In the land of mindfulness-oriented behavioral health providers, how is it that the concept of Beginner’s Mind gets lost?
I’m specifically talking about my own experience with behavioral health folks, including friends who are psychotherapists, counselors I’ve seen, as well as my neuropsychologist. In all my years of seeking out help for my issues, I have but rarely encountered individuals who were really able to suspend judgment and not get stuck in the trap of continually seeking out ways to reconfirm their own world views.
And how many times have I sat across from someone who was professionally trained to help me, watching them not listen to me for what I was saying, rather for confirmation of what they believed…?
I think it’s wonderful that there are professional tracks for people to go down, to learn how to help others. At the same time, though, people also need to not get stuck in thinking they have it all figured out.
Because the behavioral health landscape is changing dramatically, especially compared to where it was just 10 years ago. We know so much more about the brain and its mechanisms than ever before. Yet we have just only begun to scratch the surface. So, let’s not get all hoity-toity about how much we know and how clued-in we are, thanks to our specialized skills and whatnot.
To me, orthodoxy (being convinced that you’ve got THE SECRET to how things work) and rigidity (never, ever changing your world view) are even worse liabilities than a brain injury. They make it extremely hard to adapt — which is precisely what we need to do as TBI / concussion survivors. We may be changing and growing and whatnot, while our providers are still stuck in their own versions of reality — which may or may not be useful to us.
It really is a problem. But I’m not the one to run around telling people that they’re too stuck in their ways. They have to see and realize it for themselves, and let go of their pride, arrogance, hubris. I’m sure it can be very, very difficult, dealing with brain-injured folks and their families/loved-ones, not to mention the healthcare system. It can put you into a state of perpetual fight-flight, which makes you even more susceptible to egotistical tendencies, arrogance, and prideful blindness.
I think especially for those folks who have been on the leading edge for many years, who were ridiculed and marginalized and made to feel “less than” because of their forward-looking stance. When you’re continually attacked and thwarted, it can do a number on you. I know how that is, and it’s no fun.
So, that cannot help but affect you. It cannot help but color your world view and make you biochemically and neurologically inclined to behave in ways that are defensive and self-supporting. Especially if you’ve had to shore up your own self-confidence and self-image and professional reputation, lo these many years, that can train you to be a certain way… a way which is intent on finding proof that you’re right, that you were right all along, and “they” were all wrong to doubt and thwart you.
Yes, I get how that shapes and conditions you.
At the same time, the higher purpose (of being of genuine help to others) needs to trump the hunger of your ego.
In the end, isn’t it more fulfilling to continue to learn and grow, rather than being someone whose main purpose is to ease the pain of the daily stresses of life and prove their “rightness” to themself and others?
I’m not a behavioral health provider, but personally I think I’d rather be learning and growing than constantly being on the defensive about my own convictions.
In the end, it can much more interesting to find out you’re wrong… and expand your concept of what’s right. There is so much more to discover about the human systems, the brain, and how they all interact.
I am writing this after several conversations and some reading — one conversation with a former soldier who was in Iraq during the first Gulf War, several conversations with a friend of mine who sustained a brain injury about three years ago, but has never gotten help for their injury — and is making increasingly poor choices about their life, their relationships, etc… all the while saying they need to find a therapist to help them deal with childhood trauma. They need a neuropsychologist, more like… As for the reading, check this out: Two Must Reads: The struggle for comprehensive PTSD and TBI treatment. I skimmed through it quickly, but I’ll have to go back to it. And I recommend you check it out, as well.
In thinking about the conversation I had with the ex-Marine, what struck me is how he talked about dealing with the incredible challenge of having to do things that were against his own morality, like kill people and destroy things. I was reminded of my post a while back about how war damages the souls of soldiers when I was talking to him, and he said there were several things that he and other military members of his family have done to cope.
The first is talk to somebody who understands — veterans in the family with whom he and other soldiers in his family can talk, have been so critical. The other is to find a way to make peace with things. Find a way to make it okay, on some level, that this is happening. Through faith. Or some sort of belief system.
In thinking about the conversations with my BI friend, I am starting to take notice that all their talk about trauma and dealing with it, is set against a backdrop of the BI they sustained five years ago. We have mutual friends who are therapists who are convinced that a lot of people are walking around with suppressed memories of terrible abuse in their childhoods, and that those repressed memories are making them do the things they do. With my BI friend, I suspect that they have been getting the “party line” that they are dealing with old memories coming up, and they don’t know how to emotionally deal with them. Now, I know for a fact that this friend didn’t just sustain a BI three years ago… Back around 1999, they also slipped on some ice, fell and hit their head pretty badly. They were dizzy and disoriented after it, and I noticed them being more volatile afterwards. Then they seemed to get better (although their marriage has been a bit rocky over the years). In the past three years, they’ve made an amazing recovery, and if you didn’t know them before, you probably would never guess that they have this going on with them. But I can tell. Maybe because I’m more sensitive to it — and better educated.
Anyway, this friend of mine is in pretty bad shape, financially, yet they don’t quite seem to get it. They have serious impulse control issues with money, and their spouse doesn’t actively monitor what they are spending on, how much, and how often. So, they have ended up in a jam that might cost them their car or their house. But they keep going along just doing what they do. Whenever I suggest that they might want to take a look at their spending, they get defensive, aggressive, combative. Not pretty. They just blow up like crazy. So, I stopped talking to them about it. They think they’ve found a good therapist, but like the others they have gone to in the past, they may end up not mentioning the BIs, and they may start treating their symptoms as purely psychological or emotional ones.
I really need to say something more to them about this. I think I need to discuss it with my neuropsych. My NP is probably not going to be able to say much, but I do need to ask them if they know anyone like them who has the same orientation towards healing and recovery. I suspect that along with my friend’s childhood trauma, there are some neuropsychological issues that need to be addressed — and it could be that by simply changing a few of the ways they go about doing things, they could benefit immensely.
I just need to find a good way to bring up the subject. They know about my recovery, and they have said many times that they are amazed by how far I’ve come. And, come to think of it, they have also said they wished they could find someone who is like my NP for themself. The thing they have going for them, is they have documented medical evidence of their most recent brain injury. It’s all there, complete with MRI showing the places where they have lesions. So they could get medical coverage to help them defray the costs. That’s huge, considering they have almost no money. Maybe getting some help will help them change that.
So yes, I do need to bring up the possibility of them seeing a neuropsychologist. They can get pretty paranoid, so I need to be careful how I phrase things. But I at least need to try. They need help. And I might be able to help/support them.
One of the things I hear them say is that they’re “too old”. They’re in their 60s and they feel like they’re getting old. But I really believe that they can turn things around. With some basic logistical changes similar to what I’ve done, I suspect they can revitalize their life and not only add years to their life, but add life to their years.
I just hope they don’t end up with a therapist who stirs everything up, tries to get them to “feel their feelings” (trust me, they have no problem doing that), and disregards their TBI history, because they are convinced that all their problems are trauma related. They might only be partly right — trauma includes traumatic brain injury, and I would hate to see that piece of their puzzle ignored.
I’d like to propose something controversial here that probably won’t be well-received in psychotherapeutic circles. I’ve said it before, I believe, but I’m going to say it more emphatically now. Someone recently commented on another one of my posts, right when I’ve been thinking about it a lot, so I’ll say it again:
Therapists/mental health counselors (without a strong grounding in neurological information) are about the last people who are able to effectively deal with mTBI. And in the early stages of recovery, seeing a therapist to “figure things out” can do more harm than good. Much more harm than good.
It’s unfortunate, and I hate to say it, but I believe it to be true, based on personal experience with therapists and with friends/acquaintances who are therapists. What I’m about to say comes from years and years of observation, and no matter how seriously therapists may question my point of view (after all, I might be mentally impaired), I still believe it and I stand by it.
See, here’s the thing — TBI seriously screws with the functioning of your brain. Even a “minor” concussion and shear and shred axons and synapses and all those connectors that you’ve built up over the years to learn to live your life. Plus, it releases interesting chemicals into the brain that kill cells. Don’t be alarmed – the brain is a marvelously resilient organ that ingeniously figures out how to re-route connections, recruit other parts of the brain to do the jobs of parts that can’t do it anymore, and generally adapts to changing conditions in ways we are only beginning to recognize and understand.
The thing is, in the early stages of injury (and by early, I also mean the first couple of years after the incident — TBI is a gift that keeps on giving 😉 ) your brain is still trying to figure things out and it is organizing itself around a new way of needing to live your life. Generally folks with TBI don’t have a full and complete understanding of how they’ve been impacted and how it’s affecting their life – we just thing that the world has suddenly gotten all screwed up for no apparent reason. So, our brains are floundering and confused and not quite sure how to find their way out of the messes we’ve gotten into.
And the reorganization that normally takes place as a natural part of recovering from an injury — the reorganization of our brains along certain lines, so that we can resume some level of functionality — can be a bit haywire. The “plastic” brain is a lot like modeling clay. If you press it into a certain mold and leave it there, it will assume that shape and become like its environment. If you leave a lump of it lying on a table and walk away, when you come back a week later, it will be hardened into a chunk that may shatter if you drop it. If you stretch it into lots of thin, haphazard shapes and you leave it that way, it will harden into those thin and haphazard shapes.
So, when your brain is coming back from an injury and it’s looking for different ways to reshape itself, it can get all pulled in a gazillion different directions, because in the aftermath of TBI, things can be crazy and confusing, and we can come up with all sorts of skewed perceptions of ourselves. And if those perceptions are not questioned, challenged and corrected, they can harden into “truth” — which leads us even further down an erring path — into yet more trouble.
Hm. So, the crazier things get, the crazier you feel, and you wonder if you’re just plain losing your mind. You feel depressed and confused and out of sorts, and you don’t know why. So, you do the “logical” thing and you seek professional help. Your friends and family applaud you, because you’ve been getting harder and harder to deal with, and it seems like you have “emotional problems”. (Well, duh – emotional lability and impulse control are often “bundled” with TBI, as a neat little package of insult, injury, and humiliation for everyone involved.)
The only problem is, the therapist you start to see doesn’t know jack about TBI, and they come from the camp of “repressed memory” and how an unhappy childhood marked by long-forgotten/denied/overlooked abuse and neglect is to blame for adult issues. They believe with all their professional soul that most people are walking around in life cut off from their emotions, and that the true path to happiness is to connect with your inner hurt, name your pain, confront the things you are avoiding, and learn to love your demons.
There’s only one problem — none of what they say actually applies to you. The issues you have didn’t start until after your traumatic brain injury, and prior to that head injury, you were a reasonably happy and functional person with their share of troubles, but no “ticking time bomb” of forgotten abuse and neglect to throw you off course. They think that like certain childhood abuse survivors, you have been in denial most of your life, until you reached a certain point in your life when you had “advanced” enough to confront the challenges of resolving a difficult childhood… and they’re going to help you do just that — get in touch with your repressed memories, love the shadow, dance with your demons, and ultimately come to accept and love yourself, no matter what.
What they don’t realize, however, is that your brain is still recovering, still changing, still modifying itself to the world as it now is (rather than as it was before your injury). It’s volatile and highly subject to suggestion, and you’ve been wrestling for so long with not knowing for sure what’s going on with you or how best to deal with it, that your system is highly tweaked and on an emotional hair trigger. They think you’re in need of emotional “tough love” — but what you really need is some good regular exercise, a daily routine to take the guesswork out of your life, and extra patience and rest.
So, they push you. They challenge you. They test your limits. They try to get you to open up to them… pushing and pushing to get you to “admit” what’s going on inside of you, when internally, you’re in storm of emotion that’s neurologically based and totally inexplicable from a purely psychological point of view. They think you’re in denial and resisting necessary change, and you’re sitting there, week after week, looking at them like they’re from another planet, wondering “What’s wrong with me?!” and getting more and more confused and depressed by the week. You take it out on your friends and family, who have really had it with you, by now, and pull even farther away from you than before, thinking you’re just not trying hard enough.
Your therapist thinks you’re making great progress, getting in touch with your feelings and emotions, letting them come up and processing them. But you’re sinking farther and farther into a morass of emotional confusion, volatility, self-doubt, even desperation. Of course, this is all helping to create repeat business for the therapist who is “helping” you, and they can add even more diagnoses to the insurance bill, so what do they care? (Okay, in fairness, I’m sure that not all therapists are interested in creating repeat business, but any time you combine “care” with making a living, you get into gray areas and tricky territory.)
You’re increasingly worried about your emotional and mental health, and that’s keeping you stressed. You’re not sleeping well, which is taking a toll on your ability to self-regulate — your ability to do, well, everything. You’ve got all of the following TBI after-effects in abundance:
emotions, moods, agitated, can’t settle down, anger, anxiety, feeling vague fear, worry, anticipation of doom, depression, feeling down, excitability, everything feels like an effort, feeling unsure of yourself, feelings of dread, feeling like you’re observing yourself from afar, feelings of well-being, feeling guilty, feeling hostile towards others, impatience, irritability, no desire to talk or move, feeling lonely, nervousness, feelings of panic, rapid mood swings, restlessness, tearfulness, crying spells, feeling tense, feeling vague longing/yearning, etc…
And according to your therapist, it’s all due to mental health issues. Not brain issues. Emotional ones. It’s not your body that’s the problem. It’s your soul. You’re screwed.
Your brain is getting a steady stream of messages from your therapist and from yourself about “the way things are” — which is that you’re screwed up and in need of some serious intervention — and it’s causing your very plastic brain to re-form itself along the lines they’re suggesting. You feel like you’re getting worse, so your therapist dials up the intensity … and tells you all the drama is good — you’re “feeling things for the first time” (which is total, utter crap) and you’re acknowledging the difficult-to-handle aspects of your life (which really only emerged after your TBI). It throws you into even more of a tailspin, and before you know it, you’re planning on breaking up with your partner/spouse/lover, you’re riding the roller-coaster of withdrawal on one hand and aggression on the other, and you’re more and more convinced that you can’t live without your therapist, who is the one person who will sit in a room with you for more than a few minutes, as you’ve effectively chased everyone else away.
Anybody else have this happen to them? It happened to me, and looking back, all the advice from my friends and family about getting professional help from a licensed psychotherapist, was about the worst I could have gotten — and followed. It almost cost me my marriage, it turned my life into an extended experience in chaos, and the only reason I managed to escape the bogus-psychotherapy merry go round, was that I ended up seeing a truly well-meaning but neurologically clueless psychotherapist who scared the crap out of me because they had connections at a local mental hospital who could have me committed (against my will) at their say-so. A narrow escape, but an escape no less.
In fairness, I do believe that a lot of therapists are well-meaning and they are acting on the information and the training they have. But too often that training does NOT include a neurological element, and/or they decide that the awful ills of the world have psychological roots.
Another thing that makes it difficult is that a lot of therapists have mental health issues of their own. A lot of my therapist friends got into therapy because they were helped by counselors, themselves. While I applaud their eagerness to help others, it puts up a huge red flag for me. Because the nature of their mental health issues — incest or eating disorders or some other awful trauma — caused them to distance themselves from their bodies at a fairly early age, and they have grown up living outside their bodies. My therapist friends are by and large antagonistic towards their own bodies. They don’t really exercise, and if they do, it’s “gentle stretching” or yoga or something really non-challenging. They are not on friendly terms with their own physical selves, which closes their minds when I suggest that exercise and taking care of your body (as if your life depends on it, which it does) is key to mental health.
It’s all “mind over matter” for them — and I’ve witnessed the same mindset in other psychologists and therapists I’ve met. Not physically vigorous. Not physically healthy. Sitting all day in small rooms, gaining weight, losing muscle tone, planning on knee and shoulder replacements to repair the damage that their sedentary lifestyles have done to their bodies. And complaining all the while about stupid little things that a little exercise would make seem inconsequential.
Anyway, I’ll quit ranting, now. It’s a beautiful day, and thank heaven I remembered I need to move money into my bank account to cover a monthly autobill. Just to wrap up, when it comes to deciding whether or not you really need therapy, consider your neuropsychological state, and make sure you don’t get stuck with someone who doesn’t have a clue about how neurology can make you a little crazy… but that passes with time, and with the proper training and reinforcement for what your life can really be like.
‘Cuz if you aren’t crazy when you start seeing them, regular visits can make sure you really get there.
I had an interesting conversation with some acquaintances a few days back. For some reason, I ended up sitting at a table with a couple of folks who were lugging around diagnoses of ADD, like so much luggage they had to schlepp around an airport, in perpetual search of a flight that kept changing gates.
One of them embraced their ADD diagnosis with forced gusto, essentially turning the baggage into heavy Luis Vuitton satchels with special locks on all the latches. They proudly proclaimed that they were a “ready-shoot-aim” kind of person, who took things as they came… and proceeded to also comment that for all the balls they have in the air at any given time, they didn’t actually get much done.
Another of them sat silently as we discussed distractability and attention issues and what it’s like to live in today’s world. Not to be dragged down by any ADD/ADHD diagnostic belaborment, I proposed the idea that in today’s world, with all the things that are constantly thrown at us… if we have any interest at all in life, and if we are really invested in what happens to us and the world around us, we darned well sure are going to get “distracted” on a pretty regular basis.
I mean, if you give a damn about what’s going on around you, and if you have a deep and abiding interest in your surroundings, and your surroundings change and evolve, how can you not pay attention to shifting things?
“If you’re really, really alive,” I proposed, “you’re going to be prone to be distracted.”
The one with the “expensive luggage” just looked at me.
The quiet one got up and gave me the biggest hug I’ve gotten in a long time.
Most of us have been listening to the massive, round-the-clock press coverage of the latest mass shooting incident at Fort Hood, Texas. Seemingly all the possible root causes of such a horrific act of violence have been raised and discussed. However, there is an elephant in the room, and it’s something that should be obvious in this age of the school shooter pandemic.
We should be outraged at the failure of the investigative journalists, the psychiatric professionals, the medical community and the military spokespersons who seem to be studiously avoiding the major factor that helps to explain these senseless acts. Why would someone unexpectedly, irrationally and randomly shoot up a school, a workplace or, in this case, an army post? Why would someone who used to be known as a seemingly rational person suddenly perpetrate a gruesome, irrational act of violence?
The answer to the question, as demonstrated again and again in so many of such recent acts of “senseless” violence, is brain- and behavior-altering drugs.
I can see his point, and I think it is a good idea to factor in the potentially dangerous effects of psychoactive drugs. But I also believe there are many layers to this, the effect of drugs being only one of them. Something(s) else contributed to pushing the shooter to that point. And I’m not sure we can fairly lay all the blame at the feet of the pharmaceuticals industry.
Whatever the cause of the rampage, this issue of pharma-gone-bad is of particular interest to me, because as a multiple-TBI survivor with a bunch of cognitive-behavioral issues, it could be all too easy for a “qualified” doctor or neurologist or psychiatrist to load me up with a bunch of pills and send me on my way. I consider myself unbelievably fortunate and blessed to be working with a neuropsychologist who is very wary of pharmaceuticals and approaches them as a last resort, when all else fails. They are also very happy when I come up with alternative solutions to my issues that work well and do not involve drugs — like exercising regularly as an antidote for fatigue and drowsiness and a way to wake up fully in the morning.
Interestingly, my psychotherapist tends to come down on the side of drug therapies for individuals with attentional difficulties. I may have to cut them loose, if they turn out to start pressuring me to resort to drugs. If they so much as start hinting at me using them, simply because other approaches “don’t appear to work as effectively” I may have to have to reconsider working with them and seek help elsewhere. Who knows? I may even cut out the psychotherapy completely.
Hard to say, at this point. I think it’s been helping me in some ways… no, I’m pretty sure it has.
But I have been growing a little more leery of my shrink, over the past month or so. They seem more distant than they did at the start. They also have said some things to me over the past couple of sessions that don’t sit right with me, but I haven’t actually followed up on. I should probably do that, to clear the air. It’s hard for me to spend the time and money with someone who I think doesn’t believe me, or seems to be insinuating that I’m misrepresenting my difficulties to the rest of the world. I’m not sure if they think I’m worse off than I appear to be, or if they are just having a hard time, themself.
To be fair, they did suffer a devastating personal loss, last year about this time, so I think it may be messing with their head a little bit. They have definitely not been at their best, of late. So, I’ll cut them some slack, give it some more time, slow things down, and not let them pull any punches with me. We’ll see how it goes.
Bottom line (if there is one) is… mental health care providers can have problems, too. And those problems can get to them in some pretty serious ways. I’m just glad my shrink isn’t trained in small arms — I’m assuming they aren’t — and that they don’t work in an environment where the use of firearms is part of the job.