Tuesday, June 7, 2016

Angry Birds, and Items #1 and #2

A few days ago I took my two sons to see a movie called "Angry Birds."  The movie is based on a video game app!

I had pretty low expectations of this movie.  I'm not thrilled with children playing a lot of video games on handheld devices.  When I checked a review site, most of the critiques were very unflattering.  But at the time, we were visiting a small town for a performing arts festival, and we had a few hours free before our trip back home.  This was the only movie available to see.

We ended up really enjoying it!  I thought it was cute, charming, funny, and delightful.  Maybe it was just the kind of light-hearted silliness I needed at the time.

One of the themes of the movie is about how it is possible to over-pathologize anger.  It also pokes fun at  therapeutic cliches.    The main character, Red, has a short fuse, and frequently ends up having tantrums.  The community he lives in is tranquil, peaceful, and happy.  Red ends up getting into trouble, and gets sent to court-mandated "anger management therapy."

Yet, there are changes happening in the peaceful little community of birds.  Red is the only one who seems to question what's going on.  But his concerns are dismissed...

Finally, the story shows that Red's point of view should have been heeded and respected earlier--eventually, of course,he ends up saving the day, thanks to the very anger that he was initially sent to therapy for at the beginning of the movie!   

Politically, I guess we could say Red represents a kind of militaristic position; he is a "hawk," so to speak.  I'm not a fan of this position--I'm much more a fan of diplomacy and "dove-like" peacemaking.

But I am a great fan of free speech.  I believe it is important to have the courage to speak out about something, even if you are the only voice of dissent in a crowded room, or in a community.

I have felt a little bit like "Red" myself this past year.

Part of my personal and family culture is of being gentle, calm, and reserved.  Most people who know me would describe me this way.   I have been very fortunate to have had a peaceful and mostly safe environment to live in, through the course of my life.  I haven't had much to be angry about.  

I also have a wonderful job, which I love very much.  I hear many stories of terrible suffering, but I feel very lucky and honoured to get to spend time with my patients.  It is a privilege and a joy to know them.

In mental health policy,  and in working with my patients, I have some very simple principles which I hold dear:

Item 1
     take the time to know your patients, to hear their stories, and to see them regularly if they desire it
Item 2
     show kindness, gentleness, patience, compassion, humour, empathy, and open-mindedness.  Be willing to listen.  Learn from your patients before trying to teach them anything.  These are the core elements of all therapeutic encounters.
Item 3
      therapeutic tactics or advice  (such as about CBT exercises, meditation, lifestyle changes, or medication) are important, but are far less important than items #1 and  #2... unless items #1 and  #2 are attended to very well, it is often the case that all the therapeutic tactics in the world will be unhelpful.
Item 4
      resist the urge to use labels.  Terms such as "depression,"  "OCD," "schizophrenia," or "borderline personality disorder" can sometimes be useful in a discussion about mental health or therapy, but I believe it is too easy to impose these labels upon someone, or to encourage people to impose them on themselves, even if this occurs in a well-meaning way.  Here, I think a great insight comes from the genre of "narrative therapy," in which people are encouraged to create and mold their own terminology, rather than have a clinician impose it upon them.  Therapeutic guidelines about helping people often focus upon labels of this type, followed by details about item #3, while barely mentioning items #1 and #2! 

Item 5
    see items #1 and #2 again!

I am saddened to contemplate a system which, in an effort to improve efficiency, would neglect items #1 and #2.

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