Violence and Mental Illness: The Stigma and the Truth

This is a huge topic, so I will only touch on one “mental illness”, as there is a trial all about BPD in the press and the jury is deliberating whether to send the woman to be executed or not. So I am not going to write about BPD, as it is extremely complicated and I’d rather wait and see what happens with the jury’s decision and then post on BPD and violence. Just one thing to say, without any statistics, it is my experience that people suffering from BPD do a lot of self harming rather than violence towards others. Everything from extreme binging and purging, self-mutilation, repeated suicide attempts, drug and alcohol abuse, etc. plagues people who suffer from BPD.

As I was posting about the movie “Silver Linings Playbook” and felt that it gave a bad impression that people who are going through mania and manic psychosis are violent, I wanted to write about that and shed some light on it. A colleague shared with me that unlike my experiences, she had seem many males who became violent while manic and in the midst of a manic psychosis, so I wondered, is this movie off the mark or not?

Ok. I looked around the internet and found a study done in England around Sept. 20101. You can read the whole summary here:

http://www.ncbi.nlm.nih.gov/pubmed/20819987

Here’s the important finding, which is that the comorbidity of substance abuse and bipolar disorder is what increases the incidence of violence in people diagnosed with Bipolar Disorder. In regular English, this means that the subgroup of people who have BIpolar Disorder and are abusing drugs and alcohol on a regular basis, usually knows as “MICA” (Mentally Ill and Chemically Addicted), and requiring treatment of both problems, that those people are more likely to be violent than the general population. However, it seems the risk of violence in individuals suffering from BIpolar Disorder alone is minimally different from the rest of the population. This makes sense as there is probably a lot of evidence that especially polysubstance abuse but also alcoholism and any drug addiction that becomes severe and episodic can result in violent behavior. Which is not to say that every alcoholic or person suffering from drug addiction is dangerous, however, I am sure there are some statistics out there supporting a higher evidence of violence occuring among this population…

“During follow-up, 314 individuals with bipolar disorder (8.4%) committed violent crime compared with 1312 general population controls (3.5%) (adjusted odds ratio, 2.3; 95% confidence interval, 2.0-2.6). The risk was mostly confined to patients with substance abuse comorbidity (adjusted odds ratio, 6.4; 95% confidence interval, 5.1-8.1). The risk increase was minimal in patients without substance abuse comorbidity (adjusted odds ratio, 1.3; 95% confidence interval, 1.0-1.5), which was further attenuated when unaffected full siblings of individuals with bipolar disorder were used as controls (1.1; 0.7-1.6). We found no differences in rates of violent crime by clinical subgroups (manic vs depressive or psychotic vs nonpsychotic). The systematic review identified 8 previous studies (n = 6383), with high heterogeneity between studies. Odds ratio for violence risk ranged from 2 to 9.

CONCLUSION:

Although current guidelines for the management of individuals with bipolar disorder do not recommend routine risk assessment for violence, this assertion may need review in patients with comorbid substance abuse.”

So, to get back to the movie, they did not show the protagonist drinking or doing drugs at all in the movie as far as I remember. Even at the football game, I don’t think he was drunk, but I could be remembering wrong. It seemed like the only hints of drinking under stress were evidenced by the character Tiffany who did not suffer from bipolar disorder, and she was not portrayed as abusing alcohol. So I think this movie could mislead the public into associating manic and other forms of Bipolar Disorder with episodes of violence, when the evidence does not support it…

Here’s another article about the topic, talking about men vs. women but also focusing on the co-occurence of substance abuse and bipolar episodes. The memoir by Marya Hornbacher: Madness: A Bipolar LIfe, is a real roller coaster ride, and great portrayal of someone with a huge drinking problem and bipolar disorder and the self destruction and pain she undergoes after recovering from a very severe eating disorder.

Here are her words about her drinking:

I started drinking when I was ten. There’s a scene in the book where I talk about discovering the booze in the cupboard underneath the stove… It, too, functioned very briefly as a mood stabilizer… It elevated my mood, and just made me feel like I was flying. Instead of feeling like I was going up and down and up and down, there were no more crashes. For a few hours at a time, I wasn’t terrified, I wasn’t anxious — I was just high as a kite. Of course, like any other alcoholic, the reasons you do it at first become irrelevant, because then, you’re just drinking because you’re an alcoholic. When you try to stop drinking, as I did many, many times many years later, you realize it’s not about anything. It’s a function of a kind of desperation and addiction.

So, of course, this topic is extremely complicated, but it is interesting how adding addiction to any other issues magnifies the risks of impulsive behavior, self-harming and suicidal behavior, and sometimes violent behavior towards others… But it makes sense that I have worked with and known of so many cases of people suffering from various forms of Bipolar Disorder who never had any episodes of any violent behavior towards others…

Silver Linings Playbook; From A- to B-/C+ in Less than a Week!

ok. I had a terrible day today, so it feels like the perfect time to have fun writing this post because I saw Silver Linings Playbook for the second time the other day and I was blown away — by how much worse it was on a second viewing! I almost felt scammed or literally “played” that I had such a “manic” experience loving it after a first viewing.

Basically for me, the big test of a movie is, does it stand up to being seen a second and then a third and then maybe even a fourth or fifth time? Doesn’t matter how soon you see it again. As I said in my last post, that is why I love films like “Bringing Up Baby” and more modern ones like “Spotless Mind”; every time I see them, I find something else to love about them and get great enjoyment out of seeing scenes I could practically play over in my head between viewings, such as the dog and dinosaur bone garden digging scene in “Bringing Up Baby.” In fact when I realized how much lower Silver Linings sank on the second viewing I remembered that I talked a lot about Bringing Up Baby in my glowing post; and I realized it was because the elements I liked about Silver Linings reminded me of that classic and maybe reminded me too much of how great that movie was! A really good movie like the “Spotless Mind” one doesn’t remind you so quickly of other movies because there are really great cool things in it to enjoy that seem totally unique to the movie even if it is a familiar “genre”.

So what took the silver linings out of “Silver Linings”? Just about everything except the characters of Tiffany and the father played by DeNiro. The fact that on second viewing the main character Pat did not seem like a real person and those other “supporting” characters were more interesting did not help it. Other complaints that can be quickly listed off: too many montages (I challenge you to watch it again and count how many long montages there are and how much time they take up in between real scenes)– unless you’re watching a cool music video, you do not want to be aware of having a montage much less five or more of them in a movie. OK. I guess my other criticisms do not fit into a short list. Let’s take the most important one, the portrayal of bipolar disorder:
On a second viewing I was shocked I did not notice this important thing the first time: Pat’s big episode was “triggered” by a violent situation which is terrible for many reasons. One, I have worked with many people with serious bipolar disorder and others with family members and close friends with bipolar and never in all the years of hearing all the stories of these people has any of them been described as involving violence, much less two episodes with violence in them (the scene where he almost kills the history teacher and the scene in which he hits his mom and his dad gets violent). This gives the general public a very strange idea about mania and bipolar psychosis and from viewing the film if you did not know about it, you would associate violence with manic episodes. In addition, as I confirmed by talking to a married straight guy about the film, most men in Pat’s situation might have done the same thing upon coming home to their wedding song playing and their wife in the shower having sex with the history teacher, without having any mental illness issue whatsoever, so it confuses the issue to have this event be the major event that results in Pat’s hospitalization. Plus if you watch the movie carefully, you hear that the lawyer obviously used mental illness to get him into the hospital for 8 months instead of put in jail, which puts the reality of him having it in question as it is referred to as “undiagnosed bipolar”. The icing on the cake is the scene where he ends up getting violent with his mom and then realizing he needs to take his medication. None of this fits any of the accounts I have heard of others’ manic episodes. The most common thread is the transition from mania to psychosis involving religious delusions and all kinds of intense meaningful LSD like spiritual experiences as well as grandiose delusions (ie. “I was convinced I had to fly to LA to the big premier of my brilliant movie, or, “I really thought I was god” “I thought I had found the cure to cancer and was about to receive the Nobel Peace Prize,” etc.) Sometimes if a relationship has just ended or some kind of intense love feelings are involved but not receprocated in reality the person while manic is convinced someone or several people are in love with him or her who in reality are not.

Anyway, that is a big problem with the movie on second viewing that makes me change my opinion of the TV show “Homeland”. I was a bit hard on it in my last review of this movie. I still think the ECT was strange and not well explained and that I would like to see the character have a session with a psychiatrist or therapist and also know what meds she takes, however at least her episodes are more realistically portrayed. We see that she is not in reality but we see how subtle it is that her reality is becoming out of wack, which is really well done on that show in that her job is already an inherently stressful and crazy paranoid making job and her obsession with the other character makes sense.

So “Silver LInings” still gets my approval for an ok portrayal of therapy and for the character taking the right medications. Probably the best scene in the movie that reflects the stigma of all kinds of mental illness is when he points out to his family and the others in the scene that maybe he and the other two “crazy” characters in the movie see things and understand things in a way that the others do not; I think that is true. If there is a silver lining to having a serious mental illness, it is that you experience life in a way that others do not and have a unique sensitivity towards others. The way seeing impaired people report that they their sense of hearing is very good…

So, lesson learned: watch out for getting too seduced by a movie that already has a lot of hype. Watch it at least two times before writing a big “I love it” blog post!!! We therapists sometimes get it wrong, that is for sure!

Silver Linings Playbook!

I had not posted my weekly post yet as I was thinking about a complicated post about new theories about sexuality and something called “sex scripts”, part of this new idea about how people’s “sex orientations” (my phrase to describe how people think about, view sex and their fantasy lives, very different from the concept of “sexual orientation”, but both are connected in that we do not choose them, they “happen” to us or get coded in us…)

More on that when I have time to craft a long and complicated explanation of the ideas in it. Luckily I saw the movie, “Silver Linings Playbook” last night on DVD, so I have a very short (well actually it turns out to be longer than I thought!) post to write about it.

Spoiler Alert: If you haven’t seen this movie, don’t read this post!

This movie really caught me by surprise, not the topics in it, but how much I liked it. I don’t often really absolutely love a movie and want to see it again soon. In recent years the last time I felt that way about a current movie was the moive, “Stranger Than Fiction”, from 2006. So I tend to be really moved and excited about a movie every 4-7 years, I guess. There was “Eternal Sunshine of the Spotted Mind” from 2004, so I guess those years I did not have to wait as long to be totally bowled over by a movie. Then before that it was “Being John Malcovich” which I saw over and over, maybe a total of 5 times! That came out in 1999, so I had to wait about 5 years to be that affected by a movie. It’s no surprise that Silver Linings marks seven years of no great movie for me; I have to confess that I have not seen that many movies out in the theaters since 2006 anyway, even though I have rented, bought and watched Netflix.

Anyway, I was prepared to watch with my therapist goggles on to see how they portrayed mental illness, especially bipolar disorder, but I wasn’t prepared for the portrayal of traumatic bereavement reactions in the traumatized “depressed” character Tiffany, or the portrayal of a very strange functional version of OCD in the father. There was another character from the hospital who had some kind of mental illness that was not clearly defined but seemed to have some OCD involved with his obsessions about his hair.

I was not prepared to be laughing out loud throughout the movie and of course, crying at the end.

Anyway, besides just being bowled over by the writing and how great all the performances were, I was really moved by the kind of love story they were telling. Yes, the portrayal of bipolar disorder was pretty good given the standard these days as set by the tv show Homeland, which I have a lot of problems with (why don’t they ever show her in therapy or with a psychiatrist? why did she have to get ECT which is sort of unusual for people with bipolar disorder? it seemed like they did not make clear that she was actually taking any meds and which ones and why they were not working.) For those who thought it was more realistic, I send them to the scenes when Pat in Playbook talks about not taking his meds, talks about which meds, and starts taking them despite not wanting to be “flattened” out.

The portrayal in Silver Linings was really much more realistic than the one in Homeland. I think the last time I saw such good portrayal of bipolar disorder was in the tv show “Six Feet Under”. The film actually managed to have some decent therapy scenes, with an actually pretty good empathic yet firm therapist. What a relief, as the TV and Film industry seems to love portraying therapy and therapists in a negative light or choose to portray very weird unconventional types of therapists for the sake of drama. This therapist did not have that many scenes to get developed the way Dr. Melfi in The Sopranos, another good therapist, was portrayed, but at least he was pretty much doing his job and wanted to help Pat, which is a victory for showing therapy in a good light. The film dealt well with the character’s initial avoidance of taking his meds, and came up with a very dramatic but not unrealistic scene of him behaving in such a way that he got it together to start taking his medications. (If I’m remembering correctly, it was after the flashback and hitting mom with dad hitting him at the end disturbing scene…) Also, bravo for the writers, we heard exactly what meds he was on and they made sense! He was taking lithium, seroquel and Abilify, which was also right on the mark for someone with Bipolar 1 to be taking post hopitalization for stabilizing mania, and as an example of a normal “bipolar cocktail” group of meds. Lithium as a mood stabilizer, one of the first ones discovered by accident, and seroquel, a fairly recent psychotropic medication used for bipolar disorder and at higher doses for any kind of schizophrenia disorder (schizophrenia, paranoid schizophrenia, schizoaffetive disorder, schizophreniform disorder…). Serquel is sometimes prescribed with depakote or lithium to add to mood stabilization and also as an anti-psychotic. It also acts as an anti-depressant. Abilify is a relatively new medication, not yet produced in the generic, that is used to increase the “ability” of the other meds’, usually moood stabilizers or anti-depressants, effectiveness. So, good for them, they got specific and realistic with the medication.

The reason I harp on the medication is that it is an opportunity for the general public to understand more about mental illnesses, such as Bipolar 1 Disorder, that are severe yet can afford the patient a “normal” functioning life if taken responsibly and under the care of a psychiatrist. And again, it is great for people to see what a difference the medication makes. As evil as people think the pharma companies are, these meds save lives, really they do! And they aid in people being able to have much fuller lives with less hospitalizations, etc.

I was also pleased with Tiffany’s character and the portrayal of her “craziness”, about which at one point the main character says says something cruel to the effect that he can’t see himself as being seen similar to her, implying that he thinks she is “crazier” than he is. There is a good scene where she points out that she is at least at peace with her “issues” and past impulsive sexual behavior (which was triggered by the sudden death of her husband) and can he say that for himself, which gives him pause, as he is not ok with his past violent eruptions and has not integrated the shadow parts of himself fully as she seems to have…

Now about the other main character with a kind of “mental illness”/ Tiffany’s narrative describing her “acting out” behaviors following the sudden death of her husband, was nicely placed in the film before you find out how he died, which makes for a realistic progression of things; we don’t know everything in a logical linear fashion about people when we enter any kind of relationship with them. Also, it affords the movie to cause uneducated and more judgmental people in the audience to have negative reactions to her description of having sex with 11 people in her office before getting fired after some kind of sexual harrassment from her boss (that last part I don’t remember the details of as by then I think Pat is so intrigued by her description). Perhaps without thinking about it, the writer or writers of the screenplay or book it was based on, are helping people understand why, after the events of 9/11/01, there was a lot of talk about 9/11 widows being rampantly promiscuous and even that people in their circles viewed them as “sluts” or even that men meeting them easily propositioned them assuming they were all promiscous and easy to score with. Obviously, not every widow surviving an extremely traumatic death of their partner gets so traumatically depressed that she engages in such kinds of impulsive sexual promiscuity and sexual promiscuity that is somewhat self-destructive (ie. either not using condoms or having sex at one’s work place and getting fired, etc.), but Tiffany’s character is well fleshed out and complex. The great twist is that she is not ashamed of her behavior or even regretful, which is also great at getting at stereotypes or archetypes in society of the “Widow Slut”. The situation is made more complex by the fact that she also engaged in sexual activity with women. There is a brief nod to the concept of partners not being understanding or open to each others’ fantasies from the scene in the diner when she starts elaborating on her experience with one older woman and both characters are aware that Pat is fascinated and turned on by it. At this point he says the only negative thing about his marriage in the movie, as he is idealizing the concept of marriage and his now broken marriage that, that his wife did not understand or want to participate in his fantasy life or at least he alludes to some closed mindedness in the area of her husband being attracted to women or wanting to talk “dirty” with her. This relates to the post I mentioned above that I have yet to write.

Anyway I diverge from the main important things that make this film so great. Thinking more about it, I see it as being part of the genre of a particular kind of romantic comedy that “Eternal Sunshine of the Spotless Mind” and even “Stranger Than Fiction” might belong to. It’s not the remarriage comedy of the Katherine Hepburn romantic comedies but it has the formula in which one protagonist is highly aware of being in love with the other one and frustrated by the blockages the other one is facing that cause him or her to not realize they are also in love, in effect described in the movie at the end as a kind of “catching up”. This “catching up” concept is actually very common in romantic comedies, and what makes us always expect the “running on foot” chase after the loved one at the end of the movie. How many romantic comedies have you seen with the speech from some other character about seizing the day and the “go after him or her or you will regret it for the rest of your life” almost word for word. In this movie the father wonderfully played by Robert DeNiro gets to make that speech which precipitates his son literally sprinting after Tiffany who has literally run out of the building. The running metaphor is well used in the movie as Pat goes for a run and literally “runs” into Tiffany or she goes out running when she knows he will be running in here neighborhood and she litterally runs after him as she does metaphorically throughout the movie, patiently listening to his rants about his wife who left him after the big “incident” and who has a restraining order against him, and patiently waits for the here and now of her interactions with him to cause him to fall in love with her as a real person. She is competing with a fantasy. He is competing with a dead man which is no competition at all as she begins running away from him and after him from the moment they meet. She interrupts the dinner at her sister’s house to run away, at the same time asking him to take her home.

Anyway, this running after him and his “catching up” at the end reminds me most of a really great classic romantic comedy with Katherine Hepburn and Cary Grant, “Bringing up Baby”. The Hepburn character is not swayed by the fact that Grant is engaged to get married the next day. She spends the whole movie figuring out how to keep him near her and falling into one disastrous chaotic romantic event after another. A classic scene is when she has got all his clothes to the dry cleaners. He is forced to stay longer at her aunt’s house and don a very feminine white bathrobe with white fur on it. While he is in the shower, Goerge the dog finds his very valuable dinosaur bone and of course absconds with it and burries it in the garden. So the great scene is Hepburn and Grant running all over her aunt’s garden getting George to dig holes everywhere trying desperately to find the bone. The movie is hilariously full of mishaps, and Grant only “catches up” to Hepburn at the end by which time almost every character except the stiff and unadventurous fiancee is in the local jail with two leopards at large, both Baby the tame leopard and a wild leopard…

Really, Silver Linings most reminded me of that lovely film. The female characters are both equally memorable and have the same determination to somehow by keeping the man “involved” in their own daily life and keep the man with you and far away from the physical presence of the almost ex wife or the finacee. Physical presence and the charm and realness of these determined women win the day and they are rewarded with the slow minded but wonderful men finally getting it into their thick brains and hearts that they instead of wanting to run away from the women, actually want to keep them by their side for the rest of their wife.

To take this lovely cliche and still make us want it to happen and love to watch it throughout the film is just brilliant. That is what makes the film, that they can do it and I’m crying at the end. It’s a testamennt to the whole writing and buildup and chase throughout the movie…There is a great scene near the end when Tiffany convinces Pat’s father to change his mind completely about her by proving that every time Pat has been with her the Eagles have won the game; this sets off the rest of the movie being very reminiscent of the madcap old comedies like “Bringing up Baby”. I’m sure I could find several others. Philadelphia Story is a good reversal in which Cary Grant waits the whole film for his ex wife Hepburn to realize that she wants to remarry him, a slight twist on the waiting around plot that we see in every good and bad romantic comedy!

So basically, this movie works on so many levels one could go on and on about it. It’s making me want to find other such movies with the same romantic plot, but I realize even Spotless Mind works in the same way, except we the audience are waiting for both lovers to return to each other and each seems to have to catch up to the other equally…

More on Creative Blocks and Trauma/Depression

I think my most recent post was about daily habits and establishing something that works for you as a daily creative thing to do, even five minutes… So, continuing on with this series of posts about creativity as a healing process…

Creative Blocks and Trauma Related Depression

I think there is a connection between having a lot of trauma in your past and/or recent past, being depressed, and also having creativity blocks. This is a kind of depression that is not necessarily that noticeable although sometimes it is very much in the forefront of your life. For some people, it is a lowgrade depression, characterized not so much by depressing thoughts or great feelings of sadness and melancholy, but more like a kind of daily feeling of a lack of excitement and pleasure in your life. A person can get used to sort of feeling “ok” and functioning at work and with others but not really looking forward to anything or being very excited by much in their life. “Going through the motions” is part of it. Also a kind of low expectation for oneself that seems to creep up on the person slowly so that they notice they are older and don’t have a lot of “big dreams” or exciting plans for the future. Sometimes this manifests in “forgetting” to plan a fun vacation, going to work but not really liking your job while at the same time not hating it or thinking of other options. It’s also as though the idea of “other options” keeps receding and the person has stopped thinking of their “Bucket List” which may have just been things they were thinking of doing in their early 20s they didn’t end up doing and have developed a block about, such that they do not even think about other possibilities, even little things like taking a class in something new or something you liked as a “hobby” but gradually just stopped doing and “forgot” about…

The “forgotten life” is a sad part of this depression. It is easy to go about your day with blinders on and come home just tired, not expecting much, watching some tv, helping your kids with their homework but not getting much joy out of anything. Sometimes a person with this kind of depression is feeling ok or happy when with their kids and family or their dog or other animal companion and has moments of joy that are connected to these relationships but can’t muster up much gusto for doing anything for themselves. Even without depression, it’s easy to forget to talk to your parnter/husband/boyfriend/girlfriend/companion about anything much besides the usual talk about daily matters.

This is an insidious kind of depression because it is not very obvious. The person seems fine and does not demonstrate the usual big red flag signs of depression, no sudden weight loss or weight gain, no sleep problems, no crying, no thoughts of death or suicide. The big connections with really bad depression are “anhedonia”, which means lack of ability to feel a sense of pleasure and enjoyment of things, as well as a kind of hopelessness, but unlike dramatic major depressive disorder, the person is barely aware of their hopelessness as it manifests in this kind of “blinders” not expecting much from life kind of attitude. In my experience of working with people who suffer from this kind of thing (and if a person actually goes to therapy, they do start to notice these little signs, but sometimes the person has gone to therapy for some other reason and has no awareness that s/he is also depressed in this way until later on in the therapy process), many people who have this kind of barely noticeable depression have also suffered from traumatic events in their life, ranging from terrible childhood trauma to small kinds of trauma that the person does not even consider to be unusual but nevertheless, these “traumatic” kinds of events have left a mark on the person. Early or later loss of a parent, the earlier the loss, the more traumatic, or loss of a sibling or love partner, surviving a fire, moving many times, dropping out of school and other even less obviously traumatic types of events, such as living with a partner with a significant chronic physical or mental illness or addiction, or being the child of a parent with such an illness, as it is easy to forget while being the caretaker, that you have also suffered. Children of such parents are also used to thinking of others as being sick and not noticing their own suffering.

Silent and unaware suffering is sad in a very different way from very dramatic kinds of suffering.  This depression that I have described is not only accompanied by undetected or worked through traumas but also very importantly, a lack of creative drive and a lack of creative activity in the person’s life. 

The magic of creative arts therapy is that I have seen such people suddenly awaken to themselves by starting to make art in sessions with me. Often it occurs after I have been working with an adult for quite a long time and established a trusting relationship and suddenly the person becomes interested in trying out some kind of art making, maybe out of curiosity from being in my art studio for so long, surrounded by art and art materials, sometimes at my suggestion. Often it probably starts as a desire to please me, especially in people who are used to trying to please others in their lives and not thinking much of themselves. I welcome this because I know that a person cannot create for very long just for another person, even their therapist, without experiencing a sense of enjoyment and pleasure that belongs to them and is witnessed by me. As this person starts creating, some changes start occuring that are purely related to the creative process and how powerfully healing it is. I know there are studies of creativity and brain activity, and I’m certain that the act of creating lights up places in the brain and awakens parts of the brain that were not being used much, even though I don’t have the scientific knowledge of this. I have witnessed too many magical transformations that are directly related to the person creating more, even if it is only once a week in the session with me. 

This is the magic and beauty of the creative process. Of course it feels like one is back in kindergarten, so the cliche goes, but it is wonderfully true, as many adults have not made any art since the age of 4-6. To bring a person back to Kindergarten is to bring them back to the Source of Creative Healing, to a feeling of safety and trust and even a wonder at what they have made. (See my post of the wonderful poem “All I Really Need To Know I Learned In Kindergarten”)

These are the moments when I truly love my vocation and feel privileged to be witnessing such deep healing. No matter how long I do this, I am consistently amazed at the shift in energy in the room, at the sense of wonder creeping back into this person’s life and also touching me. 

On a personal note, I started making art as an adult around the age of 20, while being in college and consistently pretty depressed. A simple beginning drawing class with simple ingredients: lots of students but enough attention from a great teacher, low expectation of any kind of “realistic” type drawing, even positive reinforcement from the teacher and the assistants who loved most the images made by students that were unrecognizable as anything “real”, simply “marks on paper”, a phrase of the teacher’s that I never forgot, that had a profound effect on me. I had not thought of drawing or painting since kindergarten, probably had to do some art class in high school but I mostly remember noticing that I could take photography and avoid drawing and painting while in high school.

This elective art class in college changed my life in a profound way and is one of those moments on the journey of life that one sees later as a “marker” of a change in direction. The process of doing something non verbal and so pleasurable was so surprising and wonderful that it “woke” me up out of my depressive college “angst” at least to the point where I started drawing outside of the class to express some of this angst.

I mention this just to point out that the act of beginning to use one’s creativity in a different way can really stir up and awaken a little flame of excitement and “libidinal” creative energy and then the small flame becomes a fire, maybe quickly, maybe over time, but just lighting one little flame can really stir up the brain and knock out this kind of depression in a person to the point that s/he starts to have daydreams or quiet little desires to do new things or to enjoy little things, sometimes it results in a person taking out their guitar after ten years of no playing and playing it, or journaling daily or starting to write poetry. For some, it results in buying art supplies and having fun painting or collaging at home.

These little beginnings when fed and properly witnessed by the art therapist can result in some small or big shifts in a person’s life. The depression starts to get knocked off or dusted off, and the person starts to see more around him or her and inside him or herself. Like a small pebble tossed into a pond, the ripples go outward, the water gets stirred up and energized.

Thus begins a healing process and a slow or fast disappearance of the little depressive symptoms. Excitement and enjoyment of little things and/or big changes occur.

I strongly believe that this kind of depression is most helped by creating and bringing more creativity into the person’s life. Exercising, eating better, doing more besides the usual, that all helps too, and sometimes it actually comes along with the creative awakening. Medications do little to stir up this depression in most cases in comparison to what a few art supplies and encouragement from a safe, trusted art therapist can do.

Proposal!

After a lot of extraneous inner wrestiling with myself about this workshop proposal and whether I should even submit one (Questions like, do I really want to do this or do I just think I should be in this and doing it? Answer: don’t know. probably a little of both.), I talked to some colleagues who basically said, you’re overthinking it, just do it. Me: but I’m a therapist who doesn’t like talking in front of groups of more than about ten people, of course I’m overthinking this, and even if I wasn’t a therapist, I’m an artist, so of course I overthink everything and often arrive at the conclusion that anytihng requiring a lot of extra time and thought is just getting in the way of time that should be spent making art…

I went back to the website and just typed the answers to their questions. I stopped short of impulsively sending in the proposal right away which is what I’d be inclinded to do. I’m not going to overedit it, but it’s probably a good idea to wait a day and reread it once and find my resume before sending it in. Looking at my last blog post, I thought the writing in it was far better than the dry writing of the proposal but they limit the word count so there’s no room for metaphor…

Here is what I’ve written to submit: only missing the resume and photo

Proposal for Expressive Therapies 2013 Summit:

3 hour Workshop

 Title: Altered Books with Adults; Conquering Trauma and Creativity Based Depression

Presentation Description:

In this workshop, I will discuss how the medium of altering books in art therapy with adults can uniquely treat people suffering from low grade to serious depression that is connected with past and/or present trauma and a feeling of creative deadness or loss of the creative “spirit.” We will look at how this kind of depression is best healed through the creative process and what is unique about the altered book format that allows for the creative spirit to reawaken. I will discuss the role of the therapist in this process and through the experiential, I will invite participants to choose a book and begin to alter it. We will process the transformative experience of “messing up” and “destroying” a book to create something new and how it can jump start the creative process through the variety of options and the holding environment of therapy.

 

3 measurable objectives:

1. Participants will learn about the connections between trauma and depression, kinds of depression that do not meet the DSM criteria but are very debilitating, and how this depression is rooted in a deadness of the creative spirit which was caused and triggered in a large part by childhood and current traumas, from severe trauma to less severe but serious trauma. They will learn to identify this depression in their work and how art therapy is uniquely suited to healing.
2. Participants will learn about the technique of making “Altered Books”, including:

The importance of bringing in certain choices in books and how to present the project to their client, the difference in art techniqhes and media used to alter adult hardcover books versus children’s board books

3. Participants will choose a book and start the process of making an altered book so as to learn ways to identify different techniques that will “unlock” creativity and the importance of experiencing the making of an altered book first hand as well as the therapeutic value of making an altered book alongside their client.

Ideal Format and Preferred Length of Presentation:

This will need to be a hands on experiential workshop with time for explanation and discussion of topics presented and ample time for participants to actively start and altered book and share their process and experience with the group, so 3 hours is probably the best length.

Bio:

Natasha Elena Shapiro, ATR-BC, LCAT, holds a master’s in Art Therapy and Creativity Development from Pratt Institute. She has worked in private practice for many years in her Tribeca art studio where she specializes in working with adults and children with a variety of emotional issues. As an Advanced Reiki Practitioner and a practicing professional visual artist, she views creativity as central to the healing process. She also facilitates an art studio based supervision group for professionals and an art therapy group for women struggling with anxiety and depression. Her studio space is an environment designed to be inviting and help with self-acceptance and relaxation.

 

Literature Citation:

Gioia Chilton MA, ATR-BC, Altered Books in Art Therapy with Adolescents, Art Therapy: Journal of the American Art Therapy Association, Volume 24, Issue 2, 2007, pgs. 59-63.

 

•  Art Materials Requests: Ideally a variety of hardcover books in any language as well as some early child board books, art materials including paint, brushes, scissors, colored tape, yarn, buttons and other embellishments, collage images. (Note: If some of the basic supplies are provided, I can bring in things like rhinestones, yarn, buttons, tape and collage images. In addition, if need be, I can find more books to choose from depending on the amount of people in the workshop.

Thinking it through: meandering thoughts for a workshop proposal…

Every year there is a big 3 or 4 day “Expressive Therapies Summit” held some time in the early November. Here is the website for the 2012 Summit:

http://www.cvent.com/events/expressive-therapies-summit-2012-registration-site/event-summary-a631d616cdd6499c92f749761a4d1d3a.aspx

The great thing about this Summit is the diversity of kinds of modalities, some even mixed together…Proposals for panels, lectures, talks, workshops etc. are due soon, and I was thinking of doing a workshop. I have a little time as the deadline got extended to Sunday, April 21. I had several ideas and then hit on something that has been percolating in me for a while now, mixing creative blocks which I have been working on with patients and others and writing and thinking about since even before I was in grad school. Then a newish topic I’ve been meaning to post about on this blog, my thoughts about a certain kind of depression I have been encountering and trying to elaborate on, that I have thought of as “existential depression”, trauma induced depression and finally kind of put it all together by thinking of it as (this will sound clunky because it is not a nice neat package of words): adult depression induced by multiple childhood and/or current “traumas” that causes a feeling of emptiness that is best addressed through the healing of the creative arts. It’s a kind of depression that can be very “light” and hardly noticeable to the person suffering or the people who know him/her, a vague feeling of emptiness and dissatisfaction with one’s day to day life, a flatness and difficulty feeling engaged, excited, “turned on” by any aspect of life. This depression can also be quite different and accompany other challenges/disorders or seem like a regular kind of depression but it is characterized by not only the sadness, hopelessness and darkness of all depression but also a yearning for something to switch “on” and awaken the playful spirit or inner child to the excitement of the here and now. It can also be that the individual is depressed about other life events, relationships, family and career issues or addictions, obsessions, compulsions but coupled with it is a very conscious awareness of being blocked creatively. The person who loved writing has stopped writing and cannot get back to it after torturous months or years, or can’t paint or sing anymore. In this case there is an obvious feeling of hitting a wall and being “stuck” and wanting to get out but feeling hopeless and powerless.

The last mentioned experience I have been writing about in some posts recently such as the last post about establishing a “daily habit”.

What I want to address most of all though I’d like to have my approach be helpful for any of these types of depression, is the person who is not even aware that their depression stems from a lack of creative expression in his/her life. What amazes me about all the creative arts therapies is that by their very nature, they can heal this kind of depression in a way that traditional psychotherapy simply cannot, because the therapist and the modality of creative expression form the bridge for the person to awaken to his or her creativity. Adults who work at jobs that have nothing to do with any of the creative arts but who at one time or other may have enjoyed doing something creative, adults who never really explored their creativity since they gave it up in childhood, and adults who are engaged in some creative art form that can be visual art, writing, acting, making music etc.

I know this is meandering but the main point will be to explore experientially how the process of “Altered Book” making can uniquely heal this kind of depression. I have read quite a few articles and viewpoints on altered books and therapy and taken a few online classes about the altered book and seen how it can be healing for all kinds of people with all kinds of challenges. It is also very popular as an art therapy project for adolescents as it involves to begin with, ripping a book up or destroying and remaking a book, a real physical book that might have been on a bookshelf, nothing to do with computers or tablets! The beginning of the project as I’ve written here before, requires a sort of leap into one’s creative destructiveness, an animation of any tiny bit of rebellion inside yourself that can now come out through totally destroying and remaking a book.

So my workshop will address working with adults on altered books and how it can be a transformative experience for the complex kinds of creative block depression I just described. 

To some extent this workshop will be hard to do as one of the benefits of an altered book is that you work on it regularly over time. The other difficult part is how to articulate why being given a choice of books to alter and then altering it in the company of the therapist does anything to help people who are creatively blocked. At the moment the metaphor that comes to mind is that the book is kind of the personification of the block and the block needs to get kicked around, ripped destroyed remade to awaken the inner creative spirit alive in all of us…

To be continued…

Link

My blog Featured in “The Communicated Stereotype”!

Just wanted to announce that one of my blog posts was just featured in my colleague Anastacia Kurylo, PhD.’s great blog about diversity, multiculturalism and stereo tpying, “The Communicated Stereotype.”

I am happy to be included in this great blog that covers such an essential topic. It is everywhere. Just tonight Erin Burnett had a panel of people arguing about the new Barbie dolls that are supposed to feature different countries. The Mexico Barbie has a Chihuahua and the China Barbie has a panda. Is it a moment for education about other cultures or is it stereotyping on top of one of the biggest stereotypes ever marketed: the “Barbie” doll? Of course that could be the topic of a totally different blog post…

Anyway one of my multicultural rituals series posts, the one about different Easter rituals that I recently posted is featured on this blog. You can find it on the link above. It is also exciting to be featured on a blog that is outside of my field of therapy, art therapy, psychotherapy, healing, and in the field of Communications which has a lot of connections to our fields but is very different of course.