REsilience

Steven Moffic, M.D.

April 22, 2012

 

Resilience in Recovery

 

“There’s not a whole lot I can’t be”. – Bryan Anderson

 

I don’t know if you saw this story or not. I hope you did. Or will. It was the cover story of the weekend edition of USA Today, April 13-15. At first, I involuntarily recoiled a bit, but then came some emerging tears of sadness that turned into tears of astonishment, almost joy.

 

No, it was not a story about the Titanic 100 years later, although that, too, was a traumatic event for America and those who survived the sinking of the ship. This story was “Defending America, then inspiring her: wounded veterans of Iraq and Afghanistan become motivational speakers, sharing stories of valor and survival before riveted audiences”, by Chuck Raasch.

 

The picture of Bryan Anderson showed his resilience and what he was recovering from, at least outwardly. He was in a wheelchair, missing both legs and his left hand, but with arms outstretched and mouth depicting pride, determination, and triumph. He had just spoken at a fundraiser for the 1st Lt. Cleary Memorial Fund. Cleary was killed in Iraq. Anderson himself joined the Army on September 11, 2001, and suffered those injuries 4 years later from an improvised explosive device. Now he snowboards and gives motivational speeches, among many other activities.

 

There can be no question that the armed forces were late in preparing to treat the physical and mental injuries from this prolonged war. But they’re catching up, often with some innovative treatments, especially of so-called Posttraumatic Stress Disorder (PTSD).

 

We know pretty well that psychiatric medication does not have a whole lot of long-term success in PTSD. Maybe some brief symptom relief, at best, in preparation for other therapies. I don’t even recall that PTSD was covered in Mr. Whitaker’s book, “Anatomy of an Epidemic”. There is no anti-trauma medication. And, in contrast to most official psychiatric disorders, we know the major cause of PTSD, severe trauma that feels threatening to one’s life.

 

So, after trying to catch up with traditional treatments, the armed forces are now also innovating. One is the use of therapeutic dogs. Another is inspirational music, such as the song “Survive” by Rise Against, that helped rescue Mr. Anderson. I would like to think that Mr. Anderson would also like the Beatle’s song “With a Little Help From My Friends”. Another is to not hide their physical damage from a public that at first may be horrified and guilty, but to show and relate what happened to them. All this would fit so well how he and another buddy who lost his legs rented a car and drove it. Mr. Anderson steered, while directing his friend on the floor to work the brake and gas by hand. It seemed so astonishingly successful that the Army guard at the Walter Reed hospital gate, after a long pause, waved them on with: “You’ve gotten this far. Move on”. Of course, this won’t work or be possible for many others, but even so can be a model of inspiration. Social media and YouTube can spread their stories easily and quickly. Seeing this story reminded me of so many others in my own work.

 

I think of patients of mine that I’ve worked with in prison. One was formerly in the Army Reserves, hoping for a long and successful career in the Army. However, after an atypical night of drinking, he killed a young woman while driving. At first, he was quite depressed and his family physician gave him an antidepressant. But after he was in prison for awhile, he was determined to make amends and get off the medication. I worked with him to slowly decrease and stop the medication as he contacted the family of the deceased, asking for – and eventually receiving – forgiveness, a version of the Truth & Reconciliation process developed in South Africa after apartheid ended.

 

I think of my patient with cerebral palsy, always in a wheelchair, but always with a smile on her face. Actually, the physical limitations turned out to be the least of her problems. Powerless as a child, she was horribly sexually and physically abused, but slowly and courageously, was able to remember and reframe that abuse, now becoming a peer specialist.

 

I think of the many transgendered individuals, trying to hide their desire to be the opposite gender growing up, but being ridiculed anyways. Often having tried to suppress their desire, they marry for love but not attraction, going on pretending until they felt they would have to change or die. Then often having to risk losing most everything to go through the painful and expensive physical changes and possible social rejection if they don’t “pass”.

 

I think of my own mother. From her I got whatever resilience I seem to have. Suffering damage to her heart valves from rheumatic fever at age 19, she stayed in bed for almost a year. Later, taking at risk of her own life, she took the chance of having 2 children. Her health slowly deteriorated, though you wouldn’t know any of this if you saw her. Or heard her. Not a mean word did I ever hear. Finally, after again staying in bed for many months at a time, she had some of the first valve replacements, with long and painful recuperations, seemingly willing herself to live until all her grandchildren were born.

 

Everyone I’ve ever known in life has suffered trauma, loss, and/or setbacks. Resilience seems to be the one key quality of all who move on successfully. New studies even indicate that resilience is a key factor in those who recover from what is called schizophrenia (Anne-Kari Torgalsboen, Clinical & Related Psychoses, January 2012).

 

Though it may be hard to define exactly what resilience is, there is a measure of resilience, the Conner-Davidson Resilience Scale. We do know that resilience has little to do with continuing anger, blame, and self-pity; it has a lot to do with hope, forgiveness, and the courage to move on. Keeping in mind the inspiring stories of others helps; taking joy in the failures of others does not.

 

Our genetics can help or hinder. Just think of babies who bounce right back up instead of becoming overly fearful. The love and encouragement of others helps. Veterans coming back from Viet Nam 40 years ago were unfortunately and inappropriately much more ostracized than our current “wounded warriors”. Adequate resources are necessary, but not sufficient.

 

Robert Jay Lifton has spent a half century around the world researching our destructive and dark sides, and has come to appreciate how resilience can help us recover and adapt to a rapidly changing and risky world (The Protean Self, University of Chicago Press, 1993). By using humor and even self-mockery, being open to new ideas, being inclusive whenever possible, and maintaining an ethical commitment, a protean self may emerge that is able transform trauma into various expressions of insight,  compassion, and innovation. He views Vaclav Havel, the former President of post-communist Czechoslovakia, who recently died, as a major example of public proteanism.

 

Whether one believes or not in the ongoing “war on terror” is not the issue here. Nor is whether one believes that PTSD is a psychiatric disorder or a normal response to extreme trauma in the more vulnerable. What is of issue is how we can become as resilient as possible to be our best protean selves. This is not easy, but we must try.

Steven Moffic, M.D.

Sad in Psychiatry: Affectionately called a “gadfly,” and  known as “da man in psychiatric ethics,” Steven Moffic writes about what makes him sad about modern day psychiatry, and how to “treat” that condition so that we will become glad about what psychiatrists can do to help.

 

 

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13 thoughts on “REsilience

  1. you are right when you talk about resilience – acceptance and forgiveness are part of healing. When my son came out of hospital, he was paralysed mentally and physically after having forcibly been treated with antipsychotic medication he never needed. He went in with a badly infected toe and came out labelled severely mentally ill. He found it very difficult to “accept and forgive”. The psychiatrists refused to help him to come off the medication: he had to go it alone and it was a hell of an experience. He managed but there were physical as well as emotional wounds still to be healed. It took two years for his endocrine system to recover and two years for him to come to terms with the fact that “doctors did that to him”. He found it difficult to accept. I am not sure if he has fully forgiven yet but he will have to if he wants a peaceful and rewarding life for himself. The doctors never said sorry.

  2. First of all, thank you for writing “what is called schizophrenia”, and not just “schizophrenia”.

    However, you also write: “Our genetics can help or hinder. Just think of babies who bounce right back up instead of becoming overly fearful.” I’d question that we can be certain to be dealing with a genetic predisposition just because we can witness differing levels of resilience already in early childhood. Never mind that genes, too, are subject to environmental influences, so that, at the end of the day, nothing really is genetic in origin.

    Here’s the danger of trying to explain human behavior and character traits with genetics: Last year I worked with a woman who is dissociating to an extreme extent. She is a lawyer, and has worked for 10+ years for the UN in leading positions in some of the worst hot spots in the world like Rwanda and Kosovo. Each time she came home from a mission she was in a worse state, emotionally, than the time before. The UN offered to pay for therapy, she declined. The last time she returned home, from Kosovo, her family persuaded her to go into a psych “hospital” for help. She said to me that it was the biggest mistake she’s ever made when she listened to her family and went into the “hospital”. The day after she was admitted she wanted to leave, and was held back forcibly, and force-drugged with a neuroleptic. At admission, she had been asked about her problems, she had, roughly, told the psychiatrist about her experiences during her missions, and while her family was told that she was severely traumatised, was suffering from severe PTSD, she actually was diagnosed as “schizophrenic”. Why? Because others had experienced the same she had, and hadn’t reacted as extremely to it as she had. So, the conclusion was that there must have been this illness, “schizophrenia”, all along, and that her experiences during her UN-missions just had triggered the outbreak of the “disease”.

    Wrong. If the psychiatrist had really listened, and hadn’t been jumping to conclusions, the woman in question might along the way have told him that she also has experienced extreme trauma as an infant. When she opted for a career that would send her to some of the most dangerous places in the world, she opted for a career that gave her the opportunity to repeat this trauma, and see if there was a way out, after all. She went to save the world, and to save herself, her infant-self, through it. Unfortunately, and although she accomplished quite a lot, she of course couldn’t save the world, which resulted in her being re-traumatised time and again. To top it off, the system then asked her to tell about her experiences, which for her meant having to re-live the trauma, just to react with a “schizophrenia” label and drugs, which didn’t do anything for her but incapacitate her emotionally, cognitively and physically, leave her standing alone with her trauma, and the message that it made her a disgusting person nobody could stand near them, unless she was drugged up over her eyeballs, i.e. actually confirming her belief that what had happened to her in her past still was overly dangerous, and certainly far too dangerous and disgusting to be dealt with. Once again the message was that there was no way out. The ultimate re-traumatisation.

    You write that everyone you’ve “ever known in life has suffered trauma,…”. Same here. But what I’ve also noticed is that no two life stories are exactly the same. The devil is in the details, and there are usually a lot more details than we like to acknowledge. I don’t think that anyone, who doesn’t know all the details, should have the right to declare someone else genetically defective, genetically less resilient than others, and brain diseased, just because the person in question reacts more extreme, or in a different way, to an experience which we, on the basis of our own culturally conditioned, and often also by our own resiliency determined, subjective values, have defined as “appropriate”. Unfortunately, mainstream psychiatry lacks quite some humility here, and both in the case of the woman I mention above, and virtually in the case of everybody else I’ve met who is psychiatrically labelled other than PTS(D) — I don’t see reacting to life as a “disorder” –, this lack of humility has meant that their life was destroyed.

  3. Resiliency is a great topic. Thanks for bringing up the dialogue, especially at it pertains to military service members and veterans. There are some good links on this page for anyone who is looking for non-drug solutions -

    http://discoverandrecover.wordpress.com/2011/03/12/recovery-resources-military-service-members-and-veterans/

    Your last post was met with a lot of passion. I would only like to say that many of us long for reconciliation, but it must involve REAL reform, not just talk of reform, and continuation of a failed paradigm.

    For those doctors who are serious about a true paradigm shift, I think you will be greeted with welcome arms. For the others, I think the movement will go on without you.

    Only you, as a doctor can make the decision of where you would like to go with your career. I hope there will be those of you who join us in this paradigm shift, because there is a need for healing – both doctors and patients.

    IMO, we need honsety, and a willingness to move forward toward something much better. But the trust will need to be earned. I hope that there will be psychiatrists who are brave enough to earn it.

    Duane

  4. From Doctor Moffic’s post:

    “We know pretty well that psychiatric medication does not have a whole lot of long-term success in PTSD. Maybe some brief symptom relief, at best, in preparation for other therapies.”
    If there were actual therapies, there would be no need for symptoms relief, because this is what would be addressed in therapy. You don’t cut the wires to the warning signals and then say you’re ready to start fixing what’s wrong. If this is your approach – were you honest, you’d have to admit that you don’t really know how to fix what’s wrong. There’s also a difference between “symptom relief” when you are addressing a chemical imbalance and when you are causing one. That causing a chemical imbalance by disabling the mind can be called symptoms relief is a highly erroneous assumption.

    “ I don’t even recall that PTSD was covered in Mr. Whitaker’s book, “Anatomy of an Epidemic””

    “ There is no anti-trauma medication.”
    No, just medications that causes organic trauma. In fact it can be complicit in both sides of the spectrum. It can be what causes violence and then in turn traumatizes the victim that is looking for relief from the trauma caused by it. It is also used to maintain an oblivious mental state as to what’s truly going on in a society causing all of this.

    “ And, in contrast to most official psychiatric disorders, we know the major cause of PTSD, severe trauma that feels threatening to one’s life.”
    Severe trauma that feels threatening to one’s life. You mean like being told that you have a life long illness that doesn’t exist? And please do not make inclusive remarks in regards to the limitations of the psychiatric profession this way. When you say “in contrast to most official psychiatric disorders,” you are already working from a baffling standpoint. People who can’t fix what they label as a disease they have no proof for, and then cause the very phenomenon they have no proof existed before this, and call it healing – this is somewhere to begin from in regards to a perspective as to what causes what? And I believe that if you new what caused PTSD you wouldn’t be administering any of this method whatsoever, and there wouldn’t be the questions that abound either. Neither do I find it mystifying to be told we-don’t-know-what-this-is-because-we-labeled-it-erroneously and then indulge in finding some adventure in furthering this method.

    Marian Goldstein brought up the issue of genetics quite well. Frankly I’m baffled again to read this kind of stuff. If you would look at the material of Bruce Lipton you would see that again genetics is falsely labeled in order to capitalize on a fear, and on something that can be copyrighted (in this case a genetic code). Genetics isn’t unchangeable, it doesn’t determine as concretely what it’s made out to determining. It may be a challenge but so is having to cook food, rather than have it appear out of nowhere, when you wave your magic wand. It isn’t some cerebral magic, (something psychiatrists might take in consideration when they make diagnosis and look desperately for proof and control of others rather than what the effect is). And in this case it isn’t even applicable. There is no such proof of any “genetics.”

    I have found resilience comes from not buying into fear, and this is something that surrounds us every day at every point of time we think is linear, rather than something we create ourselves avoiding letting go of fear. The very idea that we are a body – a limitation, I don’t know what to call it, humor me – which can be defended, as if our thoughts would disappear into mayhem would we not reverse cause and effect and make out that the body created itself. Why do we even think, if it’s not because this is the cause? And I believe we come from forever, and this means that what we we truly are can’t be destroyed at any point in time. That’s completely impossible. It is possible however to focus on tangibles to such a degree that fear is allowed to create scenarios that make us invest in the very things which would (and thus do) create the destruction we would have to defend ourselves from; which we think is real already, as we fragment from who we truly are and think we have defended ourselves from something outside of ourselves. All this to go through the whole thing and find out it isn’t real. And then we defend ourselves from a death we believe would do the impossible and separate us from forever, in order to believe we’ve saved ourself to be something we couldn’t be, as we try to separate ourselves from what makes this all impossible (God forbid there’s nothing to defend); and then we don’t see we’ve created this whole illusion which would only exist would we truly have died, something impossible would we ever have existed to cause it all….

    And its not really resilience, it’s more resilience against that there every was anything to be resilient against. And now maybe you’ve read this whole post, but you can only understand it when it has no meaning. You didn’t understand it till you realize it’s not what you read, but what you already were, which could only happen would it not be the source of meaning, which is why is has no meaning…

    If there’s nothing to defend, there’s nothing to lose, there’s no guilt and there’s nothing to overlook as an offense when you forgive….

    It has to be purely meaningless, nonsensical, incoherent and psychotic to make any sense…. Otherwise there’d be something to hold onto and corrupt…..

  5. “Tui Na ( Chinese- comporable to Shiatsu) back massage technique, Still point, a CranioSacral intervention; various sensory modalities, Tai Chi-” these are ALL disciplines which existed before psychiatry, and, in contrast to psychiatry, are actual disciplines, and don’t contradict themselves. None of these disciplines need the presumed effects of helping with such things as the “Cerebral cortext” or the “limbic system”: “IF there is something to catch the full attention of someone after they are triggered- causing their ‘cerebral cortex’ to get back ‘on line’ it breaks thwarts the limbic system take over. ” If this is indeed true, which again there is no proof of, it’s only a fraction of what’s occurring. None of this “validation” is necessary because it worked before it needed such validation for “organic psychiatry.” Also, in context of defining what a certain category (traumatized children and teens) is interested in and then stating that their freedom to chose what kind of healing they were interested in was taken from them “For adolescents and children, this very uncomfortable physiological state is very often the catalyst for a wide range of acting out behavior – that falls into the category of meeting criteria for inpatient psychiatric admission: danger to self and/or others.” This again completely disqualifies such a statement, which was the first sentence of your whole post. Further more, I’m extremely busy. I’ won’t be reading or responding to your posts anymore….

    • For anyone else happening to read though these posts and wondering WTF:
      1) No, when I read that the only helpful activity going on in psychiatry is the treatments that aren’t psychiatric (from disciplines that are all available outside of psychiatry listed in prior posts, and would still exist if psychiatry was outlawed); this doesn’t drive me to the conclusion that I “know” that there’s isn’t another viable alternative to psychiatry. The only viable treatment in “psychiatry” isn’t psychiatric and these treatments certainly aren’t only available in psychiatry, although they aren’t psychiatric.

      Becoming furious and feeling attacked because someone points this out, and fragmenting into circular arguments which contradict themselves, this does seem to be “psychiatric.”

      It isn’t “casual,” to determine that it’s not one’s task to riddle through such incoherence.

      And although I’m not caustic at all, only quite humored at this: were one made caustic by something that is infuriating, this is a natural response. Not something to be disciplined as disrespectful, when the argument is that there’s no other viable alternative (while the only helpful alternative in the only supposedly viable alternative is not even properly part of it’s discipline but used to defend it, when it’s not a product of it).

      And because psychiatry has convinced the law system to become alarmed in allowing them to statistically make matters worse (not only for people with PTSD). And haul people to asylums where statistically they would have been better off not being, and where someone here trying to defend all of this lists the truly helpful treatments as not being psychiatric, although she believes this defends psychiatry. All of this doesn’t all of a sudden make the validity of the discrepancy of what they are doing dependent on my ability to chase ambulances around and have debates with these drivers as to where they are taking people that would end up in an asylum!

      I won’t be posting here anymore. If there are any questions, I can only refer one to this scientific explanation of the state of things. This is quite old, but still completely applicable. http://www.gutenberg.org/files/963/963-h/963-h.htm#2HCH0010

  6. Indoctrinating people that they can purchase a simple solution to life’s problems, as drug advertising does, undermines the development of resilience.

    In addition to undermining self-care, it makes people feel they need to be “fixed” when their lives aren’t perfect — perfect lives being another fantasy served up to perpetuate consumerism.

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