Sep 19

Intimate Partner Violence: “No Visible Bruises”

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Intimate partner violence is the subject of No Visible Bruises:What We Don’t Know About Domestic Violence Can Kill Us by journalist Rachel Louise Snyder. It’s not just a domestic issue, she argues, but a public health problem. Parul Sehgal, New York Times, reviewing No Visible Bruises: “A United Nations report in 2018 put it starkly: The most dangerous place for a woman is her own home.”

Other salient statistics from the book, per Sehgal: “In America alone, more than half of all murdered women are killed by a current or former partner — 50 women every month. Domestic violence cuts across lines of class, race and religion; it is the leading cause of maternal mortality in cities including New York and Chicago, and the second leading cause of death for black women nationwide.”

An important distinction about intimate partner violence is contained in the book review by Kate Tuttle, LA Times: “‘Love is what makes domestic violence different from any other crime,’ Snyder writes. ‘That the people involved have said to each other and the world, you are the most important person to me.’ For that love to end in injury and even death, she adds, ‘requires us to mentally, intellectually, and emotionally hurdle beyond what we can imagine.'”

Julia Kastner, Shelf Awareness, describes how the author organizes her material, starting with the fact that it’s unusual, going from “The End” to “The Beginning” to “The Middle.”

Further explanation: “That is, she first studies what intimate partner violence looks like at its conclusion: homicide and regrets that various systems (judicial, law enforcement, advocacy, etc.) couldn’t do more. Next, she investigates the beginning of such violence. Abusers often come from abusive home environments and, along with their victims, grow up in a society that values stoicism, control and violence in men, submissiveness and emotional labor in women. ‘The Middle’ examines how services are provided to victims of domestic violence, and what changes should be considered.”

Regarding the profile of abusers, Snyder tells NPR the following:

Narcissism is one of the key components of an abuser… [Most] abusers, in fact, are not people with anger problems. Generally speaking, they are about power and control over one person or the people in their family. They’re often very gregarious. Only about a quarter of the abusers fit that stereotypical definition of someone who is, you know, generally angry. And so the narcissism plays out in the idea that they are owed something, in the idea that they are entitled to their authority, that their partners have to be subservient to them. There’s very often traditional gender dynamics in abusive relationships.

Some of Snyder’s proposals for safety (New York Times):

Prosecute cases without the victim’s help, as we do murder trials. Treat restraining orders like D.U.I.s and keep them on file, even after they have expired. Train clergy members and doctors to recognize and respond to domestic violence. Promote battering intervention programs. Choking nearly always precedes a homicide attempt; teach police to recognize the signs, and instruct doctors to assess women for traumatic brain injury. And, of course, there is the near-unanimous recommendation from law enforcement and domestic violence advocates: ‘You want to get rid of homicide?’ a retired forensic nurse asks. ‘Get rid of guns.’

Sep 13

“Tiny Beautiful Things”: The Couples Therapy (Spoilers)

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Tiny Beautiful Things on Hulu is a fictional adaptation of advice columnist Cheryl Strayed‘s 2012 book Tiny Beautiful Things: Advice on Love and Life from Dear Sugar. (For additional background, see this previous post about the film Wild based on Strayed’s solo hike of the Pacific Coast Trail.)

As the series Tiny Beautiful Things begins, Clare (Kathryn Hahn) has not yet fulfilled her writing ambitions; also, she has not yet become “Dear Sugar.” She carries tremendous grief about her mom who died from advanced cancer, can’t connect with her teenage daughter, and is separated from her husband Danny (Quentin Plair) but pursuing couples therapy with him.

In Episode One we see that Clare “doesn’t trust their therapist, Mel, who wonders aloud whether Clare’s instability is due to latent anxieties about her decaying beauty as she approaches 50” (TV Line). While this statement seems out of left field and representative of a biased attitude toward Clare that gets repeated down the line, the style of this therapist (Tijuana Ricks) with Danny seems different, possibly even flirtatious. The latter has actually been acknowledged by both Hahn and Plair (Decider).

Beyond this, however, there’s a lot we don’t get to understand about the couples therapy dynamics.

For example, although it’s briefly mentioned early on that Danny has met with Mel separately, we don’t know in what context or how many times. Did Clare choose not to attend a session or more? Was Danny in individual therapy with Mel before it became couples therapy? Or maybe he still has separate sessions? Whatever the case, perhaps there were appropriate reasons for separate sessions, just as there may have been inappropriate ones.

A Google search reveals that many viewers are confused about what is happening between Danny and the couples therapist. Many wonder if Mel is a bad therapist, period. Question categories include:

  • Why is Danny seen (by Clare) chatting with Mel in her office after their session has ended? (A major stressor for Clare, by the way, who only witnessed this inadvertently.)
  • Does Mel pick on Clare unnecessarily? Is Danny Mel’s “favorite”?
  • Why did Mel single Danny out by sending him that column (that led to his realization that he needs to end his marriage)?
  • Is it appropriate that Mel then gave him a special after-hours individual session? He clearly requested it, but is this the right course of action?
  • Is Danny “Johnny,” the married sender of the letter to Sugar about falling in love with someone—and is that someone Mel?

It’s left for viewers to draw their own conclusions. As a viewer myself who’s also been a couples therapist, I do have a few thoughts.

  • The dynamics in the couples sessions do seem out of whack and biased towards Danny. (But you didn’t need me to tell you that.)
  • The dynamics outside of couples sessions do seem inappropriate. If couples therapy is going to proceed fairly, each party should be informed if separate talks are occurring with the therapist.
  • Mel did show a clear bias or favoritism by sending the column to Danny only. Why not share it with both of them, if at all?
  • It follows that the “emergency” session with Danny didn’t have to happen if he hadn’t received this special treatment from Mel. Moreover, I think it’s implied that Clare is not aware of this happening.
  • If Danny has fallen for Mel, she likely has contributed to this.  And if something more intimate is happening between them, it’s highly inappropriate and unethical on Mel’s part as a therapist.
Sep 06

Maria Bamford: “Sure, I’ll Join Your Cult”

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An acclaimed comedian chronicles her experiences with mental illness and her search for community. Warning: her hilarious riffs will make you feel seen. Adam Grant, reviewing Sure, I’ll Join Your Cult by Maria Bamford

Maria Bamford—the favorite stand-up comedian of Stephen Colbert, Tig Notaro, and other notables—and star of Netflix’s Lady Dynamite (2016-17), which dealt with the aftermath of her actual mental breakdown, has a new book: Sure, I’ll Join Your Cult: A Memoir of Mental Illness and the Quest to Belong Anywhere.

You can read an excerpt on Slate (“My First Cult Was My Family. My Mother Was in Charge“). The “cults” she tries (beyond her family) in order to belong somewhere/anywhere include 12-step programs such as Debtors Anonymous and Sex and Love Addicts Anonymous as well as Dale Carnegie’s “How to Win Friends and Influence People” and the programs of Richard Simmons.

Bamford has long been open about her various mental health struggles. Among the list are anxiety, depression and suicidal thoughts, binge eating, a form of OCD called “unwanted thoughts syndrome” (for which she named a comedy CD), and Bipolar II Disorder.

Kirkus Reviews summarizes that Sure, I’ll Join Your Cult “is a memoir that examines her life in comedy, dealing with mental illness, and finding a way to belong.” Bamford, however, advises readers this is not your typical “trauma, healing, and victory” story.

More from Kirkus: “Bamford creates an effective mix of introduction (or reintroduction) to a fascinating comedian, a guide to the self-help industry, and an encouragingly lighthearted, respectful assessment of mental health, reminding readers that they are not alone.”

Publishers Weekly: “It’s all delivered with Bamford’s trademark blend of disarming intimacy and dark whimsy. The result is a consistently funny and occasionally heartbreaking glimpse into a unique comedic mind.”

On Goodreads Kendra Gayle Lee, an indie bookstore owner, writes:

If you’ve done a 12 step program, you’ll laugh. And nod along.
If you’ve struggled with anxiety, depression, OCD, you’ll feel so seen.
If you’ve ever felt like the only person in the world who didn’t get a ‘how-to’ manual for this life, you’ve found your book!

And, finally, I think Lee’s conclusion is definitely worth adding: “But what really got me was the last chapter on suicide. Maria Bamford wrote such a tender, compassionate tribute to folks who fight suicidal ideation–and sometimes die as a result of their mental illness–that it shifted something in me. She helped me understand something heretofore incomprehensible to me. I’m grateful for that.”

Aug 30

Anxiety Vs. Bargaining in Loss Model: Claire Bidwell Smith

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Claire Bidwell Smith‘s book Anxiety: The Missing Stage of Grief  took its roots from a magazine article in which the author had posited that anxiety should actually take the place of the bargaining stage in the most commonly accepted model of bereavement.

“Even more than depression, anxiety is the response my grieving clients express a desire to overcome since experiencing loss. They describe feelings of panic and obsessive thinking about their own deaths and potential illness. They tell me about bouts of helplessness and of feeling overwhelmed by life itself, about panic attacks and moments of such paralyzing fear that they pull their cars over on the way to work.”

From an interview Caroline Leavitt conducted with Smith: “There is simply no question that loss causes anxiety. Loss is nothing but a reminder that life is precarious and that we are not in control. This realization coupled with the intense emotions of grief are the perfect recipe for anxiety. It also doesn’t help that we live in a ‘grief-illiterate nation,’ as Maria Shriver says. We often feel very alone and unsupported going through the grief process and do not know where to turn. Not having the proper support can also lead to a greater sense of anxiety.”

Smith knows from personal experience as well as professional. Her mom died of cancer during the author’s freshman year at college. Panic attacks and self-medication with alcohol became a significant part of her life. A powerful article excerpt:

My mother’s death rocked me. I was absolutely floored by it. Nothing could have prepared me for it. Not the five years we’d spent helping her combat her illness, not the talks my father had with me about her potential demise, not the school guidance counselor’s sessions. The truth was I never believed she would actually die. Because: Mothers don’t die. Bad things don’t actually happen.

I now understand that these beliefs were at the root of my anxiety. When my mother’s death disproved the two things I’d so fervently held onto, the whole floor dropped out. If my mother could die, anything, absolutely anything could happen.

Now Smith coaches grievers on understanding this aspect of the process and on learning ways to work through it. From the critique of Anxiety: The Missing Stage of Grief by Kirkus Reviews:

The author notes that while the brain is processing the separation, regret, and other emotions accompanying loss, that loss is also tangible: ‘We are forced to rearrange our lives to accommodate for the absence of this person.’ In discussing that rearrangement and those emotions, Smith turns from the canonical work of Elisabeth Kübler-Ross to more recent practitioners, such as Thomas Attig, who analyzes the changes that accompany loss, including, inevitably, changes in one’s own identity, a potential cause of grief all its own. 

Not everyone can be Claire Bidwell Smith’s actual client, of course. She does, however, provide a self-guided online grief program. Visit Smith’s site.

Aug 23

Women With ADHD: Often Looks Different Than Men’s

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Women with ADHD: the condition often looks different for girls and women than it does for boys and men.

Therapist Sari Solden pointed out years ago that girls with ADHD are often overlooked. She’s the author of the groundbreaking and bestselling 1995 book Women with Attention Deficit Disorder: Embracing Disorganization at Home and in the Workplace—revised and expanded in 2005. Her newer book, A Radical Guide for Women with ADHD: Embrace Neurodiversity, Live Boldly, and Break Through Barriers, followed in 2019.

Dr. Ellen Littman, co-author of Understanding Girls with ADHD, indicates that girls’ symptoms often increase after puberty, which is the opposite for many boys. And Solden notes that girls who are smart and receive good support and structure are less likely to draw notice.

Solden devised a self-test regarding women with ADHD. Click on the link.

One of the newest books about women with ADHD is Adult Women With ADHD: The Unconventional Guide To Coping With Neurodiversity With Tips for Avoiding Distractions, Managing Emotions and No Longer Feeling Like a Failure, Turning Into a Superwoman by Pansy Bradley. Enough said!

Zoe Kessler, who didn’t find out she had ADHD until she was in her 40’s, wrote ADHD According to Zoë: The Real Deal on Relationships, Finding Your Focus, and Finding Your Keys (2013). The online Jasper/Goldberg Adult ADD Questionnaire helped her self-diagnose (HuffPost):

By question four, I panicked. I had no idea why these questions were even on the test. Wasn’t everybody like this?

Apparently not.

Getting diagnosed, though, led to a “positive shift in self-perception” for her. She adds, “Knowledge about ADHD will set you free from a path of unmet goals and unanswered questions.”

Another resource is Linda Roggli‘s website and book. Midlife women with ADHD can find support at Roggli’s ADDiva.net. Her 2011 Confessions of An ADDiva: Midlife in the Non-Linear Lane has been widely praised by those who can relate.

A few brief quotes from “This Is My Brain on ADD”, found on her website: 

The psychiatrist who specialized in adult ADD told me to come by at 3:00 p.m. I arrived at 3:14 p.m.
He wasn’t surprised.

I did try medication—several of them, in fact. Some of them made me sleepy, which piqued my interest. If my brain slowed down on stimulants, maybe it did have some wiring problems.

Ultimately, medications didn’t work for me (in part because I couldn’t remember to take them).

The following two guides are also from the chapter in question:

ADD clues you won’t find in the DSM-IV
• Illegible handwriting
• “I have to do it my way”
• Profound sense of failure
• Feeling like a fraud; hiding yourself
• Overcontrolling of self, others, events
• Interrupting yourself
• Easily frustrated; quick trigger to anger
• Very emotional; highest highs, lowest lows
• Obsessive tidiness
• Constantly reorganizing, creating a new “system”
• Making simple tasks complex
• Inability to stick with a diet, exercise; weight issues
• Many intimate partners; impromptu sex
• Difficulty with spatial tasks–puzzles, etc.
• A constant sense of being “swamped”
• Anxiety; a baseline of unease in the world
• Sensitive to labels in clothes, bright light, loud noises

The Truth About Diagnosis
• There is no absolute test for ADHD
• It’s OK to get a “second opinion”
• A “functional diagnosis” can be made via a thorough intake interview with an ADD-savvy physician or psychologist
• Expect to feel relief and grief after diagnosis
• Not everyone has ADD – despite what you may believe
• Having ADD does not mean you are brain damaged
• Medication helps some people; expect to try several of them

See this page for additional books by various authors on this subject.