On Abandonment

"Nothing veils a star" (Aurelius, book 11, chapter 27) and we too, should confront existence with no intermediary. Indeed, we are "thrown into existence" (Aho, 2023) and in that existence, we immediately are encumbered with veils in the forms of pre-conceived meaning, religious and philosophical shackles, genetic predispositions, cultural responsibilities and expected duties. Many of these veils were placed there by our parents. Some of us willingly accepted the veils, while others of us have been figuring out ways to cast them off in order to see existence clearly and with our own eyes. Fortunately, for some, the beginning of the un-veiling takes place in the form of abandonment.

Abandonment can take a couple of forms. Whereas an individual relied on some notion for guidance, and that concept or belief failed to prove accurate or useful, then that person experiences abandonment in the form of broken trust. The other form of abandonment would be pure and simple subtraction of an idea, a person or a belief. Sometimes a single event of abandonment may fit both descriptions.

Abandonment may trigger fear and anxiety, or perhaps instill confidence. Regardless, the opportunity for growth and resilience are present with each abandonment, in that the definition and clarity of existence moves from low-fidelity to a higher fidelity until one can, eventually, comprehend existence as it is.

When Nietzsche declared the death of God, he was observing what had already transpired in the hearts of men for quite some time - that "God may have been an illusion, but ... a necessary illusion" (Gravil & Addis, 2007, p. 21). While God supplied aim, values, emotional relief and fortitude and even a future, the lived experience of man could not be fully supported by those dogmas. What he was taught on Sunday did not fully equip him on Monday, Tuesday, or any other day of the week. God abandoned man. Truthfully, however, all along, God was a creation of man and man abandoned that creation. Even for the Christian Kierkegaard, God could not be objectively ascertained (2007). Therefore, while some men may proclaim God is alive and well, he nonetheless must admit that his experience is one of faith and, at best, a belief, else eight billion people might agree on the definition and objectivity of God like they agree the sun shines.

All people must be abandoned or experienced abandonment. If they have the will to live and exist, each abandonment yields a stronger, sharper existence. While some abandonments are temporary, and others are permanent, with each successive sense of isolation, the individual is forced to use his own devices or seek help from others in his sphere - he must swim, or sink. His use of his rational thinking and volition (what is 'up to him') is what he must rely on if he is going to swim.

Below are a few reflections of milestone-abandonments, from my life, and how I dealt with each one.

I was seemingly fortunate in my childhood to avoid abandonments. Family, community, school, church and God were all relatively stable aspects of my life. My parents did not divorce, as did many of my friends' parents in the early 1980s and 1990s. There were no attacks on my religion or religion in general for that matter. My friends and I attended church on Sundays, went to school and played sports during the week, achieved our Scout badges and awards, served our community, and generally we got along and were decent kids. I felt secure in many aspects.

Certainly with visual reminders like the image to the side (The Church of Jesus Christ of Latter-day Saints, 2023), my confidence in some mental and moral foundation rested in Christ. Entwined in that mental paradigm was family and community.

But despite religious reassurances, I still suffered temporary, local abandonments. Being the youngest of seven children, my older siblings all left for college while I was still in public school. Some of the older ones would come home to visit at times, and when the hour arrived for them to drive back to college, I felt an immense sense of abandonment. To this day, I feel the sting of tears in my eyes and the pain in my gut and heart as I sat on the porch and watched them pull out of the driveway, down the street and out of sight.

Leaving the nest of home to go to college and a church mission to Guatemala felt like a deeper abandonment. The structure of church and school and being with friends and like-minded people softened the blow, but despite these lifelines, the fear and anxiety of saying goodbye, first to my parents after they dropped me off at the MTC, and then later saying goodbye to my brother and sister at the San Francisco airport, en route to Guatemala City, brought a harsh new reality of feeling alone.

3000 miles away from home and 6000 miles away from my parents (who were in Prague), living in the lush highland jungles of Guatemala brough a fresh new realization of abandonment. My courage was fortified not only in Christ, but also by the words of the prophets in the scriptures and the leaders in the Mormon church, both local and global. More experienced missionaries also were a succor to my homesickness and longing for old comforts. At that time, I had not known of Seneca's toti se inserens mundo (Seneca, 2024, Letter 66) but I certainly tossed myself into the work and service in front of me. In fact, early on, while living in Zona 18 in Pinares del Norte, I was so overcome with homesickness, I took all reminders, photos and letters of my family and stuffed them in the bottom of a suitcase and vowed to never look at them until I got over these emotions. My focus and attention, directed at learning Spanish, talking to people and serving others, proved to be the solution for overcoming the sense of isolation and abandonment. And while the spiritual practices of prayer and reading scripture were helpful, it was attending to the matters at present which ultimately resolved the fear and anxiety.

If homesickness weren't enough, I also had to manage being ill in a foreign country. I don't know what it was, but a doctor informed me that I contracted a virus. Some 29 years later, all I remember is being very sick and having the worse migraine in my life. Someone made the decision to send me to a hospital and I ended up spending a night being cared for. The next day, I was released to the care of other missionaries who kept an eye on me while I made a full recovery. During that time, I met Moses Vargas, to whom I disclosed my homesickness and loneliness.  He helped me understand I was not alone and that I lived and worked and existed alongside several hundred missionaries in Guatemala. When I said my prayers at 6am, I was praying with all the other missionaries and that thought brought me comfort. It was something more real and tangible than the comfort the Holy Ghost or Christ could provide.

One good thing about abandonment is that it reveals how humans play games with humans in the name of God. When I threw myself into the work, or when Moses Vargas and others consoled me, people would reason that it was the Holy Ghost and God and Jesus who inspired me or those 'other people' to bring me comfort and support. Looking back on this, I realize they were simply imbuing social ethics with a smattering of divinity.

When a leader of the church takes credit for other people's choices and deeds in the name of God, they do so in an attempt to garner more power for the church, not necessarily for God. A relevant example of this is from Uchtdorf (2019) wherein he makes the argument that when people perform acts of kindness, they are doing so in the name of God, and more specifically the church. However, the logic does not work both ways. If the same person (e.g. a missionary or member of the church) provides service to others, the church will attempt to take the credit, but if that same person does something dishonorable in the eyes of the church (e.g. use their tithing funds to give to a soup kitchen rather than to the church), the church will deem this act as not in the name of God and may even discipline the member (e.g. excommunication). The key message from the church to the individual is this: "obey and we will take the credit and uphold you the best we can, but dissent or misalign, we disavow you and you are on your own."

This key principal, even if unspoken, is discerned more acutely after having served a mission for the church. There is significant management and stewardship of a young man or woman for the first 20 or so years of their life. There are checkpoints, interviews, and to-do items in order to keep the person on the right track. But after those first 20 or so years, you are left to your own devices to keep the program going. As long as you follow the program after serving a mission (getting married, holding callings, having kids and repeating the cycle), you will fall under the good graces of the church. But if you don't follow the program or even fit the mold of a 'good' member, you are abandoned since your usefulness to the church is no longer valuable.

For me, in 1997, I realized I was a tool for the church. My whole life had been a checklist with regular interviews to ensure I was checking off all the boxes. And then when I returned home from my mission to Guatemala, it all went silent; I was abandoned and truly left to my own devices. When you've been told how to think and how to live the first 21 years of your life and when it all goes silent, you feel lost and disoriented.

I stayed true to the program, for the most part. I dated, eventually married, and my wife and I began a family. We accepted church callings and did all the enduring to the end we could muster. Children were born, babies were blessed, family home evenings were held, church attendance was regular like a metronome. During the week, my wife raised and cared for our children, while I commuted to work in the morning, worked all day, and commuted in the evening. Dinner, playtime, reading books, watching movies, playing games, cleaning up, bed time and then repeat. If only I had read Camus early in life, perhaps I would have been better prepared for what was coming.

In his Myth of Sisyphus, Camus observes, "we get into the habit of living before acquiring the habit of thinking" (1979). A bit later in the book he describes what I eventually would feel after 10 years of living the Mormon program. "Rising, streetcar, four hours in the office or the factory, meal, streetcar, four hours of work, meal, sleep, and Monday Tuesday Wednesday Thursday Friday and Saturday according to the same rhythm - this path is easily followed most of the time. But one day the 'why' arises and everything begins in that weariness tinged with amazement" (1979). For me the 'why' was eternal life with my family and before that, I was yearning for confirmation or refinement or even sanctification. But there was no whiff of this to be found. The weariness became almost unbearable and the platitudes Mormonism offered did not outweigh the church's never-ending demands for more time, more money, more of my soul, more sacrifice on my part only for the benefit of the church. In a time when I needed support and energy or even relief, I only ever heard calls for more sacrifice. I felt abandoned. Confronted with metaphysical abandonment, I perceived that my choices were limited and I could not see any resolution other than death.

I began seeing a therapist in May 2014. She helped me see that I was enough - that existing and being there for my wife and kids and others was sufficient. And while she helped me correct some faulty value judgements I had been making, I recognized the space in which I could simply exist. I finally existed before landing on essence. Between 2014 and 2015, I deconstructed my beliefs and eventually I abandoned Mormonism, at least in my heart and mind. Never have I grown so much, emotionally, philosophically, mentally, than in those years of truly discovering myself and what my values were. I finally could choose my essence, rather than conform to what someone else decided for me.

By 2019, my wife and kids were also "out" of the church. The last time we attended services was December 2018. On a Monday in January 2019, the lay leader (bishop) came to our home, unannounced, and correctly claimed that we were less than honest about our temple recommend responses and he demanded we surrender recommends to him. This was tantamount to a slap in the face and an abject judgment of what our church thought of us after all the sacrifices in time and money we gave it. We were abandoned by our church. There were no questions about how we got to that point and there were no offers of succor to bring us back to the 'right' path. We had been fully abandoned and we could not be happier.

2020 brought a new kind of abandonment. The COVID-19 pandemic introduced isolation policies which effectively brought a type of abandonment many had never experienced before. The only people we could come in contact with were our families, and friends and neighbors at a safe distance. The days seemed long as we sat by our computers, working remotely, and watched the evening news reports of the thousands of deaths from people who succumbed to the virus as well as people who died because of isolation polices (e.g lack of medical care). Politicians and medical experts played on our fears. Panic spread as people tried to hoard supplies and many resources became scarce.

Working for an oil and gas company during the pandemic was surreal, especially when the price of oil inverted (Gaffen, 2022). Radical changes and ruthless prioritization became the norm. Many outsourcing and offshoring projects, which had only been planned for in the coming years, became a rough-shod reality. Expats living in the United States were quickly abandoned by the corporation and were hurriedly repatriated with little to no concern for safety protocols for them or their families. Normal ranking of employees, in which a very small percentage are put on improvement plans, were flipped to become tools for cutting workforce. People who had been planning to retire in an organized fashion were shamelessly forced to quit or retire early.

When things began to somewhat stabilize in late 2021 and into 2022, those who remained with the company had to begin picking up the pieces. After losing so many people, help was hard to find. Having endured multiple rounds of complaints from his staff, one manager reportedly told his group of 300 employees "no one is coming to rescue us; we have to save ourselves." I can think of no better existentialist motto than that. While some have the luxury of creating layers of security, friends, people, processes and tools around them like a cocoon, eventually all of that gets stripped away and the individual is abandoned and he realizes no one is going to live his life for him - no one is going to provide all the answers - he is on his own, so he might as well accept it and begin rescuing himself.

Toward the end of 2022, nearly two years ago from the time of this writing, my mother died and abandoned me. To be fair, I had mostly abandoned her in my mind, but not in my heart. I loved her dearly and often remember fondly my times, memories and experiences with her. Eventually I came to see her as not only my mother, but simply another human, with flaws, insecurities, her own narrative and philosophy for life. And while it was more emotional than I had expected, her passing to me brought a new-found fortitude and love for life. As I recalled her life through my perspective, I realized how much light she gave me. Whether she intended it or not, the fact remains that I have instilled in me an unending source of motivation to seek the sunny side of life because of how she raised me. A mere glance at the sun, and feeling the rays on my face, reminds me of her. I don't know if I would have had this blessing if she had not abandoned me when she died. She died November 10, 2022 and the sun still shines.

My father still lives at the time of this writing, but he inches toward his own death. After my mother passed away, my father seemed to have a tough time adjusting. On one hand, he seemed to have a new lease in life and claimed he would live to 140 years old and even verbalized aspirations of going back to college to pursues a masters degree in psychology after he heard a speech by a trained psychologist. His need for companionship endured after mother's death and every attractive woman he met, regardless of age, became the one he was going to marry. He dominated in cornhole tournaments and he loved to sing for all the other residents in the assisted living home. He spent his days visiting and trying to inspire the remaining members of The Greatest Generation. He has always sought a way to be useful and to help others. This undying zest for life has been an inspiration to me. While amusing, his fight to continue to live and exist even to the age of 140, teaches me to also fight for meaning and existence. This passion for life is even more extraordinary knowing that his father psychologically abandoned him through anger and lack of conveying love and care to my father. Alas, my father, too, will pass; life will abandon him and when that day comes, I'll be an orphan and know that my own death will someday arrive.

All experience abandonment, even the Christian god Jesus. As Camus (1956) writes in The Rebel, even the son of God experienced the most exquisite abandonment. Believing he was solving two of mankind's greatest problems, evil and death, after he hung on the cross in agony and in utter despair, Christ came to conclude that all are abandoned no matter the divinity, luxury or privilege. Hence he gut-wrenchingly yells out the lama sabactani (see Matthew 27) and is awestruck at his total and complete isolation. Camus sardonically notes Christ's "agony would have been mild if it had been alleviated by hopes of eternity" (1956). When I read this passage a few weeks ago, it struck my like a lightening bolt. I imagined Jesus experiencing an unexpected and panicked brush with reality. After having believed his own message for over 30 years, he came to realize that he too would suffer the same fate that billions before and after him experienced. He was not who he claimed to be. No one is immune from abandonment.

Since we are all abandoned, we must all stand on our own. No one is going to fully live your life for you. You must seek out your own meaning and purpose, especially when you come to find out that no one knows what this absurd existence really means. If you come from GenX, like me, you will probably never forget the message from Dead Poet's Society (Wier, 1989): carpe diem! Seize control of your life! Make your own meaning! Exist since no one else will nor can exist for you.

In conclusion, I leave this thought and quote which conveys the idea of: no one has found an instruction manual for life and you're on your own.

The problem for Kierkegaard is entwined with our fundamental abandonment in freedom. Man is a free project: which is to say that there is no ‘world-historical’ source of instruction and no pellucid God-ward imperative. In what concerns us most deeply we are thrown back on our own decision. The speculative reason says, Kierkegaard, cannot help us in the matter of existence, for to speculative reason, existence ‘is a matter of infinite indifference’. Furthermore, I am utterly alone in my plight (Gravil & Addis, 2007, p. 47).

References

Aho, K. (2023, January 6). Existentialism. Stanford Encyclopedia of Philosophy; Stanford University. https://plato.stanford.edu/entries/existentialism/

Aurelius, M. (2021). Meditations (R. Waterfield, Trans.). Basic Books.

Camus, A. (1956). The rebel : an essay on man in revolt (A. Bower, Trans.). Alfred A. Knopf.

Camus, A. (1979). The Myth of Sisyphus (J. O’Brien, Trans.). Penguin Books. (Original work published 1955)

Gaffen, D. (2022, February 24). Analysis: Oil’s journey from worthless in the pandemic to $100 a barrel. Reuters. https://www.reuters.com/business/energy/oils-journey-worthless-pandemic-100-barrel-2022-02-24/

Gravil, R., & Addis, M. (2007). Existentialism (1st ed.). Humanities-Ebooks, LLP.

The Church of Jesus Christ of Latter-day Saints. (2023). You Are Never Alone. Churchofjesuschrist.org. https://www.churchofjesuschrist.org/media/image/mormonad-you-are-never-alone-4a54532?lang=eng

Seneca. (2024).  Ad Lucilium Epistulae Morales. Uchicago.edu. https://artflsrv03.uchicago.edu/philologic4/Latin/navigate/129/7/4/

Uchtdorf, D. F. (2019). “You Are My Hands.” Churchofjesuschrist.org. https://www.churchofjesuschrist.org/study/general-conference/2010/04/you-are-my-hands?lang=eng#p1

Weir, P. (Director). (1989). Dead poets society [Film]. Touchstone Pictures.

Margin Notes, Thoughts on "Beyond the Individual" by John Willcock

Really methodical review of how Stoics arrived at a social ethical system. It does take some 'leaps' in terms of connections (there is a bit of 'faith' and 'trust' in believing we are connected ... your daimon is a fragment of the greater part of the divine cosmos), "organized, planned and controlled system of cause and effect" in which we live. There is no room whatsoever for the Epicurean 'swerve' (sorry, Friendo).

p. 38 - is a fig tree 'bad' if it doesn't produce figs? or was it the will of the cosmos that a fig tree doesn't produce figs?

some thoughts at the end of chapter 2:

• Stoics claim there is a connection of my divine fragment to the Whole, yet *no one* and *no thing* has access to my mind.
• Socrates mentions his daimon, but *no one* had access to Socrates' mind
• Is there an "ought" or duty to listen to my daimon or other peoples' daimon?
• Who's divine fragment has priority if there a dispute of action?

Other questions and notes:

p. 67 - "no change is harmful in Stoicism. Is all change the universal's rational, harmless, systematic processes in motion?" ... Can humans cause harm to God / the Cosmos?

p. 68 - the universe does no harm to itself, "does not infer that every human will always act in accordance with the whole though." The parts can be out of harmony, but God is still unharmed.

p. 75 - "built into our rational thoughts and actions are instead the ends of our fellow rational beings and the Whole." ... Prisoner's Dilemma --> coordination. If I act virtuously (morally), then I am cooperating and coordinating with the common good.

p. 78 - the universe created hierarchy, yet Willcock pushes against this argument.

p. 102 - it is a struggle to accept one's duties, while watching many others deny their own. a challenge is: what to do when others fail in duty to you? p. 104 provides a possible answer? "how we make ourselves available as the objects of moral actions for others" ... it takes effort to 'open up' and be involved in others' lives.

For example ... p. 112 ... in 2020 global pandemic, some argued our duty was to stay 'locked down' and inject experimental vaccines for the common good. Now, four years later, it is more widely accepted that the lockdowns caused far more harm, and long-lasting harm to the common good. Many made the argument *against* lock downs and forced vaccine mandates, yet were vilified. Both sides of the debate were based on doing what is best for the common good.  This is one of many, many examples of how Stoicism does not provide a clear, objective moral compass. As long as a Stoic argument is in support of taking action and supporting duties for the common good, then it is accepted. Stoicism does not settle debates about the best course of action for the common good, hence war is the father of us all (Heraclitus).

p. 116, "the primary way in which we can live in accordance with our rational nature for the Stoics is to think and act with the consciousness that we are universally and communally interconnected beings."  fine, we are connected, but are we good about understanding cause and effect predictions? no.

p. 140, "we have at our disposal the capacity to live an emotionally stable life." Is mental illness due to lack of training?

"Developing a mental resilience to external threats requires a similar developmental process for Epictetus.  Just as people can learn to be resilient to 'heat and cold,' likewise we can develop our mind to be indifferent to external activations of our emotions." You still care about your duties, but are not emotionally tied to them.

p. 141, God defined (what is good): "well-ordered, just, holy, pious, self-controlled, useful, honorable."

p. 155, "Seneca's advice concerns how she can avoid similar kinds of grief. This does not mean viewing the present world from a position of hopelessness and with the mindset that all will be inevitably lost. Seneca advocates rather the importance of premeditating how quickly things can change, in order to hope for outcomes that are best, while being 'prepared' for what can happen that would be the 'worst.'" ... Why not? Even existential angst can teach greater resiliency!

p. 158, "We might ask here whether everyone has to be individually living rationally for the universe to be perfectly rational at any point in time. This is a difficult question to answer, given that in one regard everything in the world is perfectly rationally ordered, in that the world's causal structure rolls on whether we are individuals want it to or not." Do all need to be rational - live according to Nature - for God to be happy? Nope!

p. 161, "we see here that when we do anything, if while doing that we are aware of what we share with others, then our happiness and well-being is ordered in tandem with the happiness and well-being of others." But we still disagree about 'doing something for the common good.' 'You do your worst, I'll do my best' seems to be the attitude to take, and to remain indifferent to the outcome. Just because you argue for action for the common good, does not mean it is the best course of action for the common good. Therefore, do some propose an action 'for the common good' in bad faith?  Is it really self-interest disguised as common good? Perhaps! And what are we to make of 'my tribe' against 'your tribe'? Again, there is no objective moral compass in Stoicism.

In sum, really good book, but quite often it is R-E-P-E-T-I-T-I-V-E, to the point it could have been a fourth to third shorter if the book had better editing.

PSYCH 406 (Psychopathology) - Suicide as Related to Major Depressive Disorder

Abstract

This essay describes the symptoms and diagnostic criteria for major depressive disorder, with an emphasis on the symptoms of thoughts of death and suicidal ideation. It further reviews methods of treatment, and then finishes with a review of ways therapists can forge and strengthen therapeutic relationships with suicidal patients.

 

Introduction

To exist or not, as a human being, is up to us. Albert Camus (1979) contends suicide is the only genuinely profound philosophical question to answer. True, every individual has the choice to exit life, however the cost of that exit can be significant for those left behind. Not even counting the invaluable cost of loss of life, suicide attempts alone accounted for nearly $27B in health care costs in 2019 in the United States (Hughes, et al., 2023). Even despite the massive expense from the fallout of suicide attempts, the emotional toll and impacts heaped on loved ones and friends who remain behind in the wake of a successful or unsuccessful suicide will take countless hours of therapy and grieving and perhaps even significant pharmacological expense to remediate. From a psychological, to an emotional, to an economic perspective, any way to advance the understanding of the patient’s motivation for suicide and greater insight into how to prevent suicides would be a worthy endeavor not only for the individual, but also for the common good. To that end, this essay will explain the most common disorder which leads to suicide.

This essay will describe major depressive disorder, including all the criteria that must be met in order to diagnose an individual with major depressive disorder (Maddux & Winstead, 2016 and American Psychiatric Association, 2022). Along with those criteria, it will also outline the symptoms and warning signs of those seeking to end their life (National Institute of Mental Health, 2022). It will then review three major avenues of treatment for major depressive disorder, which include electroconvulsive, psychopharmacological and psychotherapeutic forms (Maddux & Winstead, 2016). Lastly, the essay will delve into the topic of clinicians establishing the clinician-patient therapeutic alliance to assist patients in opening up about the challenges they face with suicidal ideation (Foster, et al., 2021).

Description, Symptoms, Diagnostic Criteria

While the impacts of major depressive disorder (MDD) can be persistent and influence human productivity, symptoms can worsen and lead to the untimely death of the sufferer. Maddux and Winstead (2016) note that MDD will perhaps be the number one cause of premature death and human disability globally in the next one hundred years. In the United States alone, the suicide rate has increased over a third between 1999 and 2018 and with the recent COVID-19 pandemic, that trend has continued to rise (Moutier, 2021). Therefore, spotting MDD symptoms effectively and early is key to suicide prevention.

The symptoms of MDD described in the DSM-5-TR (American Psychiatric Association, 2022) begin with understanding what a major depressive episode is. Symptoms include nine key markers: 1) a depressed mood, which may include feelings of helplessness and hopelessness, 2) the loss of interests or pleasure in activities the person normally enjoys, 3) losing 5% or more of their weight in 30 days while not intending to diet, 4) poor sleeping habits stemming from insomnia or perhaps sleeping all day, 5) constant agitation in movement or a significant lack of movement, 6) general lack of energy, 7) self-loathing, exceptional feelings of guilt or worthlessness, 8) significant challenges in concentration, deliberation, thinking or even decision-making, and most importantly, 9) repetitive thoughts of dying, death or suicide. As for this ninth symptom, the patient does not need to demonstrate it every day for a two-week period; once is sufficient to qualify. The patient must exhibit five or more of the nine listed symptoms (two of which must be a depressed mood and loss of interests) for a period of at least 14 days, and these must cause a substantial impact on their social life, job or other important aspects of their life, and the attribution of these symptoms must not stem from some other condition such as drug use, or another disorder such as schizophrenia (American Psychiatric Association, 2022, p. 183, 185). Lastly, in order for MDD to qualify as the diagnosis, the patient must demonstrate having one or more major depressive episodes, without any type of mania or hypomania.

One other important aspect of the diagnosis is related to whether there is an identifiable cause of the patient experiencing the symptoms. Some people may have recently dealt with an impactful and emotional event in their life such as the loss of a baby, a bankruptcy or loss of job, living through an act of God such as having a home and all possessions burned down in a wildfire or even having contracted a serious medical illness such as terminal cancer (American Psychiatric Association, 2022, p. 183). While many people may exhibit major depressive episode symptoms stemming from one of these drastic life events, it does not mean the person qualifies for the diagnosis of MDD.

As noted in the ninth symptom of MDD, if a patient has repetitive thoughts of death or suicide just once in a two-week period, along with the other symptoms, then they may have MDD. It is also important to note external markers which may predict if a patient is suicidal. Maddux and Winstead (2016, p. 193) observe that a majority of suicidal people convey their intent to kill themselves. More specifically, the National Institute of Mental Health (2022) provides a list of warning signs which loved ones and other people around the patient can spot. The patient may verbally express ideas of suicide, feelings of guilt or sense of being a burden on other people. They may express feelings such as helplessness, hopelessness, being trapped, having no purpose, or being sad, anxious, angry or expressing unendurable pain be it physical or emotional. Lastly, the patient may communicate in non-verbal ways such as searching online for ways to die, pushing close ones away or retreating from normal social interactions, acting with recklessness (e.g. risky skiing, driving, cliff jumping), consuming more drugs or alcohol, and sleeping and eating less. Related to the warning sign of recklessness, Maddux and Winstead (2016) note that suicides may be underreported because the act of suicide may appear to be accidental. For example, 15% of automobile accidents with a fatality may actually have been suicide related.

Treatment Options

There are three major avenues of treatment for MDD: electroconvulsive, psychopharmacological and psychotherapeutic therapy. The essay will briefly describe mechanisms which address the first two methods and then more deeply address the third method through a discussion on cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).

Electroconvulsive therapy (ECT) was discovered as a form of therapy in the 1930s (Maddux & Winstead, 2016, p. 205). The method for application is to deliver between 70 and 130 volts of electrical shock to the patient’s brain. The patient may endure nine or ten rounds of ECT over the course of several weeks. While ECT has proven to be somewhat effective, experts still do not know exactly why it works in some cases. One theory is that electrical shocks downregulate 5-HT (serotonin) receptors. Despite proving somewhat effective, patients’ memory functions degrade, and they have a more difficult time learning and recalling knowledge. Related to ECT is transcranial magnetic stimulation (TMS). TMS does not produce memory dysfunction and can be more precisely tuned. The only side effects reported are benign headaches and minor discomfort.

Pharmacological forms of therapy for major depressive disorder address dysfunction in serotonin regulation (Maddux & Winstead, 2016). Studies have shown that when individuals’ serotonin levels are depleted or if reuptake has been altered, then it begins to have a negative impact on mood, which may act as a catalyst for a depressive episode. Three medications have been used for quite some time to treat depression: monoamine oxidase inhibitors, tricyclic and tetracyclic antidepressants. More recent developments in antidepressant medications include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). All five medications work in some form or fashion to regulate serotonin levels. As for which one should be used with a patient, it is often a matter of finding the right medication and dosage with the least harmful side effects. One emerging medication to address depression is ketamine. Rather than targeting the regulation of serotonin, ketamine seems to aid in the regrowth of important synapses in the brain, improving brain neuroplasticity (Yale Medicine, 2021). Researchers are discovering that ketamine treatment coupled with CBT provides rapid and long-lasting positive change. Not only do ketamine and CBT together prove efficacious, but Maddux and Winstead (2016, p. 198) note that CBT coupled with other appropriate medication is more effective than either CBT or medication alone.

CBT and ACT are two well-known psychotherapeutic frameworks which help the patient to fundamentally change their underlying thinking to address negative perceptions of themselves and environment (Maddux & Winstead, 2016, p. 197-199). CBT encompasses multiple ways to help the patient alter the underlying thinking framework for how the patient processes events, as well as to couple their thinking to action. For example, people who suffer from MDD would be asked to recognize and write down their negative thoughts, along with the causes and effects which lead them to think this way. They would then be asked to assess and question those thoughts to ascertain if they truly match reality and rationality. Through this process, the patient begins to reconstruct their thinking narrative in a more positive and productive manner.

CBT is especially helpful in challenging and questioning hopelessness thinking in suicidal patients. In fact, studies have shown (Bryan, 2019) that versions of CBT for suicide prevention (CBT-SP) are so effective, that these specific forms of CBT have been recommended as standard care procedures for all suicidal patients. CBT-SP typically includes three successive phases. In the first phase, clinicians assess the risk of the patient and then collaboratively work with the patient to form a crisis and treatment plan. In the second phase, the therapist and patient work on revealing the dysfunctional thinking patterns and negative internal dialogues which lead to feelings and emotions related to helplessness, hopelessness, being trapped, and having no purpose. In the last phase, therapists and patients tie everything together by creating a plan to minimize relapse. Bryan (2019, p. 249) further observes the effectiveness of CBT-SP by stating that patients of CBT-SP were one-half to two-thirds less likely to attempt suicide when compared to treatment as usual.

ACT can be viewed as an extension and evolution of CBT (Maddux & Winstead, 2016, p. 198-199). While ACT is similar to CBT, it differs from its aim. ACT does not focus on minimizing the negative symptoms of depression, but to empower the patient with greater flexibility in their thinking. ACT helps the patient understand their core values and then proceed in a consistent manner with those values. ACT prompts the patient to pause and reflect on what they deeply value in life, and then to engage with their emotions and thoughts, rather than questioning them. By engaging with their thoughts and emotions through a comparison with their core values, the patient is able to discern gaps between who they are and who they wish to be, and then take specific and meaningful action. For example, ACT has proven to be quite successful with veterans dealing with suicide (Walser, et al., 2015, p. 30). It has shown that when a patient experiences suicidal ideation, the therapist would work with the patient to explore the patient’s core values, either through dialogue or a values assessment test. As the patient is confronted with ideas of death, they can accept those thoughts and pivot toward ways to pursue and fulfill meaning in their life by focusing on something they value.

Article Summarization: Strengthening the Therapist-patient Alliance

In the context of suicidal ideation, it has been observed that most suicidal individuals do not explicitly disclose through self-reporting. Foster, et al. (2021) note that only 24% reveal their suicidal plans through disclosure. The driving causes of hesitating to divulge their thoughts of ending their life are fears of judgement, hospitalization, and losing independence. Therefore, if therapists, clinicians and others who are in a position to help the patient can establish trust and openness in communication, they may be able to garner the patient’s confidence and assist them in getting the needed medication and therapeutic treatment. Foster, et al. (2021) argue that three specific aspects on which clinicians can focus to improve the therapist-patient alliance are: 1) awareness and management of countertransference of negative emotions, 2) deploying communication techniques which are empathic and 3) leveraging the patient’s subjective experience as feedback.

Countertransference occurs when the therapist experiences conscious or unconscious projections or judgements of the patient, which in some cases may interfere with the therapeutic process (American Psychological Association, 2018). Foster, et al. (2021, p. 258) note that therapists can exude negative emotions to an individual intent on ending their life. Quickly assessing countertransference is crucial to strengthening the therapist-patient alliance. The Therapist Response Questionnaire-Suicide Form is an innovative tool to rapidly assess countertransference and enables the therapist to secure supervisory coaching and support to manage countertransference.

Empathy is how one person relates to another, including focusing on commonalities as well as differences, which enables shared insight between individuals (Foster, et al., 2021, p. 259). Clinicians and therapists must have a life-long commitment to developing and mastering empathy in their practice, especially when working with suicidal patients. Besides continuing education and hands-on training seminars to learn and practice empathy, there are also tools which assist therapists to hone their empathy skills. The Empathic Communication Coding System (ECCS) assists in identifying opportunities for the therapist to practice a range of empathic responses. The ECCS aids in identifying the patient’s statements as emotion, progress or challenge and then suggests a range of potential ways a therapist could use empathy. For example, a widow may mention how she constantly thinks of her deceased husband, to which a therapist could respond with, “Are you thinking about death?” or with the more empathic response of, “It seems that these thoughts you are having are difficult. Has suicide crossed your mind?” Therapists who master the art of empathy will improve the chances of the patient opening up and being more receptive to treatment rather than suicide.

Lastly, when therapists form a solid alliance with the patient, they can leverage that trust to gain insight from the patient feedback. Gathering feedback from a patient who has attempted suicide or had thoughts of suicide can prove rich in understanding the paths leading to death as well as paths leading to recovery (Foster, et al., 2021, p. 259). Collecting this feedback and sharing it broadly enables the wider community to benefit from this untapped resource. Tools such as the Consultation and Relational Empathy assessment and Working Alliance Inventory collect data from the patient’s perspective. These feedback mechanisms reinforce patient autonomy as well as shed light on the subjective experience of the patient.

In sum, there are innovative ways and tools to facilitate greater collaboration between the therapist and suicidal patient. First, the therapist must be aware of and manage countertransference of negative emotions. Second, they must constantly improve their communication techniques by focusing on improving empathy. Lastly, they can tap into the patient’s subjective experience to use as feedback in the therapeutic process.

Conclusion

In conclusion, with the increasing trend of suicides globally, and the severe impacts they have on society, this essay endeavored to illuminate the reader on the topic of major depressive disorder, with an emphasis on the symptom of suicidal ideation and the diagnostic criteria indicating a risk for suicide. The essay then examined three methods of treatment in the forms of electroconvulsive therapy, pharmacological and psychotherapeutic avenues. It specifically addressed CBT, CBT-SP and ACT in the context of suicidal patients. Finally, the essay discussed the importance of the clinician-patient therapeutic alliance, along with a set of tools to enable the fortification of that collaborative effort. 

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders, text revision (5th ed.). American Psychiatric Association.

American Psychological Association. (2018). APA Dictionary of Psychology. Dictionary.apa.org. https://dictionary.apa.org/countertransference

Bryan, C. J. (2019). Cognitive behavioral therapy for suicide prevention (CBT‐SP): Implications for meeting standard of care expectations with suicidal patients. Behavioral Sciences & the Law, 37(3), 247–258. https://doi.org/10.1002/bsl.2411

Camus, A. (1979). The Myth of Sisyphus, and Other Essays. (J. O’Brien, Trans.). Penguin Books Ltd. (Original work published 1955)

Foster, A., Alderman, M., Safin, D., Aponte, X., McCoy, K., Caughey, M., & Galynker, I. (2021). Teaching Suicide Risk Assessment: Spotlight on the Therapeutic Relationship. Academic Psychiatry, 45(3), 257-261. https://doi.org/10.1007/s40596-021-01421-2

Hughes, P. M., Phillips, D. C., McGrath, R. E., & Thomas, K. C. (2023). Examining Psychologist Prescriptive Authority as a Cost-Effective Strategy for Reducing Suicide Rates. Professional Psychology, Research and Practice, 54(4), 284–294. https://doi.org/10.1037/pro0000519

Maddux, J. E., & Winstead, B. A. (2016). Psychopathology : Foundations For A Contemporary Understanding (4th ed.). Routledge/Taylor & Francis Group.

Moutier, C. Y. (2021). Innovative and Timely Approaches to Suicide Prevention in Medical Education. Academic Psychiatry, 45(3), 252–256. https://doi.org/10.1007/s40596-021-01459-2

National Institute of Mental Health. (2022). Warning Signs of Suicide. Www.nimh.nih.gov. https://www.nimh.nih.gov/health/publications/warning-signs-of-suicide

Walser, R. D., Garvert, D. W., Karlin, B. E., Trockel, M., Ryu, D. M., & Taylor, C. B. (2015). Effectiveness of Acceptance and Commitment Therapy in treating depression and suicidal ideation in Veterans. Behaviour Research and Therapy, 74, 25–31. https://doi.org/10.1016/j.brat.2015.08.012

Yale Medicine. (2021, July 30). Ketamine & Depression: How it Works - Yale Medicine Explains. Www.youtube.com. https://www.youtube.com/watch?v=nW21-AYY_fs 

7/8 to 7/14 2024

What as week it has been. There have been plenty of opportunities to practice and embody Stoicism as I was taught. 

As Seneca says often, one must study virtue and learn it, then train at and practice it, then it is strengthened by action. In Letter 94 he says, "Virtue depends partly upon training and partly upon practice; you must learn first, and then strengthen your learning by action." and in Letter 90 he says, "Virtue is not vouchsafed to a soul unless that soul has been trained and taught, and by unremitting practice brought to perfection."

We were on vacation at Bear Lake, Utah at a family reunion the week leading up to the 4th of July. After going to the South Texas Merchant Marine pleb-candidate send off on Saturday June 29, we went to bed that night after saying our goodbye to our 2nd-year mid-shipman who was leaving for Kings Point on Sunday June 30. We began our two day drive to Utah at 5am. After our two-day drive, we spent the week in Utah, enjoying the cold nights, brilliant summer days on the beach and in the blue and turquoise water. We visited relatives in Logan and Salt Lake, and my wife and I got a taste of what it would be like to live in the West again. We began contemplating what it would look like and what we would do if we were to transplant ourselves to Logan.

During the whole week, we kept our eye on Hurricane Beryl. As the end of the week approached, we saw the forecasts revised multiple times with each update moving the hurricane evermore eastward toward Texas and up the Gulf Coast. By Sunday, we knew it was going to hit Houston. We began our two-day drive back, stopping in Amarillo Sunday night. We went to bed knowing that when we woke up the next day, the hurricane would be on top of Houston. Our three pets were at home and a pet & house sitter was there, but nonetheless we were worried. 

Day 1

Monday July 8 was our drive home from Amarillo to Houston. All morning long, we had KTRH streaming on iHeart. We were in contact with the pet & house sitter, but we also knew our dogs and cat (well, maybe not the cat) were stressed. Our one dog always gets super stressed with storms. Plus, we were anxious to get home to relieve the sitter and we could take on all the concern and worries. Power at the house went out at 4:39am Monday morning (based on time stamp data of my Ring cameras). The drive seemed longer. We dropped our oldest daughter off in Austin and then made our back into the greater Houston area. We stopped at Brenham, filled up and got some food, knowing we may not be able to get gas when we got into the city. Our neighbors checked on our home and said it was ok, but our back neighbor's tree fell into our yard, obliterated our shed, with our generator pinned under the tree.

The drive into our suburb was like a war zone. All traffic lights were out. There were hundreds of downed trees, some blocking the main roads, some smashed into homes or signs or power lines. We had to take many back roads and even back track a few times in order to get home. We arrived home in the late afternoon, with no power. We unpacked and then I started assessing damage and cleaning up the many limbs and branches all over our yard. I made a huge pile by the curbside of all the debris. Besides the fallen tree, there is one big branch hanging from one of our three mature trees, which has been snapped.

We began formulating a plan and determined that power would not be restored for quite some time. We went to bed that night with no AC or fans. But at least we were with the pets again and the home survived any major damage. Having gone through Hurricane Harvey, I knew the next few days or weeks would be difficult but perhaps more endurable than Harvey.

Day 2

Tuesday July 9 brought more planning and assessment of the situation. We determined that power would not come back anytime soon. We were living in Dallas during Hurricane Ike and from talking to neighbors who lived through Ike, they said it was two weeks before power was restored. In fact, our neighbors almost made it sound like it was just a two week party of BBQs and watching college football with TVs hooked up to generators. We decided that my wife and youngest would take the pets to Austin to stay with my oldest for the week. They packed up Tuesday morning, emptied the fridges and left by late morning. I got up early morning and logged into work via my cell phone's hot spot.  I read a few emails and updated my team. I was stuck in our suburb with potential blockages on roads and only a quarter tank of gas. I decided to go hunting for any gas I could find.

No gas in our suburb. No gas in adjacent towns. No gas up the freeway. I kept driving hoping for one gas station, thinking that maybe there would be power in outlying areas. But none were open. After driving almost an hour, I rolled into a town and decided to park at an H-E-B and wait.  I wasn't sure if I had enough gas to get back home.  As I watched the constant flow of cars roll by, it felt surreal. Many of them were looking for gas too. I ended up talking to a gentlemen who was stuck. He had no choice but to wait as his truck was bone-dry.  He had driven up to Livingston to help his ex-wife and now he was headed back to San Antonio, but needed gas. There was another gentlemen who pulled up while we were talking and he came from the same suburb as the one I live in.  He was doing the same thing as me - just looking to fill up. I wondered if I should attempt the drive home. I did some rough calculations in my head and decided that worse case scenario, I run out of gas very near home or in my suburb. So I trekked back home and drove below the speed limit.  I made it back all the way home with a needle just above E.

I decided I was going to be stuck home the whole week, unless my daughter's car had some gas in it. After I got home, I checked her van (it is the old family van) and she had a full tank! My plan then pivoted to driving into work (which has power and connectivity) and maybe even just sleep in the van or find a place to sleep at work.

After getting all packed, the sun set. It is an eerie experience to be in a dark, hot home all alone. I lit the candles and sad down to 

Day 3

Wednesday July 10 actually wasn't that bad. Things seemed to be more normal at work. It was nice to be in AC again and be connected. I logged in threw myself into work. Since I had been out a week, there was a lot to catch up on. We had a team member who recently left our group, and there was a going-away lunch that day. We ate lunch at the Island Grill and it had a really nice vibe with natural lighting, good food and lots of people. It felt good to have some normalcy again.

I worked the rest of the day, and when I came to a stopping point, I logged off, went to a conference room and logged onto my personal computer and began working on school. Since there was nothing to go home to, I stayed at work until around 9pm. Then I decided to drive home and go to bed.  The home was stale and warm. Cell phone reception was spotty at best and I couldn't even access anything on my phone. I lit a candle, laid on the floor and read Meditations.

Eventually I went to bed, but it was a challenge with no air flow and no sound machine.

Day 4 & 5

Thursday July 11 and Friday July 12 were pretty much a repeat of Wednesday. Getting up was easy, because I was motivated to shower and cool off. I drove to work and was there by 5:30am; I worked all day, studied school after work and then drove home to a restless sleep.

Thursday night, after wrapping up my studies, I went to Island Grill again and had a nice meal and watched the Astros game on TV. That was memorable and was a very nice reprieve from reality.

Friday was different when I got home that night. We had power again! Unfortunately, the AC would not kick on, so the house remained quite warm at 83 degrees, but at least I had some air flow from the ceiling fans. I called Jill and told her the power was back on and she said they would drive home on Saturday.

Day 6 & 7

Saturday July 13 we had the AC tech come out, but he discovered there was no power flowing to the furnace unit and we needed and electrician to come out and troubleshoot it. Jill and Camille and the pets came home later in the day and began prepping for their trip to Belize. I contacted our electrician and he said he would come out later that day.  But he never showed and wasn't responding to texts.

On Sunday July 14, I took them to the airport and then started calling and texting any electrician who could come check on our AC. I found one and he was on his way when the power went out again! But thankfully it came back on about 30 minutes later.  The electrician and his wife showed up, I told them the issue and they began troubleshooting. He discovered the wire from the main panel to a subpanel was not rated correctly and burn it to a crisp. He put a joiner or something on it and fixed it.  Power came back, the AC kicked on and things finally began to turn normal again.

Beyond

The following week, I made contact with several tree services to remove the fallen tree in our back yard. Some wanted to charge me $5000, others $2000, but we finally found two that would do it for $1000.  They cut it and hauled it to the curb. Price gouging is definitely a thing.

There are piles of dead trees and branches on every street. Some homes needed to bring in cranes to reach up to the fallen trees embedded into homes. It will be months before the rest of the city returns to normal. We had a couple stop by our home asking what work they could provide to our yard. I asked them to give me a quote to haul off the three massive piles on my yard and they said they could do it, along with breaking down and hauling off our smashed shed for under $500. Next up will be fence repair.

As of July 22, there are no hurricanes on the horizon, but even if we get to the end of July, we'll have another solid 60 days of prime hurricane weather.

PSYCH 406 (Psychopathology) - Trauma and Pathologizing the Norm

Abstract

This essay discusses the observation of Western culture’s fascination with trauma, along with the history of post-traumatic stress disorder (PTSD), and how that diagnosis has expanded its scope. It also notes that most humans are resilient in adversity and trauma. For those who suffer long-lasting effects of trauma and exhibit PTSD symptoms, they should seek professional help and support.

Introduction

For many movie-goers, the summer is a great time to head to the silver screen and watch action, drama, and intriguing stories play out in spectacular visuals and chest-thumping sounds. This year, audiences are anticipating the third installment of the Deadpool series. For the uninitiated, Deadpool is an antihero known for his sharp sarcasm and dark humor. For example, in a scene from the first Deadpool movie (Miller, 2016), when he meets his girlfriend, Vanessa, the two enter a back-and-forth banter about the trauma and rough childhood they’ve endured. While this essay won’t recall the entire repartee, one of the less dark and non-sexual exchanges gives a good sense of the dialogue. At one point, Deadpool quips his bedroom was a hall closet, to which Vanessa volleys back she had to sleep in a dishwasher box, to which Deadpool replies, “you had a dishwasher?” (Miller, 2016). While dark and humorous, this represents the zeitgeist of modern culture’s romanticization of trauma .

In a recent Psychology Today article (2022, January 4), Robin Stern wrote regarding her observations of many examples of how society, particularly Western society, has become enamored with stories of trauma. From a conversation she had with her trainee about how she couldn’t get enough details of her clients’ trauma, to books by Bessel von der Kelk and Paul Conti  on bestsellers lists and to a documentary by Gabor Maté, all are examples of how the topic of trauma is having a significant cultural moment. However, Stern and others have wondered if there is a misunderstanding of what trauma is. Are people truly experiencing trauma, or are they simply experiencing stress, grief, or big life events ? Maddux and Winstead (2016, p. 162) in the chapter on trauma and stressor disorders note that there is “larger debate [regarding the] pathologizing of normal human suffering and the overdiagnosis of disorders .”

This essay will discuss the phenomenon of society’s romance with trauma and the issue of pathologizing normal behaviors (Harrist & Richardson, 2014). It will then pivot to a discussion on what constitutes real, clinical trauma and two psychosocial models of the etiology of post-traumatic stress disorder (PTSD) (Maddux & Winstead, 2016). Lastly, the essay will contend that many people suffer significant stress and emotional events, however, most are resilient and will recover (Bonanno, 2021). For those who truly suffer trauma, they too will largely recover, but for those who meet the criteria of PTSD, they should seek professional help.

Pathologizing Normal Behavior

Harrist and Richardson (2014) discuss many ways in which seemingly normal behavior has been pathologized in Western culture. They note how melancholy and despair may actually be perfectly normal responses to the instable world in which we live, yet modern science attempts to solve these responses with pharmaceuticals . They further wonder why hoarding is considered a mental disorder when people fill their house to the roof with junk but people who “amass billions of dollars while other people starve” are not pathologized (Harrist & Richardson, 2014, p. 202). But more importantly, they discuss the roots and genesis of the PTSD diagnosis.

They cite an article published in the British Medical Journal of how the old diagnoses of battle fatigue and war neurosis were replaced by PTSD. The early supporters of the PTSD diagnosis were also part of the anti-war movement during the Vietnam War. Under the new diagnosis of PTSD, war veterans could receive unique medical care. But more importantly, PTSD fundamentally changed the way soldiers were viewed and treated. Instead of the focus being on the unique history of the soldier and his psyche, PTSD “legitimized their victimhood” and the PTSD diagnosis was perhaps more of a statement against the nature of war than anything else (Harrist & Richardson, 2014, p. 203). This change was a pivotal moment as the diagnosis expanded in scope for the next several decades to explain not only battle trauma, but also “symptoms of distress following disturbing events, even ones relatively commonplace or just witnessed, not directly experienced, by individuals” (Harrist & Richardson, 2014, p. 203).

Returning to Stern (Psychology Today Contributors, 2022, January 4), she describes why PTSD and related disorders have seemingly expanded their scope. The experiences people share of  trauma are often remarkable and fascinating and “have a strong emotional charge” especially when compared to more normal experiences of people from overprotected and isolated lives. There is an aura about traumatic stories and people who live through those experiences are imbued with a type of fame and fascination. Others wish to share their own stressful experiences to gain traumatic credibility. But as Harrist and Richardson (2014) warn, while people may indeed experience big emotional events, the trauma of soldiers, war victims, and victims of sexual violence, to name a few, should not be “trivialized.” Definitions matter and delineation must be made clear between normal behavior in response to a significant event, and clinical trauma that people suffer from living through horrific events.

Clinical Trauma and Psychosocial Etiology Models of PTSD

While there have been changes to the PTSD entry between the DSM-4 and the DSM-5, such as moving it from an anxiety disorder to the newly created category of trauma- and stressor-related disorders, the key features of PTSD remain relatively the same (Maddux & Winstead, 2016, p. 165). The traumatic experiences must be related to death, the threat of death, significant bodily injury, or sexual violence. Victims may either experience these events directly or they may indirectly experience them such as when a close family member directly experiences it and then conveys the details of the horrific event to the victim. Stemming from one or more of these experiences, the victim should demonstrate intrusive memories, dreams, or psychological and even physiological effects from reminders of the traumatic event. They will avoid any reminders of the event and may begin to have cognitive distortions, memory loss, emotional distress, and  even detachment. From there, they will develop and exhibit strong response arousal, careless behavior, hypervigilance, or experience problems with concentration or sleep. The victim must suffer many of the above symptoms for more than one month after the event. Underlying all these symptoms is the victim’s inability to process or integrate the traumatic experiences into their life. In turn, they are left with less than adequate coping mechanisms.

Based on a sample of people in the United States, it is estimated that over 60% of men and 51% of women experience trauma (Maddux & Winstead, 2016, p. 163). The majority of those adapt and do not experience long-term maladaptive coping mechanisms. As for why some people might cope well and adapt to a traumatic experience while others do not, there are many etiological theories that explain why some suffer PTSD. This essay will only touch on two: cognitive and emotional processing .

The cognitive etiological model theorizes that the individual’s beliefs and knowledge about himself, the world, and other people are maladaptive and weak, and when the individual experiences a traumatic event, their beliefs and conception of safety, are crushed (Maddux & Winstead, 2016, p. 169). They are unable to process the events and make meaning out of the experience. In fact, Harrist and Richardson (2014, p. 207) note that in a highly individualistic culture, many people don’t experience “shared meanings and coping strategies” and are thus left to their own devices to cope with trauma. In turn, they become overwhelmed and experience PTSD.

The emotional processing etiological model is based on the theory that the individual creates fear structures to deal with dangers in their environment. However, when these fear structures build excessive responses, the individual becomes inflexible in learning how to modify their responses (Maddux & Winstead, 2016, pp. 170-171). For example, a person with PTSD will demonstrate avoidance behavior, which in turn prevents them from tapping into and updating  their fear structure in a way that would enable them to successfully adapt to an event. 

As briefly noted, most people who suffer a traumatic event are able to make meaning out of the experience, adapt, and recover from the stress of trauma. In all this discussion on trauma and PTSD, it has been broadly observed that humans are quite adaptable, even when confronted with the worst of trauma.

The Resilient Human

Maddux and Winstead (2016, p. 163) produce a chart that visually demonstrates that even with the traumatic events of sexual and non-sexual assaults, people are able to recover and adapt well after the event. For sexual assault victims, 70% report PTSD symptoms one month after the event. That percentage continues to drop over time, going as low as 30% one year after the event. For non-sexual assault victims, 40% report PTSD symptoms one month after the event with a declining trend over time, going to 10% at the one-year mark. Overall, the data suggest there is a “natural recovery curve” (2016, p. 162), in which most victims can make a strong recovery. Only a small minority of victims experience PTSD .

All of this data supports the claim that perhaps by pathologizing and stigmatizing many big, emotional, stressful events, as a whole, society may be undercutting the process of recovery . To lend greater support and care for a victim, pathologies are created, and focus is placed on the symptoms, rather than successful and creative coping mechanisms. There is also a significant individualization and rights-based view of modern pathologies. Harrist and Richardson (2014, p. 204) note this paradigm “underestimates and tends to undermine the creative capacity of people to cope with, and even at times find meaning in, suffering and traumatic experiences.”

Harrist and Richarson (2014, p. 204) continue their discussion with examples of two non-Western cultures that do not pathologize not only big, emotional, stressful events, but not even trauma. Researchers and counselors went to Sri Lanka after the 2004 tsunami and worn-torn Afghanistan and realized people exhibited symptoms not on the PTSD list and when they tried to provide individualized grief counseling, the isolation “actually [exacerbated] fears of loss or disturbance of one’s role in the community.”

Returning to Stern (Psychology Today Contributors, 2022, January 4), she contends our judgment becomes impaired when we become captivated by stories of trauma . By immersing ourselves in our own emotions, we may overlook the needs of the person telling his or her traumatic story. Most importantly, we underestimate our resilience and fail to recognize our true strength. She goes on to discuss some broad observations from one researcher who has studied this topic for many years. She quotes George Bonanno who says, “Most people are resilient …some people are traumatized; some people recover. There are different trajectories.” In fact, in one of Bonanno’s more recent articles entitled The Resilience Paradox (2021, p. 2), he and other researchers reviewed 67 studies to better understand “outcome trajectories” of people who endure a potentially traumatic event (PTE). He writes, “two thirds of the participants showed the resilience trajectory. Thus, not only is resilience to PTEs common, it is consistently the majority outcome.”

In sum, many studies and researchers have noted that the human is resilient in the face of big, emotional, stressful events and even traumatic events. While trying to determine the root cause of why some suffer PTSD and others do not, researchers are finding that PTSD is fairly rare. For those who do suffer many of the symptoms of PTSD for months after the traumatic event, they should continue to seek support from clinicians, counselors, and a support structure.

Conclusion

In conclusion, this essay examined the phenomenon of society’s romance with trauma and the issue of pathologizing normal behaviors. Western culture seems to be experiencing a cultural moment with its fascination of hearing others’ traumatic experiences. While many people do experience big, emotional, stressful events, they are most likely not suffering clinical PTSD. PTSD is reserved for people who experience events related to death, the threat of death, significant bodily injury, or sexual violence. Furthermore, they develop long-lasting, maladaptive coping mechanisms. There are many theories of the etiology of PTSD, of which two are emotional processing and cognitive. Ultimately, many people suffer significant stress and emotional events, however, most are resilient and will recover. Even for those who truly suffer trauma related to death, bodily and sexual violence, they too will largely recover, but those who meet the criteria of PTSD and who have lasting effects, they should seek professional help and support from their family, friends, and social networks . 

References

Bonanno, G. A. (2021). The resilience paradox. European Journal of Psychotraumatology, 12(1), 1942642–1942642. https://doi.org/10.1080/20008198.2021.1942642 

Harrist, R. S., & Richardson, F. C. (2014). Pathologizing the Normal, Individualism, and Virtue Ethics. Journal of Contemporary Psychotherapy, 44(3), 201-211. https://doi.org/10.1007/s10879-013-9255-7

Maddux, J. E., & Winstead, B. A. (2016). Psychopathology : Foundations For A Contemporary Understanding (4th ed.). Routledge/Taylor & Francis Group.

Miller, T. (Director). (2016, February 8). Deadpool. 20th Century Fox.

Psychology Today Contributors. (2022, January 4). 5 Big New Trends | Psychology Today. Www.psychologytoday.com. https://www.psychologytoday.com/us/articles/202201/5-big-new-trends  

PSYCH 406 (Psychopathology) - TikTok and Diagnosis

 Abstract

This essay discusses the trend of self-diagnosis for mental disorders by people consuming social media, such as TikTok videos. It then examines the complexity of proper diagnosis while discussing the challenges the DSM-5 faces in providing clear guidance on diagnosis. Lastly, it addresses the risks of self-diagnosis and steps people can take to not succumb to those risks.

Introduction

In the summer of 2022, my family was about to enjoy a much-needed vacation. But before we began the 1500-mile drive, we were slightly concerned about a noise from the family van. The van was dropped off at the local mechanic who regularly changes the oil in all our vehicles. Later in the afternoon, the mechanic called back and said the van would need a $7000 repair and even suggested buying a new car might be cheaper. Shocked by this diagnosis, we took the van to another mechanic we knew from buying a used car. After a day, this other mechanic said he had seen this problem in vans many times before and it would cost less than $500 to repair. Of course, we went with the second mechanic and the van is still working great to this day.

The risks and dangers of misdiagnoses can be significant, even for a mechanical car that is relatively less complicated than the human brain. In the case of our van, the misdiagnosis would have cost us significantly and the problem would still not have been fixed. However, for humans, the risks and dangers of misdiagnosing a mental condition can be even more substantial. 

With the widespread availability of information online and the broad reach of social media, the practice of self-diagnosis and sharing one’s story online has presented new challenges to the mental health community. The framework for diagnoses, including the use of the DSM-5, is intended to facilitate common understanding and nomenclature for psychologists and psychiatrists, as well as aid in predictions and information sharing and even guide therapeutic practices (Maddux & Winstead, 2016; David & Deeley, 2024). But despite significant research and debate, the DSM-5 is not perfect, which fact underscores the complexity of diagnosis. Even so, many unqualified and untrained people self-diagnose because of ease of access to the DSM-5 and because they hear others discussing their symptoms of disorders on social media. This practice has led to problems such as definition dilution and perceived absolution of responsibility for one’s actions (Cassata, 2024; David & Deeley, 2024). While self-diagnosis may have its place, individuals who choose this route should always seek professional assistance and remain open to the possibility that their self-diagnosis could be incorrect.

Self-diagnosis of Mental Disorders Via TikTok

Juliana Dodds (The Project, 2022) did not feel understood. In a search for answers, she turned to watching content on social media, including TikTok. When she heard others’ stories, she felt they could fully explain her perspective. Many people, like Juliana, are looking for answers as to why they act the way they do. For some people, the discovery of social media influencers explaining their symptoms becomes a launching point of self-discovery, which leads to a conversation with their psychologist and may confirm the diagnosis. However, not all cases are as straightforward as watching a video, talking to a therapist, and receiving confirmation of a diagnosis. Others may feel validated after watching social media, but when discussing the issue with a psychologist, and after being tested multiple times, the self-diagnosis is incorrect. Some patients become convinced they have a specific mental disorder despite what the psychologist says. Juliana falls in the latter category, and although her doctor diagnosed her with complex post-traumatic stress disorder, she is convinced she has attention-deficit/hyperactivity disorder.

The trend of self-diagnosis stemming from social media has become so pervasive, that a recent study was conducted to understand how accurate or inaccurate these influencers are. Cassata (2024) reviewed the study conducted by Drexel University’s A.J. Drexel Autism Institute and found that less than a third of the most popular autism-related content included correct information and that over 40% of those videos “were completely inaccurate.” The study further noted the extent of the misinformation, stating that many egregiously inaccurate videos had been viewed close to 150 million times. While the power and reach of social media grants millions of people access to potentially valuable information, which may kick-start them on the path to recovery, it nevertheless remains vitally important that proper diagnosis is applied. Often the diagnosis process takes time and can be very complex.

DSM-5 and Complexity of Diagnosis

The DSM-5-TR (American Psychological Association, 2022) contains over 1,000 pages of text, criteria, definitions, tables, and statistics. Countless hours of research and debate underlies the wide-ranging scope of mental diagnoses enumerated in the manual. In the section entitled “Use of the Manual” the authors both describe the extensive assessment that should be performed, as well as warn readers of the dangers of “simply [checking] off the symptoms” (p. 21, 2022). Indeed, case formulation should include a detailed clinical history and a succinct summary of the social, psychological, and biological factors that may have contributed to the development of a particular mental disorder. Even after all factors have been considered, ultimately, clinical judgment is critical in determining the relative severity and significance of an individual's signs, symptoms, and diagnosis.

Despite the numerous hours of research and effort poured into the DSM-5, a review of its history proves that this resource is not perfect. While great strides have been made to make it the valuable resource it is today, forthcoming editions and revisions will face difficulty in basing future additions on empirical support as well as managing the shift from a categorial model to a dimensional model (see Maddux & Winstead, p. 100, 2016).

With many research questions left unanswered, some take the approach of advocating for the addition of a disorder to garner attention so that empirical data could be collected on the disorder, as was the case with “severe irritability in youth” (p. 101, 2016). While perhaps a worthy cause, this practice has the risk of defining a disorder that does not truly exist. As to the shift in classification, more are beginning to recognize the consistent failures of the categorical model, and therefore the DSM-5 has begun the shift toward a dimensional model. Shifting to a dimensional model will allow for a continuum of mental disorders based on severity, frequency, or intensity, and will allow clinicians to provide a richer diagnosis as well as improved pathways to treatment.

In sum, the numerous considerations that should go into a diagnosis are guided by years of clinical training, as well as countless hours of research and debate to produce the DSM-5. Even with the critiques the DSM-5 faces, this situation further underscores the importance of a proper diagnosis by trained and qualified clinicians, and self-diagnosis from watching a TikTok video is fraught with peril.

Risks and Proper Use of Self-diagnosis

Virtually anyone can access the DSM-5. While obtaining this resource is easy, its use in diagnosing a disorder requires hours of training and practice. Many people will read the DSM-5 and begin to draw conclusions that they exhibit the hallmarks of a particular disorder. They may even take the added step of sharing their story on social media. Others follow proper channels and seek an expert to determine if the disorder warrants an official diagnosis. Two major risks of self-diagnosing are definition dilution (Cassata, 2024) and perceived absolution of responsibility for one’s actions (David & Deeley, 2024). While self-diagnosis, whether through reading the DSM-5 or watching a video on social media, may be the catalyst for the individual to get the help they need, they must not stop there. They ought to consult an expert and seek professional help.

One major risk of self-diagnosis is definition dilution. This means as more untrained people improperly explain a diagnosis on social media, the viewers of those misinformed videos also jump to inaccurate conclusions. The viewers, in turn, spread the misinformation, as well as become convinced they have a particular disorder. When a viewer visits a trained clinician and hears they may have a different disorder, the patient may become upset and even believe they are being gaslit (Cassata, 2024).

Another major risk of self-diagnosis is the perception that the patient is absolved of the responsibility for seeking a cure because fundamentally the self-diagnosing patient believes the symptoms they exhibit are normal and do not constitute a disorder. David and Deeley (2024) observed that self-diagnosis stems from “grass roots movements” such as the neurodiversity movement, which seek to “[reframe] several diagnostic categories as (mere) variations of normality” and even propose that these are not disorders (p. 1057, 2024). Once this concept (that a disorder is normal) is accepted (either individually or socially), the individual could assume an attitude that “the world needs to accommodate him and ‘his autism’” and he need not search for a cure or alter his behavior in any way (p. 1058, 2024).

There is room for allowing the potential for self-diagnosis, with several caveats. If a person has sought professional help and if in the course of exploring all possibilities, the patient discovers information on social media, and most importantly, if they discuss what they’ve learned with their trained mental health provider, then perhaps social media has a place in the diagnosis process. The Internet has connected billions of people. For some who may have limited resources and time, perhaps social media content might fast-track the diagnosis process. But the importance of not succumbing to naïveté cannot be emphasized enough. The patient should always keep an open mind when consuming social media and should generally be willing to trust trained experts. Cassata (2024) interviewed a trained clinician who wisely stated, “Social media, in and of itself, is not the enemy … the real threat seems to be our unquestioning, naïve relationship to social media and our belief that diagnoses can be self-made without consulting a professional.”

Conclusion

In conclusion, with the widespread availability of online information and the broad reach of social media, self-diagnosis and sharing personal stories online have posed new challenges to clinicians, psychologists, and therapists. The diagnostic framework, including the DSM-5, is designed to create a common understanding and lexicon for psychologists and psychiatrists. It also aids in making predictions, facilitating information sharing, and guiding therapeutic practices. However, despite extensive research and debate, the DSM-5 is not perfect, which further highlights the complexity of diagnosis. Nonetheless, many unqualified and untrained individuals self-diagnose due to the ease of access to information and exposure to stories influencers share on social media. This practice has led to issues such as the dilution of diagnostic definitions and the perceived absolution of responsibility for one's actions. While there may be a space for self-diagnosis, those who go down this path should always consult professional help and always keep an open mind that the self-diagnosis may be wrong. 

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders, text revision (5th ed.). American Psychiatric Association.

Cassata, C. (2024, April 11). Autism: TikTok Leading People to Inaccurate Self-Diagnosis (J. Peeples & J. Seladi-Schulman, Eds.). Healthline. https://www.healthline.com/health-news/autism-self-diagnosis-tiktok

David, A. S., & Deeley, Q. (2024). Dangers of self-diagnosis in neuropsychiatry. Psychological Medicine, 54(6), 1057-1060. https://doi.org/10.1017/S0033291724000308 

Maddux, J. E., & Winstead, B. A. (2016). Psychopathology : Foundations For A Contemporary Understanding (4th ed.). Routledge/Taylor & Francis Group.

The Project. (2022, December 6). Dr TikTok: People Using TikTok To Self-Diagnose Neurodivergent Conditions Such As ADHD Or Autism. Www.youtube.com. https://www.youtube.com/watch?v=qhx7PnHZ7cY&ab_channel=TheProject 

From Shipwreck to Fire

Remembering Heraclitus: Themes

If the dry, fiery soul is the wise, “enlightened individual” (Sweet, p. 59, 2007), then the damp, wet, or even drenched soul needs genuine, philosophical insight. And how curious to encounter this footnote in Remembering Heraclitus: “Ortega y Gasset in his Loss of Self in Art suggests that the philosophic impulse arises from ‘feeling shipwrecked upon things’” (Geldard, p. 96, 2001). The image is striking: a sopping-wet captain and his crew attempting to flee their ship that has crashed on craggy rocks! How far from being dry are those souls and in that sinking moment, when lives and fortunes are ruined, they are left wondering what has become of them. What twisted turn of events in navigation, reading bearings, and accounting of weather did they go afoul? They have become shipwrecked and now the process of recovery and the path to dryness and even fire begins – their first impulse to philosophy commences.

Perhaps the analogy can be further considered. Will the shipwrecked crew try again? Will they take the lessons they learned to heart to avoid a future shipwreck, or even despite their best efforts to avoid misfortune, will they nonetheless run aground unforeseen shallow rock? Is this never-ending cycle of flux their fate? Do their daimons lead them down this looping path to the point that their fate defines their character? And lastly, if they are to tread the endless path of flux, do they ever stop and wonder what their purpose is – what their telos is? Perhaps, like Zeno of Citium, a shipwreck offers transcendence and brings deep and fundamental discernment to the unfortunate soul, thus revealing their telos, and they never return to their former endeavor (see Long, p. 109, 1986). Is misfortune truly fortune? This essay will ruminate on these questions using Richard Geldard’s Remembering Heraclitus (2001) as the backdrop for the discussion.

Your Character is your Daimon

Fragment 119 is translated in various ways. Geldard (2001) notes that most translators translate it as “character is fate.” Sweet’s (2007) translation is “one’s character is one’s divine fortune” while Robinson’s (1991) is “a person’s character is his fate (divinity). As for Geldard (2001), he translates it as, “for human beings, character is the divine force.” There is a spectrum of interpretations for how one may grasp the meaning of this fragment. We may suppose our fate is entirely out of our hands and we seemingly resign ourselves to the fates the gods have doled out to us. Or we may interpret this fragment as a declaration of our freedom in which we get to control our attitude, narrative, and volition – we are the authors of our character. Geldard reviews various analyses of this fragment, one of which represents both ends of the spectrum as one and the same.

We have no say in the matter of which life we are thrown into. We don’t get to weave our DNA and choose our parents, nor even choose the best traits and aspects of our parents. In fact, we may even be chained with generational baggage, emotions, and “debt” if you take an Eastern philosophical view of the matter (see Geldard, p. 89, 2001). From this perspective of the fragment, our daimon is exerting destiny and fate upon us the moment our cells begin to replicate. But that is only one side of the coin, to reference the analogy Geldard uses. The other side of the coin represents the “so what?”

The character Andy Dufresne from Shawshank Redemption (Darabont, 1994) faced stacked odds against him, but how he responded to his fate (his daimon) ultimately defined his character. Indeed, our fate or perhaps our daimon, as our guardian spirit, senses the required obstacles we must face which act as catalysts for us to either succumb to defeat or to achieve a defining moment. From this side of the coin, then, we should not moan or gripe in the face of impediments, but rather we should thank the gods for showing us the way to finding our true character. As the well-known Marcus Aurelius passage teaches, regarding other people, the elements, and even wild animals, these are “hindrance[s]” and “obstacles” that indicate the “path” on which we can advance (Meditations 5, 20). In sum, our fate and impediments point the way to our character.

However, in a cosmos that never rests from change, we must be cognizant of the unending myriad of obstacles. We may think our character has been refined through the process of managing an impediment, but the reality is that the constant state of flux will demand we confront barriers endlessly.

Constant Flux

Fractals are intriguing mathematical constructs that exhibit self-similarity at different scales yet are vastly complex and ever-evolving. In other words, they are shapes that look similar or even identical depending on the focus and scale of the perspective. They're often intricate and detailed, yet they are built on simple repeating patterns or processes. Fractals can be found in nature, such as in the branching patterns of trees, the distribution of galaxies, the structure of coastlines, and even in the shape of clouds. Perhaps fractals are an apt metaphor for reality and existence as a whole: infinite, ever-changing, ever-evolving. Once set in motion, the math behind the fractal iterates and expands endlessly.

One of the major themes of Heraclitus is the nature of flux and the cause of it. According to Heraclitus, part of the process of acquiring wisdom is to be awake and conscious to comprehend “the thought that directs all things through all things” (Geldard, p. 46, 2001). Geldard then makes an interesting connection by quoting Anaxagoras who noted, “mind is infinite and self-sustaining, is unmixed, alone, and by itself …. [and] drives the whole revolution, so that it revolved initially, first in a small area and now more widely, and eventually more widely still” (p. 46, 2001). Could this description be applied to a fractal? Perhaps. And if this is the true nature of the Cosmos and as humans are intricately entwined in the details of the Cosmos, we must accept the idea that our own minds are tiny fractals in a larger fractal both of which are constantly changing and evolving and part of a massive chain which is infinite. Consider Fragment 45: “One would never discover the limits of soul, should one traverse every road - so deep a measure does it possess” (Robinson, 1991). Succinctly stated, change causes change and never ceases.

However, what does flux mean to the individual? First, the individual must heed the wisdom Heraclitus states. We must accept that change is constant and never-ending. To wail at the passing of every dead skin cell or formation of a wrinkle or to be overjoyed at the birth of a kitten or bloom of a rose is not wisdom. Implied in these overextensions of emotion is a desire for something to remain the same. A better reaction to change is to accept it and even embrace it.

Secondly, the individual must look both deeper into and take a wider perspective of the fractal. Upon further reflection of flux, and the more one becomes familiar with change, he will begin to note that there is a cyclical nature to existence. Seasons change; families shrink and grow; history seems both different, yet the same. If one becomes discerning enough, he will realize that feeling sadness or anxiety about change is folly, especially since he may have a chance to experience something anew. Spring flowers are never lost. Embracing a loved one on their death bed may seem to be final, yet sometimes we may feel we love the same soul in another person, such as the way a grandmother may have cooked a particular dinner is revealed again in the way a grandchild mimics the meal.

Lastly, for the individual facing endless change, perhaps the most important lesson for them to embrace is this: given the constant change and given the fact that the more change happens, the more we see similarity, then perhaps the long-term response to all flux and cycles is to live in harmony with the Cosmos – to live according to Nature as the Stoics would propose. One could argue that the individual should assume a long-term perspective and attitude about life. If change is constant and if we encounter repeat obstacles, then we ought to seek the choice that most aligns with the nature of existence. While an entire paper can be spent on this topic, instead of reading that essay, the reader may wish to watch and ponder two videos regarding the well-known economics game theory model called The Prisoner’s Dilemma. Video one (Agar, 2014) explains the prisoner’s dilemma, while video two explains the fascinating strategies employed while playing the game repeatedly (Agar, 2016). One, brief commentary on these videos is that the successful, long-term strategies used in iterative prisoner dilemma games are not unlike living a moral, virtuous life based on Stoic ethics.

Recurrence, to what end?

While applied ethics may be one reason to assume a long-term perspective, a related idea worth discussing would be the topic of ultimate ends for the individual. Geldard (2001) dedicates an entire chapter on telos and what we can learn from Heraclitus on this topic. This essay began by discussing philosophical and actual shipwrecks and how they are catalysts for change. The literal shipwreck must have been caused by one or many variables. Was the cause a faulty rudder, an incompetent navigator, or a lackadaisical captain, or were the elements – Nature – the sole causes of the ship crashing upon waves and rock? Were the captain and the crew completely helpless and only had God to blame for the crash? Once recovered on dry land or perhaps while drowning in the deep sea, they may have wondered: who’s in charge of all this or is it all chaos? What’s the purpose behind all this? Geldard contends that in Heraclitus’ perspective, there is “someone or something at the helm, which in turn implies a vessel with a rudder going somewhere” (p. 109, 2001). And with that implication, an aim for the individual could be found.

While Heraclitus does observe natural cycles and emphasizes constant change, he does not explicitly formulate a doctrine of recurrence or eternal return in the same way that later philosophers, like the Stoics and Nietzsche, do. However, there are a couple of gems found in Robinson (1991) and Sweet (2007) that indicate recurrence is a theme of Heraclitus and that with it, there is a heading to be found for the individual. Robinson quotes Aetius who wrote, “Heraclitus held that the recurrent fire is everlasting, and that destiny is a logos which fashions existent things through the contrariety of the directions in which they tend to run” (p. 173, 1991). Sweet, in his commentary on the themes of life, death, and the soul, discusses the dry and wet soul analogies of Heraclitus. He notes that Heraclitus proposes the soul gains power through wisdom and “becomes a dry soul” and “to the extent that it is identified with the universal fire” (p. 67, 2007). Furthermore, the truly wise person can attain such a degree of wisdom that their soul is unified with the universal fire and achieves a type of immortality. However, upon death, the wet or unwise soul turns to water and then earth and is merged into nature. While Sweet is not explicit, it could be assumed that the unwise person is reincarnated to try again, as it were.

Therefore, if it were assumed that flux is endless and recurrent and that individuals are tossed into the mix over and over again until they get it right and only when they become wise do they find an exit through unity with the universal fire, is this our answer to what our telos or aim in life is? One perspective Geldard brings into the analysis is that of Fowles. In this endless flux (what Fowles calls “The Situation”), “the only telos possible is an existential one” (p. 112, 2001). He quotes Fowles who writes, “To accept one’s limited freedom, to accept one’s isolation, to accept this responsibility, to learn one’s particular powers, and then with them to humanize the whole: that is the best … for this situation” (p. 112, 2001). In brief, one perspective is to simply accept existence as is. However, if this may seem distasteful, perhaps a more transcendental attitude of existence might invigorate life. Geldard offers the aim of unity with the Cosmos, or to be more precise, metaxy.

Fragment 10 focuses on the unity with the whole. “Seizures – wholes and non-wholes, being combined and differentiated, in accord and dissonant: unity is from everything and from everything is unity” (Sweet, 2007). Fragment 30 similarly notes, “this cosmos [the unity of all that is] was not made by immortal or mortal beings, but always was, is and will be an eternal fire, arising and subsiding in measure” (Geldard, p. 129, 2001). Geldard proposes that “the unity is the telos” of the human and that many texts from the same period of Heraclitus reflect this desire for transcendence away from the human existence Fowles describes and towards a metaxy or “in-betweenness” – a place between human existence and the Logos (p. 113-114, 2001). Geldard then reviews similarities between the teachings of the Old Testament prophet Jeremiah, the Buddha, and Lao Tse and the fragments of Heraclitus, all of which offer ideas for achieving unity.

Practice Again and Again

Since the individual finds himself in an endless flux that recurs, and his telos is to transcend into metaxy, what key lessons must he practice repeatedly to achieve his telos? Geldard notes similarities between Heraclitus and his peers of the time. The first is Jeremiah who calls the people, like a shepherd to his sheep, to “feed [on] knowledge and discretion” (p. 116, 2001). Geldard notes that this call to knowledge and discretion invokes a greater individual responsibility for people to come to God’s terms and perspective. In a similar vein, Heraclitus teaches that “to God all things are beautiful, good and just” (p. 116, 2001) and humans irresponsibly assume a narrow, closed-minded perspective. If we are to achieve our telos, we must practice abandoning our restricted point of view and practice embracing the perspective of the Cosmos.

Related to the practice of assuming a Cosmic attitude is the work of letting go of the ego and its related attachments and embracing the will of the Universe. Geldard references the Buddha’s doctrine of separating the selfish ego of one’s identity and in its place, assuming an identity equal to that of Divinity. When we cease being fearful of losing ourselves and cease the longing for fame and ego, we begin to break “the bonds of attachment” (p. 118, 2001). Heraclitus similarly admonishes in Fragment 2 that we must “obey the universal” and not be like common people who cling to their own “private understanding” (p. 119, 2001). To achieve our telos, we must practice relinquishing our selfish egos every day. Every flinch or snap judgment towards grasping at some portion of fame, or power or status should be met with practicing a desire to flow with Nature and being unified with the Nature of things.

Lastly, Lao Tse noted the tension of justice in the Universe by observing that tautness is needed for a bow to succeed. If there is no tension because the string is too long, then the string must be shortened and if there is not enough string, then it must be lengthened (see p. 120, 2001). A sage practices and demonstrates his knowledge rather than simply retaining it. True, divine understanding and judgment is not simple learning, but rather, being truly awake and aware and acting accordingly. To this end, Heraclitus teaches us to not heed him, but the Logos (Fragment 50) and that common humans do not have good judgment, but only divine judgment is good judgment (Fragment 78). Therefore, to achieve our telos, we must avoid the common and instead practice observing true wisdom. It will take skill to know when to apply a virtue and how much or how little for the right amount of tension.

Conclusion

The idea of a philosophical life beginning from a shipwreck is not novel. Many observers through the years have found the analogy quite compelling. Vidauskytė (2017) notes that not only is a shipwreck a metaphor for the initiation of a philosophical life, but that seafaring also signifies the human discontent with staying on land and the desire to transcend the human domain of land and venture out to the beyond. She rightly observes Diogenes Laertius commentary on Zeno of Citium, who survived a shipwreck and traded his lost cargo of purple dye for living a philosophical life on dry land. But not everyone’s fate is a shipwreck. Our character is defined by our fate, through the endless flux of impediments and obstacles. And sometimes, the monotony and recurring nature of existence forces us to wonder what our ultimate aim is. Perhaps after enough voyages and challenges, we arrive at true wisdom and begin to see the Cosmos as it really is – we lose our common ego and pivot to a desire to be at one with Nature. With enough practice of taking the Cosmic perspective, laying aside our ego, perhaps we achieve transcendence, return to land, and dry our soul by a flaming, wise fire.

References

Agar, J. (2014, October 4). The Prisoner’s Dilemma. Www.youtube.com. https://www.youtube.com/watch?v=t9Lo2fgxWHw&ab_channel=ThisPlace

Agar, J. (2016, July 2). The Iterated Prisoner’s Dilemma and The Evolution of Cooperation. YouTube. https://www.youtube.com/watch?v=BOvAbjfJ0x0&ab_channel=ThisPlace 

Aurelius, M. (2014). Meditations (M. Hammond, Trans.). Penguin Classics, An Imprint Of Penguin Books.

Darabont, F. (Director). (1994, September 10). The Shawshank Redemption. Columbia Pictures.

Geldard, R. G. (2001). Remembering Heraclitus. Lindisfarne Books.

Long, A. A. (1986). Hellenistic philosophy : Stoics, Epicureans, Sceptics. University Of California Press.

Robinson, T. M. (1991). Heraclitus : Fragments. University Toronto P.

Sweet, D. (2007). Heraclitus : Translation and Analysis. University Press of America.

Vidauskytė, L. (2017). Metaphor of Existence: Seafaring and Shipwreck. [Egzistencijos metafora: kelionė jūra ir laivo nuskendimas] Filosifija Sociologija., 28(1), 11-19.