure from the people in the situation. He knows that he may have
to deal with the negative consequences, should they arise. He knows
his peers are not going to let him off the hook for bad choices. Not
only can he discriminate between situations, but also he can
anticipate group-specific role expectations. He can now decide to
reshape the group‟s expectations of him. He can let them have to be
the ones dealing with his change and his departure from yielding to
their negative conformity pressures. In other words, he is selectively
invoking inner processes at different stages of group interaction that
will affect consequences and his progress.
      At one stage, he is assessing the nature of the group he is
entering or about to enter and recalling the types of situations that
occur with that group and the role structure of that group. After
having entered and experienced the pressures and consequences
and then exiting, he can then decide what his future posture will be.
He can decide whether he will avoid the group altogether or will
openly reveal what his differences with the group are and how his
preferences have changed. If he decides to remain in the group, he
can let them know that it will be on his terms. Anticipating the
conflicts that will very likely arise, he can arm himself with strategies
to deal positively with the probable conflicts. He can recall the
feelings and emotions that such transactions provoke in him as well
as members of the group. He can recall the strategies he can invoke
to deal with these volatile emotions and hostile behavior as well. He
has had practice with this back with his peer group in the institution.
His interpersonal skills are becoming more sophisticated.
      One of the problems in „the free‟ that can be met with a
complementary advantage in the institution is that of identity.
Assigned roles in the family or peer group and the other types of
groups can eventually be codified in a name or names that
encapsulate the range of role-specific behaviors. Such names are
called „identity‟. Identity is owned, so to speak, not by the person
themselves, but by the social group bestowing the identity names.
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When the person departs from role expectations, group members can
say he is not being himself, meaning he is not being true to the
bestowed identity. Inconsistency can arise when identities change
from group to group. Typically, however, identities are not simple,
monolithic, and perseverating across groups. In fact, often identities
and their related role behaviors quickly change as the person moves
across organizations, settings within organizations, or even
situations within settings.
For the majority of people, these inconsistencies are normal and inevitable.
The problem is that occasionally when someone sees a member from their
group in „the other group‟ and detects inconsistent behavior, that is when
the „not being yourself‟ accusation can be made. This often carries the
even worse implication that the person is being „a hypocrite‟. This
possibility creates pressure to resolve such identity inconsistencies and
conflicts. The offender may try to either smooth out the differences by
promising to modify their behavior or to become an expert at either
providing rationalizations or rational explanations, or may try „spinning‟ a
story to avoid being called a hypocrite.
       One common problem of this type arises in the occupational
setting when a person is promoted to be supervisor over his former
co-workers. The role behaviors have to change as the office changes
and as the identity changes. The new supervisor becomes the target
of all sorts of accusations such as being a hypocrite, disloyal, lording
over, betraying, feigning superiority, etc. His task is to provide a
rational explanation that his former colleagues can accept and help
them deal with the prescribed behaviors of his new role as
supervisor. Roles, therefore, can be used to facilitate acquisition of
new, different, more skillful, and more mature behaviors.
       A hierarchical role structure for residents in an institution that
includes more mature behaviors that must be attained in order to be
elevated to higher ranks plus recommendations for promotions by
peers can help ease the way for a redefinition of his identity.
However, if his bid for promotion is turned down, he can be helped to
learn to deal maturely with rejection and failure as temporary
setbacks. If the increase in rank includes a new name, then it also
entails as well as solidifies the change in identity. If the new role
involves assisting his former peers to acquire the behaviors
necessary for them to move up as well, this also eases acceptance of
the change in identity. As he moves up through the ranks in this
fashion, he learns, from the repeated experience of making such role
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transitions, how to deal with inter-group identity changes, but he also
learns how to constructively cope with maintaining his new identity
when he re-enters old groups that still „hold‟ onto his old identity. If
the awareness of the significance of identity and its association with
related mature behavior is incorporated firm enough, then when
encountering negative peer pressure and family influences, he can
assert his new identity and shape the expectations of others with
respect to his new more mature role behaviors. Then they can
choose whether to accept his new self-assigned identity and role
behaviors or move out the group or away from him.
      As the client who is undergoing such transformations learns to
accept flexibility and positively changing identities along with the
related mature role specific behaviors, the invisible, inner processes
of intentionality are also growing. Together, we can call these new
developments the acquisition of ego mastery skills.
      The Ego mastery skills to be acquired should include but are not
limited to:
                   Inner personal skills in self-reliance
                    Independence of judgment
                    Realistic and positive goal setting
                    Strategies for persisting in the pursuit of those goals
                    Mutual support
                    Social skills that particularly involve coping with
                     interpersonal conflicts in the family and with peer
            groups
                    Management of feelings and emotions;
      As well as many other inner processes in combination with the
more observable mature behavior. As the person lives with the
beneficial consequences of this new life style, it becomes self-
reinforcing and therefore will tend to persist and resist regression.
However, notice that all of these benefits result from the structure of
the institution, from the way the Natural Systems program is
designed.


   B. Learning from the closed institutional program and adapting the
      Natural Systems Model to treatment in „The Open Society‟

     Adapting the natural systems model to treatment in „the open
society‟ means taking some of the principles of what worked in the
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closed institutional environment and some of the principles that
worked in psychotherapy and finding a way to make them work in an
integrated manner in the minimally or unstructured society at large.
Let us consider Natural Systems as having a scaffold-like model from
which to derive and design tailored types of therapies and programs
suitable for the non-institutional, natural environment. If a merging
of these principles from psychotherapy and the institutional program
were adapted to the „Open Society‟, this could mean a new genre of
treatment could be created. If this were done so that together they
could approximate the advantages and positive results seen in
programs that were designed using Natural Systems for the
structured environments of closed institutions and the results that
come from psychotherapy, this would revolutionize treatment in the
minimally structured, non-institutional, natural environment of the
„Open Society‟.
      A project like this would first require staging arenas or settings
where large numbers of people routinely gather like schools,
churches, corporations, public libraries, community activity centers,
recreational centers, social organizations, and neighborhood centers.
Next, it would have to be possible to disseminate information to
members, employees, or participants at these locations. Programs
would have to be designed for specific target groups such a married
couples, parents of teenagers, teenagers, people in positions or
professions that work with such groups, and the like. If large
corporations were targeted, programs could be designed for parents
of teenagers or employees with personal problems, for example.
Another example might be an institution like a YMCA or community
activity center where teenagers regularly gather. In such settings,
programs could be targeted to either teenagers or teenagers and their
parents. A program in a church could be targeted to married couples.
As you can, there are numerous possibilities.
      Using the Natural Systems model, for example, one type of
program could use a format like a classroom, a seminar, or a
discussion group. With this format, a program could have features
such as slide presentations of problems and potential solutions
targeted to the nature of the particular group. The information in the
slides should be such that participants can see its relation to their
own lives. Feelings would likely be evoked causing the participants
to want to share their related experiences. Since prospective
solutions would be included in the presentations, the discussion
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could also be directed to them as well. Group members would
probably weigh and exchange opinions about the likelihood that each
of the solutions would work. Rather than try to arrive at a conclusion,
assignments could be given to the members. The assignments could
involve selecting one of the proposed solutions or ways to handle the
problem. They would be challenged to experiment with using a
strategy, making a note of their results, and bringing the information
to share at the next meeting. Members would become involved in
sharing information about their unique experiences, problems
encountered, and offering each other suggestion about alternative
ways of dealing with the problem.
       Any group could be given additional structure by having them
make decisions about what issues would be addressed and in what
order they would be presented. They could decide on how the result
from their experiments should be presented. They could form a role
system in which persons would be assigned roles to orchestrate
features such as these. Roles could be rotated. The processes
involved in each of these features could also become topics for a
presentation or discussion, or both. In other words, the process of
assigning roles, transitioning in and out of roles, group interaction
during decision making about topics and about experiments and how
results of experiments are shared could all, themselves, become
topics. Each of these group activities can evoke strong feeling and
can rekindle memories of related life history episodes and past family
relationship problems. Instead of provoking endless cathartic
expression, the evoked issues and feelings can be shaped into an
educational illustration addressed by a related topical presentation
with complementary experiments or exercises. Each time the group
shares opinions, especially positive opinions, shares alternative
approaches, and shares results of experiments, the group leader can
provide recognition and reinforcement for their sharing and
encourage the members to do the same with each other. This builds
bonds between members and teaches them how to be mutually
facilitative and supportive.




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     C. Contrasting Results Expected from Traditional Group
Treatment Modalities versus the Natural Systems Groups in the „Open
Society‟

      To understand more deeply why Natural Systems groups can be
      more effective than other modalities, contrasting it with
      traditional group therapy and psycho-educational groups should
      be helpful. Let us consider group therapy first. In group
      therapy, clients with somewhat similar characteristics meet with
      a therapist. Clients each bring their unique life histories with
      them to the group. They bring all of the traumatic experiences;
      twisted and damaging relationships; life circumstances that
      distort their expectations and perspectives; prior roles in their
      family and peer groups through which they learned self-
      defeating behaviors; ascribed identities that harness their
      potentials. Along with those negative life experiences they also
      bring all of their suppressed resentments, rage, jealousies,
      rivalries, hidden taboo desires, and morbid and anxious feelings
      that went with those experiences. The confessions and
      accusations of the group members mutually provoke each
      other‟s ambivalent yearnings and fears of confiding.
      Alternatively, they compete for attention to unload or reproach
      those too timid to open up. The therapist may use the group
      interaction as means of attempting to give individuals
      awareness of or insight into difficulties in their styles of relating.
      Participants may also be encouraged to give each other
      feedback on aspects of their styles of relating. None of the
      participants will find the undivided attention of the therapist that
      they would get in a one on one therapy session. If the therapist
      imposes rules to maintain order in the chaotic group
      communication, this merely tends to suppress spontaneous
      disclosure of their delicate, fragile, private selves. There is little
      opportunity to learn and master new social skills and virtually no
      opportunity to learn more mature ego mastery skills. Finally,
      and in addition, participants in group therapy have all of the
      disadvantages of individual psychotherapy, as was mentioned
      above.
In psycho-educational groups, there is another class of
disadvantages. Typically, the participants in these groups are given
instruction in mental health, lectures on techniques of handling
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difficult life situations such a parent child relations, and group
behavioral exercises or role-playing. Occasionally the participants
are administered mental health, relationship, addiction, personality, or
mood questionnaires. Such tests are used, ostensibly, to tell the
participants what type of person they are; what their traits are; what
their values are; what their personality problems are; what their
interests are; what their aptitudes are; and even what their psychiatric
diagnosis is. Sometimes the leader presents the results to the group
and then uses their reactions to generate therapeutic discussion and
group process. An erroneous assumption implicit in these
questionnaires is that the score or scores derived are accurate and
descriptors of the testee‟s permanent personalities. In fact, what the
scores indicate are traits that have very vague meanings. It is almost
akin to reading tealeaves. The way a person answers the questions
may be quite different from what was intended by the item. They may
also, unconsciously or consciously, be trying to answer to create a
certain type of impression. In real life, the person probably rarely
exhibits that trait only in special circumstances, situations, or with
only a few people. People are always changing and rarely exhibit any
traits consistently and in their pure form.
People also can change over their lifespan and may do so often.
Whether an observer ascribes a trait to a subject may depend more
on their own bias. Who knows what the source of a testee‟s answer
to a question might be. Is it from self-observation? Common sense
and everyday observations tell most of us that humans are
notoriously bad self-observers and prone to all sorts of bias in
making self-attributions. Take any one trait and then consider that
the reference group for their comparisons could range all over the
universe. If their reference group is their peer group or small
hometown, how representative is that of what the test maker had in
mind? In other words, objective tests are not so objective! When
discussing the results of their tests in the group, many kinds of
obfuscating and misconstruing for many undisclosed reasons may
predominate. This word hash of defensive and offensive attributions
could hardly be described as therapeutic.
The approaches used in most of these groups are didactic,
assessment, experiential, guided-imagery, or some combination of
these. They usually do include a certain amount of question and
answer give and take within a leader moderated group discussion.
Within this framework, the superficial „public self or persona‟ is
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seldom challenged. If so, the reaction is likely to be defensiveness
and/or hurt feelings. This makes therapeutic, open, productive
participation very difficult for the victim but also has a dampening
effect on the other participants. Notice, however, that in psycho-
educational groups, self-expression and confession is minimized.
Participation-stress that comes from revealing secrets of their private
self is minimal and therefore participant comfort levels are much
greater. Contrasted such methods as group therapy, where there can
be an abundance of therapist feedback or group mutual feedback on
styles of interacting in the group, comfort levels can be reduced with
the consequent that private self-revelations can become minimized. If
transparency and revealing secret private selves is one of the goals,
none of these methods is very effective.
However, one of the key points regarding disadvantages of these
kinds of group methods is that they primarily tend to be intellectual
and primarily to focus on generic versions of problems rather than
uniquely individual problems. In addition, the content of these
sessions is related only indirectly or tangentially to everyday life
outside of the sessions. Furthermore, as with group therapy, most
group techniques offer little opportunity to learn and master new
social skills other than those specific to the group-process of each
group. Moreover, there is virtually no opportunity to learn more
varied and more mature ego mastery skills as they relate to each
individual‟s home life and practice them in life outside of the
sessions. Unless some aspect of the therapy takes place in the actual
home life, work, or everyday life situations, transfer of training is
highly unlikely. Otherwise, the knowledge and insights gained in
session will quickly fade when the session is over and the
participants return home. Since they are usually learning a great deal
of „academic knowledge‟ about mental and behavioral health, they
may come away with the feeling that the benefits will be carrying over
into their everyday life. On the contrary, in some cases, in fact, a
spouse or parent, for example, may remember just enough to bring up
information from a session when they want to make accusations.
With respect to group therapies, there all of the same disadvantages
associated with individual psychotherapy mentioned in Sections I. 3
and 4. The main advantages of the psycho-educational group are that
it is easier for the therapist or leader to manage and does not threaten
participants‟ comfort levels. This is not much of a recommendation,


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in light of all of the disadvantages.


     1. Understanding „Degrees of Structure‟ and why these are
expected to produce different results in institutions versus the „Open
Society‟
     TABLE 1. Needs Revision
     THE DYNAMICS OF STRUCTURAL INFLUENCES
   Effects of changing degrees of rigidity of the external structure on
  how the internal structure‟s lower levels influence dyadic interaction
                                                                                                                                                    Top Pyramid‟s Influence
                                                                                                                                                      The more loose the
                          NATURAL SYSTEMS ‟ SCHEMA PERSPECTIVES USING THE DUPLEX PYRAMIDS
                                                                                                                                                      descending levels of
  Op
                                                                Encompassing Environments                                                      ce     the upper pyramid‟s
    en                                                                                                                                      en
                           an                                                                                                            flu           structure, the more
                              d                                   Institution or Organization                                          in              influence the lower
                                  lo                                                                                               e
                                     os
                                                                       Settings within Institution                              or                    levels of the bottom
                                       e                                                                                    m
                                           Le                                                                          ls                            pyramid and the more
                                              ve                            Situations                               ve
  INTENTIONAL PROCESSES




                                                ls
                                                        le                                                        Le                                  influence the distant
                                                          ss                                                 id
                                                                            Formal Roles
                                                                                                         R ig                                        past have over present
                                                                                                                                                             behavior.
                                                                               Dyadic
                                           PAST                                                FUTURE
                                                                             Interaction
                                                                                                 In
                                                                                                    flue
                                                                  ds                                    nc
                                                             D ya           Informal Roles
                                                                                                          e
                                                                           And Relationships                  fro
                                                        on                                                       m
                                                    e                  Physical/Verbal Behavior                                                         The more rigid the
                                                  nc                                                                 Dy
                                             l ue                             Cognition                                ad                             descending levels of
                                     g   inf                                                                             sD
                                                                                                                                 ec                    the upper pyramid‟s
                                sin
                                                                          Emotion/Feelings
                                                                                                                                    re
                            crea                                              Perception                                              as                 structure, the less
                                                                                                                                         es
                          De                              Life History       Genetics      Brain Chemistry                                              influence the lower
                                                                                                                                                       levels of the bottom
                                                                                                                                                      pyramid and the less
                                                                                                                                                      influence the distant
                                                                                                                                                     past have over present
                                                                                                                                                              behavior.



     2. Assumptions of differential causal influences resulting from
degrees of structure in institutions versus the „Open Society‟
     TABLE 2.
     DEGREES OF STRUCTURE IN INSTITUTIONS



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       HIGHLY
    STRUCTURED;
       STRICT
    RESTRICTIONS



   MODERATE
                                             LE
   STRUCTURE                                   AD
      WITH                                       S
                                                     TO
    POSITIVE                                            :
    AVENUES                   LE
                                AD
                                  S
                                      TO
   LACK OF                               :
                     LE
 STRUCTURE;            AD
    HIGHLY               S
                             TO
 PERMISSIVE                    :

                                                                        REPRESSED
                      UNINHIBITED                                       BEHAVIOR:
                       BEHAVIOR:                                     PRIVATE PERSON
                          PRIVATE                       CHANNELED,    IS TENSE AND
                          PERSON                        PRODUCTIVE      ENGAGES IN
                                                         BEHAVIOR     FANTASY LIFE,
                     IS DOMINANT                                          REBELS,
                                                                     PUBLIC PERSON
                                                                       IS DOMINANT




      TABLE 3.
      Structure in the „Open Society‟




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The “Open Society” is, in general, free of imposed structure. Within it, there are
private institutions, businesses, social organizations that vary in structure.
   LACK OF
 STRUCTURE;
    HIGHLY
 PERMISSIVE


                                  LE
                                    AD
                                         S
                                             TO
                                                :




                                                                 UNINHIBITED
                                                                  BEHAVIOR:
                                                                     PRIVATE
                                                                     PERSON
                                                                IS DOMINANT




     4. Degrees of structure in institutions versus the „Open Society‟
and their relation to the chemical imbalance theory of mental illness
Neurotransmitters and their changing configurations as aspects of
the external structures change




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      5.The configuration and dynamics of Natural Systems groups
and their differential contributions to mental health, ego mastery
skills, and maturity


      6. So, does Natural Systems offer as a superior alternative to
traditional modalities when adapted to the Open Society?


VII. Designing Natural Systems Ego Mastery Skills Groups

   A. Goals for the Natural Systems Groups

     Natural Systems designs structures that will overcome the
shortcomings of traditional individual and group psychotherapy. In
psychotherapy, they just unfold. If they are unaware of some
negative behavior or if they too fearful or defensive to bring up a
problem or if it is too deeply suppressed, it will never be addressed.
Once addressed, no new coping behaviors are learned or practiced.
Expressing the feeling is somehow supposed to work major and
transform the client‟s behavior, way of relating, or way of being in the
world. NS has lessons and formats that are designed to:
   1. Reduce the need to maintain the Public Persona.
   2. Elicit suppressed emotional memories and issues as all learn
      sensitivity to and respect for delicate self revelations and
      confessions
   3. Assure comfort with openness and bonding with each other.
   4. Assist overcoming defenses against transparency and
      revealing their private self.
   5. Assist the group in learning to identify negative behavior
      patterns of which the participants are not aware and to do so
      diplomatically.
   6. Initiate advanced experiments in practicing ego mastery skills
      related to personal maturity
   7. Help the group to learn and practice sensitivity to and respect
      for each other‟s personal boundaries
   8. Initiate self-evaluation, self-correction, and participation in the
      group‟s respectful mutual feedback and correction.


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  9.  Initiate advanced experiments in practicing ego mastery skills
     related to interpersonal maturity
  10. Initiate practice in altering roles and identities, practice
     assuming different positive roles, practice switching gender
     roles, and practice new relationship skills from the point of view
     of the different, assumed role.
  11. Initiate advanced informal experiments in practicing ego
     mastery skills related to maturity in intimate relationships
  12. Replace their negative primary implicit others and secondary
     peer-related implicit others by supplanting them with the group
     leaders and the group as positive primary and secondary
     implicit others.
  13. Expand participants‟ cognitive awareness of factors or
     structures in their home, work, and everyday life environments
     that negatively influence their behavior and learn to effectively
     counter and cope with them.
  14. Expand their awareness of the influence of factors and
     structures (levels of structures, settings, situations, etc.) in the
     global culture that shape their values and behaviors and learn
     to decide whether to constructively inoculate against them,
     accommodate to them, or, when appropriate, facilitate changing
     them.
  15. Initiate advanced experiments in practicing ego mastery skills
     related to intellectual maturity
  16. Encourage practice in exploring unfamiliar settings and
     territories and experiment with altering and expanding their life
     topology
  17. Assist them in learning how to learn new ego mastery skills
     appropriate to paths in their new life topology or adapt their
     current ego mastery skills to their changed life style
  18. Assist them in understanding their choices with respect to
     whether to conform to their life conditions or to shape a new life
     style and adapt more flexible, relativistic, and situationally
     appropriate approaches to variant sets of values
  19. Assist them in learning how to be a force for changing the
     socially and psychologically significant structures of their
     world.
  20. Encourage them to experiment with practicing ego mastery
     skills related to societal maturity


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  21. Assist them in making gradual progression toward attaining
     and consistently acting based on an integration of higher levels
     of personal, interpersonal, intimate, intellectual, and societal,
     maturity.

      When a person comes to understand the way „Degrees of
Structure‟ influence behavior, they will tend not to attribute the cause
of negative behavior to inveterate personality or genetic traits. When
a person comes to understand how a minimum degree of structure in
the Open Society will cause a person‟s life history, personality traits,
and to a small extent their genetics to predominate as the cause of a
person‟s negative behavior, they can also begin to understand how
important it is to restructure that person‟s life topology. They can
also begin to understand how important it is for the person with
negative behavior to be educated with respect to the influence of both
minimum structure and which factors in the Open Society do
influence them and how those factors influence them. Understanding
these structural factors leads the way to helping people inoculate
themselves against and gain control over structural influences.
      The structure of Natural Systems groups makes it possible to
acquire new and more advanced ego mastery skills that can be
generalized to a wide variety of real life settings and situations. When
a person truly incorporates new behavioral patterns and more
advanced ego mastery skills, their painful, self-defeating, neurotic
symptoms tend to disappear. This phenomenon would seem to make
traditional therapy unnecessary.


   B. Introducing the Key Components, Procedures, and Techniques
      of the Natural Systems Groups

      The goals of the group are to increase individuals‟ ego mastery
skills and maturity in many areas of their lives. Each group will be
begun with an explanation of how Natural Systems groups work. A
format will be developed. Each group will be involved to some extent
in the design of the format for their group. This is part of the
treatment approach of Natural Systems groups. Lessons using slide
presentations will begin. Exercises to practice skills and gain insight
will be used during group sessions.


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      1. Homework related to skills learned in each lesson will be
assigned. This homework will require practicing these skills in the
home and work situations. Participants will discuss the experiences
they had practicing skills. Homework will also include viewing
movies related to the theme of the week‟s lesson. Insights gained
from viewing the movie will be shared with the group.
      2. A notebook will be kept that will include copies of lessons,
their responses to homework practice and their experiences with
ongoing participation in the group. Participants will be administered
brief questionnaires about their progress at the beginning of each
session and these will be included in the notebook.
      3. Finally, participants will keep a journal describing their
experiences, skills they have mastered, and growth related to
participating in the group. Their journal entries will be added to the
notebook. When the group is terminated, participants will have a
record of everything they learned. They could use this to turn to for
help in the future.
      The hypothesis is that the nature of the Natural Systems
treatment will increase the participants‟ ego mastery skills and
maturity. At the same time, and as a by-product, the nature of this
approach is such that it will also relieve participants of symptoms that
might possibly have been treated, but with less success, using
traditional psychotherapeutic modalities or psychotropic
medications. A parallel hypothesis is that, as there is a gradual
increase in ego mastery skills and maturity, the participants‟
neurotransmitters will also gradually change toward balance and
health. The goals of Natural Systems groups are designed to elicit,
over time, increases in ego mastery skills and maturity. Each of the
goals is should positively affect the relations between the participants
and the external structures of their home and work environments and
complementary aspects of selected internal, or intentional,
processes, brain chemistry, and physical health. The outcome should
be a successful, happy life style and positive relationships, with
optimal mental, emotional, and physical health and a dramatic
reduction in unwanted, unhealthy behaviors and symptoms as well.


1.   The first component: The nature of the Natural Systems Group
approach


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     a. Communicating the essential features of The Natural
Systems group
     b. Explaining to the group how the differences between degrees
of structure in the open society can effect their behavior;

i. minimum structure being the norm for open societies;

ii. medium structure being the goal for a Natural Systems group;

iii. maximum structure being typical of incarceration, public schools,
and many kinds of businesses and occupations;

iv. explaining the necessity for medium structure if a Natural Systems
approach is to be successful
      c. Communicating the rationale for the format of the group,
 procedures of the sessions, and the way the lessons are to be used
      d. Presenting the Table of Contents of all available lessons


      2. The second component: Developing an agenda

a.    Developing and setting a tentative agenda for the group and
selecting appropriate lessons
b.    Establishing a progression of group offices or roles that have
graduated criteria such as levels of maturity of mastery skills
c.    Designing roles so that they evoke the behaviors suggested in
lessons
d.    Periodically engaging the group in the design of plans and
setting goals that require envisioning
e.    Implementing group procedures and techniques that are
designed to develop identification with the group and bonds between
members of the group
f.    Initiating a group decision making process so that members
learn how to achieve consensus with respect to decisions about
plans and goals


      3. The third component: Introduction to Lesson Presentations
      a. Presenting the first lesson
      b. Showing the group how the message of the lesson relates to
life experiences
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    c. Instructing the group about lesson exercises
    d. Explaining to the group how, when each member shares their
experiences with applying the lesson, it benefits both themselves
and the whole group
    e. At the beginning of sessions, taking a brief inventory or
questionnaire about progress the member has made; changes they
have made in some aspects of their life such as perceptions of
others, feelings about others, general mode, ways of relating,
expressing feelings, sharing intimate affection, listening,
negotiating, managing home life, dealing with children, as others as
applicable.


      4. The fourth component: Homework done between sessions

     a. Implementing plans to perform informal experiments by
practicing lesson related skills at home, work, and organizations
with which one is affiliated
     b. Sharing and evaluating with the group the outcomes of
practiced roles and skills
     c. Going to an internet discussion site to share feelings,
thoughts, experiences, and suggestions related to the group such
as topics, procedures, group interaction, etc.
     d. Downloading last week‟s lesson to refresh their memory and
for future reference
     e. Keeping a private journal of experiences in the group, life
changes and problems, feelings, desires, etc., using the Natural
Systems Journalizing technique
     f. Viewing movies and picking out scenarios related to the
lesson‟s message and relating to personal life situations
     g. Analyzing the role of structure in shaping lives of people in
the movies viewing
     h. Discussing and practicing taking perspectives of different
levels of structure portrayed in the movie
     I .Keeping a notebook with:

      i. Records of one’s chronology of progress

      ii. Inventories and questionnaires answered

      iii. Journal writings
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      iv. Movies and their plots and one’s insights gained from seeing
            and discussing the movie

      v. Chronology of online discussions
      C. Types People Targeted for Types of Natural Systems Groups
      Working With Neuroses – Different Tracks for Different Folks –
      making different types of groups available for special
      populations -- neurotic symptoms obviated by ego mastery
      skills.

      Lessons are designed to evoke deep conflicts and suppressed
and repressed memories. These are presented in such a manner as to
imply that individuals dealing with such problems are not unique but
hold them in common with many others. They are not rotten or
untouchable lepers but rather share this plight in common with all of
humankind. Other members of the group can reveal their variation of
the disturbance can mutually facilitate each other‟s exploration of the
problem and be empathetic and mutually supportive. They can put
the problem in perspective by each recounting the origin and history
of the problem. They can also, collectively and cooperatively, explore
possible effective alternative ways, if they could revisit their
childhood trauma but as an adults, of coping with the incident, both
with respect to the past and as repetitions of similar situations occur
in the present. These new coping strategies then become homework
exercises. At the next session . . .

     Furthermore, the theme of the lesson can be examined and
discussed by the members to increase their understanding of the
many structural forces and inner dynamic factors are in play in such
themes and the situations in which they are reified.

Develop perspectives on influences shaping their lives during and
after seeing pertinent movies.

      D. Conducting a Natural Systems Group

    Male and female leaders as implicit parents



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VIII. Lesson Topics and Web Sites for Each Lesson Series
       It is possible to select from the available topics and sections listed below
those that are most relevant to the needs of each particular group. Individual
members can select from the remaining lessons any that may find helpful.
Agendas and lesson schedules can be changed through group discussion.
Members are advised, however, to adhere to the group‟s schedule.
       The format for each type of group will be similar yet adjustments will be
made so that it is relevant to the nature of each particular type of group. Groups
designed to focus on couples and their relationships will have lessons tailored to
their needs. Groups for parents, with or without adolescents present, designed
to focus on raising adolescents will have lessons tailored to their needs. Groups
designed to focus on adolescents will have lessons designed for their needs.
Groups designed to focus on personal psychological growth of individual adults
will have lessons tailored to their needs.


A.    Table of Topics for Group Types
      1. Ego Mastery Skills Training for Individuals and Couples

              Topic 1 contains seventeen Sections with a total of over
               seven-hundred slides.

     2. Training for Parents, Parents and Adolescents, or
Adolescents

              Topic 2 contains twelve Sections with each Section
               containing from five to fifteen Lessons and each Lesson
               containing from five to twenty slides. There are about
               one-hundred-forty Lessons and over one-thousand-four-
               hundred slides.

     3. Increasing Achievement and Decreasing Violence in Public
High Schools

              Topic 3 contains six Sections with a total of about one-
               hundred and ten slides.

     4. Issues Related to Psychologically Influential Structures in Our
Culture

              Topic 4 contains thirty Sections with a total of about one-
               hundred-fifty pages.

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      B.Secondary Sources and their Hyperlinks underlined below

      1. Introduction to Natural Systems Institute Theoretical Roots
      2. Natural Systems Analysis of Issues

      3. Neighborhood Organization
      4. Training for Organization Development

      5. Addiction Workshops
     6. Outlines for Workshops on Adolescence Parenting
Relationships Organization and Creativity
    7. Training Lessons for Parents, Youth Leaders, Natural Systems
Group Leaders
      8. The Essential Features of the Stars and Stripes Program


    C. Examples of Topic Choices in the Natural Systems Lesson
Pool [See: http://www.dredyoung.com )

     Leaders of Natural Systems groups can use a preset agenda,
they can design their own or they design agenda with the
collaboration of the participants. The list below is meant to suggest
topics for possible inclusion. There are lessons (see Table of Topics
above) constructed for the most part with MS PowerPoint although
some are in the MS Word format. Open the web site above, select a
sub web, and open any lesson to see an example and see what they
include and test how they operate.

1.    FAMILY INFLUENCES
      a. Assessing family styles
      b. Assessing family history
      c. Assessing immediate family and extended family structures
      d. Assessing individual roles in family systems



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     e. Describing and understanding behavioral patterns and one‟s
roles in family systems and the effects of family structure,
members‟ personalities, and on one‟s own personality
     f. Role playing practice of lesson‟s message experimenting with
playing different roles
     g. Practicing altering the influencing patterns of structures,
systems, and roles in the family and altering the influenced patterns
of family structures, systems, and roles
2.  MAINTAINING A HEALTHY BODY AND STRESS-FREE,
CREATIVE LIFE

3.    ROLES AT WORK, ORGANIZATIONS, AND INFORMAL GROUPS
4.   UNDERSTANDING AND IMPROVING CLOSE RELATIONSHIPS
     a. Assessing listening and communication skills
     b. Practicing transparency and empathy and reducing the
difference between c. public and private personality
     d. Altering inter-gender relationship styles
     e. Dynamics of attraction and romance
     f. Components of compatible relationships
     g. Exploring the effects of secret sexual criteria for fulfillment
on intimacy
     h. Assessing reciprocity and negotiation skills in interpersonal
and intimate relations
     i. Tracking stages in intimate relationships from first encounter
to post separation
     j. The role of levels of intimacy maturity in relationships
    5. THE INNER PERSON
    a. Detecting the difference between genuinely incorporated
pleasures and pseudo-incorporated preferences and likewise for
values and taste
    b. Detecting the difference between genuinely disincorporated
pains, disincorporated pains, and pseudo-incorporated pains;
genuinely disincorporated pleasures and pseudo-disincorporated
pleasures
    c. Learning to detect the difference between genuinely
incorporated and genuinely disincorporated beliefs versus pseudo-
incorporated and pseudo-disincorporated beliefs

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    d. Learning to express feelings and opinions with transparency
generally and in mixed gender groups

      6. THE INNER PERSON AND INTENTIONAL PROCESSES
      7. THE STRUCTURE OF THE PERSON‟S WORLD

     8. CHARTING AND CHANGING ONE‟S LIFE TOPOLOGY
     a. Journalizing about one‟s criteria for fulfillment, experiments
with practicing pursuing alternate criteria, and changes in
perspectives, life topology, behavioral patterns, quality of
relationships, and accomplishments
     b. Tracing the origins of criteria for fulfillment back to family
influences, community and culture influences, the media, social
comparison with peers, the structure of institutions such as schools
and churches and sports
     c. Restructuring your life topology and life style
     9. PERSONAL GOALS
     a. Learning how to foresee and anticipate environmental
conditions and consequences of actions
     b. Learning to foresee, plan, and schedule in terms of changes
or anticipated changes in circumstances, life-conditions, and levels
of structure
     c. Learning to see influences and consequences in terms of
levels of structure
     d. Practicing foreseeing, anticipating, and revising



       10. INTEGRATING GOALS AND BEHAVIOR WITH TIME AND
CONDITIONS
       a. Learning to assess the past and future in terms of different
 ranges of time spans, to gauge and coordinate with time factors,
 and to implement actions that are consciously integrated with
 skillfully estimated time
       b. Learning to envision, decide, set goals, and act in relation to
 levels of structures and environmental conditions
       c. Learning to develop and inner feedback systems to evaluate
 progress and revise strategies and behavior

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    d. Learning to be realistic about foreshadowing, accept
discrepancies between reality and what was foreshadowed, and
adapt accordingly


     11. ADOLESCENT DEVELOPMENTAL STAGES OF MATURITY
and ADULT MATURITY IN FIVE DOMAINS OF LIFE


IX. Measuring Results for Natural Systems Maturity Training
Groups
      A.What Are the Criteria for Success Using Natural Systems in
the „Open Society‟?



      Let us begin by assuming and examining a premise that there
are degrees of structure by which the way humans have organized
their social groups, social settings, or social activities. Let us
arbitrarily use three degrees of structure: maximum, medium, and
minimum. The labels for these three arbitrary degrees can be
changed depending upon what is being analyzed and how the
analysis is conducted. Sticking with minimum, medium, and
maximum for now, we can define, heuristically or tentatively, the
degrees in terms of unrestricted free choice and free movement
versus a limited number of free choices within a limited range of
options provided by a programmed social organization versus little or
no choices within a controlled and regimented social organization.
      Adapting the labels somewhat to the domains being analyzed,
we can use as examples public schools with maximum structure
being elementary school, medium structure being high school, and
minimum structure being college. Another example is adult prisons
that are categorized as minimum, medium, and maximum security
(structure). Leadership style has been classified as laissez faire,
democratic, and authoritarian. Even world religions could be
categorized in terms of specified degrees of structure, for example in
terms of their ideal or textbook descriptions and/or versus their actual
observed variations. Families could also be loosely categorized in
terms of degrees of structure. Perhaps psychotherapy modalities
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could be categorized as having minimum, medium, and maximum
degrees of structure. For example, the degree could probably be
categorized as maximum for Behavior Modification, medium for
Reality Therapy, and as minimum Rogerian Therapy or
Psychoanalysis.

     If one selects a system of categorizing for studying some form
of social organization, then the meanings of the labels and terms and
the method used in categorizing must be clearly defined, as should be
the aspects measured and the techniques for measuring and
analyzing the data. If the intent is to compare features while the client
population is in each designated group the definitions, methods, etc.
must be comparable across groups. The same would be true if one
were comparing outcomes after clients had exited the groups.
       Open society in a democracy would be an example of minimum
structure. Totalitarian, autocratic governments would be likely to be
categorized as having maximum structure, but not necessarily so.
Monarchies can have minimum structure for its citizens. The
denominations of religions and the churches within denominations
will likely vary considerably in terms of degree of structure. The same
would be for types of corporations and businesses. It is hard to
imagine any form of human social organization that would not exhibit
variations that could be categorized in terms of degrees of structure.
The point is to choose and clearly define your terms or labels for your
categories or degrees of structure, related methods of analysis, and
techniques of measurement.
      In Section II. 1., features of a closed juvenile correctional
institution were sketched and criteria for success for the program and
the clients were described. The measures for the program centered
on reduction in such things as violence and escapes and number of
grade levels achieved. These measures were compared across
several institutions, each with a different type of program. The
measures for the clients were also quantified. However, in contrast to
the program measures, the clients‟ progress in levels of maturity that
was central.

       Of course, many variations in the measurement approaches
have been used. In the juvenile correctional institution cited here,
initially aggressive, hostile, anti-social, uncooperative youths were
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tracked using objective measures. As they progressed through their
ranks, they eventually were supposed to attain a level of maturity that
involved being a positive, responsible citizen of their community as
well as being personally and interpersonally mature. Maturity was
determined by records and ratings of observed, increased maturity of
behavior before they could be awarded each successively higher
rank. Ratings were made by their peers and by all of the staff with
whom the clients were involved. Follow up reports of their post-
release behavior in their home community demonstrated that levels of
maturity attained in the institution were maintained in their home
communities. The critical point to notice here is that there was no
attempt to determine or measure any internal personality changes.

      How does this differ from criteria and measures used with
traditional psychotherapeutic modalities? It is important to note that,
traditionally, with respect to psychotherapy, the focus has been on
performance indicators or outcome results that measured personality
change, specific symptom reduction, or client satisfaction. A wide
variety of projective and objective personality instruments as well as
self-report inventories or questionnaires have been used.
Psychotherapeutic modalities have rarely used measures of retention
of benefits at long intervals such as one to five or, even more rarely,
ten years. Measurement instruments typically have been
administered during the course of therapy or immediately upon
termination. Behavior modification programs measured reduction in
observable negative behaviors or symptoms while institutionalized or
during the ongoing outpatient treatment. This is in stark contrast with
The Natural Systems institutional program or my own private
psychotherapy practice. It seems to me that without measurements
taken a long time after treatment ends, outcome measures are
essentially useless.

      B.Measuring and evaluating Natural Systems outcomes in
relation goals.



X.    Proposed Planning and Implementation Strategies


Possible locations for groups:

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      Corporations
      Social organizations
      Churches
Advantages for Businesses to consider:
             Employee Mental Health Insurance Costs Reduction
             Physical Health Outlays Reduced and Productivity Up
             Human Relations and Employee-Staff Relations
Proposed alternatives for remuneration
Marketing to organizations and to individuals
Strategies for securing cooperative agreements with prospective organizations


                        External Structures and Systems



                   Intentionality                Processes



                        Internal Structures and Processes

i
 http://www.forumonpublicpolicy.com/archive06/lazaroff.pdf
The Role of the Diagnostic and Statistical Manual of Mental Disorders in
the Maintenance of the Subjugation of Women: Implications for the Training
of Future Mental Health Professionals
Ann M. Lazaroff
Associate Professor, Center for Programs in Psychology, Antioch
University
Abstract
Since the publication of the first edition of the Diagnostic and Statistical
Manual of Mental Disorders (American Psychiatric Association, 1952), the
diagnostic classification of mental health issues has been rooted in an
individualistic view of mental disorders. Although many of the changes in
subsequent editions have resulted in clearer diagnostic classification, this
individualistic approach fails to take into account the context within which
many of the symptoms of mental disorders emerge. While the codes of
ethics of the mental health professions require a consideration of clients‟
socioeconomic and cultural experiences when diagnosing mental
disorders, the research that contributed to the classification system often
failed to take these experiences into account. This paper provides a look at
the impact of social and political pressures on the diagnostic decisions
made by mental health professionals, while also exploring the ways in
which psychiatry‟s classification system has contributed to maintaining the
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oppression of women. The historical minimization of the effects of violence
against women and the insidious trauma of sexism will be explored. Finally,
the importance of teaching a contextual understanding of the DSM, as well
as the impact of socially embedded cultural values and biases in regards to
gender will be explored.
ii
   Requirements for the court to consider the competency and insanity
pleas:
Detailed background information of the defendant.
Past psychiatric history
Medical history
Substance abuse history.
Description of the offense in question by the defendant and by the collateral
sources.
Review of collateral information reconstructing the mental state of the
defendant at the time of the offense, and the time proximate to the offense.
These usually include police reports, witness accounts, notes and
discharge summaries from recent hospitalizations, accounts of
communications of the defendant with others, etc.
Diagnostic Impression. (The absence of mental disorder usually precludes
further evaluation).
Detailed account as to how the given diagnosis was reached.
Description of the correlation between the defendants behavior at the time
of the offense with the symptoms of his/her mental illness. (In the case of
multiple legal charges, each offense would be addressed separately)
The defendant must, in order to be subjected to any criminal proceedings,
possess a satisfactory level of mental capacity to understand and
comprehend the proceedings.(8) Once the trial court is convinced that the
defendant satisfies this requisite level of competency, the defendant may
be put to trial. This guarantee of fundamental fairness during criminal
proceedings additionally incorporates those procedural safeguards
enumerated in the Bill of Rights that are "essential to a fair trial."(9)
Included in these safeguards are the Fifth Amendment prohibition against
compulsory self-incrimination and the Sixth Amendment right to the
assistance of counsel.( Virtually no state allows sociopathy to be grounds
for an NGRI defense, and voluntary intoxication cannot by itself end
culpability. Only a few states still contain the volitional question. Several
state decisions have noted that criminal intent is an absolutely necessary
part of any crime. In recent years, some states have redefined their laws to
focus more tightly on the mens rea, or guilty mind. Under those laws, a

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person must, as a result of a mental illness, lack the ability to willingly or
knowingly commit an act. This looks at criminal intent, rather than
psychiatric diagnoses, therefore claiming an end to criminals getting off
free. Public perceptions are that the insanity defense occurs far more
commonly than records indicate. In fact, the insanity defense is used in less
than 1% of criminal proceedings and is successful in approximately one-
quarter of those cases. Furthermore, defendants who are found insane
spend as much, or more, time in state custody than their criminally
convicted counterparts. The media may foster the notion that criminals get
away with feigning mental defect, only to be released and recidivate.
However, the insanity plea is actually based on a long-standing legal
tradition and is rarely successfully completed. In fact, approximately 70%
of insanity acquittals result from agreements between opposing attorneys,
in which the prosecution agrees that society would be better served by
placing the defendant in treatment, rather than in prison.
iii
    The "McNaughton rule" was a standard to be applied by the jury, after
hearing medical testimony from prosecution and defense experts. The rule
created a presumption of sanity, unless the defense proved "at the time of
committing the act, the accused was laboring under such a defect of
reason, from disease of the mind, as not to know the nature and quality of
the act he was doing or, if he did know it, that he did not know what he was
doing was wrong." The Durham rule states, "That an accused is not
criminally responsible if his unlawful act was the product of mental disease
or mental defect." In 1972, the American Law Institute, a panel of legal
experts, developed a new rule for insanity as part of the Model Penal Code.
This rule says that a defendant is not responsible for criminal conduct
where (s)he, as a result of mental disease or defect, did not possess
"substantial capacity either to appreciate the criminality of his conduct or to
conform his conduct to the requirements of the law." In 1984, Congress
passed, and President Ronald Reagan signed, the Comprehensive Crime
Control Act. The federal insanity defense now requires the defendant to
prove, by "clear and convincing evidence," that "at the time of the
commission of the acts constituting the offense, the defendant, as a result
of a severe mental disease or defect, was unable to appreciate the nature
and quality or the wrongfulness of his acts" (18 U.S.C. § 17). This is
generally viewed as a return to the "knowing right from wrong" standard




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iv
     In any given year, approximately 3.5 million Americans experience
homelessness, 39 percent of whom are children. On any given day there
are an average of 750,000 homeless.

Research by the University of Alabama last year based on
intensive interviews with 161 randomly sampled homeless people
and review of the community's Point in Time Count found a
29.1% chronically homeless population, of which 76% were male,
73% were over age 40, and 20% were veterans. 54% of those
identified in the Point in Time count self reported a substance
abuse addiction, 33% a mental health illness, and 18% reported
a physical disability.


behavior ... reciprocal relation between physical illness and becoming or
being homeless.

US in denial as poverty rises | Special reports | The Observer
http://www.observer.co.uk/worldview/story/0,11581,825150,00.html
Statistics released last month by the government census bureau show that
for the ... rate for children in the US is worse than in 19 'rich' ... Report on
Homelessness
http://www.bethesda-mission.org/report.htm
... statistical information on homeless person's mental ... except by
exhibiting blatantly bizarre or disruptive behavior ... reciprocal relation
between physical illness and becoming or being homeless. National
Coalition for Homeless Veterans - Background & Statistics
http://www.nchv.org/background.cfm#facts
... communities, 45% suffer from mental illness, and half have substance
abuse problems. ... physical health care, substance abuse aftercare and
mental health ... Homelessness in the United States - Wikipedia, the free
encyclopedia
http://en.wikipedia.org/wiki/Homelessness_in_the_United_States
Homeless individuals report mental illness as being the number three
reason for ... homeless statistics show the number of homeless has
remained high. ... Criminal Justice / Mental Health Consensus Project
http://consensusproject.org/the_report/toc/appendix/glossary

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... where patients stay for a period of time to receive treatment. ... person
who is homeless or transport to a hospital for a person who has a mental
illness. ... Mental Health and Treatment of Inmates and Probationers
http://www.ojp.usdoj.gov/bjs/pub/pdf/mhtip.pdf
State prisoners. U.S. Department of Justice. Office of Justice Programs.
Bureau of Justice Statistics. Special Report. Mental Health and Treatment
... Study finds 744,000 homeless in US
http://www.kxnet.com/getArticle.asp?s=rss&ArticleId=84514
AP-NDHomeless,0150 Study finds 744,000 homeless in U-S
WASHINGTON (AP) A study out today estimates nearly three-quarters of a
(m) million people were homeless in the U-S in 2005. It's the first national
estimate of homelessness in Study: 744,000 homeless in U.S. in 2005
http://news.yahoo.com/s/ap/20070110/ap_on_go_ot/homeless_2
There were 744,000 homeless people in the United States in 2005,
according to the first national estimate in a decade. Service Delivery and
Community: Social Capital, Service Systems Integration, and Outcomes
Among Homeless Persons with Severe Mental Illness.(Statistical Data
Included)
http://www.highbeam.com/doc/1G1:78059751/Service+Delivery+and+Com
munity~C~+Social+Capital,+Service+Systems+Integration,+and+Outcome
s+Among+Homeless+Persons+with+Severe+Mental+Illness~R~(Statistical
+Data+Included).html?refid=intlxt_watson
... outcomes among homeless people with serious mental illness. Study
Setting ... conducted of homeless people with serious mental illness at 18
sites ... system for persons who are homeless in each community ...
employment, physical health, or ... outcomes for ... Report on
Homelessness
http://www.bethesda-mission.org/report.htm
... statistical information on homeless person's mental ... except by
exhibiting blatantly bizarre or disruptive

http://www.nchv.org/background.cfm#facts
Study finds 744,000 homeless in US
http://www.kxnet.com/getArticle.asp?s=rss&ArticleId=84514
AP-NDHomeless,0150 Study finds 744,000 homeless in U-S
WASHINGTON (AP) A study out today estimates nearly three-quarters of a
(m) million people were homeless in the U-S in 2005. It's the first national
estimate of homelessness in


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National Coalition for Homeless Veterans - Background & Statistics
http://www.nchv.org/background.cfm#facts
... communities, 45% suffer from mental illness, and half have substance
abuse problems. ... physical health care, substance abuse aftercare and
mental health ...

Report on Homelessness
http://www.bethesda-mission.org/report.htm
... statistical information on homeless person's mental ... except by
exhibiting blatantly bizarre or disruptive behavior ... reciprocal relation
between physical illness and becoming or being homeless.

Service Delivery and Community: Social Capital, Service Systems
Integration, and Outcomes Among Homeless Persons with Severe Mental
Illness.(Statistical Data Included)
http://www.highbeam.com/doc/1G1:78059751/Service+Delivery+and+Com
munity~C~+Social+Capital,+Service+Systems+Integration,+and+Outcome
s+Among+Homeless+Persons+with+Severe+Mental+Illness~R~(Statistical
+Data+Included).html?refid=intlxt_watson
... outcomes among homeless people with serious mental illness. Study
Setting ... conducted of homeless people with serious mental illness at 18
sites ... system for persons who are homeless in each community ...
employment, physical health, or ... outcomes for ...

Study: 744,000 homeless in U.S. in 2005
http://news.yahoo.com/s/ap/20070110/ap_on_go_ot/homeless_2
There were 744,000 homeless people in the United States in 2005,
according to the first national estimate in a decade.

Study finds 744,000 homeless in US
http://www.kxnet.com/getArticle.asp?s=rss&ArticleId=84514
AP-NDHomeless,0150 Study finds 744,000 homeless in U-S
WASHINGTON (AP) A study out today estimates nearly three-quarters of a
(m) million people were homeless in the U-S in 2005. It's the first national
estimate of homelessness in

Mental Health and Treatment of Inmates and Probationers
http://www.ojp.usdoj.gov/bjs/pub/pdf/mhtip.pdf


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State prisoners. U.S. Department of Justice. Office of Justice Programs.
Bureau of Justice Statistics. Special Report. Mental Health and Treatment
...

Criminal Justice / Mental Health Consensus Project
http://consensusproject.org/the_report/toc/appendix/glossary
... where patients stay for a period of time to receive treatment. ... person
who is homeless or transport to a hospital for a person who has a mental
illness. ...

Homelessness in the United States - Wikipedia, the free encyclopedia
http://en.wikipedia.org/wiki/Homelessness_in_the_United_States
Homeless individuals report mental illness as being the number three
reason for ... homeless statistics show the number of homeless has
remained high. ...

National Coalition for Homeless Veterans - Background & Statistics
http://www.nchv.org/background.cfm#facts
... communities, 45% suffer from mental illness, and half have substance
abuse problems. ... physical health care, substance abuse aftercare and
mental health ...

Report on Homelessness
http://www.bethesda-mission.org/report.htm
... statistical information on homeless person's mental ... except by
exhibiting blatantly bizarre or disruptive behavior ... reciprocal relation
between physical illness and becoming or being homeless.

US in denial as poverty rises | Special reports | The Observer
http://www.observer.co.uk/worldview/story/0,11581,825150,00.html
Statistics released last month by the government census bureau show that
for the ... rate for children in the US is worse than in 19 'rich' ...
v
  Recent articles have raised questions about the assumptions concerning
the effectiveness of Managed Care. Critics of the system argue that
managed care is reducing the introduction of new technology, interfering
with the physician-patient relationship, worsening outcomes, restricting
clinical research, reducing funding for physician training and adversely
effecting community based hospitals. Others raise concern about

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monopolistic trade practices, ruthless business techniques and the
subversion of medical ethics.
        Has the essence and tradition of humane services provision been
sacrificed through management systems that embody corporate principles,
systems, language, and values. Is humane managed care an oxymoron?
        As consumers, payers, and providers of mental health services
increasingly become focused on outcomes-oriented data, states will need
to reorganize epidemiologic, financing, and service delivery data and link
databases in order to monitor mental health care and assess outcomes
associated with that care.
vi
    Managed Mental Care arising from attempts to manage (reduce) costs
http://www.cga.ct.gov/2005/pridata/Studies/Mental_Health_Parity_Briefing.
htm
http://www.fmhi.usf.edu/parity/parityreport/managedcare.html
http://www.naswpress.org/publications/books/health/humane_mngd_care/2
944preface.html
vii
    http://psychrights.org/Research/Digest/ADHD/ADHDAsFraud.htm
The American Psychiatric Association‟s Diagnostic and Statistical Manual
has grown from 112 mental disorders in its initial, 1952 edition, to 163 in
the 1968, DSM-II, to 224 in the 1980, DSM-III; 253 in the 1987, DSM-III-R,
and, 374 in the 1994, DSM-IV.
http://www.shirleys-wellness-cafe.com/ritalin.htm

____________________________________________________________




'Duplex Pyramids' above is the logo of the Natural Systems Institute.
The top inverted pyramid represents layers of external structures and
systems and the bottom pyramid represents layers of internal structures
and systems. The extension of the pyramid to the left represents degrees
of distance into the past, while extension to the right represents degrees
of projection into the future. The underlying theoretical assumption is
that effective, enduring change in humans and human social systems
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comes only when these multidimensional relationships of the external,
internal, past and future perspectives are all addressed as change efforts
are attempted.
             THE NATURAL SYSTEMS INSTITUTE
Introduction to the Theory Underlying the Natural Systems Institute

1.    Stars and Stripes: A Correctional Program for a Juvenile Institution
for Felons
2.    Parenting Skill Training
3.    Solutions to School Violence
4.    Psychological Self Help
5.    Neighborhood Organizing
6.    Addiction Online Workshops
7.    Organization Restructuring
8.    A New Paradigm for Psychological Treatment Based on Natural
Systems
9.    Stages of Growth in Maturity and Suggestions for How to Facilitate
that Growth
10. A Description of Natural Systems' Structural Theory of Personality
11. Postings of Essays Addressing Major Problematic Issues in Our
Culture
12. Outlines for Workshops on Adolescence, Parenting, Relationships,
Organization Restructuring, and Creativity
13. Creativity and Managing the Conscious Mind
14. A Plan for Restructuring the Harris County Juvenile Probation
Department
Young Family Home Page
For questions or comments, mailto:nsi@TheNaturalSystemsInstitute.org




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