Allegories of Death

A recurring dream I had throughout my childhood returned a few months ago, matured as I am and timely, as it was on the eve of my fortieth birthday. Though it was different in many ways from the dream of my youth, I recognized it immediately – an aged variant of a subliminal representation of the universal yet deeply personal struggle to coexist with the knowledge of my own death.

In childhood, beginning at age 7, the dream was this:

I’m sitting cross-legged along the side of my parents’ empty queen-size mattress, looking at it at exactly eye level. The room is dim and I’m focused only on a small, slate-gray cube resting on the edge of the bed, just inches from my face.

The cube is moving along the edge of the mattress from one end to the other so slowly I can barely tell it’s in motion. From left to right and back and forth again and again and again. Although it takes what seems an eternity to get from one end to the other, each time it does, the cube gets infinitesimally larger.

Over time, and as the cube gets bigger, it appears to be moving faster as it is only able to shift back and forth from one end of the mattress to the other. From side to side, in panicked vibrations, faster and faster and louder and louder until everything ends in blackness and a deafening silence.

I always woke from this dream with a deep sense of anxiety, terror and dread, and although I only realized it a few years ago, its meaning is quite simple – The cube is my life and its motion along a defined path representative of time, which at first moves so slowly it’s painful to bear, but over time picks up speed to a rate so fast there is no controlling or containing it. As my life expands, time races to my death.

The 40 year-old manifestation was this:

I’m in an enormous building within which all of my loved ones exist and where all of my life is lived. As the days pass, every so often and without notice, the ocean comes rushing in, crushing everything in its path and taking up almost every inch of space in which to breathe and survive. Although my loved ones and I continue to live through these occurrences, running, panicked into the small spaces allotted by luck, many around us die each time this happens.

We know that every time the ocean comes, it comes harder and more powerfully such that I also know at some point we will succumb, and that it is only a matter of time until I too am swallowed by the water.

Once again I woke with dread, though this time with far less terror and anxiety.

It makes sense that this dream has come back to me on the edge of forty. We tend to think of death, or at the very least our subconscious tends to think of death when we encounter situations, either personally or vicariously, that remind us of our own mortality. Illness, a traumatic event, significant milestones and birthdays can each do this, evoking feelings that otherwise lay buried beneath the clutter of our occupied lives.

Although the inevitability of my death is present in both dreams, my experience of life on the way to it, and the way that I encountered death were profoundly different – proof that my relationship with death has evolved somewhat over the years. Whereas in childhood, death, dimly shrouded, came while I was alone, it now comes illuminated, with all of my loved one’s near, each occupying the same space or ‘conditions’ that I am.


These conditions of course are the existential realities that come with being human – in spite of a fierce self-preservation instinct, each of us will die, each of us lives with the knowledge of our own death, each of us will die alone, and each of us exists alone, responsible for creating meaning out of an existence that provides none. This is the crux of freedom. “Man is condemned to be free; because once thrown into the world, he is responsible for everything he does” (Sartre).

For many of us, when a confrontation with these conditions creeps in by way of a dream, life event, or quiet moment alone, powerful and potentially overwhelming feelings can emerge and we are faced with a choice. We can allow ourselves to experience these feelings and examine our existence, or we can ignore them, along with any consideration of existential issues. For many, or dare I say most, it’s easier and less anxiety provoking to force each of these out of consciousness by way of distraction. Although ignoring may mean we’re able to avoid feelings of anxiety, sadness, or isolation for the moment, it also means we are denying responsibility, and giving up freedom. Many of us will relinquish freedom to anything that will create meaning for us if it means not having to face these issues or experience the feelings that can accompany thinking about them.

Soren Kirkegaard, one of the great existential thinkers believed that freedom emerged from crisis, and crisis from intellectual, emotional, or physical imprisonment (Kirk Schneider). In his day imprisonment took the form of acquiescence to the Catholic Church. With the passing of time and the advent of all things modern, we can relinquish our freedom without seeming to, and subsequently, today, imprisonment looks a lot like freedom.

In the United States we believe and assert that we are free, the freest on the planet perhaps. We make hundreds of choices every day, each of which might imply, but does not necessarily indicate freedom. Mired in addiction, be it to work, the Internet, consumption, materialism, unhealthy relationships, sex, exercise, alcohol, drugs, healthy eating, unhealthy eating, gambling, pornography, or our phones, the numbers depict a people who are far from exerting actual freedom. We are a self-medicating society, forever denying, or unable to recognize any underlying problem, and eager to relinquish actual freedom for a false sense of security.

We hand over our freedom because the responsibility that comes with it is too great, too overwhelming. To face death, meaningless, and isolation, to consider their implications, and to give them a presence in our lives is too dark, it’s too negative, and it wastes the time we do have. Be that as it may, if we desire real freedom, we need to explore and engage these givens, for in the same way too much pessimism acts as an impetus for pathology and distorted reality, so too does too much optimism. Pretending we’re fine with the idea of our own death when we aren’t, or avoiding thinking about the topic to eschew any feelings of discomfort only increases the potential for negative social, emotional or behavioral outcomes.

Research has illuminated the transdiagnostic nature of death anxiety. In other words, death anxiety is considered a basic construct underlying the development and maintenance of many psychological conditions including depression, anxiety, social anxiety, OCD, PTSD and somatic symptoms and disorders. Additionally, it has been found to be prevalent in both clinical and nonclinical populations, meaning that most people experience some amount of anxiety related to the anticipation, and awareness, of dying, death, and nonexistence. However, despite its ubiquitousness, death anxiety is scarcely talked about – or acknowledged. Many of the problems we experience in living, and many of our addictions have death anxiety at their root. An unconscious fear of death unquestionably motivates much of our behavior – whether it’s covert denial and avoidance or overt pathology.


One of my favorite quotes is a line in Cormac McCarthy’s film, The Counselor- a fantastic existentially-themed movie that is admittedly difficult to watch. “We announce to the darkness that we will not be diminished by the brevity of our lives – that we will not thereby be made less.”

And that is the point, exactly. The brevity of our life makes it all the more precious. The isolation inherent in existence makes our connections all the more important. The meaningless of the universe makes the choices we make about how to spend our consciousness all the more poignant, and the responsibility we have to create what we will from a universe with no external structure, grants us true freedom.

Nietzsche said that each of us must decide how much truth we can stand. Because the truth can be incredibly difficult, and because choosing to take the red pill to discover how deep the rabbit hole goes often means a dismantling of the comforting illusions we’ve clung to, many chose to ignore it. But it is in the dismantling that an authentic and richer existence can be found. Our existential reality only seems a grim end until we engage it. When we do, it becomes a beginning. And despite our resistance to it, sometimes, in a gracious and desperate act, the truth pushes itself into our consciousness by way of a dream or a fleeting thought, reminding us that the more unlived our life, the less freedom and the more anxiety – whether we are conscious of it or not.


Today, at forty, time has begun to pick up speed and I realize that I cannot slow it down. I try not to be frightened by its passing, but to revel in the fact that I’m here, that I’m loved by the incredible people in my life, and that I’m lucky enough to love them back. I try to let the ephemeral nature of my time here inform the choices I make and how I live. I try to always be expanding the continuum along which I chose to experience life, to let go of the dichotomous existence permeating our culture, and to allow myself to expand as a person. And as was symbolized in the allegory that was my dream, it seems this desire for expansion has been with me since I was a child, perfectly represented in the widening space the cube consumed as it traveled from one side – or one year – to the next.


Making America Great Again

For some reason, it seems so many people today can’t tolerate those who don’t see the world exactly as they do. It’s a dangerous trend and the lower road.

I’ve been privileged to have people in my life, many in fact, whom I genuinely love and respect (not merely tolerate) with all manner of political belief and it has made me a better person. I’m thinking of you, Natalie Simpson. We disagree on most all political matters. I’ve been appalled – seriously appalled – by some of her Facebook posts, as I’m sure she has been by some of my left-leaning hippie bullshit. But we genuinely respect each other. She’s a strong, smart and engaged woman who speaks her mind, has raised a beautiful family, and has the strength of character needed to continue to befriend a woman like me who, to her, must seem a pinko nutjob.

No one side has the market cornered on truth and none of us is as smart as we think we are with our perfectly thought out arguments and heir of superiority. The signs of real intelligence will always be humility and the ability to hold and/or consider opposing points of views while retaining the ability to go on with your life (so says F. Scott Fitzgerald).

My point is… the bickering is exhausting. And, the divisiveness and seeming disdain people have towards those with opposing views seems far more harmful in the long run than anything one man or woman could do during four years in office. So to make America great again, maybe take the high road – challenge yourself to make a friend who sees the world differently than you, and in an authentic way learn to love and respect them. And certainly, keep fighting for your beliefs and our democracy by being an engaged citizen. Just do it with less spite and a little more introspection, please.

“The surest way to corrupt a youth is to instruct him to hold in higher esteem those who think alike than those who think differently.”

– Nietzsche

A Farcical Education

My friend and I are the black sheep of our program. While most of our peers spend their time and energy arduously answering questions posed by professors, we spend ours proposing different, and what in our opinion are much more important and germane questions (though most might disagree). Long past the time they’ve answered scripted questions with equally scripted answers, we continue to endeavor to answer our own, touting their importance and damning the fact that others dismiss them so flippantly. While those around us are proud of the education they’re receiving and the work they’re slaving over, we view our program as manualized, sterile, and top down. We deem it primarily a hoop through which we must jump to finally access the freedom to think for ourselves, the credentials we need to serve suffering individuals in a manner not taught or even touched upon by our APA-accredited program, and the ability to work outside of a broken, biased, and profit-driven system.

We aren’t geniuses and I’m certainly not suggesting we’re smarter or any better than those around us. On the contrary, I spend a considerable amount of time wondering if I am and will be less effective as a result of the constant resistance I feel and the inherent misgivings I have towards most systems. It seems the differences between our classmates and us lie in our expectations regarding the purpose of education and the disappointment we feel that it isn’t at all what we’d hoped.

There is a transformative power in education – not in our educational system – but in education. It’s my opinion that most formal education in the United States does more to facilitate and ensure conformity, compliance and the status quo than it does to elevate and empower any one individual, let alone any disadvantaged segment of our population. The further one pursues formal education in the United States, and the higher the degree one seeks to obtain, the narrower he or she is encouraged to be, in the name of expertise, specialization, and essentially, brandability. Our formal educational system wasn’t purposed for, nor has it ever been purely altruistic. It doesn’t function as a system through which people learn to recognize and challenge the signs of social injustice, identify and address the root of an issue or fight for the freedom to decide where their true interests lie. Its primary task has never been to give individuals the ability to connect knowledge, social responsibility and democracy, or give them the means to transform their selves and their world. Education can do this, but not our educational system.

There are strains of empowerment within our institutions to be sure – really good people doing really good work in spite of the stifling nature and ivory towers of academia. And of course there are individuals who are able to overcome great obstacles thanks in part to the education our system afforded them. I would argue however that their success is more likely a function of something within them than the education they received, as on the whole, our system strives harder for a profit and to feed an economic system than it does to spur human progress. As a result of its archaic, economic underpinnings, and though in many ways it might do so unwittingly, the U.S. educational system props up existing economic and social structures, and thwarts creativity, diversity, and curiosity by doling out a pale and vapid representation of real education.

And so, when I say there is a transformative power in education, I don’t mean in our public schooling or in the majority of our universities. I don’t mean that transformation is inherent in the acquisition of any particular bachelors, masters or doctoral degree. I mean that there is a transformative power in learning, in learning to learn, and in forging your own education despite the one provided you. There’s a transformative power in taking responsibility for what it is we learn from the information handed to us, and in deciding to think critically about the world, the ways we think, our assumptions, the questions people tell us need to be answered, and the answers they provide. A real education, in my opinion, is revolutionary. It nurtures the entire person and inspires. It values their inherent skills, abilities, and ideas. It encourages the learner to think and to see in a qualitatively different manner and allows the individual at long last to recognize the water they’ve been swimming in.

Real education depends upon what we choose and refuse to attend to, to read, the breadth, depth and variety of the things we think and talk about, and how willing and able we are to thoughtfully consider ideas that contradict our own and that which is considered common knowledge. It depends upon our ability to pan out beyond the details, to choose a broader view in order that we might recognize the flawed and narrow nature of the forced choices and realities we are presented, and the egocentric assumptions upon which much of what we “know” is based. And finally, it depends upon how willing we are to ask and answer our own questions and to remain focused on them despite our culture’s tireless efforts to lure us into answering theirs.

It should be said that pursuing this type of education will inevitably lead you down a path upon which you will become a black sheep, a prodigal son or daughter, and a threat to the existing state of affairs. But despite the struggles you will encounter, the experience is invaluable and transformative, and can assist in turning a lackluster life into something inspired. And though I’ve complained for the entire six years I’ve spent earning it, I will be immensely proud of the Ph.D. I’m awarded later this year – not as a result of the education I was given, but because through navigating and weathering its shortcomings, I was able to find and forge my own.

– Missy

“I wouldn’t trust schooling for an education any more than I’d trust schooling for learning” … and … “I have never let my schooling interfere with my education.”

– Mark Twain

The Only Thing That Matters

“Write poetry, for God’s sake, it’s the only thing that matters.”

—e.e. cummings

Poetry isn’t en vogue these days but it should be. I think we need it. I know I do. My guess is that most people don’t think they have much use for poetry – they don’t relate to it – they find it obscure or archaic. Perhaps it isn’t in our nature anymore. We’re too hurried and intellectual. Too focused on doing and being productive. En masse, it seems we’re too self-sufficient to need and to take what poetry offers. But I disagree.

I’m not one of those people. I’m not self sufficient enough, nor am I stable enough. I need poetry (among other things) to help keep my sanity, to find calm, and to see the other side of things. I regard poetry a fundamental part of my education in taking life on life’s terms and learning to love it – or at the very least, to survive it. When I hear a man has used a truck to run down families on a road in Nice, or about any one of the countless tragedies that takes place every day, I need something to help carry the weight. And poetry does. It can hold what we can’t. It can hold the unimaginable, the unendurable.

Poetry lives perfectly and powerfully juxtaposed the worst in the world and the worst in us. It contradicts the hate and violence that seem ubiquitous today, and challenges the vapid and rancorous parts of our selves, coaxing us to live an examined life.

So, in a world both harrowing and sublime, I encourage you, if you haven’t already, to consider this lifeline. Sift through the innumerable varieties of poetry and like everything else, take what you like and leave the rest. It’s not all uppity and esoteric and I assure you, if you search, you’ll find something that will transform you. Here are a few that have changed me. Enjoy…


Magdalene – The Seven Devils

By Marie Howe

The first was that I was very busy.
The second — I was different from you: whatever happened to you could
not happen to me, not like that.

The third — I worried.
The fourth — envy, disguised as compassion.
The fifth was that I refused to consider the quality of life of the aphid,
The aphid disgusted me. But I couldn’t stop thinking about it.
The mosquito too — its face. And the ant — its bifurcated body.

Ok the first was that I was so busy.
The second that I might make the wrong choice,
because I had decided to take that plane that day,
that flight, before noon, so as to arrive early
and, I shouldn’t have wanted that.
The third was that if I walked past the certain place on the street the house would blow up.
The fourth was that I was made of guts and blood with a thin layer of skin lightly thrown over the whole thing.

The fifth was that the dead seemed more alive to me than the living

The sixth — if I touched my right arm I had to touch my left arm, and if I touched the left arm a little harder than I’d first touched the right then I had 
to retouch the left and then touch the right again so it would be even.

The seventh — I knew I was breathing the expelled breath of everything that
was alive and I couldn’t stand it,

I wanted a sieve, a mask, a, I hate this word — cheesecloth — to breath through that would trap it — whatever was inside everyone else that entered me when I breathed in

No. That was the first one.

The second was that I was so busy. I had no time. How had this happened?
How had our lives gotten like this?

The third was that I couldn’t eat food if I really saw it — distinct, separate
from me in a bowl or on a plate.

Ok. The first was that I could never get to the end of the list.

The second was that the laundry was never finally done.

The third was that no one knew me, although they thought they did.
And that if people thought of me as little as I thought of them then what was

The fourth was I didn’t belong to anyone. I wouldn’t allow myself to belong
to anyone.

The fifth was that I knew none of us could ever know what we didn’t know.

The sixth was that I projected onto others what I myself was feeling.

The seventh was the way my mother looked when she was dying—her mouth wrenched into an O so as to take in as much air…
The sound she made — the gurgling sound — so loud we had to speak louder 
to hear each other over it.

And that I couldn’t stop hearing it—years later—
grocery shopping, crossing the street —

No, not the sound — it was her body’s hunger
finally evident. —what our mother had hidden all her life.

For months I dreamt of knucklebones and roots,
the slabs of sidewalk pushed up like crooked teeth by what grew underneath.

The underneath —that was the first devil.
It was always with me.
And that I didn’t think you — if I told you — would understand any of this —


The Road Not Taken

By Robert Frost 

Two roads diverged in a yellow wood

And sorry I could not travel both

And be one traveler, long I stood

And looked down one as far as I could

To where it bent in the undergrowth


Then took the other, as just as fair

And having perhaps the better claim

Because it was grassy and wanted wear

Though as for that the passing there

Had worn them really about the same,


And both that morning equally lay

In leaves no step had trodden black

Oh, I kept the first for another day

Yet knowing how way leads on to way,

I doubted if I should ever come back.       


I shall be telling this with a sigh

Somewhere ages and ages hence

Two roads diverged in a wood, and I –

I took the one less traveled by

And that has made all the difference.        


I Felt a Funeral In My Brain

By Emily Dickinson

I felt a Funeral, in my Brain, 

And Mourners to and fro

Kept treading – treading – till it seemed 

That Sense was breaking through – 


And when they all were seated, 

A Service, like a Drum –

Kept beating – beating – till I thought 

My mind was going numb – 


And then I heard them lift a Box

And creak across my Soul 

With those same Boots of Lead, again,

Then Space – began to toll,


As all the Heavens were a Bell, 

And Being, but an Ear, 

And I, and Silence, some strange Race, 

Wrecked, solitary, here –


And then a Plank in Reason, broke, 

And I dropped down, and down – 

And hit a World, at every plunge, 

And Finished knowing – then –


Poetry resources:



Neoliberalism and the Death of the Art of Psychotherapy

Today, as a result of external pressures from a state-driven audit culture brought about by the cultural components of neoliberalism, there exists less and less space for thoughtful psychotherapeutic study and practice, and a questioning of the assumptions of our ever-shallowing field and current organizational practices. The overregulation of psychotherapy, the manualization of both treatment and training programs, and an overwhelming focus on modalities that offer little more than symptom reduction and short term fixes have cumulatively sacrificed the art of psychotherapy with deleterious consequences spanning client, psychotherapist, and culture.

For thirty years we have lived within the zeitgeist of neoliberalism – an economic paradigm that came into the mainstream in the late 70’s and proposes that human well-being is best advanced by ensuring individual entrepreneurial freedoms and skills. This is it’s economic interpretation but a growing number of scholars view and refer to neoliberalism as a political ideology, mode of governance, and form of public pedagogy that deems profit making an part of the essence of democracy, consuming a primary action of citizenship, and the market able to solve most problems and adequate to serve as a model for structuring social relations. The most prevalent cultural components of neoliberalism include hyper-individualism, the tendency to act in a manner that benefits the self without regard for or accountability to others, society, the world, or the environment; commodification, the transformation of goods, ideas, and services, into objects of trade to include those items, which are not generally considered commercial items, such as education and human capital; and market ideology, an economic or transactional way of viewing something that focuses on efficiency and potential advantage. Though each of these is not unique to neoliberalism, together they offer a comprehensive account of the sociocultural effects of neoliberalism within the United States. Although it began as an economic paradigm, neoliberal characteristics now dominate personal, public, and systemic ways of thinking and behaving in the United States and around the world.

As a result of thirty years of a pervasive neoliberal ideology, negative outcomes within the United States are evident across a variety of domains from personal to public. Individually, we see unacceptable rates of suicide, depression, and anxiety among children, adolescents, and young adults. Narcissism has risen. Empathy has decreased. In our relationships, child neglect in the United States is up while contact time with children has declined as a result of labor policies that place the market and profit over family. Institutionally, in tandem with the implementation of neoliberal policies in the 1980s, a shift began in the U.S. educational system. By adopting neoliberal policies and practices, the U.S. educational system has begun to function as a business rather than an educational institution driven by a human-centered purpose. The past 25 years have brought with them an institutional emphasis on standardized testing and most recently, the invention of value-added measures, evidence of business models and paradigms being implemented within the educational system. In the same way the cultural components of neoliberalism have influenced our relationships, families, workplaces, and educational system, so too have they influenced entire disciplines and fields of thought and practice, including psychology and psychotherapy.

Traditional, mainstream psychotherapy has adopted a hyper-individualistic ethos by focusing primarily on the individual, and addressing pervasive, systemic problems as individual problems.

As a psychotherapist in private practice, I treat adults and older adolescents. In this clinical, outpatient setting I’ve found that despite the uniqueness of each client and their conceptualization of and experience with a variety of symptoms, I really only ever hear and help treat a handful symptoms and disorders. Of course similar symptomatology is to be expected, as it is what any diagnostic system is based upon – a particular disorder constitutes a more or less homogeneous group of symptoms. However, it seemed that in the same way a group of homogeneous symptoms constitutes a particular mental health disorder, the prevalence and pattern of depression, anxiety, social phobia, panic, and substance abuse in the United States constitute a larger and more systemic problem. Enter the cultural aspects of neoliberalism.

It seems we need a sort of public health model for mental health to hit the mainstream. Nearly 50% of the U.S. population will experience a mental health disorder at some point in their lifetime, and we have higher prevalence rates of mental health disorders than any other country in the world. And yet, though millions and millions of individuals are experiencing the same afflictions, we continue to conceptualize, diagnose and treat these disorders as disorders of individual functioning.

Cognitive Behavioral Therapy is the most widely studied and utilized evidence-based treatment for a number of common disorders including depression, anxiety, PTSD and OCD. It, along with several other similar treatments (i.e. DBT, Brief CBT), has proven effective at symptom reduction. Despite its evidence base and widespread use, others and I view this modality (and those similar) as a technique that treats little more than symptoms, and as ill equipped to elicit deep and substantive change. Rollo May, refers to this type of therapy as gimmick:

“Psychotherapy is facing a very profound crisis. I think the teachings of the fathers – Freud, Jung, Rank and Adler has been, in this crisis, almost completely lost. The problem is that psychotherapy has become more and more a system of gimmicks. People have special ways of doing their own therapy. They learn which particular buttons to push. They are taught various techniques by which they can cure this isolated symptom or that. And that wasn’t the purpose at all of Freud and Jung and the rest of the really great men who began our field. Their purpose was to make the unconscious conscious and there’s a great deal of difference between that. The gimmick approach leads to a general boredom. And the reason so many new systems in psychotherapy spring up is that therapists are bored. They are bored because they deal with the minor problems of life. They patch a person up and send them out again. I don’t regard that as real therapy at all. The therapy that is important as I see it is the therapy that enlarges the person, makes the unconscious conscious, enlarges our view. It enlarges our experience, makes us more sensitive, and enlarges our intellectual capacities as well as other capacities. This is what Freud was setting out to do. It’s what Jung, Adler and Rank tried to do. These people didn’t talk about gimmicks. It just didn’t interest them. What did interest them was making a new person.”

Amen. We need to look upstream, think broader, and examine what might be going on culturally that may be causing or contributing to this epidemic.

I would go a step farther and suggest that rather than traditional, mainstream methods of psychotherapy simply fitting into and adopting an individualistic ethos, perhaps these methods were born of it and now act as its extension – as a mechanism – of the status quo. Culture seems to me a central determinant in the outcome of therapy. Perhaps it also is, and has been, a determinant of theory, methodology and practice.

In the name of efficiency, effectiveness, and protecting the public, and with insurance companies and evidence-based modalities leading the cause, traditional, mainstream psychotherapy has adopted a market ideology and an audit culture.

Managed care has infiltrated the therapeutic relationship and is dictating treatment decisions. Insurance companies insist on a diagnosis within roughly 3 sessions – far before a therapist has had the opportunity to develop a deep and meaningful understanding of the client, and their symptoms and context. Insurance companies limit the number of sessions a client can be seen and only cover treatments, interventions and techniques coined evidence based – regardless of the reasons behind why some are evidence-based and some are not, and regardless of the fact that not-yet-evidence-based does not mean ineffective.

Over the past thirty years, the field of psychology seems to have developed an inferiority complex over the fact that it isn’t a harder science. Its attempts to prove itself otherwise by myopically focusing on the use and dissemination of only evidence based treatments (EBTs) and interventions (EBIs) – have contributed to the slow death the craft of psychotherapy is experiencing.

Like Empirically Supported Treatments in the medical field, EBTs and EBIs dominate training and practice in psychotherapy. And why shouldn’t they? Increasing health care costs and inadequate health care systems mean it’s in the public’s interest to utilize only those treatments and interventions that have proven effective. Although this sounds quite reasonable, often times the golden appearance of evidence-based treatments and interventions can be determined spurious upon further inspection. Consequently, a growing number of people, including myself, believe that many EBTs and EBIs treat little more than symptoms, that they are not conducive to deep and substantive change, and that there are very real risks to focusing on them so exclusively.

First, despite what we’d like to think, we are not living in a world where all research is conducted with the public good as its highest priority, with transparency, or without funding sources that elucidate severe biases. A recent study at John’s Hopkins shows the drug and device industry funds six times the clinical trials as the federal government. So, often companies with great financial interest in the outcome of trials will have more control over what doctors and patients will learn about new treatments than the National Institutes of Health.

Allen Francis, chair of the DSM-IV Task force and part of the leadership group for DSM III and DSM-III-R is Professor Emeritus and former chair of the Department of Psychiatry at Duke University School of Medicine. In his latest book, Saving Normal, he discusses how commercial interests have hijacked the medical enterprise, putting profits before patients and creating a culture of over-diagnosis, over-testing, and over-treatment. He blames diagnostic inflation for the fact that an excessive proportion of the population relies on psychiatric medication and the myriad of subsequent problems.

  • 1 in 5 adults in the United States uses at least one psychiatric drug while roughly 4% of our children are on a stimulant.
  • Psychiatric meds are now the star producers for the drug companies – in 2011, over $18 billion for antipsychotics (6% of all drug sales), $11 billion on antidepressants, $8 billion on ADHD medications. Antidepressant use nearly quadrupled from 1988 to 2008.
  • Primary care physicians, who have little training in psychiatric illnesses and medication and are under significant pressure from pharmaceutical companies and representatives, prescribe 80% of these.
  • The misuse of legal drugs has now become a bigger public health problem than street drugs, with more emergency room visits and deaths due to legal prescription drugs than to illegal street drugs and 7 percent of our population is addicted to prescription drugs.

Second, even if it is transparent and as unbiased as is humanly possible, research done in a lab or with “gold standard” experimental methodology (a randomized controlled trial) does not mimic the complexity of real life or the unique experience of psychotherapy, nor is it adequate to reality. Their findings can only be accurately extrapolated to those individuals living within the exact parameters of the carefully designed experimental setting.

Third, EBIs and EBTs are based on statistics. The individual is not“In the aggregate, man is a statistical certainty. But the individual is an insoluble puzzle” (Sherlock Holmes). Similarly, William James believed the uniqueness in every individual defies all formulation.

And finally, today’s EBTs and EBIs are the “best” answers we have today, with the tools, instruments, and knowledge we have today. But theories and “best” practices come and go. Let us not forget that until 1973, our best psychiatrists and psychologists believed homosexuality was a psychiatric disorder. At any given moment, we seem to think we have the best answers from the most exhaustive information, and we have far too much confidence in what we think we know.

Prior to beginning my Ph.D., I earned an M.A. from the University of Denver in International Security, and extensively studied Intelligence and Counter-terrorism. For two years I was educated to be extremely wary of relying on patterns of data and behaviors that are most ‘expected’ of a population or group. I was taught to be continually cognizant of the elusive Black Swan – an event or occurrence almost completely beyond prediction through conventional measures, that will have an immense and overwhelming impact on an individual, group, society, nation or world (i.e. 9/11). Black Swans are, in effect, outside of the “best practices” of analysis.

As a consequence of this training in a seemingly unrelated field, I have a difficult time seeing and analyzing individuals through a paradigm of statistical norms, or how “most” people experience the world and behave, and I have trouble swallowing the overwhelming weight given to EBTs and EBIs by our field. It’s dangerous to view a client – a person – through a paradigm of statistics because although means, standard deviation and other forms of statistical analysis may tell you about a small piece of a client or their story, they won’t tell you the most important pieces, and more likely than not, they will deter you from their deepest truths. I tend to liken individuals to the Black Swan and believe that in effect, every individual is one.

As a result of viewing the world through the cultural framework of neoliberalism, which positions efficiency, effectiveness, and profit top priorities in all affairs, we have packaged psychotherapy as an evidence-based, educationally sound and manualized program, effective and able to produce short term change. Perhaps our efforts to package this as such has helped us avoid acknowledging and dealing with the variability and uncertainty inherent in the psychotherapeutic process. However, as the psychotherapeutic process and relationship are each mechanisms from which the client’s most salient struggles emerge, in avoiding that uncertainty, we have avoided our means of helping them find the most profound and cathartic answers they seek.

And so, in an effort to mitigate the deleterious effects of the cultural components of neoliberalism, and restore the art of psychotherapy, we must begin to view symptoms and disorders from a distance, and as indicative of larger, systemic problems and characteristics, while simultaneously viewing the individual as completely and utterly unique. We must be willing to seek with our clients rather than espouse a prescribed, and evidence-based answer. We must be willing to face uncertainty and the precarious nature of therapy and life along side those we aim to help. And we must always think critically about the extent to which the treatments and interventions we chose may or may not be an extension of a system whose goal is not the growth of our client but rather a bottom line. These qualitative shifts in paradigm combined with considerable amounts of empathy, and clinical expertise and skill will help reestablish psychotherapy as a thoughtful, rich, and deeply transformative experience.



Black Lives, All Lives, Oppressed Lives

Some disclaimers:

First, this is in no way a presentation of answers, but rather a brief outline of what I understand and what I don’t, with a few hypotheses thrown in for good measure. Some of this is specific, while some is quite broad, which seems representative of the issue itself. I’m genuinely confused as to which factors are most heavily behind what is happening in the U.S. these days, and despite my fear of being deemed racist, ignorant, or insensitive, I thought I’d outline them.

Second, it seems to me that the more sides of a topic we can view, the better we will understand it – that is, if we can respect ourselves and each other enough to allow questions, confusion, and differences in thought and opinion. I take it a sign of wisdom rather than idiocy to be able to hold two opposing viewpoints in one’s mind and be able to understand and subscribe to some parts of each. Besides, most “sides” of this discussion hold a piece of the truth, and it’s unlikely that everything you or I or anyone else thinks and believes holds the entire story.

Third, apart from the few years I spent as a raging evangelical Christian, I in no way feel it my responsibility or duty to change anyone’s mind, opinion or belief. I assume people are doing just fine with the answers they’ve come to, and so in the same way that there are no answers here, there is no proselytizing.

Finally, like most of you, I don’t hold an opinion about something (at least any strong enough to write about publicly) that I haven’t spent a decent amount of time and energy thoughtfully considering. Sometimes however, the issues are so complex that even with ample reading, thinking and listening, the “answers” remain elusive. This topic is exactly that for me. And with that, here we go… gulp.

What I understand and/or believe.

  • Systemic racism is very real and very destructive – not only for the individual lives weakened and inhibited by it, but for families, schools, communities, and society.
  • Explicit racism at the level of the individual, though generally rare, is very real.
  • Implicit racism at the level of the individual is very real and pervasive. Most of us, no matter how non-racist and nonjudgmental we think we are and genuinely try to be, (I’m lumping myself into this arena) have some amount of implicit racism. If you don’t believe me, please test yourself with this widely researched assessment of implicit bias:                              (Click “I wish to proceed” after having read the preliminary information then click the Race IAT – and any other you’d like.)
  • In some instances, the advent of video seems to have added more confusion, rather than less. When you can see most of the actions of each individual, it inherently means that you cannot see every action. Having hours to examine a situation that in real time allowed for only split second decision making isn’t adequate to reality.
  • We are all human. There is good and bad judgment in all of us. We are too quick to judge and we forget that every single case is unique.
  • Police need more training in non-lethal alternatives and in CPI.
  • The media focuses on what creates more viewership and profit.
  • Each year, despite the higher total number of whites killed by police, when adjusting for population, (proportionately) blacks are killed by police at more than twice the rate of whites.
  • Each year, minorities (blacks, Native Americans and Hispanics) are killed by police at higher rates than whites. (Again, proportionately.)
  • In the 75 largest counties in the United States, 62% of robberies, 57% of murders, and 45% of assaults were committed by black people, despite the fact that this population comprises only 15% of the total populations (of the same counties).
  • Black on black crime outnumbers white on black crime.
  • Blacks commit the most crimes on blacks. Whites commit the most crimes on whites and Hispanics commit the most crimes on Hispanics.
  • 40% of all individuals who have killed a police officer in the United States are black.
  • Black and Hispanic police officers are more than 3 times as likely to fire a gun at a black individual than is a white police officer.
  • Graduation rates in the 50 largest cities in the U.S. – cities where larger proportions of black and Latino students exist – average 53%.
  • The poverty rate for blacks and Hispanics is more than double that of non-Hispanic whites.
  • Whites are underrepresented in prisons. Minorities are overrepresented.
  • Incarcerated individuals have a median annual income of $19,185 prior to their incarceration, which is 41% less than non-incarcerated people of similar ages. Meaning, our jails are filled with the poor. More specifically, our jails are filled with poor minorities.

Those are the specifics. Then I pan out and my hunch is that all of this might be more about class, power, and distraction than it is about race.

Things I don’t understand and/or question:

  • Why saying “All Lives Matter” is racist. I don’t get this. I’ve read all the “saying all lives matter is like saying…” posts and I still don’t get it. It’s not that I don’t understand the explanations, I’m just not certain I agree. In my opinion, our ultimate goal should be something like: Every individual is afforded the same opportunities, rights, and protection under the law and will be allowed his or her individuality, in whatever and in every capacity he or she wishes (without infringing on the rights of others) without being subject to systemic and or individual discrimination or prejudice. Maybe this goal is too lofty to be practical at this moment, but it seems less productive to focus on the issue of race so specifically, and more effective to address larger, faulty contexts and constructs (i.e. class and power structures) simultaneously. I think some people with the propensity to claim “All Lives Matter” might be coming from this place rather than one of ignorance or racism. I know I do. Great changes need to take place but I’m not sure such a fine tuned focus (Black Lives Matter) is the most effective way to create substantive, long-term and not just reactionary change. Maybe I’m wrong.
  • Finally, I question whether the general public fully understands the variety of circumstances within which an officer is legally allowed to use deadly force. There is more leeway than the general public might think, and though it might very well be the case that these policies need to be changed and are in fact an extension of systemic racism or discrimination, this may explain some of the discrepancy between the public’s expectations of justice and trial outcomes and lack of punishment.

And there they are – my confusion and sometimes-contradictory thoughts and beliefs in bullet points. If there is a culminating thought, it’s something I previously alluded to – that beyond racial disparity, the ills of our country and the reasons behind the fact that we are urged to focus on some rather than others are intricately and carefully connected. Perhaps a focus on racial disparities distracts us from uniting against the ruling corporatocracy – that system perpetuating systemic racism, tying the hands of the poor and middle class, educating some and not others, and killing democracy, the environment and millions around the world in the wars it continues to wage.

We have a race problem in the United States, undoubtedly. Part of it is our fault, part of it is the media, and part of it is something else. I tend to view it as symptomatic of something larger and believe that if we take a myopic focus on only this piece of it, the larger problem will continue unabated. Perhaps a simultaneous and multi-tiered approach is needed and perhaps it’s our responsibility to connect those dots and demand that type of change.

“How can the oppressed, as divided, unauthentic beings, participate in developing the pedagogy of their liberation?”                                                              – Paulo Freire

If you’re interested in further reading on the topic, here is a link to a related piece:













A poem: Ephemeral

We are, each of us, a spark

Surrounded by endless night

A quick and shallow breath

Sunk deep into thick, black, blindness

Perhaps this is why we are so unable

To breathe in and remain present


Though we live knowing it’s all we have

And all that we are

We strive with all of our being

For more existence

And therein lose that small, precious,

And only piece we have


Perhaps we live in the past, in the future

Outside of our present, and inside of our minds

Simply because there’s so little room for us here

And so little time

And perhaps we live there simply because we can’t