Friday, July 28, 2023

Draft Thoughts on Professional Defensiveness (Work in Progress)

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A classic question was posted in one of my online community discussion forums this week...

"Question for professional practitioners: why is it when people criticize therapists and behavior analysts, many of you professionals jump to the defense of it?"

Service users see and experience this all the time. In public spaces. In private. Online and in person. Often doesn't matter how the question or critique is presented. If it's critical in any manner. If it's glowing praise or deferment to authority, the comment is often openly attacked. Might be a patronizing reply. Might be a brush off. Could take various forms, none of which are mutual, open-minded discussion and exploration of the issue being raised. The question is ... why?

Humans are, I would say, far to complex for a singular simple answer. Also, we should mention, not every professional jumps to defensiveness. And there will some instances where the defensiveness is arguably well-warranted. I'm here to say though, that meeting any and all critique or questioning, of any form, with defensiveness is an objective problem. It exists. I see it every day. It's time to address it.

There is no doubt in my mind that there is an identifiable trend of unwarranted and problematic professional defensiveness in modern mental and behavioral health (physical health too, though that's a space I'm less directly involved in, but still engage with enough to have seen it there too).

With those caveats, framings, and assertions out of the way, time to get into the main point of today's post. Which isn't just to point out that yes, this exists and is a problem, but to ask why it exists. Have some initial thoughts below. These observations were formed from personal and professional interactions with literally hundreds of practitioners and literally thousands of service users. 

Some Reasons Why Professional Defensiveness Might Occur

This post is called "draft thoughts" for a reason. This is a first attempt at some thoughts. Consider supporting this work or co-exploring if this seems helpful.

Reason 1: A Crisis of Faith (And Why It's Challenging To Reverse Deep-Seated Care-orrism)

This will take a couple paragraphs laying down some other groundwork concepts before we finally can connect to professional defensiveness, so hang in there. One common pattern I see is what a friend calls "care-orrism". Many people go into the various health professions out of a very genuine desire to care and help. There's real compassion. There's real sympathy. I'd also say there's quite frequently some trauma-based energy going on of various forms, a common form being: suffering happened to me or someone I deeply cared for, and now there's a resultant deep need, including trauma-induced fight-flight franticness, to prevent that suffering in others. There is a lot of care going on. 

Note that care, in this sense, is detached from some other very important things. Care is important too. But these others things include such items as respect and cognitive empathy (correct understanding the perspective of others). The concept of care, as I'm going to define it here, is about the experience of a given individual's personal belief and understanding on what counts as suffering, what counts as health, and then basing compassion on those beliefs. With that established, we can then define "care-orrism" as an unjust, nonconsensual enforcement of oppressive concepts of what health is and isn't on others. A classic historic example of care-orrism are the ongoing legacy of colonial nations supposedly "civilizing" the lands the ingenuous people being invaded and conquered.

Care-orrism is modern times is often occurring because we have this population of people desperately wanting to help others and relieve suffering. We then have society (yes, am blaming you society) selling these people a path toward being helpful. We have giant promotional ads and career guides saying "want to help people? Come be a behavior analyst! Come be a therapist! We totally help people!"

These people believe what they're told. What they're sold. They buy in (often literally, taking on massive student debt) and spend the next few years or decades in an echo chamber being told every day that they're saving the world. It's science! It's "evidence-based"! Trust authority! They are dogmatically lectured in what help is and isn't. And it feels great. Trust these methods, do what you're told, and we promise that you'll be making positive, life-altering, life-saving differences in the world. 

So that's the backdrop. Years of thinking you've helped people. You've trusted the process. You're doing good in the world. And then one day someone comes along and gets right in your face to say otherwise. They say "actually, all that stuff called "help"? Yeah, so, bad news here. Some of that help really wasn't. It wasn't help. It might've even caused a lot of additional hurt.

What we're dealing with here is no less than a literal crisis of faith. Not religious faith. But faith in the capital H Help. Faith that what you've invested years into works. Possibly sunk a huge part of one's identity into ("I'm a healer!"). 

Having one's deep-seated faith challenged can be difficult. Is that an excuse for the defensiveness? No. Is that an acceptable excuse especially given the context of who's doing the challenging and why? No. Context matters, and the context here is community advocates and service users themselves doing the questioning. Not random, hateful agenda-driven naysayers. It's the actual people in need themselves doing the questioning.

It is still understandable how difficult having the faith-in-help questioned is. It's not pleasant hearing one was misled and not told full truth. It's difficult hearing about ableism, racism, and sexism. Hearing about widespread institutional failures to respond respectfully to critique. It's hard. It's work. And yes, that can really suck. It's not an excuse, but it's understandable. 

Instead of doing of that work. Instead of choosing to bravely walk through that faith crisis, we instead see defensiveness. We see understandable fear-based denial that the help might not've worked. No-one want to be a care-orrist. 

So, that's some of it. 

Reason 2: Lack of Humility 

Another part is cultural. We live in (referencing my cultural circles of Western dominant white supremacy cultural values/attitudes broadly speaking) a deeply self-first culture where true, authentic humility is rarely practices and widely disparaged. We are told to be independent, confident go-getters. Don't let anyone stand in your way. We're told to compete. We live, right down to the capitalist economic core, in a competition filled world of winners and losers and mission in life is to win. Why question your own self when you can instead attack the person doing the questioning. Questioning is a threat. Wrongness is not tolerated or accepted much in this world.

So, that's a part of it.

Reason 3: Prejudice (Who We Call "Experts", Who We Don't)

Reference Article for this Topic: Ivan Illich - The Invention and Elimination of Disease 

On the to-do is to unpack and make Illich a bit more accessible. This passage will likely be a bit confusing but is deeply important...

" Medical epistemology is much more important for the healthy solution of this crisis than either medical biology or medical technology. Such an epistemology will have to clarify the logical status and the social nature of diagnosis and therapy, primarily in physical—as opposed to mental—sickness. All disease is a socially created reality. Its meaning and the response it has evoked have a history. The study of this history will make us understand the degree to which we are prisoners of the medical ideology in which we were brought up."

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This article brought to you by the currently unfunded Peer Voices Network. 

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