The new tie-Man?s Land: The Changing Face of I Zane PiJz'Zz'pson sychotherapy is in tumult. Professional publica- tions tell of a ?mental health care revolution? in which the state increasingly abdicates re5ponsi- bility for funding of services, insurance carriers deem treatment an unnecessary luxury, and the independent practitioner is threatened with occupa- tional extinction. Over the course of the past decade, federal, state, and local monies for virtually every form of mental health service have been decisively reduced. Not only for the poor but for much of the working class, there are sim- ply no affordable mental health services available. Even in the case of drug addiction, a problem that is pre? sumably of the highest priority in our society, clients of- ten have to wait months for any form of treatment, due to understaffed clinics and huge waiting lists. Only when an individual becomes dangerous?suicidal or homici- dal?can the few remnants of the community mental health system be brought to bear quickly. Even then, the system offers at best a few days of hOSpitalization, or antidepressant medication, and release back into the community with little more than a pre- scription and an appointment with a in a month or two to monitor the medication?s effects. That mental' illness contributes significantly to mounting homelessness, some violent crime, and drug and alcohol addiction does not seem to galvanize politi- cians into supporting mental health services. Instead, our tolerance for bizarre, confrontational, and violent behavior on our streets and in public places is simply forced to expand. Although the state supports the use of drugs for the treatment of problems, it is clear that it has virtually abandoned any commitment to or interest in Clearly the idea of funding a process that may take weeks, months, or years is un- palatable when many local governments teeter on finan- cial collapse and when the omnipresent quick-fix of drug Ilene Pbiz?zpron is a practr'a'ng in Berlecfcy; a cor:- tri?utz'ng editor ofTikkun; and the author of Ethel Rosenberg: Beyond the (Franklin 11743:, I988). therapy is advertised as a cost-saving alternative. Yet it is not only those who look to the state for help who are affected by this narrowing vision. As health care costs in general have skyrocketed, insurance carriers have pro- gressively cut back on reimbursements to the private practitioners who traditionally minister to the working and middle classes. ?Managed health care??-the health maintenance or- ganization (HMO) or preferred provider organization the means by which increasing numbers of people are obtaining health services. These organiza- tions also view as a treatment they can ill afford to support. Typically they allow their subscribers five to ten visits with a occasionally as many as twenty, but not more. After one to four months, if a problem is not resolved, there is no appeal, no further help. While this sort of stance toward physical illness would be incomprehensible, it has be- come routine in the treatment of disorder. Curiously, however, as public and private funding sources for services have radically de- clined, the number of pe0ple becoming has radically increased. In the past fifteen years the num- ber of clinical in the US. has almost tripled, clinical social workers have more than tripled, and mar- riage and family counselors have experienced almost a seven-fold increase. has not experienced any appreciable increase, but neither is it emphasizing psy- chotherapy as the mainstay of its professional identity. Rather it has undergone a process of ?remedicalization,? and offers as its hallmark. As the number of practitioners continues to increase and the funding for their services by both the state and private insurance carriers decreases, as an occupation seems to become less and less attractive to men. In fact, men are simply not entering the profession. While only 10 to 15 years ago men and women entered clinical programs at equal rates, at the cur- rent rate of change it can be estimated that by the year 2004, 80 percent of all doctorates in clinical will be obtained by women. \When we add the facts that clinical social work and marriage and family counseling 9 have always attracted more women than men, and that most of the relatively few residents who opt for training in are women, it becomes clear that the field of is becoming a world without men. Conventional wisdom gleaned from other fields that have become feminized indicates that when men aban- don an occupational category the field becomes less re- munerative and lower in status. There seems to belittle reason to believe that will differ from this pattern, particularly given the ever-increasing competi? tion within the field, the shrinking job market, and a growing belief within and perhaps the pub- lic in general, that drugs offer a better chance for ther- apeutic cure than talking. This transformation in the field of an institution in decline and increasingly pOpulated by women practitioners, mirrors changes in the contempo- rary familyaan institution in decline and increasingly populated by mothers parenting alone. I believe that the feminization of reflects larger changes regarding the relative responsibility of men and women in society to provide intimacy and what sociologist Arlie has called ?emotion work.? Men?s abandonment of the profession?dike their abandonment of families?exacerbates the widely nP?schotoothott Philosophers and prophets have hailed it. Extremists and fanatics have shunned it. Now, in his groundbreaking new book, Kirk Schneider shows how the engagement of Paradox can transform our lives. THE PARADOXICAL SELF: TOWARD AN UNDERSTANDING OF OUR CONTRADICTORY NATURE Kirk Schneider values the paradox, which profound thinkers have always pointed out. He has great company consisting of Kierkegaard, Tillich, Ernest Becker, and many others down through The Paradoxical Self will especially help to get back to its great calling again. ?Rollo May, Author ofLom.? and Will i admire {Schneider's} ability to anatomize the paradox principle and to make his analogies so accessible and stimulating. ?Norman Cousins, author ofAzmtomy ofam Hint-r: [Kirk Schneider's] theory is . .. elegant. and forges important links between and philosoph'. ?jeffrey Mishlove, PBS 'l'V?s Tbt'uh'ng Affowed This is an important book An exciting model. ?Garyr Kelly, Association for Humanistic The Paradoxical Self is available at bookstores and Plenum/Insight Books for $20.95?Phonc: 13002213?? 10 TIKKUN VOL. 6, No. 5 held belief that it is women and not men who are re- sponsible for tending to and ameliorating our emotional pain and problems. Because our society denigrates this kind of emotion work, women thera- pists??just as women in families?are finding it increas- ineg difficult to be supported economically for the work they do. Both in theory and in practice, main? tains a close relationship to contemporary family life. Adults frequently seek out with the de- sire to repair the injury they experienced in their families in the past, to work out the problems they still have with family members, or to mourn the loss or ab- sence of intimate relationships; children often are re- ferred to because of their inability to cope with problems in their families. Over the past two decades American families?and the families of patients have been no ex- ception?have increasingly been characterized by the absence of fathers, whether due to divorce, separation, or, more than ever, single motherhood in which a father has never been present. As the literature on the femi- nization of poverty, divorce, and physical and sexual abuse within the family suggests, the population from which clients emerge undoubtedly has experienced the effects of what sociOIOgist Jessie Bernard calls the ?fall of the good-provider role.? Writer Barbara Ehrenreich terms it ?the collapse of the bread- winner ethic? for men and refers to their concomitant ?flight from commitment?: By the end of the 19703 and the beginning of the 19805, adult manhood was no longer burdened with the automatic expectation of marriage and breadwinning. The man who postpones marriage even into middle age, who avoids women who are likely to become financial dependents, who is dedicated to his own pleasures, is likely to be found not su3piciously deviant, but ?healthy.? Bernard dates the demise of the good-provider role to the same period and shows that the percentage of working men with a positive attitude toward marriage decreased dramatically between 1957 and 1976, from 68 to 39 percent. During the same period, she points out, the proportion of working men who found having chil- dren ?burdensome and restrictive? more than doubled, from 25 to 58 percent. Certainly men?s shifting attitudes toward commitment and breadwinning can?t explain all the changes in Amer- ican families during the past two decades. The widen- ing gulf between rich and poor, the decline of the family wage, women?s participation in the labor force, shifting sexual and cultural norms, and feminism are critical to understanding how family life has altered. Nevertheless fl a crucial fact remains: As the nuclear family CliSlI?ttC" grates, it is women who are left with the emotional and economic re5ponsibility for rearing children on their own. It is estimated that two-thirds of first marriages now end in separation or divorce, and only 9 percent of Amer- ican homes fit the breadwinning model of a working hus- band, a housewife, and children. A quarter of all American children now live in single-parent families; in 1960, only 9 percent did. It is esrimated that more than half of all children in the US. will live in a single-parent household at some point before age eighteen. Of these, 89 percent will live with their mothers; 9 percent will live with Other relatives such as grandmorhers, and 2 per- cent will live with their fathers. Thus the term ?single parent? serves to obscure the fact that ?single parents? are typically women. From 1960 to 1980 the average number of years that men between the ages of 20 and 49 Spent in families with young children declined 43 percent (from 12.34 years in 1960 to 7.0 in 1980). In 1987, 9.4 million women were rearing children whose fathers were not living in the household. This represents an increase of 7 percent just since 1985, and almost 100 percent since 1970. Most women raising children without fathers in the home re? ceive no child-support payments. Yet even for women who have been awarded support, 25 percent do not get the full amount of that support, and 24 percent receive nothing at all. Emotional support seems to be lacking as well. Soci? ologists Frank Furstenberg and Kathleen Mullan Harris have shown that ?close to half of all children living apart from their fathers had not seen them in the previous year. . . . And less than half had ever been in their father?s home.? Their study concludes that biological fathers in- creasingly see their responsibility to their children solely as a function of their relationship to the children?s mother. If that ends, according to Furstenberg, ?the pa- ternal bond usually withers within a few years too.? The absence of the ?good-provider role,? however, may not only apply to men?s literal abandonment of fam- ilies. It may also Speak to the sexual and physical abuse adult males inflict on adult women and children of both sexes. Although it is difficult to know with any precision how much violence occurs within families, studies Show that about one in four women is physically abused by her husband or male partner. Almost a quarter of adults report having been sexually abused as children. Two- thirds of the victims were girls, and over 90 percent of their abusers were adult men. Of these adult men, al most a quarter were male relatives. \While the absence of historical data makes it impossible to say whether or not these figures represent a change in the incidence of family violence, reporting of abuse has steadily increased over the past decade. From this very cursory review of current trends, it ap- pears clear that men?s role in the family is undergoing a significant shift. \While there are definite and significant exceptions?particularly among professional and highly educated men, many of whom seem increasingly to value their involvement in their children?s lives?-more and more women and children are being confrOnted with life without father. Men?s ahanclonment of the profession?like their ahandonment offamilies? exacerhates the widely held helief that it is women anal not men who are responsihle for tending to and ameliorating our emotional pain and prohlems. The field of meanwhile, has under- gone on a professional level??a similar transforma- tion. While there is no evidence that men currently in practice are leaving the field, it is clear that men are en- tering at rates so small that is decidedly on its way to becoming a women?s occupation. Thus, as adults seek therapy to repair the injuries stemming from their childhood or their current family life, and as chil- dren and adolescents look for assistance in struggling with their current family problems, they will increasingly find that the field of like their families, is a no?man?s-lancl. This is not to suggest that many clients will have had literally no contact with adult men; neither is it to suggest that for many, particularly those who have been abused by men, this absence wouldn?t be a tremendous relief. But a large number will have had little sustained contact with men who have played an ac- tively supportive and caring role in their lives. The feminization of has made the ex- perience of examining one's inner life by working with a caring and authoritative male therapist less and less common. Men who ideally could serve as benign, car- ing, and attentive role models represent a small minor- ity in most clinical training programs throughout the country. Therefore a major helping profession, one that traditionally has served to counterbalance the effects of pathological aspects of family and society, is in the pro- cess of becoming an arena where?like the day care 11 center and the school?adult men are in short supply. If the feminization of other occupations can serve as a guide, we can expect that men will continue to have a presence in the field, but only as remotely involved ad- ministrators, teachers, supervisors, and as providing medications, consultation, and hospital care. The hands-on, day-to-day work of will be more and more the work of women alone. For the ma- jority of American children, who will live at some point before age 18 in a single-woman household, the experi- ence of they choose to have it~will appear quite familiar. Men may come and go?as psy- chotherapists offering a quick fix through medications or as supervisors, administrators, and teachers who have some imperceptible in?uence over female therapists?? but women are the ones who remain constant in their attention, willing to focus their interest and under- standing on the intimate, dirty, and mundane details of peeple?s lives. In this growing no-man?s land, it is possible to imag? ine how both in reality and fantasy, males can be seen more easily as the ?other??the abuser, the distant and longed-for father, the savior, the unattainable lover or boyfriend, the molester, the man who left one?s mother pregnant and without support, the mythical but never realized conduit to separation, freedom, power. As adult men become more removed from family life, they be- come more subject to their children?s unconscious fan~ tasy life, untempered by reality. As becomes a women?s field, clients will conclude that men are not or cannot be the ones to whom one turns for at- tention, empathy, or understanding. Women repre- sented the ?other? in the Freudian paradigm, based in the patriarchal family of late nineteenth-century Vienna, built upon the authority of the oedipal father, and prac- ticed largely by men. Now, however, in the world of neo-freudian which presumes the deter- ministic influence of the mother and is practiced largely by women, it may be men who represent the "other." 0 what does feminization mean for the women who make up the majority of prac- titioners and for the tens of thousands who are currently training to enter the field? Undoubtedly the experience of becoming a for many women has resulted in a greater sense of self-esteem and personal gratification. But increased competition and downturns in the field due to cutbacks in public and pri? vate funding are stymieing women?s desire to fulfill their professional goals. With fewer jobs available, they open private practices and compete with each other to find clients who can pay out-of-pocket. For those who do find salaried positions, their work is often in doing 12 VOL. 6, No. 5 ?McTherapy,? seeing 30 to 40 clients a week under the auSpices of preferred provider plans or HMOS, which have become the fast-food franchises of mental health care. They practice with almost no au- tonomy or control over the work process, and can often offer little real help in the five or six sessions each client is allotted. Many women new to the field are experiencing what has been termed ?surplus powerlessness? in the pages of this magazine. They see their work difficulties as per- sonal and results of their own ical problems or defects as clinicians. If they turn to their own therapists for understanding, they often hear the in- terpretations frequently applied to women who face problems with work: fear of success, guilt over perceived lack of competence, desire to fail, anxiety over being more successful than ones parents. Because the theories that underlie the profession of typically eschew social explanations of human unhappiness, ther- apists are only too ready to see themselves as the ulti- mate source of any professional problems they may have. Virtually no one in the field speaks of the implications of years of cutbacks in mental health funding on psy- chotherapists themselves, of the proliferation of free-standing professional schools that charge their students tens of thousands of dollars in tuition and then graduate them into a market that cannot ade~ quately remunerate them for their services nor provide employment commensurate with their abilities and training. These women become healers who are not al- lowed to heal, professionals who want to help others in a world that accords little recognition or remuneration to we approach the twenty-first century, we need to be fully aware of all the implications of hav- ing any part of our social world the province of one sex alone. As one of the premier helping professions, can have a tremendous influence on peo? ple, on how they experience themselves, others, and the world around them. Iwould argue that it is second only to the family in terms of the power it can have in shap- ing an individual?s emotional life?the most intimate parts of his or her identity. The fact that men are no longer choosing this work, just as they are absenting themselves increasingly from families, suggests that re- sponsibility for tending to emotional concerns, logical problems, and people's inner core of experience will fall even more into the hands of women. These women, in turn, will often be underemployed or locked into routinized work that is poorly remunerated and of decreasing status in our society. (Continued 022 p. 86) To conclude this event, the untidy sybil of redemption prophesies in hysterical hexameters. For Silk, the ?something? that can?t be openly named, such as territorial ex- pansion or elimination of the Pales- tinians, is ?talked into place? by the abused language of officials and rhetoric mongers. And yet Silk is by no means simply a satirist-ob- server. For him, the ?catwalks? and ?overpasses? of his title offer vantage but also the pathos of distance and guilt. Among the more moving and complex themes of the book is. Silk?s reminder to himself and the reader that his muse, as he hints in ?The Boat- woman,? is a kind of ?loan-word ask- ing much of us,? that one has to think of oneself and the muse as ?double,? as involved in endless self-re- flexiveness reaching for some imagined Jerusalem of moral certainty. Being ?double? means that notions of homeland and homelessness are complicated. Silk meditates on this theme throughout the book, nowhere more movineg than in ?In Memoriam,? where he writes of ?Mohammed Scaeb descendant of emirs and nomads suicide because he had no country? who didn?t know to free the song of his dispersion. The book?s more occasional poems, reflections on friends and colleagues or on lovers, meditations on paintings and other art, are also colored by dis- tances as much as geo- graphical. Dislocation becomes a way of knowing and of relating, as in the last stanza of ?Landing?: It is between towns I like best or, slantwise to the grid, to have the courage of a left hand snatching away the right?s handshake. Paradoxically, in poem after poem Silk enjoins his own dispersion. Dis- persion, above all else, seems to give him the distance necessary to clarify his themes. Fearing the mind? sets and premature closures of the zealots, he writes, ?To be provincial is death.? The ethical longing of these po- ems?deeply at odds with the preva- lent statism of Silk?s adopted region of hell?is a ?notion of a temple in vacuo,? a spiritual rather than lit- eral Holy Land. ?Take me away,? he writes at the end of this powerful and loving book, to that knifethin mountain air and I will pick an apple that isn?t there. Silk?s poems, part joke, part screed, part spiritual search, are like the little slips of paper inserted in the cracks of the Wailing Wall. Perhaps they com- municate beyond the wailing mountain of today?s Israel, for Silk too wants an apple of a state that isn?t there. El WITHOUT MEN (Continued from p. 12) This process bespeaks a greater bifurcation in our social lives along gender lines. The traditional division of labor?men identi?ed with the public sphere and women with a devalued private life?has been eroded to some degree by women?s greater labor-force partici~ pation since World War H, and by the changes in con- sciousness brought about by the feminist movement. Nonetheless, these changes have taken place against the backdrOp of a labor force still segregated on the ba- sis of gender. And this segregation continues to fall along predictable lines: Women numerically dominate occupations that can be seen as extensions of their tra- ditional roles within the family. Nursing, social work, waitressing, school teaching and day care, to name only a few, continue to be bastions of female employment. The new addition of to this litany robs society of an institution in which men traditionally have worked with emotions, tolerating and becoming im- mersed in the intimate and messy problems people ex- perience on a day-to-day basis. Men?s abandonment of 86 TIKKUN VOL. 6, No.5 as a profession confirms the idea, nur- tured in our troubled families, that if one is hurting in- side, if one is depressed or anxious, it is a woman?s job to fix it. And because it is increasingly a woman?s job, the social forces that already denigrate mental health care undoubtedly will find further excuse to undervalue and underfund in the future. Cl REPORT (Continued from p. 14) didn?t leave; they were expelled. We went into the vil- lages and said ?Get out.? And they got out. Yes, it?s im~ portant for me and others that this state be a democratic one, but you still have to consider the difference be- tween ourselves and the other countries and remember that democracy is not a value in itself but rather an in- strument. Zionism takes precedence over everything. If a group like B?Tselem had been around when Israel was being established, a Jewish state would not have come into being.