Category: Systems of Care & Psychotherapy

The intergenerational transmission of recovery

Shakespeare’s Titus Andronicus (c. 1590) is a story of revenge and rape. Titus murders Tamora’s son. Tamora then has her other two sons revenge their brother’s death by raping Titus’ daughter Lavinia. Afterwards, they mutilate Lavinia, severing her tongue and hands to keep her from testifying against them. During Shakespeare’s era (and in some parts of …

The “Trauma-Focused Turn” in Critical Psychology

A Review of: De-Medicalizing Misery II: Society, Politics and the Mental Health Industry Edited by Ewen Speed, Joanna Moncrieff and Mark Rapley Click on title to read the review (downloads as Word document or contact me for a pdf copy): The “Trauma-Focused Turn” in Critical Psychology First published with PsycCRITIQUES, June 1, 2015, Vol. 60, No. …

Transformative approaches to crises, self-doubt & extreme states

Crises and self-doubt plague all of us at different times in our lives. A natural response is to want to escape the turmoil and angst, and return to solid ground as quick as possible. Yet when we can remain open to suffering, and not shut down or numb out, troubled times can become opportunities for deep transformation. Murray Stein describes …

We can do better than desensitization as the goal of trauma treatment

David J. Morris, a former Marine infantry officer and a reporter in some of the most violent regions of the Iraq war, blacked out while watching a movie and ran out of the theater, only to regain awareness of himself in the lobby as he anxiously scanned other patrons for improvised explosive devices (IEDs). Morris’ girlfriend …

The sensorimotor approach to storying trauma

Far too often, getting on with ‘everyday life’ requires suppressing the impact of traumatic stress on body, mind, and spirit. This self-imposed desensitization to one’s own suffering also lessens how empathetic we are to others’ suffering, including to their stories of trauma. Much like the Twitter feeds, Facebook updates, and blog aggregates that keep us …

The secrets in our silences

I began reading the book History Beyond Trauma by Françoise Davoine and Jean-Max Gaudillière during a turbulent time in my life — when deaths, losses, and uncertainties continually piled up. Despite my best efforts to remain optimistic and push forward with life as planned, traumatic stress was threatening to be more than a subject I …

When soul informs psychotherapy

Research on human attachment has improved the practice of psychotherapy in part because attachment theory gives therapists permission to be “real” people with their clients. One of my favorite books on the subject is David Wallin’s Attachment in Psychotherapy, which describes how to practice attachment-focused psychotherapy. (He’s working on a new book that looks at how …

What is the function of the brain?

Photo: Sculpture of hands holding each other.

Based on her ethnographic study of psychiatric residency programs, anthropologist T.M. Luhrmann concluded psychiatry is “of two minds”: one “mind” emphasizes the role of neurochemistry, while the other “mind” places more importance on the context of our suffering, including relationships past and present. Identifying the origins of mental illness likely depends on both interpretations. There …

Want to reduce mental illness? Address trauma. Want to save the world? Address trauma.

Different explanations have been given for the increased number of people suffering from mental illness. Some have claimed the increase is the result of ever-expanding diagnostic criteria and syndromes that risk medicalizing normal emotional reactions. Others argue the increase is the result of the pharmaceutical industry financially courting the medical establishment as well as using …

Trauma-informed psychotherapy puts the body – and love – back in mental healthcare

Painting of the word "Love".

For the past 50 years, psychotherapy has taken a back seat to biomedical psychiatry, largely due to reliance on medications for the treatment of mental disorders. Yet clinical evidence increasingly points to chronic, unresolved traumatic stress as the source of many — if not most — mental disorders. Furthermore, longitudinal analyses show continued use of psychotropic medications …

Documentary: “24|7|365: The Evolution of Emergency Medicine”

24|7|365: The Evolution of Emergency Medicine from EM Residents’ Association (EMRA) on Vimeo. I attended the documentary premier of 24|7|365: The Evolution of Emergency Medicine, and was deeply moved by the commitment and drive shown by the people who fought for improving patient care in emergency departments across the country. The documentary connects the development …

Attachment theory through a cultural lens

In an article titled “Attachment and Culture (citation below),” Heidi Keller exposes attachment theory’s Western, middle-class assumptions. She argues: “… the definition of attachment in mainstream attachment research are in line with the conception of psychological autonomy, adaptive for Western middle-class, but deviate from the cultural values of many non-Western and mainly rural ecosocial environments.” …

Taking that leap of faith

Photo of paraglider.

One of my teachers at Pacifica Graduate Institute called psychotherapy “the hope manufacturing business.” And frankly, if my first meetings with a therapist left me feeling dejected, I’d likely think that person was pretty lousy at her or his job. Psychotherapy is time-consuming, expensive, and shines a spotlight on the painful stuff we have difficulty getting over …

Trauma nation?

Medicine is where hope is alive and well in America. During the past fifty years, due to rapid advances in microbiology, many persons who once might have died prematurely, or suffered debilitating diseases or disorders, instead enjoy productive lives, albeit often with chronic illnesses to manage. Through its near-miracle successes, the field has engendered the …

The mental health field has a branding problem

For over two centuries, the mental health field, and psychiatry in particular, has actively cultivated a “brand,” distinguishing itself as a remedy for societal ills, largely by adapting its philosophy and methods to the dominant social agenda. In 1793, when Dr. Philippe Pinel initiated reforms in the Salpêtriere and Bicêtre Hospitals in Paris where the …

How I practice psychotherapy with minimal intrusion from the DSM

Photo: Shed with "Freedom From Religion" painted on one side.

I started critiquing the DSM about sixteen years ago. At that time, I was conducting research for my dissertation on mood disorders as well as team teaching an advanced graduate seminar on the phenomenology of madness. Back then, mood disorders were called depression and manic depression. Both terms resonated with what it felt like to suffer …

A sensorimotor approach to becoming indigenous (and healing trauma)

Trickster plays with me. Last week I wrote about Indigenous wisdom as a “gentle” trickster for violent, destructive times. This week, while hiking among the hoodoos in Bryce Canyon National Park, I learned the Paiutes Indians called these rock pillars the “Legend People,” who coyote trickster turned to stone because of their evil ways. Looking …

ADHD: When meds (and genes) become a failure to act

Photo of mural in San Francisco's Mission District.

While reading a 2007 press release from the National Institute of Mental Health (NIMH), I became unusually hopeful for youths diagnosed with attention deficit hyperactivity disorder (ADHD). A study performed jointly by the NIMH and the National Institute of Health revealed the brains of youths with ADHD develop normally but at different rates. In the prefrontal …

Does globalization 3.0 need DSM V?

The slated 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) wobbles like jello. It can’t tell the difference between psychopathology, normal misery, or bad habits. When you know there is something definitely wrong and need help, it won’t necessarily confirm your problem. Allen Frances, MD gives a good breakdown of some …

Compassion fatigue and the fear of being a victim

What if there is something fundamental about empathy such that when we cannot act on it, we lose part of ourselves, perhaps even our humanity? What if we have unwittingly created a world in which we chip away at our capacity for empathy, and with it, one of the unique traits of humankind: the ability …

Born to be raised

I often wonder what it would take to heal centuries of violence, oppression, complicated grief, and emotional neglect. And yet the impulse to heal, social engineer, and reform often seems symptomatic of what is traumatizing about the US and the West in general — that perpetual need to fix a broken system. We know things aren’t right with the …

Pat Ogden on sensorimotor psychotherapy

I am training with the Sensorimotor Psychotherapy Institute and loving it. Not only have I witnessed amazing outcomes with clients, but practicing sensorimotor psychotherapy leaves me feeling more grounded, mindful, and peaceful, which hopefully also translates into better experiences for my clients (and perhaps even my husband). Pat Ogden founded sensorimotor psychotherapy in the 1980s. …

When psychiatry retraumatizes

Before I became a psychotherapist, I often wrote, lectured, and blogged about damaging aspects of psychiatry. I am more hopeful now — not about psychiatry improving, but about truly helpful mental healthcare for people who might otherwise be labeled “chronically” mentally ill and forever take medications to tranquillize their internal demons. Since I began combining …

EMDR: The documentary film

In the nineteenth century, psychiatrist Pierre Janet was the first to theorize posttraumatic stress resulted from the failure to integrate memories of a traumatic event with otherwise normal mental functioning. Current research in neuroscience and psychology now validates Janet’s original intuitions about the nature of traumatic stress. Treatments like EMDR (“Eye Movement Desensitization and Reprocessing”) also …

Research on traumatic stress supports paradigm shift

In the mental health system, the biomedical model is the dominant paradigm. It depicts mental disorders as chronic diseases requiring lifelong treatment with medication (like diabetes or high blood pressure). This model of mental illness has been under attack in the US, where an estimated 20 percent of the population regularly takes psychiatric medications. Arguments …

On social trauma

Every month Somatic Perspectives on Psychotherapy provides interviews with clinicians and thinkers who take a somatic approach to psychotherapy and studying the human condition. The interview below with Eric Wolterstorff focuses on social trauma, which is defined as “the impacts of threats, disasters, deprivation and violent conflict on the capacity of societies to adapt to the world, regulate …

What good is there in remembering trauma?

Would you erase devastating memories if given the chance? By blocking a memory-sustaining enzyme, scientists in America and Israel have successfully eliminated long-term memories in rats. Until now, long-term memories were thought to develop with structural changes in the synaptic connections between neurons, making it difficult to imagine removing painful memories without damaging the brain. …

Listening to schizophrenia

The National Institute of Mental Health’s (NIMH) website makes it seem the mystery of schizophrenia is resolved: “Schizophrenia is a chronic, severe, and disabling brain disorder that affects about 1.1 percent of the U.S. population age 18 and older in a given year. People with schizophrenia sometimes hear voices others don’t hear, believe that others …

Can the West save the world from mental illness?

When health care is inadequate to nonexistent in a country, mental health care is generally much worse. In places like sub-Saharan Africa, where treating AIDS and malaria burden an already overrun health care system, mental illness is largely ignored. Families in the poorest countries around the world sometimes resort to tying mentally ill family members …

Biological ≠ Medical

The New England Journal of Medicine (NEJM) published a review (2008) that concluded articles submitted to journals by pharmaceutical companies and psychiatric researchers about the effectiveness of the selective serotonin reuptake inhibitors—SSRI antidepressants—gave a rosier picture of this class of drugs than the studies actually show. By mainly publishing studies that tout SSRIs success and …

Foretelling extinction?

Mental illness has reached epidemic proportions. The National Institute of Mental Health (NIMH) estimates eighteen percent of American adults suffer from a mental disorder each year. The World Health Organization (WHO) claims depression is the leading cause of disability in the world. These numbers, however, do not do justice to the burden of mental illness in our …

Can we let children outgrow their ‘mental disorders’?

From 1994 to 2003, there was a forty-fold increase in the treatment of youths for bipolar disorder — from 20,000 to 800,000 young people in the United States alone. In almost all cases, these children were treated with medications that had not been extensively tested for use in the very young. Thus, nearly one million children and adolescents …

Why is suicide increasing in midlife?

What leads a middle-aged person to contemplate suicide? A failed relationship? Financial devastation? Drug abuse? All of these explanations have been suggested for an unexpected increase in suicides in persons 45 to 54 years old. According to the Center for Disease Control and Prevention (CDC-P), this age group had a 20 percent increase in suicides …