No Exit, No Resolution: Reflections on Postmodernism, Trauma, and Narratives

          Recently, I participated in the University of West Georgia's "Student Psychology Annual Research Conference" (SPARC) and presented my final research paper for my "Brief and Narrative Therapy" course.  In spite of preparation and lack of sleep, the presentation was well received and I felt it was quite outstanding and received several compliments on the presentation.  Below, you will find a link to a .PDF version of the the presentation that is publicly available on Google Drive as well as a .PDF of the essay which is also publicly available on Google Drive.  I have not posted the essay here in its entirety due to formatting errors in the past.  However, these documents (as stated) are publicly available for viewing, download, and searchable on the web.  I have provided the abstract from the essay for reference.

Abstract

The term “postmodernism” can refer to many different things ranging from art to politics. Postmodernism also has connotations with philosophical and social movements. The concentration of this essay is to examine the social sphere of the philosophical notion of postmodernism. It is, then, to say that the philosophical and social distributions of postmodernism are intimately connected. The first part of this essay will examine the precursor to postmodernism, “modernism”, as well as some of the movement’s weaknesses or shortcomings. The following will also address some of the social effects of interrogating meta- and personal influences. This essay asserts that we as a society and as individual persons are not, nor can we be, prepared for the “discursive construction” that embodies the heart of postmodernism. In fact, it may well be in our best interest not to be. A case will also be made against postmodernism and how it has been enacted within the world. Furthermore, I postulate that we exist within a unique state of trauma, perhaps post-trauma, in which our memories, narratives, and confidants are called into question from every angle. Nevertheless, The World and our worlds have not stopped or been enacted upon retroactively. Rather, we continue working, living, and being in a nameless age; a narrative with an innumerable amount of blank pages left to fill. So, it would seem, that somewhere between catharsis and oblivion, at the intersection of nowhere and everything, it is very probable that something quite therapeutic occurs.

Link to Presentation

Link to Essay

Trajectory of Psychotherapy - Psychological Suffering: Final Reflection

** The following was submitted as the last reflection paper for my Psychology of Suffering and Disorders course **

          For this reflection paper we were asked for our thoughts on the “trajectory of the field.” The first thing that comes to mind is part of a conversation I had with some of our colleagues after class on Thursday. I mentioned that a friend of mine, who is in her Podiatry Residency posted something on her Facebook titled “Dear Lawmakers: This is what it's like to be a doctor today.” As I read through the article (link here) I couldn't help but think of the parallels I was seeing with my own career projection. To summarize, the physician laments his soaring student debt and modest salary as a young doctor while purchasing a home and raising a family. He presents a question about why doctors still bother; and answers that it is not about the money any more, it is because they care. I thought this bore a striking resemblance to my thoughts on entering a career as a psychotherapist or even as a psychologist. As ***** pointed out below, if money is your game, you're in the wrong field. So, why do therapists still bother with 2-3 years of graduate school (5-7 if you're chasing a doctorate) and another 3 years of supervised training? I suspect it is not too different from the reasons stated in the article.

          More to the point, I think that there are two predominant directions that “the field” is headed in simultaneously. Firstly, I think the divisions between professions (Psychiatrists, Psychologists, and Therapists) is only going to deepen. As technology, science, and medicine relentlessly accelerate and are pushed by various influences (consumer demand, payment policies, research and education politics, etc...) the idolatry of a “human science” seems to be waning even from its current crippled state. Secondly, I suspect that further integration between these fields will develop regardless of who holds the “majority share.” While technology can do incredible things, the screaming voice of the last half-century or so is pleading that capital and industry can not solve all our problems.

          I mentioned Human Science in quotations and with the pejorative of “idolatry” with specific intent. I feel that emphasis is needed there and not doing so discredits what science and medicine have done to improve our (every helping profession's) quality of care. If nothing else, options are available now that would have been beyond comprehension 100 years ago. I also think it would be dishonest of us to deny that there is any “theoretical seclusion” or “mental masturbation” going on in our field. Personally, I plead no exception to this. I suppose that I am more hopeful than making a probable projection that integration will occur. I also mentioned a waning presence of “talk therapy.” I mean this in a public/political stock-holding sense. I don't think that this necessarily means a weakening of strength within our own context and scope of practice; rather, a concentration of skills and emphasis... a refining richness in quality over quantity if you will.

          On the specific subjects of this course, I think that suffering is inevitable, perhaps even integral. Sooner or later something or someone will come along and hurt us, scar us, disease, or dis-ease us; probably more than just one or once also. As part of our growth and developmental processes, I think that a radical “foundation-shaking” occurs at some point in life (a breaking of the dam) whose reaction fosters growth in one area or another, be it “orderly” or disorderly. While this can be taken into several personal contexts, I think it is also fitting to the “trajectory of our field.” As I read ****'s post, I don't think “willingness to” or “state of” suffering has ever been the question; although, certainly we are living in an age in which our career path seems dis-ordered, the foundation of the field questioned, and no where to go but onward. In one direction or another, it will grow. Decades of medicine and technology have not abolished the need for therapists, counselors, and social workers; nor has the prevalence of CACREP-accreddited programs erased the existence of non-CACREP programs. I highly doubt either of those things will ever occur. There's no replacement for human-to-human customer service; and “it takes a hell of a drug to beat a placebo.”

Cost of Caring

           I was having a conversation with a co-worker of mine the other night, I guess you could say the topic was “The Cost of Caring.” She holds the same position as I do in Psychiatric Facility, but she is studying to be a nurse, and I a psychotherapist. Interestingly enough, this conversation had nothing to do with patient/client care but rather, care for one's self. I found this conversation to be quite fitting to a recent presentation in our class about “Secondary Trauma” to therapists ala vicarious suffering through their clients or counter-transference of suffering.

          We both shared experiences when we we “burnt out.” But there was more to it than that. The term “burn out” doesn't seem strong enough, and “compassion fatigue” doesn't fit; indeed, the curse was perhaps “caring” too much. As she described it at the end of the conversation, “It was like being a zombie on an airplane set to autopilot with the wings on fire.” In her experience she said that she was working three jobs and going to school. When people asked her how she survived she said she replied, “Coffee and B12 (vitamin).” She eventually had to slow down because after being asked by a loved one “Please stop. I never see you and I hate seeing you do this to yourself.”

          I had a similar experience in the fall of 2011. I was going back to school full time taking classes to round out medical school prerequisites (at the time I wanted to be a psychiatrist). I was also working a full time job and a part time job. To make a long story short, between school and work I was sleeping about two hours per night, seven days per week for ten weeks. To say I was a zombie on autopilot would be a severe understatement. To use Heideggarian terms, I had lost all sense of being and time; I was a machine, the anonymous “das man” … but machines break. There was no one asking me to stop, but one day I realized I was done. There was no agonizing internal debate, no emotional tossing-and-turning, one evening I just decided I wasn't going to do it anymore, it was over. I'd like to make one more comment and that was to the befuddlement of my professors when I withdrew from my classes (in spite of excellent grades) and turned in my text books. I spared them the long story and just told them I had had a change in career plans. That didn't seem to ease their confusion but as I walked away at about 8 am after working all night; somewhere in the weary black rings under my eyes they nodded as if they understood the unspoken and inevitable collapse of taking on too much.

          Anyway, the moral of the story is that caring, or rather “giving”, has a price and it is steep. Hardened nerves, iron will, and a clever wit can only take you so far. Some high-octane emotional fuel can increase this longevity but the trajectory still has an end. Perhaps that end is oblivion, perhaps not, perhaps it is a cataclysmic Armageddon, perhaps only a whisper. Some last longer than others, but it seem inevitable that when you truly give everything, sooner or later something important will fall through the cracks. Indeed, the cost of giving is expensive.

          This leads me to a more current predicament. Emptiness, a feeling of the “low fuel light” coming on … different from the previous experience in this sense. There's a secret, my foot's not coming off the throttle. Why? Because while I may feel that I'm “running out of gas” (perhaps I'm just anxious for the summer break to “refuel”) it is a satisfying emptiness rather than a hopeless void of defeat. When this semester is finished, I can look back and honestly say that there is not one thing more I could have given, not to my job, not to my coursework, not to my friends. I have given all that I can in the truest sense of “giving.” So while I may turn out “bankrupt”, the currency has been well spent. Perhaps on investments that I will never see “mature” (in the financing sense), but the return has already been “given.”

Drugs, Neuroscience, and Therapy

Preface:  The following is a response/reflection to some of the topics being discussed in my "Psychological Suffering and Disorders" course.  The topic prompt was the use of MDMA (ecstasy) in treatment of PTSD (post-traumatic stress disorder).

          Typically I'd be in favor of psychotherapy first and pharmaceutical assistance second or as a supplementary procedure; not a replacement.  I'd go as far to carry that sentiment over to many other medical and psychological conditions as well.  However, the fact of the matter is that medications can provide assistance to our profession and towards easing a person's stuggle with their suffering.

          In the specific instnace of MDMA, as ***** pointed out, many other narcotics are used within the medical realm that would be highly illegal if used on the street.  The problem I see here is not in the legallity of use but in reliance, regulation, and distribution.  There is a quite significant difference between a prescription for marajuana or a prescription for cocaine and/or the in-procedure use exclusively by medical professionals.  This would be one of my main concerns with the use of ecstasy, LSD, or (insert "illicit substance").  

          One of my larger concners would be the over-eagerness of supporters.  It seems to be a freightening trend that as soon as a new medication is relased from a pharameutical company with any "cooberating" evidence for a research study that there is a cult-like bandwagon effect.  This has been seen in recent history with SRI (serotonin reuptake inhibitor) medications.  As with anything, there are politics involved.  A shocking one is the way in which funds are transfered from pharmeceutical companies to researchers to sponsoring physicians... but that is a topic for another day.

          I'm also cocnerned about a dependence on the drug(s).  This is a two-fold approach.  My concern is for both the use by "professionals" and "patients."  I would be concerned that users may become dependent on the drug (even something as simple as ibuprophen[Advil] or acetaminophen[Tylenol]) and think of it as the primary curative facillitator rather than other therapeutic interventions.  In terms of coping with struggle, other "crutches" can develop out of "need" as well; maybe its alcohol, food, laziness, impulse spending, or any other method of dissociating from a problem.  I think that this dependence could aslo develop with the practitiioners.  I have seen many antipsychotic drugs used in both strictly medical and psychiatric hospitals ... (cough) aggressively.  While some situations warrant use of the drugs in this fashion their side effect of making a patient "docile" can frequently be abused.  In addition to this general abuse, I wonder if the "therapeutic" ability of the world's counselors will come to rely on drugs more than their ability to connect with and manifest something powerful by a soley "non-synthetic" means.

           I would have similar feelings towards EMDR or other more "cognitive" based measures.  As ***** mentioned in class, I agree that, as a (future)psychotherapist I do not feel I have the training or education in neurology to adequately apply these measures in "good conscience."  Depending on one's educational orientation as a "psychologist" I think this could aslo be true.  Personally, I would be disgusted and feel totally empty if I were to hang my ability as a therapist on neurological, cognitive, or behavioral mechanisms alone.  Speaking for myself, that "just aint my style" and the practice of medicine isn't (or won't be) my job.  Perhaps a tool in a bag of tricks, but how would you feel if you were the client who found out that that's what you meant to your therapist, a trick in a bag?