Tuesday, December 27, 2011

Nietzsche and Tolstoy: Two book reviews.

I want to mention two book reviews that crossed my path this week that might be of interest to existentially-minded individuals. These works are not specifically psychotherapeutic in nature, but I believe that writers and philosophers throughout history have addressed themselves to the same concerns that trouble us in this modern world, and so I think it is always useful to maintain a connection with classic literature and philosophy.

The first is a review of Jennifer Ratner-Rosenhagen's book American Nietzsche. (The review is written by Thomas Meaney.) Nietzsche has been a topic of fascination for existential psychotherapists since Rollo May, and Irvin Yalom wrote a novel to answer the hypothetical question, "What if psychotherapy had been invented with Nietzsche as one of the first patients?" Yalom sees in Nietzsche a patient who views his intrapsychic difficulties (and in fact, physical difficulties, as Nietzsche is being treated for migraines in the book) as a source of strength, not as something to be avoided. Rather, the quote "What does not kill me, makes me stronger" is taken literally and shaped as a part of the treatment plan. (The quote is Nietzsche's own of course, from Twilight of the Idols.)

Nietzsche's gift to psychotherapy is quite large. Nietzsche questioned authority in a big way, writing "As long as the world has existed no authority has yet been willing to let itself become the object of critique." He insisted that meaning, purpose and morality could not spring from traditional beliefs and be unquestioned merely because they were traditional. He looked at the genealogy of ideas, engaging in a kind of psychoanalysis of the history of morality, and resolved that humans have responsibility to create their own meanings about morality--and even about existence. Today, the idea of taking a rigorous study of the source of a particular belief sounds like something we would do in a therapist's office, and we owe a debt to Nietzsche, who in his own way said, "Let's take a look at where these things that we believe to be true actually came from."

I have used Nietzsche's work in treatment myself--sometimes asking clients to read his work, sometimes just using quotations such as the one above, or "When we are tired, we are attacked by ideas we conquered long ago." Nietzsche's idea that we are constantly becoming ourselves--shaping ourselves into who we are--is a very useful idea for psychotherapists. According to the review of Ratneer-Rosenhagen's book, she shows how Nietzsche has been viewed by Americans since the publication of his works--both understood and misunderstood.

The second review is of Tolstoy: A Russian Life, by Rosamund Bartlett. (The review is written by Martin Rubin.) If for no other reason, Tolstoy deserves a place on the existentialist psychotherapist's bookshelf for the famous first line of Anna Karenina: "All happy families are alike; each unhappy family is unhappy in its own way."

Tolstoy has certainly given us much that is useful and engaging when it comes to examining our lives and our mental health. His short work The Death of Ivan Ilyich is one such work, which addresses the terror of death as well as the definition of a good life.

Of special note for psychotherapists who are also social workers: Leo Tolstoy was a great influence on Jane Addams, the mother of social work. She admired his ideal of working in solidarity with the "common person," rather than standing apart and working for change from a distance. She was an active admirer of Tolstoy until her death.

My favorite story of Jane Addams is of her visit to Tolstoy. Addams made a pilgrimige of sorts to visit Tolstoy on his estate, where he worked along side of the laborers. He met her dressed in working clothing, and proceded to comment on Addams' dress, criticizing her for wearing fashionable clothing rather that practical working garb. He also critiqued her for not working next to the laborers in Hull House. Addams was taken by this sentiment, and upon returning to Hull House she resolved to bake bread for two hours each day, as a way of living up to Tolstoy's values. However, she quickly saw the folly in this arrangement, writing: "The half dozen people invariably waiting to see me after breakfast, the piles of letters to be opened and answered, the demand of actual and pressing wants–were these all to be pushed aside and asked to wait while I saved my soul by two hours' work at baking bread?" (from Twenty Years at Hull House.) I think this story shows so clearly how Addams' idealism and vision were tempered by her practicality, as well as the beginnings of the professionalization of social work.

Thursday, December 22, 2011

A Christmas Carol: A model of psychotherapy?

I was working on my holiday cards the other day, which is mostly a mindless task. To keep myself entertained while addressing, folding, stamping and sealing, I was watching the 1984 version of A Christmas Carol, staring George C. Scott. I always enjoy this movie, and usually watch it once a year.

Apart from Scott's excellent portrayal of Ebeneezer Scrouge, and apart from the lush sets, I find the story to be an outstanding example a course of psychotherapy. I am sure that I am not the first person to recognize this, but I think that it is nice this time of year to remember that Charles Dickens foreshadowed modern psychotherapy in his short story.

(As a side note, Irvin Yalom says that it is a mistake to believe that the history of psychotherapy began in the 19th century, and that we should look to literature and philosophy for the true origins of the profession. I could not agree more. I came to be a psychotherapist through studying philosophy first, and becoming aware of human problems. I have also believed that it is useful to remember that the same delimias that plague humans today--death, relevance, meaning, power, and so on--have been the subject of and motivation for some of the greatest works of art and literature.)

So what can we learn from looking at Scrouge's journey to mental health? Well it usually starts with feeling that there is something that needs to be changed or resolved. In Scrouge's case, he receives a great existential wake-up call in the form of visitation from his former partner, Jacob Marley. As you remember, Marley was a man of great achievement in business, but as much (or more) of a miser as Scrouge. For his part, Scrouge had admired Marley's mind for business. But when Scrouge reminds Marley of his work ethic, Marley's restless ghost reflects on his priorities in life: "Mankind was my business. The common welfare was my business; charity, mercy, forbearance, and benevolence were, all, my business. The dealings of my trade were but a drop of water in the comprehensive ocean of my business!" Think of this as the intervention: Scrouge's friend--the only one he has in the world, as Dickens describes him as "solitary as an oyster"--tells him that he needs to change because Marley is worried about him.

Scrouge is then famously visited by three spirits. The first, the Spirit of Christmas Past, takes him to his childhood. He visits his old school and confronts his overbearing father, who we learn bears Ebeneezer a grudge because his mother died in his birth. We are reminded that Ebeneezer's beloved sister Belle died in the childbirth of Ebeneezer's nephew Fred, whom Ebeneezer spurns. We see the family patterns repeating here, and we begin to understand why Scrouge thinks and acts the way he does.

Further, we notice that Ebeneezer's upbringing was weak in attachment and empathy. He was not socialized in a loving family, but was turned over to a boarding school. This surely impacted both his ability to form bonds with his fellow persons and also possibly helped shape his work ethic, since schoolwork was valued above human attachment. We also learn that young Ebeneezer longed for human contact--he references his "beloved books" as though they were friends, in denial of the actual emptiness of his youth.

The Spirit of Christmas Past then shows Scrouge a scene from his time at Fezziwig's, in which Scrouge was happy and celebratory. Scrouge was surrounded by love, joy and human connection. For a moment, it looks like Scrouge has cast off his past of isolation and loneliness, and learned how to have satisfying human relationships. But there are underlying currents of discord: Fezziwig warns Scrouge not to put too much energy into his work, and to focus on finding a partner and starting a family.

The Spirit of Christmas Past is not done, as the process of excavation in therapy is often lengthy. She then shows Scrouge the Christmas eve in which Belle left him, as a result of his prioritizing his work over her. Scrouge becomes so distraught he refuses to see any more memories from his past. He attempts, as do many people, to put the blame for his unhappiness on the person who is reminding him of the memories that he would rather keep burred. But The Spirit of Christmas Past leaves him with a wonderful therapeutic sentiment: "You fashioned these memories yourself," reminding Scrouge that he must take ownership of his own life.

The Spirit of Christmas Present shows Scrouge, over the course of several scenes, the joy and love that exists in the here-and-now that Scrouge is refusing. They see the market place and children playing. Scrouge first sees only the money being transacted, and then is instructed by the Spirit to see more than that--to see the humanity all around him. Scrouge and the Spirit visit some of the citizens of London who are not as fortunate as Scrouge and his family, and even then Scrouge sees the love and connection as well as the hardship that Scrouge himself refuses to see. In this way, Scrouge confronts his privilege as well, and beings to think of his social responsibilities.

The Spirit of Christmas Present also takes a hard look at the way that other people view Scrouge: Cratchit and his family discuss Ebeneezer, as do his nephew and his party guests. They are not favorable in their assessment of Scrouge. At first, he defends his reputation, but as more and more evidence is gathered, his defense mechanisms begin to quiet down and he beings to see the reality that he is perceived to be a tight-fisted miser by others.

Finally, the most frightening apparition is the Spirit of Christmas Yet-to-Come. This Spirit will not speak to Scrouge, but forces him instead to draw his own conclusions, to make his own explanations. The focus this time is on Scrouge's death. The existential therapy here has been remarked on by many other clinicians: Scrouge must face and acknowledge his own death and his legacy. He must fact the fact that he is not grieved: The only person showing some emotion in relation to his death is a cleaning woman who is pawning his possessions. In contrast, Scrouge and the Spirit visit the Cratchit family, where Tiny Tim has died and is still grieved and missed. Scrouge is deeply shaken by this, and in terror he confronts his own lonely grave in a cold cemetery.

At the end of Scrouge's therapy (The spirits did it all in one night! Imagine how managed care would love that!), he makes a commitment to behavioral change, and engages that change. He finds that the real benefits of therapy come as he manifests real change in his life. Insight motivates the change, to be sure, but it is the generosity and kindness that he consciously engages that redeems Scrouge.

I encourage anyone who has any interest in mental health to watch whatever version of A Christmas Carol that appeals, and to notice the ways in which Dickens shrewdly lays out the workings of the human psyche. In particular, notice all of the interventions used on Ebeneezer Scrouge that are used in psychotherapy today. Apart from making a case for Dicken's deep understanding of human behavior, it shows that the great works of literature and art have much to teach when it comes to mental health and psychotherapy.

Tuesday, December 20, 2011

Holidays are what we make of them

While listening to to the radio on my drive home from the office, I heard an advertisement which reminded me that the "true spirit of the holidays is giving. And specifically, giving them the brand names that they want."

At one point I think the messages were limited to Christmas. But I suspect that somewhere along the line, advertisers realized that they were missing out on other opportunities to sell people stuff, and they broadened their message to include all the "holidays."

Now, the "Holidays are too materialistic" has become an old cliched trope, and I know it. But I think it is cliched for a reason--every year, we are assaulted from all sides from advertisements that are not selling us food or clothing or perfume, but holiday cheer and family harmony. The message that our lives will be better if we just purchase whatever product is on offer is not subtle.

On a par with this is the message that our holidays need to be perfect. Images of the holidays include immaculately decorations, well-dressed and smiling family members, and a lush spread of food. A Google search for "perfect Christmas" brings up "Pick the perfect Christmas gift," the "Perfect Christmas Tree," and Barbie's Perfect Christmas.

And so it deserves to be said, as it is every year, that the holidays do not have to be a frenzied time of over-spending and high expectations. Instead, this time of year can be a time to reflect on family, on the ending of one year, on celebrating what is good in our lives.

Instead of stressing over the perfect holidays, I can choose to take time to remember what it is about this time of year that is meaningful for me. I can remember traditions that I enjoy, and I can listen to music that makes me feel connected to the season and to my family. I can put up decorations that make me feel good, and I can eat foods that I associate with good memories.

Let me end by paraphrasing Nat King Cole: Although it's been said many times, many ways, remember that your holidays are what you make of them.

And a couple of links... Here is a blog entry from psych central with some ideas for gifts that do not cost money.

And below is a satirical video I found on YouTube that made me laugh.

Friday, December 16, 2011

How to Confront Privilege

I attended a great presentation on "Transgender 101" on Wednesday of this week, and the experience has caused me to think about what it is to challenge privilege.

I was talking with a colleague a few weeks ago about this specific training, and I said, "I'm looking forward to it, like I always look forward to opportunities to challenge my privilege. I think of it like working out--it's painful for a minute, but when you're done, you're better for the experience." To which my colleague replied, "Yes Matt, but not everyone enjoys working out. Some people avoid it for that exact reason."

I see that there is some truth in what my colleague said. So, I started thinking that there are certain skill-sets that might be useful in a wide range of contexts in which one is expected to confront privilege, be an ally, or work for social justice. So I thought I'd offer a quick and dirty list here, which is designed not to be specific ways to be an ally (there are lots of resources for that) but rather a "how do deal with the feelings you might have when you look at privilege." First, a disclaimer: This list is probably not complete, and represents my thoughts at this moment. With that said, I present...

Five Skills Useful in Challenging Your Own Privilege.

1. It's not about you personally.

It's really not about you as a person. It's about systems of oppression, systems that probably have in place for a very long time. It's not your fault that you may have benefited from white privilege, or heterosexual privilege. Whatever is being said or confronted, it's not a judgement on your own skills or work ethic or education. Which leads me to...

2. There is a difference between "fault" and "responsibility."

The fact that we live in a society that privileges certain groups over others is no one's individual fault. However, it is everyone's individual responsibility. There is an important difference here: "Fault" implies that an individual caused something, either directly or indirectly. "Responsibility" means that an individual takes ownership of something. No one individual caused any kind of oppression (by definition, because oppression is systemic); every individual is responsible for challenging and correcting oppression.

3. Avoid shame, and recognize that guilt doesn't help anyone.

Here's the thing about shame: It can make us feel powerless, disconnected, worthless, and anxious. Those are exactly the opposite of what is useful in confronting privilege. Further, when we feel shame, our first instinct is often to cover up whatever we are feeling shamed about. This is also not helpful, as examining privilege means being willing to talk about that which is often hidden. So ultimately, getting stuck in shame means that the likelihood that something is going to change are poor. If you are feeling shame, ask why, and examine that carefully.

Further, guilt does not help. Feeling guilty is not enough, and I do not believe that guilt is a sufficient motivator for long-term commitment. If you are feeling guilty, it is probably going to be useful to cope with that guilt: Examine where it comes from, see if you can shift it.

4. Trust.

Maybe this should have been #1, but I'm putting it here because I like to address emotions first. Essentially, it is important to trust that what you're hearing is accurate. When someone calls attention to the fact that you have privilege, or that society is tipped to favor one group over another, trust them. This is not the time to find counterexamples or challenge them on their logic--just trust them.

Now, not everyone is trustworthy, to be sure. If you cannot trust, then find someone you can trust. If you cannot find someone you can trust, ask yourself why. Can it be that everyone else is wrong?

5. Listen first, then act. But listen first.

Really, really listen. Listen carefully. If it helps to think that you will be tested on the material later, then think that. If it helps to take notes, then do that. When someone is sharing their experiences, listen. Do not change the subject. Do not shift the conversation to being about you and your experiences. Do not justify, or attempt to fix whatever is happening. Just listen first.

Once the listening is over (hint: That's when the other person stops talking, not before), then it's time for action. You may have to ask what kinds of actions will be helpful. You may be given a list, or some suggestions. But remember that listening comes first.

Monday, December 12, 2011

Can you tell how sexual someone is by looking at them?

Three studies caught my eye this morning. First, the question I asked above: Can you tell how sexual someone is by looking at them? According to this study from 2008, trained sexologists can tell how orgasmic a woman is by watching her walk.

Additionally, According to Gordon Gallup, an evolutionary psychologist at the University of Albany, you can tell by more about someone's sexual history by their handshake. He links a firm handshake (in men) to a host of factors: longevity, bone density, fat mass, and sexual behavior. Men with firm handshakes have more sexual partners, and begin having sex earlier.

Finally, this study from 2009 suggests that there is a correlation between a man's lean muscle mass and his sexual history: Specifically, more muscular men have more partners and begin having sex earlier.

All three studies have their limitations and raise questions, and could be subject to all kinds of scrutiny. I have only one that I would like to raise--that correlation is not the same as causation. In other words, while these studies look at the correlation between certain seemingly unrelated factors (1) and sexual behavior, there is nothing beyond speculation that accounts for this correlation. Evolutionary psychologists are likely to argue that anything that increases mating behavior is likely to be beneficial for an individual's chance at passing genes on, and thus the connection is in some way related to biological attraction. (One of the articles goes so far as to suggest just this--that the factor studied shows that the individual is more likely to be robust and to produce healthy offspring.) However, it could also be that definitions of masculinity and femininity in our culture account for these distinctions, as well. It could also be that our culture has evolved to value some traits over others, and the difference is related to natural selection, but cultural natural selection and not biological natural selection.

1) I say "seemingly unrelated," but I posted the article about men with more muscle mass having more sex to my Facebook, and my friends commentary could be summed up as, "Well, duh." Apparently, that connection is not seemingly unrelated.

Wednesday, December 7, 2011

Performance-based Masculinity

I came across this site today for "AlphaNail," a brand of nail polish marketed at men, and it made me think about masculinity-as-performance, masculinity-as-commodity, and the intersection of the two.

I've noticed an increase in the marketing of masculinity as a way of selling products to men. (Maybe I've noticed this because I am a white cisgender adult man, and therefore the target of much of this advertising.) A quick Google search confirms that bloggers and other commentators have noticed the same thing: Masculinity linked to consumption. Masculinity as a commodity that can be purchased.

(Interestingly, I want to note that I did a search for "Masculinity as Performance" and the Google Ads that came up were for PDE-5 inhibitors, like Viagra. Interesting and unintentional commentary, to be sure.)

I suspect that this is not a new thing. But I'm wondering what the effect of masculinity-as-consumerism is on individual conceptions of gender? Where do we get our ideas of what it is to be masculine? Certainly, advertisers are willing to sell us candles, irons, pop, anti-aging cream and other products to help us define our masculinity. But are we willing to allow part of our gender identifications to be crafted and shaped by advertising? And more--what if we do not fit into the traditional view of masculinity?

I spend a fair amount of time in my office talking to men about what it means to be a man, what it means to be masculine. Frequently, the identifying features are virtues like strength, flexibility, endurance, loyalty, devotion, protection, and so on. These are virtues that people generally want to have more of in their lives. (And I'm well aware that things like "loyalty" are not in any way the property of any one gender, but that's another article.) Lest the reader think I am portraying an overly-rosy picture of traditional masculinity, remember that these conversations are happening in a therapy, and so we do look at some of the less healthy attributes of masculinity: emotional numbness, rigidity, alcoholism, violence. For the sake of the individual's physical and mental health, we try to identify where these messages came from, and look at which values and attributes the person would like to commit to and which ones the person would like to let go.

And there's my concern with all of this, I suppose: It's hard enough to identify with masculinity in the context of a history that's equated masculinity with violence, patriarchy, and so on. It gets even harder when an advertiser is trying to sell something by playing to someone's perceived notions of manhood. For example, on this page on the "AlphaNail" website, to the right, is a picture which could have the subtitle, "It's OK to wear nail polish as long as you punch someone in the face." Is this how we want masculinity to be defined?

Monday, October 31, 2011

Horror and the Psyche

In honor of Halloween, I want to point out Christian Jarrett's great little piece in The Psychologist on the experience of horror and the psyche. Horror is a human emotion, and it seems like a primal one. It's often described as a blending of disgust and terror--certainly the kinds of feelings that we like to attribute to our more animal selves. Of course, the experience of subjecting oneself to horror would be a uniquely human experience, and both the reasons why we might seek horror and the types of things we find horrifying can offer an insight into the psyche.

Jarrett points out that the common villains in horror movies are frequently animals, or humans with exaggerated animal-like characteristics, such as giant claws or a taste for human flesh. And because I am a social worker, I have to ask what kinds of cultural scripts are also depicted in horror movies. And that's why I want to point to another piece, this one from last June's Sex Roles, called "On the Perils of Living Dangerously in the Slash Horror Film" examined one common trope in horror movies: The promiscuous girl gets killed. The researchers here examined 50 films, and concluded that yes, the more sexually active a female character is a horror movie, the more likely she will die, and the more violent and prolonged that death will be.

Tuesday, October 11, 2011

National Coming Out Day

Today is National Coming Out Day.

According to Wikipedia: "NCOD was founded in 1988 by Robert Eichberg, a psychologist from New Mexico and Jean O'Leary, an openly-gay political leader from Los Angeles." Interesting, but not surprising, that a mental health professional would create a holiday for LGBT people to "come out." I want to write a bit about coming out as an important part of a queer person's mental health and wellness as well as an act of activism--and that those two are linked.

In my practice, I often hear questions of whether or not it is important to come out of the closet. When I was in graduate school, I was taught that coming out of the closet was an essential part of mental health for LGBT people. I clearly remember the instructor, a well-known and respected psychotherapist, saying, "The closet is a coffin." I am sure that, being the high-achiever that I am, I wrote this down dutifully in my copious notes.

After years of practice in the field, I have change my tune about coming out. I have seen that the human experience is too diverse to be captured in simplistic terms like "the closet is a coffin." Questions immediately come to mind: To whom are you coming out, and how? How many people does one have to come out to in order to have good mental health? And of course, there are people for whom coming out is not a good idea. The reality is that some people would make their lives significantly worse by coming out of the closet.

And that last thing--the reality that some people's closet doors are nailed shut for safety's sake--is what brings me to my second point today: Coming out, because it can be dangerous, is also a political issue. Yes, it's a mental health issue, as evidenced by the fact that one of the founders of the holiday was a clinician. But the other founder was an activist, and that reminds us that coming out is an act of activism.

On the personal level, coming out is activism because it goes against heteronormative society, certainly. But beyond that, the more people come out, the easier coming out is. The more people get active and work to change and challenge a society that penalizes LGBT folks just for being LGBT, the easier it is to come out. (Not that it will get truly "easy"; note my use of the word "easier.") The more people who are on the side of LGBT liberation, the more success we have. And the more people are out of the closet, the more normalized LGBT becomes.

Activism, among other things, is aimed at reducing emotional stress through systemic changes: Successful activism can change or eliminate structures of control that contribute to emotional distress in individuals. This connection between interpersonal wellness and social change is one reason that I am a proud social worker, as it happens, but that is a separate essay.

So on this National Coming Out Day, I am choosing to remember that my coming out was made possible by the LGBT people who came before me, and will in some small way make it easier for those who have yet to come. And I am choosing to remind myself of the progress that we have made, and to look with hope and optimism to all that we can accomplish in the future. And I can see, today, how the personal can be political, and how mental health and activism are linked.

Here is a link to "An Open Letter to my Legally Superior Heterosexual Friends, Family, Colleagues, and Acquaintances, by Karl Frisch. I thought this summed it up nicely.

I’ve been open about who I am for ten years now. My parents still love me. My friends have stuck by my side. The jobs I’ve had in these years since coming out treat their gay employees with equality and respect. I’m lucky in that regard because for many people that is not the case. The freedom I now feel is amazing but that freedom is also limited.

Wednesday, October 5, 2011

Midlife crisis: Existential crises in disguise?

In this entry of his weekly blog, Jesse Bering looks at the notion of a "midlife crisis." He first mentions that the definition of a "midlife crisis" has shifted over the years. First, it meant a crisis of creative potential. Now, it commonly refers to that awkward age in which a man's fancy turns towards thoughts of sports cars and younger partners.

(Two parenthetical things I want to mention about this piece. First, I can't ignore Bering using the term "co-eds" when used to refer to female students, as though male students are somehow the default "eds." But then, Jesse is a psychologist and not a social worker, and we social workers are more likely to be concerned with such things as gender equity. I am willing to overlook it, but I did have to mention it. Second thing: I have seen plenty of gay men who have turned their thoughts to young men suddenly in their middle years. So while this may not be the kind of thing that Queer liberation activists want to fight for, I do not think this phenomena, if it existed, is limited to heterosexuals.)

In that last line where I write "if it existed" I betray the conclusion of Bering's article: The existence of the midlife crisis is not supported in the research. Bering reviews the literature, so I'm not going to summarize it here.

Instead, I want to mention that a mid-life crisis is fundamentally an existential crisis--a questioning of meaning, of purpose, of relationships, and an awareness of impending death. And existential crises can occur at any age, certainly, and there is no reason to assume that midlife would be any more likely to produce such a crisis than any other point.

Of course, that knowledge will not likely stop anyone from labeling their crisis of meaning/increased fear of death that occurs between 35 and 50 as a "midlife crisis." Call it what one wants--I can emphatically state that I've seen plenty of people in my office who reach a point in their lives somewhere between 35 and 50 and start to wonder, "What am I doing with my life, really?" And, in my opinion, that is a question worth exploring. And so I wonder if having the cultural concept of a "midlife crisis" could give people an opening to normalize some of these questions. I am not certain that it does, by any means, but I wonder what effect being able to say, "It's just a midlife crisis" has on any kind of existential concerns that a man who fits the definition of "midlife" might be feeling.

Tuesday, September 27, 2011

Emotions come in waves

I stumbled across this little article today, which reminds us that emotions come in waves. They have a beginning, a middle, and an end. And most importantly, emotions do not last forever.

A quick quote:
An emotion cannot hold you permanently. Every individual wave of emotion is merely a temporary state. Your mind and body are constantly in motion and are, in fact, incapable of maintaining a permanent, singular state of being. We're dynamic by nature and time rolls on, utterly unstoppable.
I often say this to clients. The one thing that I can confidently say about any emotion is that it will not last forever. It will change, shift, and mostly like it will go away after time. It's important, in the middle of intense fear or sadness or whatever, to be able to remember that emotions are temporary states.

Here is the full article. 

Monday, September 26, 2011

Inner landscape: a reflection on praxis

I am partial to decorating my office with photos and paintings of landscapes. When I was in graduate school (which seems like forever ago now), I described psychotherapy as "the process of exploring an inner landscape." At the time, the professor for whom that paper was written very much liked this description, and I believe he read it aloud to the class. (Side note: Isn't it fascinating how things can be both embarrassing and validating at the same time?)

I still think that turn of phrase is a good description for what we do in therapy. I do not think that happiness is necessarily the goal of psychotherapy--happiness is elusive and can be obtained through other means. Sometimes, happiness is a goal of therapy to be sure, but more often clients come in with concerns that start with the same interrogative pronoun: "Why." "Why do I feel sad?" "Why do I feel anxious?" "Why am I lonely?" "Why do I do things that I cannot control?" Interestingly enough, the question "Why am I not happy?" is not a question about happiness--telling for grammaticians who will notice that the subject in the sentence is not "happy," but the pronoun "I", which points accurately that the question reflects more in the person asking it than on the state of happiness.

In any case, the questions asked by a client in therapy are often resolved through introspection and questioning. The metaphor of exploring a landscape is a good one here, and I often ask clients, "Just talk about that--explore the territory." In the same sense, my job as therapist is not quite the job of being a guide--it's more the job of being an outfitter. I am prepared to cope with whatever terrain we may find, but I am not leading the expedition.

This kind of therapy is becoming less and less popular with the people who get to tell us what kind of therapy we should be practicing--HMOs are a popular target, but many academics must share the blame for the shift in focus from process-orientated psychotherapy to outcome-orientated psychotherapy. I suspect the shift from academic circles came from a desire to make psychotherapy measurable--social scientists who wanted clinical psychology and social work to stand up next to fields like biology and chemistry, in which hypotheses are measurable and testable. The ironic part is that the drive to measurablity has actually made the process of psychotherapy less measurable: The focus on outcome has overshadowed the means by which the therapist-client dyad actually reaches this outcome.

But why do we assume this is a good idea? Is the goal of therapy to provide good therapy, or is the goal of therapy to provide standardized outcomes? Why does our profession assume that the best process is that which provides easily-comparable outcomes across a wide swath of humanity? Consider two clients who both present with that most common therapeutic concern: Depression. One client is a young, successful and wealthy male who feels that he has achieved everything he has ever wanted in life, but is unhappy and does not understand why he is not pleased. The other client is a middle-aged, working-class male who has been depressed his entire life, and despite going through multiple courses of therapy, has not ever been able to reach a point in his life in which he does not feel depressed. These two people are different and present with different concerns--but likely they would be met with the "Cognitive-Behavioral therapy is an evidence-based intervention for depression" clinical disposition, and given very similar treatments.

But when it comes time to measure the outcome, what have we measured?  We measure symptoms--do you sleep better? Are you crying as much? Are you as sad as you were 3 months ago? While that may be useful information, I have to ask the question: Do you have any further grasp on why you feel depressed? Do you have a sense of whether or not this may be a life-long concern for you? And can you accept your depression, if it is? In other words, are you any closer to answering the question that brought you into therapy? Do you have an understanding of your inner landscape, or are you just more likely to answer questions about your behavior in ways that make researchers happy?

Wednesday, September 21, 2011

Quick update: Two good articles

I came across two interesting articles today. The first one, by Robert Weiss LCSW, asks the question, "Can women be sex addicts?" Certainly, the answer seems to be, "Yes." But then, why is it only male sex addicts we hear about in the news, and why do men seek treatment for sex addiction more than women do? (The author points out that the percentage of women entering treatment for sex addiction mirrors the percentage of men entering treatment for eating disorders.) He suggests that our cultural context has everything to do with how we view sexual addiction. 

A quote:
Even the woman whose sexual and romantic behaviors are causing her profound problems  (health, family, relationship, career, etc.) is not likely to identify as having a sexual problem, she is more likely to use terms like, “I have relationship issues” or “I tend to pick the wrong partners.” 

The full article is here

The second article, also by Robert Weiss, is "The Do's and Don't's of Healthy Dating for Sex Addicts," has some great tips on how to approach dating in a way that is healthy and, more importantly, enjoyable. The article is good reading for everyone, not just sex addicts. (I would suggest that the article be re-titled, "The Do's and Dont's's of Healthy Dating for Everyone.")

Some of the common-sense (but surprisingly uncommon!) tips he gives are:
Do look at your dates as potential friends. Ultimately a having a solid friendship is how you build anything long-term.

Do try to learn about the person you are dating. Find out their passions and interests. Make sure to focus on them as much as you share yourself.

Don’t go to bars alone looking for a date – you may get laid, but not likely loved.

Don’t call, email or text them daily, no matter how good it felt being together. Try to let the dating take its own course.

The full article is here

Saturday, September 10, 2011

Philosophy and psychotherapy

I came across this article in the Washington Post about "Philosophical counseling." I had heard of philosophical counseling before, when I was an undergraduate majoring in philosophy at Michigan State. I seriously considered philosophical counseling as a career--and today, I would consider myself a philosophical psychotherapist.

Here's a quote from the article:

Patricia Anne Murphy is a philosopher with a real-world mission.
Murphy may have a PhD and an intimate knowledge of Aristotle and Descartes, but in her snug Takoma Park bungalow, she’s helping a broken-hearted patient struggle through a divorce.
Instead of offering the wounded wife a prescription for Effexor — which she’s not licensed to do anyway — she instructs her to read Epictetus, the original cognitive therapist, who argued that humans often mistake their feelings for facts and suffer as a result.

I support their intentions, with one major caveat: It is  incorrect for philosophical counselors to assume that they are the only ones applying philosophy to every-day problems. I have asked many of my clients to read Epictetus and Sartre. (Well, not as much Sartre, as he can be a big obtuse.) I have quoted Nietzsche and Kierke­gaard to clients. I frequently encourage clients to discuss epistemology or ethics when they are confronting difficulties in their lives, as appropriate. And I am not a philosopher; I am a therapist, with a master's degree in social work. (Side note: One of the nice things about being a social worker is that I had a very broad liberal arts education before I got my master's degree.) And I am not alone--I know dozens of other psychotherapists who apply philosophical principles to their practice.

Never the less, the article is good, and addresses the reality that philosophy (and literature and art, as well) are means through which people can examine the concerns they have in their daily lives.

Read the whole thing here.

Friday, September 2, 2011


Over the course of the past week I've heard clients say, in some way or another, that they hate their own weakness. I want to take a minute today to write what my feelings are on the subject. 

So I have to ask: What's so terrible about weakness? Where did we ever learn that we have to be strong all the time, regardless of circumstances? And what is the cost of pretending to be strong?

There is not shortage of messages that tell us we should be strong, in our media, from our families, from our jobs. Signs of weakness are undesirable in so many situations. Consider what happens if a presidential candidate cries, if a doctor says "I don't know," or if a parent admits making a poor decision. 

Beyond that, our reluctance to express weakness can keep us isolated. If I am not willing to show my weakness, I am reducing the quality of intimacy I can have with other people. Maybe I am not willing to be that intimate with everyone, but if I never show weakness, I am keeping an important part of myself from other people. 

One of the costs of ignoring or avoiding our weakness is that we lose our opportunity to develop actual strength in that area. I am fond of physical metaphor, so let me use one here. Suppose I am a powerlifter who has a weakness on one of my lifts. Or, suppose that I am a baseball player who has a weakness in some part of my game. If I am training for my particular sport, be it lifting or baseball, should I train the things that I do well, or should I train my weakness? If I train my weakness, I take the risk of looking foolish. But if I do not train my weakness, I will not improve my overall performance. 

Likewise, when we avoid that which we perceive as our weakness in our mental or emotional health, we avoid the opportunity to address our weakness, and possibly overcome it. 

The truth is that we all have weakness. We can compensate for them in various ways, but if we want to develop resiliency, if we want to face our worlds with our best possible selves, then let us acknowledge our weaknesses--and try to do it despite our fears. 

Tuesday, August 30, 2011

Is the way to someone's heart through the nose?

Much has been made of human pheromones, in science and in industry. Advertisements for pheromone-enhanced perfumes grace the back pages of magazines, and a Google search of "Human Pheromone" turns up thousands of results, offering magic love potions just waiting to be applied. But is there any truth in it?

 Randi  Epstein, writing in Slate, looks at the evidence and says "No." Or, at least, none that we can prove. The idea that human attraction is based in pheromones is based on refuted research, and Epstein spells out why.  

However, the science between human attraction and arousal is far from being complete, and it does appear that scent plays a role. For example, do you remember that study that showed that the scent of a woman's tears was a turn-off for men? (Here's a link to the NYTimes coverage.)  The question is, of course, is this nature or nurture? 

Without a doubt, scents can be associated powerfully with memories. (Think of the smell of Christmas, or of grandma's house, for example.) But it seems this is likely to be learned. And as for pheromones, Epstein would likely advise us to save our money:

This shift in thinking is really quite liberating. It means, for one thing, that we may have more complicated relationships with our men than a female silkworm moth has with hers. It also means that we're not programmed to respond in one particular way but that we can learn—indeed, train ourselves—to respond to an odor the way we want to.

Link to the Slate article

Thursday, August 25, 2011

Rollo May on psychotherapy

In this video, Rollo May expresses his feelings of dissatisfaction with the state of modern psychotherapy. He says that psychotherapy that "patches a person up and sends them out" isn't real psychotherapy, and that the goal of real psychotherapy is to make the "unconscious conscious." Interesting perspective from one of the great minds in the field.

Thursday, August 11, 2011

Relationship Myths

Here is an interesting little piece about three common relationship myths. I hear some of these in my practice from time to time. The author addresses why there is no "the one" for a person, why longevity in relationships can be questioned, and why it is important for people to be whole individuals in order to have healthy relationships. It's a short piece, and a fast read.


Wednesday, August 10, 2011

Inside Schizophrenia

This NYTimes article about a man living with schizophrenia is good reading. It shows the reality that chronic and persistent mental illness is just that--chronic and persistent. It is something that one lives with, managing day by day, for the rest of one's life. Here's a quote:

In recent years, researchers have begun talking aboutmental health care in the same way addiction specialists speak of recovery — the lifelong journey of self-treatment and discipline that guides substance abuse programs. The idea remains controversial: managing a severe mental illness is more complicated than simply avoiding certain behaviors. The journey has more mazes, fewer road signs.

Yet people like Joe Holt are traveling it and succeeding. Most rely on some medical help, but each has had to build core skills from the ground up, through trial and repeated error. 


Wednesday, July 20, 2011

When does safety become sheltering?

This article from the New York Times suggests that taking risk away from children's play can actually be detrimental to their emotional health in the long-run:
“Children need to encounter risks and overcome fears on the playground,” said Ellen Sandseter, a professor of psychology at Queen Maud University in Norway. “I think monkey bars and tall slides are great. As playgrounds become more and more boring, these are some of the few features that still can give children thrilling experiences with heights and high speed.”

This reminds me of those e-mails and Facebook messages I see occasionally, that say something to the effect of "When I was a child we played outside and drank from the hose, we survived and today's children should do that too." I suspect that each generation bemoans the way the current generation of children is being treated, but I also think that that this article has some merit. I wonder if it's possible to have a discussion about the value of raising children with some risk without turning it into a rant about "kids these days." 

Original article here. 

Monday, July 18, 2011

Antipsychotic medication on the rise

The opening line of this article from Aljazeera says it all: "Has America become a nation of psychotics? You would certainly think so, based on the explosion in the use of antipsychotic medications."

Prescriptions for antipsychotic medications have exploded, to the point where antipsychotics are the top selling type of medication, even more so than drugs used for high cholesterol and acid reflux. As a therapist, I certainly believe this. I frequently see clients who are prescribed antipsychotic medication, who disclose that their physician gave it to them "for help sleeping," or even for depression. But the really interesting part of this article comes later, when the author suggests that the rise in prescriptions may be a result of the marketing strategies of pharmaceutical companies, and that the medications being prescribed may not actually be helping patients. 

This is not the first article of this type, but it is worth a read. 

Here is the article:  Mass psychosis in the US.

Thursday, July 14, 2011

The connection between anxiety and activity

An interesting piece of research from Southern Methodist University suggests that individuals who engage in high levels of physical activity are less likely to have anxiety and panic:
People with an intense fear of the nausea, racing heart, dizziness, stomachaches and shortness of breath that accompany panic — known as "high anxiety sensitivity" — reacted with less anxiety to a panic-inducing stressor if they had been engaging in high levels of physical activity, said researchers at Southern Methodist University in Dallas and the University of Vermont in Burlington.

The research is worth looking at, but the methodology raises questions about the practicality of using this in treatment. Often, people with anxiety are encouraged to use physical activity as a way of reducing the anxiety; this research raises the question (but does not answer it) of whether or not the level of activity matters. In other words, do those who exercise more intensely suffer less from anxiety than those who exercise moderately? That is a question worth answering, I believe.

Here is the article. 

Monday, July 11, 2011

Reparative therapy and politics

I try not to post anything too political on this blog. But the recent revelation that Marcus Bachmann, husband of current presidential candidate Michelle Bachmann, practices reparative therapy is something that I feel is of interest to those who are concerned with mental health as a profession. 

Reparative therapy--psychotherapy designed to "cure homosexuality" by helping same-gender-loving people learn to repress their feelings and act like heterosexuals--has been discredited by every major mental health association in the United States. It is unethical and damaging. 

This article in The Daily Beast by Michelle Goldberg sums up nicely what the problem is with reparative therapy, and why it's a big deal that the husband of a presidential candidate owns a clinic which practices it. A quote:
Why does any of this matter? Bachmann may be dishonest about his practice, but he’s not the one running for president. Yet in describing herself as a small-business owner, Michele Bachmann clearly takes partial credit for Bachmann & Associates, and so its activities reflect on her. 
Consider what it would mean for GLBT citizens of the US to have Marcus Bachmann, PhD, living in the White House. It is not hard to imagine that giving Mr. Bachmann access to a national microphone could be detrimental to the mental health of millions of queer Americans. 

Original article here. 

Thursday, June 16, 2011

Fathering tied to sexual behavior in daughters

This article suggests that high-quality parenting from a girl's father can reduce risky sexual decision making later in life.

Comparing sisters in the same family, the study showed that living for longer periods of time with a dad who provided high-quality fathering reduced risky sexual behavior.

More time with a dad who provided low-quality fathering actually increased risky sexual behavior.

The article doesn't tell us what "high-quality fathering" is, but I look forward to reading the article when it is published. 

Tuesday, June 7, 2011

Therapy to change "feminine boy" caused long-term problems?

This article details a tragic story of a young boy who undergoes therapy to become more masculine, and later kills himself at age 38. It is worth reading to remember that therapy that seeks to change orientation or gender expression often does more harm than good. 

Teaser quote:

In 2003 at age 38, Kirk Murphy took his own life.
A co-worker found him hanging from the fan of his apartment in New Delhi. His family has struggled for years to understand what happened.
"I used to spend so much time thinking, why would he kill himself at the age of 38? It doesn't make any sense to me," said Kirk's sister, Maris Murphy. "What I now think is I don't know how he made it that long."
After Kirk's death, Maris started a search that would uncover a dark family secret. That secret revealed itself during a phone conversation with her older brother Mark, who mentioned his distrust of any kind of therapy.
"Don't you remember all that crap we went through at UCLA?" he asked her. Maris was too young to remember the details, but Mark remembered it vividly as a low point in their lives.

Read the whole thing here. 

P.S.: It is worth noting that the therapist who treated Kirk Murphy was George Rekers, who is the prominant right-wing figure who was caught last year on vacation with a rent boy.

Friday, June 3, 2011

Is decreasing lead poisoning related to decreasing crime?

This article over at Wired looks at the link between lead poisoning and crime--in particular the theory that correlates the decrease in exposure to leaded gas and lead paint over the past 50 years with the decrease in crime over the same time period. The basic idea is that childhood lead poisoning impacts the part of the brain that is associated with decision making, impulse control and mood regulation. The whole article is worth reading. 

Teaser quote:

In recent years, neuroscientists have made important progress in identifying the precise mechanisms by which lead exposure reduces impulse control. Here, for instance, is a recent PLOS study from the Cincinnati Lead Study, in which the blood lead level of babies born in poor areas of Cincinnati were repeatedly measured between 1979 and 1984. Twenty years later, the researchers tracked down these subjects and put them in MRI machines, allowing them to measure the brain volume of participants. The researchers found that exposure to lead as a child was linked with a significant loss of brain volume in adulthood, particularly in men. Furthermore, there was a “dose-response” effect, in which the greatest brain volume loss was seen in participants with the greatest lead exposure. What’s especially tragic is that the loss of volume was concentrated in the prefrontal cortex, a part of the brain closely associated with executive function and impulse control. 

Thursday, June 2, 2011

When does grief become a mental illness?

Certainly, grief is a part of life. It is one of many experiences that comes with the territory of being alive in the world--we lose things, and we feel pain around the loss. So when does ordinary grief become a problem, and who decides what constitutes "ordinary grief" and "abnormal grief?"

This article from Scientific American covers two proposed changes to the DSM-V that would classify grief differently:

In the less controversial change, the manual would add a new category: Complicated Grief Disorder, also known as traumatic or prolonged grief. The new diagnosis refers to a situation in which many of grief’s common symptoms—such as powerful pining for the deceased, great difficulty moving on, a sense that life is meaningless, and bitterness or anger about the loss—­last longer than six months. The controversial change focuses on the other end of the time spectrum: it allows medical treatment fordepression in the first few weeks after a death. Currently the DSM specifically bars a bereaved person from being diagnosed with full-blown depression until at least two months have elapsed from the start of mourning.

There is much talk about the new DSM-V, and this proposal will likely ensure that the discussions continue.

Wednesday, June 1, 2011

Remembering Carl Jung

Carl Jung is one of the pioneers of mental health who not only influenced the field, but also captured the attention of popular culture. Terms like "collective unconscious" and "Jungian" have become part of everyday speech. The Guardian has begun a series examining the life and work of Carl Jung, who died 50 years ago on June 6.

From the article:

If you have ever thought of yourself as an introvert or extrovert; if you've ever deployed the notions of the archetypal or collective unconscious; if you've ever loved or loathed the new age; if you have ever done a Myers-Briggs personality or spirituality test; if you've ever been in counselling and sat opposite your therapist rather than lain on the couch – in all these cases, there's one man you can thank: Carl Gustav Jung.

Here is the original.

Friday, May 27, 2011

Old MacDonald had a Farmer's Market

I just came across this piece called "Old MacDonald Had a Farmer's Market: Total self-sufficiency is a noble, misguided ideal."  It's a great look at how interdependence is required for human flourishing, even when the image of the self-sufficient hermit is appealing. As a therapist, I think his analysis of connection and happiness is worth reading. 

The idea of self-reliance is so deep in our psyches, however, that even when we attempt to escape from the unhappy and unsustainable cul-de-sac of our society, we’re likely to turn toward yet more Publish Post“independence.”

Thursday, May 26, 2011

Atypical Antipsychotics in Children and the Elderly

This article in Time about using psychiatric medication on vulnerable populations (in this case, the elderly and children) raises some concerns about the way we use and view psychiatric medication in general. It also makes the point that: "Second-generation' antipsychotics like Geodon, Zyprexa, Seroquel, Abilify and Risperdal rake in more money than any other class of medication on the market and, dollar for dollar, they are the biggest selling drugs in America."

Certainly, antipsychotics and other psychiatric medications have made huge differences for people, and have saved lives. At the same time, the popular consciousness seems to be shifting into a more active and informed roll about what psychiatric medication can and cannot do for someone. 

From the article:

Pharmaceutical companies have recently paid out the largest legal settlements in U.S. history — including the largest criminal fines ever imposed on corporations — for illegally marketing antipsychotic drugs. The payouts totaled more than $5 billion. But the worst costs of the drugs are being borne by the most vulnerable patients: children and teens in psychiatric hospitals, foster care and juvenile prisons, as well as elderly people in nursing homes. They are medicated for conditions for which the drugs haven't been proven safe or effective — in some cases, with death as a known possible outcome.

Tuesday, May 24, 2011

Atheists have better sex than theists?

Who has better sex, atheists or theists? According to this piece, atheists have better sex because they are less likely to feel guilty about it:

Atheists have far better sex lives than religious people who are plagued with guilt  during intercourse and for weeks afterwards, researchers have found.
A study discovered that non-believers are more willing to discuss sexual fantasies and are more satisfied with their experiences

If this is true, it certainly has implications for sex therapy. I doubt that this means that people will have to stop being religious, but perhaps spirituality and religion will need to become more active topics of discussion in therapy. What would be interesting follow-up research--what separates those who are religious and have good sex from those who are religious and do not have good sex? My suspicion (completely unscientific speculation!) is that the factors that equal good sex in the religious are not the same as those that equal good sex in atheists.

Read more here. 

Top 10 Myths about the Brain

Here is an excellent article from Smithsonian.com entitled "Top Ten Myths about the Brain." I hear many of these myths all the time. I highly recommend reading the article--and in fact, learning as much as possible about how the brain works. 

Here is a sample: 

4. We have five senses. Sure, sight, smell, hearing, taste and touch are the big ones. But we have many other ways of sensing the world and our place in it. Proprioception is a sense of how our bodies are positioned. Nociception is a sense of pain. We also have a sense of balance—the inner ear is to this sense as the eye is to vision—as well as a sense of body temperature, acceleration and the passage of time.

Read the rest.

Monday, May 23, 2011

Men earn only one in five of all master’s degrees awarded in psychology, down from half in the 1970s. They account for less than 10 percent of social workers under the age of 34, according to a recent survey. And their numbers have dwindled among professional counselors — to 10 percent of the American Counseling Association’s membership today from 30 percent in 1982 — and appear to be declining among marriage and family therapists.

I have certainly noticed the lack of male therapists when attending continuing education and professional association meetings. Once upon a time the stereotype of a therapist was an older man--complete with gray hair, a pipe and a jacket with patches on the elbows. Now, therapists are more likely to be female. 

Of course there is absolutely nothing wrong here. But some clients prefer a male therapist, and will sometimes have difficulty finding one. The article addresses this, and some of the factors that may have changed the profession over time.