Depression: Youth, Counseling and Antidepressants

The advent of modern antidepressant medication has been a lifesaver to many. Recent research demonstrates that a combination of counselling and medication can provide the most effective treatment for youth suffering from depression.

However, there is evidence to suggest that in the early stages of medication treatment, there is an elevated risk of suicidal thought, which for some persons may lead to suicidal behaviour. This is causing a great many people to reconsider their use of medication, even when indicated.

This issue is determining which youth will benefit from one or the other or both treatments. To this end a good assessment will look for exogenous factors and endogenous factors.

Exogenous factors are those things outside of the individual that may contribute to depression. These include; family dysfunction, abuse or neglect, parental separation, school related problems and relationship problems. If it can be determined that one or more of these kinds of factors are at play, then counselling alone may be sufficient to treat depression.

Such counselling includes family therapy, or in the case of separated and fighting parents, mediation to help them resolve their conflict, so that the youth is no longer subject to their turmoil. If the youth is in a difficult interpersonal relationship, then counselling for the youth to address the difficulty may be in order. If the youth is abused or neglected, these issues must be addressed and the youth’s safety must be attained.

Endogenous factors generally relate to biological or neurobiochemical factors. If there is a history of depression in the family and there are no known exogenous factors, then medication alone may be the treatment of choice. Often though, with endogenous depression, the sufferer has difficulty controlling depressive thoughts and as such, in this situation a very specific form of counselling, CBT or Cognitive Behavioural Therapy, is also indicated.

There are times of course when both endogenous and exogenous factors are at play. In these circumstances a combination of counselling and medication could be in order and should seriously be considered.

Parents and youth are cautioned against making their decision solely on the basis of newspaper articles proclaiming the good or the bad about any treatment. Depression is a serious disorder, which left untreated can lead to suicidal thoughts, action, injury and death.

If you or your child is depressed, obtain a good assessment by qualified professionals that will look at both endogenous and exogenous factors and devise a treatment plan accordingly. Further, the counsellor and the prescribing physician should be working hand-in-glove following the individual to manage safety issues and communicating regularly about progress.

It is important to know that with antidepressant medication, it can take a good thirty days before the therapeutic effect is achieved. During this time, counselling may be of benefit to resolve other issues as listed above or to simply provide support until the medication reaches effectiveness.

If you or your child is depressed, get help. It is often advisable to start with your family doctor or community clinic. A physician can make the diagnosis and direct you to treatment.

Four Social Work Practice Models

To best assist clients as they work to overcome whatever challenges they are facing, a social worker must employ proven techniques. Different clients have different needs, and each of the following techniques approaches social work from a slightly different perspective. Social workers can choose the technique that best resonates with them, and their clients, to offer the most effective assistance possible.

Task-Centered Practice (TCP)

Sometimes referred to as one of social work’s original “evidence-based” practice models, TCP has been around for nearly 40 years. At its core, TCP asks social workers and their clients to come up with specific, achievable goals in order to treat target problems.

Task-Centered Practice uses a four-step process to do this.

  • Define the problem
  • Establish goals
  • Work on goals
  • Review goals

Once the problem has been defined, the process guides the social worker and client to establish goals to deal with the problem, creating a contract between them. They then engage in several sessions over some short period of time during which the clients and social workers share the outcomes of their work toward these goals, and how well those outcomes have succeeded at overcoming the initial problem.

Narrative Approach

The narrative approach to social work involves helping clients to talk about their problems as if they were a story. This has several effects. First, it helps clients view the problem as external to themselves, rather than some intrinsic part of them. Second, it helps them see how the problem affects their lives both in negative and positive ways, and it can assist them in developing compassion for themselves and their own situations. Finally, it presents the opportunity for the social worker and client to come up with alternate stories as a way for the client to envision what his or her life might be like without the problem in question.

The primary benefit of the narrative approach is in helping the client gain distance and objectivity in regards to the problem. The narrative approach can also be used to guide clients into discerning the causality that led to the problem, which in turn can help inform their future behavior.

Solution-Focused Brief Therapy (SFBT)

SFBT assumes that clients are the experts on their problems and that they are the makers, to some extent, of their own reality. The corollary to these assumptions is that clients already have the solutions to their problems and just need help recognizing them. SFBT then focuses on helping clients come up with their own solutions.

Much of this is done through hedging language, such as “I wonder what would happen if…”, and coping questions, such as asking clients how they manage to fulfill their daily obligations, even with the problem in question in the way. The “miracle question” is also a common technique, wherein the social worker asks a question like, “Suppose some miracle happened tomorrow and you no longer had this problem. What’s the first thing you’d notice?” By asking these questions in this way, the social worker and client work together to come up with achievable solutions and goals to help overcome or deal with problems.

Cognitive Behavioral Therapy (CBT)

The basic principle of CBT is that our thoughts and feelings shape our reality and by changing how we perceive the world, we can change how we experience it. For example, a person with anxiety might believe that everything is going to go wrong during a given day. This preconception then leads this person to pay disproportionate attention to things that go wrong, which confirms the belief and strengthens it. CBT challenges the client to confront that belief, to try to see things in a different way and be more aware of how things are, rather than perceptions.

CBT techniques often incorporate meditation, mindfulness, relaxation and out-of-session homework, in addition to traditional talk therapy. Through these techniques, CBT teaches clients to take control of their own therapy and their own world, to be more present in the moment and to be more aware of the reality around them.

Becoming a Social Worker

At Campbellsville University, the online Master of Social Work provides students with the knowledge and field practice for careers assisting people in need. Campbellsville also offers an online Bachelor of Social Work where students gain foundational skills for the profession. Learn in a dynamic and engaging online environment that allows you to advance your career on your schedule.

The Dilemma of the Professional Helper: Cognitive Dissonance, Wellness, and Unhealthy Systems

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Did you ever see the movie, Jerry McGuire?  Jerry wrote a manifesto based on the ills he experienced in his sports management company in an attempt to effect positive cultural change. Do you remember how that turned out? In case you missed it, Jerry was fired.

Another similar real life story was told to me by one of my social work professors who is no longer with us in this world.  He blew the whistle on the corruption in the insurance industry in a Canadian Province which literally led to him being driven out of the province and landing in Ontario.

What Jerry and my professor shared in common was that they were driven to try and make their worlds better places.  In the end, they ended up where they were meant to be and were healthier individuals as a result of it. They rid themselves of the cognitive dissonance and incongruence of working in a system that made them mentally unhealthy and morally/ethically bankrupt.

I’ve attempted to write versions of the following article many times in my life, but fear always prevented me from sharing my perspective and from ultimately blowing the whistle on a system that is making me – and I suspect many others – ill.  I hope to generate honest discussion and thought about the current state of society and the people charged with treating society’s ills.

I am a Social Worker in my 18th year of front line practice.  As I write, I am not well.  Although in the current positive climate of mental health and wellness strategies in our society, I should not feel shame or guilt to admit this, yet I do.  In fact, it makes my skin crawl to utter the words that I am mentally ill.

Although my legitimacy as a professional helper comes from social work education and practice, there are many other people in our field who have other education backgrounds and are equally skilled in there capacity to help, so I will herein use the term “professional helper” to refer to the field generally.

My illness is of the brain and emotional regulation kind.  Diagnosed as panic disorder it is much more complicated than that for me.  While I know that I am human, I have relied on my brain and more fully my “self” to be the treatment for my clients over the years and I feel like I am somehow broken in that I am currently unable to employ my “self” to help others. Although professional helpers rely on knowledge of human behaviour and systems, the multitude of theories and interventions designed to help people in crisis during periods of suffering, those interventions flow from the professional helper.

In addition to the tangible and measurable symptoms I am currently experiencing, I believe my illness is due to much more than my personal mental health functioning.  I have felt like I have been dancing with and around a slow wave of melancholy and dysphoria trying to taint me with its toxicity for several years.

I am under no dissolution that my situation is unique, worse than, or perhaps different than that of others who treat people for a living, but in this day of digital information I find it’s further isolating that other people in similar situations aren’t out there sharing their experiences. I suspect that the lack of information about and for professional helpers isn’t there because like me, others have and continue to suffer in silence.

I finally took a medical leave – but of course like any good helper I argued with my doctor against it – after a chain of events left me in a poor state of functioning.  At the final moment before I called the time of death, my memory was defunct and my focus was non-existent.  I could no longer exude hope for those in my charge who needed hope more than anything.  The hopeless helper is not okay because we adhere to professional ethics and values which above all else necessitate that we are hopeful and active in bringing change to our clients’ lives and society as a whole.

So, in addition to my own intrapsychic mental health, what is the toxicity that I speak of?  I think there have been several factors which have combined to help me along the path to compassion fatigue or burnout or perhaps more aptly, general malaise of the existential variety.   For the purpose of brevity and significance, I will talk about three of these factors and try and explain how these have combined to break one’s spirit.

Cubicle divided offices.

Most professional helpers do not work in offices.  The cubicle or in some cases wall-less office is not an office.  In my opinion it is in fact a legitimate workplace hazard that can make people sick.  How you ask is this possible?  Allow me to explain.  It is well known that stress and traumatic stress is a measurable and real phenomena.  When one of your colleagues is particularly stressed or experiencing trauma or secondary trauma, the stress from that person or the situation that they are dealing with impacts on everyone around them.

If you have ever worked in child protection you will understand immediately what I am referring to.  Once an apprehension has been started the details of the matter and the preparations are inherently traumatizing and everyone in close proximity is impacted by that stress.  Have you ever heard a colleague learn about a devastating event on the phone?  Of course.  What is not so tangible and measurable about the modern day cubicle divided office, is who and how much a person will be affected.  Moreover, if you are an introvert, the mere effort it takes to function in a cubicle divided office is life altering.

One size fits all therapy.

Brief solution focused Cognitive Behaviour Therapy (CBT) and mindfulness based approaches are the most used modalities for therapeutic practice. Many new professional helpers may be hard pressed to be able to identify many more therapeutic modalities than those listed above and for good reason. However, these evidence based treatments which have been the focus of the profession for more than a decade have now created client outliers whose suffering continues and who feel personally responsible for their problems and suffering.

What I mean here is that some people require more time to change and heal while some people may need more evidence based tested therapeutic long term interventions. The longer term the intervention it increase opportunity to develop a stronger therapeutic relationship consisting of accurate empathy, warmth, and positive regard.  Unfortunately, the good old social work texts such as Turner and Tuner social work treatment have no place in the political and economic climate of today.

So, we have people who are once again abused by the helping system in that the conclusion left upon service users who don’t benefit from CBT may be a feeling of failure. It may seem as if they aren’t trying hard enough to change their thoughts, perhaps worse they are resistant to therapy and want to remain in suffering. Ultimately, they are discarded from therapy and left to pick up the pieces alone.

I think would be remise of me not to note that even more appalling than an adult being left after therapy feeling that it is somehow their fault that they aren’t better is the current situation for at risk children who are treated in schools.  Same situation applies.  Although the literature and research surrounding the therapeutic and developmental necessity of at risk children having a caring adult is profound, our helping systems do not support a professional helper being that person. Do we ignore the systematic oppression and poverty while using therapy to help clients cope with society and social justice issues, and how could this be successful?

So, we have children referred for counselling for a variety of reasons (depression, anxiety, domestic family violence, substance abuse, to name just a few), they aren’t cured after six sessions but they have formed a therapeutically important and significant relationship with the helper.  What do we do to these children?

We terminate therapy, and I would suggest do them harm by adding a loss and bereavement to their list of risk factors.  I personally cannot ethically do this to children and I believe many of us in the field have found ways to undermine the system so that we can remain involved with these children beyond six sessions and even for as long as it takes.  But, this comes at a cost to us because there is a great deal of stress associated with breaking the rules even when it is best for children.

The shrunken size of the world.

It is a small world after all.  We now live in a world where global trauma, anxiety, and the perpetuation of fear are common place.  It is hard not to see that our communities and more globally, the world as a whole has both benefitted from the age of technology as well as created a Pandora’s Box.  Readers familiar with the great writing of George Orwell, Adolf Huxley, and more recently, Neil Postman, will understand the dire warnings they tried to convey to humanity as a whole.  While the benefits of technology are widely known and praised, the hazards and negative outcomes for people and communities are less discussed.

For people already suffering with anxiety, for example, symptoms are increased on a daily basis by being consumers of information.  It is next to impossible not to see the world as a scary and unsafe place.  The internet tells us every day about human atrocities and the positive psychological movement which has many potential benefits cannot counter the global anxiety index.

I believe that the global anxiety index is a measurable phenomenon which raises anxiety symptoms in individuals and human systems.  One need not look very far to see the impact of the heightened and highly sustained impact of global anxiety.  We read daily about the increase in sleep disorders, anxiety in all of its forms and symptomology, depression, and all other mental health disorders are at levels not previously seen in humanity.

I believe that this new baseline of high anxiety is not sustainable and is the root cause of many of modern day illness and dysfunction.  Ironically, this is not something imposed on us by some external entity rather than the result of technology in which we have created and embraced. Postman wrote tirelessly about the negative impact of technology on human literacy and intellect.

In my experience, the cures for global anxiety – namely meditation in its many brands – work for some people but herein lies the problem.  I strongly suspect that those of us who have resisted the destruction of our thought processes are more immune to the helpful benefits of meditation and CBT strategies. Why?

In effect, modern day therapeutic strategies are based on one’s capacity to trick one’s mind into thinking positively.  Some of us just aren’t susceptible to trickery.  We have tried and tried again to adopt mindfulness and thought distortion changes in our lives but in the end, we conclude that it is not our thoughts that are distorted.  In fact, nothing is distorted and we live daily with the impact of global trauma and anxiety.

I believe further that the only potentially possible way to get through this life as a professional helper and more generally as a mentally well citizen is to revisit and readapt existentialism. Yalom and others have embraced existentialism and used it to treat people with many mental health ailments.

But, existentialism needs a revamp in the technological age because what many people struggle with is not just the notion that we are ultimately alone, but we must now examine the unretractable information technology systems we are reliant which also may serve to perpetuate our symptomology.  I will be brutally honest, I’m not sure how else we will get through this.

For sure, existentialism is a depressing ideology, but the help in it lies in the paradoxically and poorly understood and discussed end result.  If we can find a way to embrace existential tenets, eventually the suffering goes away.  But, this is a lengthy treatment and one that requires periodic revisiting. Therefore, it cannot be supported by our current mental health systems. If you can’t trick yourself into getting better, you will be discarded to the land of “it’s your fault”.

I am not sure where we proceed from here but I am finally ready and able to be the face of change if that is what is needed.

What is Superhero Therapy?

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Did you ever want to be a Superhero? Did you ever wish that you could possess magical powers, like Harry Potter, or travel around the world in a time machine, called the T.A.R.D.I.S. with an alien who calls himself The Doctor? What if you could, in a way?

Many of us wish we had some kind of magical or extraordinary abilities, and many of us strongly identify with fictional characters, like Batman, Superman, Buffy the Vampire Slayer, characters from Harry Potter, Firefly, and many others. Recent research findings suggest that identifying with fictional characters can actually be extremely beneficial as it can teach us empathy, remind us that we are not alone in our painful experience, inspire us to eat healthier, and allow us to better cope with difficult life transitions.

The goal of Superhero Therapy, therefore, is to help patients who identify with a particular fictional character to use that relationship with that character in order to identify and process their own experiences and feelings, as well as to encourage them to make meaningful changes in their lives. Thus, the goal of Superhero Therapy is to teach us how to become the very magical Superhero-Jedi that we need in order to become the very best versions of ourselves. Superhero Therapy refers to using examples of Superheroes, as well as characters from fantasy and science fiction in research supported therapy, such as cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).

Why Superhero Therapy?

Many people have a hard time identifying their own thoughts and emotions, either because it’s too painful, or they’ve never thought about it. I see many patients with posttraumatic stress disorder (PTSD), including active duty service members, Veterans, and non-military civilians. I find that a lot of the time when I ask my patients how they felt at the time of the traumatic event, or even about which emotions they are experiencing in the present moment, many state that they aren’t sure or do not wish to answer.

However, discussing how a specific character felt at a given moment can be helpful in understanding our own emotions. For example, in the Defense Department’s recent efforts to assist Veterans with PTSD, they’ve contracted an independent company, Theater of War, to put on theatre plays for Veterans with combat-related themes, based on Ancient Greek plays. One of these plays, Ajax, for example, tells a story about a character struggling with his symptoms after the war and eventually committing suicide. Veterans and their spouses who saw the play reported that the play helped them understand their own emotions by relating to the characters. One Veteran in particular was moved by the play, stating: “I’ve been Ajax. I’ve spoken to Ajax.”

Talking about fictional characters’ emotional experiences might seem safer than talking about our own, so with my patients, that is where we often start, later drawing parallels to their own feelings and subsequently switching over to focusing on those. For instance, many service members and Veterans I’ve worked with strongly identify with Superheroes, in particular, Batman, Superman, and The Hulk. Let’s take a look at Superman.

Superman (real name Kal-El) is a comic book character who is an alien from another planet, Krypton, who was sent to Earth as a child. His Earth name is Clark Kent, and while in the Solar System, including Planet Earth, he appears to have superhuman abilities: he possesses super strength, super speed, he can fly, he can fight, he has X-ray vision, and many other cool powers. It is no surprise that Superman is a role model to many service members and Veterans, who believe him to be invincible. The phrase or a variation of the phrase I often hear in this population is “I wanted to be Superman… I failed.” This is a common response many people have, harshly judging their own experiences of having PTSD. This is a common dialogue I’ve engaged in with many of my patients:

Patient: “I just feel like such a failure.”

Therapist: “What makes you say that?”

Patient: “I wanted to be like Superman, you know? Strong.”

Therapist: “And now you don’t feel that way?”

Patient: “No, I have PTSD.”

Therapist: “And what does that mean about you?”

Patient: “It means that I’m weak.”

Therapist: “Wow, that’s harsh. Let me ask you this, did Superman have any vulnerabilities?”

Patient: “No.”

Therapist: “No?”

Patient: “Well, there’s Kryptonite…”

Therapist: “Right. What is it and what does it do?”

Patient: “Kryptonite is this radioactive material from Krypton, where Superman was born. It takes away his powers and can kill him.”

Therapist: “So Kryptonite makes him vulnerable?”

Patient: “Yes.”

Therapist: “And does this make him any less of a Superhero?”

Patient: “No, of course not… Oh, I see what you mean, that having PTSD doesn’t mean I’m not Superman.”

This is an example of how cognitive behavioral therapy (CBT) could look when using Superhero examples in session. CBT is a type of therapy that looks at the relationship between thoughts, feelings, and behaviors, which are bidirectional, meaning that they affect one another. In the example above, the patient’s thought: “because I have PTSD, that means I’m weak, and I failed in being Superman” is affecting his feelings (making him feel more depressed) and is affecting his behavior (for example, not wanting to socialize with others).

Some of the thoughts we have might not be 100% accurate, often leading to some painful emotions, and maladaptive behaviors. By challenging the validity of the thoughts (testing to see whether or not the thought is accurate), we can get out of the maladaptive loop. A CBT therapist’s job is to teach a patient how to implement the skill of challenging their own thoughts, to change the maladaptive behaviors in order to help the patient recover, as well as become their own therapist, to be able to help themselves in the future.

The other type of therapy that lends itself nicely to Superhero Therapy is acceptance and commitment therapy (ACT). I often describe it as Superhero Training, as ACT teaches us to become the very Superhero (or witch/wizard, vampire slayer, Jedi, or any other title that seems most helpful) that we wish to be by following our values, (the most important things to us, like family, friends, creativity, altruism, spirituality, and others), and by facing whatever dragons show up along the way (thoughts, feelings, personal stories we tell ourselves, such as “I’m a failure” or “I’m not good enough”) and practicing the Jedi-like skill of mindfulness.

Let’s take a look at how Harry Potter can be used in therapy to teach us some of these skills. Briefly, Harry Potter is a young wizard in training, whose parents were killed by Lord Voldemort, an evil wizard. Harry and his friends, Ron and Hermione, are studying magic at Hogwarts School of Witchcraft and Wizardry. When Lord Voldemort and his followers, the Death Eaters, start to come back to power, aiming to exterminate all non-magical humans (called Muggles), as well as all Muggle-born witches and wizards, it is up to Harry and his friends to stop them.

In the first book of the Harry Potter series, Harry, Ron, and Hermione find out that Lord Voldemort is attempting to come to power by trying to steal the Philosopher’s Stone, which grants immortality to its owner. In trying to stop him, Harry and his friends have to undergo a series of dangerous tests. One of them, the Devil’s Snare, is a magical plant that uses its tentacle-like branches to suffocate the person that touches it.

The Devil’s Snare presents a great ACT metaphor of acceptance and experiential avoidance: the plant seems to respond to tension levels, the more one struggles with it, the tighter its grip and the more likely it is to choke them. This is experiential avoidance, trying to escape the present experience, and just like the Devil’s Snare, in most cases, the more we try to escape, the deeper our struggle becomes. However, if we stop struggling and are willing to experience this discomfort (acceptance), then we are more likely to survive – when Hermione lets go of the struggle with the plant, for example, the Devil’s Snare releases her.

Here is how Superhero Therapy using ACT can look in a clinical setting. One of my clients was struggling with panic disorder and was too scared to go to places where a panic attack might take place and where escape might be difficult (this is called agoraphobia). The patient (let’s call her “Lucy”) stated that as a result of her fears of getting additional panic attacks she had to drop out of college, move back in with her parents, was unable to spend time with her friends, was unable to volunteer in a community theatre, which was something she really enjoyed, and essentially put her life on hold. While she did not have many panic attacks when staying at home, Lucy’s life became constricted, based solely around her anxiety disorder. Lucy stated that she would not be willing to go to unfamiliar places until her panic attacks went away completely and she was absolutely sure that they would not happen again. Her thoughts, such as “if I go out, I will have a panic attack” and “I’m weak” prevented her from living the kind of life she wanted.

In our sessions together we talked about the Harry Potter series; her favorite character was Harry’s friend, Ron Weasley. She said that she identified with Ron because of his fear of spiders. While Lucy herself did not have a fear of spiders, she stated that she could relate to Ron because “he knows what it’s like to be really scared, he gets so overwhelmed by spiders that he can’t even move. That’s exactly how I feel.”

In discussing Ron in therapy, Lucy was able to identify that as scared as Ron was of the spiders, when it was really important, specifically, when Hermione was Petrified (turned to stone) by an unknown monster in Harry Potter and the Chamber of Secrets, Ron (as well as Harry) followed the spiders into the Forbidden Forest in order to get the information needed to save Hermione and other Petrified students. This is a great example of the ACT concept of values. No one who read the books can deny that Ron was terrified when he followed and interacted with the spiders. He was probably also doubting his own abilities and might have had many insecure thoughts, such as “I will fail,” or “I’m not good enough,” or maybe even “I’m a coward.” And yet, despite his fear he was able to follow through, he was willing to experience whatever terrifying emotions and thoughts showed up in order to save his friend, showing true courage and heroism.

I will never forget the first time that Lucy and I drove around her block as a part of her facing her fears. She was trembling and was saying that she did not think that she could do it. However, she got behind the wheel, tightened her Gryffindor scarf, and turned on the engine. It took less than 5 minutes to go around the block and when we were finished Lucy was ecstatic. She was in tears, she was laughing, and saying, “I can’t believe I just did that!”

Lucy and I continued working on taking “superhero steps” in her valued direction and practiced driving to a movie theatre and other locations. Lucy still gets anxious sometimes but just like a true Superhero that she is, she courageously goes out with her friends, she’s back in school, and has even traveled abroad with her family.

I always say that the bravest people I know are my patients. It takes a lot of courage to experience overwhelming, and at times, incapacitating, anxiety, to come to treatment, and to face our fears. Many people believe that fear is bad, something that needs to go away for us to live a normal life. However, fear can actually be quite advantageous. In a recent Doctor Who episode, Listen, we learn that fear can be a Superpower. Doctor Who is a British science fiction TV show about an alien, who calls himself The Doctor. The Doctor travels around the universe in a time machine, called the T.A.R.D.I.S. (which stands for Time and Relative Dimension in Space) and saves those in need.

The Doctor is over 2,000 years old, and seems to know a thing or two about fear. His take is this: Fear is a Superpower. Fear causes the release of adrenaline, which makes us think faster and fight harder, suggesting that we don’t need to run away from fear, fear might actually be helpful.

The bottom line is that running away from fear and not living our lives according to our values isn’t helpful, whereas learning how to face our fears in the service of what’s most important to us, that’s what being a Superhero is all about.

Giving Students Therapy is Not the Answer to Dealing with Microaggressions in Education

This article is continuing analysis of the Atlantic’s article, Coddling of the American Mind written by authors Jonathan Haidt and Greg Lukianoff . The authors believe that ‘political correctness’, or reacting to ‘microaggressions’, is damaging students’ intellectual and emotional wellbeing on university campuses. In an earlier article, I considered what microaggressions are and some of the unsaid assumptions and attitudes of the authors as well as taking into consideration their backgrounds.

In short, microaggressions are small and unconscious acts of oppression, such as erasure, using someone’s identity (sexuality, gender, race) as an insult, assimilation as a compliment, and assuming badness or deviance as a result of someone’s identity. Here, I want to consider more of Haidt and Lukianoff’s content, beginning with their concern:

“What exactly are students learning when they spend four years or more in a community that polices unintentional slights, places warning labels on works of classic literature, and in many other ways conveys the sense that words can be forms of violence that require strict control by campus authorities, who are expected to act as both protectors and prosecutors?”

I’ve already noted their victimising, legal vocabulary – ‘polices’, ‘prosecutors’, ‘strict control’, ‘authorities’, but it is worth bearing in mind. In fact, American college campuses are surprisingly lax in their response to problems around race and sexual assault. Sexual assault is common on college campuses and misogynistic language is rife, yet policies, discussions, and ‘messages’ around dealing with rape and sexual assault properly are lacking.

Likewise, there are examples of students who have not faced consequences aside from criticism and discussion after chanting actively racist slurs on film, and there are a great many incidents of verbal or physical racism with no real consequences to the perpetrator (although, as the last link shows, there are also cases that do have real consequences, such as court cases).

Essentially, it’s difficult to believe that whilst overt cases of aggression are not being dealt with effectively, college campuses are somehow ‘policing’ microaggressions. In fact, the authors later go on to give an example of pro-‘trigger warning’ policy that was “subsequently retracted in the face of faculty pushback”, which does not suggest ‘policing’ or ‘victims’, but people who were listened to.

Haidt and Lukianoff’s lamentation that words can be treated as a “form of violence” is also somewhat problematic. They state it as though words and actions are completely separate. For example, by saying “You don’t look like a lesbian” as a compliment, you are performing the act of reducing the status of lesbians.

There are other ways that words perform actions, such as “I now pronounce you X and X” being the act of marriage, and “Sold” being the act of ending an auction. In fact, the part of the brain that responds to social pain (e.g. social insults) is the same circuitry of the brain that responds to physical pain. Additionally, words can be worse, as the damage of psychological abuse equals or outweighs the damage of physical abuse. So whilst words are clearly not the same as physical violence, that doesn’t mean they can’t be violent.

Now, let’s move on to another point they make: “Students seem to be reporting more emotional crises; many seem fragile”. These statements are curious. Firstly, somebody with a mental health or wellbeing ‘crisis’ is at risk of significantly harming themselves or others.

Most people, most of the time, are not in a state of ‘crisis’, nor would most students claim to be. And the problem is framed as the inherent fragility of the students, rather than emotional distress being a rational response to the way things are at the moment. They hedge this with “We do not mean to imply simple causation, but…” and then go on to do essentially that.

There is no mention of the fact that American college prices are utterly extortionate, and unemployment high in the young. America has been at war for most of students’ lives. Privacy is now essentially nonexistent, people’s very bodies are becoming objects as women and men are increasingly exposed to unnatural and unrealistic ideals. Lives are doctored through social media, so everyone else looks like they’re doing great while the gap between the haves and the have-nots in America is bigger than ever. More people are going to university, making it more competitive, yet job prospects are poor. This wasn’t always the case with university degrees.

Indeed, the two well-off men who wrote this article forgot, or just didn’t know, that the biggest predictor of ‘mental health’ and wellbeing problems in any society is its socioeconomic inequality.

That’s right, Socioeconomic inequality, and America does not do well on that front. On top of this, socioeconomic inequality is directly threatening university students. It seems staggering, if not downright insulting, that anyone could claim in light of this that students’ suffering is primarily due to their own faulty thinking patterns and oversensitivity to ‘triggers’.

Regarding ‘triggering’, the phrase ‘trigger warning’ can indeed be used thoughtlessly, or overmuch. Pre-discussions about potentially upsetting content, however, aren’t unreasonable. We often have these in my doctorate; it teaches us to trust and understand our rational and emotional responses together, wisely.

It also makes us realise things that weren’t a problem for us might still be a problem for someone else – the ‘social learning’ of which Haidt and Lukianoff warn is not learning to fear what others fear, but learning how to empathise with others who are bothered by things that we aren’t. Finally, it facilitates learning, because animals physically can’t learn when overly stressed and anxious.

They say of this: “However, there is a deeper problem with trigger warnings. According to the most-basic tenets of psychology, the very idea of helping people with anxiety disorders avoid the things they fear is misguided.” They appear to use one particular branch of psychological therapy to represent both their argument, and psychology as a whole.

It is difficult to provide an semi-objective reply to authors who have suggested that microaggressions based on societal oppression and ‘anxiety disorders’ are the same thing. It’s a struggle to understand quite how the cognitive leap from one to the other occurred.

The Cognitive Behaviour Therapy (CBT) data to which they refer is based on samples of people who have clinical diagnoses of anxiety disorders. The most ‘basic’ tenets of cognitive behaviour psychology suggest that, in people with anxiety disorders, exposing themselves to things they fear will habituate them, so long as this exposure doesn’t result in a negative outcome like a poisonous spider bite or falling off a high ledge.

CBT is effective for anxiety disorders not just because it exposes people to unpleasant thoughts and situations. It also provides through learned experience for individuals to see their fears aren’t as bad as they first thought. However, if your so-called ‘distortions’ are proved true through experience, then you are unlikely to be ‘cured’ as Haidt and Lukianoff suggest. This is why behavioural experiments must be chosen carefully – not to ‘fix’ a positive outcome, but to test reasonable situations. Indeed, Martin Seligman’s theory of learned helplessness suggests that the more you are exposed to negative stimuli over which you have no control, the more likely you are to get depression.

Microaggressions are rooted in real societal inequality. They cause a complex range of emotions, from anger, shame, confusion, self-consciousness, and perhaps fear if the person microaggressing seems threatening. The point is, there is an extraordinary gap between CBT for anxiety disorders, and calling people out on societally oppressive actions and comments.

Now, some people who ask for certain things (e.g. rape not to be included on an exam paper) may have PTSD or an anxiety disorder. However, that is a separate issue to ‘microaggressions’ as a whole, and should be dealt with on a purely individual basis – though I don’t see the problem in at least asking about individual support.

Additionally, we can make the argument there are some ideas we would rather people not be habituated to such as violence, hardcore porn or constant absorption in technology for example. Perhaps society-wide habituation is simply what we call ‘the norm’. In the case of microaggressions, is habituation for the people oppressed by societal power dynamics really what we want?  There is a statement about calling people up on microaggressions which has almost become proverbial:

“If you step on my foot, you need to get off my foot. If you step on my foot without meaning to, you need to get off my foot. If you step on my foot without realising it, you need to get off my foot.”

The last thing we should be doing is habituating people to having their foot stepped on. But this seems to be what Haidt and Lukianoff support by saying: “What are we doing to our students if we encourage them to develop extra-thin skin in the years just before they leave the cocoon of adult protection and enter the workforce? Would they not be better prepared to flourish if we taught them to question their own emotional reactions, and to give people the benefit of the doubt?”.

People from oppressed groups don’t suddenly hit university and therefore enter a “cocoon of adult protection” where discrimination no longer exists. They are, in fact, consistently taught to question their own emotional reactions to microaggressions, and to give people the benefit of the doubt, their entire lives. An example is women being harassed – ‘boys will be boys’, he ‘didn’t mean anything by it’, or the ever-present ‘it was a compliment’. People don’t need more of this.

Of course banning books like Huckleberry Finn isn’t appropriate. Treating such books, concepts and ideas with context, consideration and respect is appropriate. Demonising people based on their ignorant comments is an understandably contentious matter; there are unresolved arguments regarding “letting people learn” versus “when can we stop catering to the privileged”. However, the middlespace between intellectual freedom and respect is still being hashed out.  And people who have systematically been ignored and oppressed are angry. They have every right to be.

In their deep analysis of how this ‘situation’ came about, Haidt and Lukianoff fail to see that oppression and microaggressions may be becoming more prevalent discussions points on college campuses simply because people from traditionally marginalised groups are now more likely to go to universities in the first place.

Haidt and Lukianoff suggest “students should also be taught how to live in a world full of potential offenses”, but don’t seem to consider that this is exactly what people of oppressed demographics are doing by being vocal about microaggressions. They are probably pretty good at navigating the ‘offence’-laden system actually, having got to university in the first place. Now they’re trying to change it.

Perhaps we don’t want to prepare students for ‘the workforce’ as it stands. There is still racism, sexism and homophobia, particularly at higher levels of employment. There is still a gender pay gap. People’s income is still more likely to match that of their parents’ income, their skin colour, and their gender, than that of their potential. Why would anyone suggest people take therapy to get used to this system, rather than trying to change it? There is a balance to be had with dealing with and accepting current circumstances, whilst also committing to make changes where possible.

Is it not more reasonable to suggest that during their university education, students start to think about the actions that their words perform, instead of pretending ‘academia’ and ‘intellectual debate’ happens in a vacuum? Might it not be academically important to consider the context of one’s ideas, where they come from and why, and moreover in whose interests these ideas work?

If these ideas are perceived to be dangerous, and “fear of federal investigations” and “fear of unreasonable investigation and sanction” are rife within institutions, then perhaps it is not the students who should be receiving therapy for their dysfunctional thinking patterns.

Perhaps, instead, we should deal with the cognitive distortions within the system.

Microaggressions and Trigger Warnings Are Being Deemed Liberal Views Limiting College Students

PreCollegeProgramLL

After reading the article Coddling of the American Mind in the Atlantic, I felt compelled to pen a response. The article suggests that ‘liberal’ views about use of language, ‘trigger warnings’, microaggressions, and avoiding offensive language are damaging to university students’ academic progression and their emotional wellbeing. The discussion here will be in several parts, the first part considers the article’s origins and underlying assumptions.

The article is a worthwhile read after taking into consideration the initial response it elicits. There are references to evidenced based therapies such as Cognitive Behaviour Therapy (CBT), and many examples were given to support their points. Here is an excerpt:

Two terms have risen quickly from obscurity into common campus parlance. Microaggressions are small actions or word choices that seem on their face to have no malicious intent but that are thought of as a kind of violence nonetheless. For example, by some campus guidelines, it is a microaggression to ask an Asian American or Latino American “Where were you born?,” because this implies that he or she is not a real American. Trigger warnings are alerts that professors are expected to issue if something in a course might cause a strong emotional response. For example, some students have called for warnings that Chinua Achebe’s Things Fall Apart describes racial violence and that F. Scott Fitzgerald’sThe Great Gatsby portrays misogyny and physical abuse, so that students who have been previously victimized by racism or domestic violence can choose to avoid these works, which they believe might “trigger” a recurrence of past trauma.

The people who wrote this article are rich, white-skinned and well-established men, who work at the moment in business-type jobs. Jonathan Haidt has an incredible list of credentials, including top American universities, a Fulbright scholarship, and a long string of psychological research initiatives – ending in an evolutionary-based model of morality, which suggests that political conservatives have a wider moral base than political liberals. One foundation of Haidt’s theory of morality includes ‘respect for traditions’ and ‘deference to legitimate authority’. A simple reading doesn’t make clear whose authority should be counted as legitimate.

Greg Lukianoff is a “First Amendment lawyer” who spends his time purporting the right to free speech. He describes himself as politically liberal and has written books about unlearning liberty and how to have free speech on university campuses. In 2008, he received the Playboy Freedom of Expression Award ($25,000 for advocates of the First Amendment) and has written for a whole host of well-known media outlets.

The text itself begins with an anecdote about anecdotes. In other words, Haidt and Lukianoff reference an article about teaching rape law, which provides examples of college students being ‘oversensitive’. This includes students who ‘complained’ there should have been a warning before showing a video of a sex abuse investigation in class, and a student who asked, for personal reasons, that rape not be included on exam material. Following this, they provide a list of names of people who apparently agree with them. This includes an article by a ‘liberal professor’ who states he is scared of oversensitive students, which was actually later contested by a ‘liberal professor’ via the same media source, and even later contested by second professor, again via the same media source.

This tactic arguably places the authors in an apparently popular and reasonable position as stated by this professor. It’s presenting them as people who say what needs to be said in a dark era of closing down reasonable discussion due to ‘offence’. They include teachers, liberals, a woman, a black comedian and a white comedian. It fits well with current Western political rhetoric, especially in Britain and America. After all, ‘political correctness’ is no longer considered a synonym for ‘respect’ but for unnecessary censorship. And they use broad anecdotes to support this.

Another broad brush the authors use is the term ‘microaggressions’.  Dr. Derald Wing Sue in his book, Microaggressions in Everyday Life, gives a great overview of what they are, and how they affect different demographics. In essence, microaggressions reveal our unconscious biases and assumptions – if you’re interested, you can find out about some of your unconscious prejudices here. Because Western society frowns upon, and legislates against, actively hateful discrimination and incentives to violence, people tend to avoid overt demonstrations of prejudice. Prejudice is expressed more subtly, i.e. with microaggressions.

There is plenty of literature about how microaggressions are insidious and inherently damaging to wellbeing – the idea was conceived by Chester Pierce in the 1970’s and it was further developed in the 1990’s. This is not a term that has suddenly started to be bandied about on college campuses. It’s been present in literature for a while, and finally this literature is filtering to the public. One of the implicit messages present in Haidt and Lukianoff’s argument is that microaggressions are a newfangled pop-culture concept with little inherent value – “risen quickly from obscurity into common campus parlance (read: where it does not belong)”.

Coupled with this, they obscure the meaning of ‘microaggression’. The crux of Haidt and Lukianoff’s argument is that they appear to consider each microaggression as an individual event. And, of course, when you take something so small as an individual event, and totally out of context, it looks silly. But empirically, that is not how microaggressions are meant to be considered – it’s the aggregate of thousands of microaggressions throughout a person’s lifetime that makes them damaging. Actions deemed as microaggressions have no power by themselves. Think about a bee. A single bee sting does just that – it stings, it hurts. But overall there’s not much damage. The entire hive going after you at once, however, can kill. There’s a special word for this – synecdoche, where a small part of something symbolises the whole.

So, Haidt and Lukianoff ignore the context of why microaggressions are so dangerous: 1) Because they are present everywhere, all the time, and they steadily wear people down, 2) Each individual instance is so small it can be dismissed, which 3) Makes the less privileged person seem over-reactive to small misdemeanours, and therefore 4) Means nobody has to do anything about it.

Crucially, they pretend ‘microaggression’ is a monolithic term. They ignore the range of different ways microaggressions can present themselves – including using an identity as an insult (“don’t act like a girl”, “that’s so gay”), and assuming white male straightness is default (after all, gay marriage is just marriage, women’s football is just football). They ignore a huge power of microaggressions – that of erasure.

There is literally ‘nothing’ to complain about when mixed gender groups are called ‘guys’ not ‘girls’, when bisexuals are absent from discussions on the ‘gay agenda’, people are surprised when the boss is black, and when Asian women basically don’t speak in modern Western media. Indeed, it’s considered rude to reject well-meaning attempts to assimilate a person into the norm (“You don’t act gay” as a compliment, “I’m colourblind”, or “We’re all the same, gender doesn’t matter to me”).

Ironically, Haidt and Lukianoff don’t mention erasure as a microaggression at all in their discussion. They instead appear to condense all possible infractions against a minority/oppressed group as ‘offence’ at something. Even though they explicitly mention the phrase ‘I’m colourblind’ as part of an anecdote they don’t seem to pick up on what it means. And it’s on this reductionist basis they build much of the rest of the article. Whilst every point they make will not be looked at, it is worth thinking of an example they provide: “It is a microaggression to ask an Asian American or Latino American “Where were you born?”.

Of course asking an Asian-American where they were born isn’t an inherent microaggression. Haidt and Lukianoff don’t provide a reference to ‘some campus guidelines’ which have stated this. If people are talking about having been born in a different place to where they now live, then it’s not unheard of to ask about birthplace. That said, usually one would ask where people are from, not where they were ‘born’.

Either way, it’s not always microaggressive – it’s about context. If a person has only just met someone, or doesn’t know them too well, birthplace is generally not top of conversation topics. Haidt and Lukianoff’s assumption is that it’s not the university’s blanket and over-simplified definition of microaggression that’s the problem; they assume that the acknowledgement of microaggressions is in of itself is problematic.

They follow up with some additional isolated examples of microaggressions-gone-wild, coupled with the term “some recent campus actions”. Then they state: “This new climate is slowly being institutionalized, and is affecting what can be said in the classroom, even as a basis for discussion”. Perhaps this assumes that students aren’t already institutionalised and that the system as it was should be preserved. From this, it seems one of their  assumptions is that the system was better before students started speaking out about these issues i.e. the authors want to “restor[e] universities to their historic mission”.

There also seems to be an undercurrent of “we are rational and logical” versus “the oppressed (read: offended by microaggressions) are emotional” – the nuances of this will be addressed later as part of a discussion about ‘psychological harm’, ‘emotional wellbeing’ and ‘safe spaces’. It seems interesting that whilst the authors place themselves in this rational and non-emotional position, they deliberately coin the strongly-worded term vindictive protectiveness, which means ‘punishing people’ who interfere with the (admittedly atrocious) aim of ‘protecting students from psychological harm’. This is possibly a touch.. catastrophising, as CBT therapists might say.

Additional catastrophising themes include punishment and charges towards innocent victims (people who get called up on microaggressions). This is in spite of their earlier assertion that students should get themselves used to “words and ideas that they will inevitably encounter”, such as, for example, the idea that microaggressions exist and are damaging. Linguistically, microaggressions have now been reduced to words and ideas rather than oppressive actions, and also put on a par with common intellectual debate and discussion, which allows Haidt and Lukianoff to treat them as though they are the same thing.

This is something to bear in mind, as future posts will consider the content of their article, beyond some of its basic assumptions. To finish this particular analysis, readers will be left with one very telling quote about what the problem with microaggressions appears to be: “It is creating a culture in which everyone must think twice before speaking up, lest they face charges of insensitivity, aggression, or worse.”

So, to be clear, they are concerned about having to think before they speak.

As in, having to consider other people’s reaction to their words.

Otherwise one might get.. criticised.

But Haidt and Lukianoff aren’t being oversensitive, of course.

Acceptance and Commitment Therapy: A Different Approach to Anxiety Disorders

Most coping techniques that teach people how to handle their abnormal anxieties focus on skills that reduce, replace, and avoid discomfort. These techniques are many that I have tried for my own anxiety including deep breathing, relaxing music, muscle relaxation, and more.

Cognitive behavioral therapy teaches people to control and change their upsetting feelings and thoughts. On the other hand, Acceptance and Commitment therapy teaches people not to change their thoughts or feelings but to change the way they react to them. The three steps of Acceptance and Commitment Therapy are; accept, choose, and take action.

According to Psychology Today,

Acceptance and Commitment Therapy (ACT) is a type of psychotherapy that helps you accept the difficulties that come with life. ACT has been around for a long time, but seems to be gaining media attention lately. Categorically speaking, ACT is a form of mindfulness-based therapy, theorizing that greater well-being can be attained by overcoming negative thoughts and feelings. Essentially, ACT looks at your character traits and behaviors to assist you in reducing avoidant coping styles. ACT also addresses your commitment to making changes, and what to do about it when you can’t stick to your goals. Read More

  1. Acceptance: Acceptance of anxious feelings means learning how to observe and sense them without judgment. Instead, you are able to use compassion and gentleness when confronted with anxiety, fear, worry, panic, and other sensations that may cause discomfort.
  2. Choose: This step is where you decide how you want your life to go. You can ask yourself do I want to remain a prisoner to this anxiety or do I want to live a fulfilling meaningful life?
  3. Take Action: This is by far the hardest step. This involves accepting that in order for things to change you much change your behavior. Taking action means facing your fears and anxieties and making them a small part of your life instead of something that consumes you.

To learn more about Acceptance and Commitment Therapy check out the book:  The Mindfulness & Acceptance Workbook for Anxiety by John P. Forsyth and Georg H. Eifert.

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