How About We All Stop Using “Schizophrenic” as an Insult?

Posted on July 22, 2014 by jcschildbach

by J.C. Schildbach, LMHC, ASOTP

One night about two years ago, I challenged a friend for describing his behavior as “schizophrenic.” In an admittedly snide tone, I asked a quick barrage of questions referencing various types and symptoms of schizophrenia: Are you catatonic? Paranoid? Suffering from delusions? Auditory hallucinations? Visual hallucinations? And so on…

Somewhat unexpectedly, my friend responded with an apology for his use of the term, and didn’t engage in any kind of defensive posturing or attempts to justify his word choice. He clarified that he meant he had changed his mind back and forth several times in relation to a particular situation.

I was a little surprised that I had reacted in such a way to what was supposed to be a self-deprecating comment from a friend. But there were a number of things weighing on me at the time, not the least of which was that my friend was seeking advice on a matter that was best kept between him and his partner, and maybe a good couples counselor. As with most of the times he sought advice, he had already made up his mind about what he intended to do, and was looking to have his intentions validated, or to have them challenged with an argument so compelling that he would have no choice but to turn from that position.

Aside from my irritation with the immediate situation that evening, I had been in contact earlier in the week with a young man diagnosed with schizophrenia. He was in some pretty serious legal trouble, and did not appear to comprehend all that much about it except in the most concrete of terms. That is, he knew what law he had broken and why it was problematic. That information had been drilled into him during his time in court and a stay in jail. But his sense of what the crime meant, and how it was going to impact him, his connection to others, and the choices he was going to have to make, both short- and long-term, was murky at best. It struck me that he was so used to being marginalized that his current situation involved just one more bureaucratic system to interact with—as if this latest set of restrictions was little more than an additional cluster of tasks to occupy his time.

Working in crisis intervention, I also have fairly frequent (phone) contact with people coping with schizophrenia and other mental illnesses that involve psychotic symptoms of varying levels of severity, and which often fluctuate over time. There are few, if any, blanket statements that would accurately cover them all, or make a nice, tidy explanation of what they are dealing with. But, unlike the popular usage of the term “schizophrenic,” the way my friend had engaged it, the behavior, thoughts, and challenges of those dealing with schizophrenia are not simply a matter of being indecisive or changing their approach to an issue.

In the time since I first barked at that friend about his use of the word “schizophrenic,” I have seen it become more and more commonly used (or, perhaps, it was used a great deal before that, and I just hadn’t noticed). Currently, in addition to the way my friend used it, to describe his somewhat erratic decision-making behavior, it is used quite often in relation to politics, and often by writers and other figures I respect or at least tend to agree with. Such uses, though, are potentially offensive, and even insulting in a way that is beneath anyone attempting to make a serious point.

For example, in recent weeks it has been relatively easy to find articles, or to come across people on television news/opinion shows, complaining of politicians behaving in a “schizophrenic” fashion toward immigration policies. Generally, what the use of the term “schizophrenic” means in such a context is that the politicians are saying one thing and doing another, or that they have changed their position on an issue multiple times. It is basically used to mean that a politician or group of politicians have been inconsistent on an issue.

A quick Internet search can find all manner of uses of “schizophrenic” as a derogatory label–frequently in political discourse.

But the problem with using “schizophrenic” to describe contradictory political positions is that it suggests the politicians are suffering from a diagnosable mental illness that is beyond their immediate control, and which can interfere with their perceptions of reality, rather than that said politicians are making rational decisions based on what they think will get the most traction with their “base” or constituents. Politicians shifting their political positions is something that is done with the assistance of political strategists in an attempt to get a message out to voters in a way that might provoke support of a carefully crafted message, even if that message is inconsistent over time.

Schizophrenia, on the other hand, is not volitional. It is not deliberate. People who are living with schizophrenia are not choosing one day to deal with only minimal or well-managed psychotic symptoms, and the next day to pursue the exact opposite. People coping with schizophrenia do not, for example, determine that they will change the content and intensity of their auditory hallucinations based on political polling and messaging strategies. They are not thinking of the gains to be made by crafting an elaborate delusion wherein their friends and family are colluding with various government agencies to monitor and control them.

In short, saying that one’s political opponents are “schizophrenic” is just a different way of labeling one’s political opponents with the big, sloppy label of “crazy”—of indicating that their ideas do not merit any consideration because the people presenting those ideas are not grounded in reality. But, because “schizophrenic” is being used as an insult, as a way of accusing somebody of being worthy of ridicule and dismissal, by extension, it implies that people with schizophrenia are also worthy of ridicule and disrespect. Using “schizophrenic” as an insult encourages ongoing stigma towards those with mental illness. It encourages a lack of understanding of mental illness, and of how to address the needs of those struggling with it. It is dehumanizing in the way that all insults aimed at one’s “enemies” are intended to dehumanize.

And people with schizophrenia are not our enemies. They are people struggling with something that we only barely understand. They are people who, at the very least, do not deserve to be lumped in with politicians who are fine-tuning messages of anger and outrage to try and get votes.

Now, lest anyone think I’m engaging in “word policing,” let me say that I am. As much as language is a dynamic thing, there are still right and wrong ways to use words, or rather, more and less accurate ways of using them. We still make daily decisions about whether we are going to use words to clarify or to obscure, to increase understanding or to confuse. The word “schizophrenia,” unlike a number of other words used in mental health diagnoses (anxiety, narcissistic, etc.) was coined, by Eugen Bleuler around 1908, specifically to refer to the mental illness. It literally means “split mind.”

Arguably, the literal definition of schizophrenia could easily be applied to various other situations such as the one’s already described, and it would not be inaccurate. And, arguably, the mental illness or cluster of illnesses known as schizophrenia involves a broad enough range of symptoms and presentations that the diagnosis requires specifiers for clarification in individual cases. Still, rather than taking a word created to refer to a mental illness, one that will always have ties to that mental illness regardless of how one claims to be using it, and expanding the use of that word to include any behaviors one perceives as inconsistent or otherwise in opposition to one’s own beliefs about appropriate behavior, why not pursue more accurate understanding of the word, and a greater understanding of what the mental illness means, and does not mean?

It seems to me that, rather than calling politicians “schizophrenic,” it would be much more damning to say that one’s political opponents are completely inconsistent in their approach to an issue because they feel that they can achieve greater political gains by changing their position and their message, instead of sticking with real principles or working hard to find real solutions to complicated problems.

And instead of labeling our own actions, or the actions of others as “schizophrenic,” simply because they are inconsistent, appear contradictory, or we disagree with them, why not just acknowledge that most of us are not as steadfast and true as we like to imagine, and that we often don’t make decisions unless and until we have to? Why insult people with schizophrenia by suggesting our poor decision-making skills are the result of a serious mental illness, one that involves much deeper struggles than indecisiveness or occasional mild impulsivity?

How about we all stop using “schizophrenic” as an insult?

God Looks Away, Youth Minister Sex Offender Publishes Self-Serving Article (TW)

Posted on June 17, 2014 by jcschildbach

At the core of “My Easy Trip from Youth Minister to Felon,” an article posted in the online version of Christianity Today’s Leadership Journal, is an odd and self-serving theological point: that God does not look upon sin, and that when sin continues long enough, God gives us over to it so that we might hit rock bottom and then seek redemption. God turning away is, according to the anonymous author, a convicted sex offender still in prison, the reason Jesus felt God had forsaken Him while He was on the cross—God could not look on His Son/Himself as His Son/He took on the sins of the world. It is God’s looking away, the author suggests, that allowed King David to embrace selfishness and send Bathsheba’s husband, Uriah, into battle to die, so that David might have sexual access to Bathsheba. In this same fashion, the author contends, God looked away so that the author might plunge deep enough into sin to be made to answer for those sins.

The author provides no theological discussion of why God also looked away from the victim of the author’s sin, implying (through the author’s shaky theological discourse, and his frequent use of “we” and “our”) that the teenage girl who had been manipulated into a sexual relationship with her youth pastor, shared in the sin, or simply had to be sacrificed so that the author could be redeemed. Without ever naming his actual crime, the author crafts a tale of a sexual predator in need of redemption, and a sexual assault victim as sacrificial lamb, all with God’s blessing/God’s inability to stomach what was happening. But if we are to look at God as incapable of looking on sin, or even the victims of another person’s sinful behavior, then it seems only right to assume God looked away throughout the process that led to the publishing of the article.

The article, taken down from Leadership Journal after much public pressure, can be read from an alternate site here.

I’m a bit torn about whether I think people should read it—not in the sense that I think it deserved to ever be published in the first place—it didn’t—but because it provides an interesting look into the kinds of self-centered justifications, and victim-blaming that sex offenders will endorse in an effort to convince people around them that they’re sorry and won’t ever do anything like that again, because, boy, they’ve learned their lesson, and (in this case) Jesus forgave them, so you should, too.

What was meant by the editors to be taken as a moving story of sin and redemption was, instead, merely a continuation of the abuse, prettied up with self-aggrandizing mock-contrition and Bible verses. And, sadly, the editors saw fit to tag it with the “related topics” of Accountability, Character, Failure, Legal Issues, Self-examination, Sex, and Temptation. Of those tags, “Failure,” and “Legal Issues” seem the only appropriate ones. “Sex” only fits in the broadest definition; whereas “Sexual Assault” or “Sex Offenses” would have been much more fitting. “Temptation” is little more than a label that normalizes the sexualizing of underage girls.

It’s not somebody who’s seen the light…It’s a cold and it’s a broken Hallelujah

What I keep wondering in all of this is how the article came to be posted in the first place. Did the editors of Leadership Journal coordinate with prison officials to approve the project, or did they just accept it from some inmate, insisting via e-mail that he had a unique tale of a fall from grace and a re-acquaintance with God? Did they know the author prior to his incarceration? Is the author in a treatment program in prison? If so, were his treatment providers at all aware of what he was doing? Were lawyers for the author, lawyers for the victim, or the judge in the case aware of the intent to publish such a piece? And, perhaps most importantly, was the victim, or the victim’s family aware that any of this was happening? And did she/they have any say in the matter?

I ask the above questions because I cannot imagine that, prior to publication, the article was examined by anybody with any clinical knowledge of offender behavior—or, for that matter, by anyone with any sense of the damage done to victims of sexual assaults. If I give the editors the benefit of the doubt, then maybe I can view them as possibly well-meaning, but definitely confused/ignorant people looking to generate an attention-grabbing conversation about statutory rape. And while, it certainly grabbed plenty of attention, that was because it took a story of sexual assault and transformed it into a discussion about how easy it is to be seduced by a teen when one takes one’s eyes off of God, and vice versa. The sexual content is so subdued/obscured that it comes across as if it is intended to describe temptation only—definitely much more so than if it was labeled appropriately as child molestation, pedophilia, hebephilia, exploitation of a minor, statutory rape, or rape.

Any sex offender treatment provider who knows anything at all about what she/he is doing certainly would never have approved of the article as it appeared. Offenders in treatment (in or out of prison) are often given writing assignments wherein they are required to relay details of their behaviors and thought processes and demonstrate an understanding of the damage they caused, as well as the way they convinced themselves it was okay. And while I recognize that it wasn’t specifically crafted as a treatment assignment, the Leadership Today piece reads like an eloquent first draft of such an assignment, crafted with care before a treatment provider and/or members of a treatment group demanded changes due to the author taking a victim stance, failing to acknowledge the actual crime or its impact on anyone other than himself, and refusing to incorporate even the most rudimentary sense of understanding about how he built up to the offense and kept it secret for as long as he did.

Or perhaps it’s more like a second draft, after the offender removed most of the overt blaming of the victim, and switched, instead, to implied mutual blame or implied consent for the crime.

I have heard hundreds of variations on the same basic story told in the article, from the mouths of offenders, emphasizing the frustrations in their lives, the reasons they had contact with the victim to begin with, and the reasons they are not to blame (and, yes, a lot of them invoke religion as part of that). It is rare to come in contact with an offender who, from the beginning (not of the offense, but of contact with the justice system and the need for an evaluation for sexual deviancy) is capable of outlining how he (or occasionally, she) manipulated the victim to engage in sexual acts and to keep it a secret, how he justified the crime to himself, and what specifically happened (in clinically appropriate and criminally accurate terms), without putting a large portion of the blame on the victim for somehow enticing or seducing him.

Despite the author’s claim, added after the controversy erupted, that he takes 100% of the blame for the crime, and recognizes that what he once viewed as a consensual relationship was no such thing, the article itself tells a much different story—of a man who worked hard to build something up for the glory of God (and how he was really amazing at doing that work), and then how he accidentally broke it because he was being selfish. Without ever acknowledging the severe harm he did to the victim, harm that is likely to last a lifetime, he signals that he has returned to a life of service to God because he is involved in leading a ministry group in prison (another thing I have a really hard time with anybody allowing).

And while the author touches on one of his justifications for engaging in his behavior—that his wife was paying too much attention to their children, and not enough to him—he is only able to acknowledge the impact on his wife in the form of the fight they had when she found out about the crimes, and how she left in the middle of the night with the children. The author laments that he has not seen his children since, but doesn’t even mention the extreme embarrassment and devastation he caused his wife and children. Nor does he ever fully indicate that he recognizes how childish his justifications for his behavior were, or how those justifications were merely the starting point for a cycle of lying and manipulation committed for the sole purpose of having repeated sexual contacts with a minor.

In a truly terrible minimization of his behavior, the author compares his repeated sexual abuse of the victim (while implying she shared in an identical struggle with him) to the difficulty of smokers trying to turn away from cigarettes.

From the complete dearth of information in the article, if this really were a treatment assignment, once all the extraneous details, self-promotion, and claims to deserved forgiveness are removed it might sound a little more like this:

And, if the author began to actually include the most obvious missing items, the skeleton of a real assignment, or perhaps a combination of real assignments, would start to look like this:

“In my 30s, I accepted a position with a church as the coordinator of youth ministry. I built up the group from just a few members until it was one of the largest youth groups in the region. I realized I was experiencing sexual attraction to one of the underage members, and that she looked up to me in a way that made it possible for me to manipulate her. I set about grooming her. I justified my sex offenses, in part, by blaming my wife for not paying enough attention to me. I managed to work up to the point where I convinced the girl to have sex with me. I then had sex with her repeatedly while convincing myself that she wanted to have sex with me as well, that she was mature enough to handle a sexual relationship with an adult who is an authority figure in her spiritual life, and that I was in no way manipulating her. I managed to keep her from telling anybody about our relationship through various forms of coercion, and went to great lengths to keep anyone from finding out about it. We eventually got caught. My wife, understandably, left me and took the children with her. I was arrested and convicted of sex offenses. I am currently in prison. I will be a registered sex offender for the rest of my life. The teenager I manipulated and raped will need a great deal of therapy and other supports in order to cope with the aftermath of my actions. My wife, my children, and numerous other people impacted by my behavior will also need support to attempt to repair the damage I caused. I recognize that I need to stay away from minors for the rest of my life, and that I can never be placed in any kind of position where I might have authority that can be abused, particularly over any people who could be considered ‘vulnerable.’ I also manipulated editors of Leadership Today into publishing an article I wrote that completely justified my behavior, and suggested that the victim was equally to blame for my sex offenses.”

The assignment would be given back with numerous, specific requests for much more “self reflection,” “accountability,” and actual identification of his specific behaviors and thoughts.

Becoming a sex offender isn’t an “easy” path as the author’s title suggests. It is one that is pieced together with care by the offender, and crafted to secure the cooperation of the victim(s). It is not, as the author portrays it, a little trouble in a marriage, a dash of arrogance, and some innocent flirtations evolving over time into mutual passion—passion that makes God look away, as if God were easily embarrassed. Such a description may be a very simplistic explanation of how an extramarital affair (the words the author uses along with “adultery” to describe his sexually exploitative behavior of a child under his care) evolves.

Unfortunately, by diving into this discussion, without any sense of just how manipulative the author was, and how harmful his words are, the editors of Leadership Journal have put themselves in a place where they must now back away from this discussion entirely. Rather than promoting a meaningful dialog about forgiveness and redemption, they allowed a sex offender to promote himself as a victim of the temptation to have sex with minors. They allowed him to promote his story of redemption—a story that rings as false as any rapist having the arrogance to compare himself to Christ on the cross, as he suggests that God’s mercy has saved him, all while implying a teenage girl entrusted to him for guidance and education was just as responsible for being raped as he was for raping her.

THE Mental Health System Fix to Curb Gun Violence

Posted on June 10, 2014 by jcschildbach

The National Rifle Association (NRA), having confused “the mental health system” with the Pre-cog arm of the FBI’s Future Crimes Division, has endorsed the idea that mass shootings, as well as shootings of the non-mass-variety, are the responsibility of said mental health system. It is with the NRA’s assigning of responsibility for gun-related violence, and the attendant assignation of authority to resolve the problem, that I present the following mental health assessment tool: the Gun Violence Prediction and Prevention Mental Health Assessment Protocol, version 1 (GVPPMHAP-I)

The following assessment tool is to be administered any time a person wishes to purchase a firearm of any kind, regardless of how many firearms those people may already own. In addition, all current firearm owners are required to submit to the assessment by, oh, say next week. Scoring and outcomes of scores are presented at the end of the assessment.

Overcompensation? What overcompensation?

THE GUN VIOLENCE PREDICTION AND PREVENTION MENTAL HEALTH ASSESSMENT PROTOCOL, VERSION 1 (GVPPMHAP-I)

Instructions: Complete each of the following statements with the response that most closely resembles your own thoughts.

1. When you hear the phrase “assault weapon,” you think of…
a) a culturally accepted and understood term for certain kinds of weapons.
b) how you are so angry at peoples’ ignorance of gun specifics that you want to shoot somebody.
c) a pepper spray, a cumin pistol, a thyme bomb, a rosemary clooney, a mickey rooney.

2. Entering a fast food restaurant carrying an assault rifle…
a) causes other people to instantly perceive you as a threat, as it is a very irrational thing to do.
b) is my God-given right—you got a problem with that?
c) is a good idea given that a dimensional rift could open up at any time, leading to enormous, human-eating insects storming into our plane of existence, and it would really suck if you didn’t have your assault rifle with you when that happened.

3. The greatest American president of the 20^th century is…
a) FDR, because the only thing we have to fear is fear itself.
b) Ronald Reagan, who in one fell swoop proved he could take a bullet, and that mentally ill people are the real problem…not guns
c) Thomas Whitmore because he gave those aliens what-for.

4. Despite all evidence showing that women are much more likely to be the victims of gun violence when they have guns in their homes or on their persons than when they don’t…
a) women should be allowed to buy guns under the law just like men, much the same way women should be treated equally under the law in all ways.
b) the real problem is that women just don’t have ENOUGH guns.
c) women are the last, best hope for defeating the impending robot insurrection, so need to keep guns at all times, whatever the cost.

5. Guns don’t…
a) have any purpose being brandished at peaceful political rallies other than to intimidate people who disagree with those showing off their guns in public.
b) kill people; people with mental illness kill people!
c) get to tell me what to do. I tell them what to do.

6. Of the roughly 19,000 suicides in the United States each year, half of them are completed with firearms, suggesting that…
a) guns allow for impulsive, violent suicide attempts that are far more likely to be lethal than any other method.
b) See, I told you the problem is with the mental health system.
c) if I’m really serious about killing myself, I should probably get a gun.

7. We don’t need new gun laws, we just need…
a) to reinstate the old ones that were made unenforceable through the lobbying efforts of the NRA.
b) to get rid of all gun laws.
c) more mystery-flavor Doritos so that we may learn to thrive on the toxins in our environment and become one with cancer.

8. School shootings could best be stopped…
a) with a combination of measures, including reasonable gun control policies; working to get school staff, parents, and students engaged in the school community; and educating parents about the potential dangers of keeping weapons in the home when children/teens might access those weapons.
b) by displaying the Ten Commandments in the classroom.
c) by attractive teens who are able to resolve society’s ills through the power of dance.

9. Smart gun technology…
a) is a reasonable way to limit who can and can’t use a particular weapon.
b) is just another tool of the fascist government to prevent me from shooting any gun I can get my hands on.
c) is a bad step in the direction of weapons gaining full consciousness and realizing the threat posed by their human masters.

10. Each year in the U.S. there are roughly as many deaths by automobile as there are by guns, leading to the conclusion that…
a) guns should be regulated at least as heavily as automobiles and subject to similar controls, such as training in appropriate usage and safety prior to licensing, gun registration, and requirements for gun owners to purchase insurance to pay for any damages resulting from the use of said weapons.
b) automobiles are just as deadly as guns (false equivalencies and misunderstandings of statistics be damned).
c) Pixar should make a “Guns” movie, similar to their “Cars” movie, which tells the tale of waning small-town America through the eyes of a cocky AR-15, Blasty McRatatat, who becomes stranded in a sleepy, little community on the way to a gun show. Through their obvious goodheartedness, the quirky, adorable townsweapons teach the AR-15 to slow down and appreciate life one short burst at a time.

11. Banding together with other assault-rifle owners in order to intimidate government employees who are attempting to enforce a penalty against a racist rancher who has been stealing from the commons for decades…
a) makes you one of those outlaws with a gun, who needs to be stopped by law-abiding citizens with guns.
b) makes you a patriot who believes in the true values of America.
c) Cows are pretty cool. I could hang out with cows all day. It’s only good manners to always say, “Hi, cow!” every time you see a cow, although most of them would prefer if you called them by their proper names. I once knew a cow named Sister Maria Theresa Fortenzia. Isn’t that a funny name for a cow?

12. People who live in fear that the government is coming to take all their guns away…
a) are paranoid and creepy and should probably have their guns taken away.
b) are the only real Americans who are truly awake to the reality of the one-world-government dystopian hell soon to be visited on us all.
c) should know that the loss of their guns is the last thing they should be worrying about in the face of the one-world-government dystopian hell soon to be visited on us all.

13. The only thing that stops a bad guy with a gun is…
a) another bad guy with a gun, a cop, a good guy with pepper spray, a good guy who knows how to tackle a bad guy with a gun, reasonable gun control measures making it much more difficult for bad guys to get guns, enabling law enforcement to track suspicious purchases of guns and ammo, a good guy with a crossbow, a good guy with a knife, a good guy with an apple…sorry, that was several things that potentially have the power to stop a bad guy with a gun…but, y’know, if people are gonna kill somebody or stop somebody, they’re going to find a way to do it, and guns aren’t really necessary, right?
b) Wayne LaPierre’s fiery delivery of nonsensical rhetoric.
c) a well-aimed garbage truck.

14. This assessment involves a fourteenth question because…
a) paranoid conspiracy theorists would probably view an assessment with thirteen questions as being somehow satanic or otherwise involving the occult.
b) because it was probably crafted by liberal pussies who want to make sure it doesn’t reference anything patriotic or pro-America like the original thirteen colonies.
c) test subjects engaging in speculation about the number of questions on an assessment is a sure-fire way to identify people who have an unnatural obsession with the arbitrary connections they make, which seem irrational to anyone not sharing in their delusions.

Scoring is as Follows:
For every “a” answer, score one point.
For every “b” answer, score two points.
For every “c” answer…what the hell, two points seems reasonable.

Once the score is added up, engage the following procedures:

For anyone scoring a 14 or above:
• Prior to any gun purchase, a license for gun ownership must be obtained, which will include training in, and demonstrated proficiency in, use of the weapon, safe storage of the weapon, and proper maintenance of the weapon.
• Prior to licensing, the person desiring to purchase a firearm must pass a comprehensive background check.
• Prior to licensing, the person desiring to purchase a firearm must undergo a three-month waiting period.
• Prior to licensing, the person desiring to purchase a firearm must pass a rudimentary course in statistics/risk assessment so that they understand that they are much more likely to experience the death of a family member by gunshot wound due to having a gun in the home, than by not having a gun in the home, and that cars really are not more dangerous than guns unless a lot more people deliberately start using cars to kill people.
• Purchases of assault weapons, assault rifles, automatic weapons, and semi-automatic weapons will be disallowed.
• Any guns owned must be registered in a national database accessible by local government/police agencies for the basic purpose of making sure any law enforcement officers responding to a situation at a particular residence will have some idea of the level of danger they are facing there.
• At time of acquisition of any gun, owners must purchase firearm insurance at whatever going rates insurance companies deem reasonable for covering expenses related to use of firearms, including, but not limited to, costs for destruction of property, medical care, mental health care, and loss of life stemming from use of firearms.

In an ongoing effort to ensure the public safety, the “mental health system” reserves the right to impose further restrictions/sanctions on the ownership of guns. Currently under consideration: a proposal by one Dr. Rock to increase the cost of bullets to $5,000 apiece.

The “mental health system” would like to thank the NRA and the American people for their trust and support in the design and implementation of the GVPPMHAP-I and its attendant requirements.

Suicide Notes from the Cosmic Web of Coincidence

Posted on May 11, 2014 by jcschildbach

Back around Christmas, I posted a piece about how, contrary to popular belief, the ‘holiday season’ is not the most suicidal time of the year. I’m gonna let you in on a little secret…spring is.

I wasn’t giving the idea of springtime suicide all that much thought, until the news of a note from Kurt Cobain’s wallet—mock wedding vows that turned out to have been penned by Courtney Love—bounced into the news for a day or two, and I realized I’d been hearing about a lot of recent suicides–well-known and mostly-unknown.

Hearing the specifics of Cobain’s wallet note, on a local radio show as I drove home from work, knocked down a self-imposed wall that had prevented me from engaging with the stories of recently-released information and evidence from Cobain’s death, leading me to think back on my memories from that time.

Back then, my wife and I were making a living designing and printing T-shirts out of our apartment, selling them at the Fremont market, and through ads in a local paper, The Stranger, and in national publications Spin, Vibe, and Rolling Stone, as well as doing custom jobs for businesses, bands, and other organizations. News of Cobain’s death had managed to elude us until I saw it in a Seattle Times headline, there on display by the sales counter at a gas station/convenience store across the road from our apartment, where I had gone on a late-afternoon beer run.

As with most deaths, my reaction was one of stunned silence–an unvoiced, “Wow, that’s weird.” Back home, I hemmed and hawed and didn’t quite manage to relay the information, instead turning on the TV news and waiting for the story to come on.

We had only recently confirmed my wife’s first and only pregnancy; and it hadn’t been long enough for us to share the news with friends and family. I couldn’t stop thinking of that photo of Kurt, Courtney, and baby Frances from the cover of Spin. Cobain, not even a year-and-a-half older than me, had achieved what we were all supposed to want—right? Money, fame, a family—all while getting to tout his artistic integrity and give a big middle finger to…well, whoever he wanted, I guess. He was just getting started. He could continue on being a vital artist, or get old and boring, or become a recluse, or whatever he wanted. He had the resources now, and…

Well, if I steer clear of the conspiracy theories, he killed himself. How was that even possible?

Looking back through a lens of pop culture references, I think of Tyler Durden confirming that we weren’t all going to become millionaires, and movie stars, and rock gods. But Cobain had become that…or at least two out of three.

Also, prior to Cobain’s death, I’d read interviews with Eddie Vedder where he talked about being depressed and drinking too much wine, and I was worried Vedder was going to kill himself…intentionally, passively, or accidentally. Cobain said plenty of dark things, sure, but he was just kidding…right? And, yeah, I had all the Nirvana albums, and all the tracks that turned up on compilations, credited and uncredited…No Alternative, Hard to Believe, The Beavis and Butthead Experience…

In my earliest thoughts about this post, I had some germ of an idea about making a connection between Cobain’s death and my current work…like Cobain’s death had some impact on the trajectory of my life, and…oh well, whatever, nevermind. I think we all try to fit various life events into narratives that make everything add up into some kind of “everything happens for a reason” bumper sticker idea…as if the suicide of a celebrity I had never even met was meant to guide me to my purpose.

It was a good 12+ years from the time of Cobain’s death until I bounced back into school with the intention of becoming a therapist, and then a few more before I had gotten involved in suicide prevention, almost more by happenstance than by a powerful drive to do so. I found out I was good at it–able to handle the stress of trying to redirect people in crisis—trying to suss out what it was they were after, and find a way to address that (which often just comes down to listening and validating the underlying emotions of their distress).

Cobain may have been one tiny thread among numerous others leading up to where I landed, just like the other people I knew (mostly peripherally) who had taken their own lives—or tried to—the bulk of them in spring. But Cobain was never some overtly motivating factor. In fact, I think if I cited him as a big reason for my work, it would be kind of ridiculous… “Man, Cobain’s suicide really changed me, and I decided I wanted to help people.” But to be clear, I have no harsh judgment for whatever factors direct people to engage in ‘the helping professions.’

A supervisor of mine, who was instrumental in providing me with the fundamentals for dealing with people struggling with suicidal thoughts, theorized that the increase in suicides in spring might have something to do with the dashing of expectations…that slogging through a cold, dark winter is one thing when everybody has to put up with the cold and the darkness. But when spring starts peeling open, turning itself toward the sun, grasping those opportunities to grow…and you’re still stuck in that winter mindset…cold, despondent, unable to see the sun or feel its warmth, or to even care about dragging yourself out into it…well, that’s when you lose hope.

In thinking about springtime suicide, I’ve had this other little germ of a thought…that when we are constantly exposed to the idea that everything happens for a reason, it can have the inadvertent effect of making people seek out connections for why they feel shitty. And when they can’t find particular reasons…or perhaps the reasons they find are viewed as trite or easily resolved by the people around them…or maybe the reasons they find all land in the arena of self-doubt, shame, or a sense that they are apparently deserving of the bad things that have happened to them and the lack of happiness they feel…well, it can hurt that much more.

Instead, why not embrace the idea that plenty of things in life happen for no reason at all, except, perhaps, for the culmination of random factors and arbitrary decisions…the cosmic web of coincidence…which can end up dropping anyone down a deep dark hole? (Arguably, this is a ‘shit happens’ bumper sticker argument, but I like to think of it as much more involved). And why not embrace the idea that darkness is an essential part of being human? As much as happiness may be the goal, as much as we may all want to be millionaires and rock stars and movie gods, even the millionaires and rock stars and movie gods among us can’t completely avoid disappointments, disasters, trauma, and loss—hell, a lot of them are born of that negativity (although I don’t want to promote any ‘tortured artist’ stereotypes).

None of us get to insulate ourselves against negative feelings. Those negative feelings–even feelings of suicide–are actually much more common than people think. But when we’re so fixated on happy, and so fixated on the idea that we can ARRIVE at happiness once and for all, with just the right combination of attitude and effort, we set people up to wonder just what is wrong with them when happiness seems so elusive.

So, check in with your friends and family this spring and every spring (and every other season for that matter). That celebration-free, often contact-free, stretch from New Years Day until the world starts warming up in spring can be long and dark as hell…and when spring rolls around, and people are left feeling like they are still disconnected and down in a hole, despite all the blossoms and rays, that darkness can become something much more overwhelming.

Why Asking “Are You Off Your Meds?” Isn’t Funny

Posted on March 19, 2014 by jcschildbach

If somebody were to quit using their insulin, or stop taking their heart medication, would a company use that situation as a humorous way to try and sell soft drinks, power tools, or airline tickets?

In recent months, I’ve repeatedly heard a radio commercial involving a married couple discussing a particular service, which is supposed to be so great, at such an unbelievable price, that on hearing about it, the wife asks the husband, “Are you off your meds?”

Sadly, “off your (his/her/my/their) meds” is one of those expressions that is used so casually and so often that it is treated as a perfectly acceptable phrase to describe someone who is viewed as irrational, or who is behaving in any way that is deemed unacceptable by the person using the expression. If the saying weren’t so accepted, it wouldn’t be used as a joke in a radio ad, in a way that the advertisers assume will cause no offense to anyone, and will actually draw people to the company that paid for the ad.

At base, when people use the phrase “off your meds” to take a dig at someone, they are indicating that they believe the target of that phrase is delusional, or foolish in some way that is indicative of mental illness. Stripping that phrase down to its core, using “off your meds” as a joke is essentially saying that mental illness is something to be laughed at, and people who use medications to manage mental illness are appropriate targets of ridicule. In such a context, the symptoms of mental illness that might lead to a diagnosis or to a prescription for psychiatric medications are symptoms that make a person entertaining, or perhaps annoying, in such a way that it is perfectly acceptable to mock them.

Hey, you know what would be really funny? Debilitating psychiatric symptoms!!

For people working in the mental health field, and for a number of connected disciplines, such as medical practice or law enforcement, it is common to end up in situations where questions about a person’s psychiatric medications must be asked: “Are you prescribed any medications?,” “Have you been taking your medications?,” “Is your prescriber aware?,” and so on. Such questions are not jokes to be taken lightly, but queries to get a read on potentially serious problems.

Mental illness that is being treated with medication is much like any physical condition being treated with medication, in that it is ideally guided by a skilled practitioner with a well-informed client, and with the client’s best interests in mind. If medication is not being used properly, as directed by the prescriber, it becomes nearly impossible to know if medication is effective for a client, or if adjustments need to be made, or if new strategies altogether need to be employed.

So, what exactly does it mean to be “off one’s meds”? The answer to that question depends on the nature of a particular mental illness, the severity of the illness, and a huge variety of factors in the life of the person taking the medications, much the same as it is for any physical illness being treated with medications. Some mental illnesses may require use of medications over extended periods—years, or even decades—just to ensure a client’s ability to engage in daily functions. Other mental illnesses may be subject to cycles where medications can be used over much shorter periods, when symptoms intensify, rather than as a long-term, critical part of everyday routines.

For some, being “off their meds” is the difference between stabilization and falling into debilitating psychiatric symptoms which are likely to lead to an inability to manage even simple tasks. Intentional, or unintentional self-harm leading to hospitalization may be consequences of people being “off their meds.” For people falling into this most severe category, maintaining a medication regimen without both professional and personal supports can be extremely difficult.

People with chronic, severe mental illness are also most likely to repeatedly go off their medications without warning, and without informing their friends, families, or professional supports of their decisions. They are likely to do this with the thought that they are capable of handling their symptoms regardless of signs to the contrary. Many who fall into the category of chronically mentally ill are also at risk of pursuing self-medication via alcohol, street drugs, or by tampering with the dosages of prescribed medications.

For people who need medications to manage psychotic symptoms, going “off their meds” can make a return to those medications extremely difficult. Imagine, for example, trying to convince a client suffering from paranoid delusions that they need to take medications when that client views everyone urging the use of such medications as conspirators in a plot to poison and/or control that client. In such cases, the unfortunate outcome may be that mental health conditions need to deteriorate to the point where the clients can be involuntarily hospitalized before they can get the help they need.

At the same time, for a number of people struggling with mental illness, being “off their meds” is a perfectly reasonable goal, one which they may achieve after a brief period of using medications, or one which they may find they need to pursue multiple times throughout their lives. Such people may reach a point where they feel they have learned enough coping skills and health strategies to ease off their medications, as they try to maintain a healthy balance of the various elements in their lives, with the support of family, friends, and professionals. Such attempts to live medication-free can lead to careful, deliberate lifestyle choices that allow for long-term, medication-free, satisfying relationships and careers. But such attempts can also lead to disappointments, for example, when stressors become overwhelming, and people find that they need the support of medications to achieve periods of stabilization when things are at their worst.

For the purposes of full disclosure, I will say that I feel that the use of psychiatric medications without the support of counseling is almost always a mistake. Medications without other professional mental health supports can keep clients from “checking in,” both with themselves, and with professionals who can help clients establish and/or strengthen coping skills. Since it is becoming less and less common for prescribers to have the time for more than brief check-ins with clients, having mental health supports beyond just medication is crucial.

Let me also say that I know that people who call attention to such language issues are frequently accused of lacking a sense of humor, or of being overly sensitive. Those who make such accusations are also quite fond of demeaning people for taking offense at something that is “just a joke.” And, no doubt, there are also those people who fall into the potentially-offended group (people on psychiatric medications) who will say that phrases like “off your meds” do not offend them, because they have a sense of humor.

To such people, I say, go ahead and say what you want to say. I can’t stop you, and I agree it is your right to do so. But just know that you have a choice to say, or to not say, things that are potentially offensive. If you feel that it is more important to make jokes about people being “off their meds” than it is to maybe find a different way of expressing yourself, then just don’t demand that others not get offended by your words. You don’t have any more a right to expect a particular reaction to your words (especially after the potential offense has been pointed out) than anybody has a right to tell you that you can’t say something.

In the United States, we have a convoluted relationship with psychiatric medications, counseling, and mental illness in general. We rail against people wanting to take pills to solve their problems, then turn around and rail against people who don’t take medications they need. We say people need counseling to work out their issues, but then condemn counseling as something for people who are too weak to manage their own problems. And we simultaneously blame untreated mental illness for heinous events, while laughing at people with untreated mental illness.

So how about if we agree that psychiatric medications, when used appropriately, can have a great many benefits, rather than shaming people who use them? How about if we agree that counseling, entered into in good faith between practitioners and clients, is something that can be of great help? And how about if we agree that you don’t get to blame untreated mental illness for gun violence (which is a ridiculous argument) and then turn around and laugh about how funny untreated mental illness is (which is an asinine thing to do)?

People Up: Toward ‘Gender Neutral’ Suicide Prevention

Posted on March 9, 2014 by jcschildbach

Phone-based crisis intervention and suicide prevention frequently involves guiding a caller toward an (often tenuous) agreement that there’s a reason to get through the next day, or maybe just the next hour.

Toward the end of a recent call, the man I’d been talking to for over 40 minutes summed up the call by saying, “Yeah, I get it…man up.” He went on to mildly berate me, suggesting that he could have had the same stupid conversation with his dad if his dad hadn’t died. But I’ll take that as a victory. He agreed he would stay alive to see his kids on the weekend.

He would not agree to turn his gun over to a friend or family member, which would have helped lessen the likelihood of impulsive, violent suicide. But, for the time being, he had put it away. And at least he was calling.

Still, the “man up” comment stuck with me. I suppose on a greatly reductive level, “man up,” was a component of what I had been saying—especially from the perspective of someone who, based on his interpretation of the world around him, had been getting that message for quite some time–that he needed to just take care of his problems and quit complaining. But it is not the kind of phrase I would ever use with someone, or the kind of message I would try to convey.

My conversation with him had woven in and out of a number of concerns, with the crux of the conversation coming down to the caller’s children, and his responsibility (like that of all parents) to do whatever possible to ensure their well-being. It is a conversation I’ve had hundreds of times.

The majority of such calls, involving people who have children but are contemplating suicide, involve the caller expressing that his/her children will be better off without them. There are a small number of variations on the ‘logic’ behind such a thought—usually involving the children not having to suffer through the heartache of the bad parenting they will certainly continue to experience, the hassles the kids will face by bouncing back and forth between divorced parents, and the notion that the children will “get over it” in time. If the children are young, callers express that it won’t make that big of an impression. If the children are older, the parents think the children ‘don’t need me anymore’ or are mature enough to process what happened and move on with their lives.

Never mind the mental twists and turns it takes to imagine that children will have coping skills enough to deal with the suicide of a parent, when that parent doesn’t have the coping skills to deal with loss much less permanent than death—loss of a job, loss of a home, loss of a marriage—or any of numerous variations and combinations of things and people that have gotten away. Statistical studies show that children of people who commit suicide are at greatly increased risk for attempting/committing suicide themselves. In an overly-simplistic explanation, the increased risk can relate to genetic factors involved in mental health issues, but it also involves behavior modeling. Our parents are usually the most significant modelers of behavior in our lives. And we are all doomed to become our parents.

At any rate, I found myself having the same basic conversation with a woman less than two hours later. “What messages are you sending your kids if you kill yourself?” I challenged the cognitive distortions in her justifications for suicide, and explained the threat of her children committing suicide and otherwise potentially being saddled with mental health issues from the suicide of a parent. Ultimately, we got to a similar end result—the caller agreeing she would put up her pills, and live another day.

But in the conversation with the woman, there was no idea of needing to “woman up”–no need to do what was stereotypically feminine in order to go on living, even though the idea of someone ‘sacrificing’ (in this case, the twist being that sacrificing meant staying alive) for one’s children is something that stereotypically falls more heavily on women.

With the ‘man up’ comment replaying itself in my thoughts repeatedly over the next few days, I realized I was (internally) protesting too much. The notion that I had a nearly identical conversation with a woman that same night seemed like a defensive position more than a straightforward assessment.

I ran through other ideas, examining the way I deal with men versus the way I deal with women. For example, any form of counseling involves meeting the client where the client is. Such meeting includes the client’s perceptions of self in relation to gender.

Still, the client’s perceptions are not the same as my way of interacting with the client. The client’s perceptions dictate a number of things about how I will approach the client, what thoughts might be challenged and how, for example. But at base, how I deal with people of different genders is on me. And I need to be aware of whether those dealings are clinically appropriate or not, whether they are tinged with personal biases about what constitutes being appropriately manly or womanly, or fitting into any other gender identity.

I have no problem acknowledging that I speak to people of different genders differently, and that things such as age, economic status, religious beliefs, education, ethnicity, and a whole host of other concerns can color the interactions I have with them. An awareness of how clients differ in background falls under a heading of “cultural competence.” Conducting all sessions or interventions in the exact same fashion would be negligent.

Cultural competence includes the need to avoid approaching clients from any viewpoint of prejudice. In U.S. culture, with its heavy bias toward the idea of women being nurturing and emotional, and men being stoic and strong, it is easy to fall into a trap of diminishing men who seek support, while being much more accepting of women seeking support. The underlying concepts of weakness and strength, as relates to seeking support, diminish everyone. Accepting girls and women who seek support while being less accepting of men and boys who do the same indicates an underlying belief in the weakness of women–the need of women to have support, while believing men don’t–or shouldn’t.

In a context where men are expected to “man up” and take care of their problems, rather than to seek help in processing what is going on with them, it makes sense that many men reaching out for help are, if not hostile, at least pensive and anxious—feeling there is something inherently wrong with seeking help, so taking a position challenging those who might help them.

As a culture, we in the U.S. encourage defensiveness and entrenchment in men—refusal to change—with the exception of encouraging men to become ever harder, ever more willing to engage in aggressive fortifying of their position, with that position often being one of isolation. The processing men do frequently gets externalized to the point where it is not processing at all. They, for example, focus on fixing the world, usually by berating the weak, or advocating the destruction of people seen as enemies, rather than addressing the personal in their lives and what such isolation and fortification does to them.

I posit that the gender-stereotyped notion that men need to take action is in large part what leads men to commit suicide most often in a rather violent and impulsive fashion. When the problem is your whole life, and you’ve been taught that the appropriate response to problems is action, frequently violent action, then ending one’s life can seem like an appropriate reaction when that life has gone off the rails. Mix in alcohol, drugs and weapons, and suicide can seem a reasonable course of action, and be carried out quickly—a decisive form of action, a manly form of action.

This is not to say that I think men in the U.S. are “victims” of the mental health system or of some pro-suicide/anti-male conspiracy. Men, whether willingly or unwittingly, participate in, and perpetuate, the stereotypes that trap them…the stereotypes that say seeking help is synonymous with weakness. And so, long as angry men rail against the “wussification” of the nation, they are advocating for a culture of death before mental health, and ensuring that men will not seek help for mental health issues, or if they do, that it will come with a heaping helping of defensiveness and hostility, potentially putting clinicians in a position of enduring abuse, or having to break down numerous walls, before being able to engage productively with male clients.

So, instead of urging anyone to “man up,” perhaps perhaps there could be a kind of unstated encouragement to “people up”–and not in the reductive way that “man up” is used, but in a way that is expansive. To “people up” could mean to recognize our responsibilities to one another as human beings, whether that be as parents, clinicians, friends, family members, or citizens. We need to recognize the harm in gender stereotypes, particularly if seeking help and support is connected to stereotypes of weakness.

The Danger of Desensitization: Child Pornography Users and Other Empathy-Sapping Traps

Posted on February 17, 2014 by jcschildbach

In Grad School, I did my practicum work with an agency that specialized in the assessment and treatment of sex offenders, an agency I went on to work for as a contractor. As part of the practicum process, along with the work students did at agencies, we also had class meetings that were structured more-or-less like a consult group, where a small number of students could discuss cases under the supervision of an instructor. At one of these meetings, while discussing an occurrence that had thrown me off balance in the previous week, I said something along the lines of, “I was looking through the client’s file and thinking, ‘oh, child porn offender, no big deal’…”

As I continued on, I noticed several in my cohort registering mildly horrified looks on their faces. It was as if I’d just casually told everyone present that I barbecued live kittens because I was fascinated by how the dome of my Weber impacted the tonal quality of the pained mewls of the kitties as they were burned alive.

Thankfully, the instructor did what she could to rescue me by noting that in certain areas of practice people become desensitized to the peculiarities of those fields.

Such distancing and desensitization was exactly what I was trying to highlight. I had, in a fairly short period of time, gotten to a stage where a person who was arrested for possessing child pornography seemed much less insidious to me than somebody who—as we refer to it in the biz—had “hands-on” victims. This was not my attempt to minimize the seriousness of child pornography, but my admission that I had begun compartmentalizing things in a way that was making it easier for me to cope—but in a way that potentially compromised my effectiveness in dealing with clients.

The point I had been moving toward when the barbecued kittens got in the way is that the charging papers for this particular client contained descriptions of the child pornography that had been recovered from the client’s computer. For me, reading through those descriptions was a kind of reboot to the disturbing reality of just what “child pornography” or “depictions of minors engaged in sexually explicit conduct” entailed. I will spare you good readers the details, but we aren’t talking about photos of little kids splashing around in the tub. I will also say that, because the files had already been cataloged by the FBI in previous cases, the descriptions were pretty minimal, but distressing nonetheless.

As a (greatly simplified) note of explanation, the FBI tracks child pornography cases, and labels the “sets” of photos and/or videos that are uncovered in those cases—often with some readily distinguishable feature of the sets—so they can be easily identified each time somebody is found in possession of such files. The bulk of child pornography that is exchanged involves files that have been floating around for some time. In each case, efforts are made to track down everyone involved in sharing the files. However, when new sets (files not previously cataloged) turn up, there is an intensified response to identify and shut down the source, as well as to find the victims and secure help for them.

As another note of explanation, the documentation on clients with hands-on victims routinely contains detailed information from the investigation, often including transcripts of interviews with the victims. Generally speaking, case information from child pornography charges describe things such as from where the files were recovered (computer hard drive, storage disks, flash drives, etc.), the type of files (images versus video), and the number of items recovered. Obviously, reading through a child’s account of being groomed and molested carries a much heavier impact than a brief mention of how many image files were found on a client’s memory stick. Hence, my more startled reaction to reading the descriptions of the child pornography files on this particular occasion.

On some level, making a distinction between child pornography possession cases and hands-on victim cases speaks to a more generalized idea of how people interact online or with media, compared to how people interact with each other face-to-face. That is, it is much easier to distance oneself from the feelings of people one only knows from images or Internet exchanges than it is to distance oneself from the pain of an actual person one knows. From the perspective of a treatment provider, accepting such divisions becomes an easy way to compartmentalize, but also speaks to a number of lies—the lie of an offense of lesser seriousness for the offender, and by extension, the lie of lesser pain for those exploited.

A big part of the work done with offenders who have accessed child pornography, but have no hands-on victims, is breaking down their defense mechanisms that allow them to view child pornography as a “victimless” crime—the offender’s sense that they are not victimizing anybody because they didn’t create the porn or do anything directly to harm the children in it. In some ways, working to establish a sense of empathy can be more challenging with users of child porn than with those who have hands-on victims, simply because it can be easier to get an offender to understand how they have harmed somebody they actually know, than it can be to get an offender to understand how they have harmed somebody in a picture or a video. This is especially true since an offender is unlikely to have any idea what has happened to a child in a series of pornographic photos in the time since those photos were taken, and much more likely for a hands-on offender to have some knowledge of the turmoil created in the life of a victim in the time since the offense(s) took place.

Still, child pornography ties sexual gratification to children, reinforces deviant arousal with the power of images, and provides a false sense to users of child pornography that they are not complicit in the harm that it does. It also potentially creates the illusion for users that they are in control of what they are doing, and are capable of keeping that deviant gratification from making the leap out of their virtual worlds and into their real lives and the lives of potential victims. And, of course, it’s illegal as @$#*%, and with good reason…great reason…unassailable reason.

The issue of child pornography is one that I have to address with clients on a regular basis. But it is also one that I am seeing as a more frequent element in the ‘histories’ of the offenders I encounter—particularly for those in their twenties and younger. On the one hand, I understand the possibility of increased use of child porn as a consequence of Internet access and the ability to find child pornography by chasing down links on a computer, as opposed to having to go through several steps to connect to purveyors via phone, through the mail, or in face-to-face meetings. But on the other hand, I find the possibility of increased use to be somewhat shocking in the sense that I assume people realize just how much trouble they can get into for possessing it. Also, it takes some effort to get to it. It’s not the kind of thing that turns up in sidebar links when you’re shopping for curtains online. And, given that reporting child pornography that one might encounter is also a matter of clicking a few links or making a phone call or two, one would think that anybody who came across it would report it, just to keep themselves out of trouble.

At any rate, I’ve carried the ‘barbecued kittens’ with me for years as a means of (trying to) remind myself to exercise caution in how I discuss my work, particularly with those who are not in the field, but also as a way of reminding myself that each case, each client, is a serious case, a client who needs some real help. Compartmentalizing is often a necessary strategy for therapists working with challenging populations. One cannot be effective if one is carrying around every deep emotional scar of every client, or internalizing each client’s negative behaviors.

But there also has to be that place and time for the compartments to get busted open, particularly while in session or during other client contact, where the reality of what a person has done, how they got to that point, and what they are doing about it now, are not things that can be shut out. Obviously, that ‘busting open’ should not drown the therapist in overwhelming emotion of any kind, but instead needs to involve the ability of the therapist to connect with the client both as a supporter of positive changes, and as a challenger of negative habits and patterns. That de-compartmentalization and re-sensitization must not lead to complicity in allowing a client to minimize his/her actions.

In dealing with the struggles that are attached to difficult fields and difficult clients, I am frequently reminded of a quote from Neil Gaiman’s Sandman, from a story about the city of Necropolis, a home to specialists in preparing and honoring the dead: “It is our responsibility not to let it harden us.”

Indeed, as therapists working with difficult populations, it is often necessary to compartmentalize and protect ourselves from succumbing to the emotional toll such jobs can take. But it is also necessary to avoid hardening ourselves against those realities if such hardening keeps us from connection not only to clients, but also to the impacts those clients have had on others.

GUN CONTROL OR PEOPLE CONTROL? Part Two: Psych Beds and Psych Meds–Faster Than a Speeding Bullet?

Posted on February 1, 2014 by jcschildbach

As we pass the 13.5-month anniversary of the Newtown school shooting, and approach the 15-year anniversary of the Columbine school shooting (or, hell, pick a school shooting and do the chrono-math) we find ourselves struggling with the idea of stigmatizing people with mental illness in order to support easy access to guns and ammo—okay, not so much struggling as having to have a really stupid argument with people who love guns and people who know better than to engage in such a dangerous form of Objektophilie at the expense of fellow citizens, and while demeaning a particular group of citizens.

In an opinion piece that was posted on the Fox News web site just before the one-year anniversary of the Newtown school shooting, “Medical A-Team Member” Dr. Keith Ablow once again lends his severely-compromised credibility to the issue of gun control versus mental-health-system-blaming in order to craft an argument where fewer people would die if only there was increased access to psych beds and other psych services, and just as much, if not more, access to guns.

You can read the piece (all puns intended) here… http://www.foxnews.com/opinion/2013/12/12/on-newtown-anniversary-america-mental-health-system-still-mess/

Dr. Ablow fires out a random assortment of gun- and mental-health-related ideas with the precision and deadly accuracy of a single blast of #9 shot, aimed to take down the elephant in the room—that no meaningful action has been taken to reduce access to unnecessarily powerful weapons and massive amounts of ammunition. Of course, as with trying to take down an elephant with a single blast of #9 shot, all that Ablow does is irritate the elephant—or exacerbate the problem—by claiming that it is mental illness that is the real problem.

Ablow starts off by listing five mass shooters from recent years, and remarks that we “now know” that they were all severely mentally ill. Ablow then abruptly shifts to talk about Virginia State Senator Creigh Deeds, whose adult son, Austin (aka Gus), slashed/stabbed the Senator (with a knife) and then committed suicide (with a gun) in November. (Note: this crime did not involve mass killing).

Prior to the stabbing and suicide, Austin was under an emergency custody order for a psychiatric evaluation, which expired before a psychiatric bed was secured for him. Multiple hospital officials in Virginia later stated that they had open psychiatric beds at the time Austin was turned away. It’s unclear exactly how things fell apart in this case, but it wouldn’t be impossible for a six-hour hold to expire while an overwhelmed staff at one facility needed to present the case for, and secure a bed for, hospitalization at another facility. It is also possible that Austin did not meet grounds for (mental health) detention.

Dr. Ablow states that Austin was “discharged from an emergency room where he complained of severe psychiatric symptoms.” But there are a number of problems with this statement. For one, it comes in the context of one of Dr. Ablow’s “We know” statements—and “we” do NOT “know” what Austin may or may not have said or “complained” about. Also, given that Austin was under an emergency custody order, chances are that he wasn’t voluntarily seeking help. If Austin was willingly seeking help, and considered competent to do so, then the order wouldn’t have been necessary.

Unfortunately, if a client is not a clear threat to self or others, or in danger of harm due to being incapable of caring for him/herself, the client (generally speaking) cannot be detained. Senator Deeds stated, after the incident, that while he expected conflict with his son, he did not expect his son to turn violent. And in Virginia (mental health evaluation and detention procedures differ from state to state) a person cannot be detained if the emergency custody order expires before a psychiatric “bed” is found. By contrast, in a number of other states, if a person is viewed as detainable for mental health reasons, they can be held (for example, in an emergency room) until a psychiatric bed becomes available or the client is stabilized.

At any rate, Dr. Ablow devotes a one-sentence paragraph to greatly simplifying what happened in the Deeds case, and ensuring that nobody who reads his column would understand anything about how laws related to mental health treatment operate, or what is required of patients and evaluators in detaining a person for mental health reasons.

As a bit of an aside, I routinely speak with people who think that all it takes for the state to send out an ambulance with a couple of guys and a straitjacket to cart away a loved one is three people who will pinky-swear that a relative or close friend needs to be “locked up.” This is the kind of information that comes from old movies involving a group of people conspiring to get a relative “committed,” so they can usurp the family fortune. As another bit of an aside, think of how much you agree with the idea that it should be legal for the state to lock a person up based on a consensus among three people that the person is “crazy.”

But Ablow’s interest is not in creating greater understanding, or making any kind of appeal to anybody based on, say, critical thinking skills. It’s in telling us how guns are not a problem when it comes to people being shot.

Strangely enough, to make his pro-gun argument, Ablow then discusses Adam Lanza, the Newtown, Connecticut mass-shooter, in deeper detail. Lanza, Ablow explains, was “allowed” to “learn how to shoot a firearm” by his mother, Nancy, who was the first victim of Adam’s shooting spree. Dr. Ablow apparently hopes that readers don’t remember/can’t do an Internet search to find out that Lanza’s mother had numerous guns and a great deal of ammunition in her home (where Adam also lived), all purchased legally, and, shortly before the killings, had even written a check to Adam so he could go buy his own gun.

Also, as with the Deeds case, Lanza’s mother indicated that she did not fear violence from Adam, despite his statements and behavior to the contrary, and despite the large number of weapons she kept in her home. Nancy Lanza’s sense of safety in opposition to all signs to the contrary is not unusual. Most gun-rights advocates seem to suffer from some sort of collective delusion that they cannot be harmed with their own guns, although statistically speaking, gun owners and their family members are much more likely to be shot with those guns (accidentally, self-inflicted, or otherwise) than any bad-guys.

While ignoring Nancy Lanza’s love of guns, Dr. Ablow notes Adam’s obsession with mass murder, his playing of “violent video games (including one about school shootings)” and that Adam lived in the basement of his mother’s home, where he had covered the windows with trash bags and only communicated with his mother via e-mail during the three months before the shootings took place. Dr. Ablow mentions Lanza’s Asperger’s Disorder diagnosis, and posits that he “may well have merited other diagnoses.”

Well, given that most people with Asperger’s Disorder don’t take up arms against grade-school children, I’d guess Dr. Ablow might be right about that diagnosis piece. Lanza had also been diagnosed with an anxiety disorder, and with Obsessive Compulsive Disorder (neither of which tend to lead to mass killing), and had been prescribed medications related to his various diagnoses, but there was little follow-up by Lanza or his mother with regard to the psychiatric care.

This leads to another point regarding how pointless it is to claim that the “mental health system” is to blame for the problem of gun violence. If the family members of someone like Adam Lanza did little or nothing to get him help, and actively encouraged his access to guns, it seems rather ridiculous to think a psychiatrist would be able to correct that situation with a few days in the hospital and some medications.

Strangely enough…whoops, I mean, “of course,” Dr. Ablow doesn’t mention where Lanza got any of the weapons and ammunition, but instead highlights just how weird (he assumes his readers will believe) it is that Lanza lived in his mother’s basement, and spent time on computers. Remember, kids, video games kill. Living in your mother’s basement kills. Having a massive arsenal of weapons in the home is NOT the problem.

Getting all compassionate, Dr. Ablow goes on to say that “untreated or poorly treated mental illness is” a problem. He even italicizes it. Oh, wait, let me back up off of that statement a bit, so that we can see that what he actually says is that (and let this soak in), an “anti-gun agenda misses the point: Firearms aren’t the responsible variable in mass killings: untreated or poorly treated mental illness is.” (His italics)

Well, I don’t know, Dr. Ablow…I’ve got a weird feeling that there are a lot of people out there with untreated or poorly treated mental illness who don’t commit mass killings, at least in part because they don’t have access to a bunch of guns and ammunition. (My italics)

After his impassioned, italicized plea that guns don’t kill people, people with mental illness kill people, Dr. Ablow awkwardly segues to a brief mention of the 1927 Bath School disaster as the example of the “worst episode of school violence ever” and notes (italicized and underlined) that it “involved no gun.” (Yes, his underlining and italicizing).

The Bath School disaster is one of those weird things that pro-gun folk like to cite as a reason why school shootings really aren’t all that bad. Unfortunately, it kind of undermines their argument if you actually look at it—because the Bath School disaster was committed using dynamite and incendiary pyrotol—substances that are not generally sold in your local Walmart. Those explosives in particular aren’t actually available much anymore, pyrotol having been banned for sale to farmers in 1928 (the year after the Bath School disaster—committed by a guy who owned a farm), and dynamite having largely gone off the market due to the availability of more stable explosives.

Another fun fact is that explosives tend to be rather heavily regulated by the government. After that whole episode of Timothy McVeigh blowing up the Oklahoma City Federal Building, a whole lot of regulations got slapped on the seemingly innocuous components of his fertilizer-truck-bomb. So, if you want to make a connection about the appropriate action to take after somebody uses a certain kind of “tool” to kill a lot of people, bringing up explosives isn’t really helping your case. After all, we don’t encourage people to go buy more explosives to make sure the good exploders can explode the bad exploders.

Ablow also forgets to make any relevant connection between Andrew Kehoe, the man responsible for the Bath School disaster, and mental illness. Certainly, given that Kehoe was homicidal and suicidal, he could have been detained by today’s standards if his intentions were at all known. But from all accounts, he was a rather angry, vindictive individual, like a lot of people who commit gun crimes. Ablow fails to delve into the possibility that Kehoe was constantly playing Grand Theft Auto XIV, eating Cheeto-and-kale sandwiches (on Dave’s Killer Bread), and drinking Baja-Blast Mountain Dew, while masturbating to animated monster porn.

In another odd turn that undermines his argument, Ablow then chooses to discuss untreated mental illness, saying (in relation to suicide of all things) that, “shooting victims don’t come close to the body count from untreated mental illness in the United States.” Apparently, Dr. Ablow, thinks that “shooting victims” who shoot themselves don’t count. Because suicides make up about two-thirds of all gun-related deaths in the U.S. And suicide by firearm makes up about half of all suicides.

To give some nice, round numbers, there are over 30,000 firearm deaths per year in the United States, with about 19,000 of those due to suicide. There are about 38,000 suicides total. The next-highest category of suicides is suffocation, which accounts for around 9,500 deaths. But “suffocation” includes a variety of things such as hanging, cutting off one’s air with plastic bags over one’s head, and using one’s car exhaust to deprive an enclosed space (and, hence, oneself) of oxygen.

Along with failing to mention that suicides by gun account for the lion’s share (sorry lions) of suicides, Ablow also neglects to mention that a big piece in risk assessment and suicide prevention involves removing firearms from the homes of suicidal (and homicidal) people. After all, why would anyone take the guns away from people who are suicidal or homicidal (or who are so paranoid as to think that the government is coming to take their guns away)? Why would anyone take guns away as part of “fixing” the mental health system?

Dr. Ablow then makes the tragi-comedic statement that he wishes that in the year since the Newtown shootings the Surgeon General would have, “declared war on mental illness.” I suppose Dr. Ablow means a declaration of war on mental illness—like where a lot of resources are committed to treating mental illness and maybe to getting rid of the stigma associated with mental illness—as opposed to declaring war on those with mental illness. Because, in effect, blaming mental illness and the failures of the “mental health system” for mass shootings, instead of viewing easy access to the tools for killing (guns and ammo) is a rather shaky position to take. As a general rule, “untreated mental illness,” which covers a huge range of possibilities, is not the vehicle by which metal projectiles end up penetrating children’s skulls.

Ablow goes on to compliment the Obama administration for providing additional funding for mental health care through the Mental Health Parity and Addiction Equity Act. No, really, a guy on Fox news said the Obama administration kinda-sorta did something good. But he then condemns the Obama administration for undermining mental health care by trying to ensure access to mental health care via “Obamacare.” He says that insurance companies do nothing but try to block access to mental health care, and because Obamacare tries to bring down costs, it sucks that people are going to have access to mental health care and the insurance companies that want to deny them care.

So, I think Ablow’s point is that Obama tried to do some good, but failed because he didn’t devote enough resources to it. Increased access to mental healthcare is good, but failure to provide enough money for the highest levels of mental healthcare is bad? What’s the remedy for that? Dr. Ablow apparently thinks the remedy is mental health spending in whatever amount is necessary to put all people dealing with mental illness of any kind into the ongoing care of a psychiatrist…because we all know that what helps people diagnosed with a mental illness…any mental illness…is somebody who prescribes them the right medications. Right?

Let’s do it, then, Dr. Ablow: provide unlimited funding for unfettered access to psychiatrists for all people who are diagnosed with a mental illness. What does that entail? Monthly check-ins with a psychiatrist? Weekly check-ins? Daily check-ins? It’s hard to know what Dr. Ablow is talking about, because he states that MDs need to be in charge of the care of any person who needs mental health care. But unless we increase spending on mental health care by billions, and find a gusher of a grad school, spewing psychiatrists, his ill-defined proposal isn’t going to work.

What Dr. Ablow (very vaguely) proposes is sheer fantasy. And the reason he proposes fantasy to deal with a real world problem is that if a real world problem has a fantastical answer, then that real world problem never has to be solved. We can keep saying, “Fix the mental health system,” or, “Make sure the mentally ill can’t get guns” all while we ignore the fact that we have no intention or way to fix the mental health system in the fashion proposed.

Maybe a better solution is to allow mental health professionals to evaluate people who want to buy guns. If you meet certain diagnostic criteria, you are not allowed to own a gun. If you own a gun, everybody in your house must undergo annual psychiatric testing. But, then, wouldn’t the desire to own a gun be an indication of mental illness, since the intent to own a gun to protect oneself from bad guys would indicate an intention to shoot somebody? Well, nevermind, it would all be rather expensive anyway.

Dr. Albow leans toward closing his piece out by claiming that “We haven’t done anything to meaningfully coordinate police departments and the courts with the gutted community mental health system.” Aside from the idea that the mental health system has been “gutted,” I think those involved in dealing with the “mental health system” might find Dr. Ablow’s statements false and offensive. Because, despite massive budget cuts, and childish blame-cops-judges-and-mental-health-providers arguments like Dr. Ablow’s, numerous police agencies, court systems, and mental health agencies have been doing their damnedest to coordinate care, and provide community education into how to navigate the complicated legal knots of the system. They’ve also been doing what they can to get guns out of the hands of people who are potentially suicidal and/or homicidal, despite the best efforts of the NRA to make sure that everyone, regardless of mental health status, has access to guns.

Dr. Ablow actually closes out his piece by claiming that the Newtown school massacre was “entirely preventable”—which I guess it was, but not by anything that would happen in Dr. Ablow’s fantasy world where psych beds and psych meds negate bullets. He states that the real surprise in the year since the Newtown school massacre is that there wasn’t “another” Newtown massacre. But I’m guessing that the parents of the children who were the victims of the 27 school-shooting deaths and 35 gunshot injuries committed in schools in the year following Newtown might disagree with the idea that there was not “another” Newtown. Sure, there wasn’t a single incident where the same number of people were killed and injured. But what kind of world is Ablow living in where he is willing to excuse even one person being shot at a school in a given year, and to blame mass shootings on mental health providers and people with mental illness, while choosing to support the right of gun manufacturers to continue to provide just about anyone with access to firearms and ammunition designed specifically for killing people?

GUN CONTROL OR PEOPLE CONTROL? Part One: The NRA’s Build-a-Bogeyman Workshop

Posted on January 21, 2014 by jcschildbach

It doesn’t matter how many shots are fired and how many bodies pile up—particularly in those attention-grabbing mass shootings—the cry goes out, crafted by the NRA, that it is something other than guns and ammunition that needs to be addressed. The most recent and prevalent pro-gun meme is that it’s the mental health system that needs to be fixed, while guns are just great. In fact, guns are so great that everybody should have them all of the time, except for criminals and those people with a severe mental illness. But if any criminals or people with mental illness try to shoot any of us good people, then we can all pull out our guns and shoot them back, and definitely shoot them better, harder, faster, and, just for good measure, deader.

Prior to the pro-gun, blame-the-mental-health-system meme, it was the, “We don’t need new laws, we just need to enforce the existing laws” meme. Of course, since the NRA lobbied to make sure that the existing laws wouldn’t be enforced, and, in fact lobbied to have laws enacted that made it illegal to enforce the earlier existing laws, they had to come up with a different cheer for team shoot-em-up. So, hence: guns good; mental health system bad.

There’s this other, less clearly- and less frequently- articulated position underlying the broken-mental-health-system argument, that people working with the mentally ill are incompetent, first of all, for allowing the system to fall into disarray, and second of all, for not being clairvoyant enough to determine which of the people they encounter who express some form of homicidal ideation are just talking nonsense and which really are stockpiling weapons or have access to weapons their family members stockpiled, so that said mental health professionals can then direct law enforcement to stop the future crimes. Okay, in fairness, there are ways to assess for danger—not that the NRA didn’t lobby to try to prevent anybody in the medical and mental health fields from even asking people anything as simple as whether they have access to guns.

But fortunately, the NRA has finally stepped up and has been instrumental in working to address real-life situations and offer up functional ideas for systemic changes, like, “You guys need to fix the mental health system so that people with mental illness stop shooting people, okay?” Except there’s that whole thing about how people with mental illness who actually commit violent crimes (a very tiny portion of them) are not generally compliant with treatment if they’re even in treatment to begin with. So not only do mental health practitioners have to accurately determine which of their clients might commit violence and make sure those clients are stopped from doing so, but they also have to ferret out all of the potentially violent people with mental illness, even if they have never even met them.

Anyway, what I’m saying is that the argument about fixing the mental health system is a nonsensical argument for a WHOLE lot of reasons…most notably that it’s an argument designed for inaction as far as gun laws go, while setting up a bogeyman that can spring out and yell ‘boo!’ anytime there’s a high-profile shooting. For instance, if somebody commits atrocities, such as shooting up a theater or a school, then we can all say, “Wow, this guy was obviously disturbed. Why wasn’t he getting any help?” Or if said shooter was in treatment, we can say, “How come more wasn’t done to make sure he wouldn’t hurt anybody?” Or if there are no clear indications that a shooter was, for example, psychotic or in treatment, we can always fall back on the idea of undiagnosed mental illness. The broken-mental-health-system argument is also convenient for all those 19,000-ish annual suicides by gun.

The argument to fix the mental health system is also nonsensical because it essentially allows the problem of gun violence to go on forever. That is, no set of laws is ever going to solve the problem of murder 100%, but when the argument is that guns aren’t problematic, but the mental health care system is, then as long as there are shootings, we can keep hemming and hawing, failing to enact simple measures like universal background checks, or tracking of Internet-based weapons and ammunition sales, or making certain classes of weapons flat-out illegal.

In addition, the broken mental health system argument allows gun manufacturers to rack up more gun sales. After all, what are a few dead kids if you can rake in some extra dough by letting 24-hour news networks scare everybody into thinking they need to arm themselves against a bunch of crazy people who are going to shoot their kids? (or invade their homes, or shoot them in a theater, a mall, a church…) Just check out how gun sales spike after high-profile shootings, combined with talking heads appearing on news shows to say stupid things about how the crimes would have been avoided if only everybody on scene had been armed. Check out the secondary spike in sales when the same talking heads suggest that gun laws are going to suddenly become so restrictive that nobody is going to be able to buy a gun anymore.

On top of that, the majority of the people who parrot the broken-mental-health-system meme have no idea how the mental health system actually works, or how it interacts with law enforcement, hospitals, and the court system, or what could actually be done to “fix” it. Nor do most of them care, since it conveniently props up their view of things, without them having to actually learn or understand anything. They’re super-familiar with arguments about why killers are going to kill just as many people whether they have clips with 8, 27, 92, or 412 rounds; why it doesn’t make a difference if a person has access to a pop gun, a hunting rifle, an AK-47, or a BFG-9000; and why any gun control measure at all is useless because criminals are going to get guns anyway, and then only law-abiding citizens will be left unarmed.

Don’t bother trying to point out that all kinds of laws exist that, just as the concept of law implies, are followed by law-abiding citizens, and violated by criminals, and that what makes a person a criminal is that the person violates a law. After all, the no-gun-control stance involves absolutist/absurdist arguments where ANY restrictions on guns and ammunition mean all law-abiding citizens lose ALL access to their guns and ammo, and criminals suddenly have unfettered access to all the weapons they could ever want so that they can create the maximum amount of mayhem. It’s an argument that requires a good dose of the paranoia that persons with mental illness who carry out violent crimes sometimes exhibit.

But the logical extension of the no-gun-control kind of argument is that we could get rid of “gun crimes” and “gun criminals” completely if we could just get rid of all laws related to guns, because then there would be no gun laws to violate. Then we only have to enforce the existing laws against murder. Yup, what’s really broken is the anti-murder system in this country. And if we all had more guns, we could solve that, too.

Now, don’t get me wrong. I would absolutely love it if we, as a nation, were going to get serious about “fixing” the mental health system (makes it sound so simple, doesn’t it—kind of like fixing a leaky faucet or fixing your basset hound). But getting that fix all taken care of isn’t happening anytime soon, since it takes a whole lot of money, a whole lot of changes to the legal system, enough well-trained mental health professionals working in tandem with law enforcement and other community resources, a whole lot more places to keep persons with severe mental illness while they get treatment, and a whole lot of money. Oh, I guess I touched on that money one already.

Of course, a big block to getting the mental health system fixed is that a lot of the same people screaming at everybody about prying beloved guns from cold dead hands and fixing the mental health system are the same ones screaming to slash taxes and remove all government funding from everything everywhere. A lot of them are the same ones who worship former President Ronald Reagan, who loved the idea of shutting down psychiatric facilities in favor of “privatizing” the oversight of people with severe mental illness, who need a lot more than a place to stay and a minimum-wage worker to watch over them.

And even with that “privatization” of things like residential homes and intensive outpatient programs, guess who is paying for mental health care for the people with the most severe mental illnesses. Go on, guess. If you said “the government,” then you’re right. And if it’s a puzzle to you why people with chronic, severe mental illness aren’t getting good jobs with great insurance plans to pay for all the medications, therapy, and hospitalizations they require, well, then I obviously can’t make you understand how we’re ever going to “fix” the mental health system.

So, how do you reconcile de-funding everything in the government, including the mental health system—particularly those long-term inpatient facilities where the people with the most severe mental illnesses stay (or, rather, used to stay)—with the idea that we’re going to fix the mental health system to keep all the most dangerous people with mental illnesses off the street so that we don’t have to have any new gun control laws? Well, the real answer is that you don’t, because it’s a nonsensical argument in the first place.

Now, happily—well maybe not happily, since it took multiple mass shootings and the NRA clamoring to prevent any gun control laws from being enacted while simultaneously screaming about the broken mental health system—mental health funding is kinda-sorta being restored to the very limited levels that existed back when G.W. Bush was president. Unfortunately, those levels are still not anywhere close to the level—comparatively speaking—that such funding was at when dear, old Ronald Reagan became President. So, thanks NRA—you are advocating for restoring all 40,000-ish psychiatric ward long-term “beds” for those with chronic, severe mental illness that went away back when Ronald Reagan was in office, right?

Beyond the complete insincerity behind the NRA’s argument that the mental health system needs to be fixed, the NRA is actively doing a disservice to the people of the United States—a disservice that actually serves the NRA well by scaring up gun sales. By creating a bogeyman out of people with mental illness, the NRA promotes the idea that people who are diagnosed with a mental illness are inherently dangerous, unhinged, and likely to kill us all. Never mind that the mental health system deals with a wide array of concerns, from situational depression to anxiety disorders, PTSD to schizophrenia, and that the majority of those people are never going to commit a violent crime. By squawking that gun violence is a problem of the mental health system, as opposed to a problem with multiple facets, most notably of ensuring easy access to guns, while provoking fear of one’s fellow citizens, the NRA sets the country on yet another course to doing nothing about gun violence, while spreading ignorance about what mental illness is or what it means. The NRA provokes more fear of a big portion of the population, perpetuates a culture where people will avoid seeking help for mental health issues for fear of becoming part of that bogeyman group, and provides an excuse for inaction that will see no end. After all, as long as there are shootings by people who can be labeled as having a mental health issue–bam–the mental health system failed. It’s got nothin’ to do with the guns themselves.

If you want to consider whether the NRA has anybody’s best interest at heart, consider that following the Newtown school shootings, more than 85% of the American people supported instituting ‘universal background checks,’ but the NRA managed to ensure no action would be taken through the power of the almighty dollar. The NRA can threaten to withhold money from political campaigns, or worse, to dump massive amounts of money into campaigns to take out politicians who do anything they don’t like.

The NRA, aka the gun manufacturer’s lobby, knows that an occasional scare is good for business—and having a bogeyman is the best thing possible—especially when that bogeyman is easily stigmatized, poorly understood, and getting the problem of the bogeyman “fixed” could take forever. The whole fix-the-mental-health-system argument put forth by the NRA is nonsensical because it posits that it is easier to “fix” a complex system that attempts to address the needs of people with a broad range of conditions that are not set, uniform, or easily managed than it is to restrict access to the things that people—many who avoid contact with the mental health system prior to committing heinous acts—use to kill people.

Why I Don’t Hate VH-1’s “Couples Therapy”

Posted on August 24, 2013 by jcschildbach

I first realized I like Dr. Jenn Berman when, in a session with Flavor Flav and his partner of nine years, Liz Trujillo, Dr. Berman hollered, “Look at her f*cking face!” Now, some might take issue with a therapist raising her/his voice or swearing in session, especially about somebody’s face, but f*ck those people. In this case, Berman was trying to cut through Flav’s hyper-defensiveness, and get him to actually pay attention to Trujillo. And for anyone who viewed the recently-concluded third season of “Couples Therapy,” there is an obvious transition (not in this particular session) where Flav drops the clown act and actually engages with Trujillo, and where she goes from balled up and permanently scowling to opened up and smiling. The cynic in me says these could all easily be TV editing tricks, but the optimist in me says that I know therapy works, and I hope these changes hold.

I’ll confess that I first started watching “Couples Therapy” (in season three, not having any awareness of the first two seasons) because I saw a few promos and thought it would be easy to do a hatchet job on it for the sake of a blog post. In one of the commercials, Dr. Berman was shouting down Joe Francis of “Girls Gone Wild” fame (I had no idea who the guy was at the time). My first thought was, ‘Great, make insecure guys think that couples therapy really is about a therapist siding with women and berating men.’ (And I don’t mean to be overly reductive here, but anybody working in the field who has tried to refer people to much-needed couples therapy will probably have a pretty clear idea what I’m talking about).

But like much of what takes place on the show, to take the promo clip out of context is to fail to see the larger picture of what is actually taking place. That particular clip involves Dr. Berman asserting herself over an emotionally abusive narcissist for the clinically important reason of ensuring that Abbey Wilson (Francis’ partner) doesn’t have her efforts to overcome an eating disorder repeatedly derailed by Francis’ insistence that he can fix the problem by badgering Wilson into eating. Whoops…so much for not being overly reductive.

Dr. Jenn Berman acknowledges the awesome nature of this post.

To be sure, if I really wanted to rip into the show, it’s within the realm of possibility. However, to do so would show a fundamental lack of understanding about how ‘reality TV’ works. Of course there’s going to be an emphasis on confrontational interactions. And of course the show adds in exciting/gimmicky activities that fall out of the usual scope of plain, old, in-the-office couples therapy, like excursions to rock-climbing walls, a visit from a psychic, and “expressive therapy” where couples smash things in a junkyard. Without such catches, attracting an audience to a show about couch-bound therapy sessions would be plenty difficult. To the show’s credit, though, the field trips and seeming diversions are used as a way of highlighting communication between the couples in order to provide the audience with a clearer picture of how the couples behave than might be evident from therapy sessions, and is definitely more entertaining than watching couples talk about how they communicate.

And despite seeing most of the individuals and couples in some unpleasant/ridiculous situations of their own making, there are still plenty of moments that reveal the core goodness in everyone present. I actually came away thinking well of everybody, or at least not totally hating anybody, having seen their willingness to accept responsibility and engage honestly in some difficult work in a setting more conducive to fist fights, broken bottles, and thrown furniture than it is to therapy. Add to that the expectations of reality TV viewers who want blood, and the restraint shown by the cast members on the show is pretty remarkable.

On multiple occasions, cast members disengaged from decidedly negative interactions, reserving the right to judge others not on gossip, but on their own interactions with them—Tyler Baltierra walking away from Joe Francis’ cackling excitement at videos of Dustin Zito’s pornographic past being a prime example. (Weirdly enough, I didn’t see anyone call Joe on the hypocrisy of him mocking a porn performer, given the millions Joe made off of flashed breasts and college-age-lesbian-experimentation love scenes).

At other times, situations cropped up where cast members, drawn into an argument between a couple, would mediate rather than taking sides, working to make the members of the couple see each others’ perspective—as with Baltierra attempting to bridge the gulf between Temple Poteat and Chingy Bailey that opened up each time Bailey powered up his tablet.

Instances occurred where efforts to stir up trouble were met with, dare I say, Socratic challenges to the thinking driving the pot-stirring. Temple Poteat questioning Joe Francis’ obsession with Dustin Zito’s missing shoes (after Joe tried to draw Temple into complaining about Dustin) comes to mind.

In general, cast members sought out each others’ advice in earnest, and were provided with real support.

This is not to say that there weren’t plenty of instances of cast members making snap judgments or otherwise engaging in self-indulgent tantrums. Flavor Flav and Liz Trujillo were, as Joe Francis dubbed them, a “side show” for much of the first half of the season, clearly frustrating several in the group.

Joe Francis, in turn, provided the bulk of the traditional reality-show drama for the second half of the season by deeming various people or couples “trash” and whining about people interfering with “the process” and all of Joe’s hard work. Even when Dr. Berman managed on occasion to break through Francis’ deflection to draw out what is essentially a scared, little, attention-seeking boy, Joe would then appear for his “confessional”—just Joe and the camera—and say something self-important and off-putting, suggesting that his insight is about as substantial and durable as a soap bubble.

And perhaps to the dismay of audiences and the cast, the full story of what was going on with Trujillo and Flav, individually and as a couple, was never fully revealed. What little bit of privacy the cast members were granted, for legal or other reasons, was perhaps simultaneously one of the most frustrating and most endearing aspects of the show. Dr. Berman, in deference to good therapy, and in defiance of reality show convention, at least created some small pockets of safe, off-camera and off-the-record space where couples could work out things they weren’t comfortable sharing with the world.

Plenty of other reality show conventions were broken, as well, or at least bent, on “Couples Therapy.” Even with only a small portion of each episode devoted to showing actual therapy sessions, Dr. Berman gave a pretty good taste of how therapy works. The audience doesn’t just get to smirk at the cast members’ bad behavior and watch Berman cut them down. Rather, problem behaviors were identified, explored in terms of the incidents and patterns that contributed to those behaviors. Then Dr. Berman collaborated with the clients on ways to better address the issues in a productive manner.

For instance, (and to greatly simplify) Temple isn’t portrayed as a stereotypical uptight control freak for the audience to roll their eyes at, but is shown to have ‘control issues’ stemming from a chaotic past, and is challenged to relinquish some of that control and manage the anxiety that comes along with letting go. Catelynn Lowell and Tyler Baltierra have their eyes opened to how a lack of stability in childhood has led them to cling to each other, and how public pressure has contributed to them making decisions that may not be in their best interest, or the best interest of their relationship. Heather Marter and Dustin Zito, who were probably expected to have the most salacious content to work through, seem to have put all the tabloid sex scandal crap behind them, in order to struggle with the more mundane, but more relatable, questions of how to make a relationship last.

One could cynically argue that the celebrities and pseudo celebrities on “Couples Therapy” are merely trying to keep themselves in the public eye and make a few bucks. But even if that was their original intent, most of them ended up violating their “brand”—Chingy by being reflective as Temple says they need to end their sexual relationship if they are not going to have a full relationship, Temple herself by breaking away from Chingy and his greater “star power”, Tyler and Catelynn by breaking off their expected marriage, Flavor Flav by stopping his perpetual performance as court jester and openly weeping at his past failures and current joys.

And certainly if one wants to chastise Dr. Berman for being egotistical, one can find examples to try to build that argument, as when she proudly trumpets the work she’s done to help Abbey Wilson address her eating disorder. It would be too easy to sneer about Dr. Berman doing nothing more than taking Abbey to a restaurant. But that would be taking the restaurant scene and Dr. Berman’s comments out of context. The restaurant visit comes only after a great deal of preparatory work, and is rather a monumental thing, one which Dr. Berman deserves much credit for, along, of course, with Wilson.

Overall, even in the unreal context of reality TV, Dr. Berman’s show is arguably much less damaging to public perceptions of therapy and therapists than is the average movie or TV show with a therapist as a character. Such fictional portrayals of therapists often show them as oversexed, overpaid egomaniacs who go about uncaringly inflicting damage on those they are supposed to help.

In contrast, what Dr. Berman does on “Couples Therapy” is manage to sneak some actual therapy in between the egos and the outings. Ideally, viewers will see through the distractions to get a glimpse of real, honest-to-goodness therapy playing out. And at the absolute worst, Berman may get some less discerning viewers to attend couples therapy in the belief that they’ll get to smash car windows and go bowling, which isn’t all that bad if the therapists they end up with can get them to buy in without all that excitement.

Ultimately, I was so appreciative of Dr. Berman’s ability to get some snippets of real therapy on reality TV that I’m not even going to say anything mean about her distractingly sparkly and otherwise spangled collars—which are kind of weirdly cool. And everyone respects my fashion sense.

Respect the Blankie

Thumbsucking at the Intersection of Mental Health, Politics, and Pop Culture

Tag Archives: Mental Illness

How About We All Stop Using “Schizophrenic” as an Insult?

God Looks Away, Youth Minister Sex Offender Publishes Self-Serving Article (TW)

THE Mental Health System Fix to Curb Gun Violence

Suicide Notes from the Cosmic Web of Coincidence

Why Asking “Are You Off Your Meds?” Isn’t Funny

People Up: Toward ‘Gender Neutral’ Suicide Prevention

The Danger of Desensitization: Child Pornography Users and Other Empathy-Sapping Traps

GUN CONTROL OR PEOPLE CONTROL? Part Two: Psych Beds and Psych Meds–Faster Than a Speeding Bullet?

GUN CONTROL OR PEOPLE CONTROL? Part One: The NRA’s Build-a-Bogeyman Workshop

Why I Don’t Hate VH-1’s “Couples Therapy”

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