My Society, My Self

"I was depressed and went to a psychiatrist," says Mati Shmuelof, a poet and doctoral student at the Hebrew University of Jerusalem, and former editor of the literary journal Hakivun Mizrah. "I came in with a specific conflict that happened after I became a Mizrahi [i.e., of Middle Eastern descent] activist. If I were to say in front of family and friends that I'm depressed in Israel as a Mizrahi, it would be met with a big silence. I felt anxiety because of the gap between what I feel and know, and what they know. I didn't know what was okay to say to them and what was not. In therapy, the psychiatrist turned it into a question of whether these were feelings of inferiority and whether it had to do with my professional advancement. She didn't see the broader problem. She spoke with me in Oedipal terms."

Shmuelof says that after four months he left that psychiatrist and looked for a new therapist. "I felt that there was policing and silence around the subject, and I adapted myself to her talk about dreams and fantasies. It's no wonder that most of the therapy was accompanied by hidden violence," he explains, the passion in his voice attesting to the intensity of the memory. "She's an Ashkenazi woman from a good neighborhood in Haifa, who suddenly understood that she was part of a society that manufactures oppression, and that her patient, that I, was looking right at her and telling her so. She didn't know what to do with it."

N. wasn't having trouble with her ethnic identity, but rather with thoughts about couple relationships, and the balance of power between men and women. "One goal I had in coming to therapy was to touch on the issue of partnership," she explains. "I described feminist dilemmas, such as how I could bring myself into a relationship when the partner comes from the oppressor side, or how I can maneuver among societal norms that diminish my self-fulfillment. From the responses of my psychologist, I saw that she recognized these attitudes and related to them, but that there was no point in discussing them because the main thing was for me to find my way as an individual into a couple. The subject was pushed aside."

N. says that even though the therapy was successful, "something was lacking. It's as if she said, 'That's not important, what's important is just your personal happiness.' The feeling was that social discourse is irrelevant to my life."

Psychologist Nissim Avisar is not surprised to hear this. In his small office at Sheba Medical Center, Tel Hashomer, in the ps ychiatric department where he is doing his residency, Avisar explains that he left the therapeutic realm for five years, due to the upsetting feeling that his training did not prepare him to deal with the social distress his patients were bringing to him. He ascribes his motivation to deal with the political issue, "the psychologists' repression," to his perception of oppression as a Mizrahi, although he says of himself: "I'm what you could call a favorite of the nobility. I'm not the classic story of the Mizrahi with a different kind of home and an impoverished environment. It wasn't something personal with Ashkenazi friends, but it was between me and myself."

Avisar returned to psychology after he spent time in New York and saw that the connection between the political and the therapeutic was possible, and he has been researching the subject ever since. In his views he represents a not-insignificant minority of therapists, mostly young ones, who are coming out against the methods used locally for training psychologists, which ignore social discourse and sanctify the neutrality of the therapist. For now, they prefer to put the term "political therapy" in quotation marks.

Touching nerves

What exactly is political therapy? According to Avisar, it primarily concerns the way a patient's problem is defined. "When people have difficulties they ask themselves how damaged they are," he notes. "Relating politically to the social situation frees them from guilt and shame. If you understand that the source of the problem is external, tthis can lead to taking a stance and actively participating in the public space that needs to be changed."

Avisar says that political therapy has more value than regular therapy for people who suffer from problems related to work, money and gender, national or ethnic identity. Moreover, he says, other types of therapy for people with such problems can even be harmful: "The interpretation that's focused solely on the person can become accusatory."

The role of the therapist also changes, as he is prepared to represent the patient with concrete actions, Avisar adds: "This could be in the form of assistance with bureaucratic systems or with problems related to systems of power, in which the therapist can make use of his status. All of these are therapeutic actions." He notes that he has not hesitated to connect patients with potential places of employment, "if I judged that their main problem had to do with earning a livelihood."

Clinical psychologist Maya Mukamal explains that the connection to politics and social issues does not contradict the psychological theories, but it changes the way they're used. She also says that, "there's something very liberating in the patient's understanding that the problem was not created in a vacuum, that it's not something in the individual that went wrong."

Mukamal offers an example of the way in which a political perception can affect the decision of whether to hospitalize a patient: "I remember one Mizrahi patient, from a poor family and with a difficult personal history. At the time, there were a lot of terror attacks happening in Jerusalem and he had to travel three hours to get to therapy. One time, he was asked to show an ID at the Central Bus Station in Jerusalem and he was also searched. He stood there in the line that kept getting longer and started to lose his cool, to get wild, to shout and cry.

"When he arrived at the clinic where I worked he was in bad shape; he talked about the color of his skin, its darkness that incriminated him. The pain he was in is hard to describe. They almost had him hospitalized, because the way he was talking seemed like madness. But in this case, when you're coming from a sociopolitical position, you have to fight for them not to hospitalize the patient, for them to wait a few hours. At that particular point, the important thing was to relate to this feeling of humiliation. As someone who is half-Mizrahi, I shared a similar experience with him."

The psychologist adds that it's very easy in such a case to ignore the political context: "There are 8,000 techniques for ignoring the whole matter of what it means to have a Mizrahi identity. For example, to ask what exactly was taken from him when his ID was taken and what it really means when they take that from you; or what happened to you as you were facing this man, who is a policeman and a father figure. You could ask him these questions, and it's easy to say that they touched a raw nerve."

'Between self and culture'

The most established kind of political therapy in Israel seems to be feminist therapy. The Counseling Center for Women (Mercaz Yeutz La'isha), with branches in Ramat Gan and Jerusalem, charges for therapy according to a sliding scale, depending on the person's ability to pay. It was founded 20 years ago by a group of Anglo feminists. Clinical psychologist Janet Baumgold-Land, one of the center's founders, says that "the starting point is that there can be no therapy without values, and it's better to be clear about your values." What distinguishes feminist therapy, she explains, is that "traditional therapy looks for the psychopathology, but we think that there's a conflict between the self and culture, and try to search beyond the cultural assimilations for the woman's voice."

Therapy for women that doesn't come from a feminist angle can end up reinforcing a sense of guilt, notes Baumgold-Land: "I'm not criticizing other therapies, but rather their effects on women. Traditional therapies often reinforce women's feeling that there's something wrong with them. So in feminist therapy, even if the patient doesn't bring a cultural aspect, we'll bring it. We'll challenge her assumptions; there's no question that cannot be asked in connection with gender."

On the other hand, Uri Shochat, chief psychologist at the Eitanim-Givat Shaul Jerusalem Mental Health Center, represents a more mainstream approach: "At the getting-acquainted stage, I tell the patient that there are different approaches that could help: For example, he could receive social empowerment. I suggest a [dynamic] approach in which we we'll come to understand his inner world." He adds: "Someone may feel a lack of self-confidence and explain it by the fact that he was born in Iraq. He'll attribute it to the social reality that makes him feel less than equal. In the dynamic approach, the social reality is not ignored, but at the same time the patient is invited to shine a spotlight on elements of his personality that affect the way he copes with reality."

Avisar, who interviewed 115 psychologists for his doctoral dissertation on psychologists' attitudes toward the political, discovered that the most common political subjects that come up in therapy are ethnicity (in first place) and gender. But he also discovered that more than half of the psychologists refrain completely from discussing political matters during the course of therapy. He says this can be explained by the fact that over 70 percent of psychologists did not touch on sociopolitical issues at all during their studies and training (only 7 percent said with certainty that they had dealt with such subjects).

A look at the composition of the faculty in the clinical program at Tel Aviv University appears to back this up: It is totally male. Mukamal, who earned her master's degree at TAU, can't conceal her anger when recalling the silence of the students and staff regarding the overt lack of equality in the centers of power. "Most of the students were female," she says. "But did we say anything about this situation? No. And especially in Tel Aviv where supposedly so much attention is paid to social influences, and the lecturers may even have been feminists, but what does it matter if not a single woman spoke out?"

Given this backdrop, it's not surprising that at a conference last year entitled "The Connection Between the Therapeutic and the Political," sponsored by Psychoactive - Mental Health Professionals for Human Rights (an organization of Arab and Jewish mental health professionals, who have recently launched an initiative whereby free therapy is offered to activists), the participants expressed feelings of isolation and apprehension. Writing about the conference on a Hebrew Web site, clinical psychologist Tova Buxbaum said: "Many of the participants shared a sense of professional and personal isolation among the therapist community ... Fears and anxieties [paranoid - or real?] arose about how the focus on the political could hurt them at work and in their professional standing."

Indeed, as one senior clinical psychologist says: "The subject is not interesting. I have never come across such things. Most patients, contrary to what people may think, are not preoccupied with the sociopolitical aspects of their identity." Notes another psychologist, who also practices psychoanalysis and wished to remain anonymous - for one thing, because the topic is "sensitive and complicated": "Among my patients, there's no one with whom I'm working on the cultural question. I work with transference relations and this is what interests and convinces me." He continues: "To me, 'Mizrahi' is no longer an essential concept and I can't remember the last time I said 'Sephardi.' I had a female Arab patient and I did not see nationality as a focus for conflict."

Mati Shmuelof, who eventually found "an Ashkenazi therapist who is familiar with the subject and aware of the social questions and his place in them," certainly wouldn't agree with these views. With respect to the difference between the other methods and political therapy, he says: "It's another kind of therapy. We arrive at a transparency of the balance of powers between us without me feeling that I've said something that's forbidden to say, and without getting a look from him that says this has no place in therapy. In reality, the Mizrahi question is denied and becomes a personal question, and thus I ask myself if I'm not imagining it, if maybe I'm paranoid. My current therapist says, 'It is really true. It's not your problem. There's are a lot of people here dealing with surplus symbolic capital.' In this way I get affirmation of the fact that what I think derives from a social conflict I feel in my soul."