Was Dr. Phil Doing His Job?

I’ll get right to it.

Dr.Phil.  What are the prevailing opinions regarding Dr. P? I have never watched his show, but I don’t live under a rock either.  It’s hard not to be aware of his no nonsense, shoot from the hip, straight talk.  Americans love gossip and drama, and they love reality television.  It’s like red meat and red wine.

“And tonight we will be having a titillating show in which Tom is caught redhanded! We will pair that with high drama best exemplified by Martha’s throwing her drink in his face, and her ex-best friend will see this and tweet about it causing the entire bridge club of the White Haven Bridge Society to stop drinking their gin and tonics for five minutes !”

Dr. Phil has made his name and money on the backs of people’s pain and misfortune.  They have agreed to it by appearing on his show and airing their dirty laundry in front of America.  I suspect that people feel better about their lives by partaking of the hidden miseries of the lives of others.  Dr. Phil has been more than happy to oblige them.

This latest show, however, has me asking questions, and I don’t know the answers.

Dr. Phil has interviewed actress Shelley Duvall most well-known for her roles in The Shining and Popeye.  She has been out of the spotlight for almost 20 years, and this is the first time she has been seen.  Duvall is mentally ill with what looks to be a psychotic disorder or dementia.  To be honest, she speaks like and has the affect of someone with a schizophrenia spectrum disorder.

 

Dr. Phil is under heavy fire from certain people in Hollywood for this interview and receiving press attention, too.  Is he doing this for ratings and, thusly, exploiting Duvall, or is he merely trying to help Duvall? I’m not sure.

Mental illness is no different than any other kind of illness in terms of the body experiencing disease.  There are many contributing factors.  In the case of a schizophrenia spectrum disorder, it is, like MS, a neurodegenerative disease.  The illness itself is a manifestation of a brain-based, neurological disease.

Were people all up in arms when Michael J. Fox was being interviewed, his Parkinson’s Disease symptoms on full display? What about the countless documentaries on early-onset Alzheimer’s? How many interviews have been done with people experiencing dementia? Were people protesting then claiming exploitation and cruelty? No.  What about news programs and documentaries featuring cancer patients in the throes of treatment manifesting symptoms of “chemo brain”? No one was tweeting that the directors were cruel and exploitative then.

So, what about this particular interview is pushing buttons? Duvall herself admits to needing help.  She says, “I’m sick.  I need help.”  She also answers questions that clearly reveal positive symptoms elucidating some kind of underlying psychosis.  It’s upsetting to watch.  But what if psychosis weren’t stigmatized in our society?

What if psychosis were viewed as an indicator of a disease process in the brain, and everyone knew that.  People would then see this interview and say, “Oh my.  Ms. Duvall needs a medical intervention.  I feel sad that she is ill now,” instead of reeling back in horror.  You see, I don’t think that the root of people’s outrage over this interview is related to Dr. Phil’s tendency to ride the coattails of people’s misfortune.  If everyone were authentically outraged over this, then more letters to the press would have been written sooner.  Nothing that Dr. Phil is doing is new.  He’s the same misery vampire as ever, and the American people have loved it.  His show is still on the air.  It’s in its 14th season.

I carefully submit that people are horrified by Ms. Duvall and the manifestation of her illness.  It’s shocking.  It is abnormal, and no one wants to see it.  My question is this: How is mental illness to ever be normalized as part of the human experience unless people with negative, positive, and cognitive symptoms are introduced to people who are not acquainted with them? Mental illness is so stigmatized in our world.  It is hidden and shamed.  Few people outside of the reality of it want to talk about it in meaningful ways, and, when it is discussed and put out there bluntly, those with it are pitied or referred to as undignified.  That is actually the perpetuation of stigma.

Americans are very comfortable with mockery and making that which is quotidian and quite normal profane.  Disease in America is the norm.  It has become normal, and mental illness is normal as well because it is a disease process; but most Americans distance themselves from it through objectification and mockery.  How many Halloween costumes involve mocking those with mental illness–straight jackets, references to mental illness in the costumes themselves, and movie and comic book characters who are anti-heroes due to a mental illness e.g. The Suicide Squad.  It is an hyberbolic surreality that proliferates due to distancing behaviors rooted in stigma and fear.

What Dr. Phil is doing, while distasteful, may not be a bad thing.  The only thing that I might question is Ms. Duvall’s agency, and this is where dignity and potential exploitation come into play.  When we lose our agency to a disease, our dignity becomes dependent upon our caregivers.  Was Ms. Duvall acting on her own behalf, or was someone else acting on her behalf when the agreement was made to do this interview? Was her fundamental right to privacy violated by someone else acting as her power of attorney?

At the same time, do people ask these questions of other people manifesting diseases who participate in interviews? If not, then why? Why is there a double standard? Once again, I think that it may be due to the lack of societal normalization of mental illness perpetuated by stigma.  Someone has to go first and show the world what it looks like–and not in a movie for the purpose of entertainment.  Then, someone must go second, third, fourth, etc.  The world must get comfortable with what it has always chosen to hide and avoid.

Why? 75% of Americans will, at some point, require help for mental illness of some kind.  That would probably be a smaller number if 100% of Americans were willing to support them.

Further Reading:

Exploitative or Empowering? Dr. Phil’s Interview with Shelley Duvall Sparks Controversy

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Possible Etiology of Schizophrenia

I’ve posted quite a few scholarly articles on mental health, in part, because it’s cool.  I like to know what’s going on in the body and what current research is being done.  I have two other reasons.  Wouldn’t it be great to know why people aren’t feeling well mentally (etiology) and, hence, remove the stigma?

How much stigma is around dementia and early-onset Alzheimer’s? Behaviorally speaking, it looks a lot like a brain-based mental disorder.  Why? Brain-based mental disorders and Alzheimer’s both involve the brain becoming “ill”.  We don’t see adults on television shows saying things like, “Oh, that old person is so crazy! They got dementia! Let’s just lock ’em up in the Looney Bin for the Aged.” I’m not at all implying that ageism is not a problem in American society.  The elderly are not treated with nearly as much respect as they deserve.  What I am saying, however, is that certain brain-based diseases are widely accepted by the general public as legitimate illnesses requiring medical intervention.  It’s even generally understood that those diseases affect other parts of the body, in large part, because the disease in question began in the brain.

So, if one were to see an older person engaging in odd behaviors in public, one doesn’t usually jump to conclusions and say things like, “That person must be high.”  No.  More often than not, members of the general public will say, “I wonder if that person has dementia.  Do they need help?”  Even if someone is relatively uneducated, the notion of dementia is so well-known that I’ve heard people say things like, “Oh, does that person have that thing that elderly people get where their brain starts to go? I hope I never get that.  I don’t want to die like that.”  There is a general awareness that a brain-based illness exists in the elderly population and that a brain-based illness can manifest as odd behaviors.  The age of the person is what provides the context.  Also, rarely are people afraid of the elderly so fear is not present to drive judgment.

For those of us in the know, we are fully aware that bipolar and schizophrenia spectrum disorders are biologically-based brain disorders.  One can liken schizophrenia to Multiple Sclerosis in terms of how it originates in the brain and goes on to affect the entire person.  There have been many theories suggested over the years as to the possible etiology of the disease.  Personally, I’ve liked the theory around pruning because it was the only one that adequately explained the loss of white matter in the brain.  When I tell people what happens to the brain of someone with schizophrenia, they are usually shocked.  The loss of white matter and neural connections is what is causing most of the positive, negative, and cognitive symptoms.  This is indeed a neurodegenerative disease.  Once someone fully understands the disease process of schizophrenia, they usually feel less inclined to stigmatize people who carry that diagnosis much like they don’t stigmatize a person with MS or Parkinson’s disease.

Here is a new landmark study to help you in your efforts to educate yourself and others on the possible etiology of schizophrenia.  Yes! That’s right.  The etiology. In short, it’s a pruning problem.

Schizophrenia risk from complex variation of complement component 4

If you don’t feel like wading through this study, then Gizmodo succinctly summarized the study in layman’s terms here:

Scientists Have Finally Found a Biological Process behind Schizophrenia

Here’s a snippet:

“On the surface, the culprit behind schizophrenia sounds a bit odd. It’s a variant in the major histocompatibility complex (MHC)—a set of proteins that decorate the surface of your cells—that binds to foreign molecules and presents them to the immune system. But McCarroll’s new study, which looked at the DNA of nearly 29,000 individuals with schizophrenia and 36,000 without, showed that this particular MHC variant causes the expression of a gene known as C4 to go into overdrive.

And it so happens that C4 is present at neuronal synapses, the connections between neurons that transfer chemical and electrical signals in your brain. On a cellular level, too much C4 can reduce the number of synaptic connections, a process known as “synaptic pruning.” On a human-scale, this can lead to schizophrenia.”

There you have it.  The more educated we are about the etiology behind mental illness, the more we can educate others, thusly, removing the stigma and bringing the general public up to speed.  If other neurodegenerative diseases are acceptable and not stigmatized, then biologically-based brain disorders like schizophrenia and bipolar disorder should be found among them.  It just takes education.

A lot of education.

Taking Mental Healthcare Seriously

It’s no secret that there is a crisis in the healthcare system in America.  This is old news.  In fact, it’s not even news anymore.  It’s starting to become just “the way it is”.  Behavioral healthcare, as health insurance providers like to call it, is an even greater problem.  What is behavioral healthcare? As one hospital staff member explained it to me, “If it doesn’t make you sick or require surgery, then it’s not really considered an illness by the hospital and we refuse to bill insurance for it.”  This is where “behavioral health” comes in.

Behavioral health refers to biologically based mental health disorders and mental health in general.  Any disorder that can be found in the DSM-5 falls under “behavioral health”.  In my city, there is a Behavioral Health Emergency Room.  If you or someone you know is experiencing suicidal ideation, then go to the Behavioral Health ER.  When Grace stabbed herself with a fork, we took her there.  If a person with a mood disorder were to suddenly begin rapid cycling, then they would go to the Behavioral Health ER.  Anyone struggling with psychosis, mania, clinical depression not responding to treatment and in need of immediate care and the like would go to a Behavioral Health ER.  These disorders are, in fact, all manifestations of neurological disorders that are treated under the psychiatric specialty rather than neurology.  They are, however, still medical in nature and, therefore, require medical attention.  Why is the opinion even in the medical community otherwise? Does it really matter?

When hospital staff so brazenly declare that mental health disorders are not medical in nature and, therefore, will not bill health insurance for them, they are perpetuating the stigma surrounding mental illness.  Schizophrenia spectrum disorders are neurodegenerative and neurodevelopmental in nature.  They are the definition of “medical”, and yet staff members in hospital billing departments still maintain a belief that this cluster of disorders represents something more like Dissociative Identity Disorder (DID) or just bad behavior brought on by a combination of stress and poor distress tolerance.  What is the likelihood that a person experiencing psychosis will seek medical attention then if hospital staff are untrained and ignorant? What is the likelihood that hospital staff will show respect to patients struggling with psychosis, mania, or depressive symptoms if they believe that it’s “all in their head” and with some real effort these patients could simply heal themselves?

What perpetuates this stigma within the medical community itself? Let me give you an example from my own community.  I’ve written a few posts on my ex-husband’s anxiety disorder.  He has struggled most of his life with almost crippling anxiety.  Persuading him to overcome his anxiety and see an internist just for a physical examination in which he could also inquire about anxiety treatment was a huge success.  It took 16 years of convincing.  When he asked for a list of psychiatrists from his internist, the clinic gave him a list of recommended psychiatrists all of whom were no longer taking patients due to either being retired or dead.  This clinic had not bothered to keep their list of psychiatrists up to date! They certainly keep their other lists of recommended specialists up to date.  Are they giving men and women lists of recommended oncologists who have died and/or retired? Doubtful.  This is profoundly troubling since, on average, twice as many women die by suicide annually than they do from breast cancer.  Three times as many men die by suicide annually than they do by prostate cancer.  And, yet, we are surrounded by charities and reminders that breast cancer kills, and we should do something about it.  I agree wholeheartedly.  Men should get physical exams and take care of their bodies.  But, a well-known clinic can’t be bothered to maintain a list of psychiatrists so that their patients can receive psychiatric care and follow-up? Why?

Another large and well-known mental healthcare service provider in my area sent out a letter two weeks ago stating that they would be discontinuing their psychiatric services.  Period.  There was no list of local treating psychiatrists who current patients could call in order to maintain their current level of care.  Just a notice of “We’re closed for business.  Good luck getting those meds filled.”  This is shocking.  Psychiatry is a medical speciality.  Patients under the care of a psychiatrist are receiving specialized care, and it borders on unethical to suddenly stop care without transferring that care to another physician or, at a bare minimum, providing a list of physicians who are taking new patients.  This attitude, however, is prevalent within the medical community itself, and this is what perpetuates the stigma within the medical community.  If doctors, therapists, and administrators themselves believe that behavioral healthcare is simply optional and not vital to the health and well-being of their patients, then what does this say about the medical community’s view of mental health? A person receiving treatment for Multiple Sclerosis would not simply receive a letter from their neurologist stating, “I’ve decided to drop you as a patient.  Good luck finding care elsewhere,” but patients with diagnosed mental health disorders are treated like this quite often by their own mental healthcare providers.  Why?

I think that the medical community is caught between two views–the old and the new.  Animal models are showing that most mental health disorders from depression and OCD to bipolar disorder and schizophrenia spectrum disorders are biologically based meaning caused by the enteric or primary nervous system.  The research is consistently pointing to the gut or the brain.  It is an exciting time to be a neuroscientist.  Deficits in the function on a brain level often manifest behaviorally, however, and many people–even doctors–are very uncomfortable with unusual behaviors.  It’s easy to blame trauma and shove someone out the door.  Even trauma, however, becomes brain-based as the success of treatments like EMDR are showing.

We are socially conditioned to feel ashamed when we feel anything but happy and good about ourselves.  If you don’t feel happy, then pull yourself up by your bootstraps! Exercise.  Change your diet.  Lose weight.  Get a makeover.  Go for a walk.  This might work if you don’t have a biologically based mental disorder, but who, within the medical community, is willing to consider this? Furthermore, who is willing to consider that a child might have bipolar disorder or a schizophrenia spectrum disorder? What physician is willing to say that bipolar disorder, for example, is as serious as cancer and deserves the same amount of attention and care? The number one cause of premature death among those diagnosed with bipolar disorder is suicide with 15-17% taking their own life and up to 50% attempting suicide at least once due to the negative symptoms of the disorder.  These are shocking statistics, and I don’t think most physicians consider this.  Until the medical community at large is able to take mental health seriously–as seriously as it takes cancer and heart disease–there will be a lack of quality care and treatment for people struggling with mental health disorders.  Perhaps then we’ll begin seeing sparkly new hospital wings dedicated to mental healthcare right next to the breast cancer and heart surgery wings.

That will be a good day.

More Information:

Shame and Stigma

A good friend recently recommended this book to me: I Thought It Was Just Me (but it isn’t) by Brené Brown.  It was rocking her world.  In fact, she was loving it so much that she was sending me quotes from the book throughout the day, and I was finding myself wanting to read more.  Brown’s book is about shame and developing shame resilience.  She is, in fact, one of only a handful of people who has dedicated her academic career to research around shame and its effect on the brain, body, relationships, gender, and communities at large.  My interest was piqued to say the least.  I bought the book.

I’m going to recommend it to all of you.  And, in the spirit of that famous 1970s Faberge shampoo television commercial of old (but not that old), I’m going to suggest that you read it and then recommend it to your friends.

Shame is not a hot topic at cocktail parties although if someone brought up the topic next to me I would stay and chat.  According to Brown, most people run from it and dislike discussing it.  I am not one of those people.  I want to talk about shame.  What is shame? After years of listening to stories and doing research, this is Brown’s definition, and I think it’s a good one:

Shame is the intensely painful feeling or experience of believing we are flawed and therefore unworthy of acceptance and belonging.

She describes shame ever so correctly as a “full-contact emotion” meaning that we feel shame both emotionally and viscerally.  You know when you’ve been shamed.  Whether you feel it in your stomach or your chest or feel yourself suddenly sinking into that familiar emotional prison where the guard says, “You deserved that,” shame punishes from the inside out and the outside in.  It puts you in a double bind so that no matter what you do, you cannot win.  Or, at least, that’s how it feels.

Shame is at the core of the stigma associated with mental illness.  Brown’s definition of shame describes the existential experience of many people who have encountered stigma.  There’s only a certain level of “crazy” that is socially acceptable around these parts.  If anyone exceeds that? Well then, something must be wrong with them! Shun them and drive them out of town! Surprisingly, there are many ways to shun and alienate people who are viewed to be flawed and unworthy of acceptance and belonging.  This is why stigma is so dangerous.  One’s personal shame is often based in a perception that just might be false.  We feel like we are flawed and therefore unworthy, but this feeling originates in us.  Stigma originates outside of us and reinforces the feelings of shame that come from within.  We, therefore, stop questioning the validity of our shame responses because parts of our community are validating our shame for us! The logical step is then to believe that our shame is true; we must be innately flawed and unworthy of acceptance and belonging.  What’s next then? Action urges.  People usually begin to act on their feelings reinforced by stigma if they do not have a stronger message coming into their lives from somewhere else.  This is a not a healthy place to be.

Brown recounted a story about a young woman named Allison whose mother hanged herself.  She was an adolescent at the time of her mother’s suicide.  Allison recalled that her community rejected her.  Everyone began to pull away from her and her grieving father.  She lost her friends.  She and her father were shunned as if her mother’s suicide was a virus that could be passed on.  A big scarlet S was plastered to their chests–SUICIDE.  The intensity of the shame that was poured out upon this young woman and her father was crippling.  Eventually, her father died, and she reported feeling relieved because she never had to return to her hometown again.  She never again had to be known as the girl whose mother hanged herself.

Reading this story didn’t exactly hit a nerve for me, but I felt it in a raw sort of way.  I had two grandparents who died by suicide as you, my readers, know.  My mother has struggled with depression for most of her life, and she has tried to commit suicide many times.  There was an occasion when I was 14 in which she was almost successful.  In a very dramatic fashion, she was removed from our home in full view of the Trinity, the Heavenly Host, the entire country club association, and Vera the neighborhood gossiping hen.  I just stood there thinking, “How long will it take for the entire state of Texas to find out that my mother just tried to blow her head off?” Vera sidled up to me sweetly and cooed at me in her treacly voice, “Oh honey, I am so sorry! Now, tell me what happened exactly?”  There it was.  The phone calls started coming in within 24 hours.  She moved fast.  Veronica’s parents wouldn’t let me come over anymore.  Kathy’s parents wouldn’t let her come to my house, and I couldn’t go there either.  Kerri’s parents wouldn’t even let her call me.  I spent that entire summer socially isolated and alone.  In other words, I spent the summer at my stepfather’s mother’s house.  She was Lithuanian, mean, and made me embroider doilies all….summer…long.  This is one shade of stigma from an external point of view.  The internalized experience might be something like this: “No one wants you around because of your mother.”  This is a fairly accurate experience for many people who have mental illness in their family.  This is one reason why many families keep mental illness a secret which only perpetuates and feeds shame.  They don’t seek out much needed supports and interventions because they are legitimately fearful that they will lose their social support structures.  I did.

A similar thing happened to us after Grace’s first psychotic episode.  She lost most of her friends save one, and I lost friends, too–one in particular.  She has still never called me and does not respond to any attempted contact.  Apparently, schizophrenia spectrum disorders are catchy! The natural response to this is retaliation.  There is a self-righteous anger that comes to the surface.  We want to take out our metaphorical bats and go have “a talk” with the people who shamed and victimized vulnerable people.  I want to share something very important that Brown notes:

“…if we are going to understand shame, we must not only seek to understand Allison’s experiences, but the reactions of those around her. We can’t simply “shift shame” from Allison to her “insensitive neighbors.” Shaming her neighbors and friends would be equally destructive. Second, we have to dig deep and be honest about how we might react as a neighbor or friend. If I came home from work and saw an ambulance and police cars surrounding a neighbor’s house, I’d immediately patch into the neighborhood phone tree to find out what happened. I might not walk over and stand around gawking, because I’d like to believe I’m above that— or at least I’d want my neighbors to think I’m above it. Instead, I’d call someone who had walked over, which is probably worse. Unless I was extremely aware of what I was doing and I was consciously working not to gossip, I would probably be equally guilty of talking about it, speculating why, wondering about the details and drawing false conclusions. I can just hear conversations where we’re saying things like “I knew something wasn’t right over there” or “You know, one day I saw her . . .” I might even make assumptions about the mental stability of Allison’s father or about Allison herself following such a traumatic event. I might become uncomfortable letting my daughter play at her house. In other words, I might become exactly what I hated and, at first, refused to understand. Why? Because I’m a terrible person like Allison’s teachers, neighbors and friends? No— it’s because I’m human and situations like that can throw us into our own fear, anxiety, grief and, sometimes, even into our own shame. And to alleviate those overwhelming feelings, we seek connection with others— sometimes in incredibly hurtful and destructive ways, like gossiping and excluding others.  If we really want to get at the heart of the beast, we have to understand more than what it feels like to experience shame. We need to understand when and why we are the most likely to engage in shaming behaviors toward others, how we can develop our resilience to shame and how we can consciously make the effort not to shame others…Our level of resilience to shame is not dependent solely on our ability to recognize these behaviors and emotions in ourselves, but also on our ability to build connections with others. These connections require us to understand what we share in common when it comes to shame.”

And, there it is.  People who are often on the other side of our shaming experiences are human beings, too, seeking out connection to alleviate their own painful internal responses. The way in which they go about it can often be very hurtful, but shame shifting is as destructive as applying stigma.

What is Brown really saying here? The only real cure for shame and stigma is empathy.  Perspective-taking.  And, it has to flow both ways.  The real burner here is that someone has to show empathy first.  Who do you suppose is going to do that? The neighborhood associations who storm city hall in order to prevent a day treatment program from being built near them? Likely not.  Reactionary behavior like that is indicative of fear.  We still live in an age where people believe that schizophrenia is dissociative identity disorder which, to me, is just laughable.  Nonetheless, it’s true.

Clearly, I don’t have all the answers or even one great one.  I do see, however, that shame shifting, responding in anger, and blaming behavior only perpetuate the cycle of stigma in our culture.  I suspect that it will take a great deal of patient empathy and painstaking education over time as well as a willingness to listen to people air out their fears in order to begin to address and eventually lift the shadow of stigma associated with mental illness from our culture.

Anger is easy.  Empathy, on the other hand, is not, but someone has to take the road less traveled if the culture is going to shift.

Emotional Education

I’ve utilized therapy since I was 16.  I’ve always viewed therapy as a resource.  I have never fully understood the stigma applied to therapy until I was older.  Until I met my husband.

I suggested that he find a therapist a few years into our marriage, and he made a weird snorting sound and scoffed, “I will never do that.  That’s for broken people.”  I took that in and pondered.  I went to therapy.  Did he see me as broken? What a weird point of view.

Our youngest daughter was diagnosed with an autism spectrum disorder and comorbid anxiety disorder when she was three.  I took her to play therapy.  He seemed supportive.  Was she broken?

Then Eadaoin hit puberty and her subtle social anxiety soon became an anxiety disorder, and she required medication and therapy, too.  Was she broken?

Then the Big S invaded our home.  Grace developed childhood-onset schizophrenia, and therapy was the least of our problems.  Maybe she really was broken, but I was going to do whatever it took to put her back together again.

And guess who didn’t have the resiliency, communication skills, or emotional maturity to deal with any of it?

Him.

Of every member of my family, guess who is doing the most poorly?

Him.

Not Grace.  Not Milly.  Not Eadaoin.  Not even me.

Him.

You see, we all leave our families of origin with deficiencies, and we all have coping skills in place to compensate for those deficits.  We could have had the most wonderful parents, but there is no such thing as a perfect parent.  Even if our parents were perfect, we don’t grow up in the vacuum of our homes.  We go to school.  We make friends.  We travel, get jobs, and participate in extracurricular activities.  A lot happens to us as we are developing, making and losing friends, experiencing middle and high school.  We don’t emerge from the first 18 years of our lives unscathed.  Not a one of us.

We were not born knowing how to act or knowing what to do.  We learn by watching how the people around us act.  We learn what to say by modeling what others around us say.  We learn how to manage conflict by modeling how our family managed conflict.  Some people realize at a young age that what they are witnessing isn’t right.  They, however, don’t know what the healthy way is so they might fumble their way through.

This is where therapy comes in.  Contrary to popular belief, the therapeutic experience isn’t lying back and talking about your father while some mustachioed man smokes a pipe and writes on a legal pad.  In fact, that sounds a whole lot like the beginning of a porn film.  No, therapy doesn’t have to be client-centered at all (the Rogerian approach).  It can be entirely skills-based–a DBT skills group, for example.  The point is that “therapy” doesn’t have to be the four-letter word that so many people I’ve met think that it is.

Therapy is our gateway to growing up.  When we find a therapist that we like and trust, we can actually do the work of maturing and growing into the adults that we have always wanted to be.  How?

  • A good therapist walks with you through those memories that are holding you back in order to help you resolve them so that you no longer carry them, and they no longer define you.
  • A good therapist helps you learn to talk about your feelings so that you can communicate effectively within your relationships.
  • A good therapist validates you and your life experiences.  This is key because we need validation to feel safe and sane.
  • A good therapist teaches you how to self-validate so that you are no longer beholden to others for your validation and sense of self.
  • A good therapist models empathy which, hopefully, will teach us how to do the same.
  • A good therapist teaches us how to be empowered in our relationships forsaking victim thinking, codependency, and caretaking.
  • A good therapist provides a reality check and tough love when necessary so that we learn what true accountability in relationships looks like.
  • A good therapist guides us into learning distress tolerance so that we can give up maladaptive coping strategies that harm us and our relationships.
  • A good therapist provides insights into what motivates us so that we learn to become curious about ourselves and why we make certain choices.
  • A good therapist legitimizes separation, individuation, and differentiation from our parents which is so often the root of our suffering.
  • A good therapist teaches us a better way to think and shows us where we are believing negative things and, thusly, how those negative beliefs manifest in negative behaviors.

Therapy is the environment in which we continue developing as humans except that we have the opportunity to develop into better humans.  Therapy is meant to teach us so that we are equipped to deal with whatever life throws at us.

Who do you suppose does better in a crisis? The person who trusts themselves or the person who is rootless, anxious, and doesn’t trust anyone? Part of becoming an educated person is receiving an emotional education as well.  One of my favorite college professors once told a group of women that her goal in teaching us was to create educated women.  When asked what that meant, she replied, “To be truly educated means that you are critical thinkers.  It means that if you don’t know the answer to a question, then you know how to go about finding it.”

This is what it means to be emotionally educated.  It means that you are a critical thinker when it comes to yourself.  You are self-aware.  You understand your motives.  You know what you need.  You can self-advocate.  You can trust others.  You trust yourself.  You know how to ask for what you want, and you are not beholden to others for your sense of worth or sense of calm.  If you find yourself in difficult situations for which you are not equipped, then you know how to go about equipping yourself.  You know the skills you have, and you know the ones you need.  Lastly, you take responsibility for yourself–your actions, your feelings, your desires, and your needs.

This is what therapy can do for us.  All of those inadequacies that we see today? Those deficits in our personalities that we try to hide out of shame? Reframe them.  They are just opportunities when you put them in a therapeutic environment.  What if you simply need to learn a new skill? We will all be developing and maturing until the day we die, picking up more wisdom as we go.  Engaging in your own emotional education is not something to be ashamed of.  It should be celebrated.

Remaining emotionally illiterate because someone somewhere once said that only weak people see shrinks? I think that’s the least educated view of all.

Find a Therapist

 

 

Ignorance and Suicide

I want to address something. A friend of mine emailed me a link to a blog post this morning:

Robin Williams didn’t die from a disease, he died from his choice

Here are some quotes from Matt Walsh’s post written in the wake of Robin Williams’ passing:

“Suicide…I can’t comprehend it. The complete, total, absolute rejection of life. The final refusal to see the worth in anything, or the beauty, or the reason, or the point, or the hope. The willingness to saddle your family with the pain and misery and anger that will now plague them for the rest of their lives.”

“It’s a tragic choice, truly, but it is a choice, and we have to remember that. Your suicide doesn’t happen to you; it doesn’t attack you like cancer or descend upon you like a tornado. It is a decision made by an individual. A bad decision. Always a bad decision.”

“It makes us feel better to say that depression is only a disease and that there is no will and choice in suicide, as if a person who kills themselves is as much a victim as someone who succumbs to leukemia.”

“First, suicide does not claim anyone against their will. No matter how depressed you are, you never have to make that choice. That choice. Whether you call depression a disease or not, please don’t make the mistake of saying that someone who commits suicide “died from depression.” No, he died from his choice.”

“Second, we can debate medication dosages and psychotherapy treatments, but, in the end, joy is the only thing that defeats depression. No depressed person in the history of the world has ever been in the depths of despair and at the heights of joy at the same time. The two cannot coexist.”

I will now give you this:

Mutations on three genes could predispose people to suicidal behavior

The genetic basis for suicidal behavior

I will also give you this because Mr. Walsh’s post smacks of gnosticism:

The Matter of Knowing

Stigma is still an issue today because of the prevailing attitude in Mr. Walsh’s post.  What is that attitude? Choose.  Pull yourself up by your own bootstraps.  Get over it.  Stop being so selfish.  Find your joy now! It’s time to stop feeling so sad.

The reason he can’t comprehend suicide is because he isn’t clinically depressed.  Mentally healthy people should not be able to comprehend suicide.  Suicide is indeed a symptom of mental illness.  If you are mentally ill particularly with mood and thought disorders, then suicidal ideation will not be new to you.  This is why one of the criteria for a mixed state is suicidal ideation.  It’s not a choice.  People don’t simply choose to end their own lives.  They don’t choose to ignore joy.

Joy is an impossibility for certain mental illnesses.  

I don’t expect Mr. Walsh to comprehend this.  I didn’t recognize the face of these diseases until I saw them in my daughter’s countenance.  I did, however, grow up with a parent who tried to commit suicide many times.  Both my paternal grandparents died by suicide.  A family friend died by suicide a few years ago.  Looking back, I can see how he declined.  I don’t believe that he chose to die.  I believe that his suicide was a symptom of his untreated mood disorder.

I respect Mr. Walsh’s right to voice his opinion, but I vehemently disagree with him.  His view is one of the reasons why stigma still exists today particularly in the Church.  His post is judgmental and shaming, and it is ignorant.

I do, however, agree with him on one thing.  Where there is life, there is hope.  Feelings are not facts.  You might feel like you can’t go on.  You might feel worthless.  You might feel like if you disappear today, then no one would miss you.

Those are all feelings.  They are not facts.  They are not truths.  What is true? You are valuable simply because you exist.  Hold on to that.

And call this number or visit this website:

National Suicide Prevention Lifeline or 1-800-273-TALK (8255)

 

Not So Different After All

A friend sent me this article, Seeing the Child, Not the Disability, this morning.  It’s a short op-ed written by Dr. Dennis Rosen, a pediatric pulmonologist practicing in Boston.  He’s one of the good guys as revealed here:

I started my pediatric residency 18 years ago this summer, two months after my oldest was born. Over the years, I have cared for thousands of children with all sorts of conditions, and I try to connect with each and every one of them in a special way. With some, I talk about what they’re reading, the sports they’re doing, the instruments they’re playing, their dreams or their fears. With others, the communication is nonverbal, whether they are babies who haven’t yet learned to speak, or their development is delayed. I have yet to meet a child who fails to kindle my compassion or to bring out in me the most basic desire to try to help.

What he wrote next, however, may either bother you or cause you to almost produce an emotional yawn:

Perhaps this is why I was so shaken by what I had just heard, about mother and son being shunned by others who were unable to see the son she loves as a child instead of as a condition or disease.

I read this statement, took a sip of my coffee, and initially thought, “Aw, muffin.  It’s okay.  I was shaken the first time I experienced this, too.  You’ll get angry the second time it happens.  The third time? Well, you’ll just be used to it.”

Shunning children, teens, and adults because they are viewed only as a representation of their illness is more than just common.  It’s an expectation.  We know that it will happen because we expect it.  It’s called ‘stigma’.

Eadaoin watched girls in her school call the special needs students “monsters”, and she was mocked for choosing to sit next to them at lunch and in art class.  According to Eadaoin, however, they were sweet, and she enjoyed making friends with them.  It was true that they had communication delays, and one of the boys was a “hugger”.  He would often hug Eadaoin too hard and hurt her, but she understood that he was trying to communicate.  One girl could only grunt and vocalize to communicate.  This didn’t bother Eadaoin.  She saw them as people not defined by a disability.  Just people.  Like her.  Because they are.

I witnessed something very different, however, a few weeks ago at our local “splash pad”.  My friend and I took our girls to the park, and her little girl was desperate to get wet in the fountains of water.  Her daughter has epilepsy.  Grace has COS.  Milly has an autism spectrum disorder.  Taking those three together anywhere is always interesting.  As we watched Grace ride herd on my friend’s daughter and Milly, we both noticed a boy with low-functioning autism.  He was ecstatic to be in the water, jumping, flapping, smiling, and awkwardly running back and forth between what were clearly two favorite sources of water.  He had an aid who was shadowing him, giving him a wide berth to enjoy himself.

My friend and I enjoyed watching this boy.  We own a company that produces material for ASD children and caregivers and professionals who work with children on the autism spectrum so we began discussing what is known about ASD children and water.  They love water.  Consequently, there is a higher risk of drowning for ASD children than for neurotypical children due to this simply because they will often run from a parent or caregiver when they spot a lake, pool, or fountain; and, ASD children are runners.

As we watched our children and this boy, we noticed that a girl had come on the scene.  She didn’t appear to be a kind girl.  She reminded me of Veruca Salt from the Roald Dahl novel Charlie and the Chocolate Factory.  She was loud and abrasive, and she had “bogarted” this boy’s favorite water toy–the firehose.  It was something that looked like a large hose that could be aimed, and this girl decided to aim it directly at this boy’s face and chest.  It didn’t matter where he went on the wet playground.  She sprayed him in the back of the head, upper back, and face.  And she laughed.  When she felt convinced that he was far away from her she would then screech, “Mom, look at me!”

My friend and I turned to look at her mother who was, in keeping with Roald Dahl’s creation of characters, a caricature of a woman with a beehive hairdo, huge bosom, and large teeth.  She was pointing and laughing! My friend and I were incredulous.  I am one to sit back and observe before allowing my anger to influence me.  My friend, however, was viscerally affected by the sight before us.  I think I was in denial.  Could this really be happening?

The boy tried to communicate to the girl that he did not like being blasted in the face with water by putting his hands in front of his face and grunting, but the girl continued to blast him in the face with water.  Over and over again while laughing and jumping up and down.  I looked at her mother again who was…laughing.  My friend muttered, “Twat…” under her breath.  I looked around at everyone.  There were mothers everywhere.  This situation was impossible to miss.  Everyone was looking away.  The boy’s aid looked utterly helpless.  He was looking at this girl’s mother as if to plead for an intervention.  Clearly, the girl’s mother was as pleased to bully a special needs child as the girl herself.

What do you do? We felt compelled to do something.

My friend and I decided to intervene.  I clandestinely told the 16 year-old city employee stationed outside the splash pad about the situation while my friend stood behind me, arms crossed, looking intimidating.  I thought it would be pointless.  What is this poor kid going to do? Instead, he looked enraged.

“Show me who the mother is.  Where is this girl? Thank you for telling me.”

The situation ended quickly thereafter with the mother and the girl leaving tout de suite.

This is a perfect example of an adult and her offspring viewing a child solely as their disability.  He wasn’t really a person with value because he looked different.  He couldn’t speak.  He ran around awkwardly.  He flapped.  He grunted.  People like that don’t have feelings, right?

Wrong.

They do.  More than they can even begin to communicate.  As Dr. Rosen goes on to express:

I couldn’t help recognize the cruel irony of these strangers withdrawing from this child because of the very sounds and movements that he uses to try to interact with them, undeniable expressions of his humanity.

I realize that my friend and I can be firebrands, but that is what we do.  We are advocates.  It’s easier for us to step in sometimes when we see a cruelty like this at play because we’ve done it before.  The more you do it, the easier it becomes.  I don’t care at all if someone gets mad at me particularly if that person is bullying a vulnerable person.  Go ahead.  Take your best shot.  You’re only digging a deeper hole for yourself.

There are other ways, however, to include others and contribute to ending stigma and social exclusion.  Dr. Rosen suggests:

Faced with such a child in the park or at a restaurant, too many of us just stand there and stare. Instead, notice the twinkle in the child’s eyes, even if they are half-hidden behind smudged, thick-lensed glasses. Return the smile, even if it twists unusually or is wetter than what you’re used to. Wave back at him when he jerks his arms toward you, and say hello, even if it’s hard to understand exactly what she’s saying.

These children, and their families, will notice, and feel welcomed.

This is true for all of us for we are all differently-abled.  Every single one of us.  There is no one who is 100% perfectly-abled in this world.  Some of us are just better at compensating for our deficiencies than others.  I think when we can all finally see this truth, then we will see that we really do have something in common with that odd, flapping kid at the playground.

You’re really not that different from him after all.