In 1992, I was privileged to lead a multidisciplinary team that for three years intervened in a community of approximately 125,000 in Montego Bay, a Caribbean inlet on the northwest coast of Jamaica.
How we became involved and how psychoanalysis came to play a pivotal role in community change is, I think, very important to understand if we are to explore new roles for our profession.
As for most psychoanalysts, I began this work after I observed suffering patients. I was conducting seminars for mental health professionals from America in the beautiful vacation environment of Jamaica. Exquisite coral reefs, inviting beaches, and friendly and accommodating people abounded.
My attitude shifted dramatically when I visited the Blossom Gardens facility for abused and abandoned children, in Montego Bay. There are virtually no social welfare programs in Jamaica, and such children, often grossly abused both psychologically and physically, have little care available to them except what is provided by United States volunteers and wealthy Jamaicans with a conscience.
My colleagues and I then met with the mayor of Montego Bay. The mayor was so anxious about the overwhelming problem of violence in his community that during our first meeting, which lasted six hours, he was barely able to sit still.
His community is heavily dependent on income from tourism, which accounts for about 1 billion American dollars a year of Jamaica's income. Because of the violence in this seaside resort, tourist income had dropped precipitously; for example, in the most recent holiday season an unprecedented number of hotel rooms were unoccupied. Leaders of the community were desperate for help in stabilizing their community.
Remembering Freud's writings on the balance between optimal anxiety and incapacitating pain, we realized there was an opportunity for us to intervene in this community, where motivation was high, since familiar means of coping had failed. We met with citizen leaders of the community, as well as business and political leaders, including the prime minister of Jamaica, Michael Mantey, in February 1992. All of the funding for our project came from private citizens through small donations, in-kind resources, and professional staff donations of time, skill and dollars, a component that we feel is important for successful community interventions.
Commitment to a project seems to be most marked when people invest their own money in the project, as opposed to money from more distant and impersonal government and state sources. We had no problem recruiting doctoral-level professionals as they were needed. This altruistic contingent had a marked effect on the citizens, whose self-esteem was raised by the attention of many well-qualified individuals who were interested and enthusiastic about the project. Both parties then benefited from the experience.
Since we were not operating under the restrictions of a grant, we were able to adapt what we did to the changing circumstances in the best psychoanalytic tradition—for example, tailoring the treatment to the patient rather than the patient to a research format. We were inspired by Freud, who combined the best traditions of scientist, research worker, teacher, and therapist. Eventually we developed the concept of what we called “the violent community.” We used this term to describe a community that is observably anti-intellectual and action-oriented in the fight-flight sense described be Bion. Delay and negotiation are often not only devalued but are seen as signs of weakness. The intellectual and compassionate attributes of potentially effective leaders are overshadowed by the conflict rhetoric of reactionaries trying to inflame and manipulate the public rather than to inform them. In such settings the citizen is treated as naive and in need of direction by leaders who feel they are neither required to be specific, intellectually correct, nor fully accountable for proposals, action plans or consequences.
We have been greatly influenced in our work by concepts of group functioning, particularly the central role of leadership. In spite of recognizing the importance of group cohesion and peer decisionmaking that modern group theory emphasizes, it seemed to us that especially in large groups the role of the leader is central, perhaps more so than in small therapy groups. Within the violent community, with its specific and testable attributes, we realized that in such communities, leaders often have a “punishment-surveillance” approach to solving violent crime. This reactive and punitive philosophy overrides a more reflective approach, in spite of the fact that such punitive approaches have never been able to produce lasting peace, not once in human history!
We became aware of the extraordinary degree to which whole communities, in spite of highly intelligent, skilled, and sophisticated members, can still unconsciously collude and deny the failure of such models, thereby avoiding their own anxieties. Also in line with our psychoanalytically influenced theory of the violent community, we wanted to treat the causes of the community disorganization rather than treating the “symptoms.” By analogy, symptoms in the community would include social problems like: sexually transmitted diseases, child abuse, neglect
of the elderly, poverty, crime, etc.
In determining the “origins” of community disorganization, we came to the empirical conclusion that the failure of certain community systems to promote community cohesion and develop in its citizens a feeling of safety was dependent on four major systems: law and order, represented by police and military; education, represented by teachers; health and social services, represented by health professionals; and spirituality, represented by religious leaders. Politicians and governing bodies, according to this theory, should function to integrate these four major community systems and thus provide a peaceful, high quality of life in the community. Therefore, the goal of this community intervention was to change the attitude of representatives from these four major community stabilizing systems from a fight-flight orientation to a reflective work group orientation, where reflection was substituted for impulsiveness.
Clearly, we focused on leadership training. We call the leadership training a Peacemaker-Peacekeeper Model. The substance of their training was derived from many sources. We felt it important to integrate psychoanalytic theory with practical material from a number of other systems including Zen, martial arts, community systems theory, and sociology. The intent of this model of training was to create leaders whose philosophy combined strength with gentleness, whose attitude included an emphasis on altruism and compassion, self-control, courage, politeness, truthfulness, honesty, sincerity, benevolence, justice, honor, and loyalty (Bushido qualities). Such a leader should have a focus on present-centeredness and expanded self-awareness, and on the concepts that the world functions according to the way one lives in it and conceptualizes it and that one's personal view of the world largely determines the goodness and badness of things in it.
These peacekeepers/peacemakers were then seeded into the core community systems. Initially, we had the best cooperation from the police force, which was the most beleaguered and abused, and then later, school teachers participated. Health professionals and spiritual leaders showed only a general interest but no enthusiastic initial commitment to our program. We proceeded in any case in view of the enthusiasm of police and teachers. Using a seminar format with follow-up supervision and problem-solving sessions over a period of three years, we observed that the community made some remarkable changes.
The program as a whole was credited with a significant reduction in violent crime in the community and an increase in tourist revenue. But more importantly, lasting community programs were organized that enabled the community to take control of its own problem. Programs established included a domestic violence prevention program, which has an integrated connection with the police force to improve the manner in which rape prevention strategies and rape victims are handled. An extensive school violence prevention program using male role models resulted in a dramatic reduction in violence in a secondary school. A community mental health program for the homeless mentally ill was organized by the police, entirely staffed by volunteer police officers and citizens.
The effects of these and other programs, which were developed using a philosophy of community altruism focused by trained leaders, bears comment: Essentially, altruism and egoism are seen as in a dynamic, dialectical balance. Research suggests that altruism may be an independently motivated system in the human psyche that is nondefensive in nature. Altruistic activities can be self-perpetuating, since the results of altruism are generally positive. For example, one police officer, who previously would have been afraid to show his face in a deprived area of the Montego Bay community, took me on a tour of the ghetto area. He was greeted as a mentor, father, and protector by people who had been in his programs and who proudly would show their houses, children, and personal effects to him. As we left the community he said to me, “This certainly beats being shot at and spat on.” Police found that as they became altruistic and involved with the community, crime detection help provided by the grateful citizens increased. Their work also became easier because their lives were not in constant danger from angry citizens.
Gradually, the governing bodies of the community adapted to the concepts introduced and began their own process of training. As of this writing the community has in place its own mechanisms for maintaining this leadership training and has achieved a reasonable level of peace and quality of community life.
This program illustrates a series of principles that I think are of fundamental importance for the work of a community-focused psychoanalyst in the future. First, psychoanalysts must learn to work with other disciplines, even disciplines based on principles contrary to their own. For example, it was found to be very useful to work with behaviorists, systems theorists, and a variety of other nondynamic workers to achieve a comprehensive program. The psychoanalyst of the future must see himself or herself as a member of a team rather than always controlling the dominant theoretical paradigm that drives the intervention. Psychoanalytic conceptualizing may not lead to typical psychoanalytic interpretive interventions, but instead to a philosophy of intervention that is based on awareness of unconscious processes, although the specific intervention may have little obvious connection to psychoanalytic theory or practice. The concept of optimal anxiety for change in analysis is closely connected with the importance of the timing of interventions. When community need is high, motivation is likely to be high. If a community is desperate because its usual mechanisms for problem solving have not worked, then it may be more malleable by external intervenors.
To maximize change in communities, the positive qualities of the leader and the containing role of collaboration and leadership in the four stabilizing community systems are considered critical for change. Leaders are retrained so that the way they operate in their specific areas of expertise become influenced and guided by a unitary altruism-based philosophy. This philosophy is one that combines strength and gentleness, reflectiveness and compassion, and self-awareness and capacity for self-criticism.
As exciting as these preliminary findings have been, they were, however, conducted in a less than rigorous research milieu. However, enough material has been provided for us to design an intervention in a community in the United States. I now have the opportunity and privilege to work with Peter Fonagy and other investigators in the Child and Family Center of the Menninger Foundation to design a multilevel community project making use of these and other approaches to the problems of community violence. This project highlights the premise that psychoanalysis has considerable potential for relevance to the
problems of the majority of citizens, not merely a treatment for the fortunate few. One spinoff of this project on a much smaller scale is an intervention in an elementary school in Topeka, Kansas, which I will describe in a future article.
Many American and Jamaican citizens helped with this project: Ms. Vanessa and Kirky Taylor were the linchpins of the project in Jamaica. Our multidisciplinary team was co-led by Frank C. Sacco, and included representatives of the police, social work, child psychiatry, clinical psychology, research psychology, and martial arts communities from Boston and Topeka. All of them volunteered their time without remuneration beyond travel and expenses, and to them we offer our appreciation for a job well done.
Stuart W. Twemlow is in private practice of psychiatry and psychoanalysis in Topeka, Kansas. He is also on the faculty of Topeka Institute for Psychoanalysis and is a clinical professor of psychiatry at the University of Kansas School of Medicine, Wichita. He is an advanced black belt and master teacher in kempo karate and kobudo.