Tag Archives: Therapy

Forced Healing: A “Girls” Beach House Retreat

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(Spoiler Alert)

Season Three, Episode Seven of HBO’s Girls finds Marnie securing a North Fork (the vacation destination for people who feel the Hamptons are “tacky”) beach house from a family friend, in an attempt to engage her friends in some never-defined process of “healing”—healing that is supposed to take place over a duck dinner, leaving time for face masks, a viewing of “Queens of Comedy,” and a ceremony built around throwing slips of paper, inscribed with wishes, into a bonfire.

As she hops around in the turbulent surf, insisting it’s “the best swimming conditions imaginable,” while the rest of her friends wait uncomfortably on shore, Marnie observes, “I just think we have a lot of healing to do and we have a lot of ways that we could do it.”

The best swimming conditions imaginable--why isn't anyone joining in?

The best swimming conditions imaginable–why isn’t anyone joining in?

Healing rituals can be very powerful…I guess.  I can’t say as I’ve ever utilized any as part of a therapy or group therapy session.  And, just to be clear, I’m using the phrase “healing ritual” in the broadest way possible—essentially encompassing any kind of activity designed to provide participants with a positive outcome by engaging in some sort of symbolic action.

I have, at times, advocated that people use healing rituals, for example, when grieving.  But in those cases, I’ve suggested an individualized ritual, focused on something that is specific to the mourner’s connection to the deceased.  And such rituals come with the caveat that one cannot simply get over grief by coming up with a clever routine that serves as a reminder of a loved one.  You have to feel the hurt to get to the heal.

Personally, I’ve only ever taken part in one healing ritual, at a church.  That particular ritual involved dropping stones into water, and had something to do with establishing intentions and letting go of bad habits or negative thoughts that trap one in old patterns…or something like that.  While I enjoyed it, and found it to be engaging while it was taking place, it wasn’t something I was particularly invested in, or something that spoke to my own personal needs or expectations at the time.  So it didn’t really stick with me.

I suppose I associate healing rituals, or rituals in general, with religion or spirituality, rather than with therapy.  This is not to say that religion and spirituality are totally separate from therapy—perhaps different sides of the same street…finding meaning in, and ways to deal with, the difficulties of life.

Ritual, though, is imposed on reality.  Ritual says, ‘we are here now, and these are the steps we are going to take to create shared meaning.’  Therapy depends more on meeting people where they are, and taking steps as those steps become possible.  At any rate, for either rituals or therapy to work, they need the ‘buy-in’ of the participants.  If there’s no meaningful connection to the work being done, no personal sense that it is worthwhile, then little is likely to come of it.

Marnie, unfortunately, never gets the buy-in of her friends.  Hannah, Jessa, and Shoshanna come out to the beach house as much out of a strained sense of obligation to Marnie as they do because they’ve been offered a free, weekend getaway.  Hannah soon sabotages Marnie’s tightly-scheduled friendship renewal when, on a trip into town, she runs into past roommate Elijah and a group of his friends.  Inviting them to join Marnie’s restorative retreat, Hannah implores Elijah to, “save me from this hell.”

Strangely enough, the only actual healing that takes place is between specific members of Marnie’s healing retreat and Elijah.  Prior to inviting Elijah over, Hannah and Elijah excitedly reveal how much they miss each other, thus effortlessly mending a pointless rift that started because Elijah had slept with Marnie.  Later, after some icy exchanges, Marnie opens up to Elijah about her break-up with Charlie and about her connection to “Old Man Ray,” because she cannot, in the context of the healing she wants to pursue, reveal to her other friends that she is sleeping with Shoshanna’s ex.  Nor would she want to admit it, as Ray does not fit into the overly-planned, picture-perfect life Marnie envisions for herself.

In addition to keeping secrets, as much as Marnie tries to impose control and ritual on the gathering, her friends are not particularly in the mood for structure, ritual, healing, or therapy.  What growth these characters experience is a result of taking steps forward on their own, or being confronted with the consequences of their actions.  At the moment of this particular beach retreat, Jessa is recently out of rehab (where she “learned a lot of great communication games”), Hannah is (relatively) satisfied with her career and her significant other, and Shoshanna is re-evaluating her life, potentially involving splitting from her friends (who she characterizes as “fucking whiny nothings”) permanently.

It clearly is not the time for a ritual based in Marnie’s need for connection, and modeled after a pop-culture version of how women bond with each other (with acknowledgment of the irony that I’m using an extended pop culture reference to explore how and why ritual and therapy may or may not work in particular contexts).

In a shallow, drunken conversation about the impact of their parents on their lives, Hannah tells Marnie that she had been dreading the trip to the beach house, and “would have done anything to not be here.”  Then, to assure Marnie that they are having a valuable exchange, and perhaps in hopes of pre-empting the scheduled dinnertime healing session, Hannah assures Marnie that they are taking part in “one of the most meaningful weekends of the summer.”

Hannah’s dismissive comment speaks to the crux of the problem.  Marnie views the weekend as a reset button on their lives, a way to make things “like old times” and to get back to normal, once and for all.  But everyone else sees it as just a weekend…a break from their real concerns…time out from “normal.”  Their lack of ongoing, meaningful connection to one another has become ordinary and acceptable for everyone but Marnie, who is clinging to a Hollywood ideal of female friendship, particularly given that her Hollywood ideals of marriage and career have completely fallen apart.

Perhaps the problem with ritual as a strategy for healing, then, is that it is often a break, outside of commonplace daily activities, potentially gripping in the moment, but ultimately just a break.  There are few, if any, rituals we engage in that become transformative, except perhaps those rituals that are constants in our lives, practices based in our beliefs.  It is a delightful fantasy to think that we can come together with friends in a carefully orchestrated event that will have life-changing potential.  However, close relationships are a process of careful, ongoing cultivation, just as most things in our lives do not bend to sudden, planned transformation, resulting in perfection, or reclaimed perfection.

As for the Girls, whether the rest of the group is really thinking about how they fit together is up for debate.  None of them, aside from Marnie, seem particularly concerned with making sure they move forward together, developing deep bonds.  As it stands, their bonds seem more circumstantial than intentional.  Although they express concern for one another, Hannah, Jessa, and Shoshanna seem content to pursue their own ends, and let the relationships go where they go, even if that involves completely drifting apart.

When Marnie finally decides to throw down, and try to force the group to engage in whatever ritual it is that she has planned, any thought of such healing has jumped the track, and it becomes more like an impromptu, and leaderless, group therapy session—the kind where problems are brought up, but no resolution is sought.  Grievances are aired, and alliances shift rapidly, but the intent of the participants becomes wounding, not healing.

Shoshanna takes center stage in this process.  Having consumed numerous “North Fork Fizzes” throughout the day, or perhaps simply frustrated enough by the behavior of the people around her to finally demand attention and express herself, she unloads on the group for treating her “like I’m a fucking cab driver…like I am invisible.”  Then, delivering the final blow to Marnie’s healing weekend, Shoshanna tells Marnie, “You are tortured by self-doubt and fear and it is not pleasant to be around.”

In short, Shoshanna indicates that Marnie needs to go get some therapy rather than trying to heal things that were never whole to begin with.

The episode ends with the “girls,” waiting for the bus back to their regular lives, slipping back into the one ritual that did come together over the weekend—a dance routine taught to them by Gerald (with a hard ‘G’).  Not exactly a healing moment, but an indication that things are essentially where they’ve been for a long time—with individuals who occasionally connect as much as their circumstances and personalities allow.

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

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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

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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

 

 

 

 

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

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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

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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.

The Sweetest Hangover

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The last time I posted anything on Respect the Blankie I was plunging into NaNoWriMo (National Novel Writing Month)—an event/contest of sorts wherein thousands of participants each try to knock out 50,000 words—about 200 pages—of a novel (perhaps an entire novel) inside a month.  I am happy to report that I “won”—meaning I reached the 50,000 word goal.  Those 50,000-plus words now exist in the form of a partial novel that will probably never be completed.  After forcing myself through that much material in that amount of time, all while keeping up with my paid work, but while dropping most of my other ‘recreational’ pursuits, I’m not convinced the story is worth pursuing.  I latched onto a basic premise early in the month and forged ahead.  Careful plotting and ongoing revision were replaced by the drive to get the word count where it needed to be.  Okay, in truth, I never carefully plot things out, which is perhaps of one of many themes of my life.

In large part, having abandoned the writing of this blog for a month was a major factor in forcing myself to best the NaNoWriMo obstacle course.  I didn’t want to take on a challenge, use it as a reason for not tending to other things in my life, and then not complete the challenge.  Then, on December first, I experienced what others refer to as the NaNoWriMo hangover.  I had met my goal, but felt wiped out writing-wise.  And much like those suffering a hangover often promise themselves they will never drink again, I didn’t really want to engage with my story and characters that much again.  It had gotten to the point where we were all fighting each other, anyway, and being entirely too polite about it.

So, around the third of December, when it dawned on me that I was avoiding my writing life, I realized I couldn’t go cold turkey, but needed a little hair of the dog—or hair of a different dog—I still wasn’t going to go back to the novel.  I pledged to get back on track to posting at least one ‘article’ a week on the blog, with the reset button cued to the beginning of December.  I am bringing this post in under pressure of that deadline.  Having completed the NaNoWriMo challenge, though, made me consider a number of other things about what I am doing, and what I am capable of—or perhaps what I want to be doing, and how I can be more capable.  When am I actually challenging myself to do things better, as opposed to more or perhaps just enough?  When am I getting stuck in a rut, as opposed to settling into a comfortable groove?

To be sure, it was an exciting feeling to realize I had met such an ambitious goal.  But it was a goal with a built-in hangover.  It was about doing too much just to prove I could do too much—yet another theme in several parts of my life.

So for now, I reflect on my writing life and its interplay with the other aspects of my existence.  When I started this blog, my intent was to tie it to concerns of mental health, to have a focus on issues relevant to my chosen field.  I have largely kept in line with that goal, but it has been difficult at times to get a solid idea and bend it into an article worth reading.  In part, some of that difficulty is tied to my connection to some rather dark corners of this field, subject matter that is difficult enough to begin with, without the added complication of lacing it with Style.

At other times, I have written things that have been personally satisfying and entertaining, but which I decided did not adequately fit in with the mental health angle, or did fit in with that angle but were potentially…uh…antagonistic, or easily interpreted that way, and so abandoned them.  One such post that I decided to go ahead and put up anyway actually served as the seed for an article, completed with a collaborator, that has since been accepted for publication (more on that when it actually comes out, months from now).  So I’m re-evaluating my standards for subject matter.  That is, I almost second-guessed myself out of a publishing opportunity because I was afraid some ideas might be taken the wrong way—by whom, I don’t know.  Well, actually, I could tell you what I’m thinking on that account, but it’s all an idiotic circle of self-limiting hooey based simultaneously on the fear that nobody and everybody will read a post and everything/nothing will happen to make things go in a direction that can’t possibly be good unless it is.

So, for now, the goal is to write about whatever moves me to write, and in the way I want to express it, without getting too worked up about things being taken the wrong way, rather than trying to maintain a narrow, polite-ish focus.  After all, every aspect of our lives contributes to our mental health, or lack thereof/limitations thereon.  So, here’s to reasonable goals, and fewer hangovers of any sort.

GRIEF, AMERICAN STYLE, or, I’m gonna sit here and drink until I hear “Raining Blood” so f*ck you!

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I’ve lived through a few Facebook funerals now, where somebody I’m connected to via Facebook, but haven’t seen for years…decades even…dies and the news is relayed on their page and often numerous others’ pages.  Or the news intrudes on completely unrelated posts as the awkward grief styles of the American public become all the more public.  I don’t think the American people in general deal with grief well, and my own personal grieving style tends toward an above-average level of avoidance and, uh, blockage.

I’m trying not to go there right now—to the awkward social media grief, or the blockage—even as I’m posting in a social media outlet.  But a friend of mine really did die last week, (and the post I was working on about swearing therapists decided to punch me in the brain, preventing me from working on it).  In some sort of weird and possibly misguided effort to maintain some level of privacy, I’m not going to name my friend here, although not naming him seems sort of like denying any kind of tribute as well as making this post that much more about me me me.

I will say he was a kick-ass guy with a wonderful wife and kids, as well as numerous other beautiful (in the drunk, ‘you’re my best friend!’ style) family members and friends.  I can’t say as I knew him well enough to give even a marginally adequate sketch of his life, but then there are very few people, even some of my siblings, for whom I could provide such a thing.  I have my own small store of personal recollections and connections, which I’m just not going to share here.  But we’ve been down too long in the midnight sea anyway.

I don’t know if keeping his name out of this would be considered a positive or a negative, because I just don’t know how these things work anymore.  Anymore?  Who am I kidding?  Even before “social media” existed, I didn’t know what to do with the various real-world aspects of grief.  Do I call the family?  Do I leave the family alone?  Do I show up on the family’s doorstep, sobbing, Crock-Pot full of chili and bouquet of sunflowers in hand?  What about donations to charities, the family, or…?

As much as we say the grief is about the deceased, ultimately, grief often comes down to “me me me,” especially for those of us who don’t know how to “do grief” or do the funereal etiquette properly.  We can become obsessed with how the death of someone impacts us, and how we are supposed to act in the face of it.   We can become obsessed with whether we are doing the right thing or not, even when nobody is paying all that much attention to us.  I can’t imagine that anybody is sitting around complaining that I have not made it clear that I am aware of his death, or what I intend to do about it.  I’ll show up for the funeral and work that all out there, or in the days after, or…

Me, I don’t do grief well at all.

Yeah, I’m a therapist, and I have completely inadequate training in dealing with death, and more importantly, the living left behind…perhaps all by design.  It’s not my thing.  It’s not anything I’m comfortable with…not that I should be allowed to claim the privilege of comfort at this point in time.  I truly love this man, and his family, and f*ck me if I know what to do with that.

So let’s change gears.  Here’s a little example of how I function in these situations:  Following a memorial service a few years back, I was somewhat mortified when my grief fog began to lift and I realized I’d been wandering around, a forced smile on my face, at seeing people I hadn’t seen in far too long.  The awkwardness of, “Hey, good to see you,” collided with, and perhaps overrode the awkwardness of, “One of our friends/family members died.”  It’s a fine line between grief and panic…grief and meltdown…grief and straight-up weirdness(?).

It seems like grief is one of those things I should have learned or maybe just known, like you’re supposed to know how to change a tire or unclog a toilet (or how you’re supposed to know all those stupid things that are supposed to be part of a wedding).  But I’ve largely managed to avoid engaging my grief skills, in favor of engaging my grief avoidance skills.  My father died when I was still too young to really understand what that meant.  And almost nobody else I know who died since then was really all that close to me when they went, either due to time and distance, or due to design.

I distinctly remember, back in the summer of my 11th year (was it my 11th?  Maybe it’s not so distinct) when my favorite uncle died.  Due to his prolonged illness, I had intellectualized his passing, had closed myself off from having to feel much of anything.  I didn’t want the hurt, so I wasn’t going to have it.  When my mom got the call, I sat on the couch between my younger brother and older sister as the Beatles’ “She’s Leaving Home” played on vinyl, pushing my mind into that song.  My uncle was gone.  I knew he was going well before he left.  “Something inside, that was always denied, for so many years…”

I will also say that in many instances, I kept my distance, which was usually just a matter of carrying the relationships on as usual.  I guess my attachment issues lead me to downplay relationships, to where connections most anyone else would call friendships feel more like acquaintanceships to me.

And perhaps even worse, my instinct to dull the pain often leads to making jokes, usually sarcastic comments, realizing only after I’ve begun unleashing them that I am saying things that are horrifically inappropriate.  I want to imagine myself, like Superman, realizing a missile has been launched, taking off to steer that missile out into space.  Only, like Superman and the missile, I end up blowing up the Phantom Zone instead, unleashing General Zod, Ursa, and Non, ultimately raining much more hell down on everyone, myself included, than I would have if I’d learned to keep my mouth shut, or to make appropriately staid comments.

I’ll say that right now, I’m trying to do this right.  I’m trying to let myself take this in, even as I am engaging in various forms of avoidance.  I can’t promise that I won’t just crawl inside a bottle for a few days, and then drag myself out, emotions appropriately muddled and washed downstream.  But I’m gonna try to feel this one for real, dammit.

Happy Birthday to Me

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“Happy Birthday to Me” is a delightful little horror film from 1981, starring Melissa Sue Anderson, aka Mary from “Little House on the Prairie,” as Virginia, a top student at an exclusive private school who may just be blacking out and killing her annoying friends.  Now, I don’t want to get too involved in the parallels between that movie and my own academic prowess, blackouts, annoying friends—but, hey—uh…what was I saying?  And…uh…is this blood on my shirt?  Good God!  It’s everywhere!

Anyway, for my birthday I decided to treat myself to a late-60s/early 70s, cheapo Charlie Brown plastic mask I found on eBay—not so cheap now that it’s “vintage”—and, no, the costume and box are not with it.  It’s a mask I intend to hang on the wall in my office—sort of a comical homage to all that Jungian persona business, and the notion that all therapists and psychologists have at least one or two carved, ‘primitive’ masks among their office décor.  I suppose that, like with the vast majority of my comical homages, it will go largely un-understood and un-laughed-at by anybody who ever sees it.  But that’s okay.  We’ve got to amuse ourselves, right?

Still, there is a larger personal significance to the mask than just a little inside joke about Jung and the décor of therapists’ offices.  It’s tied to my second—make that my third—I think—memory ever.

My father died a week before my third birthday, in a car accident, when another driver ran one of the few stop signs in the rural Nebraska community where we lived at the time.  By October’s end, my mother had landed the family—my five siblings and me—in Oregon.  We didn’t have much to hold us to Nebraska.  We hadn’t been living there that long, and we had no relatives in the area.  We were there because that’s where my father had been placed in his role as a pastor in the LCMS.

Halloween 1971 was spent at the home of my Uncle Jim (my mother’s brother), while we waited to move into the house that had been purchased with some of the payouts from my father’s death.

That year I went trick-or-treating in a Charlie Brown costume.  The only reason I can recall this at all is that my Uncle Jim had slipped a rock or two into my trick-or-treat bag, predictably and hilariously eliciting cries of “I got a rock!” as we inspected our hauls for the evening.

It’s been a bit of a mystery to me why the end of summer and the beginning of autumn has always been my favorite time of year.  Despite what should be an obvious association with loss, I’ve always tied it to new beginnings—most obviously the start of the school year.  It also seems a bit odd that Halloween would be my favorite holiday as well, given that it’s connected somewhere back in my mind with the death of my father, and being unexpectedly uprooted.

I suppose that on some level, because fall is associated with most of my earliest memories, and it marks the time when I arrived in Oregon, which I will always consider home, fall is when I really joined the world as a conscious, if befuddled, human being.  So I suppose that Charlie Brown mask is a symbol of both that consciousness and that befuddlement…and of the idea of home.

Happy Birthday to me, indeed.

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

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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.

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.

So You Want to be a Therapist…

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By the end of the day Monday, it will have been 32 days since I’ve had a full day off.  And I’m not sure if Tuesday should really count, because I have to go to the dentist, which is sort of like taking a day off to be tortured for an hour or so.  (I’m pretty sure hell involves some lesser demon grinding that fluoride goo into your teeth, and deliberately getting it all over your gums while only letting you rinse your mouth out roughly every 45 seconds). Then it’s back to work on Wednesday.  By next week, things should slow down some, although I fear I may have just jinxed that.

Now, in fairness, some of those work days involved only a few sessions, plus attendant phone calls and paperwork.  But some involved 14 or 15-plus hour shifts or a ten hour shift transitioning into a three-hour assessment, or…  At any rate, all of those hours were tallied up between my full-time job and assisting in the start-up of a new practice.

Another thing to consider is that my full time job is in crisis services/crisis intervention, which is sort of an ugly stepchild (with apologies to ugly stepchildren everywhere) of that highfalutin really real therapy.  Metaphorically speaking, we in crisis services slap on the splints, and close wounds with superglue, and let other people set the fractures proper, and heal up the deeper damage.  Unlike most jobs in the mental health field, crisis services involves round-the-clock shift work—Hollywood depictions of therapists who are accessible 24-hours-a-day notwithstanding.

Of course, movies and TV shows are probably where most people get their ideas of what being a therapist is about.  And if one accepts those portrayals, therapists are all a bunch of immaculately-dressed, well paid, eccentric/brilliant and/or unpleasant/neurotic people with amazing office space who can’t keep from having affairs with their most attractive but least stable clients.

And while that is pretty much my life in a nutshell—aside from all of those parts—getting to the stage of your career as a therapist where you make a high-six-/low-seven- figure income by sitting around dispensing wisdom to the worried well is a potentially treacherous path that is not for everybody.   So it’s probably much better to just embrace the idea of filling a role more like Mariah Carey’s Social Worker character in “Precious” than the jet-setting millionaire therapist she played in “Glitter.” (Admittedly, I haven’t seen “Glitter” for a while and may be misremembering some things).

The short version of how the process works is: first, get a bachelor’s degree.  It doesn’t necessarily have to be in psychology, although that might help.  Once you’ve realized your bachelor’s degree doesn’t really count for anything, and everybody you know who skipped college is making more money than you, go back for a master’s degree.  Don’t worry, there are plenty of private schools out there now that will gladly take insane amounts of your money (or the government’s money that you get to pay back) so that you can get a master’s degree.  Be forewarned that in order to get a master’s degree that will be good toward becoming a therapist, you actually get to borrow money to pay a school so that you can go work for an agency for free for a period of roughly nine months.  The length of your unpaid employment will depend on how quickly you can rack up hours meeting with clients and your supervisor.  In most instances, getting the hours shouldn’t be that problematic, because there’s a good chance you will be saddled with a far larger caseload than you can reasonably manage, especially since you won’t really know how to manage a caseload.  Your clients are likely to remind you on a regular basis that they are very aware that you don’t know what you’re doing and that they would prefer to have a real therapist.  Don’t let this bother you—most of them would say the same thing if Alfred Adler himself came back from the dead for the sole purpose of conducting sessions with them.

Once you have your master’s degree, try not to think about how much money you owe in student loans—you can’t possibly afford the therapy that it would take to manage your anxiety and your sense of hopelessness about ever paying it back.  One good thing, though, is that you are now probably able to get a job where you are making as much or slightly more than at least half of the people you know who skipped college altogether.  Of course, given the severe drubbing the public mental health system has taken in budget cuts over the last decade or so, jobs can be a bit tricky to come by.  Assuming you get a job in the field, be happy in this job—you will be stuck here for at least two more years as you attempt to rack up enough supervised hours to qualify for your license as a counselor.  In addition to the supervised hours you need to log, you also get to pay hundreds of dollars to take a test designed to prove that you have learned enough in grad school and your various forms of employment to be let loose on the public without supervision.

Now you can open a private practice and just let the cash roll in—assuming you can find and maintain a big enough client load in a space with a reasonable rent payment.  You might also want to go through the painstaking and tedious process of getting on various insurance panels, or establish your suitability to take on government contracts, or…whatever else you need to do to stay afloat.  There is no shame in moonlighting in the food services industry, although you have to remember not to acknowledge any of your clients should you, say, end up delivering a pizza to their homes—unless they acknowledge you first.  And depending on the specifics of your various licenses and endorsements, you will pay hundreds or thousands a year to keep up those endorsements, as well as paying to attend various seminars and conferences to keep up your ongoing education credits in all of the relevant fields.

Just remember that anywhere along this process, anybody who gets mad at you for whatever reason can file a complaint causing you no end of distress and the possibility that you will lose everything you worked for.  Keep up your liability insurance payments and remember that homicidal ideation can be grounds for a mental health detention.

On the other hand, if you want to be a life coach, all you really have to do is watch a minimum of four episodes of “Scott Baio is 45…and Single,” (which, admittedly, is getting much harder to track down) and find a web site that allows you to print off a life coach certificate—I think Crayola’s site has some good ones.