Reality is Complex

Reality is Complex and in Polarity

A dialectical perspective holds that reality in complex, oppositional, and in polarity. Again, we intuitively recognize this from our lives and clinical work. Say a 12-year-old runaway (built like a 15-year-old) is admitted to a psychiatric unit by police. The file shows he's had horrible physical abuse as a child and mild developmental disability. As you interview him he appears to have manic symptoms with extreme irritability. Multiple drugs show in the tox screen. He's admitted for observation. At this point you think, “Huh, there is this and there is that, and then there is this other piece, wow, this is complicated.” But then he physically threatens the petite, beloved social worker in a sexually graphic way; now there is high emotion among the staff. 

As soon as someone on the inpatient unit takes the position of being flexible on program rules, it elicits someone else's description of why in this case no exceptions to the rule should be made. One person thinks the client can be reasonably discharged, which prompts someone else on the team to give reasons why that is not a good idea. We often respond to complexity in oppositional or polarized ways. The existence of “yes” gives rise to “no”, “all” to “nothing”. Maybe it is the nature of reality or may be simply the nature of human perception or language. 

Whatever the reason, we often fall into processes in which oppositional elements are in tension with each other. When applied to human conflict, often both opposing positions may be true or contain elements of the truth (e.g., there are valid reasons to discharge and to delay discharge). Taken together, these first two dialectical assumptions mean no one ever has a “whole” perspective on a client. Therapists are like the blind men each touching a part of an elephant and each being certain that the whole is exactly as the part they are touching. “An elephant is big and floppy,” “no,no, long and round and thin,” “no, no, no, solid like a wall.” Each has an alternative perspective. Each is true and each is partial.

From this view, then, smart, reasonable, people will disagree. Polarized divergent opinions are seen as inevitable when problems are complex. Nothing is wrong: the client isn't pathologically splitting the team; the therapist isn't (necessarily) naïve or narcissistic. It is simply the nature of the phenomenon. No one person on a treatment team has a lock on important. Therefore, DBT puts a large emphasis on dialogues that lead to synthesis. How does the piece I hold fit with yours to make a more complete, coherent, or workable whole? Together we search for what is valid and polarized or divergent positions rather than striving for a unified front. Rather than artificially resolve a conflict by dropping one end of the dialectic or fighting only for one position, effort is made to stay engaged without appeasing, capitulating, dominating, or accepting the invalid.

Doing Dialectical Behavior Therapy (A Practical Guide by Kelly Koerner).

Reality is complex... Photo by Elena.

Science and Creation

Science and Creation

One of the less endearing – and more dangerous -features of the 20th century has been a worldwide tendency to substitute rhetoric for discourse. By now, reasoned debate is a rarity. There is seldom even any effort to understand an opposing point of view. Instead, a person attributes opinions or attitudes to the other fellow and proceeds to heap billingsgate upon him because of them, although they may not actually be what he means at all. Living near Berkeley, California, I have over the years watched this sort of thing develop in the academic community and its hangers-on, until I am inclined to agree with a fictional character of mine who remarked, “Sure, I'm anti-intellectual. I prefer people who think...”

Well, that may be just a little exaggerated, a hint of the same behavior I was condemning. It got your attention, though, didn't it? Let me try to make the rest of this essay an exercise in rationality.

I propose to discuss the “scientific creationism” is so much in the current news. My conclusion will scarcely surprise you: that “scientific creationism” is a contradiction in terms. If that were all, there would be no point ins stating it yet again. Why preach to the choir? However, it does seem to me that spokesmen for the scientific establishment have generally made their points poorly, because often they themselves don't quite realize what the concept of evolution signifies. Thus the argument we'll advance against creationism here will take a turn that may prove surprising, therefore enlightening, to some readers. Indeed, it will be only the first step in a brief exploration of the philosophy of science. 

We begin by forswearing. The creationists are not a bunch of yahoos. They are generally well-educated and well-mannered individuals, a number of them with excellent scientific credentials. (While I don't know just what James Irwin's views on evolution are, we all know he believes the Biblical story of Noah is substantially true, and led an expedition in search of the remains of the Ark – after having been on the moon).  Nor do most of them want to suppress any other doctrine. Socially and politically, they have several quite valid, important points to make. Secular humanism has in fact become the teaching of the public schools, to the exclusion of crucial parts of our heritage. The effects on culture are already sad, the implications for the future of liberty and even for national survival ominous. Would it really infringe anybody's constitutional rights if children were to learn something about the roots of their civilization?

The question remains: How shall we persuade a lot of perfectly nice people that they are undermining a cornerstone of their entire civilization? Illustration by Elena.

But this does not mean they should learn things, at taxpayer expense, which simply are not true. By now, the scientific attitude and the body of discoveries to which it has led are themselves basic to society, and not merely Western society. “Scientific” creationism is not content to maintain that the universe is the work of God. It claims that this Earth is, at most, a few thousand years old, and that the species of living beings we know today came into being in their present forms. Of course, the First Amendment guarantees any American the right to believe and argue for that, and teach it privately. But the notion has no more claim on “equal time” in public education than do, say, astrology, psionics, or Marxism.

It is scarcely necessary here to repeat what has often been pointed out: that if the creationist assertion were true, then our astronomy, physics, chemistry, biology, and archaeology must be false. For example, evidence for geological ages includes matters as diverse as the well-established laws of radioactive decay and a cosmic red shift observed by familiar techniques of spectroscopy. Much has been made of certain unexplained anomalies in certain mineral formations – far too much. Science is always coming upon such phenomena, and needing time and effort to learn what brings them about.. We don't yet understand ball lightning very well, either; but nobody says that, on this account, we should throw out our meteorology. Instead, what understanding we do have provides a context within which to seek explanations of countless details.

Thus the claim that our planet is less than a million years old, and has undergone no significant changes during its existence, is incompatible with science. At best, a person might declare that God created the universe recently, full of misleading clues to something quite different. Emotionally, I am inclined to think this is an insult to the Creator. In the famous words of Einstein, the Lord is subtle, but He is not malicious. Logically, we need only note that the declaration is, by its nature, untestable, incapable of being disproven; therefore it is devoid of empirical meaning.

We might, though, find it worthwhile at this point to refute one statement frequently made by creationists, that the development of matter and life from primitive to complex forms would violate the second law of thermodynamics. Even some who have accepted evolution as a fact, such as the late Lecomte de Noüy, have maintained that it would have been statistically impossible without supernatural guidance. They should have known better. 

Part of the problem arises because the second law is deceptively simple looking but has profound and far-reaching implications. It can be expressed in confusingly many ways, and has been. In one of my college textbooks (Physical Chemistry, by Frank MacDougall, Macmillan, 1944) the phrasing of the law goes: It is impossible to devise any mechanism or machine by means of which a quantity of heat can be converted into the equivalent amount of work without producing other changes in the state of some body or bodies concerned in the process. Another book (Introduction to Theoretical Physics, by Leigh Page, Van Nostrand, 1928) puts it as: No self-acting engine can transfer heat from a body of lower temperature to one of higher temperature. Here a “self-acting engine” means, essentially, one which is isolated from outside influences and which takes its working substance through one or more complete cycles.

There are numerous other, equally valid versions of the same truth, but these two should be enough to show that we are dialing with something which is quite basic and not at all self-evident.

There is no scientific argument against evolution, only an antiscientific one. Image by Elena.

Marque and Reprisal

Marque and Reprisal

By Poul Anderson

1700 hours in San Francisco was 20000 in Washington, but Harold Twyman, senior senator from California and majority leader of United States representatives in the Parliament of the World Federation, was a busy man whose secretary could not arrange a sealed-call appointment any earlier on such short notice as Heim had given. However, that suited the latter quite well. It gave him time to recover from the previous night without excessive use of drugs, delegate the most pressing business at the Heimdal plant to the appropriate men, and study Vadasz's evidence. The Magyar was still asleep in a guest room. His body had a lot of abuse to repair.

Shortly before 1700 Heim decided he was sufficiently familiar with the material Robert de Vigny had assembled. He clicked off the viewer, rubbed his eyes, and sighed. An assortment of aces still nibbled at him. Once – Lord, it didn't seem very long ago! - he could have weathered twenty times the bout he'd just been through, and made love to three or four girls, and been ready to ship out next morning. I'm at the awkward age, he thought wryly. Too young for antisenescence treatment to make any difference, too old for – what? Nothing, by Satan! I simply sit too much these days. Let me get away for a bit and this paunch I'm developing will melt off. He sucked in his stomach, reached for a pipe, and stuffed the bowl with unnecessary violence.

Why not take a vacation? He thought. Go into the woods and hunt; he had a standing invitation to use Kan McVeigh's game preserve in British Colombia. Or sail his catamaran to Hawaii. Or order out his interplanetary yacht, climb the Lunar Alps, tramp the Martian hills; Earth was so stinking cluttered. Or even book an interstellar passage. He hadn't seen his birthplace on Gea since his parents sent him back to Stavanger to get a proper education. Afterward there had been Greenland Academy, and the Deepspace Fleet, and Earth again, always too much to do.

Shraply before him the memory rose: Tau Ceti a ball of red gold in the sky; mountains coming down to the sea as they did in Norway, but the oceans of Gea were warm and green and haunted him with odors that had no human name; the Sindabans that were his boyhood playmate, laughing just like him as they all ran to the water and piled into a pirogue, raised the wingsail and leaped before the wind; campfire on the island, where flames sprang forth to pick daoda fronds and the slim furry bodies of his friends out of a night that sang; chants and drums and portentous ceremonies; and – and – No. Heim struck a light to his tobacco and puffed hard. I was twelve years old when I left. And now Far and Mor are dead, and my Sindabans grown into an adulthood which humans are still trying to understand. I'd only find an isolated little scientific base, no different from two score that I've seen elsewhere. Time is a one-way lane.

With enough strength, lightweight unclefts can be made to togethermelt. Illustration by Elena.

My Object All Sublime

My Object All Sublime

By Poul Anderson

Once upon a time, a very, very long time in the future, there was a civilization. I shall not describe it to you, for that would not be possible. Could you go back to the time of the Egyptian pyramid builders and tell them about this city below us? I don't mean they wouldn't believe you;, of course they wouldn't, but that hardly matters. I mean they would not understand. Nothing you said could make sense to them. And the way people work and think and believe would be less comprehensible than those lights and towers and machines. Not so? If I spoke to you of people in the future living among great blinding energies, and of genetic changelings, and imaginary wars, and talking stones, and a certain blind hunter, you might feel anything at all, but you would not understand.

So I ask you only to imagine how many thousands of times this planet has circled the sun, how deeply buried and forgotten we are; and then also to imagine that this other civilization thinks in patterns so foreign that it has ignored every limitation of logic and natural law, to discover means of traveling in time. So, while the ordinary dweller in that age (I can't exactly call him a citizen, or anything else for which we have a word, because it would be too misleading), the average educated dweller, knows in a vague, uninterested way that millenia ago some semi-sauvages were the first to split the atom – only one or two men have actually been here, walked among us, studied and mapped us and returned with a file of information for the central brain, if I may call it by such a name. No one else is concerned with us, any more than you are concerned with early Mesopatamian archology. You see?

He dropped his gaze to the tumbler in his hand and held it there, as if the whisky were an oracular pool. The silence grew. At last I said, “Very well. For the sake of the story, I'll accept the premise. I imagine time travelers would be unnoticeable. They'd have techniques of disguise and so on. Wouldn't want to change their own past”.

“Oh, no danger of that,” he said. “It's only that they couldn't learn much if they went around insisting they were from the future. Just imagine.”

I chuckled.

Michaels gave me a shadowed look. “Apart from the scientific,” he said, “can you guess what use there might be for time travel?”

He shook his head. “Think again. They'd only want a limited number of Minoan statuettes, Ming vases, or Third World Hegemony dwarfs, chiefly for their museums. If “museum” isn't too inaccurate a word. I tell you, they are not like us. Af for natural resources, they're beyond the point of needing any; they make their own.”

He paused, as if before a final plunge. Then: “What was this penal colony the French abandoned?”

“Devil's Island?”

“Yes, that was it. Can you imagine a better revenge on a condemned criminal than to maroon him in the past.”

Punishment is a catharsis of society as a whole. Photo by Elena.

Dialectics in Behavior Therapy

Dialectics in Balancing Goals

Maintaining a dialectical stance can be hard for therapists because the pull is to become locked into a concept at either end of the pole rather than directly experience how two truths stand side by side as part of a larger synthesis. This can be particularly difficult for two of DBT's main goals enhancing client emotion regulations and decreasing priority targets such as self-injury. For this reason, DBT therapists view both these goals in dialectical terms.

Dialectics of Emotion Regulation

DBT (Dialectical Behavior Therapy) proposes a dialectical goal regarding emotion regulation. Clients learn skills to change emotion and to accept emotion as it is. In the abstract, these positions seem contradictory, a mixed message about how to respond to private experience. Yet we examine our actual experience, the paradox resolves. The most difficult moments of our lives often require both downregulating (changing and mindfully experiencing (accepting) our emotional responses..

Consider a clinical example. A client, in bitter divorce proceedings, lost primary custody of her 2-year-old daughter. The husband's lawyer built a humiliating account of her repeated psychiatric hospitalizations and suicide attempts, successfully negating her more recent treatment progress. Anyone would feel anguished at losing custody, especially when one's own transgressions contributed to the decision. However, for this client, her emotions were at an unrelenting, all-consuming intensity. She was crazed with pain. Contact with her ex-husband, both in real life and imagination, was like a match to gasoline. Her pain would ignite into rage and revenge fantasies. She loathed herself, certain that his claim she was a terrible mother was true and her daughter would be better off without her. She sobbed, grief-stricken each time she imagined a future without living day to day with her daughter. She had urges to capitulate and give up visitation rather than endure the pain. She sat in shock, detached and numb for hours.

She had little time, however, to sort out these feelings to inform her next set of actions because the court required that she begin mediation to determine visitation privileges. To establish credibility and best negotiate terms for visitation the client needed to demonstrate her competence. In these emotionally challenging interactions with the court or her ex-husband, her mind was in an uproar. Yet if she displayed even a whiff of emotion dysregulation, her husband would use it against her. Her goals in the situation demanded exquisite emotion regulation.

Dialectics in our beliefs. Photo by Elena.

Based on the chain analysis, the therapist and client identified shame as the primary emotion that led to the most escaping into problematic responding. This was especially the case when the client heard or thought she was a “bad mother.” In one extended session, the client and therapist looked in an unflinching way at how this criticism was true; that is, the client listed all the ways she had failed her daughter and failed to meet her own standards. The therapist used validation to hold the client in informal exposure episodes so that she could experience shame without escaping into problematic secondary responses.

Validation also cued adaptive emotion: the reason for her hurt and shame was how desperately she loved and wanted the best for her daughter, how terribly she longed to be a good mother. The client and therapist practiced the Dialectical Behavior Therapy skill of radical acceptance, looking at the causal web that created all the conditions that led to the failings as a mother, without sugarcoating the harm the client had done. Both spontaneously and with the therapist's help, the client experienced how shame transformed into deep regret and the healthy action urge to make amends and repair the damage. She found a kernel of pride at how fiercely she was using this therapy to change to do better by her daughter.

The client also struggled with rage at her husband, Here the therapist helped the client actively downregulate anger and avoid anger cues in order to avoid physically or verbally attacking her husband or his property (which she had done many times in the past). For example, the client's friends loyally sided with her, and fueled her anger by doing things like using the husband's picture as a dartboard, plotting to ruin his reputation at work, and talking endlessly about how unfair he had been. In the lead up to the mediation meeting, the client recruited her friends to change tactics with her: they either talked about the circumstances in a completely low-key nonjudgmental manner (e.g., “divorces are really hard”, “there are things about this situation I don't like”) or they avoided the topic and focused on areas where the client was building a new life.

Balancing therapy and life. Photo by Elena.

Further, the client and therapist identified the two most anger-provoking things the husband did and practiced drills where the therapist presented the cues and the client deliberately altered her breathing to calm herself. She inhaled for a count of 3, held her breath for a count of 2, then exhaled for 5, slowly and fully, pausing for 2 counts at the end of the exhalation. In this practice, she actively imagined picking up each thought or emotion about her situation and putting it in a box, gently saying “later”. She practiced this exercise and radical acceptance of shame on her own while gazing at a picture of her husband holding their daughter. She repeatedly put the picture into an envelope and then brought it out again to gaze at the picture and practice. The client learned how to control her attention in order to make fuller contact with emotion cues. She also learned to distract from emotion cues in order to down-regulate emotion. From a dialectical perspective, both approaches are valid and the focus was to help the client discriminate when either strategy did or did not fit her goals in the moment.

Dialectically Balancing Strategies

Using strategies dialectically keeps the therapy moving through impasse.  Validation strategies are dialectically balanced with behavioral strategies such as orienting, commitment, chain analysis, and problem solving. Three other important strategy sets are used dialectically to prevent rigid polarization: stylistic strategies, case management strategies, and specific dialectical strategies. Stylistic strategies  offer a practical dialectic in how the therapist communicates, balancing being warmly reciprocal and irreverently confrontive. Case management strategies concern how the therapist helps the client to navigate his or her social environment, balancing consulting to the client with direct intervention on the client's behalf in some limited cases. Specifically, dialectical strategies directly target polarization. In each case, the aim is to create the appropriate mix of acceptance of the client's vulnerability and change that recognizes the client's strengths.

Doing Dialectical Behavior Therapy (A Practical Guide by Kelly Koerner).

The last leaves. Photo by Elena.