DC Types Have Been Flocking to Shrinks Ever Since Trump Won.

And a Lot of the Therapists Are Miserable.

Britt Peterson
www.washingtonian.com
Originally published July 14 2019

Here two excerpts:

In Washington, the malaise appears especially pronounced. I spent the last several months talking to nearly two dozen local therapists who described skyrocketing levels of interest in their services. They told me about cases of ordinary stress blossoming into clinical conditions, patients who can’t get through a session without invoking the President’s name, couples and families falling apart over politics—a broad category of concerns that one practitioner, Beth Sperber Richie, says she and her colleagues have come to categorize as “Trump trauma.”

In one sense, that’s been good news for the people who help keep us sane: Their calendars are full. But Trump trauma has also created particular clinical challenges for therapists like Guttman and her students. It’s one thing to listen to a client discuss a horrible personal incident. It’s another when you’re experiencing the same collective trauma.

“I’ve been a therapist for a long time,” says Delishia Pittman, an assistant professor at George Washington University who has been in private practice for 14 years. “And this has been the most taxing two years of my entire career.”

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For many, in other words, Trump-related anxieties originate from something more serious than mere differences about policy. The therapists I spoke to are equally upset—living through one unnerving news cycle after another, personally experiencing the same issues as their patients in real time while being expected to offer solace and guidance. As Bindeman told her clients the day after Trump’s election, “I’m processing it just as you are, so I’m not sure I can give you the distance that might be useful.”

This is a unique situation in therapy, where you’re normally discussing events in the client’s private life. How do you counsel a sexual-assault victim agitated by the Access Hollywood tape, for example, when the tape has also disturbed you—and when talking about it all day only upsets you further? How about a client who echoes your own fears about climate change or the treatment of minorities or the government shutdown, which had a financial impact on therapists just as it did everyone else?

Again and again, practitioners described different versions of this problem.

The info is here.

A Pedophile Doctor Drew Suspicions for 21 Years. No One Stopped Him.

Christopher Weaver, Dan Frosch and Gabe Johnson
The Wall Street Journal
Originally posted February 8, 2019

Here is an excerpt:

An investigation by The Wall Street Journal and the PBS series Frontline found the IHS repeatedly missed or ignored warning signs, tried to silence whistleblowers and allowed Mr. Weber to continue treating children despite the suspicions of colleagues up and down the chain of command.

The investigation also found that the agency tolerated a number of problem doctors because it was desperate for medical staff, and that managers there believed they might face retaliation if they followed up on suspicions of abuse. The federal agency has long been criticized for providing inadequate care to Native Americans.

After a tribal prosecutor outside of the IHS finally investigated his crimes, Mr. Weber was indicted in 2017 and 2018 for sexually assaulting six patients in Montana and South Dakota. Court documents and interviews with former patients show that Mr. Weber plied teen boys with money, alcohol and sometimes opioids, and coerced them into oral and anal sex with him in hospital exam rooms and at his government housing unit.

“IHS, the local here, they want to just forget it happened,” said Pauletta Red Willow, a social-services worker on the Pine Ridge reservation. “You can’t ever forget how someone did our children wrong and affected us for generations to come.”

The info is here.

Former San Diego psychiatrist won't see jail time after admitting to sexual contact with patients

Mark Saunders
www.10news.com
Originally posted January 18, 2019

A former San Diego County psychiatrist who admitted to having sexual contact with seven female patients during office visits and sexual battery will not see any jail time.

Leon Fajerman, 75, was not sentenced to any jail time during his sentencing hearing Friday. Instead, the judge ordered Fajerman to serve house arrest for a year, pay an undetermined amount of restitution, and he must register as a sex offender.

He is eligible to have an ankle bracelet removed after six months of house arrest, pending good behavior.

Friday, victim impact statement's were read in court by the victims' attorney, who called the sentencing of no jail time absurd. Jessica Pride, an attorney representing two victims said they suffered from, “post-traumatic stress disorder, they are also suffering from anxiety, night terrors, insomnia, suicidal ideations.”

The info is here.

Why “happy” doctors die by suicide

Pamela Wible
www.idealmedicalcare.org
Originally posted on August 24, 2018

Here is an excerpt:

Doctor suicides on the registry were submitted to me during a six-year period (2012-2018) by families, friends, and colleagues who knew the deceased. After speaking to thousands of suicidal physicians since 2012 on my informal doctor suicide hotline and analyzing registry data, I discovered surprising themes—many unique to physicians.

Public perception maintains that doctors are successful, intelligent, wealthy, and immune from the problems of the masses. To patients, it is inconceivable that doctors would have the highest suicide rate of any profession (5).

Even more baffling, “happy” doctors are dying by suicide. Many doctors who kill themselves appear to be the most optimistic, upbeat, and confident people. Just back from Disneyland, just bought tickets for a family cruise, just gave a thumbs up to the team after a successful surgery—and hours later they shoot themselves in the head.

Doctors are masters of disguise and compartmentalization.

Turns out some of the happiest people—especially those who spend their days making other people happy—may be masking their own despair.

The info is here.

How to Look Away

Megan Garber
The Atlantic
Originally published June 20, 2018

Here is an excerpt:

It is a dynamic—the democratic alchemy that converts seeing things into changing them—that the president and his surrogates have been objecting to, as they have defended their policy. They have been, this week (with notable absences), busily appearing on cable-news shows and giving disembodied quotes to news outlets, insisting that things aren’t as bad as they seem: that the images and the audio and the evidence are wrong not merely ontologically, but also emotionally. Don’t be duped, they are telling Americans. Your horror is incorrect. The tragedy is false. Your outrage about it, therefore, is false. Because, actually, the truth is so much more complicated than your easy emotions will allow you to believe. Actually, as Fox News host Laura Ingraham insists, the holding pens that seem to house horrors are “essentially summer camps.” And actually, as Fox & Friends’ Steve Doocy instructs, the pens are not cages so much as “walls” that have merely been “built … out of chain-link fences.” And actually, Kirstjen Nielsen wants you to remember, “We provide food, medical, education, all needs that the child requests.” And actually, too—do not be fooled by your own empathy, Tom Cotton warns—think of the child-smuggling. And of MS-13. And of sexual assault. And of soccer fields. There are so many reasons to look away, so many other situations more deserving of your outrage and your horror.

It is a neat rhetorical trick: the logic of not in my backyard, invoked not merely despite the fact that it is happening in our backyard, but because of it. With seed and sod that we ourselves have planted.

Yes, yes, there are tiny hands, reaching out for people who are not there … but those are not the point, these arguments insist and assure. To focus on those images—instead of seeing the system, a term that Nielsen and even Trump, a man not typically inclined to think in networked terms, have been invoking this week—is to miss the larger point.

The article is here.

Forgiveness Therapy for the Promotion of Mental Well-Being

Sadaf Akhtar, Jane Barlow
Trauma, Violence & Abuse 2016 March 23

Abstract

Interpersonal hurts and violence against the individual have a high prevalence and are associated with a range of long-term problems in terms of psychological functioning. There is a growing body of research highlighting the role of forgiveness therapy in improving different aspects of psychological health in populations who have experienced diverse types of hurt, violence, or trauma. This article reports the findings of a systematic review and meta-analysis of the efficacy of process-based forgiveness interventions among samples of adolescents and adults who had experienced a range of sources of hurt or violence against them. Randomized controlled trials were retrieved using electronic databases and an examination of reference sections of previous reviews; each study was assessed for risk of bias. Standardized mean differences (SMDs) and confidence intervals (CIs) were used to assess treatment effects. The results suggest that forgiveness interventions are effective in reducing depression (SMD = −0.37, 95% CI [−0.68, −0.07]), anger and hostility (SMD = −0.49, 95% CI [−0.77, −0.22]), and stress and distress (SMD = −0.66, 95% CI [−0.91, −0.41]) and in promoting positive affect (SMD = −0.29, 95% CI [−0.52, −0.06]). There was also evidence of improvements in state (SMD = −0.55, 95% CI [−0.88, −0.21) and trait (SMD = −0.43, 95% CI [−0.67, −0.20]) forgiveness. The findings provide moderately strong evidence to suggest that forgiving a variety of real-life interpersonal offenses can be effective in promoting different dimensions of mental well-being. Further research is, however, needed.

The article is here.

Top 10 lies doctors tell themselves

Pamela Wible
www.idealmedicalcare.org
Originally published December 27, 2017

Here is an excerpt:

Sydney Ashland: “I must overwork and overextend myself.” I hear this all the time. Workaholism, alcoholism, self-medicating. These are the top coping strategies that we, as medical professionals, use to deal with unrealistic work demands. We tell ourselves, “In order to get everything done that I have to get done. In order to meet expectations, meet the deadlines, then I have to overwork.” And this is not true. If you believe in it, you are participating in the lie, you’re enabling it. Start to claim yourself. Start to claim your time. Don’t participate. Don’t believe that there is a magic workaround or gimmick that’s going to enable you to stay in a toxic work environment and reshuffle the deck. What happens is in that shuffling process you continue to overcompensate, overdo, overextend yourself—and you’ve moved from overwork on the face of things to complicating your life. This is common. Liberate yourself. You can be free. It’s not about overwork.

Pamela Wible: And here’s the thing that really is almost humorous. What physicians do when they’re overworked, their solution for overwork—is to overwork. Right? They’re like, “Okay. I’m exhausted. I’m tired. My office isn’t working. I’ll get another phone line. I’ll get two more receptionists. I’ll add three more patients per day.” Your solution to overwork, if it’s overwork, is probably not going to work.

The interview is here.

Selling Bad Therapy to Trauma Victims

Jonathan Shedler
Psychology Today
Originally published November 19, 2017

Here is the conclusion:

First, do no harm

Many health insurance companies discriminate against psychotherapy. Congress has passed laws mandating mental health “parity” (equal coverage for medical and mental health conditions) but health insurers circumvent them. This has led to class action lawsuits against health insurance companies, but discrimination continues.

One way that health insurers circumvent parity laws is by shunting patients to the briefest and cheapest therapies — just the kind of therapies recommended by the APA’s treatment guidelines. Another way is by making therapy so impersonal and dehumanizing that patients drop out. Health insurers do not publicly say the treatment decisions are driven by economic self-interest. They say the treatments are scientifically proven — and point to treatment guidelines like those just issued by the APA.

It’s bad enough that most Americans don’t have adequate mental health coverage, without also being gaslighted and told that inadequate therapy is the best therapy.

The APA’s ethics code begins, “Psychologists strive to benefit those with whom they work and take care to do no harm.” APA has an honorable history of fighting for patients’ access to good care and against health insurance company abuses.

Blinded by RCT ideology, APA inadvertently handed a trump card to the worst apples in the health insurance industry.

The article is here.

What is moral injury, and how does it affect journalists covering bad stuff?

Thomas Ricks
Foreign Policy
Originally published September 5, 2017

Here is an excerpt:

They noted that moral injury is the damage done to a “person’s conscience or moral compass by perpetrating, witnessing, or failing to prevent acts that transgress personal moral and ethical values or codes of conduct.”

While not all journalists were affected the same way, the most common reactions were feelings of guilt at not having done enough personally to help refugees and shame at the behavior of others, such as local authorities, they wrote.

Journalists with children had more moral injury-related distress while those working alone said they were more likely to have acted in ways that violated their own moral code. Those who said they had not received enough support from their organization were more likely to admit seeing things they perceived as morally wrong. Less control over resources to report on the crisis also correlated significantly with moral injury. And moral injury scores correlated significantly with guilt. Greater guilt, in turn, was noted by journalists covering the story close to home and by those who had assisted refugees, the report added.

Feinstein and Storm wrote that moral injury can cause “considerable emotional upset.” They noted that journalists reported symptoms of intrusion. While they didn’t go into detail, intrusion can mean flashbacks, nightmares and unwanted memories. These can disrupt normal functioning. In my view, guilt and shame can also be debilitating.

The article is here.

What is moral injury in veterans?

Holly Arrow and William Schumacher
The Conversation
Originally posted May 21, 2017

Here is an excerpt:

The moral conflict created by the violations of “what’s right” generates moral injury when the inability to reconcile wartime actions with a personal moral code creates lasting psychological consequences.

Psychiatrist Jonathan Shay, in his work with Vietnam veterans, defined moral injury as the psychological, social and physiological results of a betrayal of “what’s right” by an authority in a high-stakes situation. In “Achilles In Vietnam,” a book that examines the psychological devastation of war, a Vietnam veteran described a situation in which his commanding officers used tear gas on a village after the veteran and his unit had their gas masks rendered ineffective due to water damage. The veteran stated, “They gassed us almost to death.” This type of “friendly fire” incident is morally wounding in a way that attacks by an enemy are not.

Psychologist Brett Litz and his colleagues expanded this to include self-betrayal and identified “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations” as the cause of moral injury.

Guilt and moral injury

A research study published in 1991 identified combat-related guilt as the best predictor of suicide attempts among a sample of Vietnam veterans with PTSD. Details of the veterans’ experiences connected that guilt to morally injurious events.

The article is here.

A Review of Research on Moral Injury in Combat Veterans

Sheila Frankfurt and Patricia Frazier
Military Psychology
http://dx.doi.org/10.1037/mil0000132

Abstract


The moral injury construct has been proposed to describe the suffering some veterans experience when they engage in acts during combat that violate their beliefs about their own goodness or the goodness of the world. These experiences are labeled transgressive acts to identify them as potentially traumatic experiences distinct from the fear-based traumas associated with posttraumatic stress disorder. The goal of this article was to review empirical and clinical data relevant to transgressive acts and moral injury, to identify gaps in the literature, and to encourage future research and interventions. We reviewed literature on 3 broad arms of the moral injury model proposed by Litz and colleagues (2009): (a) the definition, prevalence, and potential correlates of transgressive acts (e.g., military training and leadership, combat exposure, and personality), (b) the relations between transgressive acts and the moral injury syndrome (e.g., self-handicapping, self-injury, demoralization), and (c) some of the proposed mechanisms of moral injury genesis (e.g., shame, guilt, social withdrawal, and self-condemnation). We conclude with recommendations for future research for veterans suffering with moral injury.


Combat can require individuals to violate their consciences repeatedly. For several decades, clinicians have noted the psychological impact on veterans of engaging in killing, committing atrocities, and violating the rules of engagement (Haley, 1974). Despite this clinical attention, most psychological research on veterans' war wounds has focused on post traumatic stress disorder (PTSD; American Psychiatric Association, 2013), a fear-based disorder that results from exposure to life-threatening events, rather than on the consequences of active participation in warfare.

The moral injury syndrome was proposed to describe the constellation of shame and guilt based disturbances that some combat veterans experience after engaging in wartime acts of commission (e.g., killing) or omission (e.g., failing to prevent atrocities; Litz et al., 2009). The moral injury syndrome was proposed to be constituted of the PTSD symptoms of intrusive memories, emotional numbing, and avoidance, along with collateral effects such as self-injury, demoralization, and self-handicapping (Litz et al., 2009).

The article is here.

War Wounds That Time Alone Can't Heal

by Jane E. Brody
The New York Times
Originally published June 6, 2016

Here are two excerpts:
Therapists both within and outside the Department of Veterans Affairs increasingly recognize moral injury as the reason so many returning vets are self-destructive and are not helped, or only partly helped, by established treatments for PTSD.

Moral injury has some of the symptoms of PTSD, especially anger, depression, anxiety, nightmares, insomnia and self-medication with drugs or alcohol. And it may benefit from some of the same treatments. But moral injury has an added burden of guilt, grief, shame, regret, sorrow and alienation that requires a very different approach to reach the core of a sufferer’s psyche.

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Therapists who study and treat moral injury have found that no amount of medication can relieve the pain of trying to live with an unbearable moral burden. They say those suffering from moral injury contribute significantly to the horrific toll of suicide among returning vets — estimated as high as 18 to 22 a day in the United States, more than the number lost in combat.

The article is here.

Review: Eric Fair’s ‘Consequence,’ a Memoir by a Former Abu Ghraib Interrogator

By Michiko Kakutani
New York Times Book Review
Originally published April 4, 2016

Here is an excerpt:

Of the Abu Ghraib torture photos broadcast by “60 Minutes” in April 2004, Mr. Fair writes: “Some of the activities in the photographs are familiar to me. Others are not. But I am not shocked. Neither is anyone else who served at Abu Ghraib. Instead, we are shocked by the performance of the men who stand behind microphones and say things like ‘bad apples’ and ‘Animal House’ on night shift.’”

In 2007, Mr. Fair says, he confessed everything to a lawyer from the Department of Justice and two agents from the Army’s Criminal Investigation Command, providing pictures, letters, names, firsthand accounts, locations and techniques. He was not prosecuted. “We tortured people the right way,” he writes, “following the right procedures, and used the approved techniques.”

Mr. Fair, however, became increasingly racked by guilt. He begins having nightmares. Nightmares in which “someone I know begins to shrink,” becoming so small “they slip through my fingers and disappear onto the floor.” Nightmares in which “there’s a large pool of blood on the floor” that moves as if it’s alive, nipping at his feet.

The book review is here.

Tolerable Risks? Physicians and Youth Tackle Football

Kathleen E. Bachynski, M.P.H.
N Engl J Med 2016; 374:405-407

At least 11 U.S. high-school athletes died playing football during the fall 2015 season. Their deaths attracted widespread media attention and provided fodder for ongoing debates over the safety of youth tackle football. In October 2015, the American Academy of Pediatrics (AAP) issued its first policy statement directly addressing tackling in football. The organization’s Council on Sports Medicine and Fitness conducted a review of the literature on tackling and football-related injuries and evaluated the potential effects of limiting or delaying tackling on injury risk. It found that concussions and catastrophic injuries are particularly associated with tackling and that eliminating tackling from football would probably reduce the incidence of concussions, severe injuries, catastrophic injuries, and overall injuries.

But rather than recommend that tackling be eliminated in youth football, the AAP committee primarily proposed enhancing adult supervision of the sport. It recommended that officials enforce the rules of the game, that coaches teach young players proper tackling techniques, that physical therapists and other specialists help players strengthen their neck muscles to prevent concussions, and that games and practices be supervised by certified athletic trainers. There is no systematic evidence that tackling techniques believed to be safer, such as the “heads-up” approach promoted by USA Football (amateur football’s national governing body), reduce the incidence of concussions in young athletes. Consequently, the AAP statement acknowledged the need for further study of these approaches. The policy statement also encouraged the expansion of nontackling leagues as another option for young players.

The article is here.

Is Gun Violence a Public Health Crisis?

Science Friday Podcast
Ira Flatow is the Host and Executive Producer

On Wednesday, a mass shooting in San Bernardino, California left 14 people dead, making it one of the deadliest in modern American history. In fact, there have been more mass shootings than there have been days in 2015 so far. Of course, gun violence in the United States isn’t restricted to mass shootings—firearm homicides and suicides far outpace the number of mass-shooting fatalities. Taken together, an estimated 32,000 people die as a result of gun violence in the United States annually, and an additional 180,000 to 190,000 people are injured, says Sandro Galea. He’s the dean of Boston University’s School of Public Health and one of a number of researchers calling for firearm deaths to be treated as a public health issue. Another is Garen Wintemute, of the UC Davis School of Medicine, who has done extensive research on the effects of access to guns. Wintemute and Galea join Ira to discuss why they see gun violence as a public health issue and what research must be done and steps taken to address the problem.

The podcast is here.

Implanting and Erasing Memories: Life-Changing, or Taking Science Too Far?

By Jordan Gaines Lewis
Gaines, on the Brain
Originally published November 9, 2015

Here is an excerpt:

But what if doctors and researchers could attack PTSD at the source: actually implanting or erasing specific memories in a person's brain?

It may sound like science fiction — not unlike Lord Voldemort luring Harry Potter to the Ministry of Magic by creating false images in Harry's mind, or the entire premise of the movie Inception — but science is actually getting close. In mice, neuroscientists have found ways to not only identify the location of certain memories, but to actually manipulate those memories.

But can we do this in humans — in patients with PTSD? And perhaps the bigger question: should we?

The entire blog post is here.

Healing a Wounded Sense of Morality

Many veterans are suffering from a condition similar to, but distinct from, PTSD: moral injury, in which the ethical transgressions of war can leave service members traumatized.

By Maggie Puniewska
The Atlantic
Originally published July 3, 2015

Here are two excerpts:

Identifying moral injury can be tricky for two reasons: First, it’s easily mistaken for PTSD, which shares many of the same symptoms. And second, because veterans may feel too ashamed to talk about their moral infractions, therapists might not even know to look for the signs of moral injury at all, says Joseph Currier, an assistant professor of psychology at the University of South Alabama. To help therapists better understand how to diagnose the condition, he and several colleagues have developed a 20-item questionnaire that screens patients for moral injury, asking patients to rate their agreement with statements like “I did things in war that betrayed my personal values” and “I made mistakes in the war zone that led to injury and death.”

(cut)

But healing isn’t just confined to the individual. Emotions that guide morality, Currier explains, are rooted in social relationships:  “The function of guilt is to reconcile a potentially damaged social bond, whereas with shame, the reaction is to withdraw so the social group can preserve its identity,” he says.   For many veterans, therefore, recovery from moral injury depends in part on the civilian communities to which they return. “A part of feeling betrayed or distrusted or guilty by the practices of war is feeling alienated. It’s feeling like you can’t share your experiences because people will judge you or won’t understand,” Sherman says.

The entire article is here.

Can Adversity Make Us Good?

By Eranda Jayawickreme
Big Ideas at Slate.com

Here is an excerpt:

Nevertheless, we know that adversity can help answer the question, “Why be good?” Psychologist Johanna Ray Vollhardt at Clark University has claimed that traumatic life events may in fact enhance the motivation to help other disadvantaged members of society, including people outside the groups with which you identify. One possible explanation for this “altruism born of suffering” is that trauma often forces people to recognize how limited their time on Earth is, which in turn clarifies their values and promotes moral behavior. Blackie found this to be the case in a study she published in Psychological Science, where experimentally manipulating thoughts about death—in this case, asking participants to imagine dying in an apartment fire—predicted increased charitable giving behavior (in this case, the intention to donate blood).

In other words, as the philosopher Valerie Tiberius at the University of Minnesota has argued, we want to be good because we care about having good lives, and adversity can help provide the necessary knowledge and perspective. I would call this knowledge and perspective wisdom.

The entire article is here.

Immune from Cyber-fire? The Psychological and Physiological Effects of Cyberwar

By Michael L. Gross, Dapna Canetti, & Israel Waismel-Manor
In: Binary Bullets: The Ethics of Cyberwarfare.
Edited by Fritz Allhoff, Adam Henschke, and Bradley Jay Strawser.
Oxford: Oxford University Press, forthcoming

Here is an excerpt:

Following an overview that describes the challenge that cyber-operations pose for the principle of noncombatant immunity, the following sections map out and analyze the harms of cyberwarfare. Consider, first, physiological harm.  Although no person has lost his life or suffered any kind of physical injury from a cyber-attack to date, the literature is replete with scenarios of death and devastation.  These come in the course of cyber-attacks on vital infrastructures that disrupt air and
rail transportation or poison water supplies. In many ways, these are similar to the consequences of conventional war. For the most part, however, modern cyberwarfare causes no physical injury. As a result, one may reasonably ask whether noncombatants enjoy protection from cyber-attacks that disrupt telecommunications, disable social media, or destroy, disclose or steal financial data and personal information. The answer hinges upon the psychological harm that victims suffer, particularly if belligerents target civilians and civilian infrastructures directly.  Extrapolating from studies of cyber-bullying, identity theft and ordinary burglary, and building upon the effects of simulated cyber-terrorism in the laboratory, we explore the psychological harms of cyberwarfare. Cyberwarfare is not benign but causes stress, anxiety and fear. Such mental suffering threatens to disrupt routine life, impair educational and workplace performance, impact significantly on the poor
and elderly, and increase public pressure on the government to act. Although most forms of psychological suffering are not as intense, prolonged or irreversible as bodily injury or loss of life, our analysis suggests that the psychological harm of cyberwar can affect well-being nonetheless.

The entire article is here.

If Trauma Victims Forget, What Is Lost to Society?

A pill to dampen memories stirs hope and worry.

By Emily Anthes
Nautilus
Originally posted July 17, 2014

Here is an excerpt:

However, promising studies have also stirred controversy, with some bioethicists warning that memory-dulling drugs could have profound, unintended consequences for our psyches and our society. The debate is raising tricky questions about what—and who—memory is for. The European Union’s highest court recently ruled that, at least when it comes to the Internet, we all have the “right to be forgotten” for things no longer relevant. Do we also have the right to forget?

The entire article is here.