You are currently browsing the tag archive for the ‘mental health’ tag.

Russian-ship

Zhuangzi said that the sage can walk through fire and not get burned and through water and not get wet. There is a similar passage in Isaiah 43:2 – “When thou passest through the waters, I will be with thee; and through the rivers, they shall not overflow thee: when thou walkest through the fire, thou shalt not be burned; neither shall the flame kindle upon thee.” How do we accomplish the ability to get through difficult times and be resilient? There are a couple of books that can help.

Coaching for Resilience: A Practical Guide to using Positive Psychology, by Adrienne Green and John Humphrey

The authors of Coaching for Resilience are the founding directors of Nice Work Consulting, Ltd. which specializes in workplace psychology and workplace wellbeing. Green, a psychotherapist, also authored Out Of The Blue: A Practical Guide To Overcoming And Preventing Depression. Both authors are based in the United Kingdom. Coaching for Resilience is an expanded and detailed guide based on workshops Green and Humphrey give on building resilience. Their goal is to help people manage stress so that they do not become overwhelmed and become physically and emotionally unwell. The authors see high stress and low resilience as a vicious circle, and this book helps one to get out of that vicious circle and does so with a series of thoughtful exercise based on what they call “the seven keys.”

The book is divided into two parts with each part having exercises and case studies that allow you to personalize and come up with your own way of learning to manage stress. There are also directives for reflection and specific ideas to pay attention to in each chapter to help you with the process of learning to manage and redefine how you cope with stress. Part one gives the background on what resilience and stress are, the neuroscience of the relationship of resilience and stress, the effects of stress, and why the strategies that we typically use to cope may not work so well. The neuroscience is explained in clear understandable language. Part one lays the groundwork for helping you to understand and define what is causing you problems with stress and resilience.

Part two covers their “seven keys” in detail. Key one is the need people have to be liked and/or to be in control. These needs are the underlying causes of stress. Those who need to be liked may use passivity as a communication style. Those with a need for control may use aggression as a style, while those with both needs may use passive aggression, which the authors see as the most problematic of the three styles.

Each key builds upon the prior key. For example, the second key is to live your values. They help you to determine your values, and then give you exercises to help you determine if you are actually living those values by using a continuum of whether an activity is important or not important and whether it is urgent or not urgent. The third key is that you have a right to determine your own life. Exercises, case studies and reflections teach you empathic assertiveness to help you take charge of yourself.

The subsequent keys are: change is the only constant, life is difficult and that is okay, attitude makes all the difference, and live in the present. In each section, you look at your life as you are living it and decide how you would like to change it to cope better. For example, people typically see change as either dangerous or as an opportunity. The authors use cognitive behavioral techniques to help you build self-confidence and change your self-talk to increase your coping skills. They also address challenging yourself in ways to improve your chances of functioning in a flow state by practicing mindfulness.

Despite the book’s relatively short length, it should not be thought of as a quick read. The authors include many exercises and opportunities for reflection and growth throughout the book in a structured step-by-step way. This is a workbook, and the fact that it is based on workshops the authors have given is a strength. You know as you work through the exercises that the authors have developed and refined these in their teaching. The authors also give examples from their own lives of times when it was a struggle to stay with the keys. What they teach here is realistic. It is an excellent book for getting to know yourself, how you manage stress, and how to improve your coping skills so that they become a way of life do that your life is one of resilience.

Resilience: The Science of Mastering Life’s Greatest Challenges, by Steven Southwick and Dennis Charney

Since the publication of the first edition of this book in 2012, both authors have had to put their research on resilience into practice in their own lives. Dennis Charney lost his father, and Charney himself was shot with a shotgun last year while leaving a deli in New York City by a disgruntled former employee. After five days in intensive care, he faced an arduous rehabilitation. Both of Steven Southwick’s parents died, his sister had colon cancer, and his very athletic brother’s leg was amputated, and his recovery was difficult as well. In researching this book, the authors spoke with Special Forces instructors, veterans who had suffered in POW camps in Hanoi, people who survived the World Trade Center attack of 9-11, individuals who had been raped and almost killed, who grew up in the Jim Crow South, who had lost limbs to land mines, who had survived refugee camps in the Sudan, who overcame congenital birth defects, and more. They also did an extensive literature review on resilience – what it is, what are important factors in resilience, and how to be more resilient in your life.

Resilience is a complex topic. The authors came up with what they call “resilience factors” based on their interviews with resilient people but concede that the list is not comprehensive in what gives us the strength and ability to come back. The factors are the ones that were “most often the ones described as crucial and even life-saving.” The factors are realistic optimism, facing fear, a moral compass, religion and spirituality, social support, resilient role models, physical fitness, brain fitness, cognitive and emotional flexibility, and meaning and purpose in life.

Southwick and Charney look at a multitude of influences on resilience including neuroscience, epigenetics and genetics, physiology, and environment. They also put these into the context of the United States and our vulnerability in terms of resilience. Our overall lack of physical fitness, our disconnectedness with each other, and other factors are sometimes framed as a national security weakness. According to their research, about “75% of Americans age 17 – 24 are no longer eligible to join the military.” The most common reasons are poor physical fitness, not graduating high school and a criminal record. Our all-volunteer military comes from an ever-smaller cross-section of the US.

Each chapter has an extensive list of references, so you can do further research if you like. The research is impressive and comprehensive. The stories are what really stick with me. If you need role models for resilience, this book has an abundance of them. There are famous people like James Stockdale who was the ranking officer as a prisoner in Hanoi and Bob Woodruff of ABC news who suffered a traumatic brain injury covering the war in Iraq. There is Jerry White who lost a leg to a landmine in 1984 while hiking in Israel. His struggle to recover eventually led to his winning a Nobel Peace prize along with Ken Rutherford for their work with the Landmine Survivors Network. Just the stories of the strength and resilience of the people interviewed is worth the read. The people are amazing and inspirational. And the stories of how they were able to recover is insightful and thoughtful and always respectful of the struggle. The authors write with both critical thinking and open hearts.

I am happy to have this resource. Over the years I have worked with people who suffered repeated hospitalizations in psychiatric facilities, who were repeatedly incarcerated, and who suffered physical, mental, emotional and sexual abuse. I have worked with those who have struggled with severe physical injury and illness, and who were in combat in the armed forces. I have always been impressed by the resilience of not just those who were able to thrive, as the folks interviewed in this book, but also those who somehow got up each day and survived despite living in systems and environments stacked against them. I can share this valuable resource with them.

There are two appendices to the book. One is on posttraumatic stress disorder. In pondering the section, I came to realize that there is a high probability that two of the people I was very close to as a child most likely had some degree of PTSD, one from war and one from childhood trauma. This book is enlightening on many levels.

The other is on community resiliency. All too often we are complacent and don’t plan ahead or do what is needed to be prepared for the crises in our lives that sooner or later come to be. This book is an excellent resource to help us all become more resilient in our lives. The final story is of a small teenaged boy in a track race in the Special Olympics. The young boy’s attitude and his words will leave you with a smile and feeling moved and inspired. A young girl, also in the race, pointed out to him that, “You came in last.” “Tha, tha, that’s okay,” he stuttered as he faced the girl and looked her in the eye. “I came in.”

 

The old and the new - carbon and solar power.

A  review of Bowen Theory’s Secrets: Revealing the Hidden Life of Families, by Michael E. Kerr

I first came across Bowen family therapy around 1980 in graduate school when we studied a trio of therapy theories and methods – Bowen, Minuchin, and Satir. At the time I was working at a state psychiatric hospital and the lead psychologists would periodically travel to D.C. to study with Bowen and come back and tell us beginners all about it. I have been a believer in systems theory ever since and was delighted to come across Michael Kerr’s update to Bowen.

Kerr was both a student and a colleague of Bowen beginning in the 1960s. Bowen required that one look at one’s own family history in terms of systems, and genograms are the tool for doing this. Kerr includes genograms in the families he explores in this book, so you have an idea of how to do one. I find them very helpful in looking for patterns, but I also found they could get fairly complex in nontraditional families and when people didn’t have much information on prior generations. Still, you could find relationship patterns of the interplay of over functioning and under functioning in the triangles of family members.

We are a species that look for patterns and usually that takes the construct of cause and effect. Systems is not linear cause and effect. It is more of a process dance among the participants and plays out over generations. Kerr gives us many examples of this dance in exploring the dynamics of several families including Theodore Kaczynski, Gary Gilmore, Adam Lanza and John Nash. There is even a look at President James Madison’s family, which is quite interesting. Public functioning and private functioning can be quite different. He also delves deeply into his own family relationships, particularly with his mother and with his brother who was diagnosed schizophrenic and who eventually committed suicide. Throughout, Kerr approaches and examines these relationships with compassion.

At least to some degree we are all looking for safety and to care for those we love. This can lead to patterns of overfunctioning and underfunctioning. These become “a problem if chronic anxiety intensifies the emotional reactivity (overly sympathetic, overly caring, overly controlling) and drives the relationship interaction.” The anxiety distorts one’s perception of self and others. I like the Bowen definition of maturity, “People who assume responsibility for themselves, do not distance from others if they are distressed, and do not anxiously intrude and try to control others are whole or mature people.”

Anxiety and differentiation of self are the two main variables in the theory. Anxiety itself is not a psychiatric disorder in Bowen theory and all living things have some degree of anxiety. Anxiety is evolutionary and becomes a problem when it is overly active. Kerr writes, “What psychiatry textbooks term anxiety disorders are but one of myriad symptomatic manifestations of overly active evolutionary ancient anxiety systems.” We see in some of the families examined that when anxiety becomes overly active, for example a parent becoming excessively worried and protective of a child, what one seeks to prevent many times happens. When we become enmeshed in a relationship, we can lose our “differentiated self.” Kerr does an excellent job of explaining differentiated self, which he says is the most misunderstood of the eight concepts in Bowen’s theory. You can read further about the eight concepts here.

Kerr points out how Bowen adds a framework to Skinner’s behaviorism and to cognitive behavioral theory. You look at the behaviors in the contexts of the relationship system. Our behaviors feed back on each other.

Kerr includes a chapter on societal emotional process which was once called societal regression. Human culture has always been susceptible to this, but I think it would be especially helpful today if as a culture we become more aware of this process. Progression and regression occur all the time in cultures driven by both emotional and psychological processes. Emotions drive our behavior and heightened chronic anxiety can drive us to dysfunction. Kerr even suggests that with our vulnerability to emotional triggering and irrational thinking that our species be renamed from Homo sapiens (wise man) to Homo dysrationalis. Kerr looks at the housing bubble and financial crisis of 2009 as an example and for ways that we could improve functioning.

I found the chapter on unidisease especially intriguing. Kerr suggests including this in Bowen theory. The chapter begins with a quote from Peter Libby’s “Inflammation and Atherosclerosis: A Translational Tale” – “We all study the same disease.” Kerr suggests that “the core of the symptom-generating forces is the subcortical emotional system.” Internalized anxiety shows up in mental and physical symptoms, while externalized symptoms show up socially in behaviors like substance abuse.

There is also a chapter on spirituality, supernatural phenomena, belief systems, and mind-body interaction. Kerr includes a quote from Bowen’s 1987 address to the conference “Implications of Bowen Theory for Catholic Theology.” Kerr includes the quote because he feels it gives an aspect of differentiation that is often left out when talking about or trying to understand differentiation. Bowen said, “A major quality in the differentiation of self is complete selflessness in which doing for others replaces personal selfish goals. Jesus Christ has been a model for total selflessness.” I wonder how embracing that concept, which is present in many other religions and philosophies, would affect the level of anxiety in our current culture.

I highly recommend this book. It is a welcome addition to works on Bowen theory, family therapy, and systems theory. If you have never studied Bowen before, this is a good book to begin your study. It draws from a broad realm of research, is clearly written and will make you see the world, your family and yourself in a different way if you are not familiar with systems. And even if you are, its depth will give you more perspective. Even with studying Bowen all those years ago and following the concepts of systems, reading this gave me a deeper understanding of my own family relationships.

Bowen Theory’s Secrets: Revealing the Hidden Life of Families, by Michael E. Kerr

Jamesown

A display at Jamestown

A few years ago, I reviewed a book called “An End to Murder: A Criminologist’s View of Violence Throughout History,” by Colin and Damon Wilson. It was Colin’s last book and was completed by his son, Damon. Damon noted that life is actually getting safer these days. You are much less likely to be killed by your fellow man than you were centuries ago or even just a few decades ago. He cited theories for that. Among them were the removal of lead from gasoline and other products and a “good apple” theory. He was much more optimistic than our pundits and politicians. He did address terrorism and mass murder as well as our treatment of the environment and the short- and long-term consequences of that treatment.

Here in Virginia we have had mass murders in recent years from Virginia Tech to Virginia Beach. It seems that perhaps the Wilsons might be wrong. But I read an article in the Washington Post today about nearby Jamestown, and Europeans were committing mass murder in what would become the US even then. So what is the answer?

We proclaim that rights are god given or are natural rights. Maybe so, but how does that play out in the world. Rights end up being what those in power proclaim for themselves and for whomever and whatever they deem worthy. In the beginning, those who set up the US government deemed white males with property who were older than 21 were worthy. People of color were deemed savages and worthy of slavery or removal and genocide. The definition of white was also narrow and didn’t include southern and eastern Europeans. They would get white status much later when folks like Walter Plecker were worried that those of color were out reproducing whites, since they incorrectly saw race as biological rather than the social construct that it is, their logic is faulty on their own terms.

A right that is heatedly debated today is the second amendment. There have been restrictions over the years – machine guns during the days of Al Capone and mail order guns after the assassination of John F. Kennedy for instance. There was even a restriction on semi-automatic weapons for a time, but that was allowed to lapse during the administration of G. W. Bush, and any attempt to revive it is met with emotions that one would expect if the earth were about to end. What was okay 20 years ago is now a sign of the apocalypse. The fear of change is so great that the CDC is banned from studying gun violence and MDs cannot ask about guns at home. Having a gun is a sacrosanct right. Well, except in the 1960s when the Black Panther Party in California started to open carry for self-defense. Gun rights Republicans quickly made amends to sacred rights to change that situation. So, change can happen.

When the second amendment was written, guns were black powder muzzle loaders. To commit mass murder with those weapons you needed a mass of people firing, like at Sand Creek and Wounded Knee. There was also the militia part of the constitution. Colonists were not happy with their treatment by the British Army, and there was a mistrust of the military. The original intention, despite what Scalia spun, was for those with rights and those they deemed worthy, to have guns and to train so that they would not need a big military industrial complex. It worked well for killing Native Americans and keeping Africans enslaved, but when it came to the War of 1812, we found we needed a standing army. Even then, it was kept small. It wasn’t until modern times that we give over half of our budget to the military – a time when the “big wars” are over.

Some argue that guns are necessary to protect you from the government. At some point along the way, “we the people” became the “you the enemy.” We became entrenched in tribes and if our tribe wasn’t in power, it was bad. The Wilsons could argue that tribalism is less than what it once was. People of different races, religions, creeds, sizes, colors, abilities, genders, sexual orientations, political parties, and all the other labels we put on ourselves and others, actually do get along these days, or at least co-exist nonviolently, and do not go to war on the whim of a monarch.

But it does all come down to power and culture. Pundits and politicians feed on if it bleeds it leads. We are emotional beings and fear might just be the most powerful emotion. In this culture you increase your power and your wealth at the expense of others. We express violence in culturally prescribed ways. I remember that the same day Sandy Hook happened, there was an attack in a school in China on the same number of people. The difference was that in China, the weapon was a knife. No one died. The culturally prescribed way in this culture is with a gun. Colin Wilson wrote many years ago about the evolution of violence in the US and traced it to a particular part of England. It especially took hold in the slave holding south (slavery is inherently violent) and became our honor culture. If you dishonor me, I get back at you, and it only matters if I feel slighted, for that gives me just cause to act. He even traced violence in northern cities to neighborhoods with large populations of southerners who had migrated there.

Yes, we need to do something about guns. We also need to look at ourselves and our culture. What kind of country do we want for ourselves and those who come after us? There is a universal maxim that has been around for a very long time and has been taught by everyone from Confucius to Kant to Jesus. Treat others as you would want to be treated, and don’t do to others that which you would not want done to yourself and to those you love. Remember that we are all in this together. That includes all people including people from other countries and people with less wealth and different religions and all the rest. It includes the world we live in and are a part of. To fall back on “It’s my right” is to sound as a spoiled child. As Samuel Johnson said about patriotism, it may be the last refuge of a scoundrel. With rights come responsibility. Does this right you cling to dogmatically include treating others with compassion, kindness, and respect? Does it include responsibility? What do you do for these, the least of my brothers and sisters? I always have liked the approach of solution focused therapy. As soon as you label something a problem, it gets worse. Instead, seek what you would like to happen. Suppose you go to sleep tonight and while you are asleep, a miracle happens and the problem you have is somehow remedied, but you don’t know that happened because you were asleep. How would the world be different? What would this culture look like? How would people treat each other and the world around them? What would our cultural rules, values, and norms be? Then you would ask yourself to rate on a scale of one to ten where we are now with one being nowhere near where we want to be and ten is we are there. Then we ask what we would need to do to move up even just half a point and get lots of detail. Just how will we change? What will be in that process? How will we do it? How do we adapt? How do we treat each other regardless of where they are from and where they live and what they believe? How do we treat all living things and the planet and the universe? And then you ask, again on a scale of one to ten, how much effort are you willing to put into making that change. One is to hope and pray it happens, and ten is to do whatever you need to. You need to rate yourself at least about a seven for change to have a chance of coming about. I have also found over the years that those who give a ten rating tend not to follow through.

Unfortunately, it is that need (sometimes demand) to feel respected as right, that honor culture, that supreme need to save face coupled with exceptionalism, constructed tribalism, and lack of humility and grace that makes coming to a consensus almost impossible. We are holding out hopes for the young to bring the solutions. But whatever happened to that peace and love generation that was going to save the world? The powerful have a vested interest in keeping things as they are. There is money to be made in the world of pundits and their media platforms of ratings and clicks. Money to be made in moving wealth in an upward direction and only declaring there is a class war when someone attempts to mitigate that flow. Odd that a country that so many call Christian forget that the apostles in Acts sold their possessions and gave the proceeds to others according to need. Negotiation will be difficult and a never-ending process, but that has always been so. Those with power and wealth tend to want to keep that and blind themselves and try to blind others as to the long-term consequences of a culture of greed and lacking in kindness. Native people encouraged looking out to seven generations considering the consequences of our actions. How foresighted are we these days? What effort are we willing to make? What do we need to start doing to make positive changes, what do we need to stop doing, and what do we need to continue doing? What kind of world do we want for ourselves now and for those who come after us?

Maui 2008 178

One of the sticking points with some folks in AA is the step that says you will surrender to a power greater than yourself. Surrender is not the American way, or maybe more accurately, not the Protestant work ethic way. You must give 110% even though that is not really possible. For example in running, you bonk before your glycogen levels fully deplete. Your brain takes care of you by telling you to take it easy. Think of what happens to the motherboard on your computer when you overclock the processor to increase power. You overheat and fry it. And yet, if we don’t succeed we are encouraged to keep trying to the point of attempting to get out of a hole by continuing to dig. I think of it as a Vietnam syndrome – just keep sending troops and keep bombing and victory will inevitably come. Somehow we didn’t learn much from that experience.

In Chinese philosophy there is the concept of wu wei or nonaction, trying not to try, or effortless effort. A similar state in western psychology is the flow state described by Mihály Csíkszentmihályi. It is when you are in the zone. You cannot force yourself into flow or wu wei, you have to let go – surrender – and just be with it. When you become aware you are in that state, you are out of the moment and you lose it.

We have known for a long time that outcomes for people diagnosed as mentally ill have better outcomes in third world countries than in the west. People are treated differently in the “less advanced” cultures. In the west, we also put labels on people and then try to force them to behave in what we consider socially appropriate ways. For over 50 years the work of Brown, Birley, Vaughan, Leff, Wing and others found that the expressed emotion in families was a primary causative factor in rehospitalization in psychiatric facilities. Behaviors that got on family members’ nerves were more likely to cause trouble than the psychiatric symptoms. I came across their research in the late 1970s while working on a rehospitalization factors study at a state hospital. Expressed emotion was not touted as a factor in causing mental illness – no schizophrenogenic mother theory. It was just that when someone is criticized in certain ways, even when caring and concern are at the heart – sometimes feeling judged and pushed does not lead to the outcomes that are desired by the one expressing concern. And that is true regardless of whether one is ill or not.

In the recovery movement, the shift is to treat people with dignity and respect. Ezra E. H. Griffith has edited a comprehensive book that covers issues like involuntary commitment. It is called Ethics Challenges in Forensic Psychiatry and Psychology Practice. It is an excellent read addressing all the variables we face in social control when we treat people with psychological problems differently than those with physical problems, for example, diabetes.

It also got me to wondering about how wu wei might come into being when treating those considered chronically and seriously mentally ill. The July 1, 2016 Invisibilia episode has an intriguing take. You can listen to it here. It is called The Problem With the Solution. It starts with an American dream kind of product invention, and then looks at solutions in mental illness. It reminded me of Scott Miller saying that once something is defined as a problem, it gets worse. Could a reframing, a surrender into acceptance, be one solution? The podcast looks at the story of Ellen Baxter and her search for understanding with her family. That search took her to college and to Geel, Belgium, where people diagnosed with mental illness live with foster families who accept them for who they are and have no idea of the person’s diagnosis. Does Geel, Belgium have a humane, kind and respectful solution? Baxter began a project in New York called the Broadway Housing Project. It is not only humane, it is also cost effective. Also mentioned is Jackie Goldstein and Voices of Hope. You can read more about Jackie Goldstein and Voices of Hope here. Be sure to listen to the bonus story of William Kitt at Invisibilia. Information about the Broadway Housing Project and Ellen Baxter is at http://www.broadwayhousing.org/. There is also this 1993 New York Times article – https://www.nytimes.com/1993/12/19/magazine/ellen-baxter.html.

2013 Burlington Vermont 015

 I think my life began with waking up and loving my mother’s face. George Eliot

We are social beings. We have survived as a species because of our ability to live and work together. The idea of rugged individualism is a relatively recent myth strongly believed in the West, particularly the US. I remember a study from years ago in which people were asked to draw a circle representing the self, and another representing other. Americans drew circles much larger for the self than for other. People in Asia and Africa tended to make the circles the same size or maybe even make the circle for other larger.

We are born helpless and dependent. We rely on others to help us develop as humans, and we rely on others our entire lives. Attachment teaches us how to get along in life. John Bowlby wrote about attachment after noticing how infants in orphanages after World War II in Europe failed to thrive and, in some cases, died, despite having the basic physical needs met.

How hard wired are we for attachment? Take a look at this video.

According to the polyvagal theory, we help regulate each other’s emotions throughout our lives by how our ventral vagal nerve “reads” and responds to facial expressions. In “The Emotional Foundations of Personality: A Neurobiological and Evolutionary Approach” by Kenneth L. Davis and Jaak Panksepp, the emotion of panic/sadness is linked to separation from our caregiver in our developmental years.

Martin Seligman wrote in “Learned Optimism” that he could predict the winner of a presidential election by the optimism of the acceptance speech. In “The Attachment Effect,” Peter Lovenheim looked at politics in the US and looked at politicians and even speeches from another angle – from the view of attachment.

There are four kinds of attachment – secure, anxious, avoidant, and disorganized. He writes that those with secure attachment “tend to be more giving and tolerant toward others, and they show more resilience in the face of challenges such as personal illness and the death of a loved one.” They are comfortable with intimacy and depending on others. Insecure attachments – avoidance and anxious – are more problematic. They do have strengths. A person with anxious attachment may be more successful getting a parent’s attention as a child (though the attention may not be positive) and the avoidant person becomes more independent and is less likely to feel the hurt, at least consciously. Anxious people may perceive danger more quickly, and avoidant people may see ways to escape more quickly. Anxiously attached people tend to be uneasy and vigilant about threats to relationships and are worried. Avoidant people tend to be very self-reliant and disinterested in intimacy. Disorganized attachment is coming to fear and be drawn to your care giver at the same time. They tend to be fearful of rejection, suspicious and shy.

Lovenheim found a correlation between secure attachment and centrist beliefs – more moderate, more flexible, more realistic, and more self-confidence, empathy and trust. Both anxious and avoidant people are more likely to be drawn to extremes. Avoidant may be drawn to the far right and anxious to the far left, but not necessarily. What does happen is that both are drawn to a dogmatism that gives them a sense of safety and security. “Anxiously attached voters, in particular, may project their unmet attachment needs onto leaders (and) may so crave attaching to a strong, care-giving leader that they nay be unable to distinguish between a transformative leader –one who protects encourages and empowers them – and a leader without such qualities.” The relationship of style to political leanings may be much more complicated. He also did an attachment style interview with Michael Dukakis and found the former presidential candidate and governor as avoidant. You may remember his detached analytical nonemotional answer during a presidential debate that was widely seen as costing him votes.

In speculating about recent presidents, Lovenheim found both anxious (like Clinton) but mostly avoidant including both 2016 candidates. Often anxious attached people wind up with avoidant people in relationships (and it generally doesn’t go well), and I wondered about voters and candidates. I didn’t find any data, but I am also curious because several presidential nominees (and at least two of those elected) have a history of being bullies. Is there an attachment style associated with bullies? At least among adolescents, avoidant attachment style was likely to be the style of bullies. But the relationship may be a bit more complicated. As usual, more research is needed. It also got me to wondering about cultural attachment styles. If a country tends to elect leaders with avoidant attachment styles, how does that affect the country’s relationships with the rest of the world? Also complicating that are cultures sense of the self in relation to others. The nonsecure styles would tend to lead a culture and a country to more extreme and have more rigid positions based on fear and the need to be right so that all are safe and secure, at least in our tribe. It also got me to wondering about attachment and religious belief. A concept of a power greater than yourself can give you a sense of safety. Lovenheim found that attachment styles in religion tend to reflect those we have in every day life. A secure attachment leads one to a feeling of God as loving protector, “available, reliable and responsive.” Those with anxious styles who see relationships as unreliable and unpredictable may be “deeply emotional, all consuming, and clingy.” The research he cites sees avoidant as tending towards agnostic or atheistic, but there are philosophies such as Buddhism and Daoism that have no deity or deities, and then there is rational empiricism all of which can be had by one with a secure attachment style. What I wondered about is more the disorganized style. If God is both loving and vengeful and to be feared, how would one get beyond that paradox and have a secure attachment? Again, with all the variables in daily life, it is complicated, and more research is needed.

I didn’t find any research on attachment style and likelihood of voting. I do wonder how outcomes of elections would change if a greater percentage of people voted. The best estimate I could find for the US population as a whole is that about 65% are secure attachment style, 20% avoidant, 10-15% anxious and 10-15% disorganized. About 75% of people live their whole lives in one style with no change. As Lovenheim writes, “If we’re going to raise emotionally healthy people, a consistent attachment figure must be present at least for the first eighteen months to two years of life. This is not a gender-specific role; it could be mother, father, grandparent, nanny, among other possibilities. But someone has to do it.”

Attachment is not static across a lifetime, and one can earn secure attachment. And, your attachment style may even affect your relationship with your dog.

Other books of interest in this area are “The Neuroscience of Human Relationships”, by Louis Cozolino; “The Feeling Brain” by Elizabeth Johnston and Leah Olson; and “The Pocket Guide to The Polyvagal Theory”, by Stephen Porges.

If you are curious about your own attachment style, there is an online test at http://web-research-design.net/cgi-bin/crq/crq.pl.

Kona Hawaii 2013 116

I remember Dr. Peter Derks, my very first psychology professor, many years ago discussing a study in which people were asked to find patterns in flashing lights. Lights would flash in a sequence and participants were supposed to figure out the pattern so they could predict which light would flash next. What the participants didn’t know was that there was no pattern. The lights were programmed to flash in a random pattern. In every case, however, people found a pattern. When they were ultimately proved wrong, they would typically say, “now I see what you’re doing,” and would change their theory to a different pattern. No one ever figured out that there was no pattern, it was all random.

The NPR podcast, Invisibilia, recently did a story about patterns in the context of trying to predict behavior. One story was about a woman who had a history of abuse and arrests. She had turned her life around and was trying to become a lawyer in Washington state. Her appeal went to the state supreme court, and her attorney was a man who had convictions of bank robbery. Another story was about a Princeton study that used longitudinal data to try to predict outcomes in children. The researchers, despite massive amounts of data and coding efforts were not able to predict outcomes. You can listen to the podcast at https://www.npr.org/podcasts/510307/invisibilia (it is the March 18, 2018 podcast) or you can read the transcript here. People long for patterns and predictability and typically feel very uncomfortable with randomness. With randomness you can’t predict what will happen next. And life just has way too many variables to be completely predictable.Our brain takes shortcuts to give us the comfort that we can predict things. We inherently look for patterns. It enhances our chance at survival. It is part of evolution. It also gives us a sense of self, of who we are. We are those patterns we fall into.

Michael Puett, a professor at Harvard, and Christine Gross-Loh wrote a book called, “The Path: What Chinese Philosophy Teaches Us About the Good Life.” Rather than looking inside for our “authentic true self” we are urged to “recognize that we are all complex and changing constantly. Every person has many different and often contradictory emotional dispositions, desires, and ways of responding to the world. Our emotional dispositions develop by looking outward, not inward. They are not cultivated when you retreat from the world to meditate or go on a vacation. They are formed, in practice, through the things you do in your everyday life: the ways you interact with others and the activities you pursue. In other words, we aren’t just who we are: we can actively make ourselves into better people all the time.” Every moment can be a moment of redemption or a moment of damnation. For all of us. Puett says that Zhuangzi, a Chinese philosopher of the Warring States period, said that labeling yourself is dangerous. It limits you. Saying you are an inherently shy person limits you to being that, you become stuck in that pattern. Instead, you can look at each moment for what you can become. We are not static beings.

That moment of becoming reminds me of solution focused therapy and narrative therapy. You start with small steps, like a small snowball at the top of a hill that gets bigger as it rolls down. The problem is outside yourself, and does not define you. Instead of staying with your past patterns and stories, you look at how you would like to be. It reminds me of flow – you become one with the moment you are in. But that takes practice. Humans tend to fall off the Way or Dao. We get caught up in thinking and patterns and ruts. Joseph Campbell, when interviewed by Bill Moyers on the Power of Myth, spoke about the Coptic Christians for whom the everlasting life was living forever in the moment – transcendence. Confucius used rituals to help us get there.

Chance life encounters with their randomness play a large roll in our lives, too. That can be for better or for worse. The better are situations like that if Theodore Geisel, or Dr. Seuss, who had given up on publishing his first book and planned to destroy it. That changed with a chance encounter on a walk home. You can read that story here. For worse could be an instance of just being in the wrong place at the wrong time. I remember years ago a man driving home from work, just as he did every week day, was killed when a car, driven by an adolescent girl and friends, went airborne with the front end coming down into his windshield and killing him instantly. Albert Bandura wrote an excellent article on chance life encounters in the APA Monitor back in 1982. You can read it here.

So in this life, with all its messiness and randomness and chaos, how can be live in a way of growth and loving kindness? How can we live in the present so that we are not captured by the past, but have a chance at a better future? How can we change our relationships into skillful ones? How can we flourish? The Path gives us some practical ideas from the Chinese philosophers whose ideas have been found to be supported by neuroscience.

I think a part of changing and just being in this life is to be comfortable with that randomness and ambiguity. We learn that going with the flow is being open to the results of that butterfly flapping her wings off the coast of Africa, and we adapt and adjust as best as we can. That may go against our nature of desiring predictability and a world of where everything is easily judged right or wrong, good or bad, and we always know what comes next. Rather than judge harshly and condemn or overly praise and think that something is solved for good, we look at how skillful we are and how we can improve that. We have a sense of curiosity. The Chinese philosophers all sought to teach us how to be decent people, each in their own way. It is a constant life long process, and our skill levels vary from moment to moment. The philosophers from Confucius to Xunzi all have ways of reaching a place where we automatically find and live the Way. But for all the teachings, there is an inherent paradox. The harder you try, the more difficult it becomes. In Chinese, the process similar to flow is “wu wei” or effortless effort. Edward Slingerland gives a good overview.

Kona Hawaii 2013 116You may have heard someone say, “I can’t believe I did that, that’s not me!” And sincerely believe it and be baffled at what they said or did. You may have felt that way about someone else. “My son/daughter/friend would never do something like that.”

There are at least two versions of us – the one in the moment, and the one we construct in our story over time. In the updated edition of “Full Catastrophe Living,” Jon Kabat-Zinn cites research from the University of Toronto about these two versions of the self. The study looked at people who had completed the Mindfulness Based Stress Reduction program and found “increases in neuronal activity in a brain network associated with embodied present-moment experience and decreases in another brain network associated with the self as experienced across time.” That second self is the narrative self or the self we experience as ourselves in the story we tell ourselves over time. The research findings encourage us to be in the present moment rather than caught up “in the drama of our narrative self.” “Non-judgmental awareness of our wandering mind may actually be a gateway to greater happiness and well-being right in the present moment, without anything at all having to change.”

Jeffrey Zimmerman in “Neuro-Narrative Therapy” goes a step further and cites the work of Dan Siegel. “Narrative therapy rejects the notion of a single, true self and instead embraces the idea of multiple identities or multiple versions of the self.” Siegel says that the notion of a unified self is “missing the point of the multiplicity of our normal, adaptive, ever-changing selves.” We need these multiple states to be able to adapt to the changing situations in our lives. We do tend to have states that we favor and see those override states or dominant style as our personality. Our brain is constantly taking short cuts so that we can cope with all the information we are constantly bombarded with internally and externally, and we see that dominant style as our self. “… (O)ur brain likes coherence, it has a bias for making the world appear solid and stable. To do so, it constructs an unbroken picture, giving us a continuous sense of self out of these multiple brain states.”

Mindfulness can help us be aware of those states, and to be with them in a nonjudgmental way and lessen the drama and the pain of everyday life.

I think it also helps to look deeper, even on the physical cellular level of the self. What we perceive, for example a chair, is not solid at the microscopic level. And we are not solid beings or even mostly made up of human cells, at the microscopic level. Take a look at this “Nova Wonders” called, “Nova Wonders, What is Living in You?” It not only tells about how in terms of numbers our human cells are vastly outnumbered by the bacteria, viruses, and other micro-organisms that co-habit our bodies with us, but gives some thought provoking ideas and findings about the function of our gut bacteria in illnesses ranging from C. diff to Parkinson’s to autism. You can find it at https://www.pbs.org/video/nova-wonders-whats-living-in-you-fnbfuy/. Fortunately, our human cells are bigger than all our fellow micro-organisms. Their total weight in our body is about three pounds – about the same as the weight of our brain.

When you hurt another, you may ask forgiveness from them. The Pope has asked forgiveness of those molested by priests and for the treatment of indigenous people in the New World. People convicted in court may ask forgiveness just before sentencing. Preachers and politicians ask forgiveness when caught in sin and then enter rehab to prove just how sincere they are. All of us do wrong at some time. Forgiveness is an issue that comes up often in life and in counseling. What does that word mean?

It does not mean saying that the wrong is now okay. “Sure you hurt me, but I forgive you, now it is okay.” That definition makes forgiveness extremely difficult if not impossible. It is giving a gift of dispensation to the one who harmed you. There is another view. Forgiveness can mean, “I don’t like what you did, and it is not okay but I will let it go. It doesn’t mean I want to have anything to do with you again, but I am not going to let anger and resentment devour me.” A quote attributed to the Buddha is that holding onto anger is like grasping a hot coal. The one who gets burned is you.

Many years ago I was having a conversation with a person who was working on recovery in AA and was doing step work. The eighth step is making a list of people you have harmed and you become willing to make amends to them. The ninth step is to make direct amends to those you have harmed except when to do so would injure them or others. It became quickly obvious that the person’s goal was to seek forgiveness even though in that case it would cause pain to the person wounded and to others. There was no talk about making amends. One universal principle throughout cultures and spiritual traditions (including secular ones) is to give without thought of return. When the Bodhidharma met with the Emperor Wu, one of the questions Wu asked was how much merit he had earned for all the monasteries he had built and all the other good deeds he had done in the name of the Buddha. “None,” said Bodhidharma. According to the story, the conversation was a short one. There are times when asking forgiveness is a manipulative act. We are asking forgiveness of the one we have already harmed with the sole purpose of making ourselves feel better. What is the merit of that? None. You are just doing more harm.

This is a place where the steps give good guidance. Look into your heart. It may be better to seek how you can make amends to those you hurt rather than ask forgiveness. Forgiveness belongs to the one harmed, and it is for them and within them that forgiveness occurs. If you are going to ask anything, ask how you can make amends and even then, only ask when doing so causes no further harm. Making amends with no expectations (including the expectation of forgiveness) may be a better way and work better at allowing yourself forgiveness with time.

For further thoughts on working on reconciliation and the process of forgiveness I strongly recommend “Negotiating the Nonnegotiable: How to Resolve Your Most Emotionally Charged Conflicts,” by Daniel Shapiro. Shapiro is the founder and director of the Harvard International Negotiation Program. As a psychologist and negotiation specialist, he has worked with families as well as corporate and governmental groups including conflicting parties in the Middle East. He provides a very thoughtful and guided method for the process of forgiveness and reconciliation.

The American Medical Association voted not long ago to classify obesity as a disease.  The intentions were good, for obesity and the associated health problems, do need attention. There are problems with this, for example if one uses only body mass index to diagnose, then an individual with heavy musculature could conceivably be diagnosed as “obese” when clearly that is not the case. Some, such as National Review, write that this is another attempt to lessen personal responsibility and allow government to enter into our lives and our bodies.

Physicians’ attempts to change what were at one time called “conditions” or “failings” or other terms into “disease” is nothing new.   You can read an excellent summary on the evolution of the term “schizophrenia” in the November 2011 Schizophrenia Bulletin.  The article quotes Berrios, “… schizophrenia research can be described as a set of research programs running in parallel, each based on different concepts of disease, mental symptom, and human mind.” For an overall critique of schizophrenia as a disease, Models of Madness is a good start. Alcohol dependency has been defined as a disease for decades. Dr. Benjamin Rush, a founding father of the United States, is credited with declaring that alcoholism is a disease. The research of E. M. Jellinek aoubt 60 years ago is credited with giving this diagnosis credence. David J. Hanson, PhD, of SUNY-Potsdam, gives a thoughtful critique of the disease model at http://www2.potsdam.edu/hansondj/Controversies/Is-Alcoholism-a-Disease.html.

Mosher et al in Models of Madness review the relationship of causal beliefs to attitudes.  While at times part of the motivation to define something as a disease is to lessen the stigma, often the reverse happens.  John Read and Nick Haslam wrote the chapter, “Public Opinion.” They cite numerous studies that find that when something is defined as a biological illness, the stigmatization increases. “A belief in categories that are discrete, immutable, and invariably rooted in a biological abnormality reflect the medical model’s essentialist view of mental disorders as ‘natural kinds’. Viewing mental disorders in this essentialist fashion is associated with prejudice along multiple pathways.  Believing in immutability may promote pessimism and avoidance. Believing in discreteness promotes the view that sufferers are categorically different, rather than sharing in our common humanity. These essentialist beliefs form a toxic ensemble.” This unintended consequence should be no surprise. It is rather common among diseases for which there actually are lab tests to diagnosis. Several members of my family, including my father, had tuberculosis. People, including family members, shied away for fear of catching the disease. Virginia mandated testing and x-rays for immediate family members (despite negative tests) from my earliest memories until about college age.  Susan Sontag wrote about cancer in Illness as Metaphor, and how there was an exception in confidentiality laws at the time for one disease due to stigma, and that was cancer. She later wrote about AIDS as well. I once visited Kalaupapa, which was a leper colony on Molokai. There were still people living there, now cured of Hansen’s disease. These folks also took you on the tour of the site. You got to hear stories about how people who were even suspected of having the illness were snatched off the street and taken here, banished from their lives, and isolated from friends, family, and home forever. Kalaupapa is a very moving place to visit. You can most likely think of other diseases with stigma, perhaps even some you fear. Based on our history as humans with a fear of disease, it is remarkable that anyone thought that defining a behavior, any behavior,  as a disease would make it less stigmatizing. In some ways, it is metaphorically throwing gasoline on a fire hoping this time a miracle will happen and the liquid will extinguish the blaze.

I think there are at least two issues at the foundation of this disease problem. And this excludes the political and economic and ego issues associated with the businesses of academia and treatment programs and medicine and pharmaceutical companies. That is a whole other thing. The first issue is thinking we know what a disease is, and that we all agree on what that means. But at the foundation of these troubles is deciding just what is a disease. That is how diagnoses got started – when we research and treat or even just talk about a condition, we need to know we are talking about the same thing. Let’s define it. Unfortunately in behavioral health, from the start egos and later egos and money were involved and muddied the good intentioned waters.  Berrios mentions the different concepts of disease above in the study of schizophrenia.  A quick web search gave me many definitions for disease, among them:

  • a disorder of structure or function in a human, animal, or plant, esp. one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury.
  • an impairment of the normal state of the living animal or plant body or one of its parts that interrupts or modifies the performance of the vital functions, is typically manifested by distinguishing signs and symptoms, and is a response to environmental factors (as malnutrition, industrial hazards, or climate), to specific infective agents (as worms, bacteria, or viruses), to inherent defects of the organism (as genetic anomalies), or to combinations of these factors
  •  A pathological condition of a part, organ, or system of an organism resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms.
  • A condition or tendency, as of society, regarded as abnormal and harmful.
  • Obsolete Lack of ease; trouble.

Pretty much anything out of the ordinary can be called a “disease.”  I remember folks going back 30 years who have justified the disease model in mental health and substance use by relying on the last – the obsolete – definition of dis-ease. These days, the term would be unease. So when people argue about what is a disease and whether something specific is a disease, they may be talking about very different concepts.

The second issue is, I think, with the problem of defining words and giving them great power. Steve deShazer was right, that words were originally magic.  But we use words to define words, and the definitions are circular. They have to be, and they are imperfect. The words defining an apple in the dictionary will never give you the experience of an apple.  Even experiencing one apple will not give you an idea of the taste and look and fragrance of all apples, or of the potential of apples or of the creation and life and death and return to the earth of an apple. Putting a label on an individual will not give you an experience of that individual. Being with that individual in one situation will not give you the experience of the whole ever changing person. Words have the power that we give them. We need to be careful.  I remember years ago in graduate school reading about a study in which individuals with no psychiatric problems gained admission to mental hospitals, and then just acted as themselves. Other patients caught on rather quickly that these folks were not mentally ill, but staff – not so much. The individuals took notes about their time in the hospitals, and nursing staff charted that they were exhibiting “writing behavior.”  David Rosenhan writes about the study here.

I will leave you with two quotes from Alan Watts, and also the remarkable story of Eleanor Longden in her own words.

“We seldom realize, for example, that our most private thoughts and emotions are not actually our own. For we think in terms of languages and images which we did not invent, but which were given to us by our society.”

“Trying to define yourself is like trying to bite your own teeth.”

Eleanor Longden: The voices in my head

Recently I spoke with a graduate student in counseling who needed to interview someone in the field for a paper he was writing for class. He told me he had called numerous therapists but was told that they were too busy to talk. I have gotten to talk to many students, both graduate and undergraduate, over the years and it has always been a very enjoyable experience. I encourage therapists to make time for students and to give back to them. Many have helped us along our path.

What follows is a result of several conversations with students looking for internships. It was originally published in the newsletter of the Virginia Counselors Association.

Even though it is spring, it is not too early to begin planning for a fall practicum or internship for your graduate program. Slots at agencies and programs can fill up early, especially with the number of graduate programs these days. You are not only competing for spaces with others in your program, but with students from programs at nearby schools, from online degree programs, and sometimes from students who may go to a school from a distance away but who live close by you and look for placements near home.

The first step is to check with your school for a list of agencies and programs with which the school already has a valid affiliation agreement. Affiliation agreements involve the school and the program exchanging agreements signed by the directors of both entities with each program having an original of the agreement. The agreement states the responsibilities of both parties and the liability insurance information. Students can get liability insurance for free with their ACA membership, or at a tremendous discount (approximately $35) with their membership in VCA. It is a good idea to have your own insurance even after you are licensed and working for an agency that has insurance that covers you. The insurance that the agency has looks out for you, but the primary responsibility is to the agency. If the agency can prove you failed to follow policies or procedures, you may be left on our own. Your own insurance’s responsibility is to advocate for you. If you find a place that you would really like to intern and there is no agreement, most likely you will need to find a person at the agency who is willing to follow through on getting an agreement. This can take time, and if the process is not started early, it may not be done in time for the start of the placement, if it occurs at all.

Larger agencies and schools may use the same process for taking on an intern as they would for hiring a new employee (except without the pay). This includes going through an interview process, having references, providing a transcript, resume, and completing a job application. Make sure your references are easily reachable. I remember instances when a reference had a full voicemail box and did not respond to several messages left with the receptionist nor to multiple emails. I had to ask the student for an alternate reference. Also make sure that you provide documentation as requested. If a sealed transcript is required, providing a personal copy will not work. Your placement may be delayed or may not occur at all. If a job application is required in addition to a resume, repeatedly writing “see resume” for questions on the application may not be acceptable either. Sometimes bureaucracies put their needs over user friendliness to applicants.

Once you begin at the placement, you may go through an orientation in which you learn about the organization and its structure, policies and procedures. There may also be criminal background checks, DMV and social services checks, finger printing, and drug screens. And then there is training to be done. If you are at a facility that is licensed by the Dept of Behavioral Health, that will include things like CPR and First Aid (if you have these already and the certifications are valid through the time you will be at the agency, you may be able to present your card and not have to take the training again), behavior management, client rights, cultural competency, ethics, confidentiality and privacy of health records, developing treatment plans, health record documentation, and infection control among others. You would also have to learn the ins and outs of whatever health record system the agency uses and more and more that means an electronic health record. Being comfortable with computers has become a pretty essential part of the behavioral health workplace. You may also learn about whatever other forms the agency uses, such as incident report forms.

You will probably have an easier time finding a placement at larger agencies, or at least places that provide for fee services. Since you are not licensed yet, services that you provide cannot be billed to insurance companies. If you are at a stage where you could meet the Medicaid criteria for qualified mental health provider, the agency might be able to bill for services such as case management or intensive in-home services, but not for psychotherapy at the office, unless the client pays out of pocket. The for fee services would be things like services contracted by entities like courts, Community Corrections, probation and parole, Alcohol Safety Action Program, jail programs, or social services. This may involve intake evaluations, individual counseling, group counseling and psychoeducation. The focus may be mostly on groups. Groups can be for drunk driving offenders, possession of marijuana, underage possession of alcohol, family violence, and anger management. Groups may also be part of programs like intensive outpatient programs and partial hospital programs. You may also be asked to do breathalyzers and drug screens, including observing urine drug screens. You may also have to make reports to referring agencies like probation or social services.

You will also learn the ins and outs of the culture of the workplace. Some are very nurturing and mentor very well. At the other end are toxic places with lots of office politics rife with turf and ego wars. And many have a various mix of the two. Like most things, office cultures seem to follow a bell curve from very healthy to very unhealthy with most somewhere in between. You may run across hierarchies based on credentials and clashing philosophies. The practitioner as expert pathology-based medical model versus client centered strength-based recovery model are two examples of competing philosophies that cause friction in the workplace and a difference in ideas of how best to work with clients. How would you cope with that?

It is imperative that you research the places you are applying to as much as possible and make yourself a list of questions to ask when you talk to them. They are interviewing you to see if they want to work with you and for fit, but you are also interviewing them to see if it is a place you would want to be and if it would be a good fit for you. You may feel you need to positively impress them, but they also need to positively impress you for you to consider them. This research is crucial, particularly trying to talk to folks who work there to get an idea of what it is like. Management isn’t always straightforward on what the real conditions and expectations are like, so sometimes interviews have about as much predictive value as say an SAT or GRE for academic performance – none. Write out the questions you want to ask during the interview and take them with you so you are sure to remember them. It is useful, too, if you know someone who has gotten services at a place to talk with them and see how they were treated – more than one person if possible. Also people who make referrals to a place can be a help, though less so for various reasons. But I think those who get counseling from a place can give you a pretty good idea of the treatment philosophy of the program. Also talk to students and graduates who have been placed there before if you can. Find what kind of situations they were put in and what kind of guidance and mentoring they received or did not receive. Find out if there are individuals there who will advocate for you, and who can do so effectively. And always advocate for yourself, and that especially includes after you begin the placement. If things are not going well, do not wait to the end of the semester to bring up what has not been going well.

So if you are planning on starting a practicum or internship in the fall, the time to start working on it is now. You can find out more about the Virginia Counselors Association at http://www.vcacounselors.org/.

Share This Blog

Facebook Twitter More...

Enter your email address to follow this blog and receive notifications of new posts by email.

Site Archive

RSS Psychology News Feeds