Psychotherapy happens in a political environment

 Summary

David Markham's email argues that psychotherapy inherently involves power dynamics, particularly concerning clients' self-determination. He contends that therapists face ethical dilemmas when clients' choices clash with restrictive governmental policies, citing reproductive healthcare and LGBTQ+ rights as examples. Markham suggests that these conflicts create a situation analogous to a totalitarian regime, forcing therapists to operate covertly to uphold their ethical values and support clients' rights. He emphasizes the potential legal risks for therapists who openly advocate for their clients in such circumstances. The email prompts reflection on the political dimensions of psychotherapy and the challenges faced by therapists in upholding ethical principles.

Guns are the #1 killer of children and teens in the US.

Summary 

David Markham argues that lax gun control policies, promoted by groups like the NRA, contribute to high rates of gun deaths, particularly among children and teens, in the United States. He contends that this stems from a lack of understanding regarding the long-term consequences of such policies and a societal embrace of guns as a means of protection, despite evidence showing this to be false. Markham emphasizes the need for increased public awareness and improved gun safety legislation. A commenter suggests that mental health issues are the root cause of violence, regardless of the weapon used.

 

Beyond the body, the spirit needs healing as well.

Summary Salman Rushdie's account of his rehabilitation after a stabbing explores the emotional rollercoaster of recovery, specifically highlighting the fluctuating levels of optimism alongside physical pain. A parallel is drawn by David G. Markham who details his own arduous orthopedic rehabilitation, creating personal scales to measure mental clarity, energy levels, and optimism/pessimism alongside pain. David emphasizes the crucial role of optimism in navigating such challenging circumstances and the importance of support systems, referencing his own despair and subsequent recovery. Both accounts underscore the complex interplay between physical recovery and emotional well-being during rehabilitation. David'd experience mirrors Rushdie's in the intense emotional and physical challenges of recovery.

 

It's not loneliness, it's the lack of meaning and purpose in later life.

Summary Explore the concept of successful aging, emphasizing the importance of meaning, purpose, and contribution in later life. They argue that combating the "loneliness epidemic" requires fostering a sense of usefulness and agency, rather than merely addressing social isolation. Maintaining autonomy and self-determination is highlighted, alongside the power of reframing aging to focus on continued contributions, such as the simple yet significant act of giving attention. The texts draw upon Atul Gawande's Being Mortal and offer strategies for individuals and society to support fulfilling aging experiences.

 

Psychotherapy and violence as a tool of social change

 David Markham, a mental health professional, reflects on the role of violence as a tool for social change in the United States. He observes the normalization of violence in American culture, citing recent political events and rhetoric as evidence. Markham questions the implications of this trend for psychotherapy and explores alternative approaches to social change, prompting a discussion among colleagues about effective strategies for facilitating positive change. He raises concerns about the implications for mental health professionals. The overall tone is one of concern and inquiry.

Low levels of differentiation of self makes a person vulnerable to charismatic leaders.

In the past  I have shared the idea of  the usefulness of cognitive maps for a therapist as they attempt to guide the therapeutic process. One factor in the social regression and developmental stuckness is rapid social change engendering fear but this impacts people at different levels of "differentiation of self", a Bowenian concept. 

There are many characteristics of DOS and perhaps one of the most important is anxiety levels and the ability to be self aware and regulate one's thoughts, feelings, and behavior. To use the analogy again of childhood development, most followers of mass movements who attach themselves to charismatic leaders are at a relatively low level of DOS. They are insecure and lack a sense of well integrated self. 

In thinking about how to proceed with people with low levels of DOS, we might consider how a parent deals with a 5 or 6 year old anxious child. Usually it is through reassurance along with reality testing, encouragement to "use your words" and coaching on management strategies for regulating elevated amounts of emotional arousal (anxiety.) 

Radical acceptance, a concept from DBT, can only occur when anxiety levels are decreased through soothing behaviors both self activated and facilitated by a trusted other. Radical acceptance brings peace and peace brings that ability to radically accept. So what comes first, the chicken or the egg? Basically, security is enhanced with structure and predictability.

I had a client with Borderline Personality Disorder who I have seen probably 10 or 15 times who told me in our last session "Just be honest with me. Tell me when I'm wrong and what I should do!" 

So, I have been a bit more directive with this invitation but I still walk on eggshells thinking it is only a matter of further interactions before she is offended by something I suggest and fires me and looks for another therapist.

In the long run, peace, lower levels of anxiety are not to be found externally but internally. And this I see as a spiritual problem. Radical acceptance has been known for decades in 12 step programs as "Let go and let god" or turning it over to one's Higher Power whatever they conceive their Higher Power to be.

As John Bradshaw said people are trying to fill "the hole in their soul". That's where we psychotherapists come in. How do we help people fill the holes in their souls?

The rating scales beyond physical pain: optimism/pessimism, energy, mental clarity

Optimism flooded through me—optimism, my great weakness or my great strength (depending on whom you asked and on my own mood as well). In Voltaire’s Candide (whose full title is Candide, ou l’Optimisme), the hero’s positivity in the face of the world’s horrors is close to idiotic. (If this is the best of all possible worlds, then those parallel universes must be hellish indeed.) When I wrote my novel Quichotte I lampooned my own nature by making my title character an optimist of the Candidean kind. And now, bedridden and gravely injured as I was, I began to believe that the worst was past, that Milan’s arrival was a sign that a corner had been turned, and happy days would soon be here again.

Rushdie, Salman. Knife: Meditations After an Attempted Murder (p. 81). Random House Publishing Group. Kindle Edition.

Salman writes about his experience in rehab which I found interesting because I have spent five months in orthopedic rehab from September of 2023 to February of 2024. One of the things I noticed was how the nurses would frequently ask me to rate my pain on a scale of 0 - 10. Luckily my pain was usually minimal. However there were three other things that were very noticeable and troubling to me and I constructed my own scales to rate them daily and sometimes hourly.

After pain, my second scale was “mental clarity.” I often experienced a fogginess and lack of concentration.

The third scale was “energy level.” There were many times when I just didn’t have the energy to engage in minimal things like talking with visitors. There were many days when my energy level was at 2 and 3.

The fourth scale is “optimism/pessimism” which Rushdie describes in the passage above. There were days when my optimism was 0 and I wanted to die. Had MAID, medical assistance in dying, been available in New York State as it is in 17 other states and Canada I might have killed myself. I was that despondent and pessimistic. That’s when you need someone to love you. I am blessed by three good friends when my family abandoned me and I obviously got through that desolate period to write this post.

The turning point for me was finding an apartment I could be discharged to. Finding the apartment, a place to go, gave me something to live for. Also, the PTs and OTs were very helpful and encouraging. Without them I couldn’t have recovered to the extent I have.

Yesterday, August 23, will be one year since I tore the quadriceps tendon in my right leg, and tomorrow, August 25th will be one year since I tore the quadriceps tendon in my left leg. On the 29th of August it will be one year since I had the surgery on both legs to repair the tendons and I woke up from the surgery in two leg braces from my upper thighs to my ankles at full extension with no flexibility for 6 weeks. I was a beached whale, totally bedridden, and totally dependent on others for even the smallest things like picking up things I dropped on the floor from my bed.

Optimism when a person’s life has been totally turned upside down is a huge thing. I am filled with joy to learn that Salman got his optimism back. Been there, done that as they say.

Editor’s note: I am a member of the online Allnonfiction book discussion group which discusses a different nonfiction book every month.

During August, 2024, we have been discussing Salman Rushdie’s book, Knife, which describes his attack by a man wielding a knife at the Chautauqua Conference Center in August of 2022 as a result of the fatwa proclaimed in 1989 by the Ayatollah Khomeini for what the Ayatollah said was blasphemy in Rushdie’s novel Satanic Verses 33 years prior to the attack in 2022.

The book being read and discussed by the Allnonfiction book discussion group in September, 2024 is Being Mortal by Atul Gawande.