Advocacy As Therapy?

I want to preface this by saying that in no way am I a trained therapist or counselor. Luckily, my trade allows me the opportunity to have conversations about many different aspects of health care, innovations, and policies. Many of my conversations have dealt on the realities of health care policy challenges on the ground. Many administrators of various institutions are struggling to meet demand for counseling services. Because of these resource strains, many are seeking innovative solutions and ways to make the counseling process more efficient so as to maximize value.

With that background, I have been watching, like most of the nation, the debate unfold over the high school shooting in Florida. Namely, I have been watching the reaction and the debate revolve around the outspokenness of many of these surviving students.

Yes, there are copious conspiracy theories floating around about how the students are just becoming political pawns, or potential actors, to further insidious policy goals. I choose to believe that we are watching a real time debate over an important, and complex, subject that has been delayed for years being led by real people. That being said, I do think that something is in play that is overlooked and relates to a larger trend in society that has also been overlooked over the past decade or so. This is the role of advocacy as a type of therapy in itself.

When a trauma occurs to someone we often refer them to counseling whether it be for grief, PTSD, or what have you. In addition, the most likely solution to anxiety/depression/etc. is to see a counselor and sometimes medication. There is a prevailing thought that anxiety/depression/etc. are chemical imbalances that need to be “fixed” (and I would argue that sometimes this is true). But there is a lot of evidence that anxiety/depression stem from an amorphous feeling of “lack of control” and some theories exist that these emotions are not “disorders” but rather pain symptoms no different than the mental equivalent of placing your hand on a hot stove. Your body is telling you that something is wrong so you will “fix” the problem.

It is no secret that there are many “wrongs” in society and many of these wrongs are beyond our control, thus spurring anxiety issues. Cultural tensions, economic concerns, and even global issues can all add up over time to stress our internal systems.

Whether people know it or not, many are combating their anxieties by participating in advocacy. There is a reason we have seen a massive rise in grassroots efforts the past decade. It’s communal, it strives to fix the root issues, and it’s a positive channel of energy.

For the right, the Tea Party and President Trump’s election is evidence of this. For an example, let’s look at the map. Addiction, powerlessness and hopelessness are deeply intertwined and many have speculated that there is a self-reinforcing reason that the nation’s opioid epidemic is so prevalent in certain regions of the country. These regions track, almost exactly, the voting patterns of Trump supporters. Is it really a leap to say that the economic and cultural concerns of so many rural areas are creating a sense of hopelessness and anxiety that is, negatively, contributing to addition problems, and, positively, spurring advocacy as a coping mechanism?

This crosses the political spectrum.

It is also no leap to say that if the blue wave activism that exists today existed even a few weeks prior to the 2016 election, our politics would look very different right now. Alas, that was not true and Republicans won a resounding victory on many fronts in 2016. The unexpected loss combined with new stressors and anxieties on the left to spur new coping mechanisms, one of which being advocacy. I would go as far as to speculate that some of the Florida shooting survivors are actually utilizing advocacy as a type of grief therapy.

Is it a positive or a negative development?

In a way, this is not a new development since societal concerns and anxieties have always been at the root of political movements. Few would argue that the advocacy of the civil rights movement wasn’t therapeutic in its own way. However, the sheer scale of the grassroots movements seen since the rise of the Tea Party is unprecedented. The connectivity of the internet and the prevalence of information and media are partly reasons for the scale but the size of the stressors triggering anxieties have to be accounted for. There are well-established links between financial stability and mental health and it should be no shock that the Tea Party movement initially arose over concerns of deficit spending and from the fallout of the Great Recession. Conversely, concerns about wages, job security, student loans and long-established benefit programs like Medicare and Social Security are factors in why so many millennials are organizing against the powers that be.

There are many positives in these movements. Reevaluation of existing structures often follows and honest examination and efficient repurposing of institutions is not always a bad thing. New leadership often comes to the forefront. In the mid-19th century, the nascent Republican Party combined with abolitionist social movements to produce Abraham Lincoln, typically cited as the greatest president. The American Revolution gave us the Founding Fathers, progressivism gave us Teddy Roosevelt and the 1970’s reexamination of the conservative movement produced Ronald Reagan. Like the production of new leaders, new ideas and concepts come to the forefront as well. The enlightenment produced constitutions, legal codes, and democratic institutions. The Renaissance produced artistic masterpieces, new trade networks and launched the age of exploration.

Of course, there are negatives. Inflamed passions invite conflict. Narratives begin to trump facts and honest debate. History is littered with social movements that began with good intentions only to be hijacked by violent purists or ambitious and power hungry individuals. Let’s not forget that the French Revolution began as a peaceful, attempt to solve a financial crisis. Once that issue morphed into a social movement designed to give France a new constitution in the spirit of the enlightened age, the movement was quickly hijacked by Jacobin purists (like Robespierre) constantly arguing that they were more republican than their peers. While the Jacobins played “no true scotsman”, the Reign of Terror raged and thousands were murdered and persecuted. Naturally, a man of ambition in the form of Napoleon Bonaparte, stepped in and coopted the whole revolution which he turned into his own empire.

It’s appropriate that these movements are occurring at a time when the internet, globalization and mass media are all intersecting to produce a brave new world. Like the enlightenment, this new era could produce momentous works of creativity and new economic booms. It could invite wars for hegemony and bloody revolutions. The new advocates of today working through the problems and anxieties brought about by society would be wise to heed the lessons of history.

Is this advocacy as therapy healthy?

This is a bit more complex for me to answer because this ties in deeper discussion about what is proper treatment for mental health issues, a topic I am unqualified to discuss. A cursory search indicates that not much research has occurred in this area. Certainly, advocacy alone is no treatment if for no other reason than the likelihood of falling short in one’s advocacy efforts.

However, a friend passed along an interesting case study from Canada about a young woman living in poverty and with anxiety. Prior attempts at addressing her anxiety failed because her therapists failed to inquire into her socio-economic conditions that left out critical context about her life and sources of anxiety. According to research cited in this article (but behind paywalls for our purposes) advocating for change in a patient’s life and acts of advocacy are powerfully therapeutic when advocacy honors the complexity of patient’s lives and defines the problem as separate from the client.

In this case study, the woman and her therapist tackled the immediate anxiety issues with lessons in relaxation and mindfulness. With context, the anxiety became less a “disorder” and more a natural response to the justifiably stressful situation of poverty. Fostering a collaborative relationship with the therapist, the woman and her mother worked as a team to tackle the root stressors of poverty. Together the three found welfare support which augmented their income and the girl found scholarship assistance which allowed her to attend culinary school where she graduated at the top of her class and found highly regarded employment.

At the state level, Court Appointed Special Advocates (CASAs) are critical persons within the criminal justice, family court and foster system. These advocates are volunteers appointed by judges to watch over and advocate for the best interests of abused and neglected children. The volunteers work with their kids to make sure they successfully navigate the legal system and find their way into good, permanent, homes. At an age when these children cannot advocate for themselves, having an advocate on their behalf is another powerful example of how positively tackling stressors and overcoming institutional obstacles can result in healthy outcomes.

Of course, there is a difference between advocating for oneself and having an advocate on your side. Yet, the evidence at hands appears to indicate that working to eliminate and overcome the root cause of the stress can be a powerful tool in addressing anxiety and acting as mental health coping mechanism in certain situations. On a macroscale, the intense politicization of society can be interpreted as a society-wide attempt to eliminate points of anxiety through advocacy. On a microscale we can see this occurring with the Florida survivors or the #MeToo movement.

As layman, I certainly wouldn’t say advocacy alone is a magic pill for individuals but the evidence seems to indicate it is a powerful tool that can be utilized out of the larger toolbox. And as individuals increasingly turn to this productive outlet that indicates that society will increasingly turn to advocacy and politics as a means to alleviate the root causes of collective anxieties. Like other powerful social movements and great eras of the past it is likely that society will become even more politicized before a stable status quo is achieved. The key is ensuring that these individual, and massed, advocacy efforts remain positive efforts.


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