Beacon Broadside

The Real Problem With the "Real Beauty" Campaign

Laurie Essig teaches sociology at Middlebury College in Middlebury, Vermont. She has written for a variety of publications, including Legal Affairs, Salon, and the Chronicle of Higher Education. She is the author of American Plastic: Boob Jobs, Credit Cards, and Our Quest for Perfection.

This post originally appeared on her blog, Love Inc., at Psychology Today.

Dove's "Real Beauty" has another stunning commercial. In this one, "Real Beauty Sketches," a forensic artist sits with his back turned as a woman describes how she sees herself. He draws her image. Then another woman, an acquaintance, is brought in to describe how she sees the first woman. He draws that image. In the denouement, the woman is forced to look at the portrait he made from her own description and compare it to the far more attractive and realistic one described by her acquaintance. In other words, it is a beautiful illustration of something we already know: women have a warped sense of how they look. 

But women's hatred of the way they look didn't just appear out of thin air. It was implanted in us in a variety of ways, but primarily through advertising that uses "idealized" images of beauty and asks us to compare ourselves to them.

After all, women and girls didn't think a whole lot about how they looked before capitalism. Historians such as Joan Brumberg have shown that adolescent girls prior to advertising tended to think about their inner make-up-- were they kind and good and devout. But with advertising early on telling women to buy creams, "slim" down, put on a bra and generally engage in what Brumberg calls the "body project," young girls started to worry far more about cellulite on their thighs than goodness in their hearts. Some social psychology studies indicate that even women with high levels of self-esteem will feel worse about themselves after looking at these idealized images found in advertising.

 So capitalism created the problem of women being ugly and also created the solution: beauty products. It is an ingenious business plan. Add to this beauty business certain technologies, such as cosmetic surgery and Photoshop, and you have the completely unreal moment in which we now reside where women spend inordinate amounts of money attempting to make themselves look like images of women who don't actually exist. We are caught trying to be a copy of a copy without an original. 

This beauty matrix is surely gendered (and raced and classed). Most studies show that women in conditions of hypercapitalism do in fact feel far worse about themselves than men. That's why parodies of the Dove "Real Sketches" have already popped up, with men describing themselves as far more beautiful than others see them. It's funny because it's true. Men aren't as important to the $160 Billion per yearbeauty product industry and continue to make up only about 5% of cosmetic surgery patients. 

So women- caught in a web of being sold ugliness and the promise of beauty- can be startled, even moved to tears, watching Dove's "Real Sketches," whereas for many men the body project seems laughable.

But is the solution really loving the way we look? With the aid of products that help us look more "natural" such as those sold by Dove? Or is the solution actually outside the values of the market? "Erotic capital" has always been traded among humans, but the sort of erotic capital that is now demanded from the standards set by advertising is unattainable. Even if we starve ourselves, remain young forever, and get a lot of expensive cosmetic surgery to "perfect" our features, we still exist in a world where blemishes are not touched up, eyes not made brighter, and teeth whiter whenever we look at ourselves.  Unless we can figure out a way to Photoshop our real bodies rather than images of them, we are stuck with imperfection.

Rather than telling women that they are in fact beautiful, it might be far more revolutionary to say beauty, real or otherwise, just isn't as valuable as other forms of capital, like educational capital or the sort of "goodness" that was valued by girls before the age of advertising.

 

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Monday Classics: Toward a New Psychology of Women

Women’s History Month Classics: In the thirty-five years since its publication, Toward a New Psychology of Women by Jean Baker Miller, MD, has become famous for its groundbreaking demonstration of how sexual stereotypes restrict men’s and women’s psychological development. Wendy Strothman, former Beacon director, called it “one of our books that overturn an entire field.”

Toward a New Psychology of Women is $9.99 during Women's History Month at Beacon.org.

The following excerpt is from Chapter 4: Strengths

Today in psychotherapy a central place is given to feelings of weakness, vulnerability, and helplessness, along with their usual accompaniment, feelings of neediness. These are feelings we have all known, given the long period necessary for maturational development in human beings and, in our society, given the difficulties and lack of support most of us suffer during childhood and indeed in our adult lives. Such feelings are, of course, most unpleasant—in their extreme, they are terrifying—and several schools of psychodynamic thought postulate that they are the root causes of various major “pathologies.” In Western society men are encouraged to dread, abhor, or deny feeling weak or helpless, whereas women are encouraged to cultivate this state of being. The first and most important point, however, is that these feelings are common and inevitable to all, even though our cultural tradition unrealistically expects men to discard rather than to acknowledge them.

Two brief examples illustrate this contrast. Mary, a gifted and resourceful young hospital worker with two children, was offered a new and more demanding position. She would lead a team attempting an innovative approach to patient care. It involved greater scope for the team members and for Mary a harder job of coordination and negotiation of the workers’ anxieties and difficulties. Mary’s immediate reaction was to worry about her ability to carry out the project; she felt weak and helpless in the face of the formidable task. At times, she was convinced she was totally incapable of doing the job and wanted to refuse the offer.

Her worry was in some measure appropriate, for the position of team coordinator was a difficult and demanding one that should be approached only after rigorous self-evaluation. She was, however, extremely able and had demonstrated the abilities necessary for the position. She retained some common feminine problems—having trouble admitting to, and easily losing sight of, her strengths. A clear recognition of her own competence would mean the loss of the weak, little-girl image to which she clung, in spite of its obvious inaccuracy. While some fear about the job seemed justified, her reluctance to relinquish the old image exaggerated the fears.

By contrast, a man, Charles, who was also very gifted, had the opportunity to take a higher-level job, and he was very pleased. In its administrative requirements and responsibilities it was similar to Mary’s and was equally demanding. Just before he undertook the new job, he developed some fairly severe physical symptoms; characteristically he did not talk about them. His wife, Ruth, however, suspected that they were caused by his anxieties about facing the tasks ahead. Knowing him well, she did not mention the problem directly, but opened up the topic in the only way she felt able. She suggested that it might be a good idea to make some changes in their diet, hours, and general lifestyle. His initial reaction was one of anger; he disparaged her, sarcastically telling her to stop bothering him. Later he admitted to himself, and then to Ruth, that when he feels most uncertain of his abilities and most in need of help, he can react only with anger—especially if anyone seems to perceive his neediness.

Fortunately, Charles is trying hard to overcome the barriers that keep him from acknowledging these feelings. His wife’s attempts opened up the possibility of dealing with them. He could not have initiated the process himself. He could not even respond to her initiation immediately, but this time, fairly soon after the fact he was able to catch himself in the act of denying it. Ruth easily might have remained rejected, hurt, and resentful, and the situation could have escalated into mutual anger and recrimination at the very time he was feeling most vulnerable, helpless, and needy.

It is important to note also that Ruth was not being rewarded for her strengths. Instead, she was made to suffer for them—by anger and rejection. This is a small example of how women’s valuable qualities are not only not recognized but are punished instead. Even in this case, Ruth was not able to state her perceptions openly. She had to use “feminine wiles.” Important qualities such as understanding of human vulnerabilities and offerings of help can thus be dysfunctional in relationships as they are presently structured and can make a woman feel she must be wrong.

In no society does the person—male or female—emerge full-grown. A necessary part of all experience is a recognition of one’s weaknesses and limitations. That most valuable of human qualities—the ability to grow psychologically—is necessarily an ongoing process, involving repeated feelings of vulnerability all through life. As the example of Charles illustrates, men have been conditioned to fear and hate weakness, to try to get rid of it immediately and sometimes frantically. This attempt, I believe, represents an effort to distort human experience. It is necessary to “learn” in an emotional sense that these feelings are not shameful or abhorrent but ones from which the individual can move on—if the feelings are experienced for what they are. Only then can a person hope to find appropriate paths to new strengths. Along with new strength will come new areas of vulnerability, for there is no absolute invulnerability.

That women are better able than men to consciously admit to feelings of weakness or vulnerability may be obvious, but we have not recognized the importance of this ability. That women are truly much more able to tolerate these feelings—which life in general, and particularly in our society, generates in everybody—is a positive strength. Many adolescent boys and young men especially seem to be suffering acutely from the need to flee from these feelings before they experience them. In that sense, women, both superficially and deeply, are more closely in touch with basic life experiences—in touch with reality. By being in this closer connection with this central human condition, by having to defend less and deny less, women are in a position to understand weakness more readily and to work productively with it.

In short, in our society, while men are made to feel weak in many ways, women are made to feel weaker. But, because they “know” weakness, women can cease being the “carriers” of weakness and become the developers of a different understanding of it and of the appropriate paths out of it. Women, in undertaking their own journey, can illuminate the way for others.

Until now, women who are already strong in many ways still have had a hard time admitting it. Mary, the woman in the example, illustrates this problem. But even when weakness is real, women can go on to strength and ability once they can convince themselves that it is really all right to let go of their belief in the rightness of weakness. Only someone who understands women can understand how this psychic element operates, how widespread and influential the fear of not being weak can become, and how persistently it can hang on without being recognized for what it is. It is very difficult for men, with their fears of weakness, to see why women cling to it and to understand that it does not, and could not possibly, mean the same thing for women as it does for men.

There is a further social point here. The fact that these feelings are generally associated with being “womanly,”—hence unmanly—serves to reinforce the humiliation suffered by the man who has such experiences. Women, in the meanwhile, provide all sorts of personal and social supports to help keep men going and to keep them and the total society from admitting that better arrangements are needed. That is, the whole man-woman interaction thus dilutes the push to confront and deal with our societal deficiencies. We all experience too much danger as we attempt to grow and make our way in the difficult and threatening circumstances in which we live. We all lose in the end, but the loss is kept obscure.

Further Reading

Q&A With Jean Baker Miller for Changing the Face of Medicine.

Jean Baker Miller's Obituary in the New York Times.

The Death of Chris Kyle and the Need for Soul Repair

Rita Nakashima Brock, Ph. D. is Founding Co-Director of the Soul Repair Center at Brite Divinity School.(www.britesoulrepair.org). She was a professor for twenty years, directed the Fellowship Program at the Radcliffe Institute for Advanced Study, Harvard University, a prominent advanced research institute, and from 2001-2002, was a Fellow at the Harvard Divinity School Center for Values in Public Life. Her latest book is Soul Repair: Recovering from Moral Injury After War, co-authored with Gabriella Lettini.

The killing of Iraq veteran and national figure Chris Kyle prompted media queries and questions for the three of us who run the Soul Repair Center at Brite Divinity School. Our Center is dedicated to recovery from moral injury in veterans. Rev. Dr. Coleman Baker, Chaplain (Col.) Herman Keizer, Jr. (ret.) and I spent a day reflecting together on what went wrong when Kyle tried to help a fellow vet. Here are some of our reflections.

Chris Kyle, a well-decorated Navy SEAL sniper, completed four tours in Iraq with an extraordinary record of kills. Kyle's book about his experiences in the clandestine fraternity gained him much admiration. Then, a week ago on a firing range in Texas, Eric Routh, a Marine reservist who served in Iraq, killed him and his fellow veteran Chad Littlefield.

Kyle was beloved by many because he tried to support his fellow vets in returning to civilian life, but it seems clear that Kyle himself never really left the military. He overcame his own struggles with alcohol and a fear of leaving his house by re-building a military cocoon as a means of therapy. Kyle's idea of what worked best for returning veterans was the military espirt de corps of an active unit. He used the tools of his military experience at his Fitco Care Foundation, designing treatments built on exercise, counseling and veteran camaraderie. And he kept a live-fire range open and invited others to shoot for therapy.

He recreated the military world of heroism both at work and with other vets. He wanted veterans to be seen as strong and heroic, like soldiers who serve honorably and heroically and for the sake of others. His life was dedicated to still being part of the war. "Being able to do this makes me feel like I'm still a part of it and still giving back."

In trying to treat Eric Routh by echoing his war experience, Kyle, who sought to stay in war, may have provoked a desperate Routh to seek escape from such "help." By not questioning whether military values can simply be relived in civilian life, Kyle failed to understand difficulties some returning vets might have with a "HOOHA" model of counseling and training, especially those with traumatic brain injuries, PTSD, and moral injury. For veterans who feel betrayed by the government, have serious trauma, or experience a collapse of moral meaning after war, more exposure to military life can compound the difficulty of adjusting to the civilian world.

In a telling comment, however, about his first kill in Iraq, Kyle hints at the personal cost of leaving his cocoon: 

It was hard trying to wrap my mind around "Well, how can I shoot another human being?" And even the first time I had to do it, they're yelling at me. "You have to do it! Take it! Take it!" And it's still trying to get over the fact that, well, I'm fixin' to have to kill someone.

 

And then you do it, and you have to think of it differently. You're not killing a person, you're killing an enemy that if you don't do it, they're gonna kill your guys. ... You have to de-humanize it, so you don't go crazy.

In his civilian life, Kyle continued this strategy of de-humanizing his enemies. He referred to people in Iraq as "savages." He also dismissed civilians as shallow and selfish. 

We think Kyle had a good point about civilian society. The care for each other unto death and the willingness to die in service to others bonds a combat unit in ways that are rare in civilian life. During the Iraq War, civilians were shielded from images of coffins returning home and were advised to shop, rather than make personal sacrifices to support the troops. The narcissism, personal ambitions, and self-obsessions with consumerism and celebrity culture have prompted some veterans to ask, "I fought for this?"

Without a new social, emotional, spiritual system that can help veterans of war move from a military system to civilian life, we sentence many of them to military cocoons or lonely states of limbo from which transition is nigh impossible.

Few institutions in our culture ask people to commit to each other over the whole life course, from birth to death. Few organizations welcome strangers and include them in a community of care; attend to those who need help, feel hurt or are troubled in their souls; and hold each other accountable for living into their best selves in circles of generosity and reciprocity. These commitments of lifelong weekly activities describe congregational life. Though no congregation does them perfectly, most try their best, and many do them well.

We believe that congregations are one place that should be welcoming veterans home, but few have committed to this work. It should not be undertaken with just simple good intentions, though good intentions matter a great deal. To welcome veterans into a community's life, we need to understand how to assist the transition from the values of military life to religious life. We must advocate for better services for treating PTSD, and we must support veterans' families and all they go through to welcome veterans home.

We mourn the deaths of Chris Kyle and Chad Littlefield. They are tragic, senseless killings that have left their families and friends with unimaginable loss. We may never know why they were killed. However, we hope their deaths can help us all better understand the complicated and difficult return to civilian life for combat veterans and see this as an important responsibility of us all.

Without adequate ways for veterans to process their war experience, reflect on its moral and psychological impact, and restore them to civilian life, we fail as a society to bring them all the way home. Tragically, just before he died, Kyle hinted he might be ready to come home. He wanted to slow down and just take care of his family, saying he was tired: "I'm just trying to be the me that I am and not all of this other crap."

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The Pursuit of Happiness, or a Search for Meaning?

Today's must read: The Atlantic posted this piece by Emily Esfahani Smith on the debate over happiness vs. a meaningful life, using the work of Viktor Frankl as inspiration: 

In 1991, the Library of Congress and Book-of-the-Month Club listedMan's Search for Meaning as one of the 10 most influential books in the United States. It has sold millions of copies worldwide. Now, over twenty years later, the book's ethos -- its emphasis on meaning, the value of suffering, and responsibility to something greater than the self -- seems to be at odds with our culture, which is more interested in the pursuit of individual happiness than in the search for meaning. "To the European," Frankl wrote, "it is a characteristic of the American culture that, again and again, one is commanded and ordered to 'be happy.' But happiness cannot be pursued; it must ensue. One must have a reason to 'be happy.'"

According to Gallup , the happiness levels of Americans are at a four-year high -- as is, it seems, the number of best-selling books with the word "happiness" in their titles. At this writing, Gallup also reports that nearly 60 percent all Americans today feel happy without a lot of stress or worry. On the other hand, according to the Center for Disease Control, about 4 out of 10 Americans have not discovered a satisfying life purpose. Forty percent either do not think their lives have a clear sense of purpose or are neutral about whether their lives have purpose. Nearly a quarter of Americans feel neutral or do not have a strong sense of what makes their lives meaningful. Research has shown that having purpose and meaning in life increases overall well-being and life satisfaction, improves mental and physical health, enhances resiliency, enhances self-esteem, and decreases the chances of depression. On top of that, the single-minded pursuit of happiness is ironically leaving people less happy, according to recent research. "It is the very pursuit of happiness," Frankl knew, "that thwarts happiness."

Read the rest at Atlantic.com

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Free Copies of Books About Death and Grieving

Our deepest condolences go out to the families and friends of those who lost their lives in Newtown, CT. We share the grief that is felt throughout the country. To help families, teachers, counselors, and others who are having conversations about death and grief in the wake of this tragedy, Beacon Press is offering free copies of Talking About Death: A Dialogue between Parent and Child and Living When a Loved One Has Died both by Dr. Earl A. Grollman. We hope these resources will help everyone affected begin to heal. Simply choose one or both books and submit your shipping information by Wednesday, December 19, 2012.

Visit our website to request a free copy of one or both of these books. And please share this post with anyone who might need it. 

Soul Repair: Recovering from Moral Injury After War

The first book to explore the idea and effect of moral injury on veterans, their families, and their communities 

Although veterans make up only 7 percent of the U.S. population, they account for an alarming 20 percent of all suicides. And though treatment of post-traumatic stress disorder has undoubtedly alleviated suffering and allowed many service members returning from combat to transition to civilian life, the suicide rate for veterans under thirty has been increasing. Research by Veterans Administration health professionals and veterans' own experiences now suggest an ancient but unaddressed wound of war may be a factor: moral injury. This deep-seated sense of transgression includes feelings of shame, grief, meaninglessness, and remorse from having violated core moral beliefs. 

Rita Nakashima Brock and Gabriella Lettini, who both grew up in families deeply affected by war, have been working closely with vets on what moral injury looks like, how vets cope with it, and what can be done to heal the damage inflicted on soldiers' consciences. In Soul Repair, the authors tell the stories of four veterans of wars from Vietnam to our current conflicts in Iraq and Afghanistan—Camillo "Mac" Bica, Herman Keizer Jr., Pamela Lightsey, and Camilo Mejía—who reveal their experiences of moral injury from war and how they have learned to live with it. Brock and Lettini also explore its effect on families and communities, and the community processes that have gradually helped soldiers with their moral injuries. 

Soul Repair will help veterans, their families, members of their communities, and clergy understand the impact of war on the consciences of healthy people, support the recovery of moral conscience in society, and restore veterans to civilian life. When a society sends people off to war, it must accept responsibility for returning them home to peace.

Click here to read an excerpt of Soul Repair on Beliefnet.com

Click here to read an excerpt of Soul Repair on Scribd.

"Soul Repair is an eloquent, deeply human reminder that war is not just what takes place on a distant battlefield. It is something that casts a shadow over the lives of those who took part for decades afterwards. The stories told by Lettini and Brock are deepened by what the authors reveal about the way the tragic thread of war's aftermath has run through their own families."—Adam Hochschild, author of To End All Wars 

"Those you send to war may come home with souls unclean and hearts drowning in bitter mistrust. But the need for purification after battle has vanished into the blind spot of our culture. We neither offer it to returning veterans, nor remember that we-for whose sake, in whose name, our soldiers went to war-need purification with them. Potent challengers of conventional thinking, rich in heart, those who speak here are voices you will not forget." —Jonathan Shay, MD, PhD, author of Odysseus in America: Combat Trauma and the Trials of Homecoming 

"Very important and deeply moving. I strongly recommend it."—James H. Cone, author of The Cross and the Lynching Tree 

"Soul Repair is stunning, just beautiful. Riveting. This is not just a breakthrough book, it is a breakthrough moment, the kind of work that makes history shift and emotions adjust. It restores balance and reclaims life." —Amir Soltani, author of Zahra's Paradise 

"Eloquent and unflinching discourse on war's problematic moral core."—Publishers Weekly

‘Unfortunate Experiments’ in New Zealand and Minnesota

Carl Elliott is the author of White Coat, Black Hat: Adventures on the Dark Side of Medicine. Elliott is a professor at the Center for Bioethics at the University of Minnesota. His work has appeared in The New Yorker, Atlantic Monthly, the Believer, Slate, the London Review of Books, and theAmerican Prospect. His six previous books include Better Than Well, Prozac As a Way of Life, Rules of Insanity, and A Philosophical Disease.

This post originally appeared at the Chronicle of Higher Education's Brainstorm blog.

Another spectacular winter morning in Dunedin, New Zealand. Clear blue sky, frost on the ground, lush green hills plunging into the South Pacific. It is hard to complain about the setting, still less about the kindness and decency of the inhabitants. It has been nearly 22 years since my wife and I first landed in Dunedin, in August of 1990, when I began a postdoctoral fellowship at the newly established Bioethics Centre at the University of Otago. I still wonder why we ever left.

It was an extraordinary time for bioethics in New Zealand. In 1990, the country was still reeling from the shock of a medical research scandal—the “unfortunate experiment” at the National Women’s Hospital in Auckland. In that study, which had begun in 1966 and continued for another two decades, Dr. Herbert Green, an obstetrician-gynecologist, deliberately withheld treatment of 160 women with abnormal cervical smears in an effort to prove his misguided hypothesis that the cervical abnormalities would not lead to cervical cancer. Green enrolled women in the study without their knowledge or consent. Three of Green’s colleagues at Auckland University, Bill McIndoe, Jock McLean, and Ron Jones, tried to put a halt to the experiment for years, but they were ignored until they published a 1984 article in Obstetrics and Gynecology showing that the untreated women were 25 times more likely to develop invasive cancer. According to the Cartright Inquiry, the governmental commission set up to investigate the scandal, this amounted to a total of approximately 40 women developing invasive cancer, many of whom died.

The Medical Council of New Zealand eventually brought disciplinary action against Green and his superior, Dr. Denis Bonham. While the charges against Green were dropped because of Green’s poor health, the Council found Bonham guilty of disgraceful conduct. More importantly, the results of the Cartwright Inquiry led to dramatic changes in the oversight of medical research in New Zealand—among them the establishment of regional ethics committees, the creation of an Office of Health and Disability Commissioner, a code of rights for health consumers, and the appointment of an independent patient advocate at Auckland Women’s Hospital. Many of my friends and colleagues at the University of Otago were involved in the Cartwright Inquiry and its aftermath, perhaps most notably Dr. Charlotte Paul, who served as a medical adviser.

Two decades later, it is hard for me to avoid contrasting the ”unfortunate experiment” in Auckland to the psychiatric research scandal at the University of Minnesota, where I work now. The circumstances surrounding the suicide of Dan Markingson in an AstraZeneca-sponsored clinical trial of Seroquel were very different from those in Auckland, yet they were no less shocking: a floridly psychotic young man under a commitment order, who had been repeatedly judged incompetent to make his own medical decisions, was coerced into a highly profitable, scientifically dubious clinical trial over the objections of his mother, whose desperate warnings were subsequently ignored until the young man finally stabbed himself to death.

The two scandals have some similarities. In both cases, the wrongdoing was brought to public attention not by regulators or oversight bodies, but by journalists. The “unfortunate experiment” in Auckland was brought to light by Sandra Coney and Phillida Bunkle in Metro magazine, while Paul Tosto and Jeremy Olson exposed the Markingson scandal in the St. Paul Pioneer Press. Also, in both cases, the scandals were symptomatic of deeper ethical pathology. At the National Women’s Hospital, medical students had been performing vaginal examinations on anesthetized women without their knowledge, and house staff had practiced inserting and removing IUDs on anesthetized women before their hysterectomies. At the University of Minnesota, administrators have repeatedly covered up or minimized questionable financial dealings and conflicts of interest, even in the face of sustained public scrutiny. (See this, this, this, this, and this.)

Most importantly, administrators at both institutions downplayed or ignored the warnings of their own faculty members. In late 2010, after my article about the Markingson case appeared in Mother Jones, several University of Minnesota faculty members and I wrote a public letter to the board of regents asking for an external investigation. In February 2011, when the regents refused our request, Dr. Aaron Friedman, the Dean of the Medical School and Vice-President for Health Sciences, sent an email to the faculty making it clear where he stood on the matter. “As a result of this case, our department of psychiatry has experienced significant scrutiny and withering criticism over the past five years, and through it all, the faculty of the department have performed remarkably well in fulfilling its mission,” Friedman wrote. He went on to praise the psychiatrists behind the trial in which Markingson died, Dr. Stephen Olson and Dr. Charles Schulz, and to voice his strong support for industry-funded research. As for the death of Markingson, Friedman wrote, “I see the Regents’ statement as the end of the University’s review of this specific patient’s case.”

Here is where the responses to the Markingson case and to the “unfortunate experiment” differ. In Auckland, the Metro article by Coney and Bunkle set off a national debate, and eventually, sweeping reforms. These reforms came about in part due to the refusal of many New Zealand academics, physicians, and feminist activists to let the matter die. But at Minnesota, the forceful responses by Friedman and the general counsel, Mark Rotenberg have successfully silenced internal dissent at the university.

This silence is understandable, but unfortunate. The issues at stake go well beyond the death of Dan Markingson. If more research deaths are uncovered, will the faculty at the University of Minnesota be able to say, “We did all we could to prevent them”?

'Xanax' Nation? My Anti-Anxiety Meds Give Me Enough to Worry About

Kaitlin Bell Barnett is the author of Dosed: The Medication Generation Grows Up. She is a freelance writer whose articles have appeared in numerous national and regional outlets, including the Boston Globe, New York Observer, Parents, and Prevention. This piece originally appeared at Huffington Post. 

Journalists love declaring that psychiatric medications symbolize some slice of the zeitgeist. So I can't say I was entirely surprised when I opened my mailbox the other day and saw New York magazine's cover article proclaiming that "If the 90s were the decade of Prozac, all hollow-eyed and depressed, then this is the era of Xanax, all jumpy and edgy and short of breath."

Translation: Depression is out, anxiety is in, antidepressants are passé (Statistics showing continued robust usage be damned), and anti-anxiety benzodiazepines, around since the 60s, are trendy again, the perfect no-commitment chill pills for a nation of "panicked strivers" contending with a new age of anxiety but without time or inclination to commit to actually changing their lives or going to therapy.

How convenient, I thought. My psychiatric problems -- and corresponding psychopharmaceuticals -- match up with the trends! First I was depressed and angsty and got Prozac, then I got anxious and got benzos! Of course, I happen to be getting depressed again lately, but one can't be completely on-trend all the time.

In fact, if you didn't know me better, you might well mistake me for one of the "functionally anxious" types who dominate journalist Lisa Miller's New York story, rather than the sort of person she quickly shuffles off into another category altogether -- the people with an actual, you know, anxiety disorder.

The people without anxiety disorders who do populate the New York piece are the sort most of us love to hate, but also can't resist reading about in these sorts of articles: Manhattanite professionals who in the Annie Hall era would have been called "neurotic" but who now like to describe themselves as "super stressed," like it's a badge of honor.

According to the article, they're turning more often these days to drugs like Xanax or Ativan when anxiety from their legitimately high-pressure lives gets to be too much. Prescriptions of these drugs, collectively referred to as benzodiazepines, are up 17 percent since 2006. The article does not mention that prescriptions for other psychiatric medications have increased, too -- antidepressant use in adults grew nearly 30 percent between 2001 and 2010 at Medco, one of the nation's largest pharmacy systems, and atypical antipsychotic usage grew a staggering 350 percent. Writing the New York article with a different thesis in mind, one could contend that we're all demoralized over the stalled economic recovery and turning to antidepressants -- or that we're frustrated and adding antipsychotics to our antidepressant regimens to give them a boost.

But back to benzos and anxiety.

The article makes it sound as though it's terribly easy to distinguish between the ordinary, high-functioning people who turn to benzos every so often when the stress of their lives overwhelms them and the people with diagnosed anxiety disorders. In fact, it can be quite complicated -- and that's why psychiatrists are fighting so bitterly over the definitions of the various disorders to be included in the DSM-5, the profession's diagnostic manual, which is under revision and due out in May 2013.

Doctors are curiously absent from the New York piece, though they are, of course, the ones responsible for actually doling out the prescriptions for benzos and all other drugs. They are quite rightly very concerned about how to determine which anxiety is pathological and overwhelming and warrants such a drug, and which kind might be better dealt with through other means.

This is a subject that has been troubling the medical profession for decades, In the 70s and 80s, benzodiazepine misuse became enough of a public health problem to prompt doctors to cut down on prescribing -- and publish a lot of anguished articles on the subject in medical journals. Some of the increase in use the New York article discusses may even reflect a return in doctor's attitudes to more comfort prescribing the drugs after years of shying away from them. (Recent articles in trade publications have made a case for their judicious use.)

All this difficulty distinguishing the casual users from the truly stricken lies in the nature of the conditions for which benzos are typically prescribed. Although sometimes given in high doses as sedatives to seriously agitated patients in psychiatric hospital settings, they are more commonly given to people whose anxiety is self-described and not necessarily readily observable to the doctor. This is true even when we are talking about anxiety of the sort that impairs people's day-to-day functioning, as opposed to the kind Miller focuses on in her New York article, which we might call the "just as easily dispatched with a glass of wine variety."

Anxiety is a funny thing, because although it seems the most all-consuming and obvious thing in the world when you are experiencing it, in fact it's actually quite difficult to detect. When I've been at my most anxious, I suspect that I've struck my psychiatrists and therapists as, at most, a bit agitated. Perhaps they've noticed some circles under my eyes, or that I look a little thin. Conceivably, I would talk a little faster than usual, or my eyes would dart around the room. But they have told me that, frankly, I don't seem all that different. I put on a good façade of normality.

In contrast, here is what I do experience: When I arrive at the psychiatrist for a "med check," I won't have slept a solid eight hours in weeks. I will have awoken early every morning with a jolt, my heart racing at some threat I can't place. It will continue that way all day until I go to bed. My stomach will churn and the room will spin and I'll be unable to eat. My thoughts will race from one unarticulated worry to another. I will feel desperate for companionship yet unable to listen or focus on conversation. I will feel constantly on the verge of tears. But I would have to tell my doctor all of this. She is not likely to go offering me a benzodiazepine prescription on the basis of some dark circles and a little hurried speech.

Once procured, such a prescription usually works magic, however. During the three periods of sustained anxiety I've suffered, I have taken a small dose of Klonopin, a long-lasting benzo, every few hours, as a way of keeping a steady level in my system. I've also taken it many other times when I've felt my anxiety flare on isolated occasions.

Despite the drug's effectiveness -- or perhaps because of it -- I never feel good about taking it. When my anxiety is pervasive, I need to constantly watch for a resurgence of panic. This makes me feel dependent, like a drug addict eyeing the clock for my next hit. When my anxiety returns in isolated episodes, I wonder if I'm simply the equivalent of the functionally anxious people in the New York article -- someone who happens to have a Klonopin prescription but who really doesn't need to be taking it and could just as well go to a yoga class. I tend to feel guilty about it until I get the telltale early morning waking -- and then I start to worry that I'm entering another terrible extended anxious phase.

The other reason articles like the one in New York make me cringe is that benzos, being controlled substances, already carry the taint of misuse, and talk of overworked PR execs popping pills to deal with anxiety over a work presentation or helicopter moms doing so to handle separation anxiety from their preschoolers is likely to make doctors, already cagey about prescribing, even more so.

Even for those of us with an anxiety disorder diagnosis and a history of benzo prescriptions, there's already an awkward dance involved in procuring a refill. Since benzos are controlled substances, doctors can't call in prescriptions (and may not have emergency appointments available go hand over the precious slip of paper). Anxiety, however, has a tendency to spiral -- and quickly. Many people find it useful, therefore, to have a bottle around in case of an emergency. But that means requesting a refill when you are not, technically, quaking under the covers in a fetal position.

Some doctors are sensitive enough to realize this, but, wanting to avoid tolerance and misuse, the responsible ones generally don't go around offering up refills out of the blue. For many people, especially young people in their 20s and 30s, who happen to be the group most likely to abuse psychotherapeutic prescription drugs according to federal government statistics, this makes asking for refills a delicate and awkward affair. I'm sure that my requests, for example, are accompanied by far too much justifying. One young woman I interviewed for my book on the topic of growing up on psychiatric medication suffered from debilitating anxiety and was so terrified of being judged an addict (She had a family history of alcohol abuse) that she refused to ask for benzo refills at all. This, even though it was patently obvious from the most casual encounter with her that some benzos would have done her good.

After my last psychiatrist's appointment, during which my doctor upped the dosage of my antidepressant to deal with a creeping recurrence of my depression, she ended the appointment by asking what I was doing for the rest of the day. I told her I was working on a column responding to the apparent news that benzodiazepines were the hot new drugs. She rolled her eyes as though this were the height of ridiculousness. "Benzodiazepines are the hot new drugs? Since when?" She did not ask if I would like a refill on my Klonopin.

Condemnation, Compassion, and the Complexity of Abuse

Today's post addresses the recent media surrounding revelations of childhood sexual abuse at Penn State and elsewhere. The author is Martin Moran, whose memoir The Tricky Part, was first published by Beacon Press in 2005, and was adapted from his one-man play of the same name, for which he won an Obie in 2004. Moran makes his living as an actor and writer in New York City. He has appeared in many Broadway and Off-Broadway plays, including Spamalot, Titanic, Cabaret, Bells Are Ringing, and Floyd Collins, and is currently playing Dr. Dillamond in the National Tour of Wicked. He is also at work on a new one man piece scheduled to be performed off broadway in Fall of 2012.  

Six years ago I wrote a memoir. It was about forgiveness, growing up Catholic, sex. It was an attempt to make sense of the chaos of having been molested as a kid (over a three year period) by a camp counselor many years my senior. I wrote a thoughtful book full of mercy. It went out into the world and I felt relief, gratitude. I felt I’d arrived. Somewhere. Sainthood. Peace.

I have since learned that there are moments I will be knocked to the dirt. The complexity, the half-life of sexual abuse is endless. The most recent and, for reasons I’m still unraveling, most potent sucker punch has come in the form of Penn State.

The media was already at fever pitch when, on 11/11/11, I opened the door of my hotel room to find at my feet, in huge and murderously red-colored print across the front of a complimentary copy of USA Today: “Victim Number 1.” My stomach heaved.

I didn’t want to peek but I peeled open the pages to learn that this headline was a reference, not to Sandusky’s first apparent victim, but to the brave young man (nameless in the news for now) who has been the first to step forward. Who has, with the help of a counselor, a lawyer and (I pray) his family, spoken up and brought his case, his story, to the police. Not yet twenty, this boy was described in USA Today as a hero who, because of his courage, has finally put a stop to a string of horrible crimes. Ended the ‘conspiracy of cowards,’ the countless officials at Penn Sate who remained silent.

I stepped back into my Des Moines Hotel room and fell into a chair. The tears came fast and furious.

*  *  *

On a spring afternoon two years ago I was at my desk, which overlooks the playground of a public elementary school. The kids were out for a sky blue recess, their jackets tied around their waists or tossed to the foot of the fence.  I was in the midst of writing a story about a trip to Italy. I kept looking out the window at the swirl of chirping students and the next thing I knew I had crossed to the phone in our living room. I had dialed 411 and asked for the number of a Southern California police station.

“Please hold for the Golena Sheriff’s Department.”

“Oh. OK.  Thank you operator.” Lord, it was happening. I pressed the receiver to my ear.

Golena. I am guessing it is a small town. Rural. Never been there. It is the last place that I know he resided. Where, perhaps, he still resides to this very day.

It rings twice.

“Hello. Sheriff’s office.”

The voice is female and I’m instantly relieved. Whatever it is I want to say, it seems it will be easier saying it to a her.

“My name is Martin Moran and....”   

My heart is throwing a tantrum: Hang up! This is stupid. And now the brain is off like a shot:  You’re fifty years old for God’s sake! What in the world are you afraid of? The derision of a sheriff? Disturbing Bob’s life? Do you think he could hurt you still, threaten you?  This is fucking Stockholm Syndrome kid.

“Hello?”

Breathless, I am little boy twelve and man of fifty at once.

“Yes. Hello... I am calling... I think someone may reside in your town who molested me when I was a kid. I wanted to be sure, if he’s still living, that you were aware of his... him.”

I’m relieved at how matter of fact I sound. This feels like manly progress of a sort.

“Was he ever convicted?” she asks.

“Yes, Ma'am.  In Colorado. In the Seventies. Not by me, though.”

Someone else did that brave work, I think, but don’t say as I try to quell the voices that chide me: Coward. Wimp. Co-conspirator.

“His name?

“Robert Kosanke.”

And there it is. His actual name. I said it aloud to the lady sheriff and I am writing it here now on this cold December of 2011.  In the 2005 memoir I used a Kafkaesque Robert C______. Aesthetically I loved the mystery of the blank. I felt (still do) this rendered the tale more eternal, universal. Somehow, without the weight of his real name I felt freer, less encumbered in composing the interior story of a soul, in recreating memories from thirty years before. And the publisher’s legal department felt it prudent to make slight alterations to avoid any possible litigation. Fine. It was not a book, after all, focused on blame but on a journey toward understanding.  So good, let’s not sully the page with his fucking name.

 “Still checking, the lady sheriff says.” I hear the clicking sound of what must be her fingernails at the keyboard. I am picturing a small suburban street, a ramshackle house with a truck in the drive, up on a jack, missing a wheel, tools scattered in a driveway, weeds creeping through cracked cement. I picture him gray and slow and bent as he was when I found and confronted him at a Vet’s hospital in 2002. I picture him asking a neighbor boy to help fix a tire on the old truck. Asking the kid to come on inside for lemonade. And, please God, a cop car pulling up to arrest things.

“Oh,” she says. “Yes…yes he does live here.”

So he’s alive!  I had Googled him more than once, searching for an obit or something to pop up that spoke of his demise thinking this would be the final curtain, a welcome closure. But I had (have still) never found a thing.

“We know where he is,” she continues, with a kind of Perry Mason twang. “He is a registrant.”

“What’s that?”

“He’s required to register with us periodically. It’s part of his agreement. He is current, I see.”

“ So you’re aware, I mean, able to--”

“Yes sir. We keep a strict watch on him.”

God, I pray that’s true.  The relief I feel! Someone is doing the job. The job I never did.

Before I hang up she says,  “Thanks for your call, Martin. Take good care.”

Her voice is replete with wisdom, with kindness. Or so it seems and I feel my eyes water, my throat tighten as I think: She understands. Understands everything.

It took me more than thirty years to call the cops.

Back at my desk, I kept lifting my gaze to the window, the schoolyard. Fourth graders, I guessed. Maybe fifth, leaping every which way.  They take turns at coming out for recess. The various ages have distinct qualities of play: Kindergartners all high-pitched cries, flailing limbs. With seventh and eighth graders coordination, deeper shouts and zinging projectiles. I find I often guess at the ages, at the lives of these growing, precious creatures. Sending out a wish that they safely find their way in their own time toward their authentic selves.

It knew it was the ache, the persistent niggling at the back of my head. It was an ancient guilt that brought me to the phone. A duty long deferred? A stab that says:  Marty, if you’d blown the whistle way back when, others may have been spared. How many did he go on to seduce in the months and years I remained frozen in silence. This thought kills me.

* * *

“The only thing necessary for evil to triumph is for good men to do nothing.”

Edmund Burke.

My shame is ancient. Intractable. Shame that I allowed it to happen in the first place. That I gave in and over to the wild, confusing pleasure of sex with him. It was a relationship of sorts and I remained terrified, frozen in the bond of it. Until I dug down and wrote a book that I know added an honest voice to the paralyzing complexity of childhood sexual abuse. “I never took legal action” I have heard myself say to various questioners. “I took dramatic action.” Still the shame of not having smacked or strangled the guy will sneak up and I have to remind myself again and again that I was a kid and that along the way I have done my best, that it has taken countless steps, year by year, to unravel the damn thing and move toward speaking out, toward healing, toward forgiveness. Mostly for myself.

The recent revelations (They keep coming, don’t they? They are so many) in the issue of USA Today that I held in my hands a few weeks ago made me weep crazily for about a thousand reasons. You may have wept too and or certainly cried out in disbelief, confusion or righteous anger. Yes ‘interests’ were probably being served; grown men trapped in some insane male bastion (Catholic, Mormon, Orthodox Jews, now Football) remained quiet as kids were being violated. There are inexcusable actions and non-actions.

As I sat in that hotel room clutching that oh so American newspaper, I wept for the courage of Victim Number 1. For all the victims. I wept for the apparent sickness of the accused. I wept at my own faults and frailty. But I also wept and weep now because that newspaper I held insisted on painting a black and white tale of monsters and victims, of cowards and heroes. It’s how we like our stories. It’s how we judge and keep human events at a distance. It is terribly difficult to ponder how real and how close, how human and how common what happened at Penn State is. At the fear and greed and desire that can shatter our ethics. Our hearts.

Somewhere between all the black and white, the heroes and victims in the sad story of Penn State, is the gray of frightened human beings caught up in a world of hyper-masculinity and voiceless secrets. It calls for our condemnation. Somehow, it also calls for our compassion.  How else might we learn to talk and so truly learn from these horrific events?  To be truly aware of each other’s human plight?

Your Guide to Holiday Sanity: Talking Politics in a Bipartisan Family

Today's post is by Sophia Raday, the author of Love in Condition Yellow: A Memoir of An Unlikely Marriage.

At my book talks I often show side-by-side photos of my husband and me. In mine, I am getting arrested by campus police at a divestment protest at Stanford University. The police are using a “pain compliance” technique on me, twisting my arm behind my back and pressing my hand over in a very effective wrist-crunch. [Ed's note: you can see this photo on Sophia's web site.] In the next photo, my husband is standing in front of the Oakland Police Department’s SWAT helicopter flashing a thumbs up sign and a big grin. 

Perhaps needless to say, our differences run along major fault lines in the American body politic. He is a Republican; I am a Democrat. He is a hawk; I am a dove. He likes Costco; I like food co-ops. He reads military history; I read poetry. He admires Teddy Roosevelt; I swoon for Obama. You get the idea.

I know what most of you are thinking: What do you do when you talk politics at the dinner table? How do you keep things from getting ugly? No, we don’t have a skirmish line running down the middle of our kitchen table. In fact, we talk about politics regularly and very amicably. Of course it didn’t start out that way. We argued a lot during our courtship. A lot. But eventually that got really tiring. And kind of boring. We had to figure out how to share our views or break up. And we really loved each other.  So, with some help from a good couples counselor, we stopped arguing and started connecting.

The trick is adopting an attitude not of antagonism but of curiosity.  Imagine you are an exchange student exploring a foreign country whose customs and history you would like to learn about. Your curmudgeonly conservative Uncle Frank? He’s Bora Bora. Your strident vegan niece Madison? She’s Uzbekistan.

This idea is not just based on our personal success as a couple but also on cutting edge cognitive science. George Lakoff is a linguist and writer who has come up with a very elegant case for how to explain the differences between conservative and liberal world views in the United States. Each side tells a morality story, with one applying a “strict father” family model (government as father and citizens as children), and the other a “nurturant parent” model. As people relying on a (usually unconscious) strict father family narrative, conservatives value self-reliance above all else. Liberals, on the other hand, tend to believe government should act as a nurturing, supportive parent. They consequently, value empathy above all else.

I think Lakoff is on to something profound. And I’ve found there’s even more. The story of why Uncle Frank cleaves to his political views and why Niece Madison embraces hers is a hidden treasure trove. Each of us has mapped our particular narrative of the world – shaped by all our life experiences and influences - onto political issues, usually unconsciously. This means that when we talk about politics, we are actually talking deeply about ourselves, without realizing it. The very personal story running underneath each person’s political views is the Lost Ark within the Wall of Souls.

You, then, must be Indiana Jones.

You’ve seen the movie. I don’t have to tell you that reaching your goal - uncovering the personal stories underneath political views - involves braving a viper pit. I didn’t say it would be easy or risk-free. But it’s worth it. Because just expressing curiosity about each other’s stories has an almost magical effect of softening our differences. In my sixteen-year relationship we’ve found it to be a tonic for the divisiveness of these times. (And P.S.: it works for other thorny topics besides politics.) Here are some dos and don’ts for budding Indys:

1. Stay grounded and calm. When we feel under assault, our reptilian brain takes over. We can't hear anything. We can't process complex information. We definitely can't listen. If you are upset, take care of yourself until you can be calm. This is not the time to talk to someone of opposing views. Take deep breaths, excuse yourself to baste the turkey, change the subject. For the same reason, do not take the offensive.

If, for example, your cousin starts saying “shame on the Oakland Police Department” and wagging her forefinger in your tired Oakland Police officer husband’s face:

Don’t say, “Oh puh-lease, I am so sick of people ragging on the cops. They get no credit for putting their lives on the line for this city. Why don’t YOU try it some time, huh??”

Try this instead. Put your hand over your heart and take a deep breath. Then maybe you can say, “Those were definitely some disturbing images. I know crowd control is one of the most challenging aspects of police work. It’s definitely scary for me when my honey is on the line.”

If not, there is always, “I think I hear the doorbell ringing!”

2.  Be open to looking at something differently, or learning something new. While it’s good to share your point of view, do not do it with the aim of changing the other person’s opinion. Ask for detail. Uncle Frank might say “when I was a youngster, they just would’ve called in the National Guard and run over those hooligans with tanks!” Don’t respond with “Jesus, Uncle Frank, was everybody a Neanderthal back then?” Try this: “Uncle Frank, tell us about some of the protests that went on in the sixties. Did you know anybody involved in them?”

3.  Use humor whenever possible. Did you hear the one about the cop and the protestor that got married? Laughter is a great release. I like to tell the story of what happened after my arrest photo was taken. One officer was given the job of driving me to jail. Through the metal barrier, I sang him a lusty version of Jimmy Cliff’s “Peace Officer.” Turned out cops laugh too. 

Good luck. Don’t worry if it doesn’t work at first. It gets easier with practice. Plus, the attempt will make a difference. Happy Holidays from this bipartisan family to yours, whatever your political views. 

Veteran's Day: How Do We Repair the Souls of Those Returning from Iraq?

Rita Nakashima Brock, Ph. D. is Founding Director of Faith Voices for the Common Good (www.faithvoices.org). She was a professor for twenty years, directed the Fellowship Program at the Radcliffe Institute for Advanced Study, Harvard University, a prominent advanced research institute, and from 2001-2002, was a Fellow at the Harvard Divinity School Center for Values in Public Life. Her latest book, Saving Paradise, co-authored with Rebecca Parker, was chosen by Publishers Weekly as one of the best books of 2008.

[Rev. Dr. Gabriella Lettini co-authored this piece. We led the team that organized the Truth Commission on Conscience in War and are members of the leadership team for "The Soul Repair Project."]

By year's end, 40,000 U.S. troops will return from Iraq and, according to President Obama, "America's war in Iraq will be over." But the long nightmare of the Iraq War will not be over for either side of the conflict. The U. S. will see a new surge of suffering, and it will not be over for generations.

The fatalities will not end when the troops come home. Though veterans are only 7% of the population, they are 20% of all U.S. suicides, 6000 a year, an average of 18 a day. Veterans under 30 have record-breaking suicide rates, despite mental health screenings for returning troops, better research on and treatment of PTSD, and increased VA suicide prevention programs. Between 2005 and 2007, the rate among veterans under age 30 rose 26%; in Texas, rates rose 40% between 2006 and 2009.

Recently, VA clinicians proposed another cause for suicide, a wound they call "moral injury," which may aggravate or precipitate PTSD. As Harvard psychiatrist Judith Herman notes in Trauma and Recovery, once someone begins to recover enough from PTSD to construct a coherent memory of their trauma, they can reflect on their experience. Then, the moral and religious questions emerge.

Moral injury is a wound in the soul, an inner conflict based on a moral evaluation of having inflicted or witnessed harm. It results from a capacity for both empathy and self-reflection on moral values, which means it happens to healthy human beings. The current wars are especially morally compromising because the lines between innocent civilians and combatants are so blurred. Even women, children, and pets can be dangerous or be used as shields.

Though an action in war may have saved someone's life or felt right at the time, a veteran may come to feel remorse, shame, or guilt for having had to inflict harm that violates his or her core values. Moral injury can result not only from active behavior, such as torturing or killing, but also from passive behavior, such as failing to prevent harm or witnessing a close friend be slain. And it can involve feeling betrayed by persons in authority. Just having to view and handle human remains can sometimes cause it.

In betraying their most deeply held moral beliefs, veterans often cannot forgive themselves and can no longer make sense of the world. They often abandon their faith. Such moral anguish is not PTSD, not a temporary medical or psychiatric disorder to be "treated," but a lifelong spiritual and moral struggle to live honestly, courageously, and compassionately with memories of war. It can take a long time to reconstruct a world of meaning in which it is possible to see how one's life matters to others.

The term moral injury names a deep and old dilemma of war. It may be a new clinical concept, but the moral anguish of warriors defines much literature about war from ancient times, such as the Greek Iliad, Indian Bhagavad-Gita, and the Hebrew prophets in the Bible, to the present, in memoirs of the wars in Afghanistan and Iraq. However, secular clinical approaches to such feelings usually treat them as neuroses that inhibit individual self-actualization and interfere with authentic urges and feelings. Veterans are, therefore, often misunderstood and struggle with moral conscience, loss of meaning, and spiritual despair in isolation.

In Packing Inferno: the Unmaking of a Marine, Tyler E. Boudreau, a former Marine Captain and veteran of Iraq, reflects on the apparent inability of societies to learn about the torture war inflicts on the souls of veterans, despite the many witnesses in works of art and history. He concludes that societies have understood it only as much as they really wanted to learn about it and its deeper meaning. For instance, after World War I, the prescribed process of reintegration silenced and pathologized the moral suffering of veterans, treating "shell shock" as an individual inability to put war behind.

Not everyone was so unable or unwilling to understand, Tyler observes. In Mrs. Dalloway, Virginia Woolf portrayed the suicidal anguish of Septimus Smith as if she were a veteran herself. Tyler notes:

She was just a writer. That tells me, if nothing else, that the information was there. The capacity to know existed. It wasn't beyond human understanding. They weren't too primitive. If Virginia Woolf knew about combat stress, everybody else could have known, too. They did not know because they didn't want to know.

Still, not even Tyler could face telling the truth about war. After he left the Corps, he worked as a Casualty Assistance Calls Officer (CACO), which required him to call the parents of wounded Marines. He could not bring himself to call soldiers' families and report honestly that, among the wounds they suffered, "Your boy is coming home with a broken heart." Never once was he able to say it, and he regrets it still that he did not.

We have to support veterans in telling the truths of war. Though the term moral injury is new among VA clinicians, the concepts underlying it ring true to many spiritual and religious people. We know that the loss of faith and meaning, the sense of isolation, and the self-condemnation characteristic of moral injury cannot be repaired by short-term therapies. While around 90% of the public claim a spiritual affiliation, only around 40% of clinicians claim one. VA psychiatrist Jonathan Shay, who received a MacArthur "genius" award for his work on PTSD, noted in 2002,

Medical-psychological therapies...are not, and should not be, the only therapies available for moral pain. Religious and cultural therapies are not only possible, but may well be superior to what mental health professionals conventionally offer.

Rev. Dr. Kent Drescher, who works with veterans, notes that the more judgmental and punitive a veteran's idea of God and religious authority, the more difficult is the recovery from moral injury. Veterans who grieve the losses of war and seek ways to make amends for the harm they have done need trusted places to have conversations about meaning and ethics with others who understand such issues. They need the company of others who understand the lifelong struggle to be their best selves after they have violated their deepest moral values. Recovery includes the restoration of trust in a power strong enough to carry the weight of all inner anguish and honest prayers, and, for many, it comes through trusting in a benevolent spiritual power who is deeply moved by injustice, violence, and human suffering.

Religious professionals are familiar with the personal transformations that occur in worship and community practices when they are repeated over time. Such activities embed the moral values of the community in the whole person and support their being lived out. More veterans seek counsel from clergy than from clinicians, and the clergy they need are those willing to offer a benevolent and caring presence. In addition to veterans who seek out clergy themselves, those in clinical treatment who ask moral questions and express grief, contrition, and shame are usually referred to chaplains because the formal training of mental health professionals does not include theology, discussions of faith, or philosophical questions about evil.

Veterans who do not identify as either spiritual or religious also need communities where they can explore their moral struggles and address their moral injury. More such spaces need to be created, and more civilians need to be trained in understanding the moral injury of war. Whether support for moral injury in veterans occurs in religious or secular spaces, we civilians must understand that we are not only to serve as witnesses of veterans' struggles, but we must also engage in our own ethical questioning in relation to war.

Moral injury is not only about "them;" it is also about "us." In his powerful testimony at the Truth Commission on Conscience in War, Tyler Boudreau challenged the members of the audience to remember that they will never be able to speak the truth about war until they can speak the truth about themselves. Moral injury is an issue for civilians, not just veterans. Regardless of our personal positions on a war, a society that engaged in warfare must come to terms with its responsibilities for its effects and with its own moral injury.

The hidden wounds of war do not heal when left unattended; instead, they may fester for years in depression, homelessness, addiction, and a half-lived existence finished by suicide, which doesn't end the suffering for those who knew and loved the one who died. Unattended, moral injury will linger for generations. Understanding moral injury is a necessary first step in a much longer societal healing process. We should begin that process today.

This post originally appeared at the Huffington Post.

Jonathan M. Metzl: In Medical Records, a Story of the Racialization of Schizophrenia

Today's post is an excerpt from The Protest Psychosis: How Schizophrenia Became a Black Disease by Jonathan M. Metzl. Metzl is associate professor of psychiatry and women's studies and director of the Culture, Health, and Medicine Program at the University of Michigan. A 2008 Guggenheim Fellowship recipient, Metzl has written extensively for medical, psychiatry, and popular publications. His books include Prozac on the Couch and Difference and Identity in Medicine. 

Reading the medical charts of the patients of Ionia State Hospital for the Criminally Insane, I felt a mixture of responsibility and deep sadness. For better and largely for worse, the Ionia charts documented the lives of the marginalized and the forgotten in novel-like detail, and in ways that made the medical records of today seem impersonal and flat. This was because the charts recorded people in two conflicting ways: in their roles as patients and convicts, as defined by interactions with the state hospital complex and the courts, and in their roles as sons, daughters, fathers, husbands, wives, or loners, as defined by letters, cards, and other texts. The charts also documented in minute detail the tragedy of what it meant to be warehoused in a state asylum at midcentury -- and in particular, in an asylum where short sentences devolved into lifelong incarceration. A number of charts contained yearly notes from patients to their doctors voicing such sentiments as "Doc, I really think I am cured," or "Dear Doctor, I believe I am ready to go home," or "You have no right to keep me here after my sentence is over." These letters stacked thirty deep in some charts, signifying years of pleading and longing and anger, together with thirty years' of responses from clinicians urging, "You are almost there" or "Perhaps next year." Invariably, the last note in each stack was a death certificate from the Ionia coroner.

I visited the archive regularly over the next four years. With the help of my research assistant, I analyzed and catalogued hospital administrative records and the charts of nearly six hundred randomly selected patients admitted to the hospital between the late 1920s and the early 1970s, under the agreement that I significantly alter all personal identifying information about patients, as I have done in the case descriptions that appear in this book. Names, dates, and places have been changed, and vignettes represent condensed and extrapolated aggregates drawn from the rich case materials. All doctor-patient dialogue and text in quotation marks is reproduced verbatim. I also visited Ionia on numerous occasions and conducted a series of oral histories with surviving members of the hospital staff, though, perhaps tellingly, I located no surviving patients despite numerous attempts.

What stories boxes tell. Ionia was its own planet, walled off, orbiting, a place where real people worked and lived and died. Then came a series of public scandals, the advent of psychopharmaceuticals, and changes in legal systems and penal codes. Decreased public funding followed, along with encroachment by regional forensic centers. Finally, the transformation. The boxes were but light-years of this implosion, vapor trails, found poems, measurable heat. Disembodied voices that told silent stories of what it meant to be incarcerated, or neglected, or entrenched, or immured.

Danielle Ofri: Translating the Foreign Culture of Medicine

Today's post is from Danielle Ofri, writer and practicing internist at New York City's Bellevue Hospital. She is the editor-in-chief of the Bellevue Literary Review. Her newest book is Medicine in Translation: Journeys with my Patients. This post originally appeared at her Medicine in Translation blog at Psychology Today.

If asked what a doctor does, most people would probably come up with the standard description of diagnosing and treating disease, usually while wearing an ill-fitting white coat. Before I entered practice, even during my medical training that probably would have been my answer too.

But my years in the trenches of real medicine have altered that definition greatly. I do spend time doing the things I learned in medical school like diagnosing disease and writing prescriptions, but that turns out to be only a part of the job, often a very small part.

Much of the time I find myself acting as sounding board. Recently I saw one my regular patients, a woman whose main medical issue is hypertension. But for most of our visit she spoke, often tearfully, of the strain of raising grandchildren since her daughter died of HIV. We never really got to her hypertension, and I certainly didn't have any easy answers for her difficult life situation, but this seemed to be the only time and place that she could devote to her own issues.

A good portion of my time is spent being a teacher. So much of medicine involves education-- talking about what a disease means, which medication side effects are important to watch for, how to plan a healthy diet, which screening tests are important, what a particular diagnostic test entails, what the various lab results mean, and so on.

Lillian B. Rubin: The Torture Memos

Today's post is from Lillian B. Rubin, the author of twelve books, including 60 on Up, The Man with the Beautiful Voice, Tangled Lives, Worlds of Pain, Intimate Strangers, and Just Friends. A sociologist and psychotherapist, Dr. Rubin is a senior researcher at the Institute for the Study of Social Change at the University of California, Berkeley.

It wasn't exactly a shock because, whether we wanted to or not, we really knew it had been happening for awhile. We had, after all, already heard the testimony of Lawrence Wilkerson, former chief of staff to then-Secretary of State Colin Powell, that more than one hundred detainees had died in U.S. custody, many of them tortured to their death. But seeing it in print, reading the carefully refined descriptions of what the administration and its lawyers said were legal ways of gathering information from its prisoners, was a jolt that left lasting images in my brain: men standing naked as they were humiliated and beaten repeatedly, heads banged against the wall, lying in coffins with bugs crawling over them, hooded and tied upside down on a board while water is poured over their heads so they felt they were drowning.

Now that we can no longer look away, what are we going to do about it? President Obama, who gave the okay to release the memos and promises that the United States will not torture again, says also that those whose behavior was within "the four corners" of what the Bush administration defined as legal doctrine will not be prosecuted. Wait a minute! Wasn't the I-was-just-following-orders line the defense of the guards in the Nazi death camps when we tried and convicted them at Nuremberg?

If it didn't count then, why should it count now? Yes, I know that we can't compare the systematic torture that was the policy of the German government then with American CIA agents who tortured a few prisoners. But where do we draw the line? Is it okay to torture two but not ten, ten but not one hundred? Is waterboarding a prisoner once acceptable, but 183 times crossing the line?

And who should be held accountable? The torture memos make clear that the actions on the ground rested directly on the green light from the American government's Justice Department. True, our government wasn't targeting a whole people, just a few terrorists who may have had information that endangered our security and the lives of our people. But whether the few or the many, those who torture always have what they think is a good reason to do so.

The Three 'P's: An Education System Where Play is its Own Reward

Today's post is from Chris Mercogliano author of In Defense of Childhood: Protecting Kids' Inner Wildness. Mercogliano has been a teacher at the Albany Free School since 1973 and co-director since 1985.

It was heartening to see the New York Times tout the importance of play in school settings. But how sad that the excommunication of play from American culture has reduced the discussion of its value to the question of whether five percent of the school day should be sacrificed to recess; or God forbid, should it be ten?

Let me lay my bias out straight. For thirty-seven years I have been involved with an independent school for students ages 2-14 in which students spend the overwhelming majority of their time playing. And by this I don't mean learning games or organized sports, although they sometimes participate in them too. What I'm talking about here is play as defined by Jean Piaget: "actions that are an end in themselves and do not form part of any series of actions imposed by someone else or from outside." Real play, in other words, is its own reward. It involves imagination, improvisation, and quite often the natural world. It's when kids engage in making-believe, horsing around, and inventing their own games. It's when they paint, or draw, or sing, or dance, or write a poem or story, not in order to fulfill an English or art assignment, but to answer the call of the Muse.

A great many observers consider our approach, which I once teasingly described to a dubious Alfie Kohn as the "summer camp" model of education, to be romantic or naive, if not downright irresponsible or crazy. A dose of play here and there is fine, certainly. As the Times article noted, kids' brains need a rest once in a while. Their bodies also need exercise, and everyone recognizes the vital role of play in social development. But at the end of the day, learning is serious business and a lot of hard work.

Or is it? Let's examine the evidence for a moment, which increasingly confirms the fundamental contributions play makes to every aspect of a child's growth.

Loneliness Doesn't Have to Get You Down on Valentine's Day

Today's post is from Jacqueline Olds, MD, co-author with Richard S. Schwartz, MD, of The Lonely American: Drifting Apart in the Twenty-first Century. Drs. Olds and Schwartz are both psychoanalysts and Associate Clinical Professors of Psychiatry at Harvard Medical School. They have written two other books, Overcoming Loneliness in Everyday Life and Marriage in Motion. Drs. Olds and Schwartz will discuss The Lonely American at the Cambridge Forum, Wednesday, February 11th at 7:30pm. Details here.

Here it is Valentine's Day again... and many of us are thinking, "Oh dear, I'm alone again. How I hate this celebration of couples!" There are in fact a lot of us who live alone (approximately 25% of households are single-person households according to the latest census), and the General Social Survey from 2004 revealed that many of us have no really close confidants. So how are we to cope with such a "holiday" when there seems to be so little to celebrate?

Well, much of the research done on health and social connection does not specify that to achieve longevity, you have to have a Valentine, but it does imply that you have to be socially connected to some small groups in such a way that you schmooze regularly with them. And, even though we don't know for sure whether it lengthens lives, many psychologists stress the benefits of having a couple of people with whom you "can truly be yourself" without worrying about the impression you're making. So one of the worst things you can do if you don't happen to have a Valentine is huddle at home feeling too ashamed to go out and let everyone know that there's no special someone in your life.

American Dreamers: Analyzing Dreams of Hillary and Barack

by Kelly Bulkeley

As of today a total of 116 dream reports about Barack Obama and 104 about Hillary Clinton have been posted on the metaphysicalpoll.com website. Here are some of the questions I've heard people asking about these intriguing political fables from the nocturnal imagination.

Can we accept these as real dreams? Cautiously, yes. Some of the reports could easily be fake, but most sound genuine to me. (For more on the limitations of this kind of anecdotal data, see my posting of March 19.)

Why are so many people having dreams of Hillary and Barack? It's turning into a perfect storm of political dreaming. First, the core supporters of both candidates (older white women for Hillary, multicultural youth for Barack) tend to be especially active dreamers--they are exactly the kinds of people who show up most often in dream classes and workshops, and I think it's natural their political hopes and fears would find expression in their dreams.  Second, many Democrats are genuinely torn in both directions, and one thing we know from modern dream research is that people often experience an upsurge of dreaming during times of uncertainty and indecision. And third, the feverish campaign coverage by the 24-hour news media has prompted unusually intense feelings of familiarity and intimacy with the candidates' personal lives, to the point where we hear and think and talk about them almost non-stop. In this kind of cultural environment, it would be surprising if we did not find at least some people dreaming about these omnipresent figures in the public eye.

Dreaming of Barack and Hillary (and John)

by Kelly Bulkeley

At the conclusion of a recent New Yorker story about her new website posting people's dreams of Barack Obama and Hillary Clinton, Toronto novelist Sheila Heti said, "I sort of hope that the campaign managers will change the way candidates give speeches as a result of people's dream lives. It must be telling them something."

These dreams do have the potential to reveal meaningful facets of people's political beliefs. The frequency and intensity of a politician's appearance in people's dreams can be taken as an accurate index of his or her personal charisma. The more people dream of a politician, the more likely that politician has made a deep emotional impact on them (both positively and negatively--Heti's website has instances of both).

In 1992, when I first studied dreams of politicians during that year's Presidential election, I heard numerous dreams of Bill Clinton and Ross Perot, and almost none of George H.W. Bush--no doubt where the charisma lay in that contest! As of March 18th, Heti's website contains 73 dreams of Obama, 67 of Hillary, and four of John McCain (to be fair, the space for McCain dreams was just created on March 10th). Now, as then, the dreams offer a mix of the bizarre and the trivial, the profound and the absurd, the personally idiosyncratic and the socially relevant. From a research perspective, the value of Heti's website is that it provides further evidence that people dream not only about their private lives but also about public affairs like political contests. Dreaming is not purely inward-looking; it also has the capacity to look outwards and express our feelings about the major concerns, conflicts, and challenges of our communities.