Mexican heads macheted off at the neck and dopers lying around stoned out of their minds. What’s the connection? If you’re an American and smoke dope, you’re contributing to the current violence in Mexico. You’re the demand, they’re the supply and legalizing pot won’t change that. The cartels will always come up with an attractive pot blend priced lower than Uncle Sam’s –­ a competition that would be ludicrous to initiate but oh how branding consultants would love it. We’ll see how it plays out in Colorado and Washington state.

If you don’t care about people you don’t know getting whacked by the cartels, how about this: The dope you smoke is making you stupid, stupid enough for people to notice.

Scholarly longitudinal research

On August 28, 2012, BBC News, among other outlets, reported the results of a long-term study of 1,000 adolescents who smoked pot. The Dunedin study revealed that young people suffered cognitive impairments far beyond their youth:

Having taken into account other factors such as alcohol or tobacco dependency or other drug use, as well the number of years spent in education, they found that those who persistently used cannabis – smoking it at least four times a week year after year through their teens, 20s and, in some cases, their 30s – suffered a decline in their IQ.

IQ declines, by the way, are irreversible. The Dunedin Multidisciplinary Health and Development Study was only one study, but it had an unprecedented 96 percent response rate. Participants were honest about their drug use because they had spent so much time with the researchers: The IQ testing and interviews lasted from 1972 to 2012 and included questions about mental health and psychosocial functioning.

Test yourself

You think you’re OK because you weren’t consistently smoking cannabis as a teen? Or maybe you didn’t take toking up until college when your brain was all but through with its critical development stage? Try recording yourself next time you’re stoned. (Voice is fine, videotape is better.) You might sound like someone who’s lost IQ points, despite the fact you consider yourself an ambitious, well-paid success in this world. Yeah, the stupid effects of weed are temporary but why bother? As an educated professional, wouldn’t you be curious to see if you can do without dope for two months as an experiment?

Would you not discover the unadulterated, real you?

What’s a parent to do?

The recent Newsweek cover story on psychological hazards of Internet use and other “screen time” activities (such as texting and playing videogames) leaves one wondering whether to cut all electric power to one’s home or just wait till the next study comes out contradicting what we think we now know.

I can only imagine how most parents feel. I’m confused, and I’m a psychologist. And a researcher! 

The Newsweek article is definitely worth a read. To summarize: Various forms of screen time have been linked to depression, ADHD, obsessive-compulsive disorder and diaper rash (OK, that last one’s not true, but the rest are).

More alarming to me, as a father of two boys born with silver joysticks in their hands (sorry, another slight exaggeration), there is also brain imaging research showing changes in the brains of heavy Internet users that resemble those of drug addicts. A separate study showed that the brains of non-users began to resemble those of heavy users after only five hours of Internet use (this I am not making up). 

On the other hand…

We see a story in TechNewsDaily about a new study from the University of Wisconsin showing that prior research findings of a “Facebook depression” effect may not be as dire as previously thought. They monitored 190 undergraduates over the course of a week; after dividing the sample into groups of low (less than 30 minutes per day), medium and high Facebook users (more than 2 hours per day), they found no differences in depressed mood. 

What’s a parent to do? Here’s where the media often overreact, suggesting, for example, that if eating eggs is shown to be not quite as deadly as previous studies indicated, then perhaps all health-related research is a bogus game of flip-flopping in response to the fad of the day. But we can do better than that.

So, short of throwing out both baby and bathwater, here are some thoughts, admittedly delivered with only a modicum of confidence (probably more in role of father than psychologist):

1. Most studies of effects of electronic activities, from violent videogames to Facebook activity, show increased risk of harmful effects, not one-to-one correspondence. One implication is that it is the at-risk kids, those already on the margins due to adverse histories and challenging living conditions, that we should be most worried about. As one of the researchers in the Facebook study commented, “Parents don’t have to be overly concerned [as long as] their child’s behavior and mood haven’t changed, they have friends and their school work is consistent.”
2. If your child is at-risk – struggling socially or academically – particular attention needs to be paid to addressing that child’s needs, including significant monitoring of screen time. Studies show, for example, that economically disadvantaged children tend to spend more time engaged in electronic activities than their more affluent counterparts.
3. Even if your child has all the advantages of economic security, stable home life and good adjustment at school, you’re still not off the hook as a parent. It is impossible to read the Newsweek article (not to mention actually watching a young person at a computer) without becoming convinced that various forms of electronic entertainment, from videogames to online pornography, have significant addictive properties. Excellent resources are available from such sources as the American Academy of Pediatrics or SafeKids.com, providing guidance for parents. Foremost among safe practices is parent involvement, including having the computer and other electronic gear in a public area such as your den, where you can easily monitor what your child is up to (this is sometimes quite interesting, by the way).
4. Insist that your children spend at least as much time in the real world (face-to-face conversation, shooting an actual basketball through an actual hoop, etc.) as in the virtual world (expect mainly contempt in reply, at least until the first swish of the basketball net).
5. This last point brings up an important issue (caution: psychologist hat now firmly in place). Children’s electronic activities are highly rewarding (behaviorally reinforcing), not just for children, but also for parents. Child activities that are otherwise annoying, intrusive and inconvenient (such as actually wanting to talk to you) drop to negligible levels when the child’s mind is absorbed in a virtual environment (often interacting with someone across town or even on the other side of the globe). This peace and quiet can, in itself, become quite addictive to parents; but, in large quantities, it is a definite no-no to anyone interested in the child’s mental health, not to mention a reasonable relationship with said child.

I will be interested to see comments in response to this post. If someone has better answers than these (a fairly likely scenario), then my time engaged in this particular session of screen time will have been well worth it.

The legendary Whitney Houston

My treasured colleague, Tom Ellis, wrote an impassioned post protesting simple-minded thinking about Whitney Houston’s death. I, too, am irked by glib media interpretations of the behavior of stars. I find it challenging to fathom the complexity of individual patients who courageously confide their inner life in psychotherapy; I am loath to pretend to understand anyone I observe only from afar. And diving into the murky territory of death wishes in my part is a prime example of fools rushing in where angels fear to tread. Far more foolish than angelic, I proceed.

Muddling through

I agree with my colleague in some respects. We can kill ourselves in the quest for pleasure — witness heart-stopping doses of cocaine. I am partial to the idea that addictive drugs “hijack” the normal brain reward systems. And there is no reward greater than escape from unbearable pain. Karl Menninger viewed nonsuicidal self-injury as “anti-suicidal” behavior. Cutting, banging or burning oneself can reduce emotional distress dramatically. Such behavior appears “self-destructive” only to the outside observer; to the person engaging in the behavior, it is self-preservative, a way of muddling through to live another day. The same might be said of addiction.

Penchant for self-destruction

I am less sanguine than my colleague about a thoroughgoing constructive orientation in human nature. He writes, “…All of us have the same basic agenda to find happiness and manage physical and psychic pain the best we can.” I find myself more sympathetic than he with Freud’s view of divided forces in our nature, constructive and destructive. Freud gave us a naturalized version of the age-old battle between good and evil, an enduring contest. I find ample evidence that destructiveness can be self-directed.

Granted, we are the products of evolution, and survival is the engine of evolution. But we should be humbled by the fact that well over 99 percent of species that ever lived are now extinct. Evolution does not necessarily lead to progress, much less to perfection. Perhaps we humans are not unflawed in our orientation toward life. We are hardly single minded, as Freud well understood.

Our capacity for gaining knowledge through science is stunning, but we also are developing increasingly sophisticated, life-threatening technology. Prescient about the human species’ capacity for self-annihilation and the anxiety that goes with it, Freud wrote before the advent of nuclear weapons. I wish our sociological knowledge were keeping pace with our dangerous technological advances. We humans might be unique among species in our seeming penchant for self-destruction. Above all, we need to learn how to cooperate before we join the other 99 percent (not the non-super-rich, the extinct).

Death instinct

I have no idea what was on Whitney Houston’s mind in the hours, days, weeks, months and years before her death. And I have no idea if Freud’s idea about the death instinct is best regarded as crazy or as something we should take very seriously as we witness horrific destructiveness across the globe. Our consciousness is misleading; we are aware of a tiny fragment of our mental activity, and we have little idea what our brains are up to. I think we should be more modest in our conjectures about others and, as Freud showed us, even about our own motivations. And we must be careful about generalizing about addicted persons or any other group in light of enormous individual differences — another engine of evolution.

I am not ready to throw up my hands in the face of destructiveness and self-destructiveness. I cannot fathom solutions to global problems. I cling to one uncommonly wise young woman’s reply when I asked patients in an educational group, “What gives you hope?” She replied, “I can be surprised!” But I take heart in small-scale victories. Day in and day out in this clinic, we help patients grapple more successfully with their self-destructiveness.

Whitney Houston dies at 48.

Fox TV personality Bill O’Reilly has encountered a firestorm of protest in defense of Whitney Houston following his provocative remarks about her death. However, he may have done all of us a favor by opening a door to discussing something on all of our minds.

Here’s what he said (as part of a general statement opposing efforts to reform drug laws):

Nobody takes drugs for that long if they want to stay on the planet. She follows in the footsteps of Elvis, Janis Joplin, Michael Jackson, and scores of other entertainment figures. The hard truth is that some people will always want to destroy themselves, and there’s nothing society can do about it.

If we filter out some of the harshness (and perhaps add names like Judy Garland and Joseph McCarthy), we might express this as a question:

Just as a healthy lifestyle reflects desire to live, doesn’t it make sense to assume that people with unhealthy or reckless lifestyles have a death wish?

While this brings us uncomfortably close to “blaming the victim,” one can’t help but notice something appealing about this perspective. It certainly gives us something to do with the anger we inevitably feel about poor decision-making by someone we cared about. And, conveniently, we note that the issue gets buried with the individual. After all, the problem was in the mind (soul?) of the deceased. Case closed. Better yet, as seen in O’Reilly’s remark that such will always be the case and “there’s nothing society can do about it,” we are forever excused from worrying ourselves, looking for ways to address other influences, whether social, psychological, biological or otherwise. Nope, not much you can do about human stupidity.

Must feel pretty crummy to Whitney’s family…

Here’s the fly in the ointment: Applying this mindset, we suddenly all have a wish to die. Certainly this includes all smokers and couch potatoes, who we know have shorter life expectancies. But even among us non-smoking, exercising, healthy-eating, seatbelt-wearing respectable citizens with good judgment, which of us adheres perfectly to our medication prescriptions? (Studies say less than half.) Who among us never exceeds the speed limit or occasionally takes a peek at our cell phones while driving? Doesn’t this point toward at least a hint of a death wish?

A death instinct?

Probably not. Sigmund Freud thought this was an intriguing idea and wrote at length about a “death instinct,” but eventually abandoned it as unsupportable. Suicidologists still occasionally talk about “indirect suicide” in the form of everything from unsafe sex practices to sky diving; but as we do so, we soon find that the construct of suicide itself evaporates, because it ultimately becomes identical to living itself.

A human agenda

A more reasonable idea is that we — all of us — have the same basic agenda to find happiness and manage physical and psychic pain the best we can. The fact that some get lost on this quest and end up destroying themselves in the process does not change the fact that the wish in most cases is not to die, but to find a path, at least, to a more tolerable existence.

By the way, here’s another problem with observations like O’Reilly’s: A circular explanation is one that loses meaning because it turns back onto itself. To wit: Why did Whitney do those unwise things, resulting in her own death? Because she wanted to die. How do we know she wanted to die? All together now … because she did all those unwise things!

Really, O’Reilly. We can do better than this. Scientific research over the past few decades has revealed a great deal about motivations behind unhealthy and self-destructive behaviors, and effective treatments have resulted. We still have a lot to learn, and we still lose battles more often than we would like. But stigmatizing and blaming the sufferers only impedes our efforts to win the war.

To all who struggle with addiction or substance abuse:

As a psychiatric nurse, I deal every day with people who are trying to cope with anxiety, depression, OCD, PTSD, schizophrenia or other mental illnesses. Many of them have been trying to cope with the distress of their illnesses by self-medicating. Some abuse prescription medications such as anxiolytics or pain meds, while others use marijuana and tell themselves it’s “not really a drug.” Some drink excessive alcohol, and others take anything they can from LSD to mushrooms to crack cocaine to meth.

The one characteristic all these people have is that they come to treatment in pain. And just being in treatment doesn’t mean they are hopeful about being there. A large part of the staff’s job is to help the patients find that hope. Without it, nothing else progresses because the work in overcoming illness and addiction is hard.

If someone arrives still under the influence of drugs/alcohol, they have to go through detoxification. We use medications to try to ease them through that process, but it is still not an easy one. However, almost always after detoxing, the patient is much better able to consider other things on which to focus and to stay focused on those things that form the steps of recovery.

During treatment, other means of coping with stress need to be found for each patient, along with better habits of responding in new, less destructive ways. The lucky ones find the right person with whom to explore, process and resolve their underlying issues, particularly trauma. Without that process, relapse is all too common.

I admire anyone who makes that first step and starts some kind of treatment. I use the analogy that everyone has a little red wagon, and we pull it around, carrying our emotional baggage. In treatment, we try to help the patient unpack some of that baggage, put it in the right storage or maybe even discard some of it, making the wagon a little lighter to pull.

Treatment is available, but you may have to look for it. Some people are fortunate enough to be able to afford wonderful private facilities. Others have to hope they are lucky enough to find good care in a public system. Keep looking. Ask for guidance, but seek help if you are dealing with addiction or any mental illness. I have seen life-changing results from getting the right care.

Best wishes in your recovery.

Dee G. Henderson, MSN, RN-BC

Editor’s note: Dee wrote this blog post in honor of National Recovery Month.

Fans gather outside singer Amy Winehouse's London home

Once again we hear about one of our young gods dying. Singer and songwriter Amy Winehouse was 27 when she was found dead, the same age as Janis Joplin so many years ago, both great voices stopped too soon.

Amy Winehouse’s music was a testament to rebellion, to female independence and to the twisted and tangled troubles often found within the complexities of love. For an artist, pain and suffering can be a path that leads to all sorts of lessons of the heart, and to lucrative and telling songs that speak of heartbreak. Great if you’re an artist with a healthy outlet, rough if you’re just a plain human being. Some people live life so high and so fast they burn out once they hit a certain stratosphere.

Amy, alcohol and my mom

Amy Winehouse was special to me because I was familiar with her struggles and always rooted for her to overcome her addictions. I grew up with alcoholism, but in her sixties, my mother somehow gave up alcohol and began baking bread and took up quilting. Quilts! This is a woman who was raised in New York’s Hell’s Kitchen, and I never saw her bake so much as a cookie. I found quilts hard to fathom. Yet, it was true. No more booze. Just like that. She later gave up cigarettes, too. To me, this was a magnificent example of how the human spirit can overcome its own demons, and more importantly, how recognizing the problem as your own is the first step in defeating it.

Interventions and enablers

I had fully expected Amy Winehouse to defeat her demons, and I damned the circle around her for letting her die. Yet, I once had a chance to get my mother off booze and I stumbled. My father called a family meeting, and we had an intervention. He wanted my mother to leave and was looking for a unanimous vote from my sister and me. My sister is tougher than me in many ways; so she voted in the affirmative, but I couldn’t do it. How was a 12-year-old boy supposed to vote his mother out onto the street? Of course, I learned later that my father was trying to make a point, but since I hadn’t read the script in advance, I gave all the wrong answers. So mom stayed at the house and continued to drink. I now know I was an enabler who might have acted differently and changed the course of my mother’s life much sooner. Or not.

This is the mindset I brought to Amy Winehouse. Her friends could save her. If they loved her, they could save her. Yet, we know this is not true. Individuals with addictions have to grow determined first and then they can get help. Keep in mind that Amy’s first album was released when she was 19 years old, a phenomenal achievement, and a vulnerable time to experience the intoxications of wealth, fame, love and heartbreak.

The road to rehab

Amy Winehouse in concert

Most of her songs were written by her, which offered her fans a glimpse inside her life. “They tried to make me go to rehab/I said no, no, no.” And yet she did go to a clinic and still could not find the fix she needed. This is not a criticism of the clinic. A patient has to accept his or her role first. It doesn’t matter how good a clinic is—if an individual does not become a part of the treatment, then there’s little anyone else can do.

Janis Joplin was the first celebrity who died that I cared for deeply,  and I remember how hearing the news rocked me. And now Amy Winehouse. Both women were 27, with world-famous unique voices, both full of rhythm-and-blues heartbreak, jazzy verve and great pop lyrics.

Alcohol has its place. Nothing wrong with it. But we moderate our consumption the same way we moderate our feelings, unless we can’t. My mother couldn’t. She drank despite the threat of being tossed out of her own house. She drank despite how she hurt the people around her. All these years later, I still quiver when I hear ice cubes being placed into a glass.

Amy Winehouse was rich, famous and troubled. Her lyrics are telling. Just as Aretha announced that she would have R-E-S-P-E-C-T, and we knew she meant it, Amy Winehouse celebrated a tortured view of love, something I thought was a measure of her low self-esteem. It made for great songs, but hard for living:

I cheated myself,
Like I knew I would
I told you I was trouble,
You know that I’m no good

When Janis died, I was quick to criticize the people closest to her for allowing her torment to get her so wasted she wound up dead, without a friend to intervene. I had a similar reaction to news of Amy Winehouse’s death. Then I recalled how I had failed my mother in many ways, and how she failed me, and yet eventually rose above her addiction and defeated it.

Being clear about responsibilities

We can’t be responsible for holding an addicted person to account. We want them cured. But they don’t share our timetable. They are often not ready yet to understand where they are and how much better it is not to be ruled by liquor or drugs or love or greed.

Our responsibility is not to bludgeon our loved ones with criticism over their addictions. Our job is to remind them from time to time that they are loved and if they loved themselves or wanted to, they would find help. Our job is to remind them that it is up to them to get help. It’s their job. That is the first step.

I tend to like the female singers – Aretha, Norah Jones, Alicia Keyes, Adele, great and unique voices with firm points of view. These are women who are doubly attractive to me. They have succeeded in a man’s world and they are the real deals; their music is not manufactured. Their music reflects the guts of life, the drama and passion of love.

In addition to their music, I am attracted to these singers on another level. In my little fantasy, I ask myself that along with loving their work, could I see myself sitting with any of them over a margarita at poolside dressed in my favorite Tommy Bahama shirt talking about life in general? Are you kidding? Yes, to all of them. A margarita is a happy drink and enjoyed by happy people. Healthy people can enjoy indulging in one. Yet, I could never have had that pleasure sitting with Amy Winehouse. How could I? I’ve learned that lesson. I don’t enable. I would walk away. It’s the least I can do.

Like many who came of age in the ’60s and ’70s, I was saddened to hear of Betty Ford’s death last Friday. For those of us from Michigan, we had reason to be especially proud of her role in our national life. Although I lived in a different Congressional district, Gerald Ford was the only Congressman I recognized growing up. His longevity in Congress made him feel almost like a family friend or neighbor – he was always around, affable and smiling. Gerald Ford and his wife Betty were dependable and likeable in that Midwestern way; in fact, they seemed a lot like my parents only with different politics.

When Gerald Ford was plucked from Congress to replace the disgraced Vice President Spiro Agnew, there was a new spotlight on Betty Ford. By then I was living in NYC, and I came to see Betty Ford as poised, personable and reflecting a brave honesty I hadn’t seen in our home state. I applauded her tenacity when speaking up on important issues, including the feminist issues that often put her at odds with her husband’s  political party.

As the media focused on Betty, I learned some things about her that I hadn’t known before. After high school she went to New York City and trained in modern dance with the iconic Martha Graham, who was known for her searing criticism and relentless perfectionism. I assumed Betty Ford possessed a daunting degree of self-confidence to subject herself to the demands of Martha Graham.

Televised breakdown

Once, Betty was set to narrate a live televised performance of the Bolshoi Ballet from the former Soviet Union. As a young girl, I had seen the Bolshoi and was mesmerized by the power and precision of their movements. Of course, the Bolshoi was the epitome of the traditional ballet that Graham had rebelled against, so I was excited to hear what the First Lady had to say.

Soon she appeared on the screen, resplendent in a glistening, floor-length gown. At first I thought the reception was bad: Ford’s words were not coming out in any discernable manner. I pounded on the top of the TV trying to correct the problem, to no avail. I positioned myself squarely in front of the screen and prepared to concentrate and not get sidetracked by the poor sound quality. The camera swooped in for a close-up, showing off Ford’s chiseled features.

But the usual spark in her eyes was not there. She didn’t look well.

“She’s nervous,” I thought. “Who wouldn’t be? This is new to her.”

Paying closer attention, I noticed she was speaking slowly and her “s’s” slurred. She struggled from phrase to phrase. It seemed she could hardly read the teleprompter.

I remember becoming nervous for her, and embarrassed. I shouted to no one in particular, “Oh no! I think Betty Ford is having a stroke! They need to do something! She needs help!” But as I listened more closely, the realization hit me – she wasn’t having a stroke; the culprit must be that other famous Russian product – vodka!

The next day I scoured the newspapers and news magazines for a review or anything that would explain what had happened. Nothing – there seemed to be a code of silence in the press. Was I the only one to think she was inebriated? I resigned myself to the fact that I would never know what had happened during the broadcast.

Soon, Jimmy Carter was elected, and I lost track of Betty Ford. That was until the early ’80s when she established The Betty Ford Center, a state-of-the-art rehab center to treat addictions – addictions like her own. Now a mental health professional, I felt a sense of amazement and profound respect for this person who did not bury this issue, but instead continued to work on her own health and fight for the health of others.

No ordinary woman

It is well known now that Betty Ford considered herself an “ordinary woman.” Her addictions to alcohol and medications, she said, ultimately came from her “lack of self worth” and feeling “useless and empty,” feelings she and so many others have tried to manage in the same way – externally, by self medicating with drugs and/or alcohol.

Debt owed

Ford’s feelings about herself were so different from what I had imagined, yet her willingness to use her notoriety to openly talk about her vulnerabilities and equally, to stand up for her beliefs, was a gift for all of us. In speaking out, she made a huge contribution to changing how addictions are perceived and, I believe, helped advance parity for addictions so treatment would and could be covered by medical insurance. There really is no way to measure her influence, and I feel those of us in the mental health field owe her an enormous debt of gratitude.

Former First Lady Betty Ford

When her husband became president, Betty Ford said that she was “called on stage,” but not in a manner she could have imagined when she was young. She was someone who weaved a special thread throughout my own life by proximity of birth and common interests. Now and again I had the opportunity to see how her talent, courage and grit came together in a dance much like those of Martha Graham’s – authentic, thought provoking and imbued with meaning, beauty and astounding grace.

Editor’s note: For more on Betty Ford, check out “Honor, grace and courage: a tribute to Betty Ford.”

A colleague sent me a recent David Brooks’ op-ed from the New York Times about Alcoholics Anonymous (AA) and its founder, Bill Wilson. And like a good op-ed does, it got me thinking; specifically, it got me thinking about two things:  1) how challenging it can be to overcome an addiction, bipolar disorder, borderline personality disorder or any other mental illness, and 2) how grateful I am that Brooks used his column to highlight AA’s profound impact while acknowledging the complexities of treating addiction, despite considerable advances in brain research and the mental health field.

In the piece, Brooks says “in a culture that generally celebrates empowerment and self-esteem, A.A. begins with disempowerment.”  True enough. And it’s my guess that is partly because mental illness, including addiction, is disempowering. It robs individuals of sound judgment, energy (unless, of course, you’re someone who experiences mania), direction, focus, hope, etc.

I’d even go so far as to say that this disempowerment is the definition of “rock bottom,” a common-enough phrase these days, which in my mind can only be a place of abysmal, unadulterated loneliness. It’s no place for a loved one, or even, dare I say it, an enemy.

Rock bottom

Once in, there’s only one way out and that’s up. And the only way up is through the good strong grip–maybe physically, definitely symbolically–of another person’s hand. In all likelihood, that hand will belong to a stranger, perhaps even to one of the 1.2 million members of AA, each of whom could probably teach the rest of us a thing or two about “rock bottom.”

Which leads me to another powerful statement of Brooks:  “Individual repair is a social effort.” When AA proves successful for one of its members, that success is predicated on the idea of social effort.

This makes sense to me, just as its opposite does:  individual disrepair is a social effort, too.

Between nurture and nature we’re each shaped by things beyond our control–not always entirely, of course, but often enough. These things (childhood abuse, death of a loved one, extreme poverty, family genetics, etc.) have a great affect on us as we mature and become independent adults (or at least try to).

Sometimes the convergence of these things makes us vulnerable as adults to addiction and mental illness. No one ends up dealing with alcoholism or mental illness because they’ve been living in a vacuum; so we shouldn’t expect people to overcome these problems on their own either. And when you get right down to it, the mental health profession has always been a social endeavor between patient and clinician. I mean, Freud wasn’t analyzing imaginary patients on his couch all those years ago….

Milieu therapy

At Menninger, you hear a lot of talk about milieu therapy, which is, according to the Oxford Pocket Dictionary of Current English 2009, psychotherapy in which the patient’s social environment is controlled or manipulated with a view to preventing self-destructive behavior. It may sound like a fancy term for group therapy, but it’s far more than that.

Patients here live for weeks with one another and often see each other at their worst. Because they spend so much time together, they reap the benefit of becoming, as Brooks describes AA members, “deeply intertwined with one another–learning, sharing, suffering and mentoring one another.” They see–and feel–the importance every single member of the group has on the rest of the group. It’s pretty potent, healing stuff, and it’s the social effort of the group members that makes it possible.

I’m really glad that someone as prominent as Brooks shared some of the history of AA. He’s got a big following, and it’s not everyday that addiction finds its way into such valuable real estate as this prestigious op-ed column. It’s clear that the stigma surrounding people with addiction, particularly alcohol addiction, has decreased dramatically since AA was founded, and I think Brooks has, whether he intended to or not, whether he knows it or not, has further destigmatized addiction by devoting a column to the topic.

Now if borderline personality disorder, bipolar disorder, PTSD, schizophrenia and all the rest of diagnoses in the world of mental illness can find their versions of Bill Wilson soon, there’ll be more and more of us who will find ourselves just saying “no” to stigma. Plus, Brooks will have more great stories to tell in future columns, and I, for one, am looking forward to reading them.

Yes, I still love him. No, that wasn’t me who was arrested recently for stalking him and threatening his family.

Dr. Drew Pinsky

In my previous post, I talked about how I think his shows (Celebrity Rehab, Sober House, etc.) perform a much-needed public service because they reach millions of people with powerful messages about recovery, the therapeutic process and hope.

Addiction, and indeed all mental illness, is complicated, a fact that is demonstrated on each and every episode. And this is a good thing:  If everyone sees just how complex the disease is and how difficult it is to treat, I think people are bound to develop greater compassion for those struggling to overcome their disease.

Listen up!

You know what else the audience sees on each show? Reflective listening (some of you may know this as “active listening). In individual sessions with patients and in group settings as well, Dr. Drew and his staff model this valuable skill, one that each of us could benefit from developing whether or not we are or someone we love is dealing with addiction and mental illness.

Here’s my simplest explanation of reflective listening:  putting aside your own judgments and preconceived notions to fully engage in trying to understand the speaker’s point of view. A critical aspect of this process is being sure your understanding is accurate, and the way to do this is by reviewing it with the speaker and getting either confirmation or additional information to enhance your understanding. (Free tip:  Messages: The Communication Skills Book by McKay, Davis and Fanning is filled with examples of reflective listening and practice exercises, in case you’d like to practice paraphrasing, clarifying and giving feedback in an empathic manner.)

Reflective listening is vital to recovery. In my work, I’ve seen firsthand how it makes a difference: Demonstrating a genuine and respectful interest in a patient’s feelings and experiences can help teach someone in great pain that their communication is valued, their thoughts are valid AND as a person they are valuable. This is essential if we truly want to connect with and successfully treat patients.

But the value of reflective listening goes far beyond therapy sessions.  It helps us whether we’re working with our patients, talking to our boss, hanging out with friends or dealing with our spouses and children.

Don’t get me wrong–I know it’s hard to do, especially when we’re feeling angry, stressed, offended or tired. But the consequences of not developing and using this skill are many, including defensiveness, misunderstandings and escalating negative emotions. Suffice it to say, it doesn’t lead to a happy Hollywood ending–just isolation, confusion and loneliness.

Lessons learned

So when I see Dr. Drew at work, I see him modeling this skill and helping others learn it. I also see that learning it often leads to greater understanding and less judgment, enhancing relationships not just between patients, but also between patients and their family members and friends. Of course this doesn’t happen overnight, but we didn’t perfect eating with a fork the first time we tried it, did we? It’s a skill like any other and requires practice, lots and lots of it. I think Dr. Drew, just like any other clinician helping someone with a mental illness or addiction, is simply proving that there are new skills that can be learned to aid in recovery.

If we could only get everyone to learn this new skill, I think we’d see a considerable reduction in stigma. I also think it would lead to a lot fewer people struggling alone because people with addiction and mental illness would feel much freer to seek treatment.

That would be the good news. The bad news:  There wouldn’t be a need for Dr. Drew to have all those TV shows and then what would there be to watch on TV?!

PS:  Thanks to all of you who shared my previous post with others and for leaving such great comments; all of us here at SayNoToStigma.com really appreciate it.

Dr. Oxford is a psychologist on the Hope Program for adults at The Menninger Clinic.

Dr. Drew

I have a confession to make. I love watching Dr. Drew. (If there’s anyone left out there who doesn’t know, Dr. Drew is Drew Pinsky, MD, a noted addiction medicine specialist and faculty member at USC’s medical school. Whether he’s being interviewed on CNN or appearing on his VH1 shows Celebrity Rehab with Dr. Drew or its spinoffs Sex Rehab with Dr. Drew or Sober House, it seems like the ubiquitous Dr. Drew has become America’s favorite doctor.

And I think that’s great.

Of course, I’m aware that plenty of my colleagues in the mental health field may disagree with me. They’re concerned about the exploitation of addicts and conflicts of interest, and I understand those concerns. I’m not saying they aren’t valid, but I think the value that he brings to millions of American households far outweighs them.

A big problem remains

Let’s face it:  Despite years of medical and psychiatric advances, as Dr. Oldham pointed out in a previous post, a considerable amount of stigma remains. That’s a big problem because we know stigma often prevents many people who need help from getting it and we all feel its effects whether we recognize them or not.

Thanks to Dr. Drew and others like him–think Dr. Phil and the good folks at Intervention among them–millions of people, especially young people, get to see what treatment and therapy and rehab are all about.  It may not always be pretty, but it’s definitely a trip. On display on just about any episode: tears, anger, fear, destructive behavior, gut-wrenching confessions, isolation and loneliness, shame, aggression and other not-quite-so-pleasant experiences.

You know what else makes for great television drama? All those other things viewers get to see as well: hope newly discovered, the recognition and acknowledgement that sobriety feels good, honesty, joy, contentment and peace, self-acceptance, forgiveness–not just of others but of oneself, too–strength, the power of relationships, along with other wonderful and wondrous emotions and discoveries.

A public service

Each episode amounts to what I consider a public service. Showcasing real people, even if they are celebrities (yes, even B-list celebrities), with very real and significant problems demonstrates that that lots of other people have to deal with similarly tough issues that viewers at home may be facing. Demystifying the process that gets addicts and others with mental illness from A to Z opens the door for people to feel free to seek help. There’s no doubt in my mind that stigma related to addiction and mental illness is reduced as a result.

You’ve probably heard the saying “you’re only as sick as your secrets.” Isn’t it time we applied the same concept to stigma? By coming clean about mental illness and addiction, whether in the privacy of our homes or on national television, we have the chance, like the celebrities on Dr. Drew’s shows, to prove to ourselves and to others that healing and wholeness are indeed possible.

I ♥ Dr. Drew for showing us the way.

(For those who might be interested in learning more about Dr. Drew, I recommend this recent article from the New York Times Magazine.)

Editor’s note: For more on why Dr. Oxford ♥ Dr. Drew, see part 2 of her post.