Tuesday, February 28, 2017

Benzodiazepines Continue to be Prescribed Without Psychotherapy to Older Adults

From Mad In America, 02/24/17

"A new study, published in the Journal of the American Geriatric Society, finds that older adults continue to be prescribed benzodiazepines without being offered psychotherapy. This practice persists despite decades of research warning of safety concerns with these drugs and demonstrating the effectiveness of alternative treatments."

I have a few "geriatric" clients in my practice. When they get off the benzos which is difficult because of the withdrawal which exaggerates the symptoms, such as anxiety, for which they were prescribed to begin with, they usually report that they feel better. I usually suggest they only take them if absolutely needed, and don't take them on a regular basis to avoid the development of physical tolerance.

Listening to older people's complaints takes time, time the primary care physician is not reimbursed for in our mercenary system of health care. There are many barriers and obstacles to the PCP referral to mental health professionals, but when done and psychotherapy is engaged in, benefits are worth in the cost in most cases.

Monday, February 27, 2017

Are you aware of ACEs - Adverse Childhood Experiences?

From Social Justice Solutions on 02/24/17

"In a nutshell, this ACEs science clearly shows that childhood trauma results in the adult onset of chronic physical and mental illness, violence, and being a victim of violence. It shows that most of us have experienced childhood trauma. And it shows that the systems we’ve created to change human behavior — whether criminal, unhealthy or unwanted — will actually work if we change them from blaming, shaming and punishing people to understanding, nurturing and and healing them."

For more click here.

The examined life is the beginning of a spiritual life

James Fowler has described a model of the development of faith. Readers were encouraged to assess their own level of faith. It was speculated that most people who were reading the article would be at least at stage 4, Individuative-Reflective, where a person is struggling with his/her religious beliefs. At this stage, the person is genuinely questioning his/her religious beliefs and the person becomes aware of conflicts and paradoxes and begins to doubt. At this stage many people "lose their faith" and traditional religious churches are threatened and suppress the expression of these doubts with many tactics. Often, the doubter drops away and stops attending the church and gives up the faith that the person was raised in.

Mainline churches are losing members and many sit mostly empty on Sunday mornings with only a handful of attendees most of whom are over 50. On Pew, and other surveys, increasingly Americans report that they have no religious affiliation and the "nones" as a group is rapidly growing in the United States as it has in Europe. The percentage of Americans who now say they have no religious affiliation is at 23% and is higher in younger age groups with Millennials at 36%. For more click here. Increasingly people say that they are "spiritual" but not "religious," but many seem to have some difficulty describing what this means other than that they do not participate in any organized religion.

If people are identifying as "spiritual" rather than "religious" what does this mean for them and for our society? If a person is to progress in his/her spiritual life to move up Fowler's stages of faith development what can a person do?

Spiritual health is a comprehensive idea which includes body, mind, spirit, and what some people call the shadow or the unconscious. The model is very rich in possibilities for spiritual development. In this article we will focus on the mind and the shadow. We will do this by asking what appears to be a very simple question but actually is very deep if a person wishes to explore what makes him/her tick. The question is: If you have or will have children of your own, how would you raise them the same and differently from the way you were raised?

We all grow up in our family of origin from which we inherit, at first unconsciously, but hopefully as one spiritually matures, consciously, our psychological legacy which is made up of the values, beliefs, opinions, practices, and rules of our family of origin. We realize as latency age children that there is the Smith way of doing things, the Pakula way of doing things, and the Vacarelli way of doing things. As children and young adults we assume, not consciously being aware, that this is just how things are, the way things are done.

When we consider having or have children of our own, we now have to decide, if we are conscious, whether we want to pass these values, opinions, beliefs, practices, and rules on to our children or do we want to chose some different values, opinions, beliefs, practices, and rules. Some of these values, opinions, beliefs, practices, and rules, we may decide were good for us and we want to pass them on to our children, and other of these values, opinions, beliefs, practices, and rules were abusive, or unjust in some ways and we tell ourselves, "I am not treating and raising my kids the same way I was raised." The degree to which a person makes these conscious choices is the degree to which a person is psychologically and spiritually mature.

In making these conscious choices, one might ask how these decisions are made? How does a person decide what a good life consists of and how it should be lived? Some of the information and criteria may come from reflection on the person's lived experience and the lessons he/she has learned, often the hard way, from suffering as well as from satisfying achievements and experiences. Socrates said that an unexamined life is not worth living. Are you living an examined life? If so, what are the practices that you utilize to engage in this practice? Some people journal. Some people talk with family and friends in an intentional way about their questions and concerns. Some engage in social support groups whether it is clubs, organizations, churches, AA, classes of one sort or another, etc. Some seek out professional assistance whether it is psychotherapy, pastoral counseling, and/or spiritual reading.

When it is appropriate I sometimes ask my friends and clients, "What is your interior spiritual life like?" I am always pleasantly surprised with answers I receive. There are many other questions which we don't ask in polite company, but maybe we should like "Why do you think you were born?" "What do you believe is the purpose of your life?" "What gives your life meaning?" "What do you think happens when you die?" Lately, I have been asking people who are entering their second adulthood, 50 - 80+, "What do you want to be when you grow up?"

These questions, unfortunately, are rarely asked in churches because churches try to provide institutional understandings and answers to these questions often based on some text that is claimed to be the authoritative word of god. In our postmodern age, this doesn't work any more for increasingly numbers of people who have moved on to stage 4 and 5 in Fowler's stages of faith model. Religions have not kept up with the evolution of our human consciousness. Many people at stage 5 would say, "My god is too big for any one religion."

If you considering developing some deliberate spiritual practice to enhance your spiritual life, you might consider describing your psychological legacy. What were the values, opinions, beliefs, practices, and rules you were brought up with. To what extent has your psychological legacy become conscious for you? To the extent that your psychological legacy has become conscious, what have you decided to keep and what have you decided to change? Journal about this or find someone to discuss it with for at least 60 minutes over the coming week. This may become an ongoing part of your spiritual practice to which you devote yourself on a regular and continuing basis. This reflection and consequent change in thinking and behavior will improve the quality of your life.

The pursuit of spiritual development involves more than just individual effort. It requires social support. What social resources nurture spiritual development since churches no longer seem to meet people's needs for spiritual growth in our postmodern world?

Sunday, February 26, 2017

Crisis Intervention Mental Health Teams

SAMHSA ( Substance Abuse and Mental Health Services Association) has developed a short video describing CIT (Crisis Intervention Teams) in use in various places in the country. It is a great model. In Rochester, NY FACIT (Family Assistance Crisis Intervention Team) was implemented in the Rochester, NY police department back in the 70s. Monroe County, in which Rochester NY is located has a Crisis Mental Health  Team which is a bit different in that it does not necessarily assist with the police and may not respond for up to 24 hours. It can be reached at 585-275-5151.

March is Social Work month. What do Social Workers do?

Excellent description of Professional Social Work in letters to the editor on 02/26/17 in the Daily Journal in Tupelo, Mississippi.

"March is National Professional Social Worker month. Social workers stand up for millions of people every day. Most people do not know what social workers do: Social workers help individuals, families and groups restore or enhance their capacity for social functioning and work to create societal conditions that support communities in need."

For more click here.

Videotherapy - Foxcatcher

What it the function of the humanities in our culture and society?

The humanities is a broad number of disciplines which are distinguished usually from math and science. They include literature, history, film, the arts, and philosophy. In the last few decades, the humanities have been disparaged at the university level and in our culture because their study does not lead to vocational skills perceived as valuable for employment, and yet the humanities addresses questions about our human experience answering the question of what is the good life? What is the moral universe which we have lived in, live in presently, and wish to create for the future? The humanities inform the way we view ourselves as objects in existence and the culture and society in which we live and function. These views change over time and for most people are unconscious unless they deliberately study their development, sustainability, and change over time. The vehicles for these reflections will be novels and films that lend themselves to deconstructive analysis so that their messages and meaning are made conscious for our edification and enlightenment.

As an example we will consider the 2014 film Foxcatcher.

Foxcatcher is based on a true story about multi-millionaire heir John E. Dupont and his relationship with Olympic Gold Medal Wrestling winners, two brothers, Mark and David Shultz in the 80s and 90s.

From IMBD web site:

Based on true events, Foxcatcher tells the dark and fascinating story of the unlikely and ultimately tragic relationship between an eccentric multi-millionaire and two champion wrestlers. When Olympic Gold Medal winning wrestler Mark Schultz (Channing Tatum) is invited by wealthy heir John du Pont (Steve Carell) to move on to the du Pont estate and help form a team to train for the 1988 Seoul Olympics at his new state-of-the-art training facility, Schultz jumps at the opportunity, hoping to focus on his training and finally step out of the poverty striken situation Olympic caliber athletes like he and his revered brother, Dave (Mark Ruffalo). Driven by hidden needs, du Pont sees backing Schultz's bid for Gold and the chance to "coach" a world-class wrestling team as an opportunity to gain the elusive respect of his peers and, more importantly, his disapproving mother (Vanessa Redgrave). 

John Dupont clearly is an eccentric character with money. Because of his money he is tolerated by athletes and their organizations when Dupont clearly does not have any other qualifications. Dupont has a grandiose narcissistic view of himself as a coach and patron of Olympic wrestling which is delusional but supported by those who desire his financial support and patronage. The ethical concern here is that money can buy access and bestow power of influence when other more substantive qualities are lacking. (This reminds me of Donald Trump.)

Acquiescence to Dupont's grandiose delusion of his self importance brings significant psychological suffering to Mark and death to David. The violation of the moral principle of the right use of money led to a tragic down fall for the three principle characters: John, Mark, and David. The question of whether one should sell his/her soul for financial advantage is raised and a point of reflection in discussing the moral of this Dupont/Schultz story.

And yet, the implication of this duplicity does not stop with just Mark and David. Dupont captures the whole Olympic wrestling training team at this Foxcatcher Wrestling program. Dupont buys off the United States Wrestling Association with promises of $500,000 annual contributions.

All of this happens in the United States where Olympic athletes are considered amateurs and as such train and live in poor circumstances without some other form of income. In other countries, Olympic athletes are often given governmental support. The circumstances under which a rich millionaire can capture an Olympic sports program to fuel his own mental illness is fascinating. Some cynics might say, "Only in America," but sports are captured for political and PR purposes around the world to legitimize political power and credibility as well as corporate influence on customers and the general public.

Sports for sports sake often is not the case as athletes become celebrities with endorsements and other forms of social power. Dupont clearly wants to ride the coat tails of two Olympic gold medal winners whom he is able to buy to vicariously live through their accomplishments.

This movie starts slow but is compellingly engrossing as the creative tension builds between John Dupont and Mark Schultz. I give it a 5 on my scale of 5 and highly recommend it. It should be required viewing for all high school and college level athletes.

Questions for consideration:

1. What is Dupont's motivation in inviting Mark Schultz, all expenses paid, to this home based wrestling camp?

2. What is Mark's motivation in accepting?

3. Why does David, Mark's brother, say to Mark when Mark tells David about Dupont's offer, "What does he (Dupont) get out of this?

4. Why does the U.S. Wrestling Association agree to Dupont's contribution of $500,000 per year? Should they have taken this money? What strings might be attached?

5. How are sports used for political and commercial purposes in the United States and around the world? What are some of the ethical boundaries that should be constructed so that athletes and athletic organizations are not abused by politicians and corporate managers?

Saturday, February 25, 2017

My professional code of ethics prohibits me from complying with some of the policies of the Trump administration.

As a member of the National Association of Social Workers and a Licensed Clinical Social Work Psychotherapist in New York State, I am bound by my professional ethics not to adhere to or support many of the policies of the Trump administration. I am committed to treating all my clients and their families and all members of my community with dignity, respect, and honor.

Videotherapy - I Don't Feel At Home In This World Anymore

Jean Paul Sartre, the existential philosopher, said, "Hell is other people." I Don't Feel At Home In This World Anymore is a 93 minute film which takes this theme and runs with it.

When Ruth, a 30 something, single Nursing Assistant's home is burglarized, her depression deepens with her sense of violation which morphs into anger about "not wanting people to be assholes " and she wants her stuff back.

The story then kind of careens through a series of attempts to make things right.

Ruth recruits a socially awkward single neighbor, Tony, as her "back - up" as she goes on her quest to track down the burglar(s) and her things.

The story is told in ways that are comedic and grizzly.

The creative tension is developed between Ruth's righteous indignation and the selfish, greedy, exploitative behavior of her fellow human beings. It is a conflict that most of us can identify with, on the one hand being angry and repulsed by the behavior of our fellow human beings and our desire to love them and be at peace when things are more just.

Ruth's assertiveness in channeling her anger into making things right is to be admired. There is a slogan in psychology that "you can be mad or sad." When working with client's of mine who are depressed, I often observe their moving from sad to mad as a step in the direction of health. When people say, "Gosh darn it, I'm not taking this any more! I'm going to do something about it to make things right!" I am reassured that the person is on the track to make the world a better place.

I recommend "I Don't Feel At Home In This World Anymore." I give it a 4 on my 5 point scale.

For more from IMDB click here.

"I Don't Feel At Home In This World Anymore" is on Netflix streaming.

Friday, February 24, 2017

Racism is bad for your health

From the Greater Good Science Center, University of California, Berkeley on September 8, 2016:

Researchers compared the racial biases of nearly 1.4 million people nationwide to death rates in more than 1,700 US counties. Their findings suggest that blacks and, to a lesser degree, whites who reside in overtly racist communities are more prone to dying from heart disease and other circulatory diseases.

For more click here.

Racism is not a psychiatric disorder in and of itself. Social groups often take pride in their group and feel and think they are superior to others. 

Individual racism can be distinguished from institutional and structural racism where  a culture and system are rigged by the group in power to oppress and dominate the minority group. Individuals tend to act out the beliefs and values of their reference groups. It may be more helpful to think about racism as a cultural phenomenon with individual behaviors and beliefs being a symptom of more deep seated dysfunctional norms, values, and beliefs.

Mental health professionals are not only concerned with the dysfunctional behaviors, thoughts, and feelings of their clients but also with the emotional systems in which these individuals participate such as their families, communities, states, nation, and religious and civic organizations.

Are some communities, organizations, institutions, and political and religious groups more racist than others? Could we then say that some communities, organizations, institutions, and political and religious groups more mentally healthy than others?

Mental health professionals are not interested in enhancing the mental health of individuals, but with families, communities, organizations, institutions, and cultures as well.

For more click here.

"It is what it is" leads to resilience and a miracle

Two thirds of Americans report Adverse Childhood Experiences (ACEs) which predict poorer health and more problems in adulthood. However research has show than people who can accept their childhood trauma seem to do better. This acceptance does not imply agreeing with it or condoning it.

In reading this description of the study done, and the observation that "mindfulness" helps with managing memories of the trauma, the saying "it is what it is" comes to mind. In the recognition of the trauma and the acknowledgement of it, we can rise above it.

This recognition and acknowledgement often happens best when the person can have his/her say about what happened in the presence of an understanding, trusted other. It is the non anxious listening of another who becomes an enlightened witness that this transformation can occur. Some might call this transformation a "miracle" in the sense that there is a shift in perception and understanding that is liberating and facilitates peace.

Videotherapy - Minimalism: A Documentary About The Important Things

Minimalism: A Documentary About The Important Things is on Netflix streaming and might be helpful for people considering existential concerns about the meaning of life and how to create a life that makes one happy. 

The thesis of the movie is that the pursuit and acquisition of material things while promoted by advertising and marketing in our society doesn't work. The slogan at the end of the movie is "Love people, use things, not the other way around."

The Dali Lama said that the purpose of life is happiness. This statement begs the further question of "What will make me happy?" This question is the basis of all psychotherapy even if it is not addressed explicitly in the therapy.

The movie got poor reviews on IMDB because of it superficiality which I think are justified, but for the less aware this movie can be eye and mind opening.

You can get more information from IMDB by clicking here.

The relevance to hoarding and compulsive shopping etc is apparent, but its relevance to all of us in our consumer society and growing ennui is germane.