Therapeutic Credulity

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Commenting on this article which is as hilarious as it is infuriating.

http://theness.com/neurologicablog/index.php/a-psychiatrist-falls-for-exorcism/

 

I don’t even know where to begin with this article, so I’m just going to dive right in.

This quote: Gallagher could benefit immensely from even a basic understanding of cold reading and mentalism (not part of psychiatry training).

While I’m no psychiatrist, these concepts actually are covered quite extensively in psychological/therapist training, and I’m pretty sure that psychiatrists tend to do undergrad work in psychology, but I could be wrong. I’m sure some med students decide later on to specialize in psychiatry, which I think is pretty ridiculous for very many reasons, most of which because I think psychiatrists should have a very good understanding of therapy before learning the “magic” of psychopharmacology.
The article also mentions: let’s not forget, these are mentally ill patients.
How insulting and misguided! There isn’t a line that divides crazy from not crazy, but there are many markers by which we can determine the level of a person’s functionality, and plenty of highly functional people could still benefit from therapy, including psychopharmacological therapy, and the days when general practitioners play psychiatrist and hand out psych meds just to ease the patient’s fear of being crazy SHOULD be far behind us. But comments such as “these are mentally ill patients” as if that just explains everything about them in a seriously negative fashion are exactly why people are still so concerned about seeing the proper specialist to treat their symptoms.

The author concludes by saying that if we play into a person’s delusion we’re doing them a disservice by reinforcing the delusion. Wrong!
Trust is extremely important in the client/therapist relationship, and a person who believes that they’re being watched by the gov’t, spied on by neighbors, abducted by aliens, possessed etc, are SO used to being placated and condescended to, but ultimately disbelieved. They do not trust mental health practitioners because they’re tired of being treated like a “crazy” person and to them their experiences are (most often) absolutely real. They desperately need someone to believe them. Additionally, I’m a huge proponent of the “whatever works” brand of therapy. If not, what’s to stop me from telling highly religious clients that prayer doesn’t work, and that going to church is just making things worse? I don’t believe in their god, so maybe I think these things are counterproductive, but I have to work within the framework that I’m given. What about 12 step? We know that shit does not statistically work. We have a huge body of studies to draw from, but unfortunately the medical and psych communities in many places still haven’t caught up and believe that some guy and his friend in the early 20th century were qualified to write a manual to treat addiction. Additionally, we all have had clients and people we know who did exceptionally well with 12 step, so it perpetuates the myth that it’s effective as treatment despite evidence to the contrary. So if my client has tried and failed at 12 step for years, but they love it and sometimes it works for a while, do I print out dozens of research studies to try to convince them that the shit isn’t helping and likely making them worse? Absolutely not! This falls under the Ways to Quickly Alienate Your Client and Forever Destroy Client/Therapist Relationships heading. It’s not a good idea to tell people that the things they believe to be true are not true, and that the things they hold dear are dreadfully unhealthy. There is an extremely apt, oft used but grammatically jarring phrase: Meet the client where they’re at. You start by building trust, then work within the framework presented and see where it can be taken. If a person believes that they’re possessed and that they need to have an exorcism, I’m certainly not going to refer them out to some nutjob religious fanatic, but I’ll help them to be sure that the method they choose is safe, and if they get their exorcism and it works, great! But more than likely it won’t work, or if it does it likely won’t last, and I can be there to help them through that, and to help them seek out other options to wellness. In addition, therapy is really all about helping a person to come to conclusions on their own. We’re there to guide them, to ask questions that help them to think critically about their situation and to examine their choices and beliefs in a healthy manner. If I could just tell people, Drugs aren’t healthy, or Your relationship is likely to literally kill you, or You’re just delusional those things aren’t real, and suddenly everything changes for them, well then I’d be out of a job (er, I already am, but not for this reason, heh) and there’d be little need for psychiatrists either. Most importantly with this issue, actual delusions are most likely biological, and irrational thinking, for lack of better or more succinct phrasing, is habit. If the meds work, delusion gone, but the irrational thinking is still there and even if the person doesn’t feel possessed anymore they may still believe that they were or are but that for whatever reason the demon is not active or biding its time or whatever, and they’ll still need assistance to deal with this. Plus, if a person believes they’re possessed they may refuse meds because they’ll say they aren’t crazy they’re friggin possessed, so how do we get them to give meds a try? Hint: Telling them that they aren’t actually possessed but just crazy doesn’t work.

No, I don’t believe everything a person tells me, but I’m not just humoring them either. I understand that what they’re experiencing is frightening and debilitating, and it’s all too real to them. Our perceptions are just as flawed as our memories. A person who is colorblind will see grey where I see pink. That doesn’t mean that they aren’t seeing grey. We perceive things in vastly different ways, sometimes in a very literal sense because of physiology, other times because our experiences, societal norms, family values and upbringing, have colored our perceptions. I can’t impose my values on someone no matter how much I may believe that theirs are wrong or unhealthy. But I can hope that trust, proper counseling, and application of effective therapies (which definitely does include pharmacological therapies) may help that person to recognize which values and beliefs are healthy, which are benign, and which are decidedly unhealthy.

All that said, I’m definitely never going to write a paper explaining that my clients are definitely being haunted and possessed. That’s taking therapeutic credulity a bit too far. :p

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What Dylan Knew

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I read the most brilliant article today, and would like to share it, as well as my thoughts concerning its topics, a shortened version of which I left in comment form after the article (with a quite embarrassing typo). Anyone with MS, a disability, or know anyone with such, please read: https://multiplesclerosis.net/living-with-ms/not-born-this-way/

The author, Marc discusses, among other things, personal identity conveyed through fashion, and how it relates to him. For me, it’s only been 4 years since my diagnosis, but to say “only” seems such an understatement. I refer to everything before as My Former Life, because that’s truly how it feels. As far as appearance goes, I was never one to primp or take any extra care in my appearance, but honestly I didn’t really need to. My hair was wash and go, face usually unadorned, and it was fine that way, I certainly was never accused of being plain. My clothing style was always relaxed, but it was a style. I dressed body shape and age appropriately with emphasis on ease and comfort, but also in a flattering manner, a fashion all my own, what my friends and peers believed to be both effortless and brave, as I never spent the money and time they did preparing for the day, and as far as I was concerned the reason I didn’t make much of an effort (or feel brave not doing so) was because I didn’t really care. When I think back now I realize that I did care, just not enough to inconvenience myself, only just enough that I did choose clothes specifically, but only with care at an almost subconscious level, because really it almost WAS effortless for me. It was an afterthought, get dressed and go. All of my clothes were suited to me because I chose them carefully when I shopped, and I did spend much time shopping. Clothes shopping=fun, right? Today, not so much. Not only can I not afford to buy clothes to fit my new frame, but I really wouldn’t have the energy for a shopping excursion. As many women can attest, weight gain and clothes shopping aren’t easy companions, and just the thought of such a trip makes me feel exhausted with nervous anticipation. As such, I own one pair of jeans that fits comfortably but now has a broken zipper, one pair that fits quite uncomfortably, maybe 2 properly fitting shirts, and an assortment of pajama pants that I’ve deemed appropriate for out of the house wear. I wear slippers almost everywhere, especially if it’s a wheelchair day. Why bother with shoes? I’d expend half the day’s energy trying to put the damn things on anyway.
I try not to think so hard about My Former Life. I certainly did not do so many exciting things with my life as Marc did, but it was full, productive, fun. In my professional life I worked hard to chisel out a career. Based on education and duration I say I was a counselor, but my work experience is all over the map and mostly revolves around two tethers that are human services and entertainment. An odd combination maybe, but they were two things I’ve always been drawn to, and recognized from a young enough age that entertainment would never be a lucrative career choice, not that human services ever made me a lot of money. Throughout my life in addition to doing counseling and working with developmentally disabled people, I owned a printing business, worked at a radio station, directed tv shows, did stage lighting, professional makeup for film and camera, and in my youth, was a model and a stage actress. For fun, I was a dancer and taught dance classes. I miss dancing, and I miss counseling, and I seriously miss driving fast with the top down. For me, my car represented my freedom and nothing was more relaxing to me than hauling ass down the freeway at night, wind in my hair, cranking the music and singing along like I was the only person in the world. Now I don’t even own a car, (it may be in both our names but it’s definitely my husband’s), and when I do drive, which is becoming increasingly rare, I do so slowly, carefully, hunched over the wheel tense with concentration.
I feel as if I’ve been demoted in life. Once vibrant, exciting, fun, now dull and drab. Once respected on a personal and professional level, now quietly humored or outright ignored. I worked with disabled people, in some manner or another, all my life. I heard their stories, shared their triumphs and sorrows, and was definitely no stranger to their struggles. Of course the view is certainly different from my own wheelchair, and the experience of becoming increasingly disabled is far more nuanced than I ever could’ve imagined, but at least in some fashion or another, it is familiar. What is most difficult is this feeling of becoming irrelevant, of losing status, of being pushed aside. My memory and cognition have suffered a great deal. I don’t speak as clearly or think as quickly. As such, I’m easily dismissed. In the time it takes me to complete a thought, that thought has become irrelevant. I believe, more than ever, that I can now empathize with the struggles of increased age more than ever before in my life. In such a short time I lost my career, my youth, my appearance, my self-sufficiency, my memory, and with all of those things, my self-confidence. I find myself telling the same stories over and over again, either because I don’t remember telling them or because I have nothing new to say, and being ignored. Or telling a story about my day that becomes long and meandering because I’m unable to properly organize my thoughts, and discovering that my audience is not so amused by the retelling as I was by the experience, and can’t you just remember a grandparent or great aunt who did exactly these things? I’ll be 37 in two weeks, but now understand my 80 year old grandmother, and believe I understand why she did the things that she did. I know now on more than just a sympathetic level, none of us wants to become obsolete with great dignity and grace, we want to fight and struggle and scream our way there, to rage against the dying of the light, as it were. The only question is, do we endure this struggle internally, or for everyone to see? I’ve often joked, even on this blog, that when I’m really old and living in a home in 5 years, will I be one of the ladies who quietly stares at the wall and is otherwise a pleasure to be around, or one of the old ladies who screams and throws her poo? I still don’t know. I could see it going both ways. I can understand being filled with rage at being talked down to as if I were a child, at the impatience of others while I take a very long time to do a simple task, at the confusion of knowing all I’ve lost, of knowing that I used to be able to do these things and used to remember so much more, and that there’s no way to get them back. I really don’t know if I’ll be able to face these things with outward calm, or if I’ll show my rage to everyone who cares enough to try to help me. I guess we’ll find out in 5 years. 😉

Grief and Chronic Illness

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Loss is a terrible thing. In life, we will have moments of loss that are often viewed as normal, many sometimes even so unavoidable they are expected and inevitable, but they still shake us so to our core we’re sometimes little able to function afterward. In our culture we don’t prepare for losses, particularly deaths, but wait for them to come, take us by surprise and knock the wind out of us.
Grief creates a very tangible, visceral pain. It literally hurts in our bodies. A study done recently showed that pain medication eases the psychological pain of social rejection.* Social rejection causes one to grieve immensely, and on a long-term, or chronic, scale. It seems that our grief for painful occurrences in life are just as painfully tangible as an upset stomach, a headache, and the malaise that many people feel while grieving.
There are two types of grief experienced in life. The acute, an occurrence that prevails with suddenness and quickly changes the topography of our lives, such as the loss of a job, the ending of a relationship, the death of a beloved pet, the sudden death of a beloved person, etc. These things occur swiftly, change our lives, but the primary event is over when it’s over and given time, we may adjust to our new lives with this change in it. We grieve strongly and terribly, mourn what or who we’ve lost, then we pick up the pieces and move on.
The second type of grief is chronic grief, and occurs when our losses are continual issues in our lives, when the things that we grieve are long-term, and ever changing, such as a chronic illness, the death of a loved one for which we cannot (or will not let ourselves) heal, chronic illness of a loved one, or news of the impending death of a loved one or beloved pet for which there is no definite time constraint (maybe a month, a year, or 10 years, we don’t know, but they’ve definitely got a terminal illness such as cancer that is incurable and will eventually kill them). Chronic grief is a terrible thing. Acute grief is expected, and accepted. One is supposed to hurt when they’ve suffered a loss. But people have difficulty identifying with the long-term pain associated with the chronic, of any sort. Chronic physical pain is beyond comprehension for many people. How can any person hurt all day every day? It must be something made up, exaggerated, stated excessively, because such a life cannot be feasible. Chronic psychological pain is just as difficult to grasp. How does one continually not deal with an issue or problem? How does one continue to hurt?
Truly, people can only suffer so much. Chronic pain of any sort tends to numb us. People with chronic physical pain often have very high pain tolerances. But also, they can have very low pain tolerances, as if their capacity for experiencing pain has been used up, and one more thing added to the list is enough to bring them to tears. Terrible psychological pain can cause the same effects. Maybe a person is just holding it together dealing with their various chronic and/or acute griefs, and that one more thing, like dropping a pizza cooked fresh out of the oven, and they burst into tears like their whole world has come unraveled.
Many of us with chronic illnesses deal with both chronic physical pain and chronic grief. We mourn the many things we’ve lost in our lives due to the illnesses that we struggle with every day. Imagine waking up one day and learning that not only are you going to suffer every day for the rest of your life, but you’re slowly going to lose your career, independence, self-sufficiency, hobbies, friends, mobility, the respect of those around you, perhaps your memory, and each day will be more difficult, more of a struggle to hold onto those few things you still have, and each day it’s possible that you’ll wake to find that you’ve lost something else, and you still hurt, everything still hurts.
I’m tired of being treated like a child when I become frustrated for the things I’ve lost. I’m tired of being told that it’s simply depression that causing me to grieve the things I’ve lost when it’s FAR more complicated than that. I’m tired of being looked at with pity, as if my mind is gone, when it’s really not me who has the problem understanding the situation. I’m tired of trying to justify my emotions to others.
Every person has a right, and even a need, to grieve their losses. If or when that grief becomes out of proportion to the loss there may be need for intervention. I had worked with people who continued to mourn the loss of a child so strongly that it was a disruptive force in every aspect of their lives 20 years after the fact. This is no longer healthy grieving, but obsession. I understand full well how grief can be destructive rather than palliative, but when each day presents a fresh wound, are we not entitled to our time to let it heal? 

* http://www.sciencedaily.com/releases/2009/12/091222154742.htm

Teenagers and Sociopathy

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The word of the day today, sent straight to my email inbox from dictionary.com was “columbine”, meaning “dove-like”, among other things. It stated that the columbine flower was named such for its strong resemblance to a group of doves. I thought that that sounded interesting, and didn’t believe I’d actually seen columbine flowers, so I Googled “columbine” without really thinking about what would pop up in the search, (flowers?), and I was greeted by dozens of flashy article headlines related to the Columbine HS shooting. I was in college when the shooting occurred, barely out of my teen years myself, and remember quite clearly all of the hype and speculation related to this event. I remember feeling empathy for both the victims and the shooters, which of course I could never say aloud in mixed company. High school and my teen years were a special kind of hell, as is true for many people, and for those people who had happy childhoods, never wanted for anything and went to a nice, suburban, upstanding school, it’s something they have a difficult time understanding.
My first reaction upon being greeted by the page full of Columbine HS articles was straight up disgust. I hated all of the guesswork that occurred in the aftermath. Was it the music they listened to? Were they bullied? Were their parents to blame? Was the school to blame? Whom can we blame?! Obviously someone or something has to take the fall for this, and adults country wide were wracking their brains trying to figure out what thing, things, or people should take the brunt of responsibility for turning two obviously upstanding boys into murderous maniacs. It’s got to be the music… But for me, being still very close to my teenage self and mentality, I knew they’d not find any answers, because there would BE no answers. I knew in my gut, or my heart, or my subconscious, or wherever it is that these instinctual feelings and reactions are stored, exactly how those two boys felt, and it was nothing so simple as bullies or not getting laid or listening to heart pumping music with angry lyrics. It was pure and simple rage, and it was contempt, and it was this feeling that you could not quite identify that something, everything, was not right with the world, and this urge to correct it that ran so deep that violence didn’t really seem all that excessive. It seemed, in fact, the most apt solution. Nothing can fix this but wiping the slate clean. And yes, I know I sound like I was a crazy person, but teenagers are most certainly “crazy”, and I’ll explain why momentarily.
Just as I was about to narrow my search to columbine flowers, one headline stood out. It claimed to know the REAL reason why they did it, and it was a Slate article. Being one of my more favored sources of news and information, I decided to have a look at this article from 2004: http://www.slate.com/articles/news_and_politics/assessment/2004/04/the_depressive_and_the_psychopath.single.html The headline was particularly interesting. “The Depressive and the Psychopath”. As stated in my previous post, it was made clear how I feel about calling people by their mental health diagnoses, but in this case I was willing to let it slide. It appeared that they were just trying to make a point, and it certainly did its job, it piqued my curiosity.
The article describes one of the Columbine shooters as being inwardly tortured, extremely depressed and prone to fits of destructive rage, the other outwardly calm and polite, but inwardly contemptuous of both peers and authority figures, having a major superiority complex in some instances, a practiced liar who enjoyed getting away with it, and the article describes them as being a “depressive” and a “psychopath”, otherwise known as a sociopath. Had these two NOT been known as the notorious Columbine shooters, had they not been under such microscopic scrutiny and someone were to view their case histories individually, what would most people believe of their behavior? Typical teenagers! It is so very common for teenagers to exhibit signs of depression, labile mood, acting out behavior, poor judgement and poor impulse control. It is also very common for teenagers to lack empathy, to lie, be contemptuous of peers and ESPECIALLY authority figures. Particularly if those teenagers have suffered any kind of perceived injustice, mistreatment (perceived or actual), if they are different in any way from their peers which includes being of superior intellect, having different style of dress, listening to different music from what is popular, or anything that may set them apart from the crowd, because even as teenagers yearn to be unique and find their individuality, they also yearn not to stand out.
All teenagers are “crazy”. Not necessarily mentally ill, but crazy in the sense that they don’t tend to think or act rationally or consistently, and their emotions and behavior tend to be unpredictable, to say the least. Teenagers have a very difficult time understanding cause and effect. They have very poor ability to think their actions through to a logical and inevitable conclusion.
There are a few reasons for this, some biological, some social. The teenage brain is pretty bizarre. It’s going through a period where it’s almost literally rewiring itself. New connections are being formed all over the place and old connections are being rerouted. This is why parents often stare at their 14 or 15 year old, baffled, wondering where their child went and who this alien creature is living in their house. When just a year before they may have had a smart, logical, even tempered, maybe even bubbly tween or young teen, now they have a moody, pensive teen whose behaviors are beyond comprehension. Suddenly their well planned and effective system of rewards and consequences no longer works. The parent tells the teen they’re grounded, the teen says they don’t care. The teen no longer does their chores despite the fact that this means they’ll no longer receive their weekly allowance, then they balk when they aren’t given money at the end of the week. However, if they’re offered to do a side job, such as mowing the lawn, to receive pay that day, they’re often amenable, even though the side job is much more difficult than their assigned weekly chores. This is due to that inability to correlate long term cause and effect. Instant gratification, a reward for something done right now, is very easy to grasp. Shirking duties throughout the week doesn’t necessarily correlate to the loss of money at the end of the week. It’s not that they don’t know that they won’t get paid, it’s that they’re hard pressed to illicit an emotional response right now for something that will happen so far from right now, so they decide they’ll deal with it when the time comes. Then when the time comes…so does the explosive emotional response. Often parents will ask their teen, after they’ve done something particularly incomprehensible, “What were you thinking?!”, and the teen will respond in all earnestness, “I don’t know!”, because they really do not know. They weren’t thinking things through. They only thought that at that moment they wanted to do something, so they did, consequences be damned.
So what makes the two boys at Columbine HS different from other teens? It certainly wasn’t their aspirations. I can’t even count how many times my friends and I discussed vandalizing or blowing up the school. The school was generally our focal point because it was A) the place we spent most of our time, and B) the place that generated most of our daily stressors. We couldn’t conceivably blow up the whole city, or the whole country, but the school was doable. But we never intended on following through. I honestly think the biggest difference between those two boys and other teens with similar aspirations was merely means (they had access to guns, and I hate to say that because I don’t feel that there’s anything wrong with responsible gun ownership. Then again, giving your children easy access to your gun cabinet/safe isn’t really all that responsible), and that their two personalities fed off each other in such a way that their grand dreams of blowing up the school didn’t end in chuckles and a trip to the mall to get a slice of pizza. They egged each other on to continue planning and to follow through when other kids would not have. So the Slate article is correct in discussing the toxic mingling of their relationship with each other. However, I seriously dislike the portrayal of the boys’ futures had they not followed through. Eventually the teen brain matures. Many teens reconcile their anger, disdain and contempt as this occurs. They develop the capacity for empathy as they lose their haughty sense of self (which is often a mask for insecurity), and as they stop taking things so seriously, stop brooding over all the things that anger them to their core, such as the website with the ill written list of things that one of the boys hated, they start to be more appreciative of the differences of others, more accepting of their flaws, more insightful of their own flaws, their own strengths, the insecurities that drove them to be so angry. They grow up. I don’t believe that either of these boys would have been predestined to a life of crime. It’s so easy, in hindsight, to pore over their writings and scrutinize their activities and say THERE is the mind of a killer, that is the WHERE and the WHEN that the crazy started, and it never would have stopped.
It concerns me that people might read or have read articles such as this and will overreact to teenagers’ behavior and move to stifle them, when really teenagers should be given more opportunities for self-sufficiency, not less. They should not be treated as children until the moment they turn 18, then turned loose into the world, proclaimed magically gone from child to adult in a day, with no life skills, no critical thinking skills, never having had an opportunity to explore their own boundaries. Teenagers should be treated with respect, to give them a sense of self worth and a reason to respect, not disdain, their elders. They will be adults before you know it, and they have a lot of learning to do in a short amount of time, all while their brains are throwing them into chaos, so no matter how easy or difficult their lives may be, the life of a teenager is still hard.
And by the way…the columbine flower looks nothing like a flock of doves. :p

On Mental Health

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A couple days ago someone I greatly admire in the psychology community posted a blurb on Facebook stating that some “schizophrenics” have auditory hallucinations that are quite positive, in fact giving them compliments and making them feel good about themselves. It started off a bit of a debate as to how you’d approach treatment when someone’s symptoms had an overall positive impact on their quality of life.
I was irritated, as I usually am when people who work strictly in academia or from behind a doctor’s desk come across such conundrums. The approach to treatment is always the same: it’s what the person WANTS from their treatment. If they want to take meds or go to groups or see a 1:1 counselor, great! If they want to do none of these things, more power to ’em. Just because a person is mentally ill, even if they’re symptomatic, doesn’t mean that anyone has the right to force treatment on them. Perhaps they will have a more fulfilling quality of life if they engaged in treatment, perhaps not, and that’s their decision to make. Just because a person is mentally ill doesn’t mean they automatically forfeit their rights.
The only time we should ever think of forcing treatment on a person is if they or someone else is in imminent danger of harm. Other than that, our only options are the same options we have if we want to get someone to stop smoking or to exercise more. We can talk to them, try to help them see that their lives might be better or more comfortable if they followed a treatment regimen of some sort, we can be there to assist them when they’re ready to make that lifestyle change and support them throughout.
It doesn’t matter how afraid people are of those with mental illnesses. It is not against the law to be mentally ill. Calling people by their diagnosis dehumanizes them. They are not schizophrenics or bipolars any more than a person is a cancer, or that I am an MS. They are people with an illness. Instead of being met with fear, skepticism and hatred, maybe people should try harder to give them support and understanding. They didn’t ask to be stricken with these disorders, and many of them have been met with such heinous treatment throughout their lifetimes, they have every right to be wary of assistance that is offered to them now. Try thinking about what they’ve been through, practice your best empathy, educate yourselves, imagine that’s your sister, mother, son or significant other being treated that way. They deserve better.