psychiatry

Diagnosing Difference

admin — Sat, 02 Jan 2010 01:00:00 +0000

The Diagnostic and Statistical Manual of Mental Disorders is referred to as “the Bible” by the psychologists and psychiatrists who utilize it to diagnosis and treat patients. A project of the American Psychiatric Association, the DSM was first published in 1952 and subsequently revised in 1968, 1980, 1987, 1994, and 2000; the forthcoming 2012 edition is currently in formation. If you’re feeling bored, dear reader, let me cut to the chase and tell you why this all matters.

As feminists well know—hello, hysteria!—a diagnosis of mental disability may simply be an accusation of difference or a punishment for refusing to comply with political, economic, aesthetic, or social demands. Diagnosis is not always, if ever, a neutral process. It is, instead, a process of translating behaviors (such as homosexuality or sexual fetishism) into identities (“deviants” or “perverts”). Paying attention to the historic and political context within which the DSM operates reveals not simply the prevalence of bias, but the fallacy of objectivity in social scientific inquiry.

Diagnosing Difference, directed by queer, clinical psychologist Annalise Ophelian, tackles the politics of diagnosis and the impact of Gender Identity Disorder (GID) on transgender and gender non-conforming individuals. The full-length documentary features interviews with trans-identified mental health professionals, activists, and scholars who speak to the burden of GID. Dylan Scholinski, for example, recounts being forcibly locked up in a mental hospital at age 15 for being “an inappropriate female.”

Public health advocates Willy Wilkinson, Cecilia Chung, and Renata J. Razza discuss the importance of re-educating health care providers with culturally competent and trans-positive information. The GID diagnosis, which is often required before doctors will administer hormones or provide gender reassignment surgery and government agencies will legally change a person’s name or sex on a driver’s license or birth certificate, does not represent the experience of many trans people. The GID criteria demands an individual unambiguously live and present as their “opposite” gender and deny any affiliation with their gender assigned at birth.

However, even the varied identities of transgender, transexual, gender queer, gender variant, and so on testify to the multiplicity of gender expressions beyond simply man or woman. The GID diagnosis reifies gender norms, privatizing gender variance as a “problem” for individuals. As Pauline Park, trans activist and founder of the New York Association for Gender Rights Advocacy, often remarks, “I don’t have a Gender Identity Disorder; society does.”

Diagnosing Difference builds an important bridge between mental health professionals and community advocates, and participates in the growing GID-reform movement. The documentary is a vital project for educators, public health advocates, social workers, and doctors, and anyone interested in the gender politics.

Written by: Jeanne Vaccaro, January 1st 2010

Must Read After My Death

admin — Sun, 15 Mar 2009 17:12:00 +0000

Directed by Morgan Dews

Familial dysfunction is rarely poetic, but archival footage can be visually stunning, especially paired with painfully honest audio recordings of diaries, intimate correspondence, and therapy sessions. After his grandmother Allis’ death in 2001, filmmaker Morgan Dews stumbled upon more than 200 home movies and fifty hours of tape-recorded diaries and Dictaphone correspondence which revealed a complicated story previously unknown to Dews. Until his discovery, despite his close relationship with his grandmother, Dews had no detailed knowledge of his grandparents’ fitful years together and the damage it caused his mother and uncles.

Allis and Charley’s union was unique for their time. After meeting in the 1940's while married to other people, they decided to have an open marriage, complicated further by Charley’s frequent and extended work-related travel, alcoholism, and stronger penchant for affairs than his wife. Allis, who had previously lived in Europe, began staying home in Connecticut to raise the children. The couple had their share of peculiarly imbalanced disagreements—Allis wished Charley would restrict his affairs to unpaid women, while Charley berated Allis for not keeping a tidier, more organized house—and at one point, physical violence erupted in front of the children. Looking for help navigating their unconventional marriage and the ways their idiosyncrasies affect their children, Allis and Charley hauled their family into psychotherapy in the mid-1960's.

A surprisingly feminist film, it quickly becomes obvious how much of the family’s suffering is unfairly attributed to Allis’ supposed shortcomings. Various psychotherapists repeatedly tell her to be more submissive, but not to abandon the family because while she is supposedly the one at fault, the family needs a mother figure. She is alternately praised for giving her children freedom while mothering them too much. These contradictory assessments create immense guilt for Allis, whose self-blame and sadness nearly engulfs her at times. She goes between wishing she could take the children somewhere remote to raise them alone and wanting to end it all—literally. Throughout the course of the film, narrated almost entirely by recordings of Allis’ innermost feelings, it is possible to hear her sanity slowly devolving.

Must Read After My Death is also often an indictment against the harmful early days of experimental psychiatry. Allis’ brutal doctors blame her for “damaging the whole family.” Much of the family’s communication ends up being filtered through doctors and therapists, and eventually, one son is institutionalized for unsubstantial reasons. Perhaps most revealing, after Charley suddenly passes away, the family abruptly ends all therapy and treatment. Allis’ subsequent silence, which lasts until after her own death, speaks volumes about her desire to bury the agony and trauma of those years.

At times reminiscent of Capturing the Friedmans for its intimate view into the personal lives of other families’ disturbing secrets, this film is captivating, depressing, and hauntingly voyeuristic.

Written by: Brittany Shoot, March 15th 2009

Breaking Down the Wall of Silence: The Liberating Experience of Facing Painful Truth

admin — Fri, 06 Mar 2009 00:14:00 +0000

By Alice Miller

Basic Books

In an episode of the television series Homicide: Life On The Street, detective John Munch muses on how to crack the case of a brutal murder. In his typically caustic, world-weary way he quips darkly about motive, “If it’s not one thing, it’s a mother.”

Alice Miller would add “or the father” to that line. And she would cite the collective truth-repressing forces of traditional patriarchal society—family, academia, clergy, politicians and the psychiatric community—all influential agents that encourage a child to dismiss or dance around its trauma story as if it were an electrifying third rail. Forgive and move on is the catchphrase of the day.

Not so fast, says Miller. First, air the bloody wound before forgiveness. Bad parenting must be addressed at the root. Denying and repressing guarantee that more innocent victims will be scapegoated to satisfy long festering rage. Miller contends that trauma from abuse is responsible for all of mankind’s neuroses and psychoses, and could lead to our extinction in this fragile technological world. Society must get better at protecting children against what she calls the “poisonous pedagogy”: humiliation, neglect, hitting, shaming with verbal and emotional abuse, and of course, rape, delicately called molestation by polite society.

Breaking Down the Wall of Silence is Alice Miller’s thirteenth book focusing on childhood trauma. Miller is an articulate and empathetic supporter of abused children and grownups who struggle with the betrayal and trauma that result from abuse. An impassioned evangelist for children’s rights (she is a psychologist, an abuse survivor and author of the highly acclaimed The Drama of the Gifted Child), Miller continues to make her case with great force that if the majority of people and lawmakers remain psychologically illiterate, we might as well resign ourselves to nuclear war in the near future.

As in most of Miller’s books, she uses high profile case studies to illustrate her points. She has previously written of the humiliations and beatings that were standard fare in the childhoods of Hitler and Stalin, and how those angry boys grew up to be murderous dictators who projected onto the world stage their revenge in the form of mass murder and torture. In this book, she delves into the childhood of yet another tyrannical basket case: former Romanian president Nicolae Ceausescu. This havoc-wreaking man, emotionally and physically battered and shamed as a child by his own father, rose to power and blow-torched his rage all over his country. He is dead, executed for his crimes, but the hideous abuse lives on to this day in Romania.

I was particularly intrigued by Alice Miller’s study of Ceausescu because a couple of years ago I wrote a magazine article on volunteer vacations. While interviewing people who combined a love of travel with charity work, I talked to several everyday heroes who rolled up their sleeves to work in Romanian Failure-To-Thrive baby clinics. They reported that children were still being abandoned due to the lingering poverty and ignorance from the Ceausescu regime, and so many babies needed holding and feeding that many of these volunteers declined the sightseeing part of their trips in favor of working full-time with the children.

Astonishingly (and inspiring to me about the higher nature of some humans among us), every single person I interviewed returned for a second and third tour of duty to reach out and help. They all were very emotional when I spoke with them. The horror they experienced was overwhelming and their voices quivered in the retelling. One woman brought her daughter with her and the daughter has decided to go into international law to help protect children. Another man was a banker who devotes a month each year to go to Romania and help out.

The most important and urgent case Alice Miller makes in this book is that we must legislate firmly against child abuse and be selective about the political leaders we elect to represent us.Breaking Down the Wall of Silence should be read by all who have children, or are considering having children. That said, if one is caring enough to even know about Alice Miller, then one is probably preaching to the choir.

I just watched a documentary called Deliver Us From Evil about the Catholic Church’s systematic repression and cover-up of child abuse by priests. Back in 2005, Pope Benedict was facing a ground-breaking lawsuit accusing him of conspiring to cover up the rapes of boys by a seminarian. He asked President George W. Bush, Jr. for immunity from lawsuits in the United States. It was granted.

I’ve been reading Alice Miller’s books for a long time and believe she is still a voice in the wilderness calling upon us to evolve as human beings. How do we do this? Respect children and implement laws that enforce greater protection against violence perpetuated on children. Punish people and institutions that inflict and hide abuse. The psychiatric field must also offer a model of treatment that encourages practitioners to be courageous, enlightened witnesses and guides for their patients. Gatekeepers in this field must be constantly on the alert for traumatized therapists seeking to exploit, consciously or unconsciously, victims of abuse. These wolves in sheep’s clothing must be weeded out of the field.

Alice Miller praises feminists for being pioneering whistle blowers on abuse and offers hope when she writes toward the end: “Fortunately the number of therapists who are trained in the new methods is now growing.”

This is a beautiful, fierce, necessary book written by an emotionally intelligent lioness who continues her efforts to break through the wall—one brick, one book— at a time. I highly recommend it.

Written by: Cheryl Reeves, March 5th 2009