Thursday, August 23, 2012

MENTAL HEALTH NOTES: Personal Transformation and Wrestling with the Dark Side

After writing my last post (  and reviewing the comments I received, it occurred to me that I hadn’t told Stuart Smiley’s entire story.  Stuart’s  dark side is an important part of his story, indeed an important part of all of our stories.  I did mention that he was a mess.

I’m going to switch characters here.  The story of  Jacob’s struggle with an angel in (Genesis 32:24-30), provides a more sober and profound metaphor for the following exploration.  Personal transformation is not just about affirming the positive, it’s about investigating the negative as well; its about struggle.   The task of psychotherapy,  at its most profound and meaningful level is all about transformation, inhabiting more fully who we are.  And that is Jacob’s story as well.

In Genesis (32:24-30), the first book of the Bible, the first book of the Jewish Torah, Jacob leaves home to meet his nemesis and twin brother Esau.  Esau  wants to kill him.  Esau is angry with Jacob for having stolen his birthright, his father’s blessing, many year’s before.

While on this journey to meet Esau, Jacob has the famous encounter with a mysterious entity.   It is an encounter marked by struggle and suffering.  They wrestle throughout the night.  They wrestle  to a draw and  Jacob is released by the angel who insists Jacob take a new name: Israel.

Interpreters of the Bible story have various ways of interpreting this narrative.  Who is the angel?    Is it G-d?  Is it Jacob’s own fear of the coming encounter with Esau?  Or is it Jacob's own dark side.   And it appears he had a very prominent dark side.  He manipulated his father and stole from his brother for one thing.   The latter explanation, the most psychological one, of course, appeals to me.  This interpretation has Jacob struggling with his own flawed character.   In the process he is both wounded and reborn.  He gets a new name,  he becomes more of who he really is.  And this is the nature of transformation.

What a wonderful paradigm for the best outcomes of psychotherapy.  And I emphasize best, over common.  While the power of positive thinking is an important and real possibility for us all in recasting our fates—the need to embrace the shadow,  those elements of our personality, our souls of which we are least proud, is a  necessary element of transformation.

Trudy wanted to retire and to begin working seriously at her bucket list:  to travel to Nepal,  to write more poems,  to read and garden to her heart’s delight.  She knew it was time.  She felt really burnt by her 40 years of work as an emergency room physician.  Nothing called to her any more about her profession.  The adrenaline generated by the high intensity work had in the end depleted her.  It was definitely time to move on.

Strangely she found that she couldn’t.  She was dogged by guilt, haunted by bad dreams.  And that was when she could fall asleep.  Insomnia and an exacerbation of her long dormant ulcer had her prescribing medications for herself.  Finally, feeling it was a last resort, she went into therapy.

It took about 6 months of pretty intensive work with her therapist to uncover the source of the guilt.

Trudy came from a high achieving, well to do, but essentially emotionally disconnected family.  The three children  had had to fend for themselves as their parents pursued their
own interests, their travel, and their careers.   Despite this the two oldest children adapted well.  They performed well in school, had many friends, and took care of each other. 
The youngest did less well.  He struggled in school,  seemed to be the odd man out socially, frequently got into trouble with the authorities, and was finally expelled from school.  As the oldest child, Trudy knew what was expected of her to help:  she needed to take care of  her little brother.  But she didn’t want to.  For one thing she didn’t know what to do about him,  although 5 years older, she was a kid herself.   For another she was successful both socially and academically and had no real interest in parenting. 
She had made half hearted tries but she resented anything she was asked to do for him.  And plenty was asked.  The parents were preoccupied and clueless themselves as to how to help their son.

The baby brother never did pull himself out of his troubles.  As an adolescent he got into harder and harder drugs and very tragically died of an overdose at age 20.

What Trudy discovered in psychotherapy was that she had never forgiven herself for abandoning her brother.  And she really had to acknowledge that it was an abandonment.  True, she was a child herself and did not have the knowledge or skills to help her brother,  but on a deeper level she just didn’t want to.  She didn’t much like him or sympathize with him—he was always a trouble maker and a drain on the very slim emotional  resources of the family.  The stain on her soul was not what she did or didn’t do,  it was what she felt.  

What she had to wrestle with was her own nature, or what she thought was her nature.  She had not wanted to help her brother and he had died of neglect.

It took another 18 months at least for Trudy to come to terms with all of this.  Actually it probably will take many years beyond these months.  Trudy had to seriously consider that she had become an ER doctor because it was an arena in which she could save people. And that she did.  And now she couldn’t leave it, because to do so would expose the wound: her own self-loathing.

The struggle (in this case her work in therapy) left its mark on Trudy—the wound that had been  there but invisible became visible.  For a short time she needed anti-depressant medication,  later something to help her with her anxiety.  But in the end, she knew her own name.   She became more of who she was.   And eventually she retired.

Wednesday, August 1, 2012

Mental Health Notes: Stuart Smalley and Neuroplasticity

Stuart Smalley was a  character on Saturday Night Live played by Al Franken,  now a distinguished member of congress, then a distinguished comedian. In the  90’s he was a regular on Saturday Night Live.   Blonde and dimpled, somewhat effeminate, Stuart was an earnest simpleton, distinctly un-cool in his cardigan he was “a member of several 12 step programs, not a licensed therapist.”   Actually he was a mess.

One of his funnier bits was staring into a mirror and speaking aloud affirmations, to be repeated daily? “I am good enough, I am smart enough,  and doggone it  people like me.”  There was also: “I am an attractive person, I deserve my share of happiness, I deserve good things.”

The hilarious implication was of course how silly and self indulgent it was to think flattering yourself in front of a mirror really meant anything.

But you know what, it turns out that Stuart Smalley was on to something.

What we now know about neural functioning indicates pretty strongly that what we think can and does change our brain.   In the last twenty years there has been an explosion of new understanding in brain science.  There is more sophisticated, detail mapping of the brain and its functions and very importantly we have learned that the brain is malleable, not fixed as we once thought.  This is why a meditation practice, learning a language, and taking up a musical instrument can demonstrably change brain structure, even quite late in life.

What changes the brain, and/or the mind, changes the body, the immune system, blood pressure, cardiac function, stroke recovery and so much more.    Sophisticated methods of brain scanning have given us access to how all of this works.

The slogan is : what fires together, wires together.  As neurons fire (which is what happens with thought),  they connect to each other.  The more they fire, the stronger the wire.   If you practice weight lifting, or swimming, or piano, or French, you gain more facility, you get better and better—the neural connections grow stronger and stronger.  So if you think good thoughts, that might have an effect also, right?

I have just read the book Freedom from Pain: Discover Your Body’s Power to Overcome Physical Pain, by Peter Levine, Ph.D. and Maggie Phillips, Ph.D.  This book is chock full of exercises and regular practices, that can help people in acute or chronic pain, manage their pain.  Many of the exercises are based on Somatic Experiencing (SE), many on energy medicine.  Somatic Experiencing developed by Peter Levine, is a body awareness approach to treating trauma 
Pain is a form of trauma.

See previous posts on this site on the subject of SE:

Pain management is a very challenging area of healthcare with pain conditions nearly epidemic.  Medication can be helpful, but sometimes falls far short of bringing comfort, and almost always has side effects that can be distressing.  So practices that depend only on our ability to focus attention have enormous potential benefit.   And no side effects.

I was somewhat amused to see that Stuart Smiley’s methodology was one of the practices recommended by Levine and Phillips.  Here is the scientific justification:

Neuroplasticity research has turned this theory (genetic determination)on its head and gives us an entirely new way to look at the impact of our thoughts and beliefs.We know that thoughts literally change brain chemistry.  Research indicates that the chemical composition of the body can change in relation to a specific thought within twenty seconds (Levine and Phillips )p. 112.
…Research indicates that the chemical composition of the body can change in relation to a specific thought within twenty seconds p. 11.

Neuroscience has caught up to Saturday Night Live!

Try it.  And if you need inspiration, consider where Stuart Smiley is today:  The United States Senate.