Politics, Group Identification, and Professionalism

Political discourse has been intense, divisive, and pervasive over the last year and may have reached into the psychiatrist’s office to an unprecedented extent. Whether a patient’s political views are in alignment with or opposition to the psychiatrist’s beliefs, the psychiatrist is challenged to remain mindful of his or her role as healer in patient interactions. This article will incorporate a psychological perspective on group identification into a description of the self-regulatory process required of the psychiatrist when responding to patients’ reactions to events on the national stage.

In their paper “Pride, Shame, and Group Identification,” Allessandro Salice and Alba Montes Sanchez proposed that individuals can feel pride or shame, which are uniquely personal emotions felt in reference to the self, in response to behaviors performed by members of a group to which they identify. This group can be very specific (for example, family, departmental colleagues, a religious faith) or more ambiguous (for example, people who like classical music, people who hunt). Sometimes, the group may exist only in the mind of the individual. The authors offered as an example a person’s response when walking toward a beggar on the street and witnessing another pedestrian suddenly spitting at the beggar. While anger and disgust, which are emotions directed at the other pedestrian, may also occur, a feeling of shame may arise, as if the other person’s spitting reflects on the observer’s moral character. The observer temporarily experiences himself or herself as in a group with the other pedestrian.

The divisiveness and polarization of the 2016 election process, particularly with its emphasis on groups of people (immigrants, people of color, industrial workers, women, Muslims, people who identify as LGBTQ, the privileged class, and so on) may have intensified our natural tendency to categorize ourselves and others according to groups. When this group identification finds its way into the dyadic relationship between patient and therapist, complexities of transference, countertransference, and boundaries emerge.

Take as an example the clinical encounter that occurs immediately after a patient notices a politically inspired headline or illustration on the cover of one of the magazines in the psychiatrist’s waiting room. When the patient’s and psychiatrist’s group identifications overlap or are congruent, the patient may feel very comfortable expressing his or her feelings and thoughts elicited by the magazine cover. The risk is that the psychiatrist may be tempted to slide into shared celebration or commiseration, co-opting the therapy hour to meet mutual needs for fellowship and processing. The psychiatrist must remain vigilant that his or her responses are directly related to the material brought in by the patient and refrain from introducing additional material relating to the psychiatrist’s own ideas or feelings. The psychiatrist may need to emotionally step back from group identification with a patient to reengage the physician role, available and engaged in the pursuit of the patient’s health, not engaged as a friend and political ally.

A similar emotional stepping back is equally useful when the patient’s views are quite different from the psychiatrist’s. Transference and countertransference can quickly heat up when these differences appear in the context of our current political conflict. A patient who holds divergent views or identifies with a group that the magazine cover may be insulting may feel anger or shame (or both). Like the pedestrian feeling shame at another person’s cruelty to a beggar, the patient may feel shame at the psychiatrist’s choice of magazine or feel shamed by the psychiatrist for belonging to the wrong group. Rather than reacting with defensiveness, the psychiatrist should set aside group identification in service of the therapeutic relationship. By acknowledging and exploring the patient’s responses, the psychiatrist helps to reestablish feelings of safety and “belonging” in the treatment. This may be experienced by both the patient and the psychiatrist as a restoration of the dyadic “us” that is a foundation of the therapeutic relationship.

In conclusion, the recent election and its aftermath have intensified group identifications. Nevertheless, while in a professional role, the psychiatrist must strive to remain allied with the patient in the pursuit of the treatment goals and give in to neither a desire to join together in fellowship nor an impulse to shame or reject the other for opposing views. ■