Narcissistic Personality Disorder: Illness or Character Flaw?

I've seen a lot of posts on the Narcissist Personality Disorder on my Google Reader recently. However, I've notice that most of them are not going off of recent research. The information in this paper is two years old. It is not the final format, but all the material is here.

Narcissistic Personality Disorder: Illness or Character Flaw?

Written by Amanda D. Barncord Doerr

CHAPTER 1. INTRODUCTION

Initial shock

Walking out of a therapist's office after being told that their loved one is exhibiting the symptoms of a Narcissistic Personality Disorder (NPD), a person is forced to consider the implications of this diagnosis. There is confusion about how this diagnosis affects their view of their loved one, whether the NPD should be pitied or scorned. There is curiosity about the disorder itself and the affect, if any, it would have on the self view of the one diagnosed. And then there are worries about what the diagnosis means to the therapist treating the loved one and what is the prevailing thought on the Narcissistic Personality Disorder among mental health professionals.

Two views

In the literature available to the general public, there can be found two very diverse views of the Narcissistic Personality Disorder. The more accessible sources appear to portray the disorder as a character flaw or a label for difficult people. Popular author and psychiatrist, M. Scott Peck (1983) said in his book People of the Lie: The Hope for Healing Human Evil that evil people could appropriately be classified as a variant of the narcissistic personality disorder. On a website that approaches the disorder from a layperson's perspective, Joanna Ashmun (2004) points out that in the clinical literature NPD is usually discussed as a "character disorder".

On the other hand, the inclusion of Narcissistic Personality Disorder into the DSM, would strongly suggest to many people that it is an illness. Indeed many online "psychology" sites call it just that. Though to some laypeople it is more likely to suggest that the psychology field is trying to explain away a set of character flaws by suggesting that the "sufferer" is not responsible for their actions. Of course, the laypeople who cling to this notion of irresponsibility in the mental health field rarely believe in the need to view the sets of behavior that comprise an NPD in an objective and scientific manner.

Self-proclaimed NPD sufferer and author of Malignant Self Love : Narcissism Revisited, Sam Vaknin (1997) confuses the matter further with his views on whether or not narcissistic personality disorder sufferers can help themselves on his website. He first convinces the reader that a narcissist cannot help themselves and then goes on to show that the essential ingredients to remission is for the narcissist to be humble and take responsibility for his own actions.

Professional questions

All of this leads to the following questions. What is the professional view of the Narcissistic Personality Disorder? What data supports this view? Does treating NPD as a illness give any relief to the life impairment caused by it? What are the alternatives for narcissistic personality disorder sufferer and those who must interact with them?

CHAPTER 2. DIAGNOSIS

Background and history

Narcissism may be one of the most commonly recognised character flaws. The word itself comes from the Greek myth of Narcissus, a young man who fell in love with his own image in a pool and then was turned into a daffodil by the gods for punishment for his hubris. Ellis and Nacke first introduced the term into psychiatry at the end of the 1800s, but it took Freud and Rank in the 1910s to describe the disorder. Reich an Horney expanded on the concept some in the 1930s. Then for about 40 years the issue laid practically dormant until the 1970s, when Kohut and Kernberg connected the developmental processes of self to the formation of pathological narcissism. It was their work that introduced the Narcissistic Personality Disorder (NPD) into the DSM. (Rivas, 2001)

Symptomology

According to the research of Dimaggio, Semerari, Falcone, Nicolò, Carcione, & Procacci (2002, December), NPDs often display vague sensations of emptiness, boredom and emotional anesthesia. Their emotional state is not available to their consciousness. This cognitive deficit is a form of alexithymia. Alexithymia is the inability to link the physical response to words, fantasies, and feelings to the expression thereof. An example is when an NPD shows facial expressions of annoyance, but when asked about the annoyance, they will deny feeling anything and may even start looking confused when the questioner continues to probe the matter. This lack of self-awareness makes self-reflection very difficult for the NPD. To compensate, they rely on having a rigid set of values to help make decisions and judgments. However, unable to recognise the internal signals that guide most people when there is conflict between their beliefs and actions, NPDs will often act in counterproductive ways.

One side effect of the value system reliance is that NPDs usually display two main states of mind; admiration and contempt. The overt admiration state involves disdainful grandiosity, fantasies of wealth, power, physical attractiveness, and invulnerability. The covert contempt state involves an out-of-place sensitiveness, a sense of inferiority, insignificance and fragility, and a search for glory. It is usually during the therapeutic process that other states, such as anger, envy, fear and confusion are displayed.

The rigid value system also creates many interpersonal problems when compounded with other aspects of the disorder, such as a sense on entitlement and a haughty demeanor. Unable to reflect upon their own actions, NPDs also lack the ability to emphasize with others, seeing them instead as "self-objects". This deficit in object relations has been recognised in NPDs since the works of Kohut and Kernberg. When speaking to others, NPDs tend to be rhetorical, vague and evasive in their speech, with an egocentric view of reality. It has been noted that while NPDs transmit nonverbal signals, they do not receive them. And while they may not be able to reflect on their feelings, they can use them as an engine for social action.

Despite the NPD's belief that they should only associate with other special people, they are threatened by "kindred spirits" and will treat anyone who may be their equal as competition, instead of as a compatriot. The fragile self-esteem of the NPD does not allow for true peers. Nor does it allow for narcissistic damage in the form of insult or loss of esteem. Robert Simon (2002) noted that the actions caused by such damage resembled PTSD, without the flashbacks. This would include the outbursts of anger and other antisocial acts associated with narcissistic rage.

According to Phebe Cramer (1999), NPDs are more likely than other personality disorders to seduce their environment to meet their needs. When this fails, they will fall back on rationalization as a defense, resorting to fantasy and complete denial when that fails.

DSM criteria

For a patient to be diagnosed with having a narcissistic personality disorder, five of the following nine criteria must be met: a grandiose sense of self; a preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love; the belief that the patient is special and can only be understood by other special people; a need for excessive admiration; a strong sense of entitlement; a pattern of taking advantage of other people to met their own needs; a lack of empathy; a sense of envy towards others or the belief that others envy them; arrogant behavior. (APA, 2000)

Prevalence

According to the American Psychiatric Association (2000), the prevalence of NPD is less than 1% of the general population and 2 to 16% in the clinical population. In 1999, Rivas (2001) pointed out that the Narcissistic Personality Disorder was removed from the tenth revision of the International Statistical Classification of Diseases and Related Health Problems, leading some researchers to believe that maybe NPD was a cultural disorder, specifically an American one. However, studies supported by by the National Project of Mental Health of the Istituto Superiore di Sanità, Rome, Italy (Dimaggio et al, 2002), have since given a great deal of insight into this disorder.

CHAPTER 3. VALIDITY

Character disorder

It is not without good reason that researchers like Joanna Berg (1990) and others refer to NPD as a "character disorder". Some of the more noted aspects of this disorder is a high sensitivity to criticism, grandiosity, a sense of entitlement, a lack of empathy, envy and a need for excessive praise. All of these are considered character flaws in Western civilization. In fact, if we were to compare the traditional seven deadly sins with the criteria for NPD, we would be easily be able to match three - envy, pride and greed to the DSM-IV's list. Add narcissist rage to match with wrath, and we have over half the deadly sins. Compare the diagnostic criteria with any established religious code and one might begin to wonder why the NPD is seeing a therapist instead of a religious advisor. After all, Cramer (1999) said that the NPD does have a remnant of a moral conscience. Why is a deficiency of morals being addressed in in a manual for mental disorders in the first place?

The answer is quite simple. These people have behavioral problems that need to be treated and most of them do not have the ability to acknowledge their own faults. But still, it is interesting to note that Links & Stockwell (2002) found that some pathological narcissism can be cured through real life accomplishments. If able to achieve a major real life accomplishment, a NPD can be helped to reflect on their success. Once this reflection occurs, the NPD often ends up with a more realistic view of themselves and no longer needs to hold on to the fantasies of success, wealth and power they had been previously clinging to.

Another example of a successful treatment of NPD comes from Nicolò, Carcione, Semerari & Dimaggio (2007). It requires the therapist to time when they are caring towards the NPD to coincide when the NPD is willing to accept the idea that it is okay to be flawed. Then the therapist's help is seen as an enrichment, instead of an insinuation that the NPD is fatally flawed. In the case study given, the female NPD patient found acceptance for being helped through her own childhood memories of helping elderly strangers in a public restroom.

The two ways listed in this paper of affecting NPD in a positive way does reflect the adage that for a NPD to be cured, they must first learn humility. Then, as Sam Vaknin (1997) said, they must take responsibility for their actions. One cannot miss the fact that humility and responsibility are considered positive character traits in this culture, calling to mind the question again, should character flaws be grouped with mental disorders?

Cognitive deficits

But is NPD really a set of behaviors caused by a lack of moral fiber? Or the results of cognitive defects? The evidence of alexithymia, the inability to reflect on their own actions, not being able to receive conversational cues, and the disturbances in object relations all suggest that there is something going on inside the mind of the NPD that has nothing to do with moral turpitude. Stevens et al (1984) reported that NPDs felt a great deal of discomfort while experiencing considerable excitement. And what of Simon's finding that narcissistic damage resembled PTSD in many ways? Perhaps the problem isn't the character, but the cognition of the sufferer.

Kohut and Kernberg both believed that NPD was a product of developmental problems (Stevens et al, 1984). In Kohut's self-psychology theory, the NPD is created through a deficit of parental mirroring or parental rejection at the infancy stage. Unable to develop a bond with their primary caregiver, the NPD holds on to the idealization of their own ability to affect their environment, until they can develop a bond with the therapist, which allows them to learn the developmental skills denied them as children. In Kernberg's theory of pathological narcissism, the same lack of parental warmth causes the creation of a grandiose self, which is unable to care for anyone else. For years, these two theories were referenced almost exclusively in NPD studies.

A proposed integrated narcissism model set forth by Dimaggio et al (2002) has through research and study, outlined a complex set of cognitive processes and the means by which the disorder perpetuates itself. While Kohut and Kernberg's work are still at the model's foundation, the model focuses more on the immediate meta-cognitive defect of the NPD instead of the developmental processes that created it. Since therapists rarely deal with the NPD at the time of their developmental disruption, this model is probably far more useful in treating those in practice.

Traits versus contextual

Hummelen and Rokx (2007) discussed that one problem with personality disorders is that people display consistent personality traits on an inconsistent basis, depending on the context these traits occur in based on many variables. Therefore, it is possible that an individual could display non-pathological traits in the therapist's office, while displaying very pathological behaviors with neighbors who are not available for interviews. Likewise, an individual may display previously unknown pathological traits in an office due to abnormal fears and stress of meeting with a "shrink", much like a person whose blood pressure rises whenever he is examined by a physician.

Relying on the DSM

Hummelen and Rokx also criticized the syndromal approach of the DSM, with its highly ambiguous definitions based on often unobservable behaviors. Such definitions lead to generalizations and the expectation that certain behavior will always be present. There is almost no consideration of the context of the behavior. After all, a world class soccer player would legitimately be able to say he is the best in his field and be used to entitled treatment from others, but unless the person treating him followed the sport, they might doubt the patient's claims.

The DSM (APA, 2000) itself admits that the Cluster B personality disorders resemble each other. NPD can also resemble the obsessive-compulsive personality disorder, the schizotypal personality disorder, the paranoid personality disorder, and manic or hypomanic episodes. Using the DSM alone for identifying this disorder is an exercise in eliminating other possibilities.

Using the MMPI and MCMI

Chatham, Tibbals, & Harrington (1993) state in their study that NPDs only show a significant difference on the hypomanic scale using the MMPI. This means that MMPI could not differentiate between a NPD and a legitimately talented person experiencing a mild case of mania. The MCMI was even less clear, scoring the NPD high not only on the hypomanic scale, but also the histrionic, narcissistic, and antisocial scales too. Chatham et al concluded that more data was needed for diagnosing NPD than was provided by these tests.

Using the Rorschach Inkblot test

Surprisingly, one of the tests that has consistently been able to designate NPDs from other disorders has been the Rorschach Inkblot test. Harshly criticized in the 1990s, Ganellen (2001) and others have successfully defended the test, stating that it is just as accurate as the MMPI in overall use, as long as it was used for the purposes it was originally intended for - a diagnostic test based on perception alone, with little attention paid to the projections. Weiner (1996) gives four examples of successful applications for the Rorschach: differentiating personality variables; measuring developmental changes in children and adolescents; monitoring improvement during psychotherapy; and identifying experienced distress in war veterans with PTSD. There is also evidence in at least 48 studies that the Rorschach can detect cognitive complexity, reality testing, general psychological stress, disordered or psychotic thinking, and disturbances in object relations. Published longitudinal studies have shown that the Rorschach variables were steady over time.

The disturbances in object relations is of particular interest in regards to the NPD. Both Kohut and Kernberg were object relations theorists and their theories of pathological narcissism depended in disruptions in the development of self and object relations. In Kohut theory, NPDs had arrested development. In Kernberg's theory, they were created through a developmental aberration. (Stevens, Pfost & Skelley, 1984) Therefore, it stands to reason that the Rorschach test would be a better instrument to detect pathological narcissism. In studies done by Hilsenroth, Fowler, Padawer and Handler (1997), the four variables usually elevated in NPDs are reflection responses, personalized responses, idealized responses and the egocentric index. Of these four, two - reflection and idealized responses, were found to be empirically comparable to the DSM-IV diagnostic criteria.

In an earlier study by Hilsenroth, Hibbard, Nash & Handler (1993), borderline and narcissistic personality disorders showed several differences using the Rorschach. Ironically, borderline personality disorders (BPDs) tend to show higher grandiosity than NPDs, while NPDs were more egocentric. BPDs were also more aggressive and used more primitive emotional defense mechanisms than other PDs. This might explain the findings of Hummelen & Rokx (2007), where neuro-imaging scans show BPD patients to consistently have a smaller and hyper-reactive amygdala.

While the Rorschach can be defended as a diagnostic tool, it is still open to misuse in clinical settings. As Weiner (1996) pointed out, it was never meant to be used for everything, nor was it meant to be used by those not thoroughly trained in evaluating it. One hopes that now the ability to diagnose NPDs through object relations has been proven that a less subjective test can be devised for it.

CHAPTER 4. CONCLUSION

Based on studies using the Rorschach test, other psychometric instruments and documented case studies, the current prevailing professional view of the narcissistic personality disorder would be that it a deficit of meta-cognition, probably caused by a disruption of self-development in infancy. While it is not treated with medication, approaching NPD as a disorder is very important because it easier to be less emotionally hurt by the sufferer's actions. This emotional distance is necessary when dealing with NPDs, since it allows one some control over how they are seen by the NPD. To get anywhere with an NPD requires the individual to be seen as admirable.

Cognitive therapy is the only course so far that has shown any success in treating NPDs. Confronting a NPD and calling them to repentance is pointless in most cases. The narcissistic defence system is far too sophisticated to be dismantled by such tactics. At best, the NPD will retreat into a depressive state and cycle through emptiness and fear until they latch onto their grandiose self and return to their pathology when the immediate threat of shame is past. A more successful approach is to guide the NPD to a point of real achievement, in either the present or the past, and help them to realize that not being powerful all the time is nothing to be ashamed of.

It is very easy to see how a lay person would question the diagnosis of NPD as a mental disorder, based on the literature and websites available to them. Upon seeing the criteria for NPD, many would understandably declare its sufferers as difficult people who should just straighten up their acts. However, as we look closer at the studies of NPD, it becomes apparent that the narcissist is suffering from a cognitive defect, which uses a rigid value system as a coping mechanism. Because of this coping mechanism, NPDs will have character flaws, but the treatment of the disorder is not in the flaws, but in the cognitive deficits. In his confusing way, Sam Vaknin is correct about his disorder. It is something that the NPD suffer cannot completely control, however, through humility and responsibility they can overcome their cognitive deficits. In a way, it is not much different than a bipolar patient who must manage their symptoms. The jury is still out as to whether NPD can be completely cured. It is tricky enough just to get the patient into the therapist office in the first place.

REFERENCES

American Psychiatric Association. (2000) Diagnostic and statistical manual of mental disorders, (4th ed.), Text revision. Washington D.C.

Ashmun, J. M. (2004). Narcissistic Personality Disorder (NPD) : DSM-IV Diagnostic Criteria. Retrieved September 02, 2007, from http://www.halcyon.com/jmashmun/npd/dsm-iv.html#npd

Berg, J. (1990, December). Differentiating ego functions of borderline and narcissistic personalities. Journal of Personality Assessment, 55(3), 537-548. Retrieved September 5, 2007, from PsycINFO database.

Chatham, P., Tibbals, C., & Harrington, M. (1993, April). The MMPI and the MCMI in the evaluation of narcissism in a clinical sample. Journal of Personality Assessment, 60(2), 239-251. Retrieved September 5, 2007, from PsycINFO database.

Cramer, P. (1999, June). Personality, personality disorders, and defense mechanisms. Journal of Personality, 67(3), 535-554. Retrieved September 5, 2007, from PsycINFO database.

Dimaggio, G., Semerari, A., Falcone, M., Nicolò, G., Carcione, A., & Procacci, M. (2002, December). Metacognition, states of mind, cognitive biases, and interpersonal cycles: Proposal for an integrated narcissism model. Journal of Psychotherapy Integration, 12(4), 421-451. Retrieved September 5, 2007, from PsycARTICLES database.

Ganellen, R. (2001, August). Weighing Evidence for the Rorschach's Validity: A Response to Wood et al. (1999). Journal of Personality Assessment, 77(1), 1-15. Retrieved September 22, 2007, from Academic Search Premier database.

Hilsenroth, M., Fowler, J., Padawer, J., & Handler, L. (1997, June). Narcissism in the Rorschach revisited: Some reflections on empirical data. Psychological Assessment, 9(2), 113-121. Retrieved September 5, 2007, from PsycARTICLES database.

Hilsenroth, M., Hibbard, S., Nash, M., & Handler, L. (1993, April). A Rorschach study of narcissism, defense, and aggression in borderline, narcissistic, and Cluster C personality disorders. Journal of Personality Assessment, 60(2), 346-361. Retrieved September 5, 2007, from PsycINFO database.

Hummelen, J., & Rokx, T. (2007, December). Individual-context interaction as a guide in the treatment of personality disorders. Bulletin of the Menninger Clinic, 71(1), 42-55. Retrieved September 9, 2007, from PsycINFO database.

Illness. (n.d.). The American Heritage® Dictionary of the English Language, Fourth Edition. Retrieved September 02, 2007, from Answers.com Web site: http://www.answers.com/topic/illness

Links, P., & Stockwell, M. (2002). The role of couple therapy in the treatment of narcissistic personality disorder. American Journal of Psychotherapy, 56 (4), 522-538. Retrieved September 5, 2007, from PsycINFO database.

Nicolò, G., Carcione, A., Semerari, A., & Dimaggio, G. (2007, February). Reaching the covert, fragile side of patients: The case of narcissistic personality disorder. Journal of Clinical Psychology, 63(2), 141-152. Retrieved September 5, 2007, from Academic Search Premier database.

Peck, M. S. (1983). People of the lie: the hope for healing human evil. New York: Simon & Schuster.

Rivas, L. (2001, January). Controversial issues in the diagnosis of narcissistic personality disorder: A review of the literature. Journal of Mental Health Counseling, 23(1), 22-35. Retrieved September 5, 2007, from PsycINFO database.

Simon, R. (2002, January). Distinguishing trauma-associated narcissistic symptoms from posttraumatic stress disorder: A diagnostic challenge. Harvard Review of Psychiatry, 10(1), 28-36. Retrieved September 5, 2007, from PsycINFO database.

Stevens, M., Pfost, K., & Skelly, R. (1984, March). Understanding and counseling narcissistic clients. Personnel & Guidance Journal, 62(7), 383-387. Retrieved September 5, 2007, from PsycINFO database.

Vaknin, S. (1997). Can the narcissist help himself? Retrieved on September 02, 2007, from http://samvak.tripod.com/narcissismselfhelp.html

Weiner, I. (1996, June). Some observations on the validity of the Rorschach Inkblot Method. Psychological Assessment, 8(2), 206-213. Retrieved September 22, 2007, from PsycARTICLES database.

Once Upon a School

Okay, this is a long video (25 minutes), but I promise you will enjoy this--especially if you are interested in education:



Dave Eggers' brilliant idea of mixing writers and students needing tutoring is only exceeded by the genius of its implimentation. A tutoring center behind a pirate supply store, with a publishing company in the back. Its success is a wonderful example of creativity begetting creativity and learning. And the spin-offs of a super hero supply store in NYC, the time-traveler's convenience store in LA, and others, show the repeatability of this model.

After watching it, I had to ask myself what would work in OKC. I think we would have to avoid the cowboys and indians bit; it wouldn't be whimsical enough for this region that has deep cultural roots with those groups. Possible ideas I've had:

THE INTERGALACTIC BARREL: something like a Cracker Barrel for space travelers. Filled with lots of travel games, gifts, and other touristy stuff for aliens visiting Earth. And instead of a restaurant, a vending wall or two of dehydrated fruits and meals in a tube, aka "astronaut" food, with a dining room. Could use "Diner" to avoid upsetting Cracker Barrel - or perhaps could talk Cracker Barrel into being a sponser.

THE CAVEMAN FASHION OUTLET: Select the finest in (faux) fur and leather loin clothes, tunics, vests and capes. Not to mention bone and rock jewelry, footwear, and blinged out clubs. Everything for the sophisticated caveman.

And slightly related, THE DINOSAUR FEED STORE: Everything for feeding and caring for your prehistoric animals. Could alternatively be a mythical creature feed store.

Anyway, I encourage you to visit http://www.onceuponschool.org and see what others have done.

Ants, Mushrooms, and the Internet

After posting about the TED talk that explains how the Internet works in easy to visualize metaphors, I remembered this other talk about how ant colonies function and realized it is very similar. So for your edification:



Pay particular attention to how data is sent from ant to ant and acted upon without a central decision center.


Mushroom researcher, Paul Stamets, believes that the Internet is a natural system, which is patterned after other natural systems:



As interesting as his comparison is, I find his research and work with fungi to be far more fascinating and full of potential for improving the world in general.

Geeks can be cute too

The following videos are not being put up for their content - even though that was why I watched them - but for the reaction I got from my daughter when I insisted on watching the latest one.

Several weeks ago, I saw that Brain Cox had done a talk on what went wrong with the Large Hadron Collider. I wanted to watch it, because I hadn't bothered to read the news posts on it when it happened (doing graduate work sort of saps up your time). So, I downloaded it to my laptop and decided to watch it in the evening, before I turned in. However, my 17 year old daughter was bored and wanted us to do something together. We watched a few old TED talks and then I insisted on watching this one. She rolled her eyes and sighed an "okay".



Less than a minute into the talk, I hear a delighted squeal of "he's cute!" behind me. Not used to such talk coming from my child, I asked her to repeat it. She admitted that she thought Brian Cox was really cute. She ended up watching the video several more times, so she could draw a portrait of him.

Taking advantage of her enthusiasm, I showed her his first talk on the Large Hadron Collider:



Then I looked for him on Wikipedia, where we found out that he used to be part of a band and was only four years younger than me. It gave her mixed feelings, but who knows - maybe she actually knows something about the Large Hadron Collider now?

Okay, maybe not. But it did make me, geek mother that I am, happy to see my daughter having a crush on a physicist. I tried to get her to watch Brian Greene's talk on string theory, but she informed me that he was more my type than hers.



Well, at least I learned stuff from the talks. And my daughter doesn't have a problem with geeks and nerds.

Changed the template of my blog

Decided to make it easier for more people to read. Turns out I got a few bonuses with the decision. Not only can we now search this blog, but I like how the archives in the sidebar are handled. It's much easier for me to find information in my own posts.

In other news, I need a job. Feel free to visit http://www.linkedin.com/in/amandadoerr and suggest something here. If you go to the full profile, you can even read some of my larger academic papers.

How the Internet Works

How the Internet Works

Actually, I've been wanting to write commentaries on my favorite talks at TED.com and I've finally decided to just jump into it. I'll probably be doing these in spurts.


The talks I am focusing on in this post deal with how the Internet works from a very social standpoint. This first one explains many geeks views on resource sharing:


(If the video doesn't work, go to http://www.youtube.com/watch?v=P65XdTlk4vA )

When I first watched it, I giggled a lot because it reminded me of the days when I visited local computer boards (BBSes) and conversed with people through WWIVNet. Back in 1992, it took a few days to get packets from Florida to Texas, because you had to rely on certain BBS sysops to make long distance calls (at their own expense), once or twice a day, to send and receive the packets. When I watched the video a second time, with my daughter, I realized that there are many people today, who don't understand the underlying mindset of those who were/are part of the creation and maintenance of the Internet. So I ask you to watch this video and share it, so that more people understand why computer geeks give such bemused looks when people talk about controlling internet access.



Speaking about controlling the Internet, leads us to this next video:


(If the video doesn't work, go to http://www.youtube.com/watch?v=-hFk6FDrZBc )

When I first saw the title "How the Internet strengthens dictatorships", I was more than a bit sceptical of its content. After watching it, I realized that Evgeny Morozov formalized something that I had always realized was going on--not only on the Internet, but in mass media and with many institutions. I just had never truly connected it all. I appreciate this video, because knowing about how things are spun is the best way not to get sucked into it. But at the same time, you have to realize how very, very prevalent it is and don't get too down on yourself if you occasionally get caught up in a spin cycle. If there is one thing I've learned in life, it's that insisting you can't be fooled is practically a guarantee that you will be. Better to accept the possibility and cope with it.

white paper - successful interventions

White Paper - Addictions

Amanda Doerr

KEYS TO A SUCCESSFUL INTERVENTION

When many lay people talk about having an intervention with someone about their behavior, they tend to bring up scenes of verbally abusive behavior that is expressly prohibited by the ethical guidelines of the APA. Obviously there must be something wrong with this idea of ambushing a person with their bad behavior and beating them over the head with their flaws. Such behavior sounds more destructive than therapeutic. And indeed, described that way it is, this model of intervention sounds far more satisfying to the participants than useful to the recipient.

But then why do we have interventions and confrontations still in use? The answer is that professional interventions have developed a great deal since the Synanon program and its "attack therapy" as developed by Chuck Dederich in 1958 (Polcin, 2003). At that time, it was believed that the release of emotional energy would release tension and break down denial, thereby allowing a more honest discussion about the addiction and the behavior that resulted from it. The goal at the end was to reaffirm the confronted person's importance to the group. However, many criticized this technique as a replication of the abuse many of these clients experienced in their past. The same criticism could be applied to the early therapeutic communities that use humiliation and punishment to change the addict's behavior. Faced with the alienation by the respected mental health professionals, some therapeutic communities began to use group feedback methods in the 1970s and 1980s. This moved the focus from "breaking down the denial" to confronting the dysfunctional behaviors caused by the addiction. Other factors that brought about this transformation in methodology were: the increasing number of dual-diagnoses of addiction and mental illness, the desire to be allied with 12-step programs, and the research showing that addictions were fueled by core emotional issues.

While there are still disagreements as to what one means by "confrontation", some researchers and program directors prefer to define it, more or less, as "someone being approached, in a realistic but not punitive way, that 'bad things' might happen if they don't make changes in regards to their addiction" (Polcin et al, 2006). Personal attacks are discouraged, as well as other forms of disruptive confrontation. Perhaps the term "therapeutic confrontation" should be used more often to distinguished from the more hostile versions of confrontation, such as the "beat them into submission" type.

Studies show that successful interventions usually generate gratitude and good feelings towards the confronters by the confronted (Polcin, 2006). Given the all too human reaction to be offended when someone tells us we're wrong, how is this created in a confrontation?

One element is the relationship of confronters to the client. The closer the relationship, the more successful the confrontation because the information given is seen as more valid (Malis & Roloff, 2007). Among not so close peers, a great deal of face work has to be done to create enough of a valid bond for their views to be considered. In fact, that bond often has to be there before a peer will even consider confronting someone with their addiction. With therapists, this would be the creation of a therapeutic alliance. While some practitioners claim that this is not necessary, research shows that is does help and never hurts. A study by Miller, Brown, Simpson, Handmaker, Bien, Luckie, Montgomery, Hester, and Tonigan found that there was a strong positive correlation between supportive and empathic approaches and positive outcomes (Polcin, 2003).

To up the odds of an effective confrontation, many current professional intervention programs first educate those of the confrontation team how to phrase their concerns in "a realistic but not punitive way". Alanon facilitation and Johnson Institute interventions are ways that this is done (Polcin, 2003). While the Johnson Invention has high relapse rates, it has a higher rate of getting clients into treatment and still retains clients (Loneck et al, 1996). A more effective training program for the family and friends of a client is the Community Reinforcement and Family Training (CRAFT) program, which teaches behavioral change skills. According to Bob Poznanovich, CEO of Addiction Intervention Resources, they go even further and assess the situation of the family (Conan, 2008). In fact, Poznanovich claims that they work more with the family than with the addict, because family can often enable addictive behavior without realizing it. He calls it a "family illness" and points out that many people are given bad advice about how to deal with addiction, such as it is just a matter of will power or that there is nothing that can be done.

Another important element is the timing of the confrontation (Polcin, 2003). Light to moderate drinkers gain less from interventions than problem drinkers, probably because the concerns seem less valid. However, light to moderate drinkers do respond favorably to the more empathic therapies. Addicts with major cognitive impairment from the drug they're taking, respond better after a period of detox. Addicts already in being treated in a facility benefit more from a therapeutic confrontation after they have been there long enough to emotionally stabilize. Otherwise, they will flee or regress in response to the confrontation. In many programs, the client is educated about the positive role confrontation can play in their recovery. This preparation not only makes the confrontation less traumatic, but also puts the client in a mindset prepared to make the most of the information given to them during the confrontation.

It should be noted that some addicts, because of comorbid conditions, may not be good candidates for intervention. One cannot expect a paranoid or antisocial personality disorder to respond favorably to confrontations. Nor can one expect someone with diminished cognition to fully comprehend what they are being confronted with.

The most important element is the focus of the confrontation. According to a study by Polcin, Galloway, and Greenfield (2006), when the message was on the behaviors and potential problems, clients consistently said that they were more likely to have a positive experience with confrontations. Remarkably, the more frequent the confrontations, the more individuals involved, and the more sources involved, the more positive was the views of the confrontations. Thinking distortions can also be addressed as part of the confrontation.

An element of choice also makes an intervention more successful (Conan, 2008). When the addict is allowed the choice of whether to get better or suffer from their own behavior, and then chooses to get better, they are more committed to the change. Even if the addict chooses not to change at first, some will change their minds later as the "bad things" they had been warned about happen to them.

A skilled counselor should be directing the therapeutic confrontation, in case emotions run too high or a deep issue is triggered (Polcin, 2003). The counselor should be able to switch from a confrontive stance to a clinical exploration of the issues exposed. A far cry from the "beat them until they see the errors of their ways." Modern interventions are more about support for reducing dysfunctional behaviors, than they are about making the recipient admit that they are an addict.

In summary, a successful intervention requires: a trusting and supportive relationship between the client and the intervening group; focusing on the dysfunctional behaviors and possible bad outcomes from the addiction; the client and interveners to be prepared to make the most of the situation; and a facilitator to handle any problems. Education for the family, friends, and client increases the chances that the intervention will be more effective as does the number of confronters and interventions. While old fashion interventions might make for great television drama, forcing the client to admit that they are an addict or otherwise personally attacking them, is more likely to impede than to help the situation.

Resources

Conan, N. (2008). Addicted Loved Ones: When to Intervene?. Talk of the Nation (NPR), Retrieved April 17, 2009, from Newspaper Source database.

Loneck B; Garrett JA; et al (1996). The Johnson Intervention and relapse during outpatient treatment. American Journal of Drug and Alcohol Abuse, 22(3):363-375. Retrieved April 17, 2009, from Academic Search Premier database.

Malis, R., & Roloff, M. (2007, January). The effect of legitimacy and intimacy on peer interventions into alcohol abuse. Western Journal of Communication, 71(1), 49-68. Retrieved April 17, 2009, doi:10.1080/10570310701199186

Polcin, D. (2003, January 15). Rethinking Confrontation in Alcohol and Drug Treatment: Consideration of the Clinical Context. Substance Use & Misuse, 38(2), 165. Retrieved April 20, 2009, from Academic Search Premier database.

Polcin, D., Galloway, G., & Greenfield, T. (2006, February). Measuring Confrontation During Recovery From Addiction. Substance Use & Misuse, 41(3), 369-392. Retrieved April 20, 2009, doi:10.1080/10826080500409118

being a fully functional person

Being a Fully Functional Person

Here is where the two books I am reading intersect in purpose. In Rituals of Healing: Using Imagery for Health and Wellness, the idea is to increase one's physical functionality. In On Becoming a Person, the idea is to increase one's mental and emotional functionality. So far, with the help of the first book, I have created a breathing routine, or ritual, which has helped me a lot with lower my stress and tension, as well as with my asthma problems (though it doesn't completely rid me of them). I still have yet to work on something for the chronic pain, which is a revelation in itself, since I had the underlying belief that taking care of the stress and lessening the fatigue would reduce the pain. So sometime this week, I will have to rethink my chronic pain.

Ever since my late twenties, I had often expressed the desire to be a fully function human being. But looking back, I'm not sure I really knew what I meant by that, outside of the wish to feel compentent and secure--and the ability to keep up on housework. And yet nothing I did seemed to be enough. Instead of feeling more human, I found myself feeling less and less human. Carl Rogers, based on his observation of his clients, defined being fully functional as "being the self one truly is". This means to accept that there are some things I am good at and some things that I am not good at. I have always understood to a point that I had to play with my strengths, and have even had some success with it.

However, looking over my past efforts, I approached them more as a problem in engineering, than a progression towards personhood. Instead of being more efficient, I might have been more successful if I questioned the "shoulds" more, fought the facades being placed on me in an effort to please and meeting the expectations of others. That might to make it easier to follow my own direction, with all the complexity that is me. That doesn't mean that I can ignore the expectation of others completely, but I can certainly be more picky as to which expectations I accept and those I don't.

Life is not a steady state. Years ago, I wrote the following mission statement for myself: "Everything deserves respect and an opportunity to develop itself to its fullest potential, including me. This can be achieved most effectively when the forces of our lives are in balance. Imbalance causes stress and a system in stress must compensate for that stress. This is the way of nature, whether it occurs in an ecosystem or a test tube or someone's life. My body and mind are ecosystems in themselves and need to be kept in balance. This balance is not a steady state, but a fluid, living thing that requires adjustments from time to time."

Becoming a Person

Becoming a Person

A summary by A. Doerr over Chapters 5, 6 & 7

 

[Yes, I am a few weeks late with this.  I have been reading the material, but not writing on it.  I will hopefully correct this oversight during the next few weeks.]

 

What does it mean to become a person?  Aren't we already a person because of our humanity?  While this makes sense logically, intuitively, most of us know that this isn't true.  For what every reason, many of us have experienced blocks to feeling that we are actually people and deserve to be considered as such.  The idea of taking "quiet pleasure in being" ourselves is a foreign and almost blasphemous concept, one often confused with pride and boastfulness.  Yet, there is a difference between the loudness of boasting and the quietness of acceptance--to accept that we have just as much right to exist as anything else in this universe.

 

According to Carl Rogers, the inner most core of a person is basically socialized, forward moving, rational and realistic.  But to get there, people must accept that they are human organisms, with the realistic ability to control themselves and socialize.  To quote Rogers, "There is no beast in man.  There is only man in man."  And when humans are less than fully human--when they deny various aspects of their experience--then there is reason to fear their behavior.  Such people cannot make adequate judgments because they have contorted their own data.

 

So, what are the traits of a fully emerged person, according to Carl Rogers?  First, an openness to experience.  This doesn't necessarily means to seek out new experiences, as it does to actually be open to what we are currently experiencing and seeing it without preconceived notions.  To take the situation as it is, without distorting it.  Second, trust in one's self.  To believe that we are capable to make correct choices and behave in a satisfying manner in a situation.  Third, to evaluate ourselves using an internal standard than to constantly compare ourselves to others.  This includes accepting responsibility for our actions.  Finally, to be willing to accept that we are always a work in progress and never a finished product.  We constantly flow with life and its events.  We don't jump from plateau to plateau.

 

To be able to achieve these traits, we have to move from being remote to our feelings to being able to accept them, even in ambiguity, as we feel them. We accept new experiences within their own existence, without imposing the structure of the past onto them.  We reconsider our mental constructs.  We are not threatened by other possibilities.

 

I personally believe that by lessening our frustrations created by incompatible self-perceptions, we lessen the stress that needs to be released and are more able to release it in a controlled manner that have it corrosively seep out our seams or blows up in our faces.

The Helping Environment

A Helping Relationship

 

For those who haven't heard of Carl Rogers, here's a summary of what research has found to be of the most help in counseling: That the client feels that his/her therapist is trustworthy, that the therapist tries to understand them, and that the therapist is being genuine with them.

Techniques and teaching methods alone do not bring about improvement. It's hard to trust the process, if you don't have faith in the person putting you through it. This is true for most relationships, even those that you may not consider personal. Take calling up customer service for help, for instance. If the representative doesn't seem to care about your problem or doesn't seem to understand, you're not likely to have much faith in what they tell you--especially, if like me, you normally find that this type of customer service representative is far more likely to tell you something that causes more harm than good. Not getting enough data will give diagnoses that may be very wrong and don't fit in with the other things the client is experiencing. It's hard to give sensitive information to someone whom you don't trust, even if you know intellectually you should. It's a matter of self-preservation.

But if one has the knowledge, they can tell you what's wrong. And knowing what's wrong is half the battle, right? To such a question, I answer, "Only if the diagnosis makes sense to the one it's being applied to." Though to be honest, I still believe that a diagnostician who doesn't have the client's trust is working under a handicap. Anyway, no diagnosis will help a client to make any significant change to their lifestyle if they don't comprehend it. I can't find my book right now, but I believe it is in John Bradshaw's Healing the Shame that Binds You where the author gives the example of a preschooler being reprimanded for riding their tricycle beyond the corner, after being told several times not to. While the parent was engage in rage, the terrified child looked up and asked, "What is a corner?" No one can follow instructions they can't understand.

Another situation that many people are probably more familiar with: someone is in a very abusive relationship, who really should leave, but doesn't--or if they do leave, they return to it after a while. Most people who have been on the outside looking in, often give up on the person, saying things like, "They want the abuse." "They're idiots." "They're just hopeless." However, what often happens is these people don't leave because they really cannot comprehend how to live differently. Sometimes financial or cultural issues keep them there. Sometimes they don't understand the help they can receive. However, some of them stay because of beliefs that the relationship will change if they just work hard enough at it, or love the person more, or that they are the ones at fault. These people can be pressured into leaving their abusive significant other, but they do it to please those pressuring them, not because they themselves believe the abuser is horrible. In fact, being insulting about the abuser is more than likely to bring out the protective response in them. As long as they see some hope in the relationship, they won't give it up easily. Only they can make that decision and make it stick. After all, if you are demanding them to get out of the relationship, you might appear just as bad as the abuser they are dealing with. That's not to say that you shouldn't tell them that there is something wrong, if they appear open to it. Nor am I saying that you shouldn't interfere if it becomes a matter of life and death. However, when all is said and done, only the person can finally cut those ties.

What has worked the best for me when in such a situation is to emotionally support the person in their decisions and let them know that I am there for them, even though I don't agree with them. Usually when they no longer feel pressured to defend the abuser or the relationship, they are able to make the decisions necessary for their own happiness and there are no "What if I had tried this or that?" regrets to contend with. When all is said and done, they need the support more than they need the problem labelled, though the label can help them to address the problem.

Grossly simplified: diagnosis is not the same as therapy. This is a particularly sore spot for me because as someone who intends to become certified as an art therapist, one of the greatest frustrations I have is getting people to understand that when I speak of doing art therapy, I am not talking about using the client's art to see what's wrong with them--I'm talking about the client using their art, especially the process of making it, as a means towards self-understanding and growth. Yes, it is possible to diagnose certain conditions through artwork. Studies have shown that schizophrenics often draw in a certain manner and that sexually abused children will often exaggerate certain body parts when drawing people. However, studies have also shown that it is what an individual personally attaches to an image that matters when it comes to a therapuetic art process. And non-directive therapuetic artmaking works better in most cases than telling the client what to draw, even though directive artmaking is not without some benefit.

The research on Carl Rogers' person-center therapy has been so convincing and thorough that almost all schools of therapy promote using it in addition to their methods and philosophies. But how does one foster this trusting and safe environment with a client? Not without a lot of soul searching on the part of therapist. To be able to provide a safe environment to allow the client to explore the dark and scary parts of their own psyche, the therapist has to be able to not only deal calmly with the client's fears and anger, but their own. We are never truly as good about hiding things as we often belief we are. Things slip out at times and if we do not handle those feelings with genuiness, then we give our clients very good reasons to feel at least a little unsafe around us. They will hold back telling us about certain feelings and thoughts to keep the therapist from reacting badly. However, if the therapist also has shown that they believe in the client's abilities to grow and be stronger, then the relationship has another mooring to keep it in place. Likewise, an understanding of the problem as the client experiences it creates yet another mooring.

In a way, the therapuetic relationship is like scaling a cliff with the therapist as a guide and safety line. Both therapist and client has some treacherous terrain and loose rocks to look out for, but a skilled therapist, like a mountain guide, makes sure the safety lines are in place and knows not only how to handle the situation when the client slips, but what to do in the hopefully uncommon situations when both do.

 

Symbolism and Imagery

Sources:

Rituals of Healing: Using Imagery for Health and Wellness by Jeanne Actherberg, Ph.D., Barbara Dossey, R.N., M.S., FAAN, & Leslie Kolkmeier, R.N., Med.

The Power of Symbols by A. "Mandy" Doerr, http://ldsconnections.livejournal.com/277.html 

 

Okay, I'm going to be a little lazy here.  I am going to reprint what I wrote years ago in The Power of Symbols because after rereading it, I realized that I would be hard-pressed to improve it.  (Though I have added a clarification or two as a footnote.)  After the essay, I will write a few paragraphs on the technicalities of imagery.

 

    Simply said, a symbol is something that represents something else. The letters you are reading now are visual symbols (or physical symbols if you're using a Braille reader) of verbal words which in turn are auditory symbols of concepts, ideas, objects, actions, people, etc. Numbers symbolize relationships and amounts. Individually, letters and numbers are very simple things, but put them together in patterns and manipulate them and you have the ability to communicate the depths of the soul or discover the secrets of the universe.
    Carl Jung would probably have cringed at my discription above, for I included what he termed mere "signs" in my definition of a symbol, in addition to his definition of a word or image that "implies something more than its obvious meaning." (From Man and His Symbols.) I do this because my inner engineer sees no point in the distinction when she is manipulating concepts. My inner poetess does agree with Jung, but finds what the inner engineer comes up with very intriguing and will rarely protest. The inner matriarch, however, will put her foot down if she thinks the other two are getting out of control.
    So despite what my inner engineer thinks, it is still a very good distinction to make. While signs relay only information, symbols affect us on a much deeper level. Quoting from Man and His Symbols again, I give you Jung's explanation:
    It has a wider "unconscious" aspect that is never precisely defined or fully explained. Nor can one hope to define or explain it. As the mind explores the symbol, it is led to ideas that lie beyond the grasp of reason. . . . Because there are innumerable things beyond the range of human understanding, we constantly use symbolic terms to represent concepts that we cannot define or fully comprehend.
    About this time my inner poetess smiles in smug triumph and my inner engineer goes, "That's what you think, buddy." At which point the inner matriarch gives them both cookies and milk and tells them to be quiet for a few moments.
    The point is - a symbol carries not only a meaning, but a set of related meanings, some which may not be apparent at first. Furthermore, there are different sets of meanings that exist for a symbol depending on the context it appears in - just as there are different means for many phrases depending on the context surrounding them. Alter the context just a little and new connections become apparent. Alter too much and it all becomes meaningless.
    "But how can one be sure of the correct context?" asks my inner engineer. To which my inner matriarch answers, (after smacking the back of the engineer's head for talking with a mouth full of cookie crumbs), "By finding the symbolic constants and manipulating them until everything falls into place." My inner engineer then takes a large sip of milk and starts talking excitedly about mathematical atomic models and how they progress over history, until they become better and better at predicting atomic behavior. My inner poetess sets down her cookie and asks, "And how do you know when you have reached the truth of what an atom is really?"
    My engineer blinks and says, "Well, it's impossible to know what an atom is really like because we can't see it. We can only construct mathematical representations that explain the behavior we see through experimentation."
    "Then Jung was right," my poetess says. "Man cannot understand everything. Even you must relinquish the concrete for the symbolic."
    My engineer shrugs. "I'll give you that, but it does show that signs can work the same way as symbols." 
    "I think the mathematical signs you're referring to could also be considered symbols," return my poetess. My inner matriarch hushes both up again before they get into an argument.
    There are symbolic constants that exist through the collective conscious of humankind. They are called symbolic archetypes and we have only begun to meticulously identify them in the past century or so. Many psychologists are rediscovering the power in them and more personal symbols in the transformation and maturing of self - knowledge once widely accepted among ancient cultures. After discovering that man is made up of atoms and their bodies planned through DNA, we are just now starting to appreciate that the human mind is a symbolic entity.
    This should not come as a surprise. The cornerstone of intelligence is the ability to make connections and identify patterns. That is what a symbol is - a concentrated module of connections and patterns. Some of us have just set that part aside in the pursuit of the concrete. Because of the concentrated nature of symbols, they can be very powerful things if used just right. They can explain processes, sway opinions, give direction and even predict certain events.**
    In its own way, science has stumbled across the dual nature of man. The carnal, concrete being and the spiritual, symbol-driven one. Through the use of symbols, we learn to access our spirit - to either use it or abuse it at our whim. Properly harnessed, the spirit is stronger than the body. Studies on survivors show that the factors that determines who will survive and who will not is not their physical attributes, but their emotional and mental ones.
    We as individuals are very much like symbols - we too are much more than what is obvious at first glance.

** When I refer to predictions, I mean as a mathematical model predicts behavior.  Those who have been keeping track of the recent fMRI research or read the science headlines, have probabling already seen the articles about areas of the brain becoming activated when it anticipates needing those areas.  Also, many IQ tests rely on our ability to predict the next symbol in a series.  In fact, some people insist that prediction is a major part of intelligence.  Probably a really good example of what I am talking about is one of the basis of Isaac Asimov's Foundation series, specifically the concept of psychohistory as a mathematical science.


Okay, now on to the terminology and such of imagery in a healthcare setting.  I must apologize, but after reading everything, I decided I would be better served with a vocabulary list, then an essay on imagery.  I sort of consider imagery as the practical application of symbolism.  I could share some of the data I've found in the past on the effectiveness of visualization exercises and such, I suppose.  However, this is already pretty long. 

 

Types of Imagery

Receptive Imagery - images the come into the mind of their own accord and not consciously created.

Active Imagery - images consciously and deliberately created.

Concrete Imagery - technically correct (or real-life) images.  Sometimes referred to as biologically correct imagery.

Symbolic Imagery - images that represent something else in a symbolic way.

Process Imagery - imaging step by step to the final goal.  Often uses concrete imagery.

End State Imagery - images that represent the final healed state of the individual.

General Healing Imagery - images that are involved in the healing process without being part of the process or end state imagery.

Preverbal Imagery - images that have more of a connection with the physical body than language can express.  Can include other senses such as touch and hearing.

Transpersonal Imagery - images that represent connections to other people or another power outside of one's self.

Package Imagery - imagery created by someone else to use in an exercise.

Customized Imagery - imagery created specifically by the person using it, which is unique to them.

 

Chapter 5 and 6 of Rituals of Healing cover things like relaxation exercizes and and creating your own imagery.  On pages 77 and 78, it discussed the Imagery Assessment Tool (IAT) for determining the dynamics of a patient's imagery.  There is also a list of conditions where imagery often becomes of limited usefulness, such as an inability to concentrate because of depression, pain or medication being taken; lack of motivation and/or time; or an intense need to please others with the images, instead of accepting what comes to mind.

I create art too.

I have put up some of my art for sale. Feel free to look at it and send your friends to it.

Original Art - http://amandadiane.etsy.com
Prints - http://mamaslyth.deviantart.com/store/?utm_source=deviantart&utm_medium=userpage&utm_campaign=storefront
Merchandise - http://www.cafepress.com/adbarncord

Carl Rogers

A brief background summary by A. Doerr


[Sources used: On Becoming a Person by Carl Rogers (Preface, Introduction, and Chapter 1); Wikipedia Entry on Carl Rogers; and "WE OVERCAME THEIR TRADITIONS, WE OVERCAME THEIR FAITH" by Dr. William Coulson.]


Carl Rogers was the fourth of six children from a relatively well-to-do and affectionate family. His parents were very protective and created a very rigid religious environment to raise their children in to keep them uncorrupted by worldly things. To this extent, the family moved to a farm when he was twelve. There his father, a prosperous business man, farmed as a hobby and the children were encouraged to do the same. On the upside, this installed Rogers with a strong conscience and gave him a strong animal science background. On the downside, this upbringing convinced Rogers that people were inherently good and that strict religious systems were harmful to an individual's personal development.

This last belief was further strengthened after he changed from a degree in agriculture to history and joining the ministry. He felt that he was being indoctrinated more than taught. In 1922, Rogers went with a Christian student group to France and Germany after World War I. It was then that he was exposed to the concept that very honest and good people can believe very different things. After further religious study, he became convinced that it was "a horrible thing to have to profess a set of beliefs, in order to remain in one's profession." (Rogers, 1961, p 8) This eventually lead him to becoming a children's counselor and then a very successful psychologist when it came to dealing with neurotic patients.


If we to inject the generation cycle theory put forth in the book Generations by William Strauss and Neil Howe, we can easily place Rogers in the G.I. Generation due to his birth. The quote from Wikipedia that states: "[a]ll of them entering midlife were aggressive advocates of technological progress, economic prosperity, social harmony, and public optimism" does fit Rogers a great deal. He was very optimist about human nature and social harmony. However, perhaps due to his very protective upbringing, Rogers also shares many traits of those in the Silent Generation, advocating "fairness and the politics of inclusion, irrepressible in the wake of failure."


I've included this sociological information to help explain Rogers' fame and infamy. Peter Kramer's posthumous introduction to Roger's book On Becoming a Person mentions that in some ways, Rogers was what Isaiah Berlin would call a "hedgehog"--he knew one thing, but he knew it so well that it became his world. Most of Rogers ideas were good and are still in use today, especially his push to get the field of psychology to rely more on scientific methods and studies, but his own work was mostly for neurotics. His success there was worthy of the fame he received. It was when he tried to apply his theories to people who weren't neurotic that things fell apart.

To quote Neils Bohr: "An expert is a person who avoids small error as he sweeps on to the grand fallacy." Rogers' grand fallacy was the IHM Nuns controversy. Dr. William Coulson, an assistant of Carl Rogers who was personally involved in this experiement, has spoken on the subject with much honesty and clarity. Though, like Rogers, the "all or nothing" thought distortion sometimes raises its head. Though I'm not really sure if it is them actually, or the people who are presenting their work to prove their own agenda. It is my impression that the cause of this disaster in the field of psychology was based on the following factors:


1) Rogers did not stop to consider how his own issues were being triggered. After all, the Catholic school acted much in the way his own mother did towards him and his siblings. Of course, the feedback from the progressive faction of the IHM only helped to feed his biases by suggesting that things did need to be changed. However, even though a lot of something can be bad, that doesn't mean that any bit of it of all is also bad. In fact, some of it may actually be necessary.


2) Rogers believed that all people were good. As Maslow said, there was great danger in his assumption that there weren't paranoids, psychopaths or other destructive people that would mess things up for him.


3) Rogers' own belief that people should ultimately be their own authority backfired on him. In his assumption that all people were inherently good, it had never occurred to him that not everyone had a conscience as well-defined as his, even though Abraham Maslow warned him of the evil that can exist and the failure of his methods when Maslow tried to use it with his own students. So, while the encounter groups ran by Rogers and those who were afraid of Rogers no one wandered into sexual misconduct, other facilitators were not as restrained. In fact, Rogers and Coulson were unaware that of "the reports of seductions in psychotherapy, which became virtually routine in California."

Coulson summarizes this backfiring better than I could: Rogers didn't get people involved in sex games, but he couldn't prevent his followers from doing it, because all he could say was, "Well, I don't do that." Then his followers would say, "Well, of course you don't do that, because you grew up in an earlier era; but we do, and it's marvelous: you have set us free to be ourselves and not carbon copies of you."

4) There was several older nuns and priests looking into feminism and other social reforms who neglected to provide any real guidance to their students, who were lead to believe that they would receive sound guidance. So instead of being liberated, the students were actually abandoned. Granted the studies about the human brain not being fully developed until age 26 probably weren't available at that time and the leaders didn't quite comprehend that their charges were still developing judgment skills.

5) The popularity of humanism was at its height and coupled with drug use in many cases. While Rogers had troubles with even putting soda pop in his body as a young adult, I wouldn't be at all surprised if some of his followers considered drug use as a means to overcome obstacles to being one's self.

6) California is not really a place to find "normal people" in large numbers. (I was borned there and live only a few years there and even I can't claim to be a "normal" person.) Rogers probably should have been suspicious when he couldn't get the same study to work in Wisconsin because the participants kept dropping out when they realized what was going on. Instead, he found a group willing to invite him in to do this. That in itself should have been a red flag. However, I will not judge him on that matter, considering the fact that humans have a wonderful tendency to ignore red flags and I have done it a time or time myself.

Even though this became a total failure as an attempt to improve the lives of the nun, it did eventually improve and support the ethical guidelines for psychologists. Counselling students are now taught that it is unethical to try to change a client's religious beliefs, to have sexual interactions with the client, and to be aware of one's own issues enough to know when they should refer a client to a professional without the same issues. Rogers did realize his own folly. So, while he did fall into Bohr's definition as an "expert", he and the field of psychology did learn from his mistakes.

From now on, I will be focusing more on what Rogers got right. Having accepting his human fraility, I will start on his brilliance.

Essay on the purpose and basics of rituals

Essay on the purpose and basics of rituals

A. Doerr

 

Based on the text: Rituals of Healing: Using Imagery for Health and Wellness by Jeanne Actherberg, Ph.D., Barbara Dossey, R.N., M.S., FAAN, & Leslie Kolkmeier, R.N., Med. 
 

 

For the intents and purposes of this essay, I will define a "ritual" as a planned set of symbolic actions.   Otherwise, I am going to end up writing a treatise and I don't want to.  As you will notice, I'm not being extremely scholarly about this essay, either.  If we're going to talk about the ways rituals help us, then I might as well explain the one I am performing right now.  One of my rituals is to take material that I read and see how it integrates into my already acquired knowledge and personal experiences.  I am what some call an "experiential learner".  My ritual of ingesting information by using it in the form of an original writing, organizing it in some way, or just finding a practical use for it in my own life, helps me to retain and understand the information better.  This is really the purpose of rituals--to help.  Whether by controlling anxiety through organization, recognizing achievement, dictating social actions to make things go smoother, or creating social bonds, rituals are usually established as a helpful mechanism for life's changes and challenges. 

 

In general, a ritual has three major phases to it--separation, transition and return.  I was first introduced to the structure of rituals when I was taking my bereavement class as an undergrad.  It fits for funerals, weddings, commencement ceremonies, inaugurations and even my little ritual here.  In all cases, a significant amount of planning is involved.

Separation can be either voluntary (such as becoming a graduate or a bride) or non-voluntary (such as a griever of a loved one who died).  In this phase, the major participants of the ritual become marked as different from the rest of society.  While mostly symbolic, this separation can also be a physical one.  In many cases physical separation serves a purpose.  Grieving, depressed and ill people need to conserve their energies to deal with their tribulation.  Graduates, engaged couples, presidents elect and students like myself need time to organize and plan without distractions. 

Transition is the formal part of the ritual where the participants change from their former lives to their new lives.  The grieving say goodbye to the deceased.  The bride and groom become wife and husband.  The undergrad becomes the graduate.  In other cultures, a child becomes and adult.  And I become more educated.

 

Return is the re-entry into daily life as dictated by the new social role.  In my case, it is the sharing of my knowledge with others.   However, my "re-entry" is atypical in its shortness.  For most rituals, the return to daily life can take a while as the person adjusts to their new life.

Healing rituals have a few other commonalities.  The first part if the "naming" of the problem.  Talk to any person who has finally gotten a diagnosis for an illness, and you will find that a sense of empowerment and relief often comes with it.  (I had a friend who used to tell me that I was the only person she knew, who was happy to find out I was clinically depressed.)  There are obviously some exceptions to this, but in general it is true.  However, the naming of the problem must come from someone the person trusts or it's not going to help at all.  (Like the fictional Dr. House who refuses to believe that he has lupus.)  In a way this is the medical part of the separation ritual.  By having a name for your problem, you become part of a definite and separate subgroup from the rest of society.  Part of the transistion phase of a healing ritual includes many common steps of recovery, helping the participant to live a healthier life.  Effective healing rituals help to create stronger support systems for the participant, making the return to daily life a more stable one.

Self-made class

Extracurricular Reading in Mental Well-Being
Spring 2009 - First 8 weeks
Syllabus
A. Doerr


Goal: To consider the implications of Carl Rogers’ view of psychotherapy and explore the use of healing rituals as they are presented to the nursing field.


Basically, both of these books have been waiting for me to get round to reading them. I chose to do these two together because the combination is a balance of theory and application. The dates listed are the completion deadlines for each set of assignments. Supplemental reading is not mandatory, but we’re talking about me here, so it’s pretty much a given. Essays will be posted on http://cosmicsiren.blogspot.com. Diary and ritual work will be summarized to protect privacy. Images may possibly be scanned and also posted. Readers of the blog are more than welcome to follow along themselves, and civilized questions and comments are more than welcomed.



Books: On Becoming a Person by Carl R. Rogers
Rituals of Healing: Using Imagery for Health and Wellness by Jeanne Actherberg, Ph.D., Barbara Dossey, R.N., M.S., FAAN, & Leslie Kolkmeier, R.N., Med.

Week 1 - 1/16/09
Reading: Rogers - Intro, Preface and Chapter 1 “Speaking Personally”
Actherberg, et al - Chapters 1 & 2 “The Healing System”
Assignments: Essay on Rogers’s reputation and background
Essay on the purpose and basics of rituals

Week 2 - 1/23/09
Reading: Rogers - Chapters 2, 3, & 4 “How Can I Be of Help?”
Actherberg, et al - Chapters 3, 4, & 5 “Connecting Body-Mind-Spirit”
Assignments: Essay on the characteristics of a helping relationship
Essay on imagery and symbolism

Week 3 - 1/30/09
Reading: Rogers - Chapters 5, 6, & 7 “The Process of Becoming a Person”
Actherberg, et al - Chapters 6, 7, 8, 9, 10, 11, 12, & 13 “Anxiety, Pain and Procedures”
Assignments: Essay on what it means to become a person
Do a “diary symptom chart” (p 98) for the week

Week 4 - 2/6/09
Reading: Rogers - Chapters 8 & 9 “A Philosophy of Persons”
Actherberg, et al - Chapters 14 & 15 “Healthy Breath”
Supplemental Reading: The Palette of Breath - Facts About Breathing by Lauren Robbins
Assignments: Essay on being a fully functional person
Create and use a personal breathing ritual; chart its effectiveness; and critique the process and your participation in it

Week 5 - 2/13/09
Reading: Rogers - Chapters 10, 11, &12 “. . . Research . . .”
Actherberg, et al - Chapters 16, 17, 18, 19 & 20 “Healthy Heart”
Assignments: Discuss the implications of the person centered approach in research
Based on the diary symptom chart, create a ritual for your most significant health concern and evaluate the ritual using the imagery assessment tool on pages 77 & 78.

Week 6 - 2/20/09
Reading: Rogers - Chapters 13, 14, & 15 (Education)
Actherberg, et al - Chapters 21, 22, 23, & 24 “Healthy Abdomen and
Reproductive System”
Assignments: Essay on person-centered education
1st week of full ritual with diary entries

Week 7 - 2/27/09
Reading: Rogers - Chapters 16, 17, 18 & 19 (Interpersonal)
Actherberg, et al - Chapters 25, 26, & 27 “Healthy Immune System”
Assignments: Discuss the aspects of interpersonal interactions
2nd week of full ritual with diary entries

Week 8 - 3/6/09
Reading: Rogers - Chapters 20 & 21 “The Behavioral Sciences and the Person”
Actherberg, et al - Chapters 28, 29, 30, & 31 “Peaceful Dying”
Assignments: Essay on personhood and behavioral science
Ritual reflection paper

Well...

I found out where it went and I deleted the obsolete blog, but I can't convince Google to post to this one. I might need to try this again later.

Okay, found it again. Apparently Blogger is ignoring my request to publish directly to the blog.

I'm trying to figure something out.

Basically how the "publish to blog" feature works from Google Documents. At the moment, I've posted two items and I have no idea where they are. Perhaps I have to wait for an update cycle or something.

Or maybe the stuff is being posted to somewhere else. I hope not, because it would make it a lot easier to post stuff here if I could just do it from Google Docs while working on school papers.