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

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. 😉

Multiple Sclerosis: A Quick Summary of Symptomology

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Multiple Sclerosis is an autoimmune disorder that causes the body to attack myelin, which protects nerve fibers in the central nervous system, which causes scarring known as lesions in the brain and spine. As the myelin deteriorates it is akin to having wiring without insulation. Signals get crossed and confused, causing all manner of incorrect information to be transmitted to the rest of the body which manifests in many different ways. It can cause neuralgia (extreme pain in the nerve pathways), paresthesia (feelings of tingling, skin crawling, painful stinging like multiple bug bites, or pins and needles like a limb has fallen asleep), allodynia (pain or discomfort to touch that is non-noxious or not harmful such as clothing rubbing against the skin), muscle spasms, muscle spasticity (hard, painful contractions of the muscles that will not relax or release), as well as other debilitating symptoms such as optic neuritis (swelling of the optic nerves which can be extremely painful, and can cause vision changes such as double vision, cloudy vision, light sensitivity, color changes, and even temporary or permanent blindness), and temporary or permanent loss of motor control or muscle function anywhere in the body. This includes the heart and vascular system, and diaphragm, lungs and respiratory system. In addition, MS flares ups, or “exacerbations” cause inflammation in the brain which, over time, lead to structural brain changes, the most common of which is shrinkage. The brain literally shrinks, and many of the parts of the brain that are responsible for regulating such actions as sleep, appetite and mood no longer function at full capacity, if at all. Many people with MS suffer from mood disorders and sleep disorders that are not easily treated by traditional medications.
The most common symptoms of MS are fatigue (and this is not just how you feel tired after working a 10 hour shift, it’s being so tired even after sleeping 10 hours that you can barely stay awake, barely get out of bed to get food or use the bathroom, and no matter how much you nap throughout the day the fatigue persists), loss of balance and vertigo (which also tends to cause nausea and a lot of stumbling and falling down), and what is known as “brain fog” or “cog fog”, which is a cognitive disruption, an inability to think clearly and is often accompanied by confusion, dissociation, slow reaction times (both physically and mentally) and disorientation. Often the combination of these common symptoms, the fatigue, loss of balance and brain fog, tend to cause one to appear drunk, which is very frustrating for many people with MS. People are also often accused of laziness due to their fatigue, are treated as if they’re mentally challenged, and many physicians will insist that these symptoms, especially changes in mood, fatigue and sleep disturbance, have a psychological root cause, rather than a physical one, and will continue to refer them back to a psych prescriber. These issues are both barriers to treatment, and barriers to understanding by the person’s friends and family.
What must be understood is that every person’s MS manifests differently and at different rates, and there a 4 types of MS, some types generally more debilitating than others.
So if you’ve ever seen or heard of someone with MS who is perhaps very high functioning, then you encounter another person with MS who is less so, please do not compare them, or tell the one person that the other person you know can still work or exercise or go out dancing or etc and that if they only TRIED they’d feel better, because one person may be able to do these things while another cannot.
Educate yourself. MS is sadly a very common, and very debilitating disease, but it’s also very poorly understood. Learn about each new person’s struggles and support them in whatever way help THEM, not by comparing them to others, but by learning what the individual can and cannot do, and assisting them in whatever way might benefit their situation the most, even if all you’re doing is providing a sympathetic ear.
None of us asked for this disease, and if given the choice, we all would trade to get back our old lives in a heartbeat. We’re not lazy, we’re not moping around, we’re not hamming it up, we’re sick. Imagine how you would feel if you had lesions in your brain that caused even one of these symptoms to occur all day every day, and decide what your response to that situation might be before passing judgement on anyone else. All we’re asking is a little understanding and empathy.

Chrysalis

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Living with MS, or any chronic illness, is a terrible thing. Yeah, that seems like it should be a given, but you just don’t realize how much changes, in your life, your outlook, your interactions with others, even down to who you are. It’s like undergoing this radical transformation, and they use a butterfly to signify MS, as if we’ve cracked the chrysalis and shone forth, a beautiful new being, when really, to me, it feels like I crawled into a shell and emerged a dowdy caterpillar. Once vibrant, once glowing, beautiful, able to dance on the wind, now I can only crawl.
I used to be strong, independent, and while I know I’ve struggled with this disease for much longer than I’ve been diagnosed with it and I can look back at my life and see its dirty fingerprints smudged across many of my failed accomplishments, I can still look back to the not so distant past and see just how much more full of life I was then! How I’ve become practically a stranger to myself and all those around me in such a very short time.
I try not to hide my weakness and emotion from my friends and loved ones anymore. I used to always suffer in silence and everyone thought I was okay even times when I really, really wasn’t. It’s difficult to open up, it leaves you vulnerable. The worst part is when you try to explain to someone how badly things are going and they just don’t understand, or they think you’re making excuses or blowing them off. And I don’t blame people for thinking that way about me now. They’ve gotten so used to me always bearing the lode and just keep on pushing through like nothing can stop me, but I just don’t have the emotional, or even physical, fortitude to do so anymore. I do blame myself to some extent, for everything. For not listening to my body when it needed a break, when it was telling me that there was something dreadfully wrong and I just didn’t want to hear it, and for not giving others an opportunity to support me when I needed it and now they all either think that I’m strong enough to deal or that my cries of weakness are either insincere or so out of character that I’m too changed for them to understand me anymore. I’m not the person I once was. I have to admit my faults, concede that I need assistance and surrender to the things that are now out of my control.
I feel like I should want to cry to the universe for having cursed me with such ill fate, and ill health. More than just MS, my body is coming apart at the seams and there’s nothing I can do to stop it. I’ve lived with chronic pain so long I don’t even remember what it feels like to not hurt, but any time I think about feeling angry, I just feel sad. I don’t have energy to waste on being angry. I have an extremely finite amount of energy to work with each day and I just can’t be bothered to expend it on misplaced rage.
I suppose in some ways I still do suffer in silence. While I try to make it known to others how I’m feeling, what’s happening with me, what it’s like to live my life, there’s really no way to make it clear, no way to make it understood and truly felt! I know there are people who love me, care about me, sympathize and even try to empathize, but they don’t understand. They can’t. Because I can’t explain it with words.
The best way I can describe it is that I live every day with a pall over my soul. No longer able to do any of the things I once loved or that brought me joy, not knowing who this new me is or how I fit into this new life where I’m no longer needed, an anchor to anyone who wishes to take me on, I spend each moment trying to ignore the physical pain, the emotional torture of being trapped in this body, and try very hard not to think of the future.

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.