“One cannot hope to understand the phenomena of psychological distress, nor begin to think what can be done about them, without an analysis of how power is distributed and exercised within society” David Smail
“Women are socialized to suppress feelings of anger and frustration that are often natural outcomes of interpersonal conflicts…. this socialization process leads many women to experience negative psychological and physical reactions because they are fearful of expressing their thoughts and feelings….. Comstock refers to these dynamics as “prohibitions against anger”…” Jean Baker Miller (in Allen Ivey, Michael D’Andrea & Mary Bradford Ivey)
“Dialectics allows opposites to coexist, you can be weak and you can be strong; you can be happy and you can be sad. In the dialectical worldview, everything is in a constant state of change…” Marshia Linehan
“…. I no longer see these disorders as distinct, but as individual manifestations of overwrought, amygdala-driven and dysregulated nervous systems. Just as emotion” Sebern F. Fisher
“Live it, say it, the “I can” that changes lives / all that you ask for, is where you’re afraid to go….” (Lyrics from Vasilis Lekkas’ song)
The artwork is by Vaso Katraki
In today’s post I’ll be mildly and briefly touching on some difficult and thorny topics, which require a lot more space for discussion. I’ll also refer to a song, a film, a book and a meditation session.
One of the positive things of living on a Greek island in the summer apart from the natural beauty, the sea and the long warm days are the many cultural events in open spaces. Last week I went to Vasilis Lekkas’ concert, which took place in the garden of an old mansion under a star lit sky among trees that have probably stood there for over a century. At some point the lyrics of one of the songs I hadn’t heard before caught my interest and got me thinking:
Live it, say it, the “I can” that changes lives / All that you ask for is where you’re afraid to go… / Don’t bow (to pressure)… don’t bow… / But dreams are keys that open cells … There are no prisons on earth that can lock the psyche… / Live it, say it, the “I can” that changes lives / all that you ask for, is where you’re afraid to go…. / Live it, say it, the “I can” that changes lives / you wear wings, but they will open if you say that you dare… to fly, to fly…
I thought about the lyrics and of how maybe this common metaphor of “spreading your imaginary and symbolic wings to fly” often used to represent the realisation of dreams or reaching goals might not be the only relevant metaphor. Perhaps a more useful or complementary image could be to be rooted in the earth, like a tree, rooted, connected and resilient in the eight worldly winds that may sweep through and around you, touching the ground, present in the here and now, alert to current reality, but also the past, undistracted, awakened to broader levels of inner and outer realities. From this place, I think, there are more chances of being free and of fulfilling dreams and potential.
Speaking of wings a little while ago I watched a documentary film: Take These Broken Wings, directed by Daniel Mackler, featuring Joanne Greenberg, who had been diagnosed with schizophrenia, and after much trauma and suffering in the mental health system, went on to become a best-selling author of I Never Promised You a Rose Garden, and to write many more books (I have briefly referred to her in an older post), and Catherine Penney a survivor, of a traumatic childhood, whose symptoms were labeled schizophrenia, but was supported to heal from both her trauma and her symptoms or / and maladaptive responses. She went back to school and become a clinical nurse. The film also includes interviews with: a) Peter Breggin, psychiatrist, critic of shock treatment and psychiatric medication and advocate of replacing psychiatry’s use of drugs and electroconvulsive therapy with psychotherapy, education, empathy, love and other human services, b) Robert Whitaker, journalist and author – three of his books cover the history and practice of modern psychiatry, who has won numerous awards for science writing, was shortlisted for the 1999 Pulitzer Prize for Public Service for a series of articles questioning the ethics of certain psychiatric research, and Bertram Karon, psychoanalyst, psychotherapist and author. The film raises questions in relation to diagnoses, over use of medication and misinformation and, more helpful ways of viewing symptoms or clusters of symptoms. Ultimately, I think it is important to ask: Why are the symptoms here? & What happened to you? as Mate Gabor, among many others, often says, and most importantly How can we help without harming you or taking your agency away?.
Somewhat related to the above is Dr Marsha M. Linehan’s book Building a Life Worth Living. In her teens Marsha Linehan was subjected to electroconvulsive therapy, seclusion, heavy medication and cold pack therapy. This is what she writes about cold pack therapy: “[it] involved being stripped naked, wrapped tightly in wet sheets that had been stored in a freezer, and strapped to the bed with restraints. You would lie there, immobile, for as long as four hours…. Most people find the discomfort and physical constriction so unbearable that the mere threat of the therapy is sufficient to discourage problem behavior…. The nurses had a simple but effective method of issuing such a threat. If we were talking instead of going to sleep, for instance, the nurses would rattle ice cubes in a metal container. That usually brought instant silence.” Linehan writes she was twice erroneously diagnosed. In reading her story we see that the symptoms and behaviours she displayed after she had entered the institute [not before she was sent there] were similar to today’s diagnostic criteria for borderline personality disorder, and also, that her stay there brought about severe memory loss.
During her time in the institute she made a vow to God to get out of that hell and help others get out too. She describes how this happened: “Thompson Two had a piano at one end, an upright piano, and I spent a lot of time playing. I had been an accomplished pianist at school, and I hadn’t yet lost that part of me on my descent into hell. Later, though, after I had multiple rounds of electroconvulsive therapy…… I lost my memory of just about everything and every person and, sadly, also my ability to read and remember musical notes and to play the piano. Playing the piano had always been a way to express my emotions. I still carry the hope that one of these days I will play again. It was at the piano that I later made my vow to God….. that I would get myself out of hell and that, once I did, I would go back into hell and get others out. That vow has guided and controlled most of my life since then.” A good friend that Linehan had made while in that clinic, Sebern Fisher, also went on to become a therapist and write a book on neuro-feedback and developmental trauma.
After leaving the institute when she was 20 years old, she went on to study. She earned an M.A. in 1970 and a Ph.D. in 1971, in social and experimental personality psychology, and then went on to develop Dialectical BehaviourTherapy, which according to Linehan is a behavioral treatment program, not so much an individual psychotherapy approach. Linehan is a researcher and professor of Psychology and Behavioral Science, has written many books and earned many awards. In addition to her work in psychology, she is also a trained Zen meditation teacher. In the foreword for her most recent book: Building a Life Worth Living, Dr Allen Frances, Professor Emeritus of Psychiatry and Behavioral Sciences, has written: “The therapy Marsha created is called Dialectical Behavior Therapy. DBT is the most effective treatment for highly suicidal and self-destructive people, often people diagnosed with borderline personality disorder (a terrible term, but we seem to be stuck with it). In the past half century there have been just two really influential clinical innovators in the field of mental health…… in 2011, the editors of Time magazine named DBT one of the 100 most important new science ideas of our time. That she has made this major contribution to psychology, a field previously dominated mostly by men, is testament not only to her intellectual creativity but also to her determination to overcome all obstacles. Many people come up with good ideas but don’t have what it takes to get them into the world. Marsha has the charisma, energy, commitment, and organizational skills to turn dream into reality. In myths the world over, heroes must first descend into the underworld, where they are faced with a series of epic challenges to be overcome before they can prevail in their heroic life journey. Once they succeed, they return to their country bearing some special new secret of life…..”
There is now a need for a constructive critique of practices, structures and power. David Smail claims that “One cannot hope to understand the phenomena of psychological distress, nor begin to think what can be done about them, without an analysis of how power is distributed and exercised within society” (cited in MacLachlan, McVeigh, Huss & Mannan, 2019). Another point to consider, as I’ve mentioned in previous posts, is the ineffectiveness of a biomedical understanding of health, addiction and mental distress that continues to dominate the relevant social discourse and current practices. Miriam Greenspan discusses three general myths from which many health practitioners and psychotherapists operate when working with people, in particular, women: a) “it’s all in your head”, and in doing so “avoid directing attention to the oppressive and unjust stressors that occur within women’s workplaces, families and other important interpersonal relationships.” The second myth is the medical model of psychopathology, which suggests that “all emotional pain can be treated the same way one would treat medical problems-with prescription and medication” and in doing so little time is spent on the contextual basis of personal problems. The third myth is the doctor as“The Expert”, which perpetuates the power imbalance between the patient or client and the health professional (cited in Allen Ivey, Michael D’Andrea and Mary Bradford Ivey, 7th Edition).
Also, we need to remember that patriarchy acts as an overarching oppressive force defining power structures, discourse, and dissemination of information of acceptable behaviour, girl’s and women’s behaviour in particular. There is now a lot of material concerning the DSM and the validity of some diagnoses and part of it is a feminist critique that suggests that women’s experience of oppression and inequality has been pathologized for centuries. For instance, women’s anger is pathologised irrespectively of circumstances, violence or oppression, whereas, it is rather encouraged in men. Comstock refers to these dynamics as “prohibitions against anger”…” (cited in Jean Baker Miller (in Allen Ivey, Michael D’Andrea & Mary Bradford Ivey). Girls and women are conditioned into certain gender roles from a young age and are often expected to adjust, not speak up or rock the boat, which can lead to intense distress. When women express their need for autonomy or their indignation and anger they are labeled rebellious, promiscuous, hysterical or otherwise. This disempowers women and leads to the burying of emotions, numbness and disempowerment.
I’ll provide an example from my own experience to clarify how women are conditioned from early on to be overly polite and accommodating, and also, how there are subtle and less subtle ways that society silences women or undermines their sense of safety. This particular memory came to my mind after hearing psychotherapist, Marisa Peer, provide an example from her own life of a similar experience in a talk about how to reframe experiences and make new meaning of events. So, I was in my late teens returning from some class or other when a tall man around thirty with very short hair stood behind me on the train and started talking to me. I ignored him knowing that I would be getting off soon. To my surprise he got off too and started following me continuing to chat. It wasn’t dark, I was in my neighbourhood so I turned around and asked him to leave me alone, but he ignored me. As we approached my house I started feeling some low grade fear wondering if he would actually follow me up to the front door of my block of flats and even if it was a good idea to go home. When I finally got to the door he stood close behind me as I was trying to unlock the door hoping that once I’d shut the door he would leave, but he firmly held the door open and stepped inside. I was left trying to figure out whether to go up the several flights of steps in the semi-dark or take the lift. The lift seemed a better option and I didn’t believe he’d have the nerve to get in, but he did. Meanwhile, it never occurred to me to knock on a neighbour’s door or demand he get lost… because I kept thinking “what if he gets aggressive” and “what will people think”. Even though I’ll end the story here I will say that his stalking did not end that day. There were a couple more incidents. At the time it occurred I could not yet classify it as harassment or stalking. I didn’t have the vocabulary. Only much later was I able to reframe the experience. It was only in retrospect that I realised that apart from it being an unhealthy and sexist behaviour on his part, it was a fear inducing power game not that uncommon.
As mentioned above, one issue to consider is that mental distress in society is mostly understood through a biomedical lens. Lafrance and Mckenzie-Mohr (2013) postulate that “distress is medicalized, understood as an expression of individual dysfunction” Moreover, one needs to look at the history and development of the Diagnostic Statistical Manual of Mental Disorders (DSM). The DSM has contributed to medicalising our understanding of human experience and distress and has shaped the language that we use to talk about emotional and mental distress, responses to trauma and even human experiences like grief. In their paper on gender and diagnosis, published in 2008, K. Eriksen and V. Kress write:”…… both men and women have been hurt by previously unquestioned diagnostic systems. In fact, many authors have pointed out the stigmatizing effects of diagnostic labels; the classist, sexist, racist, and homophobic assumptions embedded in both the ICD…. and the DSM-IV-TR…….; the resulting pathologizing of behaviors that may be normative within particular gender contexts; and the under-diagnosing of problematic behaviors…… In this article, we report gender-related concerns about diagnosis, including those related to the prevalence of diagnoses by gender, sex bias in diagnosis, the problematic impact of particular diagnoses on women, and the impact of socialization and social conditions on diagnosis…”
There has also been considerable critique about the relationship between psychiatry and the pharmaceutical industry, and consequently, the over reliance on the use of medication, which requires a biomedical model of explaining health in general and the need to over-pathologise and de-contextualize human experience. Psychiatry has been described as anti-feminist having contributed or colluded in practices that today would be considered as barbaric and violations of rights. All in all, patriarchal structures, upper white male middle class values and beliefs and a biomedical model of understandings of mental distress have pervaded psychiatry and psychology. Of course, mental health fields do not speak with one voice and progress is being made as science progresses and new research and more integrative approaches are formulated. There are a lot of voices, there is greater dissemination of information, and also, women and marginalised groups are now, to one extent or another, also part of the conversation.
Concerning “Borderline Personality Disorder”, in particular, there are those in the field that consider it a meaningless label and because there is a great overlap with complex post traumatic stress it is suggested that this description of the experience would be more helpful and would also shed light on the fact that a lot of serious mental distress or maladaptive behaviours stem from prolonged trauma and hostile environments. Incorporating the concept of trauma could move the emphasis away from the individual to include their external environment. The literature also reveals that there are those arguing that BPD is a “gendered diagnosis”, with women being diagnosed at a much higher rate than men. In order to understand how BPD was constructed and why women are diagnosed, I think something like nine times more frequently, it is essential to explore the link between patriarchy, power and dominant discourses of mental distress. Also, this lack of consideration of stereotypical notions of gender, on the one hand, and life circumstances, on the other, can result in biased research and conclusions.
It is suggested that rather than reducing the experience of women to medical symptoms, there is a deep need to change our oppressive, biased and unreasonable society, and also, take into consideration the upbringing of many girls across the world and the impact of oppression and social contexts from early on. Behaviours developed early to survive and protect the self in often threatening or invalidating environments are then in adulthood stigmatized and labeled out of context. Literature suggests that women who receive a BPD diagnosis have often experienced trauma and abuse, so viewing them as survivors would facilitate healing and change. Also, evidence on the effectiveness of medication is controversial. Apart from Marsha Linehan’s approach mentioned above, other psychotherapies like narrative therapy and feminist therapy have been found to be effective in exploring gender issues, power structures in society and women’s positioning, creativity, and insights into relational dynamics and ways of empowerment. Dialectical Behaviour Therapy (DBT) has four components “mindfulness (being aware of one’s emotions, distress), distress tolerance (tolerating and accepting difficult situations or emotions), emotional regulation (using techniques to reframe thoughts and shift emotions) and interpersonal effectiveness. It might also be necessary to engage in trauma work along with DBT or at some later point in order to heal at a deeper level. DBT has been critiqued for neglecting to pay attention to the oppressive power structures that have contributed to a person’s life experiences and context. Trauma work can also prevent women from seeing the broader power relations that are affecting their lives or stifling their movement. Ultimately, integrating a feminist approach and contextualizing people’s lived experiences can always complement and increase the efficacy of the therapeutic process and the process of empowerment.
I will end the discussion of this huge topic here even though there is a lot more to consider.
I’d also like to share a meditation for those who meditate from Kara Jewel Lingo, a meditation teacher, who is interested in blending spirituality and meditation with social justice. At the age of twenty-five after her studies, she entered a Buddhist monastery and spent fifteen years living as a nun. She became a Zen teacher in 2007. She has also written a book. In this particular meditation she mentions a common symbol of a wheel found in Asia with eight spokes and a hole in the centre or an inner wheel. This wheel image also represents the Eight Worldly Winds (I referred to above), which are four pairs of opposites: pleasure and pain, praise and blame, gain and loss, fame and disrepute. It seems like a helpful metaphor for life. We all universally hope for the positive things and fear the other four. The wheel is always turning, the wind is always blowing, and more or less, we get a taste of all eight experiences in different forms and to differing degrees.
https://www.youtube.com/watch?v=UXdhEwzCBDQ&t=387s
Finally, some fun resources for the summer for both those who will get the chance to go on vacations and those who won’t. The relevant research seems to reveal that “fun is an essential key to our well-being, one that needs to be defended against the encroachments of work and other responsibilities.”
https://corpmail.otenet.gr/?_task=mail&_action=show&_uid=51072&_mbox=INBOX&_safe=1&_caps=pdf%3D0%2Cflash%3D0%2Ctif%3D0