Due in large part to the tragedy in Newtown where an obviously disturbed young man and some weapons massacred 20 children and six adults, there has been a great deal of debate regarding controlling access of such people from such weapons. Nevermind that other such tragedies over the last few years also involved persons equally unbalanced, with no such discussion subsequently. Nevermind the reality that people supposedly quite sane have been responsible for gun deaths that were just not of that scope.
The suggestion (and the actual law in New York now) is to require some sort of registry for those who have been identified as "mentally ill." Similar to the existent lists of convicted pedophiles or other criminals, those on such a list would be prevented from obtaining a gun. But this is where it begins to get murky.
The biggest issue, of course, is confidentiality. There is already a major law on the books strictly protecting patient confidentiality. Without written consent, the clinician cannot even disclose the fact that someone is in treatment, even to another clinician. The only exemption is if a person discloses to a clinician that he or she is going to hurt him/herself or another person. Called the "Duty to Warn;" you gotta notify the authorities, call the person at risk, make arrangements for the client to be hospitalized. The trick is, if that same discloses that they have in the past done that same whatever, that comes under confidentiality and cannot be disclosed!
And that doesn't even get into the area of discerning the reality of the risk. Most of the current debate seems to sweep all mentally ill people into the same pile; so seriously disturbed and so violent (or potentially violent) as to be dangerous to the populace at large. Of course, not all those who we might label "mentally ill" fit into this same Procrustean bed. They are on a vast spectrum that goes from passing depression or anxiety to those who require on-going supervision and restraint. Even there, thanks to psycho-pharmaceuticals (and the cut-backs on mental health hospitalization resources), many people who would have lived their lives in a locked mental ward are now striving to live as normal a life as possible in the world around us (assuming, of course, there is such a thing as"normal.")
There is another whole issue here, to be saved for another day, of the tension between requiring medical treatment of whatever sort, versus the freedom and autonomy of the person who, for whatever reason, refuses to take the medication or have the operation. (The New York law rolls it all into one, not only registering the "mentally ill," but penalizing them if they resist treatment.)
Of course, identifying the mentally ill is complex; can we make the distinction between the obvious (the bag lady wandering the streets mumbling) and the peripheral (the functional autistic person who does what needs to be done but just wants everyone to go the hell away!) and the everyday (the arrogant/narcissistic politician)? Can we rely on the insights of the therapist to distinguish between the expression of temporary despair and anger as against the real threat of dangerous action?
And we must recognize that, as important as it is to provide the help needed for those mentally disturbed, this should not be instead of addressing the gun issue.
Tuesday, January 29, 2013
Friday, January 25, 2013
Tell Me What's Wrong
It used to be Borderline Personality Disorder. Just recently it has been Bipolar Disorder. The Diagnosis of the Day seems to change without warning or direction, depending in part on the newest edition of the Diagnostic and Statistical Manual (that's DSM to you), on the differing meds the pharmaceutical companies have come up with, and on what sort of therapy is popular just now. It shows up in treatment plans, in supervisory sessions, even in the self-diagnosis made possible by the internet.
They can be what a former supervisor of mine called "garbage terms," vague categories covering damn-near anything and especially those cases where the clinician is stuck for a diagnosis. Even with the occasional second-guessing of the insurance people, no one really questions the therapist. Sure, a good therapist reviews a case every few months, revising the treatment plans and possibly coming up with a different diagnosis to add or replace. But in a time where most clinicians are scared silly of anything that might be seen as admitting a mistake, such changes are rare if not non-existent.
So the client can go along collecting different diagnoses, as he or she moves from therapist to therapist. (That's another change; people committed to therapy usually have several therapists over their lives, either because of the abomination known as "brief therapy, or because of a mistaken understanding of therapy as only meant to deal with any immediate crisis.) Lemme tell ya a secret: therapists don't always agree, and might come up with a completely different diagnosis and treatment plan for the same client. Yes, understandable; determining the exactly right thing is not always scientific, but more like chasing a black cat in an unlit room. Throwing darts blindfolded.
The insurance people insist on a diagnosis within certain parameters; they will not accept an Axis II as the primary diagnosis And the average person wants to know what's wrong right away! (Think it's something to do with our human need for certainty when things get uncertain.) But I come from a therapeutic generation that was impatient with the whole thing; something to do with reducing a human being to a clinical term. (Even today, doctors and nurses are prone to talk about the "appendectomy in room 208.") For all the need for certain forms of professional discipline, maybe we all need to learn how to live with uncertainty and focus on who is hurting, rather than exactly what is causing the pain.
They can be what a former supervisor of mine called "garbage terms," vague categories covering damn-near anything and especially those cases where the clinician is stuck for a diagnosis. Even with the occasional second-guessing of the insurance people, no one really questions the therapist. Sure, a good therapist reviews a case every few months, revising the treatment plans and possibly coming up with a different diagnosis to add or replace. But in a time where most clinicians are scared silly of anything that might be seen as admitting a mistake, such changes are rare if not non-existent.
So the client can go along collecting different diagnoses, as he or she moves from therapist to therapist. (That's another change; people committed to therapy usually have several therapists over their lives, either because of the abomination known as "brief therapy, or because of a mistaken understanding of therapy as only meant to deal with any immediate crisis.) Lemme tell ya a secret: therapists don't always agree, and might come up with a completely different diagnosis and treatment plan for the same client. Yes, understandable; determining the exactly right thing is not always scientific, but more like chasing a black cat in an unlit room. Throwing darts blindfolded.
The insurance people insist on a diagnosis within certain parameters; they will not accept an Axis II as the primary diagnosis And the average person wants to know what's wrong right away! (Think it's something to do with our human need for certainty when things get uncertain.) But I come from a therapeutic generation that was impatient with the whole thing; something to do with reducing a human being to a clinical term. (Even today, doctors and nurses are prone to talk about the "appendectomy in room 208.") For all the need for certain forms of professional discipline, maybe we all need to learn how to live with uncertainty and focus on who is hurting, rather than exactly what is causing the pain.
Thursday, January 17, 2013
One step at a time
ADDICTION: (noun) An uncontrollable compulsion to repeat a behavior regardless of its negative consequences.
Sound familiar? The alcoholic who has to have one more drink. The compulsive gambler who has to make one more bet. The overeater who gets up in the middle of the night to check what might be in the refrigerator. Sometimes it is clearly a physical thing, a need for the drug of choice. Sometimes it is a way of escaping from other things happening all around.
If we were honest,we would acknowledge that we all have things in our lives that we do unthinkingly, even repetitively. Things that may be innocuous, even benign: getting up each morning at the same time, going to work or school by the same route, watching the same television programs. We could even include our faith group in that category: a standard ritual, a given lifestyle, a way of dressing and acting. Yes, even these things could be swept into the category with a broad enough broom.
And some would broaden the idea quite far: sex addiction, internet addiction, video game addiction. The trouble with such new forms of addiction is that they usually come from groups who frown on certain forms of behavior. If one person has a stronger sex drive than another, is such a person a sex addict? If a boy or girl spends hours playing video games rather with the rest of the family, is that young person addicted to video games?
Yes, we all can get into bad habits, and we can do certain things because we don't want to do other things. Having to be home for a favorite television show rather than going somewhere we find boring (less an valid excuse in these days of DVRs) says more about what we prefer and not so much about a compulsion. The husband who spends too much time on the computer may be avoiding his wife as much as it says about an obsession.
Granted, there can be things that take control of our lives. I remember a young man barricading himself in his room so he would not be disturbed while studying his Bible. Or the man who spent more and more time inappropriately with his daughter as he became more and more alienated from his wife. Could such things be considered "addictions?" Well, in the most generalized way, maybe. But they really have more to do with the ways we deal with the anxieties life throws at us and not so much with "spiritual addiction" or "sex addiction," whatever that might mean.
There is another aspect to all this: if we are "addicts" of whatever sort and validity, we are not really to blame. In alcoholism (which is an addiction), there is an physical component; in AA, it is called an "illness." Are we trying to absolve ourselves of the foolish compulsive things we do in our everyday lives?
Yet even in the varying 12-step programs, where addicts admit powerlessness, there is still an acceptance of responsibility to get straight again.
Sound familiar? The alcoholic who has to have one more drink. The compulsive gambler who has to make one more bet. The overeater who gets up in the middle of the night to check what might be in the refrigerator. Sometimes it is clearly a physical thing, a need for the drug of choice. Sometimes it is a way of escaping from other things happening all around.
If we were honest,we would acknowledge that we all have things in our lives that we do unthinkingly, even repetitively. Things that may be innocuous, even benign: getting up each morning at the same time, going to work or school by the same route, watching the same television programs. We could even include our faith group in that category: a standard ritual, a given lifestyle, a way of dressing and acting. Yes, even these things could be swept into the category with a broad enough broom.
And some would broaden the idea quite far: sex addiction, internet addiction, video game addiction. The trouble with such new forms of addiction is that they usually come from groups who frown on certain forms of behavior. If one person has a stronger sex drive than another, is such a person a sex addict? If a boy or girl spends hours playing video games rather with the rest of the family, is that young person addicted to video games?
Yes, we all can get into bad habits, and we can do certain things because we don't want to do other things. Having to be home for a favorite television show rather than going somewhere we find boring (less an valid excuse in these days of DVRs) says more about what we prefer and not so much about a compulsion. The husband who spends too much time on the computer may be avoiding his wife as much as it says about an obsession.
Granted, there can be things that take control of our lives. I remember a young man barricading himself in his room so he would not be disturbed while studying his Bible. Or the man who spent more and more time inappropriately with his daughter as he became more and more alienated from his wife. Could such things be considered "addictions?" Well, in the most generalized way, maybe. But they really have more to do with the ways we deal with the anxieties life throws at us and not so much with "spiritual addiction" or "sex addiction," whatever that might mean.
There is another aspect to all this: if we are "addicts" of whatever sort and validity, we are not really to blame. In alcoholism (which is an addiction), there is an physical component; in AA, it is called an "illness." Are we trying to absolve ourselves of the foolish compulsive things we do in our everyday lives?
Yet even in the varying 12-step programs, where addicts admit powerlessness, there is still an acceptance of responsibility to get straight again.
Sunday, January 13, 2013
One Step at a Time
Obstacles.
We all have 'em, emotional, physical, psychological, even spiritual. Those bumps in the road, gaps in the manuscript, lacunae in our personal or relational or professional lifehistory that prevent us , hold us back in various ways from what we would do.
We deal with these in differing ways. We develop ways around the barrier. Or we ignore the problem and live as though it weren't there. We might even make it someone else's responsibility, blaming them for what we are not able to do.
Creative types make the obstacle a matter of no significance or value, the old "sour grapes" approach. And others make such obstacles into a personal cause, advocating, for instance, for handicapped accessibility in public places or working for a group involved in social changes for a particular issue.
But some obstacles are so mundane as to seem trivial. For instance, my physical handicap makes stairs an obstacle that others would think nothing of, but which I have to face with difficulty and some pain. When someone parks in a "handicapped" parking spot without a "handicapped" tag- well, they are running into the store for just a minute, so what's the harm? But it means someone like me must park that much farther away and walk- with great difficulty- that distance.
Of course, there are people who have disability status through Social Security, and they may or may not be the driver with the "handicapped." tags. Getting SSI is not easy, despite the disgruntled few who seem to believe that it is reserved only for low-income, lazy, mentally-ill alcoholics. Even there, the disability may not be as immediately obvious, and many on SSI would prefer they weren't.
There was a time in my life when I could bound up a flight of stairs, two at a time. Now I go slowly one at a time, if I go at all. But not all obstacles we face are physical. When we have a barrier that keeps us from caring for others, or when we have handicaps that keep from seeing the human needs around us, that can be as disabling in its own way as anything physical.
We all have 'em, emotional, physical, psychological, even spiritual. Those bumps in the road, gaps in the manuscript, lacunae in our personal or relational or professional lifehistory that prevent us , hold us back in various ways from what we would do.
We deal with these in differing ways. We develop ways around the barrier. Or we ignore the problem and live as though it weren't there. We might even make it someone else's responsibility, blaming them for what we are not able to do.
Creative types make the obstacle a matter of no significance or value, the old "sour grapes" approach. And others make such obstacles into a personal cause, advocating, for instance, for handicapped accessibility in public places or working for a group involved in social changes for a particular issue.
But some obstacles are so mundane as to seem trivial. For instance, my physical handicap makes stairs an obstacle that others would think nothing of, but which I have to face with difficulty and some pain. When someone parks in a "handicapped" parking spot without a "handicapped" tag- well, they are running into the store for just a minute, so what's the harm? But it means someone like me must park that much farther away and walk- with great difficulty- that distance.
Of course, there are people who have disability status through Social Security, and they may or may not be the driver with the "handicapped." tags. Getting SSI is not easy, despite the disgruntled few who seem to believe that it is reserved only for low-income, lazy, mentally-ill alcoholics. Even there, the disability may not be as immediately obvious, and many on SSI would prefer they weren't.
There was a time in my life when I could bound up a flight of stairs, two at a time. Now I go slowly one at a time, if I go at all. But not all obstacles we face are physical. When we have a barrier that keeps us from caring for others, or when we have handicaps that keep from seeing the human needs around us, that can be as disabling in its own way as anything physical.
Monday, January 7, 2013
Gotta Have Friends
It is a word that has been so overused that it has no meaning anymore. When someone could have hundreds, if not thousands of "friends" on Facebook, the very nature of "friend" has been so diluted as to be meaningless. Originally, the definition was a person with whom one has a bond of mutual affection, typically one exclusive of sexual or family relations. Today, if it means anything at all, it has come to mean not an enemy or opponent. Many today confuse "acquaintance" with "friend," abrogating personal boundaries altogether. And, as suggested by the definition above, when a "friend" becomes a partner by marriage or intimate relationship, that title is invalid in that context.
So what is a friend? Usually it is men who have the most difficulty with the concept; they typically have few people they would call "friend," and even less they would consider a "close friend." Women have less problem, although they may move from one friend to another as the years go by. (Yes, many women have been blessed with a "best friend" from childhood, but in our transitory society today that is less so.)
Mark Twain defined a friend as "Somebody who knows all about you and likes you anyway." The whole idea of a friend, you see, should be something to do with trust. (Which is why this dichotomy of love/like, friend/lover misses the point.) A friend is someone we can risk being open with. A friend cares enough that when we are uncaring or careless, the connection survives.
This will not be the case with everyone we meet, no matter how hard we try to make that connection. Simply because a person is from the same town or state as ourselves, or shares a common interest, went to the same school, has the same name as someone we once knew, has a peripheral family connection, does not signify that there might be some sort of friendship in the offing. Simply because there was a friendship of some sort in the past does not guarantee a relationship today.
Instant friendships are the most dangerous of all. There wouldn't be enough time to get to really know each another, to make real any connections beyond the passing attraction. (This is why it doesn't work when a relationship begins sexually before all concerned know who the other person really is.)
The ideal, of course, is to combine the two options: To like the person you love, to have your friend be your lover. It is possible. The advantage is that those times when you don't like the other person, you still love. (And vice versa, of course.)
Does this mean every friendship needs to be at that extreme? Of course not; there are friends at numerous stages of life, meeting the numerous human needs we all have. But they have this in common: both sides are present and open.
So what is a friend? Usually it is men who have the most difficulty with the concept; they typically have few people they would call "friend," and even less they would consider a "close friend." Women have less problem, although they may move from one friend to another as the years go by. (Yes, many women have been blessed with a "best friend" from childhood, but in our transitory society today that is less so.)
Mark Twain defined a friend as "Somebody who knows all about you and likes you anyway." The whole idea of a friend, you see, should be something to do with trust. (Which is why this dichotomy of love/like, friend/lover misses the point.) A friend is someone we can risk being open with. A friend cares enough that when we are uncaring or careless, the connection survives.
This will not be the case with everyone we meet, no matter how hard we try to make that connection. Simply because a person is from the same town or state as ourselves, or shares a common interest, went to the same school, has the same name as someone we once knew, has a peripheral family connection, does not signify that there might be some sort of friendship in the offing. Simply because there was a friendship of some sort in the past does not guarantee a relationship today.
Instant friendships are the most dangerous of all. There wouldn't be enough time to get to really know each another, to make real any connections beyond the passing attraction. (This is why it doesn't work when a relationship begins sexually before all concerned know who the other person really is.)
The ideal, of course, is to combine the two options: To like the person you love, to have your friend be your lover. It is possible. The advantage is that those times when you don't like the other person, you still love. (And vice versa, of course.)
Does this mean every friendship needs to be at that extreme? Of course not; there are friends at numerous stages of life, meeting the numerous human needs we all have. But they have this in common: both sides are present and open.
Thursday, January 3, 2013
Say What You Mean
Recently I stumbled into another hornet's nest. Someone had posted a supposedly cute post on Facebook. "I'm a people pleaser, just not a stupid people pleaser." I made what I thought an innocuous comment, something to the effect that "stupid" is a relative term, as some people who are unfamiliar in one thing might be quite knowledgeable in another.
Sorry, didn't know I had opened that can of worms!
Someone posted a comment to my comment, using the term "common sense," and saying such things should be "obvious."
Yes, I know, shoulda just let it go. But I am forever trying to clarify things, so I responded by pointing out that what is "obvious" in one time and place would not be so in another. It used to be "obvious" that the earth was flat, and the sun went around the earth. That human flight was an impossibility. I even mentioned that people used to regard tomatoes as poisonous (which gives you an idea how frantic I had become.)
My correspondent took my well-considered words and responded by getting nasty. The obvious was what was right in front of my face, and I was unable to see that! When I tried to seek a more reasoned and civil tone, he made a perfunctory apology but then became just as nasty all over again.
Fortunately, the person who had unintentionally begun this pissing match stepped in and tried to calm the troubled waters. I felt sorry for him; my adversary was a former employer, and I used to be this guy's pastor! But he brought in the voice of reason necessary, and I regained some perspective.
We had been dealing with issues that had not been named, expressed in code words. Rather than talking about human needs and ways of dealing with them, we quibbled about the meanings of "obvious" and "common sense." He didn't want to deal with the more complicated problems of life, but just to go for the most direct and uncomplicated solutions at hand. As they say, when your tool of preference is a hammer, every problem is just a nail. And I got pulled into it.
I can remember once getting into a theological debate with a person from a particularly rigid faith group (okay, it was Jehovah's Witnesses!) Most frustrating and useless fifteen minutes of my life!But I suspect it is human nature to try to rescue people from their own folly.
Of course, these others may not see it as folly. And too often people don't come right out and say what they mean, anyway. Rather than talking about economic inequity and prejudice, some people talk about personal responsibility and equal opportunity. Rather than acknowledging our modern class structure, some talk about difficulty dealing with certain groups of people.
So we can decide to let those we disagree with alone. As I have said before, don't bother trying to teach a pig to sing; it wastes your time and annoys the pig. But maybe there is something to be said for showing people how lost they are.
But first we have to be certain what we are talking about.
Sorry, didn't know I had opened that can of worms!
Someone posted a comment to my comment, using the term "common sense," and saying such things should be "obvious."
Yes, I know, shoulda just let it go. But I am forever trying to clarify things, so I responded by pointing out that what is "obvious" in one time and place would not be so in another. It used to be "obvious" that the earth was flat, and the sun went around the earth. That human flight was an impossibility. I even mentioned that people used to regard tomatoes as poisonous (which gives you an idea how frantic I had become.)
My correspondent took my well-considered words and responded by getting nasty. The obvious was what was right in front of my face, and I was unable to see that! When I tried to seek a more reasoned and civil tone, he made a perfunctory apology but then became just as nasty all over again.
Fortunately, the person who had unintentionally begun this pissing match stepped in and tried to calm the troubled waters. I felt sorry for him; my adversary was a former employer, and I used to be this guy's pastor! But he brought in the voice of reason necessary, and I regained some perspective.
We had been dealing with issues that had not been named, expressed in code words. Rather than talking about human needs and ways of dealing with them, we quibbled about the meanings of "obvious" and "common sense." He didn't want to deal with the more complicated problems of life, but just to go for the most direct and uncomplicated solutions at hand. As they say, when your tool of preference is a hammer, every problem is just a nail. And I got pulled into it.
I can remember once getting into a theological debate with a person from a particularly rigid faith group (okay, it was Jehovah's Witnesses!) Most frustrating and useless fifteen minutes of my life!But I suspect it is human nature to try to rescue people from their own folly.
Of course, these others may not see it as folly. And too often people don't come right out and say what they mean, anyway. Rather than talking about economic inequity and prejudice, some people talk about personal responsibility and equal opportunity. Rather than acknowledging our modern class structure, some talk about difficulty dealing with certain groups of people.
So we can decide to let those we disagree with alone. As I have said before, don't bother trying to teach a pig to sing; it wastes your time and annoys the pig. But maybe there is something to be said for showing people how lost they are.
But first we have to be certain what we are talking about.
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