Jung At Heart

The pediatric bipolar horror show goes on with the appearance yesterday in the NY TImes of a long article in the magazine by Jennifer Egan. It becomes clearer and clearer to me that the dominant paradigm is that medication is the first line treatment for anything psychiatric, regardless of conflicting data about diagnosis or effectiveness. And I hope someone is looking at how and why this is. I have speculated here about the confluence of turf issues, income, increasing power of insurers, and direct advertising to consumers, but that doesn't tell me why the buy-in on this paradigm is so thorough and deep. 

I can't critique this long article any better than Furious Seasons, with his "12 Problems With The Sunday Times Magazine Piece On Child Bipolar Disorder"      and also      CP&P's "A Closer Look: Bipolar Overawareness Week".  Do read them.

Several people sent me this piece by Deepak Chopra from Huffington Post. They thought that because he used Jung's concept of the shadow that I would find it interesting. And indeed I do but not for the reasons they might have thought. Consider this paragraph from the piece:

She is the reverse of Barack Obama, in essence his shadow, deriding his idealism and exhorting people to obey their worst impulses. In psychological terms the shadow is that part of the psyche that hides out of sight, countering our aspirations, virtue, and vision with qualities we are ashamed to face: anger, fear, revenge, violence, selfishness, and suspicion of "the other." For millions of Americans, Obama triggers those feelings, but they don't want to express them. He is calling for us to reach for our higher selves, and frankly, that stirs up hidden reactions of an unsavory kind. (Just to be perfectly clear, I am not making a verbal play out of the fact that Sen. Obama is black. The shadow is a metaphor widely in use before his arrival on the scene.) I recognize that psychological analysis of politics is usually not welcome by the public, but I believe such a perspective can be helpful here to understand Palin's message. In her acceptance speech Gov. Palin sent a rousing call to those who want to celebrate their resistance to change and a higher vision. 

Obama is seen here as the good guy, the one with the good ideals and values and Palin is the carrier of the opposite - anger, hated and the like, in short bad ideals and values. The assumption is that what "we", i.e. Chopra and the readers of Huffington Post are all on the good side with high-minded beliefs and values, while those who share Palin's beliefs are on the bad side, with base motives and values grounded in hate and resentment.

But doesn't hate and resentment feed "our" dark view of those with whom we disagree? When we mark those with whom we disagree with such value-laden labels are we not doing exactly what we decry in them?

In a sense, yes, Palin is Obama's shadow -- for those who who do not share her values. And for those who do align with her, then Obama is also shadow, for them. Not by virtue of color but by holding values which seem to be opposing hers.

I don't think psychological analysis of candidates as Chopra did in his article is helpful. It is sufficient to make a decision based on the issues, on positions the candidates take. But when psychological labels begin to be casually applied in this way, it becomes all too easy to paint the election as a struggle between the forces of good vs evil. And going down that path can all too easily take us in directions that ultimately will betray our core values, no matter which side we are on.

In his last paragraph, Chopra make a statement that I have no problem agreeing with:

Not just conservatives possess a shadow -- we all do. 

That is certainly true. But then he betrays a lack of awareness of his own shadow when he says:

So what comes next is a contest between the two forces of progress and inertia.

Because it all depends on where you sit which force is that of progress and which of inertia. Of course, those on either side believe they are right. And the more deeply held the values they see in play, the values they espouse, the more likely they are to believe they hold the key to what is right. But it is all relative. And that is something we forget at our peril. It is not a very long jump to go from the way Chopra couches his analysis to seeing those who agree with Palin as evil and deserving to be eliminated. It has happened before in human history, led by people who believed themselves to be the forces of light arrayed against the darkness.

It's an election, a campaign for political office. And yes, the stakes are pretty high. But the struggle is not a final battle between good and bad. And we do well not to cast it in such terms. It is important to keep in mind that the Shadow is of the unconscious, as Jung says

Although, with insight and good will, the shadow can to some extent be assimilated into the conscious personality, experience shows that there are certain features which offer the most obstinate resistance to moral control and prove almost impossible to influence. These resistances are usually bound up with projections, which are not recognized as such, and their recognition is a moral achievement beyond the ordinary. While some traits peculiar to the shadow can be recognized without too much difficulty as one's personal qualities, in this case both insight and good will are unavailing because the cause of the emotion appears to lie, beyond all possibility of doubt, in the other person. (Jung, CW vol. 9ii, para. 16)

Lots of interesting things to report since my last post -- so today is a catch up day.

1. Reporting on a study done in Finland, Dr Shock MD PHD  gives us this:

Long-term psychodynamic psychotherapy is superior in the long term to short-term psychodynamic psychotherapy. Short-term produces benefits more quickly than long-term therapies. After 3 years of follow-up, however, the situation was reversed with a stronger treatment effect in the long-term psychodynamic treatment group both for patients with depressive and anxiety symptoms.

If a patient is capable and will benefit from psychodynamic psychotherapy which should be assessed by professionals before hand, than this kind of treatment to my opinion can be of great help to them not only for their complaints but also on the longer term.

Now this study doesn't surprise me at all. Cognitive behavioral therapy gained support because it is easy to design studies of it and because it fits with the current dominant paradigm in psychology and mental health. Insurance companies prefer it because it is short term. It is fairly easy to teach. So I love this longer term outcome study revealing that deeper work has better long term results.

2. Be sure to read this entry from Steve Diamond in his Psychology Today blog which he concludes :

 I submit that depression is not a disease that should be treated in the same way as say, diabetes (which itself is known in many cases to be stress-related). It is a biopsychosocial syndrome requiring far more than pharmacological intervention. The unfortunate fact that most contemporary psychotherapy--including CBT--fails to penetrate to the heart of the Hydra in major unipolar and bipolar depression underscores the desperate need for more effective psychotherapy rather than proving a biological cause for these devastating disorders.

Yup. Meds can, but do not always help with symptoms, but long lasting change requires getting inside and working on what it is that creates the depression in the first place.

3. More less than rosy news about medications, this study --"The persistence of the placebo response in antidepressant clinical trials" --

Abstract

Our objective was to assess the persistence of the placebo response during at least 12 weeks of continued placebo administration in depressed patients who have responded to 6–8 weeks of acute placebo treatment. We identified 8 placebo-controlled antidepressant trials with a total of 3063 depressed patients in which, after acute phase placebo treatment, placebo was continued for more than 12 weeks. The number of patients entering the continuation phase and percentages relapsing during this phase were determined. Based on the total number of patients entering the continuation phase 79% of placebo responders remained well (did not meet relapse criteria) during this phase compared to 93% of antidepressant responders. Although significantly more patients on placebo than on antidepressants relapsed in the continuation phase, 4 out of 5 placebo responders stayed well. The widely held belief that the placebo response in depression is short-lived appears to be based largely on intuition and perhaps wishful thinking.

I have been mulling over this whole thing about pediatric bipolar disorder, medicating kids, contaminating influences thing this week. I am trying really hard to see meaning in the rush to diagnose and then medicate so many children and I confess I am baffled. I think about my son, getting ready now to start graduate school to become a therapist himself, and what he was like as a young child -- intense, rarely sleeping, challenging. He gave his father and me a run for our money but not for a minute did we think of him as a problem. He was challenging because it took us time to learn how best to deal with him, how to deal with his relentless drive to take things in, to see and learn and his apparent lack of interest in sleep. But learn we did and he did also. We used to joke that anyone could be a good parent to his sister but the challenge he presented us made us into really good parents. I shudder to think what might have happened to him or  us had we been less confident in our abilities to figure it all out or less knowledgeable about mental health (we are both psychologists) because he might have becomes one of those kids placed first on this drug and then on another. Instead he remained bright, alert, active, intense and delightful -- a challenge yes, and an engaging and loving child now grown into a mature and considerate man.

So as I read all of these reports of off-label uses of atypical anti-psychotics with kids, of the FDA chief deciding that pediatric bipolar  disorder exists despite conflicting expert opinion, the revelation of his, and many other so-called leaders in psychiatry, conflicts of interest, and I feel slightly ill. (If you have not been following all of this on Furious Seasons, you certainly should do so). Why on earth are these people so eager to stigmatize so many children with diagnoses of major mental illness -- and there is no way to get around the reality that such a diagnosis is stigmatizing -- and then place them on major psychotropic drugs whose long term effects in children are unknown? How on earth did we get here?

The story last week that so few psychiatrists are practicing therapy certainly points to one piece of this puzzle. Whether those of us who are psychologists and social workers like it or not, the lay public sees psychiatrists as THE experts in mental health. The subtle nuances of the various disciplines in mental health are unknown and meaningless to the average person. So if psychiatrists are more and more inclined to psychopharmacology and less involved in therapy, then to the average person that must mean that this is the best approach. Of course other influences come into play -- relentless advertising by the drug companies, insurance companies which prefer the control they have over prescription drugs to the harder to control treatment by psychotherapy, and of course, turf wars among mental health professionals.  I want to believe that many of these psychiatrists, untrained in and not practicing psychotherapy, have reached the place where because all they have is hammers (psych meds), everything they see is a nail. I want to believe this because that almost makes it understandable.

Today I ran across this excellent piece in the Dallas Morning News, reporting 

" A state mental health plan naming the preferred psychiatric drugs for children has been quietly put on hold over fears drug companies may have given researchers consulting contracts, speakers fees or other perks to help get their products on the list.

The Children's Medication Algorithm Project, or CMAP, was supposed to determine which psychiatric drugs were most effective for children and in what order they should be tried at state-funded mental health centers. In April, high-ranking state health officials gave researchers the go-ahead to roll out the guidelines."

Never mind how mind boggling it is that there is a need for such a list. The existence of the project tells us already that there is a heavy bias in favor of medicating children. The protocol will govern particularly those children in foster care and on Medicaid, because of course, such children are simply rife with mental illness -- or maybe they have less well-educated parents or have caretakers more interested in ease of management than they are in longer term interventions?

The report goes on:

"Drug protocols are designed to ensure all patients with a particular diagnosis receive the most effective, proven treatment available. They're created by bringing together academics, researchers and public health experts, who run trials, compare best practices and recommend a road map, or algorithm, for which drugs should be used.

While the protocols are generally created with the best intentions, they can be controversial, particularly when drug companies have a hand in designing them.

Some lawmakers and activists say it's time the state took a close look at the financial motivations of experts making drug decisions for hundreds of thousands of Texans. The adult protocol determines treatment decisions in state mental health facilities, despite the lawsuit and studies that have played down the benefits of some of the drugs chosen for it.

"In our country, there's been a switch from taking care of people to focusing on big corporate money," said Rep. Juan Escobar, D-Kingsville, who unsuccessfully offered legislation last year that would have banned researchers or government employees funded by the pharmaceutical industry from designing state psychiatric drug protocols. "There need to be restrictions on how these things are done, because the victims are our children."

But it was this that really grabbed me:

"At least four of CMAP's key developers – all affiliated with the University of Texas system, and all of them published child psychiatry experts – have received research funding from drug companies, or have been consultants and speakers for several different pharmaceutical firms, according to their own published papers and financial disclosure forms filed with the university. Drugs made by some of these manufacturers appear in the children's drug protocol.

The doctors say there's no room for improper influence when their reputations are at stake. If the drugs weren't effective, they wouldn't endorse them – and the research they conducted to craft CMAP wouldn't have been published in prestigious medical journals."

Reputations trump all?? Mightn't the well being of children, who have no say in treatments they receive, mightn't that be more important than the professional reputations of those seeking to prescribe for them?

So, I believe it is good news that the CMAP is on hold. I only wish it were because the whole premise for it were under question.

And the question remains, what does it mean that we have become so willing to medicate ourselves and our children? And what price will we be paying for it in the future?

Two articles in the news this week point to a glaring contradiction in current mental health policy.

First, as referenced by Philip Dawdy and Reuters, noting a study in the Archives of General Psychiatry noting the dramatic decline in numbers of psychiatrists who practice psychotherapy --

The percentage of visits involving psychotherapy declined from 44.4% in 1996-1997 to 28.9% in 2004-2005 (P < .001). This decline coincided with changes in reimbursement, increases in managed care, and growth in the prescription of medications. At the practice level, the decrease in providing psychotherapy corresponded with a decline in the number of psychiatrists who provided psychotherapy to all of their patients from 19.1% in 1996-1997 to 10.8% in 2004-2005 (P = .001). Psychiatrists who provided psychotherapy to all of their patients relied more extensively on self-pay patients, had fewer managed-care visits, and prescribed medications in fewer of their visits compared with psychiatrists who provided psychotherapy less often.

Conclusions  There has been a recent significant decline in the provision of psychotherapy by psychiatrists in the United States. This trend is attributable to a decrease in the number of psychiatrists specializing in psychotherapy and a corresponding increase in those specializing in pharmacotherapy—changes that were likely motivated by financial incentives and growth in psychopharmacological treatments in recent years.

 As I have noted before, a psychiatrist can earn at least 57% more in a medication only practice than he or she can providing psychotherapy. So certainly money is a primary driving force here. But also implicated are the turf issues I have written about before, because prescribing is pretty much limited to psychiatrists though a few clinical psychologists do so as well. Limiting the turf to a single group also helps feed the coffers and even more so when it also serves the interests of the drug companies -- more sales -- and the insurance companies -- fewer visits.

Now I think it is not such a bad thing that fewer psychiatrists practice psychotherapy these days. Because decreasing numbers of them have received much if any training in therapy, most significantly less than that of clinical psychologists and clinical social workers. And actually, because fee schedules and  reimbursement rates tend to be based on degree category and not skill level, leaving therapy to or favoring its provision by psychiatrists drives the cost up and out of reach of many. The real problem here s that it reflects the extent to which the notion that all mental illness and emotional difficulties are medical illnesses, biologically based, has permeated the system, which now favors psychopharmacology above all else. The question that was not answered is what percentage of these prescribing only psychiatrists also urge if not expect patients they prescribe for to also be in therapy? I know of a few but not many, certainly not enough.

In an AP article discussing the same study we find the following:

"The study did not survey visits to psychologists or other mental health counselors who are not medical doctors, but who also practice talk therapy.

Psychotherapy uses verbal methods to get patients to explore their emotional life, thoughts or behavior. The goal is to ease symptoms, sometimes through getting the patient to change behavior or mental habits.

Its benefits can be seen in brain imaging studies, said Dr. Eric Plakun, who leads an American Psychiatric Association committee working to restore interest in psychotherapy by psychiatrists.

"The couch is far from dead," Plakun said. "The couch turns out to be an effective 21st century treatment."

Talk therapy can be done by psychiatrists less expensively than split treatment, where a patient sees a doctor for pills and a counselor for talk therapy, Plakun said, citing two prior studies.

It also works better than drugs for some patients, such as those with chronic major depression and a history of childhood trauma, he said.

Accreditation requirements for psychiatric residency programs are putting more emphasis on talk therapy, Plakun said. That may slow the decline of the couch.

The new study doesn't answer an important question: whether other professionals are picking up the slack, said psychologist David Mohr of Northwestern University's Feinberg School of Medicine. Psychologists and social workers provide counseling but most cannot prescribe drugs, so it's possible that for patients who require both talk and pills, some coordination in care may be lost, Mohr said."

Better but still with the assumption that therapy provided by psychiatrists is better than that by other mental health professionals because of the presumption that medication is almost always required. Says who? Does it not matter that these meds, mostly SSRIs are being shown to be far less effective than the ads would have us believe? This reminds me of my ex-husband's grandfather who used to tell him that he would pay his way through medical school so he could become a *real* doctor, this despite the fact that he was and is a successful clinical psychologists. It seems that there is a belief that *real* doctors are the best choice and the rest of us are just not quite up to the same level, even those of us who are also doctors but not M.D.s

Couple this with this opinion piece which appeared at the same time:

"What Americans are experiencing economically is clearly not "all in our heads," or, as former U.S. Sen. Phil Gramm, a John McCain adviser, recently put it, a "mental recession." But the increasing difficulty of the struggle to make ends meet and avoid homelessness is taking a correspondingly harsh toll on the mental health of our citizens...

...Increasingly, low-cost or free mental health services are being offered by nonprofit organizations like Atlanta-based Metropolitan Counseling Services. I became involved with MCS in part because I believe MCS and organizations like it can play a critical role in a community's efforts to recover from economic difficulties by addressing the mental health impact of such hardship. Indeed, counseling or psychotherapy can help one transcend despair and rebuild that healthy sense of perspective and self-esteem that is the foundation for effective planning and action in all spheres of life."

In my own community, the local paper recently suggested that it might be good to develop groups for citizens facing hardship this winter to give them a place to vent, to share and to get the relief that comes from talking with others in the same group. But community mental health centers have seen drastic cut-backs in their budgets and they have turned increasingly to revenue producing psychopharm treatment over therapy. In fact many clinics now offer case management and medication but no therapy. So, in the face of times that increase the demand and the need for therapy and counseling, what we see is money, insurance and turf making it ever ore difficult to get what is needed.

I subscribe to Google News to keep up with what's happening in psychiatry and psychotherapy. And the other day it served up an interesting item on Jungian books. But the item dates from January, 2004! I wonder what made Google cough it up yesterday?

Anyway, the list is from Deirdre Bair, who wrote a long and excellent biography of Jung, which I recommend highly. Here are her picks, courtesy of the Guardian:

1. Memories, Dreams, Reflections by CG Jung

2. Modern Man in Search of a Soul by CG Jung

3. Man and His Symbols by CG Jung (ed)

4. Jung and the Post-Jungians by Andrew Samuels

5. The Jungians by Thomas B Kirsch

6. On Jung by Anthony Stevens

7. Jung by Anthony Storr

8. The Vision Thing by Thomas Singer (ed)

9. CG Jung Speaking: Interviews and Encounters by William McGuire and RFC Hull (eds)

10. The Discovery of the Unconscious by Henri Ellenberger

What do you think? I have read all of them. And I have no real quarrel with her choices. I might not us Stevens or Storr , including instead Jung's Answer to Job and Susan Rowland's Jung as a Writer.

When I was in college, each year at the beginning of the year was a campus-wide symposium centered on a book or books that everyone read over the summer. I think it was my sophomore year that the topic was summarized as "Who am I? Where am I going?" -- absolutely spot on for 19 year olds struggling to figure out who we were. 

But these questions are the questions for a lifetime, not just for the emerging adult to wrestle with. There is an emerging notion that the goal of life is happiness, that anything short of happiness in life is indicative of some disorder, some brain dysfunction. There is a Brave New World quality to that, a denial of the value and meaning in our unhappy times, in our valleys.

Jung notes:

In the secret hour of life's midday the parabola is reversed, death is born. The second half of life does not signify ascent, unfolding, increase, exuberance, but death, since the end is its goal. The negation of life's fulfillment is synonymous with the refusal to accept its ending. Both mean not wanting to live, and not wanting to live is identical with not wanting to die. Waxing and Waning make one curve. 

In the second half of life, that long span from 40 to 90, where we spend most of our adult lives, we come face to face with disappointment and defeat. Marriages fail, parents die, friends die, careers wane or fail. But this is as much a part of the natural curve of life as are the acquisitions of the first half of life.

The turns of the second half of life when seen as depression, as a problem to be solved, made to go away may yield short term satisfaction. If instead we take them as a call to deepening, to enrichment and meaning, then what was a crisis becomes an opportunity.

Carl Jung was the first to see the psychological and spiritual significance of midlife transition. He observed that for normal development, in the first half of life we create a life and an understanding of who we are based on what parents, other significant adults, our peers, partners and society in general expect of us. In the process we learn, from the reactions of these significant others, that parts of us are not acceptable; these parts get repressed in our unconscious as shadow. For normal development in the second half of life, we need to create a life based on who we truly are. To do this we need to complete two main developmental tasks for midlife transition: First, we need to go within and reclaim those parts of ourselves repressed when young and other parts of our self we have never known. And second, we need to reshape our lives based on this increased understanding of who we truly are.

"The experience of Self brings a feeling of standing on solid ground inside oneself, on a patch of eternity which even physical death cannot touch."  Marie-Louise von Franz

Middle age is a time in which adults feel a need to reassess where they are and make changes while they feel they still have time. A person experiencing midlife symptoms may ask: Is this all there is? Am I a failure? Symptoms and behaviors during midlife crisis can range from mild to severe and may  include:

• Boredom and exhaustion, or frantic energy

• Self-questioning

• Daydreaming

• Irritability, unexpected anger

• Acting out with alcohol, drug, food or other compulsions

• Greatly decreased or increased sexual desire

• Sexual affairs, especially with someone much younger

• Greatly decreased or increased ambition

"The disintegration of personality sounds much less ominous if it is understood as an opportunity for new life rather than the end of the line. Such an attitude is more than mere consolation for the person going through the experience; it can mean the difference between life and death, for it offers the possibility of meaning in what would otherwise be pointless suffering. This is especially true in the middle years of life, when many are brought to their knees either by circumstances or by ignorance of their own psychology, and often by both" Daryl Sharp

We  go on a heroic journey at midlife as we struggle against ‘levelling down to collective standards'. This struggle is vital for us individually as it leads us to creating a personally meaningful second half of life. 

“Individuation is a natural necessity…its prevention by a leveling down to collective standards is injurious to the vital activity of the individual…any serious check to individuality is an artificial stunting.” Jung

As we move into the presidential campaign, one word seems to be everywhere -- CHANGE. No candidate wants to be the one standing for the status quo. And then this week I read Stephen Diamond's blog entry on change or acceptance in therapy. Which set me to thinking about what we mean by change in either of these contexts.

Someone last night was telling me that she had changed herself from an introvert into an extravert, by way of explaining her enthusiasm for door to door campaigning. But did she really change her basic self or did she learn to adopt what we Jungian would call an extraverted persona? C. G. Jung applied the words extravert and introvert in a different manner than they are most often used in today’s world. As they are popularly used, the term extraverted is understood to mean sociable or outgoing, while the term introverted is understood to mean shy or withdrawn. Jung, however, originally intended the words to have an entirely different meaning. He used the words to describe the preferred focus of one’s energy on either the outer or the inner world. Extraverts orient their energy to the outer world, while Introverts orient their energy to the inner world. My best guess is that the direction of her energy remains toward her inner world but she has learned how to present herself in an extraverted manner when the occasion demands it.

In a similar fashion, people who only know me from my teaching or workshop presentations would swear that I am extraverted. I am at ease speaking in front of groups, animated, energetic. But what they do not realize is that is a costume of sorts that I wear for those settings, that I wear because I have a role to play. The "real" Cheryl is the introverted one.

So, in order to be effective as a teacher or speaker, I did not change who I am; rather I became adept at donning the costume of a more extraverted version of myself.  In part in order to do that I need to be more accepting of who I am, of my basic nature in order to take on a persona that works for me. 

Therapy for many people, maybe most who seek it is about change -- changing how they feel, changing relationships, changing the direction of their lives.  And many times they don't have a clear idea of what that means, just that they are unhappy as things are. I often ask patients what is the life that they want? What would it look like? How would it be different? And what stands between them and having that life? Then comes the hard work of dealing with those obstacles, often self-created. It is important to deal with the past, to work through those issues and finally come to acceptance that it is what it is. And get on to the business of playing the cards that we have been dealt. Because we can't change the circumstances of our birth, the parents we have, the childhood we lived, the forces that shaped us. We can change how we see those things but they themselves will not change. In fact it is acceptance that paves the way for change.

One of the goals of the personal myth exploration is to reveal the story being lived, because until it is revealed, it cannot be changed. Change as a goal sounds very appealing. But the work to make it is another task altogether.

Good news! According to TVoholic, HBO has given the go for a second season of In Treatment,  which will return sometime in 2009. I am looking forward to it as you are and will, of course, blog each episode as I did this year. Most of the patients wil not be returning, though Paul and Gina will be back. What kinds of patients/issues would you like to see Paul deal with?

This is one of those posts in which my two worlds -- knitting and my work -- collide briefly.

In two knitting communities that I am a sometime member of, there are discussion threads on knitting as therapy, meaning more less in place of actual therapy. Von Franz wrote of knitting:

Everybody who has knitted or done weaving or embroidery knows what an agreeable effect this can have, for you can be quiet and lazy and also spin your own thoughts while working. You can relax and follow your fantasy and then get up and say you have done something! Also the work exercises patience...Only those who have done such work know of all the catastrophes which can happen -- such as losing a row of stitches just when you are decreasing! It is a very self-educative activity and brings out feminine nature. It is immensely important for women to do such work and not give it up in the modern rush. (The Feminine in Fairy Tales, Spring Publications, 1972, p. 40)

recognizing the value of handcrafts like knitting. And this makes a great deal of sense. Indeed, I read a post today by Dr. Smak about the meditative value of knitting which is the value that I see. And similarly with painting or writing or working in clay. They are all means for allowing us to surrender the monkey mind a bit, to allow to filter in some deeper part of ourselves which works on whatever it is that we are occupied with. But as therapeutic as these things can be, they are not in themselves therapy. Therapy puts into words the feelings and experiences and perceptions that can keep us from the life we want. Art, music, knitting, writing gives us means of expressing some of those same things, some ways of working with them transformatively or meditatively. 

Which is not to say that therapy is what any painter or knitter or writer needs. Only that each can nourish the other in the process of expanding consciousness and developing our lives. My analysis is knit into every piece I have worked on during it. Dreams, interpretations, thoughts all became part of the fabric of what I made. Each enriching the other.

Scientific American, in one of their "60 second science" features, reports on a study recently published which appears to replicate the findings of a study from at least a decade ago in the UK -- namely that grief counseling after traumatic events may be more harm than help. Again this finding seems obvious if we consider that grief and other uncomfortable emotions are normal following such events. It is only when, by community consensus, such emotions and reactions persist and interfere with normal life that treatment may be called for.

As an example, when I first met my ex-husband's mother 40 years ago, I asked her if she had any siblings. She teared up and said she had had a brother but he died. Judging from her reaction, I thought this must have been recent. But I discovered that actually her brother had died more than 50 years previous when he was a toddler and she was a young child. We could certainly say that such a reaction is unusual, but she managed quite handily to deal with the ups and downs of normal life -- a marriage, two children, family, outside interests. And she could certainly have benefitted from therapy to deal with the issues in her family that left her with a terrible burden of guilt. But, by all reasonable criteria, she was a healthy functioning adult and not in need of treatment.

Taking something like this on a larger scale, like the aftermath of 9/11, we can see that it is expectable that those who lost loved ones that day or had their own narrow escapes or lived or worked in Manhattan, might well have lingering effects of that experience. But the vast majority of those people have gone on with their lives, even though they may still have difficulty thinking about or talking about those events. It is that small portion of people whose grief and reactions have paralyzed them, frozen them in that time, who would most benefit from treatment. But we cannot know who those people will be until time has passed, until time has had opportunity to heal wounds, as it most often does.

The intentions behind grief and crisis counseling are good but research has again suggested they are not helpful.