UPPER IOWA UNIVERSITY – Dr. Steve Stein

Ok, things I don’t like about living in a Third World nation. Electricity and water are not always available when you want them. The use of toilets, when they are available, might require finding rainwater to help with the flushing duties. When you use a toilet, you can not throw the toilet paper in the toilet. You have to take your soiled toilet paper and put it in a garbage pail next to the toilet. To me, this is the grossest act of all. And yet, it does force the issue of paying attention to what we produce every day. I prefer not knowing.

If you are a “turista,” you have to be careful of the water, ice and unwashed vegetables and fruit. (See the above.) Hot water is a rarity, but we become good at soaping up and rinsing while at the same time making sure our mouths are shut tight so water doesn’t creep in.

Driving on unpaved roads has woken internal organs that I forgot I had. Also, I now expect long waits on even major highways because of cattle crossings and things like that. That part I don’t mind for some reason. It’s fun to be eye-to-eye with some bull while safely in my car with the windows closed.

I miss my ice cream, my TV, my iPhone, pizza or Chinese delivery service and golf.

I will blog later about what I don’t miss about the First World living!

Living in Nicaragua has its challenges. The vast majority of the people live in intense poverty. I am reminded what that means when I am here. For most it means continual hunger for themselves and their children, meager and limited dirt floors that are called homes, and constant confrontation with despair and hopelessness. And yet, I see many changes since last year. Free health care, compulsory education, services for abused women, help for the developmentally disabled and the mentally ill have strengthened the social infrastructure of this Third World Country. They are ardent advocates against the exploitation and abuse of children.  They also have a meager minimum wage which has helped this country to become more of a consumer based economy. With more money in the pockets of the people, you see more stores and commerce. Colleges are essentially free for those who are able to attend. Because of poverty, most do not, but there are no outrageous student loans that students are saddled with when they graduate. There are medical and graduate schools that are being built. Philosophically, they believe that education is the portal for this very poor country inching its way out of poverty.  Maybe there is something here that we can remember and reinforce in the USA.  Education is what made us great and it is education that will keep us great.

Most importantly, the greatest asset that I experience is the ingrained sense of community. The streets are the living rooms of the community where people sit outside always talking and playing. I always feel safe walking the streets at night.  I can’t say the same about us in the USA.

Carola and I are at the home of Katarina Pfortner (http://www.cbm.org/Katharina-Pfoertner-254648.php) and her beautiful family after a seamless trip to Nicaragua. We are acclimating to the culture by visiting and talking with folks.  Some talked with pride of their revolution and all that they have accomplished since then. I wonder if that is the way we felt after we freed ourselves from the British Empire?

The highlight was our walk around Estili with Marciela, Carola’s niece.  I was particularly interested in a project that is headed by a very loving and kind man who meets with children and adolescents every Saturday morning to develop and make these beautiful colorful  murals throughout the city.  The project began as a way to help children give expression to what was happening during the Revolution.  There are very few families who did not lose a loved one in this brutal conflict.   Now, the murals grace the entire city celebrating love, peace and community.  The pride was obvious.  When I asked Orlando, what he gets out of doing this, he smiled and said, “Don’t we all need to be seen?”  Exactly!   He reminds me of one of UIU’s very best student and long-time friend, Will Green who began MentoringPositives in Madison with a similar vision.  http://www.mentoringpositives.org/  Interestingly, there is no graffiti in Estili.  A coincidence?  I think not!

 

The past year brought a confluence of events that culminated and reinforced my ideas about the essence of the human being.  While each person’s journey will lead one to his or her own doubts and conclusions, this question has fascinated me ever since I was a little boy.  (For those who want to indulge in my narcissism, I would be happy to share what I wrote about the subject in the second grade.)  Suffice to say, this question and curiosity have led me to the field of psychology and psychotherapy.  I came to the conclusion that psychology, both clinically and academically, is the study of the invisible factors that makes us who we are.

To me, psychology and psychotherapy have always been about making “the invisible, visible.”  Helping people become more aware has always seemed like a noble goal.  But what helps people experience emotional stability?  Knowing why you suffer does little to alleviate it. Why is it that human beings sabotage every intention that they might have to be happy, healthy and content?  What are the invisible forces that reinforce negative thoughts, feelings, anxieties, panic, compulsions, addictions and even psychosis?   The prevailing thought among many psychiatrists and mental health specialists (with unimaginable financial support by the pharmaceutical companies) is that we are passive victims to “bad” brain chemistry or a “chemical imbalance.”  The best we can hope for is to find the right medication to “correct” the brain chemistry in order to relieve the patients of their suffering.

This is not an indictment against medications.  Medications, especially those used to treat serious mood disorders, such as depression, anxiety and bipolar illnesses, have undoubtedly saved lives and enhanced functioning. However, environmental events, trauma, child neglect and abuse strongly affect brain development and chemistry.  This last statement often escapes the thinking of many who work with the mentally ill with profound consequences.

My contention is rooted in evidence that human beings are “hard wired” social animals needing to be seen, accepted and “loved” for who we are.  While evolutionary factors have given birth to an adrenal system that pumps out adrenaline with remarkable speed to fight mightily against perceived enemies, we have also evolved in a remarkable way to produce oxytocin, which establishes and maintains meaningful “love” relationship.  Deny the human being a connection with another human being and you will inevitably create severe mental illness.  Deny an infant touch and love, you will ultimately have a baby whose brain will be severely compromised and very likely to die in a condition called “failure to thrive.”  These are the more exaggerated proofs that relationships affect our brain functioning.

Research has also shown unequivocally that physical (environmental) therapies improve brain mass in different parts of the adult brain and those who suffer from brain injury.  The advent of learning about neurostem cells and our ability to grow new brain cells indefinitely will likely usher in new treatments for brain injured patients.  The UW is researching how mild electrical currents stimulate new brain growth with very encouraging results.  But I contend that it is the human being’s ability to be understood and accepted (unconditional love?) that is the major contributor to better brain functioning and mental health. This treatment approach, which has been outlined in a previous blog, has demonstrated remarkable long-term improvement of the many adolescents who “graduated” from NorthStar Adolescent Treatment.

Parallel to these new developments in brain research is my work this year with a 27 year old man who was diagnosed with schizophrenia and steadfastly refused to take medications to the chagrin of his psychiatrists, psychiatric hospitals and those who are in charge of making sure that “mentally ill” people do not cause harm to themselves or others.  While I never was able to determine what exactly he did to have professionals argue that he met this criterion, he was conditionally released from a long-term involuntary admission from the state hospital.   His story will be part of a documentary filmed by Lise Zumwalt.  The following is a trailer for the movie:  http://www.witnessdocfilms.com/trailer/

Eric brought to my attention the serious issues of those who are neither suicidal nor homicidal, but have their rights taken away because they experience hallucinations and delusions.   His experiences brought me in touch with researchers whose studies suggest the lethality of anti-psychotic medicines that are taken over a long period of time.  Most importantly, while I have no doubt that psychosis is a real phenomenon, I began to question the validity of the high number of patients who are diagnosed with schizophrenia. Approximately, 1-2% of the adult population suffer from this debilitating disease.  However, in the 39 years of working with children and adolescents who demonstrated psychotic behaviors, thoughts and delusions, I did not know one who was later diagnosed as schizophrenic.  My colleagues, who share a similar treatment philosophy, report the same curious observations.

I was more absorbed in my work with children and adolescents to question this.  However, the implications are enormous.  When confronted with teens who were psychotic, we first ruled out trauma, bipolar, severe depression and dissociative disorder which are all treatable and/or curable disorders.  After pursuing these diagnoses, none were later diagnosed with this incurable and chronic mental illness, schizophrenia.  Until I began working with Eric, I never asked why.   Like so many of the adolescents we treated, perhaps Eric’s “psychosis” was the expression of inner turmoil that never found expression in a more “functional” way.

We all recognize the importance of “debriefing” when one experiences trauma.  Why?  The answer is self-evident; the human being needs other human beings to understand and accept our pain and rage.  It is not the trauma that makes us “crazy” but our inability to give voice to the pain.  This became evident with Eric, but other factors complicate his recovery.

I am now left with the reasonable conclusion that not only does the “chemically imbalanced” brain causes emotional, behavioral problems including psychosis, but that unprocessed traumatic events can create a “chemically imbalanced” brain.  As stated before, medications have been undeniably helpful, but I believe that they have also contributed to the muting and denial of a person’s pain and trauma which leads to a disquieting suffering that can severely effect emotional, psychological and physical well-being.  Some psychotherapeutic approaches, which only focuses on symptoms and cognition, may inadvertently ignore the systemic factors which creates this emotional and “chemical” imbalance.  Are we treating the “automobile” while denying the “driver.”   With the advent of more sensitive measurements of the brain, we are beginning to understand that the “hard-wiring” need for relevant and meaningful relationships grows brain cells, changes brain chemistry and enhances neural connections.

My return trip to Nicaragua at the invitation of CBR to explore their budding mental health delivery system will attempt to explore these issues through this prism.  The NorthStar treatment philosophy is anchored in the belief that we are continuously giving expression of who we are by our behaviors and that the offering of empathy, compassion and authenticity by trained mental health professionals yields long-lasting improvement in mental health functioning.  How helpful will this approach be to a community which as so few resources?

 

 

 

 

 

 

 

I presented to the Wisconsin College Advisers Association a few years ago on what makes a University valuable to students. An informal meta analysis of studies revealed that students who “feel” valued and “accepted,” tend to stay involved. I often talk about “inspiring” students rather than just teaching content. “Finding meaning” is the developmental challenge for young adults and maybe for all of us. Our international opportunities, the work done in Haiti are wonderful examples of these endeavors.

I have presented faculty workshops focused on “Relationship Based Teaching” and advocated by Parker Palmer and other educators. This pushes us to attend to one of the most important elements of learning; meaningful relationships. We are inspired by not only what we learn, but HOW we learn.

I love UIU because not only are we in the business of teaching, we are in the business of inspiring! Are you ready to be inspired?

Have a wonderful holiday season.

For those who are interested, Dr. Carola Pfortner and I will give a 30 minute talk about our work in Nicaragua this past summer. The presentation will be on December 1, 2011 at 6:30pm in Fayette. We are looking forward talking about developing an internship this summer for a select few students who speak Spanish and want to help us develop much needed community mental health services for adolescents and their families. This should be an outstanding experience!

As mentioned in my previous blog, CMR is interested in having us develop a community mental health center for adolescents in Nicaragua. Much of the underpinning of the program would be based on the treatment philosophy of NorthStar Day Treatment. I wonder if there are undergraduate students in psychology or human services at UIU who would be willing to join us in this adventure? It will be important to know Spanish. I believe this can be a very rich educational experience with credits earned for internship. Perhaps I can teach an undergraduate course in psychology if there are enough students who join us. Are you interested? Let me know.

Living in a Third World country, even as one as beautiful as Nicaragua, has its advantages and disadvantages. One of the “disadvantages” is the inability to find a WI-FI connection when you want. Right now, I am writing my thoughts down hoping to send this to my blog when I finally make a connection. Was my inability to make a connection to the cyber world a complete disadvantage? Not really. I felt strangely liberated from the constant barrage of news, email requests and other technological distractions that besiege me. I was able to make contact with my adult children by phone that offered some comfort that I am still connected to my world in the United States, but for the most part, I allowed myself to immerse in a culture that is warm and welcoming.

We drove from Estelí to Juigalpai to present our workshop. The drive reminded me that punctuality is quite impossible when roads are unpaved for long stretches of time and the drive will be interrupted by the crossing of cows and bulls at unscheduled times. The picture below was taken from my stopped car.

I am quite convinced that a delayed trip to Fayette from Madison would have created considerable angst. Somehow, I surrended to the idea that I had no control over my environment and when I did, I felt I was able to temporarily surrender to a culture that is perhaps less obsessed with time and performance and more focused on the moment. Isn’t that what I always tell my worried clients who see me in psychotherapy? Be in the moment; it is all that we have. I will be referring to this concept later on in my blog.

The workshop was presented to paid and volunteer consultants who work for “Community Based Resources.” This is an international non-profit organization funded by churches to provide services for the mentally and developmentally disabled. We highlighted the most recent brain research and its implications in providing family and community based services to children in order to maximize development in emotionally safe relationships. The most salient feature of our program focused on how fear thwarts learning and brain development while empathy and compassion create the opposite. The implications are self-evident when working with “acting out” children and adolescents. In spite of the 100-degree temperature and high humidity in a room with approximately 35 people, the workshop was very well received. Katharina probably had the most difficult task translating every word spoken by Carola and me. Our PowerPoint, which was translated to Spanish, helped. Below is a picture of me helping a small group of students towards the end of our presentation.

This workshop was so well received by both participants and the program director that a request was passed on to Katharina to repeat it with the parents in the community area. I was very proud.

One major faux pas was committed by me when I was comparing the brain with the “automobile’ and the invisible person inside us as the “driver.” I was clumsily attempting to give examples how the “driver” is responsible for their behavior regardless of the condition of their “automobile.” I was quickly reminded that no one in the audience has an automobile. In fact, cars are a luxury for the very few.

At the end, we raffled two Upper Iowa University shirts. Isn’t it wonderful to see Upper Iowa represented in the Nicaraguan area?

Afterwards, we were invited to visit Aldeas Infantiles SOS, Nicaragua in the same city. This is an amazing project that takes children from ages 0-12 who are neglected, abused or abandoned by their parents. For many of these children, it is a respite from a troubled family who might need some time to heal from emotional wounds that have afflicted them. It is well staffed with loving people and very clean. I walked into the infant room and a small boy named, Alberto, immediately crawled to me, grabbed the bottom of my pants and lifted himself so I can hold him. Every time I tried to leave, he would do the same thing. Here I am with my new friend looking over some behavioral charts with Katharina.

After a long day in the sweltering heat, we met with Ms. Rosalina Flores Obando who was very interested in our NorthStar Adolescent Day Treatment program. For those who are less familiar with this program, NorthStar was established 21 years ago under my supervision and co-ownership 21 years ago. The treatment philosophy is based on some basic premises; (1) adolescents often express their inner turmoil with “acting out” behaviors and (2) a vast majority of us are “hard-wired” to be understood and accepted. With very skilled therapists, we attempt to create an environment that encourages authentic communication and understanding. Dr. Pfortner’s recent research of our population demonstrated an 85% improvement rate in overall psychological functioning at discharge and 3, 5 and 8 years after the adolescent graduated from the program. Since this was not the main thesis of her research, there were many confounding variables that probably inflated the success rate. Albeit, one wonders that if these variables were better controlled, would we achieve similar results? What would the results be in a different culture? We proposed the possibility of inviting undergraduate students to help develop community mental health initiatives under my supervision. Is there interest? I will follow-up this question in my next blog submission. One of the major concerns has been the alarming increase of adolescent suicide. Numbers are difficult to obtain, but I will try.

We have spent a good portion of the day getting ready to present to educational consultants in Juigalpa. This should prove to be very interesting since our presentation will be translated to Spanish. Our major learning objective is to demonstrate that children learn best when they feel supported and accepted. I think it will be a good presentation and I plan to video tape some of it for your viewing.

Did I say 1,400 feet? I was wrong; the “Linda Ojos Finca” (http://www.finca-lindos-ojos.com/Start-E.html) is 1400 meters high which is over 4,200 feet.  Still part of Estili, a very rocky road takes you to this paradise in the Nicaragua National Forest.  The pictures I uploaded can only capture a bit of the glorious scenery and ambience we experienced.  What makes this such a delight is the very conscious sustainability efforts.  Solar panels create electricity for the entire farm.  Food is all organic including fresh milk from their cow.

On Wednesday we will be offering a workshops to teachers on “Understanding Children’s Behavioral Problems.”  This should prove to be a very interesting week.