January 21, 2009 · 4:17 pm

Madness revisited


Yesterday I made mention of Marya Hornbacher’s On Madness: A Bipolar Life. Nearing the end today and I continue to be taken with her capacity to illustrate the experience of mania, of using it to successfully do great things and of being drop-kicked into depression, of repeated hospitalizations, of the experience of being snowed under by medications, of chaotic and fearful thought patterns, of the impact on relationships and more.

She writes of the experience of ECT treatments and the struggle to regain her ability to think, write, relate, remember. After many treatments and lengthy hospitalizations, she reflects on her more stable mind:

Much is lost to those two year of hospitalizations. I remember very little, because madness erases memory, and so does electroshock.

…Memory is not all that’s lost to madness. There are other kinds of damage, to the people in your life, to your sense of who you are and what you can do, to your future and the choices you’ll have. But there are some things gained. The years that have followed my decision to manage my mental illness have been challenging, sometimes painful, sometimes lovely. The life I life, even the person I am, is nearly unrecognizable compared to the life I had when madness was in control. There are things in common,obviously–my mental illness hasn’t gone anywhere, and it still, to some extent, shapes my every day. But the constant effort to learn to live with it, and live well, has changed the way I see it, the way I handle it, and it’s probably changed me. (pp. 216-7)

The interesting thing is these sentences are not the last words or the “happily ever after” of the book. In fact, she goes on to tell how she unravels again and finds herself back in the hospital. Later, she confirms that it is hard to accept sanity as normal when it FEELS like failure. She desires normal to be the manic days. And then she reveals why. When her therapist asks why everything has to be perfect, why it’s okay for others to be “good enough” but not for her she says,

“It’s that your pretty good is better than my perfect”.

I suspect many of us can relate to that sentiment even if not bi-polar.

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January 20, 2009 · 5:51 am

A window into the world of bipolar disorder


As a teacher I am on the constant prowl for books, movies, pictures, etc. that give a realistic and personal view of the experience of mental illness. I picked up a great book regarding the world of the Bipolar I person: Madness: A Bipolar Life, by Marya Hornbacher (Houghton-Mifflin, 2008).

Marya tells of her life in short chapters beginning with her memories of life as a 6 or 7 year old. It is less biography and more of a sampling of her thought and emotional life. She has severe highs that last for a couple years, severe lows, and many rapid cycling from high to low in a matter of minutes. You can help but get a sense of her inner world from times in the hospital (many times at that) to impact of her medications and the ineffective care by several psychiatrists.

She is also author of “Wasted”, a book about her anorexia and successful treatment. Ironically, while on her book tour for that book she was drunk most days (trying to control her mania), impulsive in every way, and completely out of control.  

If you check out her book on Amazon, you can search inside. See if you can read pages 11-13 (search for the word “goatman”) and get a rich and painful flavor of her inner world in 1978.

If anyone here as read “Wasted” feel free to let us know what you thought of it.

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January 19, 2009 · 5:32 am

Things that scare counselors…


There are certain things that scare counselors. Some things are real, others are mere fantasies. Some are big scares others are smaller ones. When I teach ethics and we talk about liability, the tension in the room increases. When I teach about suicidal clients and the need for a proper response, the tension increases.

What do I fear? Not remembering a client’s name when I run into them in the public. I don’t think that has ever happened but I fear it nonetheless. More real is the fear of doublebooking, of walking into the waiting room and seeing two clients there for the same time. Now, that has happened to me and sometimes it has been my own fault. Even when it isn’t my fault, my stomach does a flipflop.

But now I have a new experience…being approached by a US gov’t official who flashes a badge and requests to speak to me in private about a matter. I had the feeling that one gets when the police car behind you starts flashing their lights. What did I do? Am I in trouble?

It turned out well however. After verifying his credentials and the release of information in hand, I learned a friend of mine was seeking national security clearances for his job. A couple of questions and the officer was on his way. Pheww…I’m not in trouble.

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January 16, 2009 · 5:56 am

Escape the cold?


We’re having an extended cold snap (but no snow!) here in Philadelphia. And though it is nothing compared to that experienced in Maine right now, I have a DVD escape for you. This week, my wife and I watched Michael Palin’s 4 part series on his trip through the Sahara. You can feel the heat at times. You might think this a boring documentary but he finds a lot of life in the villages and nomads that take him through the desert. He begins in Morocco and circles around through a number of countries. You learn of people groups, nations, and political stuff as well as seeing some stark beauty. And on top of it, you get to enjoy Michael’s quirky humor (former member of Monty Python).

Here’s a link to his site and info about the documentary. We got it from our local library. http://www.palinstravels.co.uk/static-128

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January 15, 2009 · 5:16 am

Some critical thoughts about Biblical Counseling


For those reading this site interested in christian counseling and more specifically, biblical counseling, I have a quote below for you to muse about. I’d like to hear your reactions to the author. Is he right? If not, what is wrong with his critique of the biblical counseling movement or wrong with his insistence on producing evidence of the effectiveness of biblical counseling?

The quote comes from the website www.christiancounseling.com (The Association of Biblical Counselors) which publishes an ejournal for paying subscribers. On occasion they publish interviews with those outside (but friendly with) biblical counseling. Some of their interviewees, like myself (November issue) have a foot in their world but also one in the professional world. FYI, there are more and more of us who reject the necessity of separating clinical care from biblical care but do not believe the integrative attempts of the past were all that useful either.

In September they interviewed a Dr. Stephen Farra, professor at Columbia International University and director of their psychology or counseling program. You can find him and his writings at www.ciu.edu/faculty/bio.php?id=12. He has one work there on his model of counseling called Accountability Psychology, a biblically based CBT model.

After lauding the biblical counseling movement for its deconstructive work of then accepted notions of christian and secular counseling, he says, 

…the biblical counseling movement has been better at critique than positive creation, however. Whenever I seek for an answer as to whether Biblical Counseling has developed clinically powerful counseling methods to help meet the needs of most of those suffering from severe psychological disorders, all I find are a few anecdotal accounts of counselor-reported recoveries for a few individuals… To “get it right,” we do need to move from “integration” to biblical consistency, but we must also move from anecdote to evidence. The Biblical Counseling movement needs to squarely face up to its need to provide solid, empirical evidence of effectiveness and efficiency. Without a solid evidence-based, “best practices” approach, Biblical Counseling will continue to be seen by most Christian counselors in the country as primarily a theological-critique society, making some interesting and valuable points along the way, but without practical means for helping many of the suffering souls who come to us seeking help.

Theological consistency and doctrinal purity is vital, but it is half the battle. The other half is showing that the recommended procedures really work for most people suffering with particular disorders.

Well, what do you think? I’m not looking for anyone to trumpet the superiority of biblical counseling or trash it. In fact, I think biblical counseling has one of the best understandings of biblical anthropology out there. But, should it seek empirical evidence for its methods? While empiricism isn’t the only means of truth, it does tell us something. How would one test the effectiveness of biblical counseling? That all would depend on the outcomes sought–which raises a good question: Does biblical counseling seek to reduce anxiety and depression or sinful or immature responses to it? Is it primarily discipleship or is it counseling to reduce the experiences of what has been commonly known as mental illness?

Good questions to mull over.

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January 14, 2009 · 5:26 am

On apology: Do you lose your dignity when you apologize?


Really, my last post on this topic for now. But Lazare mentions that the dignity of the apologizer is diminished in the act of apologizing. Read his comment about his wife’s apology for a false accusation against their daughter,

Louise’s apology was successful because it diminished her own dignity while restoring Naomi’s. By saying, in effect, “I am the culprit, not you. I misplaced the brownie and blamed you when I should have known better.” (p. 50).

Later he talks about how apologies restore balance in relationships and restore dignity to the wronged. I agree with that, especially when the offender has power over the offended (like the illustration of the mother over the daughter).

But does the one doing the apologizing lose dignity when apologizing? To whom does that seem to be happening? When someone apologizes to me for something, I see their dignity going up, not down. It went down with the offense and returns with the heartfelt admission and request for forgiveness.

I think he has it wrong here. What do you think?

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January 13, 2009 · 5:38 am

Does “Zero Tolerance” work?


The December 2008 edition of the American Psychologist takes up this question when their task force on the matter publishes the article, “Are zero tolerance policies effective in the schools? An evidentiary review and recommendations (pp 852-862).

What did they find?

1. “…despite a 20-year history of implementation, there are surprisingly few data that could directly test the assumptions. Moreover, zero tolerance policies may negatively affect the relationship of education with juvenile justice and appear to conflict to some degree with current best knowledge concerning adolescent development.” (abstract, p. 852)
2. Zero tolerance is based on several assumptions that the authors found wanting

a. school violence is at a crisis level and increasing still. No (is this because of the policies?)
b. Zero tolerance increases consistency of discipline and sends a clear message. Not found in the data.
c. Removal of violent children will create a better climate for those who remain. Data suggests the opposite, schools with higher suspension rates have lower climate ratings.
d. Swift punishment is a deterrent. Not borne out in the data. Opposite may be.
e. Parents are overwhelmingly in favor of the policy. Mixed data here at best, depending on whether your child is a victim or offender.

3. Impact on minority and disabled children? The assumption was the zero tolerance wouldn’t be a respecter of persons. Data suggests disproportionate discipline of students of color not based on poverty or wealth. The suspicion is that teachers may need some help breaking down cultural stereotypes.

There’s a lot more in the article but I’ll stop here. Interestingly, the policy was created to be more fair across the board. The article suggests more wise implementation with more options for psychological care (no surprise there) rather than immediately going to the juvenile justice route. Either way, the problem has to do with wisdom. If you give administration options (akin to Judges discretion with repeat offenders) some will use it well, others not so much. If you make rules, they work well in decisions IF making the decision the same way every time is the goal. But of course, no one really wants that since wisdom dictates different responses. But then underlying prejudices will come back into play. However, it appears the policy doesn’t really address prejudice and stereotype anyway.

Is there a better solution?

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January 12, 2009 · 12:14 pm

On apology II: Definitions


Last week I had a post on Aaron Lazare’s “On apology” (OUP, 2004) and while I don’t plan on blogging through his fine book, I will make a few comments on his second chapter (The paradox of apologies) since in it he tips his hand to the rest of the book. Here are some of his ideas:

1. An apology consists of “an encounter between two parties in which one part, the offender, acknowledges responsibility for an offense or grievance and expresses regret or remorse to a second party, the aggrieved.” (p. 23).
2. Some think apologies must include expressions of shame/guilt, an explanation, the intent to not do it again and reparations
3. The words “I’m sorry” may or may not be an apology and likely cause confusion since the speaker may be offering compassion or regret but not responsibility.
4. Perfunctory apologies are inadequate most of the time since you cannot tell the motivations of the offender (to restore or regain position, to empathize with the offended, etc.).
5. Many apologies offer explanation (defense, akin to the historic meaning of apology/apologetics). They are inadequate.
6. Women apologize more than men in life and in literature. It is often perceived to be unmanly to apologize. Some research say that women have a higher proclivity for guilt.
7. Other cultures have language much more clear about admitting to guilt. Japanese apologies tend to be much more admitting to shame and much more focused on restoring the relationship than relieving personal guilt. American apologies focus on sincerity but Japanese ones focus on submissiveness and avoid explanations.
8. The offended has certain needs: restoration of their dignity, assurances that they and the offender share a similar view of the situation, that they are now safe from further harm, that the offender has suffered, and promises now reparations.
9. When offender and offended are unaware of each other’s needs or motives, apologies often fail.
10. It is possible to apologize for ancestor sins even when not guilty for the act.
11. An apology can be negotiated

What do you think must be part of an apology. Reparations? Expressions of shame? A commitment to repent? Explanation for offense?

I have found that explanations tend to mute the apology and end up sounding like defenses for actions. I also find that saying that one is sorry is much easier than saying, I hurt you and I apologize. And both are easier than saying, “Will you forgive me?” I’m not sold on negotiating apologies. I’ll have to jump to that chapter to see if I might agree or not. Negotiations would seem to suggest the one apologizing is trying to control or manipulate the situation to his/her interests.

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January 8, 2009 · 5:55 am

On apology


Yesterday I went to a local bookstore to buy a calender for my office wall and couldn’t help buy browsing some of their discounted books. Found this: On Apologyby Aaron Lazare (OUP, 2004). Lazare is a psychiatrist and Dean at UMASS Medical School. Have only read the first chapter but have found it interesting thus far. He explores the impression that apologies are on the rise from the early 1990s. Apparently, there are significantly more articles in all print media about apologies for wrongdoings from 1998-2002 than in the previous era of the 90s. He suggested several possible reasons: millennial angst (those wanting to clear their consciences prior to Y2K), the internetage where the world can uncover your sins much more easily (he gives several examples of how the digital age has caught people in statements that might otherwise have been missed). He also discusses the phenomena of “failed apologies” such as “I’m sorry if I might have hurt you”. These, he calls parasites that point to the real power of authentic apologies.

A couple of other tidbits. He says he will provide evidence that women apologize more than men AND more willing to admit culpability.

Second, he says this,

People who offer a pseudo-apology are unwilling to take the steps necessary for a genuine apology; that is, they do not acknowledge the offense adequately, or express genuine remorse, or offer appropriate reparations, including a commitment to make changes in the future. These three actions are the price of an effective apology. To undertake them requires honesty, generosity, humility, commitment, courage, and sacrifice. In other words, the rewards of an effective apology can only be earned. They cannot be stolen. (p. 9-10)

Do you agree with him? I like his description and the requirements, but I do think you can complete the 3 steps with falsehonesty, generosity, humility, etc. You can offer false remorse, reparations, and acknowledge the offense fully for reasons other than concern for the other.

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January 7, 2009 · 4:49 am

Psychology for the (Christian) Masses


So, the other night I had woke up with thistitle in my head that I couldn’t get it out of my mind. Its an academic’s kind of dream/wake state–a book idea. I wondering if you have ideas to flesh this out a bit after reading some of mine.

The title came, I think, as a result of a Miroslav Volf’s comment that consumerism, not religion, was the opiate of the people. Lightbearer provided us with the context of Karl Marx’s quote. And many of summarize his point but saying that something (religion, psychology, anything) is for “the masses.”

So, I got to thinking about the tendency among evangelicals to fall into one of two trap about psychology. Either they use it unthinkingly (cut and paste bible verses on theories without much thought) OR they reject it because psychology is unbiblical and only rank secular humanism. But, I can’t tell you the amount of conversations I’ve had about the benefits of psychological study–whether about medication, therapeutic interventions, professional ethics, etc. where it was clear that few had ever drilled down below pop psychology to understand both its value and presuppositional foundation.

So, here’s my thought. What if we developed a resource for Christians to come to that would give thoughtful, sometimes lighthearted, but always honest answers (and nonanswers when they are better) about psychology, psychotherapy, medications, psychological testing, etc.

Here’s some of the questions that tend to come up most frequently (from my memory of the last 2 months)

1. Is it wrong to take psychiatric medications for my depression? Shouldn’t I be able to either handle it or get over it using spiritual resources?

2. How do you know if the problem is demonic or psychiatric?

3. Should I ever go see a secular therapist?

4. Isn’t Mindfulness really just a Buddhist form of meditation?

5. Should I go for healing prayer for my mental health problem?

6. Isn’t ADD/ADHD just a fad?

7. Can I divorce my spouse because they refuse treatment?

8. Can pedophiles ever return to the church in a safe manner?

9. Can leaders who abuse their roles ever be restored to leadership?

I’m sure there are more. What else would YOU want to read about regarding psychology/psychotherapy from a christian perspective?   

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