One photograph. A little boy in a red T-shirt, blue shorts and tiny trainers. He is face down on a beach in Turkey. The toddler, just 3 years old, was Aylan Kurdi. He drowned alongside his brother and mother.

Aylan was just one story in the huge current refugee crisis—a mass exodus of 4 million Syrians attempting to flee war and the occupation of their homeland by Islamic fundamentalists. More than 2,600 have died attempting to cross the Mediterranean for the imagined sanctuary of Europe. In stark contrast to countries like Germany and Sweden, the response from the British government has been pitiful: only 216 Syrian refugees have thus far qualified for the official relocation program and Prime Minister David Cameron originally said the total would not rise above 1,000. “I don’t think there is an answer that can be achieved simply by taking more and more refugees,” he said, thereby blithely consigning thousands to staying home to face persecution, torture, imprisonment and death, or else risking escaping on leaky, overcrowded boats.

The number of forcibly displaced people around the world reached a staggering 59.5 million by the end of 2014, compared to 51.2 million a year earlier and 37.5 million a decade ago. The massive increase in people in search of refuge over past decades is no accident. It is the direct result of globalisation, a Third World crisis born to a significant degree of First World politics. As long as there are great disparities between economic, social and political conditions between countries in the world, migration in large numbers is inevitable.

The easiest way to justify such a profoundly unequal and unfair world order is to blame its victims, through a process of “othering” or what Edward Said calls “Orientalism.” Dominant powers establish “truth” about both themselves and those over whom they exert power. “We” are surely rational, developed, humane and good, while the “other”—foreigner, immigrant, refugee, asylum seeker, eastern European, Muslim, African, Asian, black, nonwhite—is portrayed as inherently barbaric, inferior, backward, aberrant, criminal, corrupt, violent, poor, lazy and dirty. The mobilization of such negative stereotypes by politicians and press in the U.K. has been going on for generations. Both of the two main political parties compete in a dismal race to the bottom for the perceived electoral asset of “toughness” toward outsiders, while sections of the British media, which have a long, horrible history of xenophobia, compete to see which can attract the greatest number of readers by publishing the most hostile, fearmongering stories. A columnist in The Sun recently called the refugees “cockroaches”; the Daily Mail wondered why the government could stop Hitler but not “a few thousand exhausted migrants.”

As Noam Chomsky writes: “Propaganda is to a democracy what the bludgeon is to a totalitarian state.”

And then, on Wednesday, a photograph appears, the corpse of a little boy, washed up on the shores of “Fortress Europe.” And through the democracy of social media, the public responds, magnificently, with great humanity, putting the politicians and tabloids to shame with campaigns (eg. #refugeeswelcome), fundraising and relief runs, petitions, marches, banners at football matches and all kinds of extraordinary, individual offers of help.

“I’ve worked for the UNHCR for more than seven years and, to be honest, this is the most generous response I’ve seen in terms of the way it has touched people and their willingness to offer help on a very personal level,” said Laura Padoan of the UN refugee agency.

Therapy—for better or for worse?
In psychological terms, the demonizing “othering” process is called projection. All the unpleasant parts of us are ascribed instead to the “other” such that we can preserve a self-image of purity. This happens individually, between us, and it happens collectively, between nations. What Jung called “the shadow” does not live in foreigners from Third World. It lives in all of us.

Psychotherapy, too, has a tendency to project, to “other,” to blame the victims. Social environment psychologists like Erich Fromm, Harry Stack Sullivan and Karen Horney have pointed out that so much human psychological distress and suffering is born of dire circumstances, the result of a ravenous capitalism machine that mankind used to master but has now enslaved us.

Rather than looking for insight, the late British psychologist David Smail argued that therapists should look for “outsight”—an awareness of a person’s environment, of the oppressions of a deeply-unfair social order; an indefensible hierarchical power structure that keeps people down.

Not surprisingly, studies have shown considerably higher rates of psychological distress among refugees, including PTSD, depression and somatic complaints compared to the general population or other kinds of migrant. Let’s hope that the traumatized refugees who do manage to arrive at our green and pleasant land aren’t then exposed to the kind of counselling that invites them to consider their dysfunctional “negative automatic thoughts” or unhelpful “repeating patterns” of behaviour.

Writes Smail: “I can think of no mainstream approach to psychological therapy which doesn’t harbour at its core a humourless authoritarianism, a moralistic urge to control, that has the ultimate effect of causing infinitely more pain than it could ever conceivably hope to cure.”

The ways that counsellors and psychotherapists seek and work with both insight and “outsight,” the extent to which they “other” their clients, and the power dynamics in the consulting room determine whether they are part of the problem or part of the solution. Therapy, for better or for worse, operates at the intersection of the personal, the professional and the political,

Togethering
In his 1955 book The Sane Society, Erich Fromm concludes: “In the nineteenth century the problem was that God is dead; in the twentieth century the problem is that man is dead.” The future, he argued, will either see a grand, mutual destruction—or else a rediscovery of our shared humanity.

Sometimes we are woken up to that shared humanity. We meet someone who rocks us out of our complacency. Or something dreadful happens to us that makes us see things afresh. Or we see a devastating photograph that completely stops us in our tracks.

The image of Aylan’s lifeless little body cuts through all the stereotypes, the xenophobia, the UN reports, the statistics of war (the greater the number of people suffering, the greater the likelihood of a collapse of compassion). He could have been your child, or a friend’s child or any child. He could have been you.

We look at that photograph and we feel outraged. We are impelled to do something. We might not get it right. We might be clumsy and make mistakes. But we try to come out from behind our own borders and boundaries and barricades. We join forces, we connect, we act. We are One World. And so, instead of “othering,” we tiptoe towards some kind of “togethering.”

• How you can help

A sad story last week about the suicide of a British soldier who suffered terrible injuries from a roadside bomb blast in Afghanistan.
     Private Bradley Paul of the 1st Battalion The Mercian Regiment severed an artery in his neck and had multiple bone fractures from the explosion in Helmand Province in November 2012. He was airlifted home and spent more than a year undergoing physical rehabilitation.
     “Through the usual strength of character we all came to love about him and with the love of those around him he made a good recovery,” says the Go Fund Me appeal page set up to raise funds to pay for his funeral.
     But the psychological wounds, less visible than the physical ones, became impossible to live with. On February 17, he was found dead at his home in Timperley. He was 23.
     It had been a “silent struggle” according to Paul’s infantry platoon commander, Captain Chris Middleton. “He was a great character in the platoon. He was one of the guys that the other lads looked up to and respected. He was physically and mentally very strong and he had a very good sense of humour.
     “As the front man of his patrol every day, Brad carried the weight of responsibility for lives of his mates on his shoulders every time he stepped out the gate.”
     The government sends people like Paul off to the dark places of the earth, often for highly questionable purposes. They witness death, destruction, massacres, unspeakable acts of barbarism. They suffer great injuries. They see friends killed right in front of them. They kill.
     Then they’re supposed to come home, keep calm and carry on as normal. Help with the school run, go to the cash and carry, Saturday night at the movies. “As you were, soldier.”
     The return to civilian life can be some kind of nightmare. Everything looks roughly the same, yet everything has changed. You find you can’t go home again. You’re still at war. No one has prepared you for peace. There’s a good chance you’ll end up in prison, or homeless.
     The Armed Forces have presented you with a cruel double bind: your experiences in the military might have damaged you psychologically, but you’ve been trained that you’re supposed to be tough and resilient and self-reliant—someone who doesn’t tolerate vulnerability, let alone ask for help. You’ve been chewed up, spat out, and now left to cope on your own. Thanks a lot for your years of service, your courage, your sacrifices—now go away.

Red alert: Post-Traumatic Stress Disorder
Trauma is an unbearable, horrific fact of life. As with Bradley Paul, the suffering is usually silent, the wounds invisible. And it doesn’t just happen in war zones, far away. “Trauma happens to us, our friends, our families, and our neighbors,” writes Bessel van der Kolk in The Body Keeps Score. “One in five Americans was sexually molested as a child; one in four was beaten by a parent to the point of a mark being left on their body; one in three couples engages in physical violence. A quarter of us grew up with alcoholic relatives, and one out of eight witnessed their mother being beaten or hit.” The statistics for the U.K. aren’t quite the same--1 in 20 British kids have been sexually abused, for example; domestic abuse will affect 1 in 4 women in their lifetime—but still shockingly high.
     Trauma can cause a broad range of distress. There is traumatic stress, there is post-traumatic stress, and then there is full-blown Post-Traumatic Stress Disorder. PTSD is a prolonged reaction to a traumatic event; it can also be triggered many years later. The Diagnostic and Statistical Manual of Mental Disorders (DSM), which has included PTSD since 1980, lists potentially traumatic events as combat, sexual and physical assault, being held hostage or imprisoned, terrorism, torture, natural and man-made disasters, accidents, and receiving a diagnosis of a life-threatening illness. Sometimes, however, events that seem quite small and insignificant to the outside observer can be profoundly traumatic. Most people experiencing a trauma do not develop PTSD—some helpful factors, writes Babette Rothschild in the seminal trauma book The Body Remembers, are: preparation for the expected stressful event, if possible; a successful fight or flight response; good developmental history, belief system, and internal resources; prior experience; and good support from other people.
     PTSD is, like most psychological disorders, highly variable in its presentation of symptoms. But those symptoms are generally horrendous, dangerous and hard to resolve. It’s as if the traumatic event is still happening, right now, with your body responding as it did at the time, on high alert—heart pounding, fast-breathing, adenaline flooding the system. Another common symptom is dissociation—a shutting down; a kind of escape when there is no escape. Common dissociative symptoms include amnesia, fragmentation of identity, and feelings of detachment and unreality about one’s self, body and environment.
     The DSM claims that a complete recovery happens within 3 months in half of PTSD cases, but that “some individuals remain symptomatic for longer than 12 months and sometimes for more than 50 years.” In fact, PTSD requires a lengthy, painstaking spell of support and psychotherapy. It takes time to build the necessary trust, and then time for the delicate process of revisiting the hideous trauma, physically and emotionally re-experiencing it, arriving at some kind of accommodation or resolution—what Peter Levine in Waking the Tiger calls a “renegotiation”—and starting to heal. The story is told and retold, imagined and reimagined. The losses are mourned. The trauma is named, described, spoken out loud. “Without a voice,” writes Kim Etherigton in Trauma, the Body and Transformation, “our body finds other ways to speak for us.”
     Rothschild stresses the importance of “braking and accelerating” during the work with a therapist—the client gently revisits elements of the original event at their own pace, and if things become too overwhelming, one or both of you hit the brakes: slow down, do a breathing or mindfulness exercise, change the subject, stop. The potential for retraumatisation—the very opposite of healing—is great. Much more ammunition is needed to fight the enemy within than some Citalopram and a handful of sessions of CBT.
     It’s particularly difficult work because the clients often feel highly ambivalent about it.  The tendency for veterans is to downplay the problem and not seek help. Counselling is a foreign land for many of those who have served in the Services. How could a counsellor—especially a mere civilian—possibly help? They surely couldn’t even begin to understand what you’ve witnessed, the things you’ve done. What could they know about being in a constant state of super-anxious, hypervigilant high-alert, waiting to attack or be attacked at any moment. The fear of crowds. The rage. The isolation. The sleepless nights, the flashbacks. The urge to escape into drink, drugs, gambling. Or dissociation: the memory loss, the blackouts, those disturbing episodes where you find yourself in another town, miles from home, with no recollection of how you got there, or why. The powerful undertow of suicidal thoughts.
     In her research on veterans’ experiences of psychological therapy, Camilla Stack concludes: “Practitioners working with ex-military clients should gain an understanding of military society and culture and appreciate its lasting influence, particularly in terms of power dynamics. They should be sensitive to significant cultural differences between the military and civilian worlds, and watchful for the concomitant risks of misunderstanding and judgment.”

The politics of trauma
The U.K.’s the Ministry of Defence (which has had its moments as the Ministry of Attack) has been reluctant to recognise PTSD, because it doesn’t want to pay for treatments or damages or otherwise be held responsible.
    “It suits the MoD to minimise the numbers in order to reduce the extent of liability,” Tony Gauvain told The Guardian. He is a retired colonel, psychotherapist and chairman of the charity PTSD Resolution. (Another charity, founded 95 years ago, is Combat Stress , which provides specialist clinical treatment and welfare support to UK veterans suffering from a range of psychological injuries like PTSD.) “But given the numbers of people suffering symptoms now, and the latency of the condition likely to result in increasing numbers, there would seem to be a determination to avoid admitting there is a problem.”
     How many deeply traumatised people, victims of domestic abuse, rape, violence, torture, organised crime, terrorism, wars—the old kind and the new, more insidious kind—are walking on the earth today, right now, in pain, having received no treatment at all? Very many. Trauma work, writes Judith Herman in Trauma and Recovery, is political because the sufferers are generally the oppressed, and the oppressed usually have no voice. The truth does not come out. There is no reconciliation. Human wrongs are not righted.
     “Moral neutrality in the conflict between victim and perpetrator is not an option,” writes Herman. “Like all other bystanders, therapists are sometimes forced to take sides. Those who stand with the victim will inevitably have to face the perpetrator’s unmasked fury. For many of us, there can be no greater honor.”

     Paying someone to hit you with a stick might gratify masochistic tendencies but any therapeutic benefits seem extremely dubious. At my school there was a geography teacher who liked to punish students by whacking them with his hockey stick, which he called "my willy" (I swear I'm not making this up). He was also fond of hurling his wooden blackboard duster at pupils, and occasionally had been known to grab a miscreant, drag him to the front of the classroom, and plunge his head into a bucket of cold water which he kept on his desk. Who knows how many children he traumatized over the decades with such barbarism. Some people say they had a good experience of boarding school. Many however did not and still suffer today from the devastating consequences of broken attachments and a stunted, shut-off emotional life (I was spared the former—I was a day pupil). Joy Schaverien calls this boarding school syndrome, and many of the afflicted end up in positions of power. And in therapy, too. Repression and denial work up to a point, and then they stop working. The middle-age man suddenly bursts into tears on his way to work one day, or out of the blue he hits his wife, or he finally notices that his drinking has got completely out of control. A crack appears in the facade. For the lucky ones, the crack lets in a little light. With some coaxing, such men emerge, blinking, out of their psychic foxholes, to discover that the war is over.
     While this supposed Siberian spanking therapy is extreme, there are many other, subtler, more insidious ways that therapists can abuse their clients. A skilled therapist might challenge you, provoke you, stir things up, which can be all well and good. There might be times when you leave a session feeling really terrible, as fragmented as a shattered mirror. You might even at times hate your therapist. These things are often all part of a healthy, helpful therapeutic process. Psychotherapy is not just about patting a client on the head and offering nice affirmations. The "do not disturb" sign hangs on the outside of the door, not the inside.
     But if you feel that your therapist doesn't have your best interests at heart, isn't on your side, is exerting an unhealthy power over you, undermines you, always makes you feel bad, or in some way seems to take out their own issues on you, then you have a choice. You could stick around and explore what's going on, share your experience of the therapist and vice versa and analyse the dynamics of your relationship and so on, all the while blaming yourself. Or do yourself a favour and walk. Don't let anyone beat you with a stick, whether actual or metaphorical.