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Paula Joan Caplan's Authors Guild Blog

Don't Believe Everything You Read: Words Matter Desperately

Initially published January 12, 2021, at https://www.madintheuk.com/2021/01/dont-believe-everything-you-read-words-matter-desperately/

The seed for this essay is the way that the use of five words has skyrocketed in print, in media, and among both professionals and laypeople, and this is causing harm. The overuse of three of these words has especially increased during the covid-19 pandemic, leading to what I consider the unwarranted and dangerous pathologizing of feelings that should not be considered signs of "mental illness." The overuse of the other two of these words leads to the minimizing of the seriousness of behavior that is abusive and oppressive, making it hard for the targets of such conduct to feel that the degree of their upset is perfectly understandable and justified. 


Readers of this site tend to know a great deal about the harm done by psychiatric diagnostic labels. As I have said elsewhere, psychiatric diagnosis is the first cause of everything bad that happens in the mental health system. After all, if they don't diagnose you, they are not supposed to do anything to "treat" you, but once they give you any psychiatric label, they can do almost anything to you in the name of treatment, and since psychiatric diagnosis is totally unregulated, there is little or no recourse if you are harmed. Because I have written and spoken at length about these matters,1 I will not elaborate on them further here.  Instead, I will address some other harmful words that are liberally used these days and that ought to cause us alarm. 


The words on which I focus in this essay are "depression," "anxiety," "guilt," "bullying," and "microaggression." It is alarming that even people who scrupulously avoid using psychiatric labels readily use the above, apparently without concern for the ways they (1) make it harder to identify what is really happening to someone who is suffering and (2) pathologize sufferers even though the terms do not come from the Diagnostic and Statistical Manual of Mental Disorders or the psychiatric portion of the International Classification of Diseases. Often, the sufferers themselves apply these words to themselves, perhaps unaware that this can cause them trouble and get in the way of their feeling better. 


The words "depression," "anxiety," and "guilt" have in common that they are used to describe a person's feelings, and it is hard to read an article or hear a media commentator talk about the pandemic without saying that the rates of these have dramatically increased (Caplan, 2020a). "Bullying" and "microaggression" are different, because they describe behavior by others that is harmful/abusive/traumatizing to the targets of that behavior.  


"Depression," "Anxiety," and "Guilt" 
I am an actor and director, and a few years ago, I was asked by the world's best acting coach, the (now late) Eden Harman Bernardy, to speak to her students, who were increasingly being asked to audition to play characters who were described in psychiatric terms: "Chris is Bipolar" or "Marilyn is Borderline." I explained that these categories are not scientifically derived, and that for a great many reasons, two people given the same psychiatric label usually differ from each other in a wide variety of ways, so it is not helpful to try to "play Bipolar" or "play Borderline." 


I also addressed with the students what are perhaps the three most commonly used, ordinary words for emotions: "depression," "anxiety," and "guilt." Each is misleading in ways that make it hard to know what a person who ascribes it to themselves is really feeling.  


David Cohen and David Jacobs in a classic article (2007) have shown that "depression" is essentially a wastebasket term, used so variously that if no attempt is made to understand more about what a "depressed" person is feeling, it makes hard for them and for the person who wants to help. People who say they are "depressed" may be feeling loneliness, sadness, grief, hopelessness, helplessness, despair, shame, nostalgia, meaninglessness, aimlessness, lack of physical energy, or brain fog. If the sufferer and the prospective helper leave it at "depression," they will find it difficult to figure out what might be useful in alleviating the feeling. Furthermore, leaving it at "depression" is these days extremely likely to lead to the proposed "solution" being drugs marketed as "anti-depressants"; that is, if "depression" is assumed to be a clearcut, identifiable entity, then it can seem to make sense that an "anti-depressant" will fix "it." Of course, following the lead of Cohen and Jacobs, if "depression" itself is so vague, then if the people studied in research about treatments including psychiatric drugs are "depressed" people, the treatment is being tested on people whose suffering is troublingly heterogeneous. If a drug is given to people who have a certain bacterial infection, it makes sense that the drug is an antibiotic known to kill that bacterium. But giving an "antidepressant" drug to some people who are lonely, some people who have lost their religious faith and are struggling for that reason, some people who are bereaved, some people who are feeling ashamed, some who are being harassed at work but unable to leave their job because they support their children, etc., what do we think we have found when we look at the results of the drug? Indeed, how do we even begin to think about the results? If instead of calling their drugs "anti-depressants," if drug company executives were required to be truthful, they would have to name them "drugs we'd like anyone not feeling happy and fulfilled to take, in the hope that they will be helped." 


So when someone says they are "depressed," I ask them the following: "If you were not going to use that word to describe how you are feeling, what word or words would you use?" This helps that person and me to understand more about what is going on, and whether in a professional situation or speaking with a friend or family member or colleague, the road to feeling better will become clearer if the feeling or feelings are described as accurately as possible. It is unfortunate that people have been led to believe that reporting they are depressed is informative beyond conveying only "I don't feel happy." 


When someone says they are "anxious," I ask them the same question I ask someone who says they are "depressed." The reason is that having identified oneself as feeling "anxiety," one has little idea how to get to feeling better. In an acting class, a young woman performed a monologue, and afterward, Eden Harman Bernardy asked how she felt about how she had done. The woman replied, "I didn't feel good about it. You see, I have been anxious all week about doing this monologue." When I asked her what word she would use to describe how she had felt during the week if she were not going to use "anxious," she immediately replied, "afraid." She was afraid she would not do well, afraid of looking foolish, afraid it would prove she could not act.  I find that nearly always when I ask a person to use a word other than "anxiety," the word they use is "fear." In contrast to the nebulous images "anxiety" evokes, "fear" points the way to reducing suffering: Fear is always of something. Once we consider what we fear, we can ask crucial questions such as, "If the thing I fear really happens, will that be a total disaster?" and "Are there steps I can take to reduce the chances that the thing I fear will happen?" and "How do I want to handle it if the thing I fear does in fact happen?"


When we are already afraid, we paralyze ourselves emotionally if we also feel powerless, and the vagueness of "anxiety" increases not only the sense of powerlessness but our actual lack of power, because we don't know how to think clearly about moving forward. 


A parallel with the use of "depression" is that someone who reports to a professional that they feel "anxious" is very likely to light up the "anti-anxiety drug" spot in the professional's brain, so that instead of guiding the person to identify the underlying fear and ways to minimize the feared consequences or plan to cope with them, both sufferer and therapist will match the vague "anxiety" with "anxiolytic drug." Although for some people at least for awhile, drugs in that class may help suppress the physical effects of fear, they do not help the person understand the fear and learn to cope with it. 


When Dr. Nikki Gerrard wrote a paper years ago as a graduate student and called it "'Guilt' Is a Terminal Word," I was intrigued by the title. Her point was that to say, "I feel guilty" gives one nowhere to go to move beyond that feeling. Saying, "I feel guilty, because I rarely go visit my mother" does not change the situation. So in trying to help someone overcome what they are calling "guilt," that word is terminal in that it stops the person in their tracks. "Guilt" sounds like something individual and intrapsychic, but when Gerrard talked with people about what they began by calling "guilt," she found that the key factor was what she called a problem-in-relation, something about a difficulty in a connection that mattered to them, such as worry about loss of love. I thought that was a terrific insight, so I began asking people who said they felt "guilty" what word they would use to describe their feeling if they were not to use that word. Almost always, the response has been "shame." Now, that is not a terminal word! "Shame" is the emotion we have when we feel we have been seen by someone — usually someone we care about — to fail to live up  to a particular standard. Therefore, the routes to pursue are to ask "What is the standard you feel you are failing to meet?" "When you think about it, does that seem like a reasonable standard, one that you definitely want to meet?" "How did you come to accept that standard?" "Do you know who set the standard for you?" "In whose eyes do you feel you are failing to meet the standard?" "Do you agree that you are failing to meet it?" "How much do you care about that person believing you are failing to meet the standard?"  


Another important aspect about the word "guilt" is that it is easier to pathologize ("This person is just inexplicably consumed with guilt"), because it seems less understandable than worry about losing a loved or admired one's respect or care. 


"Bullying" and "Microaggression" 
These two words are causes for worry, because both of them minimize the damage done to the targets of such behavior, and that minimizing makes it easier to classify the target's upset as overreaction. 


I've never understood why the term "bullying" suddenly became popular, but each time I hear a description of behavior to which that term is applied, I am struck by the fact that the behavior is actually abuse. "Bullying" tends to evoke images of a young kid on a playground being mean to another child, and some schools have entire "anti-bullying" programs. But what possible useful distinction can be made between "bullying" and abuse? Aren't cruelty and throwing one's literal or figurative weight around in order to intimidate another person abusive? Surely nothing is to be gained by reducing such conduct to "bullying." In fact, it is damaging that the perpetrator's responsibility for causing harm is minimized.   


The history of this term is important to understand. In 1970, when condemnation of overt race-based violence had increased in some quarters, leading some people to claim that racism was behind us, Dr. Chester Pierce  (1970) coined the term "microaggression," because he recognized the importance of drawing attention to less blatant manifestations of racism. The "micro" part of the term was intended to reflect the fact that bias and oppression can take forms other than physical attacks, name-calling, and explicit rejection or humiliation.


"Microaggressions" are described as brief and/or subtle manifestations of prejudice and hatred that are "great in the power or magnitude of their consequences" (Caplan & Ford, 2014). I coordinated the Voices of Diversity Project (Caplan & Ford, 2014), in which we documented the factors on predominantly white university campuses in the United States that are manifestations of racism and sexism and that impede their targets' attempts to acquire an education. Because some overt manifestations of racism and sexism (though not sex-based assault) had declined due to laws and regulations against hate speech and to civil rights laws, most of what we heard in our one-on-one interviews with students we called "microaggression." In an irony that I did not recognize at the time we wrote the report of our research, we went to great lengths to report the students' detailed, vivid, heartbreaking descriptions of the devastating effects those manifestations had on them. Only in 2020, when I read Ibram X. Kendi's brilliant, important book, How To Be An Anti-racist (Kendi, 2019), where he criticizes the word "microaggression" as minimizing the effects that these "micro" events have did I realize how the term can make the targeted people feel that they are overreacting to "something so small." As I recently wrote elsewhere (Caplan, 2020b), "I wish I had thought to point out in [the] article [reporting our findings] that the term 'microaggression' could mistakenly imply that the effects of such acts are minor. In fact, the very nature of these acts often makes it easier for the perpetrators to claim that their targets are overly sensitive or paranoid, which can cause huge torment." I gave this example (one among a huge number) of a student's description of something that happened to him:   


An African American man said: "I have to stop and think sometimes, 'Are they being racist? Or, is that just how they act? Or, are they just not being friendly because they're having a bad day?' So I try not to let it get into my head and make me angry and things like that. I just try to think it through, like maybe there are other reasons why they're not friendly. So I try not to think about all the negative and try to think about the positive. I do speak and try to get them to speak, but if they don't want to, I just try to go on with my day. It makes me feel like I am not wanted." (Caplan, 2020b, p.5) 


Imagine if that student had been told that what had happened to him was called "microaggression." What he needed was someone to tell him that whoever told a racist "joke" or rolled their eyes when he spoke in class or turned away from him when the professor said to form work groups was being cruel and oppressive. 


I hope that readers will consider how the five words noted here cause unnecessary human suffering and in various ways impede attempts to reduce suffering. 


Caplan, P.J. (2020a). Is covid-19 making everybody crazy? https://www.madinamerica.com/2020/07/covid-19-making-everybody-crazy/ 

Caplan, P.J. (2020b). Editorial/éditorial: "Microaggression" is not micro. APORIA: La revue en sciences infirmieres/The Nursing Journal 12(1), 4-5. https://uottawa.scholarsportal.info/ottawa/index.php/aporia/issue/view/524/309 

Caplan, P.J., and Ford, J.C. (2014). The voices of diversity: What students of diverse races/ethnicities and both sexes tell us about their college experiences and their perceptions about their institutions' progress toward diversity. APORIA: The Nursing Journal 6(3), 30-69. 

Cohen, D., & Jacobs, D.H. (2007). Randomized controlled trials of antidepressants: Clinically and scientifically irrelevant. Debates in Neuroscience 1, 44–54.  

Kendi, Ibram X. (2019). How to be an Anti-racist. New York: One World. 

Pierce, C. (1970). Offensive mechanisms. In F. Barbour (Ed.), The Black Seventies. Boston: Porter Sargent, pp. 265-282. 

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Is Covid-19 Making Everybody Crazy?

Originally published at https://www.madinamerica.com/2020/07/covid-19-making-everybody-crazy/ 


The coronavirus pandemic has provided a golden opportunity for some psychotherapists, Big Pharma-funded entities, and others, who have sounded an alarm, claiming that massive numbers of people are "mentally ill" because of fears of the virus and reactions to social distancing.


Media producers have promoted these warnings during May, which was deemed Mental Health Awareness Month. A recent Washington Post article headlined "A third of Americans now show signs of clinical anxiety or depression, Census Bureau finds amid coronavirus pandemic" made that claim. And in a recent New York Times article, psychologist Andrew Solomon, reporting data that nearly half of respondents said the pandemic harmed their "mental health," shockingly equated this with mental illness becoming "universal reality."


In a June 5 press release, the American Psychiatric Association (APA), a lobby group for psychiatrists, reported an increase in psychiatric disorders during the pandemic that it based on an anonymous, online screening tool. Screening tools that allegedly tell the test-taker whether they have a "mental illness," including this Mental Health America (MHA) tool, are usually based on a list of feelings and difficulties that most people feel sometimes, and the cutoff points they give for when you should seek professional help are not scientifically based.


This tool includes instructions to take their Depression test if you are feeling overwhelming sadness. Do we really want to call overwhelming sadness in response to the isolation, fear, and unknown future occasioned by the pandemic a mental illness? They say to take their Anxiety test if worry and fear are affecting your daily functioning. Who these days doesn't worry whether their mask is adequate, whether they have washed their hands enough times and in hot enough water, whether to stay away from a beloved, elderly relative for fear of communicating the virus and thus increase their loneliness or go see them, wearing mask and gloves and staying six feet apart but still worrying because we might find out later that six feet of distance was notenough?


Such claims promise a vast expansion of the market for therapists, but such claims carry great potential for harm, adding to the burdens of people with upsetting but understandable, deeply human feelings by informing them they have psychiatric disorders. Anyone having upsetting feelings deserves love, help, understanding, and support, whether from family and friends or, if they choose, from clergy or therapists. But people also deserve to know about the dangers of classifying all upset as mental illness.


There are two common meanings of the term "black box," and both apply here. One meaning comes from the Food and Drug Administration's black box warnings to alert potential consumers to a product's dangers, and as applied here, people should be warned not to rush to call their upset "mental illness."


When people are struggling, suffering, or responding in unusual ways, they frequently fear their feelings mean they are "mentally ill," that they should be "doing better" than they are. One of the most helpful things that therapists can do is to let them know that their feelings are deeply human reactions, not signs of illness.


A hard look at four facts makes it clear that caution is warranted before pathologizing reactions to the current pandemic:

(1) Little is known about COVID-19 or how to protect oneself from it, and its effects can be fatal, so feeling confused, frightened—even terrified, powerless, and helpless—should not be classified as psychiatric disorders but rather as a normal and understandable reaction to extremely unusual events.
(2) As poet Heather McHugh observes, in our daily lives under ordinary circumstances, we tend to avoid "our fundamental terror at our own deaths," but the pandemic's massive concentration of so many deaths at once, and the fact that our own death is now more likely to be imminent, "makes the burden of the knowledge of mortality weigh" heavily on us. McHugh cites Audre Lorde's poem, ""A Litany for Survival," which ends with the line "we were never meant to survive." Suddenly to be confronted with something so terrifying for many people that they usually drive it out of awareness is a shock and disorienting in its own way: The fleeing doesn't work as well now, so how to begin finding other ways to cope with our mortality?
(3) Physical isolation from others interrupts the participation in community that is proven to be healing; but social distancing and stay-at-home policies drastically reduce participation in community. Connections via zoom calls have skyrocketed and can be helpful but have drawbacks. Many include numerous participants, which can inhibit deep conversations about feelings and creation/maintaining of meaningful relationships. Further, there is some strain involved in monitoring who is speaking and when to jump in, and it requires extra energy to remember to stay within camera range, monitor when to mute and unmute oneself, and project enough to be heard. No zoom call can replace human touch, which promotes security, happiness, and belonging. Being unable to hug a loved one without fear of unknowingly transmitting or getting the virus seriously interferes when we want to see people with whom we do not live—grandparents, elderly parents, grandchildren, friends, neighbors.
(4) Many people are grappling with increased loneliness, alarm about losing jobs and work identity, new financial crises, and child or spousal abuse. Asians and Asian Americans have been targets of discrimination and abuse because of claims that COVID-19 originated in China. Many African Americans and Latinx people and people in nursing homes, prisons, and psychiatric hospitals know that their risk of getting the virus is higher than that of others, compounding fear, suffering, and anger about the reasons for the increased risk. Upset due to any of these causes should not be called mental illnesses. The same applies to frontline healthcare and other essential workers and people who have suddenly had to provide constant care for family of all ages and education for offspring or those grieving loved ones' deaths. As with military veterans traumatized by war, or victims of all forms of oppression and violence, the last thing such people need is to be told their reactions are proof that they are psychiatrically disordered; the message that they should be "coping better" only adds to their burden.

No wonder so many people are feeling upset!


People who are suffering emotionally from the effects of COVID-19 deserve help, but it must be real help, such as lifting their economic burdens, protecting them from violence, and increasing community support, including all of us showing we are willing to listen to what they are going through and acknowledging how common these struggles are. Importantly, we must let them know that their suffering does not warrant classifying them as mentally ill (as psychiatrist Dainius Puras, Special UN Rapporteur, notes).


An increasingly pervasive pattern is the leaping to recommend "therapy" or "mental health services" when attention is drawn to human suffering. This relates to the older meaning of "black box" as something whose inputs and outputs can be viewed but whose internal workings are unknown. The terms "therapy" and "services" are black boxes, so vague that they can include the entire range of good and bad therapists and approaches. Often, well-meaning friends and family, and certainly legislators, feel they have done their bit by sending someone to therapy or voting to increase funding for such services without ensuring that the therapists are caring and effective or that the services actually help. Some therapists are terrific, and some approaches classified as "mental health services" help some people, but some therapists cause harm.


Likewise, psychiatric drugs sometimes help but very often harm, and their use has skyrocketed early in the pandemic, perhaps due to people assuming they would need them, but has now declined to around pre-pandemic levels. Other approaches can cause harm, and some services actually increase suicides. Furthermore, as soon as a person is diagnosed as "mentally ill," their own focus and that of professionals tend to veer sharply away from nonpathologizing, low-risk and no-risk approaches that are known to be effective.


More than two dozen of the latter, such as involvement in the arts, physical exercise, meditation, having a service animal, doing volunteer work, and having a listener, can be seen here (these are from a conference about veterans but can be helpful for anyone) (see also here). But entities like the APA do not tend to mention such approaches but only focus on therapy and drugs, and the MHA screening tool they cite urges people to see a mental health professional.


Lauren Tenney, Ph.D., a psychologist with expertise in trauma and human rights violations, says that "emotional responses people are having to the unnatural and traumatic circumstances created by the pandemic are not signs of supposed 'mental illness.'" She stresses that people who are "experiencing a range of emotions outside of their comfort zone ought to see these emotional upheavals as par for the course and attempt to embrace the depths of feelings social isolation can create."  She urges those who are suffering: "Actively work to connect with others who are having similar experiences" and suggests that "People should be supported in finding resiliency in the face of environmental adversities."


Even Google is getting into the act, partnering with the National Alliance on Mental Illness (NAMI) to post an "anxiety self-assessment" tool. The announcement of the partnership included description of NAMI, which is heavily funded by Big Pharma, as a "grassroots" organization and uses a tool that is based directly on a psychiatrized description of anxiety and is titled with a psychiatric disorder's name. Furthermore, they will "provide access to resources"—there's that black-box word again, "resources," developed by NAMI.


A major source of confusion is that when the terms "mental health problems" or "mental health conditions" are used—instead of, for instance, "emotional upset" or "suffering"—it is very often taken to mean "mental illness." As a result, media reports of increases in which understandable reactions to the pandemic are described as "mental health problems" are easily assumed to indicate increases in psychiatric disorders. Compounding the confusion is that psychiatric disorders are widely—but wrongly—assumed to be scientifically validated entities, so in the face of claims of increases in mental illness, rarely is the basic question, "But isn't 'mental illness' defined unscientifically and by whoever has the power to define it?" Instead, the assumption is made that it's clear what "mental illnesses" are and that they are rising.


One example is a recent warning that the pandemic will increase "postpartum depression" and "perinatal mood and anxiety disorders." The author, a psychiatrist, comes nowhere near to questioning the validity of these categories and simply alleges that they are partly neurobiologically caused, and she pathologizes expectant mothers' totally reasonable fears the pandemic provokes, despite acknowledging that social supports (harder to get in the coronavirus era) are crucial to preventing what would more properly called postpartum isolation, fearfulness, and sadness rather than psychiatric disorders.


Curiously, the World Health Organization's Director-General Dr. Tedros Adhanom Ghebreyesus warns that the "pandemic is highlighting the need to urgently increase investment in services for mental health or risk a massive increase in mental health conditions in the coming months," despite noting that pandemic factors like "social isolation, fear of contagion, and loss of family members is [sic] compounded by the distress caused by loss of income and often employment."


The psychiatrizing of America has been so efficacious that many professionals and laypeople readily assume the traditional mental health system can and should solve all emotional problems. Evidence of the limitations of that system include high and increasing rates of suicide and death and high and increasing rates of long-term disability of people treated in that system. Good therapists—and laypeople—can help normalize feelings and explore useful ways to cope.


But therapy must not be seen as the only option or as the one that will definitely help. What has been proven helpful to suffering people has included freedom from economic pressures, poverty, violence, oppression, and inadequate physical health care; a safe place to live; and meaningful human connections. Even the authors of a recent British Medical Journal article warning of a "tsunami" of "mental health cases" note that the people most at risk are those with "precarious livelihoods" and "poorest health," and fortunately, some groups are assuring people that their upset is understandable in light of the strange, new, massively and abruptly changed circumstances and being torn from their usual communities and sources of support.


Controlled studies of approaches aimed to reduce emotional suffering are nearly impossible to create, but an interesting contrast of the effects traditional, pathologizing approach and those of nonpathologizing ones is reported in a recent articleabout two neighboring Ohio regions. Although more information is needed from similar contrasts, the report from these two is of interest.


The Richland County Mental Health Board, which has encouraged the traditional use of counseling and crisis hotlines, reports a recent increase in suicides. Nearby, Ashland Mental Health and Recovery Board executive director Steve Stone, whose Board advocates nonpathologizing approaches, or what he calls "self-care" and "natural support systems," reports that their crisis services have not increased and in some respects have slightly decreased, and there have been no suicides and no increase in new people seeking help. He cited peer support programs as crucial to keeping their numbers low, including a sewing group, in which community members made hundreds of face masks, and a writing group that will write letters to patients in state hospitals during the pandemic. Stone is quoted as saying that they rely very little on state hospital and inpatient programs, and he "thinks the need for professional mental health services will remain low based on common sense approaches of people taking care of themselves as well as each other."


It will add to the tragedies caused by the current pandemic if all hope is focused on the mental health system and is diverted from the many things that reduce suffering and that do so without calling all suffering mental illness.


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A book review of "Acceptance: The Defining Voice of Validation"

First published March 13, 2020, at https://www.madinamerica.com/2020/03/acceptance-book-review/


Happily, above the flood of books about whatever the author decides to call—or accepts as defining—"mental illness," with traditional recommendations about what is helpful, usually these days amounting to psychiatric drugging, a humane, nonpathologizing, truly useful volume has appeared. It is psychologist Evelyn Sommers' book, Acceptance: The Defining Voice of Validation, whose writing is clear as a bell and whose voice is consistently of one who walks with the reader who wants to move past earlier, upsetting matters and become "unstuck" in order to get on with a more productive, forward-looking life.


As with her previous books—Voices from Within: Women Who Have Broken the Law and The Tyranny of Niceness: Unmasking the Need for Approval—the writing of Dr. Sommers, a Toronto-based clinical psychologist, is an easy pleasure to read and is deceptively simple. In her new book, she identifies a universal problem that at first glance might seem too minimal to warrant serious consideration but that in fact often causes emotional troubles ranging from transitory discomfort to an inchoate uneasiness that can last decades to major psychological paralysis and confusion about what is real.


This is no goody-goody book but one that compellingly draws our attention to what in our hurried, overburdened lives too easily gets lost, that is, the essential human need for acceptance and validation. Validation, she says, "is a joining with the distressed person to reflect or give voice to that person's feelings accurately."


Early in the book, Sommers writes that a great deal of necessary attention is being paid to the role of trauma in creating emotional suffering, but she makes a powerful case for also focusing on what may seem like minor events that in fact constitute powerful barriers to self-acceptance, self-confidence, and an ability to focus on the future and make choices rather than being stuck because of an event or a comment that the world hasn't recognized as hurtful.


Better yet, Sommers offers thoughtful solutions that are easy to understand and begin to practice. She makes us notice things we need to see, that we might have overlooked, and that, once seen, we can use to help ourselves and to avoid causing unnecessary harm to others.


Some of the examples in Sommers' book are about children, and one might be tempted at first to think that we cannot create perfect worlds in which no child ever has to navigate dealing with an incident of invalidation, but it is crucial to recognize that one of the few things that psychologists know for certain is that acceptance through validation is what helps developing human beings grow a core of strength and resilience.


Furthermore, surely few of us even as adults can say honestly that if, in a work meeting or family gathering, someone is dismissive or demeaning of our point of view, our reactions don't range from feeling unsettled and unsure of ourselves to feeling humiliated and inclined either to silence ourselves or to lash out.  And anyone who has lost a loved one or returned from a war zone can give examples of the devastating—though of course clueless—exhortations some people have offered them to "Move on with your life. You can't grieve forever." Or, as a well-meaning friend urged me about six weeks after my dear father died, when he saw that I was grief-stricken, "You're still so upset. Don't you think you should see someone professional about this (as though the grief were not normal and only a professional could help) and get a little something (psychiatric drugs, of course) to take the edge off?"


Precisely because people who speak the invalidating words are rarely aware of their harmful effects and often consider themselves to be doing something for the other person's benefit, it may never strike the person whose reality was upended that that is what has happened. The invalidated person often just feels somehow insecure, ashamed, confused, or frightened and cannot figure out why.


Sommers starts with an example from her own life that may at first strike the reader as too trivial to think about: At eight years of age, when spring had arrived but snow had fallen, she one morning resisted her mother's reminder that she put on her boots before heading to school. The child felt clumsy and confined by the galoshes and longed to don lighter shoes and run freely outdoors. When she said, "I hate the snow," her mother, whom she hastens to describe as loving and having good intentions, responded by saying, "No, the snow is pretty" and reciting a poem about it.


She doesn't take the easy and too-common way out of pathologizing or even blaming her mother, instead speculating that her mother was "trying to help me accept what couldn't be controlled." But the child not only was not comforted but felt angry at her mother, with the dual consequences of creating tension between them and doing nothing to help the child come to terms with her disappointment and go on to enjoy the day. Had her mother said, "I know you're sick of wearing those boots, but I'd hate for you to sit all day in school in wet sneakers and socks," the child would have had her feelings validated. It wouldn't have taken much to do that, but Sommers acknowledges that, as a parent and grandparent herself, she understands the various pressures of time (have to get the kid to school soon) and emotion (I don't want her to be upset) that can get in the way of stopping to think about how—quickly—to validate the child's feelings and then move on.


If that seems like a trivial example, consider that it's never pleasant to feel tension in a relationship that is the most important in one's life, and when one is a child, having the adored adult act as though one's feelings are just plain wrong can—especially if it happens more than once and perhaps even more when it is clear that the adult's intentions are good—make one start to doubt one's perceptions and consider one's emotions and thoughts to be weird or even bad… or invisible to those who matter most to them. Furthermore, children, Sommers writes, "are often unable to articulate what is happening to them, and so instead act out their suffering in ways that make no sense to adults who expect them to be rational." At worst, she says,


"Lacking validation of their basic feelings, children learn to view the world as a place dominated by denial of their reality, and they begin to see their worth as conditional on social acceptance. In reaction, they either over-comply with or resist adult demands and then grow into adults who cannot move out of those stuck ways of relating. As a result they may never feel free to make up their own minds about their lives. Still others unconsciously resign themselves to the belief that they can never have validation and give themselves over to the demands of others."


Being seen for who we are, especially by those closest to us, is essential to developing a core sense of ourselves at any age. Sommers writes that "Validation is an inferred sense of being seen." In fact, even when we feel joyful, if those around us seem not to share our joy, we can feel uneasy, "overly expressive," embarrassed about our legitimate feelings.


Importantly, Sommers broadens the view of sources of invalidation beyond parents, siblings, teachers, friends, and other individuals, writing:

"Governments that create programs and structures that fail to meet individuals' needs are guilty of invalidating people who require them. Similarly, corporations that create myths about people's needs in order to market their products effectively are also guilty of invalidating individuals. The media cannot be forgotten in this list because messages abound in "news," advertising and promotion that lead people to doubt themselves. The corporate source of invalidation is not accidental. Instead, although corporations or governments would not express it in these terms, the implicit intention is to create enough invalidation, self-loathing and insecurity to weaken people in order to then convince them that they will be better off (and validated) by following the advice, programs or pitches that each entity might propose."


Helping us to recognize the various, common forms invalidation can take, and reflecting how her approach ranges from the individual to the societal, Sommers names and discusses clichés (e.g., "She's in a better place"); trivializing of suffering ("Don't cry. You didn't fall that hard."); diminishing of the person; diversion from real problems (politicians who claim that gun violence is due to "mental illness"—my example); certain comments presented as "jokes"; established, unquestioned practices (doctors who implement "treatments" that have no proven usefulness and may even be dangerous, because that is the standard of care); and celebrating of diversity while perpetuating in-groups (dominant groups endorsing festivals to celebrate racial and ethnic diversity but being more likely to accept people who look like "the Caucasian ideal").


Because she cares about making the world a better place, Sommers packs her book with eminently do-able solutions, beginning by pointing out blind spots that make it hard for us to notice when we commit invalidation and roadblocks to validating another's experience. In that connection, she quotes a client who sent her this note about how she helped him identify his blind spots:


"One of the most striking recent discoveries I've made […] in the process of working with you, has been to realize the absolutely awesome power and responsibility a parent has to quietly validate the most microscopic of emotional wounds in their child, and to do this in real time. Critically, these wounds are healed by the child itself, not the parent—and the child possesses equally awesome power to heal itself […] All that's needed is one critical gift from the parent: to strengthen the child's emotional immune system by providing the recognition that the wound actually exists […] Wounds that are not validated by the parent […] accumulate, get infected, fester […] grow in proportion and severity, and can gather unfathomable destructive momentum as the child ages and becomes an adult. If only the parents realized that they, too, just like their children, inherently deserved to exist in a state of healing."


Once Sommers describes the common roadblocks to our validating others, it's much easier to catch ourselves committing invalidation. One roadblock is difficulty in staying present, "both physically and emotionally," and she makes useful suggestions for staying present under difficult circumstances, such as when the other person is crying or yelling.

Other roadblocks include but are by no means limited to the use of psychiatric diagnosis, which nearly always leads to the discounting of the experiences of people who are so labeled and even overlooking of their real physical problems such as terminal illnesses; sexism that leads to the dismissive treatment of women's and girls' reports of sexual harassment and assault; ageism that leads to the ignoring or minimizing of old people's suffering; and the unresolved presence of the invalidator's own "fears, preconceptions, and needs."


Throughout the book, Sommers reminds the reader that "validation, understood to be acceptance of feelings, is central to being able to progress emotionally by moving through distress," and lack of validation produces "stuckness." Her avoidance of jargon and obscuring verbiage is combined with her deep exploration of nuance and variation in how people can learn to recognize invalidating tendencies quickly and how to correct for them.


Should readers wonder whether validating someone means always agreeing with them and supporting them in their choices, she writes that "Validation is at once simple and complex, an acceptance of where someone is in the here and now" and explains that "If you believe someone is misguided you can simply and clearly express your disagreement" after you make clear that you see and understand how they feel. "If you believe someone is doing harm by acting from their beliefs you can still validate [their] being without endorsing or validating views and attitudes with which you don't agree or that cause harm," she says.


I cannot do justice here to the depth and subtlety of the insight and guidance Sommers provides, but I can say that after reading Acceptance, I have become more aware of how many times each day I notice that have many chances to validate, ignore, or invalidate the experiences of others—including people who do repairs in my building, cashiers at the grocery store who are often the butts of customers' frustration when the self checkout machines fail to work, family members and friends of all ages—and find that Sommers' suggestions about how provide validation add to my own enjoyment of life.


Near the end of her book, she writes:

"The mechanism for validating someone is rather straightforward, hinging on acceptance of the other's emotional state and allowing time for the distressed—or sometimes the happy person—to take in your words. The real challenge is to manage your own emotions and to tolerate others' beliefs or ways of seeing a situation and feelings that differ from your own."

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