Thursday, December 31, 2015

A Call to Art at a Time of Arms

On December 28, 2015 we welcomed this guest post from Bandy X. Lee MD, MDiv
Assistant Clinical Professor, Law and Psychiatry Division, Yale University

A Call to Art at a Time of Arms

 “They have guns but we have flowers,” says a father to his frightened son.  “Flowers are nothing,” retorts the child.  “See, everyone posing flowers protects us from guns,” tells the father, which instantly reassures the son: “I feel better,” he concludes.  This message from Le Petit Journal has been retweeted across the world following the Paris terrorist attacks, and there is a reason why it moves us.  It echoes a poster message once displayed in the Chartres Cathedral: “Violence destroys, but only love creates life.”  It is a fitting response of a nation that has been the creative crucible for much of Western civilization.  Yet, however poignant its message, it is still a minority voice as the world proceeds with further policing, military planning, and viewing more violence as the only viable solution to the violence.  If we took a step back to analyze the true causes of violence—which are no longer a mystery—then we would be able to come up with more creative solutions that are capable of bringing about true change.  The growing international nature of this struggle makes it all the more critical that we respond intelligently, and we now have a good deal of knowledge to be able to do so.

Since the mid-1990’s, we have observed the evolution of an interesting field.  Since a 2002 World Health Organization publication by the name of The World Report on Violence and Health,[1] violence has been established as a worldwide public health problem rather than just a security and criminal justice issue.  This means that it has become a topic for research inquiry and not merely an object of reaction after the fact.  Since then, and perhaps for the first time in history, we have come to recognize that violence is not inevitable but preventable, and not random but predictable.

This is of interest to creativity scholars because the ultimate prevention of violence lies in creativity.  Although some have recently advocated looking at violence as in decline and thus less and less of a problem, it is more pertinent than ever to take measures to prevent violence rather than merely respond to it, for we now have the capacity.  In fact, one of the preconditions for preventing violence seems to be recognizing what violence is and acknowledging that it is a problem.  Thanks to the research of many disciplines and the burgeoning courses and degree programs around the world, knowledge about the nature, causes, and consequences of violence has been growing rapidly.  Furthermore, we have grown in awareness about what are the conditions that promote peace, how to channel energies toward productivity and creativity rather than violence, and how to implement peace-promoting just governance, as outlined in the recent United Nations’ 2030 Agenda for Sustainable Development.[2]  This is where cultivation in the arts can play a role, especially in the education of future leaders, for we have come to a place in history where what is lacking is not the resources to resolve the major problems of our day, which are mostly human-made.  Rather, it is resourcefulness, and scientific and intellectual knowledge has its limits in investigating the question of social justice, equitable living, and ultimately preservation of life on this planet.

In considering violence, there is an important technical point to be made: while behavioral violence (suicides, homicides, and collective violence) is responsible for 1.5 million deaths per year worldwide, structural violence (socioeconomic inequality, discrimination, and injustice) is responsible for 18 million deaths per year worldwide—more than tenfold of behavioral violence.  If in our considerations we left out structural violence, aptly termed for the real life-and-death difference it makes, not to mention being the more large-scale, enduring, and pernicious type of violence, we would be leaving out the big fish in our quest to reduce violence.

**Inequality and injustice not only result in more diseases, disabilities, and excess deaths for the disadvantaged, it is also the most potent cause of behavioral violence, giving rise to early and excess deaths even for those who are supposedly advantaged.  Are we surprised, then, that terrorism is springing up around the world at a time when structural violence—the gap between the rich and the poor within nations, as well as the gap between rich nations and poor nations—is increasing?  We can try to go after every terrorist attempt (which we cannot) and morph our approaches to match the tactics of new and insurgent groups, but unless we address the underlying pathology, we will never advance in reducing overall violence.

Central to conceptualizing violence is that it is an ecological problem, one that has roots not only in the individuals involved but in the family, community, and society in which they take part.  Even biological predispositions require the “right” social environment, which will determine which genes are expressed, and which brain circuits activated, to bring about the end event we call violence (“born criminals” seem to elude us, no matter how hard the best and the brightest have looked for them).  And even the most individual forms of violence, such as suicide, can be traced largely to social causes, as the wave of unemployment in the late 2000’s has shown.  Large-scale epidemics of violence, furthermore, can only be predicted at the societal level.  Violence rates thus become a barometer of the collective emotional health of a society, and we know well from the ebb and flow of civilization that high points of peace and creativity have been associated with a wealth of productivity in the arts.

It is time to think more creatively about the way we organize our world, and the paradigms that we bring.  Will we continue to resort to violence of our own, knowing that the growing threats of terrorist organizations have a direct link to our wars in their regions, as many researchers are discovering?  Or will we look at our collective violence, as a society, and rightly declare it a problem?  If so, we might search for more creative solutions than the vicious circle of reacting to violence with more violence of our own.  If so, we might consider collecting flowers and what they symbolize, for a change, so that we might at least stop increasing the symbolic power of violence.  If we were truly ready for the flowering of a new civilization, we would then develop our capacity for the art of judgment, prudence, empathy, and ethics, which consist of the true substance of power, as the legacy of Athens over Sparta demonstrates.  Violence prevention is possible, and there is reason for hope: the World Health Organization has encouraged governments and sometimes entire countries, for example, to implement violence prevention programs with measurable success—sometimes exceeding expectations both in terms of time taken and extent of the results.[3]  Large-scale prevention programs at the societal level, at the very least, can be expected to yield results, whereas chasing after each terrorist is labor-intensive and costly but may or may not be effective if a key individual or two are missed (or, as we have learned, replaced).

Shortly after the two World Wars, Hannah Arendt observed that power and violence are opposites.[4]  If we are to have a truly powerful response against terrorism, it would do well for the ruling world to regain its moral authority and ethical bearing, which through a general climate of social justice and good governance would naturally root it out.  Symbolic animals as human beings are, nothing motivates more powerfully than an inspiring vision, and that vision can be one of peace, justice, harmony, and collective emotional health, rather than its poor substitute.  There are reasons why the “War on Terror” we have waged in Afghanistan, Iraq, Syria, and other nations, at great cost, has served only to embolden terrorist groups and bolster their recruits.  Psychologically and symbolically speaking, it supports the mindset of viewing violence as a legitimate means of resolving problems, in a demonstration that “might makes right.”  Compared to that, the flowers of human civilization—with its accumulated knowledge and creativity—far from irrelevant, seems in all likelihood to be a more practical weapon as well.  At least a growing legion of violence scholars (and creativity scholars) will say so.

[1] Krug, E. G., Dahlberg, L. L., Mercy, J. A., Zwi, A. B., & Lozano, R. (2002).  World Report on Violence and Health.  Geneva, Switzerland: World Health Organization.
[2] United Nations (2015).  Transforming Our World: The 2030 Agenda for Sustainable Development.  New York, NY: United Nations.
[3] World Health Organization, United Nations Office on Drugs and Crime, & United Nations Development Program (2014).  Global Status Report on Violence Prevention 2014.  Geneva, Switzerland: World Health Organization.
[4] Arendt, H. (1970).  On Violence.  New York, NY: Harcourt, Brace, Jovanovich, 1970.

Monday, December 28, 2015

Psychiatry and my mother's story, A story of depression and the psychiatric nurse

Excerpt a personal story from keynote, "Living Stories of Hope and change:  The Challenge to Change" Cheryl L. McLean, Alberta Psychiatric Association 2014 Scientific Conference

Many psychiatrists (the healers of the soul)  enter psychiatry as a profession  because they are interested in helping those who suffer and are in need of healing, opening the door to human understanding.  You want to know why people behave the way they do, you want to use your considerable education and skills to help people be well, you want to restore balance and quality of life to those you care for.  Among you today will be those who  commonly deal with issues around depression, anxiety, paranoia, and /sex abuse...

 Many psychiatrists  have themselves seen what it is to live on the other side of the door, they may know, through lived experience, through their fathers, their mothers, their aunts and uncles what abuse and alcoholism is, some have suffered devastating personal losses of those closest to them, many have grown up with family members who have lived with depression and other mental illnesses.   

Research shows that doctors, in general, are at greater risk for depression, mood disorders and suicide and psychiatrists, according to The American Psychiatric Association, commit suicide at rates at about twice that of other physicians.  Dr. Michael Myers, Professor of Clinical Psychiatry and a leader in physician health and wellbeing  also stresses deeply depressed physicians still feel the effects of the stigma of mental illness. 

I have some personal experience with this through my mother now 87, who had been the head nurse at a geriatric ward at our city psychiatric hospital (previous know as an asylum for the insane)  in Southwestern Ontario for over thirty years.  She started her career in geriatric care  as a nurse in 1952  and worked her way through the 50's, the  60's and 70's, through the days of  electroconvulsive therapies , lobotomy surgeries, insulin shock therapy,  strait jackets, restraints.  One of my mother's many assignments was to  dispense medications like tranquilizers and phenobarbital to 450 older patients twice daily on five wards.  Many of her geriatric patients lived out their later lives and died in hospital.  My mother was proud of her nursing job.  When I was a girl of  fourteen and thinking about nursing as a career myself she drove me to her hospital, turned off the main street, past the grassy fields  and up the long, shaded tree lined road and down the curved driveway leading to that big old building.  I met her patients.   They told me their stories.  Some were very interesting.   One nice lady said she was friends with a "gangster" named "Duninger"  who, she said,  went everywhere with her. 

Mom made sure she kept the staff and the ward together.  But there were serious troubles at home.  Mom worked late most nights and always took her work home with her, sitting at the kitchen table, draining the coffee pot, coughing and chain smoking Export A's while trying to get her time slips done, couldn't sleep at night, was  worried about how to cover for staff  when attendants said they were sick or took time off.  Then one day  she just stopped talking, wouldn't eat, went to her bedroom, turned off the lights and shut the door.  But somehow even through these  darkest of times she managed to get up in the morning at 5:00 a.m., get the car started in the dead of winter and  made it in ,on time,  to work. My mother, an attractive woman,  always concerned about her appearance, her hair, her makeup, was  meticulously, even obsessively neat.  We knew there was something terribly wrong when she started falling asleep at night in her uniform...  One sleepless night while fighting yet another migraine headache she cried out, "What's the use?"   Yes, she had her nursing friends,  but most of the time she tried to make it through these dark times alone.  Mom would never have admitted she had a mental health issue nor that was depressed.  You just didn't talk about those things.  She was a psychiatric nurse, and proud of it., she cared for patients with mental illness, consoled the families when their loved ones passed away, her staff came to her when they were depressed,  to solve their problems.  She was praised by the psychiatrists  for her meticulous attention to detail and  tireless  dedication to her job and her patients.   My mother wasn't just a nurse.  Nursing was my mother.  As I reflect now years later  I see that  my mother suffered with depression, the  classic DSM  indicators of major depressive disorder but she wasn't sick...she was fine.  It was her job to keep everything under control.   

Thursday, December 24, 2015

Commercials Assault the Senses in Battle to See Star Wars

Editor's Commentary
December 23, 2015

May the force get lost. My husband, son and I found ourselves fighting a battle with the load of endless commercials we were subjected to before the movie "Star Wars" at a local movie theatre. My guess would be about thirty of them plus oppressive assault on the senses for a captive audience forced to sit through mind numbing booming, flashing ads, so visually explosive and painfully loud that when I looked around I saw people with their heads down and fingers... plugging their ears....waiting....hoping....wishing...for Star Wars to begin. Nobody would argue with the realities of commercialism and a reasonable five or six commercials and trailer or two before the show begins. But I would go so far as to say that such blatant force fed sensory abuse of a paying audience is undemocratic...even hurtful when we must fight the attack or try to block it out to survive in some kind of shape to attend to, watch and listen to the feature. If theatres are losing money maybe they should consider the sensory onslaught on paying customers who have made the decision to give up the comfort of their at home armchairs and relatively non-commercially invasive Netflix movies to pay good money to enter their movie theatre. People are not stupid...they deserve more, or should I say less. And this was not a generational thing...yes I was one of the people plugging my ears and closing my eyes to fight the deadly blasting commercials but I looked beside me and my young son was doing the same thing. He said to me, "Mom that's the way it always is these days, it's really bad, it gets to can't hide from it." And after the show he commented, " I want to see the movie "The Revenant" at the end of the month, but after this...I've decided I'll watch it but it sure won't be at the theatre." The big theatres need to know we gave them our money and our attention, but there are alternatives. In the "artistic" realm of the movie theatre may the force of change be with us.

C.L. McLean