U. S. birth rate below replacement levels

U.S. birthrate falls to 32-year low

The U.S. birthrate dropped to a 32-year low last year, the Centers for Disease Control and Prevention reported Wednesday. About 3.8 million babies were born in the country in 2018, 2 percent fewer than in 2017. It was the fourth straight annual decline. The fertility rate "in 2018 was again below replacement — the level at which a given generation can exactly replace itself," according to the report. "The rate has generally been below replacement since 1971 and consistently below replacement for the last decade." The replacement rate is 2,100 births per 1,000 women; the 2018 rate was 1.728 births per woman. "We're clearly in the throes of major social change with regard to women getting married and choosing to have children," said Donna Strobino, a professor at Johns Hopkins Bloomberg School of Public Health. [USA Today, NBC News]

Editor's note:

With U.S. birth rate below replacement levels, it will have to increase immigration rates to maintain its population.


What's the best way to change an abuser?

In the May/June, 2019 issue of Mother Jones magazine there is an article entitled, "What's the best way to change an abuser?"

The answer?

There is no one best way.

My clinical experience of over 50 years has taught me that the first step is a mental health evaluation to understand the person's psycho-social functioning which is composed of thoughts, feelings and behavior. The causes of domestic violence are multi fasceted. 

The Mother Jones article notes that 86% of mass shooters studied had a history of perpetrating domestic abuse.

One program that seems to help somewhat is Men Creating Peace in California. In Rochester, NY, a Social Work colleague of mine had pioneered a program for men who perpetrated domestic violence back in the 70s and 80s. I am not sure if the program any longer exists.

For services in Rochester, NY regarding domestic violence contact Willow Domestic Violence Center.


Psychotherapeutic humanities - When to tell the children about the impending divorce?

Linda McCullough Moore's book of short stories, An Episode Of Grace, begins with the story entitled, "You choose," which begins with this paragraph:

"I’m driving on Route 91, going ten miles over the limit, on the way to my divorce, or, at least, to its announcement. My husband Jake and I decided we would tell the kids tonight. We’ve waited way too long. Our marriage died of natural causes years ago. We are planning that our children will be shocked beyond surprise, but we both know better. Any hesitation that we have about telling them isn’t fear of their surprise; it’s knowing that once we say the words, out loud, to them, it will be official, carved in stone, irreversible. But, of course, that’s what we want."

The childrens' names are Jonah who is 11 and Adam who is 6.

Of all the questions I get asked as a couple counselor and a family therapist by people going through a divorce are when and how to tell the kids?

My stock answer is "Don't tell them anything until you know specifically what the plan is unless they ask."

Kids being narcissistic in a healthy way first ask when told their parents are separating is "What's going to happen to me?" Parents need to have the answer to provide the child with whatever sense of security and predictability they are able.

The narrator in this story has her plan in place and has coordinated the telling the children with her husband and is on her way. But as she travels to the meeting with the children she gets stuck in a snow storm and as the various events unfold her ambivalence was divorcing her husband grows in poignant ways.

The ambivalence partners usually feel about a break-up with the concomitant anger, sadness, fear, hope, sense of failure and regret, are things the therapist witnesses and, hopefully, clarifies with the client(s) into some sort of coherent story that makes sense to themselves primarily and then to others affected.

The key question, often overlooked, in the emotional turmoil is, "What is the purpose of this relationship?" The genuine answers to this question usually lie at an unconscious level that the individual is not aware of and doesn't understand. 

The understandings of one's motivations, choices, and responsibilities are key to growth towards greater maturity so that the individual does not jump from the proverbial frying pan into the fire and engage in what Dr. Freud called the "repetition compulsion" to merely re-enact the same scenario over again.

The narrator of the story recognizes that telling the children about the impending divorce is a milestone in the process which she determines as a point of no return. It is an action which will make the rupture permanent and complete. The finality and the closure seems to heighten her apprehension about the decision to divorce rather than mollify it and liberate her.

You choose is a great story and much can be learned as we puruse our study of the psychotherapeutic humanities.

To be continued


Psychotherapeutic humanities - "The Maid's Story" by Adam O'Fallon Price

The story in the June, 2019 issue of Harper's Magazine is "The Maid's Story" by Adam O'Fallon Price.

The story is about a hotel maid, Hannah Kohl, who is afflicted with kleptomania and steals small items from the hotel guests' rooms. Hannah steals a ruby brooch, a piece of cheap costume jewelry, from Annette Gerson who was staying for a few days on vacation with her husband and two children.

Hannah is terrified of her thefts being discovered and being fired from her job.

When Mrs. Gerson catches Hannah stealing her brooch, Mrs. Gerson enters into a scheme to blackmail Hannah into coming to her home and staying over night by offering medical care for her son, 8, suffering from polio. 

As the story progresses Mrs. Gerson sexually molests Hannah and then manipulates the situation so that Hannah is fired from her job and has little choice but to move to Manhatten and become a live in nanny for Mrs. Gerson's children.

In this age of #MeToo, this is a story of sexual exploitation outside of the usual male/perpetrator - female/victim motiff. In this story a female becomes a perpetrator in a lesbian assault. What makes the story work is the class difference of a rich women preying on a poor one.

While sexual abuse makes the news and public outrage is fanned, class differences which often make the exploitation possible are overlooked. What appears to be sexual exploitation could not occur if class differences were not part of the situation.

As is so often the case from a psychotherapeutic perspective, the sex is the minor part of the offense in which domination, exploitation, and abuse of power is the root evil.

Domination and subjugation robs the person of his/her right to self determination and agency.

This is how the story ends.

Hannah Kohl is called into her supervisor's office and fired. She is told there is a message for her at the hotel desk to call Mrs. Gerson.

"How horrible," the woman's voice boomed in response to the news of her termination.

"Yes, I was reported."

"How horrible," she repeated. "Well, perhaps this is kismet. Mr. Gerson and I have just been discussing the need for a live-in nanny. I have so much to do, and only so much time-" she went on, but the maid was only half-listening, aware of herself as a guest watching might have aware of her: a slight woman in a sweater and long skirt and cheap brown shoes, shoulders shaking, bent over the desk in a posture of utter submission.

 

 

 

 


Psychotherapeutic humanities - overview

Medical humanities

Psychotherapeutic humanities

There are many activities that are involved in training psychotherapists. The main activities are academic learning about various aspects of human functioning: biologically, psychologically, sociologically, spiritually. The disciplines of study are varied and many.

Aside from the academic learning comes the practice, through internships, and later through clinical supervision, which consists of discussing one’s work with a more experienced psychotherapist. Learning for a psychotherapist is ongoing and lifelong.

One of the activities that may provide the most learning is the study of the psychotherapeutic humanities, a branch of the medical humanities,  which are the arts such as novels, films, plays, art, and music. The humanities have much to teach physicians, nurses, the psychotherapist, and other human service workers about human nature and life.

On Markham’s Behavioral Health we describe works of art which are helpful in our understanding of human nature and our lives. It is this understanding that contributes to the maturity and wisdom of the psychotherapist.

Over the next few weeks, material from Linda McCullough Moore’s book of short stories, An Episode of Grace will be discussed. It would be informative and enjoyable if people were to read the book and join in the discussions by commenting on the articles posted.


Therapeutic Depression


M. Scott Peck called it a therapeutic depression. What he meant by that is the idea that once a person extricates herself from a dysfunctional system of relationships, she looks back and realizes just how dysfunctional the system is. She may want to tell this to the people stuck in those relationships, but knows that, more likely than not, this information will fall on deaf ears and be rejected, leaving her feeling sad and impotent.

Karl Jaspers said one time that his definition of tragedy is "awareness in the excess of power". In other words, to know how things should be, could be, ought to be, but not having the power to make it happen, leaves one in a tragic situation. That's why they say that "ignorance is bliss", because what you don't know can't bother you, but once you do know, things will never be the same again.

To have one's consciousness raised while others are left behind because they don't get it, they don't see what you see, they don't understand what you understand, is a lonely position to be in. Many people don't want their consciousnesses raised. They are perfectly happy with their status quo. Any attempts to raise their consciousness irritate them because they feel threatened, their peace is being disturbed.

Jesus says in Luke 12: 51-53, "Do you think I came to bring peace on earth? No, I tell you, but division. From now on there will be five in one family divided against each other, three against two and two against three. They will be divided, father against son and son against father, mother against daughter and daughter against mother, mother-in-law against daughter-in-law and daughter-in-law against mother-in-law."

Keep your own counsel. It is best to be mute unless there is a person who can benefit from your awareness. It is difficult to share your wisdom unless people are ready; they are in the same place that you are. Traveling a spiritual path is a lonely, and solitary business. Occasionally we can help others along the way, but to walk along side is a rare experience. Better to find someone a little further along the way that can encourage and enlighten you.

Did you hear about the farmer who tried to teach his pig to sing? It frustrated the heck out of the farmer, and annoyed the heck out of the pig. As M. Scott Peck tells us, having chosen the Road Less Traveled to take through life can lead to great joy and satisfaction, but as we view the situation around us with compassion, it also can contribute to a therapeutic depression, one which Prozac will not help, but prayer, hope, and encouraging words judiciously shared when the timing is right, might.


How media spreads false information



Editor's note:

False information is toxic in the societal consciousness. False information distorts community norms and atittudes contributing to societal dysfunction. The computer meme is "garbage in, garbage out."

Just as we are aware of the idea of "caveat emptor", let the buyer beware, in our economic interactions, we should be aware of media distortions and strive to be "media literate" so we can develop immunity to toxic misinformation.


Books - Crow Lake by Mary Lawson

What happens when parents suddenly die in a car crash and leave a 17 yr. old son, a 16 yr. old son, a 7 year old daughter and a baby daughter in a rural farming community in Northern Ontario, Canada?

Grown up Kate, now in her 20s tells most of the story.

It is a narrative full of love, sacrifice, loyalty, persistence, projection, and descriptions of attachment styles that are fascinating.

Kate certainly has become avoidant although she had been every attached to her brother, Matt the youngest son. This attachment dynamic is the plat of the book. While Luke the oldest, and Bo the youngest are interesting characters, the primary creative tension revolves around Matt and Katie, 16 and 7 when tragedy strikes the family.

This novel is an extraordinary description of sibling relationships and the significant role they play in our growth and development.

I give Crow Lake a 4/5 and recommend it if you are interested in family dynamics especially those between siblings who are thrown upon their own resources to care for one another. 

I would recommend this book to students entering the helping professions especially for its depiction of attachment styles.


Books - The Underground Railroad by Colson Whitehead

There are plenty of slave narratives. Do we need any more?

Colson Whitehead's novel, The Underground Railroad, tells the story of a young slave woman, Cora, who escapes the Randall plantation in Georgia with a male companion Caesar and makes her way north and west on a literal underground railroad whose tunnels have been dug by abolitionists committed to undoing the bonds of slavery.

The scenes about slave torture and killings are terrible and offset to some extent by the kindness of strangers who help and conduct the slave escapees to freedom.

This is a story about the tenacity and perseverance of the human spirit against the evil of economic forces and power which exploit, subjugate, oppress, and terrorize to maintain power and dominion. It is a more extreme story of what is happening in America today with Trumpism and the championing of racism, mysogony, xenophobia, deceit and using fear and terror to undue civil liberties and the rule of law.

The Underground Railroad is an old narrative going back 300 years in the United States and continuing on in more subtle and insidious forms in our country today.

Cora and her companions seeking freedom and human development in the face of life threatening terror and domination is a souce of inspiritation and hope. The people who help her and her companions are the unnamed saints and martyrs for the cause of human dignity and respect. While a difficult book to read because of intentional pain and suffering deliberately inflicted to dominate and subjugate human beings, it is more importantly a book not only of resistance, but of endurance, hope, and triumph.

I give The Underground Railroad by Colson Whitehead a 4.5 on the Markham Behavioral Health 5 point scale.

 


What is the importance of mentalizing in attachment informed psychotherapy?

Mentalizing

In psychotherapy, the activity of "mentalizing" is where the most benefit accrues. 

"Mentalizing" is the making sense of things. Socrates said that an unexamined life is not worth living. This examining, to which Socrates refers, is what contemporary psychologists call "mentalizing."

Mentalizing is intimately linked to self understanding, the understanding of others, a sense of agency, and enhancement of social skills.

Mentalizing is a key feature of emotional intelligence which is made up of self knowledge, self regulation, empathy, motivation, and constructive and satisfying interactions with others.

In the model of narrative therapy, the narrative operates at three levels: the landscape of action, the landscape of meaning, and the landscape of identity.

The the landscape of action describes the cast of characters involved in certain activities and events over a period of time. The landscape of action is the plot line.

Superimposed on the landscape of action is the landscape of meaning. After the landscape of action is described, the story is told, one can ask, "What does it mean? What's the moral of the story? What's to be learned from this story? What do you make of it?" This is the therapeutic pay dirt.

At the third level, the landscape of identity, one can consider if this is what happened (the landscape of action), and this is what it means (the landscape of meaning), what, then, am I to think about myself and the kind of world I am living in?

Homo  sapiens are meaning making animals. We have a consciousness. This consciousness is more developed in some than in others. It is more highly developed in people with a secure attachment style. It is less developed in people with an anxious and avoidant styles, and least of all, in people with a disorganized style.

As I like to share with clients in my therapy sessions, "If you can't name it, you can't manage it. So what do you call the phenomenon (thing) we are talking about here." People with a secure attachment style can name it without much trouble. People with an anxious attachment style become flustered and bounce around looking for the right word. People with an avoidant style freeze, ponder, and have a great deal of difficulty finding the right words. People with a disorganized style often panic and become incoherent, change the subject, or rattle on about something unrelated to the topic under discussion.

The ability to reflect on one's own functioning, and the functioning of others, and to learn from the experience and adjust one's way of managing oneself and the interactions with others, is a sign of growth and what is often called "maturity." This ability to reflect and make meaning of one's experience is one of the major benefits of good psychotherapy.

This is article #2 in a series on attachment theory.