First, we saw only the tall green tree,
We were blind to the surrounding forest.
The earth was flat.
The forest, dark.
. . . They knew not what to do.
January 19, 2020, the Washington Post carried a very personal story of one family’s experience in the effort to find help for their son, Aaron. Reading this family’s misadventure through the blinding alleyways of mental health services, we can feel and see the struggles with their talented son and the state of mental health. Should we read the story and forget about the problems? Shall we accept the Mental Health Industrial Complex (MHIC) as it is, just because it is so entrenched?
Can the family be included in the search for a better way to adapt when serious mental illness comes to visit? After all, it does not matter if you have money or if you run a successful business. People fight, they blame each other. Little pockets of emotional problems exist in all families. But only one in five families seeks help from the mental health system.
What can we tell them? There may be genetics involved. It may be random that one of your children or siblings or grandchildren express emotional issues. So, try these drugs. just remember that if anyone threatens his or her life or the life of others, you can seek hospitalization. The state might offer you 3 days or a month or years in the hospital where families can come visit for two hours once a week. They know not what they do.
What schizophrenia does to families — and why the mental health system can’t keep up
Diagnosed with schizophrenia in his teenage years, Aron’s future was foreshadowed. After reading their story I wondered why psychiatry has such trouble talking to families about what might help, what might make a difference. There is no way to say how things might have been different if this family had knowledge of family systems theory?
Any family is mostly on its own to figure out what to do when mental illness arises. Some say, “I would rather have cancer. People are kinder to you.” If there is a physical symptom the role of the family member is clearer. The person is still rational so you can say without getting into a tremendous fight you can say, “I will drive you to the doctors”. Or You need to take your medicine.
But in talking to a person with mental health issues, well they often need to be in control. You cannot tell them what to do and have it work out well. People with cancer are still rational and you can sometimes tell them what to do or how to think and they might not go off on you. Who knows perhaps telling people who have cancer what to do, makes it worse for them too, but we do not hear about it.
How do any of us know what kind of relationships might work? Arron’s mother says, “Protecting the mentally ill, you become mentally ill just trying to get it all together.” Then she describes the effort as the “We can fix it stage.” The push to get them to do it right overrides the effort to define a self and manage boundaries. Is the “We must do it” statement hazardous to the mental health of everyone in the family?
From the Washington Post: A Family History: The parents marry early and have Aaron. Seventeen months later a daughter, Alishia is born and then Amanda three years later. The father joined the Air Force, trained as a dental hygienist and the family moved often. A gifted athlete, Aaron was also at the top of his class in high school. But the move to college seemed to present challenges that he was unprepared to take on. His reactivity showed up in saying he wanted nothing more to do with the military and choose Arizona State University. When he failed to be given a football scholarship his senior year he fell apart. “That broke his spirit.” He quit the football team. We have no knowledge of how the family talked to each other during this time. We do not know if they took sides, blamed someone for his problems or if they worked on being more thoughtful, independent individuals, letting Aron take responsibility for his actions. Two weeks before his graduation Arron talked in a threatening way to other students and was expelled. The parents thought it must be drugs and no one really considered the psychiatrist’s view that Arron was having a psychotic break. The family history revealed that there were suicide and abuse in his extended family. If there was any strength in the extended family, we did not hear about it. Instead, the mother is tasked with “helping.” They thought tough love would work. Sometimes it does help to set boundaries but sometimes it is just a way to try to control others. How do you know the difference?
What If: How would it have been different if family systems theory had been used to give the family an understanding of the situation? Would they have found it useful to focus on self or consider that making better contact with the extended family might, over time, decrease the anxiety and give everyone a better chance to grow? Perhaps an effort to be a more defined self could make emotional room for each individual to grow. Think of the trees in the forest if they are too crowded then there is little room to grow. The assumption is that as one person in the family settles down and thinks carefully about the situation there will be more room to grow.
The family in the Washington Post article asks, how can it be that in our country we have underfunded treatment facilities, jails that serve as treatment facilities, and a lack of advancement in medication? The unmentioned and the equally harder problem is how to provide useful knowledge about what family members can do? The story was haunting. How cutoff this family seemed to be? Only the nuclear family was spoken about. They seemed to exist in a very closed space. The mother noted she was making an effort to insulate her family from his “unpredictable behavior.” How could she know the cost of the isolation from the extended family? How do any of us know?
My Motivation: After WWII my parents collapsed with drinking problems. It was 1952 when we were adopted by our maternal grandparents. Our family was well off and could provide many things, like education, but no knowledge of the family as a system. Butch, my brother two years younger, earned the label of paranoid schizophrenia in May of 1974, just three days after our mother died. The family was turned upside down but eventually, I found a job in a psychiatric hospital. This began a long-term effort to understand the family as a system and to define “who am I, and who are you.” The result – all the family anxiety was not directed at Butch – and both of us became a bit better defined. Butch was not hospitalized for mental problems again until a few months before his death, November 2, 2020.
Knowledge: We have known since the fifties that the family is a reasonably predictable emotional unit, automatically managing anxiety by focusing negatively on the weaker ones in the family. Consider how funny that the mental health system is set up to follow the family’s emotional process. Both worry and focus on the weak ones and exclude the family from looking at itself. There are a few organizations that enable families to manage to react to the symptomatic person such as ALANON which has been useful to those trying to relate to family members who have a serious symptom.
The fact is that anxiety spreads: Few have knowledge as to managing the way people are reacting to, and about, the focus on family members. How can one be better at observing the situation, seeing the family patterns and not take them too seriously? When one person can just listen and speak about the way they see the family situation, that person is outside the love and approval of the system. Rabbi Freidman used to say: “Beware of peace over progress.”
Say what you think to any group, and they will react and pressure you to “change back.” But if anyone is motivated to alter the part they are playing, they can do it by making a plan just for themselves. When one can say – This is where I stand.” And without threats or fear of rejection let others know “This is the way I see things. This is what I am doing and or saying and it might not make sense to you, but this is the way I see the effort I need to make. You are free to do what you believe best, too.” This effort makes more room for trees in the forest.
What is HIPPA? Today the family is seen as a problem: they are weak and difficult and talking with family members is wrong. Society has rules to protect the person from the family. The medical world isolates the individual with barriers like HIPA rules. No one in the family can find out what is going on with the patient unless the patient gives permission. Is this a double bind as to how can families know what to expect or correct their part in any problem if they know nothing?
In stark contrast, family system’s knowledge allows us to describe the multigenerational relationship system that surrounds each person. People become aware of family patterns over generations. They can learn how they innocently participate in side-taking and telling others what to do. They can get to know people in the family and find emotional support there. Overall there is much to learn as the more open the family system is, the greater the opportunity each individual has to be responsible for their own life. Currently, the focus is on fixing the individual. The family as a system remains blind. There is a long and winding road through the forest, to provide knowledge about the family as a system. Our current belief system is that the individual is almighty or the devil and so it is.
Interesting Research
- Steve Porges, PhD
When you want to calm a person down, you smile and talk to them in a soothing way. The nervous system detects these cues and down-regulates or inhibits the sympathetic nervous system. But when the sympathetic nervous system is activated as a defense system, it turns off all those social-engagement behaviors.
Clinicians are aware of that. But what they often don’t understand is the role of the vagal system in shutting down as a defensive strategy in response to a life threat. When someone is immobilized, held down, or abused, the vagal system is triggered, and they may disassociate or pass out—or perhaps drop dead or defecate. It’s an adaptive response.
Social communication has little to do with syntax and a lot to do with intonation, gestures, and a cluster of behaviors we would call biological movement. The face is moving along with the voice and hand gestures. The behavioral features trigger areas of our brain outside the realm of consciousness and change our physiology, enabling us to feel closer and safer with another.
Good therapy and good social relations, good parenting, good teaching, it’s all about the same thing—how do you turn off defensiveness? When you turn defense systems off, you have accessibility to different cortical areas for more profound understanding, learning, and skill development.
https://www.pesi.com/blog/details/967/wearing-your-heart-on-your-face-the-polyvagal-circuit
2) Rethinking Feelings:An fMRI study of the cognitive regulations of emotions
We humans are extraordinarily adaptable creatures.
Drawing upon a vast array of coping skills, we can
successfully manage adversity in even the most trying
of circumstances. One of the most remarkable of these
skills was described by Shakespeare’s (1998/1623, p. 216)
Hamlet, who observed, ‘‘there is nothing either good or
bad, but thinking makes it so.’’ Although Hamlet himself
failed to capitalize on this insight, his message is clear:
We can change the way we feel by changing the way we
think, thereby lessening the emotional consequences of
an otherwise distressing experience.
The cognitive transformation of emotional experience
has been termed ‘‘reappraisal.’’ In both experimental
and individual-differences studies, reappraising an aver-
sive event in unemotional terms reduces negative affect
with few of the physiological, cognitive, or social costs
associated with other emotion- regulatory strategie s,
such as the suppression of emotion-expressive behavior
( Jack so n, Mal mstad t, Lars on, & Da vidso n, 2000;
Richards & Gross, 2000; Gross, 1998, 2002; Gross &
John, in press). The mechanisms that mediate such
reappraisals, however, are not yet understood. The goal
of the present study was to use functional magnetic
resonance imaging (fMRI) to elucidate the neural bases
of reappraisal.
George Engel’s 1977 biopsychosocial model remains effective to this day in positioning the environment on equal footing with biology in formulations of adolescent health and well-being. While the intervening “decade of the brain” and contemporary initiatives such as the Research Domain Criteria approach have most directly updated our understanding of the constitutional elements of mental health, environmental contributions to these elements have kept apace. In this chapter, emotion regulation, a key intrinsic process and transdiagnostic marker of mental health with defined neural correlates, is developed as an exemplary nodal point for demonstrating the crucial influence of the environment in the development of brain and behavior.
https://link.springer.com/chapter/10.1007/978-3-030-25816-0_7