A Few Notes on Love

As follow up to my Marsha Marsha Marsha post, I wanted to make specific reference to Irene Stiver talking about love. The following is an excerpt from the chapter by Judy Jordan entitled "What About Love" in Kottler and Carlson's book "Creative Breakthroughs in Therapy: Tales of Transformation."

Jordan's mentor, Irene Stiver, one of the founders of relational-cultural therapy, was dying of lung cancer and knew she had a very short time to live. Stiver was concerned about so abruptly ending her therapy with a number of clients under her care and so asked for Jordan's help to construct a farewell letter. 

Jordan was overwhelmed with the honor, and yet the incredible responsibility, of such a task. Stiver had given her very vague directions about what to do, so Judy carefully and respectfully wrote down what she thought her mentor might wish to say to people she had been helping. She made certain to mention elements of caring, respect, and regret in the message before showing Stiver the draft of what she had created. 

When Stiver reviewed the note, she just shook her head and handed the paper back. "Judy, you've missed the whole point. 

"I have?" Jordan answered with disappointment, feeling that she had let down her cherished friend. 

"Yes, indeed," Stiver said. "What about love?" 

"Love?" 

"You know, Judy, love is what it's all about." 

Jordan was stunned. This was her former supervisor, her mentor, her colleague of 30 years, and yet in all their time together Jordan had been so careful about the use of the word love in her work. She had been taught that speaking about love was not appropriate in a professional context since it is open to so much misunderstand. Jordan could only sit there, frozen in wonderment. Here was one of her oldest and dearest friends, one of the most influential people in her life, on her deathbed, telling her something that was utterly ground-breaking: She was talking about love as the essence of therapy. 

Stiver asked Jordan to write down what she was about to say. "This is what I want to say to my clients."

For more on love, read Dear Young Therapist: Don't Be Afraid to Love.

Marsha, Marsha, Marsha

I spent a portion of the last six months of my internship traveling around the country interviewing for a job. I came close a few times. One was particularly exciting: a community college in Oregon was hiring an assistant director of their counseling center. As I was for every other job I got an interview for, I was named the runner up. Runner up wasn't going to get me employed.

So my internship was coming to a close and I was become a little concerned. I call a friend, who calls a friend, who calls me back. They told me about this clinic in Cambridge that has a post-doctoral training program. I made a few phone calls and before I know it, I'm on Harvard Square for an interview. 

The whole interview experience was a hoot. It was a hot humid day, I was recovering from a minor surgery, and the person I interviewed was interested in giving me a hard-hitting stress interview. It took me nearly a year to forgive the psychologist who interviewed me. In the end, he became one of my favorite mentors. I'll have to leave this story for a future blog post.

In the end I was offered a part-time postdoctoral fellowship that paid just over the poverty level. I made a few other phone calls and arranged for another part time job at a local counseling center. I was busy--and barely made enough money to pay my bills--but I had the pieces I needed to get my post-degree hours in so I could sit for my license.

Apparently I interviewed for a fellowship that involved working with adolescents who were highly suicidal and engaged in self-injurious behavior. Who knew? I remember hearing something about Dialectic Behavioral Therapy (DBT) in my doctoral program. That was my main role in my fellowship: working with adolescents in an intensive day treatment program as well as in an outpatient clinic doing DBT.

Marsha Linehan and her followers can sometime take on the aura of a cult. Sometimes it feels that those "on the inside" think that DBT is the only treatment--the only way--to work with people. They have done some fantastic research. That's for sure. They've done some fantastic research in highly controlled settings with highly controlled patient populations. In real-world practice, DBT provides a useful tool to use in combination with other useful tools. Empirically supported treatments work a bit differently when they are taken out of the lab.

Below is a great clip of Dr. Linehan explaining DBT. She said something early in the clip--something important and worth highlighting (and is the point of this blog post). At 1:04 Linehan says "I love her so much." What? A psychologist loving a patient? That's not supposed to happen, right?

To date I have four examples of psychologists who I have heard talk about loving patients: Marsha Linehan, Irene Stiver, Robin Cook-Nobles (a former training supervisor and mentor), and Judy Jordan (another mentor who deeply influenced my training).  Check out the companion blog entry to this one called "A Few Notes on Love."

I think talking about love is an important dialogue for psychotherapists--and it's something that I'd like to hear Linehan talk more about. As a fellow, and then later as a psychologist in private practice, I've heard scores of psychologists, social workers, psychiatrists, and counselors talk with contempt about their patients. I watch in horror as these folks lose their ability to see the humanity in those that they work with and reduce their patients down to a list of bothersome symptoms.

One of the gifts of what Linehan offers in DBT is acceptance--acceptance of patients--acceptance of feelings--and acceptance that people are doing the best they can. Many get blinded by the tools, language, structure, and research of DBT. They loose the basic humanity--the acceptance and love--of the the patient.

Here is Linehan's entire talk. It's worth watching--especially the parts where you catch her humanity, acceptance, and love.

A message from Earth

"You matter."

"I do?"

"To me you do."

On Pottery, Perfection, Perseverance, and Tiger Mothers

The red earth is cold and wet when I open the bag. The smell--that's a different story. It's always what I notice first. As soon as I open up the rubber band that holds the plastic bag shut my nose is filled with the earthy smell of the wet forest floor.

There really is not another feeling in the world like clay warming up under my palms as I press it against a wedging table. The clay transforms into a warm supple material on the wedging table. This is a place of such potential. It also is a place where many battles have begun. Some days at the wedging table I stand before the clay and become demanding. I work the clay and want it to become a mug, platter, or perhaps a teapot. 

This is never good. When I forget my way at the wedging table and start demanding a form appear out of the clay I can always anticipate a disaster (yet strangely, I do this with amazing frequency). Without fail, this pound or two or five of clay that I demand into a particular shape will return back to the wedging table. Rather than becoming what I ask of it, this blobs of earth have been known to fly off the wheel, explode in the kiln, or break in two while I'm glazing after a bisque fire. 

When I go into battle with the clay, trying to form it into something that it is not, it simply will not yield to my fingers and imagination.

There is something else that can happen at the wedging table. I can listen to the earth. I can let the clay listen to me. A certain kind of magic can happen when we both listen to each other. The earth can yield to my imagination when I can yield to the conditions of the blob of dirt and water that is in my hands. The ambient temperature, humidity, and day-to-day changes of the  viscosity of the earth all influence what form it might take. Even the wedging table has its own influence--an eager student potter washing the dry surface with a gallon of water will influence what my little slab of cold red earth can become.

A few days ago was one of those times when the dance worked well. I did have a vision of what I wanted, and they clay wanted to become something similar. The two of us had a shared vision. We worked together and made something more than either could have made on it's own (admittedly, clay has a hard time being something other than clay without human intervention). The studio was warm and the clay rapidly became smooth and supple in my hands. It flattened right out on the wedging table--almost like it was encouraging me to create what my vision was. The clay yielded to the slab roller and flattened out into a supple disk. It easily accepted the imprint from a textured wooden roller and a piece of coral. The now textured and yet still supple round disk of earth were easily peeled off  the surface it rested on and draped right over the surface of the balloon I inflated to serve as a mold for  my clay.

When I listen to the clay, it will listen to me. Together we can create something unique. 

Now draped over the balloons there was one final step before I left the clay to try. Around the edge of the three disks of now inverted clay, I wanted to pierce a series of holes. Armed with a very small ruler and a bamboo carving tool, I measured and pierced my way around the the smallest of the three disks of clay. When I  moved to the second disk of clay a minor disaster struck. As I  moved around the inverted disk piercing the disk the clay body had trouble maintaining it's structural integrity. This is a fancy way to say that the clay started to tear.

Rats. My perfectly round disk, formed into a irregular yet symmetrical vessel, was damaged. Several tears opened up creating jagged edges. I considered for a moment rolling it up into a ball and heading over the the wedging table. Clay is forgiving like that--you can always start over (until the final firing, where clay is permanently altered to stone). I looked a little closer at the material in my hand. I liked how the inside of the holes I pierced were jagged--like a bullet had torn through the clay leaving a jagged wound. I liked the irregular edges of the tear--another reminder of the inevitableness of damage and decay. I  kept the clay as is. Rather than demanding it be something it wasn't, I listed to what it was becoming. I also learned from my mistake and pierced the holes on the final--and largest--piece prior to inverting it over the balloon.

Mistakes and imperfections aren't failures--they are opportunities to discover something new.

The earth, transformed into a supple warm clay, worked in a process of mutual discovery, now sits on a shelf drying. When it is leather hard I will take it off the balloon. Hopefully at some point before it becomes leather hard I will be able to coax the bottom to flatten a bit without the rim of the vessel collapsing (or breaking). It will sit on the shelf again until it's bone dry. Then the three vessels will go into the kiln and be bisque fired. It will be heated until it is about 1835 degrees Fahrenheit. The resulting heat will remove every last bit of water that is chemically bonded in the clay body. 

I'll dip the clay in a glaze, let it dry. It will again enter the kiln and be heated to 2165 degrees Fahrenheit. The clay will melt and become viscous and the glaze will also melt and oxidize. Parts of the clay will be transformed into silica. When the kiln cycles down and cools off, the resulting object will no longer be wet dirt: it will have been transformed to stone (take that, Medusa!). 

My vessels might crack and disintegrate on the drying rack. They might explode in the bisque firing. I might break them when glazing, or the glaze might malfunction in the final firing, drip onto the kiln shelf. This is particularly distressing because if it happens, my vessel will become fused to the surface it rested on while being fired and thus be destroyed. 

If these three vessels make it this far, there will be more work. I'm planning on applying some metal leaf along the edge and perhaps some bead work across the opening. That is the plan, at least, unless the process moves me in another direction.

Art isn't a battle, it's a dance of mutuality and dialogue between artist and their medium.

One last thought. Have you heard about tiger mothers? Law professor and memoir writing Amy Chua has been making the rounds in the media about her story of raising her children. In a Wall Street Journal essay she writes that here children were never allowed to: attend a sleepover, have a play-date, be in a school play, complain about not being in a school play, watch TV or play computer games, choose their own extracurricular activities, get any grade less than an A, not be the No. 1 student in every subject except gym and drama, play any instrument other than the piano or violin, not play the piano or violin.

I thought about Chua a bit while I was working the clay. Chua made her daughter do 2,000 math problems a night when she was number two in a math competition. She had to do 2,000 math problems every night until she became number one again. What might the results be if I had a Tiger mother hovering over me demanding I made an additional 2,000 clay vessels until I perfected them? I'd probably be able to form a perfect bowl. that's for sure. The excitement and life would be taken out of my pottery. That's for sure, too. 

It's important to master technique. I learned that in high school when a band director stopped the music, pointed to me, and told me the wrong note I just played was like poking my finger through the Mona Lisa's eyes. He had me play the passage a few times until I got I got it right and we moved on. 

There was more than having perfect fidelity to the score. I learned that from my piano professor. When I had trouble playing something he'd take the music way, close the cover on the piano, and put his CD player on. He would ask me to close my eyes and pretend to play the song. He'd open up the keyboard and ask me to pretend to play the song again--regardless of what the right or wrong notes were. 

"Feel the music," he'd say. "Don't worry about getting it right." I was usually too embarrassed to listen to him. I was too busy trying to get it right and be perfect. One those rare occasions that I actually did listen to him, I did get it right. I felt the music and then figured out how to coax the music out of the piano.

By freeing myself up and playing, I would be able to both offer fidelity to the score while being true to my heart. 

It is this same balance that I find when working with earth. Of course I need to practice and develop  my technique. I also need to spend an equal amount of time listening to my heart. This whole Tiger Mother controversy is silly: it misses the magic that happens when skill and imagination unite. 

It is in the space between perfection of talent and expression of the heart that something is formed that cannot be created by either alone.

On the Way to Work

Sometimes just walking into work is an adventure. Take today for example. Who knew that a yellow flyer, a bus, a woman waving from me out her car window, and a tweet would leave me with the impression that in general, the world isn't such a bad place?

Yellow Flyer:

The last couple of weeks I've noticed signs along the walk the parking garage to my office for a missing dog. The yellow flyers greet me on nearly every street pole: lost miniature schnauzer, answers to the name Marcel Marceau. Call this particular number--no questions asked. For a variety of reasons I was moved to call the number today. It wasn't as if I had any information that would help them: Maggie and I have spied no stray dogs (or mimes) wandering around Cambridge.  Maggie alerts me to every dog as she would like to play with them. I’m alerted by every mime because, well, mimes are generally alarming.

Still, I phoned the number. I didn’t really have a plan of what I was going to say or even why I wanted to say it. “Hi,” I said. “I saw your flyers for the last couple of weeks.” I paused a bit thinking this might be mean, maybe I got their hopes up. “I don’t have any good news for you.” There. I wasn’t being mean and offering hope as I had none. “I just wanted you to know that I hope you find your dog. That must be terrible.”

I hung up. 

Who does that?

Bus:

Moments after I hung up, Maggie and I nearly got run over by a bus. The intersection at Franklin and Western Avenue is particularly horrendous. There is a cross walk, and pedestrians have the right away, but few, if any, pay attention. It always feels like I’m stuck in the game Frogger when I cross the road. I almost lost today. Already into the crosswalk, an MBTA bus kept going. It almost ran me and Maggie the therapy dog over.

Woman in the Car:

Having already forgotten about the bus a woman stopped me at the next side street. She rolled down her window and started talking. She asked “Are you going to report that bus?” Rustling around her purse she stretches her arm out of the car with a card in her fingers. “Here,” she said. “If you need a witness call me. That bus almost hit you and your dog. It wasn’t right.”

Who does that?

The Tweet:

When I got to the office I decided that I’d tweet the MBTA. Within moments I got a response from the general manager. MBTA GM responded: “Did you catch the bus number? Would like to look into this and sorry about what happened.” A stranger tweets “Buses are brutal, more so than Taxis =/ at least you and your dog didn’t actually get hit.” A friend in another state tweets “Sorry about ur scare. Saw they responded, nice. Couldn’t help but think of that old joke “anyone get the number of that truck?”

Emboldened by the response to the tweet, I sent one more to the Cambridge Police. Within a few moments the police tweet back “Thx for the tweet. We patrol when we can & cite people if they disobey traffic laws. Glad u & Maggie weren’t hurt!” The police tweeter continued by tweeting “Thx for the info. Ur thoughts were passed on & hopefully we’ll be able to deploy some resources to make that intersection safer.” A little later I get another tweet from the police "We've sent out directive 2 our patrol/traffic officers requesting more enforcement @ that crosswalk. Let us know if u c improvement."

Who does that?

The Moral:

When the bus almost ran us over I was thinking that no good deed goes unpunished. That’ll teach me to call strangers. Right? I could have easily spent the rest of the day complaining about how awful that bus was, how people have become so self-centered and lost in their own worlds, how people have developed a me first attitude and don’t care about the perspective of the other.

I thought all those things this morning. However, as my morning progressed my bitterness softened. Rather than complain in the echo chamber of my own head I looked outward. I engaged in a bit of agency and complained--but did so in an effective way. People listened. Who knew?

Now mind you I still think I’m going to fear for my life and the life of Maggie each time I cross that intersection. I doubt things will actually change in a measurable way. I did get reminded of something important: If I want my world to be different, I have to do something. I have to speak up. I have to be responsible for living a life that mirrors what I want.

You do, too.

Snake Pit: Madness in the Movies

Poor Mrs. Cunningham. The doctor tells her "Don't be afraid, we just want to talk to you." Would you really want to talk to Dr. Kik? I'm not sure I would.

In the 1948 movie "Snake Pit" Olivia de Havilland plays the role of Virginia Stewart Cunningham. Mrs. Cunningham has gone mad and is hospitalized at Juniper Hill State Hospital. What do we learn about madness from this movie? What does the "Snake Pit" show us about madness in 1948? One interesting way to interact with a movie or text is to watch it while asking a single question framed as such: "Mad people are people who ..." 

This basic structure can be used to look at  lots of different questions. For example, what does a particular advertisement for a car company tell you about people who drive that car? In a recent car commercial I watched there were a few key images: children in the back seat, parents singing to classic 80s music, children being embarrassed, children in the backseat watching a DVD quietly, and children in another car not being able to watch TV.

Plug this into the basic structure: People who drive this car have children; people who drive this car sing 80s music; people who drive this car are embarrassing to their children; people who drive this car are better than people who don't; etc. What are you really buying here--a car or a tool to feel better than the people who don't have what you have?

Back to the movie.



3:43 "You heard me ladies, fall in. No talking." Mad people are people who need to follow rules.


4:43 "No talking ladies." Mad people are people who need to follow the rules.


4:56 "Why do we have to keep in line? I don't like regimentation." Mad people are people who need regimentation. Mad people are people who don't know what they need.


5:21 "They treat you like criminals." Mad people are people who are criminals. Mad people are people who are treated like criminals.


Part three might be traumatic for some. Watch at your own peril: it depicts a scene of electro-convulsive shock therapy from 1948.





0:05 If I say I demand a lawyer they'll have to do something. It's in the constitution." Mad people are people who have demands. Mad people are people who don't have rights afforded by the constitution. Mad people are people whose demands are ignored


This next clip offers a harrowing depiction of what might be seen as a hallucination starting at 6:17.




6:35 "Come on. Stop it. Get in there before I..." Mad people are people who are ignored. 

6:52 "Come on, cut it out. No one is going to hurt you." Mad people are people who are not to be taken seriously. 


This final clip offers us the view--and line--that gave us the title of the movie.




9:21"It was strange. Here I was among all those people and at the same time I felt like I was looking at them from someplace far away. The whole place seemed to  me like a deep hole and the people down in it like strange animals, like snakes." Mad people are people who are different. Mad people are people who are in a hole. Mad people are people who are strange animals, like snakes.

Not a pretty picture, eh? What images of madness have you seen and accepted as true? Over the years of our lives each of us accumulate schema--patterns of understanding--for madness and mental illness that create our understanding of the phenomena. What are your's? Have you questioned them?

Can you look beyond your schema and see something larger?

Smile or Die: The Perils of Positive Thinking

Smile. It's all in your head. Change your thoughts and it will all get better. Ever hear that? Ever find that won't work? In this clip Barbara Ehrenreich invites us to become realists and see things as they are. While she doesn't specifically speak about mindfulness, her message of seeing things clearly speaks directly to the power one can find when they can see things as they are without modification or flourish.

Signs of Spring

My spring is just this:

a single bamboo shoot

a willow branch

Kobayashi Issa (1763-1828) 

The last of 3,000

Recently a reader of the blog sent me a link to pictures from the abandoned Broadview Developmental Center. What this reader didn't know is that I actually have a connection to the abandoned hospital. Having spent a few years living away from Northeast Ohio, I returned. The first job I got when I moved back was as an assistant house manager for a group home serving people with profound developmental disabilities. The twelve residents who lived in this house were among the last people moved out of Broadview Developmental Center.

I never actually toured the abandoned center. The center had already been closed down for two years--the program I had worked in had been existence for two. Most of the staff remember driving the twelve residences from Broadview Developmental Center to their new home. As they described it, these 12 were literally from the last 25 people who had not been placed in a new home.

I've not thought of Maple House for years. It was a hard job. I was young and inexperienced--and yet really had the impression that I knew what I was doing. Perhaps not the best combination. Perhaps it was a very good combination. The people that I worked with had little or no language skills. Those who were able to talk were very limited. One resident was able to repeat most of the things she heard (a condition called echolalia). Some residents were able to point at things that they might like. Another, who I remember well, relied upon a sole skill at communicating: she would pinch people incredibly hard to signal that there was something she needed. Ouch.

For the most part, the residents were lost to the fog of their minds. I would sit for hours watching the residents. In my eager youthful inexperience I would sit and watch for hours hoping that I would be able to find some sort of meaning in their repetitive movements of mindless stares. I hoped that I could somehow crack the code of their language and bring them back to life.

For most, my efforts were futile. One resident and I traveled a great distance one icy winter day to a well known clinic for people with developmental disabilities. I was trying to find a way to help her: she spent her days engaged in repetitive self-mutilating behavior. The doctors told me that this is just the way it was and the best we could do is medicate the individual so she didn't have enough energy to hurt herself so much. I still feel like I failed her: there had to be some way we could have listened to her closely, heard what she wanted, and restored a bit of dignity and humanity back to her life.

I wonder sometimes if a group home was really any better than an institution. Their environment looked much better: rather than a cold sterile hospital environment they lived in a beautiful home situated on a beautiful tree-lined street in a beautiful suburban town. There were goals for each resident to help them to be as independent as possible, quarterly meetings to discuss their progress, and social programming.

On a deep pessimistic level, I sometimes feel that I was just engaged in a piece of community theater. We had a pretty set, lots of great props, had a great story line.... but behind it all, the props were just cardboard, the story line was empty, and nothing was really accomplished. It felt like we moved these people from a ugly institutional warehouse to a pretty suburban one that was designed to make us all (the non-disabled) feel better.

On more optimistic level I know that I did a lot. I would tirelessly bring in other people to consult on issues facing residents. I discovered that there were people who taught sexuality to those with developmental disabilities: I worked hard to bring those professionals in to help us find ways to restore that part of humanity to the residents (you'd be amazed, despite the evidence to the contrary, how many people insisted that the residents weren't interested in this). I devoted a significant amount of my time to learning about adaptive communication equipment and trying to find the funds to purchase that equipment to help some of the residents communicate their needs to the outside world (you'd be amazed at how many thought this was a waste of money).

The most honest assessment is that I accomplished little. There were no "Awakenings" moments for the residents. There lives were much  more comfortable, that was sure. They were afforded a bit more dignity and respect. Still, much of what we did was group home theater. There was no realistic expectation that any of the people would be living independently. Their disabilities were too profound. Their brains were too damaged by genetic defect, birth trauma, or head trauma sustained from childhood accidents.

Just because these people are damaged people does not mean we don't have to offer them dignity and respect. The hurt, lost, and forgotten of the large state institutions have taught us that lesson in a painful way. Many people who were different got swallowed up by these large institutions who could have functioned very well in an independent setting (people with epilepsy, for example, found their way to these institutions).

But what of the people who cannot be independent? What of the people who cannot ever communicate, feed themselves, or dress themselves? I think it is only right that we treat them with as much dignity and respect. I think offering them loving-kindness is the moral thing to do.

There is something much bigger here to be learned. In looking at these pictures of Broadview Developmental Center, Foresthaven Developmental Center, modern day asylums around the world, and abandoned asylums in the United States, I've learned something unexpected. In restoring humanity to those who are hurt, lost, and forgotten, what I really was doing was finding my own humanity. I hope in looking at these images you can find part of your own humanity being restored too.

Why Weep?

Online discussion forms can be an interesting place. Take for example a thread of discussion about an older gentleman who was weeping in therapy. The psychotherapist posted the question "what do you make of weeping in a case of an [older] gentleman with major depression who has been seen in therapy [a handful of times]?

The range of responses are interesting. The original poster commented that in many years of clinical experience, they have never seen a person with major depression weep. Others have pondered if there is some sort of unexpressed grief, while many others talked about us living in a culture where men don't cry. Others have questioned if there is some sort of underlying medical disorder that is causing the weeping. The most useful comment is the most recent: "Have you thought about asking the patient why they are crying?"

My first thought is that I think every psychotherapist needs to think twice about having discussion about current patients anywhere on the internet. The second thought of the psychotherapist should always be "no, I'm not going to discuss this online." Supervision is great, peer supervision is great. Internet discussions with strangers about patients is nothing more than gossip. We owe our patients more than that. In fact, our ethics require us to offer our clients more than that.

My second thought is that if you are a patient, ask you psychotherapist about their privacy policy. Ask them directly if they discuss their work with anyone else. Most skilled and competent psychotherapists seek out some sort of supervision (with a peer, with a more experienced mentor) at various points in their career. This is perfectly acceptable. In asking how they talk about you with other's, ask if they have a policy about discussion on the internet. If you aren't comfortable with their policy, discuss it with your therapist until you are either comfortable or decide that you want a different therapist.

My third thought is about weeping. What a ridiculous question. Did you know one of the first things that comes up on a search of 'weeping' is a site that lists 52 medical causes for weeping. Have we really turned a normal human emotion and behavior into a disorder? Really?

Uncontacted Tribes

You might be thinking that the only things I think looking at are difficult things. The past two posts I've made about the hurt, lost, and forgotten in asylums have been a little heavy. I'll be returning to the heavy stuff--never fear--but today is something different.

Can you imagine that in over 100 places on this planet there are tribes of humans that have had minimal or no contact with modern human beings? No knowledge of Twitter, Facebook, mobile phones, credit cards, or home foreclosures? No democrats, no republicans, no knowledge of wikileaks (or Wikipedia)? These images literally took my breath away. 

The world, which always seems like it is getting smaller, got exponentially larger for me the instant I clicked on the video and saw these people looking up into the sky at the plane that was passing by. They likely speak languages we don't know, pray to gods we are unaware of, have knowledge and wisdom we haven't thought of, and have social structures we've never thought of. 

I'm taken by these images--I will look at them again and again. I'm curious about them--I'm curious about what they might teach us. At the same time, I hope we don't get too close. I hope for once in our history we don't overrun a people. I hope we don't think we know what is best and try to civilize the so called savages. I hope we don't steal their resources and their ways.

I hope we protect them. I hope we let them be. I hope we wait until they wish to be in contact with us. I hope we we can look back into our own past and do better.

What do you see?

On the Inside

Stanley Milgram

As many do, I thought I new everything in college. It was 1991 and I was in the middle of my undergraduate education. Among other things, I was learning about the ethics of psychology. I remember hearing stories of stuff way back when--Stanley Milgram and his experiments about power and obedience, Phillip Zimbardo's Stanford Prison experiment, and John Watson's study with little Albert.

The essence of what I was taught was this: we've come a long way. Along that way we've learned about ethics, and the importance of protecting people who participate in research projects. In other words, we've gotten better at caring about people. I thought psychologists were so smart--so ethical. The world back then was dark, unethical, and filled with horrors. The world now was filled with compassion, thoughtfulness, and ethical behaviors.

At the same time I was learning this, Forest Haven Developmental Center (sometimes called Fuller State School and Hospital or Patuxent Mental Hospital) was shut down by the Federal Government after the center was successfully sued. This was not the first lawsuit: one was filed in 1978 about poor conditions and then another in the 1980s. I was so wrong about the world being filled with compassion, thoughtfulness, and ethical behaviors.

Who was in Forest Haven? Elroy was one resident. He grew up in Forrest Haven and was given a home in the community when the center was shut down. Here is what the Washington Post wrote about him in 1999 in an expose about the still damaged system for caring with people who have developmental disabilities:

Elroy lives here. Tiny, half-blind, mentally retarded, 39-year-old Elroy. To find him, go past the counselor flirting on the phone. Past the broken chairs, the roach-dappled kitchen and the housemates whose neglect in this group home has been chronicled for a decade in the files of city agencies. Head upstairs to Elroy's single bed.

"You're in good hands," reads the Allstate Insurance poster tacked above his mattress -- the mattress where the sexual predator would catch him sleeping. Catch him easily: The door between their rooms had fallen from its hinges. Catch him relentlessly -- so relentlessly that Elroy tried to commit suicide by running blindly into a busy Southeast Washington street.

These days, reconciled to living, Elroy has fashioned ways to cope. He keeps private amulets against a misery he doesn't fully grasp. There's the leatherette Bible he can't read; the Norman Rockwell calendar of family scenes he hasn't known.

And there's his strategy of groping his way down to the bare-bulbed basement again and again to wash the sheets from his violated bed, as if Tide could cleanse defilement. "God is a friend of mine," he says. But absent divine intervention, "you just gotta do what they say." Just got to add soap powder, and more soap powder, turn the dial to hot. "Gotta not let the worries pluck your nerves."

Here are a few images of what is left of this former state-of-the-art facility for the treatment of children and adolescents with developmental disabilities (and some children who were just discarded and thrown away by their parents for no apparent reason).

http://www.urbanatrophy.com/

http://www.urbanatrophy.com/

http://www.urbanatrophy.com/

http://www.opacity.us

I'd like to say that we've learned a lot since 1991 when this facility was shut down. In some ways we have. In the mid-1990s I spent some time working in upstate New York in a supervised apartment program for people with developmental disabilities that was exemplary. I learned some powerful lessons--lessons that have deeply influenced my work. Those lessons involve deeply appreciating the right of everyone--regardless of ability or disability--to make an informed choice and have the dignity of risk.

Sadly, we have a lot left to learn. One need only to look here in Massachusetts at the Judge Rotenberg Center for evidence of the work that needs to be done. In 2006 the Boston Globe released a report that detailed:

•  JRC employs a general use of Level III aversive behavioral interventions (electric shock devices, restraint chairs) to students with a broad range of disabilities, many without a clear history  of self-injurious behaviors. 
• JRC employs a general use of Level III aversive behavioral interventions to students for behaviors that are not aggressive, health dangerous or destructive, such as nagging, swearing and failing to maintain a neat appearance.   
•  The Contingent Food Program (withholding food as a behavioral conditioning tool) and Specialized Food Program may impose unnecessary risks affecting the normal growth and development and overall nutritional/health status of students subjected to this aversive behavior intervention

To my knowledge, the JRC hasn't changed. Regardless of whether their techniques work--or don't--are these ways in which we want to treat another human being? Are these ways in which we want to offer care to the hurt, lost, and forgotten?

In The Noonday Demon, Andrew Solomon writes "Most demons--most forms of anguish--rely on the cover of night; to see them clearly is to defeat them". Mistreatment is one demon that we can scatter with sunlight. We have a lot more to learn about how to care for those who are most vulnerable. We need to do better. We need to let the sunlight in.