The next few months we’ll be highlighting authors who have published in Culture, Medicine, and Psychiatry.

Lawrence D. Blum, M.D. is a Clinical Associate Professor of Psychiatry and Adjunct Professor Fanthropology at the University of Pennsylvania. He is also Faculty at Psychoanalytic Center of Philadelphia. He is a psychiatrist/psychoanalyst in private practice.  His undergraduate thesis focused on anthropology and psychoanalysis; both became lifelong interests. He has enjoyed teaching trainees in psychiatry, psychology, and psychoanalysis for decades. In recent years he helped found and co-direct the undergraduate minor in psychoanalytic studies at the University of Pennsylvania. 

What is your article ‘Minding our Minds: Obsessive-Compulsiveness, Psychiatry, and Psychology‘ about?

It is nearly impossible to be a good scientist or doctor without the advantage of some obsessive-compulsive personality traits, but these traits can also have significant disadvantages. While obsessive-compulsive traits tend to promote scientific rigor and conscientiousness, they can lead to an emphasis of method over meaning, and measurable behavior over the emotions and fantasies that are also essential aspects of being human. These traits are pervasive enough in professionals, I argue, to create an obsessive-compulsive background within scientific and medical culture. In my article, I discuss the influence of this obsessive-compulsive culture on psychiatry and psychology, using the Diagnostic and Statistical Manual (DSM) and Cognitive-Behavioral Therapy (CBT) as examples. The DSM and CBT have many salient obsessive-compulsive features, but to my knowledge, this article is the first to discuss the obsessive-compulsive qualities of either the DSM or CBT, or of psychiatric and psychological culture in general. One could regard the article as a kind of psychoanalytic ethnography of current psychiatry and psychology.

Tell us a little bit about yourself and your research interests.

One of my principal ongoing research interests is “counterdependency.” This is a term that indicates having objections to “dependent” wishes, i.e., wishes to be taken care of or helped by others.We humans start out as dependent babies, needing and wanting to be taken care of.  Though we also grow up and want to be independent, and to be able to take care of others, those early wishes to be taken care of never go away. Some cultures encourage tolerance of and continuing expression of dependent wishes, and others don’t tolerate such wishes and encourage their suppression. In my view, the United States, compared to other countries, is a cultural outlier in its rather extreme counterdependent intolerance of those who need to be taken care of. We have a conquer-the-frontier mythology of extreme self-reliance accompanied by corresponding contempt for anyone who needs to be taken care of, so compared to other developed countries, the United States does far less for new parents, children, the sick, and the poor.  As compelling as these observations seem to me, as far as I know, counterdependency has never been empirically studied on a cultural level.

I first became aware of the importance of counterdependency early in my career when I was seeing a lot of women with postpartum depression. They were often very capable, successful women who were used to doing everything themselves and never needed to ask for help. When they had a baby, they couldn’t survive without help but were emotionally unable to ask for help; their way of adapting to life failed and they became acutely depressed and anxious. Those women who, with a bit of help from me would then allow themselves to ask for a bit of help from others (often as little as possible), frequently recovered very quickly. It soon became clear to me that this counterdependent stance was a) an important unrecognized risk factor for postpartum depression, b) a significant factor in individual psychology, and also c) a pervasive aspect of our culture. A colleague and I developed a self-report instrument to assess counterdependency, which we have tested in relation to postpartum depression, and which could easily be used to compare different cultures.

Any reader who may be interested in empirically studying counterdependency, in relation to either culture or individual psychology (or who may have an interested graduate student), should feel free to contact me.

Here are two relevant references:

Blum, L.D. “Psychodynamics of Postpartum Depression,” Psychoanalytic Psychology, Vol. 24, No. 1, 45-62, 2007.

Blum, L.D., Horenstein, A., Carper, M.M., Stange, J.P., Cohen, J.N., Doyle, A. & Smith, V. (2020). A New Instrument to Assess Counterdependency, Evaluated in the Context of Postpartum Depression. Psychoanalytic Psychology, 38:1, pp 49-57, January, 2021. Published online June 25, 2020, https://psycnet.apa.org/doi/10.1037/pap0000317 .

Since reading Mary Douglas’ paper ‘The Self as Risk Taker: A Cultural Theory of Contagion in Relation to AIDS’ (1990), I have been intrigued about perceptions of risk and protection from HIV.  During research in Baltimore, Maryland in 2015, an interviewee commented that although they were engaged in sex work, they only went in their own circle. They saw this boundary as protective against HIV risk and it resonated with Douglas’ ideas about community boundaries as a protective barrier to contagion. I then developed this project as a pilot for investigating the use of Cultural Theory among people who use drugs

What was one of the most interesting findings?

I think the most central point is that an obsessive-compulsive professional culture has led to a very narrow biological and behavioral reductionism in psychiatry and psychology, with an unfortunate de-emphasis of humanism, mind, emotion, and fantasy.  A more truly scientific approach in these disciplines would incorporate a broader view of what it is like to be human, including all of our irrationality

What are you reading, listening to, and/or watching right now?

A student recently brought to my attention an excellent article called “Melancholy Anthropology,” by the Australian anthropologist, Holly High.  She draws on Freud’s “Mourning and Melancholia” and argues that the ethnographer in the field not only, necessarily, becomes deeply emotionally engaged with the people she is studying, but also inevitably becomes the object of their many often deeply irrational desires.  She cannot possibly fulfill those desires and tends to feel deeply guilty.  High then argues that this intolerable, often unacknowledged, guilt tends to be transformed into needs for ideological purity that characterize some parts of the discipline, thus making an important connection between experience in the field, individual psychology, and the culture of anthropology as a discipline.

If there was one takeaway or action point you hope people will get from your work, what would it be?

From my paper in CMP, I think the most central point is that an obsessive-compulsive professional culture has led to a very narrow biological and behavioral reductionism in psychiatry and psychology, with an unfortunate de-emphasis of humanism, mind, emotion, and fantasy.  A more truly scientific approach in these disciplines would incorporate a broader view of what it is like to be human, including all of our irrationality.

For my work in general, I think perhaps what is most central is the wealth of fascinating, bidirectional interaction between individual psychology and culture that is heavily influenced by early developmental experience, and that is typically unconscious. 

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