Wednesday, April 4, 2007

Risk Management

I generally eschew theoretical approaches to psychotherapy, believing, as Yalom does, that "a different therapy must be constructed for each patient because each has a unique story," and I am highly suspicious of therapists who claim allegiance to any one approach, but if I had to pick one I would most likely tend towards the existential. The existential approach to mental health treatment understands most human problems as stemming from death anxiety, obliteration, and we often see people who've had some sort of experience--what is sometimes referred to as a "boundary experience"--that serves as a reminder of their own vulnerability.

Katrina was, for so many of us, a boundary experience. Time after time I have sat in session and heard people express, in a myriad of ways, their shock and horror at having been so devastated. Clients often ask me how I can stand to listen to such stories, over and over, every day, such misery and suffering and despair; the answer I always give, the only one that makes sense, is that I know people suffer and I'd rather try to help than to pretend it's not happening. We live in a society that is completely enthralled by the idea of invulnerability--the mental health profession itself is wrapped in a protective layer of jargon about the wonders of "risk management"--and so many of us have come to believe that with enough insurance and a strong federal government and good pharmaceuticals and science, science, science we can beat or evade every potential disaster, personal or public or natural or otherwise. This is patently untrue, of course, but we persist in our beliefs, our dreams of perpetual existence. We do not like to admit that sometimes, when bad things happen, there's nothing we can do about it.

I was struck by some of the sentiments expressed in the Commentary section of the recent Gambit (and who writes that column, anyway? Is it a DuBos, or the managing editor, or what? Does anybody know?). The commentary argues in favor of an independent 8/29 commission to investigate the failure of the flood protection system to protect NOLA's more vulnerable neighborhoods. I agree with the folks at, and I agree with whoever wrote the piece for the Gambit, but the argument smacks of denial. "There are many reasons in support of such an investigation," it goes, "but the most compelling is the need to prevent similar catastrophes in the future." It's nice to think we can accomplish such an enormous task, but who are we kidding? Do we really believe that if we think hard enough and plan for every possible nightmare scenario, that we might avoid loss, destruction, death?

The Corps was wrong: they fucked up. They should have built better levees. And it's fine to hold them accountable, it's necessary to do so, but it seems that the conversation surrounding accountability has replaced an equally necessary conversation--about vulnerability, risk, the loss of familiar assumptions many of us have held since childhood. We all live here with the knowledge that it could happen again, no matter how hard we work to prevent "similar catastrophes." When we concentrate solely oupon protecting ourselves from every kind of suffering, life becomes nothing more than a never-ending fire drill. And I just don't see the point of that.

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