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  http://www.traumahealing.com/ 
Pain is a form of trauma.

See previous posts on this site on the subject of SE: http://www.postsfromtheunconscious.blogspot.com/2012/06/ptsd-kills.html
http://www.postsfromtheunconscious.blogspot.com/2012/04/orange-biographies-healing-narrative.html

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.

PTSD KILLS

I hope that cardiologists everywhere are paying attention to a startling finding  reported online in PloS One.  A review of over 20 observational studies of  cardiac patients found that 1 in 8 (12.5%)  heart attack victims, or patients with unstable angina  had diagnosable PTSD (post traumatic stress disorder).     That’s almost double the  (lifetime) rate for PTSD in the general population.   Even more alarmingly this subgroup had double the  mortality rate of those without  PTSD within 3 to  5 years.  In these studies PTSD is very strictly defined as meeting the criteria in the current Diagnostic Manual of mental disorders.  If post traumatic effects like depression are factored in, the rates would undoubtedly be higher.  These findings were broadcast on mainstream media as well.

The study of the effects of war trauma have also reached the headlines as  the rate of suicide among active duty  military personnel now surpasses  the rate of battlefield deaths. ( The New York Times,  6/8/12).  The rate is nearly one a day.

Think about that.   Young men and women serving in  combat zones are more at risk for killing themselves than they are for being killed by enemy combatants. The war moves inside and destroys from within, at a devastating rate.

Long before PTSD reached the headlines, long before the shock and carnage of 911 made knowledge of the sequelae of trauma practically mainstream,  mental health clinicians were reporting back from the front lines of the  child abuse wars that a goodly portion of adults who had suffered as children from sexual abuse, neglect, physical violence,  sex trafficking and child pornography suffered from chronic PTSD;  victims of domestic and sexual violence, ditto.   Suicide rates may not be as high, but soul deaths, certainly.

The articles that I read that  reviewed the heart attack studies, noted that psychotherapy and medications were the treatment of choice for cardiac patients demonstrating trauma symptomatology.

I would like to add that body based techniques such as Somatic Experiencing and Sensorimotor Psychotherapy, as well as EMDR, are  good choices in the treatment of  a trauma that is essentially body based.   A heart attack is an attack on the  heart.  It is a "mugging"  within the body that is life threatening, not unlike a near fatal automobile accident, a rape, surviving an airplane crash,  or other near death experience.

The principal behind these body based approaches is that trauma triggers biologically based mechanisms of defense: fight, flight, and freeze.  PTSD and other serious problems will follow when the tremendous reservoir of energy that is recruited when we are threatened and overwhelmed gets locked in the body and can not be discharged.  A heart attack victim doesn’t have a lot of ways to discharge the impulse to flee the “attack,” or unlock from the freeze induced by overwhelming terror (I’m going to die!”).  A child victim cannot fight the predator even though the impulse to do so might be very present.

These body based treatments, or more accurately sensory  based approaches, like Somatic Experiencing or  Sensorimotor Psychotherapy are designed to address and rebalance  the nervous system by addressing it directly and not by way of  the higher cognitive functions.

A heart attack victim coming for treatment for PTSD may be gently and progressively lead  through the body memories of what it was like to experience the crushing pain, the terror, the helplessness, the uncertainty, all this on  a sensory level.  Where is it stored in the body?  What happens when we pay attention to those sensations of the body?    Together patient and therapist track sensation, imagery, and maybe motor inclinations.  All of these activities in the interest of discharging  all that pent up energy.  The work is done from the grass roots, so to speak, from the bottom up.  Cognitive approaches might be aptly described as from the top down.

This method is direct, gentle and amazingly effective.  For more information see
www.traumahealing.com  and

www.sensorimotorpsychotherapy.org/

or write to me.

The Orange Biographies, The Healing Narrative, and Somatic Techniques

I was delighted to see in Sunday’s New York  Times that David Sedaris read the orange biographies as child.  I  believe I read them all—everything that the children’s library in Marblehead,  MA had to offer.  These were the stories of “great Americans.”   The list that I recall included Abraham Lincoln, Clara Barton, and Wyatt Earp.

Looking back I think that even in third grade I found the personal narrative captivating and inspiring.  If I was going to be a great American, these were the books to read.

I suppose I have given up my aspiration for greatness.  But I have not relinquished my passion for stories, the stories of a life.  This has sustained me over decades in the practice of psychotherapy.  My job is mostly about helping people tell their stories.  I wrote in a blog several months ago (May 16, 2011 http://www.huffingtonpost.com/may-benatar-phd-lcsw/personal-narrative-healing_b_862285.html) about the value of creating the coherent personal narrative and the role of the therapist in this creation, this construction.  Sometimes it’s like solving a thousand piece puzzle, the story is jumbled, chaotic, fragmented.  Sometimes it is like picking out threads from a weave tangled with other people’s version of our story—“Mom said I was this kind of a child/person.  Auntie M. thought I was better than that.”

Sometimes there are holes as big as a truck in the story of one’s life—the individual seemingly retaining only crumbs of a history.   Figuring out what one’s own story is, from one’s own perspective, is both challenging and fascinating. 

The enterprise of constructing a coherent narrative of one’s life is mostly a cognitive process.    With the support and guidance of a skilled, empathic and alert listener, i.e. the psychotherapist, we come to understand how we got where we are, what has motivated, shaped, and had meaning for us.  We get to claim our own experience, from the inside out.  This is powerfully healing all by itself.

I have recently been learning about another kind of narrative:  the narrative of the body or the “felt sense.”  There are two new-ish techniques in which therapist’s are being trained, adding to their store of tools.  These techniques go beyond the verbal, the cognitive, beyond the prefrontal cortex so to speak.  Developed to work with trauma, Somatic Experiencing (SE) and Sensorimotor Psychotherapy (SP) focus attention from the grass roots, so to speak: Pat Ogden (founder of the Sensorimotor Psychotherapy Institute) refers to this as moving from the bottom up, felt experience, versus working from the top down, a more cognitive process.  The basic assumption is that the human nervous system is not unlike other mammalian nervous systems which have a self correcting, self healing potential.  Peter Levine (the developer of SE) reports that wild animals face trauma every day, and seem to bounce back within minutes of surviving a life threatening experience.  Trauma does not de-rail them.  There is no PTSD in the wild.

These new technologies which are being learned and mastered by practitioners around the world, tune in to a very different story:  the story stored in our body, in our “felt sense.”  Interestingly the stories that have been lost to the cognitive narrative, may be stored in the body and be accessible if one pays a certain kind of attention.  The body may have a very different story than the “remembered” story.

Next time you have a back ache, a bellyache, an attack of anxiety:  tune in for a few minutes, place your attention on the sensation and track it with your awareness.  Watch what happens: does it change?  Does it move?  Does it yield any information, image, anything? Does tuning in make you want to move or gesture in a certain way?

 Doing this will give you a taste of what these new techniques are like. 

For more information see www.traumahealing.com and/or www.sensorimotorpsychotherapy.org

THE MIRACLE OF ADAPTATION AND MR. WHITE EGRET

I was on a walk the other day.  The sun was out after many days of rain.  The creek along which I walk so often had become almost a river.  For the very first time, I noticed a white egret standing motionless  by a man-made waterfall on the creek.  The elegant bird looked as if she were trying to figure out how to navigate the cascade.  The creek had been but a trickle all summer.  But this fall had been unusually wet and stormy.  And the water was high and fast.

Strangely the bird was still there in the same spot, standing like a statue, unchanged, 30 minutes later when I passed on my return trip.  I raced home for my camera, sure he/she would be there when I returned.  In the meantime I had an elaborate fantasy (the kind of fantasy only a psychotherapist would have!) about that poor bird.  It went something like this:  The bird, probably young, had adapted to the stream at its lowest ebb during the summer.   Growing up beside a trickle, it was well adapted to those conditions.  When the stream swelled, her/his adaptation style no longer sufficed and he/she could not figure out what to do.

Of course, this reminded me of the essential human dilemma.  We adapt as children,  with brains, nimble and flexible,  to the conditions of our environment:  the family we are born into,  the emotional surround be it one of privation or abundance.  We are veritable geniuses of adaptation.  Problems arise latter when our brilliant adaptation styles no long suffice.  When the floods of later life come, we are often at a loss.  The tools of the earlier years are more than likely useless.

The child Holocaust survivor who starved and had to scrounge for whatever food was available in order to live,  may well have trouble at the dinner table as a middle aged adult now seated at the groaning board of American abundance: obesity and diabetes II ensue. The woman who has witnessed the suffering of older siblings who resisted a controlling parent only to be vilified, and rejected by that parent, learns submissiveness at home and fails to develop the assertiveness she needs to succeed in adult life.

I returned with my camera,  maybe 15 minutes later.  Mr. White Egret was gone.  There goes my theory.  Somehow he had navigated the falls.  Maybe he was just a patient fisherman all along.

Days passed,  no egret.  No egret, but another lesson came my way.

A week or two later, I had the good fortune to reconnect with a client I had known over many decades.  She was in her mid twenties (I in my mid thirties) when we met.  We worked together for many years and then just on and off thereafter.   She was in tough shape in those early years, nearly mute in our sessions for probably two years.  I did the talking, guessing at her pain, her shame, her fear.  She cancelled more often than not.   But often I could talk her into coming.  She had adapted well to an early environment in which it was dangerous to speak up,  it was dangerous to be noticed at all.  From a very large family, dominated by alcohol, violence, including sexual violence,  she was denigrated, humiliated, unprotected.   She felt insignificant, unsafe, and unworthy. 

Most significantly she was separated from herself—to survive  her childhood her essential self had gone into hiding.  What was left was a child hovering in fear, whatever strength there was seemingly defeated.   She was the only one among 17 children who had managed to finish high school,  but there was very little evidence of pride, and certainly no accolade from the family.  Any sign of independence, strength, intelligence was seen as a negative not a positive by her family.

Fast forward 20 years.  In the interim this woman went to college, gave birth and raised a child single handedly  and successfully without a father. She bought a home,  rose in her profession to a role of leadership,  survived a life threatening illness through sheer grit.  On and off she used therapy to help her navigate these crises, at times I was the second parent to her daughter, but for long stretches of time she did not call or come in to see me.

The one longing unfulfilled,  was the inability to sustain an intimate relationship with a man.

Now in her 50’s we are again back in touch and this time because she is in an intimate connection with a man, someone who sounds mature, loving, and accepting and who wants to marry her.  She knows she needs a little extra support until she decides what to do. 

The white egret has adapted to the falls.  A sustaining relationship with me over the years was certainly part of that critical adaptation.  But the real wonder here,  the awesome reality, is that she had the capacity to use that relationship and all other positives in her life, the terrific child she gave birth to,  her teachers in school,  friends, neighbors,  a few members of the extended family that did not put her down—whatever came her way she used to grow and change and reconnected with all that was positive in her. 

She herself has described it as the child within, the one I saw cowering in the early days mute and frightened, has grown up.

This is not the only story I have of the awe-inspiring nature of our ongoing, life-long capacity for change.  It’s just the latest.

taking off for a good new year.

Mourning into Dancing

The other day a Debbie Friedman song popped up on my ipod shuffle. I had no idea it was even on my ipod or how it got there. Debbie Friedman was a singer and composer of songs, many in Hebrew, often reworking prayers from the Jewish prayerbook.

“Mourning into dancing” is Debbie Friedman’s riff on Psalm 30, a song of gratitude.

It was a day or two after I had some terribly sad, shocking news and I took it as a sign. Somehow I needed to transform my mourning into something like dancing, a creative expression of gratitude. I did not get the chance to do this before she died. She failed to give me notice.

The woman who died, suddenly, unexpectedly was my compass for over 25 years. Eda Goldstein was alternately my supervisor, or rather I was her apprentice, she was my teacher, my mentor, a model of professional accomplishment, my guru. She helped me negotiate a good bit of my professional and personal life. I was not in continuous contact with her over those 30 years, but she was always there when I got into trouble and I needed help in sorting things out. She was without peer in both her loyalty and in her wise guidance.

I think I need to say “thank you”

When I first started to go into New York City to get supervision from her, in the early 80’s, a friend and colleague noted that I was awfully quiet about what was happening there. Well I was quiet because it was a humbling experience.

I remember my  brief case was new (now scruffy, battered, ripped and repaired). The children had reached an age when I felt comfortable working more and my priorities were getting re-shuffled. I was determined to learn from a master. So I cheerfully schlepped into NYC to sit at her feet. And it was overwhelming.

She was a tough task master, she never sugar coated her counsel on cases and frequently I would smart from her observations. Later, much later, she observed that most supervisees just want to be admired, not taught. I’m sure I was one of those, but I stuck it out, nonetheless and ultimately her toughness gave me confidence.

I discovered Eda at a lecture in New Jersey. She was a annoyed with her sponsors.  Nonetheless she was a brilliant presenter at that meeting. My friend E. agreed that she was special. I decided right there that she was to be my mentor

That friend and colleague loved her too. The supervision group of which we both were a part, shared her in a way, even if they never schlepped into New York to see her, they shared her with me, her wisdom, her depth, her clear-eyed respect and compassion for clients. Among her more notable qualities was that clarity. There was a kind of laser-like quality to her thinking (and her writing). She effortlessly peeled back, down right ignored, what was extraneous, not central to the issue at hand.

Social workers all have inferiority complexes. No matter how advanced their training, no matter the length of their experience, no matter their academic credentials they feel and often are regarded as “less” than their clinical colleagues, psychologists and psychiatrists. They are paid less and related to as less, despite the fact that their training may be equivalent or even surpass other mental health professionals.

Being associated with a star like Eda Goldstein did a lot for my own professional self esteem. She is described by the Dean of New York University, School of Social Work where she taught and led faculty and students in many roles for decades: “ Eda was, and remains to the day of her death, the foremost social work scholar of contemporary psychoanalytic theory and practice. Her loss is a great loss for our community and for the field.” This scholar and brilliant clinician thought I was okay, maybe even bright. That helped a lot.

For decades I was comforted by the certainty that any idea I had, plan of action, or major move I contemplated could be run past her. I could and actually still do comfort myself with that, even though I can only do it in my imagination now. Mostly I know what she would say. But when my imagination runs aground, I am bereft.

I wish I could just send this to her. I would love her feedback. And more importantly, I would want her to know how much I loved and will miss her.

There is really an interesting "chat" on huffington post (link below) on a piece on "inner wisdom" that I wrote for this blog some time ago.  If any are interested, see the comments section.  Others have chimed in with helpful suggestions for deepening the inner conversation.

http://www.huffingtonpost.com/may-benatar-phd-lcsw/consult-inner-wisdom_b_931374.html