Paula J. Caplan's Blog, page 6
May 5, 2011
April 26, 2011
Why NOT Call War Trauma a Mental Illness?
Gains and losses of calling war trauma a mental illness
Published on April 26, 2011 @ http://www.psychologytoday.com/blog/s...
© Copyright 2011 Paula J. Caplan All rights reserved
"Scientific brilliance is an important tool but is not the magic inherent in healing."
--Dr. Patch Adams [1]
This essay comes in response to two comments written about my previous essay here. One of the comments came from theologian and counselor Dr. Roger Ray and appears at the end of my essay called "What Is a Healthy Response to War?" and the other was sent to me privately by a friend. In combination, they raise these important questions:
(1) Since some people feel better once their anguish has been labeled, what's wrong with calling it a mental illness?
(2) However we label emotional trauma from war,[2] how can we help those who continue to suffer from it?
Before I respond to the first, excellent question, let me explain what my friend wrote to me privately in this regard. Since her mother's death many years ago, she had suffered in many ways both emotional and physical. Recently, when someone told her that she had Post-traumatic Stress Disorder (which is listed in the psychiatric diagnostic "Bible," the Diagnostic and Statistical Manual of Mental Disorders [3]) because she had not done much grieving about her mother's death, she felt mightily relieved, and as she allowed the grief to come forth, she began to feel better.
I am delighted that she obtained some relief. Suppressed grief is excruciating and is common in our society, where there is much pressure to "get over it" rapidly, and one is treated as weird or sick for failing to do so. Recall that in my previous essay, I mentioned that in the DSM, someone who is grieving just two months after losing a loved one is considered mentally ill (in fact, to have Major Depressive Disorder). For both my friend and the war veterans who were the subject of the previous essay, grief has loomed large, and grief ignored carries emotional dangers. So it was important for my friend to have her feelings named and acknowledged.
What I would ask, however, are two questions:
(A) What would my friend - and war veterans - have lost if instead of being told they have PTSD, they were told that they were suffering as many or most people suffer deeply when they lose people they love - or, in the case of veterans, lose their innocence or, for some, their faith in certain people, principles, or institutions that had mattered to them? That feelings are common and powerful does not mean they are signs of mental disorders. And naming a person's feelings without saying they are signs of mental disorders can be extremely helpful.
(B) What would both my friend and war veterans gain by being told what I just suggested rather than that they have a mental illness? The gains are enormous. First, they avoid feeling that they are weak or sick for continuing to feel grief, anger, numbness, and other powerful, negative feelings (or lack of feelings). It's hard enough to deal with loss and other kinds of trauma, without shouldering the additional burden of believing that one has to stop having those feelings immediately. Second, they avoid the considerable risks that simply receiving any psychiatric diagnosis can carry, including (but not limited to) loss of health insurance or huge increases in premiums, as well as loss of custody of a child, a job, or the right to make decisions about one's medical and legal affairs.[4] Third, they avoid the blinders imposed on many therapists and many laypeople, who, once they know a person has a psychiatric label, believe that that person must take psychiatric drugs and attend psychotherapy sessions and that either or both will help.
What's wrong with those beliefs? To begin with, psychiatric diagnoses are hardly ever based on any good scientific evidence, although the DSM is surrounded by an undeserved aura of scientific precision.[5] In fact, the authors of the DSM have acknowledged that they have not even found a good way to define the overarching category of "mental illness," not to mention each subcategory. Furthermore, the widespread belief that knowing a person's psychiatric label(s) will help the therapist know how to help them and improve their prognosis is largely a myth.[6] Finally, although for some people at some times, psychotherapy and/or medication can certainly be helpful, many more are not helped at all or are seriously harmed by either or both.[7]
A look at the statistics about veterans from every single war reveals that hundreds of thousands are still suffering emotionally, are homeless, jobless, suicidal, and/or violent toward others, despite having been in therapy and taken psychiatric drugs, usually having been tried on an astonishingly long list of such drugs.[8] One of the many reasons for the harm that comes to some people from drugs and yes, even psychotherapy,[9] is that this traditional, two-pronged approach is often less helpful than other approaches that are not implemented because of the overreliance on the traditional. For instance, one of the best-supported findings in research about human behavior is the importance of social support. In some cultures, the community expects to welcome those traumatized in any way to come back into the community, find a place to belong, be productive, feel accepted, and begin to heal; but too often in this country and others, we hand over to the mental health system all of these responsibilities.
Professionals in the mental health system can help some people, but others will not enter the system for fear of being pathologized or otherwise misunderstood, because they fear that having such treatment on their record will interfere with career advancement or carry other risks, or because they know from their experience and those of others who were similarly traumatized that help was not forthcoming. And stories are legion of already-traumatized people being harmed because therapists do not assist them in reconnecting with the wider community; with finding safe places to open up about their traumatic experiences to those by whom they wish to be understood (and who are not being paid to listen to them); with finding a decent job and place to live; with making the massive changes required by the move from the military's rules, structures, and aims to the very different ones of civilian life; and with changing from a focus on death and destruction to life and creation or production. Yet all of these are ways to help. So that is a partial answer to Dr. Ray's question of how to alleviate some of vets' suffering, no matter what we call it.
Within the traditional mental health system, war trauma is more likely to be called Post-Traumatic Stress Disorder or Major Depressive Disorder than perhaps anything else, although Bipolar Disorder is increasingly used as well. Those labels mask the cause of war trauma, leaving out any words that are clearly related to war, in contrast to the transparent terms like the Civil War term soldier's heart[10] and the World War I and II terms shell shock and combat fatigue.
There is something unseemly about using a euphemism to apply to an experience of intense horror or sorrow, such as war or the loss of a beloved parent or rape. To use these psychiatric euphemisms distances therapists and the loved ones of those who are traumatized from the traumatized person's experience. It isolates the latter as we move that much farther away from sharing their experience with them and from having the chance to show that we respect the fact that they have been through hell.
So when the Reverend Doctor Roger Ray describes his father's suffering as it went on decades after the war in which he fought, and he says poignantly that hospitalization and different kinds of drugs failed to help him, that makes his father frighteningly typical of many veterans of all wars. And although Dr. Ray refers to the tens of thousands of vets who still suffer, the number is actually well into the hundreds of thousands.
To respond further to Dr. Ray's question about how to help, at this point we cannot be sure of finding ways to help every veteran, and that in itself should move us to seek for more and better answers. I know from the research I did for my book about vets that some of what I described above is helpful. And in my next essay here, I will describe a specific proposal for assisting more vets. But I certainly cannot pretend to have all the answers, and the more I talk to war veterans, and the longer I follow their struggles, the more compelling I see is the need to acknowledge when what we do is not helping but to keep trying to find what brings comfort.
--------
[1]Patch Adams. Gesundheit. Healing Arts Press, Rochester, VT. 1998, p. 35.
[2] Paula J. Caplan. When Johnny and Jane Come Marching Home: How All of Us Can Help Veterans. Cambridge: MIT Press, 2011.
[3] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders-IV. Washington, D.C.: American Psychiatric Association. 1994.
[4] See psychdiagnosis.net for 53 stories of different ways people's lives have been seriously harmed because they received a psychiatric label, as well as for solutions aimed at avoiding such harm.
[5] See psychdiagnosis.net and Paula J. Caplan, They Say You're Crazy: How the World's Most Powerful Psychiatrists Decide Who's Normal. Reading, MA: Addison-Wesley, 1995.
[6] Ibid.
[7] Robert L. Whitaker. Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. New York: Crown. 2010.
[8] Caplan, 2011.
[9] Many more reasons for such harm are described by Caplan, 2011.
[10] http://www.soldiersheart.net/
Published on April 26, 2011 @ http://www.psychologytoday.com/blog/s...
© Copyright 2011 Paula J. Caplan All rights reserved
"Scientific brilliance is an important tool but is not the magic inherent in healing."
--Dr. Patch Adams [1]
This essay comes in response to two comments written about my previous essay here. One of the comments came from theologian and counselor Dr. Roger Ray and appears at the end of my essay called "What Is a Healthy Response to War?" and the other was sent to me privately by a friend. In combination, they raise these important questions:
(1) Since some people feel better once their anguish has been labeled, what's wrong with calling it a mental illness?
(2) However we label emotional trauma from war,[2] how can we help those who continue to suffer from it?
Before I respond to the first, excellent question, let me explain what my friend wrote to me privately in this regard. Since her mother's death many years ago, she had suffered in many ways both emotional and physical. Recently, when someone told her that she had Post-traumatic Stress Disorder (which is listed in the psychiatric diagnostic "Bible," the Diagnostic and Statistical Manual of Mental Disorders [3]) because she had not done much grieving about her mother's death, she felt mightily relieved, and as she allowed the grief to come forth, she began to feel better.
I am delighted that she obtained some relief. Suppressed grief is excruciating and is common in our society, where there is much pressure to "get over it" rapidly, and one is treated as weird or sick for failing to do so. Recall that in my previous essay, I mentioned that in the DSM, someone who is grieving just two months after losing a loved one is considered mentally ill (in fact, to have Major Depressive Disorder). For both my friend and the war veterans who were the subject of the previous essay, grief has loomed large, and grief ignored carries emotional dangers. So it was important for my friend to have her feelings named and acknowledged.
What I would ask, however, are two questions:
(A) What would my friend - and war veterans - have lost if instead of being told they have PTSD, they were told that they were suffering as many or most people suffer deeply when they lose people they love - or, in the case of veterans, lose their innocence or, for some, their faith in certain people, principles, or institutions that had mattered to them? That feelings are common and powerful does not mean they are signs of mental disorders. And naming a person's feelings without saying they are signs of mental disorders can be extremely helpful.
(B) What would both my friend and war veterans gain by being told what I just suggested rather than that they have a mental illness? The gains are enormous. First, they avoid feeling that they are weak or sick for continuing to feel grief, anger, numbness, and other powerful, negative feelings (or lack of feelings). It's hard enough to deal with loss and other kinds of trauma, without shouldering the additional burden of believing that one has to stop having those feelings immediately. Second, they avoid the considerable risks that simply receiving any psychiatric diagnosis can carry, including (but not limited to) loss of health insurance or huge increases in premiums, as well as loss of custody of a child, a job, or the right to make decisions about one's medical and legal affairs.[4] Third, they avoid the blinders imposed on many therapists and many laypeople, who, once they know a person has a psychiatric label, believe that that person must take psychiatric drugs and attend psychotherapy sessions and that either or both will help.
What's wrong with those beliefs? To begin with, psychiatric diagnoses are hardly ever based on any good scientific evidence, although the DSM is surrounded by an undeserved aura of scientific precision.[5] In fact, the authors of the DSM have acknowledged that they have not even found a good way to define the overarching category of "mental illness," not to mention each subcategory. Furthermore, the widespread belief that knowing a person's psychiatric label(s) will help the therapist know how to help them and improve their prognosis is largely a myth.[6] Finally, although for some people at some times, psychotherapy and/or medication can certainly be helpful, many more are not helped at all or are seriously harmed by either or both.[7]
A look at the statistics about veterans from every single war reveals that hundreds of thousands are still suffering emotionally, are homeless, jobless, suicidal, and/or violent toward others, despite having been in therapy and taken psychiatric drugs, usually having been tried on an astonishingly long list of such drugs.[8] One of the many reasons for the harm that comes to some people from drugs and yes, even psychotherapy,[9] is that this traditional, two-pronged approach is often less helpful than other approaches that are not implemented because of the overreliance on the traditional. For instance, one of the best-supported findings in research about human behavior is the importance of social support. In some cultures, the community expects to welcome those traumatized in any way to come back into the community, find a place to belong, be productive, feel accepted, and begin to heal; but too often in this country and others, we hand over to the mental health system all of these responsibilities.
Professionals in the mental health system can help some people, but others will not enter the system for fear of being pathologized or otherwise misunderstood, because they fear that having such treatment on their record will interfere with career advancement or carry other risks, or because they know from their experience and those of others who were similarly traumatized that help was not forthcoming. And stories are legion of already-traumatized people being harmed because therapists do not assist them in reconnecting with the wider community; with finding safe places to open up about their traumatic experiences to those by whom they wish to be understood (and who are not being paid to listen to them); with finding a decent job and place to live; with making the massive changes required by the move from the military's rules, structures, and aims to the very different ones of civilian life; and with changing from a focus on death and destruction to life and creation or production. Yet all of these are ways to help. So that is a partial answer to Dr. Ray's question of how to alleviate some of vets' suffering, no matter what we call it.
Within the traditional mental health system, war trauma is more likely to be called Post-Traumatic Stress Disorder or Major Depressive Disorder than perhaps anything else, although Bipolar Disorder is increasingly used as well. Those labels mask the cause of war trauma, leaving out any words that are clearly related to war, in contrast to the transparent terms like the Civil War term soldier's heart[10] and the World War I and II terms shell shock and combat fatigue.
There is something unseemly about using a euphemism to apply to an experience of intense horror or sorrow, such as war or the loss of a beloved parent or rape. To use these psychiatric euphemisms distances therapists and the loved ones of those who are traumatized from the traumatized person's experience. It isolates the latter as we move that much farther away from sharing their experience with them and from having the chance to show that we respect the fact that they have been through hell.
So when the Reverend Doctor Roger Ray describes his father's suffering as it went on decades after the war in which he fought, and he says poignantly that hospitalization and different kinds of drugs failed to help him, that makes his father frighteningly typical of many veterans of all wars. And although Dr. Ray refers to the tens of thousands of vets who still suffer, the number is actually well into the hundreds of thousands.
To respond further to Dr. Ray's question about how to help, at this point we cannot be sure of finding ways to help every veteran, and that in itself should move us to seek for more and better answers. I know from the research I did for my book about vets that some of what I described above is helpful. And in my next essay here, I will describe a specific proposal for assisting more vets. But I certainly cannot pretend to have all the answers, and the more I talk to war veterans, and the longer I follow their struggles, the more compelling I see is the need to acknowledge when what we do is not helping but to keep trying to find what brings comfort.
--------
[1]Patch Adams. Gesundheit. Healing Arts Press, Rochester, VT. 1998, p. 35.
[2] Paula J. Caplan. When Johnny and Jane Come Marching Home: How All of Us Can Help Veterans. Cambridge: MIT Press, 2011.
[3] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders-IV. Washington, D.C.: American Psychiatric Association. 1994.
[4] See psychdiagnosis.net for 53 stories of different ways people's lives have been seriously harmed because they received a psychiatric label, as well as for solutions aimed at avoiding such harm.
[5] See psychdiagnosis.net and Paula J. Caplan, They Say You're Crazy: How the World's Most Powerful Psychiatrists Decide Who's Normal. Reading, MA: Addison-Wesley, 1995.
[6] Ibid.
[7] Robert L. Whitaker. Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. New York: Crown. 2010.
[8] Caplan, 2011.
[9] Many more reasons for such harm are described by Caplan, 2011.
[10] http://www.soldiersheart.net/
What Is a Healthy Response to War?
Initially published at http://www.psychologytoday.com/blog/s... on April 26, 2011 ©Copyright 2011 Paula J. Caplan All rights reserved
Should war-caused emotional pain be called a mental illness?
Is human emotional misery always a mental illness?
In 2003, as the Iraq War was about to begin, in my mind's eye I saw what I feared would be the future: Waves of military servicemembers would come back from war, devastated, and not only psychotherapists but the nation as a whole would say, "We know what's happening to them. They've got Post-Traumatic Stress Disorder (PTSD), a mental illness. Send them to therapists for drugs and maybe therapy."
After all, the use of psychiatric diagnoses and psychiatric drugs had ballooned to an extent almost beyond belief since the Vietnam War, so that Americans are quicker than ever to interpret virtually anything other than happiness as evidence of mental illness.
But can't we stop and think before saying that being devastated by having been in combat and thus now being plagued by grief, fear, shame, rage, numbness, moral conflicts, existential crises, and/or other kinds of upset constitutes a mental illness? Consider: What would be a healthy response to being at war?
Should we let the fact that many therapists call war trauma PTSD, which is listed in the Diagnostic and Statistical Manual of Mental Disorders (note those last two words), persuade us that what used to be called soldier's heart, shell shock, and combat fatigue is actually a mental illness? Let us not lose sight of the fact that the authors of the diagnostic manual are the folks who call stuttering a mental illness, who do the same for having more trouble with mathematics than other kinds of cognitive functions, and who say that if a loved one dies, and you are "still" grieving two months later, you are mentally ill.
In fact, the VA's Iraq War Clinician's Guide includes the instruction to avoid calling the emotional pain caused by war a "disorder," an instruction that some military and VA therapists follow and some do not.
It should be possible to say to people who are suffering because they have been traumatized by life's worst horrors that their feelings are understandable and not sick, given what they have been through. Indeed, to tell them that can be a first and major step toward their feeling better and starting to reconnect with others, once they know there is nothing weird or weak about them for reacting as they did to having been at war. They need to know that if we were sent to war, we would probably react as they have.
This is not to say that no one who has been at war suffers from anything beyond the effects of war, for some people who go to war already have or would in any case have developed other kinds of problems. But it is to say that it is important for us to avoid leaping immediately to the conclusion that if someone has been at war and found the experience harrowing, therefore they are mentally ill.
It will take much to help ease the suffering of servicemembers and veterans. Still, as a beginning, you might consider finding an opportunity to talk to at least one person who has been at war (not just a current one), and looking for a way to let them know that you consider their intense emotions and painful struggles to be signs that they are human.
Should war-caused emotional pain be called a mental illness?
Is human emotional misery always a mental illness?
In 2003, as the Iraq War was about to begin, in my mind's eye I saw what I feared would be the future: Waves of military servicemembers would come back from war, devastated, and not only psychotherapists but the nation as a whole would say, "We know what's happening to them. They've got Post-Traumatic Stress Disorder (PTSD), a mental illness. Send them to therapists for drugs and maybe therapy."
After all, the use of psychiatric diagnoses and psychiatric drugs had ballooned to an extent almost beyond belief since the Vietnam War, so that Americans are quicker than ever to interpret virtually anything other than happiness as evidence of mental illness.
But can't we stop and think before saying that being devastated by having been in combat and thus now being plagued by grief, fear, shame, rage, numbness, moral conflicts, existential crises, and/or other kinds of upset constitutes a mental illness? Consider: What would be a healthy response to being at war?
Should we let the fact that many therapists call war trauma PTSD, which is listed in the Diagnostic and Statistical Manual of Mental Disorders (note those last two words), persuade us that what used to be called soldier's heart, shell shock, and combat fatigue is actually a mental illness? Let us not lose sight of the fact that the authors of the diagnostic manual are the folks who call stuttering a mental illness, who do the same for having more trouble with mathematics than other kinds of cognitive functions, and who say that if a loved one dies, and you are "still" grieving two months later, you are mentally ill.
In fact, the VA's Iraq War Clinician's Guide includes the instruction to avoid calling the emotional pain caused by war a "disorder," an instruction that some military and VA therapists follow and some do not.
It should be possible to say to people who are suffering because they have been traumatized by life's worst horrors that their feelings are understandable and not sick, given what they have been through. Indeed, to tell them that can be a first and major step toward their feeling better and starting to reconnect with others, once they know there is nothing weird or weak about them for reacting as they did to having been at war. They need to know that if we were sent to war, we would probably react as they have.
This is not to say that no one who has been at war suffers from anything beyond the effects of war, for some people who go to war already have or would in any case have developed other kinds of problems. But it is to say that it is important for us to avoid leaping immediately to the conclusion that if someone has been at war and found the experience harrowing, therefore they are mentally ill.
It will take much to help ease the suffering of servicemembers and veterans. Still, as a beginning, you might consider finding an opportunity to talk to at least one person who has been at war (not just a current one), and looking for a way to let them know that you consider their intense emotions and painful struggles to be signs that they are human.
March 27, 2011
They Suffer in Silence
It happened again this week, first in an online article and then in a public place: The depths of silent suffering that war veterans endure appeared. Each of these two appearances is tragic on its own, and what is also devastating is that the silent suffering goes deeper and stretches more broadly across this nation and others than most of would begin to imagine.
In a piece on Wednesday at Salon.com[1], titled "My Dad is Gone, But I Can't Let Go of His Things," although the focus was on the writer's inability to throw out the father's belongings, interwoven in the article was the information that the father who died had been a war veteran, was living alone "in a room rented to him by the Veterans Administration" when his family would not take him in, and died from a pill overdose. Ah, no, another one?! And was the overdose on purpose or from the kind of drug cocktails,[2] or mixtures of drugs, that the VA hands out liberally and that has alarmed the Department of Defense because of deaths caused by drug interactions? The writer doesn't say, although the veteran had talked at the VA about killing himself, but either option is horrible, and deaths of veterans are happening far too often in both ways.
In a public, recreational area, I saw a Vietnam vet whose torment, like that of many, continues these four decades after he came home from war. The person on whom he ought to have been able to count the most for understanding and support primarily feels irritation and anger about his suffering. He is one of the most life-affirming people who ever walked the earth when he comes out of these states, but now that the torment has again become a tsunami, even his adored children do not bring a smile to his face. Watching, I could see that the skill and speed with which he can usually manage work and the warmth and graciousness of his way with people are not at this time available to him.
Is it the combination of drugs he is on, the inability of those closest to him to offer what he needs, the fortress around him that keeps away the people who want to be there for him, or some combination of these? The answer is unknown until something happens to help relieve his suffering, and at this point it is impossible to predict what that could be.
In the brilliant novel, Oldest Living Confederate Widow Tells All,[3] the widow, seeing that four decades after her husband's war, he returns to the battlefield where he saw his best friend killed, wonders "at the headlock History still had on my man," asks whether it will ever end, and struggles to find a way to bring him back from where he has gone.
Our uncertainty about how to bring these suffering souls back to where love and compassion are must not keep us from trying. What matters is that something, someone must get through. Those who love him are paralyzed with fear that he will try to kill himself, as he has tried before. When the suffering is so great, and life itself at stake, it feels unthinkable to risk any step that could harm more than help.
But let us offer to have veterans take us along by telling us how their journeys have been and where they are now. Let us listen with openness and respect, whatever our views about the war in which they fought. Let us hear what these human beings have to say about the parts of their lives where they have lived and still live in extremis, where most of us have never been. They are part of our world.
We must reach out, say we care even if they seem not to hear, even if we feel they are trying to drive us away, for it may be because they don't want to burden us, don't want anyone to see them feeling so miserable, feel confused and tormented about whether the fact that dear comrades of theirs died at war should mean that they, the survivors, ought to be unable to enjoy life themselves or ought to treasure it all the more.
In the face of their silent suffering, if we remain silent, more will feel too alone and die too soon.
[1] http://www.salon.com/life/feature/201...
[2] http://nymag.com/news/features/71277/
[3] http://www.amazon.com/Oldest-Living-C...
In a piece on Wednesday at Salon.com[1], titled "My Dad is Gone, But I Can't Let Go of His Things," although the focus was on the writer's inability to throw out the father's belongings, interwoven in the article was the information that the father who died had been a war veteran, was living alone "in a room rented to him by the Veterans Administration" when his family would not take him in, and died from a pill overdose. Ah, no, another one?! And was the overdose on purpose or from the kind of drug cocktails,[2] or mixtures of drugs, that the VA hands out liberally and that has alarmed the Department of Defense because of deaths caused by drug interactions? The writer doesn't say, although the veteran had talked at the VA about killing himself, but either option is horrible, and deaths of veterans are happening far too often in both ways.
In a public, recreational area, I saw a Vietnam vet whose torment, like that of many, continues these four decades after he came home from war. The person on whom he ought to have been able to count the most for understanding and support primarily feels irritation and anger about his suffering. He is one of the most life-affirming people who ever walked the earth when he comes out of these states, but now that the torment has again become a tsunami, even his adored children do not bring a smile to his face. Watching, I could see that the skill and speed with which he can usually manage work and the warmth and graciousness of his way with people are not at this time available to him.
Is it the combination of drugs he is on, the inability of those closest to him to offer what he needs, the fortress around him that keeps away the people who want to be there for him, or some combination of these? The answer is unknown until something happens to help relieve his suffering, and at this point it is impossible to predict what that could be.
In the brilliant novel, Oldest Living Confederate Widow Tells All,[3] the widow, seeing that four decades after her husband's war, he returns to the battlefield where he saw his best friend killed, wonders "at the headlock History still had on my man," asks whether it will ever end, and struggles to find a way to bring him back from where he has gone.
Our uncertainty about how to bring these suffering souls back to where love and compassion are must not keep us from trying. What matters is that something, someone must get through. Those who love him are paralyzed with fear that he will try to kill himself, as he has tried before. When the suffering is so great, and life itself at stake, it feels unthinkable to risk any step that could harm more than help.
But let us offer to have veterans take us along by telling us how their journeys have been and where they are now. Let us listen with openness and respect, whatever our views about the war in which they fought. Let us hear what these human beings have to say about the parts of their lives where they have lived and still live in extremis, where most of us have never been. They are part of our world.
We must reach out, say we care even if they seem not to hear, even if we feel they are trying to drive us away, for it may be because they don't want to burden us, don't want anyone to see them feeling so miserable, feel confused and tormented about whether the fact that dear comrades of theirs died at war should mean that they, the survivors, ought to be unable to enjoy life themselves or ought to treasure it all the more.
In the face of their silent suffering, if we remain silent, more will feel too alone and die too soon.
[1] http://www.salon.com/life/feature/201...
[2] http://nymag.com/news/features/71277/
[3] http://www.amazon.com/Oldest-Living-C...
March 7, 2011
What's Wrong With This Picture? Psychiatrists' Focus on Drugs and Emotional Distance
In Sunday's blog entry, "The Astonishing Power of Listening," I undertook to write a second entry that would be about the March 6 New York Times front-page article headlined "Talk Doesn't Pay, So Psychiatry Turns Instead to Drug Therapy."[1] Gardiner Harris, the journalist who wrote that story, is smart and has done brave and important work in exposing other serious problems in the mental health system.
Because this blog appears on the website for my forthcoming book about war veterans, please keep in mind that every concern raised here goes double for vets. This is both because the fact that war has shocked and devastated them is often wrongly labeled "proof" that they are mentally ill and because in the military and the VA systems, they are increasingly likely to be loaded with psychiatric drugs.
It is worth taking a look at some of the important and troubling information Harris provides in his latest piece, as well as at some serious problems with the way it is written. It is possible that the problems result from an editor's changes rather than from the writer himself, especially given Harris's sterling history.
Harris tells much of the story indicated in the headline through the experiences of Dr. Donald Levin, a 68-year-old psychiatrist who used to do a lot of "talk therapy" and currently does nothing but prescribe psychiatric drugs to patients. When patients come to him and start to talk about heartbreaking, real life problems, he sends them away, saying he is not their therapist. Was it brave of Levin to acknowledge this practice publicly? Or is he so out of touch with some of the most basic ways of being human and being in one of the "helping professions" that he doesn't even know how he sounds? Is our society so structured, even overwhelmed by the medicalizing of human problems that even a longtime psychiatric practitioner thinks at some level that this approach is acceptable? Harris quotes Levin as saying, "I had to train myself not to get too interested in [my patients'] problems." Would you see a psychiatrist if he told you that was his attitude?
Levin says he feels shame that some of his patients say he is important to them, when he barely knows them. How troubling and revealing that he attributes that shame not to healthy causes but to the fact that he "was trained in a different era." And in our era, there are plenty of colleagues who will tell him that his shame (and maybe his own missing of deeper human connections with his patients?) is unprofessional, even neurotic.
Levin's current practice of treating "1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart," in contrast to his practice in 1972 of treating "50 to 60 patients in once- or twice-weekly talk-therapy sessions of 45 minutes each" does not set him apart from most psychiatrists. Harris tells us that in 2005 a government survey revealed that only "11 percent of psychiatrists provided talk therapy to all patients, a share that had been falling for years and has most likely fallen more since. Psychiatric hospitals that once offered patients months of talk therapy now discharge them within days with only pills."
Some of the most disturbing features of this article are statements presented with no journalistic balance, no comments from people with other views. The statements purvey the notion that prescribing psychiatric drugs is mechanical, simple, and effective. Well, mechanical it certainly often is in the sense that it is often done without much heart, but it is not mechanical in the sense that it is easy to know what medication will have what effects, both positive and negative. Yet Levin's statement that in his current work he is "like a good Volkswagen mechanic" goes unquestioned. So does his statement that "there's not a lot to master in medications," as well as former American Psychiatric Association President Steven Sharfstein's assertion that brief psychiatric consultations are "very reminiscent of primary care. They check up on people; they pull out the prescription pad; they order tests," with not even a nod to the vast difference between treating physical problems that can show up on a physical exam or lab tests and treating emotional pain. The above statements are appalling assertions in light of, oh, well, so many things, but for a start, how about (1) recent admissions by major drug companies that they are cutting way back on research on psychiatric drugs, because so little is still known about how they even work; (2) Robert Whitaker's devastating revelations in Anatomy of an Epidemic[2] about the World Health Organization and National Institute of Mental Health data showing that, though psychiatric drugs help some people some of the time, on balance they do more harm than good; (3) the skyrocketing practice by psychiatrists and even family doctors of prescribing drug cocktails, multiple psychiatric drugs at once for the same person, when almost nothing is known about how these drugs interact with each other?
Sure, I know that journalists only get a certain number of column inches for any given story, and it's hard to keep the writing flowing smoothly for the reader if one keeps interrupting to present opposing views, so perhaps this one's hands were tied. Still, it would be lovely to see more stories in which nothing of such importance goes unchallenged.
See what you think about this sentence from the article: "Competition from psychologists and social workers — who unlike psychiatrists do not attend medical school, so they can often afford to charge less — is the reason that talk therapy is priced at a lower rate." Does that strike you as an apologia for the high fees that many psychiatrists charge? For how many years should psychiatrists be excused for such fees on the grounds that they are still needing to pay off the costs of their training? Levin himself says his current way of working is based on his wish to live in a certain style in which they have been living for 40 years — a far cry from, "I'm still trying to pay off my med. school tuition and the costs of my psychiatric residency." At the extreme end of the spectrum, no doubt, Harris points out that some psychiatrists charge $600 or more to treat investment bankers, and "top child psychiatrists charge $2,000 and more for initial evaluations." Just recently, a friend told me she had repeated, 15-minute appointments with a psychopharmacologist whom she paid $450 for each visit. That doctor is earning $1800 an hour.
Harris does a great job of letting Levin show us how he operates: "He was trained to allow patients to tell their stories in their own unhurried way with few interruptions, but now he asks a rapid-fire series of questions in something akin to a directed interview." Since "their own unhurried way" involves hearing the patient's troubles as the patient sees them rather than in the mold created by the prefabricated set of questions, one wonders if it occurs to Levin that he might be missing important information. Yes, he does, because he describes how, through an entire meeting with a patient, he is focusing on the man's distractibility, and only at the end of the brief session does the patient say he had been thinking of killing himself. Levin spent a full 10 minutes more than the scheduled time with this man because of the mention of suicide. Ten minutes. Wow.
Where years ago, Levin "often saw patients 10 or more times before arriving at a diagnosis," he now makes that decision in the first, 45-minute visit. No one should underestimate the harm that getting a psychiatric diagnosis can do: People have lost health insurance, lost custody of their children, lost the right to make decisions about their medical and legal affairs because of receiving what might seem like a fairly innocuous diagnostic label. Should the risks of those losses be based on a single, 45-minute visit? And I have often heard from lawyers whose clients were given diagnoses of serious mental illness after 10- or 15-minute meetings with a therapist.
Levin acknowledges that "people want to tell me about what's going on in their lives as far as stress…and I'm forced to keep saying, 'I'm not your therapist.'" Whoever would have thought that a psychiatrist would consider it not part of his role to listen to the causes of people's suffering?
Undoubtedly, we will hear protests that this guy Levin must be exceptionally steely. All I can say is that after about four decades in the mental health field, I have met some deeply caring, helpful therapists and at least as many who, like Levin, try to justify what they do but take much of the humanity out of their interactions with those who come to them for care. With that humanity missing, small wonder that Levin is disappointed when one more patient appears in his office after he thought he was finished.
Contrast that with Dr. Patch Adams,[3] who argues that the more that doctors take love and joy out of their work, the more exhausted they will be, and the faster they will burn out. Adams describes the exhilaration he feels as a result of connecting deeply and intensively with his patients. Not only psychiatrists and other therapists but laypeople as well have much to learn from Adams about the healing powers of love and joy.
The focus in this blog has been on psychiatrists, because all psychiatrists, having M.D.s, can prescribe drugs. Until recently, psychologists could not. But the American Psychological Association is pushing hard for states to give psychologists the right to prescribe drugs, they have had some success so far, and it is likely that more states will soon be added to the list of victories for that APA. We can expect, somewhere down the line, to see a New York Times story about how psychologists are doing much less talk therapy and much more prescribing of drugs. Many of my colleagues are already breathtakingly quick to refer their patients to psychiatrists, family doctors, and others with M.D.s for the purpose of getting them on these pills.
[1] http://www.nytimes.com/2011/03/06/hea...
[2] http://www.amazon.com/Anatomy-Epidemic-Bullets-Psychiatric-Astonishing/dp/0307452417/ref=sr_1_1?ie=UTF8&qid=1299565035&sr=8-1 And Harris' statement that "Recent studies suggest that talk therapy may be as good as or better than drugs in the treatment of depression [my italics] is a whopping understatement compared to what Whitaker reports about the dangers, for many people, of psychiatric drugs.
[3] http://www.amazon.com/gp/search/ref=sr_tc_2_0?rh=i%3Astripbooks%2Ck%3APatch+Adams&keywords=Patch+Adams&ie=UTF8&qid=1299567214&sr=1-2-ent&field-contributor_id=B001K7U3UY See both of Adams' splendid books: Gesundheit and House Calls.
Because this blog appears on the website for my forthcoming book about war veterans, please keep in mind that every concern raised here goes double for vets. This is both because the fact that war has shocked and devastated them is often wrongly labeled "proof" that they are mentally ill and because in the military and the VA systems, they are increasingly likely to be loaded with psychiatric drugs.
It is worth taking a look at some of the important and troubling information Harris provides in his latest piece, as well as at some serious problems with the way it is written. It is possible that the problems result from an editor's changes rather than from the writer himself, especially given Harris's sterling history.
Harris tells much of the story indicated in the headline through the experiences of Dr. Donald Levin, a 68-year-old psychiatrist who used to do a lot of "talk therapy" and currently does nothing but prescribe psychiatric drugs to patients. When patients come to him and start to talk about heartbreaking, real life problems, he sends them away, saying he is not their therapist. Was it brave of Levin to acknowledge this practice publicly? Or is he so out of touch with some of the most basic ways of being human and being in one of the "helping professions" that he doesn't even know how he sounds? Is our society so structured, even overwhelmed by the medicalizing of human problems that even a longtime psychiatric practitioner thinks at some level that this approach is acceptable? Harris quotes Levin as saying, "I had to train myself not to get too interested in [my patients'] problems." Would you see a psychiatrist if he told you that was his attitude?
Levin says he feels shame that some of his patients say he is important to them, when he barely knows them. How troubling and revealing that he attributes that shame not to healthy causes but to the fact that he "was trained in a different era." And in our era, there are plenty of colleagues who will tell him that his shame (and maybe his own missing of deeper human connections with his patients?) is unprofessional, even neurotic.
Levin's current practice of treating "1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart," in contrast to his practice in 1972 of treating "50 to 60 patients in once- or twice-weekly talk-therapy sessions of 45 minutes each" does not set him apart from most psychiatrists. Harris tells us that in 2005 a government survey revealed that only "11 percent of psychiatrists provided talk therapy to all patients, a share that had been falling for years and has most likely fallen more since. Psychiatric hospitals that once offered patients months of talk therapy now discharge them within days with only pills."
Some of the most disturbing features of this article are statements presented with no journalistic balance, no comments from people with other views. The statements purvey the notion that prescribing psychiatric drugs is mechanical, simple, and effective. Well, mechanical it certainly often is in the sense that it is often done without much heart, but it is not mechanical in the sense that it is easy to know what medication will have what effects, both positive and negative. Yet Levin's statement that in his current work he is "like a good Volkswagen mechanic" goes unquestioned. So does his statement that "there's not a lot to master in medications," as well as former American Psychiatric Association President Steven Sharfstein's assertion that brief psychiatric consultations are "very reminiscent of primary care. They check up on people; they pull out the prescription pad; they order tests," with not even a nod to the vast difference between treating physical problems that can show up on a physical exam or lab tests and treating emotional pain. The above statements are appalling assertions in light of, oh, well, so many things, but for a start, how about (1) recent admissions by major drug companies that they are cutting way back on research on psychiatric drugs, because so little is still known about how they even work; (2) Robert Whitaker's devastating revelations in Anatomy of an Epidemic[2] about the World Health Organization and National Institute of Mental Health data showing that, though psychiatric drugs help some people some of the time, on balance they do more harm than good; (3) the skyrocketing practice by psychiatrists and even family doctors of prescribing drug cocktails, multiple psychiatric drugs at once for the same person, when almost nothing is known about how these drugs interact with each other?
Sure, I know that journalists only get a certain number of column inches for any given story, and it's hard to keep the writing flowing smoothly for the reader if one keeps interrupting to present opposing views, so perhaps this one's hands were tied. Still, it would be lovely to see more stories in which nothing of such importance goes unchallenged.
See what you think about this sentence from the article: "Competition from psychologists and social workers — who unlike psychiatrists do not attend medical school, so they can often afford to charge less — is the reason that talk therapy is priced at a lower rate." Does that strike you as an apologia for the high fees that many psychiatrists charge? For how many years should psychiatrists be excused for such fees on the grounds that they are still needing to pay off the costs of their training? Levin himself says his current way of working is based on his wish to live in a certain style in which they have been living for 40 years — a far cry from, "I'm still trying to pay off my med. school tuition and the costs of my psychiatric residency." At the extreme end of the spectrum, no doubt, Harris points out that some psychiatrists charge $600 or more to treat investment bankers, and "top child psychiatrists charge $2,000 and more for initial evaluations." Just recently, a friend told me she had repeated, 15-minute appointments with a psychopharmacologist whom she paid $450 for each visit. That doctor is earning $1800 an hour.
Harris does a great job of letting Levin show us how he operates: "He was trained to allow patients to tell their stories in their own unhurried way with few interruptions, but now he asks a rapid-fire series of questions in something akin to a directed interview." Since "their own unhurried way" involves hearing the patient's troubles as the patient sees them rather than in the mold created by the prefabricated set of questions, one wonders if it occurs to Levin that he might be missing important information. Yes, he does, because he describes how, through an entire meeting with a patient, he is focusing on the man's distractibility, and only at the end of the brief session does the patient say he had been thinking of killing himself. Levin spent a full 10 minutes more than the scheduled time with this man because of the mention of suicide. Ten minutes. Wow.
Where years ago, Levin "often saw patients 10 or more times before arriving at a diagnosis," he now makes that decision in the first, 45-minute visit. No one should underestimate the harm that getting a psychiatric diagnosis can do: People have lost health insurance, lost custody of their children, lost the right to make decisions about their medical and legal affairs because of receiving what might seem like a fairly innocuous diagnostic label. Should the risks of those losses be based on a single, 45-minute visit? And I have often heard from lawyers whose clients were given diagnoses of serious mental illness after 10- or 15-minute meetings with a therapist.
Levin acknowledges that "people want to tell me about what's going on in their lives as far as stress…and I'm forced to keep saying, 'I'm not your therapist.'" Whoever would have thought that a psychiatrist would consider it not part of his role to listen to the causes of people's suffering?
Undoubtedly, we will hear protests that this guy Levin must be exceptionally steely. All I can say is that after about four decades in the mental health field, I have met some deeply caring, helpful therapists and at least as many who, like Levin, try to justify what they do but take much of the humanity out of their interactions with those who come to them for care. With that humanity missing, small wonder that Levin is disappointed when one more patient appears in his office after he thought he was finished.
Contrast that with Dr. Patch Adams,[3] who argues that the more that doctors take love and joy out of their work, the more exhausted they will be, and the faster they will burn out. Adams describes the exhilaration he feels as a result of connecting deeply and intensively with his patients. Not only psychiatrists and other therapists but laypeople as well have much to learn from Adams about the healing powers of love and joy.
The focus in this blog has been on psychiatrists, because all psychiatrists, having M.D.s, can prescribe drugs. Until recently, psychologists could not. But the American Psychological Association is pushing hard for states to give psychologists the right to prescribe drugs, they have had some success so far, and it is likely that more states will soon be added to the list of victories for that APA. We can expect, somewhere down the line, to see a New York Times story about how psychologists are doing much less talk therapy and much more prescribing of drugs. Many of my colleagues are already breathtakingly quick to refer their patients to psychiatrists, family doctors, and others with M.D.s for the purpose of getting them on these pills.
[1] http://www.nytimes.com/2011/03/06/hea...
[2] http://www.amazon.com/Anatomy-Epidemic-Bullets-Psychiatric-Astonishing/dp/0307452417/ref=sr_1_1?ie=UTF8&qid=1299565035&sr=8-1 And Harris' statement that "Recent studies suggest that talk therapy may be as good as or better than drugs in the treatment of depression [my italics] is a whopping understatement compared to what Whitaker reports about the dangers, for many people, of psychiatric drugs.
[3] http://www.amazon.com/gp/search/ref=sr_tc_2_0?rh=i%3Astripbooks%2Ck%3APatch+Adams&keywords=Patch+Adams&ie=UTF8&qid=1299567214&sr=1-2-ent&field-contributor_id=B001K7U3UY See both of Adams' splendid books: Gesundheit and House Calls.
March 6, 2011
The Astonishing Power of Listening
Studs Terkel on interviewing:
"The first thing I'd say... is ... 'Listen'. It's the second thing I'd say too, and the third, and the fourth....And if you do people will talk. They'll always talk. Why? Because no one has ever listened to them before in all their lives. Perhaps they've not ever even listened to themselves."
How sad that in the intensely psychiatrized world that is the U.S.A. in 2011, we have handed over the lion's share of compassionate listening to those who charge for it. What a coincidence that I had started writing this essay two days ago, planning to finish it today, only to discover on the front page of today's New York Times a report that even those who are classified as professional listeners are no longer particularly inclined to do that work. The story is headlined, "Talk Doesn't Pay, So Psychiatry Turns Instead to Drug Therapy."[1]
There will be two entries about this subject on my blog. The one for today is about what is wrong with our having turned over much of the work of listening to those who are paid to do it, and the next will be about some of the troubling shards in the NYT article.
How often have I overheard in restaurants sentences that still surprise and alarm me, such as, "Her partner died, and she was devastated, but I'm not a therapist, so I told her to go see one." Who decided that for human problems, even intense suffering, friends cannot possibly be enough? That we should not even start by turning to friends or loved ones? In cultures and subcultures with strong community ties, people expect that in the face of catastrophe — whether natural disaster or human calamity like war — they will take responsibility for helping the sufferer to heal and to return to the community.
In psychiatrized America, we hear three main arguments against seeking help for emotional suffering from anyone other than a trained psychologist, social worker, psychiatrist, or pastoral, marriage and family, or other counselor:
(1) "If you are suffering, you need an objective perspective on your problems." An objective perspective might help, but who says that being a trained counselor means the person is objective, has no biases, theories, knee-jerk approaches? And who says that a caring about someone — a friend, a family member — means that one cannot be helpfully objective? In any case, it's simply a myth that such a thing as true objectivity exists in relation to emotional pain. We all — therapists and laypeople — have beliefs, hopes, fears, and conflicts about the things that cause human suffering.
(2) "Friends and family fear offending or upsetting the person and thus should avoid the risk of saying something that could interfere with the friendship or the familial relationship." OK, so we cannot all do this for each other, because in some relationships there is little or no resilience that allows them to survive the ripples or the tidal waves of having different perspectives. But it is remarkable how much simply listening — and sharing times of pain — can help. I can speak from personal experience when I say that I have often been moved and pleasantly surprised by the capacity of some of my friendships to survive and benefit from greater openness. In addition, it's helpful when someone is upset if we ask them, "After you tell me what's happening, will you be wanting my advice or my perspective, wanting me to raise questions to help you talk or explore more, or just plain listen?" Furthermore, dare I say that many therapists, despite their best intentions, cannot handle it when patients bring up certain subjects. A woman who wanted to talk about having been sexually abused said that every time she brought up the subject, her therapist would ask if she wanted a cup of coffee or otherwise change the subject. And a Vietnam veteran told me that his therapist at the VA told him he had to stop talking about the memories of war that tormented him, because the psychiatrist found them too upsetting to listen to.
(3) "To help someone in emotional pain, you must have the knowledge that therapists learn in training." I have never found a therapist who could say in all honesty that they learned in training how to listen respectfully and helpfully or how to care. The most caring and effective therapists I know were caring and effective listeners and helpers before they entered their training programs. This does not mean that nothing in training is ever helpful but just that far more healing goes on in the real world than our psychiatrized society might realize. And as the deeply humane psychiatrist Dan Dorman described in his book, Dante's Cure, [2] what he has done that helped his deeply troubled patients was not only nothing he learned in his training but rather ordinary, though marvelously patient and longterm, and actually went against what his supervisors and then his colleagues thought he should do.
Not for a moment do I believe that all therapists are bad or never of use. For instance, if your pain comes from being abused, of course you will not turn to just anyone in the family or inner circle of the abuser and expect them to listen in a caring, respectful, helpful way. The problem is that too often, both laypeople and therapists themselves act as though helpful listening is only the province of the professionals…and as though they are more likely than not to be good, caring, respectful, effective listeners. Yet when someone very close to me died, astonishing compassion and support, as well as understanding and insight came from friends. These friends included women I had known to be capable of such offerings, a longtime, male friend who had previously been gracious but extremely reserved, and a man I had only just met. Nothing I learned in my training as a clinical psychologist would have helped any more than what they did.
Nearly four decades of working as a psychologist have taught me that even if one is a licensed therapist, what is most likely to help people who are suffering are the ordinary, non-technical, non-medical approaches. Listening with the intention of understanding is enormously important, and there are others. Patch Adams, [3]the physician played by Robin Williams in the movie named after Adams, lives every moment with an intense focus on bringing love and joy to others. In the company of people considered to have severe emotional problems, what does he do? He offers warmth and humor. He hugs and clowns. Recently, he told me that his record of hugging someone classified in that way was ten hours. Ten hours of caring and clowning. And when my mother, who retired some years ago from practice as a psychologist and has been one of the two best therapists I have known, heard about a young man who was in such emotional pain that he was said to be practically catatonic, she declared, "I want to take him a pizza." No one in her graduate program taught her that, but it was a great thing to do: Rather than focusing on what others called the bizarre aspects of his behavior, she reached out to him as one human being to another, connecting with the parts of him that were not tormented, with ordinary hunger and the appreciation of spontaneous giving. Did Patch's hugging and clowning or my mother's gift make all the sufferers' pain disappear? No, but many who have been through such desperate times have told me how much such offerings stayed with them, provided sustenance, and helped them move toward healing.
As Vietnam veteran David E. Jones writes about the desperate need for compassionate listening in one of the exquisite poems in his book, A Soldier's Story: The Power of Words:
Where is the voice of understanding this Soldier needs to hear?
Who'll take this place beside me when I'm choking back the fear?[4]
[1] http://www.google.com/search?q=Talk+D...
[2] http://www.amazon.com/Dantes-Cure-Jou...
[3] http://www.amazon.com/s/ref=nb_sb_ss_...
[4] http://www.amazon.com/Soldiers-Story-...
February 23, 2011
Making the World Safe for Whom?
What are we doing to the children of our military?
Whether or not you believe we are still helping the people of Iraq or Afghanistan, we cannot afford to ignore the emotions that wrack the breasts of the little ones whose fathers or mothers fly off to war.
As I wrote in my first blog on this site, the pressure many Americans feel to put a cheery face on the humans who comprise our military and on their families leads to the frequent glossing over of tender, suffering daughters' and sons' cries for help.
In a recent NBC Los Angeles story (http://www.nbclosangeles.com/news/loc...), we read of a six-year old boy whose father was being deployed by the Army to Iraq. At school, the boy drew a violent picture and said he wanted to die. According to his mother, who was about to be left alone with the child and his sibling, her son wanted to be home that day. School personnel, following a strict policy about how to respond to any student's mention of suicide, flew into action, calling a Los Angeles County psychiatric response team, which put him in an ambulance and took him to a hospital on psychiatric hold. He spent 48 hours there. His mother says he's now afraid to go to school, terrified that they will take him away again.
We can understand that school policy includes the requirement that children who show the least signs of suicidal thoughts must be taken seriously, but it's important to stop and recognize that there are alternatives to the automatic psychiatrizing of this child's fear and pain, both regarding him as mentally ill and thrusting him into the psychiatric system. Not everyone in pain is helped by getting a psychiatric label, and there are other ways to help that do not involve adding to the burdens of the person who is already suffering.
First, let's consider: "Do we want to say this child is mentally ill and plop him into the psychiatric system?" Any six-year old who loves his father would be devastated that he is about to leave, and since any six-year-old knows that some soldiers die, so of course this child was deeply sad and terrified. That should make us want to help him, but does that make him mentally ill? And in a country at war, should we be surprised to see some children, especially children of servicemembers, producing pictures filled with violence? Consider the messages especially boys receive: "Daddy is supposed to be my hero. I should try to be like him. He is going off to fight a war. Violence looms large in my life. War is taking Daddy away. But as an Army child and especially as a boy, I'm not supposed to be sad. So what do I do when Daddy is leaving, and Daddy may die, and that breaks my heart?"
As for what else school personnel and other caring people might do: Whatever happened to listening? To trying to understand what this child's life and indeed that specific day in his life was like — and why — and whether there are better, compassionate, even more effective ways to help than grabbing him from his mother, the one parent he thought he would go home to at the end of that school day, the person from whom he is probably best able to receive solace and understanding? A five-year-old child sitting in the office of a caring principal or school counselor will hardly manage to commit suicide right there. That he was on psychiatric hold means he was given one or more psychiatric labels that will in some form be likely to stay with him (and not helpfully) the rest of his life. As is usual these days, he was likely put on quite probably heavy psychiatric drugs whose effects on children no one has managed to learn much about, except that they are often dangerous (see Robert Whitaker's new book, Anatomy of an Epidemic). And whose shocking decision was it to make this child's name public?
Another heartbreaking point in the story was that his mother, understandably eager to explain that her child's behavior was not sick, said that the violent picture he drew came from a video game. Although that is more than reasonable, it also helps gloss over the role that having one's father heading to war could play in causing a child's preoccupation with violence. In this case, just maybe that picture was simply and solely a memory from a video game. But at our peril do we ignore the way that a country and a parent at war can play in increasing that preoccupation.
The masking of the effects that war has on our children by treating it as mental illness is part of the larger cover-up of so many effects of war. The latter is what moved me to write When Johnny and Jane Come Marching Home. And it reminds me of a lecture I attended shortly before President George W. Bush started the war in Iraq. The lecturer was the brilliant political thinker and journalist James Fallows. He told the audience he had interviewed dozens of highly-placed experts about whether or not they believed the U.S. should start that war, and he asked us what factor we would guess had distinguished those who said "yes" from those who said "no." The answer: Those who said "no" were vastly more likely than those who said "yes" to have been to war themselves. The message was simple and powerful: Knowing what war really is makes one less likely to advocate going to war.
Related to this, in an otherwise gratifyingly positive Publishers' Weekly review of When Johnny and Jane Come Marching Home (http://www.publishersweekly.com/978-0...), the reviewer speculated that some readers might be "impatient" with my "belief that listening to veterans will somehow bring an end to war." When I read that, I could only wish that everyone had heard Jim Fallows's speech that day and that everyone could have the chance to hear a veteran's story about the realities of war, for which no veteran ever told me they were — or could possibly have been — prepared. In the United States, where most of us have never been in combat, we are illiterate when it comes to knowing what war is. If every American interviewed a vet, we would educate ourselves and our nation about what is actually happening when our government goes to war. And it gives me hope that the more we listen to vets, the less likely we are when the next war comes to assent in innocent silence.
Whether or not you believe we are still helping the people of Iraq or Afghanistan, we cannot afford to ignore the emotions that wrack the breasts of the little ones whose fathers or mothers fly off to war.
As I wrote in my first blog on this site, the pressure many Americans feel to put a cheery face on the humans who comprise our military and on their families leads to the frequent glossing over of tender, suffering daughters' and sons' cries for help.
In a recent NBC Los Angeles story (http://www.nbclosangeles.com/news/loc...), we read of a six-year old boy whose father was being deployed by the Army to Iraq. At school, the boy drew a violent picture and said he wanted to die. According to his mother, who was about to be left alone with the child and his sibling, her son wanted to be home that day. School personnel, following a strict policy about how to respond to any student's mention of suicide, flew into action, calling a Los Angeles County psychiatric response team, which put him in an ambulance and took him to a hospital on psychiatric hold. He spent 48 hours there. His mother says he's now afraid to go to school, terrified that they will take him away again.
We can understand that school policy includes the requirement that children who show the least signs of suicidal thoughts must be taken seriously, but it's important to stop and recognize that there are alternatives to the automatic psychiatrizing of this child's fear and pain, both regarding him as mentally ill and thrusting him into the psychiatric system. Not everyone in pain is helped by getting a psychiatric label, and there are other ways to help that do not involve adding to the burdens of the person who is already suffering.
First, let's consider: "Do we want to say this child is mentally ill and plop him into the psychiatric system?" Any six-year old who loves his father would be devastated that he is about to leave, and since any six-year-old knows that some soldiers die, so of course this child was deeply sad and terrified. That should make us want to help him, but does that make him mentally ill? And in a country at war, should we be surprised to see some children, especially children of servicemembers, producing pictures filled with violence? Consider the messages especially boys receive: "Daddy is supposed to be my hero. I should try to be like him. He is going off to fight a war. Violence looms large in my life. War is taking Daddy away. But as an Army child and especially as a boy, I'm not supposed to be sad. So what do I do when Daddy is leaving, and Daddy may die, and that breaks my heart?"
As for what else school personnel and other caring people might do: Whatever happened to listening? To trying to understand what this child's life and indeed that specific day in his life was like — and why — and whether there are better, compassionate, even more effective ways to help than grabbing him from his mother, the one parent he thought he would go home to at the end of that school day, the person from whom he is probably best able to receive solace and understanding? A five-year-old child sitting in the office of a caring principal or school counselor will hardly manage to commit suicide right there. That he was on psychiatric hold means he was given one or more psychiatric labels that will in some form be likely to stay with him (and not helpfully) the rest of his life. As is usual these days, he was likely put on quite probably heavy psychiatric drugs whose effects on children no one has managed to learn much about, except that they are often dangerous (see Robert Whitaker's new book, Anatomy of an Epidemic). And whose shocking decision was it to make this child's name public?
Another heartbreaking point in the story was that his mother, understandably eager to explain that her child's behavior was not sick, said that the violent picture he drew came from a video game. Although that is more than reasonable, it also helps gloss over the role that having one's father heading to war could play in causing a child's preoccupation with violence. In this case, just maybe that picture was simply and solely a memory from a video game. But at our peril do we ignore the way that a country and a parent at war can play in increasing that preoccupation.
The masking of the effects that war has on our children by treating it as mental illness is part of the larger cover-up of so many effects of war. The latter is what moved me to write When Johnny and Jane Come Marching Home. And it reminds me of a lecture I attended shortly before President George W. Bush started the war in Iraq. The lecturer was the brilliant political thinker and journalist James Fallows. He told the audience he had interviewed dozens of highly-placed experts about whether or not they believed the U.S. should start that war, and he asked us what factor we would guess had distinguished those who said "yes" from those who said "no." The answer: Those who said "no" were vastly more likely than those who said "yes" to have been to war themselves. The message was simple and powerful: Knowing what war really is makes one less likely to advocate going to war.
Related to this, in an otherwise gratifyingly positive Publishers' Weekly review of When Johnny and Jane Come Marching Home (http://www.publishersweekly.com/978-0...), the reviewer speculated that some readers might be "impatient" with my "belief that listening to veterans will somehow bring an end to war." When I read that, I could only wish that everyone had heard Jim Fallows's speech that day and that everyone could have the chance to hear a veteran's story about the realities of war, for which no veteran ever told me they were — or could possibly have been — prepared. In the United States, where most of us have never been in combat, we are illiterate when it comes to knowing what war is. If every American interviewed a vet, we would educate ourselves and our nation about what is actually happening when our government goes to war. And it gives me hope that the more we listen to vets, the less likely we are when the next war comes to assent in innocent silence.
January 19, 2011
A Year Ago Today: Finding the Sacred on January 19
In the many years since I discovered the first seeds that grew into my book about war veterans, I have met many who have granted me the gifts of their time and their remarkable honesty about what they have been through. One year ago today I met the veteran who, most of all, took me with him, with astonishing courage and intense particularity, through the greatest number of intensely personal, excruciating times at war. He allowed me to see both the devastation those times had caused him and the glories he found or created in life through the multitude of his generous connections with other, suffering people and his continual creations of artistic beauty.
Every time I listen to veterans tell me their stories, the word sacred comes into my consciousness. For a long time, I did not know why. How could listening to stories of the worst of horrors make me feel that I was in a sacred time and place?
Because the stories shook me so, as the January 19 veteran had warned me they would, I had thought that after I finished writing the book, I would flee from war. But when I completed the writing last May 30, I found myself not yet ready to leave. I do not like to suffer, do not relish knowing these stories, but the honesty of veterans of wars from World War II to the current ones and the power of what they had shown me would not release me. So I reread War and Peace for the first time since I was a teenager. I read Matterhorn. And then the brilliant Oldest Living Confederate Widow Tells All. All the while, I wondered, "Is something wrong with me, that I do not feel ready to escape from the world of war?"
In part, what held me, as I came to understand, was that the books I read helped me further comprehend the stories that veterans had told me, and it helped me see the astonishing commonalities — regardless of the particular war — of veterans' terror, shock, love, and longing.
And last Sunday, watching "The Man Who Will Come," an Italian film about World War II, I am struck by the thought that the time and place of listening to veterans' stories are sacred because they bring me to the core of life, which is composed of life and love and death, to human experience at its most intense. This brings me as close as I have ever been to the understanding that silence in the face of cruelty or violence in any form destroys the soul and to the vision of how love and honesty are what affirm the glory of life.
Every time I listen to veterans tell me their stories, the word sacred comes into my consciousness. For a long time, I did not know why. How could listening to stories of the worst of horrors make me feel that I was in a sacred time and place?
Because the stories shook me so, as the January 19 veteran had warned me they would, I had thought that after I finished writing the book, I would flee from war. But when I completed the writing last May 30, I found myself not yet ready to leave. I do not like to suffer, do not relish knowing these stories, but the honesty of veterans of wars from World War II to the current ones and the power of what they had shown me would not release me. So I reread War and Peace for the first time since I was a teenager. I read Matterhorn. And then the brilliant Oldest Living Confederate Widow Tells All. All the while, I wondered, "Is something wrong with me, that I do not feel ready to escape from the world of war?"
In part, what held me, as I came to understand, was that the books I read helped me further comprehend the stories that veterans had told me, and it helped me see the astonishing commonalities — regardless of the particular war — of veterans' terror, shock, love, and longing.
And last Sunday, watching "The Man Who Will Come," an Italian film about World War II, I am struck by the thought that the time and place of listening to veterans' stories are sacred because they bring me to the core of life, which is composed of life and love and death, to human experience at its most intense. This brings me as close as I have ever been to the understanding that silence in the face of cruelty or violence in any form destroys the soul and to the vision of how love and honesty are what affirm the glory of life.
December 21, 2010
War's pain, unshared, creates despair. When shared, it can lead toward connection and healing.
As the holidays approach, it feels right to write my first-ever blog, creating it for this site, which is about a subject that has become dear to my heart -- veterans of all wars, those who love them, and every citizen of every country who wants to understand what veterans have been through and what they struggle with now, as well as everyone who maybe wants to try to help.
War's pain, unshared, creates despair, creates chasms between those who could otherwise be close and help each other through the pain. Early in 2010, I wrote my forthcoming book, When Johnny and Jane Come Marching Home: How All of Us Can Help Veterans (MIT Press will publish it in March, 2011), and what I heard from veterans while working on the book and since then makes thoughts of this month's holidays excruciating.
On television this week, I watched a news item showing young children at a Christmas party observe as the man dressed as Santa Claus removed his costume, revealing camouflage military garb beneath, and then removed his beard, revealing him to be their father, home on leave and surprising them. It seemed a perfect metaphor for the jollity, the "everything's swell" front that servicemembers and their loved ones are supposed to display rather than the wrenching pain of separations and losses that war creates, the physical and emotional chasms that everyone prays will be speedily bridged during brief or even not-so-brief times of home leave. How fast and effectively can these chasms be bridged, when the servicemember's and the rest of the family's lives have been so recently so different, when the children and spouse may be deeply hurt, enraged, or both because of the one parent's absence, or when they may have idealized the absent parent to a degree that no human being could ever match? And how bittersweet to want to bridge those chasms, to reconnect closely and deeply, while knowing that that parent will soon again leave.
During this holiday time, it seems more important than ever to be willing to listen to what veterans and their loved ones want to tell us, if we let them know that we are here, that we will listen.
In recent months, at performances of three plays I have written about war veterans, audience members have included current servicemembers, veterans of many wars, servicemembers and veterans with widely disparate views of their wars and of war in general, peace activists, and people who fall into none of the above categories. But in post-performance discussions, I have seen them together form choruses of people crying out for the importance of all of us learning the truth about war. It is not healthy for veterans, for us nonveterans, or for the human race to maintain the chasm between those who know about war firsthand and the rest of us, for we share the Earth and need to learn about the important things that happen on it and how it affects those most at risk. We need to learn from each other, and through that learning, to begin to increase the number of important, compassionate, human connections in the world.
War's pain, unshared, creates despair, creates chasms between those who could otherwise be close and help each other through the pain. Early in 2010, I wrote my forthcoming book, When Johnny and Jane Come Marching Home: How All of Us Can Help Veterans (MIT Press will publish it in March, 2011), and what I heard from veterans while working on the book and since then makes thoughts of this month's holidays excruciating.
On television this week, I watched a news item showing young children at a Christmas party observe as the man dressed as Santa Claus removed his costume, revealing camouflage military garb beneath, and then removed his beard, revealing him to be their father, home on leave and surprising them. It seemed a perfect metaphor for the jollity, the "everything's swell" front that servicemembers and their loved ones are supposed to display rather than the wrenching pain of separations and losses that war creates, the physical and emotional chasms that everyone prays will be speedily bridged during brief or even not-so-brief times of home leave. How fast and effectively can these chasms be bridged, when the servicemember's and the rest of the family's lives have been so recently so different, when the children and spouse may be deeply hurt, enraged, or both because of the one parent's absence, or when they may have idealized the absent parent to a degree that no human being could ever match? And how bittersweet to want to bridge those chasms, to reconnect closely and deeply, while knowing that that parent will soon again leave.
During this holiday time, it seems more important than ever to be willing to listen to what veterans and their loved ones want to tell us, if we let them know that we are here, that we will listen.
In recent months, at performances of three plays I have written about war veterans, audience members have included current servicemembers, veterans of many wars, servicemembers and veterans with widely disparate views of their wars and of war in general, peace activists, and people who fall into none of the above categories. But in post-performance discussions, I have seen them together form choruses of people crying out for the importance of all of us learning the truth about war. It is not healthy for veterans, for us nonveterans, or for the human race to maintain the chasm between those who know about war firsthand and the rest of us, for we share the Earth and need to learn about the important things that happen on it and how it affects those most at risk. We need to learn from each other, and through that learning, to begin to increase the number of important, compassionate, human connections in the world.
