Category Archives: Psychology

March 18, 2014 · 12:29 pm

Mapping Global Trauma


This week I am participating in the American Bible Society sponsored Community of Practice for trauma healing interventionists. The audience represents many organizations, Exile International, Wycliffe, SIL, the Seed Company, Food for the Hungry, as well as many bible societies. Attendees come from places such as Sri Lanka, Nigeria, South Sudan, CAR, Rwanda, Uganda plus several more.

Today, we heard from successes and challenges in several specific areas. Then, Dr. Matthew Stanford (Baylor) gave us an overview of trauma around the world. When we look at armed conflict, we see much on the continent of Africa. Natural disasters take even more of the globe. Trafficking, HIV and sexual violence cover the rest. While some 50% of the US population are exposed to traumatic events, only about 8% will meet criteria for PTSD during their lifetime. In other parts of the world, 90% are exposed to trauma and 40% will meet criteria for PTSD during their lifetime. One of the challenges missionary/humanitarian efforts face is learning about the symptoms and impact of trauma on populations. Too often people either neglect trauma or only focus on a few symptoms. We can try to work on one problem (domestic violence) but without addressing the deeper roots of trauma, it is likely not to be very effective.

After Matt, Rebecca Deng spoke of the experience of being a refugee (South Sudan) and coming to the US as a refugee. Some 42 million refugees worldwide. Some 25 million internally displaced (IDPs) on the continent of Africa. She told a bit of her story of loss and struggle even as she came to the US as an unaccompanied youth. She spoke this very important question

You can grow food, purify water, but who can clean the wounds of the heart?

We ended the morning session with a presentation from Bethany Haley of Exile International. Dr. Haley spoke about the impact of trauma on children. (Exile has work in the DRC and Uganda.) She reviewed the many sources of trauma (armed violence, sexual violence, trafficking, child labor, orphans, recruitment into armed gangs) and how it commonly impacts capacity to develop well and learn. We know that trauma changes brain structure and function. She pointed us to the work of Karyn Purvis at Texas Christian University who has done work on the effects of trauma on developing brains. In addition, she pointed us to Unicef materials available to teach about child trafficking around the world.

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March 12, 2014 · 9:55 am

The roots of genocide? Guest post at www.biblical.edu


In light of the upcoming 20th anniversary of the genocide in Rwanda, I’ve written a short post about the roots of genocide. You can find it here at the faculty blog site at biblical.edu. I interact with some material by Ervin Staub in order to go beyond either the superficial response–that it just sin and evil that causes genocide–and to go beyond the naive response that it is something we could never do.

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February 19, 2014 · 12:46 pm

When you imagine something does your brain think you see it?


What is the difference between imagination and reality? Sometimes, not that much.

The February 2014 edition of the Monitor on Psychology (v. 45:2, p. 18) lists a brief note about a study published in Psychological Science that looks at eye pupil constriction when imagining light. Here’s the abstract from the link above (emphasis mine):

If a mental image is a rerepresentation of a perception, then properties such as luminance or brightness should also be conjured up in the image. We monitored pupil diameters with an infrared eye tracker while participants first saw and then generated mental images of shapes that varied in luminance or complexity, while looking at an empty gray background. Participants also imagined familiar scenarios (e.g., a “sunny sky” or a “dark room”) while looking at the same neutral screen. In all experiments, participants’ eye pupils dilated or constricted, respectively, in response to dark and bright imagined objects and scenarios. Shape complexity increased mental effort and pupillary sizes independently of shapes’ luminance. Because the participants were unable to voluntarily constrict their eyes’ pupils, the observed pupillary adjustments to imaginary light present a strong case for accounts of mental imagery as a process based on brain states similar to those that arise during perception.

So it seems that thinking about something causes your brain to respond as if it is really seeing. What might this mean about those who are trying to break free of addictions?

  • Would imagining heroin use create observable changes in they body that would make it harder to maintain abstinence
  • Would recalling sexual images create responses that make sexual addictions harder to break?

So, what is the difference between imagining an affair and actually engaging in one? From a brain perspective, maybe not that much. Certainly Jesus’ expansion of the seventh commandment suggests there isn’t a difference between the two from God’s perspective. And yet, we know that actual adultery creates more damage to more people than merely fantasizing about having an affair.

Rumination: the health killer!

I’m currently teaching students a course on psychopathology. Each week we consider a different family of problems. Thus far we have explored anxiety disorders, mood disorders (depression, mania), anger/explosive disorders and addictions. Soon we’ll look at eating disorders, trauma, and psychosis.

There is one symptom that almost every person fitting one of those above categories experiences–repetitive, negative thought patterns.

Rumination.

The content of the repetitive thoughts may change depending on the type of problem (i.e., anxious fears, depressive negative thoughts, illicit urges, fears of weight gain, fears of being hurt, irritability, etc.) but the heart of the problem is the vicious cycle that negative thought patterns produce.

While there are many very good ancillary mental health treatments (Did you know that daily exercise, getting a good 8 hours of sleep each night, and eating a diet rich in protein supports good mental health and may even prevent re-occurrence of  prior problems?) it is essential for those of us who struggle with imagining negative events to find ways to shut down the production of rumination. Mindfulness techniques, thought-stopping, alternate focus may help to interrupt imaging bad feelings, thoughts, events and thereby interrupt the body reacting as if those bad things are indeed happening.

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February 14, 2014 · 11:34 am

Free Issue of Journal of Traumatic Stress


As a member of International Society of Traumatic Stress Studies (ISTSS), I am able to offer you a link to a free issue of their journal, Journal of Traumatic Stress.

Click this link for the February issue page with links to download individual articles.  Several essays relate to PTSD treatment for veterans, at least one essay re: child maltreatment in Uganda.

 

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February 12, 2014 · 11:46 am

Are perpetrators of abuse “other”?


I write, teach, and provide professional care about matters pertaining to child sexual abuse. I sit on a board of a fantastic organization designed to help christian organizations prevent child abuse and respond well when allegations arise. From these experiences I can tell you that victims of abuse struggle the most when they finally get the courage to speak up but then aren’t believed–whether by other family members or those within their community. Since most abuse happens in secret places and since most of us live with happy public facades, it is easy to disbelieve the victim. In fact, the temptation is great since believing the victim means we must alter our perceptions of the perpetrator and the system that supports them. And that alteration disrupts our own lives, threatens our own comfort zone. Since some reports could be, have been false, maybe this one is too…

The first problem in stopping child abuse is the failure to believe victim stories of abuse. Victims know their information will destroy life as it was before the revelation. Believing that they will be singly responsible for damage done by revealing their abuse, they keep silent. Silence always enables further abuse.

But there is another problem, a second problem faced in stopping child abuse: treating abusers as “other,” some sort of monster that is so unlike the rest of us, we can’t imagine being in their presence. Think about these words. Perpetrator. Pedophile. What garish images come to your mind? Or, do you imagine someone with virtue along with their obvious and destructive vices? Do you imagine the image of a victim in that same person?

“Does it make sense to discard an entire oeuvre of work? Or does it simply reflect an inability to live with messiness and ambiguity? To chalk it up as nothing more than the work of a monster, to cast it out of the village, is to senselessly re-affirm the same basic strategy of denial and dehumanization that, ultimately, allows abuse to continue.”

If you are interested in considering the complexities of the person of the perpetrator, I highly recommend this essay where I found the previous quote. It is written by a victim of abuse perpetrated by his father. How do we account for the virtues, the generosities, the humanness, the victim experiences found in individuals who choose to perpetrate against others? Like the author of this essay, I suggest that doing so is absolutely necessary if we are going to make any dent in the incidence of child abuse.

“Most of us would sooner discard all parties who have been tainted by this event than we would look at how tenuous the sanctity of children really is, how commonplace abuse is, or see the capacity for the mostly good to do periodic evil. We live in the same universe as those who abuse kids. We walk among them. If we want to end the sexual abuse of children, it will begin with the recognition that we are simply not that different from them.” (emphasis mine)

Won’t humanizing perpetrators harm victims?

Humanizing perpetrators of abuse does not minimize the need for justice for victims. It does not decrease the place for restitution or incarceration. Naming humanity in perpetrators does not lead to excuse-making (we do that for other reasons!) nor demand explanations for abusive behavior (though sometimes this can be helpful, most would rather have acknowledgement of abuse done). It need not change our triage policy to prioritize victim recovery over all else.

But when we recognize that perpetrators of abuse suffer from the human condition plaguing us all (self-deception, self as the center of the universe, seeing others as objects for self-comfort, choosing fig-leaves rather than truth in response to shame), we have the opportunity to name these conditions wherever they show up in our lives. Naming them early and often hinders the development of the “split-self” where we live publicly one way but privately nurse other shame-inducing habits. And when we are more able to identify these features in ourselves, we may also find that we can identify them in others as well. While we are not responsible for the abuse perpetrated by others, complicity with abusive behavior (failing to respond to evidence of abusive behavior, allowing cover-ups, etc.) does stand as judgment on us.

Let us acknowledge that we are not so different, that “treatment” must start first in our own hearts so that we can help others before abuse takes place.

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December 3, 2013 · 7:15 pm

Is PTSD an internal problem causing social problems? Or the other way around?


I am finally getting around to read Ethan Watters’ polemic Crazy Like Us: The Globalization of American Psyche (Free Press, 2010). In this book he details the way America has exported not only its pharmaceuticals but have redefined mental health and disease. As the promotional material on the front cover says, the book “[uncovers] America’s role in homogenizing how the world defines wellness and healing.”

As I read the book, I find he is overly negative and pessimistic, even as he right points out some major bumbling when bringing Western mental health ideas to the world. And yet, consider this…

In chapter two he examines the way Western mental health providers flooded (bad pun but appropriate picture) Sri Lanka after the Tsunami to treat all the PTSD that would most definitely come to light. They “educated” the country about the symptoms of PTSD and trained caregivers and counselors to provide counseling interventions. When certain symptoms weren’t presenting widely, some helpers assumed victims must be living in denial.

Watters describes how one researcher began looking to see how Sri Lankans described symptoms of poor responses to trauma–instead of using a pre-determined set of symptoms. This researcher concluded that Sri Lankans experience trauma quite differently.

1. Sri Lankan PTSD symptoms were primarily physical in nature.

2. Sri Lankans did not identify anxiety, numbing, fear symptoms but rather identified isolation and loss of social connection as key to PTSD symptoms.

The root problem in PTSD? 

So, is PTSD internal or external? Intrapsychic or social? Most Westerners think of psychopathology in terms of the individual. A sick individual will likely find their social lives eroding and less supportive. It appears Sri Lankans think of pathology in terms of social connection which when broken results in some of the physical symptoms. So, does trauma cause psychological damage which in turn harms social networks…or does trauma harm social networks which in turn causes distress?

Your answer to this question likely reveals whether you see the world as a community or a group of individuals.  Or, your answer reveals whether you focus on universal human experiences or constructed human experiences.

One semi-helpful answer

My answer? Our minds, bodies, spirits and social networks are not disconnected. While distinct entities, we are far more connected than disconnected. To paraphrase the bible, if the eye is sick, the whole body is sick. Psychopathology does not reside only in one location, even if we can see it’s impact in one specific location (e.g., cells not functioning). We would not assume that seeing the destruction after a tornado would be all that is needed to find the cause of that same tornado. Whatever interventions we devise, we will not find a one-size-fits-all solution. For some, we will intervene first in the interior of their lives (medications, private counseling). For others, we will start with social reconnection.

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November 19, 2013 · 1:40 pm

The power and perversity of labels


English: Photo of Paulo Freire

[Previous version published  in 2006]

That was great!

You are a liar!

We humans have powerful tendencies to label and categorize. It may be something that Adam passed on to us. Notice that Adam got to name the animals as he saw fit. I suspect that being made in the image of God provides us an innate drive to name things as they are?

But what happens when things don’t fit our categories? We either have to expand our definitions or shove square pegs into round holes.

  • The color line comes to mind. Those who are biracial face the repeated question, “What are you?” And the “one drop” rule still is holds power: one drop of African heritage blood in your recent ancestry makes you “Black” in this country.
  • How about those who don’t fit gender stereotypes. I’ve heard the pain of many who were accused of being gay because they didn’t fit someone’s image of a man or a woman. These labels were so powerful that they caused confusion. “If being a man means…(fill in the blank), then I must not be one. Maybe I’m gay.”

The Counselor’s Power to Label

Counselors hold tremendous power when as they label, especially those who represent both the counseling and the Christian worlds. We label right and wrong, righteous and unrighteous. We label idols of the heart. We want our counselees to see themselves and God in proper form. We see how distortions in labels (e.g., God doesn’t love me; I’m incapable of changing) harm and we want to provide healthier labels.

But, HOW and WHEN we label may be more important than whether our labels are actually correct. The temptation for counselors is to label too quickly, before the counselee is ready. If that happens, the counselee is passive and the counselor’s label is just one more among a chorus of opinionated acquaintances.  

Take a look at how Jesus interacts with sinners and self-proclaimed holy men. Who is he more likely to label? Who does he engage with deep questions? What are his means for helping others see themselves? Notice how the Pharisees were quick to label what was authentically Jewish and what was not. Notice that the Lord seems less interested in that and more interested connecting to others. He was not neutral about sin. However, he engages others in novel ways to show them the righteous path and their need for a savior.

Who Does the Labeling Matters

I’ve been enamored with the late Paulo Freire, a liberation theologian from Brazil. He describes how unthinking, impoverished, people become empowered when they are given the power to name things (problems, solutions). They do not, he says (in Cultural Action for Freedom), learn by being filled up with words and labels by dominant culture individuals. If this were the case, then counseling would only be a matter of memorizing the right words and phrases. No, counseling is a dialogue where the counselee is an active, creative subject in the process of change. In Learning to Question: A Pedagogy of Liberation, (by Freire and Faundez), they say,

I have the impression…that today teaching, knowledge, consists in giving answers and not asking questions.

The same could be said about counseling. It is the asking of questions that encourages us to search for answers. Without questions, we may never redefine the problem. When we counselors label (whether we are talking about DSM labels or right/wrong labels) without engaging  the client in the process, we rob them of their words.

What Can We Do?

Freire suggests a three-step dialogical model that may work also in building an effective counseling relationship: Investigate (ask exploratory questions, examine beliefs, myths, etc.), Name (code and decode, a process of un-naming and naming what is going on), and Problematize (identify problem and solutions).

Avoid the Temptation to Give the Gift of Your Knowledge

Freire says that gifts given by oppressors only perpetuate injustice. If the “gift” of your knowledge perpetuates the divide between the counselor (the healthy/wise one) and the counselee (the sick/naive one), then your gift may only serve to perpetuate their illness. This does not mean you should never speak or offer advice. But ask yourself, “does the way I speak to clients encourage and energize (all the better if in the form of a pushback) or cause passivity?

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November 5, 2013 · 2:05 pm

Does the DSM 5 define pedophilia as a sexual orientation?


In recent weeks I have read a couple of postings suggesting that the new version of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) has taken Pedophilia out of the realm of (psycho)pathology and made it equivalent to sexual orientation (e.g., gay, straight, bisexual, transgendered, etc.). These postings propose that the publisher, The American Psychiatric Association, has decided to normalize pedophilia–something that some believe is mere politics and a sign of further loosening of social mores. Usually, these writers point to the fact that the APA depathologized homosexuality in previous editions and now are going steps further to normalize pedophilia.

But, is this rumor true?

The facts from DSM 5

Pedophilia, or Pedophilic Disorder still exists and is considered a disorder in the family of paraphilias (patterns of abnormal sexual desire or activity). To be diagnosed with Pedophilia, one must meet 3 criteria (summarized)

  • Have sexual fantasies, urges, or behaviors for prepubescent children
  • Either urges cause marked distress, interpersonal difficulty OR the adult has acted on the urges with children
  • Must be at least 16 and seeking those who are at least 5 years younger

So, why the rumors?

Okay, so pedophilia is still a disorder. So, where is the confusion? After listing the criterion, the DSM offers some commentary to further describe the disorder. Here’s where some confusion may enter in as they describe the person who has intense pedophilic urges but who has not acted on them:

“However, if they report an absence of feelings of guilt, shame, or anxiety about these impulses and are not functionally limited by their paraphilic impulses (according to self-report, objective assessment, or both), and their self-reported and legally recorded histories indicate that they have never acted on their impulses, then these individuals have a pedophilic sexual orientation but not pedophilic disorder.” (p. 698)

Meaning?

Unfortunately, “pedophilic sexual orientation” is not defined. By the way, neither do they define any other sexual orientation. The point being that since sexual orientation is outside the purview of  a catalog of psychopathology, it need not be discussed. So, my read of the DSM 5 intent regarding pedophilic urges is this

  • Pedophilia is NOT equated with sexual orientation when the person is acting on the urges or is troubled by them, BUT
  • Those who have these attractions, yet feel no shame about them, function in society to protect children, and have not acted to harm children are not pedophiles but can be listed in a new nonpathology category: pedophilic sexual orientation. thereby, 
  • Opening the door for some to self-identify in a nonpathological manner

Is this cause for alarm?

Short answer. No, this nor the removal of homosexuality as pathology is not evidence of APA’s moral degradation.

Longer answer. this addition/change will create confusion. It does open the door for some crazy thinking and adding the “orientation” language is wrongheaded and may harm the good research being done about sexual orientation. Further, never underestimate the power of some to use this for evil intent.

Remember, the DSM is a catalog of psychopathology, not social pathology, moral pathology or the like. So, if it is possible (and there is evidence to support this) that gay and lesbian people do not experience psychopathology solely as result of their sexual feelings, then it would be right to remove homosexuality as a psychological disorder (no matter how you classify it in terms of morality).

There is another DSM feature that may be more of issue in this debate. As of now, diagnoses are locked into using the criterion, “causes marked distress” as a way of determining the floor for a pathology. Thus, you could possibly experience recurrent and persistent obsessional thoughts and images but not have them cause “marked distress…or significantly interfere with normal routine, social activities…” and therefore NOT be diagnosed with OCD. So, if it is possible to determine that a person with sexual feelings for little children is able to be not disturbed by them AND not act on them, then you wouldn’t give the diagnosis.

See the problem?  Here’s an analogy of sorts: if all 80 year old men have cancer cells in their prostate but never have any symptoms, seek no treatment, and die of other causes, should they be diagnosed with prostate cancer? Denying the existence of the cells doesn’t seem to be the answer even if no treatment is necessary.

To the point: Is there movement in redefining pedophilia?

Not in the mainstream.

It appears that there is an effort to better understand those who are being charged and convicted of child sex offenses. I see a growing research beginning to differentiate between three types of people who commit sex crimes: contact sex offenders (those who directly abuse actual children), internet offenders (those who use or send child pornography), and solicitation offenders (those who use technology to communicate with minors for sexual purposes).  The idea is that there may be differences between these three types and thus arguments for different punishments and treatments. It seems, thus far, that contact sex offenders have far more distortions in empathy for victims, cognitive distortions about self and children while the other two categories seem to have some features that might protect them from becoming contact offenders. NOTE: the data is small at this point and we can’t predict who will and who will not become contact offenders.

Go ahead and worry some

If one could really argue that child porn viewers are not statistically more likely to become offenders against actual children, you can easily imagine someone arguing that virtual child porn (i.e., digital created images of children having sex) harm no one and ought to be legal for the pedophilic orientation individuals. On recent report stated that at any given moment in time there are 750,000 individuals accessing and viewing child porn. And that is with it being a crime. Do we really want to open this door to normalization? No. We want to understand, empathize, restrict, and intervene.

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October 19, 2013 · 5:38 am

The Power of a Counselor’s Words: Guest post over at biblical.edu


I’ve been thinking and musing about the power we counselor’s wield with our words. To be honest, I do so without always being aware of the impact. It is so easy to say, “that’s abusive” to a victim with the idea that I am validating her experience without realizing I have just crushed another part of her life.

So, if you want to read some of these musings and a gentle corrective to those of us who call ourselves biblical counselors, click here to find the blog I posted for October 18, 2013.  [posted prior to leaving for South Africa]

 

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September 18, 2013 · 6:56 pm

Can you pray your mental illness away? Seems many Christians think so


Lifeway Research has published a news item about a recent survey of conservative, evangelical Christians and their beliefs about mental illness. About half feel that with only prayer and bible study, a person could be healed

Lifeway Survey Questionfrom serious mental illness.

I suppose there may be some who answer this question in such a way as to mean that it is possible to be miraculously healed. I would agree. But is that the thinking behind those surveyed? My sense is that is not what most are thinking when they answer this way.

This most likely reveals that many Christians believe that symptoms described by the medical world as “mental illness” are only or mainly character or behavior problems.

We need a more robust theology of the body if we are going to better understand how the body influences our expression of mental illness.

 

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