Therapeutic Credulity


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


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


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:

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. 😉

2014–Year in Review for my first public blog!


I’d say, overall, it wasn’t a bad year for my first public blog. Haven’t posted much in a while as much craziness abounded. My house flooded twice. I’ve been to the hospital a couple times, and otherwise my health has been precarious, especially after a very long drive to east Texas and back. I went a full month without any pain meds, thanks much to the DEA for making sure the pharmacy can’t stock enough to fill demand. Then finally, I’ve moved from the hovel I was renting that seems to think rain goes into the house, not outside. Soo…it’s been a hellish few months, but I’m hoping next year to get back on track and start posting answers to any questions you might have about MS, psychology, and life, the universe and everything. 🙂 Have a happy new year everyone!

The stats helper monkeys prepared a 2014 annual report for this blog.

Here's an excerpt:

A San Francisco cable car holds 60 people. This blog was viewed about 350 times in 2014. If it were a cable car, it would take about 6 trips to carry that many people.

Click here to see the complete report.

Selfies…the Greatest Menace to Modern Society! Just Ask These Mental Health Professionals!


Recently an article was posted to my Facebook feed that I wish I hadn’t seen. Unfortunately, once seen, things cannot be unseen, and although I strongly expressed my opinion with regards to this little nugget at the time and location of its post, I find myself ruminating on the matter and felt that it required somewhat more formal redress. The article that was posted was actually quite short and poorly written, so I won’t bother to post that particular link, but therein was cited a source with more comprehensive, and sadly more disturbing information.
Basically, as the URL states, a handful of so-called experts are claiming that the taking of selfies can cause, or are indicative of, a host of mental illnesses. If you’re behind the times, a “selfie” is a photo that a person takes of themselves or possibly two or more people (if they can fit more) by holding the camera away pointed at themselves, or by taking a photo of themselves in a mirror. This article is expounding on the dangers of taking selfies, and of online media in general, stating that selfies cause or are indicative of narcissism, low self-esteem, attention seeking behavior, self indulgence, actual addiction to taking selfies and in this extreme case they cite, a suicide attempt.
Now, I’m sure many of you have that one friend or acquaintance on a social media site who is constantly posting selfies and waiting for the compliments to roll in, so these declarations may not seem all that far from the mark, but first, let’s take a look at this article and get some facts straight.
The case that is cited in this article is about a man with Body Dysmorphic Disorder who is taking hundreds of selfies a day in the attempt to get the perfect one, which he is of course unable to do, because he has Body Dysmorphic Disorder! Whatever flaw he believes himself to have will always show up in his pictures, so he could take them for hours and hours and never take one that he found acceptable, which is exactly what he did. His parents, who are cited as “mental health professionals”, deemed his constant picture taking an addiction. Mental health professionals could mean anything. Are they case managers, counselors, aides at a hospital? Do they know how to diagnose and/or treat a mental illness? My guess is probably not on the latter if they believe his excessive selfie habit is an addiction. The term addiction is used rather loosely amongst laymen to mean any general activity or behavior done to excess, but let’s make one thing clear here. Something done to excess does not necessarily an addiction make. Addictions are all about reward responses. A person is rewarded, either biochemically, psychologically, or both, to continue to engage in a particular behavior. Yeah, over time they often come to hate their addiction because it pretty much takes over their whole lives and ruins their health, livelihood and relationships, but they didn’t start engaging in that particular behavior because they hated it, they did so because they enjoyed it and continued because they couldn’t stop. A person with Body Dysmorphic Disorder who has an issue with their physical appearance would not enjoy looking at pictures of themselves. It would be extremely disheartening, frustrating, and likely to cause, or deepen preexisting, depression. Each photo amplifying for them the terrible flaw they cannot hide no matter how hard they try. For this particular person, he wanted so badly to take just one image of himself that he could feel was acceptable, and the most comfortable way to do this would be to take the photos himself, (how are you going to enlist a friend or hire a photographer to take over 200 pictures of you a day, and of course only you can look over them because you wouldn’t want anyone to see the bad ones, right?, then tell that person that none of them were any good, let’s do it again tomorrow), but because of his preexisting mental illness, the Body Dysmorphic Disorder, there was really no way he’d ever take an acceptable photo. So with each new photo he becomes more frustrated, more depressed, more upset, until finally he becomes hopeless and attempts suicide. A very sad story, but not an addiction. Addiction to activities, such as video games or sex, or in a case of taking selfies, have a very specific pattern. That activity becomes the focal point of one’s life because that person wants to engage in that activity, even when they don’t want to, because on some level they gain some manner of satisfaction from it. A person doesn’t skip work because they stayed up all night playing video games, or neglect their child because they’re too immersed in their game world, because they hate playing them. They may hate the fact that they can’t stop playing them, that they’ve become such a destructive and disruptive force in their lives, but they keep playing them because they enjoy it and when they’re not playing them that’s all they think about doing. This poor guy didn’t take hundreds of selfies a day because he loved it, he didn’t attempt suicide over an addiction, he did this because he had a delusion regarding the image of his body that was not going to go away.
Now, moving on to some of the other points of the article. “Taking of selfies is indicative of narcissism, attention seeking behavior, self indulgence and low self-esteem.” I love how the article constantly lumps narcissism and low self-esteem together. Which is it? You can’t really be both at the same time. However, both narcissistic people and people with low self-esteem may be prone to attention seeking behavior for very different reasons, and what better way to gain attention than to snap a flattering photo of yourself and post it on your social network of choice, right? Well, what if one of these people happened to be out on the town with friends and handed a camera to one of them to take their picture with everyone so they could post it. Is that any different? What if they were on vacation? “Take a picture of me in front of the Eiffel Tower!” Narcissist. Attention seeker. What if they just got a new haircut and wanted to show their friends but there was no photographer handy? Or…what if there was? How are these two scenarios any different? To me this seems like a lot of scaremongering. People don’t know what to make of the changing landscape of technology and social media. It’s certainly a LOT easier to take and distribute images of oneself now than it ever has been, and people don’t know whether this is a good or bad thing, so they’re nervous about it. I can say that I have “selfies” of myself and a friend in Disneyland when I was 19 taken with a regular film camera. We eventually found someone to take our picture in front of the Disney castle, but prior to that we just put our heads together, held the camera at arm’s length in a very familiar pose that is seen often nowadays and took the picture. The only difference was that we had to go develop the film before we could see it.
So, let’s try looking at this from a different perspective. They seem to want to mention those with low self-esteem, and the attention seeking behavior, as a bad thing. But has anyone stopped to think that perhaps this method of self expression is healthy? Liberating, even? Imagine this person with very low self-esteem who has always hated to be photographed and never posted pictures of themselves online or sent pictures of themselves out with their Christmas cards or whatever the case may be. Now it’s the digital age. They can take as many photos of themselves as they desire in the privacy of their own home. Examine the photos at length, find angles that are flattering, see things about themselves that they never realized that were positive attributes, and eventually they manage to take a photo that they not only find acceptable, but can actually be proud of! They post it on their site, and all their friends tell them how good they look. What a major accomplishment! This person, who previously believed that their appearance was of little consequence, to say the least, suddenly is able to safely and comfortably choose a photo on their own terms and actually receive praise. It’d be a great boost to their self-esteem, and give them more confidence in themselves and their appearance.
As with many things in mental health, context is everything. I find it just appalling that people who call themselves mental health professionals would make such blanketed statements about an activity that’s mostly innocuous, at worst may fuel the flames of a narcissistic person’s ego and at best could be a very healthy and empowering activity. The particular case cited in this article is obviously not the norm, otherwise they would have cited multiple instances of “addiction” and suicide attempts linked to this activity. For all you psych types out there, remember your stats and research methods classes? We’d call cases such as these “outliers”. They do not fit the regular pattern or curve.
It’s taking pictures of yourself. That’s all. It’s not really indicative of anything concrete other than the indisputable fact that a person desired to have a photo taken and considered themselves to be their own best photographer. There’s no reason for anyone to believe this to be anything more than it actually is.

On Mental Health


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.