Why the Therapist is not Sherlock Holmes and the Beautiful Soul of Carl Rogers

I found an old copy of On Becoming a Person at Encore Books a month or two ago.  It is by Carl Rogers, the founder of client-centered psychotherapy, and I have been reading it slowly ever since.  The first essay "This is Me" is a list of the very humane things Rogers learned over his years working as a therapist and researcher.  Perhaps the central piece, the motto of client-centered psychotherapy is "I have found it highly rewarding when I can accept another person."   Really accepting another person in his or her otherness is at the heart of Rogers' vision of psychotherapy (and humanness as far as he was concerned).  My supervisor and teacher, Sylvia, has been telling me for the last year and a half that the greatest resource a therapist has is the client; I might summarize her teaching to me as, "Be curious.  Ask, ask, ask."  That is very much in the spirit of Rogers.  You may, as a therapist, think you know, but rather than proceed with that assurance, ask.  He describes the experience of the research scientist afraid that the evidence might disprove one's hypothesis;

"... It seems to me that I regarded the facts as potential enemies, as possible bearers of disaster.  I have perhaps been slow to realize that the facts are always friendly... I still hate to readjust my thinking, still hate to give up on old ways of perceiving and and conceptualizing yet... these painful reorganizations are what is know as learning." 

I cannot tell you how many times I have thought that I understood something about a client, some clever idea I had, that when I checked it out in the form of a question turned out to be totally wrong.  Sylvia gave me a great example of this that she had from another therapist;  a client comes in for a first session and announces that her father has just died.  "Oh, how horrible, I am so sorry," says the therapist.  The client has the strength to say, "I hated my father.  He was cruel to me all my life."  I am guessing many clients would not have been so courageous and might have succumbed to the therapist's assumption, really an assertion about how the client ought to feel. 

I imagine it must have been very challenging for Rogers to take such a stance in the nineteen-fifties.  RD Laing of the famed Tavistock clinic critiqued the idea that he saw current at the time that the psychiatrist is the detective who enforces the law of illness.  Even today therapists whether psychiatrists, psychologists, social workers or other allied professions, are encouraged to think of therapeutic work as detection, seeking to unmask through superior knowledge and reasoning psychopathology whether within an individual or a system.  Psychiatry and detective novels grew up together.  Freud and Holmes both proceed -- by a bizarre logic apparent only to themselves -- to a conclusion that seems inevitable once announced. 

It is very hard to practice accepting the other when you approach the other as a suspect.  I would say that Rogers' and Sylvia's teachings about client centered-ness have been a great life lesson for me.

Rogers also valued pursuing what "feels right."  In this regard he is very much a part of the existentialism of the mid twentieth century.  He quotes Kiekegaard and Buber, the philosopher of the "I-thou" relationship.  This is one piece of Roger's thought that I don't buy. 

Therapists and therapy are often informed (misinformed, I believe) by the idea that there are deeper more authentic parts of the self which are obscured by less authentic elements of the self.  A good example of this is the idea of primary and secondary emotions (see Greenburg and Safran) which informs many therapies.  Primary emotions are viewed by Greenburg and Safran as more authentic and more somatic, secondary emotions are reactions to these first feelings.  This can be a useful distinction, it can be helpful for therapists and clients to focus on feelings that are outside of the client's usual repertoire.  But I don't know how one can say definitively that one feeling is more authentic than another or distinguish meaningfully between authentic and inauthentic elements of self.  

The homunculus fallacy is the name given to the idea that there is the psychological or neurological equivalent of a little man inside each of our heads - a homunculus - who experiences our experiences and commands our responses, an authentic self buried within our bodies and minds.  The fallacy is that if there is indeed a self within the self, then why not say that within that there is  yet another self and so on.  Self becomes a Russian doll and the pursuit of the authentic self a recursive pursuit at great expense of time and money.  One of the extraordinary cultural shifts that one can see in Rogers book is in the expectation that therapy be a process that goes on for years.  He talks casually of seeing clients for a 48th or 60th session of therapy for what seems to be a therapy of self-knowledge rather than any more focused goal.  (I don't know if these were sessions for which clients paid or not).  This certainly was before the age of HMOs. 

A final piece from Rogers, perhaps his best known quote from the same essay "This is Me," and a truly beautiful bit is the paradox of acceptance and change.

“... [T]he paradoxical aspect of my experience is that the more I am simply willing to be myself, in all this complexity of life and the more I am willing to understand and accept the realities in myself and the other person, the more change seems to be stirred up. It is a very paradoxical thing — the degree to which each one of us is willing to be himself, then he finds not only himself changing; but he finds that other people to whom he relates are changing.”

Carl Rogers

What trauma leaves behind

Trauma impacts mental health especially trauma in childhood.  In a previous blog post I wrote about how kids who are poor are more likely to be exposed to trauma than wealthy kids.  Now there is research that indicates that the effects of trauma can be biologically transmitted across generations.  The researchers subjected mice to trauma in the laboratory in the form of electrical shocks.  When baby mice were conceived using the sperm of the traumatized mice, the babies had a stress reaction to stimuli that were associated with their parents trauma, in this case a particular smell, and the effects seem to stretch over several generations.  The theory put forth by the scientists to explain this is epigenetics, that certain genes are 'turned on' or 'off' by experiences creating heritable traits as a result of what happens in the environment. 

If this carries over to humans, it could mean that a kid whose grandmother or grandfather experienced trauma could still carry the impact of that trauma in his or her body.  My clinical experience is that trauma does seem to pile up in families.  Sometimes the people who come into my office will describe three generations of abuse.  It can be hard to get out from under that.  Now we have another indicator of why that might be the case.  Not only can there be a cultural inheritance of trauma in a family, the genetics of one's descendents can be marked by traumatic experiences. 

On a more hopeful note, epigenetics may work to undo some the hurt of previous generations.  Researchers here in Montreal, at the Douglas Hospital, have looked at the effect on an epigenetic level of nurturing by a parent on mediating stress (more traumatized rodents).

“Baby rats that are licked often by their mothers—with licking in rats fulfilling the same function as cuddling in humans—are calmer than rats that are not licked enough. Michael Meaney and his team delved further into this idea by tracking the imprint left by maternal care in the brain of young rats. They were able to do this because the action of licking influences the activity of a gene (called NRC31) that protects rats against stress; when activated, this gene produces a protein that helps decrease the concentration of stress hormones in the body. A specific part of this gene must also be activated via an epigenetic switch. ”

— http://www.douglas.qc.ca/info/epigenetics

According to this theory loving cuddling can help kids deal better with stress than they might even if they have an epigenetic inheritance of trauma.  So why are you still reading?  Go hug your kids. 

Teen use of internet porn. When is it time to panic?

The ubiquity of pornography has got to be one of the biggest changes in society in my lifetime.  An acquaintance asked me what I thought the long-term effects of total access to porn would be for shaping the sexuality of kids growing up today and I really had no idea how to answer.  There is much heat and little light on the subject because sexuality in general and kids' sexuality in particular is such a fraught topic.  

On the one hand, today's nearly unlimited access to pornography via the internet is part of the demystification of sexuality which has been building steam over the last one hundred years.  It is connected -- at least in a six-degrees-of-fornication kind of way -- to changes which I view as absolute social goods, like decriminalizing miscegenation and homosexuality, allowing women (and everybody) a greater degree of control over reproduction and generally removing some of the shame from sexuality for everyone, male, female, gay, straight etc.  It is worth remembering that lynchings of non-white men for sex with white women, death by back-alley abortion and 'curbing' of gay people are pieces of North American history that happened within living memory (and are practices some would like us to return to).  The impulse to curb sexual freedom, including the freedom to view porn, can be an instrument of sexual repression and shame.  A lot of the conversation about pornography and young people -- any sexual topic and young people for that matter -- seems to smack of a old-person's cocktail of wistfulness and resentment ie. "If I can't have lots of crazy sex, then nobody should."  

On the other hand, pornography has to own some of the criticisms made of it; it is hugely male-oriented and at least some significant portion is downright anti-women.  It seems pretty intuitive that a barrage of woman-degrading porn would do anybody's developing sexuality harm.  More generally, porn is, by definition, commercial sexual objectification.  Young men and women who grow up viewing sexuality (and we are talking largely about women's sexuality) as an object for purchase or trade, rather than a subjective experience seem more likely to generalize some of those lessons to non-porn sex.  These are both arguments that can be made about any type of pornography.  There is also a particular techno-bent to some anti-porn writing that makes the argument that a quantitative difference of the internet makes for a qualitative difference. 

“What happens when you drop a male rat into a cage with a receptive female rat? First, you see a frenzy of copulation. Then, progressively, the male tires of that particular female. Even if she wants more, he has had enough. However, replace the original female with a fresh one, and the male immediately revives and gallantly struggles to fertilize her.
You can repeat this process with fresh females until he is completely wiped out.
This is called the Coolidge effect—the automatic response to novel mates. It’s what started you down the road to getting hooked on Internet porn.”

— http://yourbrainonporn.com/doing-what-you-evolved-to-do

Digression:  Perhaps 2014 should be the year that nobody says "The area of the brain that lights up when..."  Regular readers will know that I am sceptical of some of the claims of 'brain science'.  The next post on "Your brain on porn" has fMRI images showing how sections of the brain "light up" when exposed to porn which proves that the subjects of the brain scans are addicted much as people get addicted to heroin. ( A primer on fMRI goofiness. )  Here is a picture of a dead fish in a fMRI with its brain lighting up when asked to imagine humans in social situations.

End digression:  There is a growing set of men who say that they are addicted to internet porn and/or incapable of erections with actual humans as a result of using porn regularly.  This is a tough claim to verify since it is so subjective.  Men may experience less frequent erections and attribute that to the use of porn; that doesn't necessarily mean that was the primary cause.  That is what is known as the post hoc ergo propter hoc fallacy.  It does seem to make intuitive sense that if you don't masturbate for a long time you are more likely to experience an erection in a particular circumstance.  It also seems like it would be pretty hard to look at a lot of porn and avoid masturbating, so the two do go hand in glove (as it were). There is a whole online Nofap community where people, mostly men, pledge to stop masturbating and/or viewing porn.  They support one another to achieve goals in days.  When does this shade over into shaming a normal and healthy sexual behaviour that has already been the target of a lot of shame?  I wrote a blog post a while ago about Marty Klein's argument that the term "sex addiction" is a way for people living in a sex negative culture not to address their sexual desires about which they feel incredible shame. 

There are a couple of things I am pretty confident about in all of this. 

1.  The whole "erectile dysfunction" piece of the conversation about porn and masturbation needs to get scaled way back.  Men are easily goaded into thinking that a rock hard penis is the only legitimate route to sex.  That's false and it isn't good for men's sexuality (or for their partners).  Start having sex without an erection and you may get one.  Keep having sex after an erection goes away, and it may come back.  But if you make having and maintaining an erection a prerequisite, that can mean a lot of heart ache.  Paradoxically, lots of porn and lots of nofap both seem to perpetuate the myth of no sex without an erection. 

2.  Porn is not sex education.  Teens need to know that what they will see in porn is not what happens between most people's sheets. Talking to teens about what porn is and isn't is part of the job description of every parent, and that needs to go beyond telling them it's bad or women-hating.  Porn:Human Sex::2Fast2Furious:Driving.  A fantasy. 

3. Teens will try to make their own porn.  Not every teen but plenty of them.  Maybe not your kid but plenty of kids your kid knows.  As Dan Savage has pointed out, smart phones are -- among other things -- mobile porn production and distribution suites.  And parents hand them over to kids without thinking about or talking about that.  If you must give your teen a smart phone, disable the camera.  Tell your kids you will search through the contents of their phones and then follow through.  Millions of adult Americans use their phones this way, should we expect teens to act any more maturely? 

Important Parenting advice! Ignore Parenting advice!

When did "parenting" become a word?  When a publisher realized that there were millions to be made from telling anxious, well-off parentingers about all the things that can go wrong with kids.  (And a guy named Stan, in marketing, suggested they move away from the term "child rearing").  Nobody ever sold a book called "If You Can Afford the 30$ to Buy This Book Then Your Kid Is Doing Better Than 99% of the Humans Who Ever Lived."  21st century Canadians live in an age and place where most of us can provide our children with nutritious food, shelter, education, clothing and medical care that most of our ancestors (and many people around the world today) would have been delighted to be able to give to their kids.  That and love will go a long way.  We live in an age and circumstance of tremendous blessing.  So why do we consume parenting advice books and lectures by the SUV-load?

I work with a lot of families in difficult situations and I have seen some pretty bad parenting (by today's standards).  I can tell you that very little of what I have seen happens because people didn't read a book on parenting.  Occasionally, I will meet parents who honestly did not know better.  I tell them to stop and, usually, they do.  Twice in my career I have told parents not to threaten to hit their kids with a belt.  These parents felt overwhelmed by out-of-control kids and thought that threatening such a beating was better than actually following through.  I told them that, for a kid, the fear of such a beating can be almost as devastating as the beating itself.  They thought about it and saw that what I was telling them was probably true.  We brainstormed some better ways to deal with their kid's behaviours and they never resorted to that kind of threat again.   

I see parents who want to stop doing things they know or suspect are bad for their kids but they can't because they have mental health issues or are struggling with the ghosts of their own past or trouble in their present.  Just about everybody knows that parents should keep their marital acrimony away from their kids.  There are dozens of books that will tell you that.  But I have seen a lot of parents who tell me that in their particular circumstance, because their soon-to-be-ex wife/husband is such a poisonous viper, it is absolutely critical for the kids to know everything.  Or they make every effort to hold back only to find themselves pouring out all their hatred to a kid who is caught in the middle.  A book may help re-inforce a message in such a circumstance but I think that person needs supportive friends, a caring community and probably counselling.  

The people who buy books on parenting are often the worried well; parents who lack confidence in their own ability to parent.  That is where I have the biggest issue with the parent-advice-industrial complex.  By turning something that humans have done pretty successfully for our whole history into a gerundified 'parenting' with classes and manuals and DVDs, it makes parents feel less confident in their own judgement rather than more confident.  Ron Taffel wrote a wonderful piece in Psychotherapy Networker a few years back called "The Decline and Fall of Parental Authority... and what therapists can do about it."  He wrote about some of the forces undermining parental confidence and what that does to people's lives.

“[A] chronic sense of being held hostage by kids and the culture at large helps explain why parents so often show up in our offices looking and sounding like spineless wimps. With so little time to bond with their children, parents are afraid to take even one step that could drive them farther away, undermine their already shaky school performance, and ruin their chances for social success when little else seems to matter. Not surprisingly, a multibillion-dollar public and private enterprise monetizes these insecurities by selling a raft of social modules and remediation services—including tutors and homework helpers for the well-heeled and supplemental educational materials designed to jack up reading and math scores. The issue isn’t just parental abdication, but what I call the “merchandising of childhood,” based on a deep-rooted fear of failure.”

— http://www.psychotherapynetworker.org/magazine/currentissue/item/1645-the-decline-and-fall-of-parental-authority/1645-the-decline-and-fall-of-parental-authority

Taffel sees economic difficulties as the driving factor in parental lack of confidence.  I would go one step further;  I think we live in a fear culture.  We are encouraged to be fearful rather than generous and open towards people and the world around us and we are especially encouraged to transmit those signals to kids.  Engagement in community organizations has plummeted in North America over the last 50 years.  People don't join clubs, religious institutions civic organizations.  In Robert Putnam's famous phrase, today people are "Bowling Alone."  And people are 'parenting' alone as well.  Living in a more mobile, deracinated society that is fearful and highly individualistic means people don't have great social networks for parenting.  There are fewer norms for parenting and the norms that exist are harder to learn than they once were.

That makes for a lack of what social scientists call self-efficacy among parents; basically the feeling that you know what to do and are able to do it.  That is a problem because self-efficacy in parents correlates highly with good outcomes for kids.  (Obviously, if you are convinced that the way to deal with a kid is by threatening to hit him/her with a belt or to dis your ex to the kids, that's not good.  But it is better to parent with confidence than to parent without confidence, even poorly, and parents who feel confident in their parenting are less likely to parent badly.)  Researchers don't know exactly why that is the case, whether confidence comes from success, or if it comes from shared norms and those things generate success in parenting or maybe that kids perceive confidence in their parents and feel a sense of safety because of that.  Or a combination of those things.  But it is clear that feeling that you can manage being a parent without getting post-doctoral training in child development and arts and crafts is good for families.  

This doesn't mean that parenting books can't be helpful for everyday kinds of problems with kids.  I have mentioned "How to Talk so Kids will Listen, How to Listen so Kids Will Talk" before which I think is great.  But I actively discourage parents from trying to anticipate and preparing a fully developed response to every potential disaster of childhood and adolescence.  Now if you'll excuse me I have to go work on the next chapter of my parenting book.  The working title is "1001 Things That Will Definitely Go Wrong With Your Kid That Only This Book Can Fix."        

Extinction is good for you.

Why do most people bounce back from a traumatic experience after a few weeks or months when others struggle for years with anxiety or PTSD?  What protects some people from the effects of trauma?  What can we do to promote resiliency from trauma? The answer might have to do with 'extinction.'

In psychological parlance 'extinction' can be a good thing.  Extinction means 'unlearning' a conditioned response.  Remember Pavlov and his dogs?  Ring the bell and feed the dogs, eventually the dogs will salivate at the sound of the bell.  That is conditioning.  Well, after a while if they get their food without the bell, the conditioning wears off and the dogs don't salivate anymore, and that is extinction learning; learning that something that was once associated with an experience may not be connected to that experience.

Maladaptive trauma responses, including disorders like PTSD, probably have something to do with conditioned response.  People with PTSD may associate all sorts of things with the original trauma so they are triggered to re-experience the trauma by a smell or sound, or they seek to avoid being in situations which call to mind the trauma, even though objectively those circumstances aren't dangerous.  Richard Bryant, a researcher into responses to trauma, has done a really smart prospective study that suggests that a person's pre-trauma capacity for 'extinction learning', his or her ability to 'unlearn' the connection between a negative experience and the circumstances surrounding it, is very predictive of the ability to bounce back from trauma.  He describes it at about 31 minutes of this video.  The whole video is interesting but this piece is only about four minutes.  

Here's the study for those of you interested in checking it out.  Bryant doesn't talk about what predisposes people to be better or worse 'extinction learners.'  Some of it probably has to do with genetic factors.  I would be curious to know to what degree cognitive flexibility, the ability to change one's ideas about the world, correlates with extinction learning.  Cognitive flexibility can be enhanced by all sorts of things.  If you want to test your cognitive flexibility, some of these tests, like the Stroop test, are good measures.  In the interests of full disclosure I did pretty badly on the Stroop test.  Not sure what that means for my chance of extinction.  

Too much social awareness and too little; Autism and Borderline

I work with a lot of kids with Autism Spectrum Disorders (ASD) in the context of family therapy.  One client of mine will sometimes say something pretty innocuous and then suddenly get worried.  He looks at me anxiously, trying to read my expression.  He asks me “Are you mad? Did I do something wrong?”  He feels like the world is filled with unexpected land-mines. Social situations seem to follow weird rules that everyone but him knows intuitively.  People often get angry at him for mysterious reasons, so I might as well.  This is pretty common for people with ASDs.  They have a tougher time with something called “mentalizing,” which means understanding that other people have different mental states -- knowledge, thoughts and feelings -- than themselves. (I wrote in a previous piece about Theory of Mind, which is very similar to mentalizing. There is a great video demonstrating what this looks like in kids.)  People with ASDs can find it really hard to figure out what those other mental states might be, based on cues that most of us read without thinking about it much like tone of voice, facial expression or posture. 

Some neuroscientists think that the neurology of people with ASDs is different from other people, that they may have fewer 'mirror neurons,' neurons that are thought to help with connecting to another's experiences on a totally unconscious, physiological basis.  Prominent among these is VS Ramachandran, who, in addition to being one of the foremost neuroscientists today, and an interesting philosophical mind, has maybe the coolest accent of anyone I have ever heard speak.

Mirror neurons are pretty spectacular according to Ramachandran, but others dissent.  One of the biggest doses of cold rain on the mirror neuron parade is the fact that we lack clear evidence that they exist in humans.   

Whatever the reason, people with ASDs do really poorly on a relatively new test for reading social cues called the Movie for the Assessment of Social Cognition or MASC. MASC is a really neat psychology test that lacks the flash of fMRIs but actually quantifies people's understanding of social situations very well.  The subject is shown a video of a social situation and asked a series of true or false questions about the mental states of the people in the video.  What is really interesting to me is what researchers have found out about people with Borderline Personality Disorder (BPD) when they take the MASC test.  

Among other things, BPD is characterized by very conflictual interpersonal relationships.  This great animation outlines some of the things that go on for people with BPD and the criteria for diagnosis.  

People with BPD do very poorly on the MASC test but for almost exactly the opposite reason than people with ASDs. While people with ASDs tend to mentalize poorly -- that is to consider and evaluate correctly the inner experiences of the people in the video -- people with BPD tend to “hypermentalize.”  They are very tuned in to the mental states of others, perhaps too tuned in.  Some research indicates that people with BPD may actually be better at correctly “reading” other people's emotional states based on limited information than non-BPD people.  But like many people with ASD, people with BPD can find the social environment confusing and overwhelming, not because they have too little information to understand what is happening, but too much.  I suspect they are also lopsided because their hypermentalizing often tends towards the negative; that is they read negative cues very clearly but positive cues get less focus.  

Think about how many quick, frustrated glances or disapproving sighs a person might encounter in the social landscape in a typical afternoon.  People who don't have BPD may register them almost unconsciously, as subtle social cues to "hurry up", "hold on a minute" or "give me some space".  Those things help most of us adjust our social behaviour.  But people with BPD experience each negative micro-expression like an angry, screaming tirade leaving them as bewildered as the young boy with ASD asking, “what did I do wrong?”

Your therapist, Ron Swanson?

Men often fear that therapy is stacked against them.  Whether it is couple, family or individual therapy, they think that they are entering a domain where their skills and strengths will be counted as liabilities and they will be asked to do things that aren't just difficult or scary but unbecoming.  That isn't a man problem.  That's a therapy problem.  I was talking recently with another male therapist, Dr. Darrell Johnson, a friend and mentor.  I mentioned this campaign to him... (Okay, it isn't Ron Swanson but a Ron Swanson knock-off.)

It is from the Office of Suicide Prevention of the Colorado Department of Public Health and Environment.  It's geared at connecting with men, particularly working-age 25-54 men who are twice as likely to commit suicide as any other age group according to the white paper that was used to develop the Mantherapy campaign (US stats).  Darrell and I talked about the idea that men are typically more resistant to therapy (part of what accounts for their higher suicide rates than women).  I joked that soon it would be possible for therapists to use cookies to give different design templates to their websites so that women and men would be presented with different web sites that are gender specific since too much "feelings" language might be off-putting for men, essentially presenting themselves as Rick Mahogany when men click through.  But the Colorado campaign doesn't seem to have been a raging success despite the high production values.  The Richard Mahogany video that has the most views on YouTube is at around 8,000.  Maybe those are 8,000 saved lives and if so, great, but I don't imagine that therapy's problem with men has been touched much.  I think the character seems inauthentic, not just playfully unreal, and for men or women authenticity in therapy is important. 

There were a few things in the white paper that I thought were really interesting for therapists to consider about working with men, things that hadn't occurred to me despite having worked with boys and men a lot.  One is the value men often place on fixing something themselves and how to make therapy an exercise in 'solving it myself (or ourselves) with help'.  One man said to the researchers of the white paper, "Show me how to stitch up my own wound like Rambo."  Okay, that's some pretty serious hyper-masculinity but the point is that therapy can benefit from emphasizing the client's efficacy in problem-solving with the therapist as trusted assistant. 

The other thing that I thought was really wonderful was the importance some men place on giving back.  I was in Hawaii last year.  A companion and I went kayaking.  We visited a small island and had a great time but when we went to get back in our kayak, we got hit by several waves in succession and my companion got knocked over in the surf and couldn't get up.  I watched, barely able to keep myself afloat trapped on the other side of the kayak thinking I might very well see this strong, capable person drown before my eyes in three and half feet of water.  But before that could happen two kayakers (much more capable than us) grabbed our kayak and my companion, hoisting him out of the water.  I thanked them.  They said, "That's what we do."  They viewed helping as part and parcel of who they were.  I, on the other hand, felt grateful but unsatisfied as they paddled away.  I couldn't pay back the debt I owed them.  Therapy is a uni-directional process as far as help goes; codes of ethics forbid outside relationships so it is very hard for a client to pay his debt with his skills through labour exchange or barter.  I never thought about how important it can be for some clients to be able to show their competency and mastery to a therapist by doing meaningful work or sharing their own products, to give help for help received, and that men might feel that more acutely.  The report points out how central the idea of repaying a debt is to AA, for instance.  Now I am considering requiring clients in some circumstances to agree to pay part of the cost of therapy by "paying forward" to others using their own strengths and capabilities (see the Milwaukee African Violet Queen).  Ron, would like the idea of paying off your therapy by carving duck decoys with kids in an after-school program? 

"I'm a a bit fearful that we are verging on what I call 'feelings territory.'"

Radical Acceptance. Do microbes or the zodiac make you depressed?

There was a neat piece on NPR today about gut flora and mental illness which postulated a link between the health of one's inner beasties and one's mind. 

But before you run out and buy an industrial tub of yogurt and a tempeh starter kit, know that something as immutable as your birth month also impacts your risk for many diseases including several mental illnesses. From the Atlantic...

“Many contemporary scientists are loath to admit to anything resembling astrology. “It seems absurd that the month you are born/conceived can affect your future life chances,” write neuroscientists Russell G. Foster and Till Roenneberg in a 2008 study. They then go on to then point out no fewer than 24 different health disorders connected to season of birth, and ultimately admit “despite human isolation from season changes in temperature, food, and photoperiod in the industrialized nations, the seasons still appear to have a small, but significant impact upon when individuals are born and many aspects of health.””

— http://www.theatlantic.com/health/archive/2013/11/your-zodiac-sign-your-health/281358/

Marsha Linehan, the psychologist who developed Dialectic Behavioral Therapy, used for treating substance abuse and borderline personality disorder, among other mental illnesses, talks about the importance radical acceptance. 

“So what’s Radical Acceptance? What do I mean by the word ‘radical’? Radical means complete and total. It’s when you accept something from the depths of your soul. When you accept it in your mind, in your heart, and even with your body. It’s total and complete. ”

— http://www.dbtselfhelp.com/html/radical_acceptance_part_1.html

Linehan does not mean that we accept our brokenness, our faults, our failings and stay there.  As Carl Rogers said in On Becoming a Person, "The curious paradox is that when I accept myself just as I am, then I can change."  Linehan, in a very courageous move, recently talked about her own experiences of mental illness, including many attempts at suicide and her recovery from it which was prompted by a religious vision which included a profound feeling of self-acceptance. 

“I decided to get supersuicidal people, the very worst cases, because I figured these are the most miserable people in the world — they think they’re evil, that they’re bad, bad, bad — and I understood that they weren’t,” she said. “I understood their suffering because I’d been there, in hell, with no idea how to get out.”

In particular she chose to treat people with a diagnosis that she would have given her young self: borderline personality disorder, a poorly understood condition characterized by neediness, outbursts and self-destructive urges, often leading to cutting or burning. In therapy, borderline patients can be terrors — manipulative, hostile, sometimes ominously mute, and notorious for storming out threatening suicide.

Dr. Linehan found that the tension of acceptance could at least keep people in the room: patients accept who they are, that they feel the mental squalls of rage, emptiness and anxiety far more intensely than most people do. In turn, the therapist accepts that given all this, cutting, burning and suicide attempts make some sense.

NYT http://www.nytimes.com/2011/06/23/health/23lives.html?pagewanted=3&_r=0

The idea of radical acceptance, even for the purpose of change, seems profoundly lacking in our thinking about health.  In North America, at any rate, we are meant to view ourselves as our own greatest work of art, as perfectible. 

I am in the change business.  If diet can help people with mental illness then I want to know about it.  But I also believe that sometimes a hyper-developed sense of agency, which is pretty much the modern condition, oddly, keeps people stuck.  Sometimes we have to accept even our darkest feelings, "meet them at the door, laughing, and invite them in" before we can learn what they came to teach us.

The Guest House

This being human is a guest house.
Every morning a new arrival.

A joy, a depression, a meanness,
some momentary awareness comes
as an unexpected visitor.

Welcome and entertain them all!
Even if they are a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still, treat each guest honorably.
He may be clearing you out
for some new delight.

The dark thought, the shame, the malice.
meet them at the door laughing and invite them in.

Be grateful for whatever comes.
because each has been sent
as a guide from beyond.

-- Jelaluddin Rumi,
    translation by Coleman Barks