Sunday, December 18, 2011

The Benefits and Importance of Empowerment

"The focus on empowerment of people with severe mental illness is important and warranted for both practical and philosophical reasons.

From a practical perspective, the empowerment of people with mental illness through meaningful participation in decision making benefits both them and the organizations that provide services to them.
  • People with mental illness who meaningfully participate in treatment planning, for instance, are more likely to meet their treatment goals and be satisfied with their services.
  • Similarly, people with mental illness who select their residences and have control over major residential decisions are more satisfied with their housing and function more independently within it. 
  • Likewise, mental health agencies that promote client participation in organizational decision making are more likely to develop service programs that are responsive to clients' needs.  
  • A focus on empowerment also is important because participation can be viewed as a right.  Simply put, people should have a right to participate in decisions and activities that will affect their lives."  
 From Empowering People with Severe Mental Illness by D. Linhorst, Oxford University Press (2006)

This passage refers to empowering people with severe mental illness and yet the values espoused may pertain to any previously or currently oppressed group - including mental health professionals who are women and/or persons of color.

To what extent do you participate in the decisions and activities that will affect your life?

This is the political process.  This is what is meant by, the personal is political.

Saturday, December 17, 2011

Empowered vs. Controlled

"Judi Chamberlin (1978) wrote about her experiences while in a psychiatric hospital in the 1960s:
The whole experience of mental hospitalization promotes weakness and dependency.  Not only are the lives of patients controlled, but patients are constantly told that such control is for their own good, which they are unable to see because of their mental illness.  Patients become unable to trust their own judgment, become indecisive, overly submissive to authority, frightened of the outside world . . . The experience [of hospitalization] totally demoralized me.  I had never thought of myself as a particularly strong person, but after hospitalization, I was convinced of my own worthlessness.  I had been told that I could not exist outside of an institution.  I was terrified that people would find out that I was an ex-patient and look down on me as much as I looked down on myself. (pp. 6-7)"
From Empowering People with Severe Mental Illness by D. Linhorst, Oxford University Press (2006)

A woman with mental illness writes about her experiences in a psychiatric hospital in the 1960s and yet the reaction provoked by this experience sounds like the same reaction of many non-hospitalized students and professionals today - second-guessing self-perceptions, profoundly doubting intuition, ambivalent about what to do, afraid to rock the boat, afraid of our own voice and desires.  The conditions of oppression, regardless of context, setting, or target, can provoke similar reactions.  We can choose a different reaction.

We can  . . .
  • trust our own judgment
  • decide what is best for us (despite social pressures)
  • have a balanced relationship with authority
  • face the world with confidence and respectful humility

Monday, December 12, 2011

Soul Migration


Just as the human being comes apart at death, with the body dying and decaying while “the breath of life” persists, we suggest that a person comes apart in a similar way at other crucial junctures of life, such as moments of excruciating shame and delirious orgasmic experience, insurmountable trauma and ecstatic spiritual experience.

The abused child, like shipwreck survivors in an overcrowded lifeboat, must sacrifice some aspects of the self in order to preserve others. The more overwhelming the assault, the more essential and closer to the core is that aspect that must be sacrificed. Inner resources such as innocence, trust, spontaneity, courage, and self-esteem were lost, stolen, or abandoned in those early traumatic moments, leaving an immense empty space. The psychic energy cast off through dissociation and splitting, the sacrificed aspects of self, do not simply disappear into thin air, but rather continues in split off form as a primitively organized alternative self.

Retrieving these inner resources in age regression to those traumatic events reunites the sacrificial alternative self with the immanent embodied person, strengthening the fabric of the soul’s energetic field.

What we are proposing here is a profound level of splitting in that what is split is neither consciousness nor ego nor self, but rather one’s essential spiritual identity, what we are calling one’s soul. A further distinction is drawn in relation to the concept of where that separate aspect of oneself is kept; that is, it is neither repressed into unconsciousness (vertical split), nor allowed to alternately come into conscious awareness (horizontal split).

It is sent into hiding from itself, in the “witness protection program” for the soul. Strength of character, resilience, determination, deep trust all come from repair of disruption in intimate relationship, not through eliminating any disruption. Likewise, the growth of the human being spiritually is achieved through the repair of the bond with his/her soul following disconnection (miscoordination).

Soul Migrations: Traumatic and Spiritual
David Hartman, MSW and Diane Zimberoff, M.A.
Journal of Heart-Centered Therapies, 2006, Vol. 9, No. 1, pp. 3-96

Scientific Progress & Human Relationships

A friend of mine recently noted that I write about my mentors and that I seem to have many.

I know what I know and I know what I don't know.  And I am not ashamed about what I don't know.  When I am stuck, I think to myself, "who can help me now?"  Then I reach out.  It surprises me and restores my faith in humanity every time an expert responds.  That is how I collect mentors.

I am finding that brilliant folks are really accessible, down-to-earth and willing to share their God-given talents and hard-won lessons learned.  So grateful for that.

When I mention I am meeting with one mentor, another mentor will note, "Wow, he's a serious scholar" and I will think, "Yikes, I should have known that" or "Yikes, I am glad I didn't know that before I asked all those silly questions."  But the truth is, I would have asked anyway, because that is how I learn.  And fortunately, no matter how brilliant the mentor, I have always been treated with respect.

Thomas Kuhn wrote about the process of scientific revolution - how we go from one set of accepted truths to a new set of accepted truths.  It is highly influenced by a political process. Privileged "normal science" shifts when sufficiently challenged and no longer socially accepted.

Scientific discovery and progress is highly influenced by a network of human relationships.  In the same way that artistic or literary circles influence each other, so do multi-disciplinary scholars.  Imagination inspires me but it is in the context of human relationships and mentoring that my ideas become tangible manuscripts and studies.

"We can only evolve in a cooperative society.  Cooperation and need for contact are built in.  There is no genetic basis for individualism.  Individuals die and cooperative groups evolve and survive."

Collectively, we push things forward.  Finding your wolf pack is essential.  Thanks for lunch, Maria, and inspiring this post.

More on Resilience

"Resilience is a concept that originated in physics. Once transplanted into the field of developmental science and social behavioral research a generation ago, it inspired the investigation of key protective factors, opportunities, and experiences that enable young people to resist stress and even thrive in the face of adversity. Increasingly, it is the basis for programs, policies, and public health practice that seeks to employ the dual strategy of reducing risk while enhancing protective factors that place (or keep) young people in a healthy developmental pathway.

"Resilience Defined
The word resilience comes from the Latin resilientia meaning the ‘action of rebounding.’ The Oxford English Dictionary defines resilience as ‘The action or an act of rebounding or springing back.’ The field of physics first adopted the term resilience to describe the capacity of materials to retrieve their initial shape following exposure to external pressure (i.e., flexibility and elasticity). More broadly, resilience represents the capacity of dynamic systems to withstand or recover from significant disturbances. Therefore, scientists can examine resilience at many levels, over varying time frames, and from different disciplinary perspectives. Some scientists might use terms like equilibrium or homeostasis when they are considering this process of ‘righting oneself,’ either as a system or as an individual. In developmental science, resilience refers to positive adaptation in the context of significant threats to development (i.e., adversity). Most developmental research focuses on resilience within individuals, although researchers also apply the concept to systems within which individual and collective development occurs such as families, classrooms, schools, or communities. In short, the term is widely applicable, well beyond its traditional, specific use in describing the ability of materials to resist stress or insult, or the capacity of objects to resume their form or function following challenging or demanding circumstances."

Resilience by Resnick, 2007

Study about Beliefs: Parents & Young People on Effective Interventions

"One surprising finding was that young people (particularly young adults) were more likely to see close family as a source of help than were parents, suggesting that parents may be underestimating their own potential role."

"Ideally, the public endorsement of recommended interventions should be close to 100%. The biggest gap is for psychiatric medications, where <50% rated recommended interventions as likely to be helpful."

"Psychological therapies, such as cognitive behaviour therapy, are recommended for all the disorders covered in the survey. Cognitive behaviour therapy was rated as likely to be helpful by less than half of adolescents, young adults and parents, and this held irrespective of the vignette presented. However, this low rating was largely because of ignorance of this treatment (which may be related to its limited availability). Unlike medication, respondents did not often see it as harmful. By contrast, the non-specific psychological intervention of counselling was overwhelmingly rated as likely to be helpful by all groups for all vignettes."

"Previous surveys of adults have shown relatively positive views of complementary and self-help therapies. In the present survey we asked about a range of interventions not covered in the earlier surveys. The complementary and self-help therapies included were those known to have some evidence for effectiveness in treating depression or anxiety disorders in adults, although the amount of evidence on these therapies with adolescents is much poorer, making comparison with young people’s preferences more difficult. Many of these therapies were frequently rated as likely to be helpful (physical activity, relaxation training, meditation, massages, morning light exposure, self-help books). St John’s wort did not rate so highly, but this appeared to be largely due to ignorance of what it was rather than a concern about possible harms."

"These findings have implications for areas on which campaigns to improve mental health literacy need to focus in the future. The first is in attitudes towards medication. Although there is evidence that attitudes of adults in Australia have become more favourable in recent years, there is still a considerable gap with clinical practice guidelines. The second is with the preference for generic psychological interventions (counselling) compared to specific interventions known to be effective (e.g. cognitive behaviour therapy). A similar gap exists with the professions providing psychological therapies (psychologists and psychiatrists vs counsellors). There is evidence that knowledge and attitudes of young people and adults can be changed by community campaigns so these are feasible goals. Recent changes in funding provided under Australia’s national health insurance scheme, Medicare, have made psychological services more readily available, but young people need to know about the availability and usefulness of these services."

"Another possible approach to improving evidence based care for young people would be to use terms to describe services that would make them more appealing to this age group and their parents. For example, services might be more acceptable if psychological therapies were labeled as ‘counselling’ and mental health professionals as ‘counsellors’. To some extent, this approach runs counter to the aim of improving mental health literacy and requires cautious exploration."

"The present results highlight the need for further evidence on complementary and self-help interventions. We face a situation in which some therapies that have a strong evidence base are perceived less favourably than others that have weaker supporting evidence. As well as trying to improve the mental health literacy of the public about what is known to work, we need to do further evaluation of interventions that already have wide acceptance and use. Interestingly, a recent study found that people who had experienced depression also rate many of these types of interventions as having helped them."

"Because of their more limited life experience, adolescents require assistance from others in their social network to seek appropriate professional help. In this regard, both family and close friends are viewed favourably as sources of help. However, parents tended to underrate their importance compared to their children. Parents need to be a target for first aid knowledge and skills to assist young people who develop mental disorders. Although it is perhaps too much to expect young people to provide a high level of peer support, there is certainly room for some basic skills. For example, adolescents often do not respond to a friend in a way that could facilitate appropriate help, such as engaging a parent, teacher or school counsellor to help. Even with a suicidal peer, many young people would not tell an adult."

"In conclusion, this is the first national survey of young people’s treatment beliefs in any country. As in previous surveys of adults, it found some gaps between public perceptions and current clinical practice. These gaps can be the target of community mental health literacy campaigns and training of key supporters in first aid skills. However, consideration can also be given to describing some interventions using terminology that may make them more acceptable to young people. Furthermore, the evidence base needs to be extended to more fully evaluate those complementary and self-help interventions that are already widely accepted by young people."

TITLE: Young people's beliefs about preventive strategies for mental disorders: findings from two Australian national surveys of youth
AUTHOR: Yap, Marie Bee Hui; Reavley, Nicola; Jorm, Anthony Francis
AFFILIATION: Orygen Youth Health Research Centre, Centre for Youth Mental Health,
University of Melbourne, Parkville VIC, Australia
SOURCE: Journal of Affective Disorders, 2007 Published online 3 October 2011

Friday, December 9, 2011

We need more family therapy training in graduate school. The evidence demands this!

Community Resilience Model

"The Linking Human Systems (LINC) Community Resilience model, a theoretical framework for initiating and sustaining change in communities that have undergone rapid and untimely transition or loss, assumes that individuals, families, and communities are inherently competent and resilient, and that with appropriate support and encouragement, they can access individual and collective strengths that will allow them to transcend their loss.

This competence can be nurtured by helping people regain a sense of connectedness with one another; with those who came before them; with their daily patterns, rituals, and stories that impart spiritual meaning; and with tangible resources within their community. Rather than imposing artificial support infrastructures, LINC interventions engage respected community members to act as natural agents for change."

Enhancing Resilience: Families and Communities as Agents for Change
Family Process
Volume 46, Issue 3, pages 351–365, September 2007

Gabor Mate on Healers

What do you call those who try to fix in others what is unresolved in self?

What works in therapy?  What is the essence of therapy?  Relationship with the client.  Must have a proper relationship with self in order to have a proper relationship with client.

In order to be an effective health care provider, take care of your own stuff.
Speak up your truth.  Those that have ears to hear shall hear.

Dysfunction is not an expression of our true nature but a suppression of our true nature.

Organize - join together for support which makes life worthwhile.

Gabor Mate on Wellness

Gabor Mate is a physician working in downtown eastside Vancouver - where misery and humanity are evident.  He works primarily with drug addicts, people in a lot of pain and practices unconditional acceptance.  His own background involves pain - he is a Hungarian Jew born during WWII. He is a writer of many books on ADHD, substance abuse, attachment and parenting, and stress and disease.

On November 30, 2011, I had the pleasure of hearing him speak in downtown Los Angeles.  Here are some of my notes from his talk.

The roots of illness and the origins of suffering is grounded in mind-body science.  There is a social basis of illness and well-being.  There is a connection between stress and disease.  You cannot just look at the individual when addressing wellness and disease.

Despite US self-perception as world elite, 50% of adults in the US suffer from chronic illness.  Simply, this society makes people sick.

"Truths" and ideology reflect the interests of the dominant class.  There are social and economic ramifications to satisfy status quo.  It is easier to explain disease in genetics terms rather than in environmental terms.

Strong medications are used in this country to control behaviors.  Foster children are given dangerous cocktails because their behaviors are difficult for adults to handle.  We are trained in a narrow biological perspective.

50% of adolescents meet criteria for one mental health disorder or another.  50% of their time is spent on screen time - we deprive children of adult contact.  Children need to hold on to something for a sense of connection (like the rhesus monkeys and the carpeted wire cages) - this has an impact on brain development and has an effect on society and context.

Sense of neighborhood and belonging is influenced by economic decisions.  There is an impact on families and parent-child relationships - where jobs are and duration of commute time.

Emotional pain, emptiness and desperation to connect are often soothed by substances and behaviors.

Medical professionals cannot explain human nature and our deep need for connection and human contact.  Human beings are not individualistic.  When social needs are not satisfied, behaviors become destructive and distorted.  Aggressive, competitive, individualistic, ruthlessness - are not our nature.

Experiment:  Mice given electric shock showed increased stress hormone levels.  Watching another mouse being shocked also increased stress hormone levels.  Even mice are wired for empathy.

Looking for genes that cause cancer - trying to understand cancer by looking at individual cell vs. context (big picture, society and environment).  Genes are not active agent in causing cancer - gene is not determinant (myth persists due to ideological purposes - doesn't threaten the way things are).  Problem is in wiring versus in the system.  African-Americans don't have the same cancer rates - must look at historical and current stressors (context).

It is nonsense to separate mind and body - like separating foot from leg.  Evidence is clear that mind and body can't be separated.  Unity of mind and body (ridiculous to have to prove it).

Fear changes physiology, immune system, cardiovascular system, hormonal system...

Stress causes physical effects.  Uncertainty, lack of information, lack of self-expression and lack of control = stress.  Control is concentrated in the hands of a few individuals.  Opaque versus transparent information.  High blood pressure is called hypertension - too much tension.  We don't know how to help because we are not looking at people's lives.  Stressing people causes disease.

75% of factors contributing to disease are not medical but factors that govern people's lives.

In what kind of society is anyone useless?  A society that values people as economic units - exploiting or being exploited, otherwise nobodies.  Elders vs. elderly - latter seen as troublesome and useless.

Western medicine separates mind and body, individual and society.  We can only evolve in a cooperative society.  Cooperation and contact built in.  There is no genetic basis for individualism.  Individuals die and cooperative groups evolve and survive.  The isolated are more likely to fall sick and die of disease.  Nurturing and loving environment is good for babies.  Emotional and supportive contact is good for recovering elders.

Fundamental set of beliefs - if you challenge - seen as outside of pale - won't be taken seriously - emotions don't compute - emotions connect us to other people.  Biopsychosocial assessments are rare in medical setting.

Evil fostered and encouraged for the sake of profit.  Tender mercies of capitalism.

Looking at causes versus effects is due to the needs of the system - integrity, ethics, truth.

Society where the average maternity leave is 6 weeks.  We are affected by our environment as soon as we have an environment - as soon as we are implanted in uterus.  Importance of non-stressed mom.  Stresses accrue in pregnancy and increase risk of behavior problems at age 3.

Delivery as mechanical process versus emotional process.  Song sung to child as soon as possible after conception - welcomed to the world.

Stressing woman and developing infant.  30% of women are having C-section which is interfering with early bonding and it's long term effect.  15% receive breastfeeding (should be continued for one year).

Parental stress affects genetic functioning of adolescents (environment turns genes on/off).

Violence in our genes?  Study in Australia - homes mattered more than genes.  Environment and sensitivy (gene).

In child pornography investigation, officer was struck by children with dead eyes (accepting) vs. screaming

Increased adversity lead to increased risk for addiction.  Rescue and protect kids or fall through the cracks - jail them because they turn to drugs to soothe the pain and sense of disconnection.

Person's experience shapes development of brain.  Question fundamental values of this society.  Social economic pressures impact on well being.  Sense of community, cooperation, support, and belonging.

Illness is derived from our alienation...
...from nature (Marx)
...from work (meaningful activity, creative and expressive of who we are - what is inside us must come out - blocking the energy is making people sick)
...from other human beings (dog eat dog, competitive)
...from ourselves (deprived of ourselves)

What it takes to be healthy?
Individual and social question.  Have you ever ignored a gut feeling and regretted it?
Aphasiacs are better able to tell inauthenticity and dishonesty (80-90% vs. our typical 50-50%) because they pay attention to gut feeling, body language, and tone versus language and content.  With our gut feeling we see right through that.

Children are born with gut feeling.  In order to be accepted by environment, we had to supress who we were.  We found it safer to express what was expected, otherwise we invite conflict that we could not handle as children.  We learned not to express our self.  Then we wonder, why is life so dreary?  Why am I trying to please?

Connect to self - do whatever it takes to reconnect to self

Connect to gut feeling - disconnected in order to survive.  Advertising is based on being disconnected (promote consumerism vs. connections)

Connect to others - challenge what we're being told is not true.  Resonate with the energies of others.  Connect now and in the future.

Speak with sense of connection and compassion - it is more effective and powerful.

Notre Dame University - what cultures are best suited to care for children?  Hunter-gatherer tribes (where shamanism predominates!!!)
Natives did not beat their kids and pilgrims were appalled.  Kids are always carried everywhere with parent - no separation anxiety and develop security.  When child cries it is immediately picked up and so develop a sense of trust and safety, not overwhelmed by stress hormones - my cries will be heard and responded to.  Children not connected to nuclear parents but clan - community.  These are the necessary conditions for healthy child development.

Mammalian brain can develop in later life.  The development of new circuits is neuroplasticity.  In problems of development, promote development instead of controlling symptoms.  What is lacking in development?  Plants require minerals and sunlight in order to grow.  Parents are stressed and distracted.  Children need to be provided essential developmental conditions.  Address underlying problem instead of symptoms.  We are an intricately connected system.  Children are affected by the stresses of their parents.

Professional Development: Academic Job Search

Four professors from the UCLA School of Public Affairs, specifically urban planning and social welfare, shared the following advice and lessons learned about the job search process.

In order to be a competitive candidate, participate in conference presentations, publications, and research projects (including collaborations).  Conference presentations may lead to networking contacts and potential jobs.  Publications provide proof that a job candidate will be productive and get tenure.

In a competitive market, a completed dissertation is a must.  At the very least, make sure your results chapter is drafted by the time you conduct job talks (presentations to faculty and students).

Hiring committees may review a CV to determine how long it took you to get through the program.  10 years is too long and may be a sign that you are not cut out for an academic position.

There is a ratcheting up of expectations about the number of publications you have by graduation.  Cache is research and publication - both your own and in collaboration - as compared to teaching experience.  Although it is helpful to show you can be effective in the classroom.

A track record of fellowship funding shows a candidate's ability to secure funding (and future potential to secure research funding).

Letter of interest - this is a key indicator of how you present yourself to the world.  This is not a time to be modest, while not sounding like the best thing on earth.  Finding a balance and putting best foot forward.

Develop relationships with professors now for later requests for letters of recommendation.  Better letters come from faculty that knows me/about me - classroom experiences and the work you do.  Who knows you?  Who recommends you?  Who is speaking for you?

Take advantage of opportunities to practice presenting your research. 

Take a lot of research and stats courses in the 4 years - there is no time to learn it later (considering the load and demands of an Assistant Professor).

One of the hardest things to learn is writing research grants - work with others.

At research institution (R1), the expectation is to bring in your own money (research grant funding).

Prepare by reading about department on the web.  Position yourself in their area of need.  "I can teach the following courses in your curriculum."  (Bring syllabi from courses previously taught).

One professor on the panel had four publications by the time she interviewed for academic positions.

Ways to publish - I have a paper I am working on, can you help me?  Can I continue it in this class?  Use course assignments as means to further manuscript development.  Can work on theory papers, concept papers, history papers, or literature review papers.  Conference presentation should become a publishable paper.  Submit to decent journals.  Prioritize publishing.  Get the best journals in your field and see what other people are working on.  How are people writing?  What methods are people using?

Observe job talks - I really like that they did X, I didn't like that they did Y.

What is it that you want to do?  Teach as a primary focus? - CSU & other teaching universities  Research as primary focus? - UC & other research universities

Publications will get you promoted.  Good teaching will be helpful but won't get you promoted.

Show your course reviews on the job market.

Prioritize research assistant vs. teaching assistant.  Balanced vita with both teaching and research accomplishments okay. 

One professor participated in national job search and leveraged 3 job offers to attract job offer from UCLA.

Family friendly policies (maternity leave and child care) - UC system has the best in the country.  Discuss way up front in job negotiation.  Do they permit "time off the clock"?  Stop the tenure process for a period of up to one year?  At UCLA, this can be done two times in 7 years.  Subsidized child care as negotiating chip.  Raise negotiations after job offer - then negotiatie, negotiate, negotiate.  Finesse family issues during job talk.  It is illegal to ask but committees do ask.  Ask about what resources the University has in a general way.  Committees are not supposed to talk about personal matters. 

It is a demanding (focused and goal driven) but flexible job.  Go about feeling good about the choices you are making and others will follow suit.  Accept it and others will accept it too (your pregnancy at job talk).

Job Talk considerations:  Is my presentation engaging?  Am I enthusiastic? exuberant? energy level? Interested and interesting?  Job talks are an important part of the interview process.  Start talk by positioning your work in a larger context, research, design/methodology, research is rigorous, what are the next things you want to do? expand? Where do you see yourself in 5 years?  envision your career?  How does it relate to the rest of the world (help people not in my area understand contribution and importance of my research).  Job talk is weighted heavily.  Present completed work - tangible findings. Research question and methodology should be extremely clear.  Pull yourself out of the details and think about what a diverse audience would appreciate knowing.  Talk about your motivation of research - why did you choose this question? Literature and practice influence.  Position current research into research trajectory.  You are the expert in the room - be in control - fielding questions versus presenting your work.  Link to the interests/research of the faculty in the room.  Stick to the time allotted - practice.  Buy an outfit that you look great in and feel comfortable in.  Practice job talk 10 times in front of an audience, talk without notes.  Use effective slides - get feedback before using - slides should be supplementary and helpful.  Present my voice, link to scholarly theory and methodology.  The whole time you are visiting the campus, you are on - present your best side the whole time, from plane landing to take off.  You are also there to see if you want them - this may not be the best place for you. 

Start your search at the top - select from top 20 R1 institutions.  It is seldom likely that you will be able to move from a CSU to an R1.  There are about 40-50 doctoral granting universities in social work.  Postdoc or research job is preferable to working at a CSU if your ultimate goal is to work at R1.  Maintain scholarly productivity.  RAND, postdoc (NIH/University), R1.

Think early about what you want on your CV.

Truth Opened

Freud presented a paper in April, 1896 to the Society for Psychiatry and Neurology in Vienna on the sexual abuse of his female patients by t...