View Full Version : POWER and Powerlessness - by Susan Rosenthal MD

09-27-07, 11:48 PM
Reviews (http://www.powerandpowerlessness.com/reviews.html)

Psychologica, Newsletter of the Ontario Association of Consultants, Counsellors, Psychometrists and Psychotherapists (in press).
Reviewed by Liv Capozzi
Reprinted with the author’s permission.

POWER and Powerlessness is a poignant, well written book that connects politics, economics, and human health. Dr. Susan Rosenthal draws from personal experience, and years of professional experience as an MD psychotherapist, to illustrate how human suffering flows from an imbalance of social power. Absolutely unapologetic in her position, and with a thoroughly researched argument, she shows how capitalism robs most people of the power to shape their lives.

The book begins by dispelling the myth that modern social problems are a fundamental part of human existence. Dr. Rosenthal observes that, for most of human history, people relied on cooperation and reciprocity for survival. However, the division of society into classes created an unjust and traumatizing social structure that pits people against each other. While many rebel, others feel powerless in the face of their problems and endure them by disassociating.

Dr. Rosenthal contends that the ruling class relies on and reinforces this sense of powerlessness. As an example, she cites the myth of “The American Dream,” which insinuates that poverty results from a lack of personal effort. She also explains how cooperation is discouraged by emphasizing people’s differences and minimizing their similarities.

The book describes how powerless and trapped people feel within the capitalist machine. However, the book also provides hope for the future by emphasizing the human ability to overcome challenges. Dr. Rosenthal’s premise is that social problems require social solutions. The detailed exploration of these solutions evokes much thought on the role that mental health workers play.

Dr. Rosenthal argues that psychology is inherently political. Mental health professionals contribute to the experience of powerlessness (their own and their clients’) when they focus exclusively on the individual. While the treatment of individual suffering is important and necessary, ignoring the societal causes of distress leads to a blame-the-victim mentality. She provides a wealth of research to show that improving social conditions is the most effective way to improve individual health.

The Book itself can be purchased from Amazon (http://www.amazon.com/Power-Powerlessness-Susan-Rosenthal/dp/1412056918), or from her website. (http://www.powerandpowerlessness.com/) The book can also be downloaded from her site.

Introduction to the book

Their power — our powerlessness.
Our power — their powerlessness.
Each calls the other into being.

The world is a puzzling place. Like Alice in Wonderland, people rush to go nowhere, too many things don’t make sense, and the threat of losing one’s head is ever present. It seems as if humanity has fallen down the rabbit hole and cannot find a way out. Yet, there is hope. If we can understand how we got here and what keeps us here, we can go forward.

Society is divided into two groups of people: a few who wield immense power and the rest who feel varying degrees of powerlessness. As a result, conflicts over power dominate life. Between individuals, the struggle for power kills intimacy. On a social level, competition drives down living standards. On a global scale, the battle for dominance threatens human survival.

Power over others and lack of power are both corrupting. However, power — the ability to control events — can also liberate. Power is not the problem; the problem is unequal access to power. For more than a hundred-thousand years, our ancestors lived in cooperative, power-sharing societies. This book explains how the rule of reciprocity was overthrown and how it can be re-established.

My experience as a physician compelled me to write this book. As the sister of a disabled child, I thought that doctors had the power to end suffering, and I wanted that power. After I graduated from medical school, I learned how powerless doctors actually are. Most of my patients’ problems were rooted in family dynamics, financial difficulties, and conflicts at school and at work. I studied psychotherapy in the hope that combining mind and body skills would be more useful. It was — I could help people move from uncommon misery to common misery. The problems created by alienation, oppression, and exploitation remained beyond my control.

After listening to thousands of people’s stories, I have concluded that social power is necessary for human health. Most people lack the happy, healthy, fulfilling lives they deserve because they are kept powerless and mistakenly accept this state of affairs as natural or self-inflicted. In fact, most human suffering is preventable. This book reveals what must be done.

Part One explains that society does not arise from human nature. On the contrary, current social arrangements violate human nature. Part Two shows how power is divided by class. Part Three investigates how power and powerlessness are perpetuated. Part Four reveals how powerlessness can be transformed into power.

Knowing that the material in this book would be controversial, unbelievable to some, I carefully referenced every fact, every quote, and every contentious statement. To my dismay, the final draft contained more than 1,400 references spanning 70 pages. To make the book shorter and more affordable, I cut out most of these references; however, I will be happy to provide specific references on request.

A just world is possible. Human beings create society, and we can change it. The need for change is urgent. Everywhere, there is injustice, anguish, and anger. This book explains how society shapes people, how people shape society, and how powerlessness can be converted into the power to transform the world.

09-28-07, 08:19 AM
Thank you Rajiv, I have just ordered the book.

10-04-07, 10:03 AM

What a phenomenal book! I am half-way through it, again, thank you for sharing it!


10-13-07, 11:35 AM
I am adding 3 articles I just got from her from a volume she edited in 1998

Market Madness and Mental Illness
The Crisis in Mental Health Theory
The state of Mental Health in the USA

from the first

“The market can and will resolve all outstanding health care issues. Market based health care is the only means of guaranteeing highquality care at competitive prices.”

“We would make out like bandits...We are going into [medical savings accounts] because these things are going to be a gold mine, but whether they are good public policy or whether they are something that will solve social problems...let there be no doubt. They are a scam, and we will get our share of that scam.”

Both of these comments came from the same man, multimillionaire Dr. Malik M. Hasan,
chief executive officer (CEO) of Foundation Health Systems. The first comment was for public consumption. The second was made at a private health sector conference.

Dr. Harold Eist, president elect of the American Psychiatric Association, sees it differently:

“[T]he market has driven seriously mentally ill from hospitals to shelters, and ‘good’ managed care companies are being forced by the ‘bottom feeders’ to cut services
to survive in the shark infested waters of unfettered capitalism. Physicians have a sworn duty to attend to the health of our citizens. It is paradoxical that those who profess concern about limited fiscal resources are not attacking profiteers leeching a system in which fewer than one in five mentally ill persons receives treatment. It is a national travesty!"

The above comments indicate the depth of the chasm which has opened up between those who praise market based medicine and those who are horrified by its effects. This chasm reflects the deepening antagonism between those who profit from the market and those who are fleeced by it.

Defining the Economic Problem

Can the market can solve all problems? As I write this, a leading British economic journal, The Economist, is posing the question of whether or not the deepening Asian economic crisis is signaling “the end of capitalism as we know it.”[4] After providing a $40 billion bailout to Mexico in 1995, the International Monetary Fund is now assembling a rescue package of more than $100 billion in loans to prevent a financial meltdown in Indonesia, South Korea, Thailand, Malaysia, Singapore and the Philippines. No one knows if the IMF package will be able to stabilize the currencies of these former “miracle economies,” which accounted for 60 percent of world economic growth between 1990 and 1995. Even if it can, the roller coaster nature of the world capitalist system can no longer be denied, and we can only imagine how much it will cost to stabilize the next major convulsion of the system.

From the Second

In their book, We’ve Had a Hundred Years of Psychotherapy and the World’s Getting Worse, James Hillman and Michael Ventura claim that psychotherapy exacerbates the problems of a sick world. By emphasizing the “inner soul,” therapy fails to connect the individual with the world, thus robbing the world of political energy that could help to make it a better place. According to the authors, the generation that abandoned political activism after the 1960’s and turned to “personal politics” has reached a dead end. “Yet therapy goes on blindly believing that it’s curing the outer world by making better people. We’ve heard that for years and years….It’s not the case.” While millions of people look to therapy for solutions and “…each week, 200 types of 12step recovery groups such as Alcoholics Anonymous or Overeaters Anonymous draw 15 million Americans to 500,000 meetings across the nation.”, the authors cite studies showing that the number of mentally ill individuals living in public shelters, on the streets, and in jails is greater than at any time since the 1820's.

The authors argue that, by operating as a social control, therapy holds back real solutions. “If therapy imagines its task to be that of helping people cope (and not protest), to adapt (and not rebel), to normalize their oddity, and to accept themselves and ‘work within your situation; make it work for you’ (rather than refuse the unacceptable), then therapy is collaborating with what the state wants: docile plebes.” They conclude that “ … therapy — even the best deep therapy — contributes to the world’s destruction.”

Hillman and Ventura criticize the middle class perspective of therapy. “Its balanced, middle ground position wants both the individual and the system to survive, by accommodating the individual as best as possible to the system. The system as such, however, remains outside its purview.” What this means in practice is “ … the consulting room [acts] as a branch of your local police station.” In contrast, the authors propose transforming the consulting room into a “cell of revolution.” Change “ … begins with the realization that things are not right….And that is the job of therapy…,” to help people become aware “ … of dysfunction in society, in the outer world.” But, without a solution to the problem that they pose, the authors get bogged down in the same middle class perspective they reject.

10-13-07, 11:38 AM

I can't attach a third file to the message. I exceed my quota. How do I do it?

10-13-07, 01:34 PM
After listening to thousands of people’s stories, I have concluded that social power is necessary for human health.

given this assertion, as well as the rest of her analysis, it is impossible that anyone outside a small power elite should be healthy. yet somehow there appear to be many healthy people in the world. [i suppose we could point to everyone's hidden, yet-to-be-expressed atherosclerosis, which has been documented in 7 year olds.] no doubt social conditions contribute in major ways to the stress that underlies or exacerbates many conditions, especially via its effects on the immune system. but i've seen just as much stress from people's personal relationships. her analysis sounds like re-warmed standard marxist thought - class divisions underlying alienation, exploitation by an empowered capitalist elite, and so on. no doubt there's plenty of exploitation and inequity [and iniquity] in the world, but bottom line, although social structure and economics have important effects on epidemiology, i'm loath to conclude that only huge political changes can effect better health. personal behavioral choices with large impacts on health status exist in realms other than the political.

10-13-07, 05:37 PM
The notion that mental illness springs from a coercive society meets further serious question by comparing the living environment and social stratification in nine tenths of prior human history, when life was "nasty, brutish and short".

According to an environmental view of the sources of human mental illness, going backwards in history we can and do find ever less empowered people, right back to prehistory, when a human was little more empowered than a dog - by his brutish environment, and notably also by primitive clan heirarchies far exceeding "modern class divisions" in their crudeness, shock and horrifying brutality.

According to the above quoted theories, deprivation of personal emancipation is a leading cause, or even a primary source of mental illness. The thesis has "ivory tower" written all over it.

In prehistory right through to recent centuries, even ordinary life must have been so thoroughly subjugating to humans that the entire species should have been subject to rampant if not 100% mental illness according to this soaringly poetic psychiatrist's construct. Living conditions for the average proletariat in the fifteenth century were one hell of a lot tougher and more brutish than they have been in the 20th or 21st centuries. Are we to assume the world's history has been written principally then by the mentally ill?

I find Dr. Susan Rosenthal's thesis to be an effete construct - product of altogether too precious a view of the quite crude origins of social organization, which have always been thoroughly moored in expressions of one group's power over another. We do after all spring from apes, not from a perfect diety's enblightened wisdom. Fairness is not in our genes - dog eat dog is in our genes.

The fact I see Dr. Rosenthal's thesis as an effete construct does not make me any less aspiring to social justice - but I am deeply wary of apologists for the license to indict society based upon the problems of the mentally ill - where this theory then leads naturally to the wholesale indictment of the strive to power that man has exhibited for ten thousand years. Dr. Rosenthal's suggestion is that "strive to power", and any leeway for it's expression in modern society should then be amputated or neutered in favor of a "fairer society" and implicitly guided by "enlightened" social science.

Implicit in Dr. Rosenthal's analysis is a risky conceit, that this sophisticated and idealistic theory enjoys real underpinnings in the earliest forms of society, let alone practically all the iterations of increasingly complex society up to modern times - which it manifestly does not. History of mankind demonstrates the opposite, that society has always been organized around heirarchies of power, and presumably the human race has not traveled through ten thousand years in a state of widespread and epidemic mental illness as a result of that!

The old saying that the idealist (and their kooky ideas) is far more dangerous than a mere adversary is not gained for naught. I continue to appreciate the balanced sobriety and skepticism expressed in JK's views.

10-13-07, 06:26 PM
Lukester are you quoting from Susan Rosenthal's book or paper?

10-13-07, 08:57 PM
Hi Rajiv -

I have not read Dr. Rosenthal's book. I must confess, even the hint of a psychiatrist's foray into social engineering has me breaking out in hives.

Does the fact I have not read the book invalidate my general observations that all societies prior to the modern one display an ever increasing index of societal repression as we go back in time? The enslavement of the modern proletariat appears almost a bucolic existence compared to the condition of serfs in 9th or even 13th century Europe.

I think I'm adhering to rudimentary common sense. It seems curious indeed from a historical viewpoint, to link psychiatric health to levels of societal repression. By this index, fifteenth century peoples must have been much more neurotic than modern mankind then, no?

Go back further to the slave labor societies of the Etruscans, Greeks or Egyptians, and schizophrenia and clinical depression must have been epidemic. It's a wonder the aristocracy of the day could find any functioning slaves, due to the psychiatric disintegration that must have been going on in the slave population.

By the time we get back to the Sumerians with the most primitive forms of government, people must have been neurotic to the point of completely dysfunctional?

10-13-07, 09:36 PM
even the hint of a psychiatrist's foray into social engineering has me breaking out in hives

I think I would generally agree with you there! -- But then there are psychiatrists and then there are psychiatrists! There are some good ones out there as well -- James Hillman (http://en.wikipedia.org/wiki/James_Hillman) among them. Reading Dr. Rosenthal's book and paper, I would tend to put her among the good ones! I think what she says makes good sense

Hillman is/has been a relentless campaigner for reform in the practice of psychiatry for over three decades -- see "On Soul, Character and Calling: An Interview with James Hillman (http://www.scottlondon.com/interviews/hillman.html)"

10-13-07, 10:29 PM
as a psychiatrist myself, having practiced over 30 years - the first 15 doing mostly psychotherapy with individuals couples and families, the last 16 doing more biological/medical/pharmacological treatment - i'd also like to think that there are some good psychiatrists in the world. as someone who is scientifically oriented, i'm skeptical of most characterologically oriented psychological theorizing, and especially so of the jungian/freudian/rankian/etc high level constructs. it's too easy to create psychological theories of that type. you can explain anything, easily, and there's no way to test your explanation. obsessive-compulsive disorder is a good example. take compulsive handwashing: our model used to be lady macbeth. "out, out, damned spot," trying to wash away her guilt. turns out that animal grooming behavior is a better model. labrador retrievers are subject to something called "acral lick syndrome," in which they lick their paws so much that they develop ulcers. give them prozac and they stop; the ulcers heal. cleaning oneself is a normal, evolutionarily useful grooming behavior, that is disinhibited in those people with compulsive handwashing. pet scans [no relation to labradors here, i mean positron emission tomographic scans] of ocd sufferers show hyperactivity in 2 symmetric subcortical regions behind frontal cortex. if you give prozac, or if you perform cognitive-behavioral therapy, you can document reduction in activity in these regions corresponding to symptomatic improvement. if you have children, then i'm sure there have been times you really, really wanted to wash your hands. that's the subjective experience of people who compulsively wash. anyway, just a tangent triggered by rajiv's link to a jungian psychologist. and, too, i'm no less skeptical of grand socio-economic theories developed from the perspective of someone's couch.

10-13-07, 10:39 PM
i'm skeptical of most characterologically oriented psychological theorizing, and especially so of the jungian/freudian/rankian/etc high level constructs.

Yes I am quite skeptical of those myself -- but not of the attempt to understand human behavior - and not of the attempt to help another human being who is asking for help.

10-13-07, 10:40 PM
JK wrote -

<< grand socio-economic theories developed from the perspective of someone's couch >>

Spot on! JK has both feet planted firmly on the ground.

10-14-07, 03:43 PM

Finished the book. Excellent factual observations she makes, unfortunately, she has not taken into account that all people are different and that a true egalitarian society can’t ever exist because of that. In other words, someone must lead, others must follow. That’s why communism does not work, and capitalism needs people to defend their natural rights in order to work.

Again, thanks for the link.