Apr 25

Mental Health Stigma Arises from Language

One of the clues to mental health stigma is in our language. Why do many, for example, talk in hushed tones about the “mentally ill” but are not so judgy or secretive when reporting about the “physically ill?”

More specifically, why do we say someone “is” his or her diagnosis, e.g., he or she IS schizophrenic, versus saying that person “HAS schizophrenia”? Do we ever say so and so “IS cancer”? Or “IS a broken leg”?

Mental health stigma is definitely at play. Another language example comes from researchers at Ohio State University. They reported (Science Daily) that when participants heard about “the mentally ill” they showed less tolerance than when they heard about “people with mental illness.”

What is “mental illness” anyway? A few definitions:

  • American Psychiatric Association“…health conditions involving changes in thinking, emotion or behavior (or a combination of these). Mental illnesses are associated with distress and/or problems functioning in social, work or family activities.”
  • National Alliance on Mental Illness: “…a condition that affects a person’s thinking, feeling or mood. Such conditions may affect someone’s ability to relate to others and function each day. Each person will have different experiences, even people with the same diagnosis.”
  • Mental Health America“…a disease that causes mild to severe disturbances in thought and/or behavior, resulting in an inability to cope with life’s ordinary demands and routines.”

Psychiatrist Thomas Szasz (1920-2012), on the other hand, famously proclaimed “the myth of mental illness” in his “Manifesto” :

Mental illness is a metaphor (metaphorical disease). The word disease denotes a demonstrable biological process that affects the bodies of living organisms (plants, animals, and humans). The term mental illness refers to the undesirable thoughts, feelings, and behaviors of persons.

Likewise, David Oaks, a “psychiatric survivor” and founder of MindFreedom International, has proposed that “‘mentally ill’ reflects a medical model that’s too narrow. If you’re okay using this model about yourself, that’s one thing, he adds, but it shouldn’t be the only way of looking at things. Thus he goes further:

…Let’s stop legitimating the use of words and phrases like ‘patient’ and ‘chemical imbalance’ and ‘biologically-based’ and ‘symptom’ and ‘brain disease’ and ‘relapse’ and all the rest of the medical terminology when we are speaking about those of us who have been labeled with a psychiatric disability.

What kind of language might serve us better?

Are we supposed to go the way of insurance company lingo, I wonder, and try to view issues as “behavioral health” versus “mental health”? Less about your brain or having an illness, more about what you do? Even though they simultaneously require billing codes that label people with mental disorders in order for them to qualify for coverage?

Anne Cooke, PhD, proposes the following to psychiatrist Allen Frances in a Psychology Today post on a related topic: .”..Why not just use people’s own language? That way we enable people to define their own experiences and avoid imposing our own ideas on them.” (This advice would be more applicable to everyday or clinical usage than helping clients use their insurance coverage, I need to add.)

But what about, asks Frances, the more severe issues that actually require proper diagnosis or labeling in order to have an understanding of how to resolve them? Back to an earlier analogy, a broken leg can’t be properly fixed if we don’t diagnose it correctly in the first place.

No easy answers, but a combination of knowledge and sensitivity will at least guide our communication toward some better places.

Apr 21

“The Handmaid’s Tale”: Horror Still Relevant

Margaret Atwood is often credited with the quote “Men are afraid that women will laugh at them. Women are afraid that men will kill them.” But killing, in The Handmaid’s Tale, is indirect. Unlike in any number of other gender dystopias, most men don’t oppress women because they hate or fear them, but because they can’t empathize enough to love them when it becomes inconvenient. Adi Robertson, The Verge

Starting next Wednesday, April 26th, Hulu will offer the hotly anticipated and still relevant The Handmaid’s Tale, a 10-episode TV adaptation of Margaret Atwood‘s 1986 dystopian novel, which was also made into a movie released in 1990.

I. The Book The Handmaid’s Tale

In her review Mary McCarthy, New York Times, noted the following imaginary setting:

A standoff will have been achieved vis-a-vis the Russians, and our own country will be ruled by right-wingers and religious fundamentalists, with males restored to the traditional role of warriors and us females to our ‘place’ – which, however, will have undergone subdivision into separate sectors, of wives, breeders, servants and so forth, each clothed in the appropriate uniform.

II. The Movie The Handmaid’s Tale

While the themes were appreciated, critical reviews of the film were not so great. A small sampling:

Janet Maslin, New York Times: “…’The Handmaid’s Tale’ is a shrewd if preposterous cautionary tale that strikes a wide range of resonant chords.”

Rita Kempley, Washington Post: “…a yarn of ’80s paranoia…that by all rights ought to frighten women right out of their Hanes ultra-sheers. Alas, [director] Schlondorff’s approach is so dispassionate it fails to prick our secret terrors, much less put runs in our stockings. In a way, he has succeeded too well. Under his austere eye, this portrait of a barren, loveless tomorrow becomes icy as a corpse.”

III. The TV Series The Handmaid’s Tale

Watch the trailer below:

Continue reading

Apr 19

“Road to Jonestown”: Where a Demagogue Led Mass Murder-Suicide

At some point I hope our culture starts making people who want to be leaders focus a little bit more on the facts, and a little less on whatever is convenient to try and make people believe something that is not necessarily true. Jeff Guinn, interviewed about The Road to Jonestown (Salon)

For many the 1978 mass murder-suicide known as the Jonestown Massacre is a remotely known thing that somehow became responsible for bringing “Drinking the Kool-Aid” into our lexicon. Now, though, you can learn much more about it by reading true-crime writer Jeff Guinn‘s The Road to Jonestown: Jim Jones and Peoples Temple.

Kool-Aid, by the way, was not really involved. More than 900 of the Reverend Jim Jones’s cult-like followers and their children died that day from drinking something called Flavor Aid laced with cyanide. The method of self-infliction for Jones was a handgun.

Terry Gross, NPR, further introduces Jones and the key events of that November day in ’78:

…He drew his followers to Guyana by convincing them that America was facing imminent threats of martial law, concentration camps and nuclear war.

After claims of abuse in Jonestown surfaced, Rep. Leo Ryan, D-Calif., came to Guyana to investigate. A number of Jonestown residents sought to return to the U.S. with Ryan, but others opened fire on the delegation, killing the congressmen and four others. The mass suicide followed.

Guinn says the lessons of Jonestown still resonate today. ‘Jim Jones epitomizes the worst that can happen when we let one person dictate what we hear [and] what we believe,’ he says. ‘We can only change that if we learn from the past and try to apply it to today.’

Jones (1931-1978) decades earlier was “a charismatic, indefatigable minister in Indiana and California preaching Christianity, socialism, vehement antiracism, and a bizarre personality cult that worshipped him as God” (Publishers Weekly).

But, as Guinn conveyed to Gross, “More and more over the years, as his paranoia increased, as his drug use increased, he began to think of himself at war with almost everyone in the outside world — the United States government, all kinds of secret forces.”

The substance abuse was indeed significant. According to Kirkus Reviews, Jones had developed “an endless appetite for drugs—’amphetamines and tranquilizers, pills and liquids to provide significant boosts of energy, or else slow down his racing imagination and allow him to rest’—and decidedly un-Christian patterns of behavior” that took advantage of many of his subjects.

How did Jones get all those people to worship him and ultimately to die en masse? Kevin Canfield, San Francisco Chronicle:

Guinn offers several reasons: Some valued the security of knowing that all of their ‘material needs were met’; others believed that in a ‘nation full of violence and hatred and greed … the poor of all races and backgrounds must care for and help each other’; still others thought that any man who acquired such a following must be touched by divinity.

Jones was a demagogue and ultimately, a mass murderer. Paradoxically, Guinn writes, he ‘attracted followers by appealing to the best in their nature, a desire for everyone to share equally.’ Nobody joined Peoples Temple looking to get rich or powerful. ‘Most members sacrificed personal possessions, from clothing and checking accounts to cars and houses, for the privilege of helping others,’ he adds. ‘They gave rather than got.’

An important takeaway for our times as expressed by Jon Foro, official reviewer of The Road to Jonestown for Amazon:

Anytime a leader is allowed to say what and act how he pleases without restraint, when followers are encouraged never to question any of his words and actions and an angry sense of ‘us versus them’ is fostered, then things will end badly no matter how well-intentioned those followers might be. Anyone claiming to be the only leader with all the right answers should never be placed in a position of ultimate power. Jim Jones was a gifted demagogue, and he led his followers to their doom. That’s what demagogues in any era do.

Apr 17

“Carrie Pilby”: Genius Teen in Need of Therapy Plan

Carrie Pilby is a new comedy/drama based on a novel by Caren Lissner about a highly intelligent young woman in therapy with a carin’ listener. Art imitating name?

Christy Lemire, rogerebert.com, sets up the plot and primary characterization of the titular character, a motherless child played by Bel Powley:

Carrie is the smartest person in the room at all times but she’s too miserable to enjoy it. She has trouble dating and making friends but she’s never at a loss for words. And while she has incisive analysis on the ready, regardless of the situation, she has a harder time understanding herself.

‘What’s so great about being happy, anyway?’ Carrie asks her therapist (Nathan Lane) in one of her weekly sessions, which give the film its narrative structure. ‘There are some brilliant, unhappy people.’ But the therapist, who’s a longtime friend of Carrie’s wealthy, widower father (Gabriel Byrne), is well aware of what an unusual young lady she is. A native Londoner, Carrie now lives by herself in Manhattan. She skipped three grades and graduated from Harvard at 18. A year later, she works as a proofreader at a law firm but doesn’t really need the job.

Whereas in the novel Carrie’s therapist, Dr. Petrov, gives her a 5-point therapy plan, in the movie it’s a 6-pointer. First, the plan presented in the book, per Reading for Sanity:

1. List 10 things you love (and DO THEM!)

2.  Join a club (and TALK TO PEOPLE!)

3.  Go on a date (with someone you actually LIKE!)

4.  Tell someone you care (your therapist doesn’t count!)

5.  Celebrate New Year’s (with OTHER PEOPLE!)

As played out in the film (Rex Reed, New York Observer):

Clearly flummoxed by her maverick, unorthodox nonconformity, [Carrie’s shrink] gives her a list of goals she should achieve before the end of the year if she wants to be happy. Go on a date. Get a pet. Make a friend. Spend New Year’s Eve with someone. Carrie Pilby is about how a girl who is profoundly disappointed in the rest of mankind decides to follow her doctor’s advice: ‘Give humanity a chance. Someone might surprise you.’

Alternatively, a snarkier description of this “feeble plot device” by David Ehrlich, Indiewire:

‘Get a job.’ ‘Make a friend.’ ‘Go on a date with Jason Ritter’ (great in an unflattering role). ‘Try to distract viewers from the overwhelmingly obvious fact that you’re going to end up with the handsome neighbor (William Moseley) who exists for no other reason than to be the nice guy who’s been right in front of you the whole time’…He’s quite a perceptive therapist, really.

In the trailer below is Dr. Petrov’s humble admission that he doesn’t “have all the answers”—“which is just about the most important thing a young person can hear, and somehow, despite the far-fetched nature of this film, comes off as inspiring,” states Jordan Hoffman, The Guardian.

Other characters of interest include a coworker played by Vanessa Bayer and a boundary-violating former professor (Colin O’Donoghue). Watch below:

The following review excerpt by Leslie Felperin, Hollywood Reporter, seems to aptly reflect the generally mixed reactions among critics:

At its worst, the film oozes the sickly smugness of a self-help pamphlet, but when it relaxes its didactic grip and lets the actors take control it can be quite charming. Powley verbally spars elegantly with her co-stars, and the best scenes are the volleys of banter back and forth between her and Carrie’s potential suitors, first Jason Ritter, nervy as an MIT grad with whom Carrie goes on a blind date, and then William Moseley as the music geek boy next door.

Carrie Pilby is currently in limited theater release and on demand at Amazon, possibly elsewhere.

Apr 14

Lying in Therapy Is a Researched Thing

The topic of secrets and lying in therapy is just one aspect of research at The Psychotherapy, Technology, & Disclosure Laboratory at Teachers College, Columbia University. Dr. Barry A. Farber is the lab’s leader, while doctoral students Matt Blanchard and Melanie Love run the Lying in Psychotherapy element.

From the latter’s online description:

Client dishonesty is a broader category of non-disclosure that includes distorting and fabricating as well as omission, avoidance, secret-keeping, etc. Our initial survey of 547 psychotherapy clients showed large percentages of clients concealing therapy-relevant information, such as suicidal thoughts. We are now preparing a follow-up survey to replicate our initial findings, conducting interviews with clients, and developing a related survey for therapists.

According to the abstract of an article by Blanchard and Farber, the vast majority of clients (93%) admitted to lying in therapy.

Common therapy-related lies included clients’ pretending to like their therapist’s comments, dissembling about why they were late or missed sessions, and pretending to find therapy effective. Most extreme in their extent of dishonesty were lies regarding romantic or sexual feelings about one’s therapist, and not admitting to wanting to end therapy. Typical motives for therapy-related lies included, ‘I wanted to be polite,’ ‘I wanted to avoid upsetting my therapist,’ and ‘this topic was uncomfortable for me.’

Ryan Howes, Psychology Today, interviewed Blanchard about the research, and some of the more interesting excerpts from their exchange are presented below verbatim:

  • Omission is about 3.5 times more likely than fabrication. Similarly, clients report minimizing the truth about 6 times more commonly than they report exaggerating.
  • …(M)ost demographic factors—gender, ethnicity, education, income—had no relationship to dishonesty in therapy.
  • …(Y)ounger clients reported more lying. Those who lied about one or more topics were on average 4-to-7 years younger than those who reported total honesty. This finding matches findings about lying in everyday life outside of therapy, too.
  • Most commonly, clients lie to avoid the shame and embarrassment they feel even in the confidential, protected space of the therapy room.
  • One of the last questions we ask clients is: “How could your therapist help you be more honest?” We imagined that clients would want more warmth or skill from their therapist, or to know their therapist shared their problems, or understood their culture or class. On the contrary, the dominant response was, “If my therapist asked me directly.” So one simple takeaway from our work is: Just ask.

A “spinoff” of the Lying Lab is called Therapists’ Lies & Detection of Lies, run by doctoral student Devlin Hughes. “Specifically, the lab is exploring how therapists respond when they believe a client is being dishonest with them…”

Tori DeAngelis, not a representative of the above resources but a journalist, has compiled her own suggestions for therapists (APA) to minimize lying in therapy. Some examples paraphrased from her article:

  • Establish a safe space for clients; convey a nonjudgmental attitude.
  • Model the practice of honesty.
  • When possible use humor and acceptance regarding omissions and lies.
  • Tread more lightly regarding possible secret-keeping of a more sensitive nature, but do consider how to reach that material, as clients usually benefit.
  • Keep in mind that you as a therapist may have also had difficulty admitting the truth in therapy. One study “found that about a fifth of 800 therapists surveyed admitted there was something important they had kept secret in therapy. In most cases it involved sexual issues.”