The Self-World Connection Implications for Mental Health and Psychotherapy by Sarah A. Conn Sarah A. Conn, a clinical psychologiat in private practice, is a research associate at the Center /or Psychological Studies in the Nuclear Age at Harvard Medical School, Cambridge Hospital, where she teaches a course on "The Psychology of Global Awareness and Responsibility: Implications for Psychotherapy." She is also a visiting lecturer at Tufts University in the Peace and Justice Program. "i n these times of rapid change on a global level, I concern about the future viability of life on Earth -i - is becoming ubiquitous. As the critical problems of our time—economic and political injustice, environmental degradation, the threat of nuclear annihilation—become more evident, psychologists must begin to pay more attention to the connection between the individual and the larger context. How is the individual affected by global problems? How does the individual respond to these problems? For those of us in the psychological professions working with individuals and families who are affected constantly by what goes on in the larger world, it is crucial to explore the 'self-world connection" and its implications for mental health and psychotherapy. As 1 explore the relationship between the individual and the global context, my major thesis is that we need to shift our models of the self to emphasize its connectedness within and to a larger context, including the Earth as a whole, in order to empower the individual both to deal more fully with personal problems and to participate more fully in and to contribute more powerfully to the world. 1 propose that it is not only possible to focus on and to deal actively with both self and world at the same time, but that doing so can be good for both. THE SELF AND THE "WORLD OUT THERE" Early in 1990, one of my clients who had struggled for many years with both cocaine and alcohol addiction was celebrating a year's sobriety and a lot of hard work in therapy by expressing an interest in the larger world. For this African-American woman, her addiction had been a way of dealing with the pain of her personal, cultural, and historical situation. She had been sexually abused by an uncle, emotionally abused by her mother, neglected by her father. In the cultural context of racism, she had grown up feeling threatened by the larger world in a vague way and had never wanted to explore it. Now, sober and feeling good about herself, she was interested in traveling around and learning about "the world out there." "But what a world out there!" she said. "Mike Tyson has lost. Nelson Mandela is free. And a McDonalds has opened in Moscow." Using a phrase from her AA meetings, she went on to say, "A person has to be 'clean and sober' to handle a world like that!" In modern times, one common Western belief has been that in order "to handle the world out there" (especially one as confusing and as threatening as the present), we have to get our individual psyches in order first. We have viewed the "self" (the construct that refers to our sense of who we are and what we can do) as a bounded, masterful agent who is separate from and prior to the "outside" world, almost as if in a vacuum.1 My client certainly believed that only after she had done intense "personal" work, in a private and inner-focused psychotherapy setting, could she then deal with the larger world. Having paid more attention to the self-world connection, I now begin to see that an important part of her recovery in fact had been achieved by connecting with the larger world, attending to and caring for others who had pain similar to hers, people with whom she identified. She had done this professionally by working with sexually abused children, and personally through twelve-step programs. 1 begin to-suspect that her therapy could have been more effective and empowering if dealing with the larger socio-political context of her personal pain and R edefinitions of mental health will require a shift in our paradigm of the self, from one that emphasizes autonomy in human relationships and separation from the natural world, to one that emphasizes our identity with others, including other life forms. Issue Twenty woman of power 11 actively enabling her to identify with others even more broadly and deeply had been an explicit goal of therapy from the beginning. In psychotherapy, personal pain has historically been addressed without reference to the larger context, without reference to the larger social, political, and cultural forces in which it is embedded.2 This has been true in all three "forces" in psychotherapy: psychoanalytic, behavioral, and humanistic.3 These traditions have all tended to reflect uncritically the larger context of radical individualism that has become a cultural pathology in our time.4 In this context, modern psychology as a whole has viewed the individual as an independent, self-contained, separate self5 motivated by purely egoistic needs and drives to seek personal pleasure and avoid personal pain.6 This view holds that the individual "handles* the "world outside' by reacting to it, being conditioned by it, defending oneself against it, gaining power over it. Further, the "world outside" has often been defined very narrowly, as parental influences, family history, or the immediate environment. If psychotherapy clients bring in 'the outside world," any intense concern about global issues, like pollution or violence, is likely to be viewed as a sign of personal pathology or projected self-interest rather than as a manifestation of our basic connection with the world. I believe there are two reasons for this. The first is a cultural overemphasis on rational thought to the exclusion of emotional responsiveness, so that pain, or indeed emotional experience of any kind, tends to be pathologized, deemphasized or truncated rather than validated, encouraged, and fully experienced.7 The tendency to pathologize deep emotions may be present even in psychotherapy, where working through emotional pain is theoretically encouraged. If we hurry the person in pain through rather than encourage her/him to enter fully into the difficult emotions, we may never enable the person to contact the power and energy which reside there.s Secondly, in psychotherapy the tendency is to view as real only those feelings which are related to an individual's internal needs and wants, or his/her personal family history. In short, we as a culture tend to pathologize and individualize personal pain, viewing any "pain for the world"9 as a personal and probably pathological experience that has been projected outward. For example, the woman mentioned above would at times express intense distress about the extent of sexual abuse of children she was seeing in her work setting. Her fear and anger could easily be seen as "pathological" by some schools of psychological thought in the following way: she herself was no longer threatened, so intense emotional reactions must be signs of "unresolved* feelings from her own individual childhood. Our models of the self do not encourage us to see her distress as a manifestation of the "pain of the world." If her personal fear and anger were fully acknowledged and validated in the psychotherapy setting, her pain might be "recontcxtual-ized" as horror and outrage that the world we live in permits such treatment of children. To have a place to connect her personal response to a larger context might release energy for her to deal both with her personal problems and with her clients'. The cultural emphasis on the self-contained individual has translated into psychological doctrines like drive-reduction, reinforcement, and exchange theories which "seem to give scientific authority to self-inter-estedness," to present "the pursuit of self-interest, of self-development and self-actualization as the primary A he more we are awake to and aware of our connectedness to the world, the more likely we are to feel its pain. ends of existence".10 Again, the "self" referred to is an individual entity whose internal needs and wants are more real than any relationship with the outside world. When this "self* does not achieve its goals, the assumption is that the problem lies in the individual and family, rather than the socio-political-historical context, resulting in psychologically devastating self-blame, which is often reinforced by therapists." "Lacking a sense of the political, economic, and social factors causing psychological problems, most therapists interpret the frustrations of family and personal life as individual failings." n A failure to connect the cognitive and emotional consequences to their "real world" factors increases rather than alleviates the psychotherapy client's sense of powerlessness.1-5 Further, the exclusive focus on the individual and his/her inner life can reinforce, if not actually create, the narcissistic disorders at the forefront of attention in modem psychopathology.14 In his analysis of the cultural and historical emphases on and reinforcement of the "bounded, masterful self," Cushman15 suggests that herein lie the root causes of personal distress. The inner emptiness which has resulted from the breakdown of community and tradition and the rise of the modern industrial state is experienced by our clients as confusion about moral values, low self-esteem, addictions, and spiritual hunger."5 According to Cushman, "in a world sorely lacking in community and tradition, the most effective healing response would be to address those absences through structural societal change by reshaping the political relationships and the cultural forms and reestablishing the i^iortance of their transmission."17 However, "this is the exact subject psychology is not allowed to address",10 given its tendency 'to decontextualize the individual, examining the patient '2 woman of power Issue Twenty as an isolated entity without considering the larger sociohistorical causes of personal distress."19 For the client mentioned above, her long struggle with substance abuse could, in the context of the model of the self-contained individual, remain an individualized struggle with personal pathology, thus reinforcing rather than effectively addressing the low self-esteem and confusion about identity that characterized so much of her experience. Recontextualizing her personal struggle as a microcosm of a larger picture of racism and sexual abuse, on the other hand, could liberate her from self-blame and provide a way for her to experience being connected to the larger world. MENTAL HEALTH AND THE LARGER CONTEXT "j n 1946, responding to the nuclear threat, Harry i Stack Sullivan observed that 'we have now reached the point where drastic readjustment of human personality and conduct appears necessary for survival."20 Sullivan thought that psychiatry had an essential role to play in contributing to the development of "world-mindedness* in people. He believed that "there is immanent in human personality a striving towards a way of life that is not destructive to others,"21 and that psychotherapy should evoke and develop the "world-mindedness" that leads to this way of life. In the 1980s, this concern reemerged: "at this particular time in the development of humankind, an adequate definition of mental health ... should include an increased appreciation for the historical moment in which we live and an increased concern for the preservation of self and others." 22 In the 1990s, some people believe that an adequate definition of mental health will have to take into account the ability to enter into "mutually enhancing human-earth relationships,"23 to act in relationship to the Earth as a whole in all that humans do. These redefinitions of mental health will require a shift in our paradigm of the self, from one that emphasizes autonomy in human relationships and separation from the natural world to one that emphasizes our identity with others, including other life forms.24 As I wrote in a previous article,25 jtjo encourage the massive behavioral adaptations required to protect the Earth from humanity's excesses, we need to broaden our concept of self to include other groups of people and other life forms. Naess26 contributes to this with his notion of the ecological self. The growth to maturity of the self, he says, includes not only growth in human relationships with family, community and beyond. True maturation of the individual includes the broadening and deepening of the self through identification with all beings. This broadened and deepened identification leads to the experience of interconnectedness, which is an essential condition of empowerment. When we are able to experience this intercon- nectedness, we need no mural exhortation to adjust our behaviors and our policies in the direction of global survival. If we broaden and deepen our sense of self, we act naturally (o care for our world. In Emmanuel Kant's terms, we then engage in 'beautiful acts' rather than 'moral acts,'2' behaving not out of motivation to do our moral duty because ii is right but rather acting out of positive inclination and pleasure. Planting trees, for example, would not be sacrificing our time and effort for the good of an Earth separated from us. Planting trees would be experienced as a natural extension of self which contributes to the Earth's respiratory capacity.1* Such a shift in our paradigm of the self will allow us to expand our models of mental health to emphasize an active connectedness with the larger world. This connectedness includes awareness of the problems in the M'orld, understanding of the interdependence of the Earth's life forms, emotional responsiveness to the pain of the world and action which addresses it. We can then begin to recontex£ualize personal pain in a global context, to develop a new understanding of psychological health that connects the personal and global both diagnostically and therapeutically. Such a recontextualization is part of a "fourth force" in psychology, one which goes beyond the psychoanalytic, behavioral and humanistic emphases on human needs and interests to emphasize the relational nature of the self,29 and the transpersonal, transhuman aspects of reality.30 We need to continue to develop a psychology which views the individual self as embedded in and creatively interactive with the larger context, including all life forms,31 and with the Earth as a whole.32 "Who I am is defined in and through my relations with others; I am completed through these relations and do not exist apart from them. Therefore, my work on behalf of others is simultaneously work on behalf of myself."33 In my previous article mentioned above,341 developed a model of the self-world connection as it applies to the concept of global responsibility. This model emphasizes four equally important, interrelated aspects of global responsibility; that is, the ability of individuals and groups to respond to global problems by engaging in global change. The first and most essential aspect is awareness, which refers both to the perception of global problems and the ability to "keep them in mind," to think about them, to take in information. A second aspect is understanding, the ability to integrate and analyze the information which comes into awareness, and particularly to recognize the interdependence of all the Earth's life forms, an interdependence that is manifested in these global problems. A third aspect is direct experience, which refers to direct, emotional response to global problems, the ability to feel and to engage rather than to become numb and dulled. A fourth aspect is action, the willingness to work actively for one's own and others' survival by engaging in behaviors which address global problems. These aspects of global responsibility are interrelated •issue Twenty woman of power and mutually interacting. When one aspect is emphasized, the others are affected. If one grows, the others are enabled. If one aspect is ignored, the quality of the others suffers, as does the quality of the person's or group's overall effectiveness in confronting a problem. A most important feature of this model is the context of connection in which global responsibility takes place. In other words, the four aspects of global responsibility are ways of connecting with the world around us, through awareness (letting in information), understanding (organizing the information), direct experience (being emotionally responsive), and action (working for change). The four aspects of global responsibility affect and are affected by our relationships at all levels: to self, to family, to friends, to colleagues, to community, to humanity, to nature, and to the Earth as a whole. Our relationships grow in complexity as we develop, and we develop as globally responsible individuals and groups as we attend to the four ways of connecting to the world around us. This growth is not a linear, one-way event but rather a mutual and THE GROWTH OF GLOBAL RESPONSIBILITY The arrows in this diagram represent several dimensions of connection. Growth (arrows from center out and back) can happen within any one aspect of responsibility at any one time, as the person or organization develops more complex connections in interaction with the world. This process will not always correspond to a circle, as one aspect is engaged in at one time more than others. However, unless the other aspects of responsibility are eventually included (arrows around and across), the person or group or movement will remain limited and ineffective. Notice that growth here is no onsidered a linear process, as all arrows move in both directions. 74 woman reciprocal process. To be effective as globally responsible activists, as global citizens, we must attend to all of these areas, though not necessarily all at once. To illustrate this model, I use the diagram shown below. The mature self in this "ecological" model is differentiated, complex, and uniquely itself, yes. But most importantly, this self derives its unique, differentiated identity from its relatedness, its connectedness as a part of the community of living beings on Earth. The self in this model does not simply act on the world or get acted upon in a mechanistic paradigm, but rather dynamically and creatively interacts with the world in an ecological, systemic, self-organizing paradigm.35 In her important paper on relationship and empowerment, Surrey36 defines relational empowerment as "the capacity to be 'moved,' and to respond, and to 'move' the other,"37 and "response/ability" as "the capacity to act in relationship'—to consider one's actions in light of other people's needs, feelings and perceptions."381 would like to expand these ideas to develop a preliminary definition of global responsibility as the capacity to "act in relationship" by considering One's actions in light of the needs, feelings, and perceptions of other peoples, other life forms, and of the Earth as a whole. One of my favorite ways of illustrating this process of connecting the "ecological self" and the world is through part of a poem by Antonio Machado, quoted by the systems biologist Francisco Varela: "Wanderer, the road is your footsteps, nothing else; wanderer, there is no path; you lay down a path in walking... ."39 In the ecological model of the self, we are creating our connection with the world moment by moment through our interactions with it. We need to learn to do this responsibly, by learning to take into account the needs of other peoples, other life forms, and the Earth as a whole in everything we do. Mental health thus includes finding one's particular way of participating in and contributing to the larger system. GLOBAL PSYCHOTHERAPY ince early in 1989,1 have been meeting with a group of psychotherapists, all women, to explore what we call "global psychotherapy." *n Surrey has described the context of our work: "The emergence of a global psychology challenges old paradigms of separate, bounded, self-seeking power, control, and dominance and builds on new visions of a relational, interdependent, and ecological self. Psychotherapy practiced from this global perspective seeks to uncover the connections between personal pain and global crises—to empower individuals to act with awareness of the larger world, to 'act locally and think globally.' "4I If we apply this model of the self-world connection to the practice of psychotherapy, then the goal of psychotherapy will of necessity be the healing of the world as part of the healing of the self. If we begin to see the self in this way, then we may see that not only our connectedness but also the roots of healing ourselves and our world "may be hidden in the very per-