Unlock Your own Healing Journey: Understand the lessons from your PAST

Reflections give us pause, reminding us where we have been and the lessons that have learned along the journey. They are as important to our health as the air we breathe, the food we eat, and the conditioning our bodies are in.

All of us have experienced traumatic events in our lives and we do not have to be diagnosable for Posttraumatic Stress Disorder to be severely affected by it. Over time we develop radar to detect specific cues that are tied to the traumas that we have endured.  When those cues are experienced, we can react. Reactions are autonomic emotional responses to triggers that are tied to past learning. They develop to keep us safe. For example: let’s say a little boy grows up with an abusive father. He has learned that his father is most abusive after he drinks, trigger #1. His father stays out late at night when he drinks, trigger #2. He comes home reeking of alcohol, trigger #3. He comes in the back door and it always slams, trigger #4. He always yells for someone to get him food, trigger #5. His tone is angry and impatient, trigger #6. When no one responds fast enough, he lunges at the first person that he sees, with his fist balled up and his arm raised, triggers #7, 8 and 9. The boy knows he is in trouble and runs to his bedroom to hide under the bed. Over time not all the cues have to occur to insight the same reaction. A neurobiological response has been created.

Now, each one of these cues become triggering enough on their own to create a reaction and emotional response because of their ties to this particular event in the past. The problem is that a lack of awareness of our own links between REACTIONS and past events makes it inevitable that we are judged by people around us who have no understanding and often no interest in WHY we emotionally trigger. They tell us the nature of our behaviors, and the reasons why we act the way we do. They can find diagnoses to pin on our behaviors and the more they assert our pathologies sitting behind their desks underneath the professional designations that give them the right to take away our connection to the truth of our experience, the more disempowered and submissive we become to their version of our truth.

So the little boy grows up and one night he is feeling antsy. His fiancé is late coming home. He finds himself pacing back and forth, the knot growing inside his gut. His cellphone rings and he picks it up to hear music and voices in the background…

“Babe, are you there,” he hears his fiancé practically scream in the phone, “we had a really good quarter so Doug decided to take us out for a drink to celebrate”.

The now grown man finds himself beginning to shake uncontrollably. “Why didn’t you call earlier” he says trying not to sound frantic.

“I got tied up finishing some last minute details on one of my files. I will be home shortly”, his fiancé said almost absent mindedly.

He could feel bile come up his throat, but before he could say anything, the cell phone cut out.

He went back to pacing and though he was unaware of his own body moving methodically back and forth from one side of the kitchen to the other, he pulled his cell phone out several times as he felt the anxiety rise in his throat, only to stuff it, like his cell phone, back into his pocket. As his hand slid by his pant leg he realized the dampness of his palm, and his own altered breathing pattern. He came into awareness as if he was drifting back to consciousness after dreaming. He forced himself to take a breath but felt no relief. The anger began to rise and his fists curled into balls, the more anger that he felt, the more strain that was unconsciously forced in the tightening of his hand. He vacillated back and forth; pacing, debating whether to call, shifting in and out of awareness and feeling the rising anger within.

He didn’t know how long it had been but he heard the car door slam and his fiancé’s voice, “Yeah, it was great…”

His fists immediately clenched and he gritted his teeth.

“Thanks so much for the ride. I will talk to you Monday.”

He could smell the booze even before she got to the door and his eyes widened.

She was giddy and called out to him… “Hey hun, I am home.” The door slammed behind her.

Already primed from learning that had taken place long before this night, he snarled and turned around the corner, “Where have you been all this time?”

She was startled by the gruffness of his voice and backed a few steps. “I just called you less than 30 minutes ago,” she said with a matching irritation rising in her voice, “Why do you have so much trouble when I go out?”

He looked at her blankly, the words not registering.

Her tone changed and she contorted her face as she spoke, “Honest to God,” she continued, “You need help… Didn’t you make dinner?”

He said nothing…

“What is wrong with you?” she said, the anger rising in her own voice.

His eyes widened as she spoke, feeling unable to move. Her words cascaded over him but lacked meaning. He was briefly aware of her tone rising and startled as he watched her move towards him and raise her arms.

It all happened in an instant, he took his hand and pushed her hard across the kitchen where she landed on her butt. She looked up, more stunned than hurt as he disappeared around  the corner of the kitchen heading for sanctuary in the bedroom.

Now this scenario is one version of many that plays out in homes across the United States. Because our young man refuses to acknowledge the impact that his past has on his current life situation, he continues to be affected by autonomic responses laid many years before. Because he CANNOT articulate the WHY of his behavioral outburst, it will be judged and his actions pathologized. His actions have meaning but ONLY in the context of his own narrative. If he lacks a connection to his own life story, he is denied the foundational elements for his current behavior. If his fiancé chooses to evaluate HIM negatively from this one incident, he is victimized by her faulty perception, his self-esteem suffering needlessly. If the police are summoned and a court case filed, he now becomes victimized by a community that is more interested in punishing the act than understanding the nature of the behavior’s development.

Within the context of his life experience, his actions towards his fiancé make sense. His behavioral motivation needs to be properly understood so any intervention can be effective. If he consistently faces people who are negative towards him, he will be negative himself. Negativity destroys productivity and reinforces the fear and anger that lie at the base of all negative behavioral outbursts. Healing can ONLY occur with person-centered, positive motivational incentives.

Mental fitness MUST BE a personal journey in recovery. It is as different from one person to the next as the fingerprints and DNA that identify us. Our narrative is our connection to our past and provides the key for unlocking a future of hope. Right now our human service delivery is failing miserably. Now is the time to develop a person centered approach to encouraging appreciation and understanding of each of our storylines, free of bias and judgment. We need to start asking the most humane of all questions… WHY?! When each of us can articulate our life story honestly and forthrightly, without fear and shame, we begin to understand the most important questions needed to improve the social conditions in which we live.

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Blame: The antithesis of Human Inquiry and Justice

Two people come into a room to discuss differing viewpoints. Each carries with them their own biases and life narrative that frames the perspective that they hold. Each also carries within reactive emotional stances that are cultivated in living an emotional life devoid of an appropriate outlet. The exchange is a confrontation and conflict by its very construct.

Culture asserts rules of conformity to reinforce social cohesion. People know their place and operate within a strict doctrine of social etiquette. These rules are only visible through the rituals that they enforce within social institutions which reinforce compliance…

In a school the loud speaker booms overhead, “Please rise for the Pledge of Allegiance”.

In a courtroom the bailiff stand to announce the entrance of the judge, “All rise… The Superior Court of Skagit County is now in session”.

Within these small examples comes an assignment of status and defines a role that one is expected to fill. Blame is the construct of a society demanding conformity from citizens.

Individuals use blame to deflect or abdicate personal and institutional responsibility. Those in positions of authority are in the best position to use the tactic. These individuals find themselves buffered by rituals that reinforce their superiority. The more that blame is used, the less real interaction actually takes place. The dynamics in these scenarios favor one side and minimize, if not nullify the input of others.  It is the epitome of a top-down hierarchy.

People who accept this dynamic find themselves in positions to enforce the same rhetorical hegemony. Their egos support the maintenance of status quo over the basic rights and civil liberties of others and their compliance is rewarded with materialistic advantages.

Lopsided Power plays

Case #1: The Case against a Single Mother facing CPS Proceedings

During work with a young woman who had lost custody of her children, allegations of a “Bipolar Disorder” came to light within Child Protective Service documentation that I reviewed. Since multiple physical diagnoses had been given, the client had been being maintained on a slew of medications prescribed by the physician who had made the original “Bipolar” diagnosis. With the tremendous amount of drugs, some prescribed for a condition that did not exist, the client’s behavior was erratic. The erratic and irrational behavior created the incentive for the removal of the children but an investigation into the authenticity of the claims was never conducted.

I was able to track down the origination of the diagnosis and discovered that it had been made by a local physician known by CPS to have some significant problems managing and treating clients. Despite the fact that it had been some time since the children were removed and it took some time to get her an evaluation by an independent professional, he concluded that the diagnosis was in error. CPS continued to overlook the fact that her behaviors stabilized when the medications were properly being administered and overseen by respected professionals within the community. The children remained out of her custody and mandated expectations multiplied to provide “proof of her ability to parent”.

In CPS proceedings the clock starts ticking as soon as the children are removed from their families’ of origin. All issues complicating reunification for safety reasons are to be resolved within one calendar year regardless of: the lack of credible information that precipitated the removal of the children in the first place; lack of timely evaluations, lack of timely treatment referrals being made by CPS; the inherent conflict of interest in which CPS appoints “independent” community professionals to write up supporting statements to back assertions made by CPS; lack of consistent expectations; repeated turnover of CPS staff,  poor communication between biological families and staff; and duplicitous alignment with foster families over that of biological families.

The stage had already been set for disaster. The department was not interested in why the young woman had acted irrationally nor was interested in looking into the implications that the slew of unneeded prescriptions had on her behavior. By withholding her children, delaying precious time, without interest into the credibility of the charges, the stage was set to seal this young woman’s fate. When institutional power encourages and rewards a blind eye by those it compensates monetarily, justice is not just blind, but deaf and dumb as well!

 Case #2: Treatment Facility Bias and Punitive Interventions: Power from the Court

The coordinator of a local drug court was facilitating a group with me in a treatment center that held the drug court contract for the local county where I lived. She confronted the group though accusing them of being complicit with a participating member who had come up with a “dirty” urinalysis, testing positive for a substance. She demanded the group member who was positive admit to using. Clearly uncomfortable, the 12 women in attendance took turns looking at each other and shifted uneasily in their seats.

The counselor looked over at me as the co-facilitator expecting me to agree with her tactics. I immediately felt uncomfortable. She looked away to continue her harassment of the ladies in attendance. By the time that she was finished, she was yelling at them, calling them names and demanding that those in attendance expose the woman who had tested positive.

I felt compelled to speak against this tactic. I knew the person who had the dirty urinalysis and knew from my sessions with her that she professed to be clean. I felt the harassment and berating being used were abusive to all in attendance and I did not agree with the tactics being employed to elicit information. I may have had deep seated feelings about what was transpiring but as a single mother of three needing a job to support my family, I kept quiet.

In front of the group, the coordinator identified the client and reprimanded her about the dirty urinalysis while threatening her with jail time. The client was visibly shaken. During break she was abandoned by the other clients to deal with her misery on her own. Clients knew if they were to console her, they would face sanction as well, regardless of their personal feeling of her innocence or guilt in the matter.

Still denying the use, she came to me in tears. I knew that I was in no “position” as a subordinate to question the tactics and at the same time ask for a more open minded approach to the client. Instead I told her to make an appointment with her physician and discuss with him the possible reasons for the dirty urinalysis. By getting authorities in a better position than I, more independent of the agency and with more status and power to back her stance, she would be in a better position to confront the allegations.

In court that week she came with a letter from a MD. She had a dirty urinalysis because she was borderline diabetic. If I had not helped her to “position” in the situation, she would have been jailed, her sense of self-esteem obliterated, and a very real physical condition would not have been addressed.

 Get the Facts Straight:

Blame is a coward’s way of avoiding a meaningful conversation.

Blame is asserted to reinforce status and power without a fair consideration of issues.

Blame is hidden in diagnoses which reinforce stigma and propaganda about groups of people.

Blame is hidden in the assertion of biological conditions for human behavior deviance creating and preserving the pathological focus and the medicalization of rehabilitation efforts.

Blame is hidden in warnings given about people with different ideas as being potential aberrant personalities.

Where bias coincides in judgment, there can be no justice or human advancement!

Male Bonding: The Cultural Cultivation of Loneliness

 

This is an overview of the cultural impact on social interaction between men and their families, most specifically highlighting the differences in perspective between the sexes.  Within these words will be reflections of each and every one of us, though the descriptions are not meant to describe the totality of the human experience for any one person. It is a starting point to critically think about the role of culture and society in the perpetuation of social problems that it insists on ameliorating through treatment services by professionals. Any intervention that refuses to understand the foundational elements of these maladies is complicit with the perpetuation of these afflictions through the loss of respect for the human condition!

I sat in front of a frantic man who was devastated by the demise of the only loving relationship that he had ever known. The grief came out in spasms of frantic and breathless verbal exclamations, disjointed and rambling… “How could she leave me? I gave her everything she ever wanted. I would do anything for her…” He looked at me imploringly as if I could impart some wisdom to release him from his pain.

“I remember a time,” I began, “when I was told that men have it far worse than women do. I doubted it at the time as a woman who has experienced the many horrors that can only be endured at the hands of men…. Despite that fact, I don’t feel that way anymore”.

He looked at me puzzled.

“From the time that boys are just babies, they have their emotional and physical pains belittled. Boys are breast fed less, they cuddle less, and have their own expression of real emotions trivialized and shamed. They are encouraged to perform in order to get the most rudimentary of acknowledgments from mothers and fathers alike. They rightly develop aggressive tendencies as the outlet for the overwhelming grief and disconnect that they have, not only with their own experience, but also with the gentle and giving nature of humanity. Eventually they can experience a complete disconnect with all that is emotional. That disconnect keeps them safe and allows them to maintain their culturally acceptable gender role as a male.  As a result, men are robbed of the language of emotionality because they are not allowed to practice it. They do not develop the skills to ask for what they need because they often are not aware that they are in need”.

He nodded his head in silent agreement.

I appreciated the gesture, but knew that the work that needed to be done was far more than he was interested in doing at that point. He was articulating a desire for the only connection with a fulfilling emotional life he had ever experienced, which he believed wholeheartedly existed only in his wife. I had seen it before.

“When many men fall in love” I continued, “they offer their heart for the first time. Women, many times with their own issues, become aware of the vulnerability in their men. While they say that they want softer and gentler men, they also fall into roles that reject the emerging emotional nature of men. Men can end up feeling isolated and powerless without the appropriate skills needed to navigate what is often perceived as a betrayal”.

His mouth gaped open and he nodded his head absent mindedly.

What he wasn’t ready to hear was my understanding of men’s responsibility in the erosion of their fragile relationships… Men overwhelmed with emotions, are vulnerable to their women and some may come to resent what they see as a power that women have over them. Their anger may surface and they may become controlling to lessen their feelings of vulnerability. These relationships can become volatile.

“For some men”, I continued, “the role of provider becomes the way that they prove their commitment and love for the women in their lives. While women appreciate a man who is willing to financially support them, they may at some point come to evaluate partner’s performance negatively. Men can try to “perform” better while bestowing their partners with more material gifts to compensate for their inability to emotionally connect, but that can fall short as well”.

Other revelations that had come to me as a result of my work as a psychotherapist; the fact that I had raised 2 boys, had 4 brothers, and suffered victimization at the hands of angry men, would remain unspoken. He was focused on performing to get his woman back, something disconnected from the way he was really feeling about himself, her, and the potential nature of his own future. The answers to everything he ever needed and wanted lay within him, a person that he was so disconnected with that he was effectively being denied effective intervention of any kind.

I knew in my own mind that the nature of heterosexual relationships was much more complicated. But I have come to understand that western men are more invested in outcome and therefore lack the commitment to the process needed to get there. Mitigating factors always complicate relationships and they would have to be considered honestly… which would mean that this man would have to be able to share intimate details of his relationship. Feeling like a failure could make that difficult. As a female psychotherapist, he could feel the need to “perform” and change details so not to disappoint me. Every detail could be explained and blame absolved, but only if I got the chance.

There are men who will choose a woman who herself is emotionally disconnected. She will demand more and more in material compensation because she has grown up in a family that refuses to cater to her emotional needs. She will have the best clothes, and the best car but can have material needs that exceed her family or partner’s budget. She will acquire the label of “high maintenance” but there will be little understanding in how that was created. She generally will be the one who knows how to use the feminine whiles to entice the men that are the most able to provide the lavish possessions that she needs to insulate her from her own loneliness and self-loathing. Men crave this woman because it is her type that gets the media attention. She focuses an inordinate amount of time on her appearance, because it is what gets her the attention that she craves and needs to feel worthwhile. She worries about the size of her breasts, her hips, the gray in her hair, and the lines on her face. Her preoccupation with acquiring and maintaining the affections of a man keeps her from ever acting on her innate gifts and talents as they are squandered away on superficial details to make her worthy of the care that she needs to feel emotionally whole and complete.

I have known men who distance themselves from the emotional discord that develops within these many dysfunctional family scenarios. In order to feel more in control of their lives and to find solace, some men may develop strong friendships with other men who struggle with the same feelings towards their own partners. Times spent with these men can be kept superficial, nothing reaching the deep feelings felt with a life partner.  Disagreements mean less, arguments never as deep or threatening. There is a huge difference in being able to walk away without feeling like you have fallen short of someone’s expectations. Men are raised with the belief that it is their performance that ensures them the caring love that they crave so much and receive so little of.  Their women though, have problems with understanding that falling short of performance standards makes men feel emasculated and unworthy of the love that they have learned to perform for; in as much as a woman’s fading beauty and her man’s disapproval of her looks deprive women of the same feeling of worth. Disgruntled camaraderie and the voicing of frustration with other men boosts male alliance but does nothing to support the ongoing relationships that they have with their women as it distances both men and women, instead pitting them against each other in mutual destruction.  Women bitch that they don’t have what they need and men complain of the high maintenance attention that is needed to keep women happy. As a result men may bond fiercely with their daughters out of a desire for the unconditional love never received, creating a further distancing of the women in their lives by promoting and fostering a competition between the women in the house.

Men, in general, do not know how to bond with their boys. Within their boys they see the injured and empty children that they had once been. In rejecting that image, they end up rejecting their boys, thus perpetuating the internalized grief and dissociative emotional status once created within them. The cycle is self-perpetuating.

The answer to empowering men lies in critical observation without pathologizing resulting behaviors and emotional responses. It manifests by absolving people of being failures by providing explanations that validate their life narratives while offering other options to promote effective and fulfilling social interactions.

 

 

Questioning the Scientific Method and Reductionist Approach in Evaluations made of Human Suffering!

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I am at a crossroads. I know that I cannot go any further in my “profession” and have come to acknowledge that my evolving thoughts do not fit within the confines of a practice limited in the focus of its definition. I am a former nurse and disability advocate, dually credentialed as a mental health and addiction practitioner. I am finding myself squeezed out of the evolving dialogue because of an education and training that appreciates the nature of a multiplicity of issues confronting people in recovery.

The Problem with the Scientific Method

Science breaks things down to understand their function.  That is the focus of the reductionist approach. The focus insists on looking at ALL phenomena through a microscope. While that might help us understand the components of a particular aspect of, let’s say, a system, a disease, or, a social phenomenon, it does not do anything to help us understand the relationships between the multiple variables which give rise to the human physical, emotional and social experience, nor does it give us an appreciation of the interplay of these three on the functioning of a living being. Because we continue to fund “professionals” to be expert on the components of systems and their function while neglecting the importance of their interaction, we are complicit in the undermining of human existence. We have come to judge symptoms and behaviors we cannot understand for lack of appropriate focus and interest. Yet many of us feel compelled to act on erroneous judgments and intervene in ways that deprive people of their most basic civil rights; support of their families and loved ones, their freedom to make informed choices and the right of self-determination, in essence, their very lives!

Reducing human problems to encourage funding over effective intervention

I remember being approached by an addict who was then a member of the local adult felony drug court. “Are you an addict”, he asked me as he sized me up.

“I may not be an addict, but I have done my own recovery” I replied with all sincerity. He seemed to relax a little but seemed puzzled by my response.

“I suffer from Posttraumatic Stress Disorder,” I clarified, “I have triggers much like you do. When I am triggered, I revert to a panic response, much like your cravings do to you. I have learned to limit my exposure to triggers, disengage from unhealthy situations so that I am not further harmed and de-escalate my triggered responses so that I can function. These are all skills you can develop and they will help you stay clean”.

My approach gained credibility with clients I served but the political and financial nature of my placement within a chemical dependency agency limited the focus of treatment to an “addiction only” priority.  As my credibility increased within the court, questions emerged concerning my interventions and my work was conveniently articulated as being solely applicable for “mental health” clientele.  The competition for funding and preference in contracts makes addiction and mental health separate entities pitted against each other for preferential consideration. I was hired for my mental health training or my substance abuse and addiction specialty, thus my holistic perspective was completely discounted. To this day when I interview for mental health positions, my placement within substance related programs causes me to be seen as being an “addiction professional”. The holistic nature of my expertise is being ignored by both streams of therapeutic approaches.

Clients continue to receive less than optimal services for complex issues that have been broken down into funding streams so fractured from each other as to make the service meaningless. I have witnessed drug court clients sent to prison for mental health conditions that have not been addressed within treatment and severely mentally ill clients fail to address their mental health symptoms due to an addiction that repeatedly them.

Fractured medical treatment:a lesson of the dangers of reductionism and protectionism

My father had multiple physical ailments. He suffered from Diverticulosis, Raynauds Disease, high blood pressure, and colon polyps. He had suffered a mini stroke from over extending himself cleaning the basement floor in 95 degree heat because “it had to get done”.  This behavioral manifestation was a clear indication of the Obsessive Compulsive nature of his personality that I was raised with. I distinctly remember him standing in front of the stove every time that the family was about to leave the house. “One, two, three, four”, he would count slowly and methodically looking first at one burner and then the next in a clockwise direction. He would repeat the sequence 5 times before including the number 5 which designated a check of the oven. He neglected his mental health all his life seemingly more prepared to deal with the mounting physical conditions that resulted.

Never diagnosed, my father pretended that he did not have mental health symptoms despite the days that I remember highs when my father would sing, dance and act silly. As a little girl he would ask me to stand on his feet and he would take my arms and dance around the kitchen. I hated the highs knowing the plummet into the opposite was just around the corner. I never knew when it would come, just that it would. Those were times filled by grumpiness and fits of anger. On nights that I would come home from swim team practice hungry, thirsty and tired, he would take my food away and taunt me. He would react aggressively to my objections and physically run me into the wall when I tried to get away from him. He would often withdrawal and work in the basement for long hours. He would not even discuss mental health issues and refused to do anything to stop the vacillation back and forth. He seemed reticent to distance himself and his emerging mental health symptoms from his own mother, a woman he called “Crazy Lil”. I am sure both he and his mother suffered from Bipolar Disorder.

Years later when my adoptive father was declining, he had undergone a colonoscopy to snip some of the polyps that occasionally occurred along his colon. Before he had gone in, his Coumadin (an anticoagulant) used to avert stroke or heart attack from a dislodged clot, was stopped. The rationale was that the action would promote a better healing post-op by allowing him to effectively clot.

After the surgery he began walking around his neighborhood again. One day the walk was taking exceedingly too long. When my adoptive mother saw him hunched over clutching his chest as he approached the house, she sprang into action. He was immediately admitted to the local hospital where he was monitored. Because his symptoms were not responding, he was transferred to an inner city hospital. His Coumadin was reintroduced and its dosage upped. To my knowledge there was no conversation between the specialist who had performed the polyp surgery and his cardiologist who was monitoring his cardiac status.  As a result, my adoptive father began hemorrhaging internally. Immediately clotting factor was introduced. He had a subsequent heart attack. He started going into respiratory distress since his heart was compromised. An order was made to ventilate him since his respirations were compromised and his oxygen saturation dropped. Like many people who are prone to mental health conditions, his gag reflex was over sensitive so he was prone to choking.  Intubating (inserting the breathing tube) caused him to vomit from his violent choking. They continued to struggle to get the bleeding contained while supporting his cardiac function, two very opposing goals since the introduction of clotting agents precipitated another heart attack. They vacillated back and forth between the two approaches. At that point he became comatose and he spiked a fever. He had turned septic, that is, his system was poisoned by the vomit he had aspirated. It was shortly after that my adoptive father expired.

The specialists indicated here are: Psychiatrist, Cardiologist, Proctologist, Pulmonary specialist, and Hematologist. Not one of them specializes in understanding how their “professional opinion” will affect the status of the others, yet, each one affects the other and together creates the neglect indicated in the condition of the patient in question, who in this case was dead!

The lesson about status and power in the abdication of patient and client rights

My fiancé has multiple health problems. He has been subject to poor treatment by physicians on a regular basis. When I met him he was in kidney failure and had dialysis 3x/week. His dry weight, meaning the weight he was when ALL extra fluid was removed from his circulation was 125 kg. The technicians at the center were instructed to make sure that they always took off enough fluid to hit his dry weight number. The problem is that technicians have very little training and, quite frankly, are not trained to think, just follow directions. These technicians do not individualize their treatment; that is, account for body mass gain, seasonal weight gain, heat of the day, perspiration expected, activity level etc. They would take off sometimes 3.5 kg in one sitting. 3.5 kg is 7 pounds of fluid!!! Cedric was repeatedly suffering dizziness and hypotension to the point of collapse. He would go home and sleep the entire remainder of the day from the tremendous stress that it put on his body. One half of his life was essentially being wasted.

I began to strongly object to the technicians removing so much fluid and we were lucky to find a technician who backed our decision. It was through her encouragement we became even more convinced that we were doing the right thing. She was an important factor in his empowerment and the developing voice that he was beginning to have in his care. The Northwest Kidney Center removed her from providing Cedric’s care as a result.

Since he transferred north, he has been receiving much better care. Despite the ability that he now has to express his wishes, none of the healthcare team WILL openly voice objections to care that he has received elsewhere, even when that care has jeopardized Cedric’s life.

The appearance of melanoma: a process of misinformed healthcare delivery and the lack of “informed consent”

Cedric is African American and has spent his whole life in the Pacific Northwest. He had been placed on Enalapril in 2007 for blood pressure management after suffering Congestive Heart Failure as a result of his failing kidney function.

In 2010 he showed his primary physician a lesion his back just below his armpit. She thought nothing of it. In 2012 when I met him, I told him about the lesion on his back as well and suggested that we keep an eye on it. Later that year, he was being worked up for a kidney transplant. Because he was a below the knee amputee, the cardiologist who wanted to do a stress test on his heart, told him that he would be doing a “chemical stress test” against Cedric’s open objections. He was injected with a radioactive isotope. He was also subject to a CAT scan and an MRI. He did blood work and was declared “cancer free” in November 2012.

Getting up early one December morning I told him not to move and started to palpate what was a more nodular and puffy side to the lesion on his back. All of a sudden, it appeared to be growing at an alarming rate. We got the name of a dermatologist and were seen…

“Ninety nine point nine percent of these are not cancerous,” he tried to reassure us, “I will schedule you to come in and take a biopsy”.

“Can’t you take it now?” I asked him.

“Well, I guess,” he said as he turned Cedric’s back away from me. When Cedric turned his back to me again it was clear that the dermatologist had just taken a small part of the lesion, leaving most of it intact.

“Aren’t you going to take the whole thing?”

“No, we can take the rest of it at another occasion”.

The phone rang the next day and the dermatologist himself was on the phone.  “The biopsy came back positive. I am going to make a referral to the University of Washington. They have a doctor who specializes with melanomas”.Stunned, Cedric turned to tell me the news.

“So, they just left the lesion on your back to possibly spread?”

“He told me that the doctor in Seattle was better prepared to do the surgery” he told me with a faraway look.

The scheduled meeting was almost a month later. I tried to have the dermatologist agree to take the lesion off but he refused to do so.

“How does that make sense when cancer spreads?” I asked Cedric, “…and what does it do when he performs a biopsy only on one portion and causes bleeding? Doesn’t that introduce cancer cells into the blood stream?”

The appointment at the University of Washington was a consult. They would not even consider taking the lesion off. A resident reported the findings of the pathology report that was done up north without ever seeing the pathology report itself.

Small talk ensued to lighten the mood as the surgeon walked in the room after almost an hour wait. “That is an interesting accent you have” I quipped.

“Well,” he said, “I am from South Africa.” I was not aware of how important that fact would become as our interaction continued…

“Well, that is odd” the surgeon said looking at the lesion, “I have never seen a melanoma that was so warty looking,” he added as if to no one in particular.

“Can you please tell me how an African American as dark as Cedric who grows up in Seattle develops skin cancer?”

“That is rare” the doctor admitted.

“How does Cedric get passed as cancer free in November and develop a melanoma within one month?”

Nothing.

“He was worked up for a kidney transplant, you would have thought that they would have noticed this lesion on his back and had it checked. Then without looking at the lesion they repeatedly dose him with radioactivity…. Wha la… I find the lesion on his back, once appearing dormant, now growing at an alarming rate”.

Cedric chimed in, “Goddamn it, can’t you just get this thing off my back.”

“No,” the physician told him in a patronizing tone patting his shoulder, “watch your language”.

“The longer this thing sits here, the greater the chance it will spread. Don’t you get that?” Cedric implored him.

“Oh, I will have to do much more than just take off the lesion. What we will do is have you come in and inject the melanoma with radioactivity…”

I couldn’t believe what I was hearing. Didn’t he hear anything I had said?

“…then we will track the radioactivity through watching it illuminate those lymph nodes that have been draining the site. We will remove those nodes and dissect them to see how much cancer is present. We will then inject dye to the surrounding area and take the tissues that show color”.

“The lesion looks very different from one side to the other. Doesn’t that indicate that the lesion might just be cancerous on one side?” I asked him.

Nothing.

“They reported that the lesion was 1.7 millimeters in depth but I think it probably is as much as 7 millimeters. In fact it is probably 7 millimeters for sure” he replied as if that answered the question.

“Don’t you know from the slides taken?” I asked him.

“Oh,” the surgeon told me with all sincerity, “I haven’t seen the slides”.

“Then how can you make the diagnosis? And we are setting him up for surgery?” I looked over to see Cedric squirming in his seat, the physician’s hand tapping him as if he were an inconsolable child.

“We will schedule you as soon as possible” he told me, “we don’t want to waste any time”.

I looked at Cedric who appeared like a deer caught in headlights. “I think we need some time to consider everything” I responded.

“No,” Cedric said reluctantly, “schedule it.”

As the surgeon left the room, Cedric turned to me with tears in his eye, “I don’t want to do this but I have to”.

When we got home, I sprang into action getting as much information as I could regarding Cedric’s medications and skin cancer, specifically melanoma. Remember the Enalapril? I came across a study that tracked people who had been on the drug over a prolonged period of time. Guess what? Some of the older patients had developed…. skin cancer, specifically melanoma! I approached his kidney physican and told him that I wanted his medication changed.

He looked at me confused, “I wasn’t the one who put him on that medication was I?”

“No,” I reassured him.

“We need to get him off that right away. Bring me the bottle and I will call in another prescription as soon as possible for you to pick up…,”

Very interesting!

I also came across information discussing the benefit of using high concentrated THC oil for the treatment of cancer. Come to find out, there were also scholarly articles that had been suggesting the importance of cannabinoids in the treatment of cancer going back to 2003 http://www.jci.org/articles/view/37948.

The day of the surgery, I was in training and was not able to be by Cedric’s side. He checked in at 9am with surgery scheduled for 11am. He was injected with radioactivity at 11am and was not in surgery until 1pm.

“I want to see slides and pictures so I understand what is happening to me”. Cedric reported saying to the surgeon.

“That is just not feasible” the surgeon reportedly replied.

“Then how can anyone give informed consent if they cannot understand the implications of what is being seen?” I asked him after it was all done.

“He told me that there is a 15-30% chance of this recurring”. That information was echoed by my son who accompanied Cedric in my absence.

Ten minutes after waking, Cedric was ushered out of the hospital with a sheet of post-op instructions without ever seeing the surgeon again. Questions were avoided that way, I guess!

The follow-up was inadvertently scheduled for a day that Cedric was in dialysis despite the fact that the staff of the University of Washington knew his other medical obligations… We met a resident for the review 2 weeks later. He was apologetic with the delivery of the news that they had indeed found cancer in the lymph nodes but that it appeared that they had gotten all of the cancer.

“You are facing three options: 1) Wait and see if there is a recurrence 2) You can begin chemotherapy, or 3) Start radiation treatments”

“If we got the cancer, why would we want to subject Cedric to these treatments?” I asked him, “Do we know how many of the nodes were cancerous? What was the percentage of cancer found within each one?”

The resident excused himself to ask the surgeon my questions. He came back just briefly to hand me the pathology report which I read carefully….

Indeed Cedric had a rare melanoma that was slow growing and generally has been implicated in a significant amount of lymph node involvement with other cases. Called “pigment synthesizing melanoma” it resembles a melanoma seen often in the grey horse. There is very little information on the progression of the melanoma’s growth over 10 years though it was not clear if that was due to the fact that intervention led to remission or not.

When the resident returned the information had drastically changed. We stand by our assertion of these events because we can NOT substantiate ANY of the surgeon’s claims, never seeing the pathology slides, the evidence of the lymph node dissection… ANYTHING.  “Four nodes were involved and two were cancerous. The doctor wants to schedule you for a follow-up surgery to go in and remove more lymph nodes to make sure that they are not cancerous”.

“How does that make sense to remove more of Cedric’s lymphatic system, a system that is there to protect him from the very cancer that we just removed? And he is immunosuppressed as a kidney patient?  After all you removed 4 nodes and only 2 were cancerous. Do we even know what percentage of the lymph nodes were indeed cancerous?”

No answer.

We declined the surgery.

When we got back home we submitted a complaint about our treatment and the lack of information provided. The physician called. The questions that I asked regarding what had transpired and what the implications of the findings were ended up being ignored as if I was not even present. I got up and walked away in disgust. Cedric tells me that the doctor kept insisting that Cedric was “out of control” when it was clear that it was the physician who was not in control of his own emotions. Without any more information, Cedric ended the conversation politely.

The complaints we have lodged with other professionals about Cedric’s care go nowhere! Clearly this surgeon’s prestige supersedes the treatment that he gives his patients while his expertise elevates him beyond reproach! Legally he is responsible for providing accessible information to his patients so that they can give him “informed consent” to perform surgery and follow-up care. He does not, nor does he have any intention to do so.

Applying relevant lessons to social services

I have arrived at a similar conclusion about my place within my own “profession”. I am expected to provide mental health or addiction services without consideration of the holistic needs of the person, couple or family I am working with. When I provide dual services, my efforts threaten the staff and administrators through the creation of trusting bonds with clients that they are paid to serve. They discount my interventions as only being appropriate for “that other approach” and insist on defining client behaviors as being centered in their own specialty. Agencies, like doctors, are politically wired to be more concerned about maintaining their funding streams than doing what is best for clients that they serve. I cannot be defined solely through one or the other and so threaten the funding of both.

What became clear to me in maneuvering through my line of work is that the number 1 producer of stress, anxiety and depression has been the understanding that adherence to my thoughts, my ideas and my approach for the good of the people I serve has made me a pariah within the political structure of a social and human service delivery system modeled by reduction of client needs into categories of ailments and conditions in need of amelioration through rehabilitation, and funding resources.

If we focus on just SYMPTOMS that result from more and more people who cannot fit into our ever shrinking focus, divvying the physical, emotional and behavioral manifestations into categories and diagnoses, we neglect the real understanding of how our socially created concepts affect the quality of living we are forced to endure. We miss the myriad of variables that influence human experience by inflicting the focus of an artificially derived lens called “the scientific method”.

Within psychological and sociological experiments, researchers are aware of a phenomenon called, Observer Bias: “This refers to the cultural assumptions which all researchers bring to their work and which help determine their method of research and their observations. It has been argued by some that all enquiry (including ‘pure’ science) is simply a reflection of such biases”. http://www.encyclopedia.com/doc/1O88-observerbias.html   Since Science has been touted as the methodology of choice in evaluation, it is important to understand its appropriate applications and its limits.

Social interaction etiquette is biased towards elite people who are put in places of judgment to uphold the status quo. We defer to those people because of their station often without consideration of the merit of their contributions, qualifications, or intelligence. The people in these positions get away with being ill informed, narcissistic, disrespectful, bigoted, hateful, and as a result, dangerous (See Stanley Milgram “Obedience to Authority” http://youtu.be/yr5cjyokVUs and Philip Zimbardo’s “Stanford Prison Experiment” https://www.youtube.com/watch?v=L_LKzEqlPto)

Summing it up

Truth is not in the sole possession of “professionals” as much as they would have you believe otherwise.  Empowerment of self through attainment of personal knowledge begins a journey that can lead to “Strategic Positioning” in the face of powerful forces and “professionals” who function within a limited scope of expertise and biased focus. The beginning lies within you.