The Microbiome and the Multiple Self

By Alexander Kriss, M.A.

This entry was originally published June 1, 2013 on inkblot.

© National Academy of Sciences, U.S.A.

Recent months have yielded increased discussion in popular journalism concerning one of the most significant discoveries in contemporary biology: the microbiome. This term refers to the trillions of microbes that live within every human being, a vast panoply of organisms that interact with our functioning in such a profound way that its alternate term is the "second genome." Emerging studies of the microbiome demonstrate a complex mutuality between us and living matter that is, strictly speaking, not us. Not only does this refute reductionist notions that "we are our genes" within the realms of biology and genetics, it fundamentally threatens dominant Western conceptions of the self. We are not autonomous beings but a colony of diverse life, a human-microbial collective. Additionally, disrupting the balance of these intertwined lifeforms (such as through the overuse of antibiotics) is increasingly thought to be deleterious to our health.

The idea that (mental) health is defined by a unified self has been a tenet of United States thinking since we first took a stance on the issue in the mid-20th century. Classical Freudian psychoanalysis emphasized incorporating disparate aspects of the psyche into a balanced and reality-based ego, and this aspect became reified during the reign of American ego psychology, as it appealed to our individualistic values that prized the idea that we are in full control of our destinies. From this perspective, health could be achieved in absolute terms when an individual (like the analyst) addressed all defenses against internal conflict to become a truly independent creature, free of neurotic illness and the societal, cultural, and interpersonal structures that caused it. Though this variant of psychoanalysis grew unpopular and has now all but faded away, the "Americanized" attitude toward mental health is alive and well. It is now represented by various interventions, including psychotherapeutic and psychopharmacological treatments, that promise quick and total results based on empirical evidence that is presented as objective and therefore irrefutable. Psychological problems are seen as unwelcome invaders that threaten our cohesion and should be eradicated in the same manner that we eradicate physical infection. However, the microbiome teaches us that this approach is reckless and often harmful, which in turn begs the question as to whether our basic cultural definitions of health and selfhood need revision.

Contemporary psychoanalysis in the U.S. has shifted dramatically from its earlier incarnations to incorporate many of the concepts stemming from object relations, interpersonal, and relational perspectives as well as Eastern philosophies, all of which tend to view the self as less solidified and more transient, or as a multiplicity of states and internalizations rather than a single ego. Within this framework we are not one self but a constellation of self-states that incorporates many ways of being, and that is dependent on context and the presence of others. Selfhood is therefore not fixed or even something to be "achieved," but a dynamic construction happening in the here-and-now. Relational psychoanalysis and attachment theory in particular argue that the striving for social interaction is a fundamental unit of human existence, and that the idea of an individual self existing in isolation borders on meaningless. (This concept, of course, has been present in non-Western thinking for millenia.)

Acknowledgment of the microbiome makes the idea of a deconstructed self even less plausible. After all, we are never truly alone. Though we cannot carry on a conversation with microbes, we are constantly participating with them. In the most basic physical terms, "we" are located not only in ourselves but in others (trillions of others!) with whom we have a symbiotic bond. Appreciation of this idea in biologic terms should make the concept that the self is intrinsically bound to other non-self entities (such as friends and family, communities, social structures, cultural values, historical trends, and so on) more palatable to the North American sensibility. Likewise, it ought to cast doubt on the "shoot first, ask questions later" approach to treatment, as our very notion of health shifts from purifying the self of pathogens to achieving a harmonious balance within a larger ecosystem that includes both the self and everything connected to it.

Appily Ever After: A Smartphone Shrink

By JUDITH NEWMAN, The New York Times

Published: April 5, 2013

When I was a kid, my favorite toy was the Magic 8 Ball. There was something immensely comforting about asking this little gizmo a question (“Will I find true love?”), shaking it and then seeing the answer that would bubble to the top of the screen: “Outlook good.”

As the world became more complicated and full of anxieties, many of us traded our Magic 8 Balls for therapists and self-help gurus. (“Will I find true love?” Answer: “First, you need to learn to love yourself.”)

But now a proliferation of psychology smartphone apps — with names like BreakkUp, iStress and myinstantCOACH — purports to help us live happier, less anxious lives. As Mark McGonigle, a therapist in Kansas City, Mo., who invented the app Fix a Fight, puts it: “Electronic devices don’t have to drive us apart. They can bring us together.” Which sounds so good. A few bucks and a lot of squinting into my phone: that certainly beats a $300-an-hour psychiatrist, right?

But can an algorithm iron out the kinks in our existence? Will I be able to get my kids to do their homework, or calm down, or simply get my husband to stop nagging, all by following the protocol of these apps? I decided to test them against the stressors of my own less-than-peaceful life: work, cranky husband, twin 11-year-old boys.

Over the course of two weeks, I did a lot of screen tapping — just as I used to spend hours shaking that Magic 8 Ball — and discovered the pleasures, and frustrations, of making my smartphone my shrink.

Fix a Fight

“Communication: it’s the sine qua non of a good marriage,” says Fix a Fight’s Mr. McGonigle and, you know, everyone else.

My problem: It is tax season, so my husband and I are barely speaking. He is the kind of person who likes his receipts carbon-dated. I am not the best record keeper. Let me rephrase that: I am not a record keeper. We’ve been having the same panicky discussions for years, usually right before we go to sleep. They go like this.

John: “Did you see that you are getting Comcast dividend checks? I thought you sold that.”

Judith: “I’ll find out tomorrow.”

John: “Oh, and do we have enough money in the checking account?”

Judith: “For God’s sake, shut up. I can’t take it anymore. You know that when I’m tired I don’t want to think about money.”

The process: My reaction is not, strictly speaking, what Fix a Fight would advise. The app instead shows how a fight is really a “golden opportunity for intimacy” if you process the emotions correctly. This involves: naming your feelings, identifying with your partner’s story, taking responsibility for your actions and describing how the fight will be different next time.

So, John and I identify our feelings (anxiety is big on his list, exasperation on mine) and are instructed to explain our positions to each other.

John: “Why are you typing this discussion into your phone?”

Judith: “Never mind, just talk.”

John’s feelings: “It’s all your fault, because it would be the simplest thing to hold on to your pay stubs.”

Judith’s feelings: “I want a divorce.”

Unfortunately, John and I never made it to the next steps because by that time we were already sleeping in separate rooms.

Conclusion: My failure is not the fault of the app. It seems a sound approach, if you have two people willing to concede some ground. This was not going to happen.

MoodKit

My problem: On the moodiness scale, I wouldn’t say I’m Sybil, but I wouldn’t say I’m June Cleaver, either.

The process: MoodKit, devised by two psychologists, is one of those whiz-bang apps that has so many things going on, you think you need a tutor just to learn how to use it. That puts me in a bad mood — which I can then track in my daily mood tracker. Other things I can do: read the 150-plus mood-lifting activities like “create something,” “choose your friends wisely” (Who has time for friends? I’ve got moods to track), “identify and write down three things you appreciate today.” And so forth.

Something called Thought Checker also invites me to write down a situation that bothered me, then gauge how strongly I felt, on a scale of 1 to 10, at which point I am told how I may be distorting my feelings.

For example, I was annoyed that my son didn’t greet me when I returned from a business trip, his eyes being glued to his beloved Knicks game. When asked, “What thought or concern was going through your mind when you started to feel this way?” I replied, “He is a little ingrate.”

Then I was given a choice of my possible distortions: “all or nothing thinking,” “blaming,” “catastrophizing,” etc. I decide that I am “personalizing,” telling myself an event relates to me even when it may not. I am told to try to find another way to think of the incident.

I know the correct answer is: “It was an exciting game, and he’s only 11.” My answer is still: “He’s a little ingrate.” I mean, it’s not as if he had a bet on the game.

Conclusion: I may be moody, but I’m not a grudge holder. So by the time I got through many of these exercises, I’d either calmed down or forgotten what was upsetting me in the first place. I did rather enjoy tracking my moods for two weeks, and while I could give you a detailed account, they could be summed up thus:

Children home from school for a week: bad mood. Family vacation during which children don’t want to leave the hotel room and pool: really, really bad mood. Everyone returns to school and the normal routine: who needs Zoloft?

Conclusion: The kit gets kudos for irony. It requires so much time to chronicle your life, you can’t really do it if you have a life.

ParentSmart

More of a reference guide than an interactive app, with advice divided into categories: actions, behavior, development, values. It asked me to enter information about my two children, keep track of their activities and devise “wish lists” — which consisted of nothing from my sweet autistic son, Gus, who wants to be allowed to watch buses all day, and about 500 requests for a Tim Tebow jersey from Henry, who has never met a piece of Jets sports paraphernalia he doesn’t love.

My problem: Oh, so many things to choose from here. But I decide to try out ParentSmart’s advice on interrupting, which my children do almost constantly. One day, when I was in the middle of a pressing phone conversation, my kids had instructions not to interrupt — instructions that did not go over so well because, when you’re 11, there are many, many things that constitute a news bulletin. On this particular day, it was the fact that there were window washers hanging outside our window, which elicited repeated cries of, “Mommy, Mommy, Mommeeeee.”

This is the kind of incident that makes my head explode. I read the advice about being proactive: teach your children not to interrupt unless there is an emergency. Talk through specific situations so that they understand what is and isn’t an emergency. Someone is hurt — emergency. I can’t find the yellow crayon — not emergency. Be consistent. If none of this works, whack them with this smartphone.

O.K., I admit I added that last sentence. ParentSmart’s advice is sound and common-sensical. I gave it a try. Apparently in my pre-app-enlightened state, I had assumed that what was and wasn’t an emergency was pretty obvious by age 11. I was wrong. Now, after much discussion: brother putting aluminum foil in the microwave — emergency. Men hanging from platform out the window — not emergency.

Conclusion: There do seem to be fewer interruptions in my household, at least when I’m on the phone. Not interrupting one another’s conversations? Well, maybe by the time they’re 30.

Unstuck

A bells-and-whistles iPad-only app by a San Francisco consulting firm that leads you through a series of exercises to help you get out of whatever rut you’re in.

My problem: I can’t seem to write today.

The process: First, I have to choose three adjectives to tell Unstuck how I’m feeling now. I pick “Overwhelmed, Uninspired, Unmotivated,” which pretty much sum up my entire life. The machine continues to interrogate me: What am I doing while I’m stuck? What thoughts am I having in this stuck moment?

This is where we get to the how-to of the whole exercise. I need to “believe in a new way to commit.” I am given useful tips to get the job done: chop it up into little tasks. Do one thing today; consider the extreme of what could happen if I don’t get it done.

O.K., I still haven’t started, but I have my marching orders.

But wait, there’s more. My iPad still wants to talk to me with a section called “Get to the Root of It” and continues hammering me with questions.

“I worry my work won’t be good enough,” I write.

“Why is that?” the machine asks.

“Because my parents were so critical,” I answer.

“Why is that?” the machine asks.

“Because they were Jewish,” I reply.

“Why is that?”

“Because they don’t believe Jesus Christ is our savior.” I feel my iPad is getting a little personal.

Then the machine triumphantly concludes: “This is what is really holding you back: because they don’t believe Christ is our savior.”

“So what are you going to do about it?” the machine asks.

“Uh, convert?” I tap.

Then the machine smugly asks: “Did this tool help you get unstuck?”

Conclusion: I spent about an hour and a half learning that I am Jewish, which does, in fact, explain a lot.

Simply Being

My problem: After spending so much time puzzling over my moods (the getting-my-marriage-working mood, the getting-my-children-in-line mood, the getting-through-all-the-mood-apps mood), I need something simple to improve my moods.

The process: Simply Being is exactly what it sounds like: a tape of 5, 10, 15 or 20 minutes (you choose), with a woman’s voice that’s calm-trending-to-coma and saying things like: “This is a time to do nothing, but simply be. Letting go of everything you’re doing, letting go of everything you need to do, simply be aware of everything going on, right now, in this moment.”

You know why this is relaxing? Because I’m not being asked to do anything. I’m sitting as someone whispers in my ear to sit down and shut up. (You can listen to the voice with music or nature noises in the background, but the recording’s a little dicey, so you find yourself thinking, “What did she say?” as she’s drowned out by a roaring ocean.) Of course, I could never find more than five minutes at a time to do this. I never got around to the 20-minute option. Still, it was five minutes well spent.

Conclusion: This app almost puts me to sleep — and in my world, that’s a very good thing.

Here’s the thing about all of these devices: They require thought. Lots and lots of thought. Thinking is what I do all day long. I needed something that would turn my mind off, not on. Something that would let me, however temporarily, ignore all of life’s problems, not confront them. Which is why you can find me pecking away, every night, at Words With Friends. Do you know how many two-letter words there are in the universe? I do! Ask me.

There is no easy solution to a life of stress and anxiety, of course. But out of all of the apps I tried, well, did I find at least one that does exactly what it says it does?

As my Magic 8 Ball says: “Signs point to yes.”

For the full article, visit: http://www.nytimes.com/2013/04/07/fashion/appily-ever-after-the-smartphone-as-shrink.html?pagewanted=1&ref=psychologyandpsychologists&_r=0

The Elephant In the Room: Race, Culture and the Therapy Relationship

by Doris F. Chang, Ph.D.

The Reality of Race In Everyday Life

Let's stop pretending we are all the same.

Published on February 12, 2013 by Doris F. Chang, Ph.D. in The Elephant In the Room, Psychology Today Blog (http://www.psychologytoday.com/blog/the-elephant-in-the-room)

Welcome! This blog is about the differences that separate us, how they shape the therapy relationship, and how to establish meaningful connections across social, cultural, and experiential divides.

Some of you are already rolling your eyes.  So let me reassure you, there will be no drum circles or choruses of “Kumbaya” here.  Not that I have anything against the celebration of diversity.  The problem though, is that for many people, celebrating diversity means pretending that our differences are superficial, that people are people.  Your hair is coarse and curly, mine is straight.  You do taichiand I do Soulcycle. You celebrate Diwali, I celebrate Christmas.  You drink your café con leche I drink my coffee with milk. So what if your skin is brown, and mine is pinky peach.  It’s all good. 

And yet, even in these celebratory spaces, there is an elephant in room.  The reality is, that these differences do matter in U.S. society in deeply disturbing ways.   In fact, research shows that one’s race, ethnicity, gender, social class, immigrant status, and sexual orientation, among other dimensions of identity shape our life prospects from birth until death, including: 

• the chance that your children will be born premature or die as infants
• your test scores on standardized tests
• the likelihood that you will be poor
• the safety and cleanliness of your neighborhood
• your ability to get a loan or a mortgage
• your chances of getting a job or gaining admission into college
• your risk for being a victim of violence
• your risk for heart attack or stroke, diabetes, cancer, and suicide
• your risk for developing a mental illness or substance abuse disorder
• your access to quality health and mental health care
• the likelihood that you will be stopped and searched by the police
• your risk of going to jail and the length of your prison sentences
• your life expectancy

In short, these aspects of the self matter more than many of us want to acknowledge, because doing so means admitting that life isn’t actually an equal playing field, that the American dream is more easily fulfilled for some than for others.  So we just smile, seek common ground, and do our best to ignore those differences right before us.  While these polite strategies help us get along, they do little to help us truly understand each other and develop the kinds of relationships that are meaningful, and in the therapeutic context, transformative.

Through my teaching, research, and clinical practice, I have tried to understand the structural, cultural, individual, and interpersonal factors that impact the mental health and treatment experiences of people of color. I have learned from my students’ struggles to overcome their own racial and class socialization in order to grapple with this beast-that-shall-not-be-named. In my current research, I am exploring what racial and ethnic minority patients think about their White therapists, how racial differences are negotiated in real-life therapy relationships, and how culture embeds the treatment process itself.  As a clinician, I try to help my patients see the structural and cultural realities that are often invisible, but exert a powerful effect on their psychological and interpersonal functioning, and our own relationship as therapist and patient. 

Beyond these professional roles and identities, I am also just a Chinese American wife and mother of two Jewish-Buddhist biracial children, who thinks an awful lot about race, culture, and difference, because well, she just wants her children to be safe, happy, and secure in the world.

This blog is about our collective efforts to understand, to learn from, and to be changed by each other’s experiences so that we can form more authentic relationships, build stronger communities, and create a more socially just world for us all.  I welcome you into the conversation.

Read more at: http://www.psychologytoday.com/blog/the-elephant-in-the-room/201302/the-reality-race-in-everyday-life

What Brand Is Your Therapist?

Posted by: Eleonora Cavalca

Illustration by Matt Dorfman. Photograph by Jens Mortensen for The New York Times.

By LORI GOTTLIEB

Published: November 23, 2012 

In the summer of 2011, after I completed six years of graduate school and internship training and was about to start my psychotherapy practice, I sat down with my clinical supervisor in the Los Angeles office we’d be sharing. It had been a rigorous six years, transitioning from my role as a full-time journalist always on tight deadlines to that of a therapist whose world was broken into slow, thoughtful hours listening and trying to help people come to a deeper understanding of their lives. My supervisor went over the filing systems, billing procedures and ethical quandaries like whether to take referrals from current clients, but we never discussed how I would get these clients. I fully assumed, in what now seems like an astounding fit of naïveté, that I’d send out an e-mail announcement and network with doctors, and to paraphrase “Field of Dreams,” if I built it, they would come.

Enlarge This Image

Illustration by Matt Dorfman. Photograph by Jens Mortensen for The New York Times.

Except that they didn’t. What nobody taught me in grad school was that psychotherapy, a practice that had sustained itself for more than a century, is losing its customers. If this came as a shock to me, the American Psychological Association tried to send out warnings in a 2010 paper titled, “Where Has all the Psychotherapy Gone?” According to the author, 30 percent fewer patients received psychological interventions in 2008 than they did 11 years earlier; since the 1990s, managed care has increasingly limited visits and reimbursements for talk therapy but not for drug treatment; and in 2005 alone, pharmaceutical companies spent $4.2 billion on direct-to-consumer advertising and $7.2 billion on promotion to physicians, nearly twice what they spent on research and development.

According to the A.P.A., therapists had to start paying attention to what the marketplace demanded or we risked our livelihoods. It wasn’t long before I learned that an entirely new specialized industry had cropped up: branding consultants for therapists.

I couldn’t imagine hiring a branding consultant to lure people to the couch. Psychotherapy is perhaps one of the few commercial businesses that doesn’t see itself as one, that views financial gain as unseemly when connected to the delicate work of emotional insight. Moreover, the field is predicated on strict concepts of authenticity, privacy and therapist-patient boundaries. Branding was the antithesis of what we did.

But a couple of months after setting up my office and waiting for people to call, I found myself wondering — first idly, then deliberately, and always guiltily — about those branding consultants and how exactly they helped therapists like me. Sitting at my desk one morning when my appointment book looked particularly dismal, a combination of curiosity and desperation got the best of me. On Google, I came across a branding consultant named Casey Truffo. Her Web site’s home page spoke directly to my situation: “You are called to be a therapist. Are you also called to poverty?” I immediately dialed her number.

The first thing Truffo told me when I reached her in her Orange County office was that I shouldn’t feel bad about my empty hours; nowadays, she said, even established veterans were struggling. Yes, the economy was bad, but the real issue was that psychotherapy had an image problem.

She told me about a therapist named Sandra Bryson. In 2009, Bryson called for help after her successful Oakland-based practice of 25 years lost patients when she stopped taking insurance. According to Truffo, Bryson shared a problem common to therapists: “a blah-sounding message and no angle.” Bryson had always done well as a generalist — treating anything from depression to grief to marital issues — but Truffo urged her to find a specialty, one that “captured the zeitgeist but didn’t feel played out.” Bryson mentioned that she liked helping parents and had an affinity for technology, and voilà — suddenly she had a brand. Not as a clinician addressing typical parenting issues like boundary-setting, which Truffo called “generic and old-school,” but as an expert who helps modern families navigate digital media. She also became a sought-after speaker on so-called hot issues like screen time, cyberbullying and sexting, and Bryson told me her practice, which is based on “mostly deep work,” had become “more advice-driven.” Now her schedule is full, and her income has increased about 15 percent a year.

“Nobody wants to buy therapy anymore,” Truffo told me. “They want to buy a solution to a problem.” This is something Truffo discovered in her own former private practice of 18 years, during which she saw a shift from people who were unhappy and wanted to understand themselves better to people who would come in “because they wanted someone else or something else to change,” she said. “I’d see fewer and fewer people coming in and saying, ‘I want to change.' "

To continue reading click on the link below:

http://www.nytimes.com/2012/11/25/magazine/psychotherapys-image-problem-pushes-some-therapists-to-become-brands.html?ref=magazine&_r=0

Fantasyland

Denial has poisoned the GOP and threatens the rest of the country too


Posted by: Jeremy Safran  


http://nymag.com/news/frank-rich/gop-denial-2012-11/

• By Frank Rich.  Published Nov 9, 2012  NY Times Magazine

Mitt Romney is already slithering into the mists of history, or at least La Jolla, gone and soon to be forgotten. A weightless figure unloved and distrusted by even his own supporters, he was always destined, win or lose, to be a transitory front man for a radical-right GOP intent on barreling full-speed down the Randian path laid out by its true 2012 standard-bearer, Paul Ryan. But as was said of another unsuccessful salesman who worked the New England territory, attention must be paid to Mitt as the door slams behind him in the aftermath of Barack Obama’s brilliant victory. Though Romney has no political heirs in his own party or elsewhere, he does leave behind a cultural legacy of sorts. He raised Truthiness to a level of chutzpah beyond Stephen Colbert’s fertile imagination, and on the grandest scale. That a presidential hopeful so cavalierly mendacious could get so close to the White House, winning some 48 percent of the popular vote, is no small accomplishment. The American weakness that Romney both apotheosized and exploited in achieving this feat—our post-fact syndrome where anyone on the public stage can make up anything and usually get away with it—won’t disappear with him. A slicker liar could have won, and still might......

Click on link below to continue

http://nymag.com/news/frank-rich/gop-denial-2012-11/

The Interpreter and the Puerto Rican Syndrome

By:  Christopher Christian, PhD

Please visit:  Critica Latinoamericana