The Peace Corps experience

Have you ever considered serving in the Peace Corps? Even before we got married in 1990, both Maria and I had, and we’d both lived abroad (Maria in Korea and me in Austria and Germany). Within weeks after our wedding we applied to serve as Peace Corps Volunteers (PCVs). At that time only one-in-three applicants was selected to serve. Would-be PCVs don’t typically choose where they’ll serve, although fluency in the language spoken is a given host country can be a determining factor. The more open you are to serving wherever your skill set is needed, the better your chances of selection. We were approved for service after a lengthy application process, and were selected by Jamaica. We had two weeks to decide if we’d accept Jamaica’s invitation, but it didn’t take us an hour after reading about our assignment to call Peace Corps headquarters in D.C. and accept. We put all of our belongings in storage, and sold our cars around the time we got our plane tickets in the mail.

The Peace Corps is an independent government agency, not a branch of the State Department. It currently has volunteers in over sixty developing countries around the world. PCVs aren’t sent to these countries to advance or influence American foreign policy, but rather to share their skills with host country nationals, in the service of sustainable development. Each volunteer serves within one of six sectors: education, health, agriculture, community economic development, youth in development, or environment. The host country, not the Peace Corps, decides how many volunteers in each sector they need, and where they will serve. Most PCVs serve for two years, after training.

In order to qualify for Peace Corps service, you have to be at least eighteen and in good general health. Most volunteers have at least a bachelor’s degree, but exceptions are made for people with experience in certain areas, including construction, business and forestry. To be accepted, you have to pass a physical (which the Peace Corps pays for) and establish that you’re not fleeing indebtedness or legal charges. People who’ve served in intelligence agencies like the CIA need not apply. You have to have a skill set (and in some cases, appropriate certification or licensure) that people in host countries need to support development projects. The largest sectors are education and health.

Some personal qualities that make for a good PCV are good people skills, self-confidence, autonomy, flexibility, and persistence in the face of obstacles. Peace Corps service is always an adventure, and sometimes an uphill struggle. As I wrote in my book, Two Years in Kingston Town: A Peace Corps Memoir, Peace Corps service can be likened to climbing a mountain; you wind up knowing more about yourself than about the mountain.

In most host countries, accepted applicants have to have three months of in-country training, including language lessons, before they’re sworn-in as PCVs and start their assignments. But since English is Jamaica’s official language, Maria and I only had six weeks of in-country training before we were sworn in (the same oath as when I joined the Army) and started working. Two things stand out from our training as development workers in Jamaica. The Peace Corps Country Director said something to the effect of, “If you think of Peace Corps service as ‘giving up’ two years of your life, Jamaica doesn’t need you that badly. You’re here to live in Jamaica for two years, and to learn as well as to teach.” A Swedish guest lecturer with years of experience in international development work said something like this: “For at least the first six months, keep your mouth shut, and your ears and mind open. Nobody needs to hear you telling them the right way to do things. You need to establish trust and credibility before you start offering advice.”

Maria taught psychiatric nursing, but had to get licensed as a Jamaican nurse before she could join the faculty at the School of Nursing. When we applied, having no idea where we’d serve, I thought I’d end up teaching English somewhere, as I have a B.A. in English. I never dreamed that I’d serve as a psychologist. But the University Hospital of the West Indies had just opened a detox/rehab ward for Jamaican addicts, and my skill set was just what they needed. So I served as the ward psychologist, and helped to develop a relapse prevention model for the ward.

As a PCV you don’t get paid a salary, but you get a living allowance that allows you to get by on the local economy. Every month you serve, a modest amount of money ($200 when we served) is set aside for your readjustment allowance, after you complete your service. Not all PCVs fulfill their two-year obligation. Some volunteers leave behind a lasting accomplishment,  however small, in terms of sustainable development in their sector; others don’t. But I still think that the Peace Corps gives more “bang for the buck” in terms of winning friends for the U.S. in developing countries than aid agencies like U.S.A.I.D., because Peace Corps service is all about developing helping relationships within host country agencies and Non-government Organizations (NGOs).

PCVs are citizen “goodwill ambassadors,” because they work at ground level with host country counterparts. After I was robbed on a bus in downtown Kingston, I heard a fellow commuter sympathetically refer to me as “jost a workin’ mahn” because – although white – I rode the bus to work, just like them. It was one of the best compliments I received while working in Jamaica.

Maria and I didn’t serve simply out of altruism or idealism. Peace Corps service was an opportunity for cultural enrichment and personal growth. We got to know the beautiful island of Jamaica, it’s people and culture. Not all PCVs leave behind an identifiable accomplishment in terms of sustainable development in their host countries; but Maria helped Jamaican nursing students to view mentally ill people as human beings first, and not as “mental patients.” I recently learned that the relapse prevention model I introduced on the detox/rehab ward is still being used at the University Hospital of the West Indies. Maria and I still echo what’s been called the “Peace Corps mantra”: we got more than we gave.

 

What is obscene?

My Webster’s Dictionary uses the following adjectives (among others) to characterize the essence of “obscenity”: foul, filthy, repulsive and disgusting. As a philosopher, I have to ask, “offensive/repulsive/disgusting to whom? Walt Kelly – creator of the Pogo comic strip – wrote, “One man’s obscenity might be another man’s lunch.”

What is obscene to you depends on your values, and perhaps the cultural norms you were raised under. It depends on what offends you as an individual or, some would say, what excites you in a way that makes you feel guilty. It’s been said that obscenity is whatever gives the judge an erection. Traditionally in our culture, obscenity refers to depictions (or descriptions) of sexual acts, but not to violent acts such as beatings, torture, murder, or explosions. This is due to the sexual repression that is deeply-rooted in our society, as exemplified by our collective fetish with  women’s breasts – as long as the nipples are covered. It isn’t like that in Europe. “Reality TV” shows that feature naked people with their “naughty bits” digitally blurred are especially obscene, to me.

Some Americans consider full frontal nudity (aside, perhaps, from the fine arts) to be obscene in itself, and many more consider any explicit depiction of sexual activity to be obscene, or pornographic. This is often rooted in repressive religious traditions that venerate birth, but characterize sexual pleasure as inherently sinful. And the aftermath of female ovulation, to which we all owe our lives, is regarded as “unclean” and/or shameful in many cultures. Clearly, things that are regarded as obscene are things that elicit visceral responses, whether lust or disgust.

When I was a young man, I introduced my parents to the concept of “obscene wealth.” It had never occurred to them that being extremely wealthy, while those around you are starving, could be regarded as an obscenity; but they eventually understood my reasoning. They had a harder time grasping the notion that violence, not sex, should be regarded as obscene. No consensual sexual act is obscene in the way rape and sexual molestation (a subset of rape, not a different thing) are obscene.

The concept of  a “right to privacy” is a fairly recent social innovation. For most of human history, privacy only existed for the privileged few. Most people who have ever lived grew up witnessing sexual acts as a part of daily life. The concept of sexual acts as intrinsically obscene is a culture-bound convention, rooted in patriarchal religious dogma.

Although I honor the soldier’s profession and served in the Army, I consider war to be an obscenity. I consider torture, rape and sexual exploitation obscene. I consider slavery, extreme economic exploitation, race hatred, human trafficking and ethnic cleansing obscene. And I consider some pornography to be obscene, if it normalizes sexual exploitation or degradation. Depictions of sexual and/or violent activity may arouse or disgust us. We don’t have to apologize to anyone for our reflexive visceral responses, only for bad behavior. (As a therapist, I encountered quite a few people who felt frightened or guilty about having felt aroused by something unexpectedly, or by something their religion told them it was sinful to be aroused by.) It’s been said that ugliness is as compelling as beauty; and ugliness, like beauty, is in the eye of the beholder.

It was Lenny Bruce who educated me about obscenity. He took standup comedy in new directions, exposing sexual hypocrisy in ways  that no other comedian had ever done. He once tried to  explain his act to his trial judge, who then found him guilty of the crime of obscenity. When I was home, on furlough from the military academy I attended, my mother and I would have late night discussions on a variety of topics – even sex. (Mom was always more comfortable than Dad, talking to her kids about sex.) During one discussion, I made an observation about our society’s sexual repression. Mom said that she thought our society was obsessed with sex, to which I replied that obsession and repression are opposite sides of the same coin. We’re obsessed with breasts, but a woman can be arrested for “indecent exposure” if she exposes her nipples in public.

Then I made the point that there’s no “respectable” action verb in English for the sex act. We use circumlocutions such as “have sexual intercourse with.” She got my point, and we both knew we were talking around “the f-word.” I had recently read The Essential Lenny Bruce, and I talked about how he’d gotten arrested for using the word “fuck” onstage. Having just made the point that there’s no acceptable  word for the sex act, I thought I could actually use the word, in this context. I was wrong. Mom was shocked. End of conversation.

Although my father could be quite profane, he never cursed in front of Mom, and profanity was forbidden in the house. The next morning, I got a stern lecture from Dad, and he made it perfectly clear that I was never to use the f-word in front of my mother again. And I never did.

Flash forward twenty years. The whole family were avid SCRABBLE players, and after we three siblings were on our own, Mom and Dad played even more frequently. Dad joked that SCRABBLE had replaced sex in their marriage. “We do it every Wednesday, and sometimes twice on Saturday!” On one visit to their home, I was sitting at the table with both of them, and Dad asked me if I remembered the night I’d said the f-word in front of Mom. I told him that I did, and assured him that I’d never done it again. He grinned and said, “She used “fuck” playing SCRABBLE recently.” Mom looked sheepish and said, “It was the only way I could get my “k” on a double-letter score!”

Motivation affects perception, and obscenity is in the eye of the beholder.

Non-suicidal self-injury

I think that one of the most baffling phenomena in the repertory of human behavior, to people outside the mental health field, is self-mutilation. Most of us fear and avoid physical pain and disfigurement, and it’s hard for us to understand why anyone would intentionally hurt themselves of self-mutilate. Over the course of my career as a psychologist, I discovered that there are a variety of motivations and explanations for self-harm.

Some people harm themselves because they are in a psychotic state of mind. It may be that voices nobody else can hear tell people to hurt themselves, or that self-harm is the result of delusional beliefs. I’ve known a man who gnawed off several fingers and another who gouged out his eyes for incomprehensible reasons, while psychotic. Other people injure themselves impulsively, because their distress impairs their judgment and they don’t know what else to do; so they bang their heads against the wall, or punch through a pane of glass.

Yet others learn from experience that cutting, or otherwise hurting, themselves provides immediate relief from overwhelming emotional pain; and it becomes a habit. The brain often responds to pain by releasing endorphins, whose molecules resemble morphine. (I recently learned that one reason some people enjoy eating really hot peppers is that the pain gives them an endorphin high.) This substitution of physical pain for emotional pain is hard for many of us to understand, but it reliably meets a need for some people. It can be viewed as a kind of masochism, with the distinction that it’s not done for pleasure, but rather for relief from pain.

What I would say to a client when I learned that they were self-mutilating was something like, “I believe that if you knew better ways to cope with your emotional distress, you’d use them, instead of hurting yourself. So let’s work on finding better ways.” Non-suicidal self-injury (NSSI) is a pathological behavior for many people diagnosed with Borderline Personality Disorder, and its elimination is one of the first goals of the most effective treatment available for people with that diagnosis – Dialectical Behavior Therapy (DBT).

DBT is the creation of Dr. Marsha Linehan. She designed it to help people who feel like they’re living in Hell, as a way out. Each patient in a DBT program is assigned an individual therapist, and is required to attend skills training groups twice a week. Two of the skills modules that are geared to the elimination of  NSSIs – or parasuicidal behaviors – are distress tolerance and emotion regulation. Borderline traits and symptoms are characterized by emotional imbalance. In learning to tolerate distress and regulate emotions, the clients learn how to achieve emotional balance. They no longer have to rely on the endorphin rush they get from cutting or burning themselves, once they’ve found better ways to cope with emotional distress.

The most extreme instance of self-mutilation I ever encountered in my career, not involving psychosis, was a long-considered and carefully executed self-castration. I speculate that the man’s motivation was related to either or both fear of a strong sex drive and/or disturbing sexual fantasies and urges. A fundamentalist Christian, he believed himself to be tempted by demonic “powers and principalities,” in a battle over his soul. He was quite intelligent and had a rationale for his agenda.

When he’d asked a surgeon to castrate him, he’d been told that no doctor could ethically accommodate his request, as there was no medical reason for the surgery. So he studied books on surgery until he felt confident that he could operate on himself. He decided to castrate himself in two  separate surgeries, coached his wife to serve as his surgical assistant, and set up a surgical suite in their home. The first surgery went off without a hitch. I never would have encountered the man if he hadn’t botched the second surgery. When he and his wife couldn’t stop the bleeding after he’d severed his remaining testicle, they had to call 911.

The local hospital contacted me to evaluate him. He was medically stable and ready for discharge, but his doctor wanted me to make a recommendation regarding any possible suicide risk. The man showed no signs of either depression or psychosis. He was pleasant and cooperative, explaining his rationale for castrating himself and answering all of my questions. He seemed somewhat embarrassed by having been found out, but seemed to have no other regrets about his actions. He persuasively denied any suicidal thinking, and he didn’t meet the criteria for involuntary psychiatric commitment. So I recommended that he be discharged. I gave him my card and told him that I was available if he wanted to follow up, but he never contacted me.

As an adult, I’ve never referred to mentally ill people as “crazy” – only behaviors. This was an example of how a legally sane person can do a carefully-considered, but crazy, thing.

Who is a psychologist?

I have a masters degree in psychology, and was trained in the profession by doctoral psychologists. I worked for over thirty years as a clinical psychologist in the public sector, but there are psychologists with PhDs and PsyD degrees who would have you believe that I’m not a “real” clinical psychologist. That’s because I can’t be licensed as a clinical psychologist in South Carolina – as in most states – with a masters degree.

I’m thankful to the American Psychological Association (APA) because I got my first job as a mental health counselor as a result of  a job interview at an APA convention. (I was subsequently certified by the state of Alabama as a psychometrist – qualified to administer, score and interpret certain psychological tests.) But I’ve since come to view the APA as a professional guild, as well as a professional association. It serves to protect private practice psychologists with doctoral degrees from competition by masters-level psychologists. There’s no established scientific basis for excluding masters-level psychologists from licensure, if they can meet the other requirements.

The central issue is demonstrated competency, but the APA contends that a doctoral degree is the established educational standard for licensure. No body of scientific evidence exists which demonstrates that doctoral-level psychologists achieve better outcomes in the provision of psychological services than masters-level psychologists. But the APA doesn’t want the competition, and has opposed all efforts in various states to allow masters-level psychologists to be licensed. In South Carolina, a hard core of doctoral psychologists even tried to “trademark” the prefix psycho (as in psychotherapy, psychological testing, etc.) for the exclusive use of doctoral psychologists.

I know this because I was the acting chairperson of the South Carolina Association of Masters in Psychology (SCAMP), a state chapter of the North-American Association of Masters in Psychology (NAMP), when the licensed psychology establishment proposed legislation that would exclude any psychologist without a doctoral degree from the possibility of professional licensure in the field. To insure passage of their “practice act,” it was written for them by one of South Carolina’s most prestigious law firms, and they hired a lobbyist to promote it in the state legislature. SCAMP didn’t stand a chance.

But it didn’t stop us from trying. We did research on the availability of psychological services throughout the state, indicating that South Carolina was underserved, and that masters licensure would make psychological services available to more people. We argued that only those masters-level psychologists who could achieve the same scores on licensing exams as the doctoral-level psychologists should be eligible for licensure. We were even open to an initial period of supervision by licensed psychologists, leading to eventual licensure for independent practice. Perpetual supervision of masters-level psychologists in private practice would have been a new revenue stream for licensed psychologists, but a period of supervision leading to independent practice was unacceptable. The psychology practice act only affected private sector psychologists. In the public sector, masters-level psychologists routinely did things that they’d been deemed unqualified to do in private practice, by the practice act.

SCAMP had some significant support when testimony was presented in legislative subcommittee hearings. A publisher of certain widely-used psychological tests testified that masters-level psychologists were competent, with appropriate training,  to administer, score and interpret their tests. Dr. Logan Wright, a former president of the APA, testified in support of masters-level psychologists being eligible for licensure as psychologists. In spite of this, the South Carolina Psychological Association got the legislation they wanted. The law didn’t  prohibit appropriately -trained masters-level clinicians in private practice from doing any testing; you just couldn’t call the service “psychological testing.”

For years I worked as a mental health counselor, but routinely did psychological testing as part of my job. I eventually got licensed as a professional counselor; but for most of my career, I was hired as, and performed as, a clinical psychologist. My colleagues who were licensed psychologists always treated those of us with masters degrees as peers; and although we couldn’t be licensed as clinical psychologists, we did essentially the same work as the licensed psychologists. For legal reasons, our psychological evaluations were co-signed by licensed psychologists; but in all my years of doing testing, I never needed to have my work corrected, and never got critical feedback from my licensed colleagues. Whenever I was hired by a psychologist, I was supervised by licensed psychologists, and always got excellent performance evaluations from them.

So, although I “work like a clinical psychologist, talk like a clinical psychologist, and have frequently been seen in the presence of known clinical psychologists,” I can’t be licensed as what I am: a competent, experienced clinical psychologist. I never regretted not getting a PhD, as I was able to do all of the things I was trained to do, as a public sector psychologist. My last clinical supervisor – a licensed clinical psychologist –  explicitly told me that I knew as much about psycho-diagnosis and psychotherapy as any licensed psychologist he’s ever known. Shortly before I retired, he nominated me for an award honoring the outstanding clinical service provider in the state of South Carolina.

Although SCAMP is just a footnote in the history of psychological practice in SC, NAMP is still going strong, advocating for the licensure of qualified masters-level psychologists. Nine states now allow masters-level psychologists to practice independently in the private sector, although usually with a qualifier like “Psychological Associate” in the title. All this to say that you don’t have to get a PhD or PsyD in psychology to be a “real psychologist.” The central issue in determining who is a psychologist is demonstrated competency in the profession, not one’s academic degree.

Exposure Therapy

Most everybody knows what you’re supposed to do if you’re thrown by a horse. If you want to keep on riding, you get back up on horseback right away, to overcome your fear of being thrown again. The only way to get over your fear of drowning, if you swim in the deep end of the swimming pool, is to leave the shallow end and swim in water over your head.

The clinical term for this principle in psychology is exposure. Exposure is the antidote to avoidance, our very human tendency to reduce anxiety by avoiding activities and situations that tend to trigger anxiety. Avoidance is like a drug that immediately and reliably reduces anxiety or fear. For example, Tom is attracted to his high school classmate Jane, and wants to ask her out. He’s told himself that today’s the day he’ll get up his nerve and approach her, but he avoids doing it as the day goes by. As the end of the school day nears, he gets more and more anxious. But the moment he decides to postpone it until tomorrow, his anxiety dissipates. Avoiding and postponing work in the short-term, but serve to entrench our anxieties and fears in the long-term. Avoidance is one of the defense mechanisms  identified by Freud.

According to Dr. Marsha Linehan,  whose Dialectical Behavior Therapy (DBT) treatment of Borderline Personality Disorder has been empirically shown to be highly effective,, exposure is a necessary component of all effective cognitive behavior therapies. Two of the skills training modules in DBT, emotion regulation and distress tolerance, help to prepare clients for exposure to things they typically avoid.

Exposure therapy can be effective in treating Generalized Anxiety  Disorder, Social Anxiety Disorder, Obsessive-Compulsive Disorder (OCD), Post Traumatic Stress Disorder (PTSD), and phobias – irrational fears. It involves habituation to the feared stimulus/situation. Imagining exposure to successive approximations of the stimulus/situation (imaginal exposure) and teaching heightened awareness of physiological responses such as heartrate and muscle tension (interoceptive exposure) can be accomplished in the therapist’s office. Exposure to the actual stimulus/situation “out in the world” (in vivo exposure) is often the third step of exposure therapy. Being aware of the thoughts, emotions, and physiological responses involved prepares the client for in vivo exposure. Gradually working your way from the shallow end of the pool to the deep end involves exposure to “successive approximations” of the thing most feared. Jumping – or being thrown – into the deep end is an example of “flooding.”

The therapeutic method known as systematic desensitization was pioneered by South African psychologist Joseph Wolpe. After doing a behavior analysis of thoughts, feelings and physiological responses involved in a phobic reaction, he did relaxation training until the client felt some degree of control over his typical responses. Then he worked with the client to develop a hierarchy of fears, from the least fear-inducing to the most fear-inducing thoughts/experiences. Using this hierarchy, he would work with the client on relaxing as they went through successive approximations, leading up to the thing most feared.

Here’s an example of how I might use this method with a client who had never flown in an airplane, due to her phobia about flying. (Because flying is statistically much safer than driving, fear of flying is considered  an irrational fear, or phobia.) Having assessed Louise’s typical thoughts, feelings, and physiological responses/anxiety symptoms, and having trained her to relax, I might start a session with a relaxation induction, leading to a guided fantasy based on her hierarchy of fears. Louise has been instructed to close her eyes, to raise her right index finger whenever she felt an increase of anxiety, and to lower it when the anxiety decreased.

“You’re in your apartment and you’re packing for your flight . . . . Now you have your bags packed and you’re waiting for a taxi to the airport . . . . And now you’re at the airport and you hear the boarding call . . . . Now you’ve stashed your carry-on and are seated, buckling your seatbelt, etc.” Whenever Louise would raise her finger, I’d switch from the guided fantasy to the relaxation induction: “And as you breathe slowly and deeply, you can feel your muscles relaxing, and your anxiety is replaced by a calm feeling . . . . ” When the finger went down, I’d pick up where I left off on the guided fantasy.

Over time, Louise learns that she has increased control over her response to fearful thoughts, getting gradually closer and closer to the thing she fears most. Once she can imagine herself staying in control as the airplane takes to the skies, we might go on to in vivo exposure therapy, which might involve me accompanying her – at least at first. Some private practice therapists specializing in the treatment of phobias might even accompany his client on his first flight, coaching and encouraging him.

People with severe OCD often engage in compulsive rituals to reduce their anxiety. Exposure therapy can help them to learn that they don’t have to rely on these rituals to reduce their anxiety. People with anxiety disorders can use the principles of successive approximation to gradually desensitize themselves to stimuli/situations that used to trigger anxiety. Exposure therapy can similarly help people with PTSD to control physiological arousal in response to stimuli/situations that used to trigger fear. But in order to overcome an irrational fear, you have to eventually face it.

Psychiatry: pro and con

I write this as someone who had a career as a psychologist in the mental health system, working within the scientific/medical model of psychiatric treatment. So, I’m not writing to reject psychiatry outright, but to examine its efficacy. I’ve written about the value and limitations of models in previous posts, and about what I call the “model muddle.” Models are just maps, helpful only to the degree that they’re accurate. No one model is demonstrably superior to all other models, in all situations. Every model has its limitations.

First, I’d like to distinguish between psychology, psychiatry and psychoanalysis. Psychology is the study of human behavior, and provides the basic theoretical structure for psychotherapy. Sigmund Freud came up with the concept of “the talking cure,” the notion that dialogue with a caring professional could help to resolve symptoms and treat psychopathology. Psychiatry is a branch of medical science, based on the concept that the accurate assessment of symptoms of mental illness can lead to an accurate diagnosis, which will result in an appropriate treatment. Psychiatrists are medical doctors who specialize in the treatment of mental illness. Freud was a psychiatrist, and psychiatrists who are trained in the system of Freudian psychotherapy are called psychoanalysts.

While I believe that psychiatric (medical model) treatment has helped a lot of people with debilitating metal and emotional symptoms, like any model, it has its limitations. Since the 1960s, the efficacy of psychiatric treatment has been questioned – with good reason. A primary critic was psychiatrist Thomas Szasz, who wrote The Myth of Mental Illness. Another psychiatric rebel was R.D. Laing, and yet another psychiatrist, David Cooper, coined the term “antipsychiatry.” Critics of psychiatry argue that mental illness/madness is a social construct and not a medical condition, and that psychiatry is a process of coercive social control. This core of criticism has led to the current antipsychiatry (alt. recovery) movement.

A primary criticism of psychiatry is that psycho-diagnosis isn’t rocket science. It’s imprecise relative to the diagnostic precision for most common physical medical conditions, and can be selective and subjective in its diagnostic criteria. Unlike with physical medical conditions that can be diagnosed by tests and procedures that reveal “markers” of a specific condition (i.e. pneumonia vs. tuberculosis), there are no such markers that distinguish schizophrenia from schizoaffective disorder or bipolar disorder. I’ve known many people with chronic mental and emotional disorders who have gotten a wide range of psychiatric diagnoses, over years of treatment. Ideally in the medical model, an accurate diagnosis results in appropriate and effective treatment. This is less often the case in psychiatry, because there’s more “educated guesswork” involved.

Proponents of the antipsychiatry movement contend that psychiatric treatment is all too often more damaging than helpful to patients. Extreme treatments such as prefrontal lobotomies haven’t proven to be effective; and the negative side effects of some psychotropic medications and mood stabilizers seem to outweigh the benefits for some patients. The term “iatrogenic effects” refers to treatments that do harm.

Another valid criticism of psychiatry is that it’s over-reliant on pharmaceuticals, and that the psychiatric profession has had incestuous ties to Big Pharma. I believe that, as a culture, we’re too dependent on medications as a panacea for health problems related to bad lifestyle choices. Drug company ads suggest that we can eat whatever we want and take pills to control any gastro-intestinal symptoms that result from a poor diet.

Having said that, psychopharmacology has its place in the treatment of what we call mental illnesses. I believe that in some instances there’s no effective substitute for the right dose of the right medication at the right time. But I also believe that other interventions can mitigate the need to rely primarily on drugs as the default treatment for psychopathologies.

The concept of recovery from mental illness doesn’t necessarily mean full and permanent remission of symptoms, but suggests that psychiatric treatment isn’t the only route to symptom control or remission. There are recovery centers in cities around the country that offer alternatives to traditional psychiatric treatment, recognizing that community and peer support can be important components of treatment. Such programs don’t preclude psychiatric interventions, but don’t rely on them as the default mode.

Factors such as physical health, stress, social stigma, chemical dependency, poverty, homelessness and nutrition can all play a role in mental health and mental illness. We need to embrace a more holistic treatment model for what we call mental illness, and to provide a range of services that give people who have been labeled as mentally ill more autonomy and more options for resolving their problems.

You can find out more about the antipsychiatry movement, the recovery model, and alternatives to traditional psychiatric treatment at <madinamerica.com>.

 

 

More about shamanism

In my last post I wrote that learning to journey in Dreamtime has profoundly influenced my philosophy. It made me reconsider my understanding of reality. My primary shamanic teacher, Michael Harner, described shamanic journeying in Dreamtime as “another reality that you can personally discover.” He said that shamanism is closer to science than religion, because it’s empirical – based on direct experience. If Dreamtime is “real,” this has implications for science in particular and philosophy in general.

Nowhere in his writings does Shakespeare use the word science in its modern sense. Science is a branch of philosophy, and in Shakespeare’s time what we call science was called philosophy. So, his famous quote about reality, translated into modern English, would read, “There are more things in heaven and Earth, Horatio, than are dreamt of in your science.” I agree. Science is very good at what it’s good  at, but it’s only one of several lenses we can look through to examine phenomena. Science can tell us things about consciousness, but it can’t definitively explain what consciousness is. That’s why we have another branch of philosophy called metaphysics.

What is “real” can’t be determined objectively, without taking consciousness into account. The term “altered state of consciousness” presupposes that there’s a standard, or ordinary, state of consciousness. I’ve come to believe that there is a range of “ordinary” states of consciousness. Our mental state while solving a math problem, meditating, playing a musical instrument, debating, or dancing are all examples of ordinary states of consciousness. But there are other states of consciousness that only some people experience in their lifetimes, either by ingesting mind-altering substances, or by engaging in activities or practices that induce non-ordinary states of awareness. Some of these are sleep deprivation, sensory deprivation, prolonged pain, pranayama breathing, prolonged prayer or chanting, shamanic journeying, and vision quests.

William James, “the father of American psychology” wrote in Varieties of Religious Experience, “Our normal waking consciousness . . . is but one special type of consciousness, whilst all about it . . . there lie potential forms of consciousness entirely different. . . . No account of the universe in its totality can be final which leaves these other forms of consciousness quite disregarded. . . . At any rate, they forbid a premature closing of our accounts with reality.”

I believe that everybody wears cultural blinders of some kind, depending on what they were raised to believe, or their rejection of what they were raised to believe. As I’ve written in previous posts, none of us can escape living in a “reality tunnel” – a mental map of reality – although we may convert from one reality tunnel (e.g. Irish Catholic, Amish, Inuit, Mormon, atheist Bohemian, gay activist, political revolutionary, etc.) to another, one or more times in our lives. I reject the idea that there is any belief system that is objectively and demonstrably superior to all others. That’s why I consider myself to be a “guerrilla ontologist” – agnostic about most things.

There are some reports in shamanic lore of shared hallucinations/visions – like several people reporting having seen the identical sequence of spirit animals presenting themselves around the ceremonial fire in the sacred circle, after a ceremony involving the ingestion of vision-inducing substances. Michael Harner told the story of taking a vision-inducing drug in the Amazon, under the supervision of a local shaman. When he later told the shaman that he’d encountered lizard-like creatures who had told him that they were the true rulers of the  universe, the shaman laughed and said, “Oh, they’re always saying that!”

The implications of this worldview are radical in light of the common belief in Western society that there’s only one reality, which we can all apprehend and comprehend: consensus reality. It addresses a central question in espistemology – how do we know what’s real? We all have to believe in some fundamental premises (e.g. is there a God?) that undergird our worldviews and life choices. We can be rigid or fluid, dogmatic or agnostic, when it comes to interpreting the evidence of our senses. I agree with Saint Augustine, who said that we must believe in order that we may know, and know in order that we may believe.

According to shamanic lore, spirit animals (shamanic allies) inhabit a different plane of existence than our own normal reality, and have knowledge to impart to shamans about healing and magic. What shamans receive from the allies they bond with in Dreamtime and bring back to the waking world with them is sacred knowledge and personal power. What the spirit animal gets in return is the experience of seeing our world through the shaman’s eyes.

Dr. Harner did a lot in his lifetime to teach people about ancient shamanic traditions, and to keep shamanic studies alive in this country and in other countries around the world. You can learn more at the website of the Foundation for Shamanic Studies, at http://www.shamanism.org.