Freedom And Mental Health

Freedom is healthy.

I have always believed this, and still do.  My perspective comes from many places — my upbringing, when I was bombarded since an early age by my Russian-immigrant grandmother how wonderful it is to be in the United States, where we are free, unlike the oppressed and subjugated multitudes left behind in the “Mother Country.”

Whether in philosophy or neurology, neuroscience or the applied study of behavior, having more options, more “degrees of freedom,” as well as — one would hope — the intelligence to make decisions among such options, is so basic a descriptor of humanity that it is part of any imaginable statement about the nature of human beings.

Some of the most heart -wrenching patients I have ever cared for are those who have been captured or subjugated in some way, and lost, to some extent at least, their ability to use their bodies or minds as they wish.

From valiant veterans who survived as prisoners of war, to those imprisoned by their own intrusive recollections of combat.

From people who were incarcerated in prisons and subjected to the harsh realities of prison life as administered by the authorities, as well as those subjugated by other prisoners.

From those refugees from other lands who come to our great USA and also our own natural citizens who are in care-taker systems – nursing homes, hospitals and mental institutions.

These are the ones where I plow though paperwork and bureaucracy, sometimes fighting tears, unaware of the passage of time and seemingly impervious to fatigue, until I can do whatever I need to do so that I can get them relief.

From brain studies in animals to behavioral studies in humans we seem to know perilously little about the effects of freedom — or lack of it – on human beings.  Neurophysiology, or neurotransmitters or any of the usual stock in trade of a psychiatrist — the places I turn first to look at the whys and wherefores of the phenomena I observe.

I must move to those frames of reference used in psychology.  I must do so because sometimes I see a lot — an amazing amount — of the problems seen in patients dominated by issues of freedom and control.

Curiously enough, many people describe their problems as a lack of sufficient control — over others.

I cannot count how many times I have been told by a woman who says “My life would be a lot better if my husband would … (fill in this blank however you please).

In such cases I am no help at all.  For despite my exalted credentials, I don’t have any pretensions of “husband-control.”

Helping people control each other is not in my skill set.

Persuasion, maybe — controlling, no.

I like the approach in a Scientific American article from the motivational psychology viewpoint – offering the definition of the factors that control us as reward, punishment, compulsion, and restraint.

Although a “reward” would certainly encourage us to do something, it is not (generally) seen as a bad thing, although I suppose a reward for doing something bad would be most regrettable.

“Punishment” may encourage rebellion more than submission to authority in the end.  I have certainly seen that happen with parents and children in shopping-malls around the nation and the world.

“Restraint” stops someone from doing something, while “compulsion” makes it happen.

With few exceptions, like professional athletes or jail inmates maybe, our freedom seems to be controlled more by ideological or intellectual barriers than by physical ones.  Concepts like “legal” and “illegal” or ‘ethical” and “unethical.”

One idea I have used in conceptualizing freedom, in my patients as well as the world at large, which was introduced to me by an especially psychologically sensitive preceptor early on in my training, was that of an internal vs. external locus of control.

Some people feel as if they are largely in control of their own lives — an internal locus of control.  They are the masters of their fate, making their own decisions and going their own way.

Whereas others feel that outside forces control their lives — primarily an external locus of control.  These are the victims of life/fate, pawns in the game, flotsam and jetsam adrift in the currents of life.

Of course, it is really hard to conceptualize someone as being wholly one or wholly the other. I would guess we are mostly somewhere in between and it varies according to circumstances.

I recall Viktor Frankl — Holocaust survivor and originator of Logo-therapy — as writing at one point that even if one was totally dependent on someone else, the reaction to the action of the caretaker was the choice of the person being taken care of, and could influence the person taking care.

In other words, I suppose, if you look at things that way, even a physically dependent person who would be expected to have a pretty exclusively external locus of control, would have an internal one, too.

This concept of internal and external locus of control comes from the work of Julian Rotter. Even though he was pretty much opposed to the medical model (which has some admittedly obvious limitations in psychiatry/psychology), I love this guy.

Any and all biographical information about him starts with an allusion to his being descended from Jewish immigrants.  Although he was born back in 1916, and published his theories of social learning about the time I was born, his integration of personal and behavioral psychology seems to me to be imbued with a sort of optimism, believing that change (hence, hopefully improvement) is always possible.

That kind of an attitude resonates with “moi,” — this descendant of Jewish immigrants.  This optimistic core, as well as his advancement through the academic system by sheer hard work — well, I love this.

He, too, grew up in a world where subjugation was left behind in favor of freedom, as well as the consequent opportunities for advancement through hard work and personal achievement.

I was sentient enough when I lived in that world.  My Russian-born Grandmother-Of-Blessed-Memory actually told my Brother-Of-Blessed-Memory that he could grow up to be president, if he actually wanted to and worked hard at it.

She said it in front of me.  I did assume this career path was not exactly open to me, as I was female, and did not so much as make a whisper about that.  This was about 50 years ago, and at that time, there were outrageous fictions about a woman becoming president!

I have seen so much change, from the post World War II United States into which I was born, into the United States where I now live, that they seem like different countries.  Except for the diminished size of cars and trucks, which looked like miniatures from the moment I disembarked the first time at the Paris airport, and despite the difference in mentalities, there was a benign and even energy-giving atmosphere that seemed to nourish an immigrant population.

Like Charles Aznavour’s song, “The Immigrants” (which I dearly love) we need to remember that French immigrants included Marie Curie and Pablo Picasso.

The American list is larger and longer, with Irish and Chinese immigrants who built our railroads, refugees of oppression in Russia like all four of my Grandparents-Of-Blessed-Memory as well as scientists like Einstein and musical icons like Irving Berlin – people who made our country what it was.

I am not saying the list and the phenomenon are ended by any means.  I am saying that pulling this off may be a great deal harder than it has been.  There certainly seem to be enough real or perceived differences that the atmosphere of delirious, pervasive optimism has evaporated.

We even have a street culture where achievement may not be an ideal as much as finances or other factors which I, as a professional brain-lover, have no pretense of understanding.

We are not in the idealistic place of my beloved pamphlet by Benjamin Franklin, “To Those who would Remove to America.”

We are in an angry, violent America, where it is rare for me to hear optimism about anybody getting a job, let alone becoming president.  Of course, being president may not be a really good job, because statistically, about 10% get assassinated and about 20% don’t survive their term of office.  Would you take a job like that?

So it has occurred to me that this may be in some way be a response to a lack of freedom.  Because of where I have been, if I can’t put things directly into a neurophysiological paradigm, I will look next at a behavioral one.

I remember early readings in my psychiatry training when I learned that stress was physiological.  Studies of mice who could not get to food because their poor little feet had been attached, albeit gently, to their cage floors to limit movement.  This is certainly curbing freedom.

They went on to get little mouse-ulcers in their little mouse stomachs.

My bet is that they were pretty ornery, too.

Maybe, just maybe, America has a big country-sized ulcer.

Classical psychology has long dealt with the notion of freedom requiring responsibility, the ability to conform to and/or ignore pre-existing, structured belief systems.  Yes, government structures seem to qualify as “belief systems” – democracy, socialism, communism, etc.

In the question from the Libertarian linked above — “So who owns you?” — various answers proffered seem to be variations on the theme of “Nobody, really,” for the person who answers can do a variety of things.

My answer would be very different.  It would be, “My belief system, thank you.”  I would like to think that it has been changed for many years from careful reflection and redecision, but most of us, including me, are just too busy. We are deeply involved in survival and in navigating the “here and now.”

Besides, I freely admit that a lot of my belief system is extrapolated from my childhood upbringing as is everyone else’s, at least a little.  Sure, we can move between the influences of internal and external loci of control.  But as I have advised friends raising children, there should be no regret in giving children an ideology, even if you realize you may just be giving them something structured they can reject later.

So obviously I think the idealistic views of God and the Universe and America and the Founding Fathers are hot stuff.  But as a sentient human, I would not be terribly bright if I were blinded to the fact that we have fallen quite short of where it seems we ought to be.  I find myself at the brink of the abyss, with only the U.S. history, constitution, and laws to shield me from the anger of the people as expressed by talk-show hosts with no instruction or knowledge except possibly, minimally, in the ability to arouse emotions with certain utterances in the English language.

I need a responsible constitutional scholar.  Moreover, I think I actually found one and I think I love this guy.

Jonathan Turley is a professor at George Washington University school of law, who seems to have both the credentials to know what he is saying and the willingness to say things.  He covers places I do not usually look, like Gallup polls, because I am not convinced that majority rules in most issues.

But knowing that many Americans feel that they have had a decline in freedom is a great starting off point for inquiry.  I mean, only 79% of us are satisfied with our level of freedom.  This has dropped.  He looks at legal reasons why.  I go to behavioral and psycho-therapeutic constructs.

Although Turley wrote this column in 2012, the situation seems to have gotten worse, and I see no signs of it getting better.

Most of the specific instances cited by Turley are specifically limiting freedom by giving the president the right to imprison pretty much anybody without meeting the customary United States laws for doing so.  Every similar example cited seems to be an example of “the pot calling the kettle black” — that is, procedures which the United States has solidly condemned as indicative of totalian regimes, presumably inappropriate, in other countries.

I love that at the end of this column, Turley quotes what Benjamin Franklin said to Mrs. Powel, when she asked him immediately after signing the constitution, whether he had created a republic or a monarchy.

He answered, “A republic, Madam, if you can keep it.”

Oy!

Free speech is in equal peril.

With the executive branch having what seems like an arbitrary ability to detain any of us for any reason (I’m fairly cute for an older woman — maybe on some level I don’t look like a terrorist) it is a wonder we are not all scared stiff.

Maybe the elephantine grandeur of our nation is so egregious, the bureaucracy so dysfunctional, that we have refocused any anger we have and redirected to their simplified, emotional view of the world status, for they actually have staff members who (might) answer the phone.

Reading Turley’s review, it seems to me that we are becoming  in plain sight and with a press that it at least theoretically “free,” not only that sort of thing we hate, but that sort of thing we had a revolution against.

Solutions?  Even on the internet, few and far between.  Nobody seems to be gearing up for the next American Revolution.

This may be a world problem.  I am reviewing sites now.

So far, this one might make the most sense.

I am still reading it. Some people (in popular culture) use the terms “crazy” and “insanity” in a non-medical and non-legal way.  They say things like, “Our country has gone crazy” or “The government is insane.”

That is hyperbole, of course.

However, our mental health is definitely affected by the way we live, and we are forced to live.

Call that what you will.