Out of Sight, Out of Mind

Did you know that as of 2005 countries such as China, Thailand, El Salvador, Turkey, and Vietnam had no laws protecting psychiatric patients? In total 25 percent of countries in the world don't offer any sort of legal protection  guaranteeing the humane treatment of people with psychiatric patients.

Eugene Richards did a photo essay of the conditions some individuals face around the world who have mental illnesses. The people that Eugene document truly represent some of the most disenfranchised, lost, and forgotten people in the world.

Why am I writing about this today? In part it's because I'm fascinated. I'm fascinated how madness/mental illness has been depicted. I'm fascinated how those depictions have both changed and not changed.

More importantly, today I'm writing about this because I think it's important to be reminded every now and again of those in our world that are hurt, lost, and forgotten. It's becoming increasingly easier to insulate ourselves from things we don't want to know about: the right has news programs that present the view from the right, the left has news shows that present the view from the left. Our friends list on social networking sites are generally populated by people who think like us. We readily agree and support those who think like us, argue in a polarized way with those who don't, and close our minds to that which is different.

Every now and again, like when I came across this photo essay, I see something that stretches me--something that  makes me think about things that I would rather not. In this era when so many say we can't afford to care for those who are most vulnerable, I think it's important to see what happens when we don't care for those who are most vulnerable. I think it's important for us to see what we don't want to see.

What don't you want to see? Can you find a way to look at it today?

A bird? A plane? A Transient Experience?

Everywhere I turn the happiness squad is hawking their wares, trying to get me to purchase the latest way to create or increase my happiness. Oprah frequently has guests on her show who offer quizzes, books, and steps toward ensuring we achieve a steady state of happiness. A quick spin through a book store offers more of the same: happiness is a state that I achieve, and once I get there, I am supposed to stay there. With his recent tweet talking about finding happiness (a thing), H.H. the Dalai Lama said, “If you want others to be happy [a state], practice compassion, if you want to be happy, practice compassion” I fear even H.H. has encountered trouble with this word that conveys a transient experience that is frequently misused to convey a state or a thing. I’ll give H.H. the Dalai Lama the benefit of doubt—perhaps it’s a translation issue–because while H.H. refers to happy as a state, he also, elsewhere, refers to it as a transient experience: “Awareness of impermanence and appreciation of our human potential will give us a sense of urgency that we must use every precious moment.”

Check out the full post, and others answering the question ""Why does the enterprise of psychotherapy matter?" on the new multi-contributor blog On Psychotherapy. Never fear--I will not be neglecting this blog!

How Far is Far Away?

NASAs Hubble telescope recently captured an image that really got me thinking. The object is rather unceremoniously called UDFj-39546284.

While this image isn't nearly as exciting as many of the others that the Hubble has offered up...I mean really. Look at it. In the larger scheme of things it is insignificant. In the larger image, I can't even see it. When we zoom in on the image it is just a little fuzzy blob. Not nearly as interesting, for example, as seeing a pale blue dot.

Or maybe it actually is a little more interesting.

This is the most distant object humankind has ever seen in the universe. The light traveled for 13.2 billion years to reach the sensors inside the Hubble Space Telescope. For comparison, in case you didn't know, we only think the universe is 13.7 billion years old. That makes you pretty old, UDFj!

So for formalities sake, it's nice to meet you, UDFj. It took you a long time to get here. I'm glad you did.

So why is this old light important to me? It humbles me. It reminds me that in the larger scheme of things, I'm smaller and even more insignificant than this little blob of old light we call UDFj. This isn't a sad thought for me. This isn't a thought that feels nihilistic. We all are prone to getting lost in our own perspectives and viewpoints. We all are prone, at times, to thinking we know what is true--what is right. From the inside, from our own vantage point, this is important. Our thoughts are valid thoughts. Yet at the same time, from the vantage point of UDFj, our viewpoint is totally insignificant. While our thoughts still are valid thoughts, they are totally lost within the context of the vastness of the universe.

There is a big universe out there. Look up, look down. Look far into the past (hello there, UDFj) or far out into the future. Move back and forth from our own narrow vantage point and into something that is larger than our comprehension allows.

What do you find? What do you see? Can we even begin to understand this large perspective--this larger gestalt?

My First Trip to the Asylum

Worcester State Hospital

One of my first jobs was a case manager for a social service agency. We worked specifically with people who were (1) homeless (2) had severe mental illnesses and (3) had never received any sort of public services before. Being the newest case manager, I was assigned to work with people who were committed to the local state hospital because they were judged to be not guilty by reason of insanity. By law, each and every person in the hospital, regardless of background or status, had a community case manager to advocate for them and help them prepare to be released from the hospital at some point in the future.

These were people that most of society had considered hopeless. All had committed some sort of violent crime. All suffered from hallucinations and delusions that medication were unable to help. Some had been in the hospital since the 1950s! Most had never used an ATM, used a phone that didn't have a rotary dial, and of course none had ever even known there was an internet. 

I went to the hospital every two weeks to visit a handful of people. Every time I went it was a strange experience. The building was something that looked right out of a Dickens novel. I'd pull into the parking lot, register in the office, and pick up a set of keys. At least, I would try to pick up a set of keys. Sometimes other case managers had all the keys so I was left to fend for myself. 

Taunton State Hospital

I'd go to the building were my clients lived. Work my way through security. When the elevator door opened to the secure floor I'd feel most of the humanity get sucked out of the room. A mass of people would be on the floor. Some would watch TV, others would stare aimlessly out the window. I never saw a single hospital person interacting with the patients. 

The staff would all be locked inside the office area. There were always a group of patients banging on the door trying to get someone's attention. They'd usually be responding to some sort of hallucination or delusion. It was sad--and I was sad. I was not yet even 23 and thought I could change the world. I learned quickly there was not much to do to help these people. My sadness grew--in part because there was not help--but mostly because I could not help the staff there. I couldn't ever seem to convince anyone to care about the people banging at the door or staring out the window. 

Greystone Park State Hospital

I also had a sub-clinical anxiety in the hospital. I worried that someday I'd be mistaken for a patient, be stripped of my humanity, and refused exit and told that I was hallucinating and wasn't actually a case manager.   Of course, this came true in a way. One day there were no keys available were the social worker's checked in. There weren't even any ID badges. I did my visiting and had a meeting with staff. I left the staff offices for the elevator to leave. Of course I couldn't leave because I didn't have a key to operate the elevator. There were no staff on the floor to be found. As you  might be guessing, I soon joined the couple of people banging on the door of the staff office. My sub-clinical anxiety now a real thing: locked inside, ignored, trying to get the attention of the staff. 

It took me 20 minutes to get someone's attention.

I leave you today with these images from 19th century insane asylums. They were big, graceful, beautiful places. The hospital I visited was similar to these images--I know what they looked like in the early 1990s. Ever wonder what they looked like in the late 1800s or early 1900s?

These images are all of Kirkbride designed hospitals. Dr. Kirkbride was a 19th century physician and asylum superintendent who wrote about hospital design. He had an enormous influence on the conceptualization and construction of insane asylums in the latter part of the 19th century. The design of the building itself was seen as an agent of change to help patients return to sanity. You can find out more here. The views change a little bit when you look inside and away from the places where the administration worked.

Buffalo State Hospital

Iowa State Hospital

Cherokee State Hospital

Athens State Hospital

Job Killing Health Care Bill: Claptrap Bill?

So with the recent vote in the House on the "Repealing the Job-Killing Health Care Law Act" has gotten the newswire and twitter all atwitter in our usual polarized mess. Many republicans are all fired up that they are going to single handedly save our economy with the passage of this bill. Democrats are all fired up saying that the republicans are placing senior citizens and middle-class Americans at risk with the repeal.


Being a close watcher of the health care reform, I've been trying to poke behind the headlines and polarization. Here is my question. Anyone reading feel free to answer. Just how exactly is the health care reform act killing jobs? I've heard that said, oh, I don't know, a million times. What I haven't seen is any credible information that supports that claim. Without it, I'm sorry to say that the "Repealing the Job-Killing Health Care Law Act" is nothing more than claptrap--empty language.


Thoughts? Anyone?

It Get's Better--With Skills

I'm at it again trying to engage people in a dialogue online. This never turns out very well for  me--maybe this time will be different? Anyway, this morning I clicked on a tweet that lead me to Towleroad. There was a brief blog post about an 18 year old young man named Lance Lundsten who recently killed himself. It got me thinking--and got me posting.

Dan Savage has started a project called It Gets Better. He writes "Many LGBT youth can't picture what their lives might be like as openly gay adults. They can't imagine a future for themselves. So let's show them what our lives are like, let's show them what the future may hold in store for them." This is a good thing, right?

As with most things, yes, sort of.

Things can get better--and often do. They don't get better on their own. Waiting around for middle school or high school to end--in and of itself--isn't going to make anything better. I worry that for many young people watching the video clips on Savage's website are getting the wrong message. I worry that young people are hearing that their lives today are hopeless.

I'm sure you remember being young. Teens aren't known for their ability to look into the future. Teens aren't known for their ability to wait. By design, the project is telling young people that they have to do the two things they are developmentally least equipped to do: wait and look to the future.

Looking forward is helpful: it helps teach youth about the possibility of the future. It also helps teach youth the whole notion that there is a future and that it's something one works toward. There is more, however, that we need to do.

We need to teach youth skills that they can use in the here-and-now. Emotional resiliency is a set of skills that can be taught. We need to teach youth about opportunities they have now for community--opportunities they have now to feel supported and loved. As hopeful as the It Get's Better videos are, they don't provide youth with these skills.

We need to show youth images that other youth create--images and lives that are filled with joy, excitement, and life. We need to let youth speak about their own experiences. For many, it's already better now. For many youth the adult vision of "better" is radically different than the youth vision of "better."

While it's important to mourn those who have killed themselves, we need to do more. We need to celebrate those who have not taken their own lives. We need to celebrate the creative vision, passion, and energy of countless young people that goes relatively unnoticed.

It's probably a good idea to actually ask youth what they want and need. As an aside, I read an article once about LGBT proms. It seems that mostly LGBT proms exist for adults who didn't go to their own proms. Most youth responding to surveys say they are going to their regular high school proms--and that they think that proms for adults who didn't get to go to their own proms are great for--you guessed it--adults.

The biggest burden for change--and making things better--isn't on the youth. The biggest burden is on adults. We need to speak up against bulling. We need to create an atmosphere in public spaces that it's not okay to be a bully--it's not okay to be hateful to someone else because their opinion or thoughts are different.

We need to create a world in which we can have meaningful dialogue about different--and connect and grow through those differences, not divide and segment.

No More Wire Mothers

from John Keatley

The clinical director of my post-doctoral training program made a comment that stuck with me. We were talking about Marsha Linehan and Dialectical Behavioral Therapy. Many see DBT as a panacea for all different sorts of problems. Evidence based therapy suggests that it would actually be unethical to use a different sort of treatment. Joe reminded us that 30 years ago, prior to DBT ever being thought of, psychologists were successfully treating Borderline Personality Disorder. Sure, we might look back on what we did 30 years ago with a little horror. 30 years from now we'll look back on some of the things we are doing now (maybe even DBT) and have that same sense of horror. How could we do that?

What were psychologists doing 50 years ago? They were building wire mother monkeys. I can't believe that's not the first thing you thought of. Harry Harlow spend years with rhesus monkeys doing various kinds of experiments. Most look back now in horror at his experiments. These are some of the experiments that brought on the development of our modern code of animal welfare laws in research.



50 years ago, this was amazing stuff. As Deborah Blum writes in her book Love at Goon Park, the psychological establishment in the 1950s believed that babies were drawn only to their mothers for milk and were motivated by a survival drive. The prevailing belief was that children were harmed by too much affection. The truths most take for granted now were far from the truth in Harlow's time. Infants need the love, attention, and physical contact from their parents.

What else did did the field offer up? Here are two more vintage clips. The first is Fritz Perls:




And of course, how could I not pay homage to B.F. Skinner and his pigeons:




These three people (some day I'll have to write about Fritz's wife, Lara, who always seems to be forgotten) were all revolutionary. From their own different perspectives, they encouraged psychologists and society at large to think about things in a new way. There ideas seem outdated now or even quaint. Much of what they have taught us has entered into our common knowledge and we couldn't even imagine a time where these things weren't known and thought about.

It seems like psychology hasn't really done much to capture the imagination of society. I'm hard pressed to think about contemporary psychology that has the potential to enter into the Zeitgeist of society and transform the way we think about ourselves.

Linehan, for example, is producing a marvelous technology that helps alleviate the suffering of many. There are countless other psychologists who are busy creating manuals and replicating studies that can help the most people with the most symptoms in the most efficient ways. This is all great. Really. I'm all for less suffering.

I'm left wanting for psychology to find new ways to inspire us to be more than we thought we can. Anyone have any suggestions of ideas from psychology that are entering into our shared Zeitgeist?

Person to Person Narratives

There has been significant talk in the media about immigration over the last year. The leading narrative in the news is that American's want to keep immigrants out. Undocumented persons from other countries are stealing jobs from hard working Americans is what I often read. The undercurrent is that these persons from other countries are out to alter the fabric of society.

Here is one viewpoint about the "dark side of illegal immigration."  It's taken from a press release from Rep. Steve King of the 5th district of Iowa. 

• The lives of 12 U.S. citizens would be saved who otherwise would die a violent death at the hands of murderous illegal aliens each day.
• Another 13 Americans would survive who are otherwise killed each day by uninsured drunk driving illegals.
• There would be no one to smuggle across our southern border the heroin, marijuana, cocaine, and methamphetamines, which plague the United States, reducing the U.S. supply of methamphetamines that day, by 80%.
• Our hospital emergency rooms would not be flooded with everything from gunshot wounds, to anchor babies, to imported diseases, to hangnails, giving American citizens the day off from standing in line behind illegals.
• Eight American children would not suffer the horror as victims of sex crimes.

Of course, King's comments are written without any supporting facts. If one digs a bit deeper to understand how he came to these statements you'd see a blatant manipulation of statistics. Let's say for example that 1% of Bassett Hounds viciously lick people on their faces. If I lock up 100% of all Bassett Hounds I will prevent 100% of vicious licking attacks by happy hounds.  This is essentially King's reasoning.

My point today isn't about statistics or  my distaste for people saying ridiculous things. 

My point is that we have forgotten to put a human face onto the issues that are polarizing our society. Both my friends on the right and my friends on the left run further in their respective directions in order to prove a point. Lost is the story of real human tragedy. We are forgetting about the people.

This past week I sat with an individual who is seeking asylum in the United States. They endured brutal torture   for publicly stating that they hoped two opposing groups could sit down at a table and work toward a peaceful solution. This person had to flee their country. They left behind a home they loved along with their child and spouse. 

This is one story of the very real tragedy that some people endured prior to entering into the United States. It's the very real human face of immigration (legal or illegal). It is the story that is lost in our polarized public discussions that are more about protecting a view point than about protecting human beings.

I'd like to write more here. I'd like to put a human face on this particular tragedy. I'd like to tell you about the deep sorrow of this individual and how, at the depth of this sorrow, I found an unquenchable sense of hope.

I of course cannot. I'm bound to protect this individuals privacy and confidentiality. I hope you each find ways to make a person-to-person encounter when you think about immigration. In fact, I hope you all find ways to make a person-to-person encounter when you are thinking about any issue that is polarizing. Thinking about an issue in context--in relation to another--is transformational. You'll change--and everyone around you will change too.

Stopping by the Woods on a Snowy Evening

Stopping by the woods on a Snowy Evening

Whose woods these are I think I know.
His house is in the village though;
He will not see me stopping here
To watch his woods fill up with snow.

My little horse must think it queer
To stop without a farmhouse near
Between the woods and frozen lake
The darkest evening of the year.

He gives his harness bells a shake
To ask if there is some mistake.
The only other sound’s the sweep
Of easy wind and downy flake.

The woods are lovely, dark and deep.
But I have promises to keep,
And miles to go before I sleep,
And miles to go before I sleep.

Robert Frost (1923)

Leaving the Bubble: A Brief Observation from the Road

I packed up the car over the Christmas holiday and did my annual migration back to northeast Ohio. The route was familiar. I-90 west, for endless miles, through Massachusetts, New York, Pennsylvania, and finally Ohio. I've driven the road so many times I hardly have to look. I know just where to stop for the cleanest gas stations and the best road food. I know just where to look from the highway for the holiday lights that are displayed in a public park right outside Syracuse New York. I know just when to slow down close to the Montezuma National Wildlife Refuge outside of Seneca Falls New York. I always hope to spot an animal and never have. Even the detours are not new--I took "new" way to get home that I've taken many times when I couldn't stand the New York Thruway anymore. This trip was a little difference because now I'm armed with a smart phone. I spent the majority of the trip learning interesting facts from Wikipedia. Take for example this helpful trivia filled entry about the Southern Tier Expressway.

Along the road this year--and deep within the city of Cleveland--things seems a lot different this year. It was a good trip for me because it helped me burst the increasingly sheltered bubble I've been living in in New England. There is a recession out there. Did you know that? I read newspaper articles about there being hard economic times but looking around the places I frequent in New England it would be hard to tell. Houses are being sold, store parking lots are filled, and store fronts are filled with enticing displays.

On the road to Cleveland, I saw a whole lot of grey. Stores were empty. Places that I once saw filled with people on the 19 years I've spent driving back and forth across New York State are empty an abandoned. In my own home town, a city that was vibrant and filled with life, has constricted down to a small alley of chain restaurants and bars. Business Corridors that were once filled with the promise of continued vibrancy are mostly abandoned and desolate.

I found myself a bit short on hope. I'm usually not the person with a short supply of hope. This was different after being confronted with so many scenes of empty desperation, signs of aging and collapse, and the general contrast from the vibrant memories I have from 20 years ago and the rude bursting of my bubble (both in memory, and my New England bubble). This may explain why the only images I captured from my trip was at the Lakeview Cemetery.

So what's my point here? I'm back in my New England and I'm again filled with my usual hope and optimism. Am I delusional? I don't think so. I found a few important things. First off, it's so important to get out of that which we find familiar and seek out a new vantage point to view the world. It makes us more whole to look at the world from many different viewpoints. To this end I've left my familiar echo chamber of NPR and am spending more time reading other sources of news and commentary (news papers from other cities and countries and *gasp* conservative papers).

It's interesting what I see from these other perches. When I separate the rhetoric and look closely, I'm seeing examples of people building new and creative things out of the ashes of what has been destroyed. My old neighborhood of Ohio City offers one small example. It's a neighborhood that has been decimated by foreclosures. Abandoned houses have been knocked down an in their place urban farms have sprouted--farms that sell to the local West Side Market, restaurants, and grocery stores.

What do you see when you look at things in a new way?