It can be very tempting, even easy, to look at a famous musician and say “that guy is a total narcissist.” When you’re sitting around talking with friends, it’s an interesting topic. But should mental health professionals engage in this sort of speculation publicly?
This interesting piece from NY Mag considers a new book by Claudia Kalb, in which she examines famous historical figures and their behavior, which she then presents to mental health professional for a diagnosis. Andy Warhol Was A Hoarder: Inside the Minds of History’s Great Personalities sounds interesting. The article above cites an NPR interview in which the author says that Warhol saved all sorts of things “from receipts and junk mail to even pizza crusts. Warhol’s goal was to sell them eventually as artifacts of his work, but he also felt a strong attachment to the objects: In his journals, Warhol wrote, ‘I can’t throw anything out’; in another entry, he wrote, ‘I’d love to have a really clean space.’ But, as Kalb notes, ‘He could never do it.’“ That distinction, between being messy and having an emotional attachment to what some call “junk,” is, indeed, the key feature of hoarding.
The NY Mag piece also does a good job of examining the ethics of such investigations. Mental health professionals are ethically forbidden from diagnosing people that they have not examined personally. There is an important reason for this. While public figures may behave in a way that is consistent with a certain diagnosis, a clinician cannot know what this person is actually thinking until they speak with them and ask them. I would be worried that diagnosing someone you haven’t examined might pose a risk to them, as people tend to embrace or “own” a diagnosis. It’s not hard to see how an inaccurate diagnosis could impact someone, famous or not.
I also worry that some of the disorders that are discussed may have been classified as “disorders” since the person died, and I believe we want to be careful about judging someone’s behavior many years ago by modern standards. After all, many “mental illnesses” may represent behaviors that had reasons to exist many years ago and are no longer necessary for human survival. For example, post-traumatic stress disorder (PTSD) may have been necessary for survival eons ago before humans completely dominated the planet, but has become problematic now that we have few or no predators in our environment. Is it possible that a behavior that is a problem now served someone well in the past and might their accomplishments be diminished by adding a presumptive diagnosis of mental illness after their death? After all, we cannot personally know what a person’s everyday life was like in the past. Andy Warhol was never a hunter-gatherer, obviously; the point is times and standards of behavior as well as values change quickly and frequently.
I have attempted to provide education about psychotherapy as well as to address the ethical conundrum on this blog by looking at behaviors of fictional characters, such as Luigi from Super Mario Brothers. Though I make no pretense of “diagnosing” Luigi, the mock therapy sessions certainly show behaviors that could lead one to make a diagnosis.
This public diagnosing also may add to a perception that mental health professionals go around diagnosing everyone in their life, a perception I can personally attest is untrue. There’s no need to be uncomfortable or worry about this just because you have friends or family members who are mental health professionals. All that diagnosing would drive us crazy, trust me!
That said, all of the figures in the Kalb book are deceased, so there will be no impact on their lives. In addition, as the author states above “My goal, I hope, is that by reading about these people, there’ll be some less stigmatization of mental-health disorders.” I think this book may very well succeed in this aspect, which is important. One of the things I try to do with this blog is praise celebrities who are open about their mental health struggles, as I do believe that every person who speaks openly takes one step towards erasing the stigma of needing and receiving mental health services.
Mike McMahan is a psychotherapist in private practice in San Antonio, Tx.
I happened to run across two articles in the last few days that both had me thinking of how we perceive narratives in our lives.
Oftentimes when someone comes to therapy, they have at least some sort of goal for the future, even if it may not be well-defined. So once the client’s goal is clear to me, the therapist, the question for the client becomes relatively straight forward. Specifically, it becomes “how do you get there?” And based on these two articles, the obvious answer may be “make a map.”
The first article , from the very cool site Atlas Obscura, concerns Andrew DeGraff, a cartographer who makes maps of fictional places. In the example provided, this is a map of A Wrinkle In Time, the classic young adult novel. I was particularly impressed at how DeGraff navigated the problems of portraying the mechanics of the physics concepts that drive the story: he simply made up a way for the concepts to look.
The reason I like this, from a therapeutic perspective, is that it gets outside of the traditional narrative, which suggests that if something isn’t “real” it cannot be portrayed on something as fact-based as a map. DeGraff’s map of A Wrinkle In Time is “real” because we can all see it, and many who have read the book would likely agree that it is a representation of the world within.
I have worked with a number of young adults who have been diagnosed with autism spectrum disorders and, when asking them to map their world, have seen some interesting results. People with a spectrum disorder often have rich inner lives, so it came as no surprise to me that the maps they produced were very detailed, if not always “accurate” with the way others might view their world. But who’s to say, really? If we accept the idea that each person’s reality is their own “truth,” a map may provide some real insight for others who attempt to navigate this world.
This leads us to the second article, which more directly concerns emotions and may have direct applications to psychotherapy. I have encountered this type of tool before, though it was similar to a family tree rather than the map described above created by cartographer Dennis Wood. The common therapeutic tool I’m referring to is called a genogram, which can provide insight into how previous generations may have shaped us. The idea of making a map of emotions is much more free-form and can be easily tailored for an individual, which I find appealing. I also liked from this article the idea of “getting lost” which I believe might be an appropriate metaphor for therapy as well. A big part of success in mental health services is the willingness to do something different and getting out of your comfort zone, which is certainly accomplished by purposely getting lost!
If I was making a map of emotions with clients, I would want to know why they chose certain locations or feelings as well as why they chose particular symbols to represent them. I believe it would also be important to ask them to consider what was left off, as when considering a person’s narrative it is important to consider not just what was included, but what was not included. Is an emotion or location that is left off simply unimportant or is it something so unsettling or worrisome that the person may not want to include it? To me, that would become, in fact, an important item to include. I might suggest putting it off to the side or in a currently inaccessible location on the map. Then the question becomes similar to the one discussed above. “You can’t get to this place now. What can we collaborate on that will let you go to that place and stare down whatever is worrying you? What obstacles are there into visiting a challenging place, and how will you be better off when you have mastered these obstacles?"
The concept of maps of places that don’t exist gives us a lot to think about. If you could map your favorite book or movie, what would it look like? And how would you use those same symbols and techniques to map your own life and emotions?
Perhaps comedian Steven Wright summed it up best: “I have an existential map. It has ‘You are here’ written all over it.”
Mike McMahan is a psychotherapist in San Antonio, Tx.
February 1 of last week marked 20 years since the publication of David Foster Wallace’s magnum opus, Infinite Jest. The book is filled with oddball characters and fancifully absurd settings. The hundred-plus pages of fictional footnotes also intrigued me. In retrospect, they foreshadow the hypertext links that we now see daily online. For the most part, I found Infinite Jest deeply weird and, at times, confusing. The book seemed to have no plot, but instead revolved around a series of digressions. At times, when first reading it, Infinite Jest seemed like it was riding on a bookish parallel to Pulp Fiction, both towers signifying the rise of postmodernism into mainstream culture. I also found Wallace’s honesty in the book and in interviews refreshing. By this time the culture had become thoroughly drenched in irony, and Wallace’s genuine enthusiasm for things he liked (rather than trying to assume an ironic distance) almost seemed more ironic than actual irony. As a whole, this book had a significant impact on me when I first read it 20 years ago. I have previously discussed postmodernism, a theory I first encountered in undergrad in the early 1990s, just a few short years earlier. Infinite Jest took this theory out of the world of academia and put it in a context I could understand: specifically, a dense-but-readable meditation on how entertainment may be a sort of addiction unto itself. The “binge watching” phenomenon currently made possible and fully embraced by Netflix (“Next episode begins in 10 seconds” anyone?) seems straight out of Infinite Jest, as does the terrible penchant for naming everything after its sponsor (e.g. The Beef O’Brady’s Bowl).
One thing that both surprises and relieves me is that we are not getting an “uncut” or "Author's Definitive" edition of Infinite Jest to celebrate and cash in on this anniversary. The book underwent numerous edits. Perhaps, for once, the world will leave well-enough alone. Of course, given the doorstop size of the novel now, one has to wonder if there is someone clamoring for new material to make this book longer. But, given the book’s cult-like following and its popularity among critics looking for new angles to analyze, the answer is probably yes.
Unfortunately, the most well-known event to have taken place in Wallace’s life in the 20 years since the publication of Infinite Jest is his suicide in 2008. In Every Love Story Is A Ghost Story, D.T. Max’s biography, Wallace's efforts to cope with mental illness and addiction are painfully detailed. That he struggled with these issues is something that is probably not terribly surprising to anyone familiar with his work. In fact, Every Love Story contains the assertion that the bulk of Infinite Jest was written during an extended manic phase. Given that much of the novel reads like a transcript of “pressured speech” often associated with a manic phase, this strikes me as a reasonable assertion as well. Pressured speech occurs when a person seems to have so many thoughts that they can’t get them all out, and may be displayed not just as talking fast, but also with a sense of grandiosity, as if these ideas can change the world if only I can get them all out of my head and do every single one of them RIGHT NOW. That Wallace likely suffered from some form of depression was hardly a stretch given that he committed suicide. The biography also details his struggles with substance abuse and the trips to Boston-area AA meetings later fictionalized in Infinite Jest.
That said, viewing Infinite Jest as a symptom of mental illness or as an extender precursor to suicide strikes me as unfair both to the art and artist. To me, great art is a synthesis of many things in a person’s life. In the case of Infinite Jest, it is also informed by Wallace’s participation in youth tennis. Should we also consider his tennis wins through the prism of mental illness and his future death?
As I stated in the introduction to this post, the novel has recently celebrated its 20th birthday. Anniversaries serve as a time not just to reflect on what happened a certain number of years ago, but also to evaluate our own life and progress with the initial happening as a sort of milepost. Looking back at Infinite Jest, I can see that it cemented my love of postmodern theory, but it also influenced what I like to read and my style of fiction writing. These influences are much more obvious 20 years on. I still love fake footnotes and fiction written with a “fake” non-fiction bent, something I attribute to Infinite Jest.
So how about you? What was your favorite book 20 years ago? Is this still a book you enjoy now? Why or why not? How has it influenced your life and what does that choice of book say about what was going on with you two decades ago? And, more than that, what did you learn from reading that book that is a lesson you can apply to coping with your life today, 20 years later? For me, Infinite Jest taught me that no matter how weird your art (or you, personally) may seem to be, there is a place in the world for oddballs and weird theories. And that place may very well be all over the New York Times Books Review and the bestseller list.
Mike McMahan is a psychotherapist in private practice in San Antonio, Tx.
Video games, video games, video games…! Must they be the bane of every parent’s existence? For every fun story I hear about “I played MarioKart all afternoon with my son the other day. It was great…the games are so much better than when we were growing up,” there are about ten that are more like “all he wants to do is play video games, all the time! I have to drag him off to do his homework or even to eat!” But are video games all bad? In a previous post, I addressed some of the therapeutic value of video games. But if you have a child who loves video games, how do you, as a parents, go about helping your child actually benefit from their video game obsession, as opposed to making it a thorn in everyone’s side and a flash point of conflict?
This post from Dorkly does a great job of succinctly boiling down some of the exact positive themes I have noticed in video games. For purposes of this blog post, I would like to focus on two of these maxims, “take pride in your work even if it’s not the prettiest” and “focus on what you’re good at” and suggest a way that parents might maximize results with these catchphrases. Though the goal and outcome may be different depending on the current status of video games in your household.
However, before you can really engage your child about video games, a dialing down or de-escalation of the conflict may be in order.
The first question parents must ask themselves is how positive or negative the topic of video games is currently: if there’s no argument and everyone’s on the same page, these may be fairly easy strategies to implement. On the other hand, if video games have everyone ready to go nuclear, it’s important to take that into account.
So, yes, let’s be honest. Depending on how old and/or cynical your kids are, as a parent, you can’t just wake up one morning and pretend that you are suddenly in love with video games, especially if they have previously been a source of tension between you and your “mini-me.” As the slogans and their illustrations are easily downloaded and printed, I would suggest that you hang one or two on the refrigerator without mentioning or calling attention to them. If your child asks about them, of course that is an opening to begin talking. If not, just leave them for a week or so and wait for an opportunity to discuss. And watching for (or even creating) an opportunity may be key to the success for this strategy.
The two "lessons" that will be the focus of the rest of this post are available below.
For example, as a jumping off point for the Minecraft maxim (“take pride in your work…”), look for your child to say something positive about something they have created or completed. You might add “that reminds me of the Minecraft picture I put up on the fridge the other day.” At this point, the child will likely either acknowledge they have seen it or give you an opportunity to say it was “something I saw on the internet that reminded me of you.” This compliment will function in two ways: one, you are reinforcing your child’s perception that whatever they created has value and that both of you are aware of it; two, it is an opening to signal your openness towards a positive view of videogames and frame your compliment in a way that gets your child’s attention. This may be especially effective if video games are a current source of tension and may have the added benefit of signaling at least a slight reduction in the rhetoric that likely surrounds the subject. Oftentimes when something is a source of argument, especially between a parent and child, the discussion can easily turn into a game of one-upmanship that escalates the problem without taking one step towards a solution. This sort of one-upmanship is an easy pattern to fall into in any relationship and may itself become the source of problems.
I would also suggest that you look for a time to apply the reinforcement “focus on what you’re good at.” When we are looking for times to reinforce a positive behavior in our children, it is amazing how apparent they can come. Oftentimes, children will take a strength-based approach without even realizing it. “We had a group project today in science and I was in charge of putting the slide together because I’m good at the little details” or “when we played volleyball today in P.E. I took the setter position because I always notice who’s in position to do what.” As a parent, this might be an opening to say “yeah, that reminds of the saying I put on the fridge the other day,” hopefully with some of the same results outlined above.
Whatever the result, the goal of this outcome is to praise your children on an important life skill, but in a way that shows you are paying attention to what is important to them. It’s very easy as parents to constantly nag, criticize or give advice, but much more challenging to simply reinforce something a child might already be doing well, but not being praised for. Working this recognition of skills into conversation may pay considerable benefits in your child’s functioning and behavior.
Mike McMahan is a psychotherapist in private practice in San Antonio, Tx.
Therapy Goes POP
Perspectives on therapy and mental health as viewed through the lens of popular culture