The Marina Experiment

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.

--Mother Goose

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

Or as my mentor Joseph Shay used to say, "I'm just one guy talking."

For more letters to a young therapist see Dear Young Therapist: Don't Be Afraid of the Dark; Dear Young Therapist: That Time My House Burnt Down; Dear Young Therapist: Cultivate Patience and Listen to the Music; Dear Young Therapist: Consider Your De Rigueur Requirements | The Post-Doctoral Tie Incident; Dear Young Therapist: Are You Ready to Jump; Dear Young Therapist: Perspective is Everything; Dear Young Therapist: Sometimes We Can't Put Humpty Back Together Again; Dear Young Therapist: Sometimes Race and Sex Matter; Dear Young Therapist: Don't Be Afraid to Love; and Dear Young Therapist: Allow for the Unexpected.

Seeking Shambhala in Gallery 280

During a recent visit to the Museum of Fine Arts in Boston I discovered a variety of interesting curiosities. One, which I blogged about previously, is the discovery that I don't ever want to own or wear man pants. The main event of this particular trip, however, was the special exhibition in Gallery 280: Seeking Shambhala. The show is up until October 21 so you have plenty of time to catch it.

Shambhala, according to Tibetan Buddhist and Indian Buddhist traditions, is a mythical kingdom hidden somewhere deep within inner Asia. The land is said to be shaped like a giant lotus flower surrounded by eight petals which, in turn, are surrounded by snow-covered mountains. The inhabitants of Shambhala are protected by both the mountains and supernatural forces which ensure the residents are protected from the rest of the world. Those who live here lead an evolved spiritual life and are free from all forms of suffering and strife. Sounds kind of nice, doesn't it?

Prior to this trip to the MFA, the closest I've gotten to Shambhala was a trip to another museum. I think it was in 1997 that a group of Buddhist monks came to the Cleveland Museum of Art and created a sand mandala that was a physical representation of Shambhala. I also got fairly close to Shambhala when a group of monks were in residence at Northeastern University underneath my office in the counseling center. They also were building a sand mandala.

On both occasions I quietly hung out in the back of the room watching the monks carefully build the mandala--sometimes a grain of sand at a time. I also got to watch the ceremony at the end of the creation of the mandala where the sand was swept up and washed away in a body of water.

Impermanence. It gets you every time.

Among the various pieces in gallery 280 I came across this Buddha by Gonkar Gyatso. It was one of those great moments with art--I got drawn into the piece and all the little adornments placed onto the Buddha. Those few moments seemed like an eternity and when I left I saw everything in a different way. I got to thinking of all the little (and big) experiences of our lives that get imprinted upon us and shape our understandings of what comes next. I also got to thinking about the form of what is beneath this surface of impressions.

What might be like to take water and a scrub brush to this Buddha (I wouldn't actually do this, of course, except within my own mind). Might it be possible to wash away these small adornments on the Buddha--these impressions of life--and reveal the true form of the statute? Might it be possible that we can wash away the impressions of life--like the monks wash away the sand mandala--and be left with something pure?

I frequently tell clients who are working through trauma something similar. Trauma work, as I see it, is much like going to the doctor for wound debridement. Every bit of contaminant needs to be located and scrubbed out. I realize that for as many times as I've told a client this, I've never talked about what is left behind.

I'm not sure what would be left. That's probably why I've not thought to talk about it with a client. It's easy to think about what this Buddha would like like with all these impressions washed away. It's a lot harder to think about what people might look like. Maybe we'll figure it out if we ever get to Shambhala.

In the meantime, it's worth it to make a trip into Boston to spend some time with this Buddha. He has a lot to teach.

Rape, Injustice "Facts," and a Call to Better Scholarship

Those of you who regularly pay attention to me on Twitter know that I go a little crazy over items presented as "facts" that are either not referenced or not verifiable. I've seen way too many examples of blatant misinformation spread as well as generally smart people who become misinformed vectors spreading about even more misinformation.

Take for example the Twitter entity known as InjusticeFacts. They describe themselves as "an open, circulating database of facts that deal with the injustices which plague our world." In general, I think the idea is great. There are copious amounts of horrible injustices that happen in the world. Many of us have no idea that they are occurring. Consciousness raising is an important tool of social change, and I'm glad Injustice Facts is doing some of that work.

My complaint is that Injustice Facts offers up sloppy scholarship. People can provide them "facts" through their website. The organizers of the website then disseminate those facts. Are the facts vetted? Are there references that are made available so we know that the fact is true? 

No. At lest Injustice Facts does not explicitly say they do fact checking. The organization also doesn't not respond to Tweets asking if they fact check.

Arguably, good scholarship involves checking out the veracity of information. Not everyone does that. I think an organization or person who presents things as facts has some responsibility to actually verify whether facts are facts -- or if they are propaganda. We've become too trusting, and have rapidly lost our ability to critically think about the world around us.

Yesterday, someone who  I follow on Twitter re-tweeted this:

InjusticeFacts Injustice Facts 

29 women out of every 100,000 are raped in the U.S. each year, 1.6 women out of every 100,000 are raped in Canada each year.

13 hours ago Favorite Retweet Reply

My (somewhat snarky) response :

jaypsyd Jason Mihalko 

@ 

.@InjusticeFacts @amandamcneil I usually like my facts with a side of references.

13 hours ago Favorite Reply Delete

My twitter follower's response, which has since been deleted by the follower, was "Questioning rape facts. Classy." I of course wasn't questioning rape. Violence is a despicable thing, and a good deal of my work as a psychologist is with women and men who have endured sexual violence. My complaint was about a disembodied fact--without reference, context, or verification--being represented as truth.

The snark probably obscured my message a bit.

I continued (I edited a few auto correct errors from my original tweets):

jaypsyd Jason Mihalko 

@ 

I question our collective lack of critical thinking about information that is presented without reference @amandamcneil @injusticefacts

12 hours ago Favorite Reply Delete

jaypsyd Jason Mihalko 

@ 

Why should I believe stats that aren't verified? That is not questioning rape. Its demanding good scholarship @amandamcneil@injusticefacts

12 hours ago Favorite Reply Delete

My twitter follower elected to unfollow me and ignore my responses. A shame, really, as she and I probably agree more than we disagree. I also think, by the way, that it's important to regularly be exposed to people who think differently than me. It makes my world bigger, richer and more diverse.

I've taken it upon myself to do a little fact checking. The UN's statistics for forcible rape in the United States for 2009 was 28.6 per 100,000 people. The count for Canada? 1.5 per 100,000 people. Ms. Magazine has put together a helpful table to demonstrate how difficult it is to get accurate statistics on rape. Scary, sad, and heartbreaking reading.

In this case Injustice Facts were accurate facts (there was a little rounding that happened). To be a more worthwhile source of information, and a trustworthy source of information, a simple addition of a reference would change everything.

It really isn't good enough to say something is true "because I said so." It's poor scholarship, breeds misinformation, and has the potential for great harm.

We need to be critical thinkers. We need to question what we read. We need to search out references to know that the facts we see are accurate and not propaganda. We need to be better scholars.

That is my point. I'm sad my Twitter follower didn't stick around long enough to hear me out.

Psychological Platitudes: It's not your fault.

One of my first experiences in the counseling profession happened in 1992. One of my final courses in college was a practicum--I arranged to volunteer at a local rape crisis center. Things didn't start off well for me. A social work intern from a local graduate program said "men do the raping, women do the healing. You don't belong here." Suffice it to say, we agreed to disagree.

I had all sorts of experiences there. I did an extensive volunteer training. I went out on hospital calls. I sat in my office and did my best to support people. I helped a group of college aged men set up a support group for male survivors of sexual abuse. I got to carry a pager--that was exciting--I felt like I was someone important.

Only important people had pagers. Well, important people, drug dealers, and people pretending to be important.  I know for sure I wasn't a drug dealer--it's unclear if I was important to just trying to look important. I'm getting distracted from my point.

I learned language of a rape crisis center well. I learned that a supportive person was supposed to say "it wasn't your fault." I learned it so well I stopped thinking about it. I said it over and over to countless people. "It wasn't your fault." I told a lot of people that it wasn't their fault. I was following a script I learned well--a script that is taught in psychotherapy programs across the country. It wasn't your fault.

Then I had to go pay attention to what I was saying and everything changed.

A couple of years ago I started listening to myself. I started listening very closely to what my clients were saying to me. I started listening very closely to their experience.

Nearly every single client that I have worked with that has experienced sexual or physical abuse has blamed themselves  Maybe it has been every single one of them. I told every single one of them it wasn't their fault. While I was so busy telling them it wasn't their fault I was ignoring all the ways in which they felt like it was. Worse yet, I was invalidating their experience.

I was wrong to do that. I'm deeply sorry that I've made this error with each of my clients.

My error was a very basic one. It is one that I find almost unforgivable. I got away away from the experience of my client and said something political. I said something that I wanted to believe. I said something that I wanted to help. Saying "it wasn't your fault" isn't something we say for clients--it is something we say for ourselves. It made me feel better--I doubt it really made anyone else feel any better.

Each time I said "it wasn't your fault" I made an inhospitable environment for a person to talk about how they felt it was their fault. Each time I uttered that particular therapeutic platitude I invalidated the experience of another and closed the door on an important part of their experience.

I learned something else while I was at the rape crisis center. The director had said that people need to do what the need to do in order to get through an experience--they need to do whatever is required to survive. Some fight. Some check out and dissociate. Some cry. Some might even pretend that they like what is happening.

What an awful situation. The only choice someone having in these particular situations in one in which someone can willingly do something shitty and feel shitty or unwillingly do something shitty and feel shitty. That's no choice at all. At least it doesn't seem like a choice. It seems like an impossible situation.

My clients have shown me this shitty situation over and over. Sometimes I've been so busy ignoring them saying "it wasn't your fault" that they've had to find creative ways to help me experience this shitty situation so I'd listen to them and understand their experience.

Once I stopped with the quasi-therapeutic political platitudes my clients started taking about all the different ways they felt the trauma was their fault. They started to talk about the most absolutely horrific and harrowing situations in which they had to choose to willingly do something shitty and feel shitty or unwillingly do something shitty and feel shitty.

I went off the reservation and started being a maverick (at least in most rape crisis and therapy circles). I started listening to clients and their experiences of blame, shame, and impossible choices. I started helping create a place where people can experience more of their experience rather than less of it.

I think it is in that very place--confronting the impossible choice of willingly doing something shitty and feeling shitty or unwillingly doing something shitty and feeling shitty--that everything begins to change. An experience is given its full voice. An individual can confront, mourn, and move forward. An individual can make a new choice.

What do you think? Am I off the reservation? Are you going to chase me down with flaming torches and pitchforks? Some have said that the this choice--willingly doing something shitty and feeling shitty or unwillingly doing something shitty and feeling shitty--"perpetuates victimhood... it perpetuates shame."

What do you think?

I think rather than perpetuating shame, it can birth a sense of radical acceptance and liberation. I think that confronting that shitty dilemma allows us all to confront a reality--and give us the space to become fully alive.