Margin Notes, Thoughts on "Beyond the Individual" by John Willcock

Really methodical review of how Stoics arrived at a social ethical system. It does take some 'leaps' in terms of connections (there is a bit of 'faith' and 'trust' in believing we are connected ... your daimon is a fragment of the greater part of the divine cosmos), "organized, planned and controlled system of cause and effect" in which we live. There is no room whatsoever for the Epicurean 'swerve' (sorry, Friendo).

p. 38 - is a fig tree 'bad' if it doesn't produce figs? or was it the will of the cosmos that a fig tree doesn't produce figs?

some thoughts at the end of chapter 2:

• Stoics claim there is a connection of my divine fragment to the Whole, yet *no one* and *no thing* has access to my mind.
• Socrates mentions his daimon, but *no one* had access to Socrates' mind
• Is there an "ought" or duty to listen to my daimon or other peoples' daimon?
• Who's divine fragment has priority if there a dispute of action?

Other questions and notes:

p. 67 - "no change is harmful in Stoicism. Is all change the universal's rational, harmless, systematic processes in motion?" ... Can humans cause harm to God / the Cosmos?

p. 68 - the universe does no harm to itself, "does not infer that every human will always act in accordance with the whole though." The parts can be out of harmony, but God is still unharmed.

p. 75 - "built into our rational thoughts and actions are instead the ends of our fellow rational beings and the Whole." ... Prisoner's Dilemma --> coordination. If I act virtuously (morally), then I am cooperating and coordinating with the common good.

p. 78 - the universe created hierarchy, yet Willcock pushes against this argument.

p. 102 - it is a struggle to accept one's duties, while watching many others deny their own. a challenge is: what to do when others fail in duty to you? p. 104 provides a possible answer? "how we make ourselves available as the objects of moral actions for others" ... it takes effort to 'open up' and be involved in others' lives.

For example ... p. 112 ... in 2020 global pandemic, some argued our duty was to stay 'locked down' and inject experimental vaccines for the common good. Now, four years later, it is more widely accepted that the lockdowns caused far more harm, and long-lasting harm to the common good. Many made the argument *against* lock downs and forced vaccine mandates, yet were vilified. Both sides of the debate were based on doing what is best for the common good.  This is one of many, many examples of how Stoicism does not provide a clear, objective moral compass. As long as a Stoic argument is in support of taking action and supporting duties for the common good, then it is accepted. Stoicism does not settle debates about the best course of action for the common good, hence war is the father of us all (Heraclitus).

p. 116, "the primary way in which we can live in accordance with our rational nature for the Stoics is to think and act with the consciousness that we are universally and communally interconnected beings."  fine, we are connected, but are we good about understanding cause and effect predictions? no.

p. 140, "we have at our disposal the capacity to live an emotionally stable life." Is mental illness due to lack of training?

"Developing a mental resilience to external threats requires a similar developmental process for Epictetus.  Just as people can learn to be resilient to 'heat and cold,' likewise we can develop our mind to be indifferent to external activations of our emotions." You still care about your duties, but are not emotionally tied to them.

p. 141, God defined (what is good): "well-ordered, just, holy, pious, self-controlled, useful, honorable."

p. 155, "Seneca's advice concerns how she can avoid similar kinds of grief. This does not mean viewing the present world from a position of hopelessness and with the mindset that all will be inevitably lost. Seneca advocates rather the importance of premeditating how quickly things can change, in order to hope for outcomes that are best, while being 'prepared' for what can happen that would be the 'worst.'" ... Why not? Even existential angst can teach greater resiliency!

p. 158, "We might ask here whether everyone has to be individually living rationally for the universe to be perfectly rational at any point in time. This is a difficult question to answer, given that in one regard everything in the world is perfectly rationally ordered, in that the world's causal structure rolls on whether we are individuals want it to or not." Do all need to be rational - live according to Nature - for God to be happy? Nope!

p. 161, "we see here that when we do anything, if while doing that we are aware of what we share with others, then our happiness and well-being is ordered in tandem with the happiness and well-being of others." But we still disagree about 'doing something for the common good.' 'You do your worst, I'll do my best' seems to be the attitude to take, and to remain indifferent to the outcome. Just because you argue for action for the common good, does not mean it is the best course of action for the common good. Therefore, do some propose an action 'for the common good' in bad faith?  Is it really self-interest disguised as common good? Perhaps! And what are we to make of 'my tribe' against 'your tribe'? Again, there is no objective moral compass in Stoicism.

In sum, really good book, but quite often it is R-E-P-E-T-I-T-I-V-E, to the point it could have been a fourth to third shorter if the book had better editing.

PSYCH 406 (Psychopathology) - Suicide as Related to Major Depressive Disorder

Abstract

This essay describes the symptoms and diagnostic criteria for major depressive disorder, with an emphasis on the symptoms of thoughts of death and suicidal ideation. It further reviews methods of treatment, and then finishes with a review of ways therapists can forge and strengthen therapeutic relationships with suicidal patients.

 

Introduction

To exist or not, as a human being, is up to us. Albert Camus (1979) contends suicide is the only genuinely profound philosophical question to answer. True, every individual has the choice to exit life, however the cost of that exit can be significant for those left behind. Not even counting the invaluable cost of loss of life, suicide attempts alone accounted for nearly $27B in health care costs in 2019 in the United States (Hughes, et al., 2023). Even despite the massive expense from the fallout of suicide attempts, the emotional toll and impacts heaped on loved ones and friends who remain behind in the wake of a successful or unsuccessful suicide will take countless hours of therapy and grieving and perhaps even significant pharmacological expense to remediate. From a psychological, to an emotional, to an economic perspective, any way to advance the understanding of the patient’s motivation for suicide and greater insight into how to prevent suicides would be a worthy endeavor not only for the individual, but also for the common good. To that end, this essay will explain the most common disorder which leads to suicide.

This essay will describe major depressive disorder, including all the criteria that must be met in order to diagnose an individual with major depressive disorder (Maddux & Winstead, 2016 and American Psychiatric Association, 2022). Along with those criteria, it will also outline the symptoms and warning signs of those seeking to end their life (National Institute of Mental Health, 2022). It will then review three major avenues of treatment for major depressive disorder, which include electroconvulsive, psychopharmacological and psychotherapeutic forms (Maddux & Winstead, 2016). Lastly, the essay will delve into the topic of clinicians establishing the clinician-patient therapeutic alliance to assist patients in opening up about the challenges they face with suicidal ideation (Foster, et al., 2021).

Description, Symptoms, Diagnostic Criteria

While the impacts of major depressive disorder (MDD) can be persistent and influence human productivity, symptoms can worsen and lead to the untimely death of the sufferer. Maddux and Winstead (2016) note that MDD will perhaps be the number one cause of premature death and human disability globally in the next one hundred years. In the United States alone, the suicide rate has increased over a third between 1999 and 2018 and with the recent COVID-19 pandemic, that trend has continued to rise (Moutier, 2021). Therefore, spotting MDD symptoms effectively and early is key to suicide prevention.

The symptoms of MDD described in the DSM-5-TR (American Psychiatric Association, 2022) begin with understanding what a major depressive episode is. Symptoms include nine key markers: 1) a depressed mood, which may include feelings of helplessness and hopelessness, 2) the loss of interests or pleasure in activities the person normally enjoys, 3) losing 5% or more of their weight in 30 days while not intending to diet, 4) poor sleeping habits stemming from insomnia or perhaps sleeping all day, 5) constant agitation in movement or a significant lack of movement, 6) general lack of energy, 7) self-loathing, exceptional feelings of guilt or worthlessness, 8) significant challenges in concentration, deliberation, thinking or even decision-making, and most importantly, 9) repetitive thoughts of dying, death or suicide. As for this ninth symptom, the patient does not need to demonstrate it every day for a two-week period; once is sufficient to qualify. The patient must exhibit five or more of the nine listed symptoms (two of which must be a depressed mood and loss of interests) for a period of at least 14 days, and these must cause a substantial impact on their social life, job or other important aspects of their life, and the attribution of these symptoms must not stem from some other condition such as drug use, or another disorder such as schizophrenia (American Psychiatric Association, 2022, p. 183, 185). Lastly, in order for MDD to qualify as the diagnosis, the patient must demonstrate having one or more major depressive episodes, without any type of mania or hypomania.

One other important aspect of the diagnosis is related to whether there is an identifiable cause of the patient experiencing the symptoms. Some people may have recently dealt with an impactful and emotional event in their life such as the loss of a baby, a bankruptcy or loss of job, living through an act of God such as having a home and all possessions burned down in a wildfire or even having contracted a serious medical illness such as terminal cancer (American Psychiatric Association, 2022, p. 183). While many people may exhibit major depressive episode symptoms stemming from one of these drastic life events, it does not mean the person qualifies for the diagnosis of MDD.

As noted in the ninth symptom of MDD, if a patient has repetitive thoughts of death or suicide just once in a two-week period, along with the other symptoms, then they may have MDD. It is also important to note external markers which may predict if a patient is suicidal. Maddux and Winstead (2016, p. 193) observe that a majority of suicidal people convey their intent to kill themselves. More specifically, the National Institute of Mental Health (2022) provides a list of warning signs which loved ones and other people around the patient can spot. The patient may verbally express ideas of suicide, feelings of guilt or sense of being a burden on other people. They may express feelings such as helplessness, hopelessness, being trapped, having no purpose, or being sad, anxious, angry or expressing unendurable pain be it physical or emotional. Lastly, the patient may communicate in non-verbal ways such as searching online for ways to die, pushing close ones away or retreating from normal social interactions, acting with recklessness (e.g. risky skiing, driving, cliff jumping), consuming more drugs or alcohol, and sleeping and eating less. Related to the warning sign of recklessness, Maddux and Winstead (2016) note that suicides may be underreported because the act of suicide may appear to be accidental. For example, 15% of automobile accidents with a fatality may actually have been suicide related.

Treatment Options

There are three major avenues of treatment for MDD: electroconvulsive, psychopharmacological and psychotherapeutic therapy. The essay will briefly describe mechanisms which address the first two methods and then more deeply address the third method through a discussion on cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).

Electroconvulsive therapy (ECT) was discovered as a form of therapy in the 1930s (Maddux & Winstead, 2016, p. 205). The method for application is to deliver between 70 and 130 volts of electrical shock to the patient’s brain. The patient may endure nine or ten rounds of ECT over the course of several weeks. While ECT has proven to be somewhat effective, experts still do not know exactly why it works in some cases. One theory is that electrical shocks downregulate 5-HT (serotonin) receptors. Despite proving somewhat effective, patients’ memory functions degrade, and they have a more difficult time learning and recalling knowledge. Related to ECT is transcranial magnetic stimulation (TMS). TMS does not produce memory dysfunction and can be more precisely tuned. The only side effects reported are benign headaches and minor discomfort.

Pharmacological forms of therapy for major depressive disorder address dysfunction in serotonin regulation (Maddux & Winstead, 2016). Studies have shown that when individuals’ serotonin levels are depleted or if reuptake has been altered, then it begins to have a negative impact on mood, which may act as a catalyst for a depressive episode. Three medications have been used for quite some time to treat depression: monoamine oxidase inhibitors, tricyclic and tetracyclic antidepressants. More recent developments in antidepressant medications include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). All five medications work in some form or fashion to regulate serotonin levels. As for which one should be used with a patient, it is often a matter of finding the right medication and dosage with the least harmful side effects. One emerging medication to address depression is ketamine. Rather than targeting the regulation of serotonin, ketamine seems to aid in the regrowth of important synapses in the brain, improving brain neuroplasticity (Yale Medicine, 2021). Researchers are discovering that ketamine treatment coupled with CBT provides rapid and long-lasting positive change. Not only do ketamine and CBT together prove efficacious, but Maddux and Winstead (2016, p. 198) note that CBT coupled with other appropriate medication is more effective than either CBT or medication alone.

CBT and ACT are two well-known psychotherapeutic frameworks which help the patient to fundamentally change their underlying thinking to address negative perceptions of themselves and environment (Maddux & Winstead, 2016, p. 197-199). CBT encompasses multiple ways to help the patient alter the underlying thinking framework for how the patient processes events, as well as to couple their thinking to action. For example, people who suffer from MDD would be asked to recognize and write down their negative thoughts, along with the causes and effects which lead them to think this way. They would then be asked to assess and question those thoughts to ascertain if they truly match reality and rationality. Through this process, the patient begins to reconstruct their thinking narrative in a more positive and productive manner.

CBT is especially helpful in challenging and questioning hopelessness thinking in suicidal patients. In fact, studies have shown (Bryan, 2019) that versions of CBT for suicide prevention (CBT-SP) are so effective, that these specific forms of CBT have been recommended as standard care procedures for all suicidal patients. CBT-SP typically includes three successive phases. In the first phase, clinicians assess the risk of the patient and then collaboratively work with the patient to form a crisis and treatment plan. In the second phase, the therapist and patient work on revealing the dysfunctional thinking patterns and negative internal dialogues which lead to feelings and emotions related to helplessness, hopelessness, being trapped, and having no purpose. In the last phase, therapists and patients tie everything together by creating a plan to minimize relapse. Bryan (2019, p. 249) further observes the effectiveness of CBT-SP by stating that patients of CBT-SP were one-half to two-thirds less likely to attempt suicide when compared to treatment as usual.

ACT can be viewed as an extension and evolution of CBT (Maddux & Winstead, 2016, p. 198-199). While ACT is similar to CBT, it differs from its aim. ACT does not focus on minimizing the negative symptoms of depression, but to empower the patient with greater flexibility in their thinking. ACT helps the patient understand their core values and then proceed in a consistent manner with those values. ACT prompts the patient to pause and reflect on what they deeply value in life, and then to engage with their emotions and thoughts, rather than questioning them. By engaging with their thoughts and emotions through a comparison with their core values, the patient is able to discern gaps between who they are and who they wish to be, and then take specific and meaningful action. For example, ACT has proven to be quite successful with veterans dealing with suicide (Walser, et al., 2015, p. 30). It has shown that when a patient experiences suicidal ideation, the therapist would work with the patient to explore the patient’s core values, either through dialogue or a values assessment test. As the patient is confronted with ideas of death, they can accept those thoughts and pivot toward ways to pursue and fulfill meaning in their life by focusing on something they value.

Article Summarization: Strengthening the Therapist-patient Alliance

In the context of suicidal ideation, it has been observed that most suicidal individuals do not explicitly disclose through self-reporting. Foster, et al. (2021) note that only 24% reveal their suicidal plans through disclosure. The driving causes of hesitating to divulge their thoughts of ending their life are fears of judgement, hospitalization, and losing independence. Therefore, if therapists, clinicians and others who are in a position to help the patient can establish trust and openness in communication, they may be able to garner the patient’s confidence and assist them in getting the needed medication and therapeutic treatment. Foster, et al. (2021) argue that three specific aspects on which clinicians can focus to improve the therapist-patient alliance are: 1) awareness and management of countertransference of negative emotions, 2) deploying communication techniques which are empathic and 3) leveraging the patient’s subjective experience as feedback.

Countertransference occurs when the therapist experiences conscious or unconscious projections or judgements of the patient, which in some cases may interfere with the therapeutic process (American Psychological Association, 2018). Foster, et al. (2021, p. 258) note that therapists can exude negative emotions to an individual intent on ending their life. Quickly assessing countertransference is crucial to strengthening the therapist-patient alliance. The Therapist Response Questionnaire-Suicide Form is an innovative tool to rapidly assess countertransference and enables the therapist to secure supervisory coaching and support to manage countertransference.

Empathy is how one person relates to another, including focusing on commonalities as well as differences, which enables shared insight between individuals (Foster, et al., 2021, p. 259). Clinicians and therapists must have a life-long commitment to developing and mastering empathy in their practice, especially when working with suicidal patients. Besides continuing education and hands-on training seminars to learn and practice empathy, there are also tools which assist therapists to hone their empathy skills. The Empathic Communication Coding System (ECCS) assists in identifying opportunities for the therapist to practice a range of empathic responses. The ECCS aids in identifying the patient’s statements as emotion, progress or challenge and then suggests a range of potential ways a therapist could use empathy. For example, a widow may mention how she constantly thinks of her deceased husband, to which a therapist could respond with, “Are you thinking about death?” or with the more empathic response of, “It seems that these thoughts you are having are difficult. Has suicide crossed your mind?” Therapists who master the art of empathy will improve the chances of the patient opening up and being more receptive to treatment rather than suicide.

Lastly, when therapists form a solid alliance with the patient, they can leverage that trust to gain insight from the patient feedback. Gathering feedback from a patient who has attempted suicide or had thoughts of suicide can prove rich in understanding the paths leading to death as well as paths leading to recovery (Foster, et al., 2021, p. 259). Collecting this feedback and sharing it broadly enables the wider community to benefit from this untapped resource. Tools such as the Consultation and Relational Empathy assessment and Working Alliance Inventory collect data from the patient’s perspective. These feedback mechanisms reinforce patient autonomy as well as shed light on the subjective experience of the patient.

In sum, there are innovative ways and tools to facilitate greater collaboration between the therapist and suicidal patient. First, the therapist must be aware of and manage countertransference of negative emotions. Second, they must constantly improve their communication techniques by focusing on improving empathy. Lastly, they can tap into the patient’s subjective experience to use as feedback in the therapeutic process.

Conclusion

In conclusion, with the increasing trend of suicides globally, and the severe impacts they have on society, this essay endeavored to illuminate the reader on the topic of major depressive disorder, with an emphasis on the symptom of suicidal ideation and the diagnostic criteria indicating a risk for suicide. The essay then examined three methods of treatment in the forms of electroconvulsive therapy, pharmacological and psychotherapeutic avenues. It specifically addressed CBT, CBT-SP and ACT in the context of suicidal patients. Finally, the essay discussed the importance of the clinician-patient therapeutic alliance, along with a set of tools to enable the fortification of that collaborative effort. 

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders, text revision (5th ed.). American Psychiatric Association.

American Psychological Association. (2018). APA Dictionary of Psychology. Dictionary.apa.org. https://dictionary.apa.org/countertransference

Bryan, C. J. (2019). Cognitive behavioral therapy for suicide prevention (CBT‐SP): Implications for meeting standard of care expectations with suicidal patients. Behavioral Sciences & the Law, 37(3), 247–258. https://doi.org/10.1002/bsl.2411

Camus, A. (1979). The Myth of Sisyphus, and Other Essays. (J. O’Brien, Trans.). Penguin Books Ltd. (Original work published 1955)

Foster, A., Alderman, M., Safin, D., Aponte, X., McCoy, K., Caughey, M., & Galynker, I. (2021). Teaching Suicide Risk Assessment: Spotlight on the Therapeutic Relationship. Academic Psychiatry, 45(3), 257-261. https://doi.org/10.1007/s40596-021-01421-2

Hughes, P. M., Phillips, D. C., McGrath, R. E., & Thomas, K. C. (2023). Examining Psychologist Prescriptive Authority as a Cost-Effective Strategy for Reducing Suicide Rates. Professional Psychology, Research and Practice, 54(4), 284–294. https://doi.org/10.1037/pro0000519

Maddux, J. E., & Winstead, B. A. (2016). Psychopathology : Foundations For A Contemporary Understanding (4th ed.). Routledge/Taylor & Francis Group.

Moutier, C. Y. (2021). Innovative and Timely Approaches to Suicide Prevention in Medical Education. Academic Psychiatry, 45(3), 252–256. https://doi.org/10.1007/s40596-021-01459-2

National Institute of Mental Health. (2022). Warning Signs of Suicide. Www.nimh.nih.gov. https://www.nimh.nih.gov/health/publications/warning-signs-of-suicide

Walser, R. D., Garvert, D. W., Karlin, B. E., Trockel, M., Ryu, D. M., & Taylor, C. B. (2015). Effectiveness of Acceptance and Commitment Therapy in treating depression and suicidal ideation in Veterans. Behaviour Research and Therapy, 74, 25–31. https://doi.org/10.1016/j.brat.2015.08.012

Yale Medicine. (2021, July 30). Ketamine & Depression: How it Works - Yale Medicine Explains. Www.youtube.com. https://www.youtube.com/watch?v=nW21-AYY_fs 

7/8 to 7/14 2024

What as week it has been. There have been plenty of opportunities to practice and embody Stoicism as I was taught. 

As Seneca says often, one must study virtue and learn it, then train at and practice it, then it is strengthened by action. In Letter 94 he says, "Virtue depends partly upon training and partly upon practice; you must learn first, and then strengthen your learning by action." and in Letter 90 he says, "Virtue is not vouchsafed to a soul unless that soul has been trained and taught, and by unremitting practice brought to perfection."

We were on vacation at Bear Lake, Utah at a family reunion the week leading up to the 4th of July. After going to the South Texas Merchant Marine pleb-candidate send off on Saturday June 29, we went to bed that night after saying our goodbye to our 2nd-year mid-shipman who was leaving for Kings Point on Sunday June 30. We began our two day drive to Utah at 5am. After our two-day drive, we spent the week in Utah, enjoying the cold nights, brilliant summer days on the beach and in the blue and turquoise water. We visited relatives in Logan and Salt Lake, and my wife and I got a taste of what it would be like to live in the West again. We began contemplating what it would look like and what we would do if we were to transplant ourselves to Logan.

During the whole week, we kept our eye on Hurricane Beryl. As the end of the week approached, we saw the forecasts revised multiple times with each update moving the hurricane evermore eastward toward Texas and up the Gulf Coast. By Sunday, we knew it was going to hit Houston. We began our two-day drive back, stopping in Amarillo Sunday night. We went to bed knowing that when we woke up the next day, the hurricane would be on top of Houston. Our three pets were at home and a pet & house sitter was there, but nonetheless we were worried. 

Day 1

Monday July 8 was our drive home from Amarillo to Houston. All morning long, we had KTRH streaming on iHeart. We were in contact with the pet & house sitter, but we also knew our dogs and cat (well, maybe not the cat) were stressed. Our one dog always gets super stressed with storms. Plus, we were anxious to get home to relieve the sitter and we could take on all the concern and worries. Power at the house went out at 4:39am Monday morning (based on time stamp data of my Ring cameras). The drive seemed longer. We dropped our oldest daughter off in Austin and then made our back into the greater Houston area. We stopped at Brenham, filled up and got some food, knowing we may not be able to get gas when we got into the city. Our neighbors checked on our home and said it was ok, but our back neighbor's tree fell into our yard, obliterated our shed, with our generator pinned under the tree.

The drive into our suburb was like a war zone. All traffic lights were out. There were hundreds of downed trees, some blocking the main roads, some smashed into homes or signs or power lines. We had to take many back roads and even back track a few times in order to get home. We arrived home in the late afternoon, with no power. We unpacked and then I started assessing damage and cleaning up the many limbs and branches all over our yard. I made a huge pile by the curbside of all the debris. Besides the fallen tree, there is one big branch hanging from one of our three mature trees, which has been snapped.

We began formulating a plan and determined that power would not be restored for quite some time. We went to bed that night with no AC or fans. But at least we were with the pets again and the home survived any major damage. Having gone through Hurricane Harvey, I knew the next few days or weeks would be difficult but perhaps more endurable than Harvey.

Day 2

Tuesday July 9 brought more planning and assessment of the situation. We determined that power would not come back anytime soon. We were living in Dallas during Hurricane Ike and from talking to neighbors who lived through Ike, they said it was two weeks before power was restored. In fact, our neighbors almost made it sound like it was just a two week party of BBQs and watching college football with TVs hooked up to generators. We decided that my wife and youngest would take the pets to Austin to stay with my oldest for the week. They packed up Tuesday morning, emptied the fridges and left by late morning. I got up early morning and logged into work via my cell phone's hot spot.  I read a few emails and updated my team. I was stuck in our suburb with potential blockages on roads and only a quarter tank of gas. I decided to go hunting for any gas I could find.

No gas in our suburb. No gas in adjacent towns. No gas up the freeway. I kept driving hoping for one gas station, thinking that maybe there would be power in outlying areas. But none were open. After driving almost an hour, I rolled into a town and decided to park at an H-E-B and wait.  I wasn't sure if I had enough gas to get back home.  As I watched the constant flow of cars roll by, it felt surreal. Many of them were looking for gas too. I ended up talking to a gentlemen who was stuck. He had no choice but to wait as his truck was bone-dry.  He had driven up to Livingston to help his ex-wife and now he was headed back to San Antonio, but needed gas. There was another gentlemen who pulled up while we were talking and he came from the same suburb as the one I live in.  He was doing the same thing as me - just looking to fill up. I wondered if I should attempt the drive home. I did some rough calculations in my head and decided that worse case scenario, I run out of gas very near home or in my suburb. So I trekked back home and drove below the speed limit.  I made it back all the way home with a needle just above E.

I decided I was going to be stuck home the whole week, unless my daughter's car had some gas in it. After I got home, I checked her van (it is the old family van) and she had a full tank! My plan then pivoted to driving into work (which has power and connectivity) and maybe even just sleep in the van or find a place to sleep at work.

After getting all packed, the sun set. It is an eerie experience to be in a dark, hot home all alone. I lit the candles and sad down to 

Day 3

Wednesday July 10 actually wasn't that bad. Things seemed to be more normal at work. It was nice to be in AC again and be connected. I logged in threw myself into work. Since I had been out a week, there was a lot to catch up on. We had a team member who recently left our group, and there was a going-away lunch that day. We ate lunch at the Island Grill and it had a really nice vibe with natural lighting, good food and lots of people. It felt good to have some normalcy again.

I worked the rest of the day, and when I came to a stopping point, I logged off, went to a conference room and logged onto my personal computer and began working on school. Since there was nothing to go home to, I stayed at work until around 9pm. Then I decided to drive home and go to bed.  The home was stale and warm. Cell phone reception was spotty at best and I couldn't even access anything on my phone. I lit a candle, laid on the floor and read Meditations.

Eventually I went to bed, but it was a challenge with no air flow and no sound machine.

Day 4 & 5

Thursday July 11 and Friday July 12 were pretty much a repeat of Wednesday. Getting up was easy, because I was motivated to shower and cool off. I drove to work and was there by 5:30am; I worked all day, studied school after work and then drove home to a restless sleep.

Thursday night, after wrapping up my studies, I went to Island Grill again and had a nice meal and watched the Astros game on TV. That was memorable and was a very nice reprieve from reality.

Friday was different when I got home that night. We had power again! Unfortunately, the AC would not kick on, so the house remained quite warm at 83 degrees, but at least I had some air flow from the ceiling fans. I called Jill and told her the power was back on and she said they would drive home on Saturday.

Day 6 & 7

Saturday July 13 we had the AC tech come out, but he discovered there was no power flowing to the furnace unit and we needed and electrician to come out and troubleshoot it. Jill and Camille and the pets came home later in the day and began prepping for their trip to Belize. I contacted our electrician and he said he would come out later that day.  But he never showed and wasn't responding to texts.

On Sunday July 14, I took them to the airport and then started calling and texting any electrician who could come check on our AC. I found one and he was on his way when the power went out again! But thankfully it came back on about 30 minutes later.  The electrician and his wife showed up, I told them the issue and they began troubleshooting. He discovered the wire from the main panel to a subpanel was not rated correctly and burn it to a crisp. He put a joiner or something on it and fixed it.  Power came back, the AC kicked on and things finally began to turn normal again.

Beyond

The following week, I made contact with several tree services to remove the fallen tree in our back yard. Some wanted to charge me $5000, others $2000, but we finally found two that would do it for $1000.  They cut it and hauled it to the curb. Price gouging is definitely a thing.

There are piles of dead trees and branches on every street. Some homes needed to bring in cranes to reach up to the fallen trees embedded into homes. It will be months before the rest of the city returns to normal. We had a couple stop by our home asking what work they could provide to our yard. I asked them to give me a quote to haul off the three massive piles on my yard and they said they could do it, along with breaking down and hauling off our smashed shed for under $500. Next up will be fence repair.

As of July 22, there are no hurricanes on the horizon, but even if we get to the end of July, we'll have another solid 60 days of prime hurricane weather.

PSYCH 406 (Psychopathology) - Trauma and Pathologizing the Norm

Abstract

This essay discusses the observation of Western culture’s fascination with trauma, along with the history of post-traumatic stress disorder (PTSD), and how that diagnosis has expanded its scope. It also notes that most humans are resilient in adversity and trauma. For those who suffer long-lasting effects of trauma and exhibit PTSD symptoms, they should seek professional help and support.

Introduction

For many movie-goers, the summer is a great time to head to the silver screen and watch action, drama, and intriguing stories play out in spectacular visuals and chest-thumping sounds. This year, audiences are anticipating the third installment of the Deadpool series. For the uninitiated, Deadpool is an antihero known for his sharp sarcasm and dark humor. For example, in a scene from the first Deadpool movie (Miller, 2016), when he meets his girlfriend, Vanessa, the two enter a back-and-forth banter about the trauma and rough childhood they’ve endured. While this essay won’t recall the entire repartee, one of the less dark and non-sexual exchanges gives a good sense of the dialogue. At one point, Deadpool quips his bedroom was a hall closet, to which Vanessa volleys back she had to sleep in a dishwasher box, to which Deadpool replies, “you had a dishwasher?” (Miller, 2016). While dark and humorous, this represents the zeitgeist of modern culture’s romanticization of trauma .

In a recent Psychology Today article (2022, January 4), Robin Stern wrote regarding her observations of many examples of how society, particularly Western society, has become enamored with stories of trauma. From a conversation she had with her trainee about how she couldn’t get enough details of her clients’ trauma, to books by Bessel von der Kelk and Paul Conti  on bestsellers lists and to a documentary by Gabor Maté, all are examples of how the topic of trauma is having a significant cultural moment. However, Stern and others have wondered if there is a misunderstanding of what trauma is. Are people truly experiencing trauma, or are they simply experiencing stress, grief, or big life events ? Maddux and Winstead (2016, p. 162) in the chapter on trauma and stressor disorders note that there is “larger debate [regarding the] pathologizing of normal human suffering and the overdiagnosis of disorders .”

This essay will discuss the phenomenon of society’s romance with trauma and the issue of pathologizing normal behaviors (Harrist & Richardson, 2014). It will then pivot to a discussion on what constitutes real, clinical trauma and two psychosocial models of the etiology of post-traumatic stress disorder (PTSD) (Maddux & Winstead, 2016). Lastly, the essay will contend that many people suffer significant stress and emotional events, however, most are resilient and will recover (Bonanno, 2021). For those who truly suffer trauma, they too will largely recover, but for those who meet the criteria of PTSD, they should seek professional help.

Pathologizing Normal Behavior

Harrist and Richardson (2014) discuss many ways in which seemingly normal behavior has been pathologized in Western culture. They note how melancholy and despair may actually be perfectly normal responses to the instable world in which we live, yet modern science attempts to solve these responses with pharmaceuticals . They further wonder why hoarding is considered a mental disorder when people fill their house to the roof with junk but people who “amass billions of dollars while other people starve” are not pathologized (Harrist & Richardson, 2014, p. 202). But more importantly, they discuss the roots and genesis of the PTSD diagnosis.

They cite an article published in the British Medical Journal of how the old diagnoses of battle fatigue and war neurosis were replaced by PTSD. The early supporters of the PTSD diagnosis were also part of the anti-war movement during the Vietnam War. Under the new diagnosis of PTSD, war veterans could receive unique medical care. But more importantly, PTSD fundamentally changed the way soldiers were viewed and treated. Instead of the focus being on the unique history of the soldier and his psyche, PTSD “legitimized their victimhood” and the PTSD diagnosis was perhaps more of a statement against the nature of war than anything else (Harrist & Richardson, 2014, p. 203). This change was a pivotal moment as the diagnosis expanded in scope for the next several decades to explain not only battle trauma, but also “symptoms of distress following disturbing events, even ones relatively commonplace or just witnessed, not directly experienced, by individuals” (Harrist & Richardson, 2014, p. 203).

Returning to Stern (Psychology Today Contributors, 2022, January 4), she describes why PTSD and related disorders have seemingly expanded their scope. The experiences people share of  trauma are often remarkable and fascinating and “have a strong emotional charge” especially when compared to more normal experiences of people from overprotected and isolated lives. There is an aura about traumatic stories and people who live through those experiences are imbued with a type of fame and fascination. Others wish to share their own stressful experiences to gain traumatic credibility. But as Harrist and Richardson (2014) warn, while people may indeed experience big emotional events, the trauma of soldiers, war victims, and victims of sexual violence, to name a few, should not be “trivialized.” Definitions matter and delineation must be made clear between normal behavior in response to a significant event, and clinical trauma that people suffer from living through horrific events.

Clinical Trauma and Psychosocial Etiology Models of PTSD

While there have been changes to the PTSD entry between the DSM-4 and the DSM-5, such as moving it from an anxiety disorder to the newly created category of trauma- and stressor-related disorders, the key features of PTSD remain relatively the same (Maddux & Winstead, 2016, p. 165). The traumatic experiences must be related to death, the threat of death, significant bodily injury, or sexual violence. Victims may either experience these events directly or they may indirectly experience them such as when a close family member directly experiences it and then conveys the details of the horrific event to the victim. Stemming from one or more of these experiences, the victim should demonstrate intrusive memories, dreams, or psychological and even physiological effects from reminders of the traumatic event. They will avoid any reminders of the event and may begin to have cognitive distortions, memory loss, emotional distress, and  even detachment. From there, they will develop and exhibit strong response arousal, careless behavior, hypervigilance, or experience problems with concentration or sleep. The victim must suffer many of the above symptoms for more than one month after the event. Underlying all these symptoms is the victim’s inability to process or integrate the traumatic experiences into their life. In turn, they are left with less than adequate coping mechanisms.

Based on a sample of people in the United States, it is estimated that over 60% of men and 51% of women experience trauma (Maddux & Winstead, 2016, p. 163). The majority of those adapt and do not experience long-term maladaptive coping mechanisms. As for why some people might cope well and adapt to a traumatic experience while others do not, there are many etiological theories that explain why some suffer PTSD. This essay will only touch on two: cognitive and emotional processing .

The cognitive etiological model theorizes that the individual’s beliefs and knowledge about himself, the world, and other people are maladaptive and weak, and when the individual experiences a traumatic event, their beliefs and conception of safety, are crushed (Maddux & Winstead, 2016, p. 169). They are unable to process the events and make meaning out of the experience. In fact, Harrist and Richardson (2014, p. 207) note that in a highly individualistic culture, many people don’t experience “shared meanings and coping strategies” and are thus left to their own devices to cope with trauma. In turn, they become overwhelmed and experience PTSD.

The emotional processing etiological model is based on the theory that the individual creates fear structures to deal with dangers in their environment. However, when these fear structures build excessive responses, the individual becomes inflexible in learning how to modify their responses (Maddux & Winstead, 2016, pp. 170-171). For example, a person with PTSD will demonstrate avoidance behavior, which in turn prevents them from tapping into and updating  their fear structure in a way that would enable them to successfully adapt to an event. 

As briefly noted, most people who suffer a traumatic event are able to make meaning out of the experience, adapt, and recover from the stress of trauma. In all this discussion on trauma and PTSD, it has been broadly observed that humans are quite adaptable, even when confronted with the worst of trauma.

The Resilient Human

Maddux and Winstead (2016, p. 163) produce a chart that visually demonstrates that even with the traumatic events of sexual and non-sexual assaults, people are able to recover and adapt well after the event. For sexual assault victims, 70% report PTSD symptoms one month after the event. That percentage continues to drop over time, going as low as 30% one year after the event. For non-sexual assault victims, 40% report PTSD symptoms one month after the event with a declining trend over time, going to 10% at the one-year mark. Overall, the data suggest there is a “natural recovery curve” (2016, p. 162), in which most victims can make a strong recovery. Only a small minority of victims experience PTSD .

All of this data supports the claim that perhaps by pathologizing and stigmatizing many big, emotional, stressful events, as a whole, society may be undercutting the process of recovery . To lend greater support and care for a victim, pathologies are created, and focus is placed on the symptoms, rather than successful and creative coping mechanisms. There is also a significant individualization and rights-based view of modern pathologies. Harrist and Richardson (2014, p. 204) note this paradigm “underestimates and tends to undermine the creative capacity of people to cope with, and even at times find meaning in, suffering and traumatic experiences.”

Harrist and Richarson (2014, p. 204) continue their discussion with examples of two non-Western cultures that do not pathologize not only big, emotional, stressful events, but not even trauma. Researchers and counselors went to Sri Lanka after the 2004 tsunami and worn-torn Afghanistan and realized people exhibited symptoms not on the PTSD list and when they tried to provide individualized grief counseling, the isolation “actually [exacerbated] fears of loss or disturbance of one’s role in the community.”

Returning to Stern (Psychology Today Contributors, 2022, January 4), she contends our judgment becomes impaired when we become captivated by stories of trauma . By immersing ourselves in our own emotions, we may overlook the needs of the person telling his or her traumatic story. Most importantly, we underestimate our resilience and fail to recognize our true strength. She goes on to discuss some broad observations from one researcher who has studied this topic for many years. She quotes George Bonanno who says, “Most people are resilient …some people are traumatized; some people recover. There are different trajectories.” In fact, in one of Bonanno’s more recent articles entitled The Resilience Paradox (2021, p. 2), he and other researchers reviewed 67 studies to better understand “outcome trajectories” of people who endure a potentially traumatic event (PTE). He writes, “two thirds of the participants showed the resilience trajectory. Thus, not only is resilience to PTEs common, it is consistently the majority outcome.”

In sum, many studies and researchers have noted that the human is resilient in the face of big, emotional, stressful events and even traumatic events. While trying to determine the root cause of why some suffer PTSD and others do not, researchers are finding that PTSD is fairly rare. For those who do suffer many of the symptoms of PTSD for months after the traumatic event, they should continue to seek support from clinicians, counselors, and a support structure.

Conclusion

In conclusion, this essay examined the phenomenon of society’s romance with trauma and the issue of pathologizing normal behaviors. Western culture seems to be experiencing a cultural moment with its fascination of hearing others’ traumatic experiences. While many people do experience big, emotional, stressful events, they are most likely not suffering clinical PTSD. PTSD is reserved for people who experience events related to death, the threat of death, significant bodily injury, or sexual violence. Furthermore, they develop long-lasting, maladaptive coping mechanisms. There are many theories of the etiology of PTSD, of which two are emotional processing and cognitive. Ultimately, many people suffer significant stress and emotional events, however, most are resilient and will recover. Even for those who truly suffer trauma related to death, bodily and sexual violence, they too will largely recover, but those who meet the criteria of PTSD and who have lasting effects, they should seek professional help and support from their family, friends, and social networks . 

References

Bonanno, G. A. (2021). The resilience paradox. European Journal of Psychotraumatology, 12(1), 1942642–1942642. https://doi.org/10.1080/20008198.2021.1942642 

Harrist, R. S., & Richardson, F. C. (2014). Pathologizing the Normal, Individualism, and Virtue Ethics. Journal of Contemporary Psychotherapy, 44(3), 201-211. https://doi.org/10.1007/s10879-013-9255-7

Maddux, J. E., & Winstead, B. A. (2016). Psychopathology : Foundations For A Contemporary Understanding (4th ed.). Routledge/Taylor & Francis Group.

Miller, T. (Director). (2016, February 8). Deadpool. 20th Century Fox.

Psychology Today Contributors. (2022, January 4). 5 Big New Trends | Psychology Today. Www.psychologytoday.com. https://www.psychologytoday.com/us/articles/202201/5-big-new-trends