Psychoanalytic Therapy and The Right to be Heard

by Patrick Cleveland M.A.

    

     Many of the people I see in therapy initially feel as though their problems aren’t worth speaking about or feel guilty that they shouldn’t be ‘complaining.’ Many of these people were raised by parents who were too consumed with their own lives, issues, or addictions to pay them any mind and hence gave them both overt and covert messages to keep quiet and not complain. This is the perfect recipe for repression. This is actually teaching repression as a means of navigating ones emotions. These are the parents who say things like, “Don’t cry”, “Man up”, or “I don’t want to hear it,” and ignorantly wonder why their children have emotional problems currently or trouble following through with goals later in life despite having provided all material needs for them as they grew up . The fact is that children and people need to be loved and heard. Everybody has a right to tell their story and share their experience to someone willing to listen. We don’t have the right to be heard by everyone, because we didn’t choose our parents and thus we cannot control them or anyone else. We may wish for them to hear us and love us, but ultimately we cannot make them do so. They may not even be capable of doing so due to their own issues.
     In accordance with the tradition of psychoanalytic therapy, I view psychotherapy as a safe time and space for you to share your experience and tell your story. It is a place for you to talk about whatever you like and express yourself however you want. In that regard, it can also be a time to unlearn the rules and demands your parents placed upon you to “be quiet.” It is a place to share the emotions and thoughts regarding your experience that you’ve long held in and make meaning out of them. It is a space to say what was once regarded as unsayable.
     There are many false notions about what is ‘strong’ in society. Many people think that crying is weak and not showing emotion is strong. While it is true that we need to maintain some sense of composure and self-cohesiveness in order to get through day to day life, pay the bills, and survive, I think there is a great strength and courage to simply allow yourself to feel. To allow yourself to feel whatever arises. To breakdown, scream, cry, yell, or do whatever your heart intends to express yourself and release your emotions. Holding things in and repressing emotions leads to mental health issues. That is a very basic fact that Freud discovered by listening to his patients in the early days of psychoanalysis. Just think of what a bold yet simple move that was. He was first physician to ever entertain and put into place the idea that simply speaking and being listened to can be healing. While I’m sure that since the birth of language people have come to know that telling their problems to a friend or relative made them feel better, it was Freud who took the further step of creating the time and space of therapeutic hour to solely focus on listening to the patient’s speech as a curative act. Therapy is like an archaeological excavation of the mind, an uncovering, and an expressive space for one to tell and learn about all the unique mysteries of their psyche.
     Recently, one of my clients who had been struggling with a resistance to fully share her experience for many weeks finally revealed that she was sexually molested by her father and that she never told her mother or anyone out of the fear of not being heard and believed. Her mother never really listened to her or attended to her needs while she was growing up since she was always too busy working and drinking. As a result, my client was always afraid to tell her mother anything that would be the slightest inconvenience out of a fear of being beaten or ignored, and so she held in her experience of being sexually abused for all these years. When I asked her why she didn’t tell her mother, she responded by saying her mother had been through the same thing and that nobody listened to her either. I pointed out how in her immediate response to my question she justified her mother’s behavior of ignoring her and created some illusory right her mother possessed to not listen to her because she had gone through something similar. I highlighted out how she didn’t respond from her own feelings and experience but instead immediately empathized with her mothers. I stressed how this pattern of disavowing and disregarding her own experience and feelings is a major factor in understanding why she has such trouble expressing and coping with any emotion besides anger in the present. Anger is the only emotion she ever got attention for precisely because anger leads to aggressive acts that demand attention and was thus perceived of as strength in her family. After processing these insights, she began to speak from her own experience about the feelings of shame and guilt she still carries regarding the sexual abuse she experienced as a child. I commended her for speaking and owning her feelings and thoughts regarding her experience and asked what it was like to share it. She said it felt strange and awkward to finally speak it, but also tremendously relieving that she finally told someone. I thanked her for trusting me to share her experience with, emphasized its worth, and told her that in therapy she has a right to be heard.

Patrick Cleveland MFTI
www.patrickcleveland.com

Mental Illness and the Was that Use to Be an Is of Christopher Dorner

by Patrick Cleveland M.A.



     I wrote my first blog on renegade ex-police officer Christopher Dorner when he was still alive. Now, he’s dead. The police killed him David Koresh style in a standoff similar to that of the 1993 Waco massacre. A mysterious fire erupted as Dorner hunkered down in a cabin in the snowy mountains of Big Bear, CA. Why on earth did Dorner go to Big Bear? A place where a tall gigantic African-American man would surely stand out?  Those questions are now unanswerable as well as the question of whether Dorner was truly railroaded by the LAPD and thereby the question I asked in my last blog as to whether he was truly mentally ill is now also harder to discern. I based both conclusions as to whether he was mentally ill or not dependent on whether the accusations and reasons for his LAPD termination were true of false. If they were true, then it could be argued that Dorner went on a paranoid delusional retaliatory rampage against those he falsely perceived had wronged him, and was thereby mentally ill. If they were false, then it could argued that he was merely an enraged and desperate man who would do anything to gain revenge, notoriety, and provoke the circumstances necessary for the truth of his case to be revealed and his name thereby cleared even if it cost him his life. In the case of the former it would be easy to justify a case for mental illness based on the criteria for delusional disorder I listed in my last blog. In the latter case it would be much more difficult.  Even though the answer may be murkier now due to his death and untold story, let us continue look at the question little more closely.

The American Psychiatric Association defines mental illness as follows:

A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (i.e., a painful symptom) or disability (i.e., an impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. The syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event. It must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual. No definition adequately specifies precise boundaries for the concept of mental disorder. Also known as mental health, mental impairment, mental illness, brain illness, and serious brain disorder (DSM-IV, 1994; p. xxi).

     Looking at the beginning of the definition, it doesn’t seem that Dorner had any distress, symptoms, or disabilities since he was quite willing and able to carry out his actions. Moving on to the 2nd sentence of the definition, it is clear that Dorner’s behavior and actions of taking revenge by killing police officers and demanding justice generated “a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.” However, other fighters of perceived injustices such as Martin Luther King, Ghandi, and Che Guevera all displayed behavior that also put them at the same risk. They also suffered pain, lost their freedom at times, and eventually their lives. Were they mentally ill? I don’t think so. Based on the definition put forth by the APA could a psychiatrist say they were mentally ill? Ironically, yes! The 3rd sentence stating, “The syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event” raises many socio-cultural questions in this case. Based on past wars (Iraq most notably), and numerous American intervention in the world against perceived enemies, as well as the many movements that have sprang up against injustice in this nation (the abolitionist movement, women’s suffrage, LGBT rights, etc.) one could argue that America is a revenge happy nation at most or an injustice fighting nation at least. Thereby, Dorner’s ambitions to right the perceived injustice against him is in line with the ‘American way’ and given the repetitive pattern of office shootings in the U.S. by fired employees (crystalized in the common phrase ‘going postal’) Dorner’s behavior was also expectable to some extent. However, given his military training, Dorner was able to take it to a whole new extreme.  Finally, the 4th sentence gives the A.P.A. a praiseworthy way out in writing, “No definition adequately specifies precise boundaries for the concept of mental disorder.” That sentence is like music to my ears. It’s like they gave it a decent shot at defining mental illness in the first 3 sentences, but then, somewhat covertly said, “but don’t take our definition too seriously because no definition could ever be ‘adequate.’” Advice taken, I never have taken the DSM very seriously and don’t plan to start now.

So was Christopher Dorner mentally ill? Once again, knowing the absolute truth as to whether he was fired justly or falsely would help me yield a better answer. I do tend to think that a key criterion for mental illness is being somewhat out of touch with reality and thus acting out against reality or developing symptoms based on delusions can be signs of we can commonly call mental illness. That’s my basis for very loosely trying to define one small facet of mental illness. Who gets to say what reality is and isn’t? Well, that’s a long standing debate that’s still going in philosophy to this day.  

In closing, due to the literal burning down of all that was Christopher Dorner and the now forever closed investigation as to facts by the LAPD, perhaps we will never know if he was truly mentally ill or not. As to my opinion just based on the evidence that I do know of, I would still conclude with the 2nd argument I listed earlier, in that I wouldn’t say he was ‘mentally ill,’ but instead I prefer to say that as a result of what happened to him, whether it be true of false, right or wrong, good or evil, he became an unemployed, ostracized, and eventually enraged man who was determined to do anything he could to clear his name, get revenge, and right the perceived injustices held against him which coalesced as an unbearable over-arching blow to his ego, cultural identity, and legacy . In that sense he was not mentally ill, but just human, ‘all too human,’ as Nietzsche would say.

Published by

Patrick Cleveland MFTI

Long Beach, CA. 3/16/13

www.patrickcleveland.com

Is Christopher Dorner Mentally Ill?

 by Patrick Cleveland M.A. 



     Right now there is a massive manhunt underway for ex-police officer turned renegade avenger Christopher Dorner after he murdered a police officer, a police captain’s daughter, and her fiancé. There has been a lot of hype in the media about his mental status as to whether he has a ‘mental illness’ or not. While watching coverage of the story after police found Dorner’s abandoned and burned out truck in Big Bear, CA., the psychological experts appeared on television to convey their opinions. While watching Anderson Cooper 360, he had a psychologist on the show who stated that it is ‘very hard to discern if Dorner is suffering from any recognizable mental illness’ and that he simply appeared to be an angry man on a vengeful rampage. Given my own reluctance and distaste for diagnoses, I pretty much agreed with that assessment. However, not even an hour later, Piers Morgan had a psychiatrist on his show who said that Dorner was ‘clearly suffering from a mental illness’.  I broke out laughing when I heard this! These were supposed to be two experts, why did they have such differing opinions?  For one thing, it speaks to the epistemological shakiness of the supposed ‘scientific’ foundation of psychology as a whole and how diagnosis can be such a tricky business. Some practitioners swear by diagnoses and the importance they have on treatment.  The range of their usefulness for me is based on the setting in which it is applied. In a private-practice setting I have found them to be almost useless whereas in a community mental health setting they are more useful for treatment, but mostly just for billing purposes.
     The two different perspectives portrayed on both shows prompted me ask myself the question: is Dorner mentally ill after all? Here is the conclusion I have arrived at. After reading through various diagnoses in the psychotic spectrum of the DSM IV (Diagnostic and Statistical Manual of the American Psychiatric Association) I arrived at a diagnosis that could fit Dorner if certain factors in his case were indeed true.

 The diagnosis is known as Delusional Disorder 297.1, and its criteria are as follows

A. Nonbizarre delusions (i.e., involving situations that occur in real life, such as being followed, poisoned, infected, loved at a distance, or deceived by spouse or lover, or having a disease) of at least 1 month's duration.

B. Criterion A for Schizophrenia has never been met. Note: Tactile and olfactory hallucinations may be present in Delusional Disorder if they are related to the delusional theme.

C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired and behavior is not obviously odd or bizarre.

D. If mood episodes have occurred concurrently with delusions, their total duration has been brief relative to the duration of the delusional periods.

E. The disturbance is not due to the direct physiological effects of a substance(e.g., a drug of abuse, a medication) or a general medical condition.

     Now here’s the clincher. In the criteria for category A it mentions ‘non-bizarre’ delusions meaning the delusions do pertain to one’s perception of reality in relation to events that actually happened.  For example, if Dorner thought he is the prince of Zaire, that would be a bizarre delusion but Dorner thinking that the LAPD persecuted and fired him wrongly could be a non-bizarre delusion. I say could be because it could be true and thereby not a delusion! No criteria for category B are met in this case since Dorner clearly does not have schizophrenia for reasons not even worth going into here.  Once again, if Dorner is wrong, he also meets the criteria in categories C and D as the vengeful behavior is typical of persecutory delusions and the mood he is acting out of is clearly one of anger fueled by a perceived betrayal and injustice. Dorner does not meet criteria for category E as he is not a drug user and this episode was not triggered by drug use. So the conclusion is that if the LAPD rightfully fired Dorner for the charges against him then Dorner is currently suffering and acting out of a mental illness as a result since his beliefs about being persecuted are false. However, if Dorner is right, and the LAPD staged a cover up for the officer in question in the incident in which he was fired for and Dorner was persecuted for being a whistle blower in that event, than he is merely acting out of anger and revenge for the betrayal and injustice persecuted against him and is in no scientific or psychiatric way suffering from a mental illness. In that case, he’s just a really pissed off guy going on an all-out vendetta. That is of course, until the American Psychiatric Association chooses to name something like ‘obsessive vendetta disorder’ into the DSM and say it is a mental illness, but how silly would that be? Silly or not, it could happen. The DSM I published in 1952 contained 106 diagnoses. That number grew quite significantly to the current edition of the DSM IV published in 1994 consisting of 365 diagnoses. How is this possible one could ask? That is a subject for another day. The main purpose of this story is to show how in Dorner’s case the main factor involved in diagnosing him with a mental illness is truth.  But are you really ill or sick if you are just drastically wrong? If you perceived the circumstances against you falsely does that makes you sick or just grossly mistaken? These are questions to take up on another occasion, but for now, the misperception of reality continues to be the key criteria for the psychotic spectrum of mental illness. I’m interested to see how Dorner’s story unfolds and how the media and the so-callled psychological experts will portray his unfolding. I wonder what the truth will actually be.

Published by
Patrick Cleveland
www.patrickcleveland.com
Long Beach, CA. 2/12/13

Sources:

http://kadi.myweb.uga.edu/The_Development_of_the_DSM.html

DSM IV