Carol Gilligan and the Dobbs decision at the American Psychoanalytic Association convention – again!

 

Carol Gilligan, Research, Dobbs Decision, Roe v. Wade, In a Human Voice

Three years ago, after having been awarded an honorary membership in the organization, Carol Gilligan gave an address at the American Psychoanalytic Convention .  Then we didn’t meet in person for two years – instead we met on zoom while the pandemic raged, and the format changed.  Instead of multiple presentations going on simultaneously, we all watched the same set of presentations.  Ironically, those presentations were, the first year, on diversity.  It is very nice to be back in New York and to be back to engaging in a truly diverse variety of small group interactions, including what are called discussion groups.  In these groups, anywhere from 10 to 50 members meet in a room and discuss material that is being presented.  Often that is a case or a particular way of intervening.  This morning it was Carol Gilligan talking about her next book, In a Human Voice, to be published on the 50^th anniversary of her revolutionary first book, In a Different Voice.

She began her talk by remembering how she came to write about women’s morality in the first book.  It turns out that it was by accident.  She had been working with Lawrence Kohlberg, the psychologist who revolutionized thinking about morality by tying it into a developmental framework.  He pointed out that we think about morality differently as we get older.  When we are five, we worry that we will get in trouble.  When we are ten, we worry about doing the right thing based on a set of principle-based rules and, when we are teenagers, and if we are really advanced, we might reconsider the rules based on our own understanding of how the world should be run.

Kohlberg studied morality by asking people what they would do in hypothetical situations.  Gilligan wanted to know how they would act when they were actually facing a morally complicated choice.  She intended to interview men who had been drafted to serve in the Vietnam war about their decision to enlist, but it was 1973 and Nixon ended the draft.  But then the Supreme Court legalized abortion in the Roe v. Wade decision, and voila…  Gilligan had a group of people who would be facing moral choices that were not abstract but very real.

She pivoted and began interviewing women in South Boston and some women who were students at Harvard about the decision that they were confronting.  It didn’t occur to her, at first, that she had moved from intending to interview an all-male cohort to interviewing women. 

What she discovered was that the Roe v.  Wade decision had given women a voice.  They were now empowered to make decisions that were incredibly complex and, unlike men, they did not make these decisions based on principles, but based on thinking about the relationships in their lives.

Pre-Roe, she maintained, the virtue of being a woman was being silent.  Roe raised the question; can you be a good woman and have an abortion?  But behind that lay the question; can you be a good woman and have a voice?

Gilligan asked one of the women how she was going about making this decision.  She said that she was concentrating on, “Being as awake as possible”.   And this, Gilligan noted (and I wholeheartedly agree), is a very difficult state to maintain.  

Being “as awake as possible” is the state that we try to help our patients achieve in psychoanalysis and psychotherapy.  It is a difficult and frequently a painful state to maintain. 

One woman decided to have an abortion in large measure because she was supporting her husband while he was going through law school and he would not be able to finish school if she had to leave her job to care for a newborn.  He relationship with her husband outweighed the relationship with a potential child.

This was a decision that was made based on the care that she used to define her goodness.  But choosing to have an abortion would also have called into question (I am imagining) her goodness in her own mind.  Making moral decisions in the real world, with real world consequences, is difficult.

So, Gilligan maintained, the Dobbs decision is intended to silence women.  To take us out of the uncomfortable place of making relationally based moral decisions and return us to the more reliable solid ground of making principled decisions.

Of course, Roe v. Wade did not prevent us from making principled decisions.  In the session with Gilligan, I realized something about my own experience with Roe.  When I fell in love for the first time, a very long time ago, Roe was new in the land and I fell in love with a self-professed feminist.  I learned a great deal from her about feminism and what it meant to be a woman.  Her position with me was that, if we became pregnant, she would have an abortion.  This pronouncement was based on the principle that this would be best for her. 

Similarly, it would be possible to decide, on principle, not to have an abortion.  Fortunately, we did not become pregnant.  We did not have to decide (and I was told up front I would not have a voice in that decision).

The next two sessions at the conference could not, on their face, have been more different.  I went from a conversation about women having a voice to two meetings about the use of research in psychoanalysis.

There is a long history here.  Aaron Beck, who invented Cognitive Behavioral Psychotherapy (CBT), was a psychoanalyst, but he was kicked out of the American Psychoanalytic Association because he was doing therapy.  It was only when the CBT folks started producing a lot of evidence that CBT was an effective therapy that the psychoanalysts started clamoring for research to prove that what we are doing is also effective.

The two research presentations each focused on the efficacy of treatment, but more than that they focused on the elements of the treatment that lead to that efficacy.  They were not just asking; How is treatment effective?  They were asking; What is it that we do that leads to change?

This is actually quite dangerous.  If we follow the path of those doing CBT research, the researchers, who are not primarily psychotherapists will begin telling the psychotherapists exactly what to do in treatment.  They will be silencing the therapists, just as Dobbs is intended to silence the women.

I was not comfortable speaking in a roomful of feminists about my experience with my principled feminist girlfriend, but I did approach Dr. Gilligan after the talk, and we agreed that my example supported her concern that the face off between the pro-choice and the pro-life people misses the mark.  It is not about the principle of choice, it is about acknowledging our discomfort with complicated decision making.  It is about our becoming more willing to trust people to make difficult decisions – and to trust them to do this bearing both principles and relationships in mind.  It is about helping them be as awake as possible to what they are thinking and feeling when they are deciding what would be best in a given situation.

Ultimately, psychological research can empower therapists to have more rather than less options available to them at any moment in a treatment to meet the needs of this patient at this moment (and to assess whether what we thought would be helpful actually turns out to have been helpful).  I was able to articulate this position to the researchers in the room.

I’m not sure that the researchers got it.  The essence of the argument is that we, as human beings, have evolved over millions of years to be able – in addition to wreaking havoc in each other’s lives – to care for each other.  This a subtle and complicated process that takes place too quickly and too subtly for us to be able to choreograph from afar.  We need to be as awake to the moment as we can be – meaning that we have to feel as deeply and access as much knowledge and skill as we able to – in order to be usefully responsive to another human being at their most vulnerable moments.

The researchers who were presenting were learning from clinicians as well as informing them.  This thing that we do called living is very complicated business.  We cannot afford to silence women – or psychotherapists.  We need to hear every human voice and respond to each one as best as we are able.

  

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