DELANY DEAN, JD, PhD

delanydean.com

KC Mindfulness

crimlawdoc@gmail.com

EMOTIONAL PAIN

DEALING WITH EMOTIONS

Joko Beck pointed out something in one of her books that has had a major and lasting influence on me: she said that emotions are simply the convergence of bodily sensations with thoughts. That is, when I am feeling an emotion, I can break down the experience into two components and, if I choose, I can become compassionately aware of each of these components. This is central to the practice of mindfulness, this deliberate, non-reactive, non-judgmental notice-ing. There may be a huge anger that has arisen in me, and if I want, I can fuel the anger, exacerbate it, brood about it, tell myself stories about it, even act out of it, causing harm to others and to myself. Or I can look at it compassionately, wisely; I can gently inquire of the experience: what is going on right now in my body? And in my thinking? Then, if I choose, I can stay with that, really feel the feelings, really see the thoughts for what they are (they are only thoughts, insubstantial, ephemeral, albeit sometimes incendiary and compelling).

One corollary of this teaching is this: you cannot be aware of your emotions unless you practice awareness of your bodily sensations. This is probably one of the reasons that, in Mindfulness-Based Stress Reduction (MBSR), participants are taught the “body scan” in the very first session, and this practice becomes their homework for several weeks. Most of us are amazingly unaware of the sensations of our bodies, most of the time; this prevents us from being fully present to ourselves, and to others.

I recommend use of the body scan, both formally (using a recorded guided meditation, at first) and informally, to all my counseling students; it is of immense importance in enhancing their capacity to be empathically present to their clients.

TELLING OURSELVES STORIES

“It’s hard to recognize this enemy who hides within us. [My desire is to] recognize the only real devil, pretending to be me or to help me. When your self-preoccupation mind tells you to do this or that, it fools you because you think it’s your own irresistible impulse. When you’re fooled that way you feel helpless against its dictates, because it presents itself as your own thought. So, when you recognize that demon, you are no longer tricked by it. You feel really happy about seeing that the thief of your happiness is your self-preoccupation, and that isn’t really you, just a mental habit.” CIRCLING THE SACRED MOUNTAIN by Robert Thurman and Tad Wise

The fundamental bases of cognitive-behavioral therapy are the understandings that some of our thoughts are distorted, and that they can contribute to dysfunctional behavior and distressing feelings.

It is our human tendency to identify with our thoughts; to believe our thoughts; and to feel as if we are the victims, or the prisoners of our thoughts. And these stances toward our thoughts are, themselves, examples of distorted thinking. When we learn to become less enmeshed with our thoughts, we begin to experience freedom. One way to become less enmeshed is to reflect on the stories (a story is a collection of thoughts) that we tell ourselves when we find ourselves doing things that are harmful or, at least, not helpful.

One example of a very short story that many people tell themselves is: “I can’t stand it!” Whatever it is that I am avoiding can be much more easily avoided if I believe that my very existence depends on the avoidance. A lot of people use this formula to stay in bad situations, and they also convince others that they are totally stuck, simply by repeating (with feeling!) the phrase “I can’t stand it if…” (whatever). The way out of the trap is to take a look at the story, bring some clarity into the picture, and some compassion, and gently ask: “But is that story true? What do I mean when I say that I can’t stand it?” Probably, what it really means is that I just really, really, don’t want to experience whatever it is that I fear will happen if I face the feared experience… And, the amazing thing is that I find out that the experience itself is a whole lot less fearsome than was the anticipatory dread…

Smiling in Abu Graib Prison

There’s an amazing article in the NYT about a photograph… and about war, and torture, and facial expressions, and responsibility. The article is called “The Most Curious Thing,” by Errol Morris (click here), and it takes as its starting point and centerpiece the (in)famous photograph of a young soldier leaning over a dead Iraqi man in Abu Graib prison, smiling broadly at the camera, and giving a “thumbs-up” signal. As it turns out, the dead man had been tortured before he died, and there was a clumsy effort to cover up the torture, the details of his death, and to shift and disperse and minimize the responsibility for the whole affair. And, as it turns out, the soldier in the photograph made an effort to document the injuries that were plainly visible on the man’s body, because it was obvious to her that he had not died a natural death (and it was also obvious that the whole situation was being energetically hushed up).

Errol Morris was intrigued by the whole situation; in particular, he found it terribly difficult to reconcile the image of the smiling young woman with the thumbs-up signal, together with the idea that this soldier was “really a good person,” a person who took no pleasure in the torture of another human being (even a suspected member of enemy forces), and who took steps to document the evidence of torture. He got interested in the science of facial expressions, and even consulted with the very renowned Paul Ekman. Here’s what he says about his decision to talk with Ekman:

“I contacted Paul Ekman, Professor Emeritus of Psychology at the University of California, San Francisco. Ekman is an expert on facial expressions and has written many books, including ‘Emotions Revealed, Unmasking the Face’ and ‘Telling Lies.’ I asked him to help explain Harman’s smile.(Oliver Sacks has written, ‘No one in the world has studied facial expressions as deeply as Paul Ekman. In “Emotions Revealed” he presents — clearly, vividly, and in the most accessible way — his fascinating observations about the covert expressions of emotions we all encounter hundreds of times daily, but so often misunderstand or fail to see. There has not been a book of such range and insight since Darwin’s famous “Expression of the Emotions” more than a century ago.’ His work is also prominently featured in Malcolm Gladwell’s ‘Blink.’)”

After reviewing the famous “soldier smiling with thumbs-up” photo, and other photos of this same soldier, Ekman concluded that the soldier’s smile was did not reflect any genuine feeling of pleasure, but rather that it was the posed smile that everyone produces on demand, in social settings when a smile is in order, for photos, etc. This was consistent with what the soldier, herself, had said about her actual feelings, at the time the picture was taken.

Here’s what Morris quotes the soldier (Harman) as saying about the situation:

SABRINA HARMAN: When we got to the prison, Captain Brinson had a meeting in the main office with all of us. [22] He said there was a prisoner who had died in the shower, and he died of a heart attack. And he told us that he was on ice, and he was in the shower in tier 1B. That was pretty much it for that. And then we went upstairs. Sergeant Frederick got the key and we just checked him out and took photos of him. Kind of realized right away that there was no way he died of a heart attack because of all the cuts and blood coming out of his nose.

[MORRIS]: I asked Sabrina whether she thought from the beginning that it was a homicide.

SABRINA HARMAN: It took a while. Like, you started undoing the bandages and looking closely. Like, you see his knees were bruised; his thighs were bruised [around] his genitals. He had restraint marks on his wrists. What else? You had to look close. They did a really good job cleaning him up. I mean, he had ice all over his body, so unless you removed things, you couldn’t really see the actual physical damage that they had done.

Morris details, insofar as is possible, the chain of events and the various organizations (military and otherwise) who played a part in this terrible mess. I especially appreciated the section in which he clearly sets out the time-honored method that government officials (among others!) use to shift blame, to “fuzz up” a situation in such a way that nobody can ever get to the bottom of it. Great article!

ON (NOT) TAKING IT PERSONALLY

“Don’t take it personally!”

Have you heard this piece of advice? Often we respond to this “advice” defensively, believing in our heart of hearts that whatever “it” was, it was not only offensive, but certainly intended personally! And, sometimes, that is true, especially when “it” is a sarcastic jab or a bigoted joke.

But, taken in a larger way, “don’t take it personally” might be the best piece of global advice, or the best wisdom statement, ever. The heart of the Buddha’s teaching is said to have been: “do not cling to ANYTHING as ‘me,’ ‘mine,’ or ‘I.’” When we think about it, we know that we are kidding ourselves in thinking that anything is “ours.” There is nothing that cannot, and will not, be taken away: our loved ones, our cars, our dogs and cats, our jobs, our youth, our ideas about ourselves, our very lives… We are constantly saying “hello,” and constantly saying “good-bye,” to new situations, and new stuff.

Experiencing this constant change, we often rebel, and panic, and act out of the related impulses of control and self-centeredness. And when we do this, we make everything worse. Instead of simple grief, we create terrible suffering when we try to control what cannot be controlled, and when we insist on believing that everything is about “me,” when clearly it is not. We focus on the amplified artificial tragedies of the Good-byes, and altogether miss the possible joy accompanying the Hellos.

Is that what the Beatles meant when they sang: “Hello, Hello… I don’t know why you say Good-bye, I say Hello…”?

We endlessly create stories about ourselves and our stuff, and, out of the stories, we create opinions, and then we inwardly transform our opinions into reality. Pretty soon, we find that we are going to war, full of self-righteousness.

Is there any hope that humanity will wake up, and find clarity and compassion in a suffering world? We long for a savior, a Christ, a Bodhisattva; habitually, we are failing to recognize that there is no alternative but that each one take on the great task of bringing into being that which we most deeply desire. We can get out of our tangled and childish thoughts, and practice compassionate awareness; we can live out of what is real, not out of what our stories urgently whisper to us. When I do this, I sometimes recognize that it really isn’t about “me.” And this frees me up a bit, to recognize “you.” How can I help you?

Jon Kabat-Zinn says: “it is helpful to recognize the intrinsic emptiness of what may seem like an enduring self-existence in any and all phenomena, and at all times. It could free us, individually and collectively, of our clinging to small-minded self-serving actions so often driven by unwise perceptions or outright mis-perception of what is occurring in either inner or outer landscapes,” from Coming To Our Senses.

ON BEING ANGRY

One of the deficiencies in my list of Literary Stuff I Have Read falls into the category of Anything Written by Oscar Wilde. For many years, Oscar has languished, sadly, somewhere in my to-do list. A couple of days ago I decided to remedy that, and I hauled out the huge “Collected Works Of” volume with all of his stuff. I decided to start with De Profundis, in which he writes a very long letter to “Bosie” (Alfred Douglas, son of the Marquis of Queensbury), the guy who was the occasion of Oscar’s downfall. It is actually a very painful thing to read. In the letter, written from prison, Oscar sets out his perception of many of the interludes in their relationship. Oscar portrays himself as endlessly loving, generous, forgiving, and talented; Bosie, on the other hand, appears to have been entirely crass, shallow, manipulative, and stupid. I suppose it goes without saying that Bosie was also very amusing and attractive.

But Oscar seems to be deceiving himself, in that he devotes tremendous effort in setting out Bosie’s faults, while denying throughout that he harbors any ill will for what amounted to the destruction of Oscar’s entire life. The very account itself is an act of self-righteous retaliation, and it reflects the obvious (and natural) mental energy Oscar had expended in remembering (and re-living) all the dreadful details of his interactions with Bosie. Yet Oscar is (understandably) unable or unwilling to face his own capacity for anger, and wish for retribution.

Of course, we all do this. When we have been harmed, we want to create a story out of the episode, in which there is a perpetrator and a victim. In this story, the perpetrator (the one who harmed us) is Very Bad and Evil; and we (the victims) are entirely without fault. This basic story-line is made even more comforting when we also tell ourselves that, not only are we without fault, but we are also magnanimous in defeat, without a trace of anger or bitterness. This latter point is where self-deception can most clearly be seen. The entire story, of course, will always be more or less a distortion of the actual event(s). In many (if not most) cases, when I have experienced hurt, I have played some kind of role in my own injury. It’s always a challenge to try to figure out how much, or how little (and where) my own mis-steps and bad choices contributed to an interpersonal problem.

But the greater challenge, I think, lies in dealing with the emotional results of having been hurt. It is, in nearly all cases of major hurt (those caused by the deliberate actions of another), impossible to avoid the normal experiences of anger, desires for and fantasies about revenge, and even hatred. They are most unpleasant, to most of us, and we would prefer to believe we are incapable of such base and ignoble feelings and thoughts; but we are human, and they are very much part of our repertoire. They arise naturally and unbidden, like all other emotions. It is important to acknowledge that they have arisen, and to be compassionate toward the mind within which they arise. It is only after admitting that they exist that we can let them be just what they are (passing phenomena, neither good nor bad in themselves), and allow them to exist and pass away (without feeding them, and supporting them, and begging them to stay!). We have to give up the temptation to remain wedded to the story, to tell it to ourselves, again and again, the way that Oscar clearly told and retold the terrible story of Bosie and Oscar. When he is able to let go of that story, however (towards the end of the letter), he gives us reason to hope that he might find peace. Here is an excerpt:

“Everything about my tragedy has been hideous, mean, repellent, lacking in style; our very dress makes us grotesque. We are the zanies of sorrow. We are clowns whose hearts are broken. We are specially designed to appeal to the sense of humour. On November 13th, 1895, I was brought down here from London. From two o’clock till half-past two on that day I had to stand on the centre platform of Clapham Junction in convict dress, and handcuffed, for the world to look at. I had been taken out of the hospital ward without a moment’s notice being given to me. Of all possible objects I was the most grotesque. When people saw me they laughed… For half an hour I stood there in the grey November rain surrounded by a jeering mob.

“For a year after that was done to me I wept every day at the same hour and for the same space of time… Well, now I am really beginning to feel more regret for the people who laughed than for myself… I have said that behind sorrow there is always sorrow. It were wiser still to say that behind sorrow there is always a soul. And to mock at a soul in pain is a dreadful thing…

“I write this account of the mode of my being transferred here simply that it should be realised how hard it has been for me to get anything out of my punishment but bitterness and despair. I have, however, to do it, and now and then I have moments of submission and acceptance. All the spring may be hidden in the single bud, and the low ground nest of the lark may hold the joy that is to herald the feet of many rose-red dawns. So perhaps whatever beauty of life still remains to me is contained in some moment of surrender, abasement, and humiliation. I can, at any rate, merely proceed on the lines of my own development, and, accepting all that has happened to me, make myself worthy of it.”

QUESTIONS ABOUT MEMORY

THE MEMORY WARS

Recently I saw a flurry of online activity about what we once called the “memory wars” in clinical psychology and psychiatry. I found it interesting that they appeared just a few days after I saw a new book at Borders by a psychiatrist who recounts his own memories of his years spent treating a person who, he says, “had” many different personalities. I had hoped that all of this had gone away…

During the heyday of what was formerly known as “multiple personality disorder” (MPD), now much less prominently known as “dissociative identity disorder” (DID), the same bad old days in which free-standing psychiatric hospitals made a fortune “treating” women (they were almost all women) who came to believe that they had been raised in satanic cults, in which their parents and the local police, and ministers, and priests, and judges (etc.) were all satanic cult members; during those days I was in training to become a psychologist. I worked part-time at two of the local free-standing hospitals (only one of them is still operating), and spent many, many 8-hour shifts right smack in the middle of the genuine insanity of that time in our culture. I watched women come into the hospital with a lot of anxiety and depression; and I saw that, by the time they left, weeks later, they were much worse off: they had “discovered” that they were “multiple” and that their whole lives had been spent under the control of satanic cults. They “had memories” of hideous, gory events involving their family members who subjected them to rape, bestiality, torture. Many of them subsequently went on disability, lost their careers and their families. But all along, they were supported by eagerly credulous therapists who “validated” them, every step of the way.

How did it happen? It was an unholy amalgam of all of the following, all at or near the same time:

In popular culture, novels like Rabbit Howled and Michelle Remembers vividly portrayed some of the atrocities that the “multiples” later “remembered.” Also, there was the supposedly legitimate (and subsequently debunked) multiplicity of “Eve,” with her “Three Faces.”

A feminist backlash arose against a version of Freudian thinking that held that women who claimed to have been subjected to incest were probably fantasizing the whole thing. This led to a swing of the pendulum in which it was impossible to ever question the plausibility of any woman’s claim that she had been sexually abused, no matter how outlandish the claim might be.

Some fundamentalist Christians became excited about the phenomenon, which they interpreted as Satan, active and walking around in the world torturing innocent children; they felt that this validated their world view.

Ego, or the desire to be special: patients who were diagnosed with MPD were thought of as special, exotic, and certainly very interesting. They were much more interesting, for example, than any regular old depressed person could possibly be. And the doctors and other therapists who treated MPD patients automatically became more interesting, too. There was always the possibility of memoirs, journal articles, and even talk show appearances.

Within psychotherapy groups, both inpatient and outpatient, the MPD patients recruited new members into their fold by telling other patients that their symptoms (depression, difficult relationships, anxiety, etc.) were likely symptoms of repressed memories of incest and/or satanic abuse. And within pop psychology, self-help books proclaimed that anyone who suspected that she had been sexually abused during childhood, probably in fact had been. The idea of “repressed memories” became rampant and widely believed.

Finally, of course, there is the money factor: the “treatment” of MPD patients was always very lengthy, and required frequent inpatient stays; this meant more money both for outpatient therapists and also for hospitals.

Anyway, this whole thing finally peaked, and then receded from the public eye. Most of the free-standing private psychiatric hospitals closed after the insurance companies got tired of paying out huge sums of money for lengthy inpatient treatment. This was probably a good thing for many women whose lives were in danger of being sucked into the MPD machine; but it also can be a problem for people who genuinely need inpatient treatment for genuine psychiatric problems.

So: a cautionary tale, indeed. For a lot more about all this, check out the web sites you can find under search terms such as “repressed memory” and “McLean Hospital.”

UNTRUE “MEMOIRS”

Several interesting cases have recently been written about, in which writers have confessed that their recently published (and highly acclaimed) memoirs were largely or entirely false.

In some of these cases, it appears that the author(s), at some level and at some times, actually believed in the truth of what they were saying about themselves. How can this happen? How might a person come to believe an untrue (even a very implausible) version of the facts of her own life? That we can do speaks to the amazing capacity of the human mind to actually work on itself. We are all familiar with the phenomenon in which it feels as if we are trying to convince ourselves of something (or trying to persuade ourselves that something is not true). It feels as if there is one of us, inside, who is capable of arguing for a certain point of view, much like a lawyer or salesperson; and another one, inside, one who may be stubborn, or may sometimes be gullible, but who is in a position to be persuaded.

This very interesting aspect of human functioning provides one part of the explanation for why radical behaviorism fell by the wayside in mainstream academic and clinical psychology: Human beings cannot be fully understood or explained simply by observable behavior and its various environmental antecedents (classical conditioning, instrumental learning, vicarious learning). There are other factors going on inside us (inside that aspect of human existence known as mind); psychology learned, after a period of infatuation with behaviorism, that “mind” cannot be discarded; nor, so far as we can see, can it be easily substituted by, or reduced to, “brain.”

There are many examples of situations in which people engage in a sort of mental argument with themselves to convince themselves of things; or they fall into a habit of thinking about something that they wish for, or fear, so that it can eventually become more and more “real” to them; or, in other ways, they come to (more or less) firmly believe things that others can clearly see are false. And all of this can take place in individuals who are “normal,” i.e., they are not psychotic, not delusional.

Earlier (above) I wrote about people who convinced themselves (with the encouragement of others) to believe that they had been raised in satanic cults and subjected to horrific abuse during childhood. And over in the “Law and Forensic Psychology” Page, I write about the phenomenon of “false memory.”

In criminal cases, there are many instances of false confessions. In one variety, the person voluntarily approaches the police and states that he committed some terrible crime. In many cases, he seems to truly believe that he has done so, although it soon becomes quite clear that he did not. In other cases, an innocent person falls under suspicion and is subjected to highly coercive and suggestive interrogation, over a long period of time. Eventually, he confesses. In some of those cases, after his confession, he truly believes that he actually did commit the crime that he has learned to describe in great detail.

In many other criminal cases, I have observed defendants become apparently convinced of their own innocence, despite massive evidence of guilt (and, often, an earlier confession). In the course of building a defense for trial, the defendant learns to pick apart the government’s case; to insist that witnesses for the government are lying about him; to deny to other inmates in jail, and perhaps to his family, that he committed the crime; to insist that there are plausible ways to explain how he could not have done the crime; and to engage in a sort of partnership with his defense attorney to “prove his innocence.” His enthusiasm for proving that he is, in “fact,” innocent can appear to co-exist with a partially suppressed understanding that he did indeed commit the crime.

You can see, then, that in the cases of people who write false memoirs, many factors could come into play that would allow them to (at least sometimes) genuinely believe the truth of what they are claiming. What is important to remember is that these cases are seldom as simple as they seem; it is usually a fairly complex matter, both as to the question of “was she lying, or not?” and as to the mental (emotional, motivational) factors that led to the distortions and allowed them to persist.

HILLARY CLINTON

Like many people, I am fascinated by Hillary Clinton’s stories about “landing under sniper fire” in 1996, on a trip to Bosnia. Not only did she say something that was dramatically and demonstrably incorrect, but it appears that she said it several times, even after others who had been there with her contradicted her in public (here’s a recent opinion piece discussing this).

The question becomes: was she deliberately lying in an effort to inflate her “toughness” credentials? Or was this an example of a “false memory” (a phenomenon I have discussed previously in this blog in several entries, here)? Or (as seems most likely to me), something in between?

The story seemed odd and unlikely to me, anyway, from the outset. I’m not a pilot, but I grew up in the US Air Force; my father was a pilot in WW II, and throughout the Cold War. I have heard a lot, in my life, about military and combat flying. I cannot imagine that a pilot would land his airplane, with the First Lady aboard, if he had been informed that there were snipers actually firing in the area. So the phrase, “landing under sniper fire” seems fishy, to me. But, probably even more significantly, a presidential candidate who is running on a platform that includes an effort to assert something that approximates to military credentials (being very, very close to the Commander-in-Chief!) should know at least as much as I do about whether or not the “landing under sniper fire” story was even plausible. That, alone, speaks (I believe) poorly as to her grasp of certain realities about the military.

One way that Clinton may have come to believe in the truth of her (untrue) story is this: She knew, before and during the flight into the airfield in Bosnia, that sniper fire had been a major feature of the combat in that area for years. It is likely that this was discussed among the passengers on the flight (even though, as some are asserting, the “war was over” by the time that Hillary visited in ‘96). There was probably some sense among the passengers that they were arriving at a place that still carried some threat of danger (particularly, the remote (?) threat of sniper activity). And that sense of danger was probably inflated just by the fact that Hillary was then the First Lady, and always accompanied by Secret Service agents who are, of course, highly sensitive to any sort of threat to the people they are protecting.

Fast-forward 12 years; Hillary Clinton is running for president, and she has no military experience, no combat experience, and very little foreign policy experience that she can legitimately call her own. And she strongly feels that it is necessary that she convince the world that, contrary to appearances, she actually DOES have all kinds of quasi-military experience, and that she has, in effect, been exposed to hostile fire. How can she do that? In rummaging through her many experiences and travels (and travails!) as First Lady, she comes upon the fact that she actually did go to Bosnia! And there were snipers in Bosnia! And she was frightened! And, if she had been frightened, it must have been a legitimate fear! So, there really WERE snipers, and everyone had to jump out of the airplane, and put their heads down, and run! Therefore, she is tough and experienced in combat situations!

Of course this is wild conjecture… or, at least, a little wild. Obviously, I don’t know what really happened inside the mind of Hillary Clinton. But I certainly don’t buy the “sleep deprivation” explanation that she apparently is now offering…

BOGUS “TREATMENTS”

Byron Katie’s “Work”?

By Delany Dean, JD, PhD

Conference clappingImage via WikipediaRecently I have become much more aware of the destructive tactics used by the “church” of scientology; I wrote about it in a previous blog entry, here. Today I was checking my Google Reader feed for blogs that use the term “mindfulness-based,” and I came across a web site (called the Ross Institute Archives: click here), devoted to the discussion of cults and what they call “large group awareness training.” The entry that I was directed to was actually written about the early evidence indicating that Mindfulness-Based Cognitive Therapy is an effective treatment for depression (and, I believe, for anxiety disorders). But it was written in the context of a discussion about Byron Katie, who has written some very popular self-help books about what she calls “The Work” (click here for her website). I had seen a little about Byron Katie’s books, and did not see anything that looked particularly dangerous or loony about her stuff. But the people who were writing on this web site have looked at it in more depth, and they report that they are finding what appears to be some alarming methods that Katie uses in her group “trainings.” Here is an excerpt from the web site, about the experiences of one person who went through one of those group “trainings”:

[H]aving met and talked with Katie personally, I want to say upfront that I believe she is very innocent/ignorant about what she is doing to people. I believe that she sincerely believes she is what she says she is, and that’s probably what makes her so convincing. At the same time, there is no doubt that she falls into the category of a… mass manipulator. The book “In Sheep’s Clothing” offers a list of tactics that covert aggressors use to manipulate, distract, and deceive… I believe that it is herself she is deceiving the most… it’s scary, because so many people are following her lead.

With many reservations, I attended her 9 day school. We were sworn to secrecy about the events that go on there so as not to “spoil it for others” who would attend in the future. [Here is] a small list of things that happen there:

>A forced 36 hour fast…

>Long, intense confessional sessions.

>Deep, excessive probing into one’s past traumas. (She used violent Korn music to trigger our worst memories.)

>No contact with family or the outside world. (We turned our cell phones into the staff.)…

>Being invited to criticize Katie and The School, and those who did were silently, subtly shunned by the group and Katie.

>Having every doubt and concern about what was going on at The School questioned and “turned around”, until no one could trust their own perceptions anymore.

I was surprised by the number of educated professionals at The School. Teachers, doctors, psychologists, social workers, counselors of all kinds. I was even more surprised how everyone seemed reduced to this “blissed out” state by the end, where they couldn’t even hold an intelligent conversation anymore. It was scary, and sad.

And, most of them would fight to the death to defend Katie’s validity and honor.

Some of what this person describes sounds a bit like a typical long meditation retreat… but other things, as listed in the quotation above, are very indicative of emotional and cognitive manipulation techniques. If this is in fact what goes on in the “trainings,” then I would have very, very strong reservations about Katey’s “Work.”

Years ago, when I was in graduate school, and working in a psychiatric hospital, I was invited by a fellow hospital staff member to attend a weekend “training” (or maybe they called it a “seminar”) for something mysterious, something that she said was really a wonderful experience. I can’t remember what it was called… something along the lines of “The Way” or something like that. After she pressured me a bit, and after she offered me a discount on the price (it was really expensive, as I recall), and out of curiosity, I went. I have experienced few things that were weirder. Everyone was made to wait out in the hallway, outside some kind of large conference room. It was a Saturday morning, and there were about 30 or so of us who were participants. We milled around, talking to each other, a bit uncomfortable about the lack of information we had been given about what we were getting into. Eventually, the doors opened, and loud, dramatic music began to play. Inside the room there was a group of people standing side-by-side, dressed in very formal business clothes. These were our instructors. They stood very still, with excellent posture… and no facial expressions at all! Just sort of staring into space! And they just kept standing there, and the loud music just kept playing, as we stood around in the room. They kept that up for a while (maybe 3-5 minutes? it seemed like a very long time), before telling us to sit down.

That was the beginning of a series of manipulative and disorienting techniques that they used for what I eventually came to believe was simply a sort of pyramid-type money-making scheme. If you finished the whole weekend doing their weird exercises (and it included some harsh tactics, and some confessional-type tactics, and techniques designed to elicit strong emotion), then you were invited to go to the “next level.” And, of course, the “next level” consisted of more “training” that cost a lot more money. And, after that? Well, you became an “instructor,” and that cost a lot of money, too; and, as an instructor, you tried hard to bring in more people to start at the bottom level. What a scam!

I think that the type of manipulation used by groups of this sort constitutes a form of terrible abuse of vulnerable people; and today, in a time when there is so much fear and uncertainty, more and more people will be in a position from which they might succumb to any sort of group that offers them hope…

MISCELLANEOUS TOPICS IN PSYCHIATRIC DIAGNOSIS AND TREATMENT

THE SEDUCTION OF PHARMACEUTICALS

Of all specialties of physicians, psychiatrists get the most outpouring of generosity from the drug companies. This is not startling, because psychiatry is unlike other specialties in ways that give rise to this phenomenon. Overall, psychiatric diagnosis is much, much less reliable than you will find in any other specialty; this is because the diagnoses themselves do not (usually) reflect unique underlying disease entities. There is huge overlap among psychiatric diagnoses, in other words, and you will find that competent psychiatrists (and psychologists) may often differ, and for good reason, about the “correct” diagnosis to assign a patient. Without agreement as to any particular correct diagnosis, legitimate (at least, temporarily so) treatment options tend to multiply, and the drug companies are happy to cater to the desire for yet another pharmaceutical weapon to throw at a fast-moving target.

A related problem is that the “standard of care,” which is fairly easy to define for the treatment of many medical disorders, is much looser and more difficult to pin down within psychiatry (and within all mental health professions). This means that psychiatrists are easy targets for drug companies, in that they are not as firmly committed to any particular treatment regimen (psychotropic) as are other physicians. It is also true that they are not very firmly committed because the available drugs for psychiatric treatment often tend not to work very well (contrary to drug company ads and promotions), for many people. Much experimenting ensues, with this or that drug or combination of drugs; sometimes this works out well, otherwise not.

And it is not just the psychiatrists who are relatively soft targets for drug companies. So are we all, if we look at magazines or watch TV! This is because most psychiatric disorders exist on a continuum with normal psychological functioning. The DSM-IVTR notwithstanding, you will find, with experience or just upon close examination, that there is no hard-and-fast dividing line between (for example) a mood disorder and normal mood fluctuation(s). Of course, there are some cases that are easy to diagnose; but there is also a vast gray area within which a good argument could be made either way. Drug companies invest a fortune in advertising to the “normal” among us who, though not really suffering from psychopathology, might easily conclude (especially with the aid of drug-company ads!) that they might indeed feel better and function better with the aid of a nice little pill.

INFANTICIDE, AND LOBOTOMIES

Two very unpleasant subjects—frontal lobotomies and maternal infanticide—each very important in its own way. Thinking and writing about it from today’s perspective, it is impossible to understand how it could have happened that a physician could develop, market, and teach a procedure as crude, brutal, and horrific as the frontal lobotomy. This is what Dr. Freeman did: He took ice picks out of his kitchen, punched them through the patient’s eye sockets and into his/her brain, and then “like a windshield wiper,” waved the ice pick through the brain tissue, back and forth, destroying much of the frontal lobes. You can see an excellent documentary about this here. Warning: some of the footage includes the actual procedure, and it is very distressing to watch.

No less distressing, of course, are the seemingly inexplicable actions of a very few mothers like Andrea Yates, those who become psychotic and kill their own children. Mind Hacks blog has a couple of good links, one for a podcast (soon to be transcribed and freely available) of an excellent discussion about this phenomenon; and also a link at which you can download the pdf of a very good paper in the American Journal of Psychiatry.

VIOLENT MEDIA and THE BRAIN

ScienceDaily (2007-12-10): This Is Your Brain On Violent Media

“Scientists show that a brain network responsible for suppressing behaviors like inappropriate or unwarranted aggression became less active after study subjects watched several short clips from popular movies depicting acts of violence. These changes could render people less able to control their own aggressive behavior.”

Above is the short blurb from today’s Science Daily post about brain changes that apparently take place when one is watching violent media (film clips). Does this really surprise anyone? When the content of our mind is filled with images of violence, it is very much like being in the midst of violence, and our brains (of course!) reflect that. And this is a reflection, or an expression, of what William James told us a long time ago: My reality really IS what I choose to pay attention to. We make choices, all day long, about what to pay attention to… and we can always bring the question to mind: What am I choosing to attend to, right now?

BIPOLAR DISORDER: EXCELLENT VIDEO

There is a remarkable video of Dr. Kay Redfield Jamison, a very prominent psychologist, talking about her own experience with bipolar disorder. She is very candid, even painfully so. Everyone should watch this; even if you are not a psychotherapist, or training to become one, it is nearly impossible to live in this world without knowing someone with bipolar disorder. It is a widely misunderstood condition, and this video should go a long way toward educating the public.

PSYCHIATRIC DIAGNOSIS (LIMITATIONS THEREOF)

I’m pointing you to an EXCELLENT review/article about psychiatric diagnosis posted on the Powell’s bookstore site. I don’t see how the book itself could possibly be better than this review by Dr. Satel. If you are in any way engaged in studying, or practicing (or just interested in psychiatric diagnosis), you want to read this review.

MALL SHOOTINGS, SCHOOL SHOOTINGS, and “GETTING HELP”

This is from the NY Times article about the young man who recently killed several people, and himself, in a mall:

“’We all cared about this child,’ said Sandra K. Markley, a deputy county attorney who represented the state in a juvenile case involving Mr. Hawkins and played a role in determining his course of treatment. ‘I’ve been reviewing his file, and, of course, there is a lot of second-guessing. But there were no indications that he was harmful in this way.’

“That is the point state officials have emphasized. Todd Landry, the director of children and family programs for the Department of Health and Human Services, said at a press conference Thursday that ‘all appropriate services were provided when needed and as long as needed.’

The state estimates it spent more than $265,000 on Mr. Hawkins’s care.

“’He was in good facilities,’ Ms. Markley said. ‘He had good supervision. It didn’t all go perfectly, of course. But we deal with a lot of troubled children, and, as far as we could tell, he was no more troubled than many of them.’

“But even with the intervention, said Denis McCarville, who runs Cooper Village, the state failed Mr. Hawkins. ‘If this were a physical health issue — if he had leukemia — you would not say that as much as possible had been done,’ Mr. McCarville said. ‘This was not pursued. As you can see, there continued to be issues.’”

It is Mr. McCarville’s comment, just above, that captured my attention. His voice is one we hear after every such horrific event, after each occasion when a person, usually a man, takes up weapons and goes to a public place, killing multiple innocent people (often strangers, but not always). Voices like that of Mr. McCarville are loudest when it is found (and often it is) that the person has had some sort of mental health treatment, usually for substance abuse and/or depression. The conclusion is quickly reached that (a) these problems are readily fix-able; and (b) therefore, somebody (someone other than the killer) should have fixed them. In other words, as we usually are told by those who knew the man, “He needed help.”

It would be comforting to think that someone (other than the killer) is to blame; this would mean that these events are preventable. Indeed, after each such event, we scramble to figure out HOW to prevent them: better “security” is often sought. Metal detectors? More videocameras? No parking of vehicles close to courthouses? Or schools, or malls? How about nobody even ALLOWED in schools and malls and courthouses… and post offices, and office buildings, and fast food restaurants?

As a forensic psychologist, a professor of counseling psychology, a former prosecutor, and a former defense lawyer, I have a fairly broad and deep perspective on the people who engage in these horrific events, and on their mental disorders, and the available treatment for any of those disorders. And I have some bad news: this business of providing “help” for those who “need help” is often, even at its best, not so effective. The unfortunate truth is that what passes for “treatment” of substance abuse disorders has a dismal success rate. Treatment for mood disorders is better, but far from perfect (believe me, it isn’t like giving someone antibiotics for an infection, or insulin for diabetes). And, usually, those who shoot up people in malls have a lot more going wrong for them, mentally and emotionally, than the usual combination of substance abuse and depression. Typically, there are deeply rooted personality disorders, as well, and those are just as hard to treat as is substance abuse and dependence.

This world will never be totally safe from people who are angry, hopeless, and unable or unwilling to control themselves. Successful “treatment” for the most dangerous of these individuals (and we seldom have any way of accurately identifying which of them are “most dangerous”) requires them to begin to exercise self-control, to begin to make effective and positive choices. Sometimes it requires them to remove themselves totally from an environment that supports their lack of self-control, and their bad choices. None of this is easy and often it is, or seems, completely impossible, both for those who are getting the help, and for those who are trying their best to give it.

There are genetic and other prenatal factors, and there are economic factors; there is the insane contemporary diet of “entertainment” that our kids are raised on; there are horrific family backgrounds, and there are neighborhoods terrorized by drugs-and-violence… There is a toxic multitude of factors that combine in many different ways to produce these individuals who “need help.” And the forces that attempt, after the fact, to alleviate these causative factors, and provide “help” to damaged and dangerous individuals, are pitifully under-funded, and too often staffed by people who have minimal training, and gigantic caseloads. Let’s not trivialize these staggering problems by believing in the fairy tale that anybody who “needs help” can “get help,” and then everything will be OK…

SLICK MARKETING FOR EFFORTLESS ACHIEVEMENT

Somehow, I got on a mailing list for an outfit called the “Nightingale-Conant Corporation.” A few days ago, they sent me a big slick envelope, with the following message on it:

Hypno-Peripheral Processing

The New Psycho-Technology

That Connects You With

Your Own Subconscious Mind

For Effortless Achievement

Experience it FREE for 30 Days!

I saved the envelope, because I wanted to show it to my students, as an example of something to be avoided at all costs. I once knew a psychiatrist who became entranced with a method of “therapy” that involved the doctor placing her hands on the patient’s head, and squeezing the patient’s head, so as to “redistribute cerebrospinal fluid in the ventricles,” thereby (supposedly!) curing various cognitive/emotional/behavioral problems. It’s frightening, and sad, to see how easily people can be seduced into promises that something shiny and new will give them happiness (it might be a new “psycho-technology,” or it might be a new flat screen TV…).

The hopeful counterpoint to all this is that there is quite a bit of research activity in the area of “positive psychology,” aimed at scientifically exploring ways that genuinely contribute to human flourishing and well-being. Check out the Seligman website for an introduction to that area.

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