Shrink Rap (Psychology Books) discussion
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Introduce Yourself.... if you'd like
I'm Janelle, I'm a masters level clinician working as a therapist and/or case manager for a permenant supportive housing program for homeless families. I'm a new therapist, I've been in the field post masters for one year. My orientation tends to be a cross of humanism and CBT. My interests are wide, but primarily trauma work, women's issues, and I'm dedicated to the idea that housing is a human right not a privledge. Outside of work I go through phases of what I like to read, right now nothing but pure escapeism!
Hi, I'm Allison and I just joined this group. I found this group through researching reviews on Love's Executioner, a book my friend lended to me that I am working my way through now. I am going back to school to get my master's in School Counseling. I want to work with middle school/high school ages because I'm most interested in helping kids deal with anxiety, depression, bullying, suicide and friendship issues. I've been adding a lot of YA books to my to-read, and I just added Thirteen Reasons Why, after reading one of the threads about this book. I am really excited about starting this new career and I would love to discuss with anyone who's going for the same thing about it, your struggles, what you like, what you don't like. I'm so happy I joined this group and I can't wait to discuss with all of you really soon!
Welcome, Janelle, Allison!You're both working on areas that are so critical to our society's future - good luck in pursuing your passions. There are people out there who haven't met you yet but whose lives will be changed for the better, maybe dramatically, by your efforts.
Even though this is an old thread, I decided to post anyways. I'm Mandy. I have a PhD in clinical psychology and I teach at a local college and do some clinical work on the side. If you have ever read Irvin Yalom, I believe strongly in all his views (except for atheism) and practice from a similar perspective. He is my mentor! I believe there is some value in every major school of thought or therapy in our field and each individual client requires the right mix of those for therapy to succeed. I love teaching and sharing my knowledge with young people. It inspires me!
I'm surrounded by people interested in psychology..fantastic! I'm a humble student in the second year of my BA in psychology. I think I want to do clinical psychology. Everything in psychology interests me, I can't narrow it down to one, or a few areas, I love the lot of it! I read whatever psychology books that I can get my hands on. I especially like learning about the psychology of politics, racism, prejudice, power etc as I think those are relevant issues in todays society. I think mental disorders are facinating, and I can't wait to learn more about them. Any recommendations on books relevant to these topics would be very welcome.
My name is Eddie. I am in the last year of a double major (Psychology and Philosophy) at Portland State. Its taken me 12 years, four universities, and three states, to get this far. I am motivated a whole lot more by ideas and experience and understanding than I am grades. I know, I know... I've been chastised by professors about this... I've not turned in papers because I felt it was incomplete or inadequate. I'm the idea guy, not the project manager. I can read a book in a night or one paragraph and go for a walk. I can read one at a time or from a dozen at a time. I am, agin, motivated on the idea and forms underneath them.
Currently, aside from bartending (ten years) and owning two cats, both of which give me insight into personality, I am trying to affect some positive change in the lives of military combat veterans, of which I am one (Marine Corps: Desert Storm; and National Guard: Iraqi Freedom II). I find my experiences with PTSD discussion (or as I prefer, combat stress injuries) to be limited, disconnected, or problematic. Frankly put, the discussion of something among academics is one thing, that same discussion presented to a population is another. Example: Using an introduction of some of the classifications in the DSM about PTSD for a group of combat veterans has disastrous effects. We are the ones who run into the places others run out of, don't tell us about our fears and helplessness.
Another issue that has grabbed my attention is the historical, cultural, and philosophical shapings of our beliefs. What schemas do we 'manly men who are soldiers' have that allow us to come to terms with our grief, or to even acknoledge that we do have grief? The superiority of the stoic attitude in the military culture continues unchecked. What other definitionso of bravery and courage might I illustrate that have breathing room for things that are other than the hypermasculine idealizations of our military culture?
I keep moving around in my mind what I'll do after graduation this summer. At 38 years old I need some sort of plan, but I am blessed/cursed in that I care not one bit for a job... I'm looking for a calling to make a big change.
HiI'm Leslie. I'm a layperson who is very interested in psychology. I am in therapy for PTSD and disassociative issues. I love to read memoirs and books about psychology. A friend just introduced me to Sheldon Kopp. I'm really enjoying his books, Irvin Yalom, many others. I'm also a writer, working on a memoir, which explores the issues of trauma, religion, family.
Welcome, Eddie and Leslie, and Semper Fi to Eddie! I retired from the Marine Corps in 1996 after 20 years (in as a private at 17, out as a captain at 37) and started a second career as a therapist. PTSD is one of the issues I've focused on, although few of my clients have been veterans.I found my own experience with PTSD (stemming from both severe abuse in childhood and some experiences in the military) very useful in working with others. My stance on self-disclosure is based on asking myself, before I say whatever has come to mind, "Would I be talking about this for the other person, or for myself?" If it's to serve their therapy, and I can frame it in terms of "here's a way that might work to deal with that", I'll be open.
I started a PTSD group in the state prison system's psychiatric hospital here. The guys in the group asked why I was doing the PTSD group, and I just told them that since I've been dealing with it since I was a kid, I've specialized in it. I started by framing it as a successful adaptation to very difficult circumstances and gave them credit for getting through situations that some people might not have, then tried to take the DSM jargon they'd had tossed at them over the years and putting it in plain English - I used some of my own experiences to describe what hypervigilance looks like, and one of the guys stood up, pointed at me, and said "You DO have this!" The group was off and running, with a problem-solving and skill-building orientation, from that point on.
A professor and an internship supervisor when I was in school recommended I look into EMDR training - my initial impression was that it sounded way too woo-woo to be legit, but these were both people I respected a lot, so I did the training, and I've found it very useful for some clients with PTSD. I always recommend that people take a look at it, along with other cognitive-behavioral tools.
The other areas I've concentrated on have been addictions and mood disorders, and they often come in the same package as PTSD. I've co-written a couple of books on treating addictions (one in the second edition now, the other with the fourth edition in the works) and wrote one solo on integrating 12-Step recovery work into addiction therapy. That's another set of tools I recommend to people, although I've never been one of those folks who think it's for everyone.
Bibliotherapy can be invaluable too. For PTSD, a couple of books that I've gotten a lot from have been Levine's Waking the Tiger and Getting Through the Day by Napier.
Again, welcome, and the best of luck to you.
I've not heard of those two books, thanks for the add. I am working on a research project right now where we are creating resources for partners/spouses of veterans with PTSD. I've encountered EMDR. It gets a lot of resistence in some circles, but those that work with PTSD (at least the ones I've met) have good things to say about it. It is more attractive than psychoanalysis.
Thanks a lot for the recommendation and Semper Fi.
I remembered some other books you might find useful in working with veterans. Two are by Jonathan Shay - Achilles in Vietnam and Odysseus in America. The Chambers of Memory by H.W. Chalsma is also excellent; all three of these were written by doctors who have done some great work with veterans via the VA. Last thing that comes to mind at the moment is a pair of books titled On Killing and On Combat, both by a psychologist named Dave Grossman who is also a retired Green Beret lieutenant colonel.My wife Jan is a clinical social worker, and did an internship at a VA community center in Santa Fe; she did some individual and group work with family members of veterans and really clicked with them.
She was hoping to find a job at the VA hospital here in Albuquerque, but they haven't had openings. Since then she's worked with some folks dealing with severe trauma, including one person with DID.
Now we're most likely going to be moving to the Atlanta area - Jan hopes to find work at a residential program in Smyrna that works with people with DID.
Eddie wrote: "I've not heard of those two books, thanks for the add. I am working on a research project right now where we are creating resources for partners/spouses of veterans with PTSD..."Hi Eddie. Welcome to the group. I work in the mental health crisis/suicide intervention field & have a personal & professional interest in PTSD. I agree with James & also recommend "Waking the Tiger" as an excellent book for professionals & lay people.
Another book you may want to consider in your work with partners/spouses of those with PTSD is "I Love a Cop - What Police Families Need to Know" by Ellen Kirschman, Ph.D. While it does not address veterans specifically, men & women in police work are essentially "at war" every day. Many of the same issues, particularly with regard to being in life & death circumstances, are a constant state for families of cops.
Good luck with your schooling & career choice.
And...Blessed Be.
Geri
I think those guys you work with, James, are lucky to have you doing their group. It sounds like you really know how to address the issues. I'll have to look into those books. Thank you. Hypervigilence is something I have a hard time with. I startle really badly at things other people barely notice. It's very frustrating.
Thanks, Leslie. Unfortunately I'm no longer working other than writing. I was missing too much time due to medical problems, and I'd gotten crossways with the unit psychiatrist after he announced his intention to "break" one of the inmates on my caseload. They ended up firing the psychiatrist after he went off on another inmate with more witnesses, but I was already gone by that time. Some of the guys I was working with have been paroled, but some will never get out. One of my wife's friends is working there, and it sounds as if things have gone downhill for the patients lately - they're more understaffed than ever, which means less treatment, less time in occupational therapy and other activities, and more time just sitting in their cells.
I'm lucky - between my military retirement, VA disability, and book income, we don't have to worry about covering the mortgage and groceries and so on.
Hypervigilance is still on ongoing issue for me too; I'm always jumping out of my skin if someone comes up behind me. Drives my wife nuts.
Wecome, Mark - good luck in the field. Those are interesting questions... there is definitely a solid place for spirituality in psychology, and important as spirituality is in so many people's lives, it's disrespectful to those clients for professionals to discount it. A.A. and the other 12-step programs have a strong spiritual focus, and Jung played a role in the founding of A.A.A lot of what was once called possession is probably the manifestation of (1) mood disorders, (2) schizophrenia, or (3) dissociative identity disorder, aka multiple personality disorder. However, the truly scientific perspective is to remain open about anything until there is solid evidence for an explanation. I've never seen or heard of any objective, reproducible evidence for possession, but as they say, absence of evidence is not evidence of absence, so I am skeptical but agnostic on it.
Art and play therapy are powerful resources - often people lack the words to express what's going on but can communicate it articulately via other media. I was watching a documentary on Van Gogh earlier today - I wonder what a capable therapist might have been able to do to help his suffering by including his art in his treatment...
That's really sad. How can someone in a caring profession want to "break" a person. It sounds like people are already broken enough by life by the time they get there. It's awful how people get less treatment and more warehousing. It makes me mad!!The other day my daughter got the idea of hiding behind a counter and jumping out to "scare" me, which surprised me, because she's 16 and she knows how easily startled I am, but she said she couldn't resist. So, after screaming to the top of my lungs, my heart was beating so hard I felt like I was going to need cpr and I was breathing hard for several minutes. UGH!!! I think she was surprised I reacted so strongly, and she's very caring, so I don't think she'll do it again. I think she felt kind of bad, actually. But to most people it's funny when someone gets startled. It's so frustrating.
You're dead on about the patients in a prison psychiatric hospital often being broken by life; I think that doctor was recreating his own unresolved issues of feeling not up to the demands of the job and finding himself scared of a lot of the guys in there. So it brought out the bully in him.That particular patient (I'll call him J) was a scary guy, I'll concede - bigger than most, very powerful physically and pretty experienced at a mixture of martial arts; worked out a couple of hours a day and built like a gorilla. Once J had shut himself in his cell when they wanted to bring him out for some reason; they brought in the five-man extraction team - huge guys, helmets, body armor, etc. The normal drill is that first they pump enough pepper gas in through the food port to make the cell totally foggy; then they open the door and charge in tightly stacked - the lead man has a plexiglass shield with a stun gun built into it, and he slams into the inmate and simultaneously zaps him and knocks him flat, continuing on to land on top of him while the other four team members each grab a wrist or ankle and immobilize it. In J's case, the gas went in, the door opened, the team charged, and J came straight out of the cell, wiped out the extraction team without slowing down and then did a kind of victory lap around the pod before he went back to his cell.
This guy was pretty volatile due to a mixture of PTSD, bipolar disorder, and having been acculturated to a lot of violence from early childhood on. He'd been repeatedly molested by older boys; saw a lot of family violence, culminating in seeing his mother shoot his father in the head and kill him, on his seventh birthday; and gotten an early start with alcohol and other drugs. Not long after that he got in enough trouble to get sent to the juvenile prison for boys that used to be nicknamed "the gladiator academy," where he found himself both the youngest and smallest kid in his barracks and also the only white kid (and blond at that) in a barracks that was otherwise all people of color.
He did want to improve his quality of life when I was working with him, though, which meant getting the tools and techniques to stay sober and avoid or manage the unwanted PTSD/mood symptoms. Motivated, because he was getting close to parole and the chance to get to know a teenage daughter he hadn't seen since she was a toddler; he'd been clean and sober for a while at this point and was proactively applying everything we were covering in his treatment. But he still wasn't inclined to respond well to condescension and found the psychiatrist irritating (as did just about everyone), and that showed although he didn't get out of line. So the psychiatrist took a look at the guy's history and got scared. If he'd "broken" him as he intended, the guy would have decompensated to the point he'd have had to spend the rest of his sentence locked down 23 hours a day in a maximum security pod instead of being in an open unit where, within the building, he could eat with his friends, shoot baskets, wander down the hall to my office or the vocational therapy shop, etc. The doc was really afraid any time he passed this guy, or others like him, in the open hallway. Not sure why he took that job to begin with, but he didn't belong there.
I checked, and was pleased to see that the inmate in question did successfully make parole and appears to be staying out of trouble. He had a pretty decent plan, to live and work with an uncle who had an auto repair business (this guy's pretty mechanically adept), get active in their church with them, continue therapy as an outpatient, and get into AA and/or NA. If he's following that plan, he's far enough from where he got in trouble to avoid the lure of old friends and activities, but close enough to be able to see his daughter regularly. I hope things are going well.
Wow, what a sad story--but with a good ending! I'm glad. There are so many people who hardly have a chance, their childhoods were so terrible. It's like some people have to dig themselves out of a 20 foot deep pit with just thier fingernails just to get to ground level. I'm glad this guy has a chance now. I'd be scared to death to be in a place like that, but I have the sense not to try and get a job there!!!! That is strange. I feel very lucky that I never got involved with drugs and alcohol to try and self-medicate. It's not that I wouldn't have, but I got heavily involved when I was 16 with a church that most people consider a cult. It did a lot of damage--I guess it was my form of self-medication--but you didn't drink or do drugs if you went to that church. It's very much fundamentalist and strict. So, in spite of the negative stuff, it did save me from all that and now that I'm not part of it anymore, I am grateful that I'm not dealing with the dual diagnosis of substance addiction/ptsd that so many people are. That sounds so, so hard. Just ptsd is hard enough!
Do you miss seeing people in therapy? It seems like it would be incredbly rewarding, and just as incredibly difficult, demanding, and frustrating. I really admire people who do it, especially knowing how much my therapist has helped me and what a difference he's made in my life.
It was interesting - I only had a couple of nervous situations while I was working there; there were a few times with guys who had serious self-injury problems when it was hard to deal with the blood. Still, overall, I felt more connection and felt more at home with most of those guys than with any other group of clients I've met. There were some other therapists there that got to be good friends, too.I've kept working with my own therapist all along, and when I told him that he cracked up and said "So you've found your people - they're the criminally insane."
The thing is, I found myself looking at these guys' lives over and over and realizing that if I hadn't gotten a couple of lucky breaks as a kid that they hadn't, I could easily have been right where they were and vice versa. I have a huge amount of admiration for the capacity for survival and resilience of a lot of those guys.
As for self-medication, it seems people can get hooked on anything that can make them feel better - relieving distress or increasing pleasure - quickly, on demand. Drugs, relationships, exercise, work, adrenaline rushes, intense emotions, etc. all work. Religion can definitely be that way.
Many, if not most, people in recovery from addictions are also living with other disorders; addictive problems lead people into situations where they're at greater risk for trauma and tweak brain chemistry directly, sometimes irreversibly, and if people start with other disorders, they're primed for self-medication for symptom relief - there are strong correlations between particular types of disorder and classes of psychoactive chemicals (e.g. people with schizophrenia are much more likely to use tobacco than average because nicotine relieves some of their symptoms; people with antisocial tendencies are more likely than average to abuse stimulants because of the thrill-seeking element of that personality style.)
I miss working with clients sometimes, but I can't depend on waking up with a pain level that will let me work on a given day. And I do like writing, and working at home in sweats without being tied to a clock; I tend to get most productive starting at about 10:00 pm.
I agree completely--I hate it when people get all judgemental when they see homeless people, or others in difficult situations. I feel angry because I know exactly what you said--they aren't standing on the street with a sign that says will work for food because they are bad and I'm not driving in my car to my job because I am good. If I had been born into their circumstances, I could very easily be the one with the sign and vice-versa. I'm sorry you're dealing with that kind of pain level, it sounds very difficult.
My sister is a research fellow at Columbia and her specialty is schizophrenia, actually, passion would be a better word. She has told me a little about the nicotine connection. It's pretty interesting, some of us want uppers, some want downers. I have prescriptions that decreases my anxiety level.
Another interesting connection is how the level of mood disorders is so high among poets and writers and the level of ocd and frontal lobe epilepsy is so high among scientists, inventors, and mathemeticians. It's pretty amazing how everything is connected the way it is!
Leslie wrote: "Another interesting connection is how the level of mood disorders is so high among poets and writers and the level of ocd and frontal lobe epilepsy is so high among scientists, inventors, and mathemeticians. It's pretty amazing how everything is connected the way it is!"Leslie, you brought up a particular interest of mine - the connection between "mental illness" and extraordinary talents or characteristics. So, I've proposed a topic of discussion to the Shrink Rap group: "On Creativity and Mental Illness".
Many creative individuals throughout history have struggled with some sort of mental illness or neurological disorder (such as epilepsy), whether it was recognized in their own life & times, or have been diagnosed posthumously. Well-known cases include: Abraham Lincoln, William Blake, Winston Churchill, Kay Redfield Jamison, Patty Duke, John Nash, Vincent Van Gogh, Saint Teresa of Avila, to name just a few.
I believe that many brain/mind "illnesses" can result in expressions of artistic creativity or philosophical/spiritual insight, and that many of humankind's greatest individuals have tested their mettle by coping with their disorder. Even personality disorders lend themselves to characteristics commonly seen in notable people of history, although sometimes with negative or disastrous consequences. While Stalin or Hitler easily come to mind as extreme examples of psychopathy, the fictional character Scarlett O'Hara would cease to be without her histrionics.
Question: Whether biographical, historical or even fictional, what books, individuals or characters describe or highlight a connection between mental or brain disorders and creativity or greatness?
Additional Topic of Discussion: By therapeutic or pharmaceutical intervention, are we hindering creative expression?
I'll start off with one such example, "Touched with Fire: Manic-Depressive Illness and the Artistic Temperament" by Kay Redfield Jamison.
It seems as if (I think Dr. Jamison said this but don't recall for certain) that the most creative part of the bipolar cycle is hypomania; once it goes the rest of the way to mania, one is too scattered and chaotic to organize efforts to do anything, and during the depressive phase it's hard to even do things like getting out of bed, eating, and taking care of basic hygiene.I am bipolar. Luckily, I am able to manage it with meds, but I can remember from the decades before my diagnosis several years ago how I often depended on hypomania to enable me to get more done; I didn't get as far into either mania or depression as many do, so I was able to ride out those periods, and I spent most of my time somewhat hypomanic. It made it possible for me to basically spend a decade working a full schedule and carrying a full academic load evenings and weekends, so I was able to go into the military with a high school diploma and retire with three degrees; it also made it possible to write a couple of books while working a brutal schedule.
Now that I'm not operating that way I don't have anything like the endurance I used to have - but I also don't make the kind of impulsive decisions that left me with major messes to clean up or obligations to fulfill, and I don't have to cope with the bleak periods of depression I used to have - my range is narrowed but there's still enough variety that it's not as if I feel numbed, as some people complain of when on their meds.
All in all this is better. I can still be creative, I just can't do as much as fast; I'm retired now except for writing, so I can still do that, but I don't think I'd be able to if I was trying to fit it in around a normal work schedule. Of course, aging is probably a factor too.
It's a really interesting topic on many levels. I've known for a long time about the connection between mood disorders and creative people, because of reading Touched By Fire, but it was a book I read that connected ocd and some forms of epilepsy to inventors and mathemeticians that opened my eyes to a bigger picture. I don't remember the name of the book. I will try and research it and find it--it was fascinating. Another interesting connection is that of epilepsy, anorexia, self-mutilation and saints and holy people from the past. The symptoms that were so revered back then would be diagnosable these days! Also, the people who smell sulphur and then went into "holy ecstacies"--they think it was a kind of epilepsy. It's all so fascinating.James, do you miss they hypomanic periods? A lot of people won't take their meds, they just can't give up that feeling.
As far as the point Geri brought up--it's a good question that probably has no answer. I think, in general, that treating people enhances their creativity, but there is a price, as well. For instance, if Sylvia Plath and Anne Sexton were still alive, they would probably be on SSRIs and still be writing poetry. But could they write what they wrote if they weren't experiencing the emotional turmoil they were? Van Gogh--what if they could have treated him? It would be great, but his nights might not have been so starry and eerie and haunting.
To use myself as an example, I work and I'm a writer and an artist. I do collage. I went through a period where my collages and mixed media creations were so disturbing to people that the gallery owner said that she would like to display them, but they would upset people too much. I don't feel the need to make those anymore. I didn't create any thing during the times I was bearly functional. It took everything I had to make it through the work week and I stayed home and cried on the weekeds. I'm on medication now and I'm pretty stable and I'm more prolific and creative than ever, because I am healthier than ever. I can work and create. I couldn't before.
Lesley, sometimes I miss having the energy level I had when I was hypomanic, but I don't want to go back - the price is too high in terms of impulsive actions I wouldn't have taken otherwise - money spent, things said, etc. For me, getting diagnosed was a wonderful thing. I'd known since I was a teenager that sometimes my judgment was terrible, and I'd thought that it was just part of my personality - that I was less mature and sensible than other people - and felt a lot of shame about it, as well as worrying about the next time I would do something disastrous that seemed like a good idea at the time. I feared my own mind. Getting diagnosed and treated gave me an explanation that didn't mean I was just defective, and it gave me a solution so I don't have to fear either my intermittent recklessness or that cold dark crushing depression anymore. I would never willingly quit taking my meds; I think they might have saved my life, because in the normal course of the disorder it often gets more extreme as a person gets older; to me that means that without treatment I might conceivably end up in prison as an inmate or dead by suicide. I am grateful beyond words that I live in a time and place, and have resources available to me through the VA, that give me a way out of that cycle that was not available to 99% plus of the people that have ever lived, or for that matter probably over 90% of the people alive in the world today.It's kind of like being in recovery in relation to alcoholism. I've been sober coming up on 19 years now, and without the 12 Step programs I might not have been able to do that either - and that's another resource that wasn't around until three generations or so ago, a solution and opportunity unavailable to 99% of humanity through history; there too, once in a while I will miss some aspect of the old life, but I wouldn't go back for anything and know that I might well die in a bad way if I did.
I've been very lucky - a lot of people and resources have shown up in my life when I needed them most. At one point five years ago, my wife was hospitalized with a serious illness (that situation turned out okay, but it was scary at the time); my daughter was in the hospital prepping for an emergency C-section due to severe preeclampsia, and they weren't sure they'd be able to save both her and the baby (they turned out fine, thanks to some super professionals at the UC Irvine hospital); my stepfather was in the hospital with pneumonia that turned out to be lung cancer (it ended up killing him a few months later); one of my brothers had been in an accident at work and had suffered a broken leg; and things were going south at work at the prison. I was unloading all this stuff with my therapist and he said he thought I was holding up pretty well, all considered. I thought about it for a minute and it was suddenly hilarious - I started laughing and said, "Yeah - an alcoholic bipolar disabled vet with PTSD, that's definitely a formula for success." He nodded and said, "You're right - you really ought to be homeless, in prison yourself, or dead."
If I know one thing by heart, it is that no situation is so bad that I couldn't make it worse if I gave up my sobriety or my meds. I like where I am now in relation to those things, and I am willing to do whatever it takes to maintain.
Mod
Although I've been a psychologist for over 25 years, I think it's only recently that I've begun to really understand about bipolar illness (prompted by an episode of a close family member.) I've read several of Kay Redfield Jamison's books. Yes, I think she does say that hypomania is the most productive phase for creative people. She also says that she writes when she'd manic and revises when she's depressed! (I suspect it may be a little tongue in cheek, but who knows.)
Another interesting thing Jamison notes are studies suggesting that the most productive writers may not have a bipolar diagnosis themselves, but rather have a first degree relative who does. Or, as a psychiatrist who worked with one of my family members said, there are probably places on the bipolar spectrum that haven't been officially labeled, with many productive, creative people being what might be called--oh, bipolar IV or V. In other words, well aware of their vulnerability to depression, but not having faced the fact that their "creative surges" may be very mild expressions of mania. That hit home for me--especially as I anticipate the publication of my first book (at age 50-plus!) in a few weeks.
Again, a very interesting and provocative discussion. Thanks!
I've heard from a friend that the panel working on the DSM-V are going to greatly expand the coverage of bipolar disorder. It does show up in more ways, and to more degrees, than the current system allows for.I'd also like to see them expand the coverage of PTSD and explore the link between trauma and the responses that often get diagnosed as personality disorders. A lot of clinicians lack the compassion and detachment for those problems that they have for Axis I diagnoses. They could cover the relationships between various Axis I and Axis II problems, such as the fact that people often get diagnosed as having borderline personality disorder (used by too many as a 'trashcan' diagnosis) when what we're really seeing are the symptoms of untreated complex PTSD.
Congrats Blair!! How exciting! I've wondered about myself, too, since I do seem to have times of a lot of creative energy and optimism and times of pretty deep depression. We're all somewhere on a spectrum, like I have issues with disassociation, very mild compared to someone with DID, but I'm further down that spectrum than a lot of people.
James, you do a great job expressing what you've experienced--WOW!! I think any one with any back ground would have a hard time dealing with all those disasters happening at the same time.
I know what you mean about the meds. A lot of people hate the idea of being on meds the rest of their lives, and it would nice to not need them, but I'd rather take them every single day til I die than feel and live how I was before.
Have you guys ever read a book called "The Day the Voices Stopped"? It's an amazing story about a man with schizophrenia and he suffered for so long and they tried all the medicenes they had and he was in and out of hospitals, then a new drug came out and they put him on that and the voices stopped! His description of that day is so moving. I don't think I'll ever forget it! He only lived three more years, but he accomplished so much in those three years, starting groups to help mentally ill people and writing his book. It's so amazing!
Mod
I agree, James, about the misdiagnosis and Axis II bias you mention. Will be interested to see what they come up with in DSM IV.
I've sometimes thought that the more judgmental a clinician is, the more troubled and scared he/she is inside. I don't know how people can work in this field without that sense of "there but for the grace of God..." and the empathy that goes with it. I used to get in arguments with some of the other staff, the gist of my argument being that the patient in question didn't start out healthy and happy and decide to be this way.Once when I was working up in Santa Fe at the state penitentiary (same one that had the infamous 1980 riot) I walked into the mental health staff room to take a break and eat my lunch, and a couple of the other therapists were having an animated argument about something. I was walking past when one of them grabbed my sleeve and said, "Hey, Jim, diagnose me!"
I said, "What?"
She said, "Imagine that I was a client and tell me what you think my diagnosis would be."
I just said, "Well, what disorders have you taken a special interest in and focused on the most in training and your work? Whatever they are, there's your diagnosis," and sat down to eat my peanut butter and jelly sandwich.
She thought for a few seconds, then said, "Oh, (deleted)!"
Not to say that it's always like that - a lot of people have worked with serial killers and not shared their problems, for example - but I think there's often a strong correlation. I think that's why I have liked working with some clients that most of my colleagues found creepy and/or too hard to deal with, like the folks with the serious self-injury behaviors that usually get diagnosed as borderlines but always seem to turn out to have histories of horrendous unresolved trauma - even if they don't, although I haven't come across anyone like that yet, the Axis II disorders are in the book because they are disorders, not sins or grounds for judgment or rejection. I'll look at the acting-out and think it makes perfect sense, even if it isn't the most effective response to their situations.
I hadn't heard of that book, Lesley, but I want to read it. I'm putting it on my "media to get" list. I haven't worked much with people with schizophrenia, and what contact I have had has been with folks who already had their thought disorders managed with meds and were now working on trauma and mood disorders. I've always had the greatest respect for people who are coping with that combo, schizophrenia plus a serious mood or anxiety disorder - I don't know how I'd handle that; from the few people I've worked with whose schizophrenia was active, I saw that not being able to trust your own senses and perceptions is devastating - it turns life into a kind of house of mirrors and trapdoors where a person can't count on anything in their lives being the way it seems. It makes me think of that moment in the book and film "A Beautiful Mind" when some approached Dr. Nash and told him the Nobel commission was awarding him the prize for his work in game theory - the first thing he had to do was stop someone walking by and ask them whether they could see and hear the person with whom he was talking, just to make sure the whole thing wasn't a hallucination.
Welcome, Tamara - this forum has some interesting discussions going on. What part of forensic psychology holds the most interest for you?
That's what my therapist says too. That I wasn't born with these issues and I didn't give them to myself. I'm trying so hard not to drive myself crazy with obsessive thoughts. I think about things in ways that are counterproductive and waste my energy, get me upset and accomplish nothing. RRRR!!! I'm kind of dealing with that right now because I am going back to work after being gone for two months, due to having surgery. Do most therapists start out idealistic and not judgemental? It would seem like they would since they went into that field. It seems like it would be so hard not to become overwhelmed and burned out. You've mentioned self-mutilation a few times--don't most people who self-mutilate have trauma issues? It seems like so much of what is making people sick is trauma. It's an epidemic! Even though it happened to me--so you wouldn't think I would have problems believing it--I still sometimes feel just like it's hard to believe that as many people have been traumatized as have. Not that I don't believe it, I do. I think maybe the reason it's so hard to accept is that accepting that this many people have been victimized means admittng what a large number of people are perpetrators. Maybe that's it. Of course most people who do hurt people don't hurt just one person, so it's not like a one on one ratio. I think I don't want to lose my illusions about the safety of life, etc. Does that make any sense?
Trauma seems to be an inescapable part of life, and everyone gets hurt, but so is the capacity for healing and adaptation. The research on resilience seems to indicate that the most important factor in developing resilience is the presence in childhood of at least one relationship with a nurturing adult - a family member, neighbor, teacher, coach, whoever - that lasts at least a few years. I think we can find that healing as adults too, though, with awareness and the willingness to do the work.Self-injury in the form of cutting, hitting, burning, etc. is usually seen as a symptom of borderline personality disorder. My view is that, as mentioned earlier, a lot of the time when people are diagnosed with that personality disorder, their problem is actually unresolved PTSD, and that's been true of the folks I've known who hurt themselves.
Self-injury is a problem-solving response to emotional pain and the sense of powerlessness. It (1) provides a sense of having some control, similar to disordered eating patterns ("At least I can control this"); (2) it often triggers a powerful endorphin release, relieving physical and emotional pain and bringing calm and sometimes euphoria; (3) for a person experiencing dissociative numbing and its sense of unreality, it brings them back into themselves and helps end the numbness; (4) it is often a way of reenacting the trauma they've suffered; and (5) for people who don't have the concepts or vocabulary to express their pain in words, it's a powerful way to show, rather than say, how they're feeling inside.
All that said, it's dangerous, the severity tends to escalate over time in a pattern similar to the tolerance seen in addiction, and it can alienate others. Even a lot of professionals in this field respond to clients' self-injury with fear, judgment, and disgust rather than assuming it makes sense on some level (like any human behavior) and approaching it with empathy and the goal of understanding it.
I found in the prison that the guys who were the most severe self-injurers were the ones who'd suffered the most physical and sexual abuse in childhood. The most effective response was to start by calmly and matter-of-factly telling them that the behavior made sense given their histories, explain that for many "cutters" it's a survival tactic, and that the needs it meets are legitimate but there are safer and better ways to meet those needs. Then we'd talk about those five functions served by self-injury and explore alternative ways to meet each of those needs (for example, getting the endorphin release by exercising or finding something to make one laugh hard, or breaking through numbness and dissociation by focusing on sensory stimuli like music or one's visual surroundings, splashing the face with cold water, clapping one's hands, or stomping one's feet; learning to identify and name feelings.)
Life is not safe, but risk can be minimized and managed (for example, by learning to spot and avoid abusive relationships), and the only way to avoid painful feelings is to turn off all feelings, and if we do that we might as well be dead already.
Well, there are a lot of people in the jails and prisons who suffer from severe mental and emotional illnesses; America's biggest inpatient substance abuse treatment program is in the L.A. County jail, and in New Mexico where I live, the biggest psychiatric hospital in the state by far (104 beds) is in the prison system, at the Central NM Correctional Facility in Los Lunas. There are plans for a major expansion of that hospital, and it's needed, but I don't know of any plan to expand any of the much smaller (non-prison) psychiatric wards or hospitals anywhere else in the state.A lot of the people I worked with, at that hospital and in a therapeutic community (TC) addiction treatment program at the Penitentiary of NM in Santa Fe, were there because of their drug addictions - their crimes were possession, smuggling, dealing, property crimes to finance buying drugs, or crimes committed under the influence that they wouldn't have committed if their judgment hadn't been impaired.
A bunch more were people with previously untreated bipolar disorder, there because of crimes they'd committed while in manic states.
There were a fair number of people whose crimes could be attributed to antisocial personalities, but not the majority of inmates I knew, and there were some who were schizophrenic and had been in psychotic states when they committed their crimes, but again not most.
For most of the people who could be diagnosed as antisocial personalities, they had histories of severe trauma and/or neglect, the kind of thing that you could reasonably expect to lead to PTSD, attachment problems, or both.
The one thing that was always true was that very, very, few people started out healthy, sane, and well-balanced and just decided one day to become felons.
The feds did a study some years back in California and found that every dollar put into substance abuse treatment programs saves society seven dollars in law enforcement and prison expenses. Another study - I've lost the reference - showed that each dollar invested in youth substance abuse prevention programs (science-based programs using proven interventions, not stuff like DARE or "scared straight" programs) saves five dollars in treatment funding - so if we put, say, a billion dollars into prevention programs nationwide, a trivial amount put next to wars and Wall Street bailouts, the return would be a savings in the tens of billions.
We need to reform the justice system. A lot of prosecutors and law enforcement people just dismiss mental illness as not real and take the attitude that people who break the law do it because they're evil. DAs stand in courtrooms, sometimes with some of the country's best psychologists or psychiatrists on the stand, and tell juries that the disorders those specialists have diagnosed in defendants don't exist - in effect saying that they, being attorneys, know more about mental health/illness than the APA. The government side of the legal profession is all too often interested only in running up their conviction stats rather than truly serving justice or making communities safer.The administration in the prison system is interested only in keeping inmates as passive, i.e. easily managed, as possible, and the habits and qualities they inculcate are directly contradictory to the initiative and assertiveness those inmates will need after release to succeed... and the prison industry's lobbyists use their substantial clout to fight anything that will reduce the rate of incarceration, even though America's is the world's highest. They have what amounts to a slave labor force, and they make a huge amount of money.
James wrote: "Well, what disorders have you taken a special interest in and focused on the most in training and your work? Whatever they are, there's your diagnosis..." And Tamara wrote: I also just have this unhealthy interest in trying to find out what it is that makes people do what they do."
Good answer, James! Although many are loath to admit it, that's about as accurate a definition as one could have. Even if the diagnosis isn't directly obvious in many cases, I'm often intrigued by the careers people choose (and not just in psych/social work) as indicative of their personality or personal history.
And Tamara, I don't think of your interest as "unhealthy" at all - quite the contrary. Curiosity about behavior is the core of psychology. But I know what you mean. With my helper/liberal/anti-authoritarian characteristics, many folks are puzzled by my interests in police & military personnel and my fascination with evil, forensics, and historical figures like Hitler or serial killers. I suppose my interest in the evils of society stems from a "know thy enemy" approach. And knowing the experiences of family members in police work & the military, in general these are the "heroes" who more than likely possess a desire 'to protect and serve' which are vital to a civil society that allows us all our freedom, even if the result of some of their actions curtail certain individual so-called freedoms. The problem comes when 'evil' and 'police/military' become intertwined.
Thinking further on this, my interests in thanatology (death) - cemeteries, grief counseling, & even spirituality - are likely a way of dealing with my own fears about death & loss. It also helps me to appreciate life by understanding the alternative.
Another fascination I have is in the realms of de-briefing and transference/countertransference, and the use of gallows humor. (See my favorite quote by Freud at http://www.goodreads.com/quotes/show_... ) It delights me (and sometimes shocks me) what buttons can be pushed when we least expect it. When it happens to me, after the shock & denial have worn off, I use it as a tool for further exploration of another one of those cobwebs in my attic that needs clearing.
I'm reminded of a comment made by a college classmate - "Psych majors enjoy studying themselves." I've often wondered what happened to those few students who did not laugh at his comment. They probably work in administration or the insurance industry by now. (grin)
~Geri~
Yes, trauma is a part of life--one we can't avoid. Thank goodness the second part of your statement, the one about reiliance and healing is also true. I'm not a psych major, but I do enjoy studying myself--I think I'm a classic navel gazer. I gaze and then spend hours writing down everything I saw in my journal!!
What you guys are saying about the justice system makes so much sense. It's like, let's not spend 500$ to get the roof fixed this year, lets's spend 5000$ to repair all the water damage this year. Except it's about human souls, not mildewed walls. It's crazy!
Remember we were talking about Touched by Fire and the connection between creativity and mental illness? I think I found the book I read a while back that connects OCD with scientists and mathmeticians--Strange Brains and Genius: The Secret Lives of Eccentric Scientists and Madmen by Clifford A. Pickover. I'm not sure that it is the same one, but if it isn't, it's similiar.
Thanks, Leslie! I just put it on my list of books to get.
Leslie wrote: "I think I found the book I read a while back that connects OCD with scientists and mathmeticians--Strange Brains and Genius: The Secret Lives of Eccentric Scientists and Madmen by Clifford A. Pickover."Great! I've also added it to my book list. Thanks, Leslie!
~Geri~
Tamara wrote: "There has to be some core reason for the behavior. If we can figure out what that is in adults, then we can recognize the signs in younger children, therefore,attemtping to treat it before it reaches a drastic status. Like I have said before, maybe that is idealistic on my part, but if we don't start to look at these things pretty soon half the world will be in a jail or a mental institution."Tamara, your idealism is appropriate & necessary. While we as a species may be able to continue on as we have, we know instinctively that we can do better.
Whenever I have those days when I believe we're "de-volving" (especially while watching the news), I remind myself that our society has made incredible progress in a short period of time. Just within one generation, changes of attitude & behavior have taken hold. As a young child, I can recall scenes of friends or classmates being beaten or bullied & it was accepted as "normal". I, of course, did not & saw it for what it was, but felt powerless to intervene. (Which also explains my career choice.) Beating a child was viewed by the surrounding adults as proper & good discipline. While abuse certainly still goes on, unfortunately, I don't believe it occurs with the uniformity & acceptance that was "normal" even 40 years ago.
Other examples of a shift in attitudes, understanding & behavior are numerous - domestic violence, rape, pedophilia, drunk driving, just to name a few. Even treatments given by mental health professionals (water therapy, lobotomies, electric or insulin shock treatments, and just plan warehousing of patients) were lauded & accepted unequivocally 50 years ago.
So, we have made progress. No doubt, there are currently accepted therapies or practices that will be shocking to future generations. But I have faith that, as a society, we are moving in the right direction.
There are always a few hold outs, & I shudder everytime I have to explain to a parent that they cannot just "lock up" their kid in a psych unit because they are disobedient. But the fact that people are willing to talk about "secrets" openly & that the stigma of "seeing a shrink" is waning, helps me to believe that the darkest days are behind us.
~Geri~
One of the things that helps for me is to reflect on that capacity for resilience - it's like M. Scott Peck wrote in The Road Less Traveled. He was talking about his experience as a psychiatrist, and how the mystery he kept encountering was not how people got as badly messed up as they were, but, considering their life experiences, how they had managed to stay as healthy and functional as they had. Over and over I've gotten to work with people who by any reasonable expectation should have been more twisted than Charles Manson, but who were still plugging away, trying to be the best people they could, working at being a positive factor in the lives of others. I agree with Peck's assessment that the best or only expectation is grace.I never give up hope as long as someone's not dead yet... I think about a young man I had last seen being literally carried away in restraints to be taken to the juvenile lockup the kids there call the gladiator academy, screaming curses, when he was 15. I cried that night because I didn't see any way he was going to survive. Then about four years later I was at an AA meeting and saw him walk up to the podium to accept a 6-month sobriety chip.
It's easy to get discouraged, but if we ask why instead of judge, it's the first big step towards making things better.
I think you are going to help a lot of people because you are going into it mindfully. It meant so much to me when someone, anyone, in my case, my therapist--wanted to know why. He never judged me so I told him everything. He was the first person I had that kind of relationship with and it's made all the difference in the world. I bet you will do that for people, too.
The fact that you're approaching it introspectively is a huge gift to the people with whom you'll work. The people in this field (and it's hard to understand why a lot of them are in the field) who waste people's time, or even worse, do active damage, are folks who are oblivious to their own unresolved problems and who never seem to get it that they need to meet clients wherever they are mentally and emotionally and to center the process on their clients rather than on themselves.My grad school program had a hard-and-fast requirement that we be actively engaged in our own therapy as a requirement for acceptance to the program, and about a third of the way through there was a further requirement to have completed at least 40 hours of therapy before being allowed to enroll in any more coursework.
I think that being in therapy or having done therapy should be an absolute must for any kind of therapist. I can't deal with my therapist's "stuff"--and I don't have too, because he already did. He helps me deal with my stuff and he accepts me and I don't think any human being could accept another human being on that profound of a level without doing some serious soul-searching, searingly difficult work on themselves.
Agreed. It's also important for a therapist to know from experience what it feels like to be the client; and to any aspiring clinician who balked at the idea, I'd have to say, "How can you say this is a good thing to do if you aren't willing to do it yourself?" A big part of our role is modeling effective ways of doing things for clients, and even if we (as is usually the case) never have occasion to bring up our own therapy when talking with a client, I think that empathy comes through. On the other hand, if we are unwilling to take the risks ourselves, or think it's somehow beneath us, that lack of openness and/or condescension will come through, too, and really get in the way of our effectiveness and usefulness.Further, at least for myself, it's been important to do three things to keep my head on as straight as it ever gets: continue my own therapy to deal with new stuff as it comes up or old stuff that revisits; work closely with a skilled clinical supervisor; and spend time with colleagues to brainstorm, prop each other up when one of us has been really clobbered by some event, and get reality checks on our perceptions.
Yeah, I wouldn't even want to be client of someone who thought of him or herself as above being in my position of getting therapy. I think it's kind of hypocritical not to be willing to do what you preach, in a way. My therapist has told me about doing therapy more than once, he's very open. I appreciate that about him a lot.It sounds like you have a good support system going--that's so important.
Yes - not so much since I've had to give up work other than writing due to health problems - no clinical supervision; but a corresponding reduction in stressors. I'm starting the process now of transitioning to a new therapist - the guy I've been working with for some years now is good, but I want to go back to including some EMDR work, and he doesn't use it.
Shrink Rap (Psychology Books)
Books mentioned in this topic
Honeycake: A Circle Of Trust (other topics)School's Out Forever: I've Done My Time (other topics)
MiXED NUTS or What I've Learned Practicing Psychotherapy (other topics)
Defying Mental Illness: Finding Recovery With Community Resources and Family Support (other topics)
A Life Lived Ridiculously (other topics)
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But working in the prison has both positives and negatives. The downside, in my experience anyway, is that the administration and the environment are toxic and destructive. But the upsides are that you are able to work with people with serious problems (that's a plus for me anyway), that you get to work with the same individuals in depth and long term, that you get to see a wide variety of psychological issues and problems, and that you don't have to mess with HMOs or other insurance-related bureaucracy. And in the case of inmates who are close to parole, you can help them increase their chances of success and avoidance of returning to prison.
I found that the majority of people in prison are ordinary individuals who had had runs of ugly circumstances and responded as most people would have under the same conditions.