By Gretchen Gibbs
The front page of The New York Times featured the sad tale of Dr. Donald Levin, a psychiatrist who once provided “talk therapy.” Now, he prescribes only medication to 1,200 clients seen every few months for no more than 15 minutes. Dr. Levin, like most psychiatrists these days, says he cannot afford the time to provide any form of psychotherapy. The article speaks of a “telling loss of intimacy between doctors and patients.”

Of course, Dr. Levin could allow his salary to plummet to the level of the psychologists and social workers to whom he refers his clients. The math is easy. If you have 40 clients a week who pay you $100 a session, you’re grossing $200,000 a year. Dr. Levin did not reveal his salary, but with four clients an hour and working more than eight hours a day, he easily is quadrupling that $200,000.

So partly the loss of intimacy is due to the desire to make money. There are other factors, however. For instance, the field of psychology is also changing. Psychologists themselves are seeking prescription privileges, and in several states have already obtained them.

Training in many graduate schools focuses on “manualized treatment,” meaning that the psychologist is following a manual telling her or him what to say after each type of comment from the client. It’s easier to prove such treatment is effective. Models of treatment are primarily cognitive-behavioral; there’s no attention paid to the causes of one’s problems, only to the treatment plan. The therapist doesn’t want to hear about your past.

I started this piece with the notion that the public is being cheated out of the kind of personal contact they want and need from mental health workers. Then I saw the headline this week in the Times entitled “Teachers wonder, why the scorn?” and I began to wonder if we really honor those whose professional role involves sharing who they are as a person. Why is the country so concerned to cut teacher salaries? Is there a profession that’s more important?

Of course, teaching also has become more technological. On the college level, I have walked the halls and noted the darkened rooms as professors present their Power Points and as students text and play solitaire. Distance Learning is a catchword, and classes are larger. Other providers of human services, like nurses and nurses’ aides, complain that their work has become more technological, with less patient contact. So perhaps as a society we are in some ways complicit with the loss of intimacy caused by these increases in technology.

I heard an interview on NPR with Sherry Turkle, about her book Alone Together, which deals with the isolation that technology is producing. She provides the ultimate example: the use of robots with children and the elderly to carry out the role a person, or at least a pet, would have had to perform previously. There’s Furbie for children and the Paro, a cute baby seal that moves in your arms and makes pleading noises, for the elderly in nursing homes. The illusion of unconditional love, without any bother. Turkle feels technology isolates us, citing adolescents who say they don’t like phoning now, it’s too intimate; they just text.

So the loss of the “human” in human services may be linked to the growth of technology and interest in making money, but many of us seem to welcome it. It’s more comfortable. Perhaps we are redefining what relationships mean. What’s a friend when you have hundreds of them on Facebook? I am too much of a psychologist to believe that people can do without intimate relationships, or that they want to. What’s the impact, though, of a world where it’s increasingly hard to find that connectedness? Perhaps we think we’ll “save” intimacy for those few we really care about. But then, when we’re in an intimate relationship, will we know how?

By Gretchen Gibbs

“Why don’t the women just leave?” I meet a man at a party, and this is how he responds when I tell him I do some work at a domestic violence agency.
 
He goes on, “I know it’s not politically correct to say so, but I don’t get it. Nobody has to stay and be abused. Just get out of there.”

“It’s not easy,” I say, and start citing all the difficulties. Financially, especially if there are children, the woman may not be able to manage on her own. Sometimes it’s dangerous to leave – the man may threaten to pursue and kill her if she goes. Abusive men are usually controlling, and the woman may not have access to any money, or keys to the car. She may not have been allowed to talk to friends, so there’s nobody to run to. And there’s something called learned helplessness. When you’ve been made powerless over and over, you stop feeling that you have any control over your life, you stop trying.

He looks skeptical.

I think of one of the cases I saw, some years ago, a woman I’ll call Rosa and about whom I’ll give only the vaguest real-life details, to protect her identity.

Rosa lived in a remote area of a Latin American country, in the mountains, married to a man who abused her verbally, physically and sexually. He liked to call her all kinds of names till she cried, then rape her.

The worst thing he did, in her mind, was to leave for days at a time, with no food in the house for her and their two small boys. There weren’t any neighbors to beg from. They were literally starving. She was desperate to escape, but she had no place to go. The only possible haven was with her mother, with whom she’d never had a close relationship, and who lived miles away in another remote village. There was no way to get there.

Then Rosa had a third child, Julio.  One evening, soon after Julio was born, her husband was beating her while she held the baby. The child fell from her arms, hitting his head. Julio never recovered consciousness.
  
Abused women often recount their tales numbly, from some inner place they’ve tried to make an unreal dream world. As Rosa told me about the dead infant, she began to howl, to rock back and forth in her chair, to bite her fingers. Usually I try to stay with the woman’s pain, but Rosa’s was more than I could stand; I asked her if she was able to move on with the story.
 
Her husband left again, after burying the baby in the yard. Rosa took the two children and whatever food she had and headed out for her mother’s. She could not take the road, as she feared her husband would come looking for her. She struck out over the mountain, carrying the two year old and urging the four year old on. Soon, she had to carry both children. She would haul one thirty feet up the mountain, tell him to stay there, then go back for the other and carry him up. Night came, and they huddled together for warmth. The food was gone quickly, and the streams for water were infrequent. It took two days and two nights to get to her mother’s. Rosa and the boys were covered with filth and scratches and insect bites, so exhausted they could barely stand.

In my office, Rosa began to sob and rock again.  She could not get the words out to tell me. Finally she said, “My mother contacted my husband to come get me. She said it was women’s lot to suffer and endure.”

Eventually Rosa ran away again and this time she did make it, with the children. I contemplate telling the man at the party about her ordeal, but I see it’s pointless to try to sway him. “However it may seem from the outside, leaving is not easy,” I repeat.

Gretchen can be reached at gretchen@zestoforange.com.