MICHELE NORRIS, host:
From NPR News this is ALL THINGS CONSIDERED. I'm Michele Norris.
MELISSA BLOCK, host:
And I'm Melissa Block. A couple of months ago, NPR's mental health correspondent, Alix Spiegel, stumbled on an unusual story about a psychologist in Indiana who works with Amish teenagers. The Amish, of course, are known for keeping their distance from modern American culture. Alix Spiegel recently visited the psychologist, Jim Cates. She wanted to learn how a mainstream American therapist tries to understand the emotional lives of people who live in a very different America.
ALIX SPIEGEL: Jim Cates first came face-to-face with the curious differences between modern Americans and the old order Amish 11 years ago. At the time, Cates was working for the state of Indiana. He was a psychological tester. One day, an elderly Amish woman appeared in his waiting room with her family. The woman was apparently mentally disabled and Jim's job was to give her an IQ test to see if she qualified for state assistance.
So Cates entered the waiting room, found this little old lady sitting there with eight of her family members, and did what he always does.
Dr. JIM CATES (Psychotherapist): I said, hi. I'm Jim Cates. Why don't you come on up? And so, I turn around and not only is she coming up, all eight of her family are coming with her.
SPIEGEL: All eight crowded into Jim's tiny office, this wall of beards and bonnets. Which would have been one thing, but as the test went on, Cates began to realize something else. Like most Amish, the woman was totally unfamiliar with the concept of timed tests. And she had a completely different set of cultural references.
Dr. CATES: And I am in the middle of the IQ test and realized, oh, no, this doesn't work. What am I going to do? So I'm trying to modify the IQ test as I'm going along to figure out what works and doesn't work with eight Amish people sitting around watching me fumble my way through. That was my first experience with an Amish person doing anything in the way of mental health.
(Soundbite of trotting horses)
SPIEGEL: Since his first encounter, the relationship between Cates and the Amish has greatly deepened. When I go to visit him in his Topeka, Indiana office, I find a hitching post in his parking lot and a large sign out front, clearly advertising his services to all the passing buggies.
These days, Cates works primarily with Amish teenagers. All kids, as Cates explains it, in the grip of a very particular Amish right of passage, Rumspringa, the period in adolescence when Amish youth are permitted to sample for the very first time, all the stuff that their American - or as the Amish like to say, English - peers long ago learned to take for granted. Stuff like cell phones, and rock music, and questionable fashion trends.
Dr. CATES: Rumspringa is a - that's a term which means running around literally is all it means. At age 16, it's evolved over time. Amish youth are allowed to run free and experience the world. For some Amish youth, all that means is that they spend a couple of years dressing somewhat English. And then, by 17, 18, they take classes and join the Amish Church they're baptized in, and that's the end of it.
Other kids go heavily into alcohol.
SPIEGEL: That last group are the kids that Cates works with. Kids who literally have never tasted a drop of liquor until their 16th birthday, who basically overnight turn into consistent binge drinkers. Now, on occasion, kids like that will get picked up by the cops and end up in the court system. And the courts will then send them to alcohol treatment, which means Cates.
Now, obviously, their parents, and the church itself, aren't in love with the fact that some Amish kids go on this extended Dionysian tear. But Cates says Rumspringa is actually theologically important.
Dr. CATES: Because it's a time when Amish youth are allowed to really experience the world they're going to sacrifice if they do choose to join the Amish Church. And without that, the Amish would be a cult. The Amish would truly not have a freedom of choice about being Amish. And that's the whole idea of that period of time.
SPIEGEL: One afternoon during my visit to Topeka, Cates and I climbed into a car with a gangly 17-year-old Amish kid named Galen Layman(ph). Layman, who is going through Rumspringa, had been enlisted to take me on a very unusual tour. We pulled out of the office driveway onto Main Street, off to visit the many places in Topeka, Indiana, where under aged Amish teenagers illegally drink alcohol.
All right, so have you ever been to any parties around here?
Mr. GALEN LAYMAN: Not in town. They'd only get busted.
SPIEGEL: Oh, really?
Mr. LAYMAN: Yeah.
SPIEGEL: We drove out of town into farm country. Layman pointed out simple white houses. Then we passed a field near some woods and Layman talked about a party he'd been to two days earlier which was described in the following way: hundreds of Amish teens in a chicken coop drinking beer and listening to hip-hop.
Mr. LAYMAN: Everybody was in there elbow to elbow, too. And then there's always people running from the cops. That's when it gets really fun.
(Soundbite of laughter)
Mr. LAYMAN: If you don't get caught.
SPIEGEL: Because Layman is in Rumspringa, he wears jeans and sneakers, a buttoned-down shirt. If you passed him on the street, even listened to our conversation in the car, it might be hard to tell that he's Amish. But after years of working with these kids, Cates is in a position to know just how different Amish teenagers are from mainstream adolescents.
Back in his office, sitting at a desk cluttered with paper, Cates explained to me that even their core struggle is fundamentally different.
Dr. CATES: If I see a quote, unquote, "normal" American teenager in my office, they are probably struggling with, what do I want to do and separating from parents and, you know, all these kind of struggles that come up in middle adolescence of who do I want to be.
SPIEGEL: But because Amish life is so prescribed, Cates says Amish teens don't entertain these questions.
Dr. CATES: What they're going to do is some of kind of manual labor, which really doesn't identify who they are. It's just something they do to make money. If they're going to stay Amish, they're going to get married at a fairly young age, and they're going to stay married for the rest of their lives. So they're not individuating. They're not becoming individuals. They're becoming part of the larger whole. And that's dramatically different emotionally than what English teenagers do.
In one sense, you would think that would be less anxiety-provoking. In another sense, it's equally or more anxiety-provoking because you either accept what the group is or you walk away from everything that you were raised with.
SPIEGEL: It's no wonder then that some of these kids turn to alcohol and end up needing Cates' job to find their way out. Cates and his co-workers do both individual therapy and group sessions for kids who've been abusing alcohol. The problem is that many of the standard tools used by mental health professionals don't quite work with the Amish.
Take this example, which was explained to me by one of the psychologists who works with Cates in his practice, a man named Chris Webber(ph) who runs some of the substance abuse sessions for Amish boys. Webber pointed out that a lot of modern alcohol treatment involves self-disclosure. The idea is that the more self-degradating, self-disclosures you make, the better you're going to be because if you're engaging in self-degradating self-disclosures, clearly you're not in denial anymore, which is fine as long as you're a mainstream American, or English person, as Webber would say.
Dr. CHRIS WEBBER (Psychologist): English people are very into metacognition. Let's talk about our feelings. Let's talk about our feelings about our feelings. Let's talk about our feelings about our feelings about our feelings.
SPIEGEL: But that doesn't really work with the Amish. The Amish view is that talking about themselves is prideful.
Dr. WEBBER: That's not part of their tradition.
SPIEGEL: So clearly, any therapy that's based on self-exploration is going to run into trouble. In fact, to get around this problem, Cates says he uses a form of feminist therapy with his Amish clients. Basically, he tries to get them to talk about the other people in their lives and works backwards to their own experience from there.
And there are other changes that Cates has had to make in his practice. He doesn't see Amish clients in his office. They're uncomfortable in that kind of formal, modern setting, and so he goes to them.
Then there's that other major pillar of modern diction treatment that doesn't quite work with Amish teens: accepting individual responsibility.
Accepting responsibility for your actions as a drinker is often central to alcohol therapy. But as Cates explains, the concept of individual responsibility is fundamentally different for the Amish.
Mr. CATES: Individual responsibility doesn't really exist in some ways in the Amish church. Everybody is responsible as a group.
SPIEGEL: For example, Cates tells me about a kid he recently saw in therapy, a teenager working on his father's farm. The kid apparently asked his dad if he could use a tractor to move a bale of hay during a time when the use of tractors was strictly prohibited.
Mr. CATES: His father says, no, we don't do that. And he's an adolescent, and being an adolescent and rebellious, he goes ahead and takes the tractor out and gets that last load of hay.
The next thing you know, it's Saturday night. The deacon's at the door, and the deacon says, you need to - to the father and the mother - you need to confess tomorrow in church because you used a tractor in an inappropriate way.
SPIEGEL: Now, in mainstream culture, and particularly in therapy, taking personal responsibility for your actions is usually seen as a good thing. But in the Amish community, to accept exclusive personal responsibility in a way is to separate yourself from the group. It's a challenge to the cohesiveness of a community where everyone is responsible for everyone.
And protecting that cohesiveness, protecting the group, in Cates's view, is absolutely essential for any therapist who works with the Amish. Cates says that single need frames many of the choices he makes in therapy.
Mr. CATES: My effectiveness in the community is going to be pretty well ruined if I start having a following of Amish youth who leave the Amish after they've been seeing me. I mean, it doesn't take too many of those in a row for me to a get a reputation as being the therapist they don't want people to see.
SPIEGEL: But even though he's trying, it's not always easy. Because these kids are at such a delicate moment in their lives, sometimes even a casual remark can potentially provoke an unintended crisis that threatens to separate a young person from his culture.
Cates talks to me about another young man he worked with.
Mr. CATES: I'd seen him for probably three months, four months, and he asked a question about how long my wife and I had been together, and I gave him the number, and he said, so you've been married that long. And I said no, we've been married - the time we'd been married, it was like two years short of that. And he said I don't get it.
And I said, well, we lived together for two years before we were married. And he was just, really, obviously uncomfortable with that. And I said well, you know, is that a problem for you? And he said well, you know, we just kind of don't do that.
SPIEGEL: Over the next couple of sessions, the boy circled back to this idea. He couldn't get over it. Remember, this is a kid in the middle of Rumspringa, which means this is a kid who is in the middle of deciding whether or not to choose the Amish way of life.
Cates is probably the first English adult that he's ever known well enough to have such an intimate conversation with, and he trusts him, which means that Cates can influence the kid, which this small remark, Cates says, clearly did.
Mr. CATES: I saw him over that time beginning to really struggle with: do I believe, the way the Amish believe, that you have to be married or do I believe that you can cohabitate?
SPIEGEL: In a way, Cates's task is to be a good therapist without luring these children away from their faith, and that is what he tries to do. Of course, the problem of having to adapt a therapy to another culture isn't unique to Cates. There are lots of therapists who work with subcultures that are either unfamiliar with or totally hostile to the practice of mental health, therapists who struggle with the same kinds of questions that seem to haunt Cates at the end of the day when he thinks back on his sessions with his clients.
Mr. CATES: What was kept from me because I'm English? What was gently told to me because I was English, and I needed to pick up on that cue, and I missed it? What was told to me in a different way than they might tell it to someone who was Amish? I've gotten better at that over time, but that's always there. There's always that line in the sand.
SPIEGEL: Eleven years after his first encounter, Jim Cates admits he's still improvising treatment with the Amish.
Alix Spiegel, NPR News, Washington.
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