The Disillusioning Process is Positive

Most of us assume other people are similar to ourselves. This is a tough trap to avoid because we can only know others through our own experience, feelings and thoughts. But to grasp the essence of another person, we may extend beyond our own (past)  experience.

Gradually, by listening and observing actions, from (hard knocks of) disappointment and dashed expectations, we’re disillusioned as we learn that the other is indeed “the other.”

The pediatrician and child psychiatrist, D.W. Winnicott addressed the challenge of the “good-enough,” mother tasked with disillusioning her child. An infant naturally assumes he is the center of the world. He must learn about other people and their needs, separate and apart from his own. (Failure to disillusion her child, can result in dire consequences like the development of an anti-social person who lacks empathy and organizes his life around fulfilling his own needs, often at the expense of others.

This process of differentiation, especially from those closest to us, continues throughout a lifetime. For example, Ms. H., a middle-aged woman, married for many years, suffered from depression. Gradually, she realized her dysphoria was rooted in anger toward her husband. She had assumed he shared her goal to pay down their credit card bill quickly, and that he’d work extra hours to do so. When he planned an expensive vacation, she realized his value system differed from hers. Her awareness of his “otherness” helped to resolve her depression and confront the matter. The couple devised a mutually acceptable repayment schedule and compromised on a less expensive vacation.

Conclusion: The disillusioning process that begins between a mother and her child early in development, continues through adulthood as we distinguish ourselves from others.  As we differentiate and  negotiate, we learn about ourselves, too.

Dear Reader: I welcome your thoughts.

jsimon145@gmail.com.

The Power of Listening

Most of us underestimate  the significance of listening. To listen is to offer a great gift. The good news: it doesn’t cost anything in terms of dollars and cents. The bad news: It isn’t easy, nor without risk.

We assume the act of listening is simple; we have ears and a nervous system capable of performing the task. But we fail to appreciate  the complexity and effort involved. Most often, we’re wrapped up in our own thoughts, and setting them aside to truly grasp the essence of another’s words rarely happens.

Early in their training, young psychiatrists are surprised to learn the power of listening. Because our culture gears us to be “active” versus “passive,” the receptive act of listening proves more difficult than offering an interpretation.

To listen differs from hearing and is more involved than perceiving sounds with our ears. Hearing happens, but listening requires concentration. The brain makes sense of the words and sentences. Listening is a learned, acquired ability that often leads to more learning.

One reason we love our dogs is that they appear to be among the best listeners. Without uttering a single word, they convey understanding and seem to be interested  Paradoxically, they can’t understand the words well enough to fit the definition of “listening.” Nevertheless, they often seem to do a better job, presumably by paying attention to the tone of our voice, our body language, and our scents.

Certainly inherent in the art of medicine is the ability to be a “good enough” listener. And we need to be aware of the fact that listening comes at an emotional cost.

My internist shared his observations. People unburden themselves to him, telling him their troubles. He notices they seem happier when they leave his office, relieved to have shared their stories. On the other hand, his mood has taken a turn to the downside because at times, he feels the weight of their worries.

What can he do?  He can realize that he has given a gift and need not feel he has to do more. It’s best not to offer advice. Since he hasn’t spent much time with them, he hasn’t collected enough details to make suggestions. In fact,  to give advice could be taken as a sign that he hasn’t adequately listened to them.

Sometimes people set us up to offer suggestions they can refuse. Or they can externalize their power on us and hold us responsible for their mistake. For example, Ms. J asked me to make a decision about where she should live. I could repeat her words, reflect back to her, or mirror, her views. But for me to make a decision would usurp the power that lies in her hands. “You’re in the driver’s seat of your own life,” I told her,  “and I trust you’ll make the best decision.”

If  Aaron Alexis, the military contractor, had been listened to and heard, he and 12 others in the Washington Navy Yard might still be alive today. (Please see my post of October 14,)

A new website www.listen.org sets a sanguine tone. The website is available free of charge to guide the listeners and those who need to be listened to. It is a valuable online resource for anyone having questions about how to help themselves as well as those to whom they’re listening.

Conclusion: Listening is an art and skill that is underestimated in value and complexity.  The website, www.listen.org. offers advice to listeners and those in need of being heard.

Dear Reader, I welcome your thoughts on this important topic. jsimon145@gmail.com.

Illnesses, Images and Insights

People who suffer with mental illness have been attracting especially negative press recently.

Let’s look at the case of Mr. Alexis, the military contractor who killed 12 people at the Washington Navy Yard last month. According to The New York Times (October 5), his mother told his bosses one month before the shootings that her son had a history of paranoid episodes and most likely needed therapy. But Mr. Alexis’ managers at the Experts Inc., an information technology firm, decided to keep him on the job. An internal company investigation has found that they did not require him to seek treatment and concluded that the “Experts” mishandled Alexis and knew more about his mental problems than it disclosed.

(Alexis had been arrested three times in three states, including once after shooting out the tires of a car in what he told the police was an anger-induced “blackout.”)

In this case (and in others) signs and symptoms exist and are ignored; what appears  “out of the blue” and unpredictable is often not so.

Another kind of mismanagement (The New York Times, September 29) is the case of Melissa Morelli, whose treating physicians said “it was not safe for Melissa to go home” from the psychiatric hospital but whose family’s health insurance carrier would not continue to pay for her to stay. ”Over the course of five months, Melissa’s mother took her to the hospital roughly a dozen times, and each time the insurance company Anthem-Blue Cross, refused to pay for hospital care.”

Melissa’s mother sought the assistance of Connecticut state officials and an outside reviewer. She eventually won all her appeals, and Anthem was forced to pay for the care it initially denied. (“Anthem, which would not comment on Melissa’s case, says its coverage decisions are based on medical evidence.”)

Few people have the tenacity demonstrated by Melissa’s mother.  By implication, many people fall through the cracks. They may not receive the necessary treatment (in spite of paying the premiums) prescribed by the practitioners!

“Patients often find themselves at odds with health insurers, but the battles are perhaps nowhere so heated as with the treatment of serious mental illness,” according to another article in The New York Times (September 29).

A federal law, the Mental Health Parity and Addiction Equity Act of 2008, was aimed at avoiding fights like this by requiring insurers to cover mental illnesses just as they cover treatment for diseases like cancer or multiple sclerosis. The federal government has not yet written the mental health act’s final regulations for insurance companies, and a crucial gap remains between the act’s intention and application.

Many agree that, five years after President Obama signed it, the law has fallen short of its goal to create parity for mental health.

Mr. K. is a former patient from my practice. He was about forty years old when he reported to the Blanton-Peale clinic for counseling. He worked for a large corporation and reported abuses that he’d observed at work. He told me, “I am so angry that if I go back to work, I will shoot up the place.”

Mr. K. gave me permission to send the evaluation to his company. Within a year, I was called to court to deliver my findings. Of course I took his threats seriously and testified that he could not return to work.  Mr. K. was placed on full disability (worker’s compensation) which paid for weekly treatment and medication. Over many years, Mr. K. continued to rage about the company and express enormous gratitude to me, although I had done nothing more than acted in the line of duty. After more than ten years, he moved to another state where he presumably continued treatment.

When I read about the above cases in which appropriate treatment was denied, I realize the impact of Mr. K’s  treatment and his gratitude: It saved his life and perhaps those of several others.

I don’t like to think we have gone backward in our psychiatric care; but the confusion of our governmental policies and the failure to reel in the abuses of the health insurance companies have led (and, sadly, may lead to more) cases of violence.

Both Mr. Alexis and Melissa are like canaries in the coal mine. Their cases point to the noxious fumes (of system failure) penetrating and polluting our environment.

Conclusion: A dire situation exists in our health care system; mental health care does not have parity with physical illness for receiving care and reimbursement. Mental health practitioners, trained to determine the appropriate treatment, have lost power (to big business including insurance companies) to deliver the appropriate care.

Dear Reader, I welcome your response to this dire situation. jsimon145@gmail.com.

Acceptance and Authenticity, a tenuous balance

The struggle to become our true/real selves is, for the most part, an unconscious effort. Early in life, we learn to curb our aggressive tendencies and refrain from hitting our classmates in school in order to gain acceptance. However, balancing acceptance with our authentic being is often a subtle and life-long journey.

To a greater or lesser degree, we conform to expectations in order to be loved and accepted by our family and our world.

If we don’t receive “good enough” acceptance in our developmental years, we’re more likely to abandon the core of our “real” being, in order to receive acceptance and/or love.

The factors that determine our courage and honesty are complex and most likely involve environmental as well as genetic factors. However the following two examples illustrate the power of the environment.

Ms. L. a married woman, felt trapped in her relationship. In order to be true to herself, she divorced. She had the courage to trust herself enough to leave her husband in spite of her family’s disapproval. Her self-confidence, in this regard, may have been related to the acceptance she knew (from her family) early in her life.

A more extreme lack of acceptance from parents and his environment left Mr. M. confused about a real sense of himself, his sexuality and his talents, in spite of the positive feedback that he received from friends and colleagues later in life.

Fortunately, our society has become more open-minded regarding sexual preference. In an earlier post  (July 29, “Life Scripts”), I discussed the writer, James Morris, who after years of marriage, realized that becoming his authentic self involved a sex change operation. (He was fortunate to be accepted as a woman by his wife with whom he continues to live.)

Beyond everyday life, the theme of many plays and movies focuses on the dilemma of authenticity vs. acceptance. 

In Tennessee Williams’s play The Glass Menagerie (please refer to the post of September 30, “Consider the Chaos”), the disapproving mother, Mrs. Wingfield,  criticizes her children incessantly and drives them to escape into worlds of fantasy. Tragically, they do not experience the (relative) contentment that results from living an authentic existence in the “real” world.

Conclusion: The psychotherapeutic relationship and the arts examine the rich and fluid space/land between authenticity and acceptance.

Dear Reader: I welcome your comments regarding this human conundrum. Jsimon145@gmail.com