Friday, March 27, 2009

I would like a new perspective

Mustafa: [taking Ego's order] Do you know what you'd like this evening, sir?

Anton Ego: Yes, I think I do. After reading a lot of overheated puffery about your new cook, you know what I'm craving? A little perspective. That's it. I'd like some fresh, clear, well seasoned perspective. Can you suggest a good wine to go with that?

You may recognize the above dialogue from the movie Ratatouille. The dreaded food critic, Anton Ego has come to Gusteau's to review the work of the new chief and he asks for new perspective and gets it!

Since seeing this movie, when I am feeling baffled by a clinical situation or just plain stuck, I now ask my supervisors for "a new perspective". What they have to say is not always so easy for me to take in or even to understand. Their advice challenges my defenses (read "EGO") : "I should know this." "After all of these years why didn't I see this?" "What I have been doing couldn't be wrong?". It forces me to see dynamic and complex issues in a different way. And when I see my patient for our next session, I more often than not have a clearer sense of how to approach what we have been working on. And like Anton Ego, I'm surprised by what I find.

Thursday, March 19, 2009

the wrong use of authority

This week the Pope, on his way to Cameroon, told people that the Catholic Church does not endorse the use of condoms to decrease transmission rates of HIV, in fact he thinks that it makes the problem worse! It is shocking to think that the leader of the largest Christian denomination (over 2 billion members and growing) selectively comments on critical public health issues. There is a body of evidence that shows that the use of latex condoms "substantially reduces the risk for HIV transmission". It also is effective for other sexually transmitted diseases, like HPV.

I thought that I would let the Pope know that I think he should reconsider his position. He supposedly has an email account: Here's what I wrote:

Dear Holy Father, I’m sure that you will be hearing from others who know about the science behind barrier protection in decreasing the incidence of HIV transmission. I wish that you and your advisers would please consider that your advocating for not using condoms is harmful. It is not informed by sound epidemiological studies. Advocating for condom use does not lead to more casual sexual encounters. Please leave your dogma behind and use your authority to speak to the pressing needs of those who still want to listen to what you have to say.

Maybe you would like to write him as well. I'll post any response that I get back from the Vatican.

3/24 update

Here is my answer:

This is the mail system at host
I'm sorry to have to inform you that your message could not be delivered to one or more recipients. It's attached below.
For further assistance, please send mail to postmaster.
If you do so, please include this problem report. You can delete your own text from the attached returned message.
The mail system
: host[] said: 452 4.2.1
mailbox temporarily disabled: (in reply to RCPT TO

So the mailbox has been "temporarily disabled". This has me thinking about the process of giving feedback. Here in the US, if we disagree with our federally elected leaders, we can go to our representatives in Congress and ask for their input. Granted this tends to be a futile effort, but we can exercises our discontent when voting comes around. To whom do we discuss our dissatisfaction with the Vatican, our local priest? I guess that is why these struggles get exercised in the press and in public opinion.

There is a connection to psychotherapy. There are a number of my current patients who are finding their "voice" and speaking up for themselves in current struggles and past abuses. They have needed to overcome their fears of retribution, relearn trust and still maintain some wariness (appropriately so) of those who have authority. The Vatican's handling important issues with blunt instruments may cause more damage than the obvious increase in sexually transmitted diseases.

Friday, March 6, 2009

bearing suffering and bearing witness

At our Grand Rounds this week, Jodie Wigren MSW, Ph.D. from the Trauma Center talked about the intersection of psychodynamic and trauma theory in working with survivors of trauma. She summarized in a beautiful way the interesting phase shift in this work:
First patients learn to bear suffering and then learn to bear witness.

In and earlier posting, I wrote about the other side of this dynamic, the therapist's learning to sit with the affect (feelings, suffering) in order to share in the bearing witness. I going to add this quote to my repertoire.