Letter 4 – Clinical Inquiry

“For a range of clinical problems, specifically cognitive interventions do not produce superior outcomes to the behavioral components of CBT [cognitive behavioral therapy].”

—  Richard Longmore and Michael Worrell,

      “Do we need to challenge thoughts in cognitive behavior therapy?”


Before I left for Russia, I asked a professor at Duke what to read about the individual psyche. We discussed mainly psychoanalysis and affect theory, but finally, she said, “You could always try scientific psychology.”

“Oh,” I said, suddenly recalling the tedium of empirical articles I read for my abnormal psychology class. “Historically, I haven’t found them to be very… inspirational.”

“Yes,” she said, “I know what you mean.”

But since that conversation in May, I’ve experienced growing cognitive dissonance: How can I be seeking to learn about the individual psyche in good faith while rejecting an entire field named after the psyche? Given the rate at which I invoke “hermeneutic generosity,” the specter of hypocrisy compelled me to detour through the world of clinical psychology research.

When I was learning about cognitive behavioral therapy (CBT), the leading psychotherapy, in class, I was constantly and “maladaptively” annoyed by its underlying theoretical assumptions. I’m sure it works decently, but to me there is something distasteful about a therapeutic model which diagnoses “real” and “distorted” thoughts as though the emotional and affective realms could be assigned truth values. I decided to read an article on precisely this: “Do we need to challenge thoughts in cognitive behavior therapy?” (2007), published in the field’s top journal: Clinical Psychology Review.

Essentially, this article reviewed the key studies that had tried to compare the cognitive elements of therapy with the behavioral ones. Cognitive therapy involved “restructuring” the patient’s thoughts by logically disproving their “distorted” thoughts and replacing them with “reality-aligned” ones. Behavioral therapies involved exposure to the feared stimuli and increased behaviors that brought pleasure and mastery, warding off depression. Across the board, the study found “no difference in effectiveness between the cognitive and behavioral components of CBT.” In study after study, the authors reported surprisingly similar clinical improvements. It’s not that neither worked; it’s that they worked equally well. From this, the authors proposed future research questions, including whether or not behavioral and cognitive systems might interact so that therapies addressing one system also impacted the other.

To reach this hypothesis, the review cites nearly 100 articles from research which took decades and millions of dollars. Because I’d been reading Freud’s Interpretation of Dreams (1900) earlier in the week, I recalled several points at which he said things like: I’m not going to prove this any further, because anyone can confirm this from their own experience. Especially given that Freud is lampooned as a pseudo-scientific figure in clinical psychiatry, I think the contrast between his methodology and that of clinical psychiatry is illuminating.

Unlike any of the researchers cited in the article, Freud makes overt use of introspection. Because of this, he does not assume that the human being is a black box, as the studies in the review did. They treated the patient like an unknowable algorithm, and thus thought it would be instructive to compare inputs (therapy packages) with outputs (symptom reduction over time). Those researchers evidently did not speculate about the subjective experience of patients undergoing various types of therapies. Had they, I’m sure they could have imagined that actively facing a fear might change your cognitive assessments about the potency of its threat and your ability to survive it. Instead, clinical psychiatry’s “empiricism” precluded introspection.

Freud shows that what gets lost in the fetishization of empiricism is the step that precedes the empirical experiment: the formulation of the hypothesis. His work implies that the hypotheses generated by introspection and intuition better approximate reality than do those formed by making no prior causal assumptions under the banner of scientific neutrality. I plan to keep reading clinical psychology articles, since it was nevertheless very instructive to begin understanding the methodologies and value systems of the discipline. I can’t wait to see how the clinical texts will converse with the literary and theoretical texts I will read over the next four weeks. I suspect that, like the cognitive and behavioral systems, these two intellectual systems can inform each other.

Letter 3 – Detours through Non-Fiction

Like many people, I have spent much of the last week learning about Chernobyl. Specifically, I did so by reading Serhii Plokhy’s book on the 1986 nuclear accident, Chernobyl: History of a Tragedy (2018). This experience has helped me further two lines of thought that emerged in previous blog posts: 1) the relation between the individual and history, and 2) the importance of aesthetics (in art, writing).

Chernobyl Book Cover
If you would like more information about the book, I wrote an intro of it for the Moscow Times: https://www.themoscowtimes.com/2019/06/08/chernobyl-history-of-a-tragedy-serhii-plokhy-a65782

The Individual & History

Last week, I discovered that traces of human subjectivity could be found in unlikely places. This week, I’ve found another unlikely place: the Chernobyl disaster in Ukraine. While reading Plokhy’s book, I was astonished to see the profound effects the impulses of a few individuals had on events which affected the world. Precisely who filled the roles of energy minister or reactor designer or construction team leader turned out to influence the course of history.

For example, the rapid and unsafe expansion of the Chernobyl nuclear plant was at least partly motivated by the ambitions of the U.S.S.R.’s then-minister of energy. He was “determined to get noticed by his bosses” by “increasing the flow of energy” from the nuclear plant as quickly as possible. The safe construction timeline of 7 years was shortened by 2 years to expedite the production of nuclear energy and the minister’s career. When the much-celebrated reactor exploded, the plant operators could not bring themselves to accept that this had happened and remained in denial for the crucial interval at the start of the crisis. Although radioactive plumes were inducing headaches and vomit, the crisis control team refused to admit that the reactor had exploded, because “the myth of the reactor’s safety was shared by everyone in the [nuclear] industry, from top to bottom.”

On the other hand, spontaneous decisions made by individuals were also often heroic. People ranging from firefighters to military employees chose to enter the dangerous radioactive zone to contain the explosion. A Ukrainian official instructed by Moscow not to evacuate people prepared the evacuation buses anyway, so that people could leave the danger zone as soon as the evacuation order came from Moscow. Such acts undoubtedly saved countless lives.

While it is difficult to isolate the effects of individuals in most cases, and it is possible to argue that their spontaneous decisions were governed by systemic social logics, the book provides ample examples of individual actions determining the fate of other lives. In my first week, I was surprised to see how profoundly systemic factors like capitalism shape the individual psyche. This week, I am even more surprised to learn how much individual actions can shape history. The relationship between the individual and history is obviously reciprocal, but how can I go beyond this to understand the contours of that reciprocity? This is a question I will ponder over the next few weeks.

Aesthetic Agendas

While reading the book, I also became aware of my own individual filter on the text. Despite the seriousness of the theme of nuclear catastrophe, I found myself gravitating to the aesthetics of absurdity and irony that suffused the Soviet response to the crisis. There were times when I laughed reading about the world’s worst nuclear disaster. For example, when radiation was spreading, local officials in Ukraine wanted to cancel the May 1 parade due to the health hazard, but their Moscow bosses demanded the parade continue for the appearance of normalcy. I couldn’t help laughing when I read that Gorbachev himself said, “Just try not holding the parade! I’ll leave you to rot!”

Perhaps this is terrible, but the following passage convinced me that the author himself appreciates these ironies:

“The orders to evacuate the village came as a complete surprise to the parish priest, Father Leonid, who believed not only in God but also in the power of Soviet science. ‘We now have powerful science, so they’ll fix all the problems,’ he told his wife soon after the explosion. Father Leonid’s belief in the power of science came crashing down on May 2, which happened to be Good Friday.”

Does it diminish the seriousness of the topic to enjoy and disproportionately focus on such ironies? Or, on the contrary, does the aesthetic of absurdity actually serve the purpose of conveying the scope of the devastation? I am inclined toward the latter view, because the parts that surprised and amused me are the parts I remember best—the parts which most inculcated the details of the disaster in my mind. When I expressed my doubts to Professor Apollonio, she said something that strikes me as deceptively simple but very true: “The aesthetics make it readable.” And if nobody read (or watched films) about the disaster, it would be forgotten. If last week, the aesthetics of surreal art were a means of escape, this week I see that aesthetics can also be used to promote an agenda in chronological time.

And this seems to be on the serious end of the spectrum. As I was reading your post I recalled photos of the Exclusion Zone when the 30th anniversary of the disaster was in the news a few years ago. In looking thru those if discovered a) that Chernobyl is now a tourist destination, and b) that there’s apparently a subculture of people who go to hunt through the Exclusion Zone illegally called “stalkers.” Apparently one of the things some stalkers are doing is moving stuff around to make more aesthetic “disaster porn”. See examples in this blog: https://theplanetd.com/chernobyl-pictures/. (Aside: I’m not sure I like this kind of travel blog. Actually I’m sure I don’t, but it’s serving as an expedient example, so mine for what’s useful….)

In any case, there’s the absurdity of insisting that things be normal even in the midst of historic disaster—a sense that puncturing the myth of invincibility is worse than physical harm. There’s also the fetishization of the aftermath. I’m kind of susceptible to this in my own way. I love hiking around this area and coming across remnants of what used to be. Old mills and tobacco barns. The old Durham pump station is a very popular hike through the ruins of early city infrastructure, now being claimed by nature. That’s “progress,” not tragedy, but it looks similar.

Letter 2 – Adventures in Surrealism

“Chagall’s…poignant, eternal world, radiant like a window opening from the darkness of our souls into bright blue skies, filled with flying fiddlers, green-faced lovers, and mysteriously smiling cows.”

— Olga Grushin, The Dream Life of Sukhanov

This week I read a novel that delighted and moved me: The Dream Life of Sukhanov (2005) by Olga Grushin. Sukhanov is the middle-aged editor in chief of the leading Soviet art criticism journal, where he pleases the Ministry of Culture with articles like “Surrealism and Other Western ‘Isms’ as Manifestations of Capitalist Insolvency.” About 25% through the book, I felt quite disappointed by it, because the characters had minimal psychic depth. Since Grushin seemed interested only in lyrical images, I resented her for writing a novel instead of a poetry collection.

Surrealist Art
While reading The Dream Life of Sukhanov, I visited an art exhibit that helped me reflect on the transformative power of art, particularly its surreal elements. This is a photo I took at Russian artist Pavel Pepperstein’s exhibit “Human Being as a Frame of the Landscape.” Pepperstein’s notion of the human as a frame resonated with Grushin’s conception of characters, where Sukhanov was primarily a frame for art and musings about art. Pepperstein’s painting and Grushin’s novel remind me that the detour of decentering the embodied individual psyche is often necessary to better understanding it.

But when I told my mentor, Professor Apollonio, that I probably wouldn’t finish the book, she advised me to continue reading. I did and learned that the same Sukhanov who wrote “Surrealism…cherishes madness and cultivates indifference toward the social good” privately adored surrealist art. In his youth, he’d been a talented artist inspired by surrealists like Dalí and Chagall, but abandoned his creative passion for the safer profession of art criticism. I realized that this book did have fascinating things to say—not about Sukhanov, but about art. By depicting moments of psychic transformation and transcendence through sensations of art, Grushin expanded my prior conception of art’s capacity for meaning making.

Last week I misunderstood the babushka in the grocery store by paying no attention to her psychic depth; this week I misunderstood the book by reading it exclusively for its psychic depth. But in both cases, my first and immediate hermeneutic lens was the agenda I had set before encountering the object. Instead of reading the book in front of me, I tried to read the book I wished were in front of me, i.e., a deposit I could mine for psychological insights.

I loved the book once I began reading it as a study of the transformative potential of art, specifically, surrealist art. Surreal images, dreams, and memories perpetually invade Sukhanov’s stable life and force him to confront his repressed artistic past. They shock him out of his chronological self by liberating a host of momentary selves overcome with the admiration of art. But as Sukhanov loses interest in his prestigious career, his momentary selves are shown to alter his chronological self, rather than simply suspend it. These meddlesome selves frustrate, destroy, and finally reinvent his chronological self and the novel concludes with him becoming an artist again. This was why the book could not have been a poetry collection: only the temporal flow of a novel could encapsulate art’s chronologicaltransformation of the individual psyche.

Ironically, I only learned something new about the psyche by abandoning my psychic mining expedition. My conception of where I might find psychic depth had been too narrow. The introspection of characters? Yes. Their sensations of colors? Please. After reading The Dream Life of Sukhanov, my notion of hermeneutic generosity is no longer simply trying to understand the other, but also allowing the other to shape the very meaning of “understand.” My linear model of insight-finding was replaced by a detour model, in which generosity is the willingness to embark on the detours suggested by others. “Alright, I will see what you have to say about surrealism, even though I’m not sure it fits into my goals.” These detours through “blue skies, filled with flying fiddlers, green-faced lovers, and mysteriously smiling cows” cease to be detours as they become sources of psychological insight, paths to the original destination. Perhaps we can never see art or books or people as they truly are, but we can at least try to see them as they think they are, instead of as we think they ought to be.

Letter 1–Incidences

Moscow landmark map
I am including a photo of one of the many maps around Moscow intended to orient travelers. These maps fascinate me because they mark only the parks, monuments, and museums, while the streets they refer to house mostly shops and commercial venues.

A Meeting
The other day a man went to work, but on his way, he met another man, who had bought a loaf of polish bread and was on his way home, to his own place.
That’s about all.
— Daniil Kharms, Incidences

“I am interested in the individual psyche,” I always say while trying to explain my academic interests. I have yet to find a less pompous or more specific way to formulate this sentence. Exploring the individual psyche (I admit, usually my own) is why I am drawn to Russian literature and how I ended up in Moscow this summer. Over the next eight weeks, I will reflect on the question: How can we ethically seek to access the subjectivity of another person?

I expected the most valuable insights into these questions to come from Nikolai Gogol or Daniil Kharms, but instead, a Russian babushka facilitated my ethical growth. While checking out of a grocery store in a sleepy suburb of Moscow, I inhabited a state of near automation: unloading the groceries onto the check-out stand, bagging them, and finally placing my basket on a stack of baskets being collected by an employee of the store. Suddenly, her stare of amused disbelief ruptured my consumerist slumber. Thoughts of bread and bananas dispersed as I studied the older woman and waited to understand the rationale behind such intense affect in a grocery store.

“Shame on you!” she exclaimed. “Forcing a babushka to carry it! The youth these days!” A chorus of shopping babushki instantly chimed in, “The young people these days. Unbelievable.” I apologized in a daze to the babushka and left the store as quickly as possible. On the walk back to my apartment, I forced myself not to immediately repress the unpleasant experience and instead examine it.

I realized that I had failed to so much as look at “the employee” before she demanded my attention. Instead of an older woman or even a human being, I had registered only the red vest worn by the store’s clerks. The decision to place my basket on top of the others had not even been fully conscious. I had implicitly assumed, “She is collecting baskets because it is her job. Because it is her job, she is compensated for doing so. Because she is compensated, I have moral license to hand her my basket.” I was unpleasantly surprised to discover how profoundly I have internalized the logic of capitalism—to the extent that I am automated by it and neglected to think that I might be burdening the woman.

Then I thought more about the red uniform, which literally covers the individuals who wear it. It symbolizes the standardization of individuals into laborers, the confinement and erasure of subjectivity. And I had completely fallen for it by seeing a worker instead of the embodied individual psyche I claim to be interested in. This experience reminds me that the individual psyche cannot be understood in isolation, either from other individuals or from systemic structures. These discoveries about my own individual psyche came through intersubjective exchange with the babushka. Moreover, this exchange revealed the extent to which systemic structures like capitalism mold the seemingly discrete individual.

Ironically, earlier in the week, I had been reading the Russian avant-garde writer Daniil Kharms’s Incidences, a series of fragmented and surreal stories about city life. The grocery store is probably the central topos of these tales, which ceaselessly stage the consumerist indifference to and instrumentalization of others along the individual pursuit of self-advancement. How had I not realized I was enacting my own Kharmsian incident in the grocery store, when my disgust at consumerism had been so vividly conscious while reading Incidences?

I am reminded that cultivating better understanding of ourselves and others is one of the things literature (and its authors) can do. In this sense, writing fiction becomes an ethical act. Over the next few weeks, I want to think about whether we have an ethical responsibility to literaturize life, to unravel the semiotics of the vest in our everyday lives, to offer to people the hermeneutic generosity we reserve for characters.