Memory Again

Today is a snow day, so between bouts of shoveling in 5 degree weather, I am perusing the web. Coincidentally, today's hot topic in the places I read is memory. How accurate is memory?, how easily can memory be falsified?, is there such a thing as recovered memory?, what does memory research teach us?

For me professionally, understanding memory is important in the process of doing psychotherapy. After all, it is with people's memories that I work all day.  Early in my career, I learned that with psychotherapy the validity of a memory is less important than its impact. A client might recall an event as a painful experience, and that memory can have a present-day effect on his mood. That effect does not affirm the accuracy of the memory, just its impact. The impact is what I work with, as I can never know, minus sources of corroboration, whether my client's memory is precise.

Is Mental Illness a Myth?

Have I piqued your interest or accidentally insulted you? I did not make this question up. Thinkers and physicians for many years have wondered the same thing. Mental illness is confusing. It is not diagnosed as is physical illness via tests for microbes, probing for damaged or diseased tissue, nor compiling a list of objectively measurable symptoms. Mental illness is diagnosed via a system of symptom clusters published in one or another manual, the contents of which are agreed upon by scholars in the field. The problems arise when the contents of those manuals change over time, because mental issues are not clear-cut diseases as are physical illnesses. Things are added and subtracted over time--but we could not imagine a time when influenza would stop being called a disease!

Science tries, year after year, to isolate specific markers for mental illness. Tests come and go, but the construct remains elusive. We can objectively test for the flu or cancer or diabetes or a broken leg, but we cannot test in a way that never changes, for depression, schizophrenia, or anxiety. This does not mean that you are not suffering with your problem. It only means in this context, that your problem is mislabeled by being lumped in with physical illness. This is important for many reasons. I hope you are still with me as I elucidate why I, and others like me, believe calling mental problems "diseases" hurts those who suffer with them.

Whose Pain Is It?

Having recently arrived in Oregon, studied diligently for (and yes, passed) my ethics exam, and at long last, received my license, I had a few months in which to explore the clinical issues prevalent in my new environment. Chronic pain kept popping up in conversation, sometimes right after "oh, you do hypnosis," and sometimes before.

What I gleaned from my participation in clinical groups and meetings was that the chronic pain treatment pendulum has swung once more. In short, and without citation: Long ago, MDs prescribed heavy doses of medication for pain patients, chronic or acute. The pendulum then swung to a fear of creating addicts. This was not entirely unfounded, as overprescribing of serious pain medication was rampant, and addiction was up. (When my children left a dentist with Vicodin for the removal of wisdom teeth, I knew something was not right). So docs lived in fear of government repercussions for overprescribing, and, as with most pendulums, now it had swung too far, and even deathly ill patients were constrained from receiving comfort, by over-regulation. Back it went, and back came too many addicted patients along with, guess what? too much chronic pain.

The Myth of Mental Illness and the Late, Great Thomas Szasz

For those who know me, you know that I dislike diagnoses. My clients have to specially request a diagnostic code to put in the little box their insurance demands in order to reimburse them. I treat people, not diseases. I treat people, not disorders. I treat people, not symptoms. I work at treating them with respect--respect for the ultimate fact they while I guide a healing process, it is the client who cures herself. Or to use words Dr. Szasz might use, it is the client who solves her own "problem in living".

People come to me with vexing life problems. They have chronic pain that has mystified a handful of competent physicians. They have had anxiety since grade school, and it has now blossomed into panic attacks. They feel depressed and unmotivated. They have failed to lose weight despite having tried a score of conventional means. My job is to look at the individual in front of me, and learn what ails her and how it may have come to be so. I apply a kind of scientific method where I form hypotheses with the help of the individual in my office, and we challenge the hypothesis with a treatment plan--if it works, it was likely true, or at least close enough to true to solve the problem.

Dr. Szasz and I have had our differences on some delicate points--can some of this material I help to discover and interrelate be hidden in the unconscious, and my client not know about it? Can historical events cause strange symptoms today that the client has not chosen as a solution, but rather that seem to have chosen her? Can my client essentially develop symptoms that solve a problem in an unfortunate way that she is consciously, directly, unable to alter? Is there a scientific way to apply psychotherapy? Dr. Szasz was quite clear that the answer to all of these questions was no. I, on the other hand, am clear that the answer is yes.

Those minor differences aside, the legacy of Dr. Thomas Szasz is immeasurable. He championed the human mind. He fought the psychiatric state--the ability of the government to control individuals by means of their mental state. He fought the medicalization of psychology, thus attempting to empower the individual to change himself rather then being at the mercy of a physician. Dr. Szasz did not believe in "helpful coercion" --a phrase that chills the blood. For me, reestablishing or maintaining the power of my client to change is the essence of good therapy.

Center for Conscious Living.......a name with a meaning. I see my task as helping you, the client, my employer, to improve the quality of your life by guiding you to discover and use your personal power to change. Yes, I guide and you do the rest of the work. Sorry, but there is no magic pill. What there is is power--the power you discover to help yourself! The joy of my work comes from seeing clients find and utilize their power and--um--get me off the payroll (not that I would mind if they gratefully paid me forever.....). Stop therapy because you are better, not because you are bored! Contact Dr. Low at the Center via e-mail: drlow@pobox.com, or phone. 630-249-1983. I look forward to hearing from you!

Trauma, Pain, and the Freeze

I get many questions about the link between pain and trauma.......for a start, chronic progressive pain syndromes like "complex regional pain syndrome type I" (formerly known as "RSD") have their basis, not in organic injury (though they often start with an injury), but in the flight, fight, freeze syndrome. In a moment of shock or fear, the system goes into auto-pilot and cuts off certain self-healing behaviors to assure safety. Sometimes, even after the injury heals and the moment of fear (auto accident, fall down the stairs, etc.) is over, the brain does not kick into recovery mode, and continues to perceive the limb as injured. We call this dissociation--in this case a divergence between perception and reality causing faulty operation of a system. This has the effect of rendering medication, surgery, and physical therapy ineffective (sometimes even harmful), as the key to healing is actually changing the perception! The freeze mode is an endorphergically charged pattern, which prevents even the strongest pain medications from breaking through, and represents wild oscillations of the autonomic nervous system, which can cause anxiety, insomnia, digestive difficulties, memory and concentration deficits, and, of course, PAIN. The key is in the brain--getting the perceptions in line with reality and exiting the freeze. RSD? Call for more information--you can learn to feel well!