The Shrink’s Links: Moral Injury

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Ball and chain

I knew a fellow who fought the Iraq War from the comfort and safety of an easy chair, piloting a drone that destroyed dozens of buildings with people in them. He was never at risk for anything more serious than tendonitis, yet he emerged from that experience with something kin to PTSD. We now have a name for it: Moral Injury.

Moral Injury refers to the wounding an individual’s conscience resulting from an act of moral transgression which produces profound shame.

Click here to go to a Huffington Post article about Moral Injury

The Shrink’s Links: Car Talk

Links

I was grieved to have learned that Tom Magliozzi, the co-host of Car Talk, recently died.

I remember him for his marital advice, as much as I do for what he taught me about cars. Here’s a bit of his wisdom:

I have my own law of marriage. It is more important to be happy than to be right. You may know that you are right. I’m always right. Whenever my wife and I have an argument, I’m always right, but, being the clever fellow that I am, I never try to prove to her that I’m right. She thinks I’m a dummy, that I’m always wrong. But she loves me.

To hear more of old episodes of Car talk, click here to go to their website.

The Shrink’s Links: Quiet

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read-books

If you would rather read a book than go to a party, read Susan Cain’s Quiet: The Power of Introverts in a World that Can’t Stop Talking. You won’t feel so peculiar. You will learn to value yourself, even if our culture, by and large, doesn’t value you.

If you would rather go to a party, then just read this:

Those introverts, they are not necessarily shy, insecure, or non-social. They just like their own company and can amuse and direct themselves.

That’s essentially the point of the book. Now go to your party and tell others.

Click here to go to the link

 

The Shrink’s Links: Mutual Help

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Broken-Chain1

If you’ve seen Ken Burns’ newest documentary, The Roosevelts, you know about the part where FDR was stricken with polio. He woke up one morning, unable to move his legs. What followed was a terrifying and painful ordeal. It took doctors weeks to diagnose the problem and then years of grueling physical therapy with little success. He didn’t want anyone to know how difficult it was for him. Eleanor and his mother both despotically forced him to do his exercises. It all but broke up their marriage. It was not until he fled both of the women and moved to the Warm Springs Institute, that he began to recover.

The reason FDR improved was not because he was performing better exercises, or doing them more frequently. He made progress because of a little appreciated factor in recovery we call Mutual Help.
At Warm Springs, Roosevelt was surrounded by other polio victims, so he did not have to be self conscious of his withered legs. He could attempt the difficult without humiliation because others were attempting around him. It was a safe place. Moreover, he had important work to do. He was not just a victim and a patient, he was also there to coach and encourage others. Gregarious by nature, he learned everyone’s name. He called himself the vice president in charge of picnics because every time someone fell into despair, he would take them on a picnic on a high bluff and show them the view, just to get a different perspective.

Objective measurements of the strength of Roosevelt’s legs before and after Warm Springs showed little improvement. However, what did change was FDR’s attitude towards his disability. He had taken something evil and parlayed it into something that could benefit others.

Fortunately, you do not have to be stricken with polio to profit from Mutual Help. Identical curative factors can be found in all the groups similar to AA, as well as many other environments where even the very sick are able to contribute to the welfare of others.

This Friday, I will begin a series about when illness takes over a relationship. It is one thing to be ill: to have polio, an addiction, a mental illness, or some other malady; it is quite another thing when the illness takes over, so there is little of the original person left. Before Warm Springs, polio had taken over FDR, as well as his relationship with his wife and mother. Afterwards, he was ascendant, even though the illness itself was little changed, and he went on to become president. I think, to the extent that Roosevelt had something to do with it, we can credit the non-judgmental mutual help of Warms Springs for getting us out of the Depression and winning World War II.

Click here to go to the page

The Shrink’s Links: Mad in America

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Chain4

Not everyone connected with the treatment of and recovery from mental illness goes along with the medical view that it is a chemical problem that has a chemical solution. Anyone interested in rethinking psychiatric care would want to read Mad in America.

Click here to go to the page

The Shrink’s Links: Old Man Gloom

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If you were amused by the post I wrote on Keith’s Crock of Shit, then wait till you get a load of what they do in Santa Fe.

Every year, the Kiwanis Club of Santa Fe, New Mexico constructs a huge effigy of Zozobra (the Spanish word for Old Man Gloom, I’m told.) People are encouraged to fill it with scraps of paper representing their gloom. Divorced wives have been known to donate their wedding dresses. Then, in a night-time ceremony, once a year, they set it on fire.

Guess, what? The gloom disappears.

 

The Shrink’s Links: A Consequential, Niggling Detail

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redtape

Today I’m going to write about something that should be irrelevant and of no concern to you, but may affect you, nonetheless: the licensing of people who perform psychotherapy.

Licenses exist so the consumer can know who to trust and who has the necessary training and experience to do what they say they are doing. Professions usually welcome licensure for the same reason that restaurant might welcome a critic’s review. It endorses and affirms their work and guides customers to their doorstep.

Licensing laws also serve to shut out the competition. New York City releases a limited number of taxi medallions, for instance, so that taxi operators can be assured plenty of business. This, of course, drives up prices and makes it hard to get a cab. Consumers complain and often find undesirable alternatives.

We often hear about how it is difficult to access mental health care. It’s expensive. It can take months to get an appointment at a community clinic. Our prisons are filled with the mentally ill. When people can’t get mental health care, they chose alternatives: alcohol and drugs, violence, anything that gives them short term relief, and it ain’t pretty. Remember that the next time you hear about a school shooting, an overdose, a suicide, a fatal DWI, domestic violence, or pass homeless people on the street. Clearly, there are not enough people providing mental health care. Obama Care and other laws will not help if there are not enough therapists to see all those who need help.

A few years ago, the New York State legislature overhauled the laws concerning licensing of psychotherapy. Licenses had been very hard to come by. You had to go through a social work school, get a doctorate in psychology, or complete medical school and a residency. There weren’t too many of these opportunities in Western New York. Folks, like myself, learned the same material in other settings and got plenty of experience working in non-profit clinics where licenses had not been necessary. The legislature recognized that there were alternative paths to the same level of competency and created several new licenses with rigorous requirements: the LMHC, or Licensed Mental Health Counselor, for one. The legislature got all that right. The trouble is, they screwed up one little detail.

They wrote in the law that we would be doing “assessments”, not making “diagnoses”. There is absolutely no practical difference between making an assessment versus a diagnoses; they both result in the same thing: a brief summary of the problem. However, when insurance contracts are written that patients require a diagnosis, all the lawyers and bean counters in the insurance company (and there are quite a few) insist that diagnosis is what they need to have.
The result of this gaff is that today we have more competent people in the profession, but many of the insurance companies will not pay them. This limits the availability of mental health care.

I’ve been told that the other professions that had previously been licensed: the doctors and social workers, lobbied against using the word “diagnosis” in the language, thus inserting a poison pill into the legislation and ensuring they would get plenty of business. However, I would like to not believe doctors and social workers could be so evil.

I’ve been told that it’s going to take another act of congress (the New York State legislature, to be precise) to correct the problem. We all know what that’s like. Try to get a politician interested in this.

If you are still reading at the end of this post, you must still be interested. So, do one more thing. Contact your state senator or member of the legislature and ask him or her to support A.7608 and S.4977.

The links:
http://assembly.state.ny.us

http://www.nysenate.gov