Saturday, September 28, 2013

Dear Young Therapist: Sometimes We Can't Put Humpty Back Together Again

Meeting Humpty Dumpty/Joanna Pasek
Humpty Dumpty sat on a wall,
Humpty Dumpty had a great fall;
All the king's horses and all the king's men
Couldn't put Humpty together again.

We don't like to admit that things that are broken cannot always be repaired. We develop empirically supported interventions that demonstrate our facility for erasing symptoms of mental illness and curing the ills of the psyche. Chemists and biologists develop powerful substances that right the wrongs of the miniature chemical metaphors for mental illness inside the synaptic cleft.

We wrap ourselves in god-like metaphors of power, control, and authority. We heal the wounded. We restore the broken to a state of wellness. We right that which was wronged. 

We try to place all of the evils, pains, and terrors of our world back into Pandora's box with the hope of this cure called psychotherapy. Our way out of mental illness, a hope for a different future, has become interwoven with these notions of restoration and repair. Returning things to the way they were.

I've grown convinced this is not always possible. Even if it was, I'm not sure it is advisable. 

...and for those we can't repair? We call them treatment resistant. We tell them they don't want to get well. We tell them they are not ready to get well. We find any number of ways to subtly make them responsible for being broken, for not allowing us to repair them, or for having experienced a trauma from which there is no repair.

I don't think that's advisable at all. 

On any given day any number of survivor stories pass by my eyes on the internet about those who have experienced sexual abuse. As our seemingly endless "war on terrorism" slogs on, I see an increasing number of wounded soldiers displayed for pubic consumption. Stories like these make me angry and sad, hopeless and hopeful. Thousands of tales of lives broken by sexual and physical trauma. Thousands of tales of lives restored through the power of hope, courage, caring, and empowerment. 

As someone recently mentioned to me, some do come out of a traumatic experience stronger. Some find a certain kind of beauty in the growth that occurs after a trauma. Some isn't all. In fact, some is a far way away from all. 

Every 65 minutes a veteran of the US Military commits suicide.

Adults who have experiences sexual abuse are twice as likely to have a suicide attempt. 

What happens when that which was broken cannot be restored? Who speaks for those who are broken and either cannot or will not be repaired?

A huge industry of self-help groups have grown up around the books A Courage to Heal and Victims No Longer. While both books, in many ways, put childhood sexual abuse on the map, they both also perpetuate a disturbing trend toward a wish to repair that which remains unrepairable. An industry has grown up around us depicting survivors of sexual and physical traumas as strong, proud, and invincible warriors. I wince every time I see this meme replicated. I realize saying this may make me somewhat unpopular in some circles of the sexual abuse healing industrial complex.

I think we've lost our way, young therapist. In following our culturally prescribed roles to be powerful healers we've forgotten that not everything we touch can be restored. Sometimes, no matter how hard we try, we cannot put Humpty Dumpty back together again.

I'm not even sure it is important that we even try.

It is not that I am against strong, proud, and invincible warriors. I think those who find their journey takes them to these places are mighty fine. They've found their voices and found ways to make their lives a life worth living. 

What about the ones who find that no measure of gold or silver can hold the pieces together again in a fashion more beautiful than that which existed before? What of those who tried kintsukuroi and found they have nothing but a pile of pretty broken pieces?  What of those who, like Humpty Dumpty, have fallen and learned that all the kings horses and all the kings men cannot put them back together again?

Who speaks for them?

“If people bring so much courage to this world the world has to kill them to break them, so of course it kills them. The world breaks every one and afterward many are strong at the broken places. But those that will not break it kills. It kills the very good and the very gentle and the very brave impartially. If you are none of these you can be sure it will kill you too but there will be no special hurry.” -- Ernest Hemingway

Somewhere along the way, young therapist, we've forgotten that our most powerful tools are not those which fix broken things. Our most powerful skill is our presence and our attention. 

Don't get lost in the illusion that therapy is about fixing the broken parts of people. It's nice when we can fix things. Don't get me wrong. It's just that fixing isn't our most important task. Somewhere in our training and acculturation as a therapist we learn to stop listening and get lost in our own theories of how to fix things. We move from being having a role of a midwife of dialogue to the role of a high-tech mechanic. 

The map is not the territory. -- Alfred Korzybski

The description is not the described. -- Jiddu Krishnamurti

The map is not the thing mapped -- Eric Temple Bell

Sometimes we therapists have a very helpful map to offer. Other times our maps are a hinderance and obscure the road ahead for our patients. In the end, the best maps are those which our patients create. The ones we have to offer are just temporary aids. 

Therapy is about helping people see the broken parts of themselves. Therapy is about being witness to that which was broken. Therapy is about co-creating a space where our clients have a place to feel fully broken, to feel helplessness and despair, and for clients to discover in their own ways the contours of the territory ahead. 

Don't forget to listen, young therapist. Create the space for people to be broken. Allow your patients the dignity of the agency to decide what lay ahead. 

Help them find their own maps and their own territories. 

Do not accept any of my words on faith,
Believing them just because I said them.
Be like an analyst buying gold, who cuts, burns, 
And critically examines his product for authenticity.
Only accept what passes the test 
By proving useful and beneficial in your life.
--The Buddha 

I can describe the mountain, but the description is not the mountain, and if you are caught up in the description, as most people are, then you will never see the mountain.
-- Jiddu Krishnamurti

Sunday, September 22, 2013

These men are not gay | This is not a farmer | Disfarmer

Perhaps an example of the original hipsters? I almost queued this up on Tumblr with a witty descriptor without a second thought. I probed a little deeper into the history of this image and am glad I did. It turns out to be a jewel of a photo that takes us on an exploration of the deep south.

The sixth of seven children born to a large German immigrant family in rural Arkansas, Mike Meyers (1884-1959) separated from his background and renamed himself Disfarmer. It is said that "he even claimed at one point in his life that a tornado had lifted him up from places unknown and deposited him into the Meyers family."

I may consider changing my name to Dispsychologist. If I do Maggie will be known as Disdog. This however is a topic for another dispost.

A self taught photographer, Disfarmer set up shop on the back porch of his house in Heber Springs Arkansas. Several years later the house was destroyed in a storm and Disfarmer set up shop in downtown Heber Springs where he worked for the rest of his life.

An opera was written about an imagined vignette of Disfarmer's life.

"Disfarmer's reclusive personality and his believe in his own unique superiority as a photographer and as a human being made him somewhat of an oddity to others. Having your picture taken at Disfarmer's studio became one of the main attractions of a trip into town." (read more here)

Saturday, September 21, 2013

From VD to Miley: A Generation of Women as Dirty Objects

Talking about how women are represented in media seems to be a popular pastime on the interwebs. I'm not at all convinced that this chatter has in any way been a significant and effective intervention to change the ways in which we perceive, talk about, and represent women's bodies.

I'm including some of the more colorful World War II era venereal disease posters that sought to reduce sexually transmitted illnesses through the depiction of women as dirty vectors of disease and depravity. Compare that with commentary at the FCC about Miley Cyrus' performance on the Video Music Awards. Despite your feelings about the value and quality of her particular performance, note these observations about women, their value, and our cultural expectations.

Have things changed from these vintage VD posters?

Have any of us changed?

  • "Had I wanted my family to see a hooker perform a live sex show, I would have taken her to Tijuana. The opening...was disturbing enough, but once the little whore started simulated masturbation and intercourse..." (read more)
  • "My daughter was even surprised of Slutty Cyrus, shame on MTV for allowing that kind of TRASH along with the tasteless condom commercial after every break." (read more)
  • "She was dress (sic) like a whore." (read more)
  • "She has shown that she is acting like a devil flicking that tongue as deamons (sic) do." (read more)

And some more vintage images depicting our collective thoughts about women.

Friday, September 20, 2013

Dear Young Therapist: Sometimes Race and Sex Matter

In a recent post on Psychology Today, psychologist/blogger Todd Kashdan wrote a post entitled "Sometimes Race and Sex Don't Matter: An Attempt to Stop the Madness with Political Correctness Run Amok." He starts with a story about his six year old twin girls:

Its beautiful to observe how at 6-years of age, my twin girls do not describe friends, teachers, neighbors, or strangers by race. This is rather typical: 
"Dad, you know who I'm talking about, the guy with the nose that kind of bends around, with the puffy cheeks. Why are you looking at me like that, you know him, I've seen you talk to him." 
"Why does that guy with the round head and bunched up legs walk his dog in the rain?" 
"My best friend at school right now is Tamina. She wears glasses, her hair is long and crunchy, and she talks really fast." 
These interactions require my full mental capacity because unfortunately, I have no idea who the hell they are talking about. In my career as a psychologist, race becomes a paramount descriptor. And while there are many reasons to do this, I want to suggest that this has gotten out of control, causing more harm than good
The blogger appears to be promulgating a color-blind perspective that involves seeing a person as a whole rather than a person with a complexion of a particular skin tone. In the above quote, the blogger/psychologist  describes his children as not seeing people by their race because they make observations about stereotypical phenotype differences in people they encounter (texture of hair, shape of nose, etc.) rather than making a specific mention of their complexion.

Hidden within his proud fatherly talk about his children, Kashdan obscures a significant body of literature within the field of psychology about the color-blind approach to race and human differences. Here are a few highlights of the thousands of peer reviewed articles written about problems of being color-blind:

Monday, September 16, 2013

Mondays with Alan: No Beginnings

Everyone Should Have Their Own Music

In this era we delegate music and dancing to professionals and it's a same. We should all be doing our own singing and our own dancing. You don't have to be famous. You don't have to perform on the stage. We have music to process our feelings and to help us work our lives out. Hep us with something that's a hard task to do. Everyone should have their own music.  
If nothing else get in the choir. I preach choirs. I think they're so important. 
--Linda Ronstadt on Good Morning America, September 16, 2013

My answer to Ian Argent's post.  

Saturday, September 14, 2013

Never do this young therapist. Never.

Yesterday I wrote about an adoption agency that posted photos and protected health information about children who were in a disrupted adoption (their adoptive parents were going to sign them away to another parent because things didn't work out). Through the efforts of many individuals, Wasatch International Adoptions was pressured to take the information down.

I found the blog of the Wasatch International Adoptions.
We use the internet to post a story about the child, using a false name, but using real photos. Our Second Chance Facebook site has over 10,000 members, and when we post a child, there are 10’s of 1000’s of cross posts. Our administrative page shows that we often have 100,000 or more people view the post! It has been as high as 300,000 views of a child.

I'm just floored that a licensed social worker would appear to have such little understanding and knowledge of the ethical codes and laws which govern their practice. Maybe I'm being generous in my assessment. Perhaps these licensed social workers are wantonly ignoring the expectations of privacy that the ethical codes of Social Workers demand.

Licensed therapists don't show real photos and real stories about their clients. There is no excuse for this. There is no reason for this to happen. Ever. There is absolutely no reason to display a client's picture and personal story to 10,000 facebook members, who cross post that information 10s of 1000s of times, making a child and their personal experiences displayed to 300,000 strangers.

How would you feel if your therapist told everyone in the city of Anchorage Alaska (population 298,610) or Pittsburgh Pennsylvania (population 305,704) about what you talked about in therapy last week? What would it feel like if the population of Valladolid Spain (312,434) knew that your mother sexually abused you? Would you be comfortable if I told the everyone in Suncheon South Korea (population 304,528) that you had problems with inappropriate masturbation?

This is just the kind of information that this adoption agency displayed on the internet--intentionally displayed on the internet--and acted as if it was ethical, legal, and the right thing. The agency felt that because they had a release of information from the parents of the children (parents who want to abandon their adoptive children), they had discharged their ethical duty to protect their patients privacy, dignity, and confidentiality.

Never do this young therapist. Never. 

Friday, September 13, 2013

Children For Sale: Get 'Em While They're Hot

Through Yahoo and Facebook groups, parents and others advertise their unwanted children and then pass them to strangers with little or no government scrutiny, sometimes illegally, a Reuters investigation has found. It is a largely lawless marketplace. Often, the children are treated as chattel, and the needs of parents are put ahead of the welfare of the orphans they brought to America. The practice is called "private re-homing," a term typically used by owners seeking new homes for their pets. [read more here]
Imagine that. Adopting a child and for whatever reason--lack of skill, planning, or resources--choosing to give that child up. What a horrible decision to have to make. I'd like to think parents agonize, soul search, and try their hardest to make it work. I'd like to think that parents marshall their resources, get help, and keep to their commitment to raise, love, and nurture their adopted child.

Based on the Reuters article, it appears this is not always what happens.

Yesterday I was made aware of one particular organization that helps "rehome" adopted children. This organization, Wasatch International Adoptions, has a program called Second Chance Adoptions. They have a Facebook page where they have pictures and information about children who are being shopped for new parents.

I was aghast at their Facebook page. The descriptions of the children, attached to their pictures, includes what appears to be protected health information about psychiatric treatment, developmental disabilities, experiences of sexual and physical abuse, and physical conditions. (n.b. since the time this blog post was initially posted, the adoption agency removed their Facebook page and later put it back up with edited information that disclosed significantly less personal information).

In exchange for $950 a year the organization offers, among other things, to "post a picture and a profile of your child on Rainbow Kids, other disruption blogs and websites, and also on our own website."

"In order for WIA to post your child’s picture you must provide a detailed profile with information about your child and also sign a release of confidentiality allowing WIA to share this information with any family who contacts us about your child." 
I understand that a prospective adoptive family would need to have access to all of a child's protected health information. I don't dispute that. I do dispute whether information like this should be made available to anyone who looks at a Facebook page.

What right do I have to know that there is a seven year old girl who has experienced sexual trauma and beats up her baby dolls? Should I know about the six year old boy who sometimes acts out in sexualized ways? How about a 15 year old girl? Should I be reading about her residential treatment, developmental disabilities, and her diagnosis of reactive attachment disorder?

Is this disclosure of information ethical? I thought it might be helpful to sort through this ethical dilemma in a public forum. 

I'm not a social worker. I'm a licensed psychologist and health service provider in the Commonwealth of Massachusetts. I'm obligated to think this through by the ethical codes, guidelines, and laws that I am responsible for following. Laws and ethics for social workers in general, and social workers in Utah specifically, might be different.

Sunday, September 1, 2013

One the Eve of War: The Measure of a (Wo)man

The ultimate test of a man is not where he stands in moments of comfort and movements of convenience, but where he stands in moments of challenge and moments of controversy 
--Martin Luther King, Jr., January 27, 1965
Returning hate for hate multiplies hate, adding deeper darkness to a night already devoid of stars. Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that. Hate multiplies hate, violence multiplies violence, and toughness multiplies toughness in a descending spiral of destruction. 
--Martin Luther King. Jr., "Loving Your Enemies," in Strength to Love