Mar 23

“What My Bones Know”: Complex-PTSD Memoir

The widely acclaimed new book by Stephanie Foo, What My Bones Know: A Memoir of Healing from Complex Trauma, is bound to educate many about a type of PTSD we don’t often hear about—C-PTSD (complex PTSD). It can occur when trauma is repeated and prolonged.

Sarah McCammon, NPR, introduces Foo:

Stephanie Foo grew up in California, the only child of immigrants who abused her for years and then abandoned her as a teenager. As an adult, Foo seemed to thrive. She graduated from college, landed a job at ‘This American Life,’ became an award-winning radio producer, was dating a lovely man, but she was also struggling. Years of trauma and violent abuse as a child had left her with a diagnosis – complex PTSD, a little-studied condition that Foo was determined to understand.

C-PTSD, however, is not to be found in the DSM (Diagnostic and Statistical Manual of Mental Disorders). This, despite its widespread recognition among trauma experts since psychiatrist Judith Herman coined the term back in 1988.

And unfortunately, many of Foo’s initial treatment experiences weren’t too helpful. As she wrote in Mental Health Journalism:

I began to try everything: acupuncture, yoga, eye movement desensitization and reprocessing or EMDR, meditation, tapping my face, hyperventilating, researching Buddhism, microdosing on acid, megadosing on psilocybin, tracking my brainwaves, joining a support group. I began researching groundbreaking possible treatments, like wearables that predict future emotions or epigenetic treatments. And throughout this process, I struggled with the loneliness of my experimentation.

Foo then heard a podcast that featured a therapist who compared complex PTSD to the Incredible Hulk (NPR interview):

Because the Incredible Hulk was actually abused as a kid. His father was an alcoholic, and now he had a hard time controlling his emotions when he was angry. He would sort of literally not be able to speak well, and he would just focus on surviving. And that is exactly what having complex PTSD is like. But the Hulk is not a villain. The Hulk is a hero.

She eventually chose him as her own shrink. Although this has certainly been helpful, her course of treatment is about management, not cure—as is the case with most chronic conditions. As Foo told NPR:

…I don’t think that you ever totally heal from complex PTSD. It’s sort of something that you carry with you all the time. But I feel like if the burden, the weight of complex PTSD, is like a pack on my back, then the process of healing has made me stronger. Does that mean, of course, that sometimes the pack gets really, really heavy and I need to sit down and take a break and cry a little bit and figure some new stuff out? Of course. Of course. That’s what life is. But now I feel like I can hold the sadness and the anger and the joy all together.

Selected Reviews of What My Bones Know

Publishers Weekly: “What takes this brilliant work from a personal story to a cultural touch point is the way Foo situates her experiences into a larger conversation about intergenerational trauma, immigration, and the mind-body connection…This is a work of immense beauty.”

Kirkus Reviews: “As Foo sheds necessary light on the little-discussed topic of C-PTSD, she holds out the hope that while ‘healing is never final…along with the losses are the triumphs’ that can positively transform a traumatized life.”

Kathleen Hanna: “This book is a major step forward in the study of trauma. It’s also a huge artistic genre-busting achievement. Stephanie Foo’s brilliant storytelling and strong, funny, relatable voice makes complex PTSD enjoyable to read about.”

Mar 16

Assisted Death the Theme of Amy Bloom’s “In Love”

Heller McAlpin, NPR, asks potential readers of the new book by writer/psychotherapist Amy Bloom, In Love: A Memoir of Love and Loss, “Would you agree to help your beloved end his life when he receives a hopeless diagnosis?” The issue of assisted death is what Bloom faced in her own marriage.

The diagnosis in question is early-onset Alzheimer’s, which struck Brian Ameche in his mid-60’s.

Not everyone will agree with Brian’s decision, or with Bloom’s agreement to support his wishes. Bloom understands that euthanasia is a controversial subject, and she addresses it with the gravitas it deserves. At various points, she worries ‘that a better wife, certainly a different wife, would have said no, would have insisted on keeping her husband in this world until his body gave out.’ In Brian’s sharper moments, she worries that they’re acting too soon. She also, rightly, rails at a system that allows animals to be put out of their misery, but not human beings.

The bumpy road to assisted death, or in this case legally “accompanied suicide” (involving drinking sodium pentobarbital) brings the couple to an organization in Switzerland called Dignatas. But you can’t just access Dignatas because you want to. One of the stumbling blocks was proving Brian’s level of “discernment and determination”:

The couple know that if they wait too long, he will no longer be capable of passing this test. They hit an upsetting delay when they learn that Brian’s neurologist had written on the MRI report that the reason for the test was a ‘major depressive episode.’ Depression is a deal-breaker for Dignitas, which does not want to be in the business of helping clinically depressed people commit suicide. Brian and Bloom have to prove that the neurologist’s note is simply not true.

Simon Van Booy, Washington Post, believes In Love demonstrates that “perhaps the two most challenging issues for Bloom as a wife” are finding alternatives to Dignatas if rejected and deciding how to tell loved ones.

While the latter, i.e., telling others, produces “some unusual reactions,” the former involves pondering various other methods of dying:

The author recounts how she considered drowning, procuring fentanyl from a drug dealer, DIY suffocation, and VSED (voluntary suspension of eating and drinking), which in the case of her husband (a former Yale football player) could take as long as a month…

In Love is currently on many critics’ must-read lists. The following review excerpt from Publishers Weekly echoes the sentiments of many, including my own: “With passion and sharp wit, [Amy Bloom] jumps back and forth between the beginning of their relationship, the Herculean effort it took to secure an agreement with Dignitas, and the painful anticipation of the final trip to Switzerland. Most poignant are the intimate moments they share as they make the most of their last days together. As she writes, ‘I imagine that Brian feels as alone as I do but I can tell he isn’t as afraid.’ The result is a stunning portrayal of how love can reveal itself in life’s most difficult moments.”

Mar 09

Harm Reduction Model and Movement: Three Books

Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use…(A)lso a movement for social justice built on a belief in, and respect for, the rights of people who use drugs. Harmreduction.org

As Stacy Mosel points out in her Harm Reduction Guide (American Addiction Centers):

Harm reduction programs exist for several types of drugs, including opioids, alcohol, stimulants, Ecstasy, and marijuana. They range from needle exchange sites to managed alcohol programs to drug-testing kits at music festivals. Studies have found many of these methods to be effective. But critics see the programs as encouraging drug use and keeping people addicted to drugs.

Go to the above link for specific tips and resources about this controversial method for addressing substance abuse and addiction.

Below are three books found by readers to be helpful: 1) a thorough guide for those concerned about their substance use, 2) a workbook for the same population, and 3) a history of harm reduction practices.

I. Over the Influence: The Harm Reduction Guide to Controlling Your Drug and Alcohol Use, Second Edition by Patt Denning, Jeannie Little (2017)

Anne M. Fletcher, MS, RDN, author of Inside Rehab and Sober for Good“Denning and Little have long been at the forefront of the harm reduction movement, and they keep the momentum going and cover all the important bases with this updated edition. This book provides meaningful information and choices instead of one-size-fits-all advice.”

II.  Power Over Addiction: A Harm Reduction Workbook for Changing Your Relationship with Drugs by Jennifer Fernandez, PhD (2018) 

From the publisher:

uses evidence-based interventions from Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Acceptance and Commitment Therapy (ACT) and mindfulness practices to help you understand the issues underlying addiction and stop problematic drug use.

III. Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction by Maia Svalavitz (2021)  

Travis Lupick, Talking Drugs, quotes Svalavitz: “Harm reduction is the idea in drug policy that we should stop people from getting hurt, rather than stop them from getting high.”

Per the publisher:

In a spellbinding narrative rooted in an urgent call to action, Undoing Drugs tells the untold tale of a quirky political movement that has unexpectedly shaken the foundations of world drug policy. It illustrates how hard it can be to take on widely accepted conventional thinking—and what is necessary to overcome this resistance.

Johann Hari, author of Chasing The Scream: “One of the most inspiring and remarkable stories you will ever read. Small groups of stigmatized people all over the world pioneered a totally new approach to drugs and addiction—and they saved millions of lives. Their incredible story has not been told—until now . If everyone in the US read this book, the drug war and so many drug myths would end tomorrow.”

Mar 02

Dunning-Kruger: Imposter Syndrome’s Opposite

Whereas many of us have experienced aspects of the imposter syndrome and can admit it, how many among us knows they’ve experienced its polar opposite: the Dunning-Kruger effect.

Bertrand Russell (1872-1970) is one who didn’t know of Dunning-Kruger (because it wasn’t yet a thing) but did utter these words: One of the painful things about our time is that those who feel certainty are stupid, and those with any imagination and understanding are filled with doubt and indecision. Well, that about sums up Dunning-Kruger.

Along these same lines, “Frequently Wrong But Never In Doubt” is how singer-songwriter Cheryl Wheeler musically described an acquaintance in 1993. Probably everyone has known someone like this.

Psychologist David Dunning and his student Justin Kruger coined the term Dunning-Kruger effect after researching the phenomenon of the inability of incompetent people to recognize their own level of incompetence.

One of Dunning’s conclusions: “We are all poor performers at some things.” Or, as he has succinctly stated on the subject, We Are All Confident Idiots.”

It’s not that we’re uninformed, Dunning states—we’re misinformed. “An ignorant mind is precisely not a spotless, empty vessel, but one that’s filled with the clutter of irrelevant or misleading life experiences, theories, facts, intuitions, strategies, algorithms, heuristics, metaphors, and hunches that regrettably have the look and feel of useful and accurate knowledge.”

There are possible solutions, though. When we’re in groups, for instance, we can appoint someone “to serve as a devil’s advocate — a person whose job is to question and criticize the group’s logic.” And as individuals we can try to play the same type of role (Big Think):

It helps to try practicing what the psychologist Charles Lord calls ‘considering the opposite.’ To do this, I often imagine myself in a future in which I have turned out to be wrong in a decision, and then consider what the likeliest path was that led to my failure. And lastly: Seek advice. Other people may have their own misbeliefs, but a discussion can often be sufficient to rid a serious person of his or her most egregious misconceptions.

A key additional point made by Dunning is that recognizing we don’t know something doesn’t have to be seen as a failure but as one more step toward figuring out the truth.

Dunning has noted (Politico) the relevance to Donald Trump and his supporters. But the rest of us must also be concerned, he adds, “about our own naive political opinions that are likely to be more nuanced, subtle, and invisible—but perhaps no less consequential. We all run the risk of being too ill-informed to notice when our own favored candidates or national leaders make catastrophic misjudgments.”

So, in our ongoing contemplation of choices, preferences, and engagement in emotionally charged debates, let’s remember that all of us are Dunning-Kruger-ites at least some of the time. “All I am saying is trust, but verify,” Dunning concludes.

Feb 23

“The Urge”: Psychiatrist On Addiction, Past and Present

Addiction is a terrifying breakdown of reason. People struggling with addiction say they want to stop, but, even with the obliterated nasal passages, scarred livers, overdoses, court cases, lost jobs and lost families, they are confused, incredulous and, above all, afraid. They are afraid because they cannot seem to change, despite the fact that they so often watch themselves, clear-eyed, do the very things they don’t want to do. Carl Erik Fisher, The Urge

Addiction psychiatrist Carl Erik Fisher knows firsthand the topic of his new book, The Urge: Our History of Addiction. Not only did he come from a family with a history of addiction he once had a dependence on alcohol and Adderall. Unlike many with less privileged backgrounds, he points out, he was able to get the right kind of help.

Fisher doesn’t subscribe to the binary controversy over whether addiction is either 1) a choice or 2) a compulsion because he’s seen many struggle in an in-between state.  From a book excerpt in The Guardian:

By claiming that addictive behaviours are simply a kind of choice, people have justified punitive measures for centuries, from putting drunkards in the stocks to imprisoning people for drug possession. If their drug use is a free choice like any other, the argument goes, people should accept responsibility for their behaviour, including punishment. The opposite view, which these days is commonly presented as a compassionate counter-argument by neuroscientists and advocates, is that addictive behaviours are involuntary and uncontrollable compulsions, and thus people with addiction deserve compassion and treatment, rather than punishment.

Among other faults he finds with addiction care is the disease model and the related medical model of treatment. Jeevika Verma, NPR, interviewed Fisher, who stated the following:

…(T)he notion of disease can be misleading because it takes focus away from the forces of racism and other forms of oppression that are so often bound up in addiction. Initially, the word disease was introduced to try to force open the doors of hospitals and otherwise get medical treatment for people with addiction. That’s because the medical profession had largely abandoned its duty to take care of people with addiction. So those advocacy efforts were absolutely necessary. But people still struggle with getting access to care. People still struggle with stigma. People still struggle to get insurance benefits for problems with addiction. There is a useful version of the word ‘disease’ when talking about addiction that says therapy and medications can save lives. But the term is messy, and it also locates all of the causes in biology and overlooks some of the other determinants of people’s health…

For too long, medicine has been dominated by an abstinence-only model. Now, I myself am in an abstinence model. I don’t think I should drink or use again. And for many people, that’s necessary and lifesaving. But addiction is also profoundly diverse, and we have emerging evidence that there are some folks who can really improve their functioning even when they have a substance problem without totally cutting out use. Or they could be in a sort of partial abstinence when they stop using heroin.

How does the author of The Urge treat his own patients? “The bottom line…is — they’re in charge. The main insight that looking at the history and looking at the science behind addiction recovery has given me is a respect for the many different pathways there are for recovery.”