Author Archives: dsgablephd@live.com

About dsgablephd@live.com

Licensed Psychologist for over 16 years. Ph.D. from the University of Tennessee.

A Perfect Storm

We are creating a perfect storm for tragedy. We have woefully inadequate mental health care and unlimited access to weapons. When I read of shooters described as mentally ill, I imagine the public spewing venom about the idiotic psychologist who failed to hospitalize the patient in time to prevent the shooting. So, I am on my soap box to say, “Easier said than done.”

Mental health professionals may press for more intense treatment, but insurance companies often resist covering the treatment of mentally ill individuals, and they certainly don’t want to foot the bill for lengthy hospitalizations. On numerous occasions, I have attempted to have a patient in active psychosis admitted, only to be told they “don’t meet the criteria.” As recently as two weeks ago, we sent a potentially dangerous patient to the ER. She was given a Prozac and sent home. Her family was able to help her safely through her episode, but it might have ended differently. There is an acute need for the revamping of the mental health system. The current practice of waiting until after a tragic event, and then imprisoning the person, or burying them, isn’t working.

What scares me the most, however, is the number of people I know of with explosive disorders, anger issues, and personality problems that have stock-piled, yes, literally stock-piled, weapons. What will it take for someone like this to slip over the edge and kill himself or someone else? And this isn’t taking into account the mood swings and impulsivity of young people. In 2010, more than 1,900 kids between the ages of 5 and 19 committed suicide with a firearm. Where do we think they got those guns? Further, eighty-five percent of suicide attempts with a gun are successful, as opposed to one to two percent with, say, wrist-slashing. We need to be more aware of depression in teens, work to get hospitals to admit severely depressed people, and do whatever is needed to protect our youths from themselves. Some gun-owning parents with children suffering from depression have actually, gasp!, removed firearms from their homes.

There is a lot of work to be done at the juxtaposition of mental health and criminal law. Let’s push for real progress.

Who Do We Think We are?

More and more, I am seeing that our self-identities may be our destinies. When we are young, we believe we are invincible, that life has no boundaries, and that our futures have no strings. But our identities harden around the edges as we make choices and begin to shape the way we live. That is a good thing. We need structure to accomplish anything. We need a foundation to build on. We need a circle of support.

But I’ve learned something from clients whose lives have been so structured, their identities so bound up with their roles, that, when they lose those roles, they become paralyzed. Some are people whose careers have ended through lay-off, down-sizing, or retirement. Some are parents who feel useless now that their children have left. It’s normal to feel the pain of loss in those circumstances.  What is not healthy is to have become so enmeshed in those roles that they can’t move beyond them.

These are the clients that, when I ask them what they enjoy now, they say “nothing”. When I ask what interests them, they say “nothing.” When I ask what new topics they might want to learn about, what places would be fun to explore, they say “none.” They’ve had a one-note song, and the song has ended. I realize it is often depression and loss talking, but because their lives have been so narrow, they are unable to move beyond this state. They remain in a sarcophagus of grief and stagnation, often for years. Sometimes for a lifetime.

So, who do we think we are? The best accountant, or nurse? A terrific parent, or electrician? Wonderful! But is that the only way we see ourselves? A single possible role? Then living that one-dimensional life will be devastating when our situation changes. So…, right now, today, we can take up a hobby or join a club or become a gardener, a runner, a scholar, a gourmet cook. We can wear a handful of hats. A closet full. This is mental preventive medicine–a lesson I’ve learned from my clients.

 

Again We Grieve

IMG_0438Again our hearts are saddened by the tragedy in Orlando–the worst mass shooting in US history. Many on social media are using this tragedy to support their fight against stiffer gun control laws. They seem to be suggesting that, if all citizens had assault rifles, we would be safer from such incidents.

I have tried to imagine how that would play out. Should all of those victims at the club have been armed, hauling in their assault rifles and propping then against the bar as they talked and danced? Just in case? Or should they have locked them in their cars, hoping for the opportunity to race from the club, retrieve their weapons, and come back shooting? Should our children in the schools be issued assault weapons to keep at their desks, or should teachers simply have rifles ready to pass out like pencils or test booklets, if gunmen appear?  Are we to carry weapons instead of umbrellas when we shop? And how can we tell if the gun-toting shopper beside us is one of the good guys?

No matter how I play the scenarios in my head, I can’t imagine how any of the tragedies we have seen could have been prevented by vast hoards of citizens stockpiling implements of death. I know that there have been dozens, perhaps hundreds, of “explanations” of how this would help, but none make sense to me. Perhaps I am just too weapon-ignorant. But  of the real experts–parents and sisters and children who have lost loved ones to gun-wielding killers–not a single one says that the answer is more guns.

And so I applaud my client who had inherited a collection of guns that were family heirlooms. Several years ago, he realized that his mood swings might one day tempt him to do something that he could never take back. He immediately got rid of every weapon. He is remarkable for his courage, because courage is not based on how easily we could kill someone, or how big our stockpile of weapons is. Those are signs of insecurity. One of the most courageous actsIMG_0018 we can perform is taking a realistic look at ourselves, acknowledging our flaws, and making the best decisions possible. Even if they’re the hardest.

 

 

Expressing Our Sadness and Our Support for the Citizens of Paris, France

This email was forwarded to me by a friend and school psychologist. I think the sentiments expressed here say what we are all feeling in the aftermath of the recent deadly attacks in Paris.

Sunday, November 15, 2015

Bethesda, MD—On behalf of our 25,000 members, the National Association of School Psychologists (NASP) joins the nation in expressing our sadness and shock at the horrific acts of terrorism in Paris, France. Our thoughts go out to the French people and to everyone affected by this heartbreaking tragedy.

Intentional acts of violence that hurt innocent people are frightening and upsetting, particularly when they are accompanied by explicit threats of further harm. Modern media can make international events feel relevant and potentially threatening to children and youth here. They will look to adults for models of how to react, and to help them understand the event. Families and school personnel can support children by establishing a sense of safety and security, helping children to process their thoughts and feelings, and placing the event in the proper context. Additional tips include:

  • Provide accurate reassurances regarding the possibility of terrorism in their community.
  • Return to normalcy and routine to the extent possible while maintaining flexibility.
  • Let children know it’s okay to have many different feelings and there is no one right way to respond.
  • Be a good listener and observer
  • Monitor and limit exposure to media, including social media and other Internet sites
  • Provide ways for children to express emotion, such as journaling, writing letters, talking, art, or music
  • Focus on resiliency as well as the compassion of others
  • Identify the various ways in which people are helping; emphasize the ability to do good

A natural reaction to acts of extreme violence is the desire to lash out and punish the perpetrators or perceived enemy. People who are angry or frightened often feel the ability to “fight back” puts them more in control or will alleviate their sense of outrage. While anger is a normal response, we should not compound an already tragic situation and react against innocent individuals with vengeance and harassment. There is a tremendous risk of unfairly stigmatizing people who are perceived to resemble the perpetrators because of their race, language, religion, or the way they dress.

Children, in particular, may have difficulty channeling their feelings appropriately and they can easily pick up negative or demeaning cues given by adults around them. Given the diversity of America’s schools, some students may become targets of hostility and blame. Bullying and harassment are never acceptable but they can be particularly damaging when certain students or segments of society feel especially vulnerable. Families and school personnel need to be prepared to prevent and to intervene quickly and effectively in the presence of abusive behaviors toward any students. Such behaviors can only further contribute to the risk of violence in schools and communities.

Adults can help children understand the importance of treating all people with dignity and not judging entire groups of people for the actions of a few. Most importantly, adults must model compassion and acceptance of differences in their words and behavior. They can encourage children to explore their feelings about prejudice and hate. Doing so is not only critical to preventing further harm, but the process presents a potentially powerful opportunity for our youth to learn and to incorporate into their values the true strength of our country—our commitment to individual freedom and upholding the respect and dignity of all people.

How the Worst Can Make You Your Best

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A brief article by Jim Rendon in the August 3, 2015 issue of Time magazine, titled “How trauma can change lives for the better,” stated that an estimated 75% of us will experience a traumatic event at some point. Those events inevitably  will cause pain and suffering. But in the 1990s, two psychologists (Richard Tedeschi and Lawrence Calhoun) interviewed 600 survivors and were intrigued to find that, after the pain, many said their lives changed for the better. They reoriented themselves, adopted different perspectives, changed their goals. The psychologists named this phenomenon “posttraumatic growth.”

I have had the privilege to witness this type of growth in many of my clients. It’s exciting to watch victims devastated by rape, sexual abuse, loss, and illness move past the trauma and become more than just survivors. They become transcenders. I have seen a mother who had been a petty criminal spearhead an annual drive to provide books for needy children after the death of her three-year-old son.  I’ve watched clients bearing scars from early abuse become counselors, nurses, and volunteers. Then there is the client who nearly died in a recent motor vehicle accident, and another who was in a coma for almost a month after her car was struck by a semi. Both of these individuals had struggled with chronic depression. Now, although they suffer residual limitations from their injuries, each has moved beyond depression to become more active in the community, more giving of themselves, more enthusiastic about life.

As Jim Rendon writes, “Growth begins with healing from trauma. But people have the capacity to do far more than just heal. Ultimately, they can become better versions of themselves.”

 

Update on Pre-surgery Hypnotherapy

Almost a year ago I wrote that I would begin using hypnotherapy to help clients facing non-emergent surgery. I can report that it is even more beneficial than I had hoped. I worked with one client who was highly anxious abut her scheduled hysterectomy. “The last time I had surgery,” she said, “I woke up from the anesthesia screaming with pain.” This client was planning to move out of the area and her surgery was scheduled for the following week, so we had time for just one session of hypnotherapy. She called about a month later to say. “I just wanted to you to know that I forgot to take my pain medication. I felt so great after the surgery that I never remembered to take it.”

I am so glad that I’ve added this intervention to my repertoire. As an aside, I recently worked with a gentleman whose health was in jeopardy after over 50 years of heavy smoking. The doctor had warned him that he wouldn’t live long unless he gave up tobacco use, but, despite his efforts, he was unable even to cut back. After our first hypnotherapy session, he had reduced his smoking to two cigarettes a day. After the second session, he was able to stop smoking. He is a highly motivated individual and I’m pleased that I was able to help him reach his goal.

Hypnotherapy does not allow the therapist to take control of the client. It enhances the client’s ability to harness his or her own strengths and willpower.

How I learned determination

A small item in the February 16, 2015, issue of Time reported, “Your hands and feet dominate your feeling of overall thermal comfort, so stock up on the gloves and boot liners.” I was instantly transported to memories of Aunt Helen, who died in 1982 at the age of 88. Unschooled, but wise and practical, she would badger us with country wisdom, including the admonition, “Put socks on. When yer feet’s cold, yer cold all over.” She was way ahead of Time.

She was my aunt through marriage, but, thanks to the fertility of my grandmother, who continued to produce babies while her oldest sons were marrying, Aunt Helen was easily old enough to be my grandmother. In my eyes, though, she was ageless. Her gray hair clearly made her ancient. Yet, she eagerly maneuvered with me through barbed wire to explore the neighbor’s cow pastures behind the house, or hiked long miles through the woods beyond Swedesford Road to spend stifling afternoons having picnics at the county park, activities for which my frazzled, diaper- and Pablum-immersed mother could never muster the energy. When my aunt was not catering to my schemes, she ran the family service station, scurrying out in her flowered house dress and red Keds to pump gas into customers’ tanks long before women officially wrestled out their rights to perform “men’s” jobs.

Aunt Helen was vibrant and sassy, and certainly no saint. To the family’s frequent frustration, she was stubborn, single-minded to a fault, and an on-again-off-again alcoholic. But what I learned from her during my summer vacations, as I scrambled to keep up on the daily three mile hikes to the gas station, sweat streaming down my skinny legs, is that accomplishment comes in the doing, not the planning or hoping. I saw the way she named her goal, then tucked her chin and plowed forward like a linebacker, elbowing each obstacle out of her way, moving on, no matter what. That’s one thing I learned from her. That’s what got me through graduate school. Thank you, Aunt Helen.

Integrity in the Face of a Dilemma

I have witnessed many demonstrations of enormous courage in my clients, but perhaps none are as poignant as those times when an individual must choose between family and personal integrity. My heart is with those clients, because they will face enormous pain and great loss, which ever path they choose.

The conflicts typically involve young men and women who are in the process of identifying their individuality, their value systems, their personal goals, and unique identities. Sometimes the issue is one of sexual orientation. Sometimes it revolves around gender identity. At times it is a career path. Often it centers on embracing or rejecting a specific religious belief system. In each case, a person has been told, This is how I want you to be. This is how I want you to live. This is what you must believe. And if you don’t, you are no longer part of the family.

It could be seen as emotional extortion. “You must pay me this part of yourself, give up this piece of your identity, forfeit this dream, or the consequences will be abandonment.” It is an extraordinarily powerful weapon. It results in a never-healing wound, the pain from which can scarcely be imagined by those of us who have never experienced this double bind. How ironic that this is often inflicted in the name of God.

Some victims of this coercion retreat, give in to the pressure, conform to expectations. They live like caged birds or puppets or masked performers, wearing costumes that never quite fit. A few, when the despair becomes too great, end their lives.

But time and again I have seen clients maintain their integrity in the face of loss and condemnation. They hurt deeply, but they stand up and move forward, building as they go the lives they were meant to live. Through the experience, they discover self-reliance and confidence. They also learn the importance of pairing power with compassion. They become doers and thinkers and leaders.

I wish I could describe in detail their specific paths, but I won’t risk the chance of making the divide worse for them. Besides, their stories are their own to tell. But their successes are an inspiration for all of us facing hard choices. Transcendence is within reach.

Remarkable hypnotherapy client

I am very impressed with a young teen I began working with recently. She had been unable to order at restaurants, fast food places, and in other situations where attention was drawn to herself. After just one session of hypnotherapy, she had no difficulty. In fact, it came so naturally that she didn’t even realize she had ordered her food until her mother said, “Did you know you just ordered?” and she replied. “Oh. Did I?” She’s a bright, creative young woman. I am pleased to be working with her.

Pre-surgery Hypnotherapy

I attended a conference last week that offered information new to me. Although I have been using hypnotherapy for 14 years, I had never connected it with surgery. At the conference I learned that my clients who come for hypnotherapy prior to surgery are likely to have less pain, require less pain medication, and heal faster. I plan to implement this immediately. I will post the results later.