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The Identified Patient—Closing Thoughts (Pt 4)

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As I sat and pondered how best to present my closing thoughts, it occurred to me that the family systems theory concept of the identified patient (talked about earlier) could be framed as “cake and eat it too.” Dysfunctional family systems often wish to maintain (and outwardly project) some semblance of normalcy while at the same time “eat” their individual dysfunctions such as dad’s excessive drinking, mom’s compulsive online shopping, or teen Bobby’s escalating drug use. It does not seem like a stretch to extend this to the national level. The U.S. enjoys its identity as one of the most powerful and wealthy countries in the world, but yet, we spend the most on healthcare (by far) with poor results, tens of thousands of young people (and adults) are dying from drug overdoses each year (about 120,000 in 2023), depression levels along with suicide rates (especially among teens) are skyrocketing, students are encumbered by loan debt and unable to find jobs[1], we are eating ourselves to an early grave, and on the woes go.

As I ponder this nationwide disconnection, I’m reminded of another family systems theory concept: family secrets. Family systems theorists and practitioners argue that “family secrets” may well be one of the most psychologically toxic agents that a family system could experience. Extreme amounts of psychic energy are consumed in trying to project a positive outer family identity while at the same time keeping family dysfunction processes a secret. Any adult child of alcoholic parent(s) will tell you this is true. Not to get too technical, however, family secrets force the developing child to know the mind of the parent(s) to the exclusion of their own mind (which is a form of role reversal—the child parenting the parent—as mentioned in the last post). Simply, a child forced to know the mind of a parent(s) is forced to never know their own mind, which, in turn, prevents this child from developing Executive Function skills like reflection, empathy, planning, problem-solving, appropriately focusing attention, and others. Equally, the use of parent substitutes sends the child a message along the lines of, “Your mind is not important nor worthy enough to be known by your caregivers.” An “unminded mind” spells trouble.[2] Again, as Gardner puts it, “[T]he absence of such a bond [of attachment] signals difficulty for an individual’s eventual ability to know other persons, to rear offspring, and to draw upon knowledge as he comes to know himself.”

The real difficulty appears when, as a function of normal development, the young adult’s upper brain (often referred to as the prefrontal cortex or PFC) calls upon the middle, object-oriented, concrete-thinking, middle brain, and asks that a majority of its middle control be given over to a new upper control center, the PFC. This transition from middle control to upper control is a period of “normal schizophrenia”[3] as new control calls emanating from the PFC are experienced as “foreign voices.” The role of initiation rites—for both girls and boys—traditionally have been about helping the young adult get through this period of schizotypal experience (i.e., being of two minds). Parents and other caring adults (e.g., coaches, mentors, etc.) who mind their charges are preparing them for this transition from middle to upper control. The unminded mind may have a particularly difficult time during this “crazy-making” transition. I do not think it is coincidental that young males who have engaged in shootings of late report hearing or being directed by “voices.” Let’s look at family secrets a bit further.

During the Adult Attachment Interview (which I have blogged about many times before), the interviewee is asked to provide evidence for the adjectives selected to describe early attachment relationships with caregivers: mother, father, or other caregivers such as a guardian or close family member. Interviewees who can provide reasonable evidence that creates an overall coherent narrative are usually coded as being securely attached. Those who cannot are often coded as insecurely attached. Interviewees who have had to guard family secrets often are not able to bridge the outside facade (e.g., “best dad ever,” or “ so, so, loving mom”) to the hidden inside realities. In turn, this lack of coherent experiences sets up a barrier to accessing and developing robust Executive Function skills such as reflection, critical thinking, empathy, planning for the future, and, yes, a solid sense of self and identity. In essence, one becomes locked within the “here and now,” object-oriented middle brain (as talked about by Louis Cozolino in his work). Don’t quote me but I think it was the psychologist Bruno Bettleheim who said that parents, adults, and leaders hold the hopes and dreams for the next generation. Today, with our neurobiological insights, we can reframe this as a need on the part of parents, adults, and leaders to act as surrogate PFCs (prefrontal cortex) for the next generation. We, as families and as a nation, must encourage the next generations to access and develop robust Executive Function skills.[4] Honestly, parents, adults, and leaders cannot do this on their own. What is needed is a strong and vibrant cultural cognitive model, like what we used to call here in the U.S. “The American Dream.”

A detailed look at cultural cognitive models would take us too far afield. So, allow me to provide a brief overview. A book from 1996 that has shaped my thinking on cultural cognitive models or maps is as follows:

Changing Visions: Human Cognitive Maps: Past, Present, and Future by Ervin Laszlo, Robert Artigiani, Allan Combs, and Vilmos Csányi.

I should point out that all of these authors write using a systems theory perspective. As an example, Csányi wrote the 2012 book entitled Evolutionary Systems and Society: A General Theory. This focus on systems theory and thinking will become more important shortly.

In the introduction to Changing Visions, the authors write:

Cognitive maps are held by individuals, but the set of cognitive maps of individuals produces a collective kind of construction that constitutes a social [emphasis in original] cognitive map. Such a map, once evolved, takes on a life of its own; it cannot be reduced or disaggregated to the particular maps held by individuals. Since we are guided both by our own individual cognitive map and by that of our society, attention must be paid to both.

The authors give us this bottom line: “Faulty maps … prompt erroneous behaviors, giving rise to various kinds and degrees of shocks and surprises.”

The authors point out that typically the development and wide acceptance of a new technology will cause cultural cognitive maps to shift and change. Here are some of those technological shifts (and not necessarily in chronological order):

  • hunting and gathering technologies
  • agriculture
  • written language
  • printed language
  • gun powder
  • wind energy
  • steam energy
  • telegraph
  • internal combustion engine
  • nuclear energy
  • the digital age

Not up on that list, salt. Yes, salt. In his 2003 book entitled Salt: A World History, historian and culinary expert, Mark Kurlansky, reveals that for centuries wars were fought with and for salt. Salt was a technology around which a cultural cognitive model or map was formed. According to Kurlansky’s account, entire island nations were decimated in a quest to extract salt from land as well as sea. Today we fight wars with and for oil. We live in a worldwide oil economy, not unlike the salt economy only a century and a half ago. Cultural cognitive maps are so wedded to technological development that it is hard to pull them asunder. But it is possible though. Today, rise of the digital age challenges all existing cultural cognitive models. As a result, we live in an age of Changing Visions, one full of shocks and surprises. When cultural cognitive maps and models change, here are the kinds of “shifts” the Changing Visions authors point to:

  • Reactivation of old cultural cognitive models from the past evidenced by renewed conservative and even totalitarian ideologies
  • The rise of maps or models that lack grounding as can be seen in certain New Age and postmodern ideologies
  • Current maps or models retrenching as we are seeing with the oil economy
  • Attempts to create new maps or models such as solar energy, hydrogen energy, and, of course, digital reality
  • Maps and models designed to create confusion and chaos such as propaganda and “fake news”

The DEI movement is one of those cultural cognitive maps that is trying to gain traction. Likewise, the Make America Great Again (MAGA) movement is also trying to gain (increased) popularity. From a cultural cognitive map perspective, these are particularly troubling times. Equally troubling, the concept of cultural cognitive maps never really caught on. As a result, it is hard to see or frame the social tectonic shifts that are rocking our world. Interestingly, sociologists will use the term “cultural narratives.”

In her 2019 article entitled Cultural Narratives and Their Social Supports, or: Sociology As a Team Sport, British sociologist Giselinde Kuipers talks about how the Brexit vote (which was swirling at the time) represented a huge shift in the British cultural narrative. Brexit (which eventually passed) represented a return to conservative, isolationist, and xenophobic times. In effect, this vote was very exclusionary, not only in terms of immigration policy but also in terms of the UK undermining its membership in the EU. As Kuipers puts it, “We were all watching as the British MPs [member of parliament] enacted the greatest drama that affects not only the US but also the UK and most of (Western) Europe: how failing cultural narratives contribute to social crisis [emphasis added].”

Interestingly, Kuipers points out that some sociologists saw the Brexit vote and the chaos it engendered as an opportunity to create new cultural narratives that have the potential to “broaden cultural membership” (a quote that Kuipers attributes to sociologist Michèle Lamont). This all sounds very much like MAGA vs. DEI here in the U.S. I’m guessing but I would suggest that Brexit threw a bunch of fuel on the already burning MAGA fire. Pulling from work by Lamont, Kuipers does a great job describing cultural narratives, where they come from, how they work, and how they could be effectively set up. So, cultural cognitive maps and models are not dead; they have changed their name and have switched their alliance from systems thinkers to sociologists. If you have any interest in cultural narratives or cultural cognitive maps, then I have put a link to Kuipers’ article in the Notes.[5]

So, knowing what we know, how would I counsel DEI? It would go something like this:

Thanks DEI for sharing this time together. I applaud your efforts designed to create a new cultural cognitive map or social narrative, one that has the ability to “broaden cultural membership” as sociologist Michèle Lamont puts it. I do have concerns. It appears that you are reaching back in time to historical events here in the U.S. such as slavery and the displacement of Native Americans, as a way of consolidating your identity. As the work of the International Dialogue Initiative (IDI) shows us, reaching back in time is common. Heck, when IDI, back in the 1990s, was working to settle conflicts between Russians and Estonians, “Russian delegates went back to a thirteenth-century massive trauma and, through a time collapse [emphasis in original], linked emotions connected to this chosen trauma to problems with Estonians after the collapse of the Soviet Union.”[6]

IDI worked to settle disputes in the Middle East before the current war between Israel and Hamas, and ran into a big “time collapse problem”: Israel had latched on to the social narrative conveyed by the slogan “Never Again” (which is a reference to the Holocaust) and would not let go. “Reaching back” and “time collapses” are powerful mechanisms designed to consolidate an identity, and, equally, a purpose. However, these social and psychological mechanisms also have the potential to hide more pressing issues in the here and now. Rather than encourage college students to “call out” professors (as talked about in the book The Coddling of the American Mind), DEI proponents and administrators should be encouraging students and other concerned adults to call out those bringing about new forms of enslavement from dismal job prospects, to student loan debt, stultifying infant and childcare, and a food environment that is making us sick. Should DEI take on each of these problem areas individually? I’m not sure that is a good plan. DEI should spend time on consolidating its identity in the here and now, providing energy to its social narrative here and now. And I think one effective way to do this would be to actively promote a systems worldview. And as Dr. Means (talked about in the previous post) correctly points out (and I paraphrase),[7]

“This will not be an incremental fix that gets us out of this monumental, devastating hole that we’re in; one where we are getting sicker, heavier, more infertile, more depressed every year, and one where life expectancy is dropping. We’re not going to get out of this hole by changing a few words in Medicare Part D, page 250. It’s going to be a wholesale reimagining of the foundation of the whole healthcare system. We’ll need to change our relationships with our bodies. We will need to build a new foundation from the ground up. That’s why I wrote my book Good Energy.”

Good energy translates to good systems. We need to look at automation and the digital age from the perspective of good systems. We need to look at the economy and good jobs from the perspective of good systems. We need to look at health care, especially care for mothers and and their children from the perspective of good systems. I like John Leguizamo’s take on DEI: Diligence, Excellence, Imagination. DEI needs to be focused, it needs a purpose, it needs a vision, a social narrative for the future that is truly inclusive and does not see predominantly male extractors as dispensable (which, by the way, would make me dispensable).

Interestingly, the NSF (national science foundation) is using the DEI brand to sell a systems worldview. In their 130+ page booklet entitled Next Generation Earth Systems Science at the National Science Foundation (2022),[8] NSF effectively says that they will withhold millions of dollars in NSF grants earmarked for effectively saving the planet unless a grantee agrees to abide by DEI. The NSF report has no concrete plan for bringing about the “wholesale reimagining of the foundation of science” (paraphrasing Dr. Means). The NSF report mentions arguably the father of organic systems science, Ludwig von Bertalanffy, in passing as if they are simply changing “a few words in Medicare Part D, page 250.” None of this will work. No coherent cultural narrative exists. As just one example, Western science will have to deal with its “family secret” surrounding its long history of reductionism, which, by design, takes an anti-systems view of the world.

To bring about a systems revolution—a new cultural cognitive map—we’re talking about revamping our entire society from schooling (K through PhD), to healthcare, to economics, to politics, and beyond. And, believe it or not, the objectification and reductionism that is so prevalent in our society, in fact, gets to stay. In the same way quantum mechanics did not displace Newtonian mechanics, a systems perspective will not replace objectification and reductionism because it includes it. As Bertalanffy points out in his work, at low levels of biological functioning, yes, cells can operate using chains of cause and effect. However, at higher levels of biological functioning, say, at the level of societal structures, systems causation holds sway. (See my post Population Growth—A Systems Tale of Two Countries.)

I think DEI has a prime opportunity here to promote both reductionism as well as systems functioning in the same way Newtonian physics has no problem being cheek to jowl with quantum mechanics. Yin and Yang. Masculine and feminine, Left brain and right brain. Dare I say, conservative and liberal. I wish you the best of luck and I look forward to seeing how you take us into the next cultural cognitive model: A Systems Worldview. Oh, and I said that I would make it clear why Dr. Csányi’s work is important. I would suggest that his book Evolutionary Systems and Society: A General Theory is a great place to start; that book and Bertalanffy’s 1969 book General System Theory: Foundations, Development and Application.

Bonus tip. In their book Changing Visions, the authors list the following last entry in their chronology of cultural cognitive models: Compassionate-Systems Revolution (circa 2018). Let it begin!

 

NOTES:

[1] – According to an article over at Intelligent.com entitled 1 In 6 Companies Are Hesitant to Hire Recent College Graduates, new hires, lucky enough to find a job in the first place, are being let go within months because they are largely unprepared for the demands and realities of the business world. Here’s a link to this article:

https://www.intelligent.com/1-in-6-companies-are-hesitant-to-hire-recent-college-graduates/

[2] – Peter Fonagy and his colleagues talk about the importance of “minds knowing minds” (also known as intersubjectivity) in their 2002 book entitled Affect Regulation, Mentalization, and the Development of the Self. Mentalization (often abbreviated Mz) is a form of minds knowing minds. Simply, growing minds need to be “mentalized” or “known” as a way of priming the mind to eventually know itself. Knowing one’s mind (and the minds of others) is key to identity formation. Minds knowing minds is a form of metacognition or “thinking about thinking.” It is not until the Executive Function skills of the upper brain come online that such metacognitions as self-reflection and empathy begin to appear in earnest. This is why early safe and secure attachment is looked at as a proxy for the development of robust EF skills (if all goes right). Safe and secure early attachment goes hand-in-hand with minds knowing minds, or, in the case of the developing infant/child, the mother knowing the mind of the child. Conversely, parent substitutes (e.g., behavioral drugs, smartphones, daycare centers, etc.) rarely if ever have the capacity to engage in Mz or mentalization. And I can guarantee you that at least for the foreseeable future (if ever), AI or artificial intelligence will have no capacity to engage in Mz. AI does not have a mind nor the biological imperative to know other minds. And, sadly, I can already see AI positioning itself as yet another parent substitute. As an example, in response to the “elderly problem” in Japan, resources are being put toward developing robot caregivers. And, yes, faced with the prospect of isolation, the elderly of Japan are welcoming these robot caregivers. Frankly, I cannot blame them. For more on this theme, see the 2010 article by Peters et al. entitled Strange Carers: Robots as Attachment Figures and Aids to Parenting (Social Behavior and Communication in Biological and Artificial Systems, 11, 246–252). You may also enjoy Sherry Turkle’s 2010 book entitled Alone Together—Why We Expect More from Technology and Less from Each Other. I think one way to frame the “online therapy craze” is to see it as a strong and largely unfulfilled societal desire to be known by another mind. Again, rather than remain unminded, people are embracing this robot form of mindedness. Again, I’m not sure I can blame them. We do what we have to do to get by.

Quick story. I have heard Bessel van der Kolk, expert in the area of trauma psychology, speak on several occasions. I heard Dr. van der Kolk speak not long after 9/11. van der Kolk and his trauma team were asked to provide trauma services to survivors and their families. He and his team set up walk-in clinics. He was surprised when very few showed up. Curious, he started investigating what was going on. He noticed that yoga studios were packed. People were taking care of themselves by getting in touch with their bodies. He also noticed another interesting pattern. As reported in the news, landlines and cell towers were jammed in the days just after the attack. Families were reaching out to loved ones. And then the traffic died down. Families were gathering in person. van der Kolk interpreted these patterns as moving from distanced forms of connection (phone calls) to actual physical contact or body-to-body contact. He then said that these patterns fit perfectly with attachment theory where we see the child, faced with fear and uncertainty, returning to the mother to regain physical and direct contact. Sure, technology may provide for distanced forms of contact, but ultimately what we need is physical and direct contact with another body. A phone does not have a body. AI does not have a body. Robots do not have a body. When students callout their teachers or professors (spurred on in large part by DEI), I would suggest that what they are really looking for is contact with a real body, and it simply is not there in our contact-adverse society. They want their minds to be minded in this increasingly mindless digital world. We are, as Turkle puts it, Alone Together.

[3] – I’m pulling this from the work of neuropsychologist Elkhonon Goldberg. See his 2009 book entitled The New Executive Brain: Frontal Lobes In a Complex World. Another book that is relevant here—one that Goldberg also points to—is Julian Jaynes’ 1976 book entitled The Origin of Consciousness in the Breakdown of the Bicameral Mind.

[4] – I’m pulling this from Russell Barkley’s 2012 book entitled Executive Functions: What They Are, How They Work, and Why They Evolved. In his book Barkley argues that Executive Functions evolved as a way of allowing humans to build justice and fair societies that are governed by such metacognitions as The Golden Rule: Do Unto Others As You Would Have Them Do Unto You. If the DEI movement is truly concerned with diversity, equity, and inclusion, then there should be a robust focus on the development of Executive Function skills. Students falling apart into emotionally dysregulated messes or calling out teachers and professors are signposts indicating that we are not on the road to robust EF skills and functioning. The critical analysis of emancipation does not appear to be leading us to the EF skill of critical thinking so needed for a justice and fair society. I’m just trying to unpack DEI’s family secrets here as well as understanding why they have set up a negative feedback loop (using systems analysis).

[5] – Here’s the link to Kuipers’ article:

https://www.researchgate.net/publication/333749272_Cultural_narratives_and_their_social_supports_or_sociology_as_a_team_sport

[6] – This is from the book We Don’t Speak of Fear.

[7] – This paraphrased quote is from the YouTube video Dr. Means did with Dr. Mark Hyman entitled “This Is Decreasing Our Lifespan!” — Dark Side of Food Industry Nobody Talks About.

[8] – Here’s a link to a PDF version of this NSF booklet:

https://nap.nationalacademies.org/catalog/26042/next-generation-earth-systems-science-at-the-national-science-foundation