Pathways

Source: Pathways

Source: Pathways

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Pathways

Source: Pathways

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What an twelve year old Palestinian girl might be thinking?

There’s a monster over there.   There is.   Everybody knows about it and they told us also.   But it wasn’t like they said.   Oh, it is a powerful beast that attacks with sudden deadly force.   It attacks cowards and fools first but eventually gets to the rest of us.   Yet they suddenly turn toward the children and other simple souls and bring us to safety.   But this was not a topic of discussion among our tribesmen.    Things were so confusing anyway.    The paramilitary training with live ammunition was fun but I’m a little afraid of all the guns anyway.   And there’s lots of guns and other things even in our aunt’s bedroom.   I guess I liked the uniforms and masks we used to make parades.     It was wonderful really.     Together with my friends.    I don’t want to hear bombs anymore.    Every time one of our heroes shoots a missile toward the monster I feel sick for a few moments or hours hoping the monster’s missiles find the right target and let us live.   I never told anyone but sometimes I think the monster is not bad.    Our heroes all die and we must get ready to join the endless war against the monster.    I’m not sad. 

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Confusion About Syria

The latest news is spreading shockwaves through Israel.   People have lined up in record numbers to acquire gas masks.    The government is forecasting shortages while the army is happy the public is finally taking it seriously.   My own children are encouraging us to get ours and stock up our bomb shelter with basic necessities.  This is all in response to threats the U.S., British and French are preparing to attack the Syrian stronghold of Bashar Assad’s government center.   

From the public’s view it’s all about a few alleged attacks on rebels and collaterals with the use of toxic chemical warfare.   Some reports say 20 people were killed, and another 300 by chemical attacks.    Do I have this right?

SO after two years of extraordinary violence where upwards of 100,00 people, children, women and combatants have died in sectarian fighting the “enlightened” western trio is indignant over the less than 1% killed by chemicals.   Even the UN is putting it up to a vote.   Up until now the horrible plight of the ‘Palestinians’ has dominated that farcical body’s proclamations over the Israel’s insufficient peace process and tyrannical tactics for more than forty years.  So what has caused this brief shift in world attention?

Presumably its the “chemical” in chemical weapons that has everyone up in arms.   For two plus years rebel combatants and collaterals have been dying from gunfire, bombs, shrapnel, falling debris, mortars, rockets, lacerations, smoke and fire as well as famine and disease..   They’ve died in the street, in their homes, in the cities and in the country in every way civil war kills people.   But nothing has produced the serious proposals and threats we hear coming out of the moralistic trio and those rallying behind them.   

So why has chemically induced killing, a grim and scary reaper for sure become the red line we hear so much about?   Humanitarianism?    A concern for massive annihilation of innocents?   Moral indignation?   Even to bring them up is obviously laughable hypocrisy.    Lets agree it’s not about the value of human life.   If that were the case sabers should have been rattling back at the beginning of the slaughter.    

Weaponized chemical or biologic warfare is the latest red line of intolerance because of what it ostensibly represents.   Killing and risk to human life is the common denominator that can be achieved in so many ways as we know.   One difference with ‘conventional weapons’ (guns, bullets, missiles and bombs, etc.) and chemicals is the human capacity to believe there is some sort of defense against hard, fast moving objects.   Surprise chemical weapon attacks are silent and invisible.    Weaponized germs seem almost supernatural and yet are no more deadly to the individual than any other well aimed lethal force.    Individual death or injury are not about statistics, death rates, or relative risk.   Ultimately the method of lethal force matters little to the one “in the wrong place at the wrong time.”

The horror and mystique of chemical warfare is an arbitrary result of a society steeped in statistics and scientific objectivity.   Unless the risk factor is extraordinarily high, the victims are represented as statistical points on a graph rather than flesh and blood individuals. In the mathematical abstraction of statistical man
we can tolerate the loss of 80,000 entities. Something about chemical, poison gas that shifts the attitude and almost becomes intolerable and a “legitimate” reason for war.

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The Art Metaphor of School Shootings

 The Art Metaphor of School Shootings

I spend my days evaluating and treating people with mental health problems.   As disturbing as the horrible slaughter of innocents is I like the metaphor of (murder) art because it takes the issue to a whole new level of accuracy without the simplification.
Just as one somehow finds himself in the role of an artist, often by exclusion of many other roles that don’t fit,  it is completely fruitless to seek the common denominator of artists.   It is the differences that give them notoriety, fame or popularity.    Then there are the issues of execution,  elegance and the power of expression.    This follows the earlier stages of development and formation of the artist, his media and style.
Of course there is a risk of sounding callous or unsympathetic to the victims when the brutality is elevated to something as sublime as art that is usually considered “harmless.”  In reality art can appear so but actually has great power to influence and form values.   This is another aspect, the influence on the “state of the art,”  our appreciation of their craft and the horizons it may open for us (in this case the opening of evil).
Contrary to the struggling artists trying to make their mark, our murder artists get instant recognition, and “fame.”   Yet our sqeamish sensitivity to evil and its reality makes it nearly impossible to speak of these things on their own terms.    We do hear in passing the evil Austrian flunked out of art school leaving him to seek recognition in other ways.
There are many other models of violent crime being tossed around, like viral loads, and the epidemiology seems to show some promise in deepening our understanding but loathe as I am to say it,   the gun seems more powerful and immediate than the brush.     There is also much less certainty of success and more competition in the creative arts.
Murder is, thanks to the widening influence of the media,  such a big seller even if the final act rapidly dwarfs once the smoke clears leaving  the survivors to grapple with their misery.    Yet the secret society of alienated and impressionable souls are waiting for the inspiration, and preparation to make their way to upstage the ones who thought they finally got it right.

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The Psychiatric Crisis

FreePsychArticles #4:   Pinchas: The Ultimate in Crisis Intervention

In the story of Pinchas, in the Biblical book of Numbers (Bamidbar), that traverses two parshiot, we see a snapshot of crisis intervention and resolution.   To review, we are witness to the malevolent scheming of Balak, the Moabite king to bring about a ‘pre-emptive metaphysical strike’ on B’nai Yisrael as they camp in the desert.    He attempts to enlist the master sorcerer Balaam to utilize his world class ‘magical powers’ and divination to invoke curses on the Jewish nation.   With this, he attempts to

drive it away from the land,” and ‘diminish their number…’ per Rashi.

Meanwhile B’nai Yisrael goes on with it’s activities and approach to the promised land, assumedly unaware or unconcerned about their neighbor’s  (enemies in this case) business.  Here we find the brewing of a significant crisis in the spiritual wellbeing of the burgeoning nation.    In truth, it is the failure of Balak’s scheme that presents another unexpected attack on Israel.    Balaam, riding the prophetic heights finds himself unable to utter narry a curse.

This leaves the intrepid Balak to devise a new approach to undo the feared and powerful “priests of the nations.”

In come the daughters of Moab, to use their “powers” of persuasion to coax the young Jewish men to forget The True G-d, diminish their enumah by submission to the charms of female beauty through the act of bowing to the avodah zorah of small gods.   This proves to be more effective than Balaam, if not more labor intensive.

The wrath of G-d is invoked and as the crisis rages, plague begins to wipe out the Holy nation.   Moshe called out for a solution.   Weeping spread through the camp yet all were frozen in shock and disbelief.   Out of the chaos emerges one clear and decisive act though the deft and righteous figure of Pinchas, son of Elazar son of Aharon who “saw” through the crisis, and ‘remembered the law.’  In this one act of true devotion and courage, Pinchas brings about the cessation of the plague thus ending the first parsha of the two part story.

Part two: Our hero is rewarded as we are taught the gravity and ultimate honor he deserves.

Moshe receives order to make take a census, as the first order of business in reorganization following the passing crisis.   Much of the rest of the parsha delineates the korbanos of all the Yom Tovim (Festival Days) as a further rebuilding of the national spiritual life.

The Psycho-Spiritual Crisis model:

In my work as an interim psychiatrist I encounter people who bring their experience to expression during our meetings.    Frequently they are distraught, upset, emotionally labile and even desperate.    Often, suddenly, as they find themselves in company of someone with a trained and empathic ear they frame the moment in extreme and tragic terms.   All the calamity of their day-to-day life can take on an epic quality as their difficulties bubble to the surface of their consciousness.    The present problems merge with emotionally charged fragments of memory bringing the overwhelming impression they are trapped in an insurmountable and tragic sea with no hope, peace or survival.

Just as frequently an objective eye can see there is more crisis than tragedy and therefore more action and intervention than bereavement and grief required.   As often happens, we find ourselves feeling overwhelmed and our emunah starts to wane.   The crisis compounds as we forget our purpose and experience the pain our own or others actions have brought.

Each of us can “fall” into this downward spiral during our lives, sometimes when least expected.    We can be riding the crest of the wave, while oblivious to an undercurrent of trouble in the making.    Suddenly the wave crashes on the shore, the surfboard shatters and we’re left wondering how it came about?    What did I do wrong?   Why didn’t I see it coming?   Is it because of prior lapses in judgment?    Is it my fault or someone elses?

With the human mind’s inclination to contain and encase experience, we have a natural tendency to view our current dilemma as the conclusion of the story.   This is the tragedy of our imagination.   True enough, there are tragedies, losses, and damages without the chance of reversal.   These events demand another topic and approach.   The issue here rests in the fallen enumah and the discomfort it engenders.   This is the psycho-spiritual crisis.

One of the results of this type of crisis is viewing it as a tragedy and viewing ourselves as powerless victims in it’s stead.    Hence we freeze up, stand by, fill with remorse and cry.

Often this fuels our imagination to further complicate (read fragment) our emunah in ourselves and Hashem, Ha Kodesh Barchu.

In our story, even Moshe Rabenu stood by.  As Rashi states, the law…was concealed from Moshe.   Pinchas, who’s been observing the unfolding events, gathering the information while maintaining his emunah, remembering his ancestral lineage and natural dedication to B’nai Yisrael unites with Divine Inspiration to fulfill the Holy dictates of G-d’s Law at the perfect moment, thus quelling the harsh decree.

Thus Pinchas personifies the man of faith who navigates the course of events through the psycho-spiritual crisis to arrive at this ultimate “crisis resolution.”    As each of us sees or experiences times of trouble in our own lives we should remember “from whom we come” and be able to see our way though thought, speech and action as needed to reach higher levels of emunah.    We can do this by realizing our current difficulties, rather than tragedies, are indeed crises and relish the emes (dynamic truth) they contain as pathways to greater levels of achievement.

Finally,  we see the division in the Torah story between two parshiot as the two stages of crisis and resolution.   In Pashas Pinchas, we see the rewards of maintaining enumah and action in spite of the calamitous events, to elevate us to greater and greater spiritual heights.

Gershon Freedman, M.D

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Dealing WIth Trauma

FreePsychArticles#24    NEW PERSPECTIVES OF TRAUMA

I use the word “New” because these observations are new to me, and may have been discussed by others already. My handle on PTSD and other trauma-related disorders has recently come in contact with a broader view. Treatment of these disorders has always been limited by my own conventional clinical view. I think I always knew current psychiatric biological approaches were limited.

Treating symptoms of PTSD or character disorders with medications certainly has merit to reduce many of them. The treatment is generally chronic and requires other disciplines often not available in public psychiatry clinics.

Some very frank conversations with a 50 year old woman patient with a diagnosis of Bipolar Disorder II and PTSD were eye opening to me. The treatment with Lithium helped to reduce her mood swings and both hypomania and depression,  but flashbacks of severe childhood molestation by her father increased. She wasn’t histrionic and complied well with treatment but was left with the question I had no answer real answer: “What do I do about the memories?”

At that stage of treatment I finished my temporary assignment at the clinic.   The patient’s psychiatric disorder had responded well to the medications but, unfortunately failed to ameliorate some very distressing subjective symptoms.

I have been talking with Rabbi Immanuel Legomsky of Tzfat,  Israel about Emotional Freedom Techniques (EFT) and other “alternative therapies” for PTSD. He showed a film called “Operation Freedom” that showed a group of clinicians trained in EFT working with several Viet Nam veterans suffering from an array of classic symptoms for 20-25 years over a five day workshop. The results were remarkable and it presented a compelling view of a very different approach to treatment.

Within the treatment is a kind of training in which each patient can “treat themselves” and maintain a level of wellbeing for decades.  Effects of chronic traumatic stress, endemic to populations exposed to chronic terrorist attacks or threats of the same are often undiagnosed due to many factors. The reasons why some people are clinically effected and show blatant traumatic stress disorders while others appear unscathed are obviously complex. Armed with more adequate psychological defense mechanisms, many “normal” subjects show subclinical effects.

Due to economic, political and personal dynamics it is assumed all but the most effected victims fall outside the range of clinical relevance. The diagnostic limitations tend to miss many suffering from levels of stress reaction that directly effect their relationships, daily behavior and social interactions. An example is an 87 year old Army veteran who suffered hyper vigilance, vivid nightmares, moodiness and irritability for over 50 years until his family insisted he come for an evaluation for PTSD stemming from his experiences at Pearl Harbor in 1941!

In the development of EFT based treatment for Traumatic Stress Disorders there is much to be said for conceptualization as an educational tool. With the de-medicalization of PTSD, addictions, and Attention Disorders among others new delivery models must be developed due to the increasing demand and diagnosis of such conditions. Another facetrelevant to delivery systems and denial is the stigma of these conditions as”mental illnesses.” When, in the case of EFT, the “treatment is training” in that it benefits both the teacher and the student. There is a considerable reduction in the obstacles of embarrassment and associations with disease.

The medical management model aspect is not replaced. Since many of the above disorders or “variations from the bell’s curve” frequently have significant findings of depression, psychosis, mania or hypomania and other conditions that can require psychotropic medications. Chronic distressing or debilitating mental states especially respond well to medications. Issues of metabolism, internal organs integrity and function, electrocardiograms, laboratory studies and appropriate medical examinations continue to serve as prudent routine aspects of holistic health maintenance. In fact it is prudent to have patients under consideration to receive EFT be seen first by a psychiatrist to screen for underlying disorders if possible. Improved diagnostic ability of trainers can reduce the need of initial psychiatric evaluations.

At this point the road map to relief from chronic stress and addictions is to convert psychophysiologic syndromes into conscious learning and training exercises. This is the shift from the medical model to sphere of education. It’s important to keep in mind it is not an all or nothing framework, rather it is a paradigm shift. Conditions amenable to EFT are, without a doubt the largest and most under-diagnosed sub-group in society. PTSD, Chronic Traumatic Stress Disorder, and addictions are all under-reported due to the medical diagnostic criteria. The broad view reveals certain populations, geographical, ethnic or politically compromised groups are effected in ways considered normal or acceptable and yet undermine relationships, interaction in and out of the home, temperance and fulfilling social and professional life.

EFT training is a parallel model to learning and living a Torah life. The serious study of Jewish Scriptures that includes actual changes in temperament and behavior has a social consciousness as well. Although Torah covers all aspects of living well in specific detail on all levels of the individual,  family and nation the particular “unblocking effects” within the traumatized person with EFT helps to establish a holistic comfort enabling one to take full advantage of his life and potential. Education ,in both, is the principle learning (therapeutic) tool. Torah learning is done in groups, with a 1:1 learning partner or alone which is paralleled in EFT by group exercises, mentor-student work and self-practice as the need arises.

In summary, there is a vast and growing field of practices that address a nitch in personal growth. This field falls between debilitating medical and psychiatric disorders and optimal health. The biomedical model’s risk/benefit ratio begins to tip to render it’s use risky or possibly harmful in this theoretical “field” of subclinical mental states. Those who occupy this field suffer quietly seeking treatment after treatment that fails to help. Due to the dominant western cultural hold on the general population the biomedical model tends to be placed at the pinnacle of disease treatment casting a shadow of doubt about the efficacy of so-called alternative therapies. EFT and other non-invasive modalities either belong to this shadowy field or can be viewed in another light, that of life education.

Gershon Freedman, M.D.

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