She spotted him across the bar,
And her pulse quickened.
She wasn’t surprised to see him;
She knew he would be here,
But she stepped outside to finish
The joint she had started earlier.
After a few long drags, she
Went back in, downed a
Shot of tequila, and walked over.
She looked him straight in the eye,
Took his hand, and led him outside.
She firmly guided him to a dark spot,
Stared blankly into the dark, and
Unzipped his pants. He was full
Of confidence. “She couldn’t get
Enough, eh? Had to come back
For more of the good stuff.”
She was numb.
He was nothing.
He meant nothing.
It meant nothing.
It was only mechanical.
She wasn’t damaged.
She was strong,
Because she could
No longer feel.
If anyone accused him of
He would say,
“If she didn’t like it,
Why’d she come back for more?”
They say the pain is all in your head, but where else could it be? I mean, some people do complain of pain in their hands or elbows or knees or whatever, but really the experience of the pain is in their heads as a matter of perception. That’s why some people can claim to have pains in hands or legs that don’t exist. Or exist separated from the rest of the body. The pain is in the head, or really the mind, which is probably in the head.
At least we think of our thoughts as being in our heads. When someone does something crazy, we say, “What got into your head?” or something like that. And our thoughts really do seem to be in our heads, except when they are thoughts of the pain that is in our feet after a long day of standing—or maybe the pain of anxiety.
Or the head might not have that much to do with it. Maybe thoughts and pains are in the mind, but the mind is nowhere near the head. Stranger things have happened. I mean, no one doing brain surgery ever found a mind sitting in a skull. You just find brains and stuff in there. And fancy brain scans give colorful and delightful images of brain activity, but not too much info on where the mind is. Pretty interesting things brains are, maybe interesting enough to make minds, but who knows? Honestly, the question never crossed my mind before (this is an obvious lie).
As a young philosophy student, a professor asked if I thought the mind was in the brain. I answered affirmatively. He asked why I thought that, because that is what philosophy professors do. I’m embarrassed to say I answered in a way that seems typical of young men—with a violent example. I said that if you smashed someone’s skull with a steel bat you would witness significant degradation to that person’s state of mind.
Without relying on violent examples, you have to admit that it is often hard to see a mind capable of pure reason in a person whose brain is seriously damaged. Brains really seem important to this discussion, you know? So perhaps all pain is in the head because all pain is in the brain, but what of my arthritic hands? Surely something in my hands is related to the pain in my brain (or my mind for the people still holding out hope for that).
When someone says the pain is all in your head they mean it is in your head and does not correspond to any injury outside of your head (you know, like a stubbed toe or something). The pain is in your brain and nowhere else. Some doctors, of course, will think this fact is enough to justify denying your pain all together and, more importantly, denying you any treatment for your pain. Because of that, your pain gets no sympathy, no consideration, no attention, or anything.
And that creates a pain in your heart, and by that I mean an emotional pain. We say emotional pain is in the heart, partly because our chests often hurt when we feel emotional pain, but I think emotional pain is also in the brain or the mind, wherever it is. Pharmaceutical companies seem to agree; antidepressants aren’t heart medications, are they?
No matter where the pain is, it is most definitely real, even if we can’t be sure the mind is real. You know the pain is real because it is hurting you, and you can’t be wrong about whether you are hurting. Show me where the pain is in your body.
Impossible. The pain just is. The pain is part of the universal pain. The pain is in stardust. The pain is free-floating. The pain is in the neurons. The pain is in the gluons. You are hurting. I share your pain. We are real. Suffering is infinite, and it is all in the mind.
I am thrilled to have two poems in the new anthology, “Please Hear What I’m Not Saying,” edited by poet Isabelle Kenyon. The profits of the anthology will benefit the UK charity, MIND, which promotes mental health services and support while also working to reduce the stigma around mental illness. If I’m completely honest, I’m most excited to have my poems in the anthology because it is the first time any of my poems will appear in print anywhere, so I’m grateful to Isabelle for that.
Secondly, though, mental illness is a subject with deep meaning for me personally, which is why I decided to submit to the anthology in the first place. It is my personal belief that 100 percent of people experience mental illness at one time or another, but a fairly high percentage of us struggle for longer periods or with deeper pain. Over the course of my life (57 years as I write), I’ve had many happy times, but I have also been diagnosed with major depression, general anxiety disorder, insomnia, high blood pressure, migraine headaches, and the all-inclusive diagnosis of “stress.” In addition, I’ve pretty much diagnosed myself with Avoidant Personality Disorder just because I relate to every item on the list of diagnostic criteria.
If you look up statistics, you find that more women report depression, but more men die from suicide. You can make up your own mind about why this is the case, but I can tell you that over the years I have been told that my depression was a “luxury” and that it made me seem weak, pathetic, and selfish. If other men get the same message, it isn’t too surprising that fewer men report being depressed. When they do report mental illness, fewer services are aimed at them. Even when services are available to both men and women, the décor of offices and language of materials often has a stereotypically feminine feel that makes men feel unwelcome.
All of this makes me especially sensitive to the high-price of masculinity. We hear quite a bit about toxic masculinity, but toxic masculinity is a by-product of what philosopher Tom Digby calls sacrificial masculinity. Men are taught from the crib to ignore their own physical and mental health. In the past, men ignored their health in order to be better protectors and providers. Increasingly, emotionless brawn is less needed and less valued in society, so men are left with poor mental health with no obvious purpose, which only exacerbates the problem.
For a time, I facilitated men’s bereavement groups, and all the men said some version of the following: “I’ve been told how I’m not supposed to grieve (crying and emotional breakdown), but no one tells me how I am supposed to grieve.” Almost every man in every group I facilitated broke down in tears, and almost every one apologised for it. For this reason, I think if we can fight like men, we must learn to cry like men. Although I haven’t been successful at getting others to use it, I occasionally post information on men’s mental health with the hashtag #CryLikeAMan.
The anthology will be available from 8 February 2018.
I was fortunate enough to be included in Isabelle Kenyon’s new poetry anthology supporting the mental health charity, UK MIND. I was happy to participate in the project because I think any effort to remove stigma around mental illness and to provide support for those suffering is a good and necessary thing to do. I don’t think I am unusual, really, but I’ve had my bouts with depression, anxiety, avoidance and attendant health problems. The more open we can be about our struggles, the easier it will be for us, collectively, to cope. I’m very grateful to Isabelle Kenyon for her efforts, which she describes below.
Isabelle Kenyon is a Surrey based poet and a graduate in Theatre: Writing, Directing and Performance from the University of York. She is the author of poetry anthology, This is not a Spectacle and micro chapbook, The Trees Whispered, published by Origami Poetry Press. She is also the editor of MIND Poetry Anthology ‘Please Hear What I’m Not Saying’. You can read more about Isabelle and see her work at www.flyonthewallpoetry.co.uk
Thank you to Randall Horton for letting me guest blog today! I wanted to spread the word about the MIND Poetry Anthology, which I have compiled and edited. ‘Please Hear What I’m Not Saying’ will be out in early February, expected date of release to be Thursday the 8th, on Amazon. The Anthology consists of poems from 116 poets (if I include myself!) and the book details a whole range of mental health experiences. The profits of the book with go to UK charity, MIND.
The book came about through my desire to do a collaborative project with other poets and my desire to raise money for a charity desperately seeking donations to cope with the rising need for its work. I received over 600 poems and have narrowed this down to 180.
As an editor, I have not been afraid to shy away from the ugly or the abstract, but I believe that the anthology as a whole is a journey – with each section the perspective changes. I hope that the end of the book reflects the ‘light at the end of the tunnel’ for mental health and that the outcome of these last sections express positivity and hope.
‘Please Hear What I’m Not Saying’ is a poetry anthology, the profits of which will go to UK charity, MIND. The book consists of 116 poets (I’m happy to be one of them) from around the world and details a whole range of mental health experiences. The expected date of release is Thursday 8th, on Amazon.
Editor Isabelle Kenyon answers questions about the project.
Question: How did this project begin?
Isabelle: I knew I wanted to work collaboratively with other poets and it was actually the theme of mental health for a collection, which came to me before the idea of donating the profits to charity MIND. This was because I knew how strongly people felt about the subject and that it is often through writing that the most difficult of feelings can be expressed. I think that is why the project received the sheer number of submissions that it did.
Question: How did you select the poems – was there a process?
Isabelle: In some cases of course personal taste came into my selection, but I tried to be as objective as I could and consider the collection as whole. I wanted the book to have as many different personal experiences and perspectives as I could find. Because of this, I have not been afraid to shy away from the ugly or the abstract, but I hope that the end of the book reflects the ‘light at the end of the tunnel’ for mental health and that the outcome of these last sections express positivity and hope.
Question: Why should people buy this book?
Isabelle: Easy – to support the fantastic work which MIND does and to support the fantastic poets involved. Rave about their work because I believe the poets involved are both talented and dedicated.
Reid Ewing of Modern Family fame recently wrote publicly about his struggle with body dysmorphia in a personal essay on the Huffington Post. Ewing revealed that his dysmorphia led him to seek and receive several surgeries. He feels his surgeons should have recognized his mental illness and refused to perform surgery. He wrote, “Of the four doctors who worked on me, not one had mental health screenings in place for their patients, except for asking if I had a history of depression.”
The principle of autonomy is by far the most discussed principle of bioethics. Discussions typically focus on the rights of patients to refuse treatments, not to seek them. On either side, the issues can be thorny. If a depressed and suicidal patient refuses life-prolonging treatment, is it ethical to respect the patient’s autonomy or should mental health services be provided first? As in Ewing’s case, the ethical problem arises from the claim that the decision is driven by mental illness and not reason. If someone is mentally ill, they are not fully autonomous agents as they are not fully rational.
This is a problem with autonomy in general. Our ideas of autonomy come largely from Immanuel Kant, who claimed that all rational beings, operating under full autonomy, would choose the same universal moral laws. If someone thinks it is okay to kill or lie, the person is either not rational or lacks a good will. How do we determine whether someone is rational? Usually, most of us assume people who agree with our decisions are rational and those who do not are not rational. If they are not rational, they are not autonomous, so it is ethical to intervene to care for and protect them.
Earlier this year, a woman named Jewel Shuping claimed a psychologist helped her blind herself. She says she has always suffered from Body Integrity Identity Disorder (although able-bodied, she identified as a person with a disability). Most doctors, understandably, refuse to help people damage their healthy bodies to become disabled, which can lead clients to desperate measures to destroy limbs or other body parts, sometimes possibly endangering others.
Jewel Shuping never named the psychologist who may have helped her, so it is impossible to check the story. It is possible to imagine, however, that some doctors would help someone with BIID in the hopes of preventing further damage to themselves or others. Shuping says she feels she should be living as a blind person, and she appreciates the help she received to become blind. In contrast, Ewing feels he should have undergone a mental health screening before he was able to obtain his surgery and that his wishes should not have been respected.
Plastic surgeons are often vilified as greedy and unscrupulous doctors who will destroy clients’ self-esteem only to profit from their self-loathing. On the other hand, these same plastic surgeons are hailed as heroes when they are able to restore beauty to someone who has been disfigured in an accident or by disease. Unfortunately, we do not have bright lines to separate needless surgery to enhance someone’s self image and restorative surgery to spare someone from a life of social isolation and shame. Some would argue the decision should not be up to the doctors in the first place but should be left in the autonomous hands of clients.
Many have similarly argued that doctors should refuse gender confirmation surgery to transgender men and women. As with BIID, many assume that transgender individuals are mentally ill and should see a mental health professional, not a surgeon. Transgender activists (and I) argue that transgender individuals need empowerment to live as the gender that best fits what they actually are. If surgery helps them along that path, they should have access.
All this leaves us with the question of when to respect autonomy and when to take the role of caregiver, which may involve a degree of paternalism (or maternalism for that matter). Is it more important for doctors who ensure the patient’s rights to seek whatever treatment they see fit, or is it more important to provide a caring and guiding hand to resolve underlying mental health issues before offering any treatment at all?
One of Ewing’s complaints is that he was offered plastic surgery on demand with no screening at all. The process for people seeking gender confirmation surgery, by contrast, is arduous. Before surgery, transgender people go through counseling and live as their true gender for an extended period of time. At the far end of the spectrum, people with BIID rarely find doctors willing to help them destroy parts of their bodies and resort to self-harm. These three cases are not the same, but make similar demands on the distinctions between respect for autonomy and a commitment to compassionate care.
It seems reasonable to accept Ewing’s claim that mental health screenings should be a part of body modification surgery, especially when someone has no obvious flaws that need to be repaired. In all these cases (dysmorphia, gender identity, and BIID), mental health support is necessary. In each case, patients describe depression, emotional turmoil, and, too often, thoughts or attempts of suicide. Mental health care does not require a violation of autonomy, but it may help a person’s autonomous decisions to form more clearly from deliberation and not desperation.
Imagine you and a friend go to see a documentary (or even fictional film) about the plight of victims of famine, war, disease, or oppression, and you bawl uncontrollably throughout the film as your friend sits next to you unmoved and indifferent to everything happening on the screen. You think anyone who isn’t moved by the extreme suffering you’ve just seen must be some kind of monster (or a sociopath at the least). You feel, in short, that crying is more moral than just sitting there.
You will admit, of course, that your crying through the movie didn’t help the victims any and your friend’s indifference didn’t really hurt anyone. Still, it seems that a moral person should have feelings for those who are suffering, even if you can’t find any real benefit for these strong feelings for strangers who get no benefit from your tears, heartfelt as they are.
In fact, your friend might point out that you are getting all worked up for no reason, and it might be better to keep your emotions in check. Your wailing for these strangers won’t change anything for them, but it might impair your ability to attend to problems you can change. What good are you to your children, for example, if your mind is on the poor souls in some far corner of the world? You should get your head together, friend, and get on with the business of life.
But, you counter, if you learn to be indifferent and unmoved by the pain of strangers, you may become indifferent to the pain of others, including friends and, yes, your own children. You don’t want to become the kind of monster you now suspect your friend of being. You want to be the kind of person who is moved by the suffering of others. You may not be able to help in every situation, but you do not want to become callous and cold. You want to be a caring individual. It isn’t about what you can do but about what you are.
And now your friend points out that not only did you cry during the movie, but you seemed, in some sense, to enjoy it. In fact, you apparently went to the movie with the prior intention of being moved to tears. You chose the movie because it was described as “moving” and “emotionally riveting.” Will you be happy when your children fall ill because it will satisfy your need to “let it all out”? Perhaps you are the monster, after all?
You didn’t enjoy the pain, you object, but you enjoyed the high quality of the film and its ability to elicit the pain. It was beautiful in its ability to enlarge compassion and trigger a caring response. The film will help, if nothing else, audiences develop a greater sense of concern for others, even if it doesn’t affect everyone (with a sly and disapproving nod to your friend).
And your friend now points out that people had to suffer in order to expand compassion and develop a greater caring response, so the suffering of others is used as a means to your own ends. You are actually acting selfishly after all, and the film makers are also exploiting the suffering of these people in order to teach a moral lesson and even to make a profit and perhaps sit in the spotlight after receiving coveted awards. You can just imagine the director’s teary expressions of gratitude and exhortations for a more acts of compassion at the ceremony.
In 2012, comedian Anthony Griffith told the story of his daughter’s cancer in a moving performance for The Moth. The video quickly went viral. You can see the video here:
The video on YouTube now has more than 1.8 million views. It is almost impossible to watch the video without sobbing, and people shared it by promising that anyone watching should have some tissues on hand. For reasons that aren’t entirely clear, we enjoy experiencing his grief with him. It might be objected that we are emotional voyeurs watching a sort of grief porn. By watching, we are not helping his daughter, we are not preventing future cancer deaths, we are not improving medical care, and it isn’t clear how we might be improving ourselves.
Paradoxically, we simultaneously want to avoid our own pain but glom onto the pain of others. Watching the story enables us to experience the pain without having to actually experience the loss of child. Doing this while watching a fictional account of loss seems justifiable in many ways, but to seek out a chance to cry and experience this kind of pseudo-grief that is provided by the actual grief of another person certainly raises an ethical concern.
We might say that Anthony Griffith needed to talk about his loss, and we are providing him with an audience. We are doing him a great favor by listening. We are honoring his loss. And he may agree with us. In this case, he is using us to help him along his healing journey, but this doesn’t seem to be what is going on. We want to see and hear his story. We want to be part of his grief story without having to do any heavy lifting ourselves. We watch the video, feel emotional excitement, hug our loved ones because one never knows when they will be gone, and then we are done with it.
We might say that we want to hear the story because it is well written and well performed. Griffith is extremely talented as a story teller, and we appreciate his talent and courage to share such a personal story. When we watch the video, we are paying tribute to his writing and his acting. The only problem is that he really doesn’t seem to be acting. He has merely put his pain on view for the world. He is certainly talented, and the story is well-written, but most people will be moved by anyone’s story of a lost child. It is relatively easy to evoke strong emotions with a story of intense pain and grief.
It may be that we want to hear his story so we can prepare ourselves for the times our story might be the main event. Someday we will have to do the heavy lifting. If we can live through Griffith’s pain, maybe we can face our own. By experiencing Griffith’s grief, we see that we can also face it and live through it just as he has done. We finish the video feeling somehow more prepared.
Or we may be drawn to the stories of others because it provides an evolutionary advantage. By hearing stories of others, we develop compassion and care. Other than providing an audience, we may not be helping Griffith directly, but we may be better able to empathize with others in the future. We are preparing not only for how to face our own struggles but to help others through theirs. If this is true, then we are actually doing something noble and beneficial by watching such videos.
Or, maybe we are just seeking the thrill of an emotional roller coaster ride.
Comments are welcome below. I appreciate corrections to typos and so forth (firstname.lastname@example.org).
We are offering a workshop on the ethics of grief on Friday, Dec. 4, from 9 a.m. till noon. We will be exploring proper responses to grieving clients. Most therapists accept the dictum that “There is no wrong way to grieve,” but we will look at extreme cases such as homicide and self-destruction and search for the “bright line” between good and bad grief. We will then ask whether “bad grief” is unethical or merely unhealthy. We will examine the ethical response to “bad grief” and explore whether men and women should respond to grief differently.
The workshop is open to anyone, but we offer 3 Continuing Education Units (CEUs) to Licensed Professional Counselors, Licensed Marriage and Family Therapists, and Licensed Clinical Social Workers.
The cost is $25.00.
For more information, write email@example.com