Dec 27

Mental Illness in the Family: Several Books

Mental illness in the family is the topic of several books worth reading.

However you define mental illness—or whatever substitute term you prefer—it’s often found within your own family, as it has been in mine. Below are four nonfiction books worth perusing.

Remnants of a Life on Paper: A Mother and Daughter’s Struggle with Borderline Personality Disorder (2013) by Bea Tusiani, Pamela Tusiani, and Paula Tusiani-Eng

The authors describe Pamela’s struggles with BPD. Pamela’s “remnants” in question are from her journals and visual art, culled posthumously.

At the age of 20 Pamela was diagnosed with severe depression. She wound up having multiple hospitalizations and 12 ECT treatments. According to Dr. Lloyd SedererThe Huffington Post, it was after this that Pamela finally received the more accurate diagnosis of BPD. She then proceeded to be admitted to other intensive programs.

Sederer: “Pamela was well into her journey of recovery when a series of treatment program and medical errors conspired to kill her. The awful irony was that she did not take her life, but irresponsible, stigmatizing and poor residential and medical care did.”

All the Things We Never Knew: Chasing the Chaos of Mental Illness (2015) by Sheila Hamilton

Hamilton’s husband was diagnosed with bipolar disorder only six weeks before he took his own life.

“Mental Illness often masks itself as selfish, anti-social behavior. It waxes and wanes, especially in higher functioning people,” Hamilton writes (Huffington Post). He’d gone deeply into debt, for example.

She has held herself partially responsible. “I’d propose one more stage of grief to Kubler-Ross’s list in the case of suicide; forgiveness…In accepting responsibility for my part in David’s death, I was able to understand his sense of futility, the level of his psychic pain, and his unwillingness to face his illness. I forgave him. I forgave myself. And in doing so, I’ve been better able to understand his decision.”

The Art of Misdiagnosis: Surviving My Mother’s Suicide (2017) by Gayle Brandeis

The book’s title takes its name from the documentary Brandeis’s 70-year-old mother Arlene was working on “about the rare illnesses she thought ravaged her family: porphyria and Ehlers-Danlos syndrome.”

“Whether they were psychosomatically induced or not,” states Kirkus Reviews, “Arlene attested that the illnesses had been repeatedly dismissed or misdiagnosed by the medical community; even the author herself admits to suffering, as a teenager, from a combination of malingering and factitious disorder.”

Melissa WuskeForeword Reviews: “Brandeis’s mother committed suicide one week after Brandeis had a baby. Those deeply contrasting experiences set the scene for the opening of this memoir: a daughter going through her mother’s things, trying to make sense of her death.”

And this quest winds up involving a “compulsive, contagious need to know her mother and herself.”

The author’s two sons were both afflicted with schizophrenia. “For his son Kevin, that struggle ended in suicide, and the heartbreak of that experience (among others) permeates every impersonal date and statistic in the book with sorrow and rage” (Shelf Awareness).

A brief explanation for the title, per Publishers Weekly:

This resounding rebuke to scornful attitudes toward the mentally ill takes its title from a notably insensitive 2010 email exchange between high-level staffers of Scott Walker during his run for Wisconsin governor. Using that moment as a touchstone of indifference, Powers…weaves a dual tale of the personal and the political…

The people who do care are usually the loved ones, of course. Shelf Awareness: “For the families of the mentally ill…caring about ‘crazy people’ is a necessity. In roughly alternating chapters, Powers allows us to watch his sons grow up, dealing with the challenges of incipient schizophrenia as well as tragic events that shape their young minds. All the while, Powers movingly relates the joys of raising creatively gifted children.”

Dec 14

Acceptance and Commitment Therapy (ACT)

“People suffer,” states the first line of a seminal work on Acceptance and Commitment Therapy (ACT) by psychologist Steven C. Hayes and Spencer Smith.

Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy advocates a scientifically based treatment approach that “is not about fighting your pain; it’s about developing a willingness to embrace every experience life has to offer. It’s not about resisting your emotions; it’s about feeling them completely and yet not turning your choices over to them. ACT offers you a path out of suffering by helping you choose to live your life based on what matters to you most.”

Emphasis is placed on such factors as language as a cause of suffering, the trap of avoidance, learning to accept pain, practicing mindfulness, being in the present, and recognizing your values.

Although seemingly related to various types of cognitive behavioral therapy, ACT is actually quite different. Instead of working on changing one’s damaging thoughts, the ACT follower is working on embracing them to a certain extent.

Adherents of ACT say that FEAR is what causes many of our problems.

  • Fusion with your thoughts
  • Evaluation of experience
  • Avoidance of your experience
  • Reason-giving for your behavior

The ACT treatment model involves the following steps:

  • Accept your reactions and be present
  • Choose a valued direction
  • Take action

ACT, Hayes believes, is helpful for a wide variety of problems, including anxiety and depression, substance abuse, and physical health concerns. In fact, how he learned to deal with his own past panic disorder influenced many of the theories underlying ACT.

The video below is meant to be a metaphor illustrating some concepts of ACT found in Get Out of Your Mind.

Russ Harris‘s workbook ACT Made Simple came a little later, and he’s been given many kudos for making this therapy approach more accessible.

Other pertinent books by Harris include the 2008 The Happiness Trap: How to Stop Struggling and Start Living (A Guide to ACT), its counterpart called The Illustrated Happiness Trap, Getting Unstuck in ACT (2013), and ACT with Love: Stop Struggling, Reconcile Differences, and Strengthen Your Relationship with Acceptance and Commitment Therapy.

The following are selected quotes from The Happiness Trap and ACT with Love:

A = Accept your thoughts and feelings and be present. C = Connect with your values. T = Take effective action.

Psychological flexibility is the ability to adapt to a situation with awareness, openness, and focus and to take effective action, guided by your values.

Mindfulness + Values + Action = Psychological Flexibility.

Stop trying to control how you feel, and instead take control of what you do.

Develop the courage to solve those problems that can be solved, the serenity to accept those problems that can’t be solved, and the wisdom to know the difference.

Harris also offers many free resources (worksheets, handouts, and book chapters) on his website.

Nov 16

Mother-Daughter Relationship Memoirs (3 Books)

Mother-daughter relationships are featured in the following three nonfiction books that offer many and varied personal accounts about real-life issues.

I. Mother Daughter Me by Katie Hafner (2013)

Hafner writes about her own mother-daughter relationship in light of what happened the year her 77-year-old mom “Helen” (not her real name) moved in with her and her teenage daughter. In a Q & A on her website Hafner states, “Mother Daughter Me asks a central question: what is our obligation to our parents as they age, particularly if those parents gave us a childhood that was far less than ideal?”

Widowed Katie had hoped that Katie and Helen’s bond would improve and that Helen would develop a closeness with her granddaughter. Per the publisher: Instead of “fairy-tale” dreams come true, there were “memories of her parents’ painful divorce, of her mother’s drinking, of dislocating moves back and forth across the country,  and of Katie’s own widowhood and bumpy recovery. Helen, for her part, was also holding difficult issues at bay.”

Kirkus Reviews reports on a crucial decision: “Desperate to bring peace to a feuding household, Hafner engaged the services of a family therapist, and their sessions revealed the extent to which both she and her mother denied the reality of their situation.”

II. Still Here Thinking of You: A Second Chance with Our Mothers by Joan Potter, Susan Hodara, Vicki Adesso, and Lori Toppel (2013)

This memoir arose from a writers’ group addressing mother-daughter relationships. Excerpts of their stories can be found on their website.

Kathleen Reardon, Huff Post Books: “This is storytelling as art. The authors excel in their ability to pull you into their recollections knowing…that you are out there vicariously living through their revelations and your own similar, heartfelt and heartrending reflections.”

III. What My Mother and I Don’t Talk About: Fifteen Writers Break the Silence, an anthology compiled by Michele Filgate (2019)

Danielle KurtzlebenNPR: “…(T)here are four main topics that these writers aren’t talking about with their mothers: terrible things their moms endured, terrible things the writers endured, what their moms were like before they were moms and the ways their moms failed to be good moms.”

More from NPR about these stories:

…(O)ur mothers still mess up — sometimes in life-altering ways. It’s about how, despite our love or desperate need for them, we mess things up too. And it’s also about the gut punch that happens when some children are forced to legitimately wonder just how good their mothers’ intentions ever were.

But then, it’s about how much more livable those relationships might be if someone just said those three magical words.

Those words are not ‘I love you’ but, rather, ‘Are you OK?’ Or, even more difficult: ‘Hey — I’m hurting.’

An important conclusion by Kirkus Reviews“…(S)ome readers may want to have their therapist on speed-dial.”

Nov 09

“The Patient” Spoilers: Therapist Lessons?

Sam, the killer, is the one seeking treatment, but by the time this drama is over, nearly everyone in this drama reflects upon past actions and decisions or dies trying. David Bianculli, NPR, regarding The Patient (Hulu series)

Don’t get any ideas, I jokingly told my client (patient) who had just raved about The Patient and was recommending it. If you’ve already seen the series, and I hope you have because this whole post is a load of spoilers, you’re aware that the premise involves a client (patient), Sam (Domhnall Gleeson), who kidnaps and imprisons his therapist, Alan (Steve Carell), hoping to be cured of serial killing.

Therapist Lessons Learned (Tongue in Cheek? You Decide)

  1. Never publish a book showing you’re an authority on therapy. Your supposed expertise could be your downfall when the next client comes a-knocking (you out).
  2. Never fire your clients for not doing the work. You might not be fired back—and your work just got a whole lot harder.
  3. Therapy provided under extreme duress does not work. Well, at least not for you.
  4. Sometimes involving a client’s loved one (or acquaintance) into his therapy backfires enormously. I mean, maybe you can handle certain people—your client’s cheating spouse, for instance—but his most recent blindfolded, hands-bound, kidnapping victim who’s now going to die because of you?
  5. Sometimes involving a client’s parent in therapy backfires enormously. Can you say Dysfunctional Enabler Who Doesn’t Want to Change?
  6. Helping your client gain insight isn’t all it’s cracked up to be. I mean, when he then strangles his abuser to the point of near-death is it really such a great breakthrough?
  7. A therapy bond, once made, can be hard to break. Or kill.
  8. The ethic of confidentiality can actually be breached. You do NOT have to keep your victimization by a client confidential. That is, if you can actually find someone to tell.
  9. Dead (or otherwise gone) therapists can still be helpful. Imaginary sessions can often lead to deep insights—if not particularly long-lasting.
  10. Never lie to your client about his prognosis. If you pronounce that your uncured, still-murdering client has in fact made great progress so it’s time to end, you just might be forced to stay around forever.
  11. Never offer your honest appraisal of your client’s need to be locked up. He is not going to want that.
  12. Accept that you’re unlikely to ever know the positive therapeutic effects you’ve created for your patient’s post-treatment life. Huh, he’s actually listened to you. And now you’re dead.

On a more serious note: “Can Serial Killers Be Rehabilitated?”

Lori Kinsella, J.D., Psy.D., answers this question in a recent Psychology Today article (not connected to The Patient). Check it out. Her main points as expressed upfront:

Serial killers prioritize rewards in decision making. Consequences are of little or no value to serial killers.

Research suggests that brains and neuronal activity of people with psychopathy are different from those of typical people.

In the future, drugs may help rehabilitate psychopaths by controlling neurons in specific brain regions.

Nov 02

Therapeutic Letter to Your Parents: Why and How

A therapeutic letter is something I’ve not only suggested to adult clients many times but have also used personally. In fact, I wrote one for the very same reason many others have—coming out to Mom. Jane Lynch, for example, wrote about this type of letter in her 2011 memoir Happy Accidents. (My own experience was fictionalized in my novel Minding Therapy.)

In Lynch’s case, her therapist suggested writing her parents the fairly standard write-it/don’t-necessarily-send-it/maybe-you-should-show-it-to-me-first kind of letter. Why not send it? There can be some satisfaction just from the process of venting thoughts and feelings and/or preparing what you might actually say in person instead. Why show your therapeutic letter to a trusted someone? In case you get carried away, a more objective eye helps ensure that the prospective target won’t be so turned off they’ll decide not to read your missive.

Coming out, of course, isn’t the only reason you might write a therapeutic letter. Maybe you’ve experienced childhood wounds you’d like to address. Or maybe the problems are more present-centered.

But, Isn’t letter writing a copout? some will ask. Not at all. Letter-writing affords the sender a chance to say what she needs to say without being sidetracked by heated dialogue, and it affords the receiver a chance to think things through before responding. And thus, both parties can work together more effectively on their relationship.

When John F. Evans, EdD, Psychology Today, addressed “transactional writing” he considered all kinds of reasons someone might try to reach another via writing. His five types of letters can all apply to reasons you may be considering writing a letter to your parents.

  1. The compassionate letter–in which you reach out to try to help someone in pain
  2. The empathetic letter–an effort to understand another’s actions or intent
  3. The gratitude letter
  4. Granting forgiveness letter
  5. Asking forgiveness letter

More specifically, Matt Smith at Modern Era Counseling suggests a process for dealing with toxic parents through writing a series, step by step, of three different therapy letters.

  1. The never-to-be-mailed letter to your toxic parent–to help the writer express things without self-censorship
  2. The realistic response letter from your toxic parent–what you might expect in return
  3. Desired response letter from your toxic parent–“the response you’ve always hoped for from your parent but never truly received”

The ultimate effect of the above process is to allow oneself to feel the type of validation never before received—and possibly not ever achievable in actual interactions.