Tuesday, September 09, 2014

Ray Rice, Power, and Domestic Violence in the NFL


Rape, now more commonly called sexual assault, is the end and the beginning of many things. It can be the end of innocence and trust, for as long as it takes to recapture that, and the beginning of guilt, shame, fear, sexual problems, infertility, mental and physical illnesses, isolation, and more.

Tearing it apart, the perpetrator overpowers a victim, a person who protests, and having more power over this person, commits a crime of passion, of sorts, Those cries of "No, I don't want you to . . ."  (do whatever it is that is objectionable at the time) are overruled by brute force.

We tend to think of a sexual assault perpetrator as larger-than-life, stronger than your average Joe, but more often than not, he's not. Sometimes he's the person you would never suspect, might even respect (think of teachers). When the suspect is a professional football player he is stronger, indomitable.

Six years ago sexual violence was outed in the NFL.  Ben Roethlisberger, accused of numerous sexual assaults settled one of them, a casino incident. Stories like this are buried, no surprise.  If you want access to our locker rooms for your sports column, you had better make this one die of natural causes.

Now we have Ray Rice beating his wife to unconsciousness. And nobody is burying anything.

Strangely enough, before I saw the infamous clip, public since February (!), I was watching highlights of Monday night football and came to a crazy conclusion.  That athletes brush off tackles and crashes to the head is astounding. These people are stupefying, superhuman. Inhuman, brushing off falls that would put most of us out of commission for weeks. How does a person endure so much physical abuse and still pop back up and play ball?* Players learn to endure pain, is the answer, and it is admirable.

But here's the point:  Maybe they project that invulnerability onto others, assume we ordinary mortals can take physical abuse, too. There are other explanations, from poor family and peer role models to the narcissism learned as a child, treated special, always, as a potential star. Groomed for college ball and maybe the NFL, women and cars, hotels and alcohol, are assumed. Those courses on ethics are skipped, too boring.  And maybe men like Ray Rice actually are fooled into thinking that women like his fiance can take a wallop on the head, like he can.

Ray Rice needs to know what it is that happened there in the elevator, decking his wife with one blow, dragging her seemingly lifeless body from the elevator floor to the corridor. He is probably as surprised as any of us, and yet, it is unlikely this is his first physical altercation. His father died when he was one year old, shot dead. John Clayton:

"I faced a lot of adversity," Rice (told me once by phone), "and I had to be a man real young.".

The NFL response? New policies are in the works that will (surely) reduce violence perpetrated by players. That is the intent.

Not everyone agrees that the new policies will be enough. Certainly not those of us who work with victims and perpetrators. It is changing personality we are talking about: impulse control, narcissism, and empathy, and a different defiintion of manhood. A year in therapy is a start, but education, workshops, testimonies from survivors of assault, so many that the words of survivors are predictable, this type of exposure is what these very large men, players like Ray Rice need. Even with those workshops there will be sociopathic players who feel they are above being told what to do and what not to do, what is expected of them as human beings, members of the human race.

Social workers approached Roger Goodell, the commissioner of the NFL, with assault prevention workshops years ago. As anti-violence experts, we received polite applications. Fill these out. Let us know your plan. We'll get back to you. Don't call us. . .We'll call you.

Something tells me the applications hit the waste basket pretty quick.

therapydoc

 *Players aren't actually superhuman, and they know it. Concussions, many of them, are an occupational hazard. The self-abuse of a life-time in sports is future-changing, predicts a difficult retirement. Cognitive functioning, you know, is a terrible thing to waste.  I hope Janay Palmer is okay.


Thursday, September 04, 2014

When the Diagnosis is : All of the Above

Most of us aren't Diagnostic and Statistical Manual (DSM) experts, but are aware of this thing we call the DSM-5, or Diagnostic and Statistical Manual of Mental Disorders that therapists memorize. The bullet-point system of features at the corner of the desk is likely a well ear-marked spiral-bound copy of the bible. Docs flip easily to a suspected disorder.

"See?" we declare knowingly. "That's you."  Or more likely, "That's her."

Some of us read the patient right away. He belongs to either the anxiety disorder family, or the affective (depressive-manic) disorder tree, because so many of us do. The lucky belong to both. The experienced professional also recognizes substance abuse, eating and gambling disorders, personality disorders, everything.

Still, we work at that differential diagnosis, want to narrow the problem down, if there even is a real disorder, one that has met the full DSM criterion. Not everyone has a particular disorder, but we live in a world replete with mental and behavioral messiness, so a typical therapy visit also means someone else, someone who is not in the room, is the subject of that "See? That's her." Yes, you should worry when your partner gets a therapist.

All well and good. But what's a therapist to do when the patient begins by saying, for example, that as a kid he had an addiction to pot, and can't remember being depressed as it presents in the books, but knows he had suicidal thoughts. He will continue to say that he treated teachers as inferior beings and passive-aggressively refused to answer questions, yet never scored lower than an 90 on a test without studying. She'll tell you, too, change the gender, that she binged and purged before even knowing it would be popular in college, and that by the age of twenty started having obsessive thoughts when she saw a knife, visualizing the knife slashing her of its own accord. Or she might irrepressibly slash herself. Add to this a social network disorder that culminated in job loss, and compulsive sexual relationships on the internet. Oh, and she has a new job and she hates it.

All this without any family history, as if to say, It is my genetics that made me do it. I have a mental disorder and none of the doctors in the past have managed to narrow it down. Would you do that for me please? I'm under a lot of stress.

I look at you, do my best to read you. You return the favor, read me. I ask, How did you find me? Why me? This yields wonderful diagnostic information. Another question: What does your primary care doctor think?

Inevitably, assuming the pri-care is a family physician, the answer is: That I need counseling. I need to talk to someone like you.

Those of us who have helped people in one or two visits, who specialize in "only evaluations" or are in a hurry or don't have evening appointments might want to pass him on to another therapist. Our patient with a million symptoms and as many diagnoses and problems likely had a very messy childhood. One of my mentors once told me that if a person has been incested, that means twice a week for years.

Makes sense, right?  There are so many forms of incest, is the thing, and indeed, twice a week on the couch for years is an incredible luxury. And it usually isn't necessary, all due respect. Who has that kind of time? Job stress is at the top of the list. There is a V-code, I think, for that.

Upshot: If the patient with All of the Above* is your new patient, then settle back and relax. Feet up on the ottoman. Do the therapy that the primary care doctor has asked you to do. And don't worry about the diagnosis, the medication, or even who else you think should be in therapy. This one's yours. Embrace it.


therapydoc

All of the Above*: Not to say that there aren't a few diagnoses, but usually there are a few features of several diagnoses. One does have to go through that process, vetting those features, finding illness. All I'm saying is, don't let the diagnostic process get in the way of the therapy. Because it really can, seductive monster that it is.