Acknowledging our Histories

Section 9 of Division 39 of the American Psychological Association recently released an apology to Native American, Alaska Native, and Native Hawaiians for the psychological harms inflicted on indigenous peoples within territories claimed by the U.S. government.  The statement acknowledges the role of psychological professionals in creating harm to indigenous peoples' communities, through their dismissals of indigenous knowledge and healing practices and participation in attacks on indigenous communities.  Specifically, they acknowledge:

"Our use of diagnostic systems that do not honor cultural belief systems and world views; The inappropriate use of assessment techniques and procedures that have conveyed misleading and inaccurate messages about the abilities and capacities of Native American, Alaska Native, and Native Hawaiian peoples; Conducting research that has benefited the careers of researchers rather than improved the lives of the Native American, Alaska Native, and Native Hawaiian participants; Developing and applying treatments that have ignored Native American, Alaska Native, and Native Hawaiian approaches to healing and that have, both implicitly and explicitly, dismissed the importance of culture in understanding and promoting social and emotional well-being; and, Our silence and lack of advocacy on important policy matters, such as the policy of forced removal and deliberate systemic assimilation policies, which resulted in the Stolen Generations."

They also list their active plans for solidarity in the future, including solidarity with water protectors at Standing Rock and a commitment to "Listening more and talking less; following more and steering less; advocating more and complying less; including more and ignoring less; and, collaborating more and commanding less."

People in the psychological professions bring skills, tools, and energy that can aid in healing from histories of trauma and oppression. But in order to build the trust that is necessary to work together, we need to acknowledge our profession's role in histories of harm.  We need to acknowledge these histories because they haven't disappeared. They are present in the counselling room every time a client pauses and wonders, "Will my culture be dismissed? Will I be stereotyped? Can I be vulnerable here, or do I need to keep my armor on and protect myself from settler assumptions that erase me?" Building trust is facilitated by naming the past, assessing our role in it, and embodying our commitment to do better in the present moment. 

As a counsellor, I believe that it is important to be careful and self-reflective about my own power, to center the strength and self-determination of my clients, and actively align myself with struggles for justice. I am grateful to be a part of a professional organization with others who share these values. 

You can read the full statement here: https://psychoanalyticactivist.com

The emotional is political

Since the U.S. election of Trump, I have been hearing from people in my communities and in my counselling practice about intensified feelings of panic, rage, and terror, as well as associated feelings of numb withdrawal from the world.  If these are your experiences, this post is written for you.

1. First, I want to say, your feelings make sense. Your feelings around the current political climate are not irrational or wrong. They are the result of a violent political climate that is intended to silence and disempower you. While some Trump voters may not have consciously meant to send this message, the U.S. election has served as an endorsement of continued violence against black people, indigenous people, latinx people, women, immigrants, Muslims, queer people, trans people, people with disabilities, and the environment. Your perceptions are right—there is something terribly wrong happening.  What is happening politically is not okay. The long histories of violence sanctioned by the U.S. and Canadian governments are not okay.

2. Understanding what is going on with our emotions is a way of taking back our power. For many of us, our feelings of panic or numbness are the result of a visceral, bodily awareness of our own vulnerability and the vulnerability of people whom we care about. Political violence is real, and it takes power away from people. It sends the message that we are alone, that we are powerless, and that we should be quiet and give up. Accessing emotional supports and figuring out new coping strategies is a way of taking back our power. Caring for our physical and emotional well-being is a crucial step towards figuring out strategies of collective connection, survival, and resistance. Figuring out tools that help us to ground ourselves and to regulate overwhelming bodily responses builds our power.  Doing this can help us to show up and support others in situations that previously felt too scary, too overwhelming. 

3.  While there is no "one-size-fits-all" response, there are resources and tools and actions that can help us feel more personally powerful. Crisis Text Line has gathered together some great resources: http://www.crisistextline.org, including action steps, free phone and text supports, and emotional regulation techniques.  This University of Michigan guide to managing election-related stress also seems helpful: https://caps.umich.edu/content/manage-election-related-stress-information. 

I want to especially endorse the 4-7-8 breathing technique that Crisis Text Line links to. This is my personal strategy of choice for slowing down my heart rate at times when I feel anxious and have difficulty thinking clearly.  Mindfulness apps like HeadSpace, MindShift, Calm, and Stop Breathe Think can be helpful for checking in with yourself and accessing a little more space to think.  Also, this website can be helpful when you're not okay, but you're not sure what you need: http://philome.la/jace_harr/you-feel-like-shit-an-interactive-self-care-guide/play.

4. You are not alone. Connecting with other living beings can be a powerful source of emotional support--what therapists call emotional co-regulation. This might mean texting or calling people you love, showing up to a rally with people who share your beliefs, sharing a meal with a friend, or visualizing the people who ground and inspire you.  Learning about the long histories of resilient and creative anti-violence struggles, including their current manifestations in #BlackLivesMatter and #NoDAPL, might also serve as an inspiration.  You are not alone in your opposition to oppression. The Icarus Project also has a Find A Buddy project for people who are looking to connect with someone for mutual support. 

When connecting with other humans feels tough, animals can also be great sources of emotional support, whether spending time with a cat on your lap or watching a video of a baby elephant playing in the ocean. Relationships with our living world, through gardening, hiking in the woods, watching birds, or listening to the ocean, are also relationships that can help us emotionally regulate in difficult times. Choose the ways of connecting that feel possible to you right now, and build from there. 

5.  You do not have to choose between taking care of yourself and taking action.  If taking action doesn't feel like a possibility right now, this may be a sign to focus on taking care of yourself and healing. Active emotional self-care builds our personal power.  When we feel more personally powerful, we can better partner with and support other people.  In Trauma & Recovery, Judith Herman notes that many survivors of violence take on "survivor missions"--activist projects to transform violence. For Herman, this is the last stage of recovery.  You may not be there, and that's okay.  The healing process can be a place where you strengthen and build the necessary tools to take political action.  

Although I definitely do not have all of the answers, my plan is to continue thinking, feeling, and struggling against violence in collaboration with my communities and my colleagues and my clients.  I am curious about how others are planning their survival and resistance, and how we can build new communities of support in the years to come. 

learning to tell a new story about anxiety

Living with anxiety can be excruciating.  Although a part of the approach to anxiety treatment involves teaching our bodies to calm down, another part of our work is to learn how to narrate our stories differently.  This means identifying the negative messages we've internalized and talking back to them.  For some, it could mean moving from telling ourselves, "I can't handle this" to reassuring ourselves, "I can get through this."  

The video linked below tells the story of a researcher who found that simply re-labelling that keyed-up, on-edge feeling as excitement can have a positive impact. 

http://www.theatlantic.com/video/index/485297/turn-anxiety-into-excitement/

Informed Consent Access to Transgender Health Care

As a clinician, I promote and practice the informed consent model for gender affirming care.  More information about this model is available at www.icath.org.  Like other ICATH professionals, I believe that trans people should have the right to make informed decisions about their care, without mental health professionals serving as gatekeepers.  To act as a gatekeeper to care is to reinforce the perception that being trans is a mental illness.  It is not.  Being trans is an identity, one that is particularly stressful in a world that pathologizes and attacks gender nonconformity.  Part of my commitment as a mental health professional to "do no harm" means that I do not endorse pathologizing trans identity and experience.  

The experience of questioning your gender and/or navigating gender transitions can be confusing and terrifying.  Anyone questioning their gender deserves a supportive, non-judgmental space that affirms a variety of gender expressions and identities.   Requirements for a therapist's letter to access HRT and surgery too often keep transgender people unable to access real counseling--the sense of being in a space where you can share your whole complicated experience, a space where you don't have to tell the "right narrative" in order to have the right to make medical decisions about your own body.  When I write letters advocating for my clients to receive gender affirming care, I always do so with the caveat that I do not think they should have to ask for my approval for their informed health care decisions. 

Trigger Warnings and Microaggressions

There has recently been a flurry of controversy over "trigger warnings"--the practice of marking that a text has misogynistic, racist, or otherwise violent content, which has moved from activist blogs into college syllabi.  (For examples, see recent articles in the NYTimes, The New Republic, or The Nation).  The intention of trigger warnings is to keep people from being surprised by violent material and to give them a greater sense of control over the experience of consuming culture.  Critics of the practice argue that it misunderstands how trauma works and that it might undermine educational goals.  As Jessica Valenti points out in the Nation, triggers are highly specific and it is impossible predict what might trigger another person's trauma memory.  Another common concern is that that students could use trigger warnings to avoid uncomfortable material, avoiding the part of college that challenges them to think in new ways (the educational part).

Although provocative and challenging in other ways, the "trigger wars" that I've encountered are missing a nuanced consideration of the different forms of violence that haunt our classrooms and impact our wellbeing.   The question of whether or not trigger warnings are a useful pedagogical tool has fallen to the background.  So to, has the question of what other tools might help navigate the felt experience of learning for students with differential experiences of and social vulnerabilities to violence.  These are the questions I'd like to explore.  In doing so, I'm trying to respond to Andrea Smith's call for the discussion to move "beyond the pros and cons of trigger warnings" into considerations of how to make spaces for collective healing. 

Violence hums in the background of every classroom experience. Students and teachers are often survivors of major trauma, experiences of terror that may or may not lead to PTSD symptoms.  Members of marginalized or oppressed groups also endure more subtle forms of violence that wound through their cumulative impact.  All learning environments exist in the context of both macroaggressive and microaggressive violence.  Although it is crucial to consider trauma, a discussion of trigger warnings that only considers experiences of explicit attack or extreme danger misses much of the bigger picture.  In order to evaluate how to address violence in the classroom, we need to talk about both big, intense moments of violence and smaller, everyday acts of violence.  We need to talk about both trauma and microaggressions. 

The term "racial microaggression" was coined by Chester Pierce to name common and often-unintentional slights directed at people of color (Pierce, Carew, Pierce-Gonzalez, & Wilis, 1978).  The category has since been expanded to look at microaggressions against other marginalized groups--a sexist image that depicts women as animals, the experience of being followed in a store, or being mistaken for the only other person of your race at your job.  They are experiences that, when isolated, are more likely to be described as annoying than traumatic.  But over time they take a toll.  (If you'd like to look at more examples, or share your own, check out this tumblr).   

Dr. Derald Wing Sue summarizes recent research:

microaggressions are constant and continuing experiences of marginalized groups in our society; they assail the self-esteem of recipients, produce anger and frustration, deplete psychic energy, lower feelings of subjective well-being and worthiness, produce physical health problems, shorten life expectancy, and deny minority populations equal access and opportunity in education, employment, and health care (Sue 2010, 6).   

Despite their demonstrated negative impact on people's health and well-being, microaggressions can feel difficult to fight.  They are ubiquitous, but on their own, each instance might be dismissed as "no big deal" or "not intentional."  It's impossible to avoid them, and it's exhausting to call them out on your own.  If you've experienced microaggressions, you might know that it can make big difference to have someone with you who is also noticing the offense, also angered or annoyed.  A recognition of humanity can offset some of these small devaluations of our humanity. 

When I see trigger warnings, they are often being used to identify microaggressive content.  For example, someone might say, "Trigger Warning--racist language" or "Trigger Warning--slut shaming".  Rather than helping people to avoid content that triggers a traumatic flashback, the function of these warnings seems to be solidarity.  It's a way of saying, "I see that microaggression too, and I don't agree."  Hopefully, the sense of shared critique defuses some of the microaggression's corrosive impact on the reader's well-being.  Microaggressions are damaging in part because they happen all of the time, without ever being called out or named.  Trigger warnings shift this power dynamic and say, "that's not okay", even as we continue to engage with the content.  

Trigger warnings are one way of acknowledging the pervasiveness of violence in our lives, and to incorporate recognition of the powerful emotional toll of oppression into educational practice.  As a response to trauma, trigger warnings on syllabi probably won't be very effective, because they can never anticipate all of the different things that might trigger traumatic flashbacks.  But as a critical intervention into a microaggressive environment, they may be a useful tool.  

Although I can see their usefulness, I do have a serious concern about trigger warnings.  I fear that using trigger warnings might promote a misunderstanding of the psychic life of oppression.  When people think in terms of PTSD, they focus on oppression as manifested in actions like "hate crimes"--assaults and attacks in which there are clear perpetrators.  The ill effects of experiencing microaggressive environments don't typically manifest as PTSD.  Rather, they show up as anxiety, stress, depression, or relationship issues.  Because there is no one discrete event, the link to oppression can feel harder to make.  People are more likely to see their suffering as de-linked from their social environment, a private issue.  Using the language of trauma to talk about all forms of social violence makes the impact of more subtle structural and interpersonal violence harder to talk about.    

Out of this felt need for a more expansive language, I have been thinking about using "microaggression alerts" in my classes.  It is impossible to label them all, and I will likely commit a few unintentional microaggressions of my own over the course of the semester.  But the point here is not to cleanse the classroom of harm--the point is to communicate to students, in every way possible, that they have entered a space in which racism, sexism, and homophobia will be interrogated. 

As an early college student coming from a school in which textbooks spoke in the unquestionable voice of Knowledge, I initially thought that professors were unequivocally endorsing texts by assigning them.  Marking some of the books' weaknesses--sexist language or the exclusion of non-Eurocentric perspectives--would have quickly communicated to me that the perspectives being presented were not the only way of seeing things.  Rather than protecting students from harm, the practice is one of many that can encourage them to think critically about the texts. It is this critical thinking, participation in an imaginary community that speaks back to our texts, that offers a level of emotional protection.  Helping students to avoid getting "stuck" on some of the more obvious failures, content warnings can promote access to the other parts of the text.  Having a content warning makes reading a problematic text a little bit less alienating.  It also avoids other options that strike me as more akin to censorship--editing the author's original words to make them less offensive, or leaving a worthwhile text off the syllabus entirely. 

In marking the possibility of feeling emotionally impacted by a text, content warnings and microaggression alerts emphasize the transformative power of education.  A book can change us, can touch us deeply, and can wound.  This isn't something that should be chased out of the classroom--it's this emotional presence and connection that makes classrooms feel alive.  Some degree of emotional vulnerability isn't simply acceptable in a classroom--it's necessary.  Our felt experiences are the only locations we have from which to speak our histories and make sense of the world.   

**Edited to change an example of trigger warnings naming microaggressions from "rape joke" to "slut shaming." I made this change after a productive exchange with a friend about the ways that rape jokes can both trigger traumatic flashbacks and be microaggressions in the context of rape culture. All microaggressions might also be trauma triggers, especially since explicit attacks are often paired with other less explicit forms of violence.  But there are some things, like jokes that make fun of or make light of violence, that  that are much more likely to trigger specific and painful memories of attackers and bystanders who did the same thing.**     

Recognizing Trauma Triggers and Building Power

As a therapist working with trauma, I have witnessed how powerful the process of identifying and learning one's own trauma triggers can be.  Recognizing triggers--the small, everyday details that remind me* of the trauma and throw my body into panic mode--can powerfully validate my sense of my own reality.  Before recognizing that I am being triggered, my emotional and physical responses feel irrational, random, and out of control.  This is part of what trauma destroys--my trust in my own ability to make meaning of my surroundings.  Healing from trauma is a process in which I regain my trust that my perceptions of the world are as valid as anyone else's.

If I'm not aware of the scent or phrase or other small detail that triggered me, I am only aware that I am acting weird--sweating, panicked, yelling, or frozen.  In those cases, I might worry that I'm losing my connection with reality.   It's not fun to be freaking out, scared, and completely clueless as to why this is happening.  As soon as I recognize that my intense embodied responses have been triggered by reminders of my trauma, my behavior becomes both understandable and linked to my history.  Naming the connection to my past trauma, I can feel again like I am a reasonable person in the present moment.  I gain a sense of control over my affective response--there are things that I can do to calm myself down, to move from a fight-or-flight state into a thinking space.  I feel rational again.  

For example, several years ago, I was trapped by flooded roads while driving upstate from New York City in the aftermath of Hurricane Irene.  On a recent drive from New York to Buffalo, I made a wrong turn and ended up accidentally retracing my path from that day.  I found myself feeling panicked, with tears in my eyes, worrying out loud to my partner that because of my wrong turn "we'll never get home."  My behavior didn't make any sense, and it disconcerted me to be acting so irrationally.  For some reason, I started thinking of that previous drive, and I slowly recognized that I was in the same location where I had been stuck driving up and down the same patch of road, blocked at every possible turn by rising flood waters.  Even though I didn't recognize the road--I had clearly been triggered by the environment.  As soon as I knew why I felt scared, the majority of my panic symptoms subsided.  As soon as I knew the narrative--how my current response linked to my history--I could move forward.

Sometimes, critics have expressed concern that engaging with trauma encourages people to think of themselves as weak or powerless.  Being able to identify a trigger doesn't make me feel weak--it makes me feel an increased sense of power over a situation in which the aftermath of trauma is making me feel out of control.  Healing from trauma is a process through which we build  power and increase our ability to take action.  Putting my embodied experience into a historical context, I regain confidence that I can trust my own perceptions and that I can use my own voice.  

*A note about language--I speak in the first person in this post, as a way of recognizing that most people experience traumatic events over the course of their lives.  I want to re-situate "trauma survivors" as a group to which most people, mental health professionals included, belong to and can speak from, and to de-stigmatize the experience of having been through a traumatic event.  

What is psychoanalysis?

Psychoanalysis is a long-term, depth-oriented process of self-exploration and increasing self-knowledge, in which you meet at least 3 times a week over the duration of years.  Rather than focusing on a specific symptom, psychoanalysis is a process of understanding how you became the person you are and gaining a greater sense of what might be possible for your life.  While it is not the best fit for everyone, some people find it to be a transformative process.  It is a space that engages with history, relationships, desires, and the aspects of our selves that are outside of our conscious awareness.  The process of analysis moves beyond easy or obvious answers, and provides a space and time for reflection outside of the demands of everyday life.  It is less structured than many therapies, and is deeply respectful of the complexities and contradictions of human experience.  Although some people lay on the couch in analysis, it can also be conducted face-to-face.  Although American psychoanalysis has had a negative reputation in the past, feminist and relationally-oriented interventions into the field have enlivened the practice in recent years.    

Most psychoanalytic institutes require their students to be experienced and licensed counselors before beginning training (though there may be special tracks for academics from other fields).  Once in the institute, a candidate complete four years of classes, several supervised training cases, and their own personal analysis.      

 

Reflections on Play

Play is a crucial form of human expression.  In Playing and Reality, D.W. Winnicott writes "it is play that is universal, and that belongs to health: playing facilitates growth and therefore health; playing leads into group relationships; playing can be a form of communication in psychotherapy."  Play is a way of communicating, and like other forms of communication, it is also an expression of health in relationships.

When I work with children, I enter into their world through play, learning about their unique worldview through the worlds they create in play.  This might mean engaging with superhero fantasies to understand a complex web of feelings about power, control, change, violence, and morality.  Or allowing a child the opportunity to reverse roles and "play the grown-up," in order to explore what it means to them to be a child.  When children are not able to directly speak to their struggles, the language of play can be a powerful way to communicate.

With couples and families, I try to attune to their forms of playfulness with one another.  Where are the spaces for creativity, joking, making-believe, and acting silly?  Strengthening a relationship creates the conditions for play, and play can be a profound form of communication.  Through play, we share not just new thoughts and ideas, but different ways of being with one another.   When it breaks down, we feel rigid and on-edge.  The defense of "I was just kidding!" can seem insincere and dismissive of our hurt, and what people describe as attempts to connect can feel more like attempts to injure.  When previous forms of play have gone sour, I work with families and couples to re-establish the safety and trust needed to be vulnerable with one another.  This might mean addressing unrecognized hurts, or figuring out how to interrupt patterns of distancing and pursuing.  When we feel safe enough with the other person to let ourselves be vulnerable, the joyful space of play re-emerges.

What's your anxiety coping style?

Anxiety is a natural and healthy response to stressful situations--it’s how our bodies make sure that we are prepared to respond to threats.  However, in today’s world, we are often inundated with warning signs and stressors.  Rather than a temporary condition that makes us more alert, anxiety can become a constant state and make it harder to cope with daily life.  We feel distracted and exhausted.  We can’t stop thinking about the things that stress us out, or we do everything in our power to avoid thinking about them or dealing with them at all.  If your anxiety is impacting your happiness, it might be a good time to assess your anxiety coping styles. 

Everyone deals with anxiety differently.  Some people depend on exercise or meditation; others feel better when they can talk it through with a supportive person.  People often use food, drinking, smoking, television, computers, and our phones as distractions or “breaks” from our anxiety.  Sometimes our coping strategies work to reduce our worry; but at other times, the anxiety just keeps building as soon as we return.  Sometimes, taking a break seems to make it worse.  In deciding if it's time to invest in some new coping strategies, it can be helpful to ask yourself:

--Which areas of my life or personal history feel low-stress?

--Which situations help me to “think through” or “talk through” the topics that make me anxious?  

--In which situations does talking or thinking about anxiety-producing topics just make me feel more overwhelmed and anxious?

--If talking with others helps, what is it that they do or say that calms me? 

--What are the things that calmed me down when I was upset as a child?

--Can I identify the “triggers” that cause my anxiety to rocket?

--Which physical activities tend to interrupt my anxiety and make me feel calmer?

 

There is no one solution to anxiety--but there are many different solutions, each of them unique to your own experience and personal style.  Through the process of investigating your unique coping style, you can discover new tools to regain a sense of peace.