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

Anger

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I was bullied endlessly as a kid, at school, in my neighborhood, and particularly at home. The household I grew up in was brutal, chaotic, and frightening. The smallest issue, that may or may not have been my fault (one of my parents had a rough day, they were angry at my other siblings and so were mad at “the kids” in general, etc), any little thing could at the least, earn a tongue lashing and at the worst, a beat down. But, sometimes the tongue lashings were worse than the beatings. You can only hear how worthless you are in so many ways for so long before it starts to wear on you. I was an EXTREMELY anxious child, so much so that my interactions with other children were tense and stunted. I cried easily, was very quiet, kept my head down and tried to be invisible. Each day of school, with its competitive curricular nature, brought fresh horrors, as I often easily surpassed my classmates and was the center of attention much to my extreme dissatisfaction. I never asked to be put in that position, and hated the stares of my classmates, the weird girl who rarely talked, always knew the answers when called on, and beat everyone at every BS competition put into place that was meant to give children incentive to excel, but did nothing but torment me as I never had to try to win these competitions, won them anyway, was rewarded for my lack of effort by the teachers and administration and taunted endlessly by my peers for their feelings of injustice that they never had a chance. Through most of this, outwardly I was quiet and anxious, but inside was seething with anger and jealousy. While the other children wanted my intelligence, I wanted the things that many of them had. I wanted their healthy families, nice clothes, and most of all, their easy going nature and ability to socialize with each other and make friends as if it was such a simple thing to do. I struggled to make conversation without being bound by fear and anxiety.
By my teen years much of the anxiety and self-consciousness had lessened, but the anger remained, and for many years after I harbored an unspoken hatred toward my parents for bringing me into the world when they were clearly so woefully unprepared, both financially and emotionally, to raise so many children. As a teenager when I still lived at home I played de facto parent to my brothers while my parents worked and my mom was too stressed to handle the responsibility. As I was preparing to leave for college she lectured me that it’d be best that I stay home and go to community college for a few years then maybe go on to a university in town because I wasn’t smart enough or strong enough to make it through a major university, and as I was going to the same school as my sister (her favorite child by far) I would only drag my sister down with me, and don’t even think she was going to take out a loan or help me financially in any way because she didn’t approve of or condone my decision! I knew she was trying to keep me home to help her, but she didn’t ask that. As with all things in my house then it was strongarm, bullying and manipulation tactics. Still, it hurt, and it still kind of does. I told her I had never asked her permission, never asked her for money, and was going regardless of whether she wanted me to go. I was just so angry for so long! So angry my head would hurt and I’d clench my jaw so tight my teeth ached. I just had such strong hatred and disdain toward pretty much everyone and everything and a giant chip on my shoulder.
But…over the years I thought about my parents and their upbringing. How my dad used to beat us but he’d always present this caveat that it was nothing like what his father did to him and his siblings, and he wasn’t kidding. His father was an angry drunk who took “head of household” very seriously. He ruled with an iron fist. My mom sometimes would describe the absolutely horrifying things her father did to her and her brother, and how they had to flee like criminals to escape him. I realized, my parents did the best by us that they could. No, it wasn’t good, or proper, or healthy, but they really tried not to repeat their own parents’ mistakes. As I was getting older I thought of the mistakes I’d made, and was making, and how I was reaching the age my mom was when she had her first child, and realized how young and ignorant I still felt, how much I still had to learn. As if a fog blown away by a strong gust of wind, my anger at them, and at the world, quickly and easily dissipated. I didn’t need it anymore. A much more phlegmatic me emerged. More calm and easygoing.
When I was diagnosed with MS I felt like I should be angry at SOMEthing. My temper always still quietly lurks under the surface. I can feel it there like a giant sea serpent, circling under the waters, stirring them up very deep, occasionally rearing its ugly head then dipping back beneath the calm waters like it never existed. My fits of temper are always a shocking and frightening thing to anyone who witnesses them, so unexpected, so out of my usual character. But with this, I wasn’t angry. A bit sad, maybe even felt a bit defeated, but not angry. My ever logical mind was already researching the disorder, planning my next move, trying to figure out how to proceed and what was best for each new circumstance.
It’s so unpredictable, and I often feel at the end of my rope, frustrated, saddened, aggrieved, tired…but not angry. I’m glad that, at least, I was able to outgrow this particular knee-jerk reaction. It did take a good deal of soul searching and coming to terms with my life as a child, but I was able to learn, and I hold out hope that I’ll be able to, in time, overcome my many other shortcomings and continue to grow to be a halfway stable adult.

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.