The Invisible Casualties of CBT

This article just below reads like a companion piece to my earlier post on my late wife’s Alison’s struggles with chronic pain.

I agree almost entirely with Alana Saltz, the author of the article, and am saddened that Alison isn’t here to read it (in fact, I had to fight my initial impulse to send it to her). Saltz lays out many of the criticisms of CBT that Alison had made to me over the years, both as a therapist herself, and as someone with chronic pain. Before hearing those criticisms, I’d always had some vague unease about CBT that I wasn’t quite able to pinpoint. It wasn’t until Alison started expressing her criticisms of CBT in the direct, concrete, and vehement way characteristic of her that I was able to re-focus my own vague, nebbish doubts about it. I wrote some of those criticisms up for grad seminars in CBT back when I was a grad student in counseling, but never did anything with what I wrote. Saltz’s piece reinforces my confidence in my criticisms; maybe I ought to take the time to write them up. Here, in any case, is a quick summary.

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Revisiting Hursthouse on the Repentant Racist (2 of 2)

In my last (recent) post on this topic, I argued that it seems absurd to blame people, or pass moral judgments of any kind on them, for what they experience in dreams. It follows that it’s absurd to blame, judge, or morally assess someone for having racist dreams, or generally, vicious dreams. But, I suggested, certain sorts of passing, stream-of-consciousness thoughts seem to bear a closer similarity to dream states than they do to conscious convictions. If so, thoughts of this variety are not a proper subject of moral assessment either, or at least less so, in proportion to their similarity to the relevant features of dreams.

One implication of this claim is that a person who encounters a lot of racist noise in his head, even racist noise voiced in the first person, is not necessarily a racist himself, and not to be judged a racist simply on that evidence–a claim that contradicts not just Hursthouse’s view, but one held by other moral philosophers. A second implication is that insofar as implicit bias/association tests function to detect a propensity to give voice to involuntary, osmotic mental noise, we have (yet another) plausible  explanation for their invalidity and unreliability, and should consider dramatically ratcheting back the use we make of them. Continue reading

Logistical Nightmare

It’s 4 am. I just woke up from the weirdest dream.

Dreamt that I’d wanted to go to Baghdad, so I’d booked a cheap flight via Dar-es-Salam, Tanzania, thinking to drive the rest of the way. But I’d somehow forgotten to book a rental, had underestimated the distance, and had forgotten about the problems posed by the existence of international borders and the Red Sea. As I belatedly made this realization, the cab showed up to take me to the airport–but I’d forgotten my flight information. So I went to my computer to refresh my memory, but inexplicably found myself in a public Internet cafe in Manhattan, able to remember but unable to type my password. When the guy next to me asked what was wrong, I explained the problem to him by bursting into tears, and then spelled my password out to everyone within hearing. Continue reading

Droning On

I’m teaching the issue of drone warfare and targeted killing in one of my ethics classes, the fifth or sixth semester in a row I’ve taught this material, via Kenneth Himes’s 2016 book, Drones and the Ethics of Targeted Killing. It’s been a frustrating, even despair-inducing experience: Of the 90 or so students enrolled, only half attend. Of the 45 of who attend, 40 are utterly indifferent to the material, unmoved even by the most shocking finding, revelation, or video I can throw at them.

My students–whether rich or poor, urban or suburban, black or white–simply do not care whether drones increase or decrease the incidence of terrorist attacks, much less whether their use is in any sense morally justified. Whether drones kill innocents or kill “bad guys,” whether the targets are justified in resisting U.S. policy or obliged to lie down and take it: none of this is nearly as important as whatever they’re doing on their phones. Continue reading

Psychotherapy and Chronic Pain: An Interview with Alison Bowles

Here’s an online interview with my wife (and PoT blogger) Alison Bowles, conducted by Raymond Barrett of the Telehealth Certification Institute in Canandaigua, New York. Alison is a psychotherapist in private practice with an on-ground presence in Manhattan, and a developing online practice.

The interview focuses on an under-discussed issue in therapy–therapy with people suffering from chronic pain. We hear so much about the “opioid crisis” that we forget that it’s overshadowedby a long shot–by a chronic pain crisis. There’s also a dangerous trend in mental health of pretending that chronic pain conditions can be managed and resolved by the magic of mindfulness and meditation. Though many studies suggest that such claims are nonsense, that hasn’t stopped the mindfulness gurus from making them: Continue reading

Against HIPPster Regulation

Consider this post a rant-by-proxy: I owe the basic idea for it to my therapist wife, Alison, but the issue occurred to me independently (though not with such clarity) a few years ago, after I took a professional ethics course for my counseling degree.

Psychotherapy is an odd vocation that’s hard to categorize in a straightforward way. A therapist is in some respects like a teacher, in some respects like a friend, in some like a parent, in some like a religious minister, and in some like a physician. But at the end of the day, therapy is a sui generis activity with its own internal standards and internal goods. Therapy may resemble pedagogy, friendship, parenting, spiritual counseling, and medicine in some respects, but isn’t any of those things. Nonetheless, the powers-that-be have decided nowadays that psychotherapy is a form of medicine, or if that strains credulity, that it ought to be medicalized as much as possible.    Continue reading

Questions About the Parkland Shooting (1): Whatever Happened to Patient Confidentiality?

The Parkland shooting seems to be one of those “tipping point” events that–like Ferguson in the case of the abuse of police power–may well change the trajectory of the debate over guns and gun control in the United States. At this point, it seems premature to come to any definite conclusions, whether about the shooting, or about what follows from its having happened the way it did. What seems more obvious to me is that far too many questions are going unasked. Here’s the first of several posts devoted to questions provoked by the shooting and the response to it–this first one provoked by the ease with which journalists seem to have gotten their hands on psychiatric or quasi-psychiatric reports having to do with the shooter’s state of mental health.

A question for people in social work/law enforcement: is there a legal/ethically legitimate way of getting hold of an adult welfare report by some equivalent of a Department of Children and Families as described in the article linked to just above? Or is journalistic reporting on the Florida DCF report on Nikolas Cruz based on a confidentiality-violative leak? Here’s some typical reporting on the release of the report, which is described as “confidential” in the same breath as it’s described as a matter of public record. Continue reading

The first thing we do, let’s criticize all the lawyers

I stick it to the lawyers’ guild at this discussion at I’m responding to Sam Glover (and others), “Why Are Lawyers So Expensive? I’ll Tell You Why.” As far as I’m concerned, he doesn’t.

Ironically, I’m the Pre-Law Advisor at Felician College.

I might add that some of my best friends are lawyers. Seriously.

Postscript, November 2, 2014: I was away for most of the weekend, so I didn’t visit to see how the Expensive-but-So-Totally-Worth-It lawyers had responded to my criticisms of their special pleading for their inflated fees. I just did.

In four days, the author of the piece, Sam Glover, who conspicuously “LOL’d” my initial comment, has backed off, shut up, and moved on without responding to anything I said. I’ve now asked another commenter, who admitted to increasing his fees on the basis of snap judgments of his clients’ “unrealistic expectations,” whether he’d be willing to universalize that judgment and allow service providers in other fields–doctors, therapists, mechanics, plumbers, educational institutions, insurance companies–to do the same without legal interference, oversight, or regulation. I’m morbidly curious to hear the answer.

It’s not that I lack respect for the legal profession as such. It’s a necessary and valuable profession with many noble practitioners. Nor do I much mind that such people have large incomes and live accordingly. What I mind is how many others of them are arrogant, misologistic sophists who thrive on the undeserved deference they get in our society, and who, despite their inflated egos, six-figure incomes, and delusional self-conceptions, cannot argue their way out of a paper bag. There are plenty of lawyers out there fitting that description, and a great number of them seem to congregate at I wouldn’t be surprised if some of them billed for being there–in which case I don’t mind giving them a run for their money. Unfortunately, I can’t bill for it, but philosophers don’t live by bread alone.

By the way, I should probably add that not only are some of my best friends lawyers, but so are some of my best former students!