In the last few years, “mental health” has become a household phrase. Exacerbated by COVID-19, individuals have higher rates of anxiety and depression (WHO, 2022), opioid and stimulant use (Abramson, 2021), as well as an increased sense of loneliness, uncertainty, and existential dread. As a nation we are recognizing the need for psychological care like never before. However, the current state of mental health care in the United States is inadequate to meet the growing demand. This is due to mental health care increasingly moving toward a privatized model, following more on American Capitalism – defined by the values of profit and individualism – than principles endemic to the psyche itself. Such privatization has limited access to care along class lines, or else pathologized and stigmatized care as a matter of institutionalized symptom reduction without care for the soul. Furthermore, turning psychological care into a project of private minds has removed psychic experience and symptoms from the interpersonal, socio-cultural, historical, and political contexts in which they emerge. Creative solutions are needed.
Returning psychological care to an interpersonal realm is first of all dyadic, in that it occurs between individuals and not just in the anonymous offering of information. Relational models of therapy address this (Aron, 1999) in ways that the rise in information-based, profit-motivated mental health app platforms do not. Additionally, psychological care exists in a social realm beyond the dyad including local communities, popular culture, and legislative policy. We know that what people bring into therapy, what they don’t, and whether or not they can is impacted by social forces like multigenerational racialized inequalities and socioeconomic exile from middle class ideals. The so-called “community turn” in psychoanalysis is beginning to address these larger relational needs pertaining to mental health (Hassinger & Pivnick, 2022). The community turn is an extension of the relational turn, wherein psychotherapy has evolved from its origins which focused on the individual mind in isolation; to the individual-in-relationship; and currently to the individual mind as relative to its larger communities. Herein I discuss the offerings of existing matriarchal social structures and how these can contribute to the development of socially embedded, effective mental health treatment.
Let’s begin by considering whether Capitalist ideas are endemic to the psyche itself. At a talk I recently gave among psychoanalysts, I was asked by a highly educated, spiritual woman “whether any system can truly stay horizontal or whether hierarchy is an archetypal phenomenon that eventually arises again, akin to the instinct of aggression or the will to power.” This question assumed that hierarchies of dominance are not only natural, but that they are also primary. When I proposed that the primacy of domination is based in socially constructed ideas, I was met with further refusals. The war in Ukraine was cited as modern proof of the eternal drive toward domination, but no mind was paid to strollers at the border and relief aid pouring in, which lend credence to the simultaneous existence of interconnected care. The assumption that hierarchies of domination will always prevail – even among psychoanalysts – shows how culturally beholden we are to the Hegelian dialectic, as Jessica Benjamin (1988) put it, of doer and done to. In The Bonds of Love, Benjamin described the entrapping cycle of domination where the inferior party gaining power merely reproduces domination, and considered non-hierarchical relationships.
Of course, profit, individualism, competition, and domination are elements of the psyche; it would be futile to deny this. What I mean to say is that they don’t prevail as dominant modes of the psyche in all people, cultures, and times. Other social structures exist which are steeped instead in multiplicity and mutuality, and these are just as extant in the primordial psyche as are structures of domination. Herein matriarchal social structures are considered as one means of creating collective care, but it should be noted that this does not only exist as a feminine principle. Other cultures embody an ethic of collective care, such as that of Aboriginal Indigenous peoples (see Yunkaporta, 2020), but those are not the focus of this chapter. Given this anarchy of the psyche and it’s potential, we must challenge normative unconscious processes (i.e., hierarchies such as the therapist is more knowledgeable about the psyche than the patient; that therapy is only concerned with the individual; or that therapy is inaccessible to the poor) when they masquerade as the only possibilities
Matriarchal Social Structures
Genevieve Vaughan (2018) is an American expatriate feminist who has popularized an understanding of the Matriarchal Gift Economy, concurrent with the development of nonprofit foundations set up to share her private inherited wealth. She recognized that Freud’s Oedipal theory required the boy child’s repudiation of identification with the mother. On the whole, his theory valorized and epitomized the boy’s identification with the father and minimized girl’s development. It condoned civilization’s move away from multiplicity, caregiving, and the realities of dependency. The patriarchal boy’s identity, and thus the pillar of identity in the west, is formed “in opposition to nurturing.”
Any number of feminst critiques of Freud exist, yet gaps remain. When it comes to theory, I wonder, can we even love the mother? Feminine biology and desire are usually portrayed as lack, lacking, or unknowable. In a 2000 article, Diane Elise suggested that much about women’s desire is knowable, but repressed by family and culture. Specifically, she suggested that the girl has a primary Oedipal love of the mother, just as the boy does, but that this desire is socially unacceptable, goes unrecognized by the mother, and is therefore erased. I am grateful to Elise for recognizing this desire, and see our primary longing for the mother as foundational to any future theory. It is only through recognition that maternality holds something we desire, that we can also identify with it, and model society after it.
Matriarchy is defined not as the rule of mother, but rather, “in the beginning, the mothers” (Goettner-Abendroth, 2007, p. 7). Thus, it is a system of multiplicity, multiple mothers that exist as the origin of being and remain as the fundament of relating. Goettner-Abendroth observed the “principle of mothering is the opposite [of the ego-centered profit principle], where altruism reigns and the wellbeing of all is at the heart of the system.” Matriarchal economies are known to focus on distribution and sharing of resources over their private accumulation. Sharing is based on need, not merit. Often it is sustained through local and subsistence practices. Fundamental to subsistence practice is that excess is not hoarded, but shared. Capitalism, in contrast, depends on the ability to profit from work and hoard excess privately.
Vaughan (2018) distinguished the gift economy from economies of monetary exchange by emphasizing the recognition of multiplicity inherent in gifting. Money is an equalizer; the one thing that stands in for many things. It is inherently reductive. Patriarchy, money, and the symbolic phallus are all exemplary of a reductive “one-to-many” equivalency. And because it seeks one greatest common denominator, it is competitively motivated. Perhaps this can be synthesized as: “I must be the best to subsume the rest.” We can see how vying for the position as the “one,” i.e. dominance of the English language or whitewashed culture, is globalizing. It flattens or erases difference.
In contrast, the gift economy requires multiplicity and maintains difference. Luce Irigaray (1985) argued for the recognition of sexual difference that we may not be subsumed in patriarchy’s vernacular. In her view, the other is not an extension of myself, but is someone inviolably and necessarily different from me. Only by maintaining difference can we relate to the other as an other. Contrary to the exchange of value that happens in tokenized economies, the logic of the gift, writes Vaughan (1998), is that it “transfers value to the receiver. Because it is other oriented, transitive, it inherently creates bonds of community” that are not possible when we exchange simply to build up our own value. Matriarchal structures are premised on organic multiplicity that cannot be reduced, which therefore foster democratic decision making and sharing equitably based on need.
A Clinical Example
Sherry admits to me that she has a history of shoplifting. It’s gotten worse lately. Back when she was unemployed, it wasn’t so bad, and she even felt at peace. Back then she received $700 a month in EBT benefits for her, her two kids, and her husband. But when she got a low-income job, her benefits were revoked, and no one filled in the gaps of her family’s need. That’s when the shoplifting got bad. It started happening every time she went to the store. “I exclusively do it at Whole Foods though,” she told me. “It’s my war against the 1%, my war on Jeff Bezos.” For Sherry, this was a private issue about her family’s food security, and it had resonances with her socialist politics. But she also seemed confused. She ended our session saying, “I think everyone should have access to more, but maybe it doesn’t work that way. Maybe I don’t have a very good understanding of economics.”
MacKenzie Scott, ex-wife of Jeff Bezos, received a $38 Billion payout in the largest divorce settlement in history. Most of us know that Bezos is no philanthropist, and even as the richest man on Earth, he refused to donate a significant portion of that wealth. However, two months after their divorce, Scott signed the Giving Pledge, a commitment made mostly by billionaires to give away half of their wealth to philanthropic causes before their deaths. Some think that in signing the Giving Pledge so soon, Scott waged a war on Bezos. However, I prefer to see this not as a post-divorce opposition of binaries but as a matriarch’s return to the fight for life. At the time of writing this, she had already donated over $12 Billion (Kulish & Cramer, 2022), and articulated wealth as developed by the masses, in need of redistributing.
In an article entitled Seeding by Ceding, Scott (2021) expressed her intent to financially seed community based projects by redistributing wealth and ceding power and voice to those who have been marginalized. She stated:
“People struggling against inequities deserve center stage in stories about change they are creating. This is especially true when their work is funded by wealth. Any wealth is a product of a collective effort that included them. The social structures that inflate wealth present obstacles to them. And despite those obstacles, they are providing solutions that benefit us all.”
In her title, I cannot help but wonder about the intentional associations to biological plant seeds and the work that Vandana Shiva (2020) has originated in India, advocating for the organic multiplicity of seeds, and preserving the Earth’s legacy through seed banks and small farming; in opposition to genetically modified organisms, monoculture, industrial farming, and the possibility of owning intellectual property rights on seeds. Not coincidentally, Shiva identifies Bill Gates and Monsanto as global threats to life disguised as solutions through homogenization. Her work is paralleled in Seeding Sovereignty, an indigenous led organization on Turtle Island that addresses climate change and grows community through farming. I digress in hopes that it makes visible the multiplicity inherent to the natural order, and how it can be a model for structuring communities and civilization.
The field of community psychoanalysis has not made explicit parallels to matriarchal social structures, although some of its tenets have recently arisen within matriarchies. Community based work was part of psychoanalysis from its origins, dating back to Freud’s free clinics (Danto, 2007). The world wars produced a large diaspora within the field, and saw a defensive turn toward more individualized care, especially in America where ego psychology and now behavioral health has come to define the landscape of the psyche (Philipson, 2017). It will be interesting to see how the world turns to understand psychological care in light of modern warfare.
In post-apartheid South Africa, Pumla Gobodo-Madikizela (2015) has worked toward psychological reparations with perpetrators and survivors of violence. She considers the indigenous concept of ubuntu, which she says “is often associated with the concept of self “I am because we are,” in contrast to the Cartesian “I think, therefore I am.” While recognizing the role of the individual, ubuntu values a sense of solidarity with others—the individual always in relation—rather than individual autonomy.”
As community psychoanalysis has experienced a resurgence in the US in the last decade, a distinction has been made between psychoanalysis in the community, which maintains the focus on individuals but in situ; or psychoanalysis of the community (Rudden & Twemlow, 2013). The latter shifts the whole focus of the mind as formed in multiple relationships. Problems and their prevention are addressed in wholistic community fields. This shift depends upon the matriarchal premise of multiplicity, where no one individual or ideology subsumes the rest. Each one is defined in relationship to many. While our private subjectivities are safe and necessary places, they are not the end all of psychic existence. In fact, we don’t know what we exclude and project onto others when we only consider the privacy of our own minds.
In discussing the community turn in psychoanalysis, Hassinger & Pivnick (2022) coined the term “Relational citizenship.” They emphasize that individual identity is embedded in an ongoing process of navigating multiple group identities. For example, Vaughans and Spielberg (2014) found that Black boys who displayed secure attachment in family relationships sometimes nevertheless displayed poor attachment to their school communities. It is common sense that a single caregiving relationship doesn’t account for all of identity. Identity also involves discerning one’s belonging or disavowal in school, on the street, in the sexual landscape of peers, and otherwise.
Another aspect of multiplicity in community psychoanalysis is addressing problems and their solutions systemically. Again, schools are a major site of this work. Even the most advanced school approaches have tended to focus on the child’s individual capacity within the community, whether that be to increase mentalization, coping, or adapting to the school environment. New work is turning the focus onto the individual’s “symptoms as expressing the needs and troubles of both the individual and the community.” (Pivnick & Hassinger, 2021). Rather than give a child detention and hope that they come back quietly afraid, this approach keeps kids in schools and works in multiple dyadic groups to understand and heal what dynamic came to the surface through them.
Working with the individual as part of communities allows for what some call the moral third (Benjamin, 2017), or the “collaborative third” (Hassinger & Pivnick, 2022). It is collective space which holds each of us and defines our sense of belonging, harkening to that matriarchal definition, “in the beginning, the mothers,” if we remember to love them. Children who have been exposed to violence but are unable to express it verbally have been found to enact it elsewhere including acts of violence (Bragin, 2019); yet those who have been part of community based interventions showed a reduction in bullying and an increase in positive attitudes. When we intentionally create spaces that allow for multiple voices to be heard, each of us can mentalize how we are holding, projecting, and/or metabolizing community and global events.
Matriarchal Model of Community Psychoanalysis
How will we get to a matriarchal practice of community psychoanalysis? We’re not there yet, and it will take a lot of work reconnecting to repressed forms of knowledge, fighting against very real and ingrained oppressive structures, and learning how to be together. In attempting to expand my own private practice into community-based work there have been many barriers. These include, among other things, limited grant funding available that recapitulates a culture of competition even among philanthropic organizations; and the established cultural code of psychotherapy as an individual endeavor, requiring much public education before individuals are responsive to collective interventions. However, some community-based models of care have already been successful, most often in schools as described above, and making further inroads into community offerings is necessary for the future of care.
Community psychoanalysis is not one model that can be replicated everywhere. Rather, it is a model that recognizes each community knows itself best and holds wisdom and resources within that want to be shared according to need. It also recognizes that problems within communities don’t represent problems with individuals but are symptoms of systemic realities in search of recognition and in need of larger holding to make that possible.
For my patient, who fears she doesn’t understand economics and moreover fears she is powerless under the autocracy of Jeff Bezos, I hold a space to see she does have some innate and deep knowledge of economics stirring up. Her inklings show a resemblance to what Vaughan (2018) calls the The Gift Economy. But I also work to create a space that is bigger than her and I alone, where she doesn’t have to steal to compensate for her lack of recognition. We remember that community enactments occur if there is no psychological space built for mentalization of community trauma, which replicates very pragmatic inequities including food insecurity. She acts out in the polis what the polis does not acknowledge. The structure of a community clinic is one way psychotherapy moves into the community sphere, creating a “third” space where a private, losing war does not have to be enacted between my patient and Jeff Bezos, but resources can be distributed in a larger group beyond the two, acting not only in the psychic components of community but the material as well.
As of now, my vision for a novel psychotherapy community clinic is a hypothesis. It remains to be seen what can be done, resting, however, on the knowledge that mutual and multiple care have long existed as inherent in the psyche.
Abramson, A. (2021). Substance use during the pandemic. Monitor on Psychology 52(2), 22-30.
Aron, L. (1999) Clinical Choices and the Relational Matrix. Psychoanalytic Dialogues 9:1-29.
Benjamin, J. (1988). The bonds of love: Psychoanalysis, feminism, and the problem of domination. Pantheon.
Danto, E. (2007). Freud’s free clinics: Psychoanalysis and social justice, 1918–1938. Columbia University Press.
Elise, D. (2000). Woman and desire: Why women may not want to want. Studies in Gender and Sexuality, 1(2), 125-145.
The Giving Pledge. Retrieved March 24, 2022 from https://givingpledge.org/
Gobodo-Madikizela, P. (2015). Psychological repair: The intersubjective dialogue of remorse and forgiveness in the aftermath of gross human rights violations. Journal of the American Psychoanalytic Association, 63,1085-1123.
Goettner-Abendroth, H. (2007). The way into an egalitarian society: Principles and practice of a matriarchal politics. Retrieved from https://www.hagia.de/fileadmin/user_upload/pdf/the_way.pdf
Hassinger, J.A. & Pivnick, B.A. (2022). The ‘community turn’: Relational citizenship in the Psychoanalytic Community Collaboratory®. The International Journal of Psychoanalysis, 103(1), 120-143.
Irigaray, L. (1985). This sex which is not one. Cornell University Press.
Kulish, N., and Cramer, M. (2022). $12 Billion to 1,257 Groups: MacKenzie Scott’s Donations So Far. The New York Times. Retrieved from https://www.nytimes.com/2022/03/23/business/mackenzie-scott-philanthropy.html
Nichols, B. & Connolly, M. (2019). Transforming Ghosts Into Ancestors: Un-silencing The Psychological Case For Reparations To Descendants Of American Slavery.
Philipson, I. (2017). Fearing the theoretical other: The legacy of Kohut’s erasure of the analyst’s trauma. Psychoanalysis, Self, and Context, 12, 211-220.
Pivnick, B., & Hassinger, J. (2021). The child in the school, the school in the community, and the community in the child.
Rudden, M.G. & Twemlow, S.W. (2013). A beginning theory of action for community analysts based on group observation, theories of the unconscious, and evolutionary psychology. International Journal of Applied Psychoanalytic Studies 10(3), 199–209.
Scott, M. (2022). Helping Any of us can help us all. Medium. Retrieved from https://medium.com/@mackenzie-scott/helping-any-of-us-can-help-us-all-f4c7487818d9
Scott, M. (2021). Seeding by ceding. Medium. Retrieved from https://mackenzie-scott.medium.com/seeding-by-ceding-ea6de642bf
Shiva, V. (2020). Oneness v. the one percent. Chelsea Green Publishing.
Vaughan, G. (2018). The Maternal Roots of the Gift Economy. Inanna Publications.
Vaughan, G. (1998). Genevieve Vaughan, Intellectual Biography. Retrieved from http://www.gift-economy.com/articlesAndEssays/autobio.html
Vaughans, K. & Spielberg, W. (2014). The psychology of Black boys and adolescents- two volumes. Praeger.
World Health Organization (2022, March 2). COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide. Retrieved from https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide
Yunkaporta, T. (2020). Sand talk: How Indigenous thinking can save the world. New York: HarperOne.