Tuesday, August 28, 2018
Entry for 28 August 2018:
In order to attend my fiftieth High School Reunion, we delayed our return to Scotland for this year’s annual late August running of Strathclyde’s Emotion-Focusing Therapy Level 1 training. Now, on our way back, I’m still thinking about What It All Means.
To prepare, I spent part of a day reviewing the 1968 Tokay, the Lodi Union High School (LUHS) Yearbook. I looked through pages and pages of coverage of sports, social events, and arts performances, finding my 17-year old self missing in action. I remember feeling that these activities had nothing to do with me, nor me with them. I remember feeling pretty socially anxious a lot of the time, and not very good about myself. Oh, there I was, popping up in a couple of places: chess club, literary magazine, minor academic honours. So I studied (but not super hard), read a lot of books, and had a few extracurricular activities to show for myself. Oh, yes, and I did a few things that took me completely out of my comfort zone: I took a public speaking course, went to some speech tournaments, and ran for Senior Class President, which involved giving a speech (fortunately, I lost). I remembered how terrifying these latter activities were.
Then, I went through everybody in my senior class, pages full of rows and rows of names and photos of scrubbed and coiffed 17-year olds, with their ties or single-pearl necklaces, some 700 in all. I spent 13 years in the Lodi public school system, kindergarten to 12th grade, and so crossed paths with hundreds of fellow students during that time. Who did I still remember? Who would I recognise at the Reunion? It was a big school, made of many overlapping subcommunities. A surprising number, at least a hundred, were met with a sense of recognition of name or face, something in my body answering, “Yes, I knew this person”. Some were friends or folks I hung out with, associated with specific memories, others were simply people that I knew I had known, faces seen, names heard again and again in attendance roll call, echoing in my memory. Human facial memory is a wonderful thing, but name recognition is pretty good as well.
After that I read through the hand-written notes from friends and acquaintances, which filled the opening and closing pages of the yearbook. My best friend Philip Frey (who died two years ago) was there, reflecting on our moderating influence on each other. He’s a person I would certainly like to sit down and talk to now. Several people commented on the speech I’d given when I ran for Senior Class President. I had remembered this as an excruciating experience, probably better off forgotten, but the comments were positive, which surprised me.
We arrived a bit after 6pm at the Woodbridge Golf & Country Club. I’d spent a lot of time there as a kid, caddying for my dad and at the swimming pool. Parts looked somewhat familiar, but most of it was completely unfamiliar, since it has been completely rebuilt. There were a lot of 68-year-old people whom I didn’t recognise, plus a mixture of spouses from elsewhere to confuse things further. We were issued with name tags with our senior yearbook photos on them. That helped. We ran into my old friend Sam Hatch, whom we’d had a visit from 18 months ago when we first arrived in Pleasanton; he introduced us to his wife Susan and we had a great time visiting with them. I also ran into several people I’d known from Saint John the Baptist Episcopal Church: Carol Gerard, Cindy Chappell, and others from various phases.
The reunion was very well-organised, with many nice features such as a free photo booth, prizes and so on, but two things really caught my attention: First, there was a set of class photographs from the LUHS’s elementary and junior high school feeder schools, so that many of us could see ourselves at even earlier stages. There I was, from kindergarten to third grade, in my plaid shirts and buck teeth. Diane had trouble seeing the resemblance but I recognised me.
Second, there was a board of about 20 people known to the organisers to have died, a sombre reminder of how much had passed and what we had lost. This was obviously a difficult thing to put together, and a thankless task. The loss was only underscored by the fact that no one, myself included, had let anyone on the committee know that Philip Frey (one of the valedictorians) and Margaret (Linstrom) Weitzel had passed. These were my two best friends from high school, and I still feel their loss keenly. A 50th high school reunion is obviously a time for celebrating accomplishments, remembering good times, and renewing friendships, but it is also a time to acknowledge losses: youth and naïve enthusiasm, of hang-ups and pretensions, of opportunities and hopes, and of people loved and lost. It is a kind of Memorial Day, of smiling through tears, of marking lives spent in the best way we knew how, of celebrating what has been and resolving to do our best with what remains of our lives: For us, the living, the best thing is to take each day as a gift, and each person met and then met again also as a special kind of gift.
Vale, LUHS Class of 1968!
Tuesday, August 14, 2018
On Psychiatric Diagnostic Categories from the Point of View of Humanistic-Experiential Psychotherapy
Entry for 12 June 2018 [revised 14 August 2018]:
This started out as a long email to Ueli Kramer & Antonio Pascual-Leone, posted, with their permission, only now two months later (a piece of unfinished business after my return from China).
I was stuck waiting in the Chinese Consulate in San Francisco for hours today, so you now have to suffer through the following screed:
Thanks for your responses and questions. I taught in a clinical psychology doctoral course for almost 30 years, and also taught Abnormal Psychology on many occasions, as well as using different structured psychiatric diagnostic instruments. Like you, I am intimately familiar with the very messy, complicated process of applying psychiatric labels to people in both clinical and research settings. I studied with Ted Sarbin, and have what I consider to be a healthy ambivalence about the larger DSM/ICD enterprise. On the one hand, I’m very aware of and have witnessed the various difficulties with stigmatisation, reification, questionable reliability and validity, conceptual muddiness/overlap, lack of etiological basis, and philosophical disharmony with humanistic-experiential approaches. I also strongly believe that the language we use and the implicit assumptions and metaphors that it contains are important and powerful, for better or worse. I regard language use as an ethical issue.
On the other hand, these categories have their merits and uses: (1) I’m aware that there are regularities that the diagnostic categories seek to capture; it’s not only or simply a social construction. I’m a dialectical constructivist here: the labels both point to something in the world and are at the same time a social construction of what’s there. (2) Some clients find acquiring a diagnostic label to be clarifying and validating. I don’t want to deprive them of that, although I don’t mind reminding them that the categories are social constructions cooked up by groups of people as part of a political process. (3) To progress and disseminate our work we have to be able to communicate with researchers with different philosophical perspectives and lived experiences, including those who exist in an unreflected way within a diagnostic system and psychiatric language that they are attached to and that feels like home to them. They will feel threated and will fight us if we try to take their cherished language from them. (4) Some labels are more useful, reliable, valid etc than others, or at least less broken or over-simplifying than others; others, I think, pretty much suck and best consigned to the dustbin of history.
Given these complexities, here is the course of action I have long tried to follow:
First, I try lead by example: I try to keep my language as clean as possible. I personally find the word “disorder” to be stigmatising, so I try to always say “difficulties” instead; this has the advantage of allowing me an alternative gloss for favourite abbreviations like PTSD (“post-traumatic stress difficulties”). I personally find “borderline personality disorder” to be especially problematic and therefore moved first to “borderline processes” and then, following Margaret Warner, to “fragile process”, which I find to be a far more accurate term anyway. I replace “schizophrenia” with “psychosis”.
Second, although I do have my strong views, I try to avoid being polemical or confrontational. Snark such as inveighing against the evils of the “medical model” can be fun but it just puts some people off, and of course also ignores the fact that this too is a kind of stigmatising diagnosis, which for starters ignores the fact that there are many quite different “medical models”. The main point here, however, is I understand that people are typically very attached to forms of language that are familiar and comfortable to them. This can be difficult at times and I’m not sure that I always succeed. In general, I try to assume good intentions in others, even when I experience their language as unreflected and potentially offensive or even harmful to some. When this happens I go back to my first strategy of leading by example; and I expect others to extend the same respect for my use of language that I offer them: we may not agree with the language the other person uses, but I expect us to respect each other’s need or habit of using that language, at least for the moment. This means that sometimes I will need to provide translations of my favoured ways of talking, even though I find these translations not to my liking. At times, gatekeepers may even try to suppress my favoured ways of talking, in which case I will try to find a mutually-acceptable compromise. Only as a last resort and for carefully-considered pragmatic reasons will I capitulate to using language that I do not agree with.
Third, I think it’s very important for us to dialog about these differences in language, to try to develop both our understanding and our language more fully so that it increases in accuracy, transparency, respect and usefulness for our clients and research participants. That’s why I raised the issue when I saw your article.
See: Kramer, U., & Pascual-Leone, A. (2018). Self-Knowledge in Personality Disorders: An Emotion-Focused Perspective. Journal of personality disorders, 32:329-350. DOI: 10.1521/pedi.2018.32.3.329
Entry for 12 August 2018:
Six days’ EFT training in Shanghai. I’ve flown from Glasgow to San Francisco, spending 3 days in Pleasanton and getting in a brief visit with Kenneth before flying on to China. California is hot and dry, and on fire in many places.
First time in mainland China (previous trip to Hong Kong, but somehow feels like that doesn’t count). Airport is full of construction; we land out in far reaches of airport; it takes bus what seems like ages to get to terminal & pick up suitcase. Foreigners have to do self-service finger-printing before they can go through immigration. Joyce has sent her helper Celia to wait for me and escort me to hotel. When I finally emerge from international arrivals; she is surprised at how long it’s taken me.
Uber car to city: Huge city: 25 million & counting. Radio is playing American pop music. It takes us over an hour to go from airport to hotel, which is apparently toward the western end of the city. It’s 30C but feels closer to 40, and very humid. It gets dark early, around 7. My room on the 12th floor has a great view of the nearby Shangfeng Park and the cityscape beyond, although it turns out that we are many miles from downtown. Joyce & Morley meet me for dinner in the hotel a bit later. There is no one else in the restaurant, although it’s Saturday night. I’m so jet-lagged I can’t later remember what we talked about, except to make plans for Sunday. I take a melatonin and go to bed about 9pm.
I get up early the next day and go for a run on one of the treadmills in the empty gym facility in the hotel. After showering and breakfast, Joyce & Morley pick me up in an Uber car (they don’t own a car in Shanghai). They take me to the International Church in Shanghai, a nondenominational evangelical church in the ballroom of a large hotel. We have to show our passports to get in, proving that we are foreign nationals. The first 45 min is prayers followed by contemporary praise music, nice enough, but after a while a bit repetitive for someone used to complicated Anglican hymns.
After church we grab sandwiches at the Starbucks and get picked up to be driven west of Shanghai to a “water town”: an old town built along a set of canals, with markets of little shops on the lanes that parallel the canals. We spend the afternoon there wandering around in the heat amidst throngs of Chinese people (almost no Westerners), looking in shops, while Morley talks to the shopkeepers, and we shop. We visit a Taoist temple, a rustic hotel, and an old tea-house where we eat fruit prepared by the owner, who is also a painter. We take a canal ride, on a boat whose boatman propels it forward with a kind of rear mounted rudder/oar. It’s very peaceful, and a great way to people-watch on a hot August Sunday afternoon. Then it’s back into town for dinner, but on the way we have a fascinating and far-ranging theological discussion/sharing. Dinner is at one of their favourite Shanghainese restaurants, whose ceilings are strikingly decorated with 20th century figurist paintings of colonial Shanghai. At every Chinese restaurant we go to, Morley orders for everyone, curating our dining experience with an expert touch. He is particularly good at selecting a wide range of vegetarian dishes, which I greatly appreciate. At this dinner, I meet Jennifer, who is going to translate for me for most of the week.
The Great Firewall of China stymies me repeatedly, even though I’ve prepared by investing in a highly-rated VPN service: they’ve blocked all Google services, including Gmail, as well as BBC news (but for some reason not NPR); Dropbox is blocked as is YouTube and Facebook. It also turns out that they’ve recently blocked my VPN service, even though there are still web ads everywhere claiming that it works. Fortunately, Skype & Zoom still work, so I can talk to Diane & Kenneth most days, working around the 15 hr time difference. Also, my Strathclyde email still works so I locate and install a recent version of Outlook, and have Diane scan my Gmail account and forward critical email to me.
Monday morning: Celia picks me up in taxi and takes me to Shanghai Care Corner Counselling Center, the clinic and training center that Joyce and Morley run with the help of Mary and Celia. They have 6 counselling rooms, which they also use for skill practice break-out rooms, plus a relatively large training room that can squeeze in up to 45. Morley embarrasses me with a totally over-the-top introduction in which he dramatically describes me in almost magical terms, with laser-like empathy coming out of my eyes.
This presages 6 days of the most intense EFT training I’ve ever had the opportunity to deliver: 1 day EFT for Social Anxiety; 2-days Advanced Empathic Attunement; 3 days Module 2 (Focusing, Reprocessing Work, Two Chair work). First, there are lots of participants in these trainings, ranging in number from 38 to 42. Second, they are eager to learn, to do skill practice, to volunteer for live demonstrations, and to ask questions on a wide variety of topics. It’s invigorating, challenging, and ultimately exhausting. It pushes my thinking forward in numerous places. They interact in an uninhibited manner with each other, sometimes arguing and challenging one another. Not all, but most fearlessly dive into their pain: rejecting mothers; overly strict, even abusive fathers; huge expectations placed on only children (an effect of China’s one-child policy). Underlying much of the personal pain, is the legacy of the Chinese Cultural Revolution of the 1960’s and 70’s, directly experienced or transmitted cross-generationally. This comes out sometimes as roughness or abrasiveness, sometimes as a kind of frozenness, which can break with a large release of emotion. There are many heart-wrenching stories that emerge during the week.
They refer to me as a “master” and “teacher”. There are endless photographs during breaks and at the end of each day. Towards the end, Morley starts running interference for me so that I can have recovery time during my breaks. They soak up what I’ve got to say, even with the sequential translation. At the best moments, the translators and I get into a kind of rhythm, as I condense what I have to say into a series of short sentences that build dramatically to climaxes. A couple of times during the week, to illustrate a key point, I find myself sharing a highly dramatic personal story, and am startled (and pleased) when they spontaneously applaud at the end. I share my mantra: Love, courage & wisdom. Love and courage they have in abundance; for them as for me, the wisdom part is a work in progress.
To cope with the intensity, I have a power nap each day, and take melatonin most of the week, to avoid the episodes of severe insomnia I had last time I dealt with double jet lag. As we finish on the 6th day, I write in my Pukka Pad, “tired, drained, relieved”. I have the feeling of being filled with ideas for how to move EFT theory, practice & training forward, too many to write down so that I am left hoping that they will come back when I need them. Here are a few that I was left with at the end of this running of Module 2: (1) The Focusing input needs a major update (reduce coverage of Clearing a Space, re-do task model to reflect flexible emotion-scheme based questioning strategy, which can also be used for skill practice, emphasize use within Chairwork). (2) Due to popular demand, I’ve written part of a new input on emotion regulation (needs to be finished, lead with emotion regulation principles; figure out good place for it in later modules, probably with first chairwork). (3) Better integration of Reprocessing Work with Chairwork is needed, to highlight its role both as stand-alone and within Chair Work. (4) Better integration of Empty Chair Work and Two Chair work is needed, underlining the role of self-interruption conflict splits in Empty Chair Work and more importantly the integrated task of Conflict Splits about an Important Other, in which it’s useful to alternate between Two Chair Work and Empty Chair Work, as each task supports work on the other.
Last day: Up early, I think maybe I’ll attempt a run in Shangfeng Park near the hotel, but it’s disgusting outside, like a steam bath: 30C already, near 100% humidity, and the rain has already started; it’s been clear and dry all week but now a typhoon is coming in. Run on the treadmill again; shower, pack, breakfast. Mary meets me at 10am, checks me out of hotel. Uber car to airport, heavy rain part of way; reminds me of Ohio summer. Long conversation with Mary about her experiences growing up. She waits with me in the queue at check-in in case of problems (they’ve taken such good care of me here!); after taking selfie with me, she leaves me at immigration & security. The flight is two hours late leaving, but I’m pleased with the first EFT training I’ve run in China.
When I visit a new country, I make a practice of learning about and collecting some of its folk and popular music. Hearing of my interest, Mary has kindly assembled a diverse collection of Chinese music of various kinds and ethnicities. (I think she said there were 17 different ethnic groups represented.) Also, the other night, Joyce & Morley took me to a record/DVD store after dinner and bought me a couple of collections of interesting Chinese music. It is going to take me quite a whole work my way through all of this richness.
One more thing: I’ve also picked up a bit of Chinese, simple words for “thank you” (“Xièxiè”, pronounced “she-she” with a falling tone on each syllable), “OK” (“Hǎo”), and “Right” (“Duì”). Chinese characters fascinate me, and as I return home I’m taken with the idea that the standard written Chinese for “San Francisco” is not a transliteration but is instead the native Chinese name for San Francisco from the 19th century:
旧金山 , in Mandarin transliterated back into the roman alphabet as “Jiù Jīn Shān”
This is not a transliteration but instead means Old (“旧”) + Gold (“金”) + Mountain (“山”), a reference to the California gold rush, which started in 1849. (I think of the archeological remains of the old Chinese dam below my brother Conal's place in Murray Creek up in the foothills of the Sierra Nevada, imagine Chinese workers trying to extract the last of the gold from the valley. I hope they found some...)
As the plane crosses the wide Pacific Ocean, I review all this richness in my mind. A word from last Sunday’s sermon surfaces: It is the Greek perissos, meaning “abundance or plenty” (from 2 Corinthians 9:8). Earlier in the week I asked Kenneth about the etymology of the word, puzzling to me because of its similarity to per- cognate with English fear. He laughed, reminding me that that is Latin, not Greek. Instead, per- is a prefix that means “around or at the edge of” (cf. “peripheral”). Issos, he said is the Greek verb “to be”; hence, “overflowing being”: perissos, abundance. That pretty much describes my week in Shanghai.