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chironwcentaur-blog · 6 years

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Can holistic and integrative therapy help disabled people?

What is a disability, can we leisurely define it; disability as a “phenomenon”? Dr. Miroslav Sarac – Chiron Wise Centaur – holistic and integrative healing center Unfortunately, disability either acquired or hereditary is the leading health and social problem in many countries including well-developed countries. It represents the significant health-social challenges of this era. As of now, as is, the healthcare system and social system is very oppressive, inadequate and inappropriate to meet the needs and challenges of the people living with disabilities. What is desperately needed is a fundamental shift in prospective approach with the application of complementary, alternative, holistic, integrative and functional treatments where the subjective experience of the disabled person is of central concern. Yes, subjective and personal experience! Life, wellness and health coaching for the disabled people are necessary and of urgent need. Some disabled people are with vocational rehabilitation services for years, not months as it should be. Actually, the primary goal of their existence, primary function and mission are to prepare and find employment for the disabled people (funded for their operation predominantly from federal resources about 75%). It looks like each disabled person is getting stuck in one of the phases, either in “the very beginning”, “hitting the wall”, “turning around”, “letting go”, “opening up”, “letting in”, and “the end of “healing” process” (1). The phase “hitting the wall” is the phase where most of the disabled people are giving up all malfunction services and so-called “independent living” where they realize that they are actually in reality heavily dependent on their family or primary caregiver for the rest of their life. All care and everyday living are on the primary caregiver’s shoulder, family and friends… Finally, we reached the point that life, wellness, and health coaching specifically designed for disabled people are “a must.” Most of the disabled people (if they can afford) are chronically placed in psychotherapeutic sessions with CBT (cognitive behavioral therapy), yes, chronically for years, instead of as CBT standards proposed 6 -16 sessions and that’s it. No achievements, no improvements, then a psychotherapist should take another way of therapy. CBT strictly focuses on challenging and changing unhelpful cognitive distortions and behaviors, improving emotional regulation, and the development of personal coping strategies that target solving current problems. Well, it sounds good, but after a short period, another challenge is coming. Severe depression is a common co-morbidity of the disabled people which is “coming” silently but persistently, stay as a shadow following the disabled person who desperately wants to find a new way of life, meaning, and purpose of life as a disabled person, employment, lost dignity…a coming poverty, a new monster. Not a problem, here are antidepressant therapeutics widely available and readily prescribed even from primary care physicians. After changing six or more different forms of antidepressant therapeutics, no expected improvements or so little with frequent relapses. Some disabled people also do not know they have treatment-resistant depression; social factors are not improved, home-bound lifestyle is still in existence and persistent, and the disabled person is falling into a severe episode of depression. Definitely, integrative, functional approach in the treatment of the disabled people is promising including holistic, alternative or complementary therapy in the form of applied intensive life, wellness, and health coaching; finding a new way of life, meaning, and purpose of life, objectively approaching a job search, employment, getting back lost dignity, fighting depression and anxiety and symptoms of post-traumatic stress disorder getting disabled. Certainly, disabled people also deserve to find and feel the greatest love of all in their lives as all other people do. What is a disability? Millions of people live with a visible or invisible disability, acquired or hereditary disability, physical, mental, intellectual, cognitive, developmental or sensory disability, disability with comorbidity and without comorbidity, nearly one in five people, currently almost 49 million people have a disability in the U.S.A. According to the data from the World Bank “one billion people or 15% of the world’s population experience, some form of disability and disability prevalence is higher for developing countries. One-fifth of the estimated global total, or between 110 million and 190 million people, experience significant disabilities” (2). Disability is not a category of disease; it is a condition caused by physical, sensory, cognitive and mental disorders that cause significant limitation in one or more major life activities. According to the Americans with Disability Act “major life activities include, but are not limited to, caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating and working (Americans with Disability Act).” Probably, much better statement about disability we can find in the World Report on Disability, World Health Organization (WHO) stated: “Many people with disabilities do not have equal access to health care, education, and employment opportunities, do not receive the disability-related services that they require, and experience exclusion from everyday life activities. Following the entry into force of the United Nations Convention on the Rights of Persons with Disabilities (CRPD), disability increasingly understood as a human rights issue. Disability is also an important development issue with an increasing body of evidence showing that persons with disabilities experience worse socioeconomic outcomes and poverty than persons without disabilities.” (3). It is imperative to understand disability as a phenomenon, fully. Yes, I would say the phenomenon. Defining disability is exceptionally complicated. A long time, I was searching for one good definition of disability. Probably, one of the best descriptions of disability is from the World Health Organization; it stated: “Disability is complex, dynamic, multidimensional, and contested. Over recent decades, the disabled people’s movement together with numerous researchers from the social and health sciences have identified the role of social and physical barriers in disability. The transition from an individual, medical perspective to a structural, social perspective has described as the shift from a “medical model” to a “social model” in which people viewed as being disabled by society rather than by their bodies” (3 - 8). Indeed, this statement provides a much better description of what disability is and how disability is transforming from a medical model into a social model. However, I did not stop searching for a better explanation and a better definition of disability. Leonardi M. and colleagues in 2006 in their article published in the Lancet stated: “Disability promoted as a “bio-psycho-social model,” it represents a workable compromise between medical and social models. Disability is the umbrella term for impairments, activity limitations, and participation restrictions, referring to the negative aspects of the interaction between an individual (with a health condition) and that individual’s contextual factors (environmental and personal factors)” (9). Generalization about “disability” or “people with disabilities” can mislead and any form of generalization should be avoided seriously. Persons with disabilities have diverse personal factors with differences in gender, age, socioeconomic status, sexuality, ethnicity, or cultural heritage; a unique culture. Each has his or her preferences and subjective responses to disability (10). A broad range of international documents has highlighted that limitation is a human rights issue, including the World Program of Action Concerning Disabled People (1982), the Convention on the Rights of the Child (1989), and the Standard Rules on the Equalization of Opportunities for People with Disabilities (1993). More than 40 nations adopted disability discrimination legislation during the 1990s (11). According to Harris J. and the article published in 2015 the Americans with Disability Act as it is stated the marquee civil rights legislation for people with disabilities expresses a national approach to disability that recognizes the role of society in its construction, maintenance, and potential remedy. But its mission is incomplete, and it has not generated the types of interactions between people with disabilities and nondisabled people empirically shown to deconstruct deeply entrenched social stigma (12). Disability as a phenomenon is very complicated, from a biological, medical, social, psychological point of view. As Sen A. in 2009 stated in his book: “Disability is a development issue, because of its bi-directional link to poverty: disability may increase the risk of poverty, and poverty may increase the risk of disability” (13). It looks like the definition of disability is not entirely reached, and still, the question of how disability supposed to be defined is fraught with political, ethical and philosophical complexities (14). How disabled people get even more impaired than actually, they are? Predominantly, disability is associated with some co-morbidities, and one of them is severe depression. Depression by itself, a separate entity is a form of disability. So, people with a disability who developed depression as co-morbidity are more disabled. Some previous research exhibited that co-morbid depression and chronic physical conditions associated with disability (15). Unfortunately, there is a substantial lack of data on disability and suicide in the U.S.A. There is a small number of national data on studies related to this topic. Some studies reaffirmed that disability is the risk factor of depression by using longitudinal data (16). Certainly, home-bound lifestyle, lack of employment, lack of transportation, malfunctioning or not provided services by vocational rehabilitation and social services, heavy dependence on a primary caregiver, the majority of disabled people will over a specified period develop the first signs and symptoms of depression and even suicidal ideation. Overall, significant indicators for increased suicidal risk in the population of disabled people are unemployed for an extended period, profound social isolation due to the homebound lifestyle and lack of transportation, significant change in health status because the majority of the disabled people require frequent medical attention and treatments. Progressively, due to lack of proper access to healthcare providers (even some primary care physicians do not want to accept Medicare and Medicaid insurance). Lack of mental health support and help either because they cannot afford due to overly expensive treatments and office visits or lack of mental health care providers locally, severe depression will be accompanied by suicidal thoughts or ideation in disability. Unproperly treated or untreated depression eventually in combination with the unbearable social status and life under the limit of poverty of the disabled people will convert into devastation condition of major depressive disorder with frequent suicidal thoughts. Majority disabled people are oppressed by ableism too, living as disabled people in a society that hates disability, or a society, the community, suffers from great stigma and taboo regarding disability. Overall, disability and its functional limitation in daily living activities have associated with suicide in the population of the disabled people (17). Still, there is a substantial lack of research data regarding what category of disabled people are more prone to develop severe depression, people with acquired disability or hereditary, and people with visible or invisible disability. Disabled people who suffer from suicidal ideation deserve to be seen by a therapist who “speaks” their language and understand their experience, thus cultural competency related to disability is a “must” for all healthcare professionals including pharmacists in the retail setting, social workers, psychologist and psychotherapists, rehabilitation counselors and our primary caregivers. There is a lack of research data what is the response of primary caregiver on a disabled person with developed depression as comorbidity and vice versa. Unfortunately, despite a substantial lack of national data on suicide and disability in the U.S. some studies have been shown that there is a substantially higher suicide rate in the population of disabled people with certain disabilities such as multiple sclerosis, spinal cord injuries and intellectual disability (18). As Giannini M. and colleagues in 2010 stated: “It is imperative that U.S. researchers and policymakers address the substantial gaps in knowledge that remain to help create a clear understanding of suicide in the disability population, especially targeting children and youth ages 10 to 24 and other at-risk age cohorts”. It sounds like a “wake up call” but still, since 2010 we do not have some significant contribution regarding research in this field. One of the possible reasons for such a condition is the fact that suicidologists are not able to find the data regarding the suicide rate in the population of disabled people, the data are hidden, or there is a lack of proper evidence regarding this particular issue. As one disabled person said: “Happy spring, I am “celebrating.” What? Six years of unsuccessful services with vocational rehabilitation services, still no job for me, with master’s and two doctoral degrees and numerous national and international certifications in the vocational evaluation process they made me an office clerk that even GED would be challenging for me, a home-bound lifestyle, severe disability, and heavy dependence on a primary caregiver…for them, I am “a low expectation and high liability.” I am “celebrating” a full five years in CBT (cognitive behavioral therapy) paying out of pocket. My potentially successful suicide was prevented by my primary caregiver, not a psychiatrist, not a psychotherapist, not a rehabilitation counselor…but holistic therapy helped me to make a balance in my body-mind-soul and found a “healthier” myself.” This blog is the first blog in the series of three blogs dedicated to disability, disabled people and how holistic therapy, life, wellness, and health coaching can help disabled people to live productive life finding “the greatest love of all.” References: 1. Lindsey E. The gift of healing in chronic illness/disability. J Holist Nurs. 1995 Dec;13(4):287-305. 2. http://www.worldbank.org/en/topic/disability 3. WHO Library Cataloguing-in-Publication Data World report on disability 2011. 4. Charlton J. Nothing about us without us: disability, oppression, and empowerment. Berkeley, University of California Press, 1998. 5. Driedger D. The last civil rights movement. London, Hurst, 1989. 6. Barnes C. Disabled people in Britain and discrimination. London, Hurst, 1991. 7. McConachie H et al. Participation of disabled children: how should it be characterized and measured? Disability and Rehabilitation, 2006,28:1157-1164. 8. Oliver M. The politics of disablement. Basingstoke, Macmillan and St Martin’s Press, 1990. 9. Leonardi M et al. MHADIE Consortium. The definition of disability: what is in a name? Lancet, 2006,368:1219-1221. 10. Learning lessons: defining, representing and measuring disability. London, Disability Rights Commission, 2007. 11. Quinn G et al. The current use and future potential of United Nations human rights instruments in the context of disability. New York and Geneva, United Nations, 2002b (http://www.icrpd.net/ratification/documents/en/Extras/Quinn%20 Degener%20study%20for%20OHCHR.pdf, accessed 21 Sept 2010). 12. Harris J. Processing disability. Am Univ Law Rev, 2015; 64 (3), 457-533. 13. Sen A. The idea of justice. Cambridge, The Belknap Press of Harvard University Press, 2009. 14. Sisti D.A. Naturalism and the social model of disability: allied or antithetical? J Med Ethics 2015, 41 (7): 553-556. https://www.dol.gov/ofccp/regs/compliance/faqs/ADAfaqs.htm 15. Deschenes SS, Burns RJ, Schmitz N. Associations between depression, chronic physical conditions and disability in a community sample: a focus on the persistence of depression. J Affect Disord. 2015; 179: 6-13. 16. Noh JW, Kwon Y.D, Park J, Oh IH, Kim J. Relationship between physical disability and depression by gender: A panel regression model. PLoS ONE 11 (11): e0166238. 17. Kaplan MS, McFarland BH, Huguet N, Newsom JT. Physical illness, functional limitations, and suicide risk: A population-based study. Am J Orthopsychiatry. 2007; 77 (1): 56-60. 18. Giannini MJ, Kreshover S, Elias E, Bergmark BA, Plummer C, O’Keefe E. Understanding suicide and disability through three major disabling conditions: Intellectual disability, spinal cord injury, and multiple sclerosis. Disabil Health J. 2010 Apr;3(2):74-8. 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marcusssanderson · 6 years

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How to Manage Perfectionism

To understand how to manage perfectionism, you first need to know what drives it. Usually, we wind up as perfectionists when this behavior is modeled regularly by our parents or caretakers and when they consistently push us to be perfect.

It’s important to recognize that, in most cases, they wanted us to do well because they loved us and, most likely, had no idea that trying to shape us into flawless beings could possibly do us any harm.

Here are some steps to take to recognize and manage perfectionism:

• Observe this tendency in yourself

If you tend to go above and beyond more often than not, observe your behavior. You’ll need to do this for a while in various situations to get a full picture of the extent of your perfectionism. Check out your behavior at work, at play, at home, with your children and in any setting in which you think might be putting in too much effort.

If you pay close attention, you’ll note an inner sense that you need to keep doing something to get it right and feel as if you can’t stop if you don’t. You might also notice that you keep driving yourself forward in the hopes of getting approval.

Should this happen a great deal, you likely to have strong perfectionist tendencies. If you go for the gold in only one or two areas of your life, you might have things just right. This may mean that you’re selective about where you put your time and effort. Alternately, most across-the-board perfectionists are all too aware of the fact that they have this trait.

• Understand how you developed this trait

Think back to your childhood and ask yourself some questions: Were either of my parents perfectionists or was anyone else who played a major part in my upbringing?

What was the emotional tenor of my childhood apropos doing things right—or wrong? Was there a competitive feeling in the family? Was success or excelling more highly regarded than other qualities?

Here are more questions to ask yourself: What happened when I didn’t do things perfectly? Of course, perfectionism translates into what your parents thought was perfect, right or acceptable. When you didn’t do something just so, did your parents express grave disappointment in or anger at you?

Were you pushed beyond your natural abilities or compared to others and found lacking? Were you punished, shamed, teased, or humiliated? Did your parents withdraw love when you did anything in less than a stellar way? Did you feel chronically not good enough?

• Evaluate your experience of feeling bad or wrong in childhood

Many people become perfectionists because anything less makes them feel as if they’re bad or wrong. As a child, especially if your parents were intolerant of mistakes or failures, feeling bad or wrong was just about the worst thing that could happen to you, particularly if it happened regularly.

Perfectionism is a learned trait that we’re conditioned to pursue for adaptive reasons. Maybe you kept trying to hit a home run or bake a cake, ace geometry, play the piano, ski down the black diamond trails, or take first place in spelling contests because you didn’t want to fail. As children, it’s normal to be desperate for praise and approval and that desperation often becomes an ingrained habit that morphs into perfectionism.

Ask yourself what the opposite of achieving perfection is. People usually say failure which is accompanied by shame or humiliation. In most cases, being afraid of making mistakes and of letting others down is what leads to the need to be perfect. If you associate failure with having less-than views of yourself, you’ll naturally want to be perfect to avoid them.

• Identify your beliefs about mistakes and failure

To manage perfectionism, make a list of what you believe about mistakes and failure such as:

I shouldn’t make mistakes.

Mistakes can be avoided if I try hard enough.

Failure is a terrible thing, to be avoided at all cost.

If I’m not perfect, I’m a failure.

I always need to try my hardest or give an endeavor my best shot.

I must be perfect to be lovable and loved.

Would you be surprised to learn that none of the above statements are true? No one can live without making mistakes and failing occasionally. They are both a natural, normal part of life. Accepting this truth will go a long way toward reframing your attitude toward perfection.

• Reframe your beliefs about mistakes and failure

Here are some healthy beliefs about mistakes and failure. Notice how you feel as you read through them, especially if you have a reaction that I must be wrong and that these beliefs couldn’t possibly be healthy. If you have such a response, know that you’ve been wrongly indoctrinated on the subject of mistakes and failure and that this is why you’re such a dyed in the wool perfectionist.

Everyone makes mistakes and I’m no different.

The world won’t fall apart if I make a mistake or fail, even when I try my hardest.

Failure is normal and natural and cannot be avoided.

I can do something imperfectly without failing at it.

I don’t need to excel at everything and I can choose where I wish to and where I don’t.

I’m lovable and expect to be loved as a flawed human being.

• Forget about always doing your best

The truth is you don’t need to be perfect at anything or everything. My father brought me up according to the adage, “Good, better, best, never let it rest, ‘til the good is better and the better is the best” and I spent half a lifetime shedding that unhelpful piece of advice, though I have absolutely no doubt that my loving father meant well by encouraging me to live by it. My guess is that he was raised with the same expectation and that, as a highly competent, successful man, he never questioned it.

Why not start from the premise that you’re going to do some things well in your life and some things poorly, that you have strengths and weaknesses just like the rest of us, and that your success or failure in an activity has absolutely nothing to do with your value as a human being. Working off this assumption, you then won’t misinterpret what doing poorly means. Of course, you might still wish to shine in, say, math, but doing poorly won’t define you’re worth or affect your self-esteem.

• Stop measuring yourself against perfection

If we measure every aspect of ourselves against some perfect ideal, we’ll be pretty bummed out nearly all the time. Considering that humans are imperfect beings and that we can’t control the universe, how can we insist that whatever we’re engaged in—playing tennis, parenting a child, giving a speech, or taking a vacation—must be a complete success?

Whenever humans are involved, we need to toss out the concept of flawless and get real. And real means flaws, faults, frailties and defects. Real means good enough, close-but-no-cigar and, often, only the best we can do at any given time.

• Decide how well you wish to do at certain activities

When you try to do everything well, you’re setting yourself up for stress, distress and exhaustion. We soon run out of steam if we try to do our best at everything. And, who says that we need to?

Mental and physical energy are not infinite resources and human beings often get depleted from trying too hard. When that happens we look for quick fixes in food or alcohol, may become irritable with others and, in frustration, often want to chuck whatever we’re trying to do and give up.

Consider this. What if you didn’t try to do everything perfectly and give every endeavor your best shot? The advantage of this mindset, to which I wholly subscribe, is that you would then have enough energy to do the things that are important to do well with excellence.

Try this: Think of endeavors as falling into the categories of excellent, good, fair or poor. When I work with clients on reducing their all-or-nothing mindset of perfectionism versus failure, I suggest that they imagine baskets with these labels on them, then determine which tasks or efforts go in which baskets.

For example, my excellent basket contains wishing to do my best as a wife, friend, and in doing therapy with clients. My aim is to do a good job as a writer, staying abreast of the news, and being politically active in my community, while I’m content to be a good-to-fair housekeeper, cook and bookkeeper for my private practice.

And, I’m okay with being a poor gardener. The point is that I don’t strive to be my best at everything I do. I don’t care if guests enter my house and compliment me on my spotless domain or leave my house raving about my cooking.

I do a decent job at bookkeeping, but find it difficult and have settled for being merely adequate at it. There are much better writers than I am, but I’m satisfied with being a “good” rather than a “great” one.

To be honest, I’m a big fan of being good enough at most things, period. I’d rather put time and effort into doing well at what I enjoy and excel in and not so much into what I don’t value or simply don’t have the smarts, talent or inclination for.

For example, when I was attending Simmons College School of Social Work, most of my classmates were driving themselves crazy trying to get top grades, while I was thrilled that I’d chosen to go the pass/fail route to reduce the pressure and increase the pleasure of graduate school. Good enough is generally good enough for me.

• Recognize when perfectionism or near perfection is important

There are jobs and times when you will wish for and seek perfectionism. If you’re a surgeon, you’ll want to do a perfect job. It’s a necessity for you and for your patients.

Ditto, if you’re a nurse dispensing medication or a lawyer arguing a death penalty case. In fact, if you work in any profession where safety, including public safety, is your focus, you’ll want to aim for no mistakes. Shooting for perfect also makes sense when you’re applying for a job, trying to make a team, or are an Olympic competitor.

There are other jobs and endeavors where striving for perfection is de rigueur. Think of saving perfection for things that really, really, really matter. That does not include making the world’s juiciest, most tender Thanksgiving turkey, folding towels, or shoveling snow.

• Learn to enjoy your imperfection

Practice laughing at your mistakes, sharing your bloopers with your friends, owning up to your own failures before someone else points them out, allowing yourself to be fair to midland at things, giving up trying to make things work out right all the time and, instead, riding with the tide and going with the flow.

Go for broke on being flawed. I once wrote a newspaper article on “The Art of Mediocrity” which extolled the merits and benefits of striving to be a mediocre skier because I doubted I’d have enough fun if I forced myself to focus strictly on perfect form.

I feel the same way as a lifelong (though on-and-off) tap dancer who’s still an advanced beginner. In fact, I challenge anyone to say they have a better time in tap class than I do. Perfectionism is a kind of slavery, whereas imperfection can feel like glorious freedom.

Throw off the shackles of having to do your best in every endeavor and start deciding exactly where you want to put your effort. When you do, you’ll find that you have a oodles of energy for the things you really wish to do well and that life becomes more satisfying and enjoyable. As an extra bonus, people will probably find your more relaxed attitude, a good deal more pleasant to be around. Good enough might actually feel just perfect.

The post How to Manage Perfectionism appeared first on Everyday Power Blog.

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carlesteph14-blog · 7 years

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*From Words to Self: a Rhetorical Journey*

“Rhetoric is the language of a message (speech, song lyrics, scripts, etc.) used to convey the message of the speaker”

10 weeks ago, I was asked to provide a definition for rhetoric; my response is quoted above. Despite having taken previous courses on rhetoric, the best understanding of it that I could articulate was completely centered around the language itself. My definition was short and concise, however it was incomplete. As we have progressed through the term, I have gained a much broader understanding of the various ways that rhetoric can be manifested. There is so much more to rhetoric than the language and a desired message and to ignore each of its components is unhelpful, and in some cases dangerous.

As we moved through the origins of rhetorical studies, it became apparent how easy it is to use rhetoric to manipulate an audience. The Sophists served as a prime example of the stereotype of rhetoric as empty words; as someone that follows politics (and avidly watches the Daily Show), I am not so naive as to think that no one employs this idea of arguing for the sake of being right. Understanding the Sophists and their belief that rhetoric can make any point a winning argument served as an important reminder for the necessity of ethics in my words and actions.

The biggest development in my understanding of rhetoric came when we transitioned into the modern study of rhetoric. Having done rhetorical analysis research prior to this class, I had already learned what role rhetoric plays in the formation of group values and identity. The article that particularly reframed my understanding of rhetoric, though, was Hauser’s section on Rhetoric and the Self. After reading that in conjunction with many of our class discussions, my understanding of rhetoric extends far beyond language and word choice; I now see rhetoric as a continued reconstruction and reinforcement of the ‘self’ of a rhetor.

The artifact I have created above is a collection of images of the refugee and immigrant soccer and mentoring program I have been running for the past 3 years. As my understanding of rhetoric has become centered in ethic and the self, I have begun to see how my program embodies that understanding every day. Every year, I make a point to tell my students my goal I have for them:

Learn to celebrate who you are and where you come from without tearing down someone else.

My students represent 4 continents, 13 countries, and speak 15 languages. They all have to live in the United States, which for immigrants is not an easy thing to do in the current climate. The goal of our program is to help them find a home in this country without having to give up the culture they were raised in. While learning English is necessary, I make a point to learn at least the basics of every language they speak (as a result I am now fluent in 3 and working on languages #4 and 5); I attend cultural and religious holidays and ceremonies; I eat whatever food they bring me without hesitation. I never want them to feel as if their culture is abnormal or shameful, my only goal is that they be proud of who they are.

The way the construct and reflect their self is at a crucial point; at 13 to 16, they are figuring out what matters to them and trying to find social groups. I hope that the rhetoric- the lessons, functions/actions, and words- of our group has given them the tools and skills to confidently reflect themselves without any doubt or hesitation. Ethical rhetoric, in my understanding, is celebrating the self you have created without diminishing others. I would argue that this celebration be added as a fifth category to Hauser’s interpretation of rhetoric and the self. The way by which we present our self to the world matters; when there is pride, confidence, and love in the way we construct ourselves, rhetoric becomes much more pure.

With this idea of celebration however comes the second part of my goal lesson: true, ethical rhetoric is not used for the purpose of tearing someone else down. When an identity is based on hate of another - such as the rhetoric and identity of Hitler’s Nazi party as discussed by Burke - while it may be passionate and reflective of on, it loses the ethical principles of my conception of rhetoric. There is another rule in my program:

If you can only make jokes about someone’s race, ethnicity, language, gender, or religion then you aren’t funny enough to tell jokes in my program.

Tearing apart someone else does not add value to your identity or society as a whole. You cannot build by breaking. If rhetoric is used in it’s truest ethical form, it adds more pieces to a bigger picture. Squires writing on the black press as a counterpublic presents how important counterpublics are to creating a more inclusive public sphere. The purpose of counterpublics is to create a space for identities left out of public discourse, but this shouldn’t mean erasing others’ cultures. I see this every day in the way my students interact with each other: my car is full of Karen, Chin, Liberian, and Burundi students singing in perfect Spanish to the music one of my Mexican students is playing; I get to watch a brave Guatemalan student try spicy Thai curry for the first time at a Karen birthday party; my students embrace their teammates for who they are without hesitation.

When I started this class, I did not see all the ways that rhetoric operated in my life. As we come to the end, I now see that rhetoric shapes my life, but more than that how my life shapes what I value in rhetoric. It is more than the words we use; rhetoric is the languages we speak (or try to), the way we treat others, the values we hold, and what principles guide our decisions. When I look at the images above, that represent 3 years of my amazing students, I see the best version of rhetoric at work. It is a celebration of identity and self in all the ways that those can be expressed.

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chironwcentaur-blog · 6 years

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Can holistic and integrative therapy help disabled people?

What is a disability, can we leisurely define it; disability as a “phenomenon”? Unfortunately, disability either acquired or hereditary is the leading health and social problem in many countries including well-developed countries. It represents the significant health-social challenges of this era. As of now, as is, the healthcare system and social system is very oppressive, inadequate and inappropriate to meet the needs and challenges of the people living with disabilities. What is desperately needed is a fundamental shift in prospective approach with the application of complementary, alternative, holistic, integrative and functional treatments where the subjective experience of the disabled person is of central concern. Yes, subjective and personal experience! Life, wellness and health coaching for the disabled people are necessary and of urgent need. Some disabled people are with vocational rehabilitation services for years, not months as it should be. Actually, the primary goal of their existence, primary function and mission are to prepare and find employment for the disabled people (funded for their operation predominantly from federal resources about 75%). It looks like each disabled person is getting stuck in one of the phases, either in “the very beginning”, “hitting the wall”, “turning around”, “letting go”, “opening up”, “letting in”, and “the end of “healing” process” (1). The phase “hitting the wall” is the phase where most of the disabled people are giving up all malfunction services and so-called “independent living” where they realize that they are actually in reality heavily dependent on their family or primary caregiver for the rest of their life. All care and everyday living are on the primary caregiver’s shoulder, family and friends… Finally, we reached the point that life, wellness, and health coaching specifically designed for disabled people are “a must.” Most of the disabled people (if they can afford) are chronically placed in psychotherapeutic sessions with CBT (cognitive behavioral therapy), yes, chronically for years, instead of as CBT standards proposed 6 -16 sessions and that’s it. No achievements, no improvements, then a psychotherapist should take another way of therapy. CBT strictly focuses on challenging and changing unhelpful cognitive distortions and behaviors, improving emotional regulation, and the development of personal coping strategies that target solving current problems. Well, it sounds good, but after a short period, another challenge is coming. Severe depression is a common co-morbidity of the disabled people which is “coming” silently but persistently, stay as a shadow following the disabled person who desperately wants to find a new way of life, meaning, and purpose of life as a disabled person, employment, lost dignity…a coming poverty, a new monster. Not a problem, here are antidepressant therapeutics widely available and readily prescribed even from primary care physicians. After changing six or more different forms of antidepressant therapeutics, no expected improvements or so little with frequent relapses. Some disabled people also do not know they have treatment-resistant depression; social factors are not improved, home-bound lifestyle is still in existence and persistent, and the disabled person is falling into a severe episode of depression. Definitely, integrative, functional approach in the treatment of the disabled people is promising including holistic, alternative or complementary therapy in the form of applied intensive life, wellness, and health coaching; finding a new way of life, meaning, and purpose of life, objectively approaching a job search, employment, getting back lost dignity, fighting depression and anxiety and symptoms of post-traumatic stress disorder getting disabled. Certainly, disabled people also deserve to find and feel the greatest love of all in their lives as all other people do. What is a disability? Millions of people live with a visible or invisible disability, acquired or hereditary disability, physical, mental, intellectual, cognitive, developmental or sensory disability, disability with comorbidity and without comorbidity, nearly one in five people, currently almost 49 million people have a disability in the U.S.A. According to the data from the World Bank “one billion people or 15% of the world’s population experience, some form of disability and disability prevalence is higher for developing countries. One-fifth of the estimated global total, or between 110 million and 190 million people, experience significant disabilities” (2). Disability is not a category of disease; it is a condition caused by physical, sensory, cognitive and mental disorders that cause significant limitation in one or more major life activities. According to the Americans with Disability Act “major life activities include, but are not limited to, caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating and working (Americans with Disability Act).” Probably, much better statement about disability we can find in the World Report on Disability, World Health Organization (WHO) stated: “Many people with disabilities do not have equal access to health care, education, and employment opportunities, do not receive the disability-related services that they require, and experience exclusion from everyday life activities. Following the entry into force of the United Nations Convention on the Rights of Persons with Disabilities (CRPD), disability increasingly understood as a human rights issue. Disability is also an important development issue with an increasing body of evidence showing that persons with disabilities experience worse socioeconomic outcomes and poverty than persons without disabilities.” (3). It is imperative to understand disability as a phenomenon, fully. Yes, I would say the phenomenon. Defining disability is exceptionally complicated. A long time, I was searching for one good definition of disability. Probably, one of the best descriptions of disability is from the World Health Organization; it stated: “Disability is complex, dynamic, multidimensional, and contested. Over recent decades, the disabled people’s movement together with numerous researchers from the social and health sciences have identified the role of social and physical barriers in disability. The transition from an individual, medical perspective to a structural, social perspective has described as the shift from a “medical model” to a “social model” in which people viewed as being disabled by society rather than by their bodies” (3 - 8). Indeed, this statement provides a much better description of what disability is and how disability is transforming from a medical model into a social model. However, I did not stop searching for a better explanation and a better definition of disability. Leonardi M. and colleagues in 2006 in their article published in the Lancet stated: “Disability promoted as a “bio-psycho-social model,” it represents a workable compromise between medical and social models. Disability is the umbrella term for impairments, activity limitations, and participation restrictions, referring to the negative aspects of the interaction between an individual (with a health condition) and that individual’s contextual factors (environmental and personal factors)” (9). Generalization about “disability” or “people with disabilities” can mislead and any form of generalization should be avoided seriously. Persons with disabilities have diverse personal factors with differences in gender, age, socioeconomic status, sexuality, ethnicity, or cultural heritage; a unique culture. Each has his or her preferences and subjective responses to disability (10). A broad range of international documents has highlighted that limitation is a human rights issue, including the World Program of Action Concerning Disabled People (1982), the Convention on the Rights of the Child (1989), and the Standard Rules on the Equalization of Opportunities for People with Disabilities (1993). More than 40 nations adopted disability discrimination legislation during the 1990s (11). According to Harris J. and the article published in 2015 the Americans with Disability Act as it is stated the marquee civil rights legislation for people with disabilities expresses a national approach to disability that recognizes the role of society in its construction, maintenance, and potential remedy. But its mission is incomplete, and it has not generated the types of interactions between people with disabilities and nondisabled people empirically shown to deconstruct deeply entrenched social stigma (12). Disability as a phenomenon is very complicated, from a biological, medical, social, psychological point of view. As Sen A. in 2009 stated in his book: “Disability is a development issue, because of its bi-directional link to poverty: disability may increase the risk of poverty, and poverty may increase the risk of disability” (13). It looks like the definition of disability is not entirely reached, and still, the question of how disability supposed to be defined is fraught with political, ethical and philosophical complexities (14). How disabled people get even more impaired than actually, they are? Predominantly, disability is associated with some co-morbidities, and one of them is severe depression. Depression by itself, a separate entity is a form of disability. So, people with a disability who developed depression as co-morbidity are more disabled. Some previous research exhibited that co-morbid depression and chronic physical conditions associated with disability (15). Unfortunately, there is a substantial lack of data on disability and suicide in the U.S.A. There is a small number of national data on studies related to this topic. Some studies reaffirmed that disability is the risk factor of depression by using longitudinal data (16). Certainly, home-bound lifestyle, lack of employment, lack of transportation, malfunctioning or not provided services by vocational rehabilitation and social services, heavy dependence on a primary caregiver, the majority of disabled people will over a specified period develop the first signs and symptoms of depression and even suicidal ideation. Overall, significant indicators for increased suicidal risk in the population of disabled people are unemployed for an extended period, profound social isolation due to the homebound lifestyle and lack of transportation, significant change in health status because the majority of the disabled people require frequent medical attention and treatments. Progressively, due to lack of proper access to healthcare providers (even some primary care physicians do not want to accept Medicare and Medicaid insurance). Lack of mental health support and help either because they cannot afford due to overly expensive treatments and office visits or lack of mental health care providers locally, severe depression will be accompanied by suicidal thoughts or ideation in disability. Unproperly treated or untreated depression eventually in combination with the unbearable social status and life under the limit of poverty of the disabled people will convert into devastation condition of major depressive disorder with frequent suicidal thoughts. Majority disabled people are oppressed by ableism too, living as disabled people in a society that hates disability, or a society, the community, suffers from great stigma and taboo regarding disability. Overall, disability and its functional limitation in daily living activities have associated with suicide in the population of the disabled people (17). Still, there is a substantial lack of research data regarding what category of disabled people are more prone to develop severe depression, people with acquired disability or hereditary, and people with visible or invisible disability. Disabled people who suffer from suicidal ideation deserve to be seen by a therapist who “speaks” their language and understand their experience, thus cultural competency related to disability is a “must” for all healthcare professionals including pharmacists in the retail setting, social workers, psychologist and psychotherapists, rehabilitation counselors and our primary caregivers. There is a lack of research data what is the response of primary caregiver on a disabled person with developed depression as comorbidity and vice versa. Unfortunately, despite a substantial lack of national data on suicide and disability in the U.S. some studies have been shown that there is a substantially higher suicide rate in the population of disabled people with certain disabilities such as multiple sclerosis, spinal cord injuries and intellectual disability (18). As Giannini M. and colleagues in 2010 stated: “It is imperative that U.S. researchers and policymakers address the substantial gaps in knowledge that remain to help create a clear understanding of suicide in the disability population, especially targeting children and youth ages 10 to 24 and other at-risk age cohorts”. It sounds like a “wake up call” but still, since 2010 we do not have some significant contribution regarding research in this field. One of the possible reasons for such a condition is the fact that suicidologists are not able to find the data regarding the suicide rate in the population of disabled people, the data are hidden, or there is a lack of proper evidence regarding this particular issue. As one disabled person said: “Happy spring, I am “celebrating.” What? Six years of unsuccessful services with vocational rehabilitation services, still no job for me, with master’s and two doctoral degrees and numerous national and international certifications in the vocational evaluation process they made me an office clerk that even GED would be challenging for me, a home-bound lifestyle, severe disability, and heavy dependence on a primary caregiver…for them, I am “a low expectation and high liability.” I am “celebrating” a full five years in CBT (cognitive behavioral therapy) paying out of pocket. My potentially successful suicide was prevented by my primary caregiver, not a psychiatrist, not a psychotherapist, not a rehabilitation counselor…but holistic therapy helped me to make a balance in my body-mind-soul and found a “healthier” myself.” This blog is the first blog in the series of three blogs dedicated to disability, disabled people and how holistic therapy, life, wellness, and health coaching can help disabled people to live productive life finding “the greatest love of all.” Dr. Miroslav Sarac – Chiron Wise Centaur – holistic and integrative healing center References: 1. Lindsey E. The gift of healing in chronic illness/disability. J Holist Nurs. 1995 Dec;13(4):287-305. 2. http://www.worldbank.org/en/topic/disability 3. WHO Library Cataloguing-in-Publication Data World report on disability 2011. 4. Charlton J. Nothing about us without us: disability, oppression, and empowerment. Berkeley, University of California Press, 1998. 5. Driedger D. The last civil rights movement. London, Hurst, 1989. 6. Barnes C. Disabled people in Britain and discrimination. London, Hurst, 1991. 7. McConachie H et al. Participation of disabled children: how should it be characterized and measured? Disability and Rehabilitation, 2006,28:1157-1164. 8. Oliver M. The politics of disablement. Basingstoke, Macmillan and St Martin’s Press, 1990. 9. Leonardi M et al. MHADIE Consortium. The definition of disability: what is in a name? Lancet, 2006,368:1219-1221. 10. Learning lessons: defining, representing and measuring disability. London, Disability Rights Commission, 2007. 11. Quinn G et al. The current use and future potential of United Nations human rights instruments in the context of disability. New York and Geneva, United Nations, 2002b (http://www.icrpd.net/ratification/documents/en/Extras/Quinn%20 Degener%20study%20for%20OHCHR.pdf, accessed 21 Sept 2010). 12. Harris J. Processing disability. Am Univ Law Rev, 2015; 64 (3), 457-533. 13. Sen A. The idea of justice. Cambridge, The Belknap Press of Harvard University Press, 2009. 14. Sisti D.A. Naturalism and the social model of disability: allied or antithetical? J Med Ethics 2015, 41 (7): 553-556. https://www.dol.gov/ofccp/regs/compliance/faqs/ADAfaqs.htm 15. Deschenes SS, Burns RJ, Schmitz N. Associations between depression, chronic physical conditions and disability in a community sample: a focus on the persistence of depression. J Affect Disord. 2015; 179: 6-13. 16. Noh JW, Kwon Y.D, Park J, Oh IH, Kim J. Relationship between physical disability and depression by gender: A panel regression model. PLoS ONE 11 (11): e0166238. 17. Kaplan MS, McFarland BH, Huguet N, Newsom JT. Physical illness, functional limitations, and suicide risk: A population-based study. Am J Orthopsychiatry. 2007; 77 (1): 56-60. 18. Giannini MJ, Kreshover S, Elias E, Bergmark BA, Plummer C, O’Keefe E. Understanding suicide and disability through three major disabling conditions: Intellectual disability, spinal cord injury, and multiple sclerosis. Disabil Health J. 2010 Apr;3(2):74-8. Read the full article

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