A confluence of topics dealing with mental health, substance abuse, health, public health, Social Work, education, politics, the humanities, and spirituality at the micro, mezzo, and macro levels. In short, this blog is devoted to the improvment of the quality of life of human beings in the universe.
I am planning on doing a series of videos on marriage. I have been a licensed clinical social worker for 40 years and have accumulated a lifetime of experience which I think may be of benefit to people. Here is the first video in the series which I have entitled, "The purpose of marriage." Please leave your comments.
Purpose of marriage video 1, part 1 of 2. Video lasts 4:18.
Dr. Maureen Didier, my Casework Professor at SUNY Albany, where I got my Masters In Social Work degree in 1972 also told me that as a Social Worker clients would manipulate me. I remember her telling me that it is OK to be manipulated if you know you are being manipulated and agree to it, but to be manipulated and not realize it will lead to a world of trouble and is incompetent practice.
Over the course of 40 years of practice, I can’t tell you how many thousands of times I have been manipulated and have known it and gone along with it. Over the same period of time I have been manipulated also by my wife, my children, my neighbors, my friends, my colleagues, my employer, my political representatives, business people, and the list goes on.
Dr. Didier told me it is OK to be manipulated as long as I am aware of it, and I have struggled for years to become more and more aware. Developing awareness takes ongoing effort. It never ends. Being aware of the need to continually increase one’s awareness requires ongoing willingness to learn, to approach life in a “not knowing” and open hearted way, and to reflect on one’s own experience and sift it for nuggets of wisdom.
This self-reflection often requires a discussion with trusted others who have the time and interest and willingness to listen carefully, ask good questions, and provide honest feedback. Seeking out consultation and supervision is critical to good Social Work practice and to just about any other endeavor in life whether to manage your own emotions, manage your intimate relationships with others, parent your children, take care of your health, manage your finances, develop your spirituality, or learn any new skill or master any new body of knowledge.
On the other hand, Social Workers also manipulate clients all the time under the guise of providing service or “treatment”. Social Workers value the client’s right to self determination and we have an ethical responsibility to obtain a client’s informed consent before we engage them in service activities and yet formalizing this idea of protecting clients from unwanted and involuntary manipulation often is illusionary because we are manipulating people all the time when we interact with them to get what we want and to influence other people’s behavior and to move situations in our desired directions.
Manipulation has taken on a pejorative meaning in our current terminology but if we change the word from manipulation to influence it doesn’t seem so bad. The point to this chapter is that manipulation goes on all the time. It is part of life. There is nothing wrong with it necessarily as long as you are aware, and when ethically required, we disclose our intentions and obtain consent. It is the way we give respect and maintain our self-respect.
I realized the other day that on October 31, 2008, I will have been a Psychiatric Social Worker for 40 years. I am thinking to myself - "What have I learned in all that time that might be valuable for me to reflect on and remember and might be of value to others?" So I decided to write a book. And part of that book writing effort I am going to put on this blog. I entitleing the book, at least for now, 40 years and counting. (If you have better titles let me know.) So, if you want to follow the progress as I write and comment on this work in progress check in regularly for the latest installment.
Here is installment number 1
On October 31, 2008, I have been a Psychiatric Social Worker for 40 years. I started my career at Kings Park State Hospital in Kings Park, New York half way out on Long Island just over the Nassau County line into Suffolk county on Long Island’s north shore. I started on October 31, 1968 as a Psychiatric Social Worker Trainee II.
My supervisor Fred Ironside asked me where I wanted to work and I told them on the Child and Adolescent unit and they put me in the geriatric building with 900 geriatric patients and where they hadn’t had any Social Worker services in over 1 ½ years.
I learned many things there but most of all to love and respect old folks.
This book is about what I have learned as a Psychiatric Social Worker over 40 years of practice. It is going to be a lot of very personal things. You may find a lot here that you disagree with or even find offensive and that’s OK. Part of practicing any profession is not what you learned in your professional training or what the textbooks say, but how you applied what you learned and made it work for you and made sense out of it.
Social Work is a very personal profession. A good Social Worker uses his/her personality astheir primary professional tool. Most of Social Work depends on developing a helping relationship with individuals, couples, families, groups, communities and representatives of all kinds of organizations, companies, agencies and governmental entities.
The key to good Social Work is the effectiveness of one’s interpersonal skills which depends on one’s emotional intelligence. It also helps if one is smart. It also depends on humility and knowing what one doesn’t know and being able to recognize one’s ignorance, incompetence, and asking for help. Without that humility you are dead in the water and would do better in some other profession or career.
I have taught over the years at various colleges as an Adjunct Professor teaching Social Work courses, Psychology, and Health Education. I have worked over my career as a clinician as well as a manager and administrator and so I bring the experience of several life times to my teaching. Angela and I were married 35 years and have 9 children so I always worked at least three jobs often 60 – 80 hours per week and sometimes more. With all this experience, I find myself saying things to my students like “I know this is what it says in the textbook, but let me tell you how it really works.” Of similarily, “I know this is how it says in the textbook to do it, but this is what it really looks like and feels like as you try to bring those principles, ethics, practices into application.”
Am I cynical? Yes. Do I passionately believe in the field and the value of the profession? Yes and more so with every passing year. I have been abundantly blessed to have entered into the profession of Social Work and my life has been richly benefited both professionally and personally. To be able to earn my living and get paid for something I love doing and passionately believe in is the greatest life any human being could have.
So, enjoy my stories of my 40 years of experience. Hopefully you will find them entertaining, maybe enlightening, and above all else, it is my wish that you find them useful as you go about living your own life and finding your way in the world.
Reading about the increased incidence of sucides in the military and the huge numbers of soldiers with PTSD has gotten me interested in something which very few people in American society talk about and that is what Dr. Rachel MacNair calls "Perpetration-Induced Traumatic Stress", PITS.
PITS is the anguish and guilt which one human being feels when he/she kills another human being. This has been increasinly labeled as a mental health problem which it surely is, but even more, it is a spiritual problem in my view. All the mental health treatment in the world, and all the medications cannot absolve the guilt induced by the willful, deliberate killing of another human being.
There is a good article that attempts to describe this problem which was published in the Seattle Times 4 years ago on July 21, 2004. Here is a snippet:
Tucked behind a gleaming machine gun, Sgt. Joseph Hall grins at his two companions in the Humvee.
"I want to know if I killed that guy yesterday," Hall says. "I saw blood spurt from his leg, but I want to be sure I killed him."
The vehicle goes silent as the driver, Spc. Joshua Dubois, swerves around asphalt previously uprooted by a blast.
"I'm confused about how I should feel about killing," says Dubois, who has a toddler back home. "The first time I shot someone, it was the most exhilarating thing I'd ever felt."
Dubois turns back to the road. "We talk about killing all the time," he says. "I never used to talk this way. I'm not proud of it, but it's like I can't stop. I'm worried what I will be like when I get home."
The men aren't Special Forces soldiers. They're troops with the Army's 2nd Armored Cavalry Regiment serving their 14th month in Iraq, much of it in daily battles. In 20 minutes, they will come under attack again.
Many soldiers and Army psychiatrists say these constant conversations about death help troops come to grips with the trauma of combat. But mental-health professionals within and outside the military point to the chatter as evidence of preventable anguish.
It is very difficult for us as a nation to face up to the immoral and illegal war which we have perpetrated and are paying for which was based on lies and deceit by our government, let alone for our soldiers who have actually killed other human beings, civilians, women, children, for reasons that are not clear at behest of psychopathic and irresponsible leaders. What does this killing do to a person's soul other than lead to anguish, revulsion, self-recrimination, and too often self destruction in one form or another.
Families of these suffering souls have wanted to be proud of their relative's service and to believe it was for a good cause, but the truth does not match the delusion. The inability of people back home to "understand", let alone accept, the truth, leaves the suffering soldier even more isolated and tormented.
What is the answer to the spiritual suffering? The truth and repentence. Will McCain or Obama lead us there? I doubt it very much unless we as a country are willing to face our demons and admit that what has been done in our name is wrong. Witnessing the suicides and PTSD of our returning soldiers fortunately or unfortunately won't let us ignore or forget the heinous acts they have been asked and compelled to do in our name. The guilt belongs to us all not just to the perpetrators, but they are the more active participants while we just watch, cheer them on, and lie to them telling them they are doing grand, honroable, and glorious things when deep in their souls they know better.
I intend to write more on this topic so I am adding a new category to my blog today called Perpetration induced stress.
Ugel describes how the lump sum salespeople prey on the weaknesses and character defects of winners to make their sales and collect thousands in commissions. Turns out Ugel has a gambling problem himself and so part of what makes him a successful salesman in this bussiness is that "it takes one to know one."
The thing that makes this book palatable is Ugel's self denigrating stance, his humor, and his humility. He is aware of his problems and he knows that at once they are his greatest assett and his greatest deficit. He makes no bones about it and seems honest in a way that is refreshing and kept me reading to the end.
The book is disjointed and written like a high school term paper, but enjoyable nonetheless and gives the reader an inside glimpse of the underbelly of state lotteries, the people who play them, and the people who prey on the unfortunate winners.
I have argued this point with various people over the last few years that motorcyle helmets and bicycle helmets save lives and traumatic brain injuries. Only 20 states require motorcyle helmets, New York where I live, being one of them. Two years ago, Pennsylvania stupidly rescinded its helmet law and guess what? Right. Head injuries and deaths have gone up dramatically. Here is a snippet from the June 11, 2008 Reuters HealthDay article based on an article which will appear in the August issue of the American Journal of Public Health:
In the two years after Pennsylvania repealed its universal motorcycle helmet law, there was a 32 percent increase in motorcyclist head injury deaths and a 42 percent increase in head injury-related hospitalizations, a University of Pittsburgh study says.
The state's universal helmet law was repealed in 2003. Currently, only riders under age 21 and those with less than two years' experience who haven't taken a safety course are required to wear helmets.
The researchers analyzed data from the state's health and transportation departments for the years 2001-02 and 2004-05 and found helmet use by motorcyclists involved in reported crashes decreased from 82 percent to 58 percent in the two years after the helmet law was repealed.
While the head injury death rate increased by 32 percent, there was no increase in the non-head injury death rate.
Along with the 42 percent increase in head injury-related hospitalizations after the repeal of the helmet law, there was an 87 percent increase in the number of head-injured, hospitalized motorcyclists who required further care at facilities specializing in rehabilitation and long-term care.
Total acute care hospital charges for motorcycle-related head injuries increased 132 percent in the two years after repeal of the law, the study found.
I was talking to a young 16 year old client of mine who is a true libertarian and who advocates for goverment to stay out of people's lives and let people to do as many stupid things as they like such as drink alcohol, drug, have promiscuous sex, ride motorcyles helmet free, etc. His point is that it would be an exercise in social darwinism, that is, the stupid will die young and not reproduce. In a way I think he has a point. It could be that New Yorkers are a little smarter when it comes to public health than Pennsylvanians. Certainly our auto insurance and health insurance companies prosper while Pennsylvanian insurance companies are paying the price of stupidity as well as individuals and their families.
There was a brief article in the Telegraph, a newspaper in the United Kingdom, on 06/25/08 about how excessive text messaging can be a sign of infidelity. Here is part of what the article says:
Excessive texting and emailing is now the number one sign of infidelity, a leading law firm has said.
Family lawyers said an addiction to text messages or emails has replaced "working late" at the office as the main tell tale signs of an extra-marital affair.
Andrew Newbury, partner at specialist law firm Pannone said: "We see the same features in so many of the marital disputes that we deal with.
In the last 3 months I have had 5 couples where the spouse is objecting to the number and type of text messages being sent by his/her spouse. In one case, the wife objected that her spouse had sent 6,000 text messages to a female co-worker the preceding month. The husband claimed it was merely a friendship with a co-worker and there was nothing romantic going on.
Last night, I saw an upset husband who stated that his wife is getting all kinds of text messages from male co-workers at all times of the day and on weekends and when he asked what was going on, his wife became very defensive and denied any wrong doing. She was further defensive when he called the cell phone company wanting the phone records.
I have several other cases now where text messaging and setting up of accounts on MySpace has concerned spouses that their spouse is engaging in behavior that could lead to infidelity. In my experience, sometimes this has happened. In one case and unhappy wife of 26 years, left her husband to meet some man she had been corresponding with on the Internet who lived in another state. The wife knew nothing about this person other than from the emails.
It is interesting to learn how the new technology is being used in human relationships. Often the concern is for children and protecting them from predators and other questionable activities like taking and circulating nude photos of themselves (which I had one 13 year old client do). And yet, it seems that adults are getting into just as much, if not more, trouble.
Like any new technology, the technology itself is value free - in and of itself is amoral, but the use to which humans put it often raises all kinds of moral issues. With technology like text messaging, we are only being to learn how this new form of communication will affect human relationships.
Lorraine Wright in her article, Spirituality, Suffering, and Beliefs writes about an incident that occurred when she was being observed working with a family behind a one way mirror. A team member who was observing said to Lorraine that
"...what he believed to be the most powerful aspect of my clinical work with families: the notion of 'reverencing' that occurred between families/clients and myself. In those moments of reverencing, there is a profound awe and respect for the individuals seated in front of you. It is not a linear phenomenon in these moments. I feel that same reverencing from family members being given back to me. In those moments of reverencing in clinical work something very special happens between the therapist and the family; it is something felt by all - a deep emotional connection. I know and have felt these moments in therapy, both in the therapy room and from behind the one-way mirror as a supervisor or team member."
Spiritual Resources in Family Therapy edited by Froma Walsh, p. 63
I am reminded of Jesus' statement that where two or three are gathered in my name, there I will be. There is something about psychotherapy that can be sacred not in a religious sense but in a spiritual sense.
Psychotherapy is a trust between the therapist and the client(s) where the psychotherapist is duty bound to put the clients needs ahead of his/her own. The psychotherapist is ethically bound to use his/her personality in a purposeful way to help the client get the clients' needs met. There is a deep listening that is empathically profound and an attentiveness that goes way beyond the ordinary. It is the conscientious attentiveness on the part of the therapist that makes psychotherapy hard work in the sense that it takes discipline to set aside one's own narcissistic preferences and desires in service of another. This "being there" for another is what begins to make the rapport sacred and the quality of reverencing begins to emerge.
I share with my clients the idea that honesty is the sine qua non of a good relationship. A relationship based on dishonesty is not worth having because the feedback one gets from the partner is distorted, it is based on illusions and misunderstandings. The feedback has very little value. As they say in the computer field, "garbage in, garbage out."
Further, lying takes unnecessary emotional energy. The liars' anxiety goes up a bit because now they must expend the energy to keep the lie straight with other communications and/or to keep the truth in the dark. That lying is stressful for most people, and has physiological symptoms of stress, is the underlying assumption of how lie detectors work. These machines, supposedly, are able to detect these more subtle symptoms of stress which the human eye cannot detect.
Can people who lie be kind? At a superficial level, I suppose they can, but at a spiritual level it is very difficult because there is a pretense, a charade, and illusion created which is not authentic, not genuine, and comes between the people in the relationship.
In counseling I often hear the complaint, "He/she is not the man/woman I thought he/she was!" Or, "if I knew then what I know now, I would never have done it."
Learning the "truth" can be very disillusioning and often comes with a sense of betrayal. The dishonest presentation of self was not kind, but in the long wrong cruel, even if the cruelty was unintended.
Honesty is the best policy and in the long run is the kindest thing. Remember, being nice and being kind are not the same thing. You can be "nice" and lie your ass off - salespeople and politicians do it all the time, but being kind always requires honesty.
Honesty is also directly related to one's mental health. People who lie and equivocate loose track of who they really are, what they really think, how they really feel. They not only mystify others, they even mystify themselves and they loose their authentic voice. As Polonius says in Hamlet, "This above all: to thine own self be true, and it must follow, as the night the day, thou canst not be false to any man."