Surviving trauma and laughing it off

What doesn't kill us makes us stronger.  Well, at least if we aren't killed, we are still alive.  Stronger, maybe.  Smarter, hopefully.  And, perhaps, a little wiser.  No matter how bad the trauma, I'd like to think that a person can find something out of a traumatic experience that is of use.  If not to them personally, then perhaps to others.  Thus, here is the one of my personally traumatic experiences that may be of help to others even if just for their amusement.

Note well: These experiences were arrived at through poor judgment and could have been quite fatal.  Realize that your own adventures will befall you without putting yourself at unnecessary risk.  Please, do not purposely try any of these experiences for yourself.

My girlfriend, K, was going on a trip to the Devil's Hole State Park and she asked me to meet her there.  In retrospect that alone should've given me pause. But, being who I am, I agreed.

If you've never been there, it is a beautiful park on the American side of the Niagara Gorge that not only provides a breathtaking view of the gorge and the rapids, but also a long stairway that you can take down to the Niagara River.  Looking to get away from the crowd, K and I took the stairs and then walked along the river.  

The walls of the gorge are made up of layers of shale and sandstone as well as some limestone with a cap-rock of dolomite. There are tremendous dolomite boulders at the bottom of the gorge along the path that fell after wind and water had eroded the shale below them.  Down near the path, the rocks provided a tempting wall to climb and I decided to take them up on that challenge.

I was about seven feet up when the wall presented an overhang.  Considering that I had done well up to that point, and my girlfriend was watching, I figured I should stretch and pull myself up.  What I did not consider was how I would get back down.

Looking back over the edge as best I could, I did not see the path and I only imagined twisting my ankle of even breaking my leg if I went  back down blind... hey, those were some nasty looking boulders on that path!  For some horrible reason, I thought climbing up a shale gorge was a much better idea.

The first challenge I encountered was dwelling on my situation and freaking out.  Fortunately, I remembered the movie "Capricorn One."  When one of the three astronauts was climbing up a rock-face, the astronaut told a long joke while he climbed to keep himself from freaking out.  It really worked!  Even later, when things got dire, telling long jokes kept me distracted from the true gravity of my situation...

This brings me to the second challenge; friction or the lack thereof.  The first 20 or 30 feet up the gorge wasn't so bad.  Then I noticed that the angle of the side of the gorge was, quite naturally, getting increasingly steeper the higher I went.  This did not seem at first to be much of a concern until the rock walls started to crumble in my hands.  Worse was around 50 feet when I started sliding back down.

I realized that if I began to slide and did not stop, by the time I got to the bottom I would end up with worse than a twisted ankle.  The image of my twisted body broken across the rocks was more than enough to initiate a new strategy.  Whenever I felt I was sliding, I would press my forearms and my legs into the shale surface... which would catch a hold of me and stop my descent at the cost of some skin and blood.

The third and final challenge was breathing.  Every time a downward descent would begin, shale would crumble around me until I managed to grind myself to a halt.  Much of the crumbled shale would turn into a cloud of dust that swirled around me.  I didn't quite realize the hazard until I started to cough and began an almost immediate second descent.  Fortunately, the solution was readily available.  By tucking down my face into the collar of my sweat-soaked t-shirt, I was afforded a decent though foul air filter.

When I finally reached the top and climbed over the guard rail, from the wrong side, and looked down it was hard to believe what I had just experienced.  Certainly I was so dazed that I was not aware of anyone around me.  When I turned to go to the restroom, I blundered through a wedding party apparently there for a scenic backdrop for their pictures.  I remember hearing some gasps but I thought it was because they thought I was being a jerk.  It was not until I got to the restroom mirror that I discovered how I appeared.

From head to toe, I was covered in shale dust which gave my hair and my skin a gray tint.  At my elbows and knees, streaks of blood contrasted brilliantly against my gray skin.  I began laughing so hard that I coughed up a bunch of black phlegm and I shook a cloud of dust out of my hair.

What is there to learn?  Well, aside from "don't climb the Niagara Gorge," I know that survival can be won by keeping a clear head, making sacrifices, and being resourceful.  Hmm... did I really have to climb the gorge to learn that?  Okay, not really.  Then perhaps the best lesson here is that, if you survive, you really should try to laugh about it.  It might help knock off some of the darkness and help clean out some of the crap that got inside. 

Caretaker of souls

A Jesuit once told me that the word "psychologist" is derived from the Greek word psyche, meaning "soul," and that the suffix, logist, indicated someone who is devoted to the care of the given concept.  Thus, he defined psychologist as "caretaker of souls."  I have come to see this as the simplest and best definition of the work I do.  And, I must admit, some of the parallels between my work and that of a priest are striking.

The most common of the duties of a psychologist is helping someone work through how they came to their state of distress and then helping that person find some degree of serenity.  Often that work leads to a belief that suffering is connected to wrong doing or a weakness.  Thus, some people ultimately hope to find forgiveness or absolution in their therapy.  While generally I try to help people find their own self-forgiveness,  I have recommended that some perform an act for the purpose of reconciliation and even employ the expression of positive affirmations.  This effectively transforms my office into a psychotherapeutic confessional.  To be certain the similarity ends here.   Where a priest can accomplish a similar function in one session, it often takes me much, much longer.

In these days of third-party payment, one of the classic duties of a psychologist has been waning but there are still some who are willing to pay out-of-pocket for this service -- making meaning out of life and its various experiences.  People come to therapy seeking guidance for getting perspective on their life and perhaps how it relates to something bigger.  Again, while I may be sought out as some sort of guru, I guide people in developing their own meaning and their own sense of connection to life.  I feel this function has some similarity to what a priest might try to accomplish through a sermon or pastoral work.

Finally, like a priest, I have a responsibility to care for people and not judge and/or abandon them.  Indeed, although possibly misguided, I feel it is my responsibility to care for as many souls as I can.  Currently, in my work at a state hospital, I have come to work with some of the most challenging people in my career.  Many of these people have histories where they have burned all their bridges to family and community and are now very alone and very distrustful of help.  And despite our ideals and the general battle against prejudice, they remain pariahs.  Evidence of this was in Monday's Buffalo News.  Its front page featured an article on plans to make the old Richardson Complex into a financial profit center.  There was no mention of the over 240 people currently residing on those grounds and the various mental health service buildings on those same grounds.   Nothing on their fate if said plans were to be realized.  This appears to me to betray society's true feelings -- that the mentally ill are a burden on society's progress and, as long as everyone is willing to be complicit, we are justified in pushing them away from the parkland and facility that was meant for their healing and into less trafficked areas of our community.  Social lepers, they live in a colony at the mercy of their unwilling host.  Like a missionary, I work with them, trying to help them find something of a satisfying life and, if not acceptance, then at least humane treatment.

It is my specific charge to be a caretaker of souls.  And while prejudice and stigma remain for those with mental health problems, I will have a job.  Often I like to imagine a world that did not need psychologists.  But I think that can only occur when all people believe that taking care of souls is part of their job too.

Psychotherapy and third-party payment

Three psychologists and a managed care rep were driving down a steep mountain road when the brakes began to fail.  They bring the car to a stop using the emergency brake.  All four get out and discuss how to deal with the problem.

One psychologist states, "we should get back in the car and drive again.  Do not react to anything the car does or fails to do.  The resulting free action demonstrated by the car will be very informative regarding its pathology and eventually lead to a solution."

"That's ludicrous!" bellows a second psychologist.  "We should get back into the car and drive.  But, every time the car succeeds in braking we should reward it with gasoline."

The third psychologist offers, "I think we should just accept this car for itself.  It should feel supported by us whether it can brake or not."

The managed care rep declares, "well, no matter what any of you do, every 100 yards I'll decide whether we keep driving or jump out of the car."

So, all four get back in the car and resume driving down the road.  One hundred yards later the managed care rep makes them all jump out.  They watch with some sadness as the car goes over a curb and then off of a cliff.

Internet parasites

I had the opportunity to speak to some middle-schoolers regarding sex offenders on the internet.  While preparing for this presentation, I had an insight; there really is not much out there designed with children as the primary audience.  If you browse the internet or even contact the FBI directly, you will find out that what is out there is created for parents.

As a psychologist, I knew this kind of material would be difficult to bring across effectively to children.  So, here is an analogy that parents can use to help their children understand the need for internet safety rules. 

Imagine the internet as a forest.  It is huge and you can find all sorts of things in it: beautiful things and grotesque things; safe things and dangerous things.  If you stay on the paths, you can be led to all sorts of interesting and wonderful things.  Stray from a path and you could get lost or even hurt.

A child should be nodding along up until the getting hurt part.  After all, how could the internet hurt someone?  Ask them, when they are in a forest, how often they think that an animal is watching them?  They will likely guess a low number.  You can say with confidence that, whether they knew it or not, most of the time some animal is watching a person as they go through the forest.  Some of those animals are dangerous. 

You can remind your child that they have never gotten hurt by any animal while in the forest.  Then ask them, why is that?  If they don’t come up with the answers on their own, tell them: because they were with an adult they knew; because they followed basic rules that pretty much assured their safety.  The internet has its own version of dangerous animals. If people don’t follow basic rules for safety, those animals will try to hurt them. 

At this point you will have to decide how much more your child can or should know with regard to exactly how these people can hurt a child.  For most children, I would say that these people try to fool you into thinking they are a friend.  And, once they think they have fooled you, they will try to hurt you. 

Now, with a more understandable image of the internet in place, your child is ready to hear some of the material available to parents with regard to basic internet safety.

There is one other point on this topic.  It regards the term “internet predator.”  This is a key phrase associated with this topic and it is the first time I’ve used it in this commentary.  That is because I really do not like that phrase.

For me, the word “predator” has a cool “danger-mystique” surrounding it.  When I think of the word predator I think of wolves, tigers… you know, cool, beautiful, dangerous animals.  This is not the image I want to associate with sex offenders.  They are dangerous.  Some could be physically engaging but all sex offenders are certainly NOT cool.

So, what other phrase would I suggest?  I believe the word predator is used because we think of sex offenders as “hunting” for their victim like a predator hunts its prey.  In addition, the word predator suggests something that we must be aware of and guard against.  There is another type of animal that we must guard against and hunts for its prey besides predators.

Parasites!  Parasites have a specific prey or host that it hunts.  We must take precautions against parasites or be attacked by them.  Like a predator, a parasite can cause physical harm to its prey.   In addition, unlike a predator, a parasite can cause lasting change in the behavior of its prey!  For those of you who know someone victimized by a sex offender, you know that the physical trauma does heal, but the traumatic stress will change your loved one’s behavior for years afterward.  Finally, where we attempt to respect predators and live alongside them, I believe that most people want to stay as far away from parasites as possible.

So, I propose that we drop the term “internet predator.”  It is not only a horrible allusion to predatory animals but I believe it is also inaccurate in both the image and the idea it conveys about sex offenders on the internet.  Instead, I would encourage the use of the phrase “internet parasite.”  Personally, I think it is not only more accurate, it just feels right.  I would rather associate the idea of an internet sex offender with a tick or a worm than with a tiger or a wolf.

Big girls don't kiai... why?

I was in a martial arts class back in the '80s when someone first talked about watching babies to relearn how to breath.  Since then I've also studied babies to learn how to get a really good stretch.    It appears that for many people the process of growing from an infant to an adult involves the corruption of basic functions: sleeping, breathing, and stretching.  It also leads to the "modulation" of the expression of basic emotion.  Certainly there is often a true necessity to this in our adult life.  Since I began working on an inpatient unit I've experienced several patients who actually cry just like an infant and it is one of the more disturbing experiences I've ever had.  Aside from this extreme example, I believe crying is generally an under-utilized behavior.

When I am training in a dojo here in Buffalo, I find it intriguing how many students will not perform an audible kiai -- a short yell or cry before or during a technique.  This is one of the few settings where making odd yells should not get you negative attention.

As an aside, in truth, the sound is not critical.  A powerful yet relaxed exhalation of air, coordinated with movement, is what is actually necessary for the technique to be most effective.  The audible just helps me as a teacher to get an easier sense of the student's breathing, posture, and focus in a technique.

But, it is surprisingly common for a student who is not using an audible kiai to still not really kiai even after you insist that they do so.  Why?  I tell them it will help startle their attackers.  I tell them it will psyche them up for the brief struggle to come.  Sometimes I may even remember to tell them how the kiai helps engage key muscles that will help protect their internal organs.  Still, they often mew like a kitten or make no noise at all.  Even with permission, yelling or crying, despite the context, is resisted by adults.  I suspect for many of those students it is simply a matter of being embarrassed to draw attention.  But for some I have found that it can be much more. 

You might think that people simply fear that crying would be viewed as a sign of vulnerability and/or weakness.  Despite this, I have had multiple clients who wanted help to be able to cry as adults.  These adults often shared the same story of being told by parents or childhood peers to stop "acting like a baby," in other words, appearing weak.   And some share that their parents would strike them until they stopped crying!  But as adults, they come to realize that they lack a critical function.  They notice that there are situations where others cry and they do not.  More importantly, they have the insight that this is not healthy.  Fortunately, after following through with the exercises I provide, they do cry and report that it was a great experience.  Some say they actually feel lighter and happier since they cried!

Next time I encounter a student who won't kiai, I think I'll tell them that performing an audible kiai does not make them weak it makes them strong.  More important, it could truly make them happier.  

Who supervises the supervisors?

As with most things, we can only be as good as the people we surround ourselves with.  For a psychologist in particular, the most important person in that mix is the supervisor.  Having been trained to provide supervision, I used to think that I was pretty good at it.  Fortunately that delusion was dissolved when one supervisee as much as told me that she had felt like she was floating in an ocean with sharks circling.  What did I do wrong?  Well, probably a lot of things at the time... but, how can I be at least a "good enough" psychologist-supervisor for my next victim... I mean supervisee?  Here are three rules:

First things first, supervision is not therapy.  While I believe it is important for a supervisor to be aware of any particular "buttons" or "issues" the supervisee feels could effect his or her performance, a supervisor should not use "the voice" and try to get the supervisee on the proverbial couch.   I know I had a couple of supervisors who I dreaded talking to because I got the impression they were more interested in my personal damage  than helping me improve my clinical technique.

Second, provide structure.  No matter how advanced your supervisee is, everyone likes to start off being directed as if they were a first year student.  Give articles to read.  Tell the rules of the setting and go over how therapy works -- according to your school of thought.  Really scrutinize technique and give plenty of feedback early on.   More advanced supervisees should quickly tire of your structuring and give you signs that they are ready to go beyond the basics.  I try to pick up on clues before the snoring or blank stares followed by standing up and walking out of supervision 30 minutes early.  Of course, with experience you will be able to rely less on their level of irritation to inform you as to when to back off.

Third, balance the challenge.  Certainly meet the supervisee where they are at from a professional development standpoint as well as an emotional one.  Push too softly and they will feel like the experience is a waste.  Push too hard and you will crush their spirit.

So far, I have been good with point one.  That's it.  For those receiving supervision, give feedback as soon as you realize what is not going well.  These are the basic opening lines that I think supervisees should use (with me anyway):

For problems with Rule 1: "I was wondering if we could spend more time on my conceptualization of this client I am working with?"

For problems with Rule 2: "I am not sure I quite understand how you believe I could be handling this case.  Could you work with me a little on how to develop a treatment plan?"

For problems with Rule 3 - low challenge:  "I think I would like to work with some more challenging cases."

For problems with Rule 3 - excessive challenge: "Wow, I feel like I have a long way to go.  I think I need a lot more supervision on this."

Try these out.  Raise your voice level as need be but, please, no spitting or hitting.  Talk to your supervisor's supervisor if you must.  And, believe me, you might have to.  I know I have had supervisees who used some of the above statements and I do not think I responded well to their hints at a need for improved supervision.  My only defense is that providing supervision is as much a work in progress as developing a therapeutic style. 

Medical model versus Psychodynamic theory

The word "iatrogenic" is almost exclusively used to mean an adverse effect or complication related to the provision of health care.  The word "iatrogenesis" really refers to both the good or bad effects related to but not the actually intent of the actions of a healer.  So, why is iatrogenesis almost always used to refer to negative effects? I could just say that many who use the term in this manner are control freaks and think anything that happens that they did not will to be is therefore bad.  But, then this would be a short post.  Instead I will focus on how I believe that the emphasis on the negative points to what I believe is the essential difference between the medical/behavioral model and psychodynamic theory.

The medical/behavioral model, in my opinion, operates on the assumption that what is critical in the success of an intervention is not the interventionist, it is the quality of the intervention itself.  A medication will be successful if it is the appropriate medication at the appropriate dose.  A homework assignment will be successful if appropriately presented, conducted, and reviewed.  The only concern for the exact nature of the relationship between a healthcare recipient and a doctor is that it be professional.  Anything that occurs that was not expected from the intervention is interpreted as due to "error" or a "placebo effect."  

Psychodynamic theory, conversely, is very concerned with the nature of the relationship between the psychologist and the client.  The concepts of transference and counter-transference clearly emphasize that it is the therapeutic relationship which is the critical component of healing.  When anything occurs that was not expected from the intervention, it is interpreted as informative about the client's personality, history, and presenting problem.  The unforeseen improvement or insight is considered a boon not a burden.  

Then what should we do with undesired, unforeseen, negative results of intervention?  How should we react to institutionalization -- an iatrogenic effect of long-term care?  I believe psychodynamic theory indicates that we should understand the dynamics of the relationship between the client and the institution.  For example, does a client become institutionalized because at some level the hospital unwittingly promotes that result?  Or could it also be that a battered soul will choose the safety of a cell over the responsibility and dangers inherent in freedom? Such informed analyses could potentially lead to both policy and procedural change that could reduce the incidence of institutionalization.  With the current emphasis on the medical/behavioral model, I am doubtful that such analyses will be performed, let alone operationalized, in the near future.  But, it is a seed that should be planted and nurtured by new, up-and-coming doctors -- psychiatrists as well as psychologists.