Yes, Gina, There is a Bipolar Disorder: Tom Sullivan’s Pretend Apology

by JC Schildbach, LMHC

I have a hard time believing anybody really cares about anything Fox News Radio Host/Fox Business News Anchor Tom Sullivan said two weeks ago, or a week ago, or ten minutes ago. But, after a segment on his radio show, wherein Mr. Sullivan expressed his belief that Bipolar Disorder is a made up malady, Mr. Sullivan got a bit more attention than he maybe wanted.  And then he apologized.

I feel compelled to share Sullivan’s apology in all of it’s glory, because it is such a perfect example of a non-apology, the kind that one writes when one is drunk, and mad at the people to whom one is being made to apologize–the kind of apology that would properly elicit a playground response of “If you were really sorry, you wouldn’t have said it in the first place.”

You can hear the questionable five minute clip of Mr. Sullivan’s rant–mind you, on the web site for his own show–here: Bipolar “not a problem” and “not a disability” says Tom Sullivan.

To access his apology, you need only scroll down through the Facebook-linked comments on the same page.

Sullivan’s apology starts off thusly: “Gina, Thank you for your email.” From the get-go, it’s just plain weird. Sullivan is apologizing via Facebook to an (alleged) email that nobody can see. I’m not sure if Gina’s email is presented somewhere on Sullivan’s Facebook page, or elsewhere. I have the feeling he doesn’t want anybody to see the alleged email he is pretending to respond to, because Sullivan isn’t actually addressing any concerns that any real person has about what he said. He’s interested in presenting himself as the victim in the ruckus he started, as a means to reiterate some of the same obnoxious points he made in his original rant.

He continues: “May I tell you I have received a number of similar messages but usually laced with profanity. Your message stood out for the kindness of your words.” Oh, poor Mr. Sullivan, bombarded with bad language from nasty people. But, lo—here is one kind soul, just one person moved to express words of concern and seek clarification about just what happened in this horrible controversy that was visited upon the abused Mr. Sullivan.

“First,” Mr. Sullivan goes on (in sharp contrast to his original words for which he is now apologizing), “I need to tell you I do believe in bipolar disease.” I won’t hammer on Mr. Sullivan too much for not using the proper term “Bipolar Disorder” rather than “bipolar disease.” But I do have to question what he means when he says that he ‘believes in’ Bipolar Disorder. Bipolar Disorder isn’t some mythical creature like the Yeti or the Easter Bunny to entertain or scare people or to serve as a fun part of some childhood tradition. It’s not, as Mr. Sullivan says in his audio clip, some disease made up by pharmaceutical companies and the mental health industry for the purposes of financial gain. But, I suppose when you work for a network that promotes the idea that climate change is a hoax, and white privilege is mythical, your sense of reality can get knocked out of whack.

And speaking of having problems with reality, Sullivan then writes, “There is a two minute clip going around of my comments out of a two hour discussion. It is easy to take comments out of context.” Sullivan’s complaint of a two-minute, out-of-context clip is just a few scrolls down from a five minute clip, again, on the web site for his own show, in which he says he does not believe Bipolar Disorder is a real thing, but a ‘created’ illness.

He then repeats his newly-found belief system: “Of course I believe bipolar is real and is a mental illness that needs to be treated.” Well, of course, Tom! Why would anybody think you would have any other view–I mean, aside from the five-minute (not two-minute) clip where you repeatedly say that Bipolar Disorder didn’t even exist 25 years ago, and is completely made up?

Sullivan does a 180 and becomes a champion for those with mental illness--asks why people think he said things he plainly said.

Sullivan does a 180 and becomes a champion for those with mental illness–asks why people think he said things he plainly said.

Sullivan clarifies: “The program began with the subject being the huge increase in disability claims made to the Social Security Disability Fund which is going broke in 2016.” Never mind that what Sullivan means is that the Social Security Disability Fund could be insolvent as early as 2016 if changes aren’t made to the structure or funding of benefits—saying it is going broke in 2016 is much more alarmist and easier for his audience to understand, so that they can get angry like he wants them to.

Then, explaining (well, sort of) why he chose to target people with Bipolar Disorder, Sullivan writes, “The increase in claims is startling and the number one reason for the big increase in claims is mental illness and a subset (according the way Soc Security categorizes) of mood disorder.” Sullivan doesn’t bother to explain that what now comes under multiple categories of “Mental Disorders” used to be categorized as two separate categories: “Mental Retardation” and “Neuroses and Psychoses.” It wasn’t until 2010 that Social Security broke down those two categories any further, to include numerous items, including the “mood disorders” that so irk Sullivan.

Sullivan pouts, “All I was trying to do was to point out that out of that big increase I suspect there are people who are not sick but looking for a disability check.” Yes, “all” Mr. Sullivan was doing was accusing people on disability of trying to cheat the government. No big, deal. Everybody likes to take pot shots at people on disability, right? But Mr. Sullivan didn’t just voice his ‘suspicions.’ He outright said that Bipolar Disorder is “not a disability.” In other words, Mr. Sullivan said that anybody receiving disability payments due to a diagnosis of Bipolar Disorder is cheating the government. In fact, the title of the same page of Tom’s website where he posted his pretend apology is “Bipolar Woman Says She DESERVES Disability Benefits. Tom Tells Her She’s WRONG!”

The pout goes on: “My further point was by doing so, those people were hurting those who really are sick and need help, i.e. funding, treatments, etc.” In other words, people who get disability payments for mental illness are not really sick—people who can’t walk, or who have cancer are sick!! This is perhaps the best part of Sullivan’s whole apology—the part where he truly demonstrates that he’s learned nothing from the reaction he provoked with his ignorant comments by engaging in the exact type of behavior/speech/thinking that demonstrates classic stigmatization of people with mental health issues: the ‘you don’t really have an illness, you just feel bad’ way of thinking.

And then comes the righteous indignation of a true champion for those with mental illness: “I have for years advocated on my program for more funding and insurance coverage of mental illness. Too many have ignored it and as a result our jails are now the ‘mental institutions’ where the people get zero help.” First of all, if you have advocated so long for “more funding and insurance coverage of mental illness” but are now mad that there is more funding and insurance coverage of mental illness, what is it you really want? Where is this funding and insurance supposed to come from? What form is it supposed to take. Oh…I get it. You mean that when there have been mass shootings, you’ve complained that we do not need gun control, but we need more funding for mental illness. Got it. The jails…right. So, yeah, more mental health funding to stop people who might go on a shooting rampage—but anybody else can step off. Way to advocate, Tom.

Sullivan then writes, “I apologize to those who were hurt by the clip of my comments.” I think he might be apologizing to himself right here, as he seems to think he’s the victim in all of this, and the only one who was really hurt by the unfair “clip” of his comments—which he maintains is all out of context. It’s one of those classic ‘I’m sorry you got upset about what I did’ apologies. He doesn’t actually say he’s sorry for what he said—he says he’s sorry if you had a stupid reaction to it.

Mr. Sullivan then explains that he is just misunderstood: “I am a somewhat jaded person who thinks some people are gaming our system due to their greed.” Yes, plenty of people are out there pretending to have Bipolar Disorder because of their all-powerful greed–the kind of greed that drives them to want to live off of an $1100/month disability check. I can see how life as a corporate accountant and media figure has caused you to see the true evils in life and become hardened by them, Tom.

“But,” he goes on, returning to his sensitive side, “I also believe mental illness is a very serious problem that is ignored by too many.” Well, at least you aren’t ignoring it, Tom, like those “many” others.

Quick switch back to victim: “This episode shows how easy it is to distort a persons (sic) comments, especially when the subject is very important.” Wait, where’s the distortion, Tom? You do realize that there is a five-minute audio clip of you talking smack about people with Bipolar Disorder and mental health professionals, right on your web page, just slightly above your apology—don’t you?

Then, he brings the powerful close: “It will and has reinforced my commitment to making mental illness on a (sic) equal par with physical illnesses instead of the stigma it currently receives. Again, thank you for your email and your concern, Tom Sullivan.” Well, it’s a good thing Tom’s had his commitment reinforced, because in that five-minute clip there, it sounded a whole lot like he was super-supportive of stigmatizing people with mental illness—especially phony mental illnesses like Bipolar Disorder. And, really, could that sentence about stigma be any worse? It’s like somebody read over the rough draft and said—‘Not bad, just make sure you add in some bullshit about stigma and how mental illness is just as important as physical illness in there at the end,’ but Tom wasn’t quite sure how to properly use the word “stigma” in a sentence, and didn’t feel like taking the time to look it up.

In the end, Sullivan wants to be viewed as someone who is just the victim of vicious attacks, with his words taken out of context. Unfortunately, it’s hard to have much sympathy for someone claiming his words were taken out of context when, well, they weren’t, but also when he made no effort to provide any context for anything he said in the first place, such as by touching on the way Social Security disability operates, the different categories now used, and why those changes were made. The simplest explanation (although there are a wide range of factors) is that there has been an evolution in the way “disability” is viewed and understood—in terms of both physical and mental illnesses. And, in terms of Social Security disability, there have been changes in the ways statistics have been kept and various issues have been categorized.

To give some credit, there is support for Sullivan’s complaints that the number of disability claims for “mood disorders” is increasing substantially. However, that increase is not grossly out of proportion to the increase in overall numbers of disability cases, particularly when one considers that mood disorders such as Bipolar Disorder and various forms of Depressive Disorders are more widely understood today than they were 25 years ago (when Mr. Sullivan apparently thinks the mental health community, in cahoots with pharmaceutical companies, fabricated the idea of Bipolar Disorder as a way to make money).

So, as I said in an earlier piece about Sullivan’s original comments (which you can read here), we can either find legitimate ways to address issues like the funding of Social Security disability, and support those suffering from mental illness, or we can demonize them and…uh…let them…er…receive stigma like always. And now, at least we all know where Mr. Sullivan stands—right, Gina?

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Sylvia Frumkin’s Place

by JC Schildbach, LMHC

I’d venture a guess that many who enter the mental health field, as with any potentially dramatic profession all the way from police to executives, do so with visions informed by Hollywood. One of the main Hollywood portrayals of the mental health worker is is that of the therapist/psychiatrist as a well-compensated genius, ensconced in a plush office, treating the worried well or other “eccentric” or “neurotic” types, while constantly being admired by clients for one’s observational skill and ability to call forth ‘breakthrough’ moments. The other end of the spectrum is the heroic social worker who, through sheer tenacity, overcomes all the problems an impoverished neighborhood can throw at her, overcoming multi-generational patterns, and very recent traumas, to really, really make a difference in the lives of an entire community.

Many in the field are drawn to books by Yalom, or Rogers, or perhaps even some acolytes of Oprah, who tell us that just by listening and accepting our clients, or by throwing the right bit of tough-love advice a client’s way, true transformation will take place, and clients will make huge leaps forward, forever changing their lives for the better.

Susan Sheehan’s “Is There No Place on Earth for Me?” is perhaps the perfect antidote to the pie-in-the-sky visions of one’s brilliance and dedication making all the clinical difference in the world. It balances out the ideas about the wondrous gift of therapy with the reality of chronic and severe mental illness, and its resistance to ‘ah-ha moments’ and dramatic progress. It pushes past that “we don’t need no medications” mantra, which can, in fairness, apply to a lot of mental health issues.

“Is There No Place on Earth for Me?” was first published as a four part series in The New Yorker in 1981, then published as a book in 1982. For it, Sheehan won the Pulitzer Prize for General Non-Fiction in 1983. A new edition of the book was released roughly a year ago, including a new afterword by Sheehan. On reading about the re-issue in the online version of the New York Times in January of 2014, and having never read it before, I put it on my ‘to read’ list, and eventually checked out an old edition from the library.

Frumkin cover

The book, written from the perspective of a journalist, and not of a therapist trying to convince the readers of the efficacy of particular approaches to treatment, is involved in ways that few case studies can be. Sheehan spent over two years with Sylvia Frumkin (not her real name), a woman diagnosed with schizophrenia. Sheehan had a great deal of access not only to the information on Frumkin’s treatment and behavior during the period when Sheehan shadowed Frumkin, but also to family members and others, getting a great deal of background on Frumkin’s life prior to her diagnosis, and the progress and setbacks that took place before Sheehan had ever met her.

Having had numerous contacts with clients diagnosed with schizophrenia, or suffering from other forms of psychosis, most often from a distance, it took me a while to get through the book. That is, the kinds of delusions, rants, and flights from treatment that plague Frumkin and those trying to help her, and which Sheehan documents in detail, were familiar to me—of course, with Frumkin’s behaviors being particular to her own case. Still, it was like trying to read about many of the most frustrating aspects of work during one’s down time.

For the uninitiated, I imagine the book is much more compelling, rather than overly familiar, and thus, somewhat draining. In discussing “Is There No Place on Earth for Me?” with colleagues, I’ve most often likened it to Kafka’s “The Trial”—a book that is deliberately tedious in its depiction of a bureaucracy more intent on sustaining itself than serving any clear purpose—although, that comparison probably has much more to do with what I bring to the reading of Sheehan’s book than to what she has documented in such depth of detail. Also, I don’t think the mental health system—either now or at the time—is deliberately set up to be frustrating…it just frequently is, particularly for those most in need of help.

In addition to capturing the daily details of the behavior of a (this) client with schizophrenia, Sheehan also does a masterful job of explaining, simply and concisely, some fairly complicated legal, medical, and treatment-related concepts. For instance, Sheehan outlines the concept of “least restrictive” forms of treatment, both the bane and the beauty of our mental health system, which has been around since well before the current lack of options made it so completely mandatory.  In doing so, she answers that most familiar of questions about why we can’t “just lock up” people suffering from chronic forms of mental illness who can become rather taxing to a variety of public and private resources.

The most fascinating elements of Frumkin’s story to me, though, were the ‘side treatments’—pointless, and sometimes dangerous, programs that Sylvia was subjected to. Without going into a great deal of detail, the treatments ranged from moving in with a relative and his family who believed that all Frumkin needed was a good dose of Jesus and discipline to overcome her laziness and wicked ways, to a doctor who felt that manipulating the insulin levels of patients to extreme degrees could cure them of schizophrenia.

Ultimately, what works for Frumkin (or worked back around 1980) is what still works for clients today: a small number of medications that prove effective in treating schizophrenia, as well as (to greatly simplify things) a structured environment and supportive professionals. Unfortunately, said medications can lose their effectiveness over time, or the side effects can become increasingly detrimental to the clients. It is also quite common for clients to simply quit taking their medications, feeling them unnecessary or viewing them as the root cause of various forms of discomfort or other troubles in their lives. In addition, the structured environments can only be maintained for as long as clients are compliant with treatment, and as long as the treatment remains effective, and as long as funding and various programs allow. On top of that, anything from the restructuring of institutions, to changes in law and other policy, to the career changes of providers, to differences of opinion between providers and family members, can lead to new doctors and other providers making changes, sometimes rather arbitrarily, to a client’s medication regimen or support systems. In Frumkin’s case, alterations to her treatment and medications were made numerous times, in the most haphazard of fashions, often by doctors and other providers who seemed ignorant of her case history, or of how the medications work.

One might also note that this book was written back before the U.S., under President Ronald Reagan, decided that people with chronic mental illness enjoy the freedom that homelessness brings. So, Frumkin’s movements within the system are relatively easy in terms of her various forays into decompensation leading to fairly quick, and relatively long-term inpatient placements, with step-downs to semi-independent housing, and other supports that are much rarer today (and for most of the last three decades).

Ideally, Sheehan’s book would be taught in graduate schools, or maybe at earlier levels, by instructors who are familiar with the clinical aspects of schizophrenia; the current and historical treatments for it; and the current and historical state of affairs with regard to mental health facilities, available inpatient beds for clients with mental health issues, and legal and systemic complications to accessing those beds or other program options.

To be clear, it is necessary, as therapists, or in other capacities in the mental health field, to come equipped with a belief that we can make a difference. Without a bit of the dreamer in us, we would never head down this path to begin with.

But it is also necessary for providers at all levels to understand just what they are up against, particularly given that almost all providers in the mental health field will end up doing at least a round or two in the public mental health system–from practicums/internships to early jobs to entire careers–where the most challenging of clients often end up by default—frequently after being abandoned by families and other support systems, including insurance companies.

Frumkin’s family, as dysfunctional as they are, and as frequently detrimental to her treatment as they can be, at least hang in there to the extent that they can—which I imagine was at least somewhat less difficult when hospital beds and supported living options weren’t at such a premium as they are today. In the end, though, this isn’t a story of a family hanging together and triumphing over a terrible disease. It’s the story of a debilitating mental illness, and the toll it takes on the client, as well as those around her, and the wildly inconsistent efforts by a variety of people and systems to help her cope.

Welcome to Sylvia’s Place.

Dropping Keys, Dropping Letters

by Jonathan C. Schildbach, LMHC, waning ASOTP, reforming soul-eater

An eighth-season episode of The X-Files was built around a “soul-eater”—a person who could draw the disease out from others into his own body, eventually vomiting it out. The concept of the soul eater is based in various forms of folklore involving a range of ideas about curses and cures, and the ability of some to take away those things that most harm or most sustain a person. Unfortunately for this particular soul eater, the demands of those who knew of his powers began to overwhelm his ability to process and expel the disease. He existed in a perpetual state of deformity and misery.

I like the soul eater as a metaphor for the work done by many people in “the healing professions.” In this field, many of us work at building a skill set that allows us to help extract the mental and spiritual toxins in others. Ideally, those receiving help will find a way to vomit out the toxins themselves. Yet, such toxins are in no short supply, and many who are most in need of help thrive on a constant diet of disease coupled with a willingness to let others take on the burdens of that disease. It becomes far too easy for helpers to end up like the suffocating soul eater, awash in the illness of others.

In the professional parlance, we call all that business of being overwhelmed by the problems of others “secondary trauma.” There’s a tendency to assume that, as trained professionals, we are able to recognize and address our own forms of distress. But, like many people in positions of suffering, particularly those who are considered high-functioning, it is entirely too easy to soldier on without addressing our own needs. We know how to address all this, and yet we often don’t, or we often address it in an unhealthy fashion, assuming it will pass in time. We take on more than we can handle, and think nothing of it. Whatever doesn’t kill me makes me more convinced I’m strong enough to take it.

Hey--eat any good diseases lately?

Hey–eat any good diseases lately?  The X-Files’ soul eater.

I bring this all up by way of saying that I’m in the midst of a career shift—not out of the helping professions, but into some different channels in the same field.

In particular, last night I dropped off the keys to the office where I’ve been serving as an ASOTP for the last year-and-a-half, at least temporarily distancing myself from a particular portion of the field that I have been involved with for over seven-and-a-half years—the treatment of sex offenders.

The change was forced by way of making a shift in my full-time employment in crisis services. As I write this, I am deliberately allowing myself only some small bit of awareness of the insanity of my professional life over the past several years. Yes, I have been working full time in crisis services, while also working anywhere from zero to ten hours per week with sex offenders. Such arrangements are not unusual in the helping professions—where we are pushed to learn our craft in rigorous, unpaid positions, while also attending school and working a paid job just to stay afloat. The habits of overextension established while in graduate school can extend out into professional life, and feel totally normal, even as we are pushed toward deformity and misery.

Currently in a break from a years-long pattern of toxic soul-eating, and ready engagement with secondary trauma, I realize I’ve become numb to plenty of very bizarre things. Running plethysmography assessments, I can sit through audio scenarios of sexually violent behaviors, paying them as little attention as if they were overplayed Top 40 hits from yesteryear piped over a grocery store or dentist office sound system. I’ve become entirely too comfortable asking people about their masturbation habits, and pressing them when I think they’re lying (only in the course of assessments, of course—well, mostly). Fortunately, I haven’t become so numb that I’ve lost all awareness of the twists and turns of my mind, although I frequently find myself stumbling in otherwise polite conversations when frighteningly dark and vulgar jokes spring to mind—an entirely appropriate coping mechanism in certain circumstances and with particular people—but definitely nothing you want to spring on friends of friends who don’t even have the most limited of contexts for understanding where such thoughts could come from.

And all of that was on top of 40-plus hours per week of run-of-the-mill crisis intervention, suicide prevention, utilization management…

So, if I want to mix in some metaphors, I can say I’m now a ronin—a samurai without a master—an ASOTP without a CSOTP—which, really just makes me a guy with an expensive piece of paper that says I’m an ASOTP until next September, but which conveys no real ability to treat any offenders unless and until I take on another master/CSOTP. Weighing the massive number of hours I still have to accrue across assessment, face-to-face treatment, and supervision, in order to get the full credential myself, I think this may be it for my involvement in offender-land.

I’ve dropped off the keys; and, with no further action, the letters, too, will drop—as will the level of…expulsion required of me on a regular basis. Sure, I’ll still do what I can to draw out various forms of mental/spiritual disease when that is required of m—but hopefully now in more manageable, fun-sized portions.

 

 

Happy Birthday to Me II: Contemplate This on the Cake of Woe

by J.C. Schildbach, MA, LMHC, ASOTP, Fashion Icon

(for part one, click here https://respecttheblankie.com/2013/09/20/happy-birthday-to-me/ )

Check out this picture:

It's 1971--do you know where your emotions are?

It’s 1971–do you know where your emotions are?

Pretty amazing, right?

No, no, I don’t mean the fetching haircut accentuating the perfect, potato-esqe shape of my head. That haircut was a dad special a la 1971—the hairdo all of my brothers and I had by dad’s decree. I’m thinking a “1” setting on the clipper.   Quick and easy, nice and tidy.

And, no, I’m not talking about the fashion, although I am pretty damn suave in that dual-layer, v-neck with mock-turtleneck, combo. Or, more accurately, I guess that would be a mock-mock-turtleneck, given that it’s not even a real mock turtleneck, but just the neck and a little bit of the chest of a mock-turtleneck sewn into a shirt. The dead giveaway is that the striped part of the outfit is short-sleeved, and who ever heard of a short-sleeved mock-turtleneck? Right? The dove-gray slacks perfectly compliment the olive stripes sandwiched between the ocean blue stripes that match the mock-mock-turtleneck.*  Still, I’m thinking that this getup would definitely make it into a top ten list of my all-time most fashionable outfits, such is the limited ability I have to dress myself.

No, I’m not even talking about the gift, proudly displayed—that Fisher Price Little People airplane—the red winged version. Pure brilliance of design, down to the weird, yellow plastic string tied to the front so it could be pulled along the ground, the pilot, head flipping back and forth, ever vigilant. Of course, the pilot eventually wanted to break free from the tarmac, and I obliged. The plane today (still in a closet of my mother’s home, or perhaps in a box in the “workshop” of my house) is missing the door, and a chunk of one of it’s horizontal stabilizers, courtesy of a few attempts over the years to see if I could get the thing to fly properly. Perhaps such confusion over aerodynamics is tied to why I became a therapist, and my older brothers went into the “hard sciences.”

Anyway, any other guesses as to why the photo is so amazing? The cake? Well, I did reference it in the title of this piece, I suppose. And it is pretty impressive—home-baked, double-layer, chocolate frosting on devil’s food, set atop a shimmering, crystal cake stand, the candles, playfully askew. But, that’s not it, either.

Are you ready for it? The big reveal?

What’s so amazing about this picture is that it was taken, by my mother, one week after my father’s rather unexpected death. That the picture is so normal, that it fits in so perfectly with the small parade of yearly birthday pictures of all of my siblings and me (all featuring the birthday kid, with a cake and a gift, either posed alone or with that year’s cadre of siblings) is what is amazing to me.

My mother managed, seven days after what I assume was the absolute pinnacle of the sadness and distress in her entire life, with that sorrow still hanging heavily over her and the entire family, to make a cake, wrap a gift, and provide me and our family with some small bit of normalcy. I can imagine my mother just realizing that it was her duty to do so, that she signed up to have kids, and, well, that’s what you do when you have kids…you soldier on and keep things as stable as possible even if everything just collapsed right out from under you.

I have always wondered (and I suppose it wouldn’t take all that much to ask, but since mom will be reading this, I’m sure I’ll get an answer of some kind) if that plane was purchased before or after my father’s death…since it wasn’t until after my father’s death that what would be my first plane ride—out of Nebraska, and on to Oregon—would even be a thought. Was it a gift meant to help prepare me for that trip, or was it merely a coincidence? Was I fascinated with planes at the time? Was it just kind of a cool thing my parents thought I would like? Or was I manipulated by television commercials telling me I wanted that plane?

As a bit of an aside, here’s a Fisher Price commercial from 1972, including the plane, and narration by Dick Cavett. The gentle pitch to parents (although the images would definitely grab the attention of children) is rather quaint now, compared to todays ads telling kids that they MUST HAVE THESE TOYS NOW!!

At any rate, one thing I never noticed in this photo until I scanned it and really looked at it earlier this morning—is that the door behind me opens onto my parents’ bedroom—or what had recently become only my mother’s bedroom.   I can clearly see the same bed that my mother still sleeps in through that open door just behind me.

Not long ago, I told my mother that one of my earliest memories was of going into her bedroom (I believe after being told to leave her alone) and finding her lying on her perfectly-made bed, crying. I asked her why she was crying. I don’t recall that she said anything, only reached out to me and put her hand on my arm, which I had rested on top of the bed. Soon thereafter, somebody—a brother? Some other relative? A family friend?—stepped in and ushered me out of the room, closing the door behind us.

In my mind, the setting for this memory always defaults to our house in Oregon, because that is the only house my family lived in that I consciously remember. But seeing that, in this photo, the bed is covered in a white bedspread, just as it always was in our house in Oregon, it is easy to imagine that same scene playing out here, in the Nebraska house, although to ‘block out’ the scene would require flipping certain elements in different directions. I can definitely imagine that the dining room furniture in the photo here would have provided me with some measure of blockage between me and whoever (may have) told me to leave my mother alone, just as the short distance between our dining room and my mother’s bedroom in the Oregon house would have given me that tiny bit of time to do the same. Nebraska in September (probably more likely) or Oregon in November, it makes sense to me either way.

Getting back to the specific elements of the photo, certainly, other mothers have done the same as my mother did, in similar circumstances, just as other mother’s have fallen apart. Certainly, plenty of fathers have also had similar experiences following the loss of a spouse, and the effort to carry on and keep things stable for their children (or of falling apart). But it’s my birthday, and if I want to tell my mom she did an amazing thing—then I get to do that.

So, happy birthday to me, and thanks, mom!

 

*Color matches approximated using Ingrid Sundberg’s “Color Thesaurus” which can be found here: http://www.boredpanda.com/color-thesaurus-char-ingrid-sundberg/ .  If you have suggestions for better labels of the colors in the photo, feel free to submit them in the comments section below.

Dad’s Grave

by J.C. Schildbach, MA, LMHC, ASOTP, Preacher’s Kid

The Summer of 1977 is forever burned into my brain as a collection of hallowed moments experienced while on a cross-country, family car trip in a Pine-Green Chevy Impala Station Wagon: Seeing a lightning storm roll toward St. Louis from the top of the Gateway Arch, enjoying a traditional Chinese wedding banquet in San Francisco, swimming in Lake Michigan, watching “Star Wars” at a theater in Chicago when we were unable to procure tickets to the King Tut exhibit. (As a decades-long fan of the movie, it pains me to note that I nodded off sometime after the scene of R2-D2’s capture, later jarring awake to the battle cry of a Tusken Raider).

There were days-long visits to farms in communities we had lived in before I was old enough to remember, where I got to ride a horse for the first time, play in a rubber raft in a flooded cornfield, and experience the frightening speed of an angry mother pig as a newfound friend and I were made to race it to the fence of its pen after said friend pelted the sow with a dried-out corn cob. There was the morning I inadvertently released the inmates of a henhouse as I made a rather misguided effort to helpfully gather the eggs before breakfast, and the wonder of first experiencing the Beach Boys’ “Endless Summer” surf anthems from a landlocked farm community in the midwest.

Somewhat more mundane moments have stuck with me as well—attending a Saturday night church service in Sheboygan; staying up late to watch “Sssssss” on TV on a rainy night in Independence, Missouri; settling into the perfect stereo situation in the back seat of the Impala as my brothers played Blue Oyster Cult’s “Agents of Fortune” on the car’s cassette deck—“This ain’t the Garden of Eden,” indeed.

But there was one great disappointment in the whole epic adventure: the trip to my father’s grave in a small town in Nebraska. The victim of a stop-sign-running driver, and the shoddy engineering of the late-60s AMC vehicle he was driving, my father, the local Missouri Synod Lutheran minister, lost his life in the late summer of 1971. I am writing and posting this on the 43rd anniversary of that unhappy day—a day I was too young to remember or properly process—a day that gave birth to the attachment issues referenced in the subtitle of this blog.

Pops at 21...on his way to change the world.

Pops at 21…on his way to change the world.

The occasion, for me, was already lacking the appropriate sense of solemnity, with the shouting from a baseball game just across the road filling the bright, evening air. Things seemed even further amiss as we headed in the direction of…well, what seemed to be nothing.

Where was the towering monument? The magnificent marble Pieta? Or at least a moderately ornate cross?

Being a big fan of horror movies, and fascinated with the ornamentation and mythology of the church, I had built up the idea in my mind that my father’s grave would be marked by something appropriate to his stature as an important religious leader. My ideas were perhaps weirdly informed by my recent reading of Scott Corbett’s “Here Lies the Body”—a story set in a graveyard, and involving a massive grave marker with a statue of a pointing, judgmental angel—not to mention occult symbols scrawled in blood, and a murder mystery. On top of that, to pass the time on the drive from state to state, I had also read and re-read a book of “real life monsters,” which included stories of Vlad Dracula, and Haitian zombification procedures.

So when I saw the flat, drab grave marker, I wouldn’t say my heart exactly sunk, but my 8-year-old mind certainly underwent some shifts in its understanding of the world–shifts I filed away for later examination.

A little over a decade later, when I bought a copy of Tom Waits’ “Blue Valentine” album, and heard the song “A Sweet Little Bullet from a Pretty Blue Gun” (about the 1977 suicide of a 15-year-old girl who jumped from the 17th story of a Hollywood hotel with her guitar) which contains the line, “Nebraska never lets you come back home,” that scene of my father’s grave came back to me, despite not having given it much thought at all in the interim.

The passage of time, and hopefully the acquisition of some tiny bit of maturity, led me to reassess the precise meaning of my father’s grave. I realized that that grave marker wasn’t about his importance in the world, or his stature in a small Nebraska town. It was just some sign, marking the place where the material–or perhaps more preciseley, the matter-bound–part of his existence was left. His influence, his importance, extends way beyond that little concrete or stone marker.

My father’s influence in the communities he served extends to this day, in part through the connections my family made in those communities.  His impact, which, combined with the hard work and diligence of my mother, who raised five sons and a daughter in the years after my father’s passing, extends out into the world in myriad ways, through the hard work and community involvement of all of my siblings and their children—all in their own ways striving to make the world a more humane place.

For my own part, struggling to understand my father’s path in life before it was cut short, and trying to find my connection to it, has been a lifelong endeavor. And while I may have, at times, viewed my father and his life in weirdly iconic terms—iconic in the sense of symbols, signs, and signals to the outside world—I now view it as iconic in the sense of legitimate meaning and influence, the ability to impact the world positively by being a decent person…the same sort of influence I can only hope to emulate.

Happy death day, pops!

Sons of Guns & Daughters of Rapists

by Jonathan C. Schildbach, MA, LMHC, ASOTP

The last several weeks have seen charges of molestation, “aggravated crimes against nature,” and rape of a child, among others, brought against Will Hayden of Red Jacket Firearms and the Discovery Channel’s “Sons of Guns” reality show. Hayden has protested that the alleged victim, his own 12-year-old daughter, made the accusations only after his angry ex-girlfriend put the child up to it. The police and many news sources are now walking back their identification of the victim as Hayden’s daughter under laws that protect the identity of minors…but since it’s already splashed all over the Internet, I’m not sure what good that’s supposed to do.

I’ll put forth the disclaimer that anyone accused of a crime in the U.S. is innocent until proven guilty. I’ll also say I’m all for keeping things like this out of the media—but that’s clearly not the world we’re living in, particularly when such charges involve a public figure. After all, Hayden’s show was abruptly cancelled, and his business partners openly distanced themselves from him as a form of damage control to keep their custom gun business afloat. In addition, in the time since the accusations from Hayden’s minor daughter first surfaced, multiple other alleged victims have come forward, including Hayden’s adult daughter Stephanie, who initially defended him against the charges, but is now reportedly slated to appear on the “Dr. Phil” show later this week to explain that she was molested and raped by Hayden when she was a child.

And to add to the various disclaimers and caveats, I must also say I don’t know enough about Hayden’s past, or his current behaviors, to suggest that I, in any way, know that he fits, or doesn’t fit, the general clinical conditions suggesting high-risk behaviors for pedophilia or sexual abuse of a minor.

Let me also put forward that as much as there is an assumption of innocence for the accused, if we really want to make any headway on addressing sexual abuse of children, the assumption needs to be that children who come forward to seek help for sexual abuse are not making things up. When children are lying, their stories do not hold up particularly well, although depending on how skilled or unskilled, careful or careless, someone is when interviewing children, plenty can go wrong with the information that is gathered. But if our first reaction to children who report sexual abuse is to shut them down, or leave them in the homes of the accused, they are potentially being put at further danger, and a likely increase in the level of that danger.

And speaking of making headway in addressing issues of sexual abuse, I’ve noticed, at least as indicated by Internet comments, that when it comes to stories like this, we can count on public opinion to fall into a small number of categories:

1) Kill ’em all: This just involves amped-up vitriol aimed at sex offenders, and those accused of having committed sex offenses. I understand the anger. But, seriously, if you think that killing more people, or addressing problems of abuse with violence is the way to move toward a better society, a more healthy understanding of human sexuality, or better protection for children, you’re taking an overly simplistic view of the way the world works. And if you think this approach has some merit, why weren’t you able to spot Hayden and bring him to justice earlier? Is that anger and all those demands for vengeance really accomplishing anything?

2) “He’s obviously a rapist because he does/likes/thinks X.” Whenever somebody is in trouble for being an (alleged or convicted) sex offender, people like to equate the offender’s other behaviors and beliefs (that don’t jibe with their own) with the offense behavior. In the case of Hayden, some have connected “gun culture” to sexual abuse of children. And while, as anybody who has read my other posts knows, I am no fan of guns, I just can’t see anything productive coming from conflating gun ownership or gun manufacture with child molestation. Of all the people I know, holding varying levels of support for gun ownership or gun control, none of them have ever expressed an endorsement of sexually abusing children. This lack of support for sexually abusing children is pretty universal, regardless of one’s political beliefs, religious beliefs or hobbies.

Furthermore, while I have worked with a few offenders who have had guns figure prominently or incidentally in their abuse behaviors, they have been the exception, not the rule. In terms of grooming behaviors, things like money, jewelry, candy, drugs/alcohol, video games, clothing, toys, and porn have been involved in many more of the offenses I’m aware of than have guns.  And I’m not going to advocate for the banning of any of those items based on the ability of abusers to involve them in abuse patterns. I’m more than happy to advocate for a ban on guns based on their use in—well, shootings—homicide and suicide and attempts at both, not to mention all manner of other crimes and accidental deaths, but as for their involvement in child molestation–not a huge concern, at least from what I’ve personally seen.

3) “How can somebody do this?” This is usually sideways of the “Kill ’em all” concept, and often involves plenty of name-calling. I get that it is very difficult to understand how somebody could rape their own daughter—or sexually abuse any child—but many of the factors involved are not beyond explanation. Most people just don’t want to hear the explanations…or deal with them…except in punitive, harsh ways once somebody has committed such acts.

Generally speaking, though, a person doesn’t sexually abuse a child because he or she is thinking clearly, or because he or she has just suddenly come up with such an idea after a long life of healthy relationships. If Hayden was engaging in sexual abuse of children, he wasn’t, one assumes, doing it out in the open, as such behaviors usually involve a great deal of secrecy and manipulation, like Hayden’s alleged warnings and threats to his daughter not to tell anyone, because, “I’m all you’ve got.”  In short, people who sexually abuse children are ill and engage in a number of behaviors to try and mask that illness, or keep others from learning of it.  I’m not sure how to properly emphasize this enough.  Sexual abusers of children are not just random guys who are bored and horny.  There are a lot of factors involved, including a huge number of elements (rationalizations, justifications, creating situations where one has access to children and is willing to take advantage of that access while plotting to keep anyone from finding out) that involve breaking down the normal barriers that prevent such sexual abuse.  In other words, “How does somebody do this?” is a question that involves a long and extended answer.

…And now for a clip of Hayden that seems weirdly re-contextualized, check this out–especially the last 20 seconds or so…y’know, where he talks about people becoming bad headlines and how he tends to his own conscience.

Anyway, let’s say that way back before Hayden had ever (assuming he did) touched his daughter or any other young girls in a sexually inappropriate manner, he realized he was having thoughts in that direction, and that he needed to do something to steer clear of that behavior. What would he do?

For those of you who know what kinds of resources are out there for dealing with someone who is having thoughts of sexually abusing a child, bravo. Please do what you can to make sure others know. I will say that over my years working on the crisis line, I have fielded a very small number of calls from people (both men and women) who were concerned about the nature of some of their sexual thoughts towards minors—either specific minors in specific situations, or more generalized sexual thoughts—and were seeking help.  In my years of dealing with offenders, I have seen numerous people who just might have sought help if they had any idea how to, and if they hadn’t felt like total garbage for acknowledging that they needed help.

But most people facing thoughts of sexual attraction to children do not have the wherewithal to seek help, much less have any idea where such help could be sought. It is a much more common reaction to deny that there is a problem, to try to push the thoughts away, or even to feed the thoughts (as in masturbating to inappropriate fantasies) while assuming that the actual offense behaviors can still be avoided.

Furthermore, treatment providers in the field of sexual abuse can have a difficult time promoting services. People tend to come to providers by referral from a lawyer or a community corrections officer (CCO) after they are already in trouble or have already served time, even though the same types of treatment could be just as effective before any offenses were committed. After all, just how welcome do you think a provider would be if they hung a sign out on their business that said “Sex Offender Treatment” or “Specializing in the Treatment of Sexual Deviancy,” or something similar? The stigma and shame that prevents people from seeking help for mental health issues as relatively common and accepted (and I mean relatively accepted) as depression, is increased a great deal for issues surrounding sexually inappropriate thoughts and behavior.

So, regardless of all that business about stigma and secrecy and providers protecting the privacy of their clients and confidentiality of their services…here’s a site that has a directory of providers throughout the U.S.  It’s basically set up for people who are already in trouble.  But it doesn’t have to be.  This is through “Stop It Now” which has referrals to the Association for the Treatment of Sexual Abusers (ATSA) and numerous other organizations.  Get help if you need it.  Get help for others if they need it.  That’s right, help, and try to discontinue the hurt.

http://www.stopitnow.org/faqs_treatment

Maybe if everybody calmed the f*ck down and decided they were more interested in actually protecting children than in getting angry at offenders, we might make some progress.  And maybe tend to that part of your conscience that’s problematic before you become a bad headline, or before you celebrate a bad headline.

Peace.

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

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!!

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

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

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.

 

When Therapists Attack: Self-Care Fails on the Road to Implosion

Within the past few days, it’s become abundantly clear to me that too many transitions and too many stressors, combined with an inability to engage my deepest self-care strategies, led to some, shall we say, unbalanced behavior.

Really, it was the kind of week where having to tolerate even the smell of flavored coffee, much less the existence of it preventing access to real coffee, was essentially the second-to-last straw in a minor blowout.

It wasn’t until after having about five-and-a-half hours of dead-to-the-world sleep, with no pressing concerns to address on waking, that it began to dawn on me just how skewed I had become, and what the sources of the real stress were.  That is, I can cope with flavored coffee (it’s existence, not me consuming it–yuck!) when I’m actually able to process the big, looming weirdness and stress that comes with the fields I work in.

Even now, as I’m trying to write this, I’m “fixing” other things rather than fully committing to exploring the issue.  I started off by repairing a latch on a coffee container, and then moved to cleaning out the battery compartment of a remote control (a battery had leaked inside of it earlier in the week).  I then rapid-wrote multiple pages of another potential blog post.  So, really, when things are big and disturbing, I engage my rather developed ability to avoid directly addressing or processing things.  Unfortunately, I still haven’t gotten to the point of being able to engage the big guns among my stress-reducers—those that allow near-complete disengagement from the stress—the re-set button to problem solving.  Although, come to think of it, I could probably do that now.

[Right here I wanted to insert a clip of a deleted scene from the movie, Out of Sight, wherein George Clooney and Ving Rhames discuss the joys of taking a hot bath—which would have made sense in the discussion I would have had around said clip, but seeing as I couldn’t find a copy of that clip…anyway, if you know where I can link to it, let me know.]

Still, writing falls into the category of de-stressors—which is another thing that should have been an obvious sign to me that things were off.  That is, I was unable to come up with a single thing to write about until I actually realized what was bothering me (stuff), why (because it was annoying/disturbing), and what I could do about it (nothing, really).  And when I say I was unable to come up with anything to write about, I don’t mean that in a literal sense.  I’ve got plenty of topics.  I just wasn’t connecting with a particular angle or idea long enough to make anything out of any of them.  In fact, I hadn’t even opened a “new” document to get down to work, or scribbled anything in my notebook, or on a scrap of paper that I could reference later.  I just felt dead about the whole concept of writing (aside from pointless Internet political arguments, which are usually one of my most easily identifiable procrastination strategies).

Perhaps the thing most getting in the way of the established stress reduction routine involves changes in my schedule that leave me with less “alone” time, where I am free to do what I want without having to consider the plans of others.  Ultimately, this is a good thing, but in the adjustment phase, a little trickier than I prepared for.

On top of the change in routine, there has been what I’ll call a health concern within the family that is being addressed but is not fully resolved (as if anything ever is).  But we’re in the “looks fine, but let’s just check out one more thing so we can provoke some more anxiety while you wait to see how this turns out” phase.

On the counseling front—people working in the mental health field are bound by ethical codes that make it essentially impossible to openly discuss our jobs, except in very limited ways with very specific people—generally speaking, people who are bound by the same ethical codes.  Over the years, I have developed a way of discussing work with my wife, without really discussing work with my wife, so that I can vomit out all of the really disturbing shit that hits me on a near-daily basis, and move on with life, leaving the clinical concerns where they belong–back in the office.

Because of the way our schedules now synch up, or fail to synch up, there are points in the week where that discharge of emotion and thought that I usually work through with my wife (who patiently allows it without pressing me for details) is not happening in the relatively immediate way that had previously been possible.

So, let’s just say that among the more run-of-the-mill stressors, and in addition to the less run-of-the-mill stressors, something was relayed to me that knocked me sideways, and led me to fixate on [redacted for the purposes of avoiding an ethics violation].

Keep in mind that I routinely speak with people who see suicide as the best possible solution to their problems, and people who have committed heinous acts against other people they should have been protecting.

Despite de-briefing with a colleague who was also aware of the situation, I didn’t realize how much I was carrying the ‘relayed information’ with me when I went on to another work environment—one where flavored coffee has recently become a hazard—one where a malfunctioning printer complicated routine tasks—one where an unusually lively conversational environment led me to (attempt to) stifle many of the extremely dark, sarcastic remarks that are often a part of the purging process that allows many of us who work with disturbing situations to avoid becoming swallowed by that dark void of unholy despair.

Laugh and the devil laughs with you.  Cry and the devil knows he bested you.  Make a sick enough joke, and the devil realizes you’re not worth the trouble (although such jokes should only be made in the company of people who are involved in the same dark field as you, and who understand the devil the joke is aimed at).

At any rate, the stressors of the job with the on-the-fritz printer and the flavored coffee and the enthusiastic conversations, and an inability to productively address some of the simple, usually fixable things that were happening, led to what can only be described as an overreaction on my part to a co-worker asking me to take on something which I felt was not, and should not be, in any way, my responsibility.  Even worse (in terms of sparking my overreaction), the thing I was being asked to address would not have been an issue if the previously aforementioned unusually lively conversational environment hadn’t led to something of a shirking of normal, simple responsibilities.

Now that I’ve done some explaining, although not justifying, of my overreaction, let me say that one of the great things about working with other counselors, which can also be a terrible annoyance about working with them, is that in situations where people are distressed in some fashion or another, they will, first of all, tend toward the supportive, and second of all, tend toward calling one on one’s bullshit—of course, in a supportive fashion.  Wait, I think I left out the potentially annoying part—which involves the voicing of exploratory questions about why one might have behaved in a particular way.  Note that this is only annoying when one does not want to have to, say, be held accountable for one’s behavior and would prefer to just be left alone in one’s asshole-ishness.

I will say I was particularly fortunate to have worked that night with a colleague who frequently has a different take on things than I do, but whom I also feel has extremely sound clinical judgment.  And while I won’t say she identified the specifics of what was going on with me—at least not in one concise interpretation (and to be fair, I had not shared with her a great deal of what was going on in my little world)—she did indirectly prod me to recognize the vast number of adjustments I’ve been making of late, and how much I’ve been minimizing their impact on me.  She also gently kept me accountable to the concrete reality that my overreaction was in no way necessary, and was also damaging not only to the target of my overreaction, but to me as well (most notably because I spent the rest of the night obsessing about it and why I let it happen in the first place).

I was also fortunate to have another colleague remind me that I love my co-workers and have a lot of fun at work, despite the stressful nature of the job.

Looking back a few days later, it should have been obvious to me that I was carrying a big burden regarding the ‘relayed information’ when I found myself unable to discuss it (in a vague, clinically appropriate way) with the colleague I was working with that night.  I brought it up briefly, but used ethical concerns as a way of dropping the subject—when really what was going on was that talking about it, or trying to process it, was provoking such anxiety in me that I just wasn’t ready/willing to deal with it.

I will just say now that I am extremely grateful to be in constant contact with some great people who are pretty amazing at this work, and who can tolerate my faults, but are also willing to help me do what I can to address those faults in a positive fashion.

Oh, and I would also do well to remember this…

Lake control