The Power of Diversity

In sociology, stigma is defined as something that prevents a person from being accepted into normal society.   https://www.reference.com/world-view/sociological-definition-stigma-6e94fe5a36dc02c3#

If we look at stigma as arising from the fear of things perceived as unfamiliar and judged abnormal, then we must think of challenging stigma by making the characteristics associated with stigma more familiar and thus less fearful.  For me, central to stigma is discrimination and exclusion.  The antidote:  working with someone as a colleague, knowing such a person as a neighbor and friend.

The hard fought battle for accessibility, fueled by the Americans with Disabilities Act of 1990, has made jobs and community participation possible.  Whereas it is easy to observe the progress that has been made in the realm of physical (observable) disabilities, there has been little progress for those who have been defined as mentally ill – those crazy people. 

For me, the key to the lack of progress is the failure to use what we know about how to diminish Fear.  Horror movie producers utilize a basic principle:  the dreaded monster is not clearly seen until the climax.  If we are given enough time to see the movie monster, familiarity diminishes the required fear of the movie-goer. Throughout history, those of us who have experienced anomalous, extreme mental states, regardless of the causes, have been removed from our communities.  That isolation makes re-entry, with the added burden of stigma, a formidable life-long task for many of us.

For years I have been disturbed by the various attempts made to extinguish stigma.  What I have seen are futile public education campaigns that barely make a dent in the public consciousness.  Typically, such campaigns center on education about the nature of mental illness and the current treatments that are in vogue and validated by testimonials.   Popular are statements equating mental illness with other forms of manageable illnesses that can be treated with medications. 

 Some pundits speak of what a dangerous time we live in.  Random, unpredictable violence is attributed to people with mental illness.  The media thrives on sensational stories while citizens desperately look for predictability to soothe their fears.  The other, the different, become the target.  Control with its illusion of safety, is believed to be attained by identifying, excluding and isolating those projected to be dangerous. 

 In his book, The Better Angels of Our Nature: Why Violence Has Declined, Steven Pinker, a professor of psychology at Harvard University, makes a compelling argument that statistics show a decrease in human violence.  Yet his treatise does little to challenge our heightened perception of lurking danger.

Fear remains high.

I offer my thoughts as to what I believe to be keys to more effective approaches to overcome the exclusion and isolation engendered by stigma.  Inclusiveness is the antidote. 

 An encouraging sign of progress is the increasing valuation of people with lived experience or perhaps more aptly, experts by lived experience.   I have been fortunate to be a psychiatric survivor and a psychologist.  In my dual role, I have been privileged to be invited to speak to students and faculty at various universities.  While responding to questions I frequently say, I know that among you there are those who have had experiences similar to what I have spoken about.  Wouldn’t it be enlightening if students and faculty could freely discuss their experiences with anomalous and/or extreme states of consciousness?  Theories and treatments could be evaluated and new ideas would be generated when considered through the lens of those with lived experience.  I have suggested that I would not need to be invited to speak if openness was supported so that those resources that were already there among students and faculty could inform.  My wish is for lived experience to be valued as a credential, and a special effort be made by universities to support such students who are in various stages of overcoming adversity.

Last week I attended the American Psychological Association Annual Conference.  For many years I have attempted to support and encourage those psychologists with lived experience to consider being open about their background – that is if they are in a position to do so.  I regret to say that we still remain few in number and those who disclose are usually near the end of their careers.   A few of us who are open, along with a law professor, have recently co-authored a journal article surveying discrimination in state licensing laws for psychologists.  The article “State Psychology Licensure Questions About Metal Illness and Compliance with the Americans with Disabilities Act (ADA)” is scheduled for publication in the American Journal of Orthopsychiatry.

 Another critique of mine is directed at the often cited remarkable people who have made major contributions.  Anti-stigma campaigns cite famous figures who have struggled with mental illness.  Mentioned frequently are: Abraham Lincoln, Winston Churchill, Virginia Wolff, Beethoven, Sylvia Plath, Issac Newton, Judy Collins and many others.  My objection:  Do we have to be famous with extraordinary talent in order to be accepted?  Does one become extraordinary simply by virtue of having recovered or transformed their experience?  Do those in various stages of recovery need to act super normal with no eccentricities in order to be included?  Perhaps we see here why so many remain “the hidden recovered.”  Some years ago I developed a three hour recovery training module for the 18 New York State psychiatric hospitals.  Former patients presented to hospital employees about their experiences and the factors that propelled their recovery journeys.  The most profound feedback came from ward staff.  Many said they were not aware of what these former patients expressed.  Most salient of the comments was:  We never see the successes, we only see the failures who are readmitted.

 I remain hopeful.  Progress is slow.  The fight for passage of the ADA was a protracted battle where many heroes put themselves on the front lines.  I believe our progress is dependent on more of us accepting the risk of being open and joining in the fight for rights and Justice for All.

I borrow a principle which I believe comes from the Western Massachusetts Recovery and Learning Community that I put in juxtaposition to the popular “recovery is possible.”

Recovery is PROBABLE

 

 

Madness and Freedom

When I switched web servers I discovered that subscribers to my blog were not automatically receiving my blogs. I am sending out this blog to see if it has been corrected.

What follows are two poems that explore madness and freedom. Madness has long been a topic for both famous poets and psychiatric survivors (some are both) to grapple with meaning.

In a Dark Time by Theodore Roethke

In a dark time, the eye begins to see,
I meet my shadow in the deepening shade;
I hear my echo in the echoing wood–
A lord of nature weeping to a tree,
I live between the heron and the wren,
Beasts of the hill and serpents of the den.
What’s madness but nobility of soul
At odds with circumstance? The day’s on fire!
I know the purity of pure despair,
My shadow pinned against a sweating wall,
That place among the rocks–is it a cave,
Or winding path? The edge is what I have.
A steady storm of correspondences!
A night flowing with birds, a ragged moon,
And in broad day the midnight come again!
A man goes far to find out what he is–
Death of the self in a long, tearless night,
All natural shapes blazing unnatural light.
Dark,dark my light, and darker my desire.
My soul, like some heat-maddened summer fly,
Keeps buzzing at the sill. Which I is I?
A fallen man, I climb out of my fear.
The mind enters itself, and God the mind,
And one is One, free in the tearing wind.

 

I Know Why the Caged Bird Sings by Maya Angelou

The free bird leaps
on the back of the wind
and floats downstream
till the current ends
and dips his wings
in the orange sun rays
and dares to claim the sky.

But a bird that stalks
down his narrow cage
can seldom see through
his bars of rage
his wings are clipped and
his feet are tied
so he opens his throat to sing.

The caged bird sings
with fearful trill
of the things unknown
but longed for still
and his tune is heard
on the distant hill
for the caged bird
sings of freedom

The free bird thinks of another breeze
and the trade winds soft through the sighing trees
and the fat worms waiting on a dawn-bright lawn
and he names the sky his own.

But a caged bird stands on the grave of dreams
his shadow shouts on a nightmare scream
his wings are clipped and his feet are tied
so he opens his throat to sing

The caged bird sings
with a fearful trill
of things unknown
but longed for still
and his tune is heard
on the distant hill
for the caged bird
sings of freedom.

Giving Meaning To My Life

This blog is a little late.  My excuse:  I was asked to write a brief essay on The Meaning of Life.  I did not know the person making the request so I looked at the website.  I was stunned to see the amazing group of people who had make contributions.  I felt honored and privileged to write on this weighty topic.  I found myself thinking about it for several days – wondering what if anything unique I might have to offer.  What I wrote is below and can also be found at:  www.excellencereporter.com

Locked in the seclusion room of the mental hospital, secured in restraints with mind-numbing psychiatric drugs coursing through my body, my spirit found a safe hiding place where it could hibernate.  Such was the major crisis that would be instrumental in determining the trajectory of my life.  I was blessed to learn that the human spirit has the power to overcome an imprisoned broken body.

I am not privy to a universal truth that would assign and define a meaning that all living organisms share.  I humbly submit what gives meaning to my life: that the unknown and unknowable nurtures in me an awe and respect for the power of spirit.  My good fortune obliges me to use what I know in service to others.  I believe that each of our lives has unique meaning that emerges as we play out our corporal existence.

To contemplate the meaning of life was more important to me during the years I struggled to emerge from my formative cocoon.  Now I am aware that meaning is manifested in the way I live my life rather than in the ruminating. philosophizing and searching to conquer life’s mysteries.  My decisions and the actions they generate are guided by an experience-based pragmatism vested in intuition, empathy and compassion.  Meaning is embedded in the tough choices that inform my attempts to live with integrity.

What clears my vision and supports my journey are principles forged in a crucible that challenged my survival.  I believe that in our darkest moments or in our greatest highs we have an opening to find the courage to seek clarity within our hearts.  Meaning is developed through events where circumstances do not allow equivocation.

I offer what gives me meaning – what I strive for within my imperfect life.  I wish for one principle to be accessible to all:  A Never Give Up attitude that makes you available to the always possible mysterious miracle that hovers in all of our lives.

NAMI and ME

NAMI and Me

Every soul has to learn the whole lesson for itself. It must go over the whole ground. What it does not see, what it does not live, it will not know. (Ralph Waldo Emerson)

For years, I have spoken with passion and rebelled against the purported medical “incontrovertible truths” that mental illness is the result of a broken brain, non-contextual, and manageable but not curable with an array of psychiatric drugs (with little discussion of the potential life-long adverse effects on body and mind).  NAMI, as a national organization, has held fast to its uncritical support of psychiatric drugs, while being rewarded with major financial support from Big Pharma.  NAMI has reflected the polar opposite of my beliefs, promoting policies I have railed against, most particularly in their denial of hope and change.  I write now about both of these – to passionately re-state my absolute belief in hope, and to acknowledge humbly the change I have witnessed in myself –towards many things, including my stance towards the families that make up NAMI.  But I do remain strongly opposed to policies that lobby for easing forced treatment requirements and more hospital beds instead of less restrictive interventions.

The shame of it is that this massive organization may be the only one that offers solidarity and community for families. When one becomes a member of NAMI, a family can find a common bond with other families that have loved ones whose distress has been inexplicable and beyond the help they have sought from experts.  Many find solace in not being alone and isolated.  They are taught that no one is at fault because their offspring suffer from a biologically-based illness.  The NAMI literature advises families to regard treatment and outcome as similar to how one deals with diabetes.  Also conveyed is the explicit message that since it is a disease, there is no stigma attached to it and that members can join an important mission of NAMI – to fight stigma.  Paradoxically, research and common sense experience have demonstrated that stigma is not eradicated by adhering to an illness model.  A much greater impact accrues from strategies that combat stigma by making it easier for people – all people – to be integrated into communities where there is safe affordable housing and employment with a livable wage.

 

So what propelled me to speak to a NAMI meeting?  I believe that after decades of activism, the passion and anger that drove me has changed.  I believe the anger is gone and the passion that remains is imbued with greater compassion towards the people who seek understanding and community that local NAMI groups offer.  I have become more open, more aware of complexity and I have a greater recognition of how much I don’t know.  When I looked around that meeting room, I was acutely aware of how much pain and suffering those who were there had experienced and how those emotions still remain close to the surface.  Clearly, the mental health services they had sought had failed them and NAMI was the default organization that gave them support and sustenance.  NAMI’s positions were reassuring and also instilled the belief that promoting the work of NAMI was a contribution they could make and be proud of.

 

Last week when I spoke at the Boulder County Annual NAMI meeting I described the Hearing Voices movement and other alternatives that were emerging that were showing positive research outcomes.  I said that I was encouraged by the budding recognition by state and federal funders of the benefits of employing peers who were experts by virtue of their lived experience.   I saw eyes opening in curiosity and I would like to believe hope.  I was surprised.  There is so much more that we know is now available which supports the individual road to recovery and infinite possibilities of yet untapped potentials.

 

People in all their diversity must be valued and raised up above the rigidity of dogma and old paradisms.  We have only begun to explore what is possible for the mind and soul when working in synchronicity.  May we all remain open and Never Give Up!

Facing Uncertainty

“Never underestimate the importance of what we are doing.  Never hesitate to tell the truth.  And never, ever give in or give up.” Bella Abzug speaking to a group of activists

Living presents us with many challenges.  Even the rare few who seem to skate through life by virtue of being gifted with remarkable talent and/or being kissed by good fortune will likely face the inevitable emotional and/or physical pain associated with the changes that life hands us.

Each of us is tasked with finding the path best suited to the dynamic interplay of: strengths, weaknesses, range of abilities, sensitivities, developmental experiences and the changing contexts (family, culture) within which we live. The seemingly random obstacles we encounter for moving our journeys forward in wished-for directions can be influenced, and at times managed, by the perspective we adopt.  Often I hear people introduce themselves as if they are a label or category that is defining.  Knowing that you are a psychologist, economist, mechanic, Christian, Moslem or schizophrenic does not tell who you are.  Is that label more important than knowing that you are a father, brother, son, friend and strive to support the environment.  Even knowing all of the above, it is really no more than what a snapshot shows you at a particular time.  Wanting to stay the same is a losing battle, much like trying to keep a string of beautiful sunny days from eventually yielding into becoming a rain storm.   Or the oft used example – once you put your foot in the river, that river will never be available to be stepped into in the same way.  Like the river, our experiences change us.  I believe that it is good for us and keeps us open to possibilities.

My many years of work to facilitate growth and offer alternatives to others in their failed attempts to alleviate pain and to live more fully has taught me that there are no theories or techniques that are consistently successful.  Some work much better than others, yet all are dependent on the specific individual, and the timing – where that person is at a particular time in his or her life.  It is somewhat confounding to recognize that what did not work 11 months ago might work now when the timing is right.

Paramount to me is the mandate to think critically, while not denying what you need to accept, yet never forsaking the possible.  When I was studying psychology, much was directed at studying what was abnormal to the neglect of ever really establishing acceptable guidelines for what is the ideal mentally normal person.  The best description I heard of back then was: ‘Being mentally healthy is best construed as the ability of the individual to tolerate ambiguity.’  Life is unpredictable and absolute truth remains elusive in the “sciences” that look at humans and their relationships.

Being social animals, we need physical and emotional contact with others.  Last night in our Hearing Voices group, Tim, a co-facilitator talking about himself said, “People are the best medicine.”  I really like that.

 

“If you come to help me, you are wasting your time.  But if you have come because your liberation is bound up with mine, then let us work together.”  Lila Watson, an Australian aboriginal activist.

 

Is Boredom the Enemy

The cure for boredom is curiosity.
There is no cure for curiosity.”
 Ellen Parr

Except in a psychiatric institution

If you are confined to a psychiatric hospital the two main  choices on how you spend your time are:  Sit in a plastic chair and watch TV or pace the hall.  Sure there are some other choices: you can mop the floor, you can go to therapy groups or attend other activities – cooperation means improvement.  You will simply do anything that gets you off the ward and gives you some short semblance of respite from painfully cruel boredom.  Subduing curiosity is destructive of our capacity to connect with our resilience and re-engage with our potential to live a life of meaning.

There is speculation among researchers that there is a link between boredom and depression.  Some have given it the name “apathetic boredom.” Another type of boredom is identified as “crushing boredom.”  I wonder if it is linked to more conditions than depression.

Chimpanzees, who may be considered our evolutionary cousins, are highly social animals who are stimulated by the daily novelty of life in the wild.  When confined to research laboratories, the endless boredom is crushing.  So crushing that we can see the dysfunctional behavior and emotions that mirror the experience of what we call “mental illness.”  What else might we expect when we put curiosity in a strait jacket?

A memory that sticks with me is the complaint a middle-aged woman expressed to me while I was conducting an educational seminar on self-help.  She said that she was frustrated by having to work her way through various inane steps in order to be eligible for independent housing. She was forced to  live with the restrictions of  a group home until she was judged suitable to live in her own home. To do this, she had to learn meal preparations and other self-care skills.  My memory of her complaint: “I cooked and kept a proper home while raising three children, why must I demonstrate that I can shop, cook and brush my teeth.  I am bored to death in classes where I learn nothing that I don’t already know.  And when I get angry, I am demoted to a lower rung on the ladder to independence.

I am often reminded of the Dignity of Risk – so essential to our development.  If we are forbidden from being open, facing our fears and embracing our curiosity, we remain frozen in apathetic boredom until it becomes crushing boredom.  If it is not our choice to sit with boredom, if it is imposed by controlling outside forces, it gives rise to impotent anger and all that is left is “learned helplessness.”

Investigators of boredom are also recognizing the benefits of certain kinds of boredom.  If we choose to stay with our boredom and contemplate the emotions and thoughts that spontaneously arise, hints of our creativity often emerges.

“I think, at a child’s birth, if a mother could ask a fairy godmother to endow it with the most useful gift, that gift would be curiosity.” Eleanor Roosevelt

Standing at the Threshold of the Rain Forest

The failure to fulfill one’s potential can be one of the most devastating and damaging things to occur to a person.  A kind of gnawing emptiness, longing, frustration, and displaced anger takes over when this occurs. Whether the anger is turned inward on the self or outward toward others, dreadful destruction results.  Edward T. Hall

Before you stands the vast rain forest where the road you once pursued has ended.  It is no longer viable.  The vibrant dancing shades of yellow, green, blue and red of the forest saturates your senses.  The cacophony of sounds reverberate through your spine.  Overflowing with energy and life, the unknown beckons.  Your skin tingles with sensuality.  Although frightened, you feel as if you are alive in a dream – a dream rich with possibilities.  Do you suspend caution and enter the forest?  Somehow you know, or maybe just hope, that within the mystery you will be able to re-build your spirit and find a new, desirable way of being.  Will you risk entering and surviving your dark night of the soul?  Perhaps for some, the need to be Awake and Present forces the acceptance of the challenge.   Others might persist in re-tracing the well-worn path from which their misery emanated.   A deep breath, conviction of need, desperate to find your unique authenticity, you jump off the path and embark on the journey to find yourself.

I’ve been there.

I believe that we are born with a diverse mix of strengths, weakness, capacities and gifts, or soul signatures as some say.  Those of us who are fortunate, discover at an early age what makes them feel good – that which is right about themselves – and how to pursue and develop their unique combination of talents.  Supported by family, teachers, friends and a myriad of fortuitous circumstances (environment, country of birth, economics, race, ethnicity, timely opportunities) they may find that rare unwavering path to the good inner and perhaps outer life.

Each of us self-define how much pain, misery and turmoil is too excessive to be tolerated.  When it becomes over-whelming, the choice can be made to abandon consensual reality.  In a way, it is an attempt re-claim yourself and to start over.  Without a guide, and often with the censure of community, it is easy to get lost in a forest absent the street signs we always depended upon.  With more experienced, trusted guides, there are more possibilities for success.  Perhaps if we developed a culture where there is more sensitivity to people’s needs, there would be less necessity to make such dangerous journeys.  Building bridges and more roads back from the abyss without sacrificing choice and freedom can make those unmapped trips less damaging for intrepid explorers.   And those that are able to return from their immersion in the untamed wilds of the imagination often bring us remarkable gifts in art, music, literature and insights into the potential and resilience of the human spirit.

 

 

 

The Hubris of Predictability

“The only freedom which deserves the name, is that of pursuing our own good in our own way, so long as we do not attempt to deprive others of theirs, or impede their efforts to obtain it.”  John Stuart Mill


How do we respond to probability?  Each of us has a different level of tolerance for risk.  Would you take a chance if the probability of a successful outcome is one in three?  Perhaps it depends on the reward.  What If the odds are 50 to 1 against having the desired result that you have chosen?  In horse racing the odds are set by experts who look at how the horses performed in past races with a similar class of horses.   An inexact science at best, where on occasion longshots of 50 to 1 or more defy predictions.  Is psychiatry more capable in predicting the course of mental illnesses than the horse racing experts?  Should we not be more humble in our predictions when we take into account how humans are more complex and diverse in their cognition, emotions and motivations than horses?

When scientists witness human beings defying predictions, they may call it an error – an error in measurement or perhaps the design of their experiment.  It is an unexplained anomaly.  And this anomaly too often does not disprove the truth (opinion) of the investigator, but merely reflects the need for this confounding variable to succumb to future discovery.  It is a mystery which begs to be solved.

If you were to win mega millions in the lottery, how would you regard it: as a miracle, chance luck, God’s gift?  The lottery can accurately tell players the probability of winning – the odds are astronomical but it doesn’t prevent people from playing.

My question:  who predicts, and with what accuracy, that a person will not be able to recover from being diagnosed with serious mental illness.  What are the odds, and how do we explain away the people who do recover and transform their experience?   Absent any formula, perhaps it is best to give people the freedom to find their way and provide the assistance and guidance they find suitable as long as they are not a danger to the community.  An advertisement for the New York lottery proclaims, “If you don’t play, you can’t win.”  In providing support to people attempting to deal with emotional challenges, I think we need to give them a chance at winning (transformation) by giving them the choice of how to play.

I believe that there is danger in being absolute in our convictions of what works and what does not, while exclusively focusing on the avoidance of risk.  There is Dignity in Risk.  If we are over-protective and tranquilize pain, we are subduing the spirit and the opportunity to develop innate potential and reshape one’s life course.

In my journey of 4 plus decades working on myself and others, I have come to value how much we do not know.  I am skeptical of absolute certainty in whatever knowledge-base it is presented.  Mystery is an ally that allows us to challenge unfounded dire predictions and fuels our motivation to Never Give Up.

John Stuart Mill, whose book On Liberty written in 1869, remains the classic treatise on the rights of the individual in relation to the community.  At age 20, he experienced what was then called a nervous breakdown.  He went on to become an influential Member of Parliament. Today, On Liberty is so highly regarded that the book is given to each new president of the Liberal Party in England.  I wonder what would have happened to this remarkable early feminist and advocate of individual rights for all, if his “mental breakdown” was treated with the absolute certainty that he must be forced to use psychiatric drugs.

Two additional quotes from On Liberty:

It is given to no human being to stereotype a set of truths, and walk safely by their guidance with his mind’s eye closed.”  

“A state which dwarfs its men, in order that they may be more docile instruments in its hands even for beneficial purposes–will find that with small men no great thing can really be accomplished.”

 

 

 

Sounds of the Heart

“Only those who have helped themselves know how to help others, and to respect their right to help themselves.” (George Bernard Shaw)

I love listening to blues music. Why, you might ask that after I spend so much time listening to people’s real life blues, do I find enjoyment in listening to such music? Perhaps, it is best explained by what I once heard discussed on a radio program – the blues come in through your ears, go straight to your heart and end up touching the spirit. Reminds me of another saying: the blues is the poor person’s alternative to psychiatry.

At a Native American Powwow, I heard Grammy winning composer and singer Bill Miller say that during a low point in his life he became depressed, and was hospitalized and injected with psychiatric drugs. He then said he would have done much better if they had prescribed for him an iPod full of music.

My wish is for all helpers to embrace mystery, know and monitor their own needs, and most importantly listen to the experiential based wisdom of those who have swam and survived their immersion in the seas of emotional pain and turmoil. Let’s listen to, respect and thoughtfully consider the suggestions and criticism that arise from those with experience based wisdom.

“You must have chaos within you to give birth to a dancing star.”  (Friedrich Nietzsche)

 

Interpersonal Relationship: The Foundation and Path of Growth

“The art of medicine consists in amusing the patient while nature cures the disease.”
(Voltaire 1694-1778)

In my studies to become a psychologist, I often heard my professors say that, Psychotherapy is both an art and a science. I have come to believe that it leans most to the side of art.

Mom and Dad are in the kitchen doing their taxes while 3 year old Johnny finds himself unattended for longer than usual. Chasing the cat, he trips on the rug, falls into the edge of the coffee table and cuts and bruises his arm. His first reaction is to look around to see if he has been busted for chasing the cat. When he realizes that no one saw him, his attention shifts to the pain coming from his bleeding arm. Suddenly he lets out a piercing cry, predictably, his mother and father dash into the living room. The intensity of their response makes Johnny howl even louder verging on hysteria. Mom and dad quickly survey the situation, look at each other knowingly and calmly and soothingly tell their son, verbally and with a calm demeanor that they will fix it. And so they do with the magic of mother’s kiss and father’s cajoling humor. All is well.

It is not just the innocent child who is master and slave to belief. Our thoughts, feelings and perceptions are passively shaped by our beliefs. I wonder if the powerful placebo effect is the material manifestation of the marriage of hope and belief. Today, wherever we turn, our attention is pulled to inducements to try the latest formulaic solutions to our problems. Few of us can resist being seduced by any number of fixes in the form of a pill, therapy strategy or one of the many forms of self-help. All of which may or may not work depending on the individual and the context and timing. A quick and easy intervention, heavy with promised results with a minimum of side effects has much appeal. Yet we often seem to be bumping against choices that do not take into account the fullness of who we are and offer only a temporary diversion for our immediate pains and concerns.

No one is immune to the physical and emotional pain of living. Such is life and perhaps it is especially so in these times in which we are now living. Having devoted much of my life to working with people who are in various states of distress, I think a lot about what we can do when who we are, and how we are leading our lives has become intolerable. How do we change and develop new ways of being?

We are socially interdependent creatures, rather than the independent heroes who are lauded in our current culture. Young people now live in various states of dependence within families for longer and longer periods of time. Yet Ayn Rand’s myth persists – that the highest ideal is to aspire to become the independent giant of industry who is only responsible to a personal ethical and moral code which is not accountable to anyone. To the contrary, no matter how rich or poor we are, we all need somebody. Of all living organisms, we require the longest period of care to survive childhood. To flourish, the importance of a caring family cannot be overestimated.

Absent the ideal, families may be assessed to exist along a continuum marked at polar opposites of good and bad. Most of us can probably assign our family of origin to a point somewhere within one standard deviation from the good-bad mean. If the family can provide just the right amount of love and protection coupled with a sensitivity to the child’s changing developmental needs, one might see the possible maturation of a capable adult. Probability perhaps, but not inevitable. Even the strongest foundation is likely to meet significant challenges – the greatest being Relationships. What happens to those of us who find ourselves residing closer to the pole of dependence on the continuum of self-sufficiency? What can provide us with what was missing in our development when we have been raised in less than adequately nurturing families?

In our culture, when we are confused and in emotional pain, the expert we are referred to is usually someone who is a psychotherapist. Research has shown that psychotherapy works, but whenever different forms of therapy are compared, the results are inconsistent and are not replicated by later studies. The confounding variable is the therapeutic relationship and its impact on the results. A unique relationship is not amenable to being measured by what is deemed to be the gold standard of research protocols, the Randomized Controlled Trial (RCT).

MedicineNet.com describes RCT as follows: “A study in which people are allocated at random (by chance alone) to receive one of several clinical interventions. One of these interventions is the standard of comparison or control. The control may be a standard practice, a placebo (“sugar pill”), or no intervention at all. Someone who takes part in a randomized controlled trial is called a participant or subject. RCTs seek to measure and compare the outcomes after the participants receive the interventions. Because the outcomes are measured, RCTs are quantitative studies. In sum, RCTs are quantitative, comparative, controlled experiments in which investigators study two or more interventions in a series of individuals who receive them in random order. The RCT is one of the simplest and most powerful tools in clinical research.”

I believe that RCT, cited above as a simple and powerful tool, is not a valid method for evaluating relationships. Perhaps the most illuminating study of therapy effectiveness was conducted by Consumer Reports and published in the American Psychologist in the December, 1995 issue. The study concluded that patients benefited very substantially from psychotherapy and that long-term treatment did considerably better than short-term treatment. No specific modality of psychotherapy did better than any other for any disorder.

The therapeutic relationship, unique and resistant to quantitative measurement is essential. Since it is virtually impossible to match up therapists, most studies are designed to compare the effectiveness of different forms of therapy. In addition, some studies are designed to discover and evaluate the traits of effective therapists. I believe that the individual traits of therapist and client cannot be isolated or combined so that we can come up with uniform standards. More likely, it is the meeting and connection of two whole people who form a therapeutic alliance that is critical to outcome. Dissecting the characteristics of individuals or the therapy process is not amenable to simple quantitative studies.

At various stages of our lives we look to develop relationships where our better selves can be seen in the eyes of others. Feeling like we belong and are a valued part of a community can comfort us in times of turmoil. It is in relationships where we feel valued that we are able to take risks and are not unduly inflated by our successes or deflated by our failures. A growth-enhancing relationship is not necessarily exclusive to psychotherapy. For those seeking help there are a plethora of choices like hypnosis, neurofeedback, nutrition, exercise, meditation, prayer, spiritual discipline and retreats on the ever expanding list of change agents. A lover, support group, AA, an athletic group, a book club or other interest group can validate our self-worth and be the catalyst for growth. Such pursuits, may not be all encompassing answers, but might be doorways to new experiences that can enhance how we define our worth, meaning and self-acceptance.

For me it is the relationship, the connection, the ability to embrace the positive aspects of a surrogate parent, friend, uncle, or caring sister. I think it is safe to say that with few exceptions we all benefit from a caring relationship. It is within a caring relationship that we are able to look at ourselves and be ourselves in ways that allow us to re-define our goals and reconstruct who we are and how we will attempt to be in the world.