Monthly Archives: September 2012

Thomas Szasz, critic of psychiatry, dies


Did you see the obituary notice for Thomas Szasz, a 92-year-old psychiatrist who made it his life’s work to attack his own profession? If not, read the NYT’s article here. Szasz’ beef with psychiatry centered on two complaints: the diagnostic system treated individuals as having “things” rather than describing what they do (thus making it seem like people have diseases AND the coercive nature of treatments (forced treatment and meds for psychotic individuals.

What makes Szasz important to Christian counseling is that many biblical counselors and nouthetic counselors touted Szasz in their criticism of secular psychology and psychiatry. The Bobgans and Jay Adams used Szasz quotes to bolster their own criticisms.

How he was right AND wrong about diagnoses

Szasz was right in that DSM diagnoses tend to treat problems as discrete disease states when in fact they are descriptions of clusters of symptoms. More Venn diagram than discrete thing. Yet, Szasz and his ilk often used examples of diagnoses that he thought were not disease states. Well, some of these diagnoses have turned out more disease than not disease. Take ADHD for example. Many critics complained that there wasn’t anything that could be seen under a telescope…thus ADHD isn’t a real disease. Well, we can see significant differences in brain activity in the frontal lobes of those carrying the diagnosis. While we can’t yet point to a specific cellular structure or gene (and we likely never will since it is more complex than just biology), we are understanding the biological aspects of a number of mental health diagnoses.

Szasz was right that some portions of psychiatry treated those diagnosed as victims and ignored responsibility. Interestingly, as our understanding of genes and brain functioning have improved, the victim mentality has decreased. We are doing better in identifying responsibility even as we are more articulate about the effects of the Fall on the body.

We should thank critics like Szasz for pointing out serious flaws in the foundation of mental health philosophy and practice. And yet we should avoid the all/nothing approach that Szasz and his opponents took in criticizing or defending psychiatry. One common human reaction is to either (a) always look to be the critic, or (b) always look to explain away criticism. Both responses are normal but disastrous to helping others.

3 Comments

Filed under History of Psychology, Psychiatric Medications, Psychology, Uncategorized

Dissociation (amnesia) and remembering abuse anew?


How is it that someone could forget a horrific event or experience? What is happening when something new is remembered about a very old event? Is it possible to forget (lose the capacity to recall) for long periods of time but then later remember?

Continuing my series on memory, abuse, and the controversies of recovered memories [you can read my previous posts: here, here, and here], I now want to address the issue of dissociation, amnesia, and remembering abuse. In those previous posts we have looked at how memory can be degraded by intent (conscious denial or unconscious rejection), by other overwhelming stimuli, or by failure to encode. But, since I have not spent much time on the topic of dissociation and repression, I want to say just a few words about these two ideas–in part because they are frequently used but poorly defined.

What is Dissociation? Is Amnesia a better term?

People define dissociation in a variety of ways but most definitions include some disconnection from present reality–sensations of disconnection from self, others, or time–and exists on a continuum. The most mundane forms happen everyday. You are driving from point A to point B but realize you cannot remember what you saw along the way. While we could describe this as a failure to encode data into memory, we could also describe the process, a disconnecting from what is happening in the present. Some dissociation is even beneficial. If you have ever been in pain but then got a distracting phone call, your pain perceptions probably decreased. You were, in effect, dissociating from the present experience of pain.

Now, when we talk about dissociation from a counseling perspective, we are talking about a more significant disconnection from present experiences, one that often seems to happen outside the conscious control of the person (but may be a practiced habit that happens without mindful decision). Dissociative experiences include feeling unreal, disconnected from the body, unable to engage the present, unable to remember salient portions of pesonal identity, or even, rarely, the presentation of alternate personality states that appear to fight for control of the individual.

You can imagine that if you are in the position of a repeated trauma (such as child sexual abuse by a parent figure) and unable to escape it, you might develop ways of dealing with the pain by disconnecting from the present. As a result, you might find that any time you begin to feel unsafe, you naturally disappear in some minor or major way. What happens during that “disappearance” depends on the individual. For some, they are reliving some other experience (I’m no longer present but reliving a painful event in my life). For others, they report being blank–thinking and feeling absolutely nothing. The most telling sign to a therapist is that the client no longer seems to be present in the room (nonreactive or reacting clearly to something other than is going on in the present). Whatever the form of disconnection, most then experience some level of inability to remember portions of the trauma.

Interestingly, there is some evidence that those who dissociate have greater capacity to self-hypnotize. In addition, McNally describes a study (in Remembering Trauma) that followed a person with psychogenic amnesia who had altered brain function when in amnestic states.

Does dissociation lead to forgetting traumatic data?

Can a person dissociate enough to create a persistent amnesia for a traumatic event? There is evidence that those who experience frequent disconnected states have greater difficulty remembering important details of traumatic events. However, many would say that repression is a better conceptual tool to explain such forgetting. But then, repression is not well-defined either (even Freud himself interchanged repression and suppression when talking about decisional vs. unconscious forms of forgetting). Despite the frequent use of repression in common parlance (and without the Freudian baggage) I would suggest that amnesia or motivated forgetting may be better terms, a bit more descriptive and less connected to psychoanalytic theory.

Whatever you call it, some level of forgetting can happen to those experiencing relentless traumas.

  • a young Jewish woman forced into an internment camp has her infant child ripped from her and killed. After the war, a relative asks the woman about the child and the woman responds, “what baby?” Only much later does she remember having a child or how this child died.
  • A young male cannot remember much about his childhood. When asked about his Uncle (only 5 years older than he), he can only remember a vague uncomfortable feeling. His younger brother recounts this uncle would routinely enter their bedroom at night to sodomize both boys. Only after numerous conversations does the older brother begin to remember abuse details, even beyond those supplied to him by his younger brother.

Forgetting then Remembering anew?

In my 23 years of counseling I have never encountered someone who recovered memories of a trauma after completely blocking all memory (I believe it is theoretically possible but extremely rare). I have, however, had a number of clients recall previously long forgotten or vaguely remembered traumas. Often when they recall events with VASTLY new interpretations, so new that it feels like an entirely new memory even as they admit the memory isn’t new to them. Here’s a real example (with details changed to disguise identity),

Alice, a 52-year-old elementary school principal, enters individual therapy at her husband’s insistence to deal with her irritability at home. She admits she has developed a fantasy of leaving her husband for the new (and younger) president of the school board. She discloses that this fantasy began not long after her husband suffered a work-related accident rendering him partially disabled. During the initial intake Alice denied any history of trauma or abuse. As the therapy progressed, it became evident that Alice connected her personal identity to that of being pursued–something that her husband no longer attempted. In addition, her attempts to flirt with the school board president had been ignored. In a moment of frustration, Alice exclaimed, “I’ve always known that men found me very enticing, ever since I developed [breasts] at an early age. I’ve always had to be so careful around men, especially married men. I knew they wanted me and that made me feel dangerous but desirable. Now, who am I if no one wants me?” Alice’s therapist asked her to recount a bit of her early sexual history and without much delay Alice reported her first sexual experience at age 12 with her 35-year-old, married Sunday School teacher. She recalled her teacher hugging and fondling her breasts while telling her about his failing marriage and the need for the two of them to avoid further sexual temptation. At age 16, she reported that she and a 4o-something father of a child she babysat engaged in a 6 month sexual relationship.  Alice’s counselor indicated some surprise at how Alice described both experiences. She asked Alice how she would describe the same interactions between one of her current 6th grade students and a school teacher. Alice immediately flushed with horror. “Why, it would be child abuse!” Once Alice regained her composure, she explored how she had always remembered herself as the protagonist in both experiences. In that session and over the next several weeks, Alice reported a flood of new memories, mostly about things done or said by the two sexually abusing men and now interpreted to be predatory behavior. On several occasions she reported that it felt like she had never had these memories before even though she recounted that she never forgot the sexual encounters. The new interpretations and labels created the experience of recovering long-lost memories–ones that seemed blocked as long as she was responsible for the trysts but freed in light of her victim interpretation.

In this little vignette I want to illustrate that memories of abuse can be forgotten, whether only small portions or large, and remembered anew. Recalled or recovered memories are frequent as individuals gain the freedom to explore events from different vantage points. A therapist does not need to go on an abuse hunt or attempt to conjure up forgotten memories for this to happen. Merely exploring the narrative of a prior difficult experience can be all the priming a client needs to begin to experience “new” remembering.

But here’s where good therapy differs from unethical therapy: how the therapist responds to or pursues memories may be the determining factor when it comes to the development of false memories of past abuse. In the next post we will take up the ethics of memory work and explore therapist habits that may produce false memories of abuse.

7 Comments

Filed under Abuse, counseling, counseling science, memory, Post-Traumatic Stress Disorder, ptsd, Uncategorized

Is All Counseling Theological?


Why do we have to study theology? I don’t need that to be a good counselor?

These are words I have heard from students studying counseling and/or psychology in both university settings and seminaries. What would you say?

Biblical and theological training in professional programs?

Most Christian institutions offering counseling or psychology graduate programs require some level of theological engagement. Otherwise, why exist? Some do so via specific course work while others embed the theological or biblical material into classic counseling courses. At Biblical, we do both. We require traditional counseling courses such as Marriage & Family, Helping Relationships, Psychopathology, Social & Cultural Foundations, etc. In these courses we explore counseling theory and practice from an evangelical Christian psychology perspective. We also require students to complete courses like, “Counseling & the Biblical Text” and “Counseling & Theology: Cultural Issues” where they engage biblical texts and theological study as they consider how it forms counseling theory/practice and shapes the character of the counselor.

Is all counseling theological?

Yes. And David Powlison in the most recent CCEF NOW magazine (2-4) talks about this very fact. Here are some choice tidbits,

…counselors deal with your story. In fact, they become players in that story. By word and deed, even by their line of questioning, they inevitably offer some form of editing or rescripting, some reinterpretation of your story.

Counseling is inescapably a moral and theological matter. To pretend otherwise is to be naive, deceived, or duplicitous.

…all counseling uncovers and edits personal stories…. All counseling must and does deal with questions of true and false, good and evil, right and wrong, value and stigma, glory and shame, justification and guilt.

All counseling explicitly or implicitly deals with questions of redemption, faith, identity, and meaning.

Thus, if value-free counseling is not possible (the very questions we ask lead clients in one direction or another), then it stands to reason that every counselor ought to explore the theologies (doctrines, interpretations, beliefs, etc.) he or she brings into the counseling room. Who is God? How does God operate? What is the purpose of the Bible? Does it have anything to say about my life, my attitudes, my relationships? What is sin? What is my purpose in life? What does God think about my suffering? And on we could go.

But counseling is NOT theologizing

But lest you think that Christian counselors spend a great deal of time plying clients with the right answers, on sin hunts, or catechising clients, let us remember that exhortation rarely makes for good counseling. In fact, most clients are well aware of their sins–even those who do not call themselves “believers.” And those who have correct theology are not less likely to have trouble in their relationships or less likely to struggle with racing thoughts or depression or less likely to get caught in addictive behavior.

Instead, good christian counseling consists mainly of,

  1. loads of stimulating questions designed not to get the “right” answer but to awaken the client to how they think, act, believe, relate, etc.
  2. Short observations to stimulate more critical understanding of the personal narratives being written, and
  3. Collegial exploration and practice of new narratives, perceptions, and behaviors.

Wait, just what is Christian about these three points? Couldn’t unbelieving counselors agree with this list? Sure they could. What makes these three activities Christian is the submission of both counselor and client to core convictions and practices of Christ followers.

2 Comments

Filed under biblical counseling, christian counseling, Christianity, counseling skills, Doctrine/Theology, teaching counseling, Uncategorized

What is it like to go to war? Book note


Just began reading Karl Marlantes’ What it is Like to go to War (Atlantic Monthly Press, 2011). If you have loved ones who have served in combat I highly recommend you read this to understand a bit of their experiences. Karl Marlantes is a veteran of the Vietnam War and in this book details the spiritual and psychological impact of killing and combat. While his view of God would vary from most Christians, I think most believers will find his descriptions of war’s destruction on a person very accurate.

Marlantes considers the spiritual nature of war,

Many will argue that there is nothing remotely spiritual in combat. Consider this. Mystical or religious experiences have four common components: constant awareness of one’s own inevitable death, total focus on the present moment, the valuing of other people’s lives above one’s own, and being part of a larger religious community such as the Sangha, ummah, or church. All four of these exist in combat.

Most of us, including me, would prefer to think of a sacred space as some light-filled wondrous place where we can feel good and find a way to shore up our psyches against death. We don’t want to think that something as ugly and brutal as combat could be involved in any way with the spiritual. However, would any practicing Christian say that Calvary Hill was not a sacred space? (p. 7-8)

Just prior to this quote he tells of a harrowing experience where he was in charge of a small band of men defending US interests with no opportunity for backup. Decisions he made led to the deaths of enemies and fellow marines. In a break in the action, a chaplain was flown in bringing, “several bottles of Southern Comfort and some new dirty jokes.” (p. 7) He tells how this “help” wasn’t what he really needed,

I felt responsible for the lives and deaths of my companions. I was struggling with a situation approaching the sacred in it terror and contact with the infinite, and he was trying to numb me to it. I needed help with the existential terror of my own death and responsibility for the death of others, enemies and friends, not Southern Comfort. I needed a spiritual guide. (p. 7)

Consider the book if you live with, love, or work with a veteran of combat.

2 Comments

Filed under Post-Traumatic Stress Disorder, Psychology, ptsd

Abuse and Pastors: An Open Letter from a Pastor to Pastors


This letter and website link was forwarded to me today. I don’t know Jeff Crippen but I do like his utter honesty about the cultural influences in some conservative settings that encourage domestic and sexual abuse and that implicitly encourage injustice to victims of oppression.

I encourage you all to read this…especially if you were once a victim and your church didn’t care well for you. Maybe this will bring some healing.

Abuse and Pastors: An Open Letter from a Pastor to Pastors.

2 Comments

Filed under Abuse, Christianity, Christianity: Leaders and Leadership, church and culture

Know a ministry couple who needs time away to retool or refresh?


This question is a bit like asking if you know whether the sky is blue. Of course you know a ministry leader couple who could use a retreat specifically designed to encourage them! The Haft, situated in the Northern Poconos, is running just such a retreat for no more than 7 pastor/leader couples on October 2-4, 2012.

I have had a part of developing this retreat format and highly recommend it for anyone who might wish to catch their breath with a few other like-minded couples. Going doesn’t mean you are burned out (though you might be) or that you are on the verge of collapse (though you might be). Going means you want to sustain your ministry trajectory.

Check out the link above to see more information about the location and some great pics of the place. I’ve been there a couple of times and find the buildings and the surrounding countryside very refreshing. Even if you are unable to attend this event, you can work with them to set up your own personal retreat.

2 Comments

Filed under pastoral renewal, pastors and pastoring

Guest post over at Christianpost.com


The website, www.christianpost.com has picked up one of my recent blog posts about whether our bodies can cause us to sin. Never heard of the site before but nice to be noticed. You can see the post here if you missed it on my site: http://blogs.christianpost.com/guest-views/can-your-body-cause-you-to-sin-11696/

Leave a comment

Filed under biblical counseling, christian counseling, christian psychology, counseling, Doctrine/Theology