Markham's Behavioral Health

Suicidal soliders is not so much a mental health problem as a spiritual crisis

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.

Nation & World | Soldiers trained to kill, not to cope | Seattle Times Newspaper.

 

Excessive texting is a tell tale sign of infidelity

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.

Excessive texting is a tell tale sign of infidelity - Telegraph.

Praying for clients?

Continuing with the discussion of spirituality in therapy I was struck by Lorraine Wright's statement that she sometimes prays for her clients. Here is part of what she writes in her article, “Spirituality, Suffering, and Beliefs”,

“ Over the past few years, I have on occasion, independently adopted Dossey’s (1993) practice of praying for, although not with, clients and families with whom I work. As Dossey (1993) suggested, if a health professional believes that prayer works, not to use it is analogous to withholding a potent medication or surgical procedure: ‘Both prayer and belief are nonlocal manifestations of consciousness, because both can operate at a distance, sometimes outside the patient’s awareness. Both affirm that, “it’s not all physical”, and both can be used adjunctively with other forms of therapy.” (p.141) In praying for our clients, we perhaps also heighten our connection with them and our investment in their recovery and well-being.”

P. 64 in Spiritual Resources In Family Therapy edited by Froma Walsh

In further research, Dossey's claims have not been affirmed and it appears that there is no physical benefit to praying for someone who does not know they are being prayed for.

However, I wonder if praying for clients detracts from the psychotherapy? Is this a counter transference issue that would enhance the therapeutic alliance or interfere with it in some ways? If you had a student or supervisee who told you in clinical supervision that he/she was praying for his clients without the client's knowledge how would you handle it? Supposing it was with the client's knowledge?

Is praying for clients something that should be encouraged or discouraged? 

I, myself, sometimes pray for my clients and if wishing them well is considered praying, I pray for them all. I think that whether a therapist or a health care provider prays for clients would depend on the therapist's beliefs and spiritual practices. Certainly, clients pay a health care professional for a professional service and not for prayer, but I think that most clients would want their therapist to wish them well and care about their lives and the outcome of the therapy and not just be in it for the money.

Unfortunately, health care has turned into a business. It has become a commercial enterprise and is no longer a human service or a ministry in the broad sense of the word. I do not run my practice only as a business enterprise. I want to be of service to my clients and my community and take a number of clients pro bono and at reduced fees. I could make more money if I only served the more affluent who could pay me full fee, but that is not why I became a therapist and that is not what I believe God has called me to do with my professional skills.

Perhaps it is this desire to serve that is a prayer in and of itself.

Psychotherapy involves a sense of reverence

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.

Discussing clients spiritual beliefs as part of therapy

I have been reading Spiritual Resources In Family Therapy edited by Froma Walsh and there is an article in the book by Lorraine Wright entitled, "Spirituality, Suffering, and Beliefs: The Soul Of Healing With Families."

 

Lorraine describes herself as a family therapist/nurse educator who works predominantly with families experiencing illness. She says some interesting things like:

 

The influence of family members’ spiritual and religious beliefs on their illness experiences has been one of the most neglected areas in family work.” P. 62

 

I wonder why that would be? What is the fear or the constraining beliefs that therapists have that would make it nonconductive to discussing clients' spiritual beliefs as part of the therapy?

 

Part of the contraints probably have to do with the split between the secular and the sacred, between science and religion, between evidence based practice and the clinical arts, between the psychological helper and the ministry.

 

I have been trained as a psychotherapist not as a pastor and our roles are different and yet without understanding and taking into account my clients' spiritual and religious beliefs especially when they are suffering, I am not likely to be of much help.

 

Thankfully, there is increased interest in the health care professions in the role that spirituality and and religion play in a person's physical health and mental well being. To describe someone as "broken hearted" or as having "killed their spirit" is to describe a person who is in need of some sort of spiritual uplift. There is a difference between a physical cure and a healing of the spirit.

 

My friend and colleague, Ed, recently died on June 30, 2008 at age of 56 of Esophogeal cancer. I last had lunch with him on June 18,2008. Even though physically he was having difficulty his spirits, as always, were good. I am not sure what Ed's religious and spiritual beliefs were, but he loved life, he loved people, and he lived every day up to his last to the best of his ability and for this I am very grateful to Ed for inspiring me with a great example of how to die.

 

Paul Pearsall, the neuropsychoimmunologist, who had four near death experiences himself, said, that no therapist can hope to be of much help to someone unless the therapist understands at least three basic things about the person's world view. The therapist needs to understand how the client would answer these three questions: Why was I born? What is the purpose of my life? What happens to me when I die?

 

I usually don't ask clients directly these 3 questions unless they come up in our conversation but usually by the 3 interview I have some good understandings of how they might answer these questions.

 

"I don't know. I don't know, and I don't know" are not good enough answers and people have to be pushed sometimes to a scarier and more difficult place, but if they trust the therapist enough, they usually can come up with some sort of answer that probably means more than they would like to believe.

 

The purpose of a healthy spirituality is to decrease suffering as both Jesus and Buddha and other spiritual masters have taught. This is the same goal of good psychotherapy.

 

Consequences of insomnia

Gayle Greene, the author of the book Insomniac, describes the physical consequences of insomnia.

Over the last few years I have inquired more aggressively into people's sleep patterns because I find that many of the symptoms they complain about that have been diagnosed as depression and anxiety disorders are related to their poor sleep.

There is a chicken and egg phenomenon in the sense that is the poor sleep a symptom of depression or is the depression a symptom of poor sleep.

 Americans as compared to people from other cultures get about 1 hour per day less sleep.

Video lasts 3:24.

On Chesil Beach, the book

The year is 1962 and Edward 23, marries Florence, 22 and both virgins go to Chesil Beach on the Dorset Coast for their honeymoon. Edward is horney as hell and Florence is scared out of her wits, and though they love each other ostensibly, their first attempt at sex is a disaster which sets off a round of recriminations that dooms their once hopeful marriage.

Ian McEwan's novella is a masterful description of human emotion, interpersonal dysfunction, and tragedy entirely of our own making. It would be a wonderful book to use in a course on Marriage and Family Therapy.

I recommend this book, Ian McEwan's, On Chesil Beach

Truth is dangerous

"If the people believe there's an imaginary river out there, you don't tell them there's no river there. You build an imaginary bridge over the imaginary river."

Nikita S. Khruschchev (as remembered by Richard Nixon) in Rick Shenkman's book, Just How Stupid Are We? p. 53

People can only take so much truth. As Oscar Wilde said, "If you tell people the truth you better make them laugh or they will kill you." This is true in psychotherapy as it is in politics and just about any other walk of life.

People do not like cognitive dissonance. They do not like their thoughts disturbed. It raises their anxiety, and they can become dangerous.

My Social Work professor drilled it into our heads to "take the client where they're at, not where they ought to be, not where you think they should be, not where they could be, but take people where they're at."

My Social Work professor's advice has been stellar advice. And so we get the government we deserve. We get the lives we deserve, because people are very unaware. To wake them up might mean a punch in the face or at the least, protest and complaint, and a grump or two. Very few people wake up with a smile on their face, a song in their heart, and expressions of gratitude.

When you tell the truth, tread lightly, stand back, and fortify yourself with large amounts of compassion otherwise it can be a hurtful and destructive experience.

It may be easier and will undoubtedly make you more successful to build imaginary bridges over imaginary rivers, but some would say it is immoral, unethical, and in the long run we deserve the truth if we are to become human beings worthy of our potential.

How to deal with deceit and dishonesty in people who have power over you?

"Gaslighting exploits weaknesses in the human mind and has a debilitating effect on the victim's ability to think rationally and to function independently of the gaslighter. It can take many forms. In all instances, however, it involves the clever manipulation of 'reality' by the predator that undermines the victim's independent mental functioning for the gaslighter's own political, financial, or psychological motives."

Dr. Bryant Welch, Assault On The American Mind, p. 6

One of the more difficult things for me to deal with as a psychotherapist is to sit in the counseling room and watch a spouse swear up and down that he/she is not having an affair, being unfaithful, and lying when it fact there is proof positive evidence that the spouse is having an affair and is lying about it. Sometimes I watch parents tell their children that things are one way when they are in fact another and they are wanting the child's cooperation, compliance, and loyalty. I have worked in organizations when supervisory personnel only told employees what was going on on a "need to know basis" to maintain control over the workforce which might otherwise object to the company's operational procedures.

When politicians lie to their constituents, there is a break down in democracy because constituents can no longer play an authentic role in the life of their community, state, and nation. They are kept blind to what the real agendas are and why things are happening in their name which do not have their agreement and assent. Lying, saying one thing and doing another, creating a charade to project one reality when something else is going on, is a crazy making experience.

It is cause for great concern that the reality projected to the American people has been distorted for political purposes. It has made us all anxious, depressed, confused, and dependent. This is good for the pharmaceutical industry but not good for our democracy.

There are some positive signs with fake news shows like The Daily Show and Colbert Report which daily poke fun at the hypocrisy, duplicity, and inanity which passes these days for leadership. There are the Scott McClellan's whose conscience would no longer allow him to not speak up and openly admit to the deceit. This is hardly news because we all knew it all along, but to have an administrative official publicly admit it, is the first step in recovery.

The ability to recognize gaslighting is a higher level skill. Not all Americans are emotionally capable of reflecting on their own experience, and observing this communication dynamic. Back in the 60s we called gaslighting a "mind fuck" which means that we knew we were being fucked with. Gaslighting works best, of course, when it is so subtle that it cannot be observed, when it is not noticed. The national therapeutic effort is to help people recognize gaslighting and hold the gaslighters accountable. Individually, in our families, our communities, and our nation we would be much better off psychologically, socially, and politically.

This will require a level of literacy never before achieved in a society. And more than just literacy, it will require a level of emotional intelligence never before achieved as well. The major question which needs answering is how to manage deceit and dishonesty in people who have power over you? The answer is very carefully. I will write more about this in the next few days.

McClellan is finally getting it right about how the Bush administration has gotten it wrong. Illuminating the gaslighting being perpetrated against the American people

Former Press Secretary Scott McClellan now thinks telling the truth is important even though Republicans suggest he is disloyal and should have taken the lies to his grave. Really. They really suggest this. Watch the associated press video which lasts 1:50 seconds.

In some ways this is good therapy. It is time, in the United States for the truth. The gaslighting which has been going on for 7 years is finally being exposed. Do Americans have the stomach for the truth or do they still want to be lied to? I sure hope they have the courage to face up to the truth. These hearings are a form of national psychotherapy which is good for the national soul.