If Someone is Risking Your Life, is it Acceptable to Shame them?

Just saw this segment on “The Beat with Ari Melber,” today on @MSNBC. While I feel that @MSNBC has overwhelmingly failed at addressing mental health issues adequately on any of their respective shows by having actual clinical psychologists interviewed, today with @AriMelber was no exception. In discussing some people’s reactions to seeing others walking around not wearing masks, not social distancing and addressing the constructive use of shame, he interviewed an NYU professor who wrote a book on shame, but who is neither a sociologist or a psychologist, in addition to interviewing an internal medicine doctor. Over 10,000 mental health professionals in New York volunteered to offer their services at the behest of Governor Cuomo - I guess MSNBC doesn’t know that, if you throw a rock in New York City, you’re bound to hit a shrink, most of whom include the issue of SHAME in their clinical domain.

I started watching the interview and had to stop because what the NYU professor was saying was so ridiculous and utterly off point. However, I am including the link to the clip below. I will be posting a Podcast in the coming days about the issue that I believe was meant to be discussed on Mr. Melber’s show today.

https://youtu.be/PbJNds5Otlk

Preview YouTube video Shaming Works: Mike Pence Shamed Into Wearing Mask As Grim Reaper Hits The Beach | MSNBCShaming Works: Mike Pence Shamed Into Wearing Mask As Grim Reaper Hits The Beach | MSNBC

When Defenses Fail to Work

I’ve often been asked how I manage to not be flattened by the heaviness that comes with the kind of work I do. I say that, when I started, I used to practically crawl on the sidewalk when I was done with my day’s sessions. But then, I figured out how to manage the balance of being emotionally available to my patients while simultaneously having emotional boundaries in the space of the work. How? I wouldn’t know how to articulate the process. And, with the below article, I don’t want to suggest that my daily work involves making repetitive life and death decisions. I do, though empathize with the way these doctors and nurses, always needing to “not be overly personal” with their patients, are finding that their respective defenses are frayed, not protecting them as they may have before, having them be raw and exposed with their own vulnerability and that of their patients. Overwhelming. Traumatic. Will need much time to heal and reconstitute.

https://nymag.com/intelligencer/2020/04/medical-workers-looming-mental-health-crisis.html?fbclid=IwAR2dPToy084aaR8kbebHW4pvkfFp3cQVQ2Jz1Bk6mBH9y_GNOVxWKh-szuw

https://nymag.com/tags/diary-of-a-hospital

Self-Soothing

I’m often asked in my practice when someone reveals they are anxious or that they anticipate being anxious “what do I do?” Good question. Not easy to answer. Everyone wants (and who wouldn’t?) my magic wand to cast a spell so that the anxiety, present or anticipatory can go away. Haven’t gotten that wand from Olivander’s yet, but when mine picks me, I’ll be sure to let everyone know.

In the meantime, I would ask said-person “what kinds of things have you done before when you’re anxious that have helped? I always think it’s important for people to rely on familiar sources of comfort before we start collaborating on discovering new methods of self-soothing that said-person could avail themselves of should that feel necessary. It’s about building upon and creating a greater arsenal of self-soothing techniques that you can use when you want to and when you need to do so. “Striking when the iron is cold” is a saying taught to me by an old supervisor and it’s meaning is profound. When not in the throes of feeling overwhelmed or anxious, one can think and when one can think, ideas and clear-mindedness is available to us. When overwhelmed, anxious, scared, depressed, our ability to think is hampered and we’re not very good at dipping into those solutions that we’ve cultivated when thinking clearly. Thus, creating this arsenal of coping/soothing techniques in a thoughtful way has a greater chance of integrating internally and, if we allow ourselves, in the middle of feeling any of the aforementioned, to take a breath, count to 10, it is more likely that our minds will have the space to collect those techniques we’ve assessed that are useful for self-care in those moments.

Here are some examples of self-soothing techniques:

  • Breathing

  • Reaching out to friends, loved ones via the phone, FaceTime, Skype etc…some video platform so that you can see one another if you’re not able to be in each other’s presence

  • Taking a walk

  • Listening to music

  • Binge-watching fantastically stupid t.v.

  • Taking a bath

  • Spring-cleaning (yes, some people find this soothing)

  • Cooking/Baking

  • Putting a pot of water on the stove and simmering in it some cinnamon sticks, nutmeg, vanilla so that the warming smells waft through your home

  • Writing in a journal how you’re feeling

  • Finding online communities in which to participate that help you feel useful, connected and give you a sense of belonging.

  • Etc…

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Stupid is No Excuse Because There is NO Excuse

What if it was your sister? Your daughter? Your granddaughter? Why would a woman EVER put herself in such a position for public decimation and a reliving of a devastatingly traumatic event if it wasn't to out the truth - her truth - THE truth of an event that DID happen. It doesn't matter that it was 30 years ago. Trauma inveigles its way into your soul, your bones, your sense-of-self - it changes you and stays with you even if you're not fully conscious of it. And when you are conscious of it, no one is going to voluntarily speak out so publically about it unless she/he was aware of what it would stir up and what kinds of shame she/he might re-feel all over again because speaking up is right thing to do. Think of all of the adults who recently acknowledged being repeatedly sexually abused by their priests when they were children - not being able to speak about it then - the resurging of shameful, terrorizing feelings that arose as a result of speaking about these horrors - who would voluntarily do that to themselves if there wasn't true meaning to doing it?

This man - this judge - no one - has the right to give (or accept from someone else) an excuse of being young and stupid as a reason for why an assault has taken place. For everything that has been claimed about Kavanaugh, there was no possible way he was or is "stupid." It's a ridiculous and demeaning excuse that has absolutely no merit and zero weight in a situation so serious and so life-changing - this is a man anyone wants as a judge in the highest court? A person who would accept an excuse of being "stupid" so that he could be confirmed for SCOTUS?

https://www.huffingtonpost.com/entry/young-stupid-kavanaugh-christine-blasey-ford_us_5ba12085e4b04d32ebfd335f

How Is This The Same Person?

I don't necessarily align with all of this psychologist's premises, or the language she uses to explain her theories, but I do believe that it's quite possible for ANYONE who seems one way and claims to be that way, can operate via another self-state in a manner that completely defies the original claims of self-definition.

https://www.huffingtonpost.com/entry/why-male-allies-abuse-women_us_5af35072e4b04d3b2c903373

Projection Isn't Just for the Paranoid

We all do it. Assume. Imagine others are thinking things. Being certain others are feeling things. But you remember what Walter Matthau said about assuming in "Bad News Bears?" Did I just date myself? I wouldn't go so far as his explanation for the problems of assumptions, but I would say that when we project onto others, we are causing an unfair dynamic between the projector and the object of that projection.

The idea of projection is commonly discussed in the realm of paranoid ideation. In this arena, projection is used unconsciously and in profound ways to relieve the paranoid person of his/her poisonous, frightening feelings and experiences of their inner world. Somehow it seems safer to believe it is coming from an external source, but if you've ever worked with or spoken with a paranoid person, nothing about their projective process renders a feeling of safety for the paranoid. What is does is dually make the paranoid person feel unsafe inside and outside the self.

But what I am addressing here are those times, for example when person A is afraid to speak with person B, BELIEVING that person B will react badly. Person A is certain of it and thus avoids Person B. What I refer to above as unfair is that Person A doesn't give themselves the space to speak and Person B isn't given a chance to be themselves - reply as they will, which just might not be anywhere in the vicinity of Person A's concern. Think of the discussions that aren't had, that are avoided and the resulting challenges that ensue in all kinds of relationships as a result.

When this occurs in the consultation room from the patient to the analyst, it becomes very useful fodder for interpretations of transference and can prompt evocation of recollections of historical experiences and information as to how those experiences have become both internalized and might explain the fabric of later relational dynamics. Unlike in life outside of a therapist's office, when this projective behavior happens in the analytic space, there is room to explore and understand and see how this behavior is operating elsewhere, realizing the dangers of generalizations...and finding alternative solutions for these situations. 

These projections are feelings we have about ourselves - they can become so strong that we convince ourselves that others MUST feel the same way. When we give others a chance, we do often find that our own feelings are matched, but, in my experience, when given the opportunity, others can prove to disprove our beliefs/worries/concerns. It can be scary, for it is a risk. At the same time, by speaking and giving another person a chance to respond in their own way, relationships can evolve and strengthen, even if the object of the projection disappoints in his/her response. At least there is genuineness there because you've made space for it. 

 

 

Can One Become Resilient To the Ongoing Threat of Trauma?

I once supervised a young woman who grew up in Jordan, here in the States for her graduate school training to become a psychologist. At the time, some of the cases we discussed were trauma-oriented, thus we often spoke about coping with trauma. This was also around 9/11 and no one here was untouched by that traumatic day. I recall her telling me that, growing up in Jordan, she was used to the sounds of explosions because it happened so regularly. It was almost as if it didn't faze her anymore.

I came across this article on CNN's website about Israeli psychologists finding their way to work with Parkland, Florida's Marjory Stoneman Douglas High School students, equipping them with coping skills that have been found to be useful in many Israeli areas, given constant awareness that a bomb might hit...and how to manage living day to day, moving forward, doing regular things without that fear getting in the way.

https://www.cnn.com/2018/03/08/health/parkland-trauma-israel/index.html

A Survivor's Story

This is an exceptionally brave man. Not everyone who's been sexually abused talks about it as openly as he has here. Not everyone who's been sexually abused as a child even tells the "non-abusive" parent because of fear of imagined or threatened repercussions, but he did tell his mother...and she kept him in the lion's den of rape. It is often said that it is NOT the abusive adult committing the violating behavior that is most to blame, but it is the absent parent who bears the most fault - in this case, even if the author hadn't told her, the theory is, she MUST have known - she is his mother after all, she lives in the same home. Mother's know. That's what is said. However, in this case, she was told by her son this was happening, kicked her husband out, allowed him back in and when he physically abused her in earshot of this paper's author, she didn't kick him out again. Childhood rape leaves indelible footprints on its victims. In this man's case, it seems like he kept trying to find his way through...that takes hope and a desire for self-preservation. Not always easy to access when you're led to believe that being raped is part of the normal fabric of your life. Please read this. 

https://www.huffingtonpost.com/entry/stepfather-child-rape-therapy_us_5aa03542e4b002df2c603c06

Repeat Offenders

I was asked to speak about domestic violence yesterday for this piece on Inside Edition. While most of the interview was cut due to time restraints, I spoke about the seeds of domestic violence for the violator, that it takes OWNING the responsibility for being abusive in order for change to happen (and Rob Porter vehemently denies all charges); how people in relationships in which there is domestic violence have enormous difficulty extricating themselves from the relationship and the reasons why. I was asked if Hope Hicks is in danger of being abused because she is dating Rob Porter - I acknowledged that she is already in an abusive relationship by working for a man who is a BULLY and abusive and thinks it's ok to grab a woman by her genitals because of who he is, a man who was accused of rape by his first wife...perhaps it's a dynamic that Ms. Hicks knows and, therefore is drawn to Mr. Porter's dynamic familiarity that puts her in a position of being vulnerable to abuse. I can't say for sure (no one can) if she will be abused by this man, but I do believe that, until Mr. Porter recognizes his behavior and acknowledges it fully for the impact it has had and the danger he presents, she is best to remove herself from the relationship while it's in its early stages...if she can and if she has sufficient support and resources to help her do so. It's so often a task of removing oneself that is impossible to do on your own.

https://youtu.be/TsQTgyFdVlA

Men are saying "Me Too."

If you ask around, most people believe that eating disorders are the domain of the female population. Whenever this "belief" arises in conversation, I counter with the argument that, while it might seem that women suffer from eating disorders more than men, I believe it's MORE about the space that is given to women to talk about their eating disorders....and the absence of that for men to surmount their own shame to address their self-destructive relationship with food and body. In the same way that people are now wondering why it seems that there are so many more people today being abused, I argue that it's not that there are MORE people being abused...it's that there is more of a forum of acceptance for discussing it and addressing it than ever before. Abuse. Eating Disorders....these and other horrors people endure, have been going on forever. Voices to speak of them seem to be more amenable to shouting these days. And everyone benefits from that phenomenon.

https://www.nytimes.com/2018/02/13/sports/olympics/figure-skating-adam-rippon.html

Why Speaking Up Continues to be the Most Important Thing

Another powerful and important opinion piece. A good follow-up to what I posted last night. It is true that as women, we often expect men to read our minds without us having to speak up about what we really want, feel, need. It is true that men cannot read our minds. The problem is that nothing gets communicated clearly, misinterpretations are bound to happen and, in one's perception there was a misunderstanding and, in another there is a feeling that "my signals" should have been clearly understood. It doesn't work that way. 

https://www.nytimes.com/2018/01/15/opinion/aziz-ansari-babe-sexual-harassment.html?_r=0

The Murkiness Around What Constitutes Consent

This is a very important article for both men and women to read. I think everyone reading it will recognize either themselves or someone they know from past experiences of "agreements" made that did not feel as if consent was actually being given...or that consent was actually heard. But first I have a few things to say:

Not long ago, when a colleague’s daughter was just entering her teenage years, I was told that she noticed her daughter’s friends wearing different colored beaded bracelets on their wrists, commenting about how pretty they were. Her daughter, given the open relationship that they have, told my colleague that the bracelets were not worn for aesthetic purposes, but that they were signifiers of having engaged sexually in some way or another with similarly-aged boys. Each colored bracelet represented a different “activity.” For example, pink for kissing, blue for letting a guy feel her up, green for giving a guy a blow job, etc…Understandably my colleague was horrified at hearing about this, as was I learning that this was going on in a very upper-middle class suburban area – there’s my naiveté. 

I wonder, in the context of our current climate of discussing variants of sexual abuse and harassment, how did these sexual activities get negotiated? Is there consent between pre-teens? When it’s an adult and a minor involved, there is no such thing as consent. Of course, we need to assume there was peer pressure involved. Some coolness factor? Badges of success gotten amongst the group with greater admiration derived vis-à-vis the more bracelets you got. And who bought the bracelets? The parents? Did they know what they were contributing to by purchasing a pretty trinket that served to BRAND their respective daughter? Is that implicit consent? Complicit consent? 

In college, I knew a girl whom I referred to as “peach jacket.” Yes, she has a name, but her peach leather jacket was so fabulous that it became her identifier. But she had another identifier amongst the guys….and the girls: Blow-job Queen. As I understood it at the time, and not from her words, this meant that, if she was hanging out with a guy, either he would ask or she would offer, and down she would go. I don’t know if she knew that this is what people thought of her. In all other respects, this was a young woman who seemed confident and fun, with many friends and without struggle. But I bring her up because I now wonder how she agreed to enter into such an a priori known with these guys? Was she actually consenting? She was of age, so consent, legalistically pertains. But was she consenting WITH also having DESIRE? Or because she felt she HAD to in order to, I don’t know, be popular with the boys, elicit envy from the girls because of her popularity? Was she re-enacting some earlier trauma that had not gotten respectfully and compassionately addressed? I’ll never know. 

But read this article and ask yourself these questions about why YOU might have participated on either side of this dyad once, twice…. many times. What was going on for you that, while you didn’t want to do something, you did it anyway to be liked, for example, or for many other possible reasons. Why you seductively pressured a woman into a sexual situation that, on some level, you KNEW she didn’t want, but because she didn’t outright say “no,” you negotiated your way into her pants? Not caring before, during, or afterwards that this woman might one day reflect back on that occasion and not see it as a “stupid thing I did,” but rather as an assaultive experience about which she feels shame and guilt and anger. 

https://www.huffingtonpost.com/entry/aziz-ansari-sex-violating-but-not-criminal_us_5a5e445de4b0106b7f65b346?ncid=inblnkushpmg00000009

Why I Can't Yet Say "Me Too"

I recently opened up about my history in a certain work setting in which the environment was burdened by a sexual harassing vibe. I wrote how it affected me personally, how I saw the effects on those with whom I worked and those I heard about after I no longer worked there, I wrote of how no one said a word - well, I did say something to the perpetrator, but the conversations usually were laughed at or turned into some kind of a joke....or simply more flirty-over-the-line discourse, in which I participated. I wrote about how uncomfortable this environment was for me. I also wrote about how I benefited from this "attention," professionally, AND how it served to stir rumors about me that were wholly unflattering and untrue. 

I had the bold idea of speaking about it in a public forum - truly speaking out. Without naming names, as was the case when I originally shared my story. I thought that it was about time. And then I was thoughtfully asked if I really knew what I was doing by offering my story in a public setting? The rational side of me knew that, even if names weren't included, I work in a profession in which many people are known to each other. It wouldn't be difficult to figure out the people about whom I was discussing. And as I was deliberating whether or not to do this, I could see the look of alarm on the faces of those who were offering me the forum. I could hear their concern for me and my professional mobility should I do this. While no one used the term, I could almost hear them telling me I'd be blacklisted should I go forward and speak.

I decided not to go forward and I feel very torn about it. I feel my decision IS the very thing that keeps this deplorable behavior going on. I'm complicit in its perpetuation by being protective of my professional future, even though it's no longer affecting me. I'm sure it's still affecting other women presently. But unlike the celebrities who were brave enough to speak out about their professional compromises over the course of their respective careers, I am still building my career. These women in Hollywood seemingly are in positions where screaming "j'accuse" will not boomerang back on them any longer. I am in no such position.....yet. 

I am successful, skilled at what I do, I'm ambitious and I believe in speaking up. At the same time, my need for self-preservation is at odds with the latter point. This IS the very cycle of abuse that you hear about in situations of domestic violence, for example. The battered wife who stays (while others think she is nuts and weak) because the alternative seems more dangerous. Now, I'm not being battered or abused. I'm feeling a self-imposed silencing that, particularly because of the current political wave of "Me Too," feels abhorrently difficult to tolerate. But I will. 

Until the moment feels more right. And then I will shout. 

The Cycle of Trauma in Chicago

I'm watching live this powerful story/narrative of the cycle of trauma in Chicago, with much emphasis given to the Mental Health effects of constantly living in a place where violence has happen, is happening, and will happen again and again. Discussions with kids about PTSD symptoms with Trymaine Lee. Worth watching. Excellent discourse about trauma in understandable terms. And this obviously is not just happening in Chicago. 

Emphasis on how mental health care is inadequate, marginalized, not adequately (if at all) covered by health insurance...and how seeking mental health services continues to be a source of shame and how there is a DESPERATE need for treatment seeking to be normalized and dramatized as NECESSARY for moving forward in life, particularly in the face of chronic trauma situations.

 

https://www.allinamericachicago.com/

 

When You're First Diagnosed: Managing the Initial "Attack"

Shock. Disbelief. Confusion. Relief at having an answer. Depression. Anxiety. Fear. Feeling betrayed by one’s body. Loss of control. Feeling unsafe. Why me? I’m sure many of you who were diagnosed with MS and are reading this, recall feeling at least one of the listed emotional experiences when you were told you had this disease. Hopefully when this diagnosis was transmitted, you had someone in the room with you to help you process what was being said, to serve as your ad hoc memory stick, so to speak, (since there was no possible way you could really hear much more than “yes, you have multiple sclerosis”), to hold your hand and tell you that everything was going to be okay...even if you felt, at the time, that your world had just fallen apart. You might not have been able to speak. You might have prepared many questions to ask the doctor, but were finding yourself unable to recall any of them at the time of your appointment. When given the opportunity by your doctor to inquire about what’s next, and what this diagnosis really meant for you—you probably were at a loss for words.

Depending on your symptom picture and your brain/spinal cord lesion activity at the time of diagnosis, your doctor likely wanted to discuss medication options with you, asking you to consider one or several of the available treatments, encouraging you to make a decision as soon as possible. The medications are meant to slow down disease progression and your physician probably wanted to help you manage your illness in the most proactive way possible. However, at the time of diagnosis, your head was likely spinning in all directions and the thought of making a decision as important as medication may have seemed impossible to you. And that’s okay.

What I want to emphasize is that it is perfectly normal and acceptable to feel overwhelmed and shut down when you have been informed you have MS. It is a life-altering piece of news...NOT A LIFE SENTENCE, but something that will take time to digest, internalize, accommodate to and incorporate into one’s life in a way that can be quite manageable and productive. In my opinion, it is important, if not vital, to give yourself some time to reflect on what has been said to you by your doctor before any next steps are taken...to determine what you actually were able to hear and attend to, versus the information that did not penetrate. With this said, once you find yourself a bit more grounded, I would suggest seeking out ways to ask or re-ask questions about MS...particularly YOUR MS, UNTIL you feel more secure in understanding what is happening in your body, what your options are for medical and self-care and what kinds of resources are available to you to facilitate this NEW experience being incorporated into your life in the least toxic way.

I often hear patients talking about how they feel "out of control" following diagnosis, how their bodies seem to be acting as independent agents and how frustrating and helpless they feel as a result. Despair and hopelessness seem to take center stage. I completely empathize with this experience, affirming the importance of feeling empowered and having a sense of agency over decisions and the path one chooses.

MS has a way of making people feel disempowered - yet giving yourself some time to work through the initial shock of being told you have MS, finding ways to ground yourself vis-à-vis asking questions, seeking information in a manageable (not overloading) way, reaching out for support from existing networks or new resources...ALL of these actions have the marvelous capacity to help one feel stronger, more engaged with one’s body and generally more empowered over decisions in ways that can make living with MS possible...and perhaps even acceptable, even if at the time of initial diagnosis that idea seemed inconceivable.