The “patchwork”

Note: this was originally a letter to the editor at The Globe & Mail, which in turn was published April 26th. It was in response to two articles posted in the G&M, the first a featured essay by Norman Doidge MD, a psychiatrist and psychoanalyst, and the second an op-ed by Ari Zaretsky, chief of the department of psychiatry at Sunnybrook Health Sciences Centre. Each of these were responding to cuts by the province of Ontario to the provision of psychotherapy. I have expanded upon my original letter, which was edited for publication.

Every few months I’m asked by someone seeking information on the process of finding a psychotherapist to describe what the landscape and rules are. The word “patchwork” is the first to come up in my attempt at an answer, what with it being a maze of publicly funded dead ends and privately available add-ons. But to call the mental health system in Canada a “patchwork” is to insult quilt-making. One only needs to scan the pieces by Norman Doidge and most recently Ari Zaretsky to discover how confusing this might be for the average person seeking support.

If this average person exists let’s attempt to make sense of the road ahead from their angle: a day devoted to research will show there are psychiatrists and psychologists, who, as it turns out, may or may not have extensive training in psychotherapy. Then you have psychotherapists, whose profession may or may not be regulated depending upon the province you live in. Assuming our average person isn’t privately wealthy we must then ask: which profession — psychiatrist, psychologist, psychotherapist, social worker — is covered by what public or private health plan, and for whom is this available? Imagine being in the midst of a panic attack then trying to find support when you most need it only to discover that, to use Ontario as an example, despite being the only profession covered by OHIP, more and more psychiatrists are less and less interested in delivering psychotherapy versus managing prescriptions where, coincidentally, they can see more clients in a day and make a larger income. Meanwhile social workers enjoy vastly more private health benefits coverage than do psychotherapists.

Both Doidge’s and Zaretsky’s pieces are coming from a perspective that seems to make things more about the therapist, justifying their modal belief system or cost benefit analysis over the basic needs of those who are not privately insured. They rightly hail the benefits and importance of psychotherapy, but in their own ways go on to mount a self-interested defence of their turf: psychodynamic vs cognitive delivery methods. This battle over which therapeutic approach is more quantitatively or qualitatively effective than the other reeks of the privilege of those who have probably never been in long-term individual therapy themself.

The cart before the horse is that there is too little public access to trained professionals — particularly those who don’t have the MD designation of psychiatrists or the PhD of a clinical psychologist, but nonetheless have specialized training in psychotherapy — while we are in the midst of a steadily growing demand, with grave consequences for some who aren’t able gain access to professional assistance. Let individuals decide on the right approach for them. To qualify for the College of Registered Therapists of Ontario (CRPO) I cannot practice psychotherapy in this province without qualifying for membership, which means being a graduate of (or currently in training with) one of the approved training institutes registered with the college. Given this thorough certification process why should we then disregard the diverse modalities the CRPO explicitly acknowledges and pretend that this can be boiled down to a binary choice between a conservative interpretation of psychoanalysis or the limitations of CBT? In my experience as both a therapist and someone who has been in long-term personal therapy as part of my training program’s ethos — an ethos I feel should be obligatory for anyone training to be a psychotherapist — therapy works best when the “fit” is good, not about which style is supposedly better than the other.

The most important point — and one lost in both Doidge’s or Zaretsky’s articles — is the primacy of allowing Canadians the ability to gain access to psychotherapy in the first place.

[I would also recommend reading Heather Weir’s contribution to the G&M letters to the editor]

 

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Pain

I have this weird, recurring thing. It starts with a dull soreness in my left glute, kinda like someone kicked it the day before and it feels bruised. Then, in a day or so, an odd stiffness and soreness stretching from the glute all the way down the back of my left leg, going down to my ankle. Within a day or so it reaches the zenith of its pathology: pain.

Two weeks ago yesterday I tried getting out of bed. I swung my legs over to the side of the mattress, and between that everyday action and my feet touching the floor I became a crumbled mess, bent over in agony. I was in so much pain I was crying. I was unable to stand. I was unable to sit. I was unable to do anything without experiencing the sort of intense, unrelenting pain that makes you realize in seconds why anyone would unhesitatingly reach for opiates.

What I have goes by two names: pseudo sciatica, or piriformis syndrome. The sciatic nerve travels from the spine and down the leg where it provides sensation to the skin of the foot and the lower leg. Unlike classic sciatica which involves irritation of the nerve from the spine via a disc, what I got is caused by the irritation via the piriformis muscle — something you’ve likely never hear of, but it’s a band of muscle in the core of your glutes. If the piriformis is aggravated it can bother the sciatic nerve in a similar way to classic sciatica. [Update: please see the follow-up post]

I’ve described the pain to people as like having your hamstring replaced with razor wire. It’s actually worse, because of how the pain “glows” all through the leg. At its worst, the pain cuts through your thoughts, your feelings. It takes priority over everything. It doesn’t care if you are happy or if you had plans to go somewhere that day. I’m always humbled by how quickly physical pain cuts through everything, taking priority, and how it terrorizes me with its power. I end up impatient with others, downright angry 24/7. I catastrophize: this is never going to end, I’m going to be like this forever.

I can afford physiotherapy, which makes me lucky. I don’t have health benefits because I’m self-employed, so anything not covered by provincial health care comes out of my wallet. I immediately checked myself into a physio clinic and I remember being furious: this again. This being physio. Physiotherapy (and related physical therapies) is something I have a good deal of experience with and I never hesitate to recommend it to people; the irony is that when I find myself being forced to return to physio it feels as if I’ve failed at something. Something tells me I’ve been irresponsible, which is silly.

Piriformis syndrome can happen to people who sit a lot. While I’m one of the most physically active people I know (I walk to work every day, I go to the gym, I run, I practice baguazhang) my job as a psychotherapist means I’m sitting for an hour at a time. Piriformis syndrome also prefers distance runners, which makes me a prime candidate.

For the last two weeks I’ve been doing physio exercises three times a day, combined with visits to a clinic, combined with acupuncture and Chinese medicine. Progress was very, very slow. The last time I had this it lasted all of a week or so, and I was able to work it out on my own with stretching and massage. This time it’s been remarkably more painful and long-lasting.

Yesterday, on the two week anniversary of not being able to stand out of bed, it felt like something had subtly changed. My mobility felt more easy, I didn’t have the feeling like I couldn’t extend my lower leg when I was walking on the sidewalk doing errands. I stayed outside, pushing myself a little, forcing myself to stay active. Today, for the first time in many weeks (partly because of the terrible weather we’ve had) I was able to practice ba gua outside on our terrace. I nearly cried.

My relationship with physical exercise is a personal one. It allows me to connect with my body. It is embodied movement, whether it’s running a 10K circuit or doing ape offers fruit. I’ve gone two weeks without any chance of significant exercise, and so the things that gave me internal relief — running, baguazhang, gym — were off-limits, which in turn made me miserable, feeling imprisoned.

I suppose I’m sharing this because it’s important to take a moment to reflect on the relationship between body and mental health. How it directly affects my spirit. The pain is slowly receding, I have my mobility, and I know that soon I’m going to be able to run outside and feel better. But my experience pales beside anyone with chronic pain, and I am humbled when I consider anyone who has to go through life under such conditions, be they due to injury or living conditions. Not to mention the fact that, when this has passed, I will have spent hundreds of dollars on physical therapies that many cannot access.

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The Brain & Science – The Problem With Wanting It All

As a psychotherapist, I have taken an interest in the rise of neurobiological research being applied to my field. At first, particularly upon hearing about “interpersonal neurobiology” (or IPNB), I was excited — I was seeing the intrapsychic and biological converge into what appeared to be a fascinating model of understanding human behaviour. But here’s the thing: while I have a deep reverence for the subjective life of the individual, I’m also interested in looking at things empirically, where applicable. Without this latter aspect, I feel we fall prey to magical thinking.

The more I looked into some of the new ideas permeating my field, I became aware of a few things. While certain concepts, such as the idea of neuroplasticity, were taken from science, the more I looked at who was writing about this, the more I noticed that the people applying these complicated concepts to psychotherapy weren’t neurologists or geneticists. One of the oft-referenced authors in the field of IPNB is Allan N. Schore, who is a psychologist and researcher. His books are popular with those looking to harmonize neurology and psychotherapy. And while I respect his multidisciplinary work, I have difficulty with binary conceptions of how the left and right brains work (whereas, supposedly, the right brain is responsible for emotional attunement, the left brain for insight and analysis). Why do I have difficulty with this? Because many neuroscientists would contend that this is too simplistic a way to look at the brain.

This is a blog post and not a long-form essay. I could go on. I suppose what irks me is the amount of material being written about a myriad of complex neurobiological research findings that skip over the necessary cautions that are the hallmarks of science. Correlation is not causation. How big was the sample size? Continue reading “The Brain & Science – The Problem With Wanting It All”

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Book Review: Conflict Is Not Abuse, by Sarah Schulman

I’ve noticed more and more over the last decade that less and less people want to use the phone. I cannot help but draw a correlation between this observation and the ubiquitous rise of digital communication. Email? Sure. Text? Yup. And what’s wrong with this, you might ask? On paper it would objectively appear that text-based communication (particularly including social media) is superior at transferring information without error, if only us pesky humans didn’t make mistakes. And this last part is key: we are not objective, we balance the objective world with our much less easily measurable experiential (or personal) reality; this second reality is informed by our experiences, which are diverse and sometimes punctuated by trauma or loss. When we talk to someone on the phone we are leaving ourselves prone — to fallibility (stammering, going off on a tangent), or having our hesitations read as something we may not otherwise wish to reveal.

I was thinking about these things (and many others) when I began reading Sarah Schulman’s powerful book, Conflict Is Not Abuse: Overstating Harm, Community Responsibility, and the Duty of Repair. The problem with nearly all forms of digital communication and social media (with the exception of apps like Skype, etc) is that there is no actual dialogue — we aren’t allowed to have the sort of vulnerable conversations that speaking in-person or on the phone forces us into. And, in one of the book’s more important diagnoses, Schulman recognizes this as a key ingredient in the escalation of violence. Instead we are only allowed to trade unidirectional statements, leaving nuance and human connection by the wayside. So, when we have a disagreement with someone via text it becomes easy to pile on them, to vilify them. We can’t see them and there is no way for them to interject. On a social media platform like Twitter, this sort of conflict easily escalates into directing the wrath of groups upon an individual. Continue reading “Book Review: Conflict Is Not Abuse, by Sarah Schulman”

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Essay in Humber Literary Review #6

I’m happy to say that the latest issue of Humber Literary Review (#6) is out, and I have an essay included. This is their first themed issue, and it’s about mental health. Because I’m a psychotherapist who is deeply reflective about the way in which we choose to see the world, I saw this as a golden opportunity to submit a pertinent perspective; my essay, On Madness Within Imagination, confronts a cultural blindspot – the depiction of madness in fiction.

 

 

 

 

 

 

 

 

 

 

It is available at the following Toronto bookstores:

Another Story (on Roncesvalles)
Book City on the Danforth
Book City on Queen
Book City on St Clair
Book City in the Village
Presse Internationale on Bloor
Presse Internationale in the Beaches
Type Books (on Queen)

It is available elsewhere, of course, but I have no clue where. You can also purchase a subscription from HLR.

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Keep Moving / Being Wrong / Keep Moving

Sometimes I feel that I stand in-between too many things. Un-firm. Undecided. This is in part due to my fond appreciation for not only a lot of disparate topics but also disparate approaches. I believe in the vigour of an approach which involves good research. I also believe that we can lace “good research” with wishful thinking so that the evidence it produces is wishful thinking presented as fact. I believe that there are charlatans who willingly or naively provide a distraction that slows us down. I also believe that we dismiss many things as charlatanism not because they pose a danger but because they conflict with the politics of our personal or professional lives. I believe in intuition. I also believe intuition alone brings us too close to a raw reflexiveness which doesn’t serve long term needs.

So when someone asks me What do you think about x? I sometimes find myself considering a number of things and contexts to understand the question. The drawback is we’ve created a world where this sort of complexity is undesired. Certainly, in some industries and roles, complexity is unnecessary — a prime example would be assembly line work where the task is to simply crank out carbon copy iterations of something already conceived-of and revised to an acceptable standard. If you want to know what roles robots and AI are going to swallow up in the future, it’s those things. Complexity, on the other hand, keeps us guessing, reminds us that there are no set answers, or if there are they are kludges we developed until the next discovery forces us to revise our notions, our presumptions.

In an essay in this weekend’s New York Times Magazine, Ferris Jabr profiles someone turning to exotic flora in order to stave off our imminent depletion of effective antibiotics. The researcher in question turns to the lore of sometimes ancient civilizations, the extracts and tinctures from nature that one might rightly think come from fantasy, or from a presumably primitive culture. From some pharmaceutical industry perspectives, this is quackery. And yet, in one example, Continue reading “Keep Moving / Being Wrong / Keep Moving”

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The Trouble With The Trouble With Physics

I’m on my second attempt reading Lee Smolin’s 2006 book The Trouble With Physics. I am reminded of a similar situation with another book, Joyce’s Ulysses. And, similarly, my second attempt with The Trouble With Physics is not a reappraisal but a confirmation: this is hard to read.

Smolin’s book is making a case for the fact that string theory is a failure; a spectacular failure that its adherents defend with a most byzantine theoretical web; that, because string theory is de rigueur in so many of the top schools, with so many reputations at stake, no one wants to recognize the fact that string theory — an attempt to harmonize the ideas of quantum theory and relativity so that we might understand the foundation of the universe more clearly — is a dead end.

The problem I’m (still) having with the book is that Smolin is writing to an audience that is willing to take a steep (try 90 degrees upward) climb in order to understand the various concepts and theories which not only formed the foundation of string theory, but the issues that weren’t resolved through the original work of Newton, Einstein, etc. Smolin lays out in the beginning various fundamental aspects of how things work that we simply don’t know — instilling early that scientific inquiry is, if anything, about the need for curiosity. However, given Smolin’s densely described approach to get us ready to understand his arguments, and while I don’t doubt the necessity, I think he would need to double the length of his book to do so effectively for interested readers who are not physicists.

What is more successful, and the reason I continue to read it, is how Continue reading “The Trouble With The Trouble With Physics”

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Too Much Change

So much has happened…

– sold house (add to this: renovated house)

– bought condo (add to this: mourning house, moving)

– moved psychotherapy practice to newly-leased office (add to this: find office space, renovate, move)

– had my application to the College of Registered Psychotherapists of Ontario accepted

– began intense revision process on novel (coming out in September)

So there you have it. I also hope to have a new short story published around the time my novel comes out, so yeah. All hands on deck at the moment.

I leave you with the cover for my novel, The Society of Experience:

 

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Now

Right now, it’s about keeping my energy and clarity in some sort of balance with the demands of reality, whose shifting path I have been navigating for the last while.

I am, by all rights, completing work on the last film I will ever work on. I say this with understandable trepidation since walking away from something you’ve done for 20 years, swinging to a new vine which depends solely on me and me alone: intimidating. Also experiencing the predictable though nevertheless white-knuckle bullshit of completing work on a film.

My psychotherapy practice is humming along nicely, which I am grateful for.

I am awaiting editorial notes on my novel, The Society of Experience, and hoping that they are neither too overwhelming nor the window I am given to do them within too short. Nobody wants to publish a bad book–that’s the good news and the bad news.

I am gratified by the progress I have made as a writer this year, not only in that I had a short story published, but that I feel I have turned a corner with respect to my writing process and the way I approach the development of stories.

I still have bad habits, but that’s what keeps life interesting.

 

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Updates

Hello all. It’s been a while. So, what’s new…

1) My psychotherapy site has had a facelift. If you’re looking for a psychotherapist in Toronto, I’m your man. Unless you’re looking for a woman.

2) I have completed my accreditation with TIRP and am now (slowly) preparing to join the College of Registered Psychotherapists of Ontario (CRPO). I am no longer a “Candidate” – yay!

3) My novel has an official title now. It’s called The Society of Experience. For updates, you can go here for now. It’s to be published in the Fall of 2015. It will be published under the recently-launched imprint Buckrider Books (a subsidiary of Wolsak & Wynn).

I’m extremely excited about the upcoming months. I don’t doubt there will be more things to announce. I will also try to come here more often and actually post something other than point-form updates.

 

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