Tag Archives: Mental Health

Physician, Heal Thy Self

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“Physician, heal thyself.” These words of Jesus (Luke 4:23) apply to all care givers. My particular concern is mental health care givers, having been one for about twenty years.

The dilemma with being a professional care giver is that we tend to have as our main issue our own personal issues/agenda. We have to be very careful to avoid the pitfall of waking up one morning and realizing, “Oh no. This is all about me.” I know. Been there. Done that.

I remember giving one of my college professors pause when, on this general topic, I posed the question, “What would happen to our profession if suddenly there were no mental illness?” The answer is obvious—“we would be out of a job.” So, in a way, counselor educators should provide a course in which students are taught to be effective in alleviating client’s woes…but not too effective! We don’t want the market to dry up!

Seriously, “we wage the war we are.” (W. H. Auden) Yes, we go into the care-giving fields to address our own ills as well as those of our clients. That is because we are human. We are flawed. But, we care givers need to be always aware that mental health (and spiritual health) is a process and that as we provide it, we are seeking it. And somewhere in our life….in our own therapy, or spiritual discipline, or church…we need to acknowledge that we “wage the war we are” and own our personal demons and recognize that always, “it is me, it’s me, it’s me O Lord, standin’ in the need of prayer.”

Family dysfunction

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“There’s something wrong with me.” During my clinical practice, this observation from a client was often a turning point. This often represented a shift in perspective, a realization that the problem was not merely “the world out there” but “the world in here”. This often meant that the client was willing to recognize that he/she had a history of very poor choices and that these choices had created the morass that had led him/her into counseling in the first place. This usually involved contemplating various labels, i.e. diagnoses, clinical contrivances designed to “give shape to our anguish.”

This always involved addressing how harsh the world had been to the individual…dysfunctional family and all…but it entailed quickly realizing that choices one had made on a daily basis had perpetuated the problem. It always involved looking at the “chooser” that one had formulated early in life, a mechanism that continued relentlessly to perpetuate the maladaptive behavior pattern, aka the “shame cycle.”

This usually involved the experience of hell in some fashion. It involved realizing that one was trapped, that there was no escape (“No Exit” as Sartre put it), and the bitter anguish of hopelessness. This was the “bottoming out” phenomena, the reaching of the limit of the ego’s machinations, and subsequently the dawning of the possibility of a turn-about in life.

The client was often brought face to face with a real paradoxical dilemma. The more he/she voiced his/her anguish…particularly to the family of origin…the more he/she remained imprisoned in his/her private hell. R. D. Laing wrote decades ago about the dilemma of the individual who was caught in an “untenable position” in a dysfunctional family. The more this individual protests, the louder and more passionate be his/her protestations, the more “proof” does the family have that the individual is…for lack of a better term…nuts. So the anguish intensifies and so do the screams. And the family will often look on with bewilderment, perhaps asking, “What is wrong with Johnny or Susie…”

Often the client would have to realize that the validation he/she sought would never come from the family of origin. It just was not possible. Some families are trapped in their own pathology and any individual in that family that protests, that deigns to confront the systemic poison that consumes them all, will not find a ready ear within that family. That “ready ear”, that validation, is going to have to be found elsewhere. Note here what Leonardo da Vinci noted on this issue:

O cities of the sea, I behold in you your citizens, women as well as men tightly bound with stout bonds around their arms and legs by folk who will not understand your language; and you will only be able to give vent to your griefs and sense of loss of liberty by making tearful complaints, and sighs, and lamentations one to another; for those who bind you will not understand your language nor will you understand them. (from “Of Children in Swaddling Clothes”.)

Validation is powerful medicine. As Conrad Aiken said, “And this is peace to know our thoughts known.”

Shame and Socialization

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Wittgenstein said, “The notion of following a rule is logically inseparable from making a mistake.”  I would like to make my own modification of that observation and say that it is “logically inseparable from being a mistake.”

When a child reaches the age of two or so, he suddenly becomes mature enough (neurologically and emotionally) to learn of a strange, curious, and often bewildering world “out there”.  He discovers that there is a myriad of rules, of “do’s and don’ts” that he has to subscribe to,  and on some level he really does not understand why this is necessary.  After all, he is doing just mighty fine already!  For example, why should he subscribe to what “they” call “potty training”?  Why hell, merely evacuating his bowels when the urge strikes appears to be working just fine!  If a need is frustrated, why shouldn’t he just throw a conniption fit?  After all, isn’t the world his oyster?  If he doesn’t like the morning gruel, why shouldn’t he just throw it across the kitchen?  And as for that cat’s tail, doesn’t it just beg to be pulled! And of course, any self respecting young male should be able to play with his wee-wee anytime he wants, even in church!

But, the child is hard-wired neurologically to decide that it is beneficial ultimately to subscribe to those rules being proffered by the “world out there” and to “join the human race”.  And most of us do, more or less.  But when we make this decision, it always involves saying good-bye to that delightful world of instinctual experience, where all of our needs were miraculously met by our mere whim, where we were the Lord and Master of our private little kingdom . We then have to “admit” on some deeply subjective, unconscious level that this private little kingdom of ours is “wrong” and that the world “out there” is right . That is tantamount to saying that we are wrong and they are right.  It is the advent of existential guilt.

But, if things go right, the “external world of rules” will be proffered by healthy family headed by mature parents who will gently escort the young tyke into this new kingdom.  He will learn that the advantages of “selling his soul” and joining the new world will outweigh the advantages of continuing to dwell in his private, autistic shell.

However, not all children are welcomed by kindly parents and a kindly world.  Sometimes the world is unforgiving and harsh if not brutal.  The child is shamed, humiliated, and physically brutalized into subscribing to the social mores.  And, many times this does suffice and the child will learn to comply but the price tag will be a core of shame that will haunt him the rest of his life.

I would like to share an excerpt from a D. H. Lawrence novel which so eloquently illustrates this shaming process and the devastation it can wreak on an innocent child.  In Lawrence’s novel, The Rainbow, Ursula is a little girl who is delighted with the new world she is discovering and is often totally consumed with its beauty and delight . This would often run her afoul of her unforgiving father who was very insensitive to her childish curiosity and would brutally scold her for trampling on his garden when all she had been doing was taking delight in a budding plant or daisy or chasing a butterfly.

But…her soul would almost start out of her body as her father turned on her, shouting:

Who’s been trampling and dancing across where I’ve just sowed seed? I know it’s you, nuisance! Can you find nowhere else to walk, but just over my seed beds? But it’s just like you, that is—no heed but to follow your own greedy nose.

The child was …shocked. Her vulnerable little soul was flayed and trampled. Why were the footprints there? She had not wanted to make them? She stood dazzled with pain and shame and unreality.

Her soul, her consciousness seemed to die away. She became shut off and senseless, a little fixed creature whose soul had gone hard and unresponsive. The sense of her own unreality hardened her like a frost. She cared no longer. And the sight of her face, shut and superior with self-asserting indifference, made a flame of rage go over him. He wanted to break her.

And there is more and more you might wish to read if this anecdote interests you.  Lawrence is very eloquent about describing the subjective experience of his characters, including children.

He concluded with, “And very early she learned to harden her soul in resistance and denial of all that was outside her, harden herself upon her own being.”

So often this anecdote from the Lawrence novel illustrates what happens with children.  Their parents do not have any sensitivity to the reality of children and are brutal in their correction of them.  Sure, children must be corrected, they must learn about social rules and propriety.  They must learn that there are consequences for various misbehaviors,  some of which do not even appear to be misbehavior.  But these consequences do not have to be issued with such brutality and heartlessness.  When this happens, often the child dies within, shame over whelms him, and at best he becomes a little shame-bound automaton compulsively complying with the rules handed down from the existing social order.

Boundary problems and early intervention

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In my clinical work and with some people I have met socially I have seen how that only incarceration could provide the boundaries necessary for purposeful behavior. I know one man who is now in his late thirties who has functioned very well during numerous imprisonments, at times proving himself to have real artistic skills. But whenever he has been released, he always goes back to drugs, alcohol, and criminal mischief. I had a young male client one time who was court-ordered to a military-style youth ranch due to persistent incorrigible behavior. I will never forget how proud he was upon his return that he had excelled in that highly-structured environment and had won numerous awards. And I saw many clients benefit immensely from the structured therapeutic environment of residential treatment. These young men and women had not internalized a boundary structure so that they could function in the world and had to have it imposed from the outside. And some were so damaged that they will never function without some “external ego” such as a parole officer or a life-sentence.

I often got the feeling with some of these young clients that with their behavior they were basically screaming for someone to set the boundaries their parents had not been able to provide. It is as if they were echoing the comic smirk of Jim Carrey, “Somebody stop me!!!!!” Too many times in our self-indulgent modern world no one will stop them and they are enabled repeatedly, basically rewarded for behavior that can only create severe problems for them in their adult life.

Maladaptive behavior reflects emotional needs that have not been met. As long as the maladaptive behavior is permitted to continue, the “emotional needs” cannot be felt and change cannot be effected. The behavior must be stopped, then the anguish can be experienced, and then new behavior patterns can be taught. But when the intervention is not applied early enough, the behavior patterns become too deep-seated, they become “hard-wired” neurologically, and change is very difficult if not impossible.

Clinical dimensions of “nakedness”

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(Yesterday’s posting was about the subjec of nakedness in the book of Genesis.) The notion of nakedness and vulnerability is also relevant in clinical work. In one of my first cases as a therapist, a young man in his thirties had recurrent images of nakedness in his day to day life, often looking down to see if he was wearing his pants in public. He knew this was “crazy” but he also knew that it was clinically significant. He also quickly saw that this disconcerting imagery was related to several significant recent losses in his life—he had become estranged from his family, he had serious doubts about his childhood faith, and he has resigned from his job. Furthermore, he was feeling estranged from his friends. He had been cast adrift in his life. He had shorn the trappings of the middle class life that had been bequeathed him and he felt vulnerable, he felt naked.

The clinical work involved helping him to embrace this nakedness, to avoid the temptation to immediately “prozac’em”, and to explore the depths of his despair.
It amounted to holding his hands figuratively, allowing the grace of God to envelop him, and to facilitate rebirth. I offered comfort and direction as this young man dwelt for a while in what T. S. Eliot called, “the breakage, in the collapse of what was believed in as most certain, and therefore the fittest for renunciation.” Metaphorically speaking, I was a midwife. Or, a metaphor I like even better, I was a witness to a death, burial, and resurrection.

The theme of nakedness is so relevant to the work of a minister. Frederick Buechner in one of his books (and the specific title escapes my memory) wrote of the need of a minister to find the temerity and courage (and grace) to first “disrobe” his congregation before he could “clothe” it with the Grace of God. He explained that God’s Grace only comes as one is disrobed of his/her pretenses, illusions, false gods, and hypocrisies and that a minister who is not willing to address this facade cannot offer any genuine Grace. Without this disrobing there is only an easy believism that really doesn’t believe anything, there is only a religion of convenience. And, I might add, no minister can accomplish this task if he/she has not been disrobed himself/herself and does not experience recurrently from time to time.

Political Polarization and Spirituality

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I am following this political brouhaha closely this year in part because it is such a look-see into the human psyche, individually and collectively. I’ve said many times, “We wage the war we are” (W. H. Auden) and that is true also on the individual and collective levels.

I’m really appalled at the overt hostility present today in the political process, the unabashed hatred of O’Bama in particular. At times, on the extreme, it is not even subtle. And I look at the other side…my side…and I see that we too, the “good guys” (wink, wink)…are dug in at the heels also. I recently casually noted to a couple of friends that the real problem in our country is a spiritual problem. But, I quickly backed down, realizing how dorky that sounded. And, merely trotting out the words “spiritual problem” can sound kind of dorky.

But, let me say the same thing but in different words. We have a problem of “values”. The issue is, “What do we value, individually and collectively?” Our need is some unifying ultimate value, “Ultimate” if you please, toward which we can strive individually and collectively. Without this Ultimate value we are inevitable fragmented and any collective purpose is difficult to achieve. Now as far as naming this “Ultimate Value” I have no problem with the word “God”. But that word has been so banalized and vulgarized that many people find it off-putting.

And let me close with a John Masefield sonnet which explains why this word has become so banalized, so vulgarized:

How many ways, how many different times
The tiger mind has clutched at what it sought,
Only to prove supposed virtues crimes,
The imagined godhead but a form of thought.
How many restless brains have wrought and schemed,
Padding their cage, or built, or brought to law,
Made in outlasting brass the something dreamed,
Only to prove themselves the things held in awe.

Masefield saw that so often the object of our worship, our “highest value”, or “God”, is merely our self.

“Heavenly hurt it sends us”

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Richard Rohr argues that there is “an incurable wound at the heart everything” and that in the second half of one’s life maturity comes when we recognize and accept this. He states in a recent blog that “your holding and ‘suffering’ of this tragic wound, your persistent but failed attempts to heal it, your final surrender to it, will ironically make you into a wise and holy person.”

Now, I would qualify this and note that this “incurable wound” comes to us in varying degrees. For many, those who are merely the “walking wounded” it presents itself as plain vanilla depression and anxiety. But even that “plain vanilla” version of pain must be confronted, just as others must confront their “incurable wound.” It makes me wonder if this is what Paul meant by his “thorn in the flesh.”

And note here what a “difference” Emily Dickinson’s “heavenly hurt” brought her:

There’s a certain slant of light,
On winter afternoons,
That oppresses, like the heft
Of cathedral tunes.

Heavenly hurt it gives us;
We can find no scar,
But internal difference
Where the meanings are.

None may teach it anything,
‘Tis the seal, despair,-
An imperial affliction
Sent us of the air.

When it comes, the landscape listens,
Shadows hold their breath;
When it goes, ‘t is like the distance
On the look of death.

“Black Milk,” feminism, & depression

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I’ve read a lot of feminist literature in the past two decades, scholarly
endeavors as well as literary. Feminism was one of the powerful “isms” that the
20th century introduced and I think one of the most important of them in terms
of creating a new voice and in introducing to us the notion that new “voices”
are always in the making…or they should be if there is any “life” present in
the culture. Elif Sharak’s memoir Black Milk reflects one of these new
“voices” in Turkish culture. Sharak’s experience of becoming a new mother is
the framework of the memoir but it also delves significantly into the history of
feminism in the past century or so. She intertwines into the story line of the
memoir short vignettes of significant feminist figures in this time frame and
highlights some of the battles they fought with themselves, their romantic
partners, and their culture. She also eloquently describes her battle with a
debilitating post-partum depression.

There are many astute observations she makes in the book. I will share only
one, a piercing observation about depression which touches on faith in God. She
describes depression as, “that sinking feeling that your connection to God is
broken and you are left to float on your own in a liquid black space, like an
astronaut who has been cut loose from his spaceship and all that linked him to
Earth.”

I have read clinical tomes on the subject of depression and many of those that I
find most insightful, from a psycho-dynamic viewpoint, approach the subject of
depression as a loss, as the experience of “the lost object.” And from my own
clinical work I can note that one of the most significant signs of depression is
when a person starts breaking off connections, therefore “losing” friends, work,
family, faith…and if the downward spiral is not interrupted even life
itself. Ultimately this spiral leads to Hamlet’s famous lament, “To be or not to be,
that is the question.” These words of Shakespeare and the quotation above from
Shafak bring to my mind the famous Edvard Munch painting, The Scream. That is
one visual image of ultimate despair, the subjective experience of that
aforementioned astronaut being cut loose from his spaceship.

The sky is falling! The sky is falling!

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Chicken Little’s apocolyptic warning never ceases to be relevant.  For, anytime a natural disaster such as earthquakes or tornadoes threaten, the doomsayers crawl out from under their rocks and announce, “The end is nigh!  The end is night!  It is a sign of the end times!  Jesus is coming back soon!”  Glen Beck was one of the best at this, as apocalyptic doom was a stable of his chart-laden dog-and-pony show.

Now sooner or later one of them is going to be right.  For example, a mutant gene could run amok and wipe us all out.  Or some right-wing crazy with a nuclear weapon could annihilate us all.  The heavenly bodies, all so routinely dancing with intricate precision, could suddenly hiccup and this simple little planet could be smashed into the cosmic gruel it used to be.  And, the scientists say that one of these days this universe will stop spinning, will grind to a halt, and sink back into oblivion anyway.  See, we are doomed!  We are all going to die, individually and collectively!  And, when it does happen, someone will be shrieking, “The sky is falling!  The sky is falling!”  At that time I hope they all feel good about themselves and get appropriate tv news and talk-show coverage!

But these apocalyptic nut jobs just need to get a life and stop terrorizing people with their cosmic insecurity.  You see, this is all about death and death is something we have a life time to prepare for.  Someone in mental health has noted, “Those that are afraid of death are afraid of life.”  The issue in death, the “sting of death” spoken of in the Bible, is just our fragile ego sensing its finitude and realizing that it could be snuffed out like a candle at any moment and will, at some point, meet that fate.

And I’m not ready for my own little “flickering candle” to be snuffed out.  I want it to continue to burn brightly for years.  But, I’ve accepted that this is not going to happen and have determined that the best thing to do is to accept this fact, to trust my Source which gave rise to me in the first place, and to busy myself taking care of hearth-and-home and trying to offer something to the world.  It would be self-indulgent and spiritually immature to constantly bemoan my death or the death of the species.

Thousands of years ago Aeschylus noted this insanity, simply noting, “The gods created disaster so that the people will have something to talk about.”