Tuesday, September 20, 2016

Witness my Life: A Psychotherapist's Journey to Healing

Witness my Life: A Psychotherapist Journey to Healing

Why is it that people participate in research?

A new method of recording and documenting perspectives from a community perspective, called photovoice, has started generating interesting results. Photovoice is where community members are provided with a camera, video or voice recorder to document events at the community level. Photovoice was developed in 1992–by Caroline Wang of the University of Michigan, and Mary Ann Burris, at Women's Health at the Ford Foundation, Beijing, China--for rural women in Yunnan Province, China to advocate for new policies and programs. This method has been producing some amazing documentaries on homelessness among teenagers, illegal drug trade, as well as images of dementia. And the motivation for participating in this kind of documentation is that it seems we want someone to be a witness to our life. Not to judge it, or even be part of it, but just to witness our trials and tribulations. Perhaps an affirmation, that because someone sees our lives nearly as close to as we experience them, that somehow, then, we matter. Perhaps it is seen as some form of non-judgmental validation. All of those screaming social network sites are but another expression of this desire for others to witness our lives.  In this case of witnessing, it is a form of benevolent narcissism.

Albert Camus wrote about this in 1956, in one of his most understated novels, The Fall. This story tells of a confession to a stranger. It takes place in a bar called Mexico City in Amsterdam, by the protagonist of the story Jean-Baptiste Clamence. From his success as a wealthy Parisian defense lawyer culminating on an unidentified crisis which brings about a vague fall from grace. After making some broad and general confession to a stranger in a bar, Jean-Baptiste Clamence ventures out into the night one last time. We are meant to assume that his last act is suicide. Jumping off one of the may bridges in Amsterdam. But the point of the novel is that the only way to bring meaning to the suffering of living, without a god, without objective truth is if there is some recognition that we exist. 
Jean-Baptiste Clamence’s confidant, an unknown character, becomes his final witness to his life. The Fall was awarded the 1957 Nobel Prize in Literature and was Camus’ final piece of fiction until he died in a car crash. The book’s complexity allows for different interpretations and for me it has been the fact that we are ultimately responsible for everything. By your activity or inactivity, we choose to support an outcome. But such an interpretation is too shallow for a deeply complex and ambivalent story.  We might be responsible for our actions, but then there is no morality to pass final judgement. Our final judgement is to have a witness. Good or bad actions do not matter if there is no one to witness it.

Maria Arman with the Karolinska Institutet in Solna, Stockholm, Sweden, in her book, Bearing witness: An existential position in caring has one of the closest meaning to this interpretation of witness. That witnessing is part of the definition of who we are. As social beings, our awareness of self is influenced (if not completely defined) by what and how we think others are defining us.  A basic assumption in caring, or being empathic is to be present for the other person. To bear witness for someone, to share their awareness is to share their burden. But there is more to witnessing, because by sharing an awareness you are affirming their journey through life.

The philosopher Emmanuel Lévinas defines an encounter with another person as a privileged experience. The proximity of the other person is the acknowledgement of being real. In a world where images are held as real, and truth is negotiated, the idea that I matter is a consoling balm on the rawness of my ever changing world.
To be a witness you share a physical space and experience the same perspective with another person. You share, verbally, emotionally or spatially a mutual reality. There is a convergence where you become the other person as much they become you. This is the healing of witnessing. Developing such a relationship is a willful act on your part. Witnessing is an affirmation that we have passed through life. No judgment about good or bad outcomes. There is a validation of my presence, and my journey. A memorable tune, a remembered story, a shared intimacy. All experiences that when witnessed can assert my place in this world. That although there might be nothing else but my experiences, that for one brief moment, that internal and closed trove has been acknowledged.

Isn’t this what psychotherapy is all about? If Sigmund Freud in 1905, the father of psychotherapy, was not so misguided as to suggest that because learning stops at age 50, older adults are not good candidates for psychotherapy, perhaps we would be able to see the effect of witnessing in alleviating despair. As psychotherapists try to instill trust, the experience of witnessing remains the bedrock for affirmation of one life.

 © USA Copyrighted 2016 Mario D. Garrett

Witness my Life: A Psychotherapist's Journey to Healing

Witness my Life: A Psychotherapist Journey to Healing

Why is it that people participate in research?

A new method of recording and documenting perspectives from a community perspective, called photovoice, has started generating interesting results. Photovoice is where community members are provided with a camera, video or voice recorder to document events at the community level. Photovoice was developed in 1992–by Caroline Wang of the University of Michigan, and Mary Ann Burris, at Women's Health at the Ford Foundation, Beijing, China--for rural women in Yunnan Province, China to advocate for new policies and programs. This method has been producing some amazing documentaries on homelessness among teenagers, illegal drug trade, as well as images of dementia. And the motivation for participating in this kind of documentation is that it seems we want someone to be a witness to our life. Not to judge it, or even be part of it, but just to witness our trials and tribulations. Perhaps an affirmation, that because someone sees our lives nearly as close to as we experience them, that somehow, then, we matter. Perhaps it is seen as some form of non-judgmental validation. All of those screaming social network sites are but another expression of this desire for others to witness our lives.  In this case of witnessing, it is a form of benevolent narcissism.

Albert Camus wrote about this in 1956, in one of his most understated novels, The Fall. This story tells of a confession to a stranger. It takes place in a bar called Mexico City in Amsterdam, by the protagonist of the story Jean-Baptiste Clamence. From his success as a wealthy Parisian defense lawyer culminating on an unidentified crisis which brings about a vague fall from grace. After making some broad and general confession to a stranger in a bar, Jean-Baptiste Clamence ventures out into the night one last time. We are meant to assume that his last act is suicide. Jumping off one of the may bridges in Amsterdam. But the point of the novel is that the only way to bring meaning to the suffering of living, without a god, without objective truth is if there is some recognition that we exist. 
Jean-Baptiste Clamence’s confidant, an unknown character, becomes his final witness to his life. The Fall was awarded the 1957 Nobel Prize in Literature and was Camus’ final piece of fiction until he died in a car crash. The book’s complexity allows for different interpretations and for me it has been the fact that we are ultimately responsible for everything. By your activity or inactivity, we choose to support an outcome. But such an interpretation is too shallow for a deeply complex and ambivalent story.  We might be responsible for our actions, but then there is no morality to pass final judgement. Our final judgement is to have a witness. Good or bad actions do not matter if there is no one to witness it.

Maria Arman with the Karolinska Institutet in Solna, Stockholm, Sweden, in her book, Bearing witness: An existential position in caring has one of the closest meaning to this interpretation of witness. That witnessing is part of the definition of who we are. As social beings, our awareness of self is influenced (if not completely defined) by what and how we think others are defining us.  A basic assumption in caring, or being empathic is to be present for the other person. To bear witness for someone, to share their awareness is to share their burden. But there is more to witnessing, because by sharing an awareness you are affirming their journey through life.

The philosopher Emmanuel Lévinas defines an encounter with another person as a privileged experience. The proximity of the other person is the acknowledgement of being real. In a world where images are held as real, and truth is negotiated, the idea that I matter is a consoling balm on the rawness of my ever changing world.
To be a witness you share a physical space and experience the same perspective with another person. You share, verbally, emotionally or spatially a mutual reality. There is a convergence where you become the other person as much they become you. This is the healing of witnessing. Developing such a relationship is a willful act on your part. Witnessing is an affirmation that we have passed through life. No judgment about good or bad outcomes. There is a validation of my presence, and my journey. A memorable tune, a remembered story, a shared intimacy. All experiences that when witnessed can assert my place in this world. That although there might be nothing else but my experiences, that for one brief moment, that internal and closed trove has been acknowledged.

Isn’t this what psychotherapy is all about? If Sigmund Freud in 1905, the father of psychotherapy, was not so misguided as to suggest that because learning stops at age 50, older adults are not good candidates for psychotherapy, perhaps we would be able to see the effect of witnessing in alleviating despair. As psychotherapists try to instill trust, the experience of witnessing remains the bedrock for affirmation of one life.

 © USA Copyrighted 2016 Mario D. Garrett

Thursday, September 8, 2016

If Alzheimer’s disease was Treated like Cancer

The 2016 Cancer Moonshot, headed by Vice-President Joe Biden, the most potentially funded-health research enterprise in the USA just issued a set of 10 recommendations for cancer research. The Blue Ribbon Panel of expert advisers suggested basic steps in research that are very similar to the steps we should be taking in dementia research if we are serious about a cure. What would these Blue Ribbon Panel of expert advisers advise on dementia? Perhaps something along the following lines below:


  1. Establish a network for direct patient involvement; engage patients to contribute their comprehensive dementia profile data to expand knowledge about what therapies work, in whom, and in which types of dementia.
  2. Establish a dementia immunotherapy clinical trials network devoted exclusively to discovering and evaluating immunotherapy approaches.
  3. Develop ways to overcome dementia’s resistance to therapy, through studies that determine the mechanisms of misfolded proteins, in addition to the Beta Amyloid and Tau Protein.
  4. Create a national ecosystem for sharing and analyzing dementia data so that researchers, clinicians, and patients will be able to contribute data, which will facilitate efficient data analysis.
  5. Intensify research on the major drivers of early onset dementia; improve understanding of the genetic component of early onset and use new preclinical models to develop inhibitors that target them.
  6. Minimize dementia treatment's debilitating side effects; accelerate the development of guidelines for routine monitoring and management of patient-reported symptoms to minimize debilitating side effects of dementia and its treatment.
  7. Reduce dementia risk and dementia health disparities through approaches in development, testing, and broad adoption of proven prevention strategies.
  8. Mine past patient data to predict future patient outcomes; predict response to standard treatments through retrospective analysis of patient specimens.
  9. Create dynamic three-dimensional maps of human dementia evolution to document the genetic lesions and cellular interactions of each neuropathological event  as it evolves from a preclinical to advanced dementia.
  10. Develop new enabling dementia technologies to characterize neuropathology and test therapies.

For a complete summary of the faults with Alzheimer’s research and why we need a similar Blue Ribbon Panel of expert advisers of Alzheimer’s disease:

Garrett MD & Valle R (2016) A Century of Confusion in Researching Alzheimer’s Disease. Dementia: The International Journal of Healthcare 2(2), 13-22.

Garrett MD, Valle R (2015) A New Public Health Paradigm for Alzheimer’s Disease Research. SOJ Neurol 2(1), 1-9.

Garrett MD & Valle RJ (2016).A Methodological Critique of The National Institute of Aging and Alzheimer’s Association Guidelines for Alzheimer’s disease, Dementia and Mild Cognitive Impairment. Dementia: The International Journal of Social Research and Practice,15(2) 239–254. DOI: 10.1177/1471301214525166

Garrett MD (2015) Politics of Anguish: How Alzheimer's disease became the malady of the 21st century. Createspace. USA

© USA Copyrighted 2016 Mario D. Garrett