Wednesday, May 15, 2013

Heroic Treatment Plan

I saw Iron Man III over the weekend. After discussing the portrayal of PTSD with a colleague, and after coming across this article by Travis Langly, I began to wonder what a treatment plan for Tony Stark would look like.

So I took a few minutes and wrote a treatment plan for Mr. Stark. Here it is.

(Click to see the larger versions.)

Monday, May 13, 2013

Wednesday, May 8, 2013

A modest proposal for the DSM-5

I have a proposal to address some of the criticism of the DSM-5, and all future DSMs, and any other mental health manuals. My proposal is still pretty rudimentary in my own mind, so bear with me while I sort it out in a public way.

Here it is, basically:

Stop trying to create a manual that works for both psychotherapy and for psychiatry. 

Here's the thing: The wants of psychotherapists and of psychiatrists are different. Broadly speaking, psychiatrists want to know what the mechanisms are behind disorders so they can more accurately provide chemical interventions. Whereas psychotherapists want to know what clusters of symptoms respond to what interventions. Psychiatrists want to know how to provide the most effective chemical for a given clinical presentation. Psychotherapists want to know what techniques to use with someone who is reporting symptoms like crying spells or panic attacks.

Many of the critical voices from the psychiatric community want mental health to have more of a biological basis. These folks want to understand the biology of mental disorder--they want to move away from classifying symptoms, and towards classifying underlying biology.

But the criticisms of the DSM-5 from the psychotherapy community are often focused on the increased medicalization of normal life experiences. In other words, the psychotherapy community and the psychiatry community have opposing desires. One side wants to reduce mental health to biology of the brain, the other side wants to see mental health as a holistic part of human life.

So, as a revolutionary step, what would happen if we took psychotherapy away from a medical model all together? We know that if a person presents with symptoms of depression, we can engage them in cognitive-behavioral therapy for depression and get good results regardless of biology of the brain. If someone presents for anxiety, we can work on anxiety-reduction and management techniques, regardless of what a brain scan shows. Psychotherapy is always focused on symptoms, and that's not a bad thing. In fact, that's the point: People come to mental health treatment because of symptoms, and they want relief from symptoms.

Further, clients who present with adjustment issues, or grief, or any of the other countless parts of a normal life that cause someone to want to see a therapist, do not need to be shoe-horned into a diagnosis that they do not fit. And, we can treat these normal life issues as just that--normal life issues--that are not pathology.

The reality is that it might be impossible to create a manual that identifies disorders based on biology and also on symptoms. And maybe it is in our best interest to stop trying.

Friday, May 3, 2013

One day...

One of the biggest myths that constrain us in unhappy patterns is this: “One day, everything will be different.” Whether this is in our careers, our relationships, our financial lives, or something else, we often carry this belief that one day, everything will be different.

We hope for that someday when we have the job we want, or the body we want, or the partner we want (or that our current partner will change), or the security we crave. On that day—and not before—we will be able to move forward with our lives. We postpone living, being happy, feeling good, for some distant day in which everything is changed to be what we want. 

Sure, it is a good thing to make positive changes in our lives. I am not suggesting that we stop moving forward in the direction of our dreams. But I am reminded that "life is what happens when we are making other plans." Can we be OK with where we are, even if we are working for change?

One of the things I sometimes tell clients is this: “There will never be a point in your life in which you have everything you want with perfect security.” I believe it is preferable to face a hard truth than to deny it. The reality is that craving for something different is rarely satisfied by having that thing. (Sure, there are exceptions, but if we have our needs of food, shelter and love basically met, then we are not one of the exceptions.) The question is not how do we get everything we want, but rather how do we engage our lives in the face of discontent?

Wednesday, May 1, 2013

Professional athlete comes out... what does the response say about us?

Did you hear about the basketball player who came out of the closet? Her name is Brittney Griner, and she's played for Baylor University. She's the #1 draft pick for the WNBA, and her coming out is certainly a momentous occasion for professional sports...

Wait... Is she not the basketball player you were thinking of? Perhaps you were thinking of Latasha Byears, who is one of the best players in the WNBA's history? No? Maybe you were thinking of Sheryl Swoopes? Or  Michele Van Gorp? Maybe Sue Wicks? Maybe Ann Wauters?

No, of course not. You were thinking of that Jason Collins fellow, surely. But I think I make a point that there is already a list of professional women basketball players who are out, and for whom there is little fanfare.

I don't want to take anything away from Jason Collins. Coming out of the closet is a Big Deal. Having the courage to step into one's authentic life is an act of revolution. I am fully supportive of Mr. Collins.

Further, I do hope this paves the way for other athletes to come out, regardless of what league they are playing in. Professional athletes deserve to live their authentic truth, too.

Even further, I want to support and recognize what Mr. Collins actually said: "I'm a 34-year-old NBA center. I'm black. And I'm gay." This might be a way to start talking about the intersection between race and sexual orientation, and that would be a good thing for our culture as well.

But our national news media is not interested in those things, by and large. This is not a story of a man trying to live his truth. If that were the story, it would have been just as big a news story when the athletes I listed earlier came out.

The point of this little post is this: Mr. Collins' coming out of the closet is a big news item for two reasons. One, because it might discomfort heterosexual men, who are the only ones anyone is talking about. ("Will the fans follow him? What will his fellow teammates think?" Notice the assumption here that the fans and teammates are heterosexuals who are likely to be threatened, and not queer folks who are likely to feel validated.) And two, because it might cost someone some money. ("Will people still watch? Will sponsors back out?")

It's still early days on this, and maybe someone else will say something more insightful later, and I'll be able to post a link to that. But for now, I think it is always interesting to notice when the power lines of our culture are exposed. And here, it's about heterosexual privilegehegemonic masculinity, and profit. And so good for Jason Collins coming out of the closet, and challenging those things.