Saturday, December 05, 2009

Book Review: God, A Biography

I've wondered ever since I began to grasp the implications of "cognitivism" if the Judeo-Christian bible really is the bedrock of the confusing and conflicted cultural values, beliefs, idea(l)s, assumptions, convictions and attitudes of Western culture. In Jack Miles's 1996 Pulitzer Prize winner, God, A Biography, I think I found a lot of support for that notion.

The author demonstrates, albeit in his own confusing fashion, that God -- as reported by the writers of the Old Testament -- is alternately involved and uninvolved, caring and unconcerned, kind and vicious, verbal and silent, obvious and opaque, powerful and powerless, creative and destructive.

Miles may or may not have not set out to write a book about the topic as I have defined it above, but for those who understand not only personality theory (see http://www.google.com/search?sourceid=navclient&aq=1&oq=psonality+theory&ie=UTF-8&rlz=1T4ADBF_enUS304US306&q=personality+theory+psychology) but values clarification (see http://www.google.com/search?sourceid=navclient&ie=UTF-8&rlz=1T4ADBF_enUS304US306&q=values+clarification+), his remarkable book may leave the reader with a much clearer sense of where we came from and why we act as we do on every interpersonal level from the intimate to the geopolitical.

See the amazon.com listing for this book at http://www.amazon.com/God-Biography-Jack-Miles/dp/0679743685/ref=sr_1_1?ie=UTF8&s=books&qid=1260069204&sr=1-1.

Here is the review I left on both amazon.com and barnes&noble.com:

Values Clarification & the Cultural Norms We Take for Granted

Those who’ve taken the word of the (supposed) experts in the pulpit could learn a lot here about “the big picture” of the “biblical epic,” even if they don’t like Miles’s take on it. But those who flatly refuse to take the word (or The Word) as anything more than “history,” “cultural manipulation,” “authoritarian intimidation” or even “Jewish Quran” may learn a lot they didn't expect to, as well.

Miles is neither out to debunk the Old Testament nor is he out to hand the “religious” any sort of neatly packaged, theological “final proof.” Instead, GAB is a characterological (in the distinct, dictionary sense of that word) deconstruction of the numerous roles played by the title character along the course of a millennium.

There are parallels here to Julian Jaynes’s The Origin of Consciousness in the Breakdown of the Bicameral Mind (1976), which may be an even more intriguing examination of the initially powerful but ultimately flagging communion between deities and men during the very same period of time. (Jaynes’s reading of stone tablet and papyrus documentation asserts that man was able to hear the “voice of god” quite directly and easily when Homer, Moses and Abraham were around… but that the men of Alexander’s and Nehemiah’s day found it very difficult to tune in to the “signal.”)

But the similarities end there. Jaynes seems to be looking to provide us with an explanation for our present disconnection with a spiritual deity; Miles appears to be handing us a case to explain the nature of the connection we believe we have.

The author chooses not to take a controversial position out of which he cannot wriggle. He offers an hypothesis (near the end rather than the beginning) that the god of the Israelites displayed six distinct -- and quite diverse -- characters or “value systems” or “trait sets” described by the numerous writers of the Old Testament. But he wastes no words whatsoever about “god” being a literary invention, or, as many a-theist debunkers have put it, “made in the image of man.”

Clever. Very clever.

He could have laid the characters out near the beginning and then set out to demonstrate them, but instead, Miles chooses to go deductive rather than inductive. For a good reason… which may or may not become evident to the reader as he trudges through Miles’s fascinating -- if often logically suspect -- appraisals, interpretations, evaluations, assertions, judgments and attributions of meaning along the way.

One may come away from GAB feeling as though he’d stuck with it to arrive at somewhat obvious and even disappointing conclusion, but also grateful for having acquired a much greater grasp of a major part of the Western world’s most significant -- and everlastingly influential -- piece of literature. Far more permanent as an effect on the reader than the author’s stated conclusion, GAB makes a subtle yet powerful case for how our culture came to have the hugely confusing and conflicted beliefs, values, idea(l)s, assumptions, convictions and attitudes it has… about itself and others.

© 2009 by Rodger Garrett; all rights reserved. Links are fine. Please contact not_moses@fastmail.fm with comments or questions. Thank you.

Tuesday, December 01, 2009

12 Action Steps for Recapturing Intimacy

This is something on "recapturing real intimacy" I put together for someone yesterday. I'm indebted to Fruzzetti and Iverson in Hayes, Follette and Linehan for the quotation below, as well as the underpinnings for the 12-step (not "12 Step") method outlined below. The five stages of recovery are from my own work, but are influenced by Prochaska and DiClemente*.

Intimacy is...

"...a pattern of interacting in which
one person is able to disclose accurately
his or her thoughts, emotions, wants, and so on,
and in response to those disclosures,
the other person expresses acceptance
and understanding
through validation, which in turn leads to
the experience of closeness and of
being understood and/or supported."

Willful (even if wholly unconscious) dis-engagement from intimacy functions very similarly (perhaps even identically in many respects at the cognitive, behavioral and brain function levels) to "addiction." As with any form of addiction, one has to move through the following stages of recovery:

1) denial / pre-contemplation,
2) contemplation / consideration,
3) acceptance / identification,
4) committment / action,
5) maintenance / relapse prevention.

*See http://www.cellinteractive.com/ucla/physcian_ed/stages_change.html.

Stage 1 is where we are in active, willful addiction and dis-engagement from intimacy.
Stage 2 is where we are when we become willing to at least look at the possibility of addiction or dis-engagement from intimacy.
Stage 3 is where we are when we accept that we are addicted or dis-engaged from intimacy.
Stage 4 is where we are when we begin to do something useful to put an end to the addiction or re-engage in intimacy.
Stage 5 is where we are when we recognize the need to stay in the process to assure that we will remain addiction-free or capable of intimacy.

There are specific activities (behaviors) at each stage:

In stage 1, the activity is partcipation in addictive behaviors (e.g.: alcoholism, drug abuse, workaholism, over-exercise, obsessive shopping, binging and purging with food, etc.) or defending against reality and intimacy by engaging in pseudo-certainty and self-righteous rectitude.

In stage 2, the activity is increasingly open-minded examination of possibilities other that those in which we still continue to believe (e.g.: "I might be better off if I gave up the booze" vs. "Booze handles my problems" or "My own behavior may be part of the reason my marriage is coming apart" vs. "It's all her fault.")

In stage 3, the activity is complete acceptance and ownership of one's choice to continue to be addicted or to insist that one is always right and the other is always wrong.

In stages 4 and 5 (of recapturing intimacy), the activities are as follows:

1) Recognize the precise similarities and differences in your values. (Values include core beliefs, ideas, assumptions, convictions and/or attitudes that leads to current appraisals, interpretations, evaluations, decisions, judgments, analyses and/or attributions of meaning.)

2) Accept each others' values as simply there (rather than being "about" anything, including each other).

3) Notice which precise values are in agreement... and which are in disagreement. (Put them on paper and write about them at length. Write about what is valuable to you, not about anything the other person says or does that conflicts with your values.)

4) After consideration, give each of the conflicting, as well as agreed, values a rating from one to five.

5) Start discussing the lower-rated conflicting and higher-rated agreed values with each other from a position of complete acceptance that the other person has a right to have those values and without trying to change them.

6) Move one-by-one toward the higher-rated conflicting and lower-rated agreed values in the same way, just allowing each other to have those values. Make "presentations," as it were, but do so as is done in CoDA meetings without crosstalk between each other (i.e.: expressions of judgment, analyses, criticism, evaluation, interpretation, appraisal or attribution of meaning to you).

7) Sit still and feel your own feelings about each other's specific values and presentations thereof, then write about what came up.

8) Validate each other verbally for the bravery and willingness required to be honest with each other with any if's, and's or but's. Make sure the validations are genuine expressions, not just form-al declarations.

9) Make an agreement to do nothing more than think about what was written and said, and...

10) Sit still and feel what you both feel (even if it's fear, anger, frustration, upset, sadness, disappointment, grief, whatever) without expressing it to each other for three days.

11) Agree to have a meeting to discuss what all has come up (plenty will; I assure you) using active listening without cross-talk until you are both satisfied that you have at least been heard -- if not fully understood -- by the other.

12) Notice whether or not self-disclosure followed by validating (rewarding) each other's willingness to feel what you're actually feeling and report those feelings (and thoughts about them) accurately and dispassionately is making a significant difference in your ability to understand, appreciate and like (as well as "love") each other.

A caveat: In a relationship with a true narcissist, everything from step 2 onward is essentially impossible. The malignant narcissist (see http://samvak.tripod.com/) cannot "come to the table" because he cannot see that there are any other points of view than his own.

Further, those in intimate (actually pseudo-intimate) relationships with people with other personality disorders besides the narcissistic type may find it difficult to get very far past step 4. Some examples:

Those with chaotic, drama-obsessed, attention-seeking histrionic personality disorder may be too attached to their need to defend themselves (with drama and chaos) against what they believe to be intolerable emotions.

Those with suspicious, "certain-of-the-worst," "everyone-is-out-to-hurt-me" paranoid personality disorder may convince themselves that recapturing intimacy (if indeed they ever had any) is just another sneaky way to injure them.

Those with activity-addicted, busy-every-second, "wait-I-have-to-do-this-first," cannot-sit-still obsessive-compulsive personality disorder are usually certain that they must do what they believe they have to do right now that may make recapturing intimacy next to impossible.

Those with nihilistic, negativistic, "the-world-is-going-to-hell," "everything-is-just-so-awful" depressive personality disorder may believe that recapturing intimacy is as "impossible" as enjoying a football game on TV or even walking the dog.

Those with snivelling, "it's-all-your-fault-that-I-(fill in the blank)," convinced-of-being-powerless, but "put-up-with-crap-'cause-I-have-to" passive-aggressive personality disorder may appraise that there's no other alternative to sabotage the process of recapturing intimacy the way they sabotage everything else.

There are other variations of these complex personality disorder defense mechanisms, including...

schizotypal (odd, strange, wierd),
schizoid (not interested in intimacy to begin with),
dependent ("I'll go along with anything you say; you have all the answers"),
antisocial ("what's mine is mine, and what's yours is mine, too"),
sadistic ("you really dig it that I abuse you, 'cause you know you deserve it"),
masochistic ("I really dig it that you abuse me, 'cause I know I deserve it"), and
borderline (usually desperate for pseudo-intimacy -- actually "rescue" -- one minute, then desperate to get as far away as they can the next, often by "persecuting," to avoid seeing themselves as the dependent, helpless "victim;" see http://sighkoblahgrr.blogspot.com/2009/04/karpman-drama-triangle-summary.html).

If one is in a pseudo-intimate relationship with a partner who has a personality disorder, recapturing intimacy may be impossible until the personality disorder is effectively treated and that particular "style" of dis-engagement is reduced in intensity. And that takes a lot of time, typically several years. If the personality-disordered partner cannot move into at least the contemplation / consideration phase of recovery (see above), the better choice in such circumstances may be to "detach with love" and move on.

Resources, References and Further Reading

Adler, R.; Rosenfeld, L.; Towne, N.: Interplay: The Process of Interpersonal Communication, 6th Ed., New York: Harcourt Brace, 1995.

Alpert, R. (“Ram Dass”): Be Here Now, San Francisco: Lama Foundation, 1971.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: DSM-III-R, New York: APA, 1987.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, New York: APA, 2000.

American Psychoanalytic Association et al: Psychodynamic Diagnostic Manual (PDM), Silver Spring, MD: Alliance of Psychoanalytic Organizations, 2006.

Anonymous: Adult Children of Alcoholics: Alcoholic / Dysfunctional Families, Torrance, CA: ACA World Service Office, 2006.

Anonymous: Co-Dependents Anonymous, Phoenix, AZ: Co-Dependents Anonymous, 1995.

Antony, M.; Swinson, R.: When Perfect Isn't Good Enough, Oakland, CA: New Harbinger, 1998, 2009.

Bandura, A.: Self-Efficacy: The Exercise of Control, San Francisco: W. H. Freeman, 1997.

Beattie, M.: Codependent No More, San Francisco: Harper/Hazelden, 1987.

Beattie, M.: Beyond Codependency, San Francisco: Harper/Hazelden, 1989.

Beattie, M.: Codependents’ Guide to the Twelve Steps, New York: Simon & Schuster, 1990.

Beck, A.; Freeman, A.: Cognitive Theory of the Personality Disorders, New York: Guilford Press, 1990.

Beck, A.; Wright, F.; Newman, C.; Liese, B.: Cognitive Therapy of Substance Abuse, New York: The Guilford Press, 1993.

Beck, A.: Prisoners Of Hate: The Cognitive Basis of Anger, Hostility, and Violence, New York: Harper-Collins, 1999.

Benjamin, L. S.: Interpersonal Diagnosis and Treatment of Personality Disorders, Second Edition, New York: Guilford Press, 1996.

Benjamin, L. S.: Interpersonal Reconstructive Therapy, New York: Guilford Press, 2003.

Berne, E.: Games People Play: The Psychology of Human Relationships, San Francisco: Grove Press, 1964.

Bernstein, A.: Emotional Vampires: Dealing with People who Drain You Dry, New York: McGraw-Hill, 2000.

Black, C.: It Will Never Happen to Me: Children of Alcoholics as Youngsters-Adolescents-Adults, New York: Ballentine, 1981, 1987.

Bockian, N.; Jongsma, A.: The Personality Disorders Treatment Planner, New York: John Wiley & Sons, 2001.

Bowlby, J.: A Secure Base: Parent-Child Attachment and Healthy Human Development. London: Routledge; New York: Basic Books, 1988.

Bozarth, M.: Drug addiction as a psychobiological process, in Warburton, D. (ed.): Addiction controversies, London: Harwood Academic Publishers, 1990.

Bozarth, M.: Pleasure systems in the brain, in Warburton, D. (ed.), Pleasure: The politics and the reality, New York: John Wiley & Sons, 1994.

Cassidy, J.; Shaver, P.: Handbook of Attachment, New York: Guilford Press, 1999.

Castonguay, L.; Beutler, L.: Principles of Therapeutic Change that Work, London: Oxford University Press, 2005.

Cermak, T.: Diagnosing and Treating Co-Dependence, Minneapolis: Johnson Institute, 1986.

Clarkin, J.; Lenzenweger, M.: Major Theories of Personality Disorder, New York: The Guilford Press, 1996.

Cross, K.: Reactive Attachment Disorder and Attachment Therapy, Kansas City: Kansas Attachment Center (online .pdf), 2005.

DiClemente, C.; Prochaska, J.: (1982). Self-change and therapy change of smoking behavior: A comparison of processes of change in cessation and maintenance, in Addictive Behaviors, Vol. 7, 1982.


Dimeff, L.; Koerner, K.: Dialectal Behavior Therapy in Clinical Practice: Applications Across Disorders and Settings, New York: The Guilford Press, 2007.

Dodes, L.: The Heart of Addiction: A New Approach to Understanding and Managing Alcoholism and Other Addictive Behaviors, New York: Harper & Rowe, 2002.

Dodi, G.: In Search of the Real: The Origins and Originality of D.W. Winnicott, Jason Aaronson, 1993.

Ekleberry, S.: Seminar on Substance Abuse and Axis II Personality Disorders, San Francisco: Arcturus, 2000.

Ellis, A.; Harper, R.: A Guide to Rational Living, North Hollywood, CA: Melvin Powers, 1961.

Ellis, A.; Dryden, W.: The Practice of Rational Emotive Therapy, New York: Springer Publishing Company, 1987.

Ellis, A.: Overcoming Destructive Beliefs, Feelings, and Behaviors: New Directions for Rational Emotive Behavior Therapy, New York: Promethius Books, 2001.

Engle, B.: The Emotionally Abusive Relationship: How to Stop Being Abused and How to Stop Abusing, Hoboken, NJ: John Wiley & Sons, 2002.

Evans, F.: Harry Stack Sullivan: Interpersonal Theory and Psychotherapy, London: Routledge, 1996.

Evans, P.: The Verbally Abusive Relationship, Expanded Second Edition, Avon, MA: Adams Media Corp., 1996
Evans, P.: Controlling People, Avon, MA: Adams Media Corp., 2002.

Fairbairn, W.: An Object Relations Theory of the Personality, New York: Basic Books, 1952, 1984.

Fonagy, P.: Attachment Theory and Psychoanalysis, New York: Other Press, 2001.

Forward, S.: Toxic Parents: Overcoming their Hurtful Legacy and Reclaiming Your Life, New York: Bantam Books, 1989.

Fossum, M.; Mason, M.: Facing Shame: Families in Recovery, New York: W. W. Norton, 1989.

Frances, R.; Miller, S.: Clinical Textbook of Addictive Disorders, New York: Guilford Press, 1991.

Fromm, E.: Escape from Freedom, New York: Avon, 1965.

Goodman, A.: Sexual Addiction: An Integrated Approach, Madison, CT.: International Universities Press, 1998.

Goldenberg, I.; Goldenberg, H.: Family Therapy: An Overview, Belmont, CA: Thomson Learning, 2000.

Goleman, D.: Emotional Intelligence, New York: Bantam, 1980.

Gordon, T.: Parent Effectiveness Training: The Proven Program for Raising Responsible Children, New York: Three Rivers Press, 1970, 1975, 2000.

Gorski, T.: Gorski-CENAPS Clinical Model of Substance Abuse Treatment, Spring Hill, FL: Gorski-CENAPS, 2001.

Harris, T.: I’m Okay—You’re Okay, New York: Harper and Row, 1968.

Hayes, S.; Follete, V.; Linehan, M.: Mindfulness and Acceptance: Expanding the Cognitive-Behavioral Tradition, New York: The Guilford Press, 2004.

Iberg, J.: Unconditional Positive Regard: Constituent Activities, in Levant, R.; Schlein, J.: Client-Centered Therapy and the Person-Centered Approach: New Directions in Theory, Research and Practice. New York: Praeger Press, 1984.

Jongsma, A.; Peterson, L. M.; Bruce, T.: The Complete Adult Psychotherapy Treatment Planner, 3rd Ed., New York: John Wiley & Sons, 2001.

Kelly, G.: The Psychology of Personal Constructs; New York: Norton & Company, 1955.

Kernberg, O.: Severe Personality Disorders: Psychotherapeutic Strategies, New Haven, CT: Yale University Press, 1977.

Khantzian, E: The self medication hypothesis of substance use disorders: a reconsideration and recent applications, in Harvard Review of Psychiatry, Vol. 4, No. 5, Jan-Feb 1997.

Klee, T.: Eight Stages of Object Relations Therapy, online at ObjectRelations.org, 2001.

Linehan, M.: Cognitive–Behavioral Treatment of Borderline Personality Disorder, New York: Guilford Press, 1993.

Lissette, A.; Kraus, R.: Free Yourself from an Abusive Relationship: 7 Steps to Taking Back Your Life, Alameda, CA: Hunter House, 2000.

Livesley, W. J.: Practical Management of Personality Disorder, New York: Guilford Press, 2003.

Ludwig, D.; Kabat-Zinn, J.: Mindfulness in Medicine, in Journal of the American Medical Association, Vol. 300, No. 11, September 2008.

Lundin, R.: Alfred Adler's Basic Concepts And Implications, London: Routledge, 1989.

Marra, T.: Dialectical Behavior Therapy in Private Practice, Oakland, CA: New Harbinger, 2005.

Masterson, J. (editor/author): The Personality Disorders Through the Lens of Attachment Theory and the Neurobiologic Development of the Self, Phoenix, AZ: Zeig, Tucker &Theisen, 2004.

McKay, M.; Rogers, P.; McKay, J.: When Anger Hurts: Quieting the Storm Within, 2nd Ed., Oakland, CA: New Harbinger, 2003.

Mellody, P.; Miller, A. W.: Facing Co-dependence…, San Francisco: Harper, 1989.

Mellody, P.: Miller, A. W.: Facing Love Addiction…, San Francisco, Harper, 1992.

Mellody, P.; Freundlich, L.: The Intimacy Factor…, San Francisco: Harper, 2003.


Millon, T.; Simonsen, E.; Birket-Smith, M.; Davis, R.: Psychopathy: Antisocial, Criminal, and Violent Behavior, Guilford Press, 1998.

Millon, T.; Grossman, S.; Meagher, S., Millon, C., Everly, G.: Personality Guided Therapy, New York: John Wiley & Sons, 1999.

Mosac, H.: Primer of Adlerian Psychology: The Analytic - Behavioural - Cognitive Psychology of Alfred Adler, London: Routledge, 1999.

Nichols, M.; Schwartz, R.: Family Therapy: Concepts and Methods, 5th Ed., Needham Heights, MA: Allyn & Bacon, 2001.

Ogden, P.; Minton, K.: Sensorimotor Psychotherapy: One Method for Processing Traumatic Memory, in Traumatology, Vol. 6, Issue 3, October, 2000.

Paine-Gernee, K.; Hunt, T.: Emotional Healing: A Program for Emotional Sobriety, New York: Warner Books, 1990.

Patterson, C.: Respect (Unconditional Positive Regard), in Patterson, C.: The Therapeutic Relationship, Monterey, CA: Brooks/Cole, 1985.

Perls, F.: Gestalt Therapy Verbatim, San Francisco: Gestalt Journal Press, 1992.

Pizarro, D.; Uhlmann, E.; Salovey, P.: Asymmetry in Judgments of Moral Blame and Praise: The Role of Perceived Metadesires, in Psychological Science, Vol. 14, No. 3, May 2003.

Polster, E.; Polster, M.: Gestalt Therapy Integrated: Contours of Theory & Practice, New York: Vintage, 1974.

Premack, D.; Woodruff, G.: Does the chimpanzee have a theory of mind? New York: Behavioral and Brain Sciences. 1:515-526, 1978.

Prochaska, J.; DiClemente, C.: (1982). "Transtheoretical therapy: Toward a more integrative model of change, in Psychotherapy: Theory, Research and Practice, Vol. 19, No. 3, 1982.

Rapson, J.; English, C.: Anxious to Please: 7 Revolutionary Practices for the Chronically Nice, Naperville, IL: Sourcebooks, Inc., 2006

Rotter, J.: Generalized expectancies for Internal vs. External Locus of Control of reinforcement, in Spielberger, C.: The Development and Application of Social Learning Theory, New York: Praeger, 1982.

Ruggiero, V. R.: Beyond Feelings: A Guide to Critical Thinking, 4th Ed., Mountain View, CA: Mayfield Publishing, 1995.

Schaef, A. W.: Escape from Intimacy, New York: Harper-Collins, 1987.

Seigel, D.: Reflections on the Mindful Brain, in Mind Your Brain, Los Angeles: Lifespan Learning Institute, 2007.

Shaffer, H.; LaPlante, D., La Brie, R.; et al: Toward a Syndrome Model of Addiction: Multiple Expressions, Common Etiology; in Harvard Review of Psychiatry, Vol. 12, 2004.

Shaver, P.; Mikulincer, M.: Psychodynamics of Adult Attachment: A Research Perspective, in Journal of Attachment and Human Development, Vol. 4, 2002.

Skinner, B. F.: Beyond Freedom and Dignity, New York: Alfred A. Knopf, 1971.

Skinner, B. F.: About Behaviorism, New York: Random House, 1974.

Simon, S.; Howe, L.; Kisrchenbaum, H.: Values Clarification: The Classic Guide to Discovering your Truest Feelings, Beliefs and Goals, New York: Warner Books, 1972, 1978, 1995.

Stone, M.: Abnormalities of Personality Within and Beyond the Realm of Treatment, New York: W. W. Norton, 1993.

Symington, N.: The Clinical Thinking of Wilfred Bion, London: Routledge, 1996.

Tangney, J. P.; Dearing, R.: Shame and Guilt, New York: Guilford Press, 2002.

Vaknin, S.; Rangelovska, L.: Malignant Self Love - Narcissism Revisited, Prague: Narcissus, 2003.

Van der Kolk, B.: The Compulsion to Repeat the Trauma: Re-enactment, Re-victimization, and Masochism, in Psychiatric Clinics of North America, Vol. 12, No. 2, 1989.

Watson, J.: Behaviorism, Revised Edition, Chicago: University of Chicago Press, 1930.

Weinhold, B.; Weinhold, J.: Breaking Free of the Co-dependency Trap, Revised Edition, Novato, CA: New World Library, 2008.

Wessler, R.; Hankin, S., Stern, J.: Succeeding with Difficult Clients: Applications of Cognitive Appraisal Therapy, San Diego: Academic Press, 2001.

Wilson, B.: Alcoholics Anonymous, New York, A. A. World Services, 1939, 1955, 1976, 2001.

Winnicott, D.: Human Nature, London: Routledge, 1990.

Woititz, J. G.: Adult Children of Alcoholics, Pompano Beach. FL: Health Communications, 1983.

Woititz, J. G.; Garner, A.: Life Skills for Adult Children of Alcoholics, Pompano Beach, FL: Health Communications, 1990.

Young, J.: Cognitive Therapy for the Personality Disorders: A Schema-Focused Approach, 3rd Ed., Sarasota, FL: Professional Resource Press, 1999.

© 2009 by Rodger Garrett; all rights reserved. Links are fine. Please contact not_moses@fastmail.fm with comments or questions. Thank you.

Sunday, November 29, 2009

TRAP, TRAC & ACTION for Rebuilding Intimacy

Powerful emotions come and go. When they’re pleasant, we dive right into them. When they’re not, we most often try to get as far away from them as possible. Both responses can produce unfortunate results. Over-stimulation with pleasure (as well as pain) can induce last changes to the nervous system that are now, with the help of computer-aided brain scanning, well understood.

While it may be “standard operating procedure” in our culture to FEAR.1 (Forget Everything And Run) in the face of uncomfortable emotions, it works far better (according to voluminous scientific research) to FEAR.2 (Face Everything And Recover). Many who’ve used the 12 Step methods for recovery from everything from alcoholism and drug addiction to gambling and sex addiction will testify that FEAR.2 is the “way out.”

One of the better methods of actually “doing” FEAR.2 is described below. I’ve taken a slight bit of liberty with the original version I encountered in studying Behavioral Activation Therapy (BAT), a new technique somewhat similar to SIQR and the Drop Drill. One of the versions of BAT I encountered works by using the acronyms “TRAP,” “TRAC,” and “ACTION.” Here’s how:

1) Remember the word “TRAP,” which stands for Trigger, Response and Avoidance Pattern.

2) Ask yourself, “What is the Avoidance Pattern right now?”

3) Look at what you’re doing that is helping you avoid your feelings… or avoid doing anything useful about them. Are you hiding under the covers? Are you self-medicating? Are you romanticizing or sexualizing? Are you eating or over-exercising? Are you still at work at 8:30 pm?

4) Remember the word “TRAC,” which stands for Trigger, Response and Alternative Coping.

5) Ask yourself, “What Alternative Coping can I use to get out of this Avoidance Pattern right now?”

6) Look at all the available alternatives you can do right now, including taking the opposite action, faking it ‘til you’re making it, split tee cognitive therapy, SIQR, and/or sitting still and feeling your feelings (possibly the most difficult, but ultimately, likely the most effective in combination with some cognitive work).

7) If you cannot go directly into one or more of these activities, remember the word “ACTION,” which stands for Assess, Choose, Try, Integrate, Observe and Never give up.

8) Assess the function of the avoidance pattern behavior. What is its purpose? (It’s almost always to avoid feeling feelings.)

9) Choose to either continue the avoidance pattern behavior (even though you are aware of its purpose) or choose to change the behavior. Either way, note that it is a matter of your own conscious choice. You are the one with the power here.

10) Try the opposing or different behavior you have chosen (see item 6 above).

11) Integrate the new behavior into a routine prior to making any conclusions about the outcome. This means do the opposing or different behavior enough times to make it clear that it either does or doesn’t produce the desired emotional change. (If the uncomfortable emotions are linked to events or circumstances with a lot of “weight” or “value,” this make a few hours or even days… but rarely longer.

12) Observe the results of the new ACTION you have chosen. Are you feeling better? Or are you, at least, feeling like you can now handle the emotions without doing anything to run from them?

13) Never give up. If the first ACTION doesn’t work, ask yourself why. You may have actually selected another TRAP instead of a TRAC. A trial-and-error approach is sometimes necessary.

Thanks to Chris Martell, Mike Addis and the hugely gifted and helpful Neil Jacobson (one of the world’s leading experts on behavioral-change therapies) for the development of this approach in their 2001 book, Depression in Context: Strategies for Guided Action (New York: Norton).

Resources and References

Behavioral Activation Therapy – http://www.personal.kent.edu/~dfresco/CBT_Readings/BA_&_MBCT.pdf.

Cognitive Therapy – from the creator’s mouth at http://www.beckinstitute.org/InfoID/220/RedirectPath/Add1/FolderID/237/SessionID/%7BB82C8935-45A8-4D4D-8980-1C31C81C1F84%7D/InfoGroup/Main/InfoType/Article/PageVars/Library/InfoManage/Zoom.htm.

The Drop Drill – likewise from the creator’s mouth at http://sighkoblahgrr.blogspot.com/2009/11/drop-drill-for-withdrawal-from-painful.html.

SIQR – likewise from the creator’s mouth, as well, at http://sighkoblahgrr.blogspot.com/2009/11/siqr-for-new-users-and-other-lay.html.

Further reading on “affect tolerance” and dealing with uncomfortable emotions (including supporting literature) is available at http://sighkoblahgrr.blogspot.com/2009/11/getting-through-hangovers-withdrawal.html.

© 2009 by Rodger Garrett on the discussion, though not on the original concepts; all rights reserved. Links are fine. Please contact not_moses@fastmail.fm with comments or questions. Thank you.

Friday, November 27, 2009

Stockholm Syndrome and SIQR for Lay Readers

Carver, J. M.: Love and Stockholm Syndrome: The Mystery of Loving an Abuser,
at http://www.mental-health-matters.com/index.php?option=com_content&view=article&id=167.

Joseph Carter’s article on mind control in interpersonal relationships has become a minor Internet classic, probably because it grapples with a relatively common form of grief in our dominance-and-submission-oriented society… and it’s widely available at no cost.

In recent years, many have come to see Stockholm Syndrome as an extreme form of codependence involving a selfish, self-obsessed, controlling narcissistic rescuer / persecutor and a selfless, other-obsessed, controlled dependent who’s come to see the dominance as “natural and normal.”

Carver’s original text is in black; my comments are in dark red.


On August 23rd, 1973 two machine-gun carrying criminals entered a bank in Stockholm, Sweden. Blasting their guns, one prison escapee named Jan-Erik Olsson announced to the terrified bank employees "The party has just begun!" The two bank robbers held four hostages, three women and one man, for the next 131 hours [about five and one-half days]. The hostages were strapped with dynamite and held in a bank vault until finally rescued on August 28th.

After their rescue, the hostages exhibited a shocking attitude considering they were threatened, abused, and feared for their lives for over five days. In their media interviews, it was clear that they supported their captors and actually feared law enforcement personnel who came to their rescue. The hostages had begun to feel the captors were actually protecting them from the police. One woman later became engaged to one of the criminals and another developed a legal defense fund to aid in their criminal defense fees. Clearly, the hostages had "bonded" emotionally with their captors.

While the psychological condition in hostage situations became known as "Stockholm Syndrome" due to the publicity – the emotional "bonding" with captors was a familiar story in psychology. It had been recognized many years before and was found in studies of other hostage, prisoner, or abusive situations such as:

Abused Children
Battered/Abused Women
Prisoners of War
Cult Members
Incest Victims
Criminal Hostage Situations
Concentration Camp Prisoners
Controlling/Intimidating Relationships

…bonding with an abuser is actually a strategy for survival for victims of abuse and intimidation. The "Stockholm Syndrome" reaction in hostage and/or abuse situations is so well recognized at this time that police hostage negotiators no longer view it as unusual. In fact, it is often encouraged in crime situations as it improves the chances for survival of the hostages. On the down side, it also assures that the hostages experiencing "Stockholm Syndrome" (SS) will not be very cooperative during rescue or criminal prosecution. Local law enforcement personnel have long recognized this syndrome with battered women who fail to press charges, bail their battering husband/boyfriend out of jail, and even physically attack police officers when they arrive to rescue them from a violent assault.

SS has occurred in males bonded with abusive females, as well. My personal experience with this includes the dedicated “rescuer” (the “white knight” position on the Karpman Drama Triangle; see http://sighkoblahgrr.blogspot.com/2009/04/karpman-drama-triangle-summary.html) of a two-time murderess. He paid her legal expenses during the second murder case and continued to foot the bills for her parole motions despite having been beaten over the head by her with a tire iron (see http://www.palmspringslife.com/Palm-Springs-Life/Whispering-Palms/The-Black-Widow-of-Rancho-Mirage/index.php).

Stockholm Syndrome can also be found in family, romantic, and interpersonal relationships. The abuser may be a husband or wife, boyfriend or girlfriend, father or mother, or any other role in which the abuser is in a position of control or authority. Once the syndrome is understood, it's easier to understand why victims support, love, and even defend their abusers and controllers.

Every syndrome has symptoms or behaviors and Stockholm Syndrome is no exception… several of these features will be present:

1) Positive feelings by the victim toward the abuser/controller
2) Negative feelings by the victim toward family, friends, or authorities trying to rescue/support them or win their release
3) Support of the abuser's reasons and behaviors
4) Positive feelings by the abuser toward the victim
5) Supportive behaviors by the victim, at times helping the abuser
6) Inability to engage in behaviors that may assist in their release or detachment

It has been found that four situations or conditions are present that serve as a foundation for the development of Stockholm Syndrome. These four situations can be found in hostage-taking, severe abuse, and abusive relationships:

1) The presence of a perceived threat to one's physical or psychological survival and the belief that the abuser would carry out the threat.
2) The presence of a perceived small kindness from the abuser to the victim.
3) Isolation from perspectives other than those of the abuser.
4) The perceived inability to escape the situation.

The veteran cult deprogrammer will immediately recognize that every one of the four circumstances is identical to those found in mind-control cults. The interpersonal dynamic is, in fact, virtually identical, even if it is “dressed” differently.

By considering each situation we can understand how Stockholm Syndrome develops in romantic relationships as well as criminal/hostage situations. Looking at each situation:

1) Perceived threat to one's physical/psychological survival

The perception of threat can be formed by direct, indirect, or witnessed methods. Criminal or antisocial partners can directly threaten your life or the life of friends and family. Their history of violence leads us to believe that the captor/controller will carry out the threat in a direct manner if we fail to comply with their demands. The abuser assures us that only our cooperation keeps our loved ones safe.

Indirectly, the abuser/controller offers subtle threats [to prevent being abandoned or resisted], reminding you that people in the past have paid dearly for not following their wishes. Hints are often offered such as "I know people who can make others disappear." Indirect threats also come from the stories told by the abuser or controller – how they obtained revenge on those who have crossed them in the past. These stories of revenge are told to remind the victim that revenge is possible if they leave.

Witnessing violence or aggression is also a perceived threat. Witnessing a violent temper directed at a television set, others on the highway, or a third party clearly sends us the message that we could be the next target for violence. Witnessing the thoughts and attitudes of the abuser/controller is threatening and intimidating, knowing that we will be the target of those thoughts in the future.

2) The "Small Kindness" Perception

In threatening and survival situations, we look for evidence of hope – a small sign that the situation may improve. When an abuser/controller shows the victim some small kindness, even though it is to the abusers benefit as well, the victim interprets that small kindness as a positive trait of the captor. In criminal/war hostage situations, letting the victim live is often enough. Small behaviors, such as allowing a bathroom visit or providing food/water, are enough to strengthen SS in criminal hostage events.

In relationships with abusers, a birthday card, a gift (usually provided after a period of abuse), or a special treat are interpreted as not only positive, but evidence that the abuser is not "all bad" and may at some time correct his/her behavior. Abusers and controllers are often given positive credit for not abusing their partner, when the partner would have normally been subjected to verbal or physical abuse in a certain situation. An aggressive and jealous partner may normally become intimidating or abusive in certain social situations, as when an opposite-sex coworker waves in a crowd. After seeing the wave, the victim expects to be verbally battered and when it doesn't happen, that "small kindness" is interpreted as a positive sign.

In SS victims with whom I’ve worked during their continued participation in and abusive relationship, several believed that any small kindness was positive proof that abusive partner truly loved and was genuinely concerned about them despite repeated and severe verbal and/or physical abuse. The patients often argued very energetically about this, clearly believing in a distorted view of reality not supported by other family members and/or friends.

Similar to the small kindness perception is the perception of a "soft side."

In working with several employees of a “tag-team” pair of charismatic “good cop” and verbally abusive “bad cop” bosses, it became evident that many believed that both bosses had a “soft side.” Five of the six employees had very evident drug, alcohol and eating disorder problems, by the way, as did the “bad cop” boss.

During the relationship, the abuser/controller may share information about their past – how they were mistreated, abused, neglected, or wronged. The victim begins to [believe they may be capable of “fixing” the abuser/controller’s behavior]… or worse yet, that they (abuser) may also be a "victim" [as described by the characteristics of the position at the bottom corner of the Karpman Drama Triangle]. Sympathy may develop toward the abuser and we often hear the victim of SS defending their abuser with "I know he fractured my jaw and ribs…but he's troubled. He had a rough childhood!"

…abusers may admit they need psychiatric help or acknowledge they are mentally disturbed, however, it's almost always after they have already abused or intimidated the victim [for years or even decades]. The admission is a way of denying responsibility for the abuse. In truth, [those with personality disorders, including criminals] have learned over the years that personal responsibility for their violent/abusive behaviors can be minimized and even denied by blaming their bad upbringing, abuse as a child, and now - video games. One murderer blamed his crime on eating too much junk food – now known as the "Twinkie Defense."

The personality disorders most commonly seen among SS abusers include those in the “aggressive” Cluster B of the American Psychiatric Association’s Diagnostic and Statistical Manual, Axis II. Almost all are narcissistic or subtypes thereof, including antisocial, sociopathic, psychopathic, sadistic and/or sadomasochistic. Most victims of SS tend toward the “submissive” Cluster C in Axis II, which includes dependent, avoidant, depressive and obsessive-compulsive personalities. (See http://www.mayoclinic.com/health/personality-disorders/DS00562/DSECTION=symptoms and http://www.merck.com/mmpe/sec15/ch201/ch201a.html.)

The narcissist tends to believe “what’s mine is mine and what’s yours is mine, too.” The dependent tends to believe “what’s mine is yours if it will buy me some sense of security.”

While it may be true that the abuser/controller had a difficult upbringing, [a show by the victim of] sympathy for his/her history produces no change in their behavior and in fact, prolongs the abuse. While "sad stories" are always included in their apologies after the abusive/controlling event, their behavior never changes. Keep in mind; once you become hardened to the sad stories, they will simply try another approach.

3) Isolation from Perspectives Other than those of the Captor

In abusive and controlling relationships, the victim has the sense they are always "walking on eggshells," fearful of saying or doing anything that might prompt a violent/intimidating outburst. For [what they believe to be] their survival, they begin to see the world through the abuser's perspective. They begin to fix things that might prompt an outburst, act in ways they know makes the abuser happy, or avoid aspects of their own life that may prompt a problem. If we only have a dollar in our pocket, then most of our decisions become financial decisions. If our partner is an abuser or controller, then the majority of our decisions are based on our perception of the abuser's potential reaction. We become preoccupied with the needs, desires, and habits of the abuser/controller.

In more than 30 years of work with cult survivors, as well as with battered wives and other victims of interpersonal mind control, investigation of the victim’s early life nearly always turns up a parent, older sibling, grandparent or other significant caregiver or early life authority figure who was highly invasive, demanding, controlling and/or threatening. Most survivors of SS and other forms of interpersonal mind control appear to me to have learned to seek out new controllers, in large part because they grew up believing that they did not have to capacity to make the choices required to manage their own lives.

The presence of this belief – associated with a sense of both threat and hopelessness – in so many victims of SS is what leads most modern therapists to utilize a combination of cognitive restructuring and sensory exposure therapies to unravel the typical emotion-and-belief system of most SS, spousal abuse, cult and other mind-control victims. Cognitive restructuring is little more than identifying, questioning and revising self-talk (as in SIQR; see
http://sighkoblahgrr.blogspot.com/2009/11/siqr-for-new-users-and-other-lay.html); sensory exposure is “sitting still and feeling what you feel,” more or less as in mindfulness meditation (see http://www.amazon.com/Coming-Our-Senses-Mindfulness-ebook/dp/B000FC2PNS/ref=sr_1_2?ie=UTF8&s=books&qid=1259287065&sr=8-2, and the easily and quickly learned, fast-acting “drop drill;” see http://sighkoblahgrr.blogspot.com/2009/11/drop-drill-for-withdrawal-from-painful.html).

Taking the abuser's perspective as a survival technique can become so intense that the victim actually develops anger toward those trying to help them. The abuser is already angry and resentful toward anyone who would provide the victim support, typically using multiple methods and manipulations to isolate the victim from others. Any contact the victim has with supportive people in the community is met with accusations, threats, and/or violent outbursts.

Victims then turn on their family, fearing family contact will cause additional violence and abuse in the home. At this point, victims curse their parents and friends, tell them not to call and stop interfering, and break off communication with others. Agreeing with the abuser/controller, supportive others are now viewed as "causing trouble" and must be avoided. Many victims threaten their family and friends with restraining orders if they continue to "interfere" or try to help the victim in their situation.

Again, this is often precisely what occurs during the deprogramming of religious and/or mind-control cult members. (Therapists beware: Working with such people is often a litigation minefield in which licenses and/or certifications are often suspended or even lost altogether, especially when the SS abuser, cult or religious sect has “lawyers, guns and money.”)

On the surface it would appear that they have sided with the abuser/controller. In truth, they are trying to minimize contact situation that might make them a target of additional verbal abuse or intimidation. If a casual phone call from Mom prompts a two-hour temper outburst with threats and accusations, the victim quickly realizes it's safer if Mom stops calling. If simply telling Mom to stop calling doesn't work, for his or her own safety the victim may accuse Mom of attempting to ruin the relationship and demand that she stop calling.

In my own experience, the break-with-family pattern is more likely if the SS abuser or cult has material wealth and/or the original role model of invasive, boundary-breeching, abusive, demanding, shaming, guilt-heaping control remains invasive, boundary-breeching, abusive, demanding, shaming, guilt-heaping and/or controlling. Because the victim has come to perceive greater reward and less punishment with the new victimizer / rescuer / persecutor (refer again to the Karpman Drama Triangle), the original victimizer / rescuer / persecutor will be far more accurately perceived than his or her current replacement.

This presents a second potential minefield for the therapist / deprogrammer. Successful interventions may require considerable deprogramming of those who =hired= the therapist in the first place. I usually start with the Karpman Drama Triangle as an explanatory tool, strongly endorse reading of Pia Mellody’s Facing Codependence (see
http://www.amazon.com/Facing-Codependence-Where-Comes-Sabotages/dp/0062505890/ref=sr_1_1?ie=UTF8&s=books&qid=1259288026&sr=1-1) and/or any or (better yet) all of Patricia Evans’s four books (see http://www.amazon.com/s/ref=nb_ss_1_14?url=search-alias%3Dstripbooks&field-keywords=patricia+evans+books&sprefix=Patricia+Evans).

In severe cases of Stockholm Syndrome in relationships, the victim may have difficulty leaving the abuser and may actually feel the abusive situation is their fault. In law enforcement situations, the victim may actually feel the arrest of their partner for physical abuse or battering is their fault. Some women will allow their children to be removed by child protective agencies rather than give up the relationship with their abuser. As they take the perspective of the abuser, the children are at fault: they complained about the situation, they brought the attention of authorities to the home, and they put the adult relationship at risk.

Sadly, the children have now become a danger to the victim's safety. For those with Stockholm Syndrome, allowing the children to be removed from the home decreases their victim stress while providing an emotionally and physically safer environment for the children.

In a significant percentage of SS cases, the children are also being victimized by the abuser. Many are battered and/or sexually abused. Abusers, after all, abuse. They do not tend to be selective, especially among those “under their thumbs.”

4) Perceived Inability to Escape

As a hostage in a bank robbery, threatened by criminals with guns, it's easy to understand the perceived inability to escape. In romantic relationships, the belief that one can't escape is also very common. Many abusive/controlling relationships feel like till-death-do-us-part relationships; locked together by mutual financial issues/assets, mutual intimate knowledge, or legal situations.

As with other cognitive schemas (beliefs, evaluations, interpretations, appraisals, etc.) about powerlessness, helplessness and/or hopelessness, SIQR and the other cognitive restructuring therapies are designed to help the SS or cult victim identify, question and revise their inaccurate self-talk. Martin Seligman’s work on the topic of “learned helplessness” is germane here (see http://en.wikipedia.org/wiki/Learned_helplessness), as are Wayne Dyer’s many popular books on one’s “erroneous zones.”

Many SS survivors are initially very surprised to discover how they learned to believe themselves to be helpless, hopeless and powerless, especially after asserting that they are “no such thing.” In my experience, one out of three SS and three out of four mind-control cult victims will assert themselves to be anything but helpless, hopeless and powerless unless or until they are through the denial / pre-contemplation and contemplation / consideration phases and well into the acceptance / self-identification phase of recovery from their ardently denied victimization.

Here are some common situations:

Controlling partners have increased the financial obligations and/or debt in the relationship to the point that neither partner can financially survive on their own. Controllers who sense their partner may be leaving will often purchase a new automobile, later claiming they can't pay alimony or child support due to their large car payments.

The legal ending of a relationship, especially a martial relationship, often creates significant problems. A Controller who has an income that is "under the table" or maintained through legally questionable situations runs the risk of those sources of income being investigated or made public by the divorce/separation. The Controller then becomes more agitated about the possible public exposure of their business arrangements than the loss of the relationship.

The Controller often uses extreme threats including threatening to take the children out of state, threatening to quit their job/business rather than pay alimony/support, threatening public exposure of the victim's personal issues, or assuring the victim they will never have a peaceful life due to nonstop harassment. In severe cases, the Controller may threaten an action that will undercut the victim's support such as "I'll see that you lose your job" or "I'll have your automobile burned".

Controllers often keep the victim locked into the relationship with severe guilt – threatening suicide if the victim leaves. The victim hears "I'll kill myself in front of the children", "I'll set myself on fire in the front yard", or "Our children won't have a father/mother if you leave me!"

In relationships with an abuser or controller, the victim has also experienced a loss of self-esteem, self-confidence, and psychological energy. The victim may feel "burned out" and too depressed to leave. Additionally, abusers and controllers often create a type of dependency by controlling the finances, placing automobiles or homes in their name, and eliminating any assets or resources the victim may use to leave. In clinical practice I've heard "I'd leave, but I can't even get money out of the savings account! I don't know the PIN number."

In teens and young adults, victims may be attracted to a controlling individual when they feel inexperienced, insecure, and overwhelmed by a change in their life situation. When parents are going through a divorce, a teen may attach to a controlling individual, feeling the controller may stabilize their life. Freshmen in college may be attracted to controlling individuals who promise to help them survive living away from home on a college campus.

In unhealthy relationships, and definitely in Stockholm Syndrome, there is a daily preoccupation with "trouble." Trouble is any individual, group, situation, comment, casual glance, or cold meal that may produce a temper tantrum or verbal abuse from the controller or abuser. To survive, "trouble" is to be avoided at all costs. The victim must control situations that produce trouble.

That may include avoiding family, friends, co-workers, and anyone who may create "trouble" in the abusive relationship. The victim does not hate family and friends; they are only avoiding "trouble." The victim also cleans the house, calms the children, scans the mail, avoids certain topics, and anticipates every issue of the controller or abuse in an effort to avoid "trouble". In this situation, children who are noisy become "trouble." Loved ones and friends are sources of "trouble" for the victim who is attempting to avoid verbal or physical aggression.

Again with regard to the early life experiences that condition many victims to accept control and abuse from partners, bosses or co-workers, most SS victims I have encountered pretty much the dynamics described above in their “families of origin.” For most of them, the controller/abuser’s behavior seems “normal,” “natural,” “expectable”… and acceptable. The victims were “normalized” to the SS dynamics in their lives at an age too early for them to question or wonder about them. The concept of normalization is described in depth in the anonymously written Fellowship Text of Adult Children of Alcoholics, the relatively new “big book” of one of faster-growing 12 Step self-help groups (see http://www.adultchildren.org/lit/Handbook.s).

Stockholm Syndrome in relationships is not uncommon. Law enforcement professionals are painfully aware of the situation, making a domestic dispute one of the highest-risk calls during work hours. Called by neighbors during a spousal abuse incident, the abuser is passive upon arrival of the police, only to find the abused spouse upset and threatening the officers if their abusive partner is arrested for domestic violence. In truth, the victim knows the abuser/controller will retaliate against him/her if, 1) they encourage an arrest, 2) they offer statements about the abuse/fight that are deemed disloyal by the abuser, 3) they don't bail them out of jail as quickly as possible, and 4) they don't personally apologize for the situation – as though it was their fault.

In many jurisdictions, the concepts described in this article are taught in police and sheriff’s academies. Most recently trained law enforcement officers are taught to look past what is being said, recognize the victim and abuser for who and what they are, and look for evidence of physical abuse (e.g.: fresh bruises, bleeding, swelling, burns) in the children as well as in the spousal victim.

While it is statistically far more likely that the victim will be a female, it is not always the case. The ratio I have heard in most presentations is four or five to one, meaning that officers see the signs of victimization in many males during domestic disturbance calls. Working with court-mandated anger-management group populations, it becomes clear in a hurry that female victimizers are not at all unusual.

Stockholm Syndrome produces an unhealthy [sadomasochistic: of, relating to, involving, or exhibiting the deriving of pleasure, especially sexual gratification, from inflicting or submitting to physical or emotional abuse] bond with the controller and abuser. It is the reason many victims continue to support an abuser after the relationship is over. It's also the reason they continue to see "the good side" of an abusive individual and appear sympathetic to someone who has mentally and sometimes physically abused them.

Sadomasochism is the bedrock of all chronically abusive, SS-style relationships. While the term is widely confused with sexual bondage and dominance, it more accurately refers to the punishing, abusive and even violent results of an ongoing state of dominance and submission between two or more people (see http://www.amazon.com/Sadomasochism-Everyday-Life-Dynamics-Powerlessness/dp/0813518083).

It also refers to the value- and experience-driven interpersonal behavior of many adults who were victims of SS in childhood. The abused child may come to feel “powerless,” “helpless” and/or “hopeless.” He may also come to feel very resentful and angry. And the adult child within may turn that rage about his or her own victimization onto others when and if it becomes possible.

The contributing writers in Theodore Millon, et al’s, hugely influential Psychopathy: Antisocial, Criminal, and Violent Behavior portray case after case of child-abuse-induced sadism and interpersonally criminal behavior. Most mental health professionals with direct knowledge of prison incarcerees will point to child abuse (including abandonment and neglect) as the principle driving force back of criminal behavior (see
http://www.mayoclinic.com/health/antisocial-personality-disorder/DS00829 and http://www.mcafee.cc/Bin/sb.html).

Is There Something Else Involved?

Carver’s theory of cognitive dissonance underlying the seemingly paradoxical thinking of the SS victim holds some water, so I have elected to retain it in this edited version of Carver’s original article. I have other ideas, however, and I will get to them.

In a short response, yes! Throughout history, people have found themselves supporting and participating in life situations that range from abusive to bizarre. In talking to these active and willing participants in bad and bizarre situations, it is clear they have developed feelings and attitudes that support their participation. One way these feelings and thoughts are developed is known as "cognitive dissonance."

"Cognitive Dissonance" explains how and why people change their ideas and opinions to support situations that do not appear to be healthy, positive, or normal. In the theory, an individual seeks to reduce information or opinions that make him or her uncomfortable. When we have two sets of cognitions (knowledge, opinion, feelings, input from others, etc.) that are the opposite, the situation becomes emotionally uncomfortable. Even though we might find ourselves in a foolish or difficult situation, few want to admit that fact. Instead, we attempt to reduce the dissonance; the fact that our cognitions don't match, agree, or make sense when combined. "Cognitive Dissonance" can be reduced by adding new cognitions – adding new thoughts and attitudes.

Leon Festinger coined the term "Cognitive Dissonance" [in the 1950s]. He had observed a cult in which members gave up their homes, incomes, and jobs to work for the cult. This cult believed in messages from outer space that predicted the day the world would end by a flood. As cult members and firm believers, they believed they would be saved by flying saucers at the appointed time. As they gathered and waited to be taken by flying saucers at the specified time, the end-of-the-world came and went. No flood and no flying saucer!

Rather than believing they were foolish after all that personal and emotional investment – they decided their beliefs had actually saved the world from the flood and they became firmer in their beliefs after the failure of the prophecy. The moral: The more you invest (income, job, home, time, effort, etc.) the stronger your need to justify your position. If we invest $5.00 in a raffle ticket, we justify losing with "I'll get them next time". If you invest everything you have, it requires an almost unreasoning belief and unusual attitude to support and justify that investment.

Studies tell us we are more loyal and committed to something that is difficult, uncomfortable, and even humiliating. The initiation rituals of college fraternities, Marine boot camp, and graduate school all produce loyal and committed individuals. Almost any ordeal creates a bonding experience. Every couple, no matter how mismatched, falls in love in the movies after going through a terrorist takeover, being stalked by a killer, being stranded on an island, or being involved in an alien abduction. Investment and an ordeal are ingredients for a strong bonding, even if the bonding is unhealthy. No one bonds or falls in love by being a member of the Automobile Club or a music CD club. Struggling to survive on a deserted island; you bet!

Abusive relationships produce a great amount on unhealthy investment in both parties. In many cases we tend to remain and support the abusive relationship due to our investment in the relationship. Try telling a new Marine that since he or she has survived boot camp, they should now enroll in the National Guard! Several types of investments keep us in the bad relationship:

Emotional Investment: We've invested so many emotions, cried so much, and worried so much that we feel we must see the relationship through to the finish.

Social Investment: We've got our pride! To avoid social embarrassment and uncomfortable social situations, we remain in the relationship.

Family Investment: If children are present in the relationship, decisions regarding the relationship are clouded by the status and needs of the children.

Financial Investment: In many cases, the controlling and abusive partner has created a complex financial situation. Many victims remain in a bad relationship, waiting for a better financial situation to develop that would make their departure and detachment easier.

Lifestyle Investment: Many controlling/abusive partners use money or a lifestyle as an investment. Victims in this situation may not want to lose their current lifestyle.

Intimacy Investment: We often invest emotional and sexual intimacy. Some victims have experienced a destruction of their emotional and/or sexual self-esteem in the unhealthy relationship. The abusing partner may threaten to spread rumors or tell intimate details or secrets. A type of blackmail using intimacy is often found in these situations.

In many cases, it's not simply our feelings for an individual that keeps us in an unhealthy relationship; it's often the amount of investment. For this reason, the most common phrase offered by the victim in defense of their unhealthy relationship is "You just don't understand!"

While Carver’s notions about cognitive dissonance are applicable, cognitive theorists have come a long way since Festinger’s day. In modern parlance, the chronic victim of SS chooses to be a victim because of his acquired beliefs and values, and because he or she does not know what his or her acquired values are. “Values clarification” (see http://www.amazon.com/Values-Clarification-Dr-Sidney-Simon/dp/0446670952) came into vogue in the 1980s as a means of determining what one’s core beliefs, ideals, assumptions, convictions and attitudes – therefore, values – are… and how those values determine how one will appraise, evaluate, interpret, analyze, consider, conceptualize, judge and/or attribute meaning to the world around him.

(One should credit Jeffrey Young for much of this, as well as Richard Wessler and Sheena Hankin; see
http://www.amazon.com/Cognitive-Therapy-Personality-Disorders-Schema-Focused/dp/1568870477/ref=sr_1_3?ie=UTF8&s=books&qid=1259298268&sr=1-3 and http://www.amazon.com/Succeeding-Difficult-Clients-Applications-Professional/dp/012744470X/ref=sr_1_1?ie=UTF8&s=books&qid=1259298330&sr=1-1).

As simply put as I can offer it, those who are sufficiently conscious of their values can elect…

1) to be relatively satisfied with them,
2) to make minor adjustments to them here and there, and/or
3) to identify, question, and revise their values…

...so that their appraisals, evaluations, interpretations, analyses, considerations, conceptualizations, judgments and/or attributions of meaning to the world around them are more accurate and serve them to produce more functional and effective behavior.

Combining Two Unhealthy Conditions

The combination of "Stockholm Syndrome" and "cognitive dissonance" [as well as a lack of clarity about one’s values] produces a victim who firmly believes [values] the relationship is not only acceptable, but also desperately needed for their survival. The victim feels [actually, believes] they would mentally collapse if the relationship ended. In long-term relationships, the victims have invested everything and placed "all their eggs in one basket." The relationship now decides their level of self-esteem, self-worth, and emotional health.

While most of them deny it initially, many SS victims in heterosexual, romantic relationships actually believe that of the 3.35 billion people in the world of the opposite sex, their mate is the only one who could possibly “love” them. They simply cannot see that they have narrowed the field of possibilities from billions down to one.

For reasons described above, the victim feels [actually, believes] family and friends are a threat to the relationship and eventually to their personal health and existence. The more family and/or friends point out the controlling and abusive nature of the relationship, the more the victim leans on his or her cognitive dissonance [and unclarified values] and [defends his or her position that the relationship is “okay”]. At this point, family and friends become victims [or “co-victims,” in the terminology of Codependents Anonymous; see http://www.codependents.org/core/index.php] of the abusive and controlling individual.

Importantly, both Stockholm Syndrome and cognitive dissonance [and the unclarified values that support the cognitive dissonance and evaluation of their SS as “acceptable”] develop on an involuntary basis. The victim does not purposely invent this attitude. Both develop as an attempt to exist and survive in a threatening and controlling environment and relationship.

Despite what we might think, our loved one is not in the unhealthy relationship to irritate, embarrass, or drive us to drink. What might have began as a normal relationship has turned into a controlling and abusive situation. They are trying to survive. Their personality is developing the feelings and thoughts needed to survive the situation and lower their emotional and physical risks.

The co-dependent SS victim’s collection of fundamental beliefs appears to be, “I cannot survive on my own. I need to turn my will and my life over to someone else more powerful. I will be okay if I depend upon others for my sense of reality.”

The SS abuser’s (KDT "persecutor's") collection of fundamental beliefs appears to be, “I must control everyone and everything near me to feel safe and secure. My ideas are inherently correct. I know all the answers. Others must obey me if they want to be close to me.”


All of us have developed attitudes and feelings that help us accept and survive situations. We have these attitudes/feelings about our jobs, our community, and other aspects of our life. As we have found throughout history, the more dysfunctional the situation, the more dysfunctional our adaptation and thoughts to survive. The victim is engaged in an attempt to survive and make a relationship work. Once they decide it doesn't work and can't be fixed, they will need our support as we patiently await their decision to return to a healthy and positive lifestyle.

At this point in Carver’s article, the author moves into a lengthy discussion of what the family members should and shouldn’t do around the victim and current abuser. I have deleted it for brevity because I want to focus on enlightening the victim to the exclusion of any suggestion of further dependence upon others, including the original abuser or abusers who are often still part of the family. Those who wish to see the deleted section can do so at http://www.mental-health-matters.com/index.php?option=com_content&view=article&id=167&limitstart=3.

Final Thoughts

You may be the victim of a controlling and abusive partner, seeking an understanding of your feelings and attitudes. You may have a son, daughter, or friend currently involved with a controlling and abusive partner, looking for ways to understand and help.

If a loved one is involved with… a controlling and abusing partner, the long-term outcome is difficult to determine due to the many factors involved. If their relationship is in the "dating" phase, they may end the relationship on their own. If the relationship has continued for over a year, they may require support and an exit plan before ending the relationship. Marriage and children [along with financial encumbrances and couple relationships with significant third parties] further complicate their ability to leave the situation. When the victim decides to end the unhappy relationship, it's important that they view loved ones as supportive, loving, and understanding, not a source of pressure, guilt, or aggression.

Carver’s final sentence above is significant. What I have seen again and again in the course of working with victims of this type is that family members attempt to gain access to the Karpman Drama Triangle (KDT) at the upper left “rescuer” position to displace the abuser to the upper right “persecutor” position while the abusee =remains= in the bottom “victim” corner (see http://sighkoblahgrr.blogspot.com/2009/04/karpman-drama-triangle-summary.html). As a direct result, the dynamics of the KDT are actually reinforced rather than dismantled.

Family interventions must be undertaken with the objective changing the paradigm (a set of assumptions, concepts, values, and practices that constitutes a way of viewing reality for the community that shares them) from rescuers, persecutors and victims to non-invasive supporters, functional adaptors and detached boundary setters (again described at
http://sighkoblahgrr.blogspot.com/2009/04/karpman-drama-triangle-summary.html).

This article is an attempt to understand the complex feelings and attitudes that are as puzzling to the victim as they are to family and friends. I've outlined recommendations for detaching from a controlling / abusive individual (http://www.drjoecarver.com/) but clearly, there are more victims in this situation. It is hoped this article is helpful to family and friends who worry, cry, and have difficulty understanding the situation of their loved one. It has been said that knowledge is power. Hopefully this knowledge will prove helpful and powerful to victims and their loved ones.

Please consider this article as a general guideline. Some recommendations may be appropriate and helpful while some may not apply to a specific situation. In many cases, we may need additional professional help of a mental health or legal nature.

Stockholm Syndrome describes what amounts to an addiction on the part of one person to another for the purpose of obtaining what is perceived by the victim to be vital to their well-being. The dynamics of SS are thus no different (at least in this respect, and many others) to any form of behavioral obsession, including self-destructive gambling, romance, sex, work, food, exercise or shopping.

The SS victim believes that his or her comfort is dependent upon obtaining the payoff of the addictive behavior. Without that payoff, the victim believes that he or she will suffer intolerable emotions he or she “cannot possibly stand.” So long as the payoff far outweighs the price, the relationship addict is likely to deny that the dynamic I have described here is in play.

The process of detaching and recovery from a controlling and/or abusive partner in a pseudo-romantic, marital, family, employment, cult, religious or other relationship is the same as for any other form of addiction. The formally schooled and experientially trained addictions counselor or psychotherapist will assist the recovering SS victim from seeing themselves as “normal” (if they are still in the denial / pre-contemplation phase), through “abnormal” (in the contemplation / consideration phase), through “victim” (in the acceptance / self-identification phase), onto “survivor” (in the commitment / action and maintenance / relapse recovery phases).

By now, I hope it’s becoming evident that removing the SS victim from the relationship, the cult, the employer, or the abusive family, is not the be-all and end-all of the problem. Those who come to believe from experiential learning that the rescuer, persecutor and victim positions on the KDT are “normal” have a continuing potential to (as Bessel Van der Kolk put it) “repeat the trauma” (see
http://www.cirp.org/library/psych/vanderkolk/).

They will do so for the simple reason that their core beliefs, values, ideas, orientations, assumptions, convictions and attitudes remain the same, leading inexorably to the same kinds of appraisals, interpretations, evaluations, judgments, analyses and decisions about who they are and what they must do in life that got them into the trouble to begin with.

Current appraisals, interpretations, evaluations, judgments, analyses, attributions of meaning and decisions can be traced back to core beliefs, values, ideas, orientations, assumptions, convictions and attitudes with some form of cognitive therapy and critical thinking (see
http://en.wikipedia.org/wiki/Cognitive_therapy and http://en.wikipedia.org/wiki/Critical_thinking).

This is what occurs in the process of Self-talk (or Schema) Identification that make up the “SI” of SIQR therapy (see http://sighkoblahgrr.blogspot.com/2009/11/siqr-for-new-users-and-other-lay.html). Once the core beliefs, values, etc., are identified, they can be submitted to the five-step SIQR process that includes the Questioning and Revision stages (the “QR”) of SIQR.

Other forms of cognitive, cognitive-behavioral, cognitive appraisal and/or schema therapy (see Beck et al, Ellis et al, Wessler et al, and Young, respectively, in the References below) can be utilized for this purpose, of course. SIQR’s strength as compared to may of the older CBT therapies is that it can be so easily learned for self-administration by the SS survivor without having to buy another workbook, let alone return to a therapist for help.

Additionally, many recovering SS victims will benefit from using the Drop Drill (see
http://sighkoblahgrr.blogspot.com/2007/10/drop-drill.html), another new therapy derived from mindfulness meditation (see Hayes et al, Kabat-Zinn, and Marra in the references) and other meditation practices, to work through the uncomfortable emotions (e.g.: sadness, rage, anxiety, grief, hatred) that usually come up during SS recovery.

Finally, most SS victims on the way to becoming survivors will benefit from attending meetings of the 12 Step self-help groups Co-Dependents anonymous and Adult Children of Alcoholics (even if their parents were not alcoholics or substance abusers). Reading the literature and working the 12 Steps almost in variable turns up a treasure trove of clues leading to beliefs, values, ideas, assumptions, convictions and attitudes that can be worked through with SIQR or other forms of cognitive therapy.

Resources, References and Recommended Reading

Recommended reading for non-professionals is called out in blue.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: DSM-III-R, New York: APA, 1987.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, New York: APA, 2000.

American Psychoanalytic Association et al: Psychodynamic Diagnostic Manual (PDM), Silver Spring, MD: Alliance of Psychoanalytic Organizations, 2006.

Anonymous: Adult Children of Alcoholics: Alcoholic / Dysfunctional Families, Torrance, CA: ACA World Service Office, 2006.

Anonymous: Co-Dependents Anonymous, Phoenix, AZ: Co-Dependents Anonymous, 1995.

Antony, M.; Swinson, R.: When Perfect Isn't Good Enough, Oakland, CA: New Harbinger, 1998, 2009.

Arsenault, L.; et al: Being Bullied as an Environmentally Mediated Contributing Factor to Children’s Internalizing Problems…, in in Archives of Pediatrics & Adolescent Medicine, Vol. 162, February, 2008.

Baumrind, D,: Current Patterns of Parental Authority, Monograph in Developmental Psychology, Volume 4, Number 1, Part 2, New York: American Psychological Association, 1971.

Beattie, M.: Codependent No More, San Francisco: Harper/Hazelden, 1987.

Beattie, M.: Beyond Codependency, San Francisco: Harper/Hazelden, 1989.

Beattie, M.: Codependents’ Guide to the Twelve Steps, New York: Simon & Schuster, 1990.

Beck, A.: Cognitive Therapy and the Emotional Disorders, New York: Penguin-Meridian, 1976.

Beck, A.; Freeman, A.: Cognitive Theory of the Personality Disorders, New York: Guilford Press, 1990.

Beck, A.: Prisoners Of Hate: The Cognitive Basis of Anger, Hostility, and Violence, New York: Harper-Collins, 1999.

Benjamin, L. S.: Interpersonal Diagnosis and Treatment of Personality Disorders, Second Edition, New York: Guilford Press, 1996.

Benjamin, L. S.: Interpersonal Reconstructive Therapy, New York: Guilford Press, 2003.

Berne, E.: Games People Play: The Psychology of Human Relationships, San Francisco: Grove Press, 1964.

Bernstein, A.: Emotional Vampires: Dealing with People who Drain You Dry, New York: McGraw-Hill, 2000.

Black, C.: It Will Never Happen to Me: Children of Alcoholics as Youngsters-Adolescents-Adults, New York: Ballentine, 1981, 1987.

Bowlby, J.: A Secure Base: Parent-Child Attachment and Healthy Human Development. London: Routledge; New York: Basic Books, 1988.

Branden, N.: The Disowned Self, New York: Bantam Books, 1976.

Branden, N.: The Psychology of Self-Esteem, New York: Bantam Books, 1973.

Centers for Disease Control and Prevention: The Effects of Childhood Stress Across the Lifespan, Atlanta, GA: CDC, 2008.

Cermak, T.: Diagnosing and Treating Co-Dependence, Minneapolis: Johnson Institute, 1986.

Cialdini, R.: Influence Science and Practice, 4th Ed., New York: Allyn and Bacon, 2000.

Clarkin, J.; Lenzenweger, M.: Major Theories of Personality Disorder, New York: The Guilford Press, 1996.

Courtois, C.: Guidelines for the Treatment of Adults Abused or Possibly Abused as Children (with Attention to Issues of Delayed or Recovered Memory), Washington, DC: The Psychiatric Institute of Washington, 1997.

Cross, K.: Reactive Attachment Disorder and Attachment Therapy, Kansas City: Kansas Attachment Center (online .pdf), 2005.

DeBellis, M.: Developmental Traumatology: Neurobiological Development in Maltreated Children with PTSD, in Psychiatric Times, Vol. 16, No. 11, 1999.

Dodes, L.: The Heart of Addiction: A New Approach to Understanding and Managing Alcoholism and Other Addictive Behaviors, New York: Harper & Rowe, 2002.

Ellis, A.; Harper, R.: A Guide to Rational Living, North Hollywood, CA: Melvin Powers, 1961.

Ellis, A.; Dryden, W.: The Practice of Rational Emotive Therapy, New York: Springer Publishing Company, 1987.

Ellis, A.: Overcoming Destructive Beliefs, Feelings, and Behaviors: New Directions for Rational Emotive Behavior Therapy, New York: Promethius Books, 2001.

Engle, B.: The Emotionally Abusive Relationship: How to Stop Being Abused and How to Stop Abusing, Hoboken, NJ: John Wiley & Sons, 2002.

Erikson, E.: Childhood and Society, New York: W. W. Norton, 1950, 1967, 1993.

Erikson, E.: Identity and the Life Cycle, New York: W. W. Norton, 1959, 1980.

Evans, F.: Harry Stack Sullivan: Interpersonal Theory and Psychotherapy, London: Routledge, 1996.

Evans, P.: The Verbally Abusive Relationship, Expanded Second Edition, Avon, MA: Adams Media Corp., 1996

Evans, P.: Controlling People, Avon, MA: Adams Media Corp., 2002.

Fairbairn, W.: An Object Relations Theory of the Personality, New York: Basic Books, 1952, 1984.

Fonagy, P.: Attachment Theory and Psychoanalysis, New York: Other Press, 2001.

Forward, S.: Toxic Parents: Overcoming their Hurtful Legacy and Reclaiming Your Life, New York: Bantam Books, 1989.

Fromm, E.: Escape from Freedom, New York: Avon, 1965.

Goleman, D.: Emotional Intelligence, New York: Bantam, 1980.

Gordon, T.: Parent Effectiveness Training: The Proven Program for Raising Responsible Children, New York: Three Rivers Press, 1970, 1975, 2000.

Grand, S.: The Reproduction of Evil: A Clinical & Cultural Perspective, Hillsdale, NJ: The Analytic Press, 2000.
Hare, R.: Without Conscience, New York: Guilford Press, 1993.

Hayes, S.; Follete, V.; Linehan, M.: Mindfulness and Acceptance: Expanding the Cognitive-Behavioral Tradition, New York: The Guilford Press, 2004.

Hoffer, E.: The True Believer: Thoughts on the Nature of Mass Movements, New York: Harper and Row, 1966.

Kabat-Zinn, J.: Mindfulness Meditation: Health benefits of an ancient Buddhist practice, in Goleman, D.; Gurin, J., editors: Mind/Body Medicine, New York: Consumer Reports Books, 1993.

Karpman, S.: Fairy tales and script drama analysis, in Transactional Analysis Bulletin, Vol. 7, No. 26, 1968.

Khantzian, E: The self medication hypothesis of substance use disorders: a reconsideration and recent applications, in Harvard Review of Psychiatry, Vol. 4, No. 5, Jan-Feb 1997.

Klee, T.: Eight Stages of Object Relations Therapy, online at ObjectRelations.org, 2001.

Kopp, S.: Guru: Metaphors from a Psychotherapist, New York: Bantam, 1976.

Korzybski, A.: Science and Sanity: An Introduction to Non-Aristotelian Systems and General Semantics, 4th Ed., New York: Institute of General Semantics, 1958.

Laing, R. D.: Knots, New York: Penguin, 1973.

Lissette, A.; Kraus, R.: Free Yourself from an Abusive Relationship: 7 Steps to Taking Back Your Life, Alameda, CA: Hunter House, 2000.

Ludwig, D.; Kabat-Zinn, J.: Mindfulness in Medicine, in Journal of the American Medical Association, Vol. 300, No. 11, September 2008.

Lundin, R.: Alfred Adler's Basic Concepts And Implications, London: Routledge, 1989.

Madanes, C.: Sex, Love and Power: Strategies for Transformation; New York: W. W. Norton, 1990.

Mahler, M.; Pine, S.; Bergman, A.: The Psychological Birth of the Human Infant: Symbiosis and Individuation, New York: Basic Books, 1975.

Marra, T.: Dialectical Behavior Therapy in Private Practice, Oakland, CA: New Harbinger, 2005.

Masterson, J. (editor/author): The Personality Disorders Through the Lens of Attachment Theory and the Neurobiologic Development of the Self, Phoenix, AZ: Zeig, Tucker &Theisen, 2004.

Mellody, P.; Miller, A. W.: Facing Co-dependence…, San Francisco: Harper, 1989.

Mellody, P.: Miller, A. W.: Facing Love Addiction…, San Francisco, Harper, 1992.

Meloy, J. R.: The Psychopathic Mind: Origins, Dynamics, and Treatment, New York: Jason Aronson, 1994.

Miller, A.: For Your Own Good: Hidden Cruelty in Child Rearing and the Roots of Violence, London: Farrar, Straus & Giroux, 1983.

Millon, T.; Simonsen, E.; Birket-Smith, M.; Davis, R.: Psychopathy: Antisocial, Criminal, and Violent Behavior, Guilford Press, 1998.

Millon, T.; Grossman, S.; Meagher, S., Millon, C., Everly, G.: Personality Guided Therapy, New York: John Wiley & Sons, 1999.

Mosac, H.: Primer of Adlerian Psychology: The Analytic - Behavioural - Cognitive Psychology of Alfred Adler, London: Routledge, 1999.

Negrao, C.; Bonanno, G.; et al: Shame, Humiliation and Childhood Sexual Abuse: Distinct Contributions and Emotional Coherence, in Child Maltreatment, Vol. 10, No. 4, Nov. 2005.

Ogden, P.; Minton, K.: Sensorimotor Psychotherapy: One Method for Processing Traumatic Memory, in Traumatology, Vol. 6, Issue 3, October, 2000.

Paine-Gernee, K.; Hunt, T.: Emotional Healing: A Program for Emotional Sobriety, New York: Warner Books, 1990.

Peck. M. S.: People of the Lie: The Hope for Healing Human Evil, New York: Touchstone, 1998.

Rapson, J.; English, C.: Anxious to Please: 7 Revolutionary Practices for the Chronically Nice, Naperville, IL: Sourcebooks, Inc., 2006

Schaef, A. W.: Escape from Intimacy, New York: Harper-Collins, 1987.

Schiraldi, G.: The Post-Traumatic Stress Disorder Source Book, 2nd Ed.; New York: McGraw-Hill, 2009.

Schore, A.: Affect Dysregulation and Disorders of the Self, New York: W. W. Norton & Company, 2003.

Seigel, D.: Reflections on the Mindful Brain, in Mind Your Brain, Los Angeles: Lifespan Learning Institute, 2007.

Seligman, M.: Learned Optimism: How to Change Your Mind and Your Life, New York: Knopf, 1990.

Shaffer, H.; LaPlante, D., La Brie, R.; et al: Toward a Syndrome Model of Addiction: Multiple Expressions, Common Etiology; in Harvard Review of Psychiatry, Vol. 12, 2004.

Shaver, P.; Mikulincer, M.: Psychodynamics of Adult Attachment: A Research Perspective, in Journal of Attachment and Human Development, Vol. 4, 2002.

Skinner, B. F.: Beyond Freedom and Dignity, New York: Alfred A. Knopf, 1971.

Siegel, A.: Heinz Kohut and the Psychology of the Self, London: Routledge, 1996.

Stone, M.: Abnormalities of Personality Within and Beyond the Realm of Treatment, New York: W. W. Norton, 1993.

Stovall-McClough, K.; Cloitre, M.: Unresolved attachment, PTSD, and dissociation in women with childhood abuse histories, in Journal of Consulting Clinical Psychology, Vol. 74, 2006.

Tangney, J. P.; Dearing, R.: Shame and Guilt, New York: Guilford Press, 2002.

Vaknin, S.; Rangelovska, L.: Malignant Self Love - Narcissism Revisited, Prague: Narcissus, 2003.

Van der Kolk, B.: The Compulsion to Repeat the Trauma: Re-enactment, Re-victimization, and Masochism, in Psychiatric Clinics of North America, Vol. 12, No. 2, 1989.

Van der Kolk, B: Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society, New York: Guilford Press, 1996 / 2007.

Weinhold, B.; Weinhold, J.: Breaking Free of the Co-dependency Trap, Revised Edition, Novato, CA: New World Library, 2008.

Wessler, R.; Hankin, S., Stern, J.: Succeeding with Difficult Clients: Applications of Cognitive Appraisal Therapy, San Diego: Academic Press, 2001.

Wood, M.; Balduf, J.; Howard, K.; Huang, H.; Marino, P.; McConky, K.: Reactive Attachment Disorder: A Disorder of Attachment or of Temperament? Unpublished but peer-reviewed manuscript at
http://www.personalityresearch.org/papers/wood.html, Rochester, NY: Rochester Institute of Technology, 2003-2005.

Woodward, G.; Denton, R.: Persuasion & Influence in American Life, 4th Ed., Prospect Heights, IL: Waveland Press, 2000.

Woititz, J. G.: Adult Children of Alcoholics, Pompano Beach. FL: Health Communications, 1983.

Woititz, J. G.; Garner, A.: Life Skills for Adult Children of Alcoholics, Pompano Beach, FL: Health Communications, 1990.

Young, J.: Cognitive Therapy for the Personality Disorders: A Schema-Focused Approach, 3rd Ed., Sarasota, FL: Professional Resource Press, 1999.


© 2009 by Rodger Garrett; all rights reserved on the commentary only. Links are fine. Please contact not_moses@fastmail.fm with comments or questions. Thank you.

Sunday, November 15, 2009

Getting through Hangovers & Withdrawal

The following is edited from a pair of emails to a medical professional who is a binge alcoholic with underlying co-dependency (addiction ot a more powerful person) problems struggling with deep beliefs in external locus of control and learned helplessness (see Rotter, and Seligman) and withdrawal-induced anxiety.

It is my experience that those two particular cognitive schemas (see Young) are what cause the sense of "powerlessness" and "overwhelming anxiety" that prevents many practicing addicts from being able to establish some length of abstinence.

I contend that external locus of control and learned helplessness should be addressed as early as possible with such patients to empower a sense of efficacy (see Bandura) sufficient to maintain abstinence until the have moved through the contemplation / consideration stage of recovery into acceptance / identification and committment / action.

The chart below describes the cycle of addiction all addicts (regardless of the type of addiction; e.g.: alcohol, pills, cocaine, food, binge-purge, gambling, sex, romance, exercise, work, whatever) go through again and again.

Cycle of Addiction

Addictive Activity
…to get relief and control
. . . . . . . V
Dissatisfaction
…experienced as shame and guilt
. . . . . . . V
Moral Resolve
…promises and amends
. . . . . . . V
Pain Returns
…disillusionment and despair
. . . . . . . V
Demand for Relief
…entitlement and anger
. . . . . . . V
Back to Addictive Activity

Intervention is possible at two points in the cycle: One is at Dissatisfaction; the other is Demand for Relief.

At Demand for Relief, one can challenge…

1) the belief that one will feel better if they indulge in the addiction, and
2) the belief that the emotions experienced in the Demand for Relief phase are truly "intolerable."

At Dissatisfaction, one can challenge…

1) the all-or-nothing, all-bad-or-all-good, either-or beliefs about "acting out" that lead to the experience of shame, guilt, worry, remorse, regret and morbid reflection, and
2) the belief that the emotions experienced in the Dissatisfaction phase are truly "intolerable."

12 Step recovery is not the only way to challenge these beliefs. But the impact of being a regular member of a group of people who have banded together to challenge those beliefs with the help of the 12 Steps produces results.

Those who come to believe that a power greater than their own will (e.g.: the way things are and not the way they are not; in short: the truth) as they come to grasp it for themselves... find that the old beliefs they had that they...

1) cannot handle their emotions;
2) will feel better if they indulge; and
3) "should," "ought to" or "must" experience shame, guilt, worry, remorse, regret or morbid reflection about being "failures" or "bad" or "helpless" or "hopeless"

...are just not true.

All addictions are nothing more than suspect beliefs interacting with neurochemistry.

"As we believe, so we feel. And as we feel, so we act."

Addicts, I have come to see over the past 22 years, tend to dislike and fear what they believe about "the way things are." So they do something about it.

Trouble is, their addictions make their ability to perceive, appraise, interpret, evaluate, analyze and/or attribute meaning to "the way things are" increasingly inaccurate.

After a time, they believe in "the way things are not." But they continue to act upon them as if "the way things are not" is still "the way things are."

Identify, question and revise the beliefs (what AA members call "stinking thinking") and you will feel differently. And when you feel differently, your behavior will change. (See http://sighkoblahgrr.blogspot.com/2009/11/siqr-for-new-users-and-other-lay.html and http://sighkoblahgrr.blogspot.com/2009/01/siqr-over-base-of-ta-for-addictive.html.)

There are five stages in addiction recovery:

1) denial / pre-contemplation;
2) contemplation / consideration;
3) acceptance / identification (as an addict);
4) commitment / action; and
5) maintenance / relapse prevention.

These stages equate precisely as follows to AA's 12 Steps:

1) denial / pre-contemplation -- where we are before we admit we're licked;

2) contemplation / consideration -- where we are when we stop bargaining with reality long enough to begin to admit (at least some of the time) we're powerless and life has become unmanageable in Step 1;

3) acceptance / identification (as an addict; a level of admission that we really are licked by the addiction, do not have the capacity to control our addictive behavior, and will have to find a way that actually works) -- the process of Steps 2 and 3;

4) commitment / action – continuing agreement that one has to do what is required to overcome the addiction by those who have already done so; the "action" Steps 4, 5, 6, 7, 8 and 9;

5) maintenance / relapse prevention – continuing agreement that one is "given" or "oriented" to addiction (even while "siber") and will have to continue to work the maintenance Steps 10, 11 and 12.

Go to meetings. Share that you are what you are. Ask for help. (Call your friend and ask her how she did it.) Don't figure you're stuck with the first person in AA or NA who offers it. You can change sponsors as you need them to be more sophisticated and adept.

But you have to start at Step 1. Which means acceptance of things as they are and not the way they are not. Following are some quotations on the matter from Robins, Schmidt and Linehan in Hayes, Follette and Linehan (2004):

"...the wisdom of wanting to gather rather than disperse, catching the context while enduring the moment... focusing on the current moment, seeing reality as it is without 'delusions,' and accepting reality without judgment... let[ing] go of attachments that obstruct the path to enlightenment... the fully open experience of what is, entering into reality just as it is, at this moment... without constrictions, distortion, judgment, evaluation [or] attemps to [either] keep an experience or get rid of it... without adding judgment of good and bad... experiencing something without the haze of what one wants and does not want it to be... without discrimination... not choos[ing] parts of reality to accept and parts to reject... the solution to suffering is to increase acceptance of the here and now, and decrease craving and attachment that inevitably keep one clinging to the past, which has changed already..."

Subsequent to listening to a phone message during which the caller accepted her addictive nature and present state of mind:

Good. Sounds like you're on the "doorstep" looking in now. "Hangover" and "withdrawal" are (on the addiction cycle) "Pain Returns / Disillusionment / Despair."

It is crucial to recognize that "PR / D / D" (hangover / withdrawal) is a temporary state that does not last. (Many addicts believe that what is happening right now is what will necessarily happen forever.)

One either sits still and feels the feelings previously believed to be intolerable and gets off the cycle... or continues to believe that the feelings are intolerable and moves on to "Demand for Relief / Entitlement / Anger."

Off the cycle is off the cycle. But moving on is on the cycle and will inevitably lead again to "Addictive Activity / Relief / Pseudo-Control" (because the "control" is clearly not actual; it is pseudo-control).

After 22 years in this game (as a professional), it's entirely clear to me that the recovering addict benefits hugely from sitting still and feeling her feelings to get off the cycle.

This is called "affect tolerance by graded exposure" (see http://books.google.com/books?id=2Ldsrt1VwTUC&pg=PA60&lpg=PA60&dq=affect+tolerance&source=bl&ots=gzPqvDNzq-&sig=Fu1NLle34548_eHtg_QqZA7BFf0&hl=en&ei=vY8AS5WHDJK2swPBu_CHCw&sa=X&oi=book_result&ct=result&resnum=5&ved=0CBwQ6AEwBDgK#v=onepage&q=affect%20tolerance&f=false and http://books.google.com/books?id=s7QJgE72fSAC&pg=PA212&dq=graded+exposure#v=onepage&q=graded%20exposure&f=false). It does not mean that we dwell on the feelings and sink under the weight of them. It means we simply sit still and feel them whenever they hit us instead of doing anything about them (like drinking, drugging or other "acting out"). See also: http://sighkoblahgrr.blogspot.com/2009/11/drop-drill-for-withdrawal-from-painful.html.

That said, "water works" (well) for hangovers. Alcohol is a diuretic. So are many drugs. Hangovers are partially the result of dehydration, so drink water. Coffee is also a diuretic, so I do not recommend drinking it.

Low-cal Gatorade ("G2") and no-cal Powerade Zero are the best solutions for dehydration I know of. 10 to 20 oz. per "dose." No more unless you are severely dehydrated, but all the plain water you can handle is fine.

Patience is key. Hangovers and withdrawal are painful, but they do no last forever. The important thing to remember when they are over, however, is that returning to the cycle of addiction will inevitably result in another hangover and withdrawal.

And find ways to pat yourself on the back for...

1) being patient;
2) sitting still and feeling your feelings;
3) questioning your addictive beliefs;
4) staying in the present; and
5) electing to stay "sober."

The experience of simply "being in greater control of their lives" is sufficient reward for many.

Added after a further exchange with someone using this technique:

The emotional impact of the memories and thoughts we have about them remains in place until...

1) the memories and thoughts are fully accepted as memories and ideas, rather than stipulated to be memories and facts; and

2) processed to the point where the memories make sense to us instead of continuing to mystify us and/or upset us as a result of giving us ideas about being powerless over our emotional reactions to those memories.

So, it works to just...

1) allow the memories to be there, and

2) notice the feelings we have about those memories.

If we just observe them without doing anything about (taking any action upon) them, we see that memories are just memories, feelings are just feelings, and that we have the power of choice to act upon them or not act upon them.

Done for a time, one learns that he or she can "stand those feelings" increasingly easily during the process of integrating them into whole, complete narratives about "how it was with mom" or "how it was with the lover" that ultimately have no more emotional "load" on them than memories of a movie we saw that struck us emotionally.


Resources

Alpert, R. (“Ram Dass”): Be Here Now, San Francisco: Lama Foundation, 1971.

Anonymous: Adult Children of Alcoholics: Alcoholic / Dysfunctional Families, Torrance, CA: ACA World Service Office, 2006.

Anonymous: Co-Dependents Anonymous, Phoenix, AZ: Co-Dependents Anonymous, 1995.

Bandura, A.: Self-Efficacy: The Exercise of Control, San Francisco: W. H. Freeman, 1997.

Beattie, M.: Codependent No More, San Francisco: Harper/Hazelden, 1987.

Beattie, M.: Beyond Codependency, San Francisco: Harper/Hazelden, 1989.

Beattie, M.: Codependents’ Guide to the Twelve Steps, New York: Simon & Schuster, 1990.

Beck, A.: Cognitive Therapy and the Emotional Disorders, New York: Penguin-Meridian, 1976.

Beck, A.; Wright, F.; Newman, C.; Liese, B.: Cognitive Therapy of Substance Abuse, New York: The Guilford Press, 1993.

Bozarth, M.: Drug addiction as a psychobiological process, in Warburton, D. (ed.): Addiction controversies, London: Harwood Academic Publishers, 1990.

Bozarth, M.: Pleasure systems in the brain, in Warburton, D. (ed.), Pleasure: The politics and the reality, New York: John Wiley & Sons, 1994.

Branden, N.: The Disowned Self, New York: Bantam Books, 1976.

Branden, N.: The Psychology of Self-Esteem, New York: Bantam Books, 1973.

Carnes, P.: Out of the Shadows: Understanding Sexual Addiction, Minneapolis: Hazelden, 1989.

Castonguay, L.; Beutler, L.: Principles of Therapeutic Change that Work, London: Oxford University Press, 2005.

Cermak, T.: Diagnosing and Treating Co-Dependence, Minneapolis: Johnson Institute, 1986.

Chandler, R.; Fletcher, B.; Volkow, N.: Treating Drug Abuse and Addiction in the Criminal Justice System, in Journal of the American Medical Association, Vol. 301, No. 2, January 2009.

Cheever, S.: My Name Is Bill: Bill Wilson – His Life and the Creation of Alcoholics Anonymous, New York: Simon and Schuster, 2004.

Cozolino, L.: The Neuroscience of Psychotherapy: Building and Rebuilding the Human Brain, New York: W. W. Norton, 2002.

Dimeff, L.; Koerner, K.: Dialectal Behavior Therapy in Clinical Practice: Applications Across Disorders and Settings, New York: The Guilford Press, 2007.

Dodes, L.: The Heart of Addiction: A New Approach to Understanding and Managing Alcoholism and Other Addictive Behaviors, New York: Harper & Rowe, 2002.

Ekleberry, S.: Seminar on Substance Abuse and Axis II Personality Disorders, San Francisco: Arcturus, 2000.

Ellis, A.; Harper, R.: A Guide to Rational Living, North Hollywood, CA: Melvin Powers, 1961.

Ellis, A.; Dryden, W.: The Practice of Rational Emotive Therapy, New York: Springer Publishing Company, 1987.

Ellis, A.: Overcoming Destructive Beliefs, Feelings, and Behaviors: New Directions for Rational Emotive Behavior Therapy, New York: Promethius Books, 2001.

Endo Pharmaceuticals: Pain Management Learning System, Chapel Hill, NC: ETSI, 2003.

Fossum, M.; Mason, M.: Facing Shame: Families in Recovery, New York: W. W. Norton, 1989.

Frances, R.; Miller, S.: Clinical Textbook of Addictive Disorders, New York: Guilford Press, 1991.
Gazzaniga, M.; Ivry, R.; Mangun, G.: Cognitive Neuroscience: The Biology of the Mind, 2nd Edition, New York: W.W. Norton, 2002.

Goodman, A.: Sexual Addiction: An Integrated Approach, Madison, CT.: International Universities Press, 1998.

Gorski, T.: Gorski-CENAPS Clinical Model of Substance Abuse Treatment, Spring Hill, FL: Gorski-CENAPS, 2001.

Hamilton, L.; Timmons, C. R.: Principles of Behavioral Pharmacology, Englewood Cliffs, NJ: Prentice-Hall, 1990.

Hayes, S.; Follete, V.; Linehan, M.: Mindfulness and Acceptance: Expanding the Cognitive-Behavioral Tradition, New York: The Guilford Press, 2004.

Jones, E.; O’Connor, P.: Diagnosis and Pharmacologic Management of Opiod Dependency, in Hospital Physician, Vol. 43, No. 10, Oct. 2007.

Jongsma, A.; Peterson, L. M.; Bruce, T.: The Complete Adult Psychotherapy Treatment Planner, 3rd Ed., New York: John Wiley & Sons, 2001.

Joubert, A.; et al: CNS Image Bank: The anxiety disorders, Skodsbord, Denmark: The Lundbeck Institute, 2005.

Kabat-Zinn, J.: Mindfulness Meditation: Health benefits of an ancient Buddhist practice, in Goleman, D.; Gurin, J., editors: Mind/Body Medicine, New York: Consumer Reports Books, 1993.

Kannon, J.; et al: Narcotics Anonymous, Van Nuys, CA: World Service Office, 1983.

Khantzian, E: The self medication hypothesis of substance use disorders: a reconsideration and recent applications, in Harvard Review of Psychiatry, Vol. 4, No. 5, Jan-Feb 1997.

Kleiber, H.: Methadone Maintenance 4 Decades Later: Thousands of Lives Saved But Still Controversial, in Journal of the American Medical Association, Vol. 300, No. 18, 2008.

Kubler-Ross, E.: On Death and Dying, New York: Macmillan, 1970.

Kuehn, B.: Findings on Alcohol Dependence Point to Promising Avenues for Targeted Therapies, in Journal of the American Medical Association, Vol. 301, No. 16, April 2009.

Laing, R. D.: Knots, New York: Penguin, 1973.

Lazarus, A.: Brief but Comprehensive Psychotherapy: The Multimodal Way, New York: Springer, 1997.

Lazarus, R.: Emotion and Adaptation, New York: Oxford University Press, 1991.

LeDoux, J.: The Emotional Brain: The Mysterious Underpinnings of Emotional Life, New York: Simon & Schuster, 1996.

Ludwig, D.; Kabat-Zinn, J.: Mindfulness in Medicine, in Journal of the American Medical Association, Vol. 300, No. 11, September 2008.

Marra, T.: Dialectical Behavior Therapy in Private Practice, Oakland, CA: New Harbinger, 2005.

Mauss, I.; Wilhelm, F.; Gross, J.: Autonomic recovery and habituation in social anxiety, in Journal of Psychophysiology, Vol. 40, No. 1, January 2003.

McKay, M.; Rogers, P.; McKay, J.: When Anger Hurts: Quieting the Storm Within, 2nd Ed., Oakland, CA: New Harbinger, 2003.

Mellody, P.; Miller, A. W.: Facing Co-dependence…, San Francisco: Harper, 1989.

Mellody, P.: Miller, A. W.: Facing Love Addiction…, San Francisco, Harper, 1992.

Munich, R.; Allen, J.: Psychiatric and Sociotherapeutic Perspectives on the Difficult-to-Treat Patient, in Psychiatry, Vol. 66, No.4, Winter 2003.

Mycek, M.; Harvey, R.; Champe, P.: Lippincott’s Illustrated Review of Pharmacology, 2nd Ed., Philadelphia: Lippincott, Williams & Wilkins, 2000.

Ogden, P.; Minton, K.: Sensorimotor Psychotherapy: One Method for Processing Traumatic Memory, in Traumatology, Vol. 6, Issue 3, October, 2000.

Peckenpaugh, N.; Poleman, C.: Nutrition Essentials and Diet Therapy, 8th Ed., Philadelphia: W. B. Saunders (Harcourt Health Sciences), 1999.

Perrifoy, R.: Anxiety, Phobias and Panic: Taking Charge and Conquering Fear: A Step-By-Step Program for Regaining Control of Your Life, New York: Warner Books, 1992.

Pollack, M.; Otto, M.; Rosenbaum, J.: Challenges in Clinical Practice: Pharmacolgic and Psychosocial Strategies, New York: Guilford Press, 1996.

Polster, E.; Polster, M.: Gestalt Therapy Integrated: Contours of Theory & Practice, New York: Vintage, 1974.

Prendergast, W.: Treating Sex Offenders in Correctional Institutions and Outpatient Clinics: A Guide to Clinical Practice, New York: The Haworth Press, 1991.

Rapson, J.; English, C.: Anxious to Please: 7 Revolutionary Practices for the Chronically Nice, Naperville, IL: Sourcebooks, Inc., 2006

Rosenzweig, M.; Breedlove, S. M.; Leiman, A.: Biological Psychology, 3rd Ed., Sunderland, MA: Sinaur Associates, 2002.

Rotter, J.: Generalized expectancies for Internal vs. External Locus of Control of reinforcement, in Spielberger, C.: The Development and Application of Social Learning Theory, New York: Praeger, 1982.

Ruggiero, V. R.: Beyond Feelings: A Guide to Critical Thinking, 4th Ed., Mountain View, CA: Mayfield Publishing, 1995.

Sanderson, W.; Rego, S.: Empirically Supported Psychological Treatment of Panic Disorder and Agoraphobia; Washington, DC: Medscape CMEs; 2000.

Sarason, I.; Sarason B.: Abnormal Psychology, 8th Ed., Upper Saddle River, NJ: Prentice Hall, 1996.

Schaef, A. W.: Escape from Intimacy, New York: Harper-Collins, 1987.

Schiraldi, G.: The Post-Traumatic Stress Disorder Source Book, 2nd Ed.; New York: McGraw-Hill, 2009.

Seigel, D.: Reflections on the Mindful Brain, in Mind Your Brain, Los Angeles: Lifespan Learning Institute, 2007.

Seligman, M.: Learned Optimism: How to Change Your Mind and Your Life, New York: Knopf, 1990.

Shaffer, H.; LaPlante, D., La Brie, R.; et al: Toward a Syndrome Model of Addiction: Multiple Expressions, Common Etiology; in Harvard Review of Psychiatry, Vol. 12, 2004.

Siegel, A.: Heinz Kohut and the Psychology of the Self, London: Routledge, 1996.

Stanton, M. D.; Todd, T.: The Family Therapy of Drug Abuse and Addiction, New York: Guilford Press, 1982.

Tangney, J. P.; Dearing, R.: Shame and Guilt, New York: Guilford Press, 2002.

Ursano, R.; Bell, C.; Eth, S.; et al: Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder, in The American Journal of Psychiatry, November, 2004.

Van der Kolk, B.: The Compulsion to Repeat the Trauma: Re-enactment, Re-victimization, and Masochism, in Psychiatric Clinics of North America, Vol. 12, No. 2, 1989.

Weinhold, B.; Weinhold, J.: Breaking Free of the Co-dependency Trap, Revised Edition, Novato, CA: New World Library, 2008.

Wessler, R.; Hankin, S., Stern, J.: Succeeding with Difficult Clients: Applications of Cognitive Appraisal Therapy, San Diego: Academic Press, 2001.

Wilson, B.: Alcoholics Anonymous, New York, A. A. World Services, 1939, 1955, 1976, 2001.

Wilson, B.: The Best of Bill: Reflections on Faith, Fear, Honesty, Humility and Love, New York: A. A. Graprevine, 1986.

Wilson, B.: Twelve Steps and Twelve Traditions, New York: A. A. World Services, 1951.

Woititz, J. G.: Adult Children of Alcoholics, Pompano Beach. FL: Health Communications, 1983.

Woititz, J. G.; Garner, A.: Life Skills for Adult Children of Alcoholics, Pompano Beach, FL: Health Communications, 1990.

Yalom, I.: Existential Psychotherapy, New York: Basic Books, 1980.

Young, J.: Cognitive Therapy for the Personality Disorders: A Schema-Focused Approach, 3rd Ed., Sarasota, FL: Professional Resource Press, 1999.

© 2009 by Rodger Garrett; all rights reserved. Links are fine. Please contact mailto:rajah524@fastmail.fm with comments or questions. Thank you.

Friday, November 13, 2009

PTSD Induction in Modern War

If there’s anything “positive” about the following article, it may be that it illustrates an increased awareness among military and political leaders, as well as the press, that for those on the front lines, war is not a video game. And it does not necessarily end when a soldier comes home. The original article is in black; my comments are in dark red.

Army says Morale Down among Troops in Afghanistan

By PAULINE JELINEK, Associated Press Writer Pauline Jelinek, Associated Press Writer – November 13, 2009

WASHINGTON – Morale has fallen among soldiers in Afghanistan, where troops are seeing record violence in the 8-year-old war, while those in Iraq show much improved mental health amid much lower violence, the Army said Friday.

Soldier suicides in Iraq did not increase for the first time since 2004, according to a new study.

Though findings of two new battlefield surveys are similar in several ways to the last ones taken in 2007, they come at a time of intense scrutiny on Afghanistan as President Barack Obama struggles to come up with a new war strategy and planned troop buildup. There is also perhaps equal new attention focused on the mental health of the force since a shooting rampage at Fort Hood last week in which an Army psychiatrist is charged.

Both surveys showed that soldiers on their third or fourth tours of duty had lower morale and more mental health problems than those with fewer deployments and an ever-increasing number of troops are having problems with their marriages.

The new survey on Afghanistan found instances of depression, anxiety and other psychological problems are about the same as they were in 2007. But it also said there is a shortage of mental health workers to help soldiers who need it, partly because of the buildup Obama already started this year with the dispatch of more than 20,000 extra troops.

Efforts already under way to get more health workers to the Afghan war could be hampered somewhat by last week's shooting. The psychiatrist charged with 13 counts of premeditated murder was slated to go to Afghanistan. Some of the dead and wounded also were to deploy there to bolster psychological services for soldiers.

The new Afghanistan survey found that individual soldier morale was about the same as previous studies, but that "unit morale rates ... were significantly lower than in 2005 or 2007," said an executive summary of the report that was to be explained in a news conference Friday. The units referred to were mostly platoons of roughly a couple dozen people each.

In Iraq, some 2,400 soldiers in randomly selected platoons filled out surveys from December 2008 through March 2009 and a mental health assessment team went to the warfront for a month starting in late February to analyze the results and hold interviews and focus groups.

In Afghanistan, more than 1,500 troops in more than 50 platoons filled out the surveys from April to June, and the assessment team when through the same process from May through June.

Mental health providers also were interviewed in each country.

It's the sixth such survey, a program that was groundbreaking when started in 2003 in that it was the biggest effort ever made to measure the health of troops — and the services they receive — right at the warfront.

The survey was different from previous ones in that it sampled two types of platoons. Some were maneuver units that war-fighting groups engaged in combat-related tasks and others were support units such as aviation, engineering and medical elements less likely to have as much direct exposure to violence.

Other findings of the Afghanistan survey included:

1) Junior enlisted soldiers reported significantly more marital problems than noncommissioned officers, stating they intended to get a divorce or that they suspected their spouses back home of infidelity.

Are we seeing a paranoid orientation toward the environment that is over-generalized from the highly stressful immediate environment to the emotional environment that concerns them most? From a cognitive perspective (see Beck et al, Ellis et al, Lazarus, Livesley, Seligman, Wessler et al, and Young) the younger, less experienced, less “tempered” and less capable of accurate reasoning one is; the more likely it will be that he will mis-interpret, mis-appraise and mis-evaluate… and attribute the same or similar meanings he experiences in combat to other circumstances (see also Frankenberg and Kymalainen, Giardino, Grand, Kira, and Lang et al, as well as Skinner, and Watson, regarding the behavioristic view of associating attributions about events in one realm with events in another).

2) Exposure to combat, long recognized as a strong factor in mental health problems, was significantly higher this year than rates in 2005 and similar to rates in 2007 for the combat units.

Is this chronic, autonomic nervous system agitation? Does repeated exposure to combat, as well as worry about the next battle, induce ever-increasing imbalance between the “fight or flight” sympathetic and “relax and soothe” para-sympathetic branches? Does repeated exposure to combat promote a sustained sense of “learned helplessness and hopelessness” that must then be (somehow) “un-learned?”

3) Combat units reported significantly lower unit morale in the last six months of their tours of duty, more evidence of the wearing affect of long deployments.

Does PTSD develop – and become systemic – as the para-sympathetic branch “burns out” from trying for too long to re-balance the fight-or-flight-driven dopamine, norepinephrine, testosterone and adrenaline flow in the sympathetic branch? Does combat induce lasting changes to “neural plasticity” that cause the formation of associative “triggers for terror?” Should we expect these modifications to neural netting in the limbic system (see Carlson, and Rosenzweig et al) to just “correct themselves over time” without therapeutic attention?

4) Troops in their third or fourth deployment reported significantly more acute stress and other psychological problems, and among those married, reported significantly more marital problems compared to soldiers on their first or second deployment.

See items one and two above. The continuing exposure to stress is permanently conditioning their autonomic nervous systems into a state popularly called “post-traumatic stress disorder” (PTSD). Unless or until the military and VA develop truly effective combinations of cognitive restructuring and affect exposure therapies (see Beck et al, Cohen, Colby, Courtois, Dimeff and Koerner, Ellis et al, Friedman, Hayes et al, Kabat-Zinn, Laing, Linehan, Livesley, Ludwig and Kabat-Zinn, Marra, Munich et al, Ogden and Minton, Perls, Perrifoy, Preston, Sanderson and Rego, Schiraldi, Ursano et al, Van der Hart et al on Janet, Van der Kolk et al, Wessler et al, and Young) for this condition, many of these combat (and some non-combat) veterans will develop “therapies” of their own to deal with it. Their “therapies” have historically included alcoholism, drug addiction, sex addiction, workaholism, eating disorders, and other obsessive-compulsive “stress management” behaviors to dissociate from unprocessed terror and grief (op. cit., as per above, as well as Bozarth, Dodes, Khantzian, and Shaffer et al).

5) Soldiers on their third or fourth deployment reported using medications for psychological or combat stress problems at a significantly higher rate than those on their first deployment.

Medicine provides a “quick fix” by managing the symptoms of PTSD, but medication does nothing whatsoever to revise the tortured belief systems of combat veterans, many of whom come to believe that “life is hell,” “no one is trustworthy,” and that the best way to deal with others is to “get them before they get you.” Work with combat veterans (as well as rape and child abuse victims) who come from long experience in “impossible circumstances” for a while. See what “learned hopelessness” does to many (though not all) people (see Seligman, and Rotter).

6) It was significantly harder to get behavioral health care this year than in 2005, a finding that may be owing to the fact that troops are spread out at hundreds of posts around the rugged terrain of Afghanistan.

As during Vietnam, modern war is not fought in large, set-piece battles like those of WWI and WWII. Our military continues to be geared towards “shock and awe,” but “shock and awe” is not battlefield reality. Since Korea in 1950-53, our enemies have seemed to know this, and manipulate us into slow, grinding wars of attrition that not only defeat us militarily but leave us with large numbers of PTSD-suffering veterans who then become a significant “security issue,” and burden, to society. (They were taught how to use guns and explosives to kill people, after all.) Are we being manipulated by the power-seeking sociopaths in older, wiser cultures that understand how to destroy us over the “long run?”

7) Troops who spent two to four hours daily playing video games or surfing the Internet as a way to cope helped lower their psychological problems, but spending time beyond that — three to four hours — had the opposite effect. Those who exercised or did other physical training decreased their mental problems, regardless of the time spent.

Distraction is well understood as an intermediate therapeutic tool, but too much distraction is as toxic to the autonomic nervous system as other forms of stress, and therefore counter-productive. Too much physical assertion can be neurotoxic, as well, because of lactic acid buildup and ensuing conversion to sodium lactate, which is toxic to the nervous system (see Kelly et al).

(Regarding the broader neurotoxic foundations of persistent PTSD, see Agarwal, Barbay et al, Cozolino, DeBellis, Dolcos et al, Driessen et al, Duman, Gazzaniga et al, Heim and Nemeroff, Huttenlocher, Ito et al, Johnson et al, Joubert, Kaufman et al, LeDoux, Maret, Mauss et al, McGowan et al, Panksepp, Perry, Putnam, Stein et al, US Dept. of Health and Human Services, Vermetten et al, and Watt.)

8) Troops reported more and better training in suicide prevention and other mental health programs the Army has been increasing over recent years in an unprecedented effort to focus on the force's mental health.

The short-term results of these programs are encouraging, but we do not yet know what the long-term results will be. And one has to have concerns; see Quarantini, and Yaffe et al, for example, as well as the extensive work done by the US Dept. of Health and Human Services.

9) The mental health care system in Afghanistan is understaffed based on the Army doctrine of one mental health worker for every 700 troops.

The entire notion of sending people to war over and over again (some troops have now done three, one-to-two-year combat tours) and then asserting that combat-induced PTSD can be “managed” (at least statistically) by sending mental health workers out there with them seems like suspect logic. Especially if the mental health workers are themselves exposed to the second-hand stress of hearing tale after tale of hopelessness from soldiers who have to return to combat the next day.

Resources and References

Agarwal, N.: fMRI Shows Trauma Affects Neural Circuitry, in Clinical Psychiatry News, Vol. 37, No. 3, March 2009.

Barbay, S.; Zoubina, E.; Nudo, R.: Neural Plasticity in Adult Motor Cortex, Kansas University Medical Center website and CRC Press, 2005.

Beck, A.: Cognitive Therapy and the Emotional Disorders, New York: Penguin-Meridian, 1976.

Beck, A.; Freeman, A.: Cognitive Theory of the Personality Disorders, New York: Guilford Press, 1990.

Beck, A.; Wright, F.; Newman, C.; Liese, B.: Cognitive Therapy of Substance Abuse, New York: The Guilford Press, 1993.

Beck, A.: Prisoners Of Hate: The Cognitive Basis of Anger, Hostility, and Violence, New York: Harper-Collins, 1999.

Blair, J.: Neurological basis of psychopathy, in the British Journal of Psychiatry, Vol. 182, 2003.

Bozarth, M.: Drug addiction as a psychobiological process, in Warburton, D. (ed.): Addiction controversies, London: Harwood Academic Publishers, 1990.

Bozarth, M.: Pleasure systems in the brain, in Warburton, D. (ed.), Pleasure: The politics and the reality, New York: John Wiley & Sons, 1994.

Buhler, K.; Heim, G.: General introduction to the psychotherapy of Pierre Janet, in American Journal of Psychotherapy, 2001.

Castonguay, L.; Beutler, L.: Principles of Therapeutic Change that Work, London: Oxford University Press, 2005.

Centers for Disease Control and Prevention: The Effects of Childhood Stress Across the Lifespan, Atlanta, GA: CDC, 2008.

Cohen, J.; et al: Identifying, Treating, and Referring Traumatized Children, in Archives of Pediatric and Adolescent Medicine, Vol. 162, May, 2008.

Colby, K.: A Primer for Psychotherapists, New York: Ronald, 1951.

Copeland, W.; Keeler, G.; et al: Traumatic events and posttraumatic stress in childhood, in Archives of General Psychiatry, Vol. 64, 2007.

Corey, G.: Theory and Practice of Counseling and Psychotherapy, 4th Ed, 6th Ed., Belmot, CA: Thomson Learning, 1994, 2001.

Courtois, C.: Guidelines for the Treatment of Adults Abused or Possibly Abused as Children (with Attention to Issues of Delayed or Recovered Memory), Washington, DC: The Psychiatric Institute of Washington, 1997.

Cozolino, L.: The Neuroscience of Psychotherapy: Building and Rebuilding the Human Brain, New York: W. W. Norton, 2002.

DeBellis, M.: Developmental Traumatology: Neurobiological Development in Maltreated Children with PTSD, in Psychiatric Times, Vol. 16, No. 11, 1999.

Dimeff, L.; Koerner, K.: Dialectal Behavior Therapy in Clinical Practice: Applications Across Disorders and Settings, New York: The Guilford Press, 2007.

Dodes, L.: The Heart of Addiction: A New Approach to Understanding and Managing Alcoholism and Other Addictive Behaviors, New York: Harper & Rowe, 2002.

Dolcos, F.; Morey, R.: Cognitive PTSD Changes Are Evident on fMRI: Study of American soldiers provides early evidence of disorder's specific neuroanatomy biomarkers, in Clinical Psychiatry News, Vol. 37, No. 5, May 2009.

Driessen, M.; Herrman, J.; Stahl, K.; et al: Magnetic resonance imaging volumes of the hippocampus and the amygdala in women with borderline personality disorder and early traumatization, in Archives of General Psychiatry, Vol. 5, No. 7, 2000.

Duman, R.: Neural plasticity: consequences of stress and actions of antidepressant treatment, in Dialogues of Clinical Neuroscience, Volume 6, 2004.

Ekleberry, S.: Seminar on Substance Abuse and Axis II Personality Disorders, San Francisco: Arcturus, 2000.

Ellis, A.; Harper, R.: A Guide to Rational Living, North Hollywood, CA: Melvin Powers, 1961.

Ellis, A.; Dryden, W.: The Practice of Rational Emotive Therapy, New York: Springer Publishing Company, 1987.

Ellis, A.: Overcoming Destructive Beliefs, Feelings, and Behaviors: New Directions for Rational Emotive Behavior Therapy, New York: Promethius Books, 2001.

Endo Pharmaceuticals: Pain Management Learning System, Chapel Hill, NC: ETSI, 2003.

Frances, A.; Clarkin, J.; Perry, S.: Differential Therapeutics in Psychiatry: The Art and Science of Treatment Selection, New York: Brunner/Mazel, 1984.

Frances, R.; Miller, S.: Clinical Textbook of Addictive Disorders, New York: Guilford Press, 1991.

Frankenberg, F.; Kymalainen, J.: The clinical significance of co-morbid post-traumatic stress disorder and borderline personality disorder: Case study and literature review, in Journal of Personality & Mental Health, Vol. 3, No. 3, July 2009.

Frankl, V.: Man’s Search for Meaning, New York: Pocket Books, 1984.

Friedman, M.: Post-Traumatic and Acute Stress Disorders: The latest assessment and treatment strategies, 4th Ed., Kansas City, MO: Dean Psych Press dba Compact Clinicals, 2006.

Gazzaniga, M.; Ivry, R.; Mangun, G.: Cognitive Neuroscience: The Biology of the Mind, 2nd Edition, New York: W.W. Norton, 2002.

Giardino, N.: Doing no harm: A commentary on ‘The clinical significance of co-morbid post-traumatic stress disorder and borderline personality disorder: Case study and literature review,’ in Journal of Personality & Mental Health, Vol. 3, No. 3, July 2009.

Grand, S.: The Reproduction of Evil: A Clinical & Cultural Perspective, Hillsdale, NJ: The Analytic Press, 2000.
Hamilton, L.; Timmons, C. R.: Principles of Behavioral Pharmacology, Englewood Cliffs, NJ: Prentice-Hall, 1990.

Hayes, S.; Follete, V.; Linehan, M.: Mindfulness and Acceptance: Expanding the Cognitive-Behavioral Tradition, New York: The Guilford Press, 2004.

Heim, C.; Nemeroff, C.: The role of childhood trauma in the neurobiology of mood and anxiety disorders: pre-clinical and clinical studies, in Biological Psychiatry, Vol. 49, 2001.

Heim, C.; Nemeroff, C.: Neurobiology of early life stress: clinical studies, in Seminar on Clinical Neuropsychiatry, Vol. 4, 2002.

Herman, J. L.: Trauma and Recovery, New York: Basic Books, 1992.

Huttenlocher, P.: Neural Plasticity: The Effects of Environment on the Development of the Cerebral Cortex, Cambridge, MA: Harvard University Press, 2002.

Iberg, J.: Unconditional Positive Regard: Constituent Activities, in Levant, R.; Schlein, J.: Client-Centered Therapy and the Person-Centered Approach: New Directions in Theory, Research and Practice. New York: Praeger Press, 1984.

Ito, Y.; Teicher, M.; et al: Increased prevalence of electrophysiological abnormalities in children with psychological, physical and sexual abuse, in Journal of Neuropsychiatry and Clinical Neurosciences, Vol. 5, No. 4., 1993.

Johnson, S.; Ballister, C.; Joiner, T.: Hypomanic vulnerability, terror management, and materialism, in Personality and Individual Differences, Vol. 38, 2005.

Jongsma, A.; Peterson, L. M.; Bruce, T.: The Complete Adult Psychotherapy Treatment Planner, 3rd Ed., New York: John Wiley & Sons, 2001.

Joubert, A.; et al: CNS Image Bank: The anxiety disorders, Skodsbord, Denmark: The Lundbeck Institute, 2005.

Kabat-Zinn, J.: Mindfulness Meditation: Health benefits of an ancient Buddhist practice, in Goleman, D.; Gurin, J., editors: Mind/Body Medicine, New York: Consumer Reports Books, 1993.

Kaszniak, A., et al: Toward a Science of Consciousness, Editions I, II and III, Cambridge, MA: MIT Press, 1996, 1998, 1999.

Kaufman, J.; Plotsky, P.; Nemeroff, C., et al: Effects of early adverse experiences on brain structure and functions: clinical implications, in Biological Psychiatry, Vol. 48, 2000.

Kelly, D.; Mitchell-Heggs, N.; Sherman, D.: Anxiety and the Effects of Sodium Lactate Assessed Clinically and Physiologically, in British Journal of Psychiatry, Vol. 119, 1971.

Khantzian, E: The self medication hypothesis of substance use disorders: a reconsideration and recent applications, in Harvard Review of Psychiatry, Vol. 4, No. 5, Jan-Feb 1997.

Kira, I.: Taxonomy of Trauma and Trauma Assessment, in Traumatology, Vol. 7, No. 2, 2001.

Kluft, R.; et al: Childhood Antecedents of Multiple Personality Disorder, Washington DC: American Psychiatric Press, 1985.

LaGow, B., Chernin, T.; Murray, L.; et al: PDR Drug Guide for Mental Health Professionals, 2nd Ed., Montvale, NJ: Thomson PDR, 2004.

Laing, R. D.: Knots, New York: Penguin, 1973.

Lang, A.; Laffaye, C.; et al: Relationship among childhood maltreatment, PTSD, and health in female veterans in primary care, in Child Abuse and Neglect, Vol. 30, 2006.

Lazarus, R.: Emotion and Adaptation, New York: Oxford University Press, 1991.

LeDoux, J.: The Emotional Brain: The Mysterious Underpinnings of Emotional Life, New York: Simon & Schuster, 1996.

Linehan, M.: Cognitive–Behavioral Treatment of Borderline Personality Disorder, New York: Guilford Press, 1993.

Livesley, W. J.: Practical Management of Personality Disorder, New York: Guilford Press, 2003.

Ludwig, D.; Kabat-Zinn, J.: Mindfulness in Medicine, in Journal of the American Medical Association, Vol. 300, No. 11, September 2008.

Maret, S.: Frank Lake's Maternal-Fetal Distress Syndrome: An Analysis, Dissertation - Clinical Theology Association, St Mary's House, Church Westcote, Oxon, England, OX77SF, 1996.

Marra, T.: Dialectical Behavior Therapy in Private Practice, Oakland, CA: New Harbinger, 2005.

Mauss, I.; Wilhelm, F.; Gross, J.: Autonomic recovery and habituation in social anxiety, in Journal of Psychophysiology, Vol. 40, No. 1, January 2003.

McGowan, P.; Sasaki, A; D’Alessio, A.; et al: Epigenetic regulation of the glucocorticoid receptor in human brain associates with childhood abuse, Journal of Nature Neuroscience, Vol. 12, No. 3, March 2009.

McKay, M.; Rogers, P.; McKay, J.: When Anger Hurts: Quieting the Storm Within, 2nd Ed., Oakland, CA: New Harbinger, 2003.

McNally, R.: Research on Eye Movement Desensitization and Reprocessing (EMDR) as a Treatment for PTSD, Washington, DC: Department of Veterans Affairs, 2004.

Meally, L.: The sociobiology of sociopathy: an integrated evolutionary model, in Behavioral and Brain Sciences, Vol. 18, No. 3, 1995.

Munich, R.; Allen, J.: Psychiatric and Sociotherapeutic Perspectives on the Difficult-to-Treat Patient, in Psychiatry, Vol. 66, No.4, Winter 2003.

Mycek, M.; Harvey, R.; Champe, P.: Lippincott’s Illustrated Review of Pharmacology, 2nd Ed., Philadelphia: Lippincott, Williams & Wilkins, 2000.

Newberry, L.: Sheehy’s Emergency Nursing Principles and Practice, 4th Ed., St. Louis: Mosby (Harcourt Health Sciences), 1998.

Ogden, P.; Minton, K.: Sensorimotor Psychotherapy: One Method for Processing Traumatic Memory, in Traumatology, Vol. 6, Issue 3, October, 2000.

Paine-Gernee, K.; Hunt, T.: Emotional Healing: A Program for Emotional Sobriety, New York: Warner Books, 1990.

Panksepp, J.: Affective Neuroscience: The Foundations of Human and Animal Emotions, New York: Oxford University Press, 1998.

Patterson, C.: Respect (Unconditional Positive Regard), in Patterson, C.: The Therapeutic Relationship, Monterey, CA: Brooks/Cole, 1985.

Perls, F.: Gestalt Therapy Verbatim, San Francisco: Gestalt Journal Press, 1992.

Perry, B.: Incubated in Terror: Neurodevelopmental Factors in the Cycle of Violence, in Osovsky, J. (ed.): Children, Youth and Violence: The Search for Solutions, New York: Guilford Press, 1997.

Perry, B.: Childhood Experience and the Expression of Genetic Potential: What Childhood Neglect Tells Us About Nature and Nurture, in Brain and Mind, Vol. 3, 2002.

Perrifoy, R.: Anxiety, Phobias and Panic: Taking Charge and Conquering Fear: A Step-By-Step Program for Regaining Control of Your Life, New York: Warner Books, 1992.

Pollack, M.; Otto, M.; Rosenbaum, J.: Challenges in Clinical Practice: Pharmacolgic and Psychosocial Strategies, New York: Guilford Press, 1996.

Polster, E.; Polster, M.: Gestalt Therapy Integrated: Contours of Theory & Practice, New York: Vintage, 1974.

Preston, J.: Integrative Treatment for the Borderline Personality Disorder, Oakland: New Harbinger, 2006.

Preston, J.; O’Neal, J; Talaga, M.: Handbook of Clinical Psychopharmacology for Therapists, 5th Ed., Oakland, CA: New Harbinger, 2008.

Putnam, P.; Saevarsson, S.; van Honk, J.: Hypomanic trait is associated with a hypovigilant automatic attentional response to social cues of danger, in Bipolar Disorders, Vol. 9, No. 7, November 2007.

Quarantini, L., et al: PTSD Worsens Outcomes in Bipolar Disorder, in Journal of Affective Disorders, Vol. 119, August 2009.

Rogers, C.: On Becoming a Person, Boston: Houghton Mifflin, 1961, 1995.

Rosenzweig, M.; Breedlove, S. M.; Leiman, A.: Biological Psychology, 3rd Ed., Sunderland, MA: Sinaur Associates, 2002.

Rotter, J.: Generalized expectancies for Internal vs. External Locus of Control of reinforcement, in Spielberger, C.: The Development and Application of Social Learning Theory, New York: Praeger, 1982.

Rouanzoin, C.: Using EMDR with Dissociative Disorders: Specific Protocols, Fullerton: Rouanzoin, 1999.

Sanderson, W.; Rego, S.: Empirically Supported Psychological Treatment of Panic Disorder and Agoraphobia; Washington, DC: Medscape CMEs; 2000.

Schiraldi, G.: The Post-Traumatic Stress Disorder Source Book, 2nd Ed.; New York: McGraw-Hill, 2009.

Schore, A.: Affect Dysregulation and Disorders of the Self, New York: W. W. Norton & Company, 2003.

Seigel, D.: Reflections on the Mindful Brain, in Mind Your Brain, Los Angeles: Lifespan Learning Institute, 2007.

Seligman, M.: Learned Optimism: How to Change Your Mind and Your Life, New York: Knopf, 1990.

Shaffer, H.; LaPlante, D., La Brie, R.; et al: Toward a Syndrome Model of Addiction: Multiple Expressions, Common Etiology; in Harvard Review of Psychiatry, Vol. 12, 2004.

Shahar, G.; Scotti, M.; Rudd, M. D.; Joiner, T.: Hypomanic symptoms predict an increase in narcissistic and
histrionic personality disorder features in suicidal young adults, in Journal of Depression and Anxiety, Vol. 25, No. 10, October 2008.

Shaprio, F.: EMDR: The Breakthrough "Eye Movement" Therapy for Overcoming Anxiety, Stress, and Trauma, New York: Basic Books, 1999.

Shapiro, F.: Eye Movement Desensitization and Reprocessing (EMDR): Basic Principles, Protocols, and Procedures, 2nd Ed., New York: Guilford Press, 2001.

Skinner, B. F.: Beyond Freedom and Dignity, New York: Alfred A. Knopf, 1971.

Skinner, B. F.: About Behaviorism, New York: Random House, 1974.

Simonsen, S.: You can’t always get what you want: A commentary on ‘The clinical significance of co-morbid post-traumatic stress disorder and borderline personality disorder: Case study and literature review,’ in Journal of Personality & Mental Health, Vol. 3, No. 3, July 2009.

Spreen, O.; Risser, A.; Edgell, D.: Developmental Neuropsychology, New York: Oxford University Press, 1995.

Stahl, S.: Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, 2nd Ed., New York: Cambridge University Press, 2000.

Stein, M.; Koverola, C.; Hanna, C.; et al: Hippocampal volume in women victimized by childhood sexual abuse, in Psychological Medicine, Vol. 27, No. 4, 1997.

Tangney, J. P.; Dearing, R.: Shame and Guilt, New York: Guilford Press, 2002.

Townsend, M.: Psychiatric/Mental Health Nursing, 1st Ed., Philadelphia: F. A. Davis, 1993.

Ursano, R.; Bell, C.; Eth, S.; et al: Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder, in The American Journal of Psychiatry, November, 2004.

US Dept. of Health and Human Services: In Focus: Understanding the Effects of Maltreatment on Early Brain Development, Washington, DC: US Government Printing Office, 2001.

Van der Hart, O.; Brown, P.; and Van der Kolk, B.: Pierre Janet’s Treatment of Traumatic Stress, in Journal of Traumatic Stress, Vol. 2, No. 4, 1989.

Van der Hart, O.; Friedman, B.: A Reader's Guide To Pierre Janet: A Neglected Intellectual Heritage, in Dissociation, Vol. 2, No. 1, 1989.

Van der Hart, O.; Horst, R.: The Dissociation Theory of Pierre Janet, in Journal of Traumatic Stress, Vol. 2, No. 4, 1989.

Van der Kolk, B.: The Compulsion to Repeat the Trauma: Re-enactment, Re-victimization, and Masochism, in Psychiatric Clinics of North America, Vol. 12, No. 2, 1989.

Van der Kolk, B: Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society, New York: Guilford Press, 1996 / 2007.

Van der Kolk, B.; Hopper, J.; Osterman, J.: Exploring the Nature of Traumatic Memory: Combining Clinical Knowledge with Laboratory Methods; in Journal of Aggression, Maltreatment & Trauma, Vol. 4, No. 2, 2001.

Vermetten, E.; Schmahl, C.; Lindner, S.; et al: Hippocampal and amygdalar volumes in Dissociative Identity Disorder, in American Journal of Psychiatry, Vol. 163, No. 4, 2006.

Vignarajah, B.; Links, P.: The clinical significance of co-morbid post-traumatic stress disorder and borderline personality disorder: Case study and literature review; in Journal of Personality & Mental Health, Vol. 3, No. 3, July 2009.

Watson, J.: Behaviorism, Revised Edition, Chicago: University of Chicago Press, 1930.

Watt, D.: Implications of Affective Neuroscience for Extended Reticular Thalamic
Activating System Theories of Consciousness, in Emotion and Consciousness: The Association for the Scientific Study of Consciousness Electronic Seminar, 1998.

Wessler, R.; Hankin, S., Stern, J.: Succeeding with Difficult Clients: Applications of Cognitive Appraisal Therapy, San Diego: Academic Press, 2001.

Wilkins, P.; Bozarth, J.: Unconditional Positive Regard in Context, in Levant, R.; Schlein, J.: Client-Centered Therapy and the Person-Centered Approach: New Directions in Theory, Research and Practice. New York: Praeger Press, 1984.

Yaffe, K., et al: PTSD Nearly Doubles Risk of Later Dementia, in Clinical Psychiatry News, Vol. 37, No., August 2009.

Young, J.: Cognitive Therapy for the Personality Disorders: A Schema-Focused Approach, 3rd Ed., Sarasota, FL: Professional Resource Press, 1999.

© 2009 by Rodger Garrett; all rights reserved. Links are fine. Please contact not_moses@fastmail.fm with comments or questions. Thank you.

Thursday, November 12, 2009

Film Review: The Coens' "A Serious Man"

Stuck in Job's Jewish Paradigm

This is the review I submitted to the International Movie Database. We'll see if it ever sees the light of day on their website.

*** This comment may contain spoilers ***

Perusing the other comments (and ostensible explanations) after seeing the film at an art-house near Cal Poly SLO tonight, it seems that the Coens once again set out to have fun at the expense of most viewers' emotional comfort, and shoot well over the heads of the pseudo-intelligencia. Because I see "ASM" (and other films of this sort) through the filtration of the little-known Karpman Drama Triangle, I probably will, too.

"ASM" is not "Blood Simple," "Miller's Crossing" or "No Country...," so if you're looking for that kind of entertainment, look elsewhere. Those films were made to beat people over the head emotionally and make money. Like "Barton Fink," "Fargo" and "The Big Lebowski," this film was make to make people squirm.

As with those mighty "little" films, "ASM" is about life turned upside down again and again (and shaken, not stirred) because the protagonists are stuck in the dense, black-or-white, all-or-nothing belief and value systems of their cultures. As in those films, the protagonist here is mystified at the buckets of chaos raining down on him because he can only perceive life from within a paradigm of which he is wholly unaware. Yet, like chaos theory, there's an obvious order to the whole package... if one looks for it.

In this case (and here's the spoiler), it's that Larry Gopnik cannot see the world in any other fashion than through the eyes of an orthodox Jew in pre-gange (read pre-pseudo-"enlightenment"), 1967 Minneapolis. He is so encapsulated in the values and beliefs of his surrounding culture that it does not occur to him to seek other interpretations of his deepening dilemmas. It is as though he is a member of some rural mind-control cult.

Poor, helpless (and hopeless) Larry looks for answers in a faith he has never really put to the test before. And everyone he turns to smothers him with the assumptions, assertions and convictions of a legalistic and absolutistic culture that espouses unquestioning acceptance of the mysterious, arbitrary and alternately rescuing and persecuting Hebrew god of the Pentatuch. "Life is awful, and then you die and go who knows where?" everyone seems to tell him.

The orthodox Jew has no concept of heaven, I guess; and hell is accepted as right here on earth. How, then, could he arrive at any other appraisal or evaluation of his Job-like existence than the one he does? Even if the audience is given a powerful hint at the very end that there are other ways to see things.

I found this film largely tragic and hilarious: Tragic because I see a world full of people in 2009 who continue to believe there's only one way to see the world around them... And No Other. Hilarious because I was lucky enough to be let in on The Big Joke about "the whiz" and all that. But I had to work very hard to be let in on it.

I'm just glad that for the time being, at least, I still live in a country that (usually) guarantees the freedoms it does. It was Veteran's Day yesterday. Two people I knew thanked me for wearing a uniform to Vietnam. Nice of them. Freedom of speech does not come cheap. You may have to kill for it.

© 2009 by Rodger Garrett; all rights reserved. Links are fine. Please contact not_moses@fastmail.fm with comments or questions. Thank you.