The Clare Spark Blog

December 12, 2013

The Wall Street Journal discovers lobotomy craze for vets

VA quackeryAs late as today, December 12, 2013, The Wall Street Journal, has discovered that traumatized veterans of WW2 and even later conflicts were routinely lobotomized, a procedure that is said to have its greatest application in the 1940s and 1950s. Written by Michael M. Phillips (pages A1, A8-A9), the author relies on “dusty” boxes found in the National Archives.  The surgery was primarily applied to “depressives, psychotics and schizophrenics, and occasionally on people identified as homosexuals.”

Where have journalists been all these years? Even anti-science, anti-psychiatry students of the history of medicine consider this lurid chapter to be closed, though my blog index to lobotomies remains popular. See https://clarespark.com/2010/11/29/index-to-lobotomy-blogs/.

But even more relevant to the WSJ alarming discovery is the series on military psychiatry, which remains in a primitive state, perhaps owing to the assumption that wars are inevitable, and that fighting men are expendable, whereas blundering diplomats and governments are not. Above all, we must maintain hierarchies and obedience to our betters, a message amplified by such favorite television series as NCIS, where the good father (Gibbs, played by Mark Harmon) protects his cohesive fighting family, ever the uncomplaining “team.” https://clarespark.com/2010/04/22/links-to-blogs-on-military-psychiatry/. On blundering diplomats see https://clarespark.com/2013/08/31/the-devil-in-history-a-j-p-taylor-vs-r-palme-dutt/ (with an addendum by Niall Ferguson).

As I have argued before, WSJ, like Fox News Channel or Commentary is an outpost of the moderate men. (See https://clarespark.com/2010/11/06/moderate-men-falling-down/.) I had hoped that the WSJ article would exhibit some homework in other archives, hence pointing to our continued confusion over the causes of anxiety, depression, “shell shock,” “PTSD,” and other mental illnesses that might be preventable without the taboo associated with any of the “personality disorders” said to be curable now with cognitive behavioral therapy, guided by DSM-5.  (See https://clarespark.com/2009/11/16/nobody-is-perfect/, one of my items in the lobotomy blogs.)

Quacks

The point of this blog is that ordinary people take the rap when our “betters” give the orders and fail in their jobs to keep individual, social, and international peace. Is it possible that our world is run by quacks? Are we quacks for trusting them? If so, what can we do about it? Leave your comments on the blog.

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December 9, 2012

Holiday blues, Unhappy families

norman-rockwell-coupleOne of Freud’s primary themes in treatment of his patients was the separation of (idiosyncratic) neurotic anxiety from objective anxiety. Since anxiety disorders (along with depression and post-traumatic stress disorders) are widely present in our culture, I thought that the general subject was worthy of focus and exploration.

Keep in mind that many of Freud’s original writings were published before the events of the 20th century, with horrors such as the Great War leading to innovations in his repertoire, for instance “the death wish” or a general pessimism regarding the human condition (“everyday unhappiness”), not to speak of his attack on all religion as infantile regression in The Future of An Illusion (1928). But the Freudians today are few and cater to an older, usually moneyed urban clientele, while it is the Jungians whose influence has penetrated into popular culture and even school curricula, owing perhaps to Jung’s postulation of a racially-specific unconscious that blends well with racialist theories of multiculturalism. (For my numerous blogs on Jung and Jungians, see https://clarespark.com/2010/05/10/jungians-rising/.)

It is more often the case that Freud’s influence, if any, is filtered through the structural functionalism of Talcott Parsons and similar social theorists who are more interested in adjustment and functionality (stability in interpersonal and international relations), than in the tracking of personal traumas and intertwined social traumas that lead to troubling “symptoms” such as the anxiety disorders. Indeed, The Diagnostic and Statistical Manual of Mental Disorders  has been funded by liberals and their foundations and related organizations, including the MacArthur Foundation, U.S. government agencies, the World Health Organization, and the American Psychiatric Association. Their approach is managerial, as opposed to an orientation to cure, for that could lead to radicalization or other postures deemed destabilizing to social order imagined by the moderate men.

NPR recently interviewed a psychiatrist in the know about changes to DSM-V, the diagnostic manual used by physicians of every kind in labeling and prescribing treatment for their patients. This psychiatrist stated that it was likely that grief (a subject that has not been previously “medicalized” as abnormal) would be limited to two months, after which antidepressants might be indicated. (For a general summary of proposed changes in DSM-V see http://www.goodtherapy.org/blog/controversy-changes-dsm-diagnosis-1205127, posted December 6, 2012.)

Some passages from the Introduction to DSM-IV bear quoting, especially as they are not only as indecipherable as Parson’s own famously awful prose, but are careful to avoid positing dualisms between mind and body, or labeling suffering “individuals”:

“In DSM-IV, each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. In addition, this syndrome or pattern must not be an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one. Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual. Neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of dysfunction in the individual as described above.” [I have not yet found a definition of “the individual”; rather, progressives are careful to define the “individual-in-society.”  See https://clarespark.com/2009/12/12/switching-the-enlightenment-corporatist-liberalism-and-the-revision-of-american-history/. CS]

[DSM-IV, cont.:]  “A common misconception is that a classification of mental disorders classifies people, when actually what are being classified are disorders that people have. For this reason, the text of DSM-IV (as did the text of DSM-III-R) avoids the use of such expressions as “a schizophrenic” or “an alcoholic” and instead uses the more accurate, but admittedly more cumbersome, “an individual with Schizophrenia” or “an individual with Alcohol Dependence.” ( my emphasis, pp. xxi-xxii)

This is the language of progressivism, pretending that these experts believe in the discrete, unique individual, while all along using quantification and statistics that attempt to describe disruptive (mal-adjusting) group behaviors: “disorders that people have.” Moreover, their language is so vague and abstract that I for one, can barely decode their language. But I suspect that “defiant” individuals (who have their own section in DSM-IV) are deemed dysfunctional no matter how rationally based their nonconformity may be. (I was considered to be “defiant” or excessively “experimental” in graduate school by leading professors, sometimes in private, sometimes in public. See https://clarespark.com/2012/12/22/my-oppositional-defiant-disorder-and-eric-hobsbawm/.)

The language that I have quoted is so abstracted from the real life experience of classes, genders, or other groupings that one wonders if the suspicions of the anti-psychiatry theorists are not themselves more rational than the mental health practitioners who rely upon DSM’s diagnostic codes to prescribe pills and other remedies for symptoms that are imposed by the concrete life experiences of soldiers, abused and neglected children, or simply members of families that do not meet their individual emotional and biological needs.

But as I read the section in DSM-IV on post-traumatic stress disorders, I was struck by the usefulness of these causal situations to current day problems that are often global in nature: the direct experience of war and falsifying propaganda; the demoralizing teaching of history as non-stop atrocity; the hyper-sexualization of American culture that exposes children to sexual scenes at early ages; the crime shows on television or in the movies that are graphically violent and sexual in nature; the constant broadcasting of apocalyptic scenarios that blame industrialization for the imminent end of life on our planet; “rage against the machine” by rock bands and other counter-culture wannabe stars; gangsta rap; the barrage of images of the happy gift-giving, problem-solving family (especially from Thanksgiving on through Christmas)–families untroubled by generational conflict, misunderstanding, or sibling rivalry.

While I object to the introductory material that I have quoted, the many social-cultural-political sources of PTSD are useful to the understanding of “objective anxiety.”

How neurotic are we, or are most of us rationally reacting to an objectively terrifying world? (For a related blog see https://clarespark.com/2009/11/16/panic-attacks-and-separation-anxiety/. For a description of the controversy surrounding revisions of DSM-IV, see http://www.theatlanticwire.com/national/2012/12/inside-controversy-over-bible-mental-disorder/59849/.)

Why does Norman Rockwell have a German helmet circa WW1 perched on top of his easel?

Norman Rockwell

Norman Rockwell

March 18, 2012

History as trauma (2), Rosebud version

In response to my hint on Facebook that Staff Sergeant Robert Bales, who recently went on a rampage killing 16 Afghanistani civilians,  might be suffering from a mental disorder, X wrote: “The only thing new here is the growth of a professional class of social leeches who use all human discomfort as a niche for some absurdly over-credentialed “helping” professional as a “grief counselor” or PTSD expert, all of whom are in full retreat from American values that have stood us in good stead for 240 years and pushing us towards some kind of Euro Social Justice oblivion. The “Say a Prayer for Peace” commercials make me want to hurl as the vet is coached to say he would have committed suicide without the counseling of some leech or other we should send money to support.

[“X” cont.] If I was in command of a military force today, and a Sgt Bale popped up, I’d make sure some “tragedy” or other took place before he got in the hands of the touchy, feely, lawyered up creeps who are infesting our nation and preserving and supporting the lives of now millions of marginal people who could actually be making a contribution to a better America.”[end X message.]

[Clare:] Clearly, much more needs to be said about the current state of medicine with respect to PTSD and other forms of disabling responses to traumas. This blog will comment further on the material introduced here: https://clarespark.com/2012/03/14/history-as-trauma/. I have finished reading Robert Scaer MD’s book, The Body Bears the Burden: Trauma, Dissociation, and Disease (Routledge, 2007), and now can argue for its importance, especially in the light of Obamacare and primary care medicine in general.

Who won’t like this book? Government officials invested in the Affordable Care Act, insurance companies, trial lawyers, many feminists, and those who, out of life experience or conviction, disregard any type of medicine that relies solely upon a materialist (empirical) study of the brain, the endocrine system, and the mind-body continuum.  For what Scaer’s book delivers is a comprehensive survey of the field of neurophysiology and the pathologies that stem from trauma, especially those that result from a failure of mother-child attunement and bonding, though he does mention the many traumas that his patients have experienced, including natural disasters, automobile accidents, military combat, assaults, child abuse, incest, rape (including date rape) and more. But when mothers experience post-partum depression, for instance, Scaer considers such a calamity to be a form of child abuse that damages the child for life, including the proclivity for violent crime or any other antisocial activity. He returns to the infant and pain so frequently that one wonders if this frequently reiterated factor is not a part of his personal biography. (Examples: fetuses feel pain, circumcision must be accompanied by anesthetic, new born baby should be put on the mother’s breast immediately.)

I am convinced that Scaer’s work and that of other neurologists who have produced work since the last half of the 20th century are correct in refining the field of neurology and psychiatry, especially in overthrowing the Cartesian dualism of Mind as separate from Body, and in defending the idea of the unconscious, even though it is not Freud’s unconscious. Moreover, many practitioners, including students of healing in other cultures, have developed treatments that release the original frozen trauma, so that the patient does not experience subsequent physical and mental disorders such as fibromyalgia and panic attacks. These are all listed by Scaer, and evaluated by him as a scientist. His rather tentative and humble book is not about selling a fast track to cure; nor is he in agreement with DSM-IV in their limited understanding of trauma.

This is why I consider Scaer’s book to be a revolution in patient care, but one that makes recommendations that are not yet capable of being broadly realized, for HMO’s do not support long term mental health services, nor do primary care physicians have the time to take lengthy family histories. I have written elsewhere about panic attacks, in which it is suggested that each of us make a list of those terrifying, helpless-making moments in our past that could have contributed to the separation anxiety that is called panic or other names. See https://clarespark.com/2009/11/16/panic-attacks-and-separation-anxiety/. If there is something amiss with mother-infant bonding, the patient must resort to inferences about the relations between mother and child, for mother’s mood after birth cannot be directly recalled, although mother’s intent on escaping domesticity offers hints.

Even to read Scaer’s book may be a form of preventive medicine. Return to the Affordable Care Act. For those who wrote the legislation, preventive medicine entails screening for cancer, such as mammograms and colonoscopies.  They do not mention lifestyle choices and/or mental health services that can be shown either to lead to optimum functioning or, conversely, to unnecessary and persistent pain and suffering, not to speak of early death.

Poster Coming Home

Why do I, as feminist and mother of one son and two daughters and grandmother to two grandsons and five granddaughters, dwell on the mother-infant attachment? I am convinced that many men are determined to control women because of earlier experience with mothers who were either (subtly?) rejecting or clinging to their sons, to the exclusion of other mature attachments (e.g. the Orson Welles-directed film of 1942 The Magnificent Ambersons). The first version of Nancy Dowd’s movie (Buffalo Ghosts) that was eventually released as Coming Home, featured a souvenir store on an army base in the Dakotas that emphasized the soon-to-be deployed Viet Nam soldier’s tie solely to Mother, not to wives or other love objects. Such sappy mementos as embroidered mommy pillows, for sale to officers and enlisted men alike, may have been too hot to handle.

Nancy Dowd, screenwriter

Scaer is the first author I have found who mentions the switch from happy face to angry face that causes baby to feel shame and guilt, literally turning his face away from the scary mom. For these men, women are always dangerously unpredictable and fit the archetype of Gorgon or Medusa. See https://clarespark.com/2009/10/23/murdered-by-the-mob-moral-mothers-and-symbolist-poets/. Moreover, women, especially modern women, may signify the onset of a terrifying modernity that will only make mother more overpowering and omnipresent. Rosebud!

Here is what I find most instructive about Scaer’s work. He deals with the highly variable individual case history, yet government bureaucrats, not to speak of other professionals, deal with large populations, for whom one size fits all—the latest DSM manual for psychiatrists, the state-imposed school curriculum, the rules set up by Medicare and insurance companies. If childhood trauma is as frequent as Scaer’s stats suggest, then we are not educating youngsters where they need it most. For the lesson of trauma is this: every child needs a safe place with clear boundaries in order to explore the real world that s/he must master to survive and thrive. Distant bureaucrats or entirely cerebral teachers, or  hurried, un-empathic, physicians, hemmed in by the fear of litigation, or simply untrained in the latest discoveries in neurology and endocrinology, cannot treat the traumatized patient or student, and as Scaer argues, that includes a huge proportion of their clientele.

Finally, can children in isolated rural areas, dominated perhaps by religious fundamentalists, ever feel safe? Can kids in urban ghettoes, or anyone who is a member of a stigmatized group ever feel safe in public schools or anywhere else? And how do we know if we feel safe or not; we may be stoic or too polite to admit even to ourselves how we feel as we face the great questions of the day. There are private questions that often arouse shame when discussed publicly. I do not expect that my readers will divulge intimacies either here or in social media in general, nor, I suppose, should they.

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