Robert J. Lifton’s Memoir

Robert J. Lifton is a psychiatrist who has spent his career studying some of the great historical events of his life time. His major projects have been studying the survivors of Hiroshima, Chinese thought control, the Nazi doctors and the anti Viet Nam War movement. In this memoir he reviews the events, the people and his own thoughts as he went through his journey.

BOOK REVIEW- Witness to an Extreme Century by Robert J. Lifton

I had always wanted to learn more about the interesting work of psychiatrist Robert J. Lipton that I had heard about, but I never got around to reading his various books and other writings. This is the reason that I was pleased to embark upon reading this recent memoir. The author not only reviews his four main projects but he shares his recollections and feelings about the many people he has met along the way of his fascinating life’s work.

Lifton’s  psychiatric training was interrupted by having to join the military as a physician during the Korean War. Although he was able to resume and even ultimately have some training at the Boston Psychoanalytic Institute, he never became a conventional psychiatrist or analyst. After spending sometime in Hong Kong Lifton became intensely interested what had become known as Chinese thought control. The Chinese communists had embarked upon what they had called a “reeducation” program  aimed at indoctrinating everyone in the country but especially the educated and the young people to completely and without any question accept the sanctity of their leader and the validity of their doctrine.. Lifton’s technique of gathering data was to make contact with appropriate subjects and then hold open ended exploratory interviews. He used a trusted translator most of the time. He had made friends and contacts in Hong Kong who led him to meet various people from China who had been subjected to this mind control. A variation of this technique was applied to the Americans airmen taken prisoner of war by the Chinese in the Korean War. At that time the term “ brain washing” became popularly applied to what was being done .The techniques involved isolation, repetition of ideas, raising self doubts about old ideas. It was a relentless style of re-education which also included the encouragement of reporting to the authorities anyone known to rebel and not accept this new way of thinking. As Lifton saw the overall impact on Chinese society, he applied the term “totalism” to the complete penetration of this doctrinal thinking in all phases of living in China. Lifton was to also use this term when he studied other groups particularly the German people falling under the influence of Hitler. His suggestion that any group whether it be religious, political or even social which makes an all out effort to control the thinking of it’s potential followers should be identified as applying “totalism” to its efforts. He is very clear about the destructive nature of such thinking and the reader cannot but think how various modern day movements may be leaning in this direction.

While it is difficult to say which of his experiences had the greatest impact on him as they all obviously did and each embellished on the other. However, it seemed to me that his study of the survivors of the Hiroshima atomic bombing  which he did when he was in his early 30s, emotionally penetrated deeper than anything he subsequently experienced and irreversibly changed him. Through his personal interviews with the subjects of his research, as a relatively young man he repeatedly encountered the meaning of death, destruction and mutilation. He appeared to feel their despair. While he intellectually understood and scientifically described the complicated grief and walking death that so many of the Japanese were to live throughout the rest of their lives, Lifton was transformed into a lifelong and very effective pacifist. Those of us who never had the emotional confrontation with the results of the A Bomb, might be able to  accept President Truman’s decision to bomb Hiroshima and Nagasaki based on the calculation to save the lives of many thousands of Americans who would have invaded Japan. Lifton I believe, never raised this issue and appeared to believe in retrospect it had to be the wrong decision. He continues to bring a pacifist point of view to every relevant  modern political and social issue of his time.

While I never met with anyone who went through  anything approaching the magnitude of Hiroshima, my experience as a consultant to a major burn unit and having had some professional work in the aftermath of 9/11 gave me some perspective to to relate to  his writing on this subject. However his decision to attempt to interview the Nazi doctors was “ mind boggling” to me, meaning that I had no frame of reference to this subject. Since this was his memoir, it probably was relatively short on the details of this work and conclusions which was covered in his earlier published work.  But this book was  relatively long on his personal reactions to the people with whom he met. His own perspective in approaching the Nazi doctors was as physician, psychiatrist, pacifist and a Jew. He seemed to have no trouble making the contacts and finding the surviving doctors who were willing to speak with him. In this memoir Lifton shares his struggle to understand whether these doctors were inherently evil people or whether circumstances might induce people to do terrible things to other people.

Lifton’s analysis and discussion of his experience in looking at the Viet Nam War and anti-war movement carried through to his comments on the U.S. war in Iraq. His reasoning and anti-war point of view is not simply founded upon his pacifist point of view but brings in a political and historical analysis. He also describes his interest in understanding post traumatic stress. He may have originated the term psychic numbing based on his earlier observations as well as those on the returning Viet Nam veterans. It is not surprising that he had great interest in understanding the My Lai massacre and raised once again how could descent people (in ths case the American soldiers)  do horrifying deeds.

It was a special treat to learn about the many writers, historians and other intellectuals  with whom Lifton interacted over the years. His personal discussions with people as diverse as Erik Erikson and Norman Mailer were recounted. Many of them took place at seminars he and his wife held at their summer home in Wellfleet. Betty Jean Lifton died shortly after her husband finished most of his memoir  She was a writer mostly of children’s books but she shared his passion for psychohistory  and their relationship is warmly reflected at many places in this book.

First CAPA Graduation Held In China

CAPA stands for Chinese American Psychoanalytic Alliance which is an organization created by Dr. Elise Snyder a New York psychoanalyst. The organization runs a training program where mostly American psychoanalysts teach Chinese psychoanalytic students theory and technique as well as providing individual supervision all via Skype. The first graduation of this two year program was recently held in Beijing China .

Report From Beijing

In the future when Chinese psychoanalysts look back at the beginnings of what may be a vigorous psychoanalytic movement in China, they will remember October 24, 2010 when The Chinese American Psychoanalytic Alliance (CAPA) held the first graduation ceremony of it’s psychoanalytic training program at the Mental Health Institute of Peking University. I had the pleasure and the honor of attending that graduation.

Elise Snyder, M.D. Driving Force Behind CAPA

Elise Snyder, M.D.

The creative and driving force behind CAPA is a New York psychoanalyst by the name Elise Snyder. It all began several years ago when she was visiting China with her husband Michael Holquist who is Professor Emeritus of Comparative Literature at Yale University and was attending a conference there. Dr. Snyder met several Chinese mental health professionals who were very interested in learning more about psychoanalytic theory and practice. This led to a series of visits to China by Dr. Snyder where she gave lectures, held various meetings and did some consultations. She returned several times and also became very involved during a subsequent major earthquake where she was helpful in advising about mental health services.

Dr. Snyder was encouraged to set up a training program for Chinese therapists and students interested in learning about psychoanalysis and psychodynamic psychotherapy. She began to involve American colleagues and utilized Skype an Internet Video Conferencing tool. This evolved into a program which was training Chinese psychiatrists and other mental health professionals in 4 different cities. There would be 4 hours of classes per week via SKYPE. Each class would be an hour taught by an expert mostly in the United States, although psychoanalysts in Canada, Australia and France also were recruited as teachers. In addition the students were required to have one hour per week of a supervisory session for their own clinical work also done by Skype with CAPA instructors. Many students chose to have their own psychoanalysis or psychoanalytic therapy mostly via Skype.

CAPA is Non Profit but Students Pay a Fee

CAPA is a nonprofit organization. The students do pay a tuition, the equivalent of about $1500 /year, which goes towards administrative expenses. The teachers donate their time for teaching classes and supervising students. Those students, who are being treated, pay very modest fees in the range of $5-25/session, which means that most of the therapists are essentially donating their time. The students themselves are usually employed as mental health professionals. Some are psychiatric residents working in a hospital or if graduated may be working in mental health clinics or a few may be in private practice. There are even medical school faculty members in China who have chosen to get the credential as a CAPA graduate. Others are psychologists, counselors or other mental health professionals who may be working in clinics, hospitals or other settings.

I was asked to participate in in the CAPA teaching program about one year ago. I subsequently have taught classes in Wuhan and Shanghai, both via Skype. I am now supervising a young psychiatrist who is in Qingdao, Shandong Province, an eastern coastal city of China. There is a 16 hour difference between China and Los Angeles where I am located. So for example, on Tuesday evening at 11pm I sit in my office and fire up my computer and will be viewing my supervisee and chatting with him for his supervisory session on Wednesday at 3 pm in China. While I was in China  with the recent CAPA tour I  meet with him in person.

CAPA has caught on in China and in the United States. There are over 200 faculty members who donate their time to the training of psychoanalytic theory and therapy in China. Approximately 30 students were graduated in Beijing in October. There were also informal graduation ceremonies for another 20 students in Shanghai and Wuhan. This means that  this nascent organization of Chinese and American professionals has close to 350 members and counting. In Beijing and in other cities where I traveled as part of the three week CAPA tour, I met Chinese professionals and professional students who were eager to learn about CAPA. Many were preparing themselves for a career in the mental health professions and were anxious to get training through CAPA.

The Historic First CAPA Graduation

Prior to the historic graduation and the handing out of diplomas, there was an academic program for the CAPA students, the faculty and for other guests from the Mental Health Institute at Peking University. The moderate size auditorium was quite filled. First, there was a case conference, which was led off by Dr. Ba Tong, one of the graduates who presented a clinical case in which she demonstrated her knowledge of transference and countertransference. Dr. Cecile Bassen, a psychoanalyst form Seattle, sensitively discussed the case. We later met Dr. Ba Tong who came across as a very capable young woman who showed us pictures of her new private office, which she will be sharing with a colleague as they start their private practice in Beijing. The second part of the academic program was a presentation by Dr. Shari Thurer from Boston who gave a lecture on Sexuality and Gender identity in which she reviewed homosexuality, transgender sexuality and transsexuality. There was a very interested response from the students in the audience some of whom told of their clinical experience with patients.

The program concluded with a few words from Dr. Snyder who is now seeing her “baby” coming to fruition. She seemed quite proud, as she should be as she called the graduates to the podium. There were also many beaming faculty in the audience. Dr. Snyder announced that there would soon be an advanced additional two year segment available in the CAPA training program, making a total of 4 years of training being provided by CAPA. I later asked Dr. Snyder what she was thinking as she saw the graduates come up to the podium to shake her hand and receive their certificate.  She said, “I felt overwhelmingly moved. I felt happy. I started to cry and couldn’t believe it was happening.” She want on to explain how proud she was of the students and the faculty. She viewed  this event as an historical moment . She ended by saying “This is really the  beginning of an interest in psychoanalytic therapy (in China) that arises from the bottom rather than from the top down.”

Shanghai Girls-Insightful Novel

Shanghai Girls a novel about two Chinese sisters and their struggles in becoming immigrants in the United States is reviewed. The book is quite engrossing as well as providing empathic insights into the immigrant experience.

The Privileges and Pleasures of Being A Therapist

After treating  patients with psychoanalytic or psychodynamic psychotherapy for a period of time we usually have a fairly good understanding of their personal and family dynamics. We come to understand their  relationships as well as their culture and customs which may be quite different than our own. If the the therapy has gone on for several years, we have seen how the patient and his or her environment interacts with important life events such as going to college, pregnancy, tragedies and even epic historical events such as war and 9/11. This is one of the privileges and great pleasures of being a therapist. In addition to helping our patients  have a more gratifying and forfilling life, we have learned a great deal, been enriched all the while sitting in our offices ( hopefully remembering to take time for exercise and other things.)

As Well As Reading A Good Novel

I recently was reminded how we can get a similar rewarding experience by reading a good novel.  I just completed such a book titled Shanghai Girls by Lisa See . As best I can tell  from supplementary reading, the author is not explicitly writing about her own life and family. She has researched her subject and her characters quite well by conducting many interviews and reviewing  oral histories in order to convey a very authentic story.  She also appears to have very good insight and empathic understanding of the emotions that the protagonists of novel could have.

Shanghai Girls

As the story opens the reader is introduced to two “beautiful” sisters age 18 and 21 who are living somewhat of an upper class exciting city life in Shanghai, China in 1937. We get a feel for their family dynamics which are embedded in the Chinese customs and culture of the time. We see devotion to parents but yet a struggle when an arranged marriage is imposed upon the sisters. We follow these girls and their family as they confront the Japanese invasion of their country, their attempt to flee, the death of family members and most poignantly, a brutal rape and the consequences of it. The story covers a time span of about twenty years which allows for a maturation and evolution of the characters as well as the effect of new historical events. The sisters come to the United States and struggle with the problems that  immigrants had to face in trying to make this transition. They confront cruel discrimination against the Chinese. Family secrets fester. We see the impact of parental values surface. Religious views, issues of conscience, teenage rebellion , the effects of previous traumatic experiences are all interwoven in this story. There are insights into the thoughts and feelings of immigrants trying to live in a new culture which can easily be reapplied when we look at the plight of the undocumented Latinos in the US today or reflect back on the experiences of the Jews as well as other groups who have tried to become part of the melting pot which is America.

I strongly recommend this book and contend it will  provide useful clinical insights for therapists as well as good reading for everyone.

Consulting on a Suicide Epidemic

The New York Times and other media outlets recently reported 13 suicides at the the Foxconn factory in China. This situation reminds this author of a similar situation in which I was part of a small consultation team studying an epidemic of suicides in a large city in the United States. The approach which we took and the response to our report is discussed.

13 Suicides In One Factory in China

According to recent reports from China, since the beginning of the year 13 workers form Foxconn a large factory in Shenzhen have committed suicide. Foxconn manufactures products for Apple, Hewlett Packard and Dell. Some reports in the media tell of difficult working conditions where plant workers could not talk while working and were fined for mistakes. The average salary of workers in the factory was $140/month but since the reports of suicide, it reportedly has been raised 66%. On the other hand, in an effort to discourage suicides, the factory has stopped offering compensation to families of those who have killed themselves since it must have been thought that this compensation might be an incentive for some of the workers to commit suicide. It is also reported that some of the political leaders in China are unhappy with the bad publicity that this rash of suicides has been bringing to China and are taking steps to stop it. Nets are  being built around the dormitories where many of the workers have jumped off in their suicide attempt. More appropriately counselors were being trained and brought in.

Similar Situation in the United States

This situation reminds me of a somewhat similar set of circumstance in which I had been involved. Many years ago I was asked to be part of a small team to study a series of suicides that had occurred at a large entity that was frequently in the public eye. The press was clamoring for answers about this unusual problem and management was concerned about the bad publicity. They assured us that they would do whatever they could to help us get to the bottom of  this problem and expected a full report from our team within 60 days.

Approach to the Consultation

Our first step was to meet with the managers and supervisors, as well as the union leaders. Management agreed to help us in any way but the union people were suspicious that we were going to whitewash the problem.  After much discussion and many meetings, we convinced them that we were independent of management and although we would ultimately be reporting to them, we would pull no punches. They agreed to encourage full access for us. This initial step was very important.

We obtained the all records and documents of the workers who had suicided. We attempted to meet with their co-workers. Although meeting with their families would probably be enlightening, we ultimately decided not to do so. Since  much of the work of this entity involved vehicles driving from place to place we arranged to ride with them and chat informally in addition to the structured interviews that we did as noted above.  As some of the emerging information indicated that working condition, time schedules, salary, benefits and opportunities for advancement might be an important factors in the suicides, our team made an effort to benchmark this entity in regard to these factors  using similar entities in other cities in the US and internationally.

Findings

We found that there was a great deal of demoralization among the highly skilled work force which may have contributed to the suicides. As far as we could determine, most of the employees were very dedicated to their work but felt that management did not care a great deal about them. They were expected to frequently work overtime (with pay) but often did critical work while sleep deprived. A small undetermined percentage took drugs mostly to stay awake and mentally sharp (some to deal with their demoralization and depression). We heard of examples of workers doing work which could endanger other’s lives while under the influence of such drugs. They felt that their work skills were not easily transferred to other jobs and also  believed that there was little chance for advancement within their current job. There were some circumstances where workers became psychologically traumatized related to their work.  However most people whom we interviewed shared the belief that if they complained of being depressed, anxious and not able to work , they would be penalized in the job.. We had the impression that this lack of support contributed to the suicidal behavior which had occurred in at least several instances.

Our study team prepared an extensive report with these findings and with a list of constructive suggestions which was based on our interviews and our benchmarking inquires. We suggested policies concerning time off , breaks and areas where breaks could occurs. We advised  drug and alcohol educational programs with a guaranteed no penalty for those who sought help for these issues or any mental health concern which should not be part of the employment record. We suggested a review of the salary, vacation  pension and promotion policy   based on the preliminary information that we had from our examination of other similar entities. We did not think that meaningful changes would be a financial burden and in the long run would provide more efficient functioning. We also suggested a mentoring program utilizing senior people, many of whom were held in high esteem by the younger workers.

Consultation Report Initially Rejected

We were surprised at the total rejection of our report by the highest level of management. They told us we would have to rewrite the report or we would not be paid for our services. I believe that they had expected us to confirm their belief that the people who suicided were mentally unstable and not typical of the work force. While that was true in some of the cases, we obviously felt that there were factors stressing the workers and that suicidal behavior was one result of these factors which needed to be addressed. It also appeared that the highest level of management was concerned that his report might be leaked to the press which of course we had no intention of doing. Ultimately the report was accepted as a confidential report. Some but not all the recommended changes were made over several years. The unusual number of suicides did not continue and in fact  may have been a coincidence which unearthed some problems which needed to be addressed.