Let’s Stamp out Stigma

High profile, gruesome incidents- like the crash into the French Alps of the Germanwings jet on March 24, 2015 that killed 149 helpless people-naturally invite questions about the mental state of the perpetrator, Andreas Lubitz. In addition, the event may increase fear of people who suffer from mental disorders. My concern is that these incidents offer the opportunity to stigmatize and/or scapegoat those who acknowledge and seek help for psychological conflicts.

Dr. James L. Knoll, the director of Forensic Psychiatry at the State University of New York Upstate Medical University, echoes my concern. “People want an easily graspable handle to help understand this, to blame something or scapegoat,” Dr. Knoll said Erica Goode, The New York Times, April 6, 2015).

In an earlier blog related to gun control (2013), I quoted the forensic psychiatrist Michael Stone who said, “Most mass murders are done by working class men we’ve been jilted, fired, or otherwise humiliated, and who undergo a crisis of rage.”(The New York Times on January 16, 2013).

We aren’t privy to the content of co-pilot Andreas Lubitz’s sessions with his psychiatrist beyond the fact that he revealed suicidal tendencies. Had Lubitz openly spoken about his intentions, it is possible that the catastrophe could have been averted.

I had one instance in more than 30-plus years as a psychiatrist, in which a patient revealed his intention to commit mass murder. The patient, who I refer to as Mr. C., held intense grievances toward his employer. He was grateful that I was willing to testify in court for him advising his retirement from the workforce. 

As a result of my testimony, he received workers’ compensation, and for the next twenty years of psychotherapy, he continued to rail against the company.

Although we don’t know for sure if Mr. C. would have acted on his threats, in these instances I certainly think erring on the side of caution is preferable to taking chances.

CONCLUSION: To scapegoat and stigmatize people with psychological problems may discourage them from seeking treatment and result in a backlash including the occurrence of an increased incidence of violent episodes.

As a nation, we benefit from increasing access to psychological/psychiatric care, as well as propagating the principles of good-enough parenting, which can help:

1.     develop a healthy sense of self-esteem

2.      gain respect for human life

3.     acquire ways to deal with disappointment, frustration, loss and other grievances that obviate the desire to act destructively.

Dear Reader, I welcome your opinions. Jsimon145@gmail.com
You can also follow me on twitter:@js145 or comment anonymously below. 

Evil: A Dimension Beyond Disorder

The co-pilot Andreas Lubitz deliberately crashed the Germanwing airliner into the French Alps on March 24, 2015 killing himself and 149 people.

We frequently assume that a person who performs an irrational, seemingly impulsive act suffers from mental illness. But we need to distinguish between emotional ‘disorder’ and evil, otherwise we’re in danger of stigmatizing individuals who acknowledge their conflicts and seek to resolve them.

It’s important to note that in the vast majority of mentally ill people, emotional problems mainly affect the sufferer. In extremely rare circumstances do they harm others, and then not scores of people. By contrast, Lubitz deliberately calculated mass murder. Voice recordings show that he was at the controls of the plane, having locked the pilot out of the cockpit and refusing to allow him re-entry. Lubitz then set the plane on a crash course, deactivating the speed alarm twice as he flew the jet into the mountains, killing all on board.

An examination of his computer revealed that Lubitz had researched the topics of suicide and the mechanics of locking the cockpit door. In summary, he knew exactly what he was doing.

Although not all of us do need to address our psychic conflicts, the human condition is a conflicted one. For example, although we are not necessarily conscious of it, we constantly balance or juggle our individual needs and wants with those of others to whom we are responsible.

People with psychological disorders don’t conspire to harm multiple others but rather to diminish their psychological distress. Rarely do they harm anyone, except in the rare circumstance when they feel endangered. Even then, they are more likely to harm themselves psychologically or physically.

To stigmatize people who seek support and exploration of psychic conflict places us in danger of loosing our caring bonds, our humanity. Therefore, to avoid stigmatization,  evil needs to be explored and differentiated from psychiatric disorder.

Scott Peck, a psychiatrist and author of the  1978 best seller, The Road Less Traveled, addressed the controversial issue of evil in  his book, People of the Lie: The Hope for Healing Human Evil.  Citing examples of evil that he encountered in his psychiatric practice, Peck defines evil as a characteristic in those who deny their problems, blame others, and intentionally harm or destroy the lives of innocent people.

The current aviation system relies on pilots to report any medical or psychological problems they may have suffered. Tragically, human history reveals that often, we are the last to know ourselves. We can’t always rely on a person’s honesty to reveal problems when doing so jeopardizes his position of power over the lives of many others.  Psychological tests (like the Minnesota Multiphasic Personality Inventory (MMPI) help to diagnose psychopathic or homicidal tendencies.

Conclusion: Failure to make the distinction between psychological “disorders” and “evil” stigmatizes those who seek help for our human conflicts and results in dehumanizing our society.

The roots of the destructive tendencies and potential lie beyond labels such as “disorder” and “evil” It is the quality of our connectedness to others and the ways in which to nurture bonds of caring (with understanding and empathy, especially in early developmental years) that ultimately will diminish crime.

Dear Reader, I welcome your comments. Jsimon145@gmail.com

Gratitude for Life’s Challenges

When I was 10 years old, my baby brother was born. This blessed event threw me into a state of emotional turmoil. Feelings of love and hate raced through my mind like a brazen cat chasing a nervy, intruding mouse.

I adored this exquisite little brother and longed to hold and care for him.  Simultaneously I resented his arrival; now I had to share my mother’s overstretched attention with him and three other siblings.

To confess to feelings of “hatred” was out of the question. In a quandary about what to do, I resolved to keep a diary on a small pad of paper hidden between blue plastic covers. In silent, secret letters, I could express taboo feelings and thoughts, raw emotions, feelings of love, pride and resentment, as well as record my brother’s milestones: the first day he sampled a banana, the morning he sat up by himself, the day he mastered his first steps.

The private confessor was magical in its ability to relieve distress, any time of the day or night. Giving form to these thoughts seemed to validate them and at the same time allow them to be tossed aside.

When I was 12 years old, my parents separated. Once again, the writing tool seemed like a life jacket to buoy me over a raging tsunami. I could acknowledge my thoughts without having to share my feelings and possibly exacerbate my parents’ tense situation.

I didn’t understand how jotting down thoughts converted into relief and a sense of power and control until years later I discovered the work of the great philosopher and psychologist William James. James viewed the mind/self as divided into two parts: 1. the aspect (of mind) that participates and registers the experience in the moment and  2. The (aspect of) mind that reflects on the experience after it has occurred. In essence the writing tool was an expression, an expansion of the observer.

James’ clarification of the mind split into experiencer and observer imputed an ability of power to control and the possibility of change. If a person revisited an event he might be able to see the role he played in it. Going a step further, she might perceive her potential to alter her behavior and affect a different outcome.

In the early days of civilization, we humans believed we were at the mercy of the Gods; they determined our fate. We couldn’t conceptualize that we could control our destiny, at least to a certain extent. But the course of human development has shown us that we possess the power to change. The reflecting/observing part of our brain imbues us with this potential.

Along the lines of James, David Brooks, The New York Times journalist, wrote a column about a  “sense of agency” (November 14, 2014) that applies to people who recognize the control they exert in their lives. These people hold the reins and steer their life course. (I realized that the writing tool places a person in the driver’s seat of her life, granting the ability to take charge.)  By contrast a person who lacks “agency” feels jostled about, acted upon by outside forces, similar to how we experienced life in the days of early civilization.

Another turning point came when I was 20 years old. I had just finished the first year of med school in Puerto Rico and had been living with my father and his family when without warning, he announced that I’d have to move out. What seemed disastrous at first, proved a great blessing.

At first, I thought about returning home to New York City, But I realized I’d be abandoning my goal to become a physician, and that I needed to reframe my approach to think more like a ballplayer, to keep an eye on the game in order to score. My goal was to become a doctor; my intention wasn’t to live with my father.

I was most fortunate to find human angels in my path. In searching for a place to live, I knocked on the door of the YWCA on Ponce de Leon Avenue in Old San Juan.  A kindly woman opened the warped, wooden door of the Y, a rambling unpainted structure that looked as if it might be blown away by the next big hurricane. I shall never forget Mrs. Rodriquez, a short, middle-aged woman with wavy, salt-and-pepper hair, a pixie face and twinkling brown eyes. When I explained my situation, she immediately recognized that I needed a quiet place to study and assigned me the only single room available. (Mercifully the Y remained standing for several years for which we residents were infinitely grateful.)

Once out of my father’s house, I was both frightened and thrilled to have freedom to come and go, no longer having to rely on Dad for transportation. Because of my pierced ears, brightly colored clothing and ability to enunciate Spanish phrases, I passed as Puerto Rican.  I basked in my newly- acquired identity. Gaining facility with the Spanish language helped me communicate with Spanish-speaking patients once I returned to the States.

Another miracle occurred when I met an American physician who was vacationing with his family in Old San Juan; he wrote me a letter recommending me to a medical school in Philadelphia where I could move to be closer to my mother and siblings.

In summary I’m grateful for what I’ve discovered in the face of some challenging  circumstances.

1. The writing tool and the ability to observe myself. 

2. To think like a ball player, to keep an eye on the goal to overcome obstacles.

3. The discovery of human angels who appear at unpredictable moments and add blessings, pleasure and excitement to the journey.

Dear Reader, I welcome your thoughts. jsimon145@gmail.com 
You can also follow me on twitter:@js145

Fifty Shades of Grey: from the Personal to the Political

Although some may confine their interpretation of Fifty Shades of Grey, the E.L. James novel and recent film, to the sexual realm, the story highlights the dynamic of domination and submission that pervades all our lives. The question of who wields power and who submits elucidates aspects of our personal relationships, world cultures, conflicts and wars.

According to the Bible, our story begins in Paradise with Adam and Eve. Their “heavenly status” required submission to God’s dominance. As long as they obeyed, they enjoyed His domain.  Ultimately, of course, they rebelled, ate the apple and lost some of the perks of that privileged relationship.

Metaphorically speaking, the experience of Adam and Eve isn’t unusual. Many people submit to domination in minor and/or major ways in order to reap the benefits, When they don’t follow the protocol, they risk a drop in status.

Fifty Shades of Grey focuses on the relationship between Christian Grey, a handsome, young billionaire, and Anastasia, an innocent college student. Anastasia enjoys the privileges and excitement as well as frustrations in her relationship to Christian Grey.

“I don’t do the girlfriend thing,” Grey says, exposing his peculiarity soon after they meet. His honesty enhances his appeal and arouses our curiosity. He explains the origins of his behavior; he was physically and sexually abused in childhood and adolescence.

Grey and Anna are locked in a battle to have their personal needs met. These clash, in essence, creating a clash of personal civilizations. Each wants sympathy and understanding. Anastasia desires closeness and intimacy. Grey needs to feel safe which he equates with (sexual) domination. Each attempts to change/manipulate the other to get more of what they want and need and less of what repels them.

As Anastasia experiences the tug of war between attraction and repulsion, she pushes toward resolution by inviting Grey to show her the ultimate “game.” Repelled by his brutality, she ends the relationship.

To turn to the real world, it is not uncommon to find households in which one parent dominates another. The power play in turn impacts the children.

 Ms. R., for example, was troubled by her mother’s submission to her husband’s  mind control. Nor did her mother stand up to him when he psychologically abused Ms. R.  Instead, she accepted domination in exchange for the perks of married life and peace with the man she loved.

Themes of power and control originate in our early lives and determine a great deal about the kind of person we become. For example, a 15 month old baby threatens to throw his bottle on the floor. “Oh no!” his mother says, laughing, trying to convince him to desist. He shifts the bottle out of her reach to the other side of the highchair. Threatening to drop it again, he experiences the thrill of power he wields over his mom.

 The “good enough” parent or caretaker plays along and enjoys this innocent game which in turn, grants the child a sense of play and power.  On the other hand, if the adult doesn’t grasp the nature of play, the child’s behavior may be viewed as a defiance of (parental) authority. In an extreme situation, the grownup may punish, even striking the youngster who may later come to equate the need to be violent with survival and safety.

In his new book Helland Good Company, the Pulitzer Prize-winning writer Richard Rhodes describes the early life of the Spanish dictator Francisco Franco.

“Franco was short, with small, girlish hands and a high-pitched voice... The school disciplined with physical punishment. ...He was bullied as well. He learned to hold a grudge. ...His school experiences compounded a childhood under an abusive father who beat his children while his unresisting wife ...stood by. Both home and school experiences preconditioned the boy for the violent socialization required of military men.” 

As an adult, Franco staged a coup in Spain in 1936 that started the Spanish Civil War and led to World War II. Longing to rule the world, Franco tried to join the German forces. But Hitler’s refusal to give him a portion of France proved a stroke of good luck that kept him out of WWII, and allowed him to rule Spain as dictator from 1939 until his death in 1975.

Conclusion: Feelings of power and impotence originate in childhood. The manifestations of this pervasive theme run the gamut from benign games to world wars.

Dear Reader, Your comments are welcome. Jsimon145@gmail.com

Conflict Isn't Crazy

From the beginning of time, humankind has been faced with conflict. The story of Adam and Eve embodies one of the oldest struggles: between good and evil, or an alternate interpretation between innocence and knowledge.

Fortunately some choices don’t create conflict. The child who chooses between red and blue overalls knows that his favorite color is red. (No one has yet derailed his sense of agency or will).

Experiencing conflict, although confusing, can actually be a sign of mental health. Conversely, the fear of exploring options can be hampering.   Mr. A., for example, was  raised by an abusive, alcoholic father, who hit him for reasons he couldn’t understand.  As a result, Mr. A. was fearful of making the “wrong” choice that would result in punishment. Therefore, he tried to squelch conflicts. This theme played out in his life, preventing him from speaking up for himself, and creating anxiety and psychosomatic symptoms. Recognizing the source of his fear helped him resolve the issue.

Conflicts don’t always just arise from personal experience: culture as a whole can create them. As Samuel Huntington asserted in his 1992 Clash of Civilizations, the primary source of global conflict now lies in cultural and religious identities, which can have very personal ramifications.

Ms. D., for instance, experiences the results of this conflict. Raised from birth in the U.S. by parents from a Balkan country who expect her to agree to an arranged marriage, she is torn between choosing  smooth relationships with her family or American customs. A conflict of this nature can take years to resolve.

Our psyches can delude us when we equate certainty with stability. The classic poem, Richard Cory by the poet Edward Arlington Robinson (1869-1935) graphically portrays a person who appears to have his life together but suffers unbearable turmoil.

Richard Cory

Whenever Richard Cory went down town,

We people on the pavement looked at him:

He was a gentleman from sole to crown,

Clean favored, and imperially slim.

And he was always quietly arrayed,

And he was always human when he talked;

But still he fluttered pulses when he said,

“Good-morning,” and he glittered when he walked.

And he was rich—yes, richer than a king—

And admirably schooled in every grace:

In fine, we thought that he was everything

To make us wish that we were in his place.

So on we worked, and waited for the light,

And went without the meat, and cursed the bread.

And Richard Cory, one calm summer night,

Went home and put a bullet through his head.

Conclusion: Conflict is inherent in the human condition and is more likely to cause problems when we fail to acknowledge, rather than face, it.

Dear Reader: I look forward to your comments.

 Jsimon145@gmail.com.

Love and Need: What’s the Difference?

On the week of Valentine’s Day my mind drifts to the subject of love versus need, a topic with which each of us deals in our own way. In essence, love is a luxury, while need is obligatory.

Love has a broad range: from positive connections to inanimate objects, to our vocations and avocations, to a deep sense of caring and concern for another person(s). 

In our culture we harbor the lofty expectation that romantic love and the fulfillment of our needs will be met in our intimate relationship.

Ideally, love transcends one’s own needs to include caring and concern that go beyond self-interest.

However, achieving the goal of combining romantic love with need fulfillment rarely comes naturally and probably occurs less frequently than we assume.

For example, Mr. K. has met a woman he “loves.” But he “needs” someone to help in his business. His partner prefers to pursue her own career. Mr. K. must decide if his “love” transcends his “need.”

In a long-term relationship in which one partner becomes chronically ill, the other person tends for the loved one in spite of having few of his own needs met. In the absence of love, a partner is more likely to abandon his mate.

In the 1992 best selling novel The Bridges of Madison County by Robert James Waller, a married but lonely Italian immigrant, Francesca, living in 1960’s Iowa meets a photographer who is filming the bridges in the area. In their four-day affair, Francesca is awakened to the difference between duty (to husband and family) and romantic love, and must choose between them.

The fact that the book has been made into a movie (1995) and more recently a musical, attests to the universality of the conflict--romantic love vs. responsibility.

Sometimes the relationship must be tested to permit a partner to grow. Mr. L’s wife wanted to return work. Until she threatened Mr. L. with divorce, he didn’t agree. He realized his love for his wife surmounted his need for her presence at home. In the long run, he benefitted from the change; while preparing dinners for the family, he discovered his love for cooking.

Conclusion: Love (beyond need) takes into account the object of one’s love. It is a luxury that may involve inconvenience but grants each partner freedom to develop their individual talents.

Dear Reader, I welcome your comments. Jsimon145@gmail.com

Why We Can't (Always) Trust Ourselves

Trusting ourselves and our feelings is a complicated matter that deserves lifelong attention.

Like road signs, feelings guide us but are also capable of leading us down blind alleys. For example, we do well to sort out the internal voice of the judge from the internal voice of the critic.

The voice of the judge condemns, punishes, berates delivering negative messages such as: 

You’re a bad person.

You’re not worthy.

You’re a loser.

You can’t get it right.

There’s no hope.

The internal voice of the judge depletes our energy, diminishes our self-esteem, contributes to hopelessness, and distracts us from taking positive steps.

Since he has retired, Mr. D. says he doesn’t see the point in getting out of bed and taking care of his apartment. The internal judge tells him his life is pointless.

Indulging in his feelings of hopelessness, worsens his predicament.

On the other hand, the internal voice of the critic assesses with a realistic eye, to guide us to improve and make progress.

Here are messages of the voice of the internal critic:

There is a solution.

There is hope.

You can do it.

You can learn from mistakes.

You can try a different way/alter your plan.

You can find the windows of opportunity.

The voice of the critic helped Ms. W. face her fear that she could become a bag lady, and motivated her to earn an advanced degree to secure a better job.

 Writing blocks stem from giving power to the internal voice of the judge. The “unblocked” writer has learned to distinguish the voice of the condemning judge from the encouraging critic.

As writer Graham Greene wrote in The Ministry of Fear, “It is impossible to go through life without trust: That is to be imprisoned in the worst cell of all, oneself”.

Conclusion; In brief, distrust the internal voice of the judge. Trust the internal voice of the critic, and learn to distinguish one from the other.

Dear Reader, I look forward to hearing from you. Jsimon145@gmail.com