Welcome to From Insults to Respect.
From time to time I have written about the growing lack of respect for the current manner in which people seeking to obtain mental health services are treated. Particularly upsetting to many is the requirement that they be labeled as having a mental disorder.
This labeling process relies on descriptions provided in the Diagnostic and Statistical Manual of Mental Disorders–Fifth edition (DSM) and the International Classification of Diseases–Tenth edition (ICD). Both are manuals that are conceptually similar, utilizing as their core concept, mental disorders, and both share the same “diagnostic” codes. Because of their similarities, I will simply refer to them as the DSM/ICD approach.
Many professionals defending the use of this approach explain that it provides a common language for mental health professionals to communicate about those utilizing their services; its various classification terms, such as major depressive disorder, anxiety disorder, and so on, are short phrases that are convenient for placing into titles and search engines, and for efficient/streamlined communication in high-speed hospitals and clinics; third-party payers of mental health services have found that their coding system works well as part of a practical method for their record keeping; with the aid of these codes, people manage to access mental health services, mental health service providers manage to get paid, and for-profit health companies tend to make a profit.
Unfortunately, there are a number of serious weaknesses with this approach. 
It tends to be stigmatizing to mental health service users. The lack of reliability and validity of the various so called diagnoses violate basic principles of science. The process of coming up with a psychiatric label privileges the clinician’s perspective over that of the mental health service user. It ignores the fact that many people who have been labeled with these stigmatizing psychiatric terms come to realize that the experiences which led to their seeking services, rather than being an indication of a pathological condition, are really an essential element to their creative development. Many have also expressed concerns about the “mental illness” terminology which medicalizes mental health concerns, thus leading to an incredible number of people being prescribed psychiatric drugs, the use of which leads to numerous serious side effects.
Just as I was writing this post, major news outlets began to report that researchers found nearly a 50% increased odds of dementia for those taking the most popular drugs for treating depression and other mental health concerns. Although the study could not prove conclusively that these drugs caused the increased risk of developing dementia, because these same drugs had already been linked to confusion or memory issues, the new evidence is deeply troubling. The researchers expressed concerns that if this association is causal, it “would equate, for example, to around 20,000 of the 209,600 new cases of dementia per year in the United Kingdom.” With the population of the US being 6 times larger, this could mean that over 100,000 cases of dementia may be attributed to these drugs every year here in my own country.
Adding fuel to these types of concerns about negative effects of ingesting these drugs are the recent findings indicating that despite the fact that more Americans than ever are being prescribed so called antidepressants, the rate of suicide has climbed to an all-time high. Is the increased use of antidepressants causing this increased rate of suicide? Although definitive evidence is not yet available, it is a well known research finding that these drugs do increase the risk of suicidal thinking in many patients.
Meanwhile, the DSM/ICD approach has created a monolithically wealthy pharmaceutical industry, with all of the drawbacks associated with such institutions.
Given these problems, an international effort has been seeking to come up with some reasonable alternative that could provide all of the perceived practical benefits of the DSM/ICD approach, while having significantly fewer shortcomings. 
As part of this effort, I have come up with one alternative proposal which I discuss most extensively in a peer reviewed article published in a 2018 volume of the Journal of Humanistic Psychology (see HERE). Today, I shall summarize my approach, and then we’ll look at some of the published discussions on this topic that have come out after my article first appeared.
A Summary of My Approach
My proposed alternative to the DSM/ICD approach calls for the development of The Classification and Statistical Manual of Mental Health Concerns (CSM). In contrast to the DSM/ICD approach’s overarching concept of “mental disorders,” the CSM’s overarching concept is “mental health concerns.”
The CSM approach begins with a full recognition that individuality outruns any classification system. It is for this reason that the CSM does not classify anyone. Instead, it classifies the expressed concerns of individuals seeking to have their concerns addressed by a mental health service provider. A mental health concern occurs when a person seeking mental health services expresses to a mental health service provider a concern about any of these topics: behavior, emotion, mood, meaning of life, death, dying, managing chronic pain, addiction, work, relationships, education, eating, cognition, sleep, and challenging life situations.
Classifying the expressed concern would provide mental health service providers a common language that is helpful when communicating among other professionals. So, a professional might say to a colleague something like, “My 9:00 a.m. case is concerned about feeling depressed, my 10:00 case is concerned about his failing grades, my 11:00 case is concerned about how anxious she is in social situations.” Such communications are straightforward and easy to understand, not only for professionals, but for the general public as well.
Each expressed concern listed in the CSM would be a sufficiently short phrase so that it can be conveniently used in titles and search engines to retrieve valued relevant information. Along with each classified expressed concern, there would be a numerical code that would be convenient for third-party payer bureaucratic record keeping.
The CSM, in addition to coming up with a brief label for the expressed concern and a code for third party payers, describes a collaborative approach between the person expressing the concern and the mental health service provider for creating a psychological formulation narrative of a few paragraphs that eschews the DSM/ICD pathologizing jargon. 
This process involves a mental health service user and a mental health service provider co-constructing a hypothesis or “best guess” about the origins of the mental health service user’s concerns in the context of his or her relationships, social circumstances, cultural heritage, life events, and the sense that he or she has made of them. Once it has been established what the concerns are, the immediate next question is, “How do we jointly understand these experiences, why they arose, and how we might be able to address them?” This formulation is not something that is shared with third party payers of mental health services, but is utilized exclusively by the mental health service user and service provider.
With the CSM approach, no one is viewed as mentally ill, having a mental disorder, or having some psychopathological condition. Instead, it highlights that the progress of society is due to the fact that individuals naturally vary from the human average in all sorts of directions, that the originality is often useful, while, at the same time, being different can create a variety of concerns. Moreover, some people become concerned about how they are handling enormously stressful and traumatic experiences. Still others are living in unhealthy ways, such as making unhealthy choices in what they consume, or getting insufficient exercise. Mental health professionals, with the CSM approach, are viewed as seeking to address these types of concerns that arise from these conditions in a supportive setting while relying on a variety of wisdom traditions. Central to this approach, is an honoring of what Ralph Waldo Emerson referred to as the grand sweep of humanity.
Compared with the DSM/ICD approach, the use of the CSM would be less stigmatizing, more respectful to those seeking services, and more practical because of the ease of understanding the words and phrases that it utilizes. Moreover, it would be more consistent with principles of science because instead of using as its core concept the vaguely defined “mental disorders,” the CSM uses as its core concept “mental health concerns,” which is a clearly recognized event that occurs at a specific time and place. Finally, the CSM approach would provide a new choice to both mental health service users and providers, challenge old ideas, stimulate fresh perspectives, and open new avenues of research.
The Latest Discussions
Since my article on the CSM was published, the Journal of Humanistic Psychology (JHP), in its May 2019 issue, has several articles that discuss my approach as well as a few others. Let’s take a look at some of what was said, and as we do so, I’ll share a few thoughts about my reaction.
In an article titled, “What Might an Alternative to the DSM Suitable for Psychotherapists Look Like?” Jonathan D. Raskin notes that recent surveys of psychologists and counselors indicate they are dissatisfied with the DSM/ICD approach and are interested in coming up with alternatives better suited to their professions. Nevertheless, more that 90% said they will use the DSM/ICD; after all, that is how they get paid by third party payers.
What would be a better alternative for psychotherapists and counselors than the DSM/ICD approach? According to Dr. Raskin, it would have to be a system that allows them to contextualize psychosocial and biological aspects of human suffering in a more nuanced manner. And then he writes,
“Jeffrey Rubin (2018) has proposed that we classify concerns that clients bring to therapy, not disorders they have. Identifying concerns is very different from identifying disorders. Concerns are things such as feeling anxious about one’s job, unhappy about one’s marriage, emotionally distraught about past abuse, or unable to move past what one witnessed while fighting in a war. The current diagnosis system encourages clinicians to translate these concerns–which are clearly contextual and not reducible to biology alone–into disorders that afflict people. But therapists and counselors do not actually treat disorders. Instead, they talk to people about their concerns–some of which are quite serious and lead to extremely challenging and intransigent difficulties.”
To Dr. Raskin, any alternative to the DSM/ICD approach must be a better fit with what therapists and counselors actually do. The CSM approach admirably achieves this.
In a commentary on Dr. Raskin’s article that appears in the same JHP issue, Rachel Cooper, a senior lecturer in philosophy at the United Kingdom’s University of Lancaster, and author of Diagnosing the Diagnostic and Statistical Manual of Mental Disorders, puts in some of her own thoughts on this topic.
She begins by agreeing with Dr. Raskin that most psychologists and counselors would be keen for an alternative classification to be developed. She then reviewed research indicating that social workers should be included among the professionals unhappy with having to use the DSM/ICD approach. In surveys, most indicated they would not use it if it was not required for insurance purposes.
Despite this finding, Dr. Cooper expresses pessimism about any alternative becoming accepted for funding psychotherapy via health care insurance. Among the factors that make it particularly challenging is the marketing of psychopharmaceuticals, which heavily promotes the idea that certain drugs treat the specific conditions listed in the DSM and ICD. The sum of money being acquired with this approach, she points out, makes producing a competitor classification far beyond the reach of most organizations.
She then refers to my CSM approach, stating that I suggest that insurance companies could be persuaded to pay for “Mental Health Concerns,” as they would readily come to understand, with a little explaining, that mental health service providers now using the current DSM/ICD approach do not turn anyone away who has mental health insurance coverage and comes to their office expressing what the CSM refers to as a mental health concern. She then writes,
“I think that Rubin’s optimism is misplaced. The fact that some (but by no means all) therapists currently get away with recording DSM diagnoses to facilitate payment even in cases where a diagnostic criteria may not be met will not be news to insurance companies. It is a practice that insurers have long known about and usually try to prevent. I think it unlikely that insurers would easily agree to cover Rubin’s ‘Mental Health Concerns.'”
First of all, when Dr. Cooper says insurance companies usually try to prevent mental health providers from recording diagnoses to facilitate payment even in cases where a diagnosis criteria is not met, I strongly disagree with her. I’ve never in my entire career heard of an insurance company questioning a diagnosis, and on what basis could they possibly do so? Insurance funders are not present in the room when a so called diagnosis is made. All that they get as documentation for a given diagnosis is a code indicating the diagnosis.
Moreover, the ICD actually encourages mental health professionals to come up with a diagnosis when criteria are not met. Thus, it states, “When the requirements are only partially fulfilled, it is nevertheless useful to record a diagnosis for most purposes” (WHO, 1992, p. 8).
I do agree, however, with Dr. Cooper when she says that getting the change that I have been advocating for is not going to be easy. Nevertheless, I believe we–professionals, service users, and service users’ relatives and neighbors–have a responsibility to try. Moreover, I have been encouraged by the steady increase in the influence of mental health service user advocacy groups who are becoming more and more vocal about the need for their members to be treated respectfully. And whenever I am invited to speak to professional organizations about the CSM approach, the rousing applause that I receive at the end of my presentation, along with the positive comments from audience members afterwards, keep my hope alive.
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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.
In an extraordinary Feeling Deeply podcast, Emily Whyte Rubin, my daughter-in-law, interviews Jack Baxter, a guy from London who, having struggled with these issues, started a program to help others who are dealing with similar challenges. Called, “Good Grief,” the program essentially assists people to come together in small groups to share their experiences and to support one another. Let’s take a few minutes to look at some of that interview, and then I’ll express my views on this topic, and then invite those of you who are reading this post to weigh in.
“Sure. I’ll tell you a little bit about my story. It started with sadness, unfortunately. It started when I lost my father, Dave. He was 48. He was my best friend. You know, people talk about soulmates; I don’t believe you only have one soulmate, because, you know, I met someone else that I can label that. I’ve since met another soulmate, and I hope to continue to meet more, but my dad was very much my first soulmate; he connected with me in ways that I never connected with anyone. He was my best friend. I could tell him anything, and likewise, he would tell me anything–his advice, his wisdom, and I was lucky enough to have that man for twenty-two years. 
“Sadly, he passed September 13th. He had skin cancer, which was, you know, tough for anyone to deal with, as you can imagine. I was only twenty-two at the time. It was like the center of my world had fallen out. It was a very tough time for me to deal with. I no longer had that support, and of course I had some friends and family, but no one like my dad who was, you know, who was there for me at times when I needed him most, and to be honest, I need him even now. You know, a young man needs his dad. And, well, we went on a journey of self discovery and I believe he was with me all that way as well. I made mistakes, ups and down, left and right, and, but, you know, I eventually sought some direction in “Good Grief” which, um, is a support group that I launched with some friends, Ben and James, and we offer support and advice for young people, in London at the moment, but we hope to venture out wider then that, for young people who have lost love ones, much like myself, and Ben, whose father died recently of brain cancer…. 
For me, personally, I tend to grieve internally, letting the experience flow through me, and I don’t feel a need to reach for a supplemental support group. In the past, when someone close to me died, I went to the funeral, spent a few days with people close to me, and then I processed the most challenging aspects of the experience that was, and is still, running through me mostly on my own. I have a supportive wife, and my children are a great source of comfort to me.
Although my personal approach is working for me, over the years I have met people who, it seems to me, really would benefit with the type of group Jack has put together. For example, a friend of mine whose wife died suddenly is now in his house all alone. It has been very rough on him. What a wonderful resource it would be for him if he could share what he has been going through, and offer support to others in a Good Grief type group. And I know others who, within their family structure, would meet with disrespect when showing any signs of tearfulness. “Man-up!” would be the demand they would face, or, “Don’t cry, it will all be okay.” For these folks, a more supportive group could be an enormous help.
It’s a Sunday night. Eight-year-old Carl is playing a computer game. Suddenly, his mom cries out, “Time to head up to bed, tomorrow’s school.”
“Don’t ‘but mom’ me, let’s go,” and she takes Carl firmly by his arm and begins to guide him to his bedroom. Carl’s eyes tear up, which infuriates his mother, and she cries out, don’t you start with this crap or I’ll give you a real reason to cry! You’re acting like an infant!!! Now you stop this instant and get to bed!!!”
“I see you are feeling sad. That’s understandable. You were enjoying the game so much, and you’re disappointed about having to stop. You know, when we feel sad, it’s to help us figure out how to better handle what we do in the future. I wonder how we can better handle the going to bed situation in the future. Any ideas, Carl?”
We could also go to the library and pick out some books that have pleasant short stories, and you can read one right before bed. Short stories come to an end in a reasonable period of time, and the reader feels a sense of completion when it’s over, without making you feel like you have to read the next chapter to see what happens next. That might work also. So, in the future, why don’t we try having you each night choose one of these ideas. I’ll let you decide each night which approach feels right to you.”
Suppose a guy named Fred tends to be sad more than the average person. This might be due to some natural born tendency to experience life in a more sensitive manner than most, or because of some rough stuff going on in his life, or some trauma in the past has been leading to recurring anguishing memories. For whatever reason, Fred regularly comes to work expressing his sadness from the look on his face as he goes around doing his job. Co-workers often stop what they are doing to ask what is wrong, and offer help by taking time to listen to Fred in a caring way. This would be nice in some ways, but let’s say it happens so often, coworkers begin to find that their work at the end of the day doesn’t always get done on time and they end up having to stay late. 
Some resentment begins to arise. Moreover, in this scenario, the boss begins to dislike what has been going on partly because of the time being taken from the tasks that have to get done with top-notch efficiency in a competitive business environment, and she was brought up by parents who taught that there is something wrong with people who are sad more than average. In the end, Fred loses his job.
Perhaps Fred, if he could afford it, would be better off hiring a professionally trained personal counselor to help him work through his sad experiences in a positive manner so that he doesn’t put too much on the shoulders of friends and family members. There are, in most communities, some counselors available, and at the top of any of my blog post there is a link titled “Counseling Services” that when clicked on provides descriptions and contact information for two excellent personal counselors that I personally can recommend who conveniently provide services through Skype, Zoom, or your phone.
However, counseling services do cost money, and if it is too expensive for someone’s budget, an alternative is to set up via such internet resources like meetup.com, a support group that meets regularly for the specific purpose of sharing challenging emotional experiences. Of course, the members will be unlikely to have the expertise of a trained personal counselor, but with trial and error it is often very possible to find the right mix of caring, empathic participants.
We’re here to emotionally support one another.
The Provigil made it hard for Laura to sleep, so her pharmacologist prescribed Ambien, which she took every night. In the course of a year, her doctors had created what’s known as “a prescription cascade”: the side effects of one medication are diagnosed as symptoms of another condition, leading to a succession of new prescriptions.
It was at this point that Laura decided to see what would happen if she stopped taking the drugs, and found that the process was an excruciating experience because of the medication withdrawal reactions. It took her many extremely rough months before her goal was achieved.
Prior to coming off the psychiatric drugs, Laura had been unable to have stable relationships. “I honestly thought that, because I was mentally ill, the numbness was just part of me.” Now she wondered about the other effects of the many medications she had been taking. “On this very sensory, somatic level, I couldn’t bond with another human being,” she said. “It never felt real. It felt synthetic.”
From today’s post, I hope that you will consider the value of giving up any belief that you may have that feeling sad means you are bad. If, when you experience sadness, you find yourself saying such words like, “I can’t believe I’m feeling sad again, what an idiot I am,” consider how it may be far more helpful to view your sadness as a useful tool for helping us to better plan our future. If you are a parent, consider the value of teaching your children this “sadness is a helpful tool” idea.
For some, like Lincoln and Joni, their suffering never completely went away, but they, in a sense, made friends with it. They did so by coming to understand that experiencing challenges more deeply than people with a happy-go-lucky temperament has the potential to provide a motivating force to bring forth valued achievements. As Joni so beautifully expressed this, 
Leo Tolstoy provided us the most vivid example. His depression stimulated a gnawing questioning that eventually led to one insight after another. His trouble had not been with life in general, not with the common life of common people, but with the life of the upper, intellectual, artistic classes, the life that he had personally always led, the cerebral life, the life of conventionality, artificiality, and personal ambition. By spending more time in nature and in a supportive community, “things cleared up within me and about me better than ever, and the light has never wholly died away.” According to Tolstoy, his suicidal feelings disappeared, and he went on to live a productive life until he passed away at the age of 82 of natural causes.
William James’s story is more in line with this second type of depression experience, in that he, like Tolstoy, found that by making certain changes in how he was living and the situation in which he was living, his experiences of dealing with depression decreased to a point that he felt he was getting more out of life. I briefly reviewed these changes in an earlier post titled, “William James’s Personal Bout with a “’Mental Disorder’” (see 
Simultaneously there arose in my mind the image of an epileptic patient whom I had seen in the asylum, a black-haired youth with greenish skin, entirely idiotic, who used to sit all day on the benches, or rather shelves, against the wall, with his knees drawn up against his chin, and the coarse gray undershirt, which was his only garment, drawn over them, inclosing his entire figure. He sat there like a sort of sculptured Egyptian cat or Peruvian mummy, moving nothing but his black eyes and looking absolutely non-human. This image and my fear entered into a species of combination with each other.
It is of special interest that William tells us that his experience “has made me sympathetic with the morbid feelings of others ever since.” For those of us who value people who can sympathize with those having such feelings, we see that something positive came out of William’s own experience. This theme that depression is often a tool to create something of value, runs throughout William’s writings for the rest of his life.
Initially, William, upon having his fearful experience believed that all mental health concerns now referred to as mental disorders are required to have a physical basis and that there was nothing anyone can willfully do about them. Today, short of taking a pill, many of today’s psychiatrists are promoting a similar view. Thus, their basic position is that these concerns are due to something within the patient’s physical makeup. This misses the overwhelming evidence that how people construe their past and current experiences, and their current social and work situations, are often the central causative factors.
One thing that he had decided to do was to spend more time than he had been on focussing on some uplifting life experiences. For example, he began to read poems by William Wordsworth. Consider Wordsworth’s poem, “I Wandered Lonely as a Cloud.”
Continuous as the stars that shine
For William, the delight that Wordsworth had for the beauty of nature was catching, and William began to spend more time in nature, especially in the Keene Valley area of the Adirondack Mountains. Also, of enormous help, was to find the right type of work for his temperament, as we see from a letter he wrote to his brother, the gifted novelist Henry James:
Michael Cohen served as the president’s personal lawyer and was brought in to the hearing to answer questions by the Congressional House Oversight Committee about possible criminal conduct and unethical behavior on the part of his former client and others connected with him. Rather than to devote their time to the task at hand, Republican after Republican spent the vast amount of time insisting that the whole hearing was a waste of time and a scam by Democrats to do nothing more than to try to gain political points.
Characteristic of the tone of the hearing by Republicans was Paul Gosar, a Republican representative from Arizona, who set up a sign behind his chair. The sign showed a picture of Mr. Cohen superimposed on flames, emblazoned with the words “LIAR, LIAR, PANTS ON FIRE!”
To this claim, Rep. Cummings soon corrected the record by indicating the clearly documented fact that under his leadership during the 116th Congress the committee had already had three other hearings. At each, there were several announced witnesses. For example, at one such hearing, the high prices of pharmaceuticals, which is in the process of being investigated by the committee, had executives of the pharmaceutical industry called to answer questions.
Rep. Jordan went on from his untruthful statement, to claim that the present hearing was nothing more than to serve the Clintons, their loyalists, and operatives, as well as to harm the President. To defend his position, Rep. Jordan mentioned that the committee was limited to answer only certain questions. In making this statement, he failed to mention that the reason for these limits was to cooperate with the special counsel and the Southern District of New York that had asked for these limits because certain questions could interfere with their ongoing investigations. This is a standard requirement under this set of circumstances. No doubt Mr. Jordan is well aware of this, and nevertheless, he attempted to slip this by the public’s eye.
Throughout the hearing, when it came time for each of the other Republicans to have their five minutes to question Mr. Cohen, with little exception, they parroted, over and over again, what Rep. Jordan had done. Several of the Republicans asked no questions at all, and most of the others, after consuming the vast majority of their allotted time with insulting Chairman Cummings and the other Democrats for setting up this hearing, hastily asked a single question. This dramatically reduced the time to examine what Mr. Cohen replied.
The United States Intelligence community has concluded that Russia, a US adversary, took illegal action during the last presidential election seeking to help President Trump win.
Together, they provide sound reasons to bring Mr. Cohen in for questioning by the Oversight Committee. Thus, by denying that there were any sound reasons, Republican participants were lying. In my opinion, those lies are even more harmful to Americans than the lies Mr. Cohen has been convicted of telling.
I well recognized the pressure these Republican representatives have for saying something supportive about the President whenever they appear in public. Each of them has in their districts a majority of voters who continue to support President Trump. Swimming against this type of tide is hardly to be expected of politicians. Nevertheless, this did not justify their conduct at the hearing.
Concerned that your romantic partner’s respect for your kissing technique might not be all that you desire? Is it okay to offer a romantic kiss on a first date? Will your date think less of you if you accept a romantic kiss on the first date? A discussion of Bob Dylan’s Theme Time Radio Hour episode on kissing will enlighten us on these and other related topics.
Does she love me? I wanna know
How long do you think that I can wait
Moreover, if instead of lingering in your arms during the kiss, she or he ends it a little too quickly, well, that may be another signal that something is wrong. Given how popular the song was, spending 12 weeks on the country charts, clearly indicates it touched something pretty sensitive in the heart of many a listener.
Bob goes on from here to songs that bring up such topics as passionate kissing, kissing in the dark, french kissing, finding lipstick on your collar, catching your woman kissing your best friend, making up after an argument kissing, and the fact that you don’t have to be rich to enjoy a wonderful kiss. He eventually gets back to our “romantic kissing” topic, with the Everly Brothers song, “Till I Kissed You.” Here’s a few lines of its romantic lyrics:
Never felt like this until I kissed ya’
Well, Lawrence, kissing is an important part of a relationship. And it’s one of those things that you have to be relaxed to do. So the fact that you are getting anxious about it isn’t helping you one bit. However, I can give you a few tips. Armed with this knowledge you’ll feel a little more confident and be able to set things right. First of all, make sure your lips are moist. Run your tongue over your lips once before you kiss her. No one wants to kiss sandpaper. 
Stand close to your partner, you don’t want her to reach too far. Tilt your head slightly to one side. Close your eyes just before your lips meet. Just close them. Some people like to keep their eyes opened during a kiss, but until you understand your partner’s preference, better to play it safe and close your eyes. Open your lips slightly, not like you are about to swallow her whole head, just a little bit, and don’t hold your breath. Breath through your nose. Press your partner’s lips gently. Move your lips in a slow circular motion. Be gentle but firm. And finally, and I can’t stress this enough, have a pocketful of mints. There is no underestimating the fact of good breath. Good luck and happy kissing. I hope it won’t be long till you hear your girl say, “baby let me kiss ya just one more time.” 
That there is a pretty decent description of a decent kiss, but I would add one more suggestion for helping him. Why not encourage him to ask his girlfriend what she would like him to do differently when they kiss? For example, she might prefer to be held within his arms more firmly while they are kissing, or perhaps a little gentler approach would be more to her liking.
Jerry not only sees Margaret home, but opens the door for her, and then, well, they’ve been going steady for some time now, and there are some customs that are very enjoyable. But now Frank has a new problem, should he try on a first date to kiss his date. He sees her to her door, and thanks her for going out with him. No, he should not try to kiss her good night on a first date. But he does ask her for another date soon. 
I grew up in Brooklyn, and before I was married, and was dating back in the late 1960s and early 70s, when I asked a gal out, I did so because I had some romantic feelings for her. If, by the end of the evening, when we arrived back at her home, if I still felt romantic toward her, I would say I had a very pleasant time, and pause to see if she said something similar. If she did say something similar, I would very slowly and gently lean toward her, observing her reaction as I did so, and if I saw no sign of resistance, my eyes would close and our lips would join for a romantic kiss. If she seemed to get into it, I would feel a wonderful high sensation, not only during the kiss, but all the way home. I never had any sense of disrespect toward the gal for joining me in such a good night kiss.
He introduces the song by inviting us to “listen to one of the old masters, the fountainhead from which all music flows, Louis Armstrong, and a song that was the centerpiece for his live performances in the later period of his life. This is a version that he recorded in 19 and 51, ‘A Kiss to Build a Dream on.'”
Leave me one thing before we part
Some in such programs advocate that serious problem drinking be viewed as a no-responsibility illness. The topic is a useful vehicle for clarifying some confusion about the nature of “guilt,” “fault,” “blame,” and “responsibility.” Whether or not folks have a crystal clear understanding of these concepts can be the difference between whether or not others will regard them with respect. 
“One Tuesday evening I sat in a saloon in Harlem, a homeless, friendless, dying drunkard. I had pawned or sold everything that would bring a drink. I could not sleep unless I was dead drunk. I had not eaten for days, and for four nights preceding I had suffered with delirium tremens, or the horrors, from midnight till morning. I had often said, ‘I will never be a tramp. I will never be cornered, for when that time comes, if ever it comes, I will find a home in the bottom of the river.’ But the Lord so ordered it that when that time did come I was not able to walk one quarter of the way to the river. As I sat there thinking, I seemed to feel some great and mighty presence. I did not know then what it was. I did learn afterwards that it was Jesus, the sinner’s friend. I walked up to the bar and pounded it with my fist till I made the glasses rattle. Those who stood by drinking looked on with scornful curiosity. I said I would never take another drink, if I died on the street, and really I felt as though that would happen before morning. Something said, ‘If you want to keep this promise, go and have yourself locked up.’ I went to the nearest station-house and had myself locked up.
“I was placed in a narrow cell, and it seemed as though all the demons that could find room came in the place with me…. I was finally released, and found my way to my brother’s house, where every care was given me. While lying in bed the admonishing Spirit never left me, and when I arose the following Sabbath morning I felt that day would decide my fate, and toward evening it came to my head to go to Jerry M’Auley’s Mission. I went. The house was packed, and with great difficulty I made my way to the space near a platform. There I saw the apostle to the drunkard and the outcast–that man of God, Jerry M’Auley. He rose, and amid deep silence told his experience. There was a sincerity about this man that carried conviction with it, and I found myself saying, ‘I wonder if God can save me?’ I listened to the testimony of twenty-five or thirty persons every one of whom had been saved from rum, and I made up my mind that I would be saved or die right there. When the invitation was given, I knelt down with a crowd of drunkards. Jerry made the first prayer. Then Mrs. M’Auley prayed fervently for us. Oh, what a conflict was going on for my poor soul! A blessed whisper said, ‘Come’; the devil said, ‘be careful.’ 
I halted but a moment, and then, with a broken heart, I said, ‘Dear Jesus, can you help me?’ Never with mortal tongue can I describe that moment. Although up to that moment my soul had been filled with indescribable gloom, I felt the glorious brightness of the noonday sun shine into my heart. I felt I was a free man. Oh, the precious feeling of safety, of freedom, of resting on Jesus!…
As the events unfold at the mission, Mr. Hadley continues to experience his actions, not based on choices that he is making, but a surrendering to what the mission might do to help him. Thus, at one point, he says to himself, “I found myself saying, ‘I wonder if God can save me?'”
So, in this general discussion of Mr. Hadley’s experience, we can see the outlines of several components that may have been helpful to him. He recognized that he had come to a pretty awful situation as a result of his drinking. 
He found some people who took some kind interest in him. He began to hear, over and over again, stories of people who had gone through very similar experiences who did have success recovering. He surrendered, at least to some extent, his own will, replacing it in faith in God and the program he had entered into at the mission. He also began to help others who were struggling with similar problems.
Perhaps the reader might have noticed that in Mr. Hadley’s account of his experience, he does not try to make the case that his difficulty controlling his drinking is a no-responsibility disease. There is little doubt that heavy drinking is a risk factor for several diseases, and Mr. Hadley was clearly experiencing some toxic reactions to his heavy drinking. But to certain strict scientific minds, confirming that someone has a disease requires a pathological report that identifies the presence of a lesion, tumor, microbe infection, tissue tear, bone fracture, organ blockage, or physiological poison.
Over the years, I have met AA members who refer to their drinking problem as a disease. I have also witnessed some members getting very angry and defensive when someone in front of them questioned whether or not their problem is a real disease.
The Big Book states that alcoholism “is an illness which only a spiritual experience will concur.” Ernest Kurtz says this is “The closest the book Alcoholics Anonymous comes to a definition of alcoholism.”
The sentence provides one citation that leads us to the two major mental and behavioral disorder classification systems. One of them (DSM-5) has been criticized by scientists for being heavily funded by the pharmaceutical industry seeking to classify as many psychological concerns as diseases to legitimize the prescribing of psychiatric drugs. Another one of the classification systems describes it as follows:
As I mentioned at the beginning of this post, there is a subgroup of folks who got there drinking problem under control and believe they did so because they took responsibility for their actions, and that was all that was needed. Some of these folks also believe there is a certain strength and dignity to handling their problems in this way, and those who don’t handle their problems in this way are weak, shameful, and maybe even deserving of punishment.
For them, they may have been spending substantial periods of time agreeing that they are indeed weak, shameful, deserving of punishment, that their negative drinking pattern is their fault, and the insults directed at them because of their drinking problem are well deserved and accurate.
The “sins” which they are eager to escape from almost exclusively engrosses their attention, so their efforts at recovery is a process of struggling away from the “sins,” rather than of striving for the positives that can be achieved. For William James, it would be far better for them to lay less stress on their various social miseries, the harm they are doing to their family, stomach, kidneys, and nerves, and far more on “the blessings of having an organism kept in lifelong possession of its full youthful elasticity by a sweet, sound blood, to which stimulants and narcotics are unknown, and to which the morning sun and air and dew comes as sufficiently powerful intoxicants.” 
This can be a time when suicide is considered, or one decides to surrender to a faith in a process that has worked for others. The personal will is given up, and the person ceases to resist. Sometimes this process includes religious or spiritual themes.
This frees up the subconscious forces to take the lead for a period of time. Instead of trying to force themselves to become alcohol free, by falling back on some larger power, the work that had begun by their will is further worked on in this subconscious incubated process, and, if the soil is right, finally burst forth into flower! 
By framing drinking problems as a disease, it is hoped that people will respond altruistically toward those struggling with this issue in a manner analogous to what happens when a mother’s altruistic emotions spring up when her baby is stricken with an illness. With this line of thinking, instead of laying fault, guilt, insults, or punishment upon the drinker, the focus, it is hoped, is upon a plan to help the drinker deal with the disease.
This strategy, however, is far from perfect. By calling serious drinking problems a disease leads some people losing respect for you. Those who took responsibility for their drinking problems and managed, through an act of will, to free themselves from its clutches will feel you are dodging responsibility where it rightfully belongs.
The actor Will Smith, in his popular YouTube video titled “Fault Vs Responsibility” tries to clarify this (see 
“If it’s somebody’s fault, we want them to suffer, we want them punished, we want them to pay…. As long as we are pointing the finger at whose fault it is, we’re jammed and trapped into victim mode. The road to power is in taking responsibility! Your heart, your life, your happiness is your responsibility and your responsibility alone…. taking responsibility is not admission of guilt. You are not admitting it is your fault. Taking responsibility is a recognition of the power that you see when you stop blaming people. It’s not like letting people who wronged you off the hook, but taking responsibility is an emotional self defense; it is taking your power back.” 
I actually believe there is often a shared responsibility in the types of situations that he is referring to. That is, whenever those of us in our communities begin to see some folks getting into some serious trouble, it is a sign of wisdom if we take some responsibility to try to find ways, out of kindness, to be helpful in some way. For example, many communities, recognizing that problems with addiction is a problem for the whole community, have worked together to provide places for peer support groups to meet at no cost to the support groups.
Second, when Mr. Smith says, “It’s not like letting people who wronged you off the hook,” I’m not quite sure what he means by this. However, just to clarify my own position, I believe that there are times when a person who is having difficulty getting a drinking problem under control, and has tried all of the admonishments, and blaming that often goes along with the frustration of not succeeding, there may come a time when putting aside these negative approaches, and replacing them with something different, makes a world of sense. 
Now, I well understand that when someone has been self-admonishing and self-blaming for quite some time, to suddenly stop doing it is often difficult. Here’s a simple technique for learning to replace this habit with something far more helpful, and it does not cost even a penny.
After about a minute of this, for another minute, turn your attention to the physical sensations that you are experiencing as these words fly by. If you wish to linger, that’s fine. Then, for another minute, imagine what good things would come about if you did manage to solve your drinking problem.
Well, in conclusion, I encourage you to consider whether or not it is wise for you to tell others that serious drinking problems is caused by the disease of alcoholism. It seems to me that even if you do believe that it is a disease, there are enough people promoting this idea so for those who are open to that belief, they already believe it is a disease and need no further push in that direction from you. However, each time you tell people you think it is a disease, you risk the possibility that some who hear will lose respect for you because they will view your attitude as a base attempt at eliminating essential responsibility from people who would be far better off accepting responsibility for their actions. 
On this blog, I have been making the case that how we respond to criticism can have an enormous influence on how much respect others have for us. To support this position, from time to time I provide a tentative outline of five levels of maturity for responding to criticism, with level 1 being viewed as the most immature, I give specific examples of people using the different levels, and I discussed the consequences of responding at each level.
A very disturbing example of someone responding to criticism has now crashed upon the international stage. I am referring to the actions of Saudi Crown Prince Mohammed bin Salman. According to the US CIA and many others who have reviewed the evidence, the Prince ordered the murder of the Washington Post reporter Jamal Khashoggi because the reporter criticized him. The details are gruesome, with those who carried out the deed actually using a bone saw to cut him into pieces.
1. This level requires displaying one or more of the following:
5. In addition to actions consistent with level 4, people responding to criticism in a manner consistent with level 5 seek ways to use, whenever they disagree with the criticism, a technique known as steering in the direction the criticizer would prefer to go. That is, rather than just disagreeing without being disagreeable, the criticized person seeks to find a new choice of action that creatively utilizes some aspect suggested from the criticism. Steering cannot be incorporated into all situations, but it is an additional goal of the most mature individuals.
The Saudi Kingdom, an absolute monarchy, has long imprisoned its own citizens who criticize the government. However, entities outside of the Kingdom, when criticizing the Saudis, found that it was typically handled quietly, with the Saudis usually ignoring them. Things began to change when the Prince gained power.
In August 2018, when Canada criticized the recent arrests of Saudi rights activists, the Prince threatened to break trade agreements with Canada and to break off trade with other Western countries if they, too, spoke out about political repression in the kingdom. An additional threat involved an unspecified, tit-for-tat response to further criticism, 
The Prince’s threats, it seems to me, clearly results in a rating of 2 because it matches the level 2 phrase, Threatens the criticizer. His other actions clearly results in a rating of 1 because actions such as breaking off trade and withdrawing thousands of students are costly, thus they are a fairly good match with the level 1 phrase, Damages Property. The murder is clearly a level 1 response because it matches the level 1 phrase, Physically attacks the criticizer. Overall, I think the Prince deserves a rating of 1.
The experiences of Joni Mitchell (see 
To continue this series on the experiences of famous persons who dealt with depression, I just finished reading a wonderful book titled, Lincoln’s Melancholy: How Depression Challenged a President and Fueled His Greatness, by Joshua Wolf Shenk.
I actually began discussing the book in my last post, which has the title, “
Lincoln, up till his mid-twenties, was not viewed as being a melancholy kind of guy. Friends and neighbors saw him as sunny and persisting tirelessly. For example, during the Black Hawk War, a fellow soldier said of him, “I never saw Mr Lincoln angry or desponding, but always cheerful… the whole company, even amid trouble and suffering, received strength and fortitude, by his buoyancy and elasticity.” Also typical of comments made of him, a neighbor said, “He was the best natured man I ever got acquainted with.”
Oh, there is evidence of cracks in his sunny disposition during his early years, but they occurred during times of great disappointments, which is pretty typical of most people. For example, after he and a partner opened a store and it soon failed, as we might expect, some described him as moping around, and one person reported hearing him say he might “let the whole thing go.”
…after that event he seemed quite changed, he seemed retired, and loved solitude, he seemed wrapped in profound thought, indifferent, to transpiring events, had little to say, but would take his gun and wander off in the woods by himself, away from associations of even those most esteemed, this gloom seemed to deepen for some time, so as to give anxiety to friends in regard to his mind.
The next period in which people who knew Abe clearly saw he was very depressed began at the beginning of January of 1841. Letters reveal how concerned people became. “We have been very much distressed on Lincoln’s account,” wrote one person. “Lincoln you know was desponding & melancholy when you left,” wrote another. “He has grown much worse and is now confined to his bed sick in body & mind,” wrote another.
For not giving you a general summary of news, you must pardon me, it is not in my power to do so. I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on the earth. Whether I shall ever be better I can not tell; I awfully forebode I shall not. To remain as I am is impossible; I must die or be better, it appears to me.
Some people experience depression, and then they have a “breakthrough” or “turning point,” and it goes away. This is what happened to Leo Tolstoy.
He spent an increasing amount of time alone, which can be profoundly important as people come to terms with loss, and sort out their ideas. Crucially important for him is that he found a cause that provided him a reason to live.
He yoked his feelings to a style…of melancholy that was, more than anything, philosophical. He saw the world as a sad, difficult place from which he expected considerable suffering. “There was a strong tinge of sadness in Mr Lincoln composition,” said his friend Joseph Gillespie. “He felt very strongly that there was more of discomfort than real happiness in human existence under the most favorable circumstances and the general current of his reflections was in that channel.” 
When Abraham Lincoln was 19, several neighbors were assigned to inform him of the heart wrenching news that his sister had died. As one of them described the incident, “We went out and told Abe. I never will forget the scene. He sat down in the door of the smokehouse and buried his face in his hands. The tears slowly trickled from between his boney fingers and his giant frame shook with sobs.”
Crying is as Natural as a Smile On a Baby’s Face
In Lincoln’s Melancholy: How Depression Challenged a President and Fueled His Greatness, the author, Joshua Wolf Shenk, tells us that when Abe was particularly sad, his friends’ reactions are insightful. They didn’t merely seek to help him, they vied with each other for the pleasure or honor of assisting him.
So far, I provided arguments that crying is natural because it encourages others to help and it is an important part of the creative process. If this is true, how can we explain why people become embarrassed about crying and frequently apologize for doing so?
Using this line of reasoning, it makes sense that although the usual characteristic of human beings is to feel sympathy for someone who is crying, nevertheless, there is some variation around this central tendency. Thus, some people are less sympathetic, and some may be so unsympathetic that they treat people who cry very disrespectfully. They might call the person a “cry baby,” or “immature,” or a “wimp,” or if the person is a male, “unmanly.”
Add to this that in our society, a new trend has added fuel to the idea that people who cry have something wrong with them. A billion dollar industry that sells antidepressants have enormous resources to saturate the media with sales pitches that seek to convince people that crying is a symptom of a serious mental illness that urgently needs to be treated with some drug.
You gotta accent-u-ate the positive,
Squashing the tears, rushing through the insulting scripts with words like, “wimp,” “momma’s boy,” “weakling,” “mentally ill,” etc., along with all of the negative emotions that accompany these words, leave us with far less of the energy that we would otherwise be able to call upon to address the cause of our sadness. Moreover, feeling like there is something wrong with us when we experience sensitive feelings results in millions of us turning to alcohol and drugs, which typically results in a number of unhealthy side effects.
At such times, as soon as you can, go to a place where you can have some alone time, preferably in a pleasant place out in nature, but even a bathroom will do in a pinch.
Observe them like you were a scientist objectively observing a flock of birds flying by, off in a distant sky.
Here’s another great exercise that I recommend. Over the course of four days, write for a minimum of 15 minutes at each sitting about something that has led you to experience sadness. As you do so, make sure you include not only what happened, but also what you felt when it happened, and how you now feel about what happened. Include your deepest emotions and thoughts about what occurred. Really let go and explore your feelings and thoughts about it. As you do so, recall the sensory experience of these feelings, not just the words that define the experience. After you finish the day’s writing assignment, read it over, and if you had called yourself any unkind names, cross them out, and read, once again, what you had written without any of the nasty name calling.
This assignment, like the other, does not cost any money, and by the time you finish this assignment, you will probably find you have made friends with your sad experiences. However some people may feel they have a few steps left to go before fully embracing sadness.
As I explained in another post about ruminating on certain anger experiences, meditation can be very helpful in dealing with any distressing ruminating experiences. You can learn how to meditate for free by clicking 