Thursday, June 4, 2020

Comments by James Schroeder, PhD

Showing 151 of 151 comments.

  • Thanks, Stephen, for the point you are making here. I could add work productivity & ethics to the laundry list of concerns regarding mobile devices, and yet as there are so many other areas at play, this topic hardly sees the light of day (although I think you should write an article giving it some). The same issue is going on in schools all over the place, and administrators and teachers and parents often seem to “throw up their arms” and indicate as if we can’t really do anything about it. To some degree, as schools are spending massive amounts of $ to keep up with the trends while the data supporting these decisions has been disappointing at best (see this prior article I linked:
    http://www.stvincentevansville.org/app/files/public/1243/banning-computers-in-the-classroom.pdf), they are not making it easier on themselves. Yet ultimately, if school personnel and parents recognized, embraced, and acted on the problem, quick, sustainable gains could be made.

    Ultimately, I think we are going to get to a point in the next decade where we are either going to reach a point of societal crisis with all this, or there is going to be a real countercultural shift towards practices and policies that support health & being. I just worry that if the shift doesn’t occur, we are headed towards dire straits.

  • Yes, it appears they are. And that should be hugely concerning to all of us. It is too callous to say that it is an industry without a conscious, but like most for-profit agencies, their number one goal is to make a profit and increase their market share. The problem is that the tech business directly affects people’s health and well-being, and it is leading to massive problems. In China, it was recently declared that internet addiction is the number one problem for adolescents, and the government has invested a tons of money in treatment facilities to address the issue (for better or worse). If we all don’t take this more seriously, it is only going to get worse. Hate to sound pessimistic, but the mad rush of the last 10 years to “keep up with tech trends” defies logic and thoughtfulness – it speaks of an industry that has created an incredibly-enticing product that is changing the landscape faster than anything in history, and it speaks of a population that can’t seem to control its own urges and desires.

  • Hi SurvivingtheSystem,

    Thanks for taking the time to provide thoughts on this subject. It spurred a few of my own. One, although you are correct that much of the past research regarding devices is correlational, this is changing, and the data coming out looks similar. Here is a link to an article of mine that describes a RCT looking at the challenges of using devices in the classroom when it comes to learning:

    http://www.stvincentevansville.org/app/files/public/1243/banning-computers-in-the-classroom.pdf

    In regard to your comment about using the phones to provide brief doses of enjoyment and/or goodness for those struggling with various matters, I understand what you are saying. There is no doubt that for the cost of smartphone/plan, the accessibility to an infinite number of experiences is unrivaled. But my worry is that although there is nothing necessarily wrong with getting reward and pleasure this way, I feel that it can stagnate the individual from seeking out other sources of offline enjoyment, pleasure, and community that might actually cost very little or nothing at all. We have small, wooded trails near our house that provide a free source of outdoor enjoyment/silence/reflection that are close enough to walk to, and much of my enjoyment comes from stepping just outside the house. Again, I realize that finances do limit other opportunities, but I also think that the hidden expenses of all this technology (including such things as direct TV and other electronic offers) adds up in a way that hinders other opportunities.

    On a personal note (up until recently getting a 2nd car due to our 7th child being born), we only had 1 car for 10 years and I don’t have a phone, any cable television, and anything besides internet access at home. The savings without all these things have been in the 10’s of thousands of dollars, and it is allowed financial freedom that would have not otherwise been the case. So, as I fully get what you are saying (and appreciate your note about the “opiate of the masses”), I just worry that devices on our hips might be stagnating, not activating us, as the commercials might say.

    Hope you have a good week. JFS

  • Thanks for your thoughts. In regard to my position, I would simply say that I believe we should value our health and well-being more than convenience/accessibility, and if there are factors (such as smartphone use) that compromises us as individuals, we need to be aware of this. Adults will ultimately make choices of what they value the most, but I think it is especially important for parents to be well-informed given that the first 20 years of life (and all the development, including neurological) of our youth is something we can never get back. What I find interesting is that in just 10 years or so, we are protecting the “mobile industry” like we would protect our minds & bodies (which I do consider sacred). Regardless of how amazing the technology is, if the costs to ourselves, families, and communities are higher than the benefits (of the way they are currently being used), then it would indicate that changes need to occur.

  • Thanks, Francesca, for taking the time to offer your thoughts. I laughed when I saw your comment about the “dumb phone”, but sadly the research is starting to look like this may be the case. As always, there is a certain percentage of people who use them well, but as they continue to utilize more methods that create distractions/anxiety, the choice of going back to a flip phone (or none at all, which is where I have been for almost 20 years) should be a real consideration. I love what the internet/email offers, but I just don’t want it consistently derailing intentional, focused thoughts and reflections. Even if a person uses them well, they can’t control how others use them, which means that incoming communications remain a challenge.

  • Hi Reverend Dr. Epperson,

    I just wanted to say thanks for taking the time to read my article in response to yours, and for providing such a great forum about an important topic. Just as with your article, the insights on your comment are much enjoyed and appreciated, and I loved your creative take on the portal comment. Your note on biblical interpretation was very interesting. It would be fun to sit across the table one day and hash out this discussion in person, but I just wanted to say thanks for taking the time to read and write back.

  • To All Who Have Commented,

    I first want to thank you for taking the time to read my post. A few thoughts as it is tough to keep up on life these days, especially with a little infant in the house, so a mass post is the most conducive given that finding even a few minutes is challenging. I had a feeling that this topic would provoke a lively discussion given it critical nature and deeply entrenched topics, and it didn’t disappoint. Despite the sense of feeling despised and vilified at times for being a professional who is writing on this site, I have no ill will towards any of you. I know some of you have experienced some real tough situations with mental health professionals; I just wish you would consider that being a psychologist has as much diversity as any other profession.

    As far as the article, I will let it stand on its own merits. Certainly all my articles could use more work, but I feel it adequately expressed what I wanted to say. I do admit disappointment that I felt a number of commenters “read over” some of the sections, and then commented as though I had not acknowledged certain important issues. I appreciate MartinMC for bringing this clearly to light. Although the article was intended to explain a particular position, these comments were not caveats or afterthoughts—they are critical pieces of the entire piece I mentioned, which without them, my whole position falls apart.

    I notice that some of you have tried to characterize me by my “Catholic” or “psychologist” self, or even using words like “controlling”. It disappoints me that you pigeonhole me in this way as an attempt to discard what I say. Yes, I am open in saying that I am Catholic and obviously a psychologist. Does that mean I don’t struggle with particular Catholic beliefs in trying to discern what is best from a humanistic and/or theological perspective? No. Does that mean I don’t constantly speak out on other sites and locally about reforms desperately needed in the church? No. To try and sign me off by using these labels is exactly the kind of practice that I hear so many of you openly despise on a constant basis, so it shocks me you would do it here. So I would ask that you consider this first: I am a human being that is Catholic and works as a psychologist. I also run in the woods for hours on end in subfreezing temperatures by myself in the dark. I am one of the 2% of those in my age group who don’t own a mobile device (and have no desire to own one). And for 10 years, my wife and I owned 1 car while raising 6 children, and I bussed, biked, and ran to work (and still do). If you think you know me, I think you are wrong, and unless you really start reading much more of what I have written and understand that I could care less about religion or authority or any other practice unless it turns out to be the best for humans in this life and the afterlife (which, yes, despite being a rationalist, I do believe), then you are far from knowing what I am about.

    Second, I do echo Brett’s comments as I am concerned about the kind of culture MIA is developing. Few professionals—including those that share similar values as mine—would ever step into this forum for multiple reasons—the biggest being the responses they would receive. Some professionals which have already posted in the past—and really are in it for the right reasons—have already told me they are considering stepping out. If MIA is really going to be a community and a forum for discussion about all that is best that is related to psychology, psychiatry, mental health, or whatever term is best used, then you want more people writing, not a small group of people that are going to largely play to a group of constituents. There is a danger that this is happening, although I do think that on a global scale, MIA has already started to make a difference. But the question is just how much and for how long, and if not careful, any organization can implode upon itself if not careful. And I worry about that here.

    Enough for now. I just ask everyone to please remember that we are all people first, and everything else second. I just got done changing a diaper, picking forks off my back driveway, and trying to figure out how I am going to talk to my son about his latest interesting decision. Please consider having patience with me and others on this site as I will with you. I am not responsible for others past sins and mistakes, but I am responsible for my own. And I have a lot of work to do in this regard.

    jim

  • As someone who knows Dr. Carey well as a friend and colleague, I hope all that read her story will realize that it comes from the best place—a place of deep conviction to help her family and yours consider the best options in improving health and well-being. Dr. Carey would be the first to tell you that she like everyone else does not have all the answers when it comes to health related issues, of whatever kind. But a close reading of what she has written will serve as a great reminder for all parents and providers; that is, we must constantly be learning and discerning with what we are doing, and considering whether a countercultural move is necessary to take care of what matters the most. Potential solutions abound, if we have the courage to take the first steps.

    Thanks Rebecca for having the courage to share your story so that many others will consider a “road less traveled”, when it might make all the difference despite the bumps and potholes along the way.

  • Thank you Bonnie and Julia for all that you are doing to improve the health of many, and to provide more natural options to address mental health issues. Anyone who understands the basic physical properties of the brain and body would easily surmise that nutrition could impact health in a variety of ways, including psychologically. As you noted, there is no such thing as a cure all. But no doubt that your efforts and of those like you, who strive to conduct science in an ethical, service-oriented manner, will provide many with hope where there was little or none before.

  • Hi Steve,

    Really appreciate your perspective. Technology has brought us many things, but no doubt it has not brought a sense of deep peace and contentment with what the world offers. Sometimes less really is more. One of my greatest joys these days is witnessing my kids experience people and nature in an authentic way – when you see it happen, it is so rich, so intimate, so beautiful to watch how it unveils itself. And yet, when others, even little children, struggle to see the world outside of how technology presents it, I am saddened.

  • Hi Andrew,

    Your comment made me smile. It also spurred a reflection of my own:

    “Young man forgets that clouds are formed from the ground up.”

    Before I respond any further, I want to give you the chance to elaborate on your summary statement. I think there is a great interaction waiting. On a related note, I would love to hear your thoughts on global warming as I think there is a great parallel to the media/technology issue of which I speak.

    Regards,

    Jim Schroeder

  • Yes, Julie, as you say, in the end, apologies are not needed (although part of it was certainly done tongue-in-cheek, as one of my friends – still a friend – told me that was no apology at all. He was right. It just my way of saying this is where I am going). In the end, we all make conscious decisions such as these because they are driven by matters more important than what we are leaving behind. And with me not having a mobile device, or my wife and I not having two cars for the past 10 years despite going on 7 kids (as I think I noted in the article, I bike, bus, or run to work most days), we are in essence leaving behind those who feel that relationships should be grounded on different factors than we perceive.

    I applaud you for your principled-driven life of deeper matters. Too many people today are living largely on the principle of convenience and trendiness, and eventually I believe (and already feel) that it is catching up with our society.

  • Amen, Julie. Beautifully said. Like any skill that requires engagement and tolerance of discomfort, when we fall out of practice because of “easier” alternatives, it is very unlikely we are going back. The art of the conversation is being lost by many. It is one thing to text and see about getting an extra gallon of milk on the way home, but it is whole other phenomenon when breakups and seriously personal conversations are repeatedly occurring by sent, not spoken, word that is fractured and often reactive. Certainly not a good thing for our human development.

    By the way, you might appreciate that years ago after college, I made the conscious decision to be one of the 2% of my age group who doesn’t have a mobile device. Other than an occasional inconvenience, it is absolutely wonderful, and I believe that it affords me clarity of mind, efficiency, moments of reflection, decreased anxiety, and the like that so many others don’t have. If you are curious more about this and our family’s low tech decisions, feel free to check out this article on my Just Thinking column:

    http://www.stmarys.org/app/files/public/689/november-2014—dear_friends_and_family.pdf

    Appreciate your thoughts.

    jim

  • Hi Alex,

    As always, you bring up great points. I certainly think it is a combination both of what technology allows us to do (for the worse in this case) and how people model technology use for others. But I have to say that in working with teens (with the exception of a small subsection that use it responsibly), they simply lack the development and life experiences to use it well (of course, many adults with the life experiences and brain development struggle, too). Therefore, these incredible innovations, when placed in many youth’s hands, simply are so in tune to the immediacy and gratification and connectedness that they desire that they simply struggle to stem the tide of immersion unless their parents and other caregivers set clear limitations about what they can have, and what they can do. I notice this even in my own kids, who have significant limitations compared to most of their peers and engage in all sorts of hands-on and face to face activities. But if left unabated, they would easily engage in activities of distraction and immediacy for extended periods of time just like they would raid the candy jars until their stomachs start really hurting.

    It is a massive issue, and only getting bigger. And honestly, generations of people are changing right in front of us in ways that belie health from a social, psychological, physical, and spiritual standpoint unless something markedly changes. We will see.

    Thanks as always.

    jim

  • Hi Garyg,

    Thanks a lot for your astute reflections and observations. I concur completely with what you say about the connection between stimulation and aerobic exercise from a scientific and personal perspective. As you noted, I find that consistent exercise seems to be a huge component in reducing my desire for the instantaneous stimulation that surrounds me. As one further example, I don’t have a mobile device for many reasons (if curious, read my article from my Just Thinking column – http://www.stmarys.org/articles – [November 2014 entitled Dear Friends & Family…). We don’t have cable television, we aren’t on Facebook, Twitter, etc… My wife doesn’t have texting on her phone. Anyway, there are many reasons why this is the case, but one big reason is that although I believe the technology that allows it is phenomenal, I have very little desire for the stimulation (and distraction) that it provides. It holds almost no allure. I am fortunate to find that other aspects/people of my life provide this, one of which certain being aerobic exercise outdoors, experiencing silence and nature. But you are so right that it attenuates because many false promises loom very easy and so full.

    Thanks again for your reflections.

  • Hi Daniel,

    Thanks for sharing the beautifully written and heartfelt passage. So much of you said speaks of a constant search to understand how our humanity interacts with another, and yet how our world may be worlds away from another. Pain is undoubtedly a communicator – one in which our world seeks to suppress for many reasons, some rather obvious and understandable, some rather sinister and indiscernible. I love this excerpt:

    “I am surprised to find that what comes next to mind is something very personal and even more uncomfortable: that we must become aware of our own pain and that I must, in some fashion, speak of my own pain, out of my own little universe, even knowing that there are far worse things happening elsewhere to others. There is no particular reasoning behind this thought, just an intuitive clarity.”

    Although some might regard this as invalidating, I think it has the potential to be empowering. We all are quick to note how pain is connected to horrible atrocities, but often fail to recognize how it be a conduit to the most enlightened perspectives and the most empathetic responses. Even in pain, options remain — and I think when options surface to step outside of our pain and see into the eyes of another, known personally or from afar, we suddenly realize that Merton was right when he said , “no man is an island.”

    Keep up the great work.

    jim

  • Yeah Boans, knowing what to do with pain, and when to stop and when to push on, still remains one of the biggest questions I ponder. Probably the best known North American ultrarunner of all-time, Scott Jurek, once said that “all pain is not significant.” My response (and perpetual query) back remains, “Okay, so which pain is?”

    Hope your week is wrapping up well. Always appreciate your thoughts, serious and comedic in nature.

    j

  • Hi Madmom,

    Really appreciated your thoughts here, and understanding that the purpose of the article had nothing to do with achievement (IM finish or not), but simply the belief that much more exists beyond the pain we feel. I realize that sometimes people are turned off by others like myself who mention accomplishments as I did, but ultimately I feel that I am asked to tell the truth of what occurred (good or bad) and let others make their judgments as they will.

    By the way, in regard to your comment about a spiritual piece, I saw quote today from CS Lewis that seemed to have good timing, both in regards to an individual and societal response. It is as follows:

    “God whispers to us in our pleasures, speaks in our conscience, but shouts in our pains: it is His megaphone to rouse a deaf world.”

    Hope you have a good day.

    jim

  • Hi kwb1965,

    Thanks for taking the time to read and reply. In regards to your question, I would first say that the pain I mentioned (on internship) was not just a physical reaction, but an emotional one – I was attempting to deal with a lot of stress, but not effectively so. As noted, I was offered a psychotropic prescription (which was Zoloft), but declined. But, in a broader sense, the connection to MIA’s purpose is the understanding that much pain – regardless of expression – has the opportunity to be informative and formative if we are open to its messages. Although we might blame others or environmental circumstances for our pain (and be partially right in doing so), there is often much to learn about ourselves.

    Furthermore, I would suggest that the division between emotional and physical pain is a false dichotomy. As noted by one of the commenters, there is no such thing as this division in the body. The same brain and nervous systems receives and transmits all pain messages – and all types of pain are incredibly interrelated. In regard to your note about stigma, this was not the focus of this article, but I encourage you to read my 3-part series on this topic if you are interested in a fuller perspective. However, I would challenge you in saying that many physical conditions with pain carry stigma – consider the pain suffered through obesity, lung cancer (smoking induced), STD’s, and many other chronic conditions. But, ultimately I do agree that we are far from really understanding what it means to be in emotional distress and pain.

    Thanks again for your perspective.

  • “I agree. I’d use the school system as an analogy. There were good teachers in the system as well as evil ones.”

    Steve, I appreciate your thoughts on this matter, but I must strongly disagree on a few points. First of all, the quote above illustrates what I mentioned before about the “myth of absolute evil” being alive and well. Certainly there are teachers who commit evil, bad, and inept acts – some even profoundly more than others. But to characterize people in these positions is perpetuating the very “us vs. them, ” static mentality that makes stigma alive and well, in whatever forum it may be. Consider if you had used this idea to characterize those struggling with psychological issues of any kind, as if saying that the “evil” ones could not change or grow in anyway. Not only do I believe you wouldn’t do it, but I think you would be appropriately slammed by the MIA crowd and beyond for doing so. Ironically, the “evil” teachers you speak of were more than likely struggling with their own psychological challenges – this in no way justifies how they treated the students, but speaks to an obvious reality.

    Furthermore, in staying with the school system analogy, consider what has happened when people have vacated our schools, especially inner city schools, for various reasons that are partially manifested through suburban flight. It has gutted communities as a whole. Rethinking the system is not a problem. Vacating it as if this was the obvious solution I think carries huge risks.

    Finally, consider the number one read article right now on MIA by Kelly Brogan. In the article, she states this:

    “A friend gave me Anatomy of an Epidemic and I can still remember crying on the subway when I turned the last page. The entire house of cards crumbled for me that day. I never started a patient on a medication again.

    I spent about 2 years taking patients off of medication, developing first-hand insight into the dependency-forming character of these drugs. It wasn’t until I realized that I needed to enhance their resiliency first, before beginning a taper, that I developed my program of nutrition based, root-cause resolution of symptoms. I wanted to heal the imbalance – so often physiologic – that led to the pursuit of medication treatment before we took the medication away.”

    She didn’t leave the system. She set out to change it from within.

    A few weeks ago, I was invited to talk to a large group of MH professionals about my new book entitled, “Wholiness: The Universal Pursuit of Health, Harmony, Happiness, and Heaven.” There was no discussion of medications. There was no discussion of diagnoses other than reporting of statistical data for illustration purposes. The discussion was simple. How do we provide people with more holistic care, the kind that costs very little, lines up perfectly with their organic existence, and corresponds with the 4 dimensions of their whole being? There was/is great interest around this topic, and since then I have been invited, ironically, to do the same presentation to the school psychologist in our local district. The point of all this is to say that if I was not “in the system”, and well connected to many people “in the system”, the chances of potentially being an agent of change in this way are basically nil.

    Everyone has a right to go where they are called. But to imply that it is always to a brand new place ignores the history of who we are, and how change often occurs.

  • Alex, I hear everything that you are saying and understand that without having personally experienced the travesties that others have at the hands of mental health professionals, there is nothing I can say that is going to fully illuminate (and alter) at just how flawed the system is – conceptually, practically, and soulfully.

    But I want to hone in on your comment below:

    “It’s really hard for me to not say something here when the system just continues to hurt and drain a lot of people while paid professionals are having discussion after discussion, complaining of not being recognized for being one of the ‘good ones’ and above the fray.”

    I want to be absolutely clear in regards to what I said in my article. The purpose of recognizing the positive attempts that people make in these circumstances should not be for recognition alone. Not for me. Not for others. Otherwise, it is vain and self-indulging. The purpose of recognizing and discussing this matter is understanding that positive growth must occur from within the flawed system (in whatever way it is flawed) and from beyond the flawed system. I know many on MIA advocate scrapping the system completely, and starting over. I increasingly understand their reasons. But the reality is that few systems change in this manner. Many times big changes occur when people are part of the system. It is kind of like what happens with any group. You can choose to leave and criticize/legislate/innovate from the outside. Or you can choose to stay, and work from the inside. Each has its place.

    But if we don’t recognize the positive, constructive, empathetic efforts that already exist with people (and even the system itself), then it renders us only partially informed about steps that need to occur. It also threatens to perpetuate the “absolute evil” myth that I think is alive and well in some people’s view of mental health/psychiatry. I have learned a lot from MIA and other forums about negative aspect of the MH system. But I have come no closer to this idea than I was before, and appreciate the Bob & Lisa’s newest book among others recognized how this is often not the case.

    As always, thanks for caring enough to take the time to go further on these threads.

    JFS

  • Hi Boans,

    Always appreciate your thoughts, and I recognize what you said about the difficulty in reconciling what we desire in people’s behaviors with regard to what does happen. Abuses of power in psychiatric units, prisons, or anywhere else that others exist in the care (I realize care isn’t always what it is) are a horrible travesty. Nothing I or others say about striving towards virtuous practice changes that.

    However, I think it is important to note that there are many individuals that work in these units, who although certainly flawed like all of us, do strive towards compassionate, empathetic care towards others. Previous to starting graduate school, I worked in a child/inpatient adolescent unit. I certainly witnessed care (which I previously have spoken about on MIA) that I did not consider to be person-centered. But I also witnessed a number of individuals who really did work hard to do the right thing by the patient and themselves. These are the stories that almost never get told as certainly they do not draw the attention that stories such as you mentioned. But I think it is important they are recognized, whether it is a mental health technician or a psychiatrist. Otherwise, it makes it appear that simply by working in these facilities (prisons or psychiatric units), you are an uncaring person. And this mentality only serves to further divide people, and not provide discussion about how we improve care in an albeit flawed system.

    Thanks again for your thoughts.

    JFS

  • Hi Kallena,

    You noted the following question/thoughts:

    How can we even separate out what is physical and what is not? Does “physical” mean it has to be visible to another person? If so, then yes. Many things we struggle with aren’t physical. Another way of separating out these domains is by the origin of their cause -as you indicate: psychological, social or spiritual.

    I agree that at some level all of our attempts to categorize are artificial and inaccurate to a certain degree, for one obvious reason: we are one person, one body, one mind, etc… That being said, though, what I would say (as you discussed somewhat) is appropriate is for us to describe the different expressions of our one being – i.e., physical, social, psychological, and spiritual. Someone throwing a ball obviously is seen as a physical expression although we know full well that it involves psychological and potentially social underpinnings. The thoughts we have are obviously described as a psychological phenomenon even though we all know that physical, spiritual, and social aspects can have an effect on them. So, yes, their is an artificiality to all of this, but in saying this (unlike how others might feel), I don’t necessarily think that we should throw out any means of expression/categorization simply because it doesn’t perfectly reflect a true reality that exists. If we continued to take this route, we might find ourselves one day unable to speak to each other because we are so hamstrung (or tongue tied might be a better word) with imperfect nature of the words that we are using (and our fear that they might offend someone) that we no longer feel free to speak authentically in the way we are ultimately called. Words mean something–what we do with them means more.

    More to come…

  • Frank, you said the following:

    Disability is physical or it is not disability.

    Getting away from the politics, psychiatric backlash, and the connotation of the word itself, I will simple offer this thought that I wholeheartedly believe until proven otherwise:

    People can and do struggle in all primary domains, whether is be psychological, physical, social, or spiritual. Struggles in these domains can and do lead to impairing circumstances that are contrary to what people themselves desire. Impairing circumstances lead to the need to seek help from various places, including professions such as mine. Professionals such as mine, although flawed in many ways, often do attempt to assist individuals to assume a level of functioning that they deeply desire, not necessarily one that is artificially constructed by societal norms or expectations. Ultimately, people do desire to feel/be healthy, happy, and harmonious when all is said.

    Whatever way this is all defined often, in my perspective, misconstrues the obvious point. People that are struggling often need other people to help them, even though the person seeking the help and the person giving it are fallible, as noted in the prior post. Being too harsh towards either, and assuming them to groups that might be despised or despising the groups that might be used to define them, is not a way towards progress.

    Just a few simple thoughts. Appreciate your willingness to weigh in.

    jim

  • Kallena, you said this:

    “But, might not the whole of society be better served by learning that humans are fallible beings who can not function at 100% effeciency in any and all circumstances and conditions, and that when things get too tough, we do need the help and support of others around us to manage our feelings. We are and need to be connected to those around us so survive those times when our emotions and feelings become overwhelming. That our environments matter, that our own personal feelings matter and we both need and deserve help.”

    What you said encompasses a massive volumes of faith and psychology at its best. When all of us start to let go of our pride and realize that we are not independent beings, but interdependent people, the world suddenly has potential it did not before. The process can be brutal, but the results can be beautiful if we take this to heart. One of the best things about being a psychologist is understanding full well that so many things that people think they struggle with alone are actually the things that so many struggle with together, without even knowing it. I will address how we take this understanding and move to a more authentic place in the next installment.

    JFS

  • Anonime, what you said is a good reminder to all of us as professionals. We must first come from the perspective of a person, parent, friend, family member, etc…before we ever come from the perspective of a professional. I don’t mean that we should take on these roles in a professional setting, but I do mean that we must always attempt to empathize with the other person in this way, otherwise we risk disconnecting ourselves further from the true human experience.

  • BPD, you make a ton of great points, most of which I agree and some of which I will attempt to further flesh out in the next installment about how I think we should treat others that struggle in any domain, physical, psychological, or otherwise. I definitely understand what you mentioned about how destigmatization efforts can backfire as it implies (or clearly indicates) that these individuals are impaired for good instead of recognizing that we all have a capacity for renewal and positive growth. The only thing counter I would say to you and others who hold the beliefs regarding destigmatization efforts (and you alluded to this) is that many people do have good intentions (albeit misguided) and care about others, and are not part of a larger conspiracy that is sometimes put forth here on MIA. They really want to treat people well, but a combination of fear, misinformation, and their own challenges may lead the results to be less than desired.

    Thank you for your time and thoughts.

    jim

  • Hi S1w2f3,

    I don’t disagree with you. A well-meaning, humble, well-informed, well-trained, other-serving psychologist could help wean people off drugs that may be unnecessarily prescribed, thus helping that patient. One of my colleagues in town has expressed this very thought in regards to this issue. But as I believe Robert Whitaker demonstrated very well in his latest book, individual people often start out with good intentions, and then slowly over time many factors (such as those I have illustrated in this and the prior article) begin to insidiously take over and before you know it, those psychologists you mentioned are surrounded by a larger profession that doesn’t support or emulate them.

    I don’t say this as a scare tactic nor as a conspiracy theorist, but as someone who tries to learn as much about history and human nature, and how the interactions between both repeat themselves. And in a nutshell, that is why I think that history would tell the story about how the marriage of psychology and pharmacology would do more harm than good. But I certainly understand and respect that others may disagree.

  • Hi bpd,

    Thanks for weighing in as always, and I wanted to provide a few further comments to what you said below, which I agree with very much.

    “In other words, the overwhelming majority of how people’s lives go is influenced by their extra-therapy life circumstances and resources, not by the therapist. I am a bit doubtful about this generalization because I think length, frequency, and quality of psychotherapy vary considerably between different settings and between different therapists. And I think that a long-term intensive psychotherapy can be truly helpful and transformative; something I have personally experienced”

    What I echo greatly is the humility needed to understand that therapy is just a small piece of what can help people heal and live healthy lives. When I published the article “Want to Be Drug Free – It’s Time to Live More Simply” on MIA, you will note not a single piece of advice references seeing a therapist and/or psychologist. I think as the meta-analysis suggests, much of what we seek is all around us, if (and this is the big IF) we can find ways to harness it. No doubt that much of what I treat in session could be solved in different ways if individuals and families learned how to seek and sustain practices that really matter.

    Having said that, in a country of 260 million + and a world of more than 7 billion, I do believe that we have tremendous value to millions in that some need a place to start, clear mechanisms, and a source of motivation to overcome either intrinsic challenges or unfortunate, unfair experiences that may have afflicted them. And this is where as a psychologist, in what I consider one of the most humbling jobs around (if we forego any hubris can cloud our judgment), can and do have tremendous value to others.

    Thanks again for your thoughts. Always enjoy them.

  • Hi John & Others,

    I really appreciate the great discussion over the merits of the MTA study, and I do think it is very important to consider all design and statistical factors that may have influenced outcomes. Ultimately, we all need to understand exactly what the study teaches us, not how it may confirm or dispute our prior convictions.

    But in staying with the theme of the article, I very much agree with what Steve McCrea said in an earlier comment. I quote:

    “And it is to me disturbing that despite what is now a fairly solid set of literature data showing this to be the case, no one, and I mean basically no one, in the mainstream discusses this fact, and they still tell parents willy-nilly that “untreated ADHD” leads to delinquency, school dropout, drug use, teen pregnancy, and low self-esteem, without telling them that on average, stimulant treatment improves NONE of these measures over time. ”

    I believe that Steve is very accurate with this point. Every since graduate school, and through countless classes and trainings, never once until I became more connected with MIA and Bob’s writings was it unveiled to me that there are serious concerns about the long-term outcomes of ADHD (and for that matter, many other classes of medications). I repeatedly heard the opposite from publicized studies (admittedly I am learning to seek more on my own), and parents have undoubtedly heard the same over and over.

    As my article emphasized, I just am really concerned that if something fits a convenient, cutting edge market (that can be patented and restricted), so often professionals and the industry seek to promote it even when serious risks, or questions of utility, do exist. Regardless of anyone’s perception of the MTA study, my 2nd example was just as egregious (although seemingly less harmful, or maybe not). As with the drug studies, it seems that so often, efficacy is determined in weeks, not months, years, and decades as it should be. For me, a drug that is efficacious for 8 weeks or 14 weeks when it comes to psychological issues means very little when we are talking about a whole lifetime to consider.

    Thanks John for your perspective, and all others weighing in.

  • Hi B (and Steve),

    As always, it is great to have you in the conversation. Obviously, I too have big concerns about DSM, but I think there is a danger in completing opting out in providing feedback about possible changes that could improve a flawed system. Regardless how many feel, there is a good chance that DSM will continue to exist in the future. And if so, I think it is important that many people have input on the process, not just those on the committee. I don’t believe that it sanctions it, but just acknowledges that the DSM is a current player in the psychiatric world. It is a similar situation when many people completely at odds with other institutions, such as the U.S. government. A person always has a right to opt out of the political process completely, but given that the government will likely continue on even in very imperfect form, it renders this individual null & void when things proceed on. I feel like that is the last thing that MIA would want to be when it comes to issues such as the DSM.

    Just a thought. But I certainly understand the significant frustrations, as I have noted some of my own.

  • Hi Annalisa,

    Appreciate your interest. In regards to the insurance question, I am not an expert, but do have a few thoughts. One, insurance companies unfortunately regularly find ways to not insure kids with mental health conditions, the most common way by creating exclusionary diagnoses. This becomes a huge challenge for us because while they often regularly cover services related to anxiety or depression, some will exclude so-called “developmental conditions” such as ADHD, learning disabilities, even autism spectrum disorders. I don’t know as much in regards to adults, but also do know that previously diagnosed conditions can have an impact on life insurance, both at least with rates and possibly coverage altogether.

    I am sure there is a lot more, but these are definitely two concerns that exist. Sadly, my understanding is that insurance plans that include exclusionary conditions are often adopted by companies because they are cheaper. As always, it seems to come back to money.

  • Hi Saul,

    I hear what you are saying, and I agree with much of it. I think the ultimate demise of the DSM will be largely associated with the fact that it got carried away with dissecting human functioning into too many parts. I cringe when I see reports of a 10-year-old come to me with four psychiatric diagnoses, and also cringe when diagnoses/medications become a point of almost bragging and/or a justification for every behavior or thought that a person can possibly have. That too, does a person little good, and relegates them to being completely defined by the label(s) they have been given.

    Your Onion headline was classic, and it reminds me that I need to get back to reading them more like I used too. Sometimes, good satire conveys more inherent truth than the reported truthful reports we often read.

    Thanks for weighing in.

  • “One could even say absolutely nothing about this and the attitude would still translate. Stigma is felt by whether or not people are heard and listened to, how we engage with others, the quality of our responses. I believe it’s in the quality of the engagement where stigma can be perceived on the most subtle level. Do you engage with a client with the same attitude with which you engage with a colleague, and is that the same quality of engagement as with your boss? More than likely, it is not. That is the essence of ‘discrimination.”

    Alex, I think this IS the heart of the matter, and this ultimately is where stigma begins and ends. Although I agree much of what many have said about the power of labels/diagnoses, I really think that stigma comes back to the way in which you treat the person across from you, regardless of diagnosis or any other factor. Do you treat them as you would want to be treated? Do you value them as a human being as much as yourself and anyone else? Do your recognize that their worth to society is not determined by who they are, what they do, or how we describe them, but by the fact that they, like all, are a human being deserving of deep respect, care, and love.

    All of us come with some biases, certainly of a different nature, intensity, and degree. If we think we don’t, then we are lying to ourselves. But, when it comes time to treating another human being, regardless of the roles we perceive ourselves in, we repeatedly make decisions about how we do this. And when we devalue others, and use labels as a justification to do this, then as you said discrimination and stigma rise up.

    When we were growing up, all of us (and many of us were subject to this at times) saw how our classmates were often stigmatized (i.e., called nerd, geek, retarded, etc…) and degraded. Often this occurred not because they had a formal diagnosis (or that we knew of), but because it was rationalized that they were doing things different or looked a different way. And so they were harassed. Regardless, what is clear is that stigmatization and discrimination long existed before any formal label was used, and will long exist even after labels are gone.

    What I find interesting, though (and for better or worse), is that many of these same derogatory terms – nerd, geek, wimpy, etc.. – are increasingly showing up in a different way in the public domain, often in ways of solidarity, as an attempt to neutralize and counteract was previously only held in a negative way (e.g., Geek squad, “Diary of a Wimpy Kid, etc…). In many ways, the label is being flipped upside down, and for some, has almost become a sense of pride (again for better or worse). Maybe there is something to learn from this.

    As you said, though, the conversation around this topic has been wonderful, and it has inspired me to follow-up this initial article with more discussions. We will see what comes.

    jim

  • Hi Steve,

    The more we write, the more I do realize that we share a similar vision in many ways. The vision you share for your boys echoes so much of what we share for ours, too (and our girl, of course). I do see their temperaments eventually develop in many ways as they interact with their environment, and like you, we want to do everything possible both in teaching them and addressing their environment that will make them successful. Beyond anything else, it is what truly matters.

    I will just let it go at that because I think that remains the most important thing. In the end, you and I desire a system that allow people (as I indicated before) to live up to their highest capacity (whatever that may be in the context of the experiences they have had) and in communion with others. We may not fully agree on the all aspects of how this would occur, but we do agree clearly on one thing – that is, if anyone works with our children who does not embrace this idea, then not only do I have no desire for my child to be connected with them, but I will do everything possible to make sure the issue is rectified even though I understand that I may not be successful.

    I realize that many people are not afforded this luxury from an early age and at later times. It does make me sad. Because once the trust is broken, it is hard to repair and leaves many scars; but if the trust is honored, it creates a lifetime of potential.

    Thanks to all of the time spent to you and others weighing in on this topic. I hope that it provides not only great insight for me, but many others as I hope to return to this issue down the road in different ways. And I hope that everyone has a great weekend.

  • Hey Steve, thanks again for continuing to weigh in. Although we clearly have our differences, I think we actually overlap and agree on many areas.

    But before I let go of this thread, I want to hone in on exactly what I was trying to say in my response to your initial post. Most recently you said this:

    “To assert that all oppositional children are oppositional for the exact same reason or need the same kind of help is a reductionistic absurdity that has zero factual basis in reality. It is entirely a social construct, end of sentence. So to re-assert my original point, something like “ADHD” exists because teachers (and many adults) don’t like having to deal with kids like that, and never have.”

    I and others are not saying that children are oppositional or ADHD-life for the same reason. I agree that some children are this way because different systems (e.g., home, school, etc…) have failed them. I agree (as clearly described in a past article entitled “Addressing the Mental Health Crisis) that many psychological issues exist due to lifestyle factors (e.g., sleep deprivation, poor diet, technology immersion). But where it seems that you and I depart is that I do believe that certain kids, who have resided in highly-functional systems and with good lifestyle circumstances, still exhibit seemingly innate difficulties with impulsivity/inattention or oppositional/antagonistic behaviors that is not entirely a social construct and can’t be blamed on unresponsive teachers or parents.

    When you look at the research on early temperament (i.e., from day 1), we see kids really do arrive with different biological driven temperaments – whether it is an anxious/slow to warm up temperament, pleasant, or for a certain percentage, a difficult temperament (in addition to other differences, such as sleep patterns and feeding). Of course, most of these kids will develop and don’t deserve a formal label, but there are those few (and I have worked with them), that despite better efforts, remain either really impulsive/inattentive or significantly oppositional. We should always continue to find a better way, but it doesn’t mean that the reality doesn’t exist.

    Again, I agree that diagnostic labels are often used unfairly in the ways you described (which I will address more in an upcoming column). But I do believe that just like every other area of physical, psychological, and social functioning, there are those cases, albeit much rarer than the current psychiatric community reports, in which functioning goes awry even without an environmental, social, lifestyle, etc… explanation. And I don’t think that this should be a far stretch to imagine, as this reality exists for every other area of human functioning.

    Anyway, appreciate your interest and passion. And as a father of 5 boys (and 1 girl), I certainly understand how boys are often pigeon-holed into certain behaviors that are not fair in regards to their disposition. I just think that it is important to work from both sides (i.e., what they can do and others can do) in improving the situation.

  • Hi Steve,
    Thank you for your taking the time to read, and thoughtfully reply to this subject further. As noted in my article, I do have concerns about the stigmatizing effects of psychiatric labels/terms/diagnoses. I think about this a lot in my role as a child psychologist and a father, and do believe that the continued effort needs to be made with making sure that the labels used are as accurate and compassionate as possible.

    In many ways, I agree a lot with what you said and appreciate the real challenges that people face when dealing with these issues. But (and without writing another article), there are a few fundamental differences that you and have.

    You stated, “I think the essay misses the most salient point: psychiatric labeling is unique in being almost entirely BASED ON preexisting stigmatization, while at the same time PROMOTING AND EXACERBATING these stigma in society.”

    I disagree, although like you, I have significant concerns about DSM and similar labels/diagnoses and feel there is a better way. But, for millennia, long before any the “psychiatric labeling” issue existed in the way it is largely criticized here, people have experienced true psychological symptoms that have significantly impaired their lives and caused tremendous distress, independent of a diagnosis. Reports show up throughout writings of any age. Whether it is someone who has no energy, stops working and eating regularly, can’t sleep, bombarded with recurrent negative thoughts – whether it is tremendous anxiety, constant edginess, repeated fears that won’t end – whether it feeling bugs crawling on their skin or hearing people screaming at them (when neither is truly the case) or believing that they are God or that the remedy to a sore toe is to cut it off. These have been, and remain realities to millions of people, regardless if we use the labels currently given or not. Personally, I believe it is a huge disservice to suggest that stigma and labeling is almost entirely responsible for the tremendous challenges that people have always faced on a daily basis. I worry that this message inadvertently backfires, and renders many people feeling disempowered because what they truly experience is being described as a “social construct” and not something they can change on an individual level.

    You also said, “And since these social constructs have no objective basis in reality, they can’t be tested for, so the person who is said to “have” these disorders has no defense. At least if they say your cholesterol levels are too high, they have to identify a number and measure it, and you can argue about what the right number is or do things to lower your number, but at some point, there is a way you can say, “No, you’re wrong, I don’t have what you are labeling me with.” In psychiatry, there is no such recourse.

    I again find myself disagreeing with you and other commenters on what I perceive to be a false dichotomy. First of all, many medical conditions (which ironically often have more to do with psychological and social issues than physical ones, such as obesity) carry significant stigma while others carry less, as is the case with psychological issues. People with AIDS, lung cancer, STD’s, lupus, obesity, and many other conditions experience much stigma, and many times over the course of history they have been subjected to treatments or detainments with which they did not agree. In regards to the “number” issue you mention, I think believe this is a misnomer – the statistics used for blood pressure are exactly the same type as is used for psychological measures. The difference, of course, is that one appears “objective” because it is mediated by technology whereas the other is based on a person’s self-report or many other methods. But the more I have learned about the “numbers” in medicine, the more it is clear that much subjectivity runs through this, and the numbers and parameters are always shifting. Regardless, though, at some point, it seems we must acknowledge that the condition of hypertension and obesity actually exists, just as I believe we must acknowledge that depression (or insert word of choice) or autism (by whatever name) is a real phenomenon because all of these in their true form cause serious outcomes if they remain.

    Ultimately, I think that my biggest concern with this line of reasoning is that it seems to create a “situation of parts” and divorces aspects of an individual from their whole selves. Again, I recognize that psychiatric labels have caused significant harm and difficulties to many people, but as I said in the article, it is not a one-way street. But, if we keep carving out this issue, and negate a focus on our functioning at a whole, synergistic level, I really worry the outcome is going to be not what you and others desire. Stigma has, and will always exist, at a psychological, physical, social, and spiritual level. IMHO, we should tirelessly work to reduce it on an individual and organizational level, but along the way realize that there is a greater goal to pursue – that is, recognizing ALL factors that prevent an individual with living up to their highest capacity (whatever that may be in the context of the experiences they have had) and in communion with others. To me, anything that detracts from this possibility on an individual and global level should be met with significant caution, but I appreciate and understand that you and many others will disagree.

    Thanks for the conversation on a really important topic.

  • Hi Alex & CatNight,

    I greatly appreciate your time in responding, and as I noted in the article, I realize this is a very difficult and often divisive topic. Obviously, I do agree with many concerns voiced about the potential negative outcomes regarding labeling, especially when it comes to a diagnosis. I realize that many people (consciously and unconsciously) have negative reactions immediately upon finding out about a diagnosis, and this really concerns me especially as a father myself.

    But there still remains real challenges with this. If we remove the issue of a diagnosis for a second, it still is clear that most communication involves some type of labeling. If I described you “down” or “sad”, this remains a label – and no matter how it/when and for how long it was used, the person remains labeled, and then the question is what becomes of it? Clearly, the DSM system is fraught with huge issues, and likely any system will always be although we should all advocate for something much better. But in the meantime, I think there are many ways people can be empowered and taught how to respond when people negatively evaluate them on the basis of perceived labels that could make a huge difference in their quality of life.

    There is another side to this. When a person’s weight is above the 95th percentile, they are labeled as obese by the medical profession. When their blood pressure is 140/90, they are labeled as hypertensive. I wonder. Should these labels exist? Do these labels result in stigma? Obviously, we all know that these two issues are not purely physical by nature, but often significant psychological underlay.

    I say all this in knowing that the answers are very complex, but I do feel like one of the best ways to combat stigma is to not necessarily throw all communication out that involves labeling and descriptors (as eventually ANY word can come to have a negative connotation if used long enough), but to really empower those who have been given the labels to disprove the faulty assumptions of those they encounter. It seems only then, when a person is face to face with their own humanity, and realizes that their judgments have been unfair and even wrong, does the grip of stigma start to lesson its tight hold. I say this largely because I have seen it happen before, and even experienced it myself and seen what a difference it can make.

    Thanks again. I always appreciate the time spent to discuss subjects such as these.

  • B, tough issues you bring up for sure. No doubt there is a strong connection between mental/physical health and poverty; the question that always looms with me is what are the factors that mediate and moderate this link. As you described, the logistics alone of poverty can make it more challenging to carve out the time, place, or $ to seek out a more healthy existence. And yet, I wonder whether those in poverty today face the same challenges that exists generations before. Ironically, it seems that poverty of a 100 years ago was met with more silence, more required activity (just to make a livelihood), more connections with others (just to stay afloat or alive), simpler diet, etc…For many today, poverty is a more sedentary, disconnected, louder, unhealthy existence – not all, of course, but for some. Although generations have always dealt with the same fundamental problem (i.e., lack of adequate resources), I worry that many of the families I meet today are also struggling with a more fundamental problem — that being, a complete disconnection from their core selves – physically, social, psychologically, and spiritually. This, even more than poverty, seems to be leaving them immobilized.

    Anyway, just musings on the topic, and no easy answers, but without a doubt, every good revolution starts from within.

    Appreciate your interest.

  • Hi Alex, what a wonderful illustration of these ideas put into practice. I must admit some envy at the fact that you have a Redwood forest out your back door. Years ago, my brother and I went to Yosemite and first laid eyes on the giant Sequoias – to this day, I can remember (but not articulate well) the unbelievable gratitude and synergy I felt with these thousand year old giants. It warmed my heart beyond belief, and although I already considered myself as someone who wanted to protect the environment for future generations, standing next to those trees just solidified at how important it is that we do this, not just for future generations, but also to maintain a sense of real continuity in our world from times harkened past to who we and our planet will become. Again, really hard to describe, but very easy to feel when you are there.

    Thanks for reminding me.

  • Hi B, thanks as always for your interest and kind words. I think you bring up an interesting line of discussion in regards to potential solutions and SES issues. Certain challenges, like the limited presence of grocery stores in inner city areas – and the reduced amount of produce in grocery stores that exist in these areas – are definitely a concern. I know that green spaces are not as readily available, although even in our city (which I would not consider progressive in this area), there are increasing numbers of trails and parks that are close to all areas. As far as exercise and silence, I know worries about safety and noise pollution/neighborhood environment can cause challenges and deter some.

    However, I would love to hear your thoughts more on this. Despite these challenges, I do still feel that all of these are available in some form for any person who really seeks them, even though something for one may look alot different than the other even though the underlying practice or solution still involves the same pursuit.

  • Hi Boans, your honesty is beyond commendable, especially for the difficult, difficult circumstances you described. And I certainly appreciate your interest, and that of others, on what may be the least read MIA article of the year, but certainly IMHO a very important topic when it comes to our psychological well-being.

    Hope your week ends well.

  • Any savings is definitely better than none. And it seems like it isn’t just the actual savings themselves that makes the difference, but the satisfaction and knowledge that comes from knowing that you can live in this way and still remain joyful and contented. I continue to try and find ways to live more simply and find my joy from the things that are available to all human beings – regardless of income, resources, or privilege. Like the tremendous sunrise that I experienced this morning on my run into work.

  • Thank you for your kind thoughts and support, especially in regards to my sharing of the ways in which my faith and professional calling influence each other. I am glad that faith has played an important role in your life, too.

    In regards to your comments about being perceived as a “mean mom”, I obviously feel quite different – I would characterize the choices you made as being a very conscientious mom. We, too, struggle with all the gifts that come our way from friends and family, and work to keep our celebrations simple, yet joyful in order to hopefully set the stage for our children not needing to have a lot when they get older in order to “feel happy”. In fact, I speak about the “trend of early indulging” in my article on MIA “Are We Losing Our Parental Will?” because I think ultimately, this practice is only making it harder on parents, not just kids as they get older.

    Thanks again for weighing in.

  • “Spiritual abundance trumps money because when you have spiritual abundance, money comes when you need it. When we have spiritual abundance, we can afford to be generous because resources are unlimited.”

    I love this thought, Alex, and I think it can be a very liberating way to live. When money ceases to be a huge, or the, guiding factor of our lives, and spirituality begins to trump this worldly pursuit, suddenly a greater clarity seems to emerge in the daily choices that we make in our lives. Along the lines of our economic-based world, though, I would highly recommend the book, “Monoculture” by FS Michaels as a perspective on just how much the fiscal world has become a compelling force in almost every capacity of our world. I just don’t think most people are aware of this.

    As always, appreciate your insights.

  • Hi Richard,

    Once again, you provide great thoughts. But I am afraid that one truth I can comfortably profess is that if I don’t end this discussion, my wife and kids might wonder if I am coming back to them 🙂 So for most of this, we are going to have to agree to disagree. If seeking out the truth means I have an agenda, whether or not this coincides with the Catholic faith, then I guess I have an agenda. But when the word political is added to it, I believe again that this couldn’t be further from the truth.

    I wanted to close with reflections about your final thoughts. You said as follows:

    We are not born “sinners” we don’t need these kinds of harmful moral burdens. There is no such thing as “eternal sins.” Human being make mistakes not sins.

    This burden of “sin” and “damnation” is intimately connected to the type of self hatred that is so much apart of the symptoms and behaviors that get labeled as “mental illness.” Religion’s role in this phenomena in the world must be critically analyzed.

    How do you know that the first three statements to be true – that we are not born sinners, there is no such thing as eternal sins, and human don’t sins? Where exactly do you claim to have this knowledge from as I am curious what authority you draw on? these are tremendously bold statements to state so assuredly. On my part, I am happy to acknowledge that I have no way of knowing absolutely for sure if the Catholic Church is correct what it teaches until the day I die, and then I must see whether it all ends or something actually exists more beyond our humanism.

    And as far as sin and damnation being connected to self-hatred, I actually see it quite the opposite. First of all, no human can damn another human, as we simply don’t possess this kind of divine authority. And as far as sin, as I mentioned to Truth in Psychiatry, nothing could be more freeing and liberating than knowing that I sin constantly, and am still loved. Sin should not be blamed for self-hatred – the person him or herself must own that. Otherwise, any critique that we ever receive in being told that we have done wrong (whether from parents, teachers, pastors, etc…) would just be one more notch in our image of self-hatred.

    As GK Chesterton once replied famously when asked what is most wrong with the world today, “Me. Thank You.”, I too will say that what is most wrong with the world today is me, myself, and I. Slowly, I hope I am improving, but no doubt my utter sinfulness, my undying imperfections, leave me with great hope that better is always to come.

    Thanks for your passion in taking care of those who struggle in this world.

    jim

  • Hi Richard,

    As always, thanks for taking the time to weigh in. And I, too, have read a number of your articles and have benefitted from them, and I greatly appreciate your contributions to MIA. That being said, I want to ask you a favor. Repeatedly, in your comments, the word “agenda” kept coming up especially in regards to politics. If you knew me, you would quickly learn that there couldn’t be a word that less describes me than this as I have no energy or time for political agendas. I and the columns are about one thing – truth seeking. I am sure that I am wrong at times (although believe I am in good company) and I know that you and others may accuse me of moral gymnastics, too. But the ONLY thing I care about is understanding what truly is, no matter how inconvenient, unpopular, antiquated, or mundane they appear. Period. This column was no different.

    That being said, you raise great points as always, and as I have repeatedly said in this discussion, these are very difficult topics. I first ask you a question. Have you read or listened to any of the resources that I provided for Truth in Psychiatry, which of course are just the smallest of the tip of the iceberg in regards to these teachings? If not, it is really hard to criticize the Church if you don’t understand why the teachings exist, and how they can and do benefit many people who follow them (both on earth and to the best of our understanding, eternity). It would be like people criticizing many MIA’s writer’s positions on psychiatry without really taking the time to understand them.

    Second, I always find it ironic when people criticize the Catholic Church. There is no doubt that like any human entity, many mistakes have been made over the centuries and continue to be made. Yet the same people who criticize the church seem to forget that no institution provides more worldly care of the poor, education for the masses, healthcare for all, etc… than the Church itself, now and for centuries before. Many people want the Church to compromise her beliefs – no one is asking the Church to stop providing aid to people in all parts of the world, no matter how people have lived and what conditions they reside. Seems really questionable to demand both, especially if the Church truly believes she is carrying on divine teachings.

    In regard to your specific content areas, I should make it clear. I and millions of Catholics do support the right for someone being abused to divorce. I support the right for people to have birth control who want it, just not to force Catholic institutions to compromise their beliefs by providing it. I support those who are gay to live as they feel they should and for committed partners to have equal rights under the law. I personally may not, after much discernment and study, agree with all their decisions for different reasons, but I certainly respect their right to make them and will love them just the same. But I simply cannot accept, especially for my own children, that we simply should act as if every decision a person or culture makes is perfectly fine if evidence from many fronts continues to indicate it is an unhealthy or unsustainable practice. I won’t get into the AIDS discussion as I believe it would require you and I to sit down together and have a discussion given its highly charged nature, but I would simply suggest that birth control is not the primary issue we should be talking about. But I think there is chapter in the book “Unprotected” that approaches some of these issues well.

    Your comments about marriage and traditional family values are interesting to me. As I noted, I support the right for any person to divorce, and no one (rightly) in Catholic Church here in the US is saying otherwise. If they are, I disagree vehemently even though their may be issues to work through from a moral standpoint. I recognize that in other countries, a separation of church and state may not exist in this way, but again I think that people should have a right to divorce if they so choose.

    But to suggest that marriage is and of itself is not kind is to focus on when marriage goes wrong, not right. When marriage goes right, there is a massive wealth of information (which I only briefly touched on) that clearly indicates for the spouses and the kids that it can be very kind compared to the alternatives. Again, I don’t like assertion that I am promoting an agenda. I am promoting what I feel are best health practices for the social, psychological, physical, and social development of all involved in the family.

    The birth control topic is a tough one again, but to assert that I am obviously on the wrong is a bold statement. WHO recently labeled oral contraceptives as a Class One carcinogen. It has strong links to breast cancer and other health conditions. It takes a healthy state of being (fertility) and shuts it down, which common sense says that anytime this occurs, serious repercussions can and do happen. Imagine doing that for any other state of health in our body. As noted in 1968 when this belief was upheld in Humanae Vitae,

    “Let them first consider how easily this course of action [widespread birth control] could open wide the way for marital infidelity and a general lowering of moral standards. Not much experience is needed to be fully aware of human weakness and to understand that human beings—and especially the young, who are so exposed to temptation—need incentives to keep the moral law, and it is an evil thing to make it easy for them to break that law. Another effect that gives cause for alarm is that a man who grows accustomed to the use of contraceptive methods may forget the reverence due to a woman, and, disregarding her physical and emotional equilibrium, reduce her to being a mere instrument for the satisfaction of his own desires, no longer considering her as his partner whom he should surround with care and affection. Finally, careful consideration should be given to the danger of this power passing into the hands of those public authorities who care little for the precepts of the moral law. Who will blame a government which in its attempt to resolve the problems affecting an entire country resorts to the same measures as are regarded as lawful by married people in the solution of a particular family difficulty? Who will prevent public authorities from favoring those contraceptive methods which they consider more effective? Should they regard this as necessary, they may even impose their use on everyone.”

    Are you so sure that the Church is the wrong one, and the oppressor, and you are on the right side?

    As far as equality of women, the New Testament clearly records that Christ’s elevation of women was supremely radical for its time, and for centuries later. Christianity’s beliefs have long been misinterpreted and misconstrued to support anything less than equal rights for women. I recognize the male dominated hierarchy of the Pope, Bishops, priests, etc.. poses issues for many – but, as I mentioned to Truth in Psychiatry, how many people outside (and inside, even) the Church even understand why this exists. There are millions and millions of Catholic women (my wife included) who feel the Church is anything but oppressive.

    In the end, I have no agenda other than what I presume you do – to do the best we can to seek out greater clarity and understanding about what improves our world, for those living now and for generations to come. If I end up being wrong about everything, well, I apologize. But I really can’t face my kids every night and the families I see every day without knowing that I am doing my best to provide what will matter. I am sure I fail. But I ask you to seriously consider that I may not be part of the problem you perceive because I can guarantee you that it is not an easy or enjoyable thing to be putting this out on places like MIA given current societal beliefs.

    Thanks again for your time and thoughts.

  • I really appreciate your willingness to dialogue. I even more appreciate your mutual respect even in light of our differing views and beliefs. A few final thoughts. As I noted before, I have struggled with the issues you mentioned, and to be honest, it is only until I took on a much deeper study of these beliefs that I find they make more sense. But, still they are difficult, and I do believe above all that every person deserves a deep dignity and respect regardless of what life they live.

    A 2nd challenge, too, is that the Catholic Church attempts to preserve what she believes are divinely inspired teachings that at times defy our rational, human understanding as to all that they entail. In essence, as we take a human, worldly perspective, the Church professes to take an eternal, divinely perspective – at times, these two perspectives may not necessarily correspond, and therefore, may appear oppressive. But I think that for those who believe that there are eternal truths and that heaven does exist, our life on earth looks much more like a blip on the radar than our eternal destination, thereby making what we do here most important in how it affects the next life. Much of this, of course, is above my head, even as I work to understand and ponder more, but I do think that taking this perspective is necessary to understand better why certain teachings exist.

    Blessings to you and your family, too. And thanks to all that have made MIA a place where we can have whatever conversations we need to have.

  • Thanks again for continuing this discussion. It is really one of the things I appreciate greatly about MIA is that people of seemingly very divergent opinions can come together about important issues.

    Okay, a couple of initial thoughts about your questions and comments. First of all, if the question posed by your daughter’s friend was handled in the manner you mentioned, that was horrible. Anyone at any time, especially young children, should be allowed and supported in any question they have, and be given a reasonable explanation other than that is what the Church teaches. Otherwise, how is anyone supposed to understand the faith? Second, there is no doubt that many of the Catholic beliefs are challenging for even those of myself who are practicing Catholics, and especially so given that many beliefs of our current culture are generally different. I have struggled with many of the Catholic teachings ever since I came to an age I could really consider them.

    That being said, there was once a well-known bishop (Bishop Sheen) that said (and I will paraphrase slightly I am sure) that there are “many people who disagree with the Church’s teachings. But there are very few who actually disagree with the Church once they fully understand her teachings.”

    You bring up 3 of the most controversial teachings of today, and although I have some trepidation about opening myself in a vulnerable way in regards to these questions, I really value an open dialogue, so I will. As a starter, feel free to check out an article that I wrote on a different site (Aleteia), but please, please know that this title was not title I wanted to be printed (as some sites, unlike MIA, take ownership over only the title, not the content) as the title was supposed to be “Church Teaches; Science Reveals; Culture Says”

    http://www.aleteia.org/en/scienvironment/article/10-ways-that-science-is-proving-the-church-is-right-and-the-cultures-wrong-5881921179484160

    In regards to your specific topic areas, let me start with birth control. You might be shocked to find out (as I described in my own book “Into the Rising Sun”) that prior to getting married, I assumed that my wife and I would use birth control like 90-95% of other Catholics. And then she dropped the bomb on me that this was not going to happen because it did not correspond with both Catholic teachings and her own personal values. 16 years and 6 kids later, I now understand the underlying wisdom behind this even though it remains a hard teaching personally for certain reasons. But if you want a good starter on truly understanding why this teaching exists, check out Christopher West’s Theology of the Body, which you can find on Amazon.

    Gay Marriage – again, a really difficult teaching as I have close friends and family members who are directly affected by this teaching. I also struggle a lot between questions of civil unions vs. gay marriage, and also what our society rightly should allow and provide for partners of all kinds. But again, to truly understand the Church’s teachings, you really have to understand what drives what is perceived as oppression, but I believe is not what it seems. A great initial explanation is given by Fr. Michael Schmitz in a Lighthouse Catholic CD entitled, “From Love, By Love, For Love”. I have attached the link below:

    http://www.lighthousecatholicmedia.org/store/title/from-love-by-love-for-love?gclid=Cj0KEQiAr9ymBRDdqYrH6Mj5170BEiQAcRUsi8T1qmtzyGTZuboGmkHELnQ_XYwM-u1snPNnglpz30UaAtvx8P8HAQ

    Full Equality of Women. Again, you didn’t make it easy on me here 🙂 This is a struggle given that in the upper echelons of the church, men seem to have a clear and disproportional representation. But once again, I think a few things are critical. One is that you have to return to just how Christ ordained men in the church, but also significantly elevated women in his time and forever in a way that was shocking to people of the time. There is a lineage that comes from this that truly deserves deeper study and understanding that I can’t do justice here. But you also might be shocked to know that in the Church, there are as many Holy Days of Obligation dedicated to Mary as there is for Jesus, and there are thousands of canonized female saints, multiple female Doctors of the Church, etc…The Church “herself” is conceptualized in a feminine way as Christ is in a male way. Anyway, there are volumes upon volumes written on this topic, but I also think it is important to note that there are legions of women in all places, positions, and powers that hold the Catholic faith dear and do not regard it at all as oppressive. Check out “Women Speak for the Themselves” site to get a sense of just one contingent of Catholic women who believe to the contrary and why. But I certainly understand that from the outside, when all people see are male Popes, Bishops, Priests, and Deacons, it seems like an old boys club. I believe when people take the time to understand, it is not (which as a male I realize my opinion may mean less) and my wife would be the first to proclaim this, even probably more than me.

    Okay, that is enough, but I hope at least a reasonable reply and I hope that others who read this understand that in the end, we are all in search of the truth. I am just trying to do my best and remaining compassionate, understanding, and respecting of all people, regardless of creed, culture, or conviction. I just think too often we are quick to judge, especially in using examples of when things go wrong (and not right), and don’t spend enough time considering why beliefs really exist.

    Thanks again for being willing to engage in this discussion

  • Appreciate your comments on this matter. You bring up a number of important points, and ones which really deserve a much longer forum to discuss. I certainly agree that community and transcendence are a huge key to why faith can be a buffering force against psychological difficulties. However, I think that negative views towards organized religion are often unfairly propagated. There is no doubt that religion used the wrong way, or oppressive or abusive acts can have horrible outcomes. But as practicing Catholics, I can tell you that my wife and I see our faith as anything but oppressive and restrictive – in fact, the deeper we have explored the faith we have grown up with, the more liberated we feel we have become. The first and foremost liberation is that we are all imperfect sinners in need of something much greater – although I used to regard that as demoralizing, I now actually would say it is one of, if not the most, freeing realities that I have ever come to known. It opens up opportunities for self-improvement among many other things that were simply never available.

    The other way that I feel currently trends in religion and spirituality have negatively impacted our psychological health is that so many people have gotten away from faith practices that were not just good for faith, but also their overall well-being. One quick example is the discipline of fasting, which has largely fallen by the wayside even for many people actively practicing religion. Long regarded as a measure of personal sacrifice, increasing research has not surprisingly found that responsible fasting can actually help an individual improve self-control and increase a number of positive physical markers associated with energy and endurance. Connectedness is great, but I worry that without incorporating disciplined practices, we are actually losing many of the benefits that faith can provide.

    Thanks again for taking the time to read and comment. I really appreciate your thoughts.

  • Hi Iski,

    I appreciate you taking the time to weigh in on this matter. It is obviously a critical one, and I think that you make a number of valid points. But without rehashing my entire article, I think a few main contentions can’t be ignored. One, we as psychologists really do have to learn from history on this one – look at how the field of psychiatry has largely morphed over the past 50 years into medication management. The lure of pharmaceuticals is so, so str0ng (despite concerns) and the moment that a psychologist opens their doors to prescription privileges, it is the moment that many pressures (conscious and unconscious) become a reality and our profession is at real risk for also just becoming medication managers. We have to be realistic with ourselves in considering this option.

    But if the benefits of psychotropic medications clearly reduced or eliminated many areas of mental illness (as vaccines have done for many serious diseases), then I think this possible risk might be worth to consider. Yet it hasn’t, and many signs/research suggest that we have never been more psychologically unhealthy (which I fully recognize is connected to many more factors than just psychopharmacology). If this is the case, then, why would psychology risk diluting its profession to take on something that doesn’t have clear gain. I just think the risks are too big and the benefits are too small or not at all.

    Despite understandable concerns, I actually do believe that psychologists have unique value to our public as a whole that is not available by others in the mental health field. We see this in our own practice, as our skills in psychological testing, empirically-based interventions, consult & liaison, truly holistic treatment (biopsychosociospiritual model) among other things can shine through. I feel that many people in our community have come to recognize the palpable difference between seeing a pediatric psychologist and someone trained with a briefer, more general mental health degree. Our waiting list is one reflection of this, as many local mental health professionals offer spots within a week or two as opposed to the 4-6 months our waitlist generally remains. I say this not to toot our horn, but suggest that a high-level of training (one in which never stops) can be recognized for what it is. But so often, I think that psychologists do not utilize, maintain, and enhance the training they have received, and dive into a mode of practice (e.g., doing general therapy) that makes them appear very similar to other mental practitioners.

    In the end, I think that one of the worst things a profession can do is to diversify beyond its expertise, and start doing things, especially those with potential for great harm, at a mediocre (or worse) level instead of taking on a few important roles, and doing them really, really well. We aren’t the only profession being pushed in this way. Multiple OT colleagues bemoan the fact that they used to really, really focus most of their profession on reducing and eliminating fine-motor problems, which is a really important area for humanity. Now they are asked to do sensory therapy, general social skills, adaptive skill training, etc.. (especially in the schools) that they are less well trained to do, and are feeling less satisfied and competent in their careers.

    Anyway, appreciate the continued interest, and certainly all of us need to make sure that our resistance to change doesn’t just occur because we dislike change, but is actually for good reasons.

  • Awesome, Hermes. I love the idea of experimenting with different types of weather and learning to not only tolerate it, but embrace it. You might have noticed, but trail running and ultramarathons have become a certain passion of mine. You might be interested in my article “In Search of a Hundred Miles of Gratitude” – the first part is on MIA, but the whole series is on my column (June 2014) under the same title at the following link:

    http://www.stmarys.org/articles-1

    Hope you have a good trail run today or tomorrow. I had a really enjoyable one yesterday with a couple of good friends on the grounds where Abraham Lincoln grew up

  • B, I really agree with your comment about spending time outside during winter. Although I don’t have clear research at hand to cite, I feel that part of the winter blues people feel is not just related to change in temperature/light, but also increased sedentary activities because many do not like getting out in the cold and exercise. I can’t tell you the number of people over the year that have described this as a deterrent

    And yet we are fortunate to live in an age where there is clothing for all seasons no matter how harsh, and are bodies are remarkably adapted to provide warmth, especially during vigorous activities. For me personally, I bike to work year round no matter what the temps are (unless ice and snow cover the roadways) and really prefer to run in the winter temps/precipitation more than any other time of year. There is something deeply moving, deeply spiritual about the quietness and isolation that winter can provide, and nothing spurs thankfulness for a warm place like being in the cold

  • Not my intention to blame, just a hope and an observation in regards to being able to seek out what we all need to be healthy. But I certainly understand how people’s negative experiences affect treatment seeking in other areas. And as I noted in my prior comments, it is unfortunate that many providers do not take sleep concerns seriously, especially again given the irony of just how much of our life sleep dominates for important reasons.

  • Hermes,

    You bring up a really important point for the many people that live in parts of the world where the light cycle is skewed in one direction or another, especially studies have indicated increased risk of negative mood, anxiety, and even suicide in these regions. Increasingly, there are tools such as you have mentioned to provide the appropriate light needed and hopefully others will look to access these more appropriately when natural light is not available regularly.

    Thanks for weighing in on this.

  • Mike, I absolutely agree with your final line. Psychiatrists or any other MH professional should not be diagnosing people based on their dreams. Dreams are one of the most enigmatic, and likely misunderstood, part of our being that exist. As I noted in my piece, they likely serve an organizing or processing function, but I think that it is safe to say we may never fully understand their purpose or representation of what we do in our wakefulness

  • I am going to tie AA’s question about how MH professionals screen for sleep –

    “As one who was diagnosed with sleep apnea a year after finishing my psych med taper, I am wondering how mental health professionals screen for sleep disorders?”

    and also further thoughts about your comment that “but I’m quite certain the psychiatric industry knows proper sleep is important.”

    Sadly, I first must admit that my training in sleep was minimal at best until I took on a role at a sleep clinic in a pediatric hospital. It was only then that I began to acquire much more knowledge through my own seeking, and that I learned from ENT, neurology, and other specialties. I would love to believe that the psychiatric industry knows proper sleep is important, but if even if they know (which some do not), this often does not often translate into practice. This also goes for our pediatrician colleagues. In a survey published by Mindell & Owens in 2005, they found that 20-40% of pediatricians and family physicians did not screen for sleep issues in a well-child visit, which is pretty amazing that toddlers are supposed to sleep half of their day. I hate to say it, but I would believe that these numbers are similar for psychologists and psychiatrists.

    In screening for sleep issues on my end, it first involves taking a history of various issues that related to onset/ending, snoring, night awakenings/parasomnias, excessive daytime sleepiness, health issues, bedwetting, etc… I then ask about other factors (e.g., diet, media/technology use, bedtime routine, etc… that may be affecting sleep onset or quality). Then, if needed, I utilize a sleep log, and if all of this still raises questions about a possible OSA or narcolepsy, then I refer on our accredited pediatric sleep lab for a further intensive study

  • Yes, I so wish that people wouldn’t ignore, or be fearful of having a sleep evaluation. As AA noted below, there are issues with sleep med as with any other discipline, but the value of a good sleep history, or a polysomnography or MSLT if needed, can be huge, especially for someone who has OSA issues. And then utilizing sleep hygiene, stimulus control, and/or CBT if needed, is such a better road to go than diving immediately into artificial sleep aids. But, as always, these steps require commitment and follow through in a way that filling a prescription does not.

  • Hi Mike,

    I appreciate the additional resources. I think we are still just beginning to understand the connection between sleep and mental health issues, and also as you noted, just how synchronizing our sleep with natural markers, such as the seasonal light cycle, may be of benefit. I didn’t include it in my article because I struggled to come across the citation, but a couple of years ago I came across a study that indicated that pregnant women whose sleep synchronized better with the seasonal light cycle had infants who slept better. I will be interested to check out the additional video you provided.

    Thanks for your interest.

  • Hi B,

    As always, you raise a really important issue, and I appreciate your willingness to share this from a very personal place. I worry that as people seek out less rehabilitative, lifestyle, or behavioral measures, such as physiotherapy, insurance companies are going to feel less pressure to pay for extended options and as the demand decreases, the supply of professionals and organizations will decline, thereby decreasing options altogether. Ultimately, this only makes it harder for people to take a holistic approach until the tide turns the other way, and through this, there is a demand for this type of infrastructure to re-emerge.

  • You raise really important issues and questions, CatNight, and unfortunately we do not have regular, direct contact with pediatric orthopedic services although hopefully in the future, this is somewhere that we could expand. The concerns that you, Richard, and others raised is undoubtedly a huge concern for many reasons, especially with our youth. Although the idea of reducing pain can have noble underpinnings, I worry that both the addiction issue and trying to completely remove physical pain from youth’s experience can both have dire consequences. These are certainly huge topics in themselves, though.

  • Hi Russerford,

    Great to have you offer your thoughts no matter what the time frame. I love that you are talking through these ideas with your daughter, as we are increasingly talking with our kids about these areas as they grow older. Two things you said that really struck me – one, was your ironic (or not) experience of inner psychological and/or spiritual angst as you were reading this. I think this funnels into that last statement of yours about resistance, which other commenter have spoken of, and which I feel myself on a daily basis. Often, there is an acute awareness of two different courses that I can take in many situations – one that I feel will take me/others to better places, and one that will keep me constrained – and it is this deep resistance that I feel I have to work through if I am to take the former step. But sometimes the resistance seems strong, and as Boans mentioned, I want to just “paint it black” and remain mired in the place I am. For me, this resistance is my pride, and it does prevent me from pursuing the One I am called to pursue and growing in ways I feel I am called to grow.

  • Hi Ann,
    I am enjoying our discussion so I figured that I would offer a few further thoughts. I want to first say that I greatly value those such as yourself of an older age and with more experience. I have learned and will learn so much from those who go before me. But I think it would be a misnomer to suggest that older age and greater experience automatically equal more wisdom. Although time and experience provide more discernable opportunities for wisdom, the reality does not always play out this way. Many of our greatest thinkers, healers, innovators, and such had a paucity of both in comparison to others. But one thing is clear for me – with greater age/experience has come more questions and less answers, but the dynamic answers that persist appear to do so because they possess a universal truth even in the ever-changing world of human uniqueness. But you are right, we are always learning.

    Although I agree that prescriptive help without working with each individual uniquely can be unhelpful, this is one of the difficulties of writing to a vast audience that does not sit across from you in a quiet room. In a room, you can see and hear and feel his or her presence in order to modify in this way, and so writings such as mine get criticized as being prescriptive, although I would like to think (maybe wrongly) that I work to be descriptive, not prescriptive. If you read what I write, you will not find me espousing 5 steps to better gratitude or ten steps to forgiveness (although I do not criticize those who do as some people do yearn for this type of direction). Instead, I attempt to describe a process that is often so foreign, so complicated that many simply forgo or ignore it, such as channeling. And along the line of practices, I do believe that some come to their own unique identity through practices, and some arrive at specific practices through their own uniqueness. But in all cases, people do rely on practices (internal and external) to guide them each day.

    I want to address your thoughts on the following matter: I quote, “Over and over I have observed that people without children will readily admit that trauma probably causes dysfunction, but once people have children, they usually become much less willing to accept this paradigm. Do you see how this guilt syndrome affects our response as a society to hidden predation? Finally, joy is brief and not easy to find for victims of torture, trauma, etc. We are damaged. Period.”

    Let me be very clear. I know that trauma causes dysfunction, often significant dysfunction. It is a large part of the reason why I wrote this series. I see its tragic consequences in my office daily and the more kids I have and work with, the more its consequences become so apparent. My wife and I work very hard to minimize the trauma that our children experience, both directly and vicariously (e.g., media exposure). I know it causes damage. On all this we complete converge. But where we diverge is the “period.” I not surprisingly see your reference to “parents admitting this less” in a different way. I believe that it is not that parents such as myself enter denial or naivety in regards to this paradigm. It is that we can’t accept the “period”, and I believe we have many measures of faith and reason to support that people can and do heal even if they never forget what happened. And I think that when we become parents and caregivers of children, we understand that one of the roles that we are deeply called is to always seek out healing. It is why band-aids are never far away.

    There seems to be a sense by some on MIA that when a person writes about hope and healing in the way that I have, they are somehow denying the widespread atrocities or horrors that do exist. That is why I painstakingly made sure to make clear in this series as with other writings that although I am attempting to describe potential practices that may help, I am in no way denying or justifying their presence (or invalidating their horror), which is why I discussed issues anywhere from the Rwandan genocide to childhood sexual abuse. It is really, really sad to me at just how far atrocities such as these extend, and how often people and organizations turn a blind eye on them. It is why courageous communication may be one of the scarcest commodities today.

    And in regards to one of your final questions, “Is my view hopeless?” Well, your secondary comments were more hopeful to me than your first, which as I said before implied to many that happiness and joy after trauma was a matter of chance and good genes. I don’t think the idea that 100% of parenting practices are harmful is hopeful, as parenting practices are just one microcosm of imperfect human practices that often do have good intent and merit, which would then suggest that 100% of human practices are harmful. But what is hopeful to me is that you continue to work with others, in a deeply caring and unique role, in the hopes that a light will emerge from an otherwise dark place. For that I thank you deeply and you give me hope that others like yourself truly care. For although it may seem that we both are staring at each other across a dark valley, we are both trying to find a way across, and hoping and discerning that the other’s strategies may hold keys for our own success.

    Hope your weekend has been good. Sorry for my long windedness. I just want to be clear.

  • What can I say Boans that you haven’t said already through the series. You are right – the music video expressed very well what I think you are trying to say. I think we all have a desire to just “paint it black” at times. I certainly know that I find myself fighting this urge at times when I just want to be negative and glum, even if I know positive and resilient options are available. It really is part of the human experience. Ironically, though, it is those black, rainy, cold moments in the early morning on my bike commuting to work or in the middle of the woods running that remind me that black does not have to stay, and that the sun will rise again. And so I keep plunging myself into the darkness in search of a greater light.

    Keep pressing my friend, keep pressing…

  • Hi Sharon,

    It is good to hear from you, and I actually appreciate you clarifying some of what I said in your comment below. I want to be clear, as I tried to in lines such as “a suffers influence through their witness” that all life can have meaning even through survival and perpetual struggle. I absolutely agree with these last lines, which by the way are beautiful in themselves:

    Many of us never achieve anything beyond bare subsistence. We still have value. Those who have died in the woods have value. Those who remain in the woods have value and never do anything beyond remaining have value. Things that are not beautiful have value as well.

    I couldn’t have said it better. But in writing the series, and this last article itself, many people do want to feel less distress and more happiness, and that was the reason I undertook it. But again, I appreciate what you are saying, and in your suffering, you have great meaning and value no matter what happens. I hope and pray, though, for you (if you have this desire) that greater happiness and contentment will come.

    Thanks again for your thoughts.

  • Thank you very much, Someone Else. Your thoughts and insights are appreciated, and your gratitude for the series is meaningful to me. I especially agree that the link between the psychology and the spirituality of a person is something that can’t be ignored. And prayer can’t be forgotten, even as someone who often struggles to know which way to go. As far as the “intrapsychic barbs”, I was referring to those psychological aspects that continue to cause us pain (as barbs on a fish hook do) and prevent further self-growth. Probably not the clearest way to say it, though.

    Thanks again for all the ways you provide hope to those who have been faced with seemingly insurmountable odds.

  • Little to add except that your comments are often a post in themselves. I can only say that your thoughts are so appreciated. I poured alot of time, reflection, and study into this series in the hopes that at least a few would find it worthwhile and helpful. I actually decided to write it after one commenter on a previous article (don’t remember which one) said that I/we should spend more time talking about ways to reduce distress then discussing issues around the describing and defining of mental illness. And yes, “limited” would probably be a better choice than “poor”. Sometimes the alliterative lure takes over in me and does not fully serve to articulate exactly the way it should be said.

  • Hi Ann,

    Thanks for taking the time to share your insights. Your witness as someone who has found joy in suffering is very valuable. And I agree that genetics, fortunate encounters, and luck (although others might disagree with the connotation of this term) do play a role in transcending trauma and distress. But where we diverge is the idea that all people do not have an ability to influence the level of happiness in our lives, at least to some degree. I have to be honest in saying that this seems like a very hopeless message, especially as someone who works with young people and parents regularly who are looking for ways to reduce distress and feel greater happiness. You are right in saying that it will be a different path for every person, but if we remove the options that come with highly effective practices below (which are taught daily even to those with bad luck and as you would say, genetic challenges), then we are basically saying that there is nothing we personally can do to improve our situation. I recognize that these may feel unnatural to some or that they should arise spontaneously, not necessarily in a prescribed way as we often do for improving diet, exercise, etc.., but I would ask you an honest question:

    What would you tell someone who came to you yearning to feel more joy and less distress in their lives?

    Where I do appreciate your remarks again greatly is that they are witness to how many do feel. But in feeling they do not have an ability to find ways to reduce distress/increase joy, I would argue that this is one of the top reasons, if not the number one reason, that people voluntarily seek out psychotropic drugs. And then of course we enter into a different domain of conversation.

    Thanks again for taking the time to read and comment all of these despite our diverging thoughts. And thanks for being a witness to others.

  • Hi B,

    As always, I appreciate your willingness to continue reading and weighing in with great thoughtfulness despite your frustration with much of what I have said. I actually agree with much of what you said, most importantly that everyone ultimately must choose the direction they want to go. I certainly don’t feel I am forcing my vision down yours or anyone else’s throat, and just as you have a right to retain a pessimistic perspective, I have a right to retain an optimistic, or what I believe is a reasonable perspective. In fact, I would say that pessimistic perspectives are available daily on MIA, and often I stick out like a sore (and probably poorly read) thumb.

    But as the title of my personal column professes, I am always “just thinking” , much of which is thought focused on how I can better my life, but more importantly that of my kids and others close to me. Daily, I do have many people coming to me in search of greater happiness/contentment and less distress. And although you may tire of what you describe as “positive thinking propaganda”, I actually think practices such as gratitude and forgiveness are anything but propaganda, but actually ____ (however they are categorized) that are available to everyone free of charge and without serious side effects. And although we would like if the feeling of gratitude (or other practices) simply emerged, it is clear that it often doesn’t happen until we repeatedly put these practices in place, sometimes through regular teaching (especially with kids). If I and others don’t speak about these viable, potential life-changing practices, then the airwaves and the internet will be even more filled with discussions of psychotropic medications, of which I know you are not in favor of.

    As far as the kids in Africa argument (or in my case, the kids in Haiti as my father spends time there at least yearly), I actually think in many ways, they have it better than we do as the joy they exude despite deplorable conditions is remarkable. And a large part of the reason seems due to their deep sense of gratitude.

    Thanks again for taking the time to comment. You will probably be glad I only have one part left. Hope you might be willing to still check it out.

  • Hi Sally,

    Thanks also for sharing your thoughts about this and others matter. What you expressed is why many people shy away from these topics, as they arouse such strong emotions and unintended hurt. I know they are often not received well, and yet I feel like there is so much that is important to still discuss and communicate that can be helpful to people. But, I realize that when it comes from another person, especially someone who has a career as mine, it can be felt as blaming or condoning wrongdoings. But, as I made very clear in my posts on forgiveness and gratitude, none of this excuses wrongdoings done or minimizes hurt that people feel. As I mentioned in my comment below to fluffbunny, I just try to do my best in discussing opportunities that we all have, and I certainly know and respect that each person will make their own decision. But it is certainly a lonely place to write at times, and I do hope that people know who read my material that my intentions are to just do the best by others that I can.

    Thanks again for your thoughts and time.

  • Thank you so much for weighing on what is a difficult topic. I actually thought you articulated your concerns and difficulty with gratitude well, and i hope that you know I really tried my best to be sensitive to the concerns you voiced. The last thing that was intended with this or previous posts was to blame victims – in fact, my humble hope is that these articles and others would empower people to recognize the great opportunities that we all possess to reduce distress and increase happiness in our daily lives.

    But, I recognize that when I write in this area, of which focuses on self-improvement (as much for myself as for anyone), I do thing that we are all faced with possible decisions that could improve our well-being that do not sit well with us for different reasons. But, in the end, if the research is actually true, and areas like gratitude, helping others, forgiveness, etc… actually increase the odds that our distress is reduced and our psychological well-being is improved, we are faced with a decision. Do we forego these possible avenues of growth due to our inherent, and very understandable uneasiness, or do we work through this uneasiness for the possibilities that lie in store? Again, this is a question that I continue to ask myself this on a regular basis, but it is one that I think we are all asked to consider when it comes to topics like these. But I know that each person considers this from their own experience, especially those that can be very difficult.

    Thanks again for your thoughts – I really appreciate from your thoughts.

  • Few things are better than an authentic thank you, given and received. You are right about the bank account – I hope by the time I pass on there is nothing left in it except for what I have given meaningfully to others. And as you indirectly noted, there is a tremendous link between psychology and spirituality that few people seem to acknowledge, or recognize.

    Thanks for filling up my bank account the only way it matters. Hope the rest of your week is good.

  • Again, Boans, the fact that these articles have meant much to you, and hopefully others, is greater payment than anything else I could ever receive. Thank you for that.

    And as far as true altruism, I actually do believe that it does exist. No doubt that eudaimonic well-being is available to us, but I feel that it is often an unconscious by-product, not an intended result, of a charitable act that we do. When someone dives into a lake to save a drowning child, I do not believe (or hope, of course) that most people do it because they think it will make them feel better about themselves. I think they do it because they want to preserve that child’s life, in a pure moment of the foregoing of self so that another might life. So often, and so sadly, those that attempt to save others die themselves, in what may be an ultimate atruistic sacrifice.

  • To Duane, Chaya, Truth in Psychiatry, and Fred, I greatly appreciate your enthusiasm and positive sentiments on this piece. It speaks to me, of course, so deeply too, and although it is not new information, I feel like it is important to never forget, myself included, that this is always available to us no matter how we are feeling.

    Thanks for all that you do, too, in your own lives to help that of others.

  • Hi Boans, I am always moved when someone like yourself feels that what I have written is relevant enough to apply it to his or her life. I hope that the decision to “let it go” pays dividends for you and others over the next days, months, and years.

    In regards to your thought about Bourdieu, I am not familiar with his work but you have raised my curiosity enough to seek out further information. I think your comment is spot on, as channeling is certainly significantly affected by the larger subculture that a person is a part of. No doubt that Shane not only had to harness his energy in a different way, but also had to surround himself with others doing the same, and not connected to his previous lifestyle. I really appreciate you bringing this to my consciousness here.

  • “Thus, I think all of these approaches using various words or definitions come down to pretty much the same thing: that changing self destructive habits or life styles is almost impossible unless we substitute uplifting, healthy, inspiring habits for positive change or channeling those negative energies into positive ones as you say.”

    Very well said. And it is funny what you mentioned about channeling, because either due to my age or just my life to this point, I hadn’t ever thought about channeling any other way than I wrote about, and am clearly very ignorant of the New Age/channeling connection. Just one more example about how much the connotation of a word is affected by the zeitgeist and ortgeist that coincide with our personal experiences.

    Add “The Power of Habit” by Charles Duhigg to your wealth of knowledge about this topic. Definitely an interesting read.

    Such a critical topic that unfortunately bores many people and consequently, is often left by the wayside of discussion for more intriguing, controversial matters. But obviously I keep putting the material out there because of its importance. More to come on “Turning Distress into Joy”…

    Thanks again for your interest.

  • Hi Donna,

    Your comparison to Dr. Glasser’s theory is very astute, and although there are slight deviations in what I am describing, there is definitely a significant overlap. I will focus on one paragraph in the link you provided:

    There is much debate about what makes a negative addiction ‘an addiction,’ but in general terms I think we can all agree an addiction is something we repeatedly do that negatively influences our lives or the lives of those around us. (I’m sure that is already sparking debate in your minds but I am talking in extremely simple terms so just please bear with me.) So a positive addiction would, generally speaking, be the opposite – when something we repeatedly do has a positive influence on our lives or the lives of those around us.

    Channeling is certainly doing things repeatedly for the purposes of having a positive, not negative effect on our lives. When he speaks of building a repository of strength that can be used at later times, this is very central, too, to the idea of channeling. I liked the example used of running because that is exactly how I feel when I run – it is the simplistic movement of a time-honored tradition of human meeting earth, over and over, that in some indescribable way channels positive energy that comes through a certain degree of suffering (running is never completely effortless, of course, and at times is very difficult). I have written a fair amount about this (some of which I have yet to publish), but if you are interested in it more, check out the series on my column (www.stmarys.org/articles-1) entitled “In Search of a Hundred Miles of Gratitude”. You will recognize one of the article from here on MIA, but the other two were not posted here.

    Yeah, in regards to your comment about the term “channeling” and New Age, I obviously don’t mean it in this way, but it is difficult to find terms that sometimes denote a larger idea of practice that unfortunately, at this point in history, don’t overlap with another connotation.

    Thanks again for all your comments about forgiveness, and no, I was not aware of the Stanford program, but look forward to learning more. And the Problem of Pain is definitely on my list. You are right in saying that CS Lewis continually captures in words that so many others fail to articulate well.

  • Hi Boans, a delayed thanks for weighing on this topic, even partially in jest. It is difficult to see exactly how someone would channel or sublimate sadistic urges, whether you are speaking of related to sexual impulses or just cruelty. But I actually think it happens everyday in many ways (although the line between morphing it appropriately or not is very thin, just the quote of Shane’s I used at the beginning indicates). I think many people that go into law enforcement or armed forces or even physically-natured professional sports probably are in some ways trying to channel urges to be violent in an appropriate way, although obviously sometimes negative consequences ensue. As with anything, though, it seems the process definitely involves daily, conscious decisions to use the energy well and not fall prey to temptations that abound.

    Thanks again for your interest in this article, and the series in general.

  • I like this thought alot, and as always when we are dealing with experiences such as these, it seems more helpful to conceptualize in a continual or multi-dimensional manner than in a dichotomy. Moving from intense hatred simply to position of less absolute loathing, even if forgiveness never occurs or does not seem possible or appropriate, could still be a step in reducing psychological distress that causes serious problems. No doubt that people find themselves all over the axes on this issue.

  • B, thanks for weighing in. You and others bring up some of the most difficult points regarding the issue of forgiveness, and as I said before, I won’t presume to either have the answers or understand what it must be like to have experienced what you have. But, I do want to be clear, as I go back to the Lewis quote that I used, “forgiving does not mean excusing. Many people seem to think it does. They think that if you ask them to forgive someone who has cheated or bullied them you are trying to make out that there was really no cheating or no bullying.”

    In no shape or form by forgiving, do I indicate that we should not seek justice, even if we choose to forgive. Obviously, again, this is a personal decision. But I pose the question back? What if justice never comes? Many are/were faced with this possibility, as a number of Nazi’s and Nazi sympathizers were not brought to justice and many involved in the Rwandan genocide walk around today freely. The example I used of Azim was just one example, but many people across the world are faced with the possibility that no matter what their efforts are, justice may not happen in their lifetime. And, so, here is why I included this as a critical option for “turning distress into joy”.

    Simply put, justice requires another party (i.e., the perpetrator) besides ourselves in order to accomplish its goal. Forgiveness does not, as I focused on the INTRA personal process. If an individual feels that their anger towards a perpetrator is so intense that it is causing them significant distress and taking their life down a self-destructive road, and that despite best efforts, justice is not being served, then what happens next? Again, they can choose to go wherever they decide, but in these situations, some form of forgiveness may be one of the best ways to reduce distress. I completely agree that it seems unfair to even consider this, but in this situation, forgiveness would really have nothing to do with the perpetrator and everything to do with the person who is victimized.

    As always, I am just working to provide discussion around options for reducing distress that can be done by all without pharmacological intervention.

  • As always Donna, your comments are a post in themselves. The questions you ask are tremendous ones, and as you know well, ones that no one seems to have a clear answer for. But I highlighted what I thought was the most critical piece you said, and why I emphasized the INTRApersonal nature of forgiveness as much as I did the INTERpersonal one in my post. As you stated:

    My current view is when one continues to hate an evil doer who has done them much harm, it causes the hater much harm in terms of ill health, bitterness, negative impact on other relationships and many other unintended consequences, so I think it is important to continue the struggle to forgive though one has to do it repeatedly when angry feelings rise up due to ongoing negative consequences and losses due to the perpetrator’s actions. I believe the Buddha said that hating another person is like drinking poison and waiting for the other person to die. Or, as Buddy Hackett said, “While your stewing in anger, they’re out dancing,” which can be all the more maddening to think about, but also motivating.

    To me, this is the critical piece. I really appreciate Lewis and other’s surmising about how God will or will not forgive others, or even how we are or aren’t supposed to do the same based on ethical and theological principles. But in the end, this is all based on interpretation from many different sources. What I don’t feel is interpretive, but very real, is how forgiveness affects us daily, both in the context of our individual lives and how it allows us to live alongside others. I feel there is little doubt that we may be best served to remove ourselves from certain people and environments that are so, so harsh and unhealthy. But, unless we choose a hermetic exist, we can’t remove ourselves from people in general, and certainly not from ourselves. And so for me, I guess forgiveness is first, and very critically, about practicality even though I believe that my eternal salvation does depend on it.

    Thanks again for taking on this topic despite your wariness as you bring a wealth of insight and critical thinking. And yes, having now read “Mere Christianity”, “The Great Divorce”, “Grief Observed” and still getting his daily doses, I have quickly become engrossed in what Lewis offers.

  • Hey Steve, really appreciate you weighing in. You are so right in saying that forgiveness is so hard, for reasons that you and others have mentioned. I realize that for some, when I write posts like these, they aren’t necessarily popular because they feel I might be negating suffering that continues to exist, or not truly understanding just how difficult it can be. As you aptly put, easy (for me or others) to say, really, really hard to do sometimes, especially when I can’t truly know how many others feel. But beneath all that, and why I am so inspired by those I know personally or through other outlets, is that some of the most amazing stories of forgiveness have come from those in worst possible situations known to man. And I firmly believe that though our human experiences may be infinitely different, our humanness is so much the same. It seems the need to be forgiven and to forgive never changes, if we are to renew ourselves daily to the authentic transcendent humanness we seek to embrace.

    Thanks again for taking the time to share your thoughts and insights. I have really enjoyed the discussion from everyone about this, and hopefully Part II soon to come will spur the same.

  • Thank you for weighing in on this topic and sharing your story. I am deeply saddened by all the suffering you and others close to you have experienced at the hands of those who are supposed to be healers. I clearly do not have the answers to the significantly important questions you ask. I only have one thought that comes from what I have learned from others who have also experienced horrible atrocities that continue to occur. It is this: when those who have suffered mightily can find a way to not only survive, but thrive again, and in thriving not only speak truthfully about their encounters, but inspire a movement that results in a great good, this to me is to me is the ultimate expression of human resilience and progress. Everything other testimony pales in comparison to that in which a person rises from their own horrors to a place of authentic esteem, so that in the end, countless others do not have to suffer the same.

    I hope and pray this for you and those close to you throughout whatever modalities can make this possible. Thanks again for sharing your stories and insights.

  • Hi Monica,

    Thank you for sharing this. I would have loved to be part of that training and hear Azim. It is great for me to hear that your personal experience of him is consistent with what I have read and heard. He certainly is a tremendous model for people who think that forgiveness is not an option, and it is great that his voice is being heard across the world. His is certainly the kind of life I want to live, too.

  • Hi Ted, thanks for weighing in as always. I definitely agree that anger can be huge motivator, and certainly spur many changes both personally and on a societal level. But it seems that when anger towards individuals/entities goes unabated (and I think this has been illustrated in countless ways through history, not just the ones I highlighted), it often carries a serious price for personal and societal well-being as I noted in the piece. One example (and I will talk more about this in an upcoming part of the series) is that long-term hostility has long been shown to be connected with negative health outcomes.

    As far as your sense that forgiveness has to do with a privileged life, I would have to disagree. Those affected by the Rwandan genocide had anything but a privileged life, as so many others who have chosen to forgive. I think it is a universal virtue that we all must embrace although some, as yourself, might disagree. But as I emphasized, this does not mean we accept wrongs as rights, or stop militant actions against atrocities that exist. It simply means that forgiveness remains an option for each of us. But each person obviously retains their right to make decisions about this matter even though I think it is important to know the likely consequences of our choices.

  • Hi Mary, great to hear from you as always and appreciate your positive feedback. Without repeating myself, I just really worry that many psychologists advocating for prescription principles are not giving enough credence to the very psychological principles that influence our thoughts, feelings, and behaviors (consciously and unconsciously) – the ones that many of us first learned in Psych 101, but often easily forget.

    Thanks again for your input.

  • As always, your comments are full of thought-provoking insights and resources. Appreciate the time spent, and especially your related focus on the serious issues about the old idea that catharsis was a good thing, which research has clearly contradicted. As you noted, through the many fads and trends, certain practices never change, one of which is clear, honest, transparent communication. Even young children quickly come to “see through” others when this does not occur, and the outcomes from poor communication are seen throughout our families and societies. Once kids come to learn that you will love them regardless, but may not love certain things that they do while other things you do, and you will let them know when this occurs, it opens up so many opportunities for growth throughout the family, including as you noted, with adults themselves.

    Thanks again for all your thoughts and positive sentiments. On a side note, I continue to delve into more of CS Lewis’s writings, and am thoroughly enjoying them. His insights, and the way in which he is able to convey them to the readers (speaking of honest, direct communication) is simply remarkable. Thanks again for this recommendation.

  • Appreciate the positive thoughts. Yeah, I probably should have clarified more about “systematic ignoring”, which first comes out of the Applied Behavior Analysis (ABA) literature, but has sense been used in a number of paradigms. Basically, it is the process by which we as parents/caregivers consistently ignore negative behaviors (that we want to extinguish), such as temper tantrums and whining. It is advocated not only to be done consistently across time and different settings (unless the behavior becomes significantly destructive or harmful to self or others), but also involves refraining from engaging the child in 3 ways: verbal remarks, physical contact, and eye contact. Although initially it can increase negative behaviors (e.g., child screams even louder thinking that it will result in getting attention), combined with the other 2 strategies (i.e., positive reinforcement and environmental adjustments), it remains one of the most effective ways to reduce negative behaviors regardless of the child’s cognitive or social skills.

    Hope that makes it clearer. Thanks for the question.

  • Dear Oldhead and Others,

    Thank you so much for all the time spent in your continued responses to this topic. One of the great things about my personal and professional life is that each day brings an ongoing education of the human experience. I appreciate all the information, now and in the future. I would love to respond to each of you independently, but as mentioned before, having 6 children under the age of 8 always makes me consciously aware of making sure that my writing does not interfere with the more important roles of my life, that of course being a spouse and a father. Thanks for your understanding.

    But as I reflected on all the opinions expressed, I can’t help but me moved by the similarities that seem to exist among our differences. We all (to be best of my summation abilities, and I apologize for those who still disagree),

    1) Are passionate in helping those struggling with psychological difficulties
    2) Feel that much growth and change needs to happen in the current system
    3) Feel that words and categorizations both can fail to capture human struggles adequately and can result in stigma and other negative outcomes
    4) Recognize that millions of individuals experience daily psychological challenges that cause problems for themselves and others that need to be best understood
    5) Understand that the human experience is infinite and vast in many ways (and in essence, makes up everything that has occurred since the beginning of time)
    6) We are all interconnected in more ways than we know and have a responsibility to do right not just by ourselves, but by those around us

    Again, there is nothing profound about this reflection, but just a sense that these commonalities bind us in a singular mission even if our ideas about how this should occur differ in many ways. Along this line, I have a great heart for some of the most unpopular, controversial, outdated, and counterculture topics of our day (both by MIA standards and general society). I do so for one reason – I feel they are often the unspoken and unseen entities that affect our daily lives to a dramatic degree, but the ones that either don’t capture the attention of the masses (due to their mundane nature) or arouse so much fear, that people simply don’t want to discuss them. But I do, and I think this is one of the reasons that through my endurance training, I seek out the harshest, most isolative conditions possible to strengthen my heart and soul for this call. If you allow me, these are the topics that I desire to continue to post on MIA in hopes that the ensuing discussion will lead to a groundswell that will change peoples lives, including my own and that of my children, for the better. And although all of you don’t know me, from beyond what you have read here, I hope to convey that through all of this, I have no desire (although temptations seep in at time) for power, wealth, and fame. I write and speak and work with families because it is a calling, and I am perfectly content living out the rest of my life riding my bike to work and owning one junky, outdated car.

    I look forward to future discussions. Hope all have had a good weekend.

  • Thanks, Greg. I really appreciate your thoughtful and passionate approach to this subject, and I, too, look forward to contemplating these and future writings.

    All of this makes me think of one thing. Wouldn’t it be great if we could get beyond the semantics of language in trying to understand the reality that exists within each person and the entire human experience?

    From a spiritual sense, I believe that this what Thomas Merton was trying to say in the following quote, and why one of the biggest risks to our humanity (future article) is the gradual loss of silence and solitude. He says:

    “Words stand between silence and silence: between the silence of things and the silence of our own being. Between the silence of the world and the silence of God. When we have really met and known the world in silence, words do not separate us from the world nor from other men, nor from God, nor from ourselves because we no longer trust entirely in language to contain reality.”

  • Let me give you another example of the “natural law”, or if you would like to call it the “moral law”. This one comes from the world of education, in working with children who come from some of the most deplorabel, traumatic situations we can imagine.

    KIPP, the Knowledge Is Power Program, is a national network of free, open-enrollment, college-preparatory public charter schools with a track record of preparing students in underserved communities for success in college and in life.

    There are currently 141 KIPP schools in 20 states and the District of Columbia serving 50,000 students.

    More than 86 percent of their students are from low-income families and eligible for the federal free or reduced-price meals program, and 95 percent are African American or Latino.

    Nationally, more than 90 percent of KIPP middle school students have graduated high school, and more than 80 percent of KIPP alumni have gone on to college.

    KIPP’s motto is Work Hard. Be Nice.

    The program is largely founded on character building, which focuses on 7 very predictive, highly researched traits:
     Zest
     Grit
     Self-Control
     Optimism
     Gratitude
     Social Intelligence
     Curiosity

    What KIPP educators have realized, just as well as anyone who works with those from a psychological or physical perspective, is that there are universal principles that transcend experience, culture, and time that remain so critical to positive outcomes. Not surprisingly, in dealing with psychological issues, these qualities remain paramount, and if not addressed, it is unlikely that the person will ever pursue the life they are called to pursue. When people become unhealthy, they fall away from these practices and ultimately suffer greatly.

    That is why I said that I really wanted to get away from discussion of the DSM, and ultimately psychology and psychiatry as professions, and just really want to talk about health as the most basic level.

    Thanks again for your time spent in sharing your views. It is very helpful to me.

  • Hi Wayne, good to hear from you. It is an exciting time to see that CBT is increasingly providing an alternative for individuals experiencing these issues. And if CBT techniques are able to help people improve functionality and reduce distress even while voices, etc… remain, then this is a huge step forward. And I wholeheartedly agree with this line:

    Mental health/mental illness not being an either/or dichotomy – but how well is person getting their needs met is the way I believe PWilliams put it.

    At the end of the day, this is what matters. But, of course, the human mind and experience being as complex as it is makes defining it all a never-ending debate.

  • Always enjoy our discussions and so much of what you say rings true to me, too. I hear what you say about healthy vs. normal, and in general, prefer the former, too. With one caveat (which you are already alluded to) and that is that healthy is not solely situationally / relationally defined (which is ever-changing), but is also based on a deeper sense of principles.

  • I appreciate your perspective and all the time spent explaining it. It is helpful to hear you flesh it out. But I really would like to get away from the DSM on this discussion because it obviously arouses a lot of questions and negative reactions, many for good reasons. I really go back to the sense that there is a natural law that has existed for millennium, even as institutions and professional societies have changed dramatically. It is based on time-honored universal ethical principles and an equilibrium that our bodies and minds really do seek to sustain. When it is disrupted and the person becomes unhealthy (again, of whatever name), it is just important that the individual is able to recognize it and gets help.

  • “But I don’t hold everyone in “the system” responsible? I know because I have since met others and know there are psychologists and believe it or not a few p-docs who truly care and want to work to change “the system”.

    “I sure wish we could all try to be a bit kinder, a bit more accepting like when MIA authors compose articles to review.”

    First of all, I want to say that I can’t imagine the pain that you have (and do) go through in regards to the death of your son. I so greatly appreciate your willingness to reach out to others in your sorrow and despair, and speak authentically about your experiences in this way so that others might benefit.

    I highlighted two of your quotes at the top of this reply because I actually think that you have nailed the two critical things that must happen on MIA for this community to truly take the next steps in changing mental health for the better. Until civility occurs, in the midst of obvious struggles that people feel, many who need to be engaged in these conversations will never engage, and therefore, significant movement cannot occur.

    Secondly, until certain bloggers/commenters refrain from blaming everyone in the system for atrocities that have been committed to them by other professionals, and assume that we are all are out for evil and greedy purposes, certain conversations that are so, so needed, will rarely or never happen. There is a sense by some that those of us with a PhD are not subject to true pain, true sorrow, true powerlessness, and of course, to some degree (as someone who has never been involuntarily drugged or admitted), they are right although we may have experienced pain of a different kind unknown to others. But to act that because we have not experienced what others have, we cannot understand the depth of human emotion is to suggest that are of a different species, a different origin all together. Again, let me be clear, I can never know the true experience of another person, but I can certainly come to be a part of the collective body that guides our universal lives.

    Apologize for the tangent, but really appreciated your thoughts on this matter, and didn’t want to just let them go.

  • “What I care about is what is being done about them, what kind of help can people get and if this help is really worth the name.”

    Wonderful. Wonderful. And that is what I care about. The focus on what we call it all negates the reality that an existence in either case is not healthy, pleasant or desired, and not something that we want to experience. It would be a great world if schizophrenia could be treated effectively as you said. Hopefully that is where we see things headed at some point. Interestingly, though, much of physical medicine is struggling with similar issues. No matter how many drugs a person takes for Type II diabetes, it struggles to negate poor habits and other environmental influences from having a negative impact.

  • Hi Alex,

    Good to have you weigh in as always. I agree that in dealing with human behaviors, there is always a certain degree of subjectivity. But, I really bet that if you and I sat down, even with our differences, we could come to a consensus that many others of different philosophical persuasions would agree about what is normal/healthy vs. abnormal/unhealthy, whatever again we agree to call it. The biggest reason I think we would agree is because regardless of our differences, there is such a great universality that runs through all of us about what is important in our lives, and when something disrupts that, and we are honest about it, we come to know it.

  • Hi Mary,

    Great to have you weigh in, but I probably should allow my wife to respond to this one. She would have quite a contrasting view to yours, as someone who has birthed six children. She would tell you that childbirth is the epitomie of normal functioning and is one of the most beautiful things that occurs in this world, even with the pain that one experiences. I would have to agree. Now, of course, childbirth that goes wrong, and results in injury to the baby and mother, with or without professional assistance, must be a tremendously scary thing and is not desired by anyone. But if childbirth itself was an impairment of normal functioning, well, our population would be seriously in danger of not existing.

    I must admit that although I cannot be you in your exasperation, I think your anger towards me is misplaced. Not a day goes by, when at home, or in my office, or in the general public, people seek help from me because they are unhappy with where they are. Sometimes I feel ineffective, sometimes I think I might be actually helping. And as far as the shots taken at my education on these posts, which I think are rather cheap and don’t help in actually addressing the issue raised, it is important to understand the best education I have ever had, from the moment of birth until now, comes from my real, personal, raw, truthful encounters with other people. They are the ones who have taught me what I profess here, not the educational system for which you and others despise.

  • Hi Greg,

    Appreciate your comments and those of others below on this important topic. There were a couple of very critical things that you said that speak to the heart of this post, and where it appears that our beliefs diverge. In one, You noted:

    It is absolutely possible to address unhealthy behavior without attributing it to erroneous causality. Whether or not behavior is healthy ought to be determined and addressed contextually via relationships.

    First of all, my article had little to do with “erroneous causality”. It simply stated that causality is of multiple, and interactive origins, of an external and internal nature. But more more importantly, specifically in regards to that last line, i don’t believe that determining normality in the context of relationship works, and there are thousands of examples (now and historically) that illustrate this. I will use just one. I regularly have adolescents that come into my office, who are engaging in cutting and other high risk behaviors, just like close peers of theirs are. But, and this is the key, in the context of their relationships, they perceive this behavior as normal and healthy, until potentially further discussions ensue. But, unfortunately, it is anything but, and could ultimately lead to serious consequences, including death. If this same mindset continued, and translated into a population-wide belief (e.g., we all began to believe that cutting and other high risk behaviors were normal because our friends did it), dire consequences would follow. And we as parents and society, with our primary goals to provide the best opportunities for safety, health, and happiness, would fail.

    As far as the human experience being crazy, goofy, tough, etc.. at times, no doubt you are right. You could even say people like Dali, Phil Mickelson, Peyton Manning, and CS Lewis were abnormal, because the skills that they had were way different from the average population. Does that give them a mental illness? Well, no, of course. But as I said in the article, if behaviors cause significant discomfort/pain/distress and/or are significantly impairing (and don’t resolve in a reasonable time frame) to the core areas of functioning that we all experience, then it becomes a condition/illness, or whatever preferred term is used.

    Stigma and all the other negative outcomes from labeling, as again I clearly stated in my article, are again huge issues that we need to address. But avoiding clearing defining something (based on symptoms, intensity, impairment, and distress) as what it is, whatever term is used, is I feel the worst thing we can do. In just saying that it is part of the human condition, and that nothing is wrong, my worry is that personally, and as a civilization, we will find ourselves sliding into an existence that is so relative that we don’t even know where to begin, especially when it comes to teaching our kids from the youngest age about what matters and trying to understand why we are all struggling so much

    Again, i appreciate your thoughts on the matter.

  • The question about BP changes from DSM-IV to DSM-5 is definitely another article in itself, and one that I may undertake in the future. But, for now, here is the APA official response on this topic:

    Bipolar Disorders

    To enhance the accuracy of diagnosis and facilitate earlier detection in clinical settings, Criterion A for manic and hypomanic episodes now includes an emphasis on changes in activity and energy as well as mood. The DSM-IV diagnosis of bipolar I disorder, mixed episode, requiring that the individual simultaneously meet full criteria for both mania and major depressive episode, has been removed. Instead, a new specifier, “with mixed features,” has been added that can be applied to episodes of mania or hypomania when depressive features are present, and to episodes of depression in the context of major depressive disorder or bipolar disorder when features of mania/hypomania are present.

    Other Specified Bipolar and Related Disorder

    DSM-5 allows the specification of particular conditions for other specified bipolar and related disorder, including categorization for individuals with a past history of a major depressive disorder who meet all criteria for hypomania except the duration criterion (i.e., at least 4 consecutive days). A second condition constituting an other specified bipolar and related disorder is that too few symptoms of hypomania are present to meet criteria for the full bipolar II syndrome, although the duration is sufficient at 4 or more days.

    Anxious Distress Specifier

    In the chapter on bipolar and related disorders and the chapter on depressive disorders, a specifier for anxious distress is delineated. This specifier is intended to identify patients with anxiety symptoms that are not part of the bipolar diagnostic criteria.

  • I believe you are right in saying that it is of great, great importance, and of all the topics that I have posted about on MIA, I have little doubt that it is the most important of all. If we look beneath the atrocities and pain that so many speak about on MIA (whether on a macro or micro level), I feel comfortable in saying that they will all find a root that traces back to injustices and misunderstandings that occur within the most intimate relationships we have. It is a subject that I feel few really want to take the time to address on an intricate, personal level. In some ways, it easier for all of us to work against the atrocities committed in our communities and nations than to address the discomfort and discord that exists in our own lives and our own homes. The former we often seek to engage, the latter we often seek to avoid. It is one reason I feel that posts like these will largely be ignored by the masses while those that speak out against institutions or professions will be embraced over and again.

  • “I would think it would have value, though, as a way for someone who wasn’t used to standing up for themselves in a relationship to have a set of guidelines for themselves of what they were entitled to in a relationship.”

    Ted, you echoed very well in the paragraph above the purpose of the post – as I noted before and I am sure you certainly feel, many people have experienced so many difficult circumstances in their lives that it is difficult to articulate the basic rights of a relationship not only to potentially address the current one they are in (if salvageable), but also to make it possible to have a close relationship in the future.

    IMHO, for many these statements don’t ring true because many of the relationships that people have experienced are only a shell of what each of us deserves. And, so it leads people to settle (or even protect and make excuses for those who abuse) and assume that this level of intimacy is not possible, or simply not seek close relationships out at all. But again, I think we have to be careful in assuming that all people, even those who have abused in the past, have no desire for change and potentially, more meaningful connections with others.

    Thanks for your thoughts

  • I recognize your reasons for cynicism, and agree very much that certain situations necessitate that a person leave, but don’t agree this should be the only action considered. It would imply that even at the early signs of discord in relationships (which often occur in the presence of emotional abuse) there is not potential for change, which basically paints the picture that negative, divisive patterns of communication (often passed along through generations) cannot be altered. Although I think leaving can send a clear message to the person that this should not be tolerated, it does not provide for a clear opportunity to work through the often painstaking shifts in communication that do not occur naturally for people who grew up in environments with significant expressed emotion and communication deviance.

    Appreciate your interest.

  • Appreciate your thoughts, Francesca. I agree that the statistics are always difficult to decipher, especially depending on just how the questions are framed and analyzed. And I think your observation about the likely underreporting of physical abuse towards men is astute given that society would often perceive men in a questionable, emasculating light for doing this. In the end, your last line says it perfectly – we need to acknowledge when people are mistreated, and not shy away from daily, basic steps (no matter how uncomfortable they may seem) that can really improve both lives.

    Thanks again for taking the time to share your thoughts

  • I just love this story. It speaks to the transformative power of putting another ahead of our own, whether it be a person or a turtle. Thank you so much for sharing.

    P.S. I probably loved it even more because as a kid, we would find box turtles in the woods, create a home for them during the summer, and then release them when it started to get cold only likely to find them the next summer. Probably not recommended by animal advocates, but we certainly got to know them well and it became one more experience that really turned me into an environmentalist at heart.

  • Hi Alex,

    Always appreciate the observations and insights. A few further reflections. One, I completely agree that our emotions are critical to both our identity and the choices we make, and that understanding and embracing them is one of the biggest keys to finding ourselves in places that we feel called to be (see “What Our Emotions Are Trying to Tell Us” from my personal column to get my further ideas on the matter). However, where emotions can cause us to go awry is when they take us away from our self-professed goals. Last week, I had an adolescent in my office who acknowledged that his fear and disdain about issues at school was leading him not only to avoid school completely, but have a future life that “sucks”. But in his anger, he stated that he didn’t care, and just wanted us to allow him to go on this path. This became a great example of how the 3 C’s were really impacting his overall mental health. As you astutely noted, we must create our own reality (although truths do clearly exist in this world), but when our state of mind is taking us away from our self-professed goals, we must reconsider.

    In regards to your thoughts about CBT, I would agree that there are certain aspects that I don’t like, including the idea that we can (or should) have control over all of our feelings (especially anxiety), which obviously are part of being human. This is where ACT (Acceptance-Commitment Therapy) does much better. But I don’t think we should throw out much of what CBT has to offer. We all have thoughts that are irrational at times (whether on our or other’s apprisal), but the key is in what way they guide our actions. Again, if they guide our actions against our goals/callings and/or the rights of other people, then we must challenge them. The reality is that we all use CBT everyday in our lives, constantly assessing our thoughts and feelings, and determining how grounded and rational they are. Simply because it has been used as a therapeutic modality (and sometimes in a control, inept way), then, should not necessary make it an evil.

    Finally, I really appreciated your last thought:

    “Most importantly, I learned to discern my voice from the external judgment and opinions of others, who may not be aligned with my beliefs, which is fine. Many are, and those are the ones to whom I gravitate for coherency and community support.”

    Ultimately, we must discern for ourselves about where we go, and never trust anyone fully to do this, whether a psychologist or even a parent. But, I do think there is a trap in sometimes only seeking out support and wisdom from those that align with our beliefs. Although it may be comfortable to our psyche, and certainly we do not want to surround ourselves with detractors, it may also prevent us from the challenges needed to improve ourselves. In my own life, it is no secret that faith is important to me – but over the last few years, I have felt compelled to seek out authors, atheistic or otherwise, that challenge my conventional way of thinking and make me really consider all points of view. I figure that not only will this give me insights I would likely have not had, but it will also put my beliefs to the ultimate test.

    By the way, “discerning your own voice” was actually one of the main points of my story about my father. So many people as I said (over the years) have thought that his ideas are irrational and really “out there”. But through his conscious actions and persistence, I think that many (as I am sure people have experienced in knowing you) are coming to understand him more clearly.

  • I always appreciate optimism, or at least realism with a hopeful perspective. I definitely consider myself an optimist person by nature, which hopefully my articles convey at least to some degree. I think there is much potential for gain from unique self-perspective, but only in the context of ethical teachings, as CS Lewis spent much time discussing in the “Abolition of Man” that have not really changed much for thousands of years. That is, until more recently, and that I think is what tends to temper my optimism. As far the evolution of consciousness, I certainly concur with the constant evolution in this area, although in certain periods of history, I am not sure that we evolved in a positive direction. And like the dodo bird, I just hope that the way we are evolving doesn’t end up being a factor in our demise.

    Thanks again for your interest. Whatever it takes, I hope we are just doing it right for our kids.

  • “Critical moral practices” also evolve. When you are aware and awake, you do better. The po-po-mo generation is on its way to unique self perspective. They are going to evolve to a post-egoic nondual realization of unique perspective. They are going to do better, if the other generations keep their relational contract.”

    I am intrigued by your analysis of this, but would love more clarity on this final piece, especially what you mean by relational contract. I have some thoughts regarding yours, but wanted to make sure I was understanding you clearly before you responded.

  • I echo your concerns, and am curious about the two books that you mentioned. It remains a strange paradox that many children of today have more than their predecessors could have ever imagined, and yet in psychological terms, often feel more constrained than ever before. The same goes for parents, and ultimately the price of lost parental influence could have serious detrimental outcomes in the areas of public health, global economics, and overall societal viability.

    I appreciate your interest in the matter.

  • “We are not only medicating children with drugs; we are medicating them food and television.”

    This is a critical point, and one that I think few really understand the gravity of it all, but I appreciate you indicating here. As I have already alluded to here, and certainly talk much about on my column, poor nutrition and media/technology immersion have become two of the biggest threats to the vitality of our youth, and our population as a whole. If you are curious about more about my thoughts in these two areas, check out three series I wrote in 2013 (January, April, and September) at http://www.stmarys.org/articles-1. Almost everyday in my office, parents acknowledge struggling to maintain healthy practices in both, and if negative trends in these areas are not curbed, I worry that the long-term on our population could be tremendous.

  • Thanks for taking the time to reply, and it was neat to hear how painting has become so therapeutic in your life. I appreciate your emphasis on the idea of promoting health through natural endeavors, as I very much agree that there are an infinite number of ways to sustain health and well-being that are available to us every day with no prescription needed. If you go on my column at http://www.stmarys.org/articles, you will see that I am constantly promoting the research that supports this idea, and ways that we promote positive well-being and good relationships through our daily practices and timeless pursuits. Writing and endurance training happen to be two of my favorites, which happen to support each other very well.

  • Hi Donna,

    You are certainly right about the documented long-term effects seen in children and especially in adults. My comment in the article was actually in regard to the author’s conclusions (or lack of) about this preschool population given that antipsychotis use are still relatively (in psychiatric terms) new with them. But, I agree, there is no reason to believe that long-term effects would be any better (and I too worry they will be worse as I am already seeing really concerning issues with significant weight gain etc.. for those preschoolers that present in my office on the antipsychotics), and a qualifier in the article about this data would have been good.

    By the way, on a totally different note, I am really enjoying my daily dose of CS Lewis. Thanks for the info – his words certainly carry remarkable insight.

  • I couldn’t figure out how to respond to your last comment in reflecting on my articles, but I thank you greatly for the time spent reading and certainly the great encouragement. I think your perceptions have captured my purpose very well, and when you say that I write no one off and believe that change is always possible, I absolutely agree and hope that my writing always conveys that. Otherwise, I feel all is lost. And I certainly appreciate your openness about your own experiences and your journey, in pursuit of life and health. I am sure you bring great comfort to many who seek their own unique pathway midst the challenges of life. Keep it up!

  • Hi Jeffrey, I appreciate you illuminating your concerns as I recognize that many have not experienced them as medications. In regards to the use of the term “antipsychotic medications”, I suspect that I used this term for the same reason that Robert Whitaker used it periodically in AOAE as it denotes the categorization/labeling that is often commonly used in the general public, not necessarily the connotation of the name or the true experience of taking them. Nothing more, nothing less.

    As far as be “on the other side of the fence”, I am not really sure what that means. But I strive to be on whatever side humanity is – at times I am sure I fail, at times I hope I succeed. But at the very least, I hope my efforts reflect an intense and passionate desire to seek out the truth, however inconvenient, boring, or unpopular, so that my children and many others have opportunities to live the best life possible

  • Really appreciate your enthusiasm in all of this, and at the very least, I am attempting to repeatedly take on topics that often have little voice and yet I feel ring through us all in some way and are critically important if we are to progress in the direction most of us aspire. That is my hope with “Just Thinking” and all else that I write. We will see where the story leads.

    By the way, you will notice a decent amount of redundancy with the new posts on both columns since I started writing here, but some on Just Thinking will just remain there and certainly there is a lot before on there that I feel strongly about before I posted on MIA.

  • Hi Alex, I once again appreciate your positive sentiments and agree with so much of what you said. This especially spoke to me:

    By radical self-responsibility, what I mean is for parents to own their stuff, and not take issues out on the kid. Sometimes, the kid needs direction or boundaries; other times, the parent is the one being unreasonable and not hearing the kid’s heart and spirit. That can come back to haunt the family. It’s hard for everyone concerned when that happens.

    In many ways, I hear you saying that it is all about letting go of the pride that serves to often immobilize us, and recognize the humility that is needed to be both a great parent and a great person.

    In response to your question about indicators for sound parenting, I do believe they exist, but I also believe that certain gray areas are present. I think that the research around authoritative vs. authoritarian/permissive/neglectful parenting is especially helpful, but certainly parents have to be authentic to themselves and be mindful of the goodness of fit that exists between their personality and their child’s temperament. If you are interested in some side reading of mine that focuses on this question, check out the following articles from my column at http://www.stmarys.org/articles, specifically August 2013 and part IV of May 2013 (Cultivating Our Future).

  • I very much agree that it not just a clinical problem, but a societal and political one among others. That was the reason for my emphasis as follows…

    “there is little doubt about the role that widespread advertising, physician influence (especially upon at-risk populations), and limited options play in this trend. This must continue to be exposed.”

    But as the truth continues to emerge in these sectors, what I feel is most conducive and accessible for change for most people (especially parents) on a daily basis are the countless interactions that ultimately culminate in patterns of behavior that can either lead to healthy lifestyle choices or the pursuit of artificial agents of comfort, of which include psychotropic medications such as the antipsychotics.

  • You bring up very good points, and a couple of specific thoughts came through after reading your comments. One was a personal one. I remember my mom, the city girl from Indianapolis, describing her early experiences with death as she witnessed the regular chicken slaughter down at her grandmother’s farm in rural Indiana. I do think in many ways it was a learning experience for her, as you said your early experiences were for you.

    It is interesting, and of course good in many ways, that our insulation from death seems to largely be an artifact of the fact that we experience it much less than those that just lived a hundred years before. As the infant and childhood mortality rates have plummetted thankfully over the past century, it seems that simply through our lack of exposure, we unintentionally have begun to not see it as a natural part of life in the way that people did for centuries before. In reading journals from those in the 1800’s, it seems that many parents and family members felt similar pain in the death of their loved ones, but for the most part, they had little choice but to find ways to carry on (often immediately), otherwise they themselves might quickly be subjected to the same thing. It is a strange paradox – none of us want death to present itself in greater frequency in our current culture, and yet as we strive to live longer and eliminate causes of unpredictable death, it seems that the by product will likely be less ability to see it in its context and deal with it when it comes.

    Thanks for your thoughts.

  • Hi Maria,

    I am going to start with the second question, but feel free to backchannel me and I would be happy to have a conversation around this because I likely won’t directly answer specific questions and for sure won’t do the topic justice on this reply.

    As far as the ashes, my basic response would be that there are different ways to remember those we love. Some people bury them and have a gravestone, others cremate them and keep a person’s ashes to remember them in this way. If they asked for more specifics about cremation, I would tend to just give a general response about using a very hot place to produce ashes from the body, and plead ignorance regarding more specifics (of which most of us can do given that we really don’t know the process firsthand and largely because this image may be difficult for some children this age). I think the one main emphasis would be that because the person is dead, they don’t feel any pain at all when this occurs.

    In regards to your question about children’s questions regarding Toran’s death, this is a huge topic that carries a lot of variables in my mind in leading your responses. Again, feel free to backchannel, but I will start with what I feel are a few basic principles to consider, and then give you a couple scenarios that illustrate this without knowing more details from your end.

    Principle/Issue #1 – Really make sure that parents have full consent about what will be told to children. Given the understandable range of values and comfort levels with parents around this topic, I would find some way to get a sense of parents comfort ahead of time regarding this topic, or at least send letter/email indicating your general points of discussion.

    Principle/Issue #2 – To me, I would communicate differently depending on what audience I am talking to at this age (i.e., general audience vs. children referred to you given their own challenges with depression, suicidality, etc…) Although children this age understand that people die permanently, and certain will voice suicidal statements at times, many really do not have a concept of what suicide really means in practical terms, and I think that there a reasons why this is not necessarily a bad thing (e.g., dealing with questions about why someone would do this that may be difficult to reconcile in their own mind).

    Principle/Issue #3 – I would tend to emphasize areas such as a) impact of suicide on others b) permanent act for problems that may change c) alternatives/deterrents to consider and go light on the actual details of Toran’s suicide. My reasoning for this is to not only encourage ways to think about this topic broadly/empathetically, but I do worry that too much details about the act itself can paint a picture in a kid’s mind that may be difficult to resolve/remove given their cognitive limitations. It is why when it comes to specific questions regarding his suicidal act, I would tend to provide what you feel comfortable in giving to the parents, and encourage the kids to talk with them.

    That all being said, I can imagine that kids questions come in different forums. If, for example, a kid’s parents felt that talking to you individually would help because his or her current issues in this area, then I would feel freer to speak more openly, although I would still hesitate to give too many details. But if you were speaking to class regarding suicide (e.g., due to someone in the school committing suicide), then I would tend as I said before to limit details, encourage parental conversations, and just emphasize all the factors that involve impact, alternatives, deterrents, etc…

    Not sure if this is helpful, and I am sure you could get a range of opinions, as it is challenging topic given the age you have mentioned. I certainly would be interested in hearing your thoughts/experiences in this matter as I know much of your mission focuses on prevention and helping those affected. And beyond the questions, I just want to say thanks for all that you do for others struggling, in taking your own pain and sublimating it into a call to leave this world a better place.

  • Hi Alex,

    Thank you for your willingness to continue following my postings despite your initial skepticism, which of course I think is always a critical element in deducing information and ideas that we consume. I certainly appreciated your thoughts on my previous post, too.

    Again, I agree wholeheartedly with what you said, and feel that in order for any valid movement to be effective, especially one that is perceived as countercultural, it must have two major things in place. One, it must seek to truthfully expose the wrongs that have been committed, but just as important, it must illuminate a clear pathway to follow. It must do this on both a micro and macro level. Until this happens, IMHO, I don’t think that it can ever be effective in the way it desires. My hope is that my message will better illuminate a clear pathway on a micro, yet universal level. We will see.

    Thanks again for taking the time to read and comment, and certainly pass along to anyone you think might benefit. I have a feeling, too, that you will enjoy the next part of the series to come…

  • Hi Duane,

    Your comments were a poignant post in themselves. As a father of young children, I often wonder how the memories that evolve each day will be recalled in years to come. And often, I worry that I am not available to my kids fully in the ways that I need to be as they grow up. Yet the words of your son reminds me once again that I need to find greater value in taking the time to carving out simple moments, simple experiences that can live a lifetime and beyond.

    Appreciate very much the personal reflection.

  • Hi Alex,

    Thank you very much for your kind thoughts and wonderful insights. You are so right in saying that it is “universally revelant” – no doubt that all of us will be touched by this topic very closely many times in our lives. And I think when you said “reassuring”, that is the hope that I have for my kids, that although the deaths of those close to them will, and should be, very difficult to them in many ways, there is great reassurance that comes with knowing a person intimately and maintaing that relationship into eternity.

  • Hi Lisa,

    I really appreciate your thoughts, and definitely agree that many medical student who seek out psychiatry, as in other disciplines, certainly do so with helping others as the primary reason. But, as you said, they often become caught in a billing/coding/reimbursement system that emphasizes medication administration/management over any other type of practice.

    In doing so, i also hate that it overshadows contributions that psychiatrists have made over history despite the evident atrocities of which some have been involved. First in my mind is always Frankl as you mentioned (if you check out my column at http://www.stmarys.org/aticles, you will see him cited more than once), whose development of logotherapy I still feel is one of the most important advances in psychology. Unfortunately, I feel at least in the US, its tenets/practices have been way underutilized.

    Regardless, my hope is that more psychiatrists enter this conversation (as Dr. Martin did with the most recent post), and will work to change the profession from within as those of us from beyond do in the same way.

    Always curious to hear more ideas. Thanks again.

    JFS

  • Hi Vicki,

    I want to simply say thanks for taking the time to write and join the conversation on Mad in America. As you can see from my post at the bottom of the front page (When I Grow Up, I Want to be a Psychiatrist: Redefining the Conversation for the Betterment of All), I think there is great opportunity for psychiatrists today in the field, but it is going to take significant changes in many ways. I so appreciate your willingness to take up the critical cause despite huge obstacles, and to work with others both on MIA and beyond to really look at what are the best options for kids today. I think the number of “Likes” you received should be a testament to the appreciation others feel for taking these courageous steps in putting yourself out there as you have. I certainly would be interested in talking with you more.

    Regards,

    Jim Schroeder

  • In addressing concerns noted along this line of comments, I was fully aware that John Ratey was co-author of Driven to Distraction, as I actually purchased this book during graduate school after it was recommended by professionals in the program. I, like those of you have posted, am also curious about the seeming departure from this previous book to the author’s current body of work. However, I think that we have to be careful about dismissing any book based on the author’s previous endeavors – this would be synonymous with saying that we should not be allowed to evolve in our careers (and for that matter any belief) and that any work we do can easily be dismissed because of our past practices. As Abraham Lincoln once said (and I apologize for the paraphrased, likely butchering of eloquence)- I will continue with my current practices for time being, but if someone clearly shows me a better way, I must be willing to change. In a similar vein, I appreciate the concerns voiced regarding the quotes pulled from Spark, but I think again it is a dicey proposition to dismiss an entire body of work based on a few excerpts that do not fit with what we believe. In fact, to this point in my life, I have yet to read a book by a professional that I completely agreed with all of the observations and assertions made, even for those I have come to highly respect. Again, IMHO it is definitely important to have a healthy level of skepticism, but not dismiss entirely. That is again why AOAE moved so many people – Whitaker did not dismiss the allopathic practices of psychiatry altogether, but raised enough questions that many people started saying, “Hmmm, this doesn’t make sense.”

    As with any recommendation that I make to my patients or the general public through my writing, I only do so if I feel the potential gains far outweighs possible negative consequences. In this case, I felt there were two huge potential gains in recommending this book. One has already been stated clearly in my post. Despite the concerns regarding the quotations above, what I have no doubt of is that any reader of Spark will come away with a new, and clarified appreciation of how strategic, and well-planned exercise can improve academic performance, and decrease depressive, anxiety, inattentive, addictive, hormonal, among other issues. The author clearly conveys how exercise can make drastic changes in these areas, and should often be used in lieu of more traditional psychiatry practices, including medication and ECT. In fact, the author also acknowledges his own professions reluctance in admitting that exercise is a bona fide method of potential change.

    But as importantly, and maybe even more, I felt the potential gain in recommending this book came from informing, and empowering the general public, in making demands of psychiatry that went against the current grain. I think it is fair to say that 99% of the general public feels that when they are going to the psychiatrist, they are going for one thing: to get medication (the second maybe being to get a diagnosis). So the conversation almost always stops there. But, if the public begins to realize that psychiatry can, and should mean, much more than medication, then conversations, and eventual demands, can drive the profession in a different direction. Comments like, “Doc, you know for the last couple of years we have only talked about my meds, but recently I have been reading more about the powerful effects of exercise, and I wonder why we haven’t talked about this” created thousands of times over can shift the practice. In fact, whether we like it or not, we all know that professions, just like the marketplace, are largely driven by consumers, or in this case, patients. Until we provide consumers (patients) with different ideas about a practice, they will likely continue to acquiesce to the current trend.

    As a psychologist, I can talk to the end of time about how I think the practice of psychiatry should change, but I will likely be dismissed as just one more outsider who should take care of his own profession. But if I can use those in the profession itself to make the case, and even better use someone who is highly regarded, then suddenly my legitimacy goes way up, and then who knows what possibilities are in store.

    In the interest of ending what may be the longest comment in the history of MIA (I apologize -brevity is not my strong suit), I ultimately feel that the book presents much greater opportunities than potential consequences. As an aside, I did contact John Ratey personally in hopes that he would be willing to engage around these topics – we will see if that happens.

    Thanks again for all the time spent and your passion in helping those who very much need it.

  • Hi Duane, appreciate your thoughts, especially in regards to the importance of addressing issues with relationship, which of course includes past trauma and poor communication. It is always concerning when professionals themselves struggle to establish good, working relationships and deal with conflict, as this makes it increasingly difficult to address this core issue.

    The social dimension certainly reigns extremely important in interaction with the other three.

    Thanks again for your thoughts.

  • Richard, Jonathan, AA – really appreciate all your thoughts on this topic and agree with much of what you said. You are no doubt right in saying that there is a vein of idealism that runs through my post as I feel any large-scale proposal probably has. But I can’t escape the reality that hundreds into thousands of psychiatry departments/residency programs exist today, and probably will for the indefinite term, that seem to be churning out psychiatrists with a med-first mentality. You also make a great point that psychiatrists are doing a minority of the prescribing and that even if the profession went defunct, someone (likely even less qualified) would be prescribing psychotropic meds. Jonathan, as you mentioned, the $ plays a huge factor in this, and frankly many psychiatrists feel pressured by the current standard (that their hospitals likely abide by) regarding patient volume. Until these professionals are inspired to a more meaningful practice, one in which they would actually be wiling to take a pay cut, for a happier and more purposeful professional existence, I just worry the medication rates will continue to climb.

    Thanks again for taking the time to share your thoughts

  • One more great irony to add to all of this discussion regarding psychiatry and Nazi atrocities. Out of all the horror emerging a few remarkable lights, some of which would change generations to come for the better. One of these, of course, was Viktor Frankl, a psychiatrist himself who found the ability to transcend all of the horror only to provide the world with inspiration that would change the lives of millions.

    Maybe naively, then, I am reluctant to completely discard a profession, despite all of its tremendous misgivings, when there remains individuals previously and now that seem to actually take on a noble call in this profession.

  • There is no doubt that much of psychiatry has a sordid history, with its large scale involvement in the Holocaust being the nadir for sure. I greatly appreciate the resources included to provide me with a better sense of the atrocities committed through the Nazi regime. The practice of psychiatry has undoubted been tainted from the beginning, but the same argument could be made regarding the medical profession in general, including other professional involvement in the Holocaust. I certainly understand sentiments as yours and others regarding a general distrust that would be difficult for the public to ever move forward with, but I do feel the premise of psychiatry (as I perceive), i.e., the integration of physicality and mental health in understanding the whole person, remains a noble pursuit even if the practice has fallen woefully short. As was noted by Fred, there may be healing traditions better suited to address this holistic practice, but at least in the current professional climate, the shell of the profession suggests that it could be suited to taking on this cause. But I realize that the changes would have to be massive to allow for this to happen. Wouldn’t be the first time in history, though, such a large scale paradigmatic change occurred.

    Appreciate your thoughts and resources.

  • Hi Donna,

    Thanks again for your kind words and personal thoughts in regard to the subject of gratitude. I did see your comments regarding CS Lewis, and look forward to delving into the resources mentioned. As you probably saw in the bio, we have a hopping family of six, the youngest of which was just born a month ago so things are even busier than usual right now.

    I agree wholeheartedly about stamina being a requirement for endurance, and that a conscious choice to use effort in this way must be made as opposed to negative acts. Like every important activity, nothing occurs if the energy is not there. But as I alluded to in the post, it seems that the energy needed for gratitude is not often for a direct act of gratitude itself, but moreso the actions needed to manage the challenges and sufferings that may spur new pathways that would not be available in more pleasant situations. It is in many ways transforming the experience of uncertainty and anxiety into a conscious awareness of what is good even in knowing that bad things can always happen.

  • Hi Donna,

    Thank you very much for your kind words regarding my recent post. I certainly think that the New Year provides a unique opportunity in reassessing what is important in our life, and also the obstacles that present themselves in making desired changes. I appreciated very much your insight from your own personal experience, and agree much that we must replace negative addictions with positive pursuits in order for deep-seeded, long-term changes to occur.

    I hope you have a great start to 2014, and yours isn’t the first comment that makes me think I need to invest more in C.S. Lewis’s writings.

    JFS