The theme of this conference, as you know, is Psychotherapy’s Challenge: Courage in the Face of Uncertainty. And I am here today to speak with you about both, uncertainty and courage. The uncertainties we face, as psychotherapists and as citizens, are unparalleled. (Of course, every generation thinks its challenges are unique.) But I think what makes ours more perilous is that the precipice we are on, politically and professionally, threatens our very existence.

Let me spell it out. Our generation, like the one immediately before us, has the capacity of ending all sensate life on this planet. And our generation of depth psychotherapists may also be the last of its kind, even if the world avoids the ultimate catastrophe.

So the questions I will try to wrestle with during this talk are:
What kind of courage do we need now?
What kind of response can we give to these threats to our survival?

Hemingway defined courage as “grace under pressure.” Perhaps we can call on our hidden reserves of grace, because the pressure is not going away. Let me pause first for a brief prologue which addresses, I think, both courage and uncertainty.

This ancient fable, whose actual origins are shrouded in mystery, is reputed to have been the work of an early teacher of the Sufi sect of ancient Islam. At a Sufi academy, deep in a Middle Eastern grotto, a group of disciples suffered through some painfully difficult privations, both physical and mental. At the end of their discipleship, they would be considered fit to join the ranks of Sufi masters.

The academy was so demanding, that out of twenty who began the discipleship, only five of the most courageous remained after six months. Each day, the pupils were given new tasks to perform, requiring endurance, wisdom, and bravery. They had to learn how to tame wild tigers, cross deep rushing streams, sit motionless for hour after hour in meditation. They had to traverse a wire suspended above a pit of poisonous snakes. Learn to scale a sheer cliff barefoot. Struggle with predators for their downed game. Outwit a troop of clever, thieving monkeys.

One day, one of the remaining students, perhaps the most courageous of all, bravely approached the master and asked him if he could define courage. The master looked deeply into the disciple’s eyes but refused to answer the question. He sat silent for a long time. Then, as was his habit, he turned the question back upon the pupil. The disciple came up with one definition of courage after another, but none were to the master’s liking. Finally the master took out a small rectangular object and handed it to his pupil. The pupil looked at it anxiously. It was a mirror.

Much like this. (That's the only prop I've got, so…) Of course, if this had been a Jewish mystic, he would have dispensed with all the subtlety. “Courage? Courage?” he would have shouted, “Don’t talk to me about courage, you meshugener!” I’ll tell you what courage is. Courage is going home to your mother and telling her you decided to become a Sufi!” You may have wondered—I certainly did—why I was asked to give this address. It wasn’t because anyone gave me a mirror to look into or congratulated me on my courage.

The conference committee first met over two years ago. The subject of the keynote came up, and someone, I forget who, suggested, “Let’s get Alex to do it.” I was flattered, excited and scared, but I didn’t say no. Since then, I’ve gone through many an anxious moment and many versions of this talk, and I could have gone through many more, but I had to stop sometime. This is the sometime.

Of course I knew that the main reason I was asked to give the keynote was the theme that the committee had picked, and the assumption that I must know something about courage, because I had lost both of my legs and didn’t seem defeated by the loss. I wasn’t an expert on courage, believe me. But I thought I could at least demonstrate courage by agreeing to give this address to my peers and colleagues.

So let me address the uncertainty, and arguably the courage, involved in the loss of my legs to diabetes. I remember wondering, after my second leg came off, do I want to be remembered as a sniveling, depressed, craven, chicken-hearted old fart, or as a brave and intrepid old fart? I didn’t have to ponder very long. I chose answer “b.”

It was also clear to me that I could treat the occasion as a challenge or as a cause for dwelling on my new handicap. So I put one imaginary foot in front of the other, and, more recently, as you can see, one prosthetic foot in front of the other, and decided to take on the challenge. I guess that’s how a lot of so-called acts of courage may be born.

As you can figure out from what I’ve said so far, I have no overarching theory about courage to offer you. (I’ve wanted to use that word, overarching, ever since I heard a lecture by a Harvard professor, who used it three times in a single paragraph. The other word I love is plethora, but I haven't found any way to use it). But I have witnessed tremendous acts of courage by others, from people struggling with the loss of a child to people taking care of an incontinent parent; from walking into swinging billy clubs on a civil rights march, to standing up in a hostile crowd while defending an unpopular position; from Martin Luther King to the Dixie Chicks.

Winston Churchill, a man of considerable courage himself, had this to say: “Courage is rightly esteemed the first of human qualities because it is the quality which guarantees all the others.”

When it came to the saga of my legs, I was heading into uncharted territory. After my second leg was amputated, there was a short while when I was feeling pretty depressed. Then I got a call in the hospital from a stranger. He said he was a retired cop. He told me he had been in a shoot-out with some bad guys. Both of his legs had been riddled with bullets from a submachine gun. He had to have them amputated. Then he had been fitted with prosthetic legs, like the ones I’m wearing. The bad news, he said, was that it took a lot of practice and persistence. The good news was that he was playing golf again, doing leg-lifts, and mowing the lawn. I, a Jewish city boy who had never mowed a lawn in his life, was duly impressed.

Later that day, my lovely wife Carole came to visit and confessed that she had asked the policeman to call, hoping it would cheer me up. I told her what he had said. “Does this mean you’re going to start mowing the lawn from now on?” she asked with a twinkle in her eyes.

Kids are less inhibited than adults, so they stare at me, realize something is missing, and aren’t afraid to ask. When I was in Israel, a little German boy came up to me and said, “What happened to your legs?” I told him I had lost my legs. He was very concerned. “Oh, he said, “let’s go find them.”

I’ve since learned to be more precise. I tell kids that I had a sickness only old people get (so they wouldn’t be frightened), and that the doctor had to cut my legs off in order that I could feel better. This didn’t stop another little boy. “Can we go to the doctor’s and see your legs right now?” he asked hopefully. I wanted to tell you some stories about people I know who have demonstrated tremendous acts of courage. All names have been changed, and all details tweaked to help make my point.

A friend of mine, I’ll call him Rob, who lives in New York, was taking a walk one night in his own neighborhood. Suddenly he saw a woman across the street being attacked by two young hoodlums. He knew he was taking a big chance, but he rushed to her defense. As he got close, Rob noticed that one of the men had a gun in his hand. Nevertheless he grabbed the man and started shouting “Fire, fire!” at the top of his lungs, the way he had learned from a book on survival. (Always shout “fire” rather than “help”—people are more likely to respond.)

When Rob grabbed the man, the gun went off and a bullet smashed harmlessly into a nearby building. The men let go of the woman and ran away down the street. She was sobbing. Rob comforted her as best he could. He was shaken himself, but he escorted her to the police station nearby. Later he wondered why he had been willing to take the chance. He had never thought of himself as a particularly courageous man. But that event changed his mind forever.

He recalled and finally understood what Albert Camus wrote many years ago: “Courage isn’t part of a man’s personality. It resides in the act, not in the man.” Another friend, let’s call her Sarah, was dying of breast cancer in a West Coast city. We hadn’t spoken for a couple of months. Then she called me at work. Her voice was weak. She seemed exhausted. She told me she had only a short time left, and wanted me to come out soon. I had a critical meeting about a child patient the next day and asked if she could hold out for 48 hours. She said she could.

When I got there, Sarah had gotten out of bed. She had a rosy complexion and seemed fully recovered. Her voice was strong, resonant. After we talked for a while, she let me know that she and her eldest daughter, Toby, had a falling out about a year ago, and though they lived in the same city they hadn’t spoken since. “Let’s go see her,” I suggested.“Oh, no, she wouldn’t even let me in her house.” I cajoled her a little, and she finally agreed. When we rang Toby’s doorbell, Toby opened the door and gasped in surprise, then threw her arms around her mother. Toby and Sarah were both in tears. So was I.

While they sat and talked, I went for a long drive. When I returned, they were animated and looked quite happy. They seemed to have worked everything through. Sarah said she told Toby she was dying. Twenty hours later she did die, her hand in mine.

This is about a third friend, an acquaintance really. Let’s call him Duke. Duke signed up for a windjammer trip out of Camden, Maine. His legs were badly crippled by childhood polio. He could only get around on the ship by using his crutches. But it didn’t keep him from doing his share at swabbing the deck and handling the rigging. On top of that, every morning he hurled himself off the boat and into the frigid North Atlantic waters. He swam several laps around the ship. Then, using his overdeveloped upper body, pulled himself up over the stern. “I’ll be damned,” the captain said. “Never seen nothin’ like it.”

Another story is about my friend Gail. She was a wonderful woman, then in her seventies, an academic, who had retired as an internationally acclaimed expert in her field. Gradually she discovered that her memory was beginning to fade in a rather dramatic way. She couldn’t comprehend the journal articles she was reading. Nor could she write coherently any more. Then she lost the ability to communicate well with others.

When her doctor gave her a diagnosis of early Alzheimer’s, she wasn’t surprised. Other family members had been victimized by the same disease. Calmly but resolutely, she determined that the one disability she couldn’t stand was losing her keen intelligence. She decided to deliberately stop eating and taking liquids, a painless and effective way of self-delivery. Shortly after, surrounded by her loving family, Gail died peacefully in her sleep.

My fifth and final story is about Nathan, a much-admired psychiatrist who found out that he was dying of a rare but lethal cancer. He had always been a caring, modest sort, free of the pretensions of some physicians I have known. As he battled his illness, he never failed to be kind to his colleagues and his patients. He turned over his research to one of his students and his practice to his partner. He spent his remaining days with his children and his wife, bravely savoring each day, fully alive as death approached (illustrating writer Anais Nin’s observation that life shrinks or expands depending on how courageously one lives it.)

By now you’ve probably guessed that all of the people I’ve described were, or are, members of this Academy. This has been my way of holding up a large mirror to all of them and all of you.

Let me turn now to look at some of the dire uncertainties which we face publicly and professionally, and at some of the ways in which we might respond courageously to them. I’m going to paint a deliberately pessimistic picture, in order to emphasize the intractable dangers and problems we need to look at. Needless to say, I don’t claim to have any special talent for predicting the future. Anyone who knows me well can attest to that.

When I first saw The Beatles on the old Ed Sullivan Show, I predicted they would never make it big. They couldn’t sing, they couldn’t play their instruments very well, they had stupid haircuts, and being named after a creepy bug couldn’t help. Some time earlier, in 1960, I was sure that Japanese cars would never sell in the United States, with their foreign-sounding names like Honda, Toyota, and Subaru. After all, the Japanese were known to be great imitators, but they couldn’t possibly manufacture a first-class car like the ones made by Ford and GM.

So you can’t say I didn’t warn you. My record isn’t great. That having been said, let me go back to the uncertainties and dangers we face. At the beginning of the 21st century, the United States was still the most powerful nation on earth. Its power was based largely on its military might and somewhat less so on its strong financial industries: banking, insurance, and stocks. But it was already clear that the U.S. primacy wouldn’t last that long. India and communist China were in hot pursuit. Islamic extremists were mounting a serious political-military challenge.

Our precious standard of living was looking more precarious than precious. What we call civilization could easily collapse in the face of economic upheavals and repeated terrorist attacks. Within our own national boundaries, we have suffered six years of an incompetent and thoroughly corrupt government, a government that claims it’s keeping us safe, but can’t even protect us from the after-effects of natural disasters, like Rita and Katrina. We have witnessed major assaults on our civil liberties by that same government, and a pre-emptive war, which has mortgaged our future and needlessly cost the lives of thousands of our young men and women, not to mention hundreds of thousands of Iraqi civilians.

Most of the time, we shut out awareness of what is really happening, but as therapists we know that pretending can only lead to future disasters. In our AAP family/peer group, we often make reference to a story: Two missionaries were captured by cannibals in the Brazilian jungle. They were thrown into a mud hut with a single barred window. Through it they could see what appeared to be preparation for a religious ceremony.

On the third day of captivity, the cannibal chief and guards came into the hut and seized one of the missionaries. The chief told him he had a choice between roo-roo and death. Of course he chose roo-roo, since he knew what death meant but had no idea what roo-roo might be like. They took him out, tortured him, beat him to a pulp, killed him, and then cooked him in boiling oil.

On the next day, the second missionary was dragged outside. He had seen what happened to the first, so he was prepared. “What will it be,” the chief said, “death or roo-roo?”“I choose death,” the missionary said defiantly.

The chief shrugged. “All right then,” he said, “but first a little roo-roo.” It often feels as if that is our choice too, a little roo-roo before our final destiny. Or even if we manage somehow to avoid disaster, our children and grandchildren may not. Those are the uncertainties we face as Americans at the beginning of the new century.

Now let me speak of the uncertainties that confront us as psychotherapists. But first, once more, a historical perspective. Not everyone reading this is a therapist, so those of you who are, please bear with me for a few moments. When I was an undergraduate, in the early 1950’s, the only therapy I had ever heard of was psychoanalysis. Four or five days a week on the couch, thirty bucks a session (don‘t forget inflation), analyst sitting behind you, taking notes or embroidering or falling asleep.

If you were a patient, and I was, you learned to talk in a “stream of consciousness,” Freud’s approach to accessing the unconscious. There were some alternate practitioners of psychoanalytic psychotherapy whose theories were based on Adler’s and Jung’s work, and innovations like psychodrama which departed totally from Freudian orthodoxy. But for professionals who wanted to do therapy, the only entry to psychoanalytic studies in the United States was an MD degree, a psychiatric residency, and years spent in analytic institutes. The first shot of the incipient revolt against Freudian analysis was fired in 1951, with the publication of Gestalt Therapy by Fritz Perls, Ralph Hefferline and Paul Goodman. Goodman is still remembered as the author of “Growing Up Absurd,” Perls as the founder of Gestalt practice, but poor Ralph Hefferline has disappeared from sight into the bowels of academia. Most of you know that what followed was a major revolution in our field, with the founding of Esalen, bio-energetics, transactional therapy, primal therapy, and so on. The writer John Barth had a good time with the proliferation of therapies, when in one of his early novels, The End of the Road, he championed pugilistic therapy, recommended as a treatment for intransigent and difficult patients.

At about the same time that the new therapies appeared, the field of psychotherapy began opening up to psychologists, who were no longer perceived simply as test-givers, and to social workers, who were no longer perceived as little old ladies who find housing for the indigent. During the sixties and seventies, creativity in psychotherapy flourished, as it did in society as a whole.

Meanwhile, other professions, like pastoral and secular counselors, and nurse practitioners, were allowed to provide psychotherapy as well. And then the chill of managed care, punitive boards and legalistic ethics commissions, not to mention fanatic right-wingers, who thought God was the only proper healer, came down on us. For a time, too, it looked like psycho-pharmacology might put an end to therapy. Just as that barricade was breached, along came evidence-based treatment, which erected another obstacle to innovation and creativity, the qualities that many of us loved most about doing psychotherapy. And cognitive-behavioral became the only therapy taught to most new practitioners. So much for a 60-second course in theory and systems of psychotherapy.

Throughout the upheavals of the past thirty years, the members of this Academy, like others who share our philosophy, have courageously endured as practitioners of long-term, intensive, eclectic psychotherapy. We have defended our values in the face of criticism, legal challenges, and widespread skepticism. It’s always dangerous to generalize about these values, but I think I can make a good case for the following:

• We believe that awareness of, and engagement with, process—is critical for effective psychotherapy.
• We believe that transference and counter-transference are inevitable components of psychotherapy, and must be attended to.
• We believe that dealing with a patient’s defenses is important, though not always critical for our work.
• We believe that our behavior as therapists, and particularly our commitment to authenticity, integrity, honesty, and vulnerability can serve as a model for the patient’s own behavior.
• We believe that mind/body interaction is essential to psychotherapy, and that intervention can focus on either body or mind.
• We believe that appropriate touch has a place in the process of psychotherapy.
• We strongly believe that all feelings, no matter how shocking or outlandish, by either patient or therapist, can be dealt with in the safe climate of the consulting room.

Therapists demonstrate their courage by their willingness to confront when necessary, to comfort when needed, and always to examine, as I’ve said above, their own characterological issues as they affect the process of psychotherapy. A question this raises is: Do I think therapists are especially courageous, more so than other people? Speaking broadly, of course not. All over the world, millions of acts of indomitable courage occur every day, from the single or widowed mother who manages to survive and raise her children on a pittance, to aid workers of all kinds, policemen and firemen and third-world doctors, who risk their own lives saving the lives of others But there is one special way, I don’t mind repeating, that good psychotherapists, and I emphasize good, display their unique kind of courage, and that is by being continually willing to examine their darkest motives, as well as the static of their character issues, any and all of which might contaminate the work of doing therapy. This has always been the hallmark of the American Academy of Psychotherapists, whether we called it counter-transference or self-awareness or self-reflection.

None of that is different in kind from the courage we ask of our clients, only different in the professional responsibility we assume when seeing six or twenty people a day, individually and in groups.

A word about our clients, or patients, whatever we want to call them. Everyone, including me of course, often underestimates their courage, their tenacity in tackling some very painful aspects of the past and present. I’ll share a case with you that highlights what I’m talking about. Carole and I are co-therapists in two groups which meet every other week. One of our patients, a professor, let’s call him Lewis, has been seeing Carole individually for several years. He was also in and out of one of our groups over most of that time.

After he obtained his doctorate in another part of the country some years earlier, he worked briefly as an academic until he had his first severe depression, which landed him in a hospital. Upon release from one of the better snake pits of the day, he again taught at a college until he experienced a manic episode. He was hospitalized for that, too, and later tried to commit suicide, barely surviving his attempt. A series of chance events brought him to Atlanta and then to Carole. He had been supporting himself for a couple of years by tutoring foreign students, which was all he could do.

When he started therapy, he was extremely withdrawn, paranoid, and lacking in the most primitive social skills He had also become obese over the years, although in undergraduate school he had been quite handsome, judging from a photograph he brought.

When he started group, I found him very difficult to relate to. Lewis broke in to talk at the most inappropriate times, made bizarrely insensitive comments, or sat silently with an angry frown on his face. His constant anger, barely concealed, and his massive, intimidating presence reminded me of all the bullies I had to deal with and struggle against when I was a kid. But I respected Carole’s tenacity in sticking with Lewis. And, I must say, Lewis’ tenacity in sticking with therapy.

He developed a courageous way of dealing with almost every new situation. Tutored by Carole, he treated each new event, no matter how frightening, as an “experiment.” That made him more willing to learn novel behaviors without scaring himself into paralysis or inaction.

For example, Carole suggested that since he had always loved reading and writing poetry, he might go to a beginning writers’ group one time as an experiment. He did, enjoyed it, went a second time, and continued going. That led to several casual friendships and eventually to a couple of more intimate ones. Over the years, through more manic and many depressive episodes, he has come, week after week, to therapy, struggling with the demons that plague him. Apart from Carole and me, he has been aided in that struggle by a skilled and caring psychiatrist, who carefully monitors his medications.

But the principal portion of the struggle has been Lewis’s. He lost well over 100 pounds and is now fully employed as an academic dean. He can still seem strange in group, but we call him on it and you can see him making a mental note about it each time. You know that on the next day or the next week, he will perform the experiment of modifying his behavior based on what went on in group.

My relationship with him continues to be tenuous. But I’ve begun to have warm feelings for him, from time to time, so I’m definitely getting better. As Lewis’s case demonstrates, the courage to change is an inspiring quality often exhibited in psychotherapy. But even this kind of courage may be eclipsed by some patients’ willingness to overcome shame, character flaws, self-destructive habits, and reckless addictions.

One of the myths of psychotherapy, propagated by some of the early pioneers, is that character defects are incurable. By character I don’t mean a moral quality, of course, as it is used in everyday speech. What I’m talking about is narcissism, sociopathy, borderline disorders, addictive personality, and similar diagnoses. We’ve known for a long time that character issues can indeed be modified and even cured. And that probably the best approach is some type of group therapy, where the patient is repeatedly confronted by other members of the group, and where reliance on the group process shapes new attitudes and behavior. Over the years, we have found that even such difficult traits as narcissism and sociopathy can be ameliorated in extended group treatment. People like to tell funny stories about how silly psychotherapy is. And sometimes, when it seems very trendy and new-agey and clichéd, I’ve thought it deserving of parody. But when I think of the kind of work done by Lewis and others, who have come back from an ominous state, I become a true admirer. I’m also a long-time admirer of the mind/body connection. It almost seems obvious today that body and mind are inseparable, and that good therapy requires an awareness of the complex, total nervous system interactions that influence behavior. But for decades only a few therapists, including many among you, struggled courageously to find acceptance for these ideas. One of the extremely exciting things happening today is the development of technology, like the PET and MRI scans, which enable us to look directly into the brain and correlate behavior with changes in brain function. The latest research in neuroscience seems to validate much of what we have been doing as therapists.

Several neurologists have proposed that the limbic system of the brain—in evolutionary terms, the next-to-last to develop, just before the cortex and neo-cortex, and then only in mammals, the system situated beneath the neo-cortex, the system responsible for our emotional life— may also be the locus where mammals intuit what fellow members of their species, and sometimes other species, feel and think.

Any of you who have had a dog or cat, or perhaps some other pet, know that after a while, the pet can almost intuit what you are going to do next, and viceversa. My Great Pyreneese, a big white dog named Shayna, can always tell, in tight quarters, which way my wheelchair is going. She moves around me with the grace of a ballerina. And I can pretty much tell what she wants without her having to bark or poke me with her big wet schnozzle. In other words, the apparent ease with which we empathize may be a specific function of the brain, arguably most developed, as I said before, in people like therapists. The New York Times reported recently that all across Africa, India and parts of Southeast Asia, “elephants have been striking out, destroying villages and crops, attacking and killing human beings.” Young male elephants in South Africa have engaged in the abnormal (and previously unknown) behavior of raping and killing dozens of rhinoceroses. For centuries, elephants and humans lived in peaceful co-existence, but the loss of habitat, and competition with humans for resources have led to numerous killings by elephants of people, and, apart from poachers, mostly retaliatory killing by humans. Gay Bradshaw, then a graduate student at Pacifica Graduate Institute, three years ago began a study of elephant trauma based on what is known about human trauma disorders. Combined with knowledge about normal elephant behavior, she and her colleagues found that the herds they were studying were profoundly dysfunctional.

Under normal circumstances, elephants are extremely social animals. A herd functions essentially as a single animal. Studies of established herds have shown that young elephants stay within 15 feet of their mothers for the first eight years of their life. After that, the females are incorporated into the matriarchal network, while the young males join an all-male cohort, but eventually return to the fold as mature bulls.

Habitat loss, poaching, and translocation of herds have caused profound disruptions in these patterns. As a result, newborn elephants are being reared by ever younger and inexperienced females, and there are numerous orphan elephants who have witnessed the killing of their parents. I mention all this about elephants because it appears that limbic communication among them has been disrupted by what appears to be a form of PTSD. A limited number of brain scans that have been done so far indicate damage or dysfunction to the limbic area of the elephants similar to what has been observed in humans who have experienced traumatic events.

Daniel Goleman, whom you may remember as the author of Emotional Intelligence, has written recently about mirror neurons, which describes another level of mammal to mammal communication. It appears that in the limbic system, as well as in the cortex, there are neurons that fire sympathetically to similar neurons firing in someone else’s brain. For example, if you are thinking about a roll in the hay, someone close to you, preferably of the appropriate gender, might start to think about the same thing, more or less simultaneously. Of course, if they have reached a certain age, the other person might start thinking about ice cream, or football, or a beach in Barbados. It hasn’t been proven yet, but mirror neurons probably deteriorate with age like everything else, as some of us know all too well.

The apparent ease with which we empathize seems to be a specific function of the brain, arguably, as I said before, most developed in people like therapists. I’m speaking here of the limbic system again, and one of its most interesting functions is that when two people get to know each other well, their limbic systems begin to resonate with one another. I’m sure all of you have had the experience of finishing someone’s sentences, or having it done for you, with eerie precision. When two limbic systems resonate, it creates a two-way circuit of empathy. Furthermore, the limbic system is connected to circuits in the entire nervous system, and thus throughout the entire body. It is suspected that this could be an explanation for how therapy works through the body as well as the brain. This does not primarily involve the neo-cortex, except as it later interprets the feelings and corrects those that are not useful, giving further credence to the priority of emotional learning over intellectual learning, at least in psychotherapy, and possibly in many aspects of everyday life. Incidentally, that very same resonance may explain how love works, which is not such bad company for therapy to keep.

You may well wonder why I think this is such exciting news. Well, it finally erases any lingering Cartesian separation between mind and body. It suggests, as we have long known, that memory endures in places other than the brain, like the fingers of an experienced pianist or the upper body of a baseball slugger, who has less than a second to decide whether to swing at a pitch or not. It also supports, what we have long known, that purely intellectual interventions don’t lead to long-term change. And the artificial divisions between doctors of the body and doctors of the mind, I believe, will not survive forever. Psychotherapy may finally be accepted, especially the kind most of us do, as a transformative process, dealing with emotions which affects both mind and body.

There will have to be further proof, of course, but it could radically—and in a profound way—affect how we, as therapists, are perceived. It will require, too, a courageous response from us, as we chart new territories in our work, acquire new skills, and take many unknown risks.

So here we are, chroniclers of two kinds of courage, that of the patient and that of the therapist. But what about the other half of this theme, that nervewracking, anxiety-filling, unsettling issue of having to live in this world without knowing, without even a modicum of certainty?

I’d like to tell you a bit about my own dance with uncertainty, and about situations that probably exposed me to some early familiarity with courage, although I make no claim to having responded courageously myself. It goes back some sixty-five years, when I survived the Nazi bombing and occupation of my birthplace, Yugoslavia.

I came to this country as an eleven year old boy with my parents, the three of us having fled from our hiding place in my grandparents’ cellar, and then to a 3½ year sanctuary in Cuba. I was wide-eyed about the great American paradise. I didn’t believe that the streets were paved with gold, but I wasn’t looking for gold. I was looking for justice and freedom, for peace and safety. I was looking for a country I could give my heart to. And I found it. I fell in love with the Brooklyn Dodgers and so-called race music, the forerunner of Rhythm & Blues. I was smitten with Charlie Parker and Walt Whitman. My biggest everyday heroes were Pete Seeger and Roy Campanella, the Dodgers’ catcher. I dreamed we had dropped the atom bomb on Adolf Hitler rather than some remote Asian emperor.

And then, slowly at first, my love affair with America, like most love affairs, hit some rough and rocky shoals. I grumbled about that upstart hick, Harry Truman, who succeeded the incomparable, wonderful Franklin Delano Roosevelt. I had experienced segregation in Florida, where we first landed, and it made no sense to me, having just come from an inter-racial, yeararound Cuban carnival. I asked my father about segregation. He told me to mind my own business, that I would just get in trouble. Remember, there are people who hate Jews everywhere, even here in America. Then I heard about the lynchings of blacks taking place mainly, but not only, in the South. I learned there were many poor people trying desperately to survive in America, especially in rural areas and big-city slums. And in the same year that I got here, the United States incinerated the civilian populations of Hiroshima and Nagasaki.

I didn’t understand the complexities behind these issues. But I knew there was something wrong. My love had gone astray. I was heartbroken. Wise elders have often counseled young people to avoid rebound romances, but I rebounded directly into the arms of Karl Marx and Uncle Joe Stalin, that seemingly kindly, pipe-smoking mustachioed man who reminded me of my loving grandfather. I thought the Communists were committed to social justice and equality, to anti-racism—although it was called prejudice back then—and a peaceful foreign policy. So I joined the youth wing of the Communist Party for a few years, did a lot of dumb and violent things, and gradually found out what a monster Stalin really was.

By the time I reached my late teens, I had regained a little judgment and balance, but I was loveless again. Besides, I had discovered golf and baseball, sports which suited someone who wasn’t very talented, but was willing and eager to spend countless hours in pursuit of such distractions. All of this is offered here as prelude to where you and I find ourselves today. The world is a much more dangerous place. Despite what some of our leaders believe, there is no longer a simple dichotomy between good and evil. The uncertainties we live with every day, as I implied before, can be terribly complex and overwhelming.

And, on the professional level, the uncertainties we live with as psychotherapists can be daunting as well. Our courage will be measured by how we respond to these uncertainties.

I will have more to say about this, but as the Alcoholics Anonymous dictum says, first we have to take an inventory of the ways in which we, as psychotherapists, have failed to live up to our ideals. It will give us a clue as to how courage failed us, how we didn’t take risks that needed to be taken, how we ignored our opportunity to soar and stayed anchored instead to terra firma, looking up at the moon and stars and declaring them beyond our reach.
As Rumi, the 13th century Sufi poet, reminds us:
No mirror ever became iron again
No bread ever became wheat
No ripened grape ever became sour
You will never be dull and ignorant again
Become the light that you truly are.

I
We haven’t found any way of treating working-class or impoverished people, whose psychological suffering may be even worse than the ravages of poverty. As someone who has spent a fair amount of time in clinics for the underprivileged, I understand some of the problems involved. I know how hard it is to adapt a mostly verbal, middle class treatment to people who aren’t very verbally inclined, who may lack the discipline of making on-time appointments, who often are used to communicating in a language that’s unfamiliar to the therapist. Nevertheless, I think our profession has left many in this population down. The failure is widespread, and there’s plenty of blame to go around, from the collapse of community mental health programs to the medicalization of our profession.
II For years we timidly accepted the Diagnostic and Statistical Manual (DSM), developed mostly by non-therapist psychiatrists, instead of developing our own. Finally some of our colleagues are beginning to do something about that, offering an alternative that is truer to our psychological understanding and less dependent on a medical version.
III We haven’t done very well with treating addictions, which are a scourge in our society. Treatments that have worked best of all are mostly of the addicts’ own invention, from twelve step programs to take-no-prisoners confrontational groups. Our contribution has been meager. Not that this is necessarily bad, but logic would dictate that after many years of dealing with addiction, we might have a successful treatment strategy, not just a referral to Narcotics Anonymous.
IV We have sometimes been more interested in pursuing turf wars than cooperating across professions. An example that comes to mind is the relentless way psychologists fought for prescription rights, long the province of psychiatrists, who then felt justified in retaliating by colluding with insurance companies to underpay psychologists and social workers for exactly the same service they—the psychiatrists—were providing.
V Perhaps worst of all, we have aided and abetted the spread of foolish superstitions and quack cures when we should have known better. I’m thinking here of astrology, homeopathy, channeling, muscle testing, all kinds of cataloging and dehumanizing pseudo-sciences, like the Rorschach, the Myers- Briggs and the other personality inventories, which sort human beings as if they were products in a catalogue, three measures of this quality and six measures of that one. I’m thinking also of the phony epidemic of multiple personalities, and too little skepticism about recovered memories of abuse, sexual and otherwise. In an effort to be non-judgmental, we have not stood up to the spread of the latest psychological fads, even when we had our doubts. Not all of these mishaps and follies are equally questionable, but some of the far-out notions are downright dangerous. I realize not all of you share my attitude about these practices and beliefs. While I was writing this, it occurred to me that I had probably managed to insult many of you. But when I hear of people with legitimate doctorates and other graduate degrees defying all logic to promote some unlikely new cure or nostrum, it worries and saddens me.

In a time when our notions of reality are severely challenged by political spin and out-and-out lies, by photographs altered to suit the perpetrator, by a million passionate essays declaiming the “one truth,” by the unreality of the internet, where 50-year-old perverts pretend to be teen-age boys looking to meet girls, we need something to anchor us to reality. It makes it even more important for us, as therapists, to listen and respond with integrity, honesty, and authenticity to our patients, helping them discern what is true and real—and we have to be meticulous for any claims we make about the validity of our beliefs.
* * *
You may disagree with me about some or all of these issues, but I’m grateful that you are willing, by your presence, to give me a forum in which to voice my concerns. There is no conflict, I am quite certain, between our values as citizens and our values as psychotherapists. I don’t know of any therapists in this Academy who are religious fundamentalists or any other kind of fundamentalist. All of us, I assume, are turned off by anyone who thinks that she or he possesses the ultimate truth about matters of faith.

• We believe in the rough and tumble of democracy, not in any individual or cabal having a monopoly of power.
• We don’t accept theologies which hold that human beings are born sinful, or that salvation, if it exists at all, is reserved only for members of a chosen tribe.
• We believe that every human being is precious and can aspire to happiness in this life right here on earth.
• We abhor the abuse of children and animals, who are unable to defend themselves. This is a criminal offense and must be stopped.
• We are convinced that the government’s drug war is misguided, punitive and doomed to failure, and therefore advocate some new, creative approaches to the drug problem.
• We believe that good physical and mental health for all its citizens are deserved by every American. These beliefs, and others, lie at the core of our shared values as citizenprofessionals, and give us an inkling of how to respond to the uncertainties I mentioned earlier.

The values which I cited, and others that bind us in a common endeavor, are the basis on which our profession was created. From the earliest days of psychotherapy, from the time of Freud, Jung, and Adler, these values have been implicitly part of our work. Tyrants and demagogues have always opposed what we do because they know that freedom of the individual is our ultimate goal, freedom from confusion, obsessions, and debilitating impulses.
Freedom from blind allegiance to nation when our nation is in the wrong.
Freedom from patriotism for its own sake.
Freedom from irrational action.
Freedom from compulsion.
So when we practice our professions, we can take pride in work that is almost always on the side of liberty. (I say “almost always” because I know that even therapy and therapists are not immune to corruption, as we have seen in the interrogations of so-called enemy combatants at Guantanamo and at the infamous “black site” detention centers abroad).

Many of you, I know, are involved in political work of one kind or another. Others are still wrestling with the notion that one person cannot change the world. Eleanor Roosevelt’s well-known response to you would have been, “All changes of any importance in history began with a single human being.” There are literally hundreds of organizations promoting progressive change. They need your money but they need your talent even more. And if you’re a certified introvert, as I am, there are things you can do all alone, like writing letters for Amnesty International, or to your local newspaper.

I think you’re familiar with the following fable, a little worse for wear after all these years, and somewhat of a cliché by now:
A father and son are walking on the beach. They encounter hundreds of washed-up starfish, dying and drying up in the sun. The boy picks up a starfish and tosses it into the ocean “Forget it, Billy,” the father says. “That won’t make any difference. You can’t save all these starfish.” “No,” says the boy, picking up another and throwing it in the sea, “but I can save this one.”

So if you’re not inclined to political work, there are lots of starfish out there that need your help. But sometimes the best clue as to what appeals to you is to look at what frightens you most. When I was most terrified of nuclear war, I started an anti-nuclear organization, Psychologists for Social Responsibility. A lot of the help I got in getting it started came from people in this Academy. It’s still out there, like me, limping along. I actually started lots of organizations, but none of them ever made enough money. My ex-wife fondly called me the king of non-profit entrepreneurs.

The kind of psychotherapy we do, and by we I mean those I know best in the Academy, stresses authenticity and honesty, perhaps above all else. In the real world beyond the therapy office, this translates into a hunger for what is genuine, sincere, and truly meaningful. It can transform relationships, dignify work that is inhumane, and convert work that is degrading. It can insist on a world that is decent, peaceful, and free of coercion.

You know, I’ve spent a lot of time and a lot of words painting a picture of our reality which is bleak and desperate. The future, at times, looks painfully desolate. The writer John Ross said it well: “Underground nuclear testing, defoliation of the rain forests, toxic waste…let’s put it this way: If the world were a big apartment, we wouldn’t get our deposit back.”

But I am quite aware that an alternate future exists as well, which looks full of promise, excitement, discovery, and the prospect of universal freedom. In a book edited by John Brockman, over 100 scientists and philosophers, artists and innovators contributed brief essays on “What I Believe but Cannot Prove.” One of the startling aspects of what they wrote was the overwhelming optimism about the future by the majority of the authors. They are our contemporaries and they are neither fools themselves, nor do they suffer fools gladly. I think they are surely worth listening to.

Martin Rees, a cosmology professor at Cambridge, believes that human beings will eventually populate our galaxy and those beyond, and that we will have evolved into unknown forms of vast intelligence. Joseph LeDoux, a University Professor of science at NYU, is convinced that all animals, even cockroaches, possess some form of consciousness, and that we will eventually understand how to tap into this rich reservoir of knowledge.

Daniel Gilbert, professor of psychology at Harvard, thinks we will be able to create artificial consciousness in robots in the near future, who will talk, walk, wink, lie and swear like sailors, and do all of the crud work so we won’t have to.

The overwhelming sentiment of these varied authors is that the future holds such treasures that we can barely imagine them. The social scientist Hazel Henderson, when asked about her view of the future, had this to say: “If we can recognize that change and uncertainty are basic principles, we can greet the future…with the understanding that we do not know, and never will know, enough to be pessimistic.”

Much of what can give us hope is inherent in the work we have chosen, or been chosen, to do, the work that some among us have called sacred. So when our spirit falters, and darkness seems to infuse the world, we can always call on our talent as healers. After that, we will need to care for each other, hold each other, and love one another.

If we ultimately go down in flames, we’ll at least have left an eloquent impact on this lonely, lovely planet, spinning courageously through the far reaches of uncertain space.