Race and American Psychiatry, Curley Bonds, MD, DFAPA.

 Race and American Psychiatry

By Curley Bonds, MD, DFAPA

(reprinted with permission from Dr. Bonds)

Now that I am working full time as a public sector psychiatric administrator with a daunting array of duties of responsibilities, I’m frequently asked “Why do you still do private practice?” The question usually comes from friends and colleagues who worry about my mental wellbeing and fear that I’m overworking. 

When Dr. Goldenberg asked me to write a companion piece to his article about the Central Park Five [Southern California Psychiatrist,  July issue 2019] , I readily agreed. While collecting my thoughts I realized that the primary reason I still travel to Westwood every other Saturday to do med checks and psychotherapy is that it helps me to maintain my sanity.  I spend my work week trying to help restructure and create a new level of responsibility and accountability in the largest public mental health system in the country. This is a Sisyphean task - so It helps to spend time providing care that also allows me to do advocacy at a grassroots level. The words that follow are my attempt to explain how this works.   

  

At least once a month I receive a request from a distressed family seeking something very specific - an African American psychiatrist to help them intervene with their young son or daughter in the throes   of what they perceive to be a mental health crisis. The stories that they tell are strangely predictable. The common denominator is that they have witnessed themselves or been told by an instructor/coach/neighbor that their child is exhibiting unacceptable behaviors that put them at risk for everything from school expulsion to incarceration. In the worst of these scenarios their loved one has already had an encounter with law enforcement that invariably did not go well. Their worst nightmare is to have their child become the next opening story on the evening news, another young Black suicide/homicide-by-cop statistic. (One need only watch or read the press nightly regularly to realize that their fears are not delusional).  In many cases they have already attempted to access mental health treatment, but the outcomes have been disappointing. They are sent on an endless goose chase by their insurance company as they attempt to find providers who are ‘in network’ who accept their coverage. Those who have the financial resources to afford a private psychiatrist quickly learn that the number of African American psychiatrists even in a booming metropolis like Los Angeles is very small. The most recent statistics available suggest that only about 2 percent of American Psychiatrists self-identify as being of African descent. If you apply this statistic to the roughly 1000 active SCPC members, one could estimate that about 20 would are Black. When you subtract those of us who have positions that are mostly administrative, academic or institutional – the number of APA affiliated African American psychiatrists available to see private patients can practically be counted on one hand.

One might question the necessity of having culturally congruent psychiatric treatment. Arguably any psychiatrist can treat any patient provided that they share a common language and possess basic diagnostic and treatment competencies. But another perspective is that we all harbor unconscious biases that may cause us to prejudge individuals with backgrounds different than our  own resulting in suboptimal care. A clear example is the research (replicated multiple times) that African Americans are over diagnosed with schizophrenia and other psychotic disorders than non-white patients presenting with the same constellation of symptoms. African Americans also tend to receive higher doses of antipsychotic medications than whites despite the fact that they may be at greater risk for untoward side effects like tardive dyskinesia. It is hard to pin these findings on blatant racism, but they do point to institutions that have allowed systemic discrimination to persist. 

There are multiple unmeasurable or difficult to measure aspects of care that contribute to treatment  adherence and outcomes like countertransference, comfort with disclosing private or embarrassing secrets and the ability to efficiently communicate using culturally specific language without having to provide subtitles. As an example, if a patient tells me that they grew up in Baldwin Hills, belong to an AME Church,  pledged Delta  Sigma Theta at Spellman and that they participated in Jack and Jill social clubs as a child – I instantly know volumes about their values, socioeconomic status and robustness of their social network. These things are impossible to learn by completing a mandatory 2 hour CME course on so-called cultural competence or unconscious bias. My treatment plan, crafted with the patient’s input, will incorporate culturally relevant elements that others might overlook. By these statements I do not mean to imply that only Black  psychiatrists can be effective providers for Black patients. But I would strongly argue that for some, they are much more likely to seek care, remain in care and benefit more from care if their doctor  or therapist share a similar  cultural and ethnic background. 

In 1999, Surgeon  General Dr. David  Satcher produced a groundbreaking report on Mental Health in  our country. His report highlighted the fact that despite many efforts to reduce disparities, the ability for African Americans to access mental health treatment is far below their non-Black peers. Sadly, twenty years later, this situation remains unchanged. A primary reason for the inequity is the failure of American medical schools and psychiatry residency programs to train a sufficient number of psychiatrists and other mental health professionals to meet community demands of underserved minority communities. Evidence has shown that institutions like Charles R. Drew, Morehouse and Howard that have missions dedicating them to train minority physicians do indeed produce more doctors who practice within the safety net. Since 1969 the Black Psychiatrists of America (BPA) has created a space for political activism and provided a platform supporting academics who have dedicated their careers to teaching and research focused on Black patients.  The founders of this organization saw a need for a group focused on the priorities of the African American community in a way that the APA did not. The election of Dr. Altha Stewart as the first African American president of the APA coincided with the 50^th Anniversary of the BPA and was a shining moment of optimism for our field. 

While attending the annual meeting in San Francisco I appreciated the increased volume of sessions dedicated to the notion that the APA can and should do more to highlight and address health disparities among underrepresented populations. 

While we have advanced in many ways towards parity and equality in access to care and training, the number of African Americans entering our specialty still   lags behind where it should be. Programs like the APA Minority Fellows Program and The APA Black Men in Early Psychiatry Mentorship Program (BMEPP) encouraging African  American male  undergraduate students  to consider careers in psychiatry. These programs help to reduce some of the barriers that contribute to the low percentages of African American psychiatrists. They are much needed, especially as senior psychiatrists retire or pass away. A notable recent loss to our field was Dr. Carl Bell who devoted his career to issues relevant to the African American community like the impact of interpersonal violence, trauma and fetal alcohol syndrome. Dr.  Bell was well known for raising the alarm bell through his insightful lectures about how risk factors that impact Black Americans were tempered by protective factors like strong families, spirituality and appropriate mental health care. 

The challenges facing African American patients cannot be addressed solely by minority providers. If we are to move forward towards the ultimate goal of closing the health disparity gap, we need all hands-on deck. The first step in this direction is awareness and education for all of us so that we can come together as a profession to take a stand that racial discrimination in any form is unacceptable. Advocacy is an important but underutilized tool that may at times require us to navigate territory outside of our comfort zone. 

One key question that we should all ask ourselves is “What am I doing to create access and safe spaces for patients of all backgrounds?” 

Soul to Soul ~ The Celtic understanding of friendship

Soul to Soul

by John O’Donohue

The human journey is so short.  We no sooner realize that we are here than it is already time for us to be leaving. The brevity of life gives a subconscious urgency to our desire to know ourselves.  Dostoyevsky said that one of the greatest tragedies is that so many people live their lives without ever finding themselves in themselves.  Perhaps this is what a friendship gives us.  The real mirror of your life and soul is your true friend.  A friend helps you to glimpse who you really are and what you are doing here.  

The Celts had a refined and beautiful notion of friendship.  In the early Celtic church, a person who acted as a teacher, companion, spiritual guide was called an anam cara, the Gaelic words for “soul friend.”  The anam cara was the person to whom one confessed, revealing confidential aspects of one’s life,  one’s mind, and one’s heart.  This person had a special intimacy with you, and your friendship was an act of primal recognition.  It cut across all barriers of convention, morality and religion.  The anam cara could see you from an eternal perspective.

In the contemporary world, we experience so many relationships solely in terms of personality.  But the Celts did not get bogged down in the magnetism, refraction, or negativity of personality; they pursued friendship on a deeper level, toward a person’s soul essence.  The anam cara friendship had a strong commitment to truthfulness.  With your friend you could be truly as you are.  You were encountered in the place where your deepest individuality lived.

Today, this remains the mystery and beauty of the anam cara.  The art of true friendship awakens and calls all that is ancient within you.  The clay out of which your body is formed is as old as the universe itself.  It has a memory that precedes your mind and journey, both of which are relatively recent.  Perhaps this is the deeper, mystical meaning of human friendship. It is the coming together and rediscovery by the clay of its lost memory.  Such a friendship is thus an act of discovery.  Friends are not made; they are discovered and recognized.  In true friendship an ancient circle closes again.

It is unnerving sometimes when you look at your friend and remember how accidental your first meeting was.  If you had not gone to that party or that lecture, if you had not walked down that street, you never would have met.  Now in the season of your friendship, it is unimaginable that this person would not have been part of your life.  The contingency of the beginning of friendship seems to suggest that there is a providence that brings friends together.

There is no such thing as just two friends together; there is always a third force between them.  Each friendship has a special spirit.  This is the soul texture where the meeting of the two friends joins.  The Celts had a wonderful sense of soul.  They recognized that physical space was not to be understood merely empirically.  In other words, in spiritual space there is no distance.  In the anam cara friendship, two people are brought to an eternal level where distance does not control connection.  When two people awaken the power and light of their souls, they are sheltered by the power of the eternal.  A sense of this light can nurture and transfigure lives.  

The Celtic idea of friendship opens up the mystery of interior life in a new and refreshing way.  It brings us back to the intimacy of the human face and the infinite world that stretches behind the face.  In a sense, the whole journey of creation from the dark night of the cosmos, from the silent and concealed night of the clay, has been a journey toward the intimacy that comes alive in the human face.  If you practice silence before the otherness of the human face, you will gradually come into a sense of the eternity that it incarnates.  The mystery of the face will draw you into the fascinating journey of intimacy.   This is the heart of the divine -- the transfiguring warmth that turns the anonymity and darkness of the vast cosmos into intimacy.  

Likely Cause of Addiction Has Been Discovered, and It Is Not What You Think

From The Huffington Post.  Original link here:
http://www.huffingtonpost.com/johann-hari/the-real-cause-of-addicti_b_6506936.html

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Author of 'Chasing The Scream: The First and Last Days of the War on Drugs'

The Likely Cause of Addiction Has Been Discovered, and It Is Not What You Think

Posted: 01/20/2015 3:20 pm EST  Updated: 03/22/2015 5:59 am EDT 

It is now one hundred years since drugs were first banned -- and all through this long century of waging war on drugs, we have been told a story about addiction by our teachers and by our governments. This story is so deeply ingrained in our minds that we take it for granted. It seems obvious. It seems manifestly true. Until I set off three and a half years ago on a 30,000-mile journey for my new book, Chasing The Scream: The First And Last Days of the War on Drugs, to figure out what is really driving the drug war, I believed it too. But what I learned on the road is that almost everything we have been told about addiction is wrong -- and there is a very different story waiting for us, if only we are ready to hear it. 

If we truly absorb this new story, we will have to change a lot more than the drug war. We will have to change ourselves.

I learned it from an extraordinary mixture of people I met on my travels. From the surviving friends of Billie Holiday, who helped me to learn how the founder of the war on drugs stalked and helped to kill her. From a Jewish doctor who was smuggled out of the Budapest ghetto as a baby, only to unlock the secrets of addiction as a grown man. From a transsexual crack dealer in Brooklyn who was conceived when his mother, a crack-addict, was raped by his father, an NYPD officer. From a man who was kept at the bottom of a well for two years by a torturing dictatorship, only to emerge to be elected President of Uruguay and to begin the last days of the war on drugs.

I had a quite personal reason to set out for these answers. One of my earliest memories as a kid is trying to wake up one of my relatives, and not being able to. Ever since then, I have been turning over the essential mystery of addiction in my mind -- what causes some people to become fixated on a drug or a behavior until they can't stop? How do we help those people to come back to us? As I got older, another of my close relatives developed a cocaine addiction, and I fell into a relationship with a heroin addict. I guess addiction felt like home to me.

If you had asked me what causes drug addiction at the start, I would have looked at you as if you were an idiot, and said: "Drugs. Duh." It's not difficult to grasp. I thought I had seen it in my own life. We can all explain it. Imagine if you and I and the next twenty people to pass us on the street take a really potent drug for twenty days. There are strong chemical hooks in these drugs, so if we stopped on day twenty-one, our bodies would need the chemical. We would have a ferocious craving. We would be addicted. That's what addiction means.

One of the ways this theory was first established is through rat experiments -- ones that were injected into the American psyche in the 1980s, in a famous advert by the Partnership for a Drug-Free America. You may remember it. The experiment is simple. Put a rat in a cage, alone, with two water bottles. One is just water. The other is water laced with heroin or cocaine. Almost every time you run this experiment, the rat will become obsessed with the drugged water, and keep coming back for more and more, until it kills itself. 

The advert explains: "Only one drug is so addictive, nine out of ten laboratory rats will use it. And use it. And use it. Until dead. It's called cocaine. And it can do the same thing to you." 

But in the 1970s, a professor of Psychology in Vancouver called Bruce Alexandernoticed something odd about this experiment. The rat is put in the cage all alone. It has nothing to do but take the drugs. What would happen, he wondered, if we tried this differently? So Professor Alexander built Rat Park. It is a lush cage where the rats would have colored balls and the best rat-food and tunnels to scamper down and plenty of friends: everything a rat about town could want. What, Alexander wanted to know, will happen then? 

In Rat Park, all the rats obviously tried both water bottles, because they didn't know what was in them. But what happened next was startling. 

The rats with good lives didn't like the drugged water. They mostly shunned it, consuming less than a quarter of the drugs the isolated rats used. None of them died. While all the rats who were alone and unhappy became heavy users, none of the rats who had a happy environment did. 

At first, I thought this was merely a quirk of rats, until I discovered that there was -- at the same time as the Rat Park experiment -- a helpful human equivalent taking place. It was called the Vietnam War. Time magazine reported using heroin was "as common as chewing gum" among U.S. soldiers, and there is solid evidence to back this up: some 20 percent of U.S. soldiers had become addicted to heroin there, according to a study published in the Archives of General Psychiatry. Many people were understandably terrified; they believed a huge number of addicts were about to head home when the war ended. 

But in fact some 95 percent of the addicted soldiers -- according to the same study -- simply stopped. Very few had rehab. They shifted from a terrifying cage back to a pleasant one, so didn't want the drug any more.

Professor Alexander argues this discovery is a profound challenge both to the right-wing view that addiction is a moral failing caused by too much hedonistic partying, and the liberal view that addiction is a disease taking place in a chemically hijacked brain. In fact, he argues, addiction is an adaptation. It's not you. It's your cage.

After the first phase of Rat Park, Professor Alexander then took this test further. He reran the early experiments, where the rats were left alone, and became compulsive users of the drug. He let them use for fifty-seven days -- if anything can hook you, it's that. Then he took them out of isolation, and placed them in Rat Park. He wanted to know, if you fall into that state of addiction, is your brain hijacked, so you can't recover? Do the drugs take you over? What happened is -- again -- striking. The rats seemed to have a few twitches of withdrawal, but they soon stopped their heavy use, and went back to having a normal life. The good cage saved them. (The full references to all the studies I am discussing are in the book.)

When I first learned about this, I was puzzled. How can this be? This new theory is such a radical assault on what we have been told that it felt like it could not be true. But the more scientists I interviewed, and the more I looked at their studies, the more I discovered things that don't seem to make sense -- unless you take account of this new approach.

Here's one example of an experiment that is happening all around you, and may well happen to you one day. If you get run over today and you break your hip, you will probably be given diamorphine, the medical name for heroin. In the hospital around you, there will be plenty of people also given heroin for long periods, for pain relief. The heroin you will get from the doctor will have a much higher purity and potency than the heroin being used by street-addicts, who have to buy from criminals who adulterate it. So if the old theory of addiction is right -- it's the drugs that cause it; they make your body need them -- then it's obvious what should happen. Loads of people should leave the hospital and try to score smack on the streets to meet their habit.

But here's the strange thing: It virtually never happens. As the Canadian doctor Gabor Mate was the first to explain to me, medical users just stop, despite months of use. The same drug, used for the same length of time, turns street-users into desperate addicts and leaves medical patients unaffected. 

If you still believe -- as I used to -- that addiction is caused by chemical hooks, this makes no sense. But if you believe Bruce Alexander's theory, the picture falls into place. The street-addict is like the rats in the first cage, isolated, alone, with only one source of solace to turn to. The medical patient is like the rats in the second cage. She is going home to a life where she is surrounded by the people she loves. The drug is the same, but the environment is different. 

This gives us an insight that goes much deeper than the need to understand addicts. Professor Peter Cohen argues that human beings have a deep need to bond and form connections. It's how we get our satisfaction. If we can't connect with each other, we will connect with anything we can find -- the whirr of a roulette wheel or the prick of a syringe. He says we should stop talking about 'addiction' altogether, and instead call it 'bonding.' A heroin addict has bonded with heroin because she couldn't bond as fully with anything else. 

So the opposite of addiction is not sobriety. It is human connection. 

When I learned all this, I found it slowly persuading me, but I still couldn't shake off a nagging doubt. Are these scientists saying chemical hooks make no difference? It was explained to me -- you can become addicted to gambling, and nobody thinks you inject a pack of cards into your veins. You can have all the addiction, and none of the chemical hooks. I went to a Gamblers' Anonymous meeting in Las Vegas (with the permission of everyone present, who knew I was there to observe) and they were as plainly addicted as the cocaine and heroin addicts I have known in my life. Yet there are no chemical hooks on a craps table.

But still, surely, I asked, there is some role for the chemicals? It turns out there is an experiment which gives us the answer to this in quite precise terms, which I learned about in Richard DeGrandpre's book The Cult of Pharmacology. 

Everyone agrees cigarette smoking is one of the most addictive processes around. The chemical hooks in tobacco come from a drug inside it called nicotine. So when nicotine patches were developed in the early 1990s, there was a huge surge of optimism -- cigarette smokers could get all of their chemical hooks, without the other filthy (and deadly) effects of cigarette smoking. They would be freed. 

But the Office of the Surgeon General has found that just 17.7 percent of cigarette smokers are able to stop using nicotine patches. That's not nothing. If the chemicals drive 17.7 percent of addiction, as this shows, that's still millions of lives ruined globally. But what it reveals again is that the story we have been taught about The Cause of Addiction lying with chemical hooks is, in fact, real, but only a minor part of a much bigger picture.

This has huge implications for the one-hundred-year-old war on drugs. This massive war -- which, as I saw, kills people from the malls of Mexico to the streets of Liverpool -- is based on the claim that we need to physically eradicate a whole array of chemicals because they hijack people's brains and cause addiction. But if drugs aren't the driver of addiction -- if, in fact, it is disconnection that drives addiction -- then this makes no sense. 

Ironically, the war on drugs actually increases all those larger drivers of addiction. For example, I went to a prison in Arizona -- 'Tent City' -- where inmates are detained in tiny stone isolation cages ('The Hole') for weeks and weeks on end to punish them for drug use. It is as close to a human recreation of the cages that guaranteed deadly addiction in rats as I can imagine. And when those prisoners get out, they will be unemployable because of their criminal record -- guaranteeing they with be cut off even more. I watched this playing out in the human stories I met across the world.

There is an alternative. You can build a system that is designed to help drug addicts to reconnect with the world -- and so leave behind their addictions. 

This isn't theoretical. It is happening. I have seen it. Nearly fifteen years ago, Portugal had one of the worst drug problems in Europe, with 1 percent of the population addicted to heroin. They had tried a drug war, and the problem just kept getting worse. So they decided to do something radically different. They resolved to decriminalize all drugs, and transfer all the money they used to spend on arresting and jailing drug addicts, and spend it instead on reconnecting them -- to their own feelings, and to the wider society. The most crucial step is to get them secure housing, and subsidized jobs so they have a purpose in life, and something to get out of bed for. I watched as they are helped, in warm and welcoming clinics, to learn how to reconnect with their feelings, after years of trauma and stunning them into silence with drugs. 

One example I learned about was a group of addicts who were given a loan to set up a removals firm. Suddenly, they were a group, all bonded to each other, and to the society, and responsible for each other's care. 

The results of all this are now in. An independent study by the British Journal of Criminology found that since total decriminalization, addiction has fallen, and injecting drug use is down by 50 percent. I'll repeat that: injecting drug use is down by 50 percent. Decriminalization has been such a manifest success that very few people in Portugal want to go back to the old system. The main campaigner against the decriminalization back in 2000 was Joao Figueira, the country's top drug cop. He offered all the dire warnings that we would expect from the Daily Mail or Fox News. But when we sat together in Lisbon, he told me that everything he predicted had not come to pass -- and he now hopes the whole world will follow Portugal's example.

This isn't only relevant to the addicts I love. It is relevant to all of us, because it forces us to think differently about ourselves. Human beings are bonding animals. We need to connect and love. The wisest sentence of the twentieth century was E.M. Forster's -- "only connect." But we have created an environment and a culture that cut us off from connection, or offer only the parody of it offered by the Internet. The rise of addiction is a symptom of a deeper sickness in the way we live -- constantly directing our gaze towards the next shiny object we should buy, rather than the human beings all around us.

The writer George Monbiot has called this "the age of loneliness." We have created human societies where it is easier for people to become cut off from all human connections than ever before. Bruce Alexander -- the creator of Rat Park -- told me that for too long, we have talked exclusively about individual recovery from addiction. We need now to talk about social recovery -- how we all recover, together, from the sickness of isolation that is sinking on us like a thick fog.

But this new evidence isn't just a challenge to us politically. It doesn't just force us to change our minds. It forces us to change our hearts. 

Loving an addict is really hard. When I looked at the addicts I love, it was always tempting to follow the tough love advice doled out by reality shows like Intervention -- tell the addict to shape up, or cut them off. Their message is that an addict who won't stop should be shunned. It's the logic of the drug war, imported into our private lives. But in fact, I learned, that will only deepen their addiction -- and you may lose them altogether. I came home determined to tie the addicts in my life closer to me than ever -- to let them know I love them unconditionally, whether they stop, or whether they can't. 

When I returned from my long journey, I looked at my ex-boyfriend, in withdrawal, trembling on my spare bed, and I thought about him differently. For a century now, we have been singing war songs about addicts. It occurred to me as I wiped his brow, we should have been singing love songs to them all along. 

The full story of Johann Hari's journey -- told through the stories of the people he met -- can be read in Chasing The Scream: The First and Last Days of the War on Drugs, published by Bloomsbury. The book has been praised by everyone from Elton John to Glenn Greenwald to Naomi Klein. You can buy it at all good bookstores and read more at www.chasingthescream.com.

The full references and sources for all the information cited in this article can be found in the book's extensive end-notes.

If you would like more updates on the book and this issue, you can like the Facebook page: https://www.facebook.com/chasingthescream

Follow Johann Hari on Twitter: www.twitter.com/johannhari101

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The ongoing repercussions of minimizing childhood trauma in a person’s life and relationships.

Childhood trauma and neglect are the principle barriers to a person being able to individuate and separate (emotionally) from the person’s parents. Individuating and separating from our parents is a normal phase of human development, necessary for a child to grow to full adulthood emotionally and establish healthy boundaries between his/her self and the parents.  

In “normal” child centered homes, adolescents are allowed to do this.  The parents put the emotional needs of the child first so that the children are free to have a childhood that is centered around self discovery, and exploring the world in which they live.  This enables them to flourish as adults because they have a core sense of security and “belonging.”

In dysfunctional homes (alcohol centered, deprivation centered, co-dependent parents) the children assume the role of emotional caregivers for the parents, who (usually) themselves did not individuate and separate, so they remain “adult children.”  This deprives the children of their own childhood because they become emotionally responsible for the parents well being at a very early age.  

This also makes the children (and the adults when they grow up) very easy to control.  The child/person is afraid of their anger, so they cannot use it to protect themselves when they are being assaulted, emotionally or even physically.  Instead of feeling natural and appropriate anger and acting upon it, the person feels internally conflicted, and often re-directs the anger inward on his/her self.  This is one of the principle causes of depression in our culture.

NOTE:  The names and some details have been changed in this story to maintain confidentiality.  I specifically asked permission to share it, and both parties stated they were fine with it.  Both recognize the healing potential for others in their processes.  

I recently had one of those sessions in my office that reminds me of how valuable my life and training has been with regard to working with people and helping them make peace with inner demons.

Frank and Claire have been coming in for about 4 months.   They are early middle aged, each has children from previous (failed) marriages.  Both are in “recovery” in respective (and shared) 12 Step programs.  So they both already have some skills at dealing with themselves.  They came to me because they don’t always get along very well.  Claire often takes “pot shots” at Frank, and Frank’s best coping skill to deal with that is to withdraw and not say much.  

This is a common pattern.  Women are more verbal than men, and tend to want to talk about things.  Men are more comfortable with just doing it.  Ask a man how he does something and unless he has had training at communicating, he feels awkward and embarrassed.  It’s why stuttering is much more common in men, and according to some men, nagging is more common with women.

We have gotten to a place where they can talk to each other better and not feel shame over their differences, not blame themselves and each other so much of the time.

They came in to this particular session reporting “things are better.”  None of us were expecting what happened next.

I felt something “flat” about their emotions, like they were talking at and about each other, but not really experiencing their emotions.

So, I utilized an exercise I learned graduate school (thank you Pincus Gross) in which each person sits very close and directly faces the other person.  I then ask them to maintain eye contact (not a staring contest) and only talk about what they were feeling, not any other beliefs about what was going on.

For some clients this is difficult.  They want to describe the experience, but not actually be in it.  Because Frank and Claire have done 12 Step work, and work with me focusing on the difference between “Beliefs” (cognition, thoughts ABOUT living) versus “Feelings” (the actual experience of what their body is feeling in the moment), it was easy to keep them focused.

As they started, I noted the time, and when things were unfolding.  Most folks start to “cave” in the first few minutes.  They didn’t, but Claire reported feeling “nervous” then “giddy.”  Frank had less to say, just that he felt “scared.”  We went on with this, and I asked them what part of their bodies they were feeling the most.  Frank said his gut, “like a screw in my gut that is tightening.”   I said, “If your gut had a voice, what would it say?”  He said, “I’m afraid.”  We went with that for a while.  He started feeling his social awkwardness, his fear of revealing himself, his feelings of unworthiness, his fears of messing up in this relationship.  It was a personal experience of “When in doubt, don’t.”  

We then moved to Claire, still maintaining mutual eye contact with each other, she said she still felt nervous.  I asked her what part of her body felt the nervousness, she said her shoulders, arms and hands “feel numb.”  

At that point, I knew where to go.  As I stated in an earlier post, we store our EMOTIONAL MEMORIES in our body.  If we are feeling something in our bodies, it is because we are going back to the original trauma, and our body is shutting down so as not to feel that pain (again).

The source of my hunch was (and usually is) if her body has stored pain in her shoulders, arms and hands, it is probably due to some actual pressure on those parts of her in the moments of the original trauma.  

The content can come from many sources, being thrown around in an auto accident, being physically assaulted in a violent manner, witnessing a loved one being assaulted or violated (one’s mother being raped or beaten by a violent man is a frequent one), witnessing violence to a sibling (often that sibling being beaten or raped), etc.

Because Claire had mentioned that her father (please note, not a step-father, her actual biological father) had molested her as a child, I had a good guess that her arms and shoulders were back to the child being held down in bed while her father had his way with her.

So I asked her, “If your shoulders, arms and hands had a voice, what would they say?”  She quickly said, “Leave me alone.”  Her voice was flat, she was still engaged in eye contact with Frank.

I offered, “Close your eyes if that helps.  What else is your body saying?”  She closed her eyes, and her feelings started trickling in.  We moved from “Leave me alone” to “Get off of me” to “I hate you,” each step marked by more emotions attached, and her affect closer to the child (within her) who was being raped.

Frank felt some initial discomfort, he tried to look away, and I silently re-directed him back to his wife, he sat still, watching her, having his own response.

Claire progressed through re-living the molestation(s) which had been a routine and regular part of her childhood.  She moved from “leave me alone” etc to “Why won’t you leave me alone?”  Why do you do this?”  Then she called out to her mother, “I want my mother.  Why isn’t she protecting me?”  

She expressed her puzzlement about the situation, as most children and “adult children” do in the face of trauma.    But she was not expressing any anger at either parent, just questioning (bargaining) with them.  With a little encouragement from me (I asked if she had any anger) she moved to the edge of her anger, saying,  “I hate you.”  

When I asked her who she hated, the answer was predictable, “Myself.” 

I asked her,”How about your mother, your father?  Don’t you have anything to say to them?  

Like most “Adult Children” who are still protecting our parents, at our own expense, she said “No, it’s my fault.  I should be able to protect myself, and I can’t.”  

I then asked her to respond to her parents as if she was an adult and this was happening to one of her own children.  That was when her anger fully kicked in.  She got very aggressive and turned her anger outward, towards her parents, where it should have been directed all these years,  “You’re not protecting me (to her mother).  What kind of mother are you?  You should stop him.”  Her protests to her father changed too, “I don’t feel safe in this house, you are supposed to protect and take care of me.  Instead you do this, what kind of parent are you?”

She then went on to tell both of them that they had failed as parents, that she never felt safe in that home, or any home, or in any relationship, because she was never protected by them.  She specifically connected with how angry she was at her mother for ignoring her fathers behavior.  

Once she had come out the other side and returned to her “adult” we reflected on what she had done, and the awakenings her work had brought to her.   Frank then reflected, and broke down with tears, about his own anger at her having been violated and not protected in her childhood.

The important thing for Claire that was empowering, was connecting with her anger at her parents.  Children protect parents at all costs.  Rather than blame her father or mother, she blamed herself for what was happening.   That’s what children do, all children do it.  What makes a person an “Adult Child” is continuing to protect our parents well into adulthood.  She even reported that many years later when her father was found to be molesting another girl in the family and was arrested, she lied about him because he was old and she didn’t want him to go to jail for his last years of life.  

I explained that while that was “noble”, she also said nothing to the man, or her mother, expressing her additional anger about compromising her integrity to save him.  My  example, “buttonholing” him after and saying “Look you #%#$^, I just covered for your sorry self, you owe me one, you owe all of us one, and if you ever do this again, you will pay dearly.”   

Instead, no anger was expressed at him, boundary was set, no consequences were established.

All of this helped her to realize what had been missing all these years in her recovery and therapy regarding the incest.

Elizabeth Kubler-Ross identified the five (5) stages of loss and grief.  They are:

Denial

Anger

Bargaining

Depression

Acceptance

The acronym is DABDA.

Claire had been doing what most people in this culture learn, not feeling comfort with one’s anger. 

In a functioning “Child Centered” home, children are allowed to express their anger about injustice without fear of punishment or shaming.  

In a dysfunctional home, the home is not “child centered” but rather centered around the needs of the parents.  This can come from many reasons, and one of the most pervasive in civilization is poverty.  If mere physical survival is the most important thing, then no one is allowed to question the wage earners, and everyone knows that protecting them is the first and only priority.   This includes telling validating and supporting them, even when they are wrong.

 So the outcome is the “cardinal rule of a dysfunctional home,”  don’t feel,  don’t talk about feelings (especially anger), no matter what.

So Claire stuffed her anger so that the family could survive, because life without a wage earning man was unthinkable, her mother (who was herself an incest survivor) could not confront her fathers behavior.  

Claire had spent years coming out of her denial about the incest, and could talk about it (cognitively) without much discomfort, but also without any emotions.  So she had worked through the “Denial” phase.  

But she jumped right over “Anger” for a variety of reasons, all of which she rationalized in her ongoing “Bargaining” phase, which had more or less defined her coping mechanisms regarding the incest, and much of the rest of her life, including her relationships.

While she remained in this palpable emotional nether world, using being “giddy” to express most of her emotions, she also nit picked at virtually all who loved her, and functioned in relations in a co-dependent manner.  She could provide, entertain, manipulate and deflect.  But actually trusting someone and letting them in was impossible.  She was stuck in the “I can’t trust anyone, the people who say they that they love and care for me are raping me and not protecting me.  So I know not to believe anyone who says they love me.”  

If she felt Angry, she would Bargain it back to taking responsibility for the incest because that way she could have the illusion of control.  This obsession with care taking and controlling formed the core of all of her relationships because she could not access her anger.

Anger is the emotion we are given to protect ourselves from being assaulted.  It is a necessary tool in protecting ourselves, AND cleaning out the residues that trauma leaves in our lives.  

When we are not comfortable with using our anger, expressing it, to set healthy boundaries, we ALWAYS become depressed.

Until we can access our anger about a traumatic situation or loss, our EMOTIONS remain stuck in that moment.  So for Claire, she was constantly feeling un-safe and being raped, in any and all situations involving persons who she perceived had power over her, including her husbands.  

So when Claire FINALLY moved into feeling her anger about her childhood, the bargaining stopped, and after years of also being depressed, she is finally starting to move into the acceptance phase of grieving her very very messed up childhood.

I see this over and over again, people who stay stuck in Bargaining for years, decades, and wonder why they are still held hostage by certain situations and people, almost always their parents (or parent) and or other caregivers.  It applies to other trauma too.  For example, all refugees have pain about their departure from their homeland.  Until they can process their fear and anger, they remain stuck in that place of terror about their safety.

We did a lot of “connecting the dots” closing, her realizing all the observations made about her as a child, sitting quietly with her head down and her arms over her abdomen at most family and public events.  The excuses she made for her parents, always at her own expense.  Her blanket mis-trust of any relationship that she could not be in control of.  Her constant fears of not being good enough.  Frank echoed that one himself, from his own childhood, which did not contain incest, but was defined by emotional neglect.

And ultimately, being able to do this work with Frank (which is why FAMILY THERAPY is so powerful) present cemented their relationship in ways that no solo counseling experience could have done.  They are now full partners.  Most of their secrets and fears about their worthiness died in that session.

Lastly (regarding these issues) it is very difficult to impossible to have a healthy intimate relationship until a person has completed individuation and separation from one’s own parents.  If we are not emotionally free of our parents, and able to easily use our FULL EMOTIONAL RANGE to engage a partner as an equal, we will have problems because our primary relationship is still with our parents.  We continue to live in their emotional “shadow” even if they are long gone.  This is what Frank and Claire came to understand and FEEL in themselves and each other.  

I hope you find this valuable in your own recovery.  Most clients who explore and make peace with their childhood trauma and deprivation eventually come to realize that their parents were also traumatized and deprived, often even more than the client was.  They remained stuck in their trauma, and by doing so, unconsciously passed it on to their children.

But the necessary key to full recovery is feeling “good” about being angry, expressing that anger about the trauma and deprivation, and being comfortable with utilizing anger (in appropriate ways) to protect ourselves from further trauma and deprivation in life.  This is the essence of developing self esteem and self empowerment.  

The failure of "Organized Religion" and the Epidemic of Fear in American Life

In my practice of psychotherapy and addiction recovery, I am on the front line, in the trenches, and see what’s going on, from a very intimate perspective.

I subscribe to “Alternet” News, and today in my inbox, the following two stories appeared.  I found it precipitous because the two are directly related.  

In other words, “Organized Religion”s failure is one of the leading causes of the epidemic of fear that grips this country.  That’s why people are leaving churches, voting with their feet, and why so many identify as “spiritual but not religious.”

Fear is a very powerful emotion, and most of us can rationalize our way right into it with well meaning intentions.  

My prior blog post "We Are Thinking Ourselves Crazy" explains this in greater detail.

Here are the links to the two articles, I hope you will take the time to read them.  If you attend a church, consider if it teaches love or fear.  If it is based in keeping rules and fear of punishment, then consider looking for a different one.

If you do not attend any church, consider looking for some sort of "Spiritual Fellowship" that is not based in rule keeping or fear.  We need the strength of others to get us through hard times.  Being spiritual on your own is a very lonely place.

http://www.alternet.org/belief/americans-turning-away-organized-religion-record-numbers?akid=12838.318602.a2Kkq7&rd=1&src=newsletter1032614&t=7 

http://www.alternet.org/culture/fear-dominates-politics-media-and-human-existence-america-and-its-getting-worse?akid=12838.318602.a2Kkq7&rd=1&src=newsletter1032614&t=3

We Are Thinking Ourselves Crazy

We Are Thinking Ourselves Crazy

The classic idea of “Mental Health” is a situation where a person is able to easily integrate our emotional selves and our intellectual selves.  We have many ways of expressing each aspect of life, “Trust your gut” is one way of elevating our emotions, “Use your head” is another way of elevating our intellect.  

In our current world, we have created a paradigm in which the only model we have for conflict resolution is academic debate.  Each side presents their best argument, the person (or team) with the most logical argument (which often means the stronger facts) wins the debate.  The problem is, someone has to lose, and in our culture, no one likes to lose.  In our very competitive society, losing equates to poverty and shame.

In my work with clients, I see this over and over again.  Couples come to me as if I am a judge who can declare the winner, and then magically, the person with the weakest reasoning will be instantly changed. Individuals come to me, filled with logical reasoning as to why they have a problem, and an equally logical solution to their problems.  They just need “strategies” to carry out those solutions.

In the “shrink” profession, most of us realize that “strategies” are rarely the “cure.”   People come into therapy because their feelings and intellect are no longer working as a team.  This usually happens because of trauma that has been minimized or “forgotten.”  Much of the time, they grew up in homes and families that taught them very systematically to ignore how they were feeling about things going on in their homes and families. 

The defining rule of a functional family is one in which people feel encouraged to share their feelings with other family members.  We are social beings.  We need human interaction to develop emotionally, intellectually and spiritually.  If free and open interaction is encouraged, we grow and flourish in all of these areas of our humanity, including the ability to acknowledge all of our emotions and our intellect to respond to them in a productive manner.

THE DEFINING RULE of a “Dysfunctional Family” is:  

 “DON’T FEEL

DON’T TALK ABOUT FEELINGS

 NO MATTER WHAT.”

People who grow up in dysfunctional families learn at a very early age that no one is interested in their emotions.   Often they are shamed, or punished for expressing that they are having feelings.   If there is trauma attached to emotions, people just shut down.   Just today in my office, the younger son was telling his mother that the reason he had not told her about the bullying he was experiencing at school was because he knew how busy she is with work and a new toddler.  So he kept it to himself, but was also acting out in other ways he was not aware of, such as picking fights with his older brother, and ignoring her when she wanted him to do change his behavior.

Ironically, most dysfunctional families usually “look good” from the outside.  That is because the rule in the family is so pervasive to keep up appearances no matter what.   

People often assume that drama and chaos are dysfunctional, but in fact, life is both dramatic and chaotic.  Being able to comfortably talk about the drama and chaos, and how we feel about it, without fear of judgement or punishment is normal.

When we shut off our feelings, our thoughts take over, and they quickly become obsessive.  

Our school system deeply encourages this.  We don’t learn to feel in school, we learn to think.  We are taught in many different ways that our emotions are not valued, only our academic performance matters.  Only our ability to think in an organized and competitive manner is important.  

As we progress through learning the Scientific Method for resolving problems, and academic debate for solving differences, we quietly build within us an internal conflict mechanism.  

When fear based rules are imposed, rules so powerful that no one even has to speak them, then the development of the person is thwarted and conflicted.   This is where obsessive thought patterns usually develop.  Since we are not sharing ourselves honestly with those around us, we develop imaginary conversations in our heads.  We imagine what others might be thinking, always most critical of us, and develop these self critical “voices” in our heads.  In 12 Step programs, people refer to this chatter as their “committee.”  

This “chatter” inside of our heads continues because it makes an excellent smoke screen for deeper painful emotions that lurk behind the internal conversation.  Much of the time, these emotions are based in shame and fear.  The two are deeply interwoven.  

If I don’t think I’m worthy, then then I live with internalized shame, and the pervasive fear that my unworthiness will be discovered and I will be shamed even more because now I am both unworthy and a fraud.  

Many people spend a lifetime stuck in this pattern.  The principle symptom, constant chatter in our heads, criticizing, questioning, “Yes But” ing (we in the “shrink” profession call these the “Ya Buts”) and never trusting ourselves, especially our instincts.

If we are trauma survivors, the cycle is even deeper.  We have the “taint” of the trauma swirled into the mix.  The film “Prince of Tides” is an excellent film to illustrate this.  The story is about a Southern family that has an abusive/alcoholic father, a co-dependent mother, and secrets to hide.  The mix proves lethal for one child, and is the source of signifiant misery for the other two children in their adult lives.   We from the South have a special relationship with these issues, but not a unique one.  A psychiatrist friend from the Gulf coast said it best, “The Jews and the Asians have nothing on we Southerners.  Southern culture is both guilt and shame based.”

But most cultures and families survive by keeping secrets, not realizing those secrets are lethal.  In 12 Step programs, another powerful truth circulates, “We are only as sick as our secrets.”

Clients come to me with truckloads of obsessive thoughts, well considered understanding of their issues, they have it all figured out.  I ask them, “Then why are you here?”  The answer is very predictable, “Because I can’t quite get them to work.  I need strategies and tools to be more effective in implementing my solutions.”

I smile internally, and gently (most of the time) begin the work of unraveling their thoughts so they can begin to feel the fear and shame that is lurking behind them.  The findings are fairly predictable, at least emotional abuse and/or neglect, often physical abuse as well.  People who have survived other traumas, class or racial oppression, particularly if they have come from another country, or a part of the United States that is more socially rigid.  It is impossible to deal with these issues without considering race, gender, social class, etc.  

One of the things we discuss are the five stages of loss and grief, as identified by Elizabeth Kubler-Ross.  While we tend to think of them only in terms of the original study issue "Death and Dying" they are also contextual to all of the "little deaths" we experience in our lives.  The loss of a parent through separation, death or divorce, failed love affairs or marriages, not getting a lover or a job that we have pinned our hopes upon, etc, etc, etc.  Life is filled with disappointments and pain. 

Kubler-Ross identified these five stages of grief:  

Denial

Anger

Bargaining

Depression

Acceptance  

The problem is, we have to work through all of them and if we come from a dysfunctional family we have great difficulty with Anger.  So we get stuck there, often for a lifetime.

People can spend a lifetime processing pain and anger by rationalizing and explaining these events and situations, “normalizing” them to sanitize the pain so we won’t feel the anger.  In the process, we turn down, or off, almost all other feelings.  When a feeling does pop out of our bodies into our heads, it is immediately put into the “Ya But” machine where it is either shredded, or comes out the other side so sanitized and re-structured that it rarely translates into action.  Instead it becomes a part of the “Ya But” machine, and a part of the rationalization structure, feeding both fear and shame.  In 12 Step it is called “The Paralysis of Analysis.”

The original definition of Schizophrenia was (and is) the separation of emotions and intellect to the extent that the person becomes incapable of integrating the two so that they can function in life.

Although most of us don’t meet the full clinical measures of Schizophrenia, we spend a lot of time in a place that has schizophrenic elements, ignoring our feelings, and arguing with ourselves in our heads.

This “chatter” keeps us from having clarity in our lives.  The most recent issue of “Psychology Today” has an article about how calming our thoughts, becoming less “focused” (if not taking some time every day to un-focus) is essential to gaining clarity in life.  

In the movie “What’s Love Got to Do With It?” ("loosely" based on the story of Tina Turner) Tina goes to a friend for help.  Her friend, also from an abusive childhood and having had abusive relationships, has become a Buddhist and meditates by chanting every day.  She is meditating when Tina arrives.  She invites Tina to join her, saying that chanting is (for her) the path to clarity and understanding her life.

I use a few metaphors to describe that place of being paralyzed in thought.  “Holding one’s breath” (for years on end), “Hovering” is another, “Paralysis” can also work as a metaphor to illustrate the state of being emotionally frozen.  

So while our emotions are “stuck,” our head is spinning constantly, analyzing, worrying, rationalizing and other processes that make sleep, or even relaxation possible.    People say they are “stressed” or “anxious” and they are usually caught in obsessive thought patters, trying to hold on to beliefs that are the strongest part of their internal “chatter.”  

I often have to stop clients mid sentence to get them to actually listen to themselves.  It’s like they have put in a recording they made decades ago and have hit “play.”  They no longer have any emotional attachment to what they are saying.  It’s just chatter.  So I cut them off, which encourages them to actually listen to what they are saying.

The work of unraveling our chatter and gaining clarity cannot be done intellectually.  We cannot think or read our way to clarity (self help books can be the worst, though some do provide insights that are helpful).  The best work is done with the parallel processes of private meditation or prayer, combined with regular interactions with a person who is honest enough to tell us their truthful experience of being with us, not some polite lie that supports our B.S.  This is the role a good therapist, or sponsor in a 12 Step Program can provide.  They are not exclusive, but the relationships do need to be based in honesty.

And that person should be secure enough to handle our anger, because until it comes out, we cannot be healed.  This is not talking ABOUT our anger.  That is just part of the bargaining stage, and while socially acceptable, it is not very effective at healing.  This clip from the film "Passion Fish" is an excellent example of how the character May Alice finally comes to terms with having had her back broken in a car accident.  It takes her over a year, and a very honest companion Chantel, who is not afraid of dealing with hard emotions (she's having some of her own).  Once the anger comes out, May Alice can move forward.

Some simple tools you can use to free yourself from obsessive thought patterns is learn to accurately introduce comments about your thoughts as “I believe” and comments about feelings as “I feel.”  Most people discuss their beliefs with the “I feel” introduction.  This is very confusing and contributes to being “stuck.”  

A belief is described with a sentence, which is a complete thought.  It recounts either historical information, “I believe the reason my car wouldn’t start was because I left my lights on all night” or projections about the future “I believe the battery in my car is old and I should get a new one before it leaves me flat.”

Feelings only exist in the here and now.  So an accurate use of “I feel” might be, “I feel angry because my car is dead.”  I feel angry at myself for leaving the lights on.”  And later, “I feel safer now because I bought a new battery.”

Start noticing how you use “believe” and “feel” in your language.

The other tool you can use is to use “I” when you are talking about your life and experiences.  We are taught in school to use “third person” in writing.  We are taught to use “second person” (you) when we are talking about ourselves so we won’t appear conceited or selfish.  The problem is, it can become a distancing tool so that we don’t feel our emotions when we are describing our experiences to others.  So in describing the above situation, one might say, “Well, you know when you leave your lights on and the next morning your car won’t start, and then you find out the battery was old and now you have to buy a new one.”  Read this out loud, and then try this one out loud, “I left the lights on in my car and ran down the battery.  The next day my car wouldn’t start, and I found out that the battery was old and I needed to buy a new one.”

Notice how you feel when you read each one.  Our lives do not exist in a second or third person abstract.  Our lives are real, and filled with emotions and thoughts.  Acknowledging and processing both brings all sorts of mental and physical health benefits.

These simple tools will help you clarify your thoughts and feelings.  And they will make your therapists job easier if you choose to go for therapy.