The New York Review of Books carried and a scathing and mostly right-on article about the medicalization and over-medication of mental illness by Marcia Angell. It's a review of three books about the history of psych meds, the power of the drug companies, and the minimization of psychotherapy. Read it here.
Check out Damien Cave's article in today's New York Times. Women are less likely to be granted disability on the grounds that they weren't in combat, even though they are seeing plenty of action in Iraq. Unrecognized, they feel shame about having the flashbacks and aggression that characterized PTSD and are even less likely to seek treatment than male soldiers.
More than half of my clients have mentioned the economy and/or the election in the last two weeks. Some of them are in real world trouble, having lost jobs or facing foreclosure or eviction due to the "downswing" Many are troubled by the divisive discourse in the political realm. What do we do when the real world intrudes on the inner world in our offices?
1. If you, the therapist, have lost value in your retirement/savings/house value/security , notice what you're feeling and up your own self-care. Take more walks, see your friends more, have places outside your office to get support and voice your distress. Keep breathing and remind your clients to keep breathing.
2. Validate and normalize your clients' concerns. Don't tell them "it will be all right". You have no way of knowing that. If they are in great financial difficulty, you can explain the grief cycle: "When you realized that you were laid off/losing your house/facing eviction, you were numb. Now you are in the angry/blaming phase of grief. Notice that you can be angry at anyone, including yourself, in this phase. Notice the anger, feel it, and try not to take it out on yourself or your beloved, in the meantime. The sadness should hit after a while. That's often mixed with hopelessness. Don't confuse the hopeless feeling that goes with grief, with your life being truly hopeless. Hopelessness is a feeling, not a state of being. Feel it, all. We'll process it in here. You'll go through stages with it. You need to function to deal with this mess, so we'll keep the feelings moving and unstuck, so you don't shut down and lose the ability to deal with it."
3. Clear the trauma of the situation, in whatever way you have to do it. I've used EMDR, Brainspotting and Somatic therapies to help clients deal with "the moment I realized I couldn't retire this year./when I got the foreclosure notice/the layoff notice/etc."
4. Don't minimize, but do collectivize: "As you feel your fear about X,Can you connect with the 10 million homeowners going through this same thing? Your situation is yours and it sucks. And you can notice that you're not going through it by yourself."
5. After you've validated their emotions and moved the trauma, bring in the resources. "How did you get through the last bad thing? What strengths got you through it? Where do you feel (each strength) inside? Think of a time you used intelligence/ stubborness/creativity/etc. and it worked for you. Then think of a time you used (another strength) and it worked for you. Now imagine using those strengths to get through this awful time." Don't forget external resources--friends, family, welfare, etc.
6. Some clients need action plans. If they're panicked, they can't think. Help them think, after calming them down.
7. Clients who already worry about everything are going to worry about the economy, even if they're financially secure. I've asked, "How much are you picking up on the free floating anxiety out there? How much is yours versus how much is out there? What's yours about? Let's deal with that.
8. Politics. I live in lefty-liberal Seattle. My clients' political distress tends to be in a few veins: "What if he (Obama) doesn't win?" "What if someone shoots him?" and "I can't stand the polarization. They're saying I'm not a real American because I'm not White/Conservative/small town/working class/straight/Republican! I'm so mad."
For the first two-- losing Obama, one way or another, I ask, "What if?" We talk grief and it usually leads to a plan about defeating the next guy. For the other, I ask them to define American, and ask them if they qualify. (All say yes.)
"Do the small town conservative people qualify?" "Yes".
"Are you going to demonize them the way their leaders are demonizing you?" "Of course not."
"Then who are you mad at?" (Most say one leader or the other.) "Let's process that anger." And after that, we think of what they could do to empower themselves to be/feel American. Many say, "volunteer for a politician."
If I were dealing with a distressed, feeling hopeless conservative client, I'd validate her feelings, discuss the grief process, clear the trauma, and imagine what she'd do next.
9. Summing up: Validate and normalize the grief and distress. Move the trauma and grief, as many layers as you can. Connect them to the collective angst. Help them tolerate their anxiety, but differentiate it from others' anxiety. And let them feel about the poliitics, while acknowledging their identity.
Mother Jones said, "Don't Mourn. Organize." I say: Mourn, then organize. If appropriate.
PBS's Frontline has a new show about the psychological effects of the Iraq War on soldiers, including the culture of "suck it up" in the service that prohibits many soldiers from getting treatment, go here to read about it or watch it online.
The New York Times Magazine has a cover story about rape and sexual harassement in the military. Go here to read it.