When I first heard of Chef Jose I felt a surge of excitement, awe and longing. Jose Andres, born in Spain, and immigrated to the US as a young man, soon made a name for himself as a celebrity chef, opening several highly acclaimed restaurants and winning prestigious awards in the highly lucrative world of gourmet food. Certainly, in the Bay Area, food is almost at the status of a religion. In 2010, perhaps having his fill of money and adulation, he founded the World Central Kitchen, established to feed masses of people left hungry or displaced by some sort of large-scale disaster, be it a natural or political one. He sets up  traveling kitchens providing free meals to large numbers who need it. Hunger itself is a form of trauma, let alone the trauma of hurricanes, wildfires, war or crazy immigration policy. My longing was to grab my husband, drop everything and go join his team. I even found he has a local team right next door to me here in Oakland. Of course, I wouldn’t do that. But the idea of helping the traumatized in that way grabbed me hard for a minute. Admittedly, one of the things that makes me happiest, is making food for people I love. I realized that only in the past few years, and probably it has not been true much longer than that.

A Rocky Road

Like many survivors of childhood trauma and neglect, I have a long and troubled history with food. Starting when I was a little girl, for whatever reason I did not like meat, and it became a power struggle between my mother and me, with my occasionally being spanked with a serving spoon. I was known early on as a “bad eater,” and I was. My parents had their own wartime history with food. I remember our dad talking about when he first came to this country and saw the bounty at Safeway, he could not believe how much food there was in the store! He simply could not stop drinking milk, because he could. My mom used to always say “Mahlzeit” before we ate. (My little sister thought it was “mouse-ite” or something rather cute!) That is German for “Enjoy the meal,” which I really never could. To this day I feel a little spark of anger in my belly when someone says “Bon Appetit” or some such, remembering the regular unpleasantness of mealtimes. 

By the age of 12 I had a full-on eating disorder, being severely anorexic. At 5 feet 2, I weighed 79 pounds, and in typical neglect fashion, no one really noticed. By then I had taken over much of the cooking for the family which was a way to control what we ate, and also gave me an excuse to be jumping up and down from the table during mealtime, so what was going on with my own plate might be less obvious. It was 1967 so anorexia was not recognized, nothing like the household word it is now. When I finally collapsed and could not even walk to the bathroom, I got attended to, but mostly with anger, blame and coercion. The nightmare that went on for decades ensued.

 As with many survivors of trauma and neglect, food becomes another form of the “dilemma without solution” identified in attachment theory, where the source of comfort and the source of terror are the same, be it the parent or the food – most likely both. In reality the comfort sought by the child in both forms, and in general, is regulation. The desperate attempt to calm the agonizing hyperarousal of the nervous system. Ironically there was something calming about the numbing of starvation. I do remember the mild state of euphoria and power I had when I was 20 and embarked on what I called “the Long March” which was a 14-day fast where I literally took in nothing but water. I felt somehow super or sub-human, but definitely different if not special. That is one I remember, but I am sure I felt it long before that.

 I have always bristled when I heard people who struggled with their weight, envying anorexics. First because it is such a relentless and devastating tyranny. But also because my 12 year old anorexia slid amoeba-like into a new form, I am not sure when. Suddenly I became compulsively driven to eat. It was terrifying. I began a routine where I ate sparsely through the day, but after dinner and washing the dishes, when everyone in the family was in bed, or where were they? I consumed between half a gallon and a gallon of ice cream, standing up and straight out of the cartons. I guess my parents kept me supplied, I don’t remember. But I could not stop. Each night, completing my routine, completely numbed out and bloated, I stumbled off to bed. In the mornings, I would get up and secretly run twenty miles in the dark, also a compulsion. The peril of gaining weight being the whip. I stayed on that merry go round, probably until I discovered alcohol which had a similar numbing/regulating effect. So, anorexia was no free ride to thinness for me.

“As with many survivors of trauma and neglect, food becomes another form of the “dilemma without solution” identified in attachment theory, where the source of comfort and the source of terror are the same, be it the parent or the food- most likely both. In reality the comfort sought by the child in both forms, and in general, is regulation.”

A Mixed Bag

I became a waitress as a way to earn money for college and graduate school. I was really good at it, discovering that if I got a lot of saliva in my mouth, and a sparkle in my eye when describing a pricey special, I could get people to order whatever I wanted them to. In that way food was an ally. In my activist days I became a cook in a community cultural center and restaurant that supported refugees and exiles from Latin American dictatorships. I cooked ten-gallon pots of soup, and learned all kinds of Latin specialties that I still love to make. And it was an opportunity to lend my preoccupation to something socially useful.

At a young age I became very interested in the interface between body and mind. I knew my terrible eating obsession was a confused tangle of both. I just had no idea what to do. The simple recipe of “eat less and exercise more” was surely not the answer. And the worst of it, was how my mind was always crowded with thoughts, worry, anticipation, terror, hope, fear and self-hatred about food and weight. It really was 24/7, and so boring, not to mention the shame and loneliness, and utter waste of time of the secret world, and of being constantly “on the run.”

“And the worst of it, was how my mind was always crowded with thoughts, worry, anticipation, terror, hope, fear and self-hatred about food and weight. It really was 24/7, and so boring…”

What Is To Be Done?

 So what is the answer? I will start with the “ending.” I can joyfully say I have a wonderful, pleasurable, healthful and spacious relationship with food today. I only think about it when I am deciding what kind of cheese to make this weekend or appreciating something delicious I just ate. I am grateful that I can eat whatever I want and it is not a struggle to know how much is enough or too much. I remember seeing people like that with envy and despair, and thinking “that will never be me.” Kind of a “homestead girl” I make all the bread and butter and cheese in our house. I aspire to grow vegetables but I have not quite cleared the time for that. 

 How did this happen? As with every other aspect of trauma and neglect healing, the magic is regulation. I believe the winning elixir is a healing attachment relationship, in my case with a truly wonderful therapist, and regulating modalities of therapy also. I did “everything” but I do like neurofeedback best. I am not saying neurofeedback is a “cure for eating disorders” nor would I tout any non-evidence-based solution for anything. I know there are some neurofeedback providers who specialize in eating issues. They are an often-seen component of the constellation of trauma and neglect symptoms, so one must search out the trauma therapists that have a somatic modality to offer, (but one should do that anyway!)  

The third major ingredient, I must add, is time. Because most of these conflicts go back so far, and neglect often goes back to preverbal ages, this rewiring does not happen in twenty sessions, unfortunately. My healing journey took maybe four decades? Oy vey, I don’t want to tell you it will take that long. Most of what we now know about the brain and about regulation emerged since the 1990 decade of the brain. And I know I am not the only one devoted to speeding up the process of healing.  

 I discovered cheesemaking at the ripe age of 63. I am 66 now. It bit me like a bug, out of nowhere. I found it to connect me to people all over the world, and across time, all of whom discovered that letting milk “rot” in effect, makes a glorious, nutritious food that enables fresh milk to last longer. I feel connected to cows, goats and sheep, and all milk producing females. And cheese is a living thing, requiring regular attention and care like a pet. 

Perhaps most valuable of all, is that it has taught me to wait. Not passively. But taking the time, doing the daily practice of care, and waiting months for it to be ready, or at its best is the lesson. It is a hard sell, but like the work of healing, it is well worth the wait.

Meanwhile, I think I will go send Chef Jose another donation!

Each time I write a blog, I always try to think of a song that I love that goes with what I’ve written. This is a favorite of mine, a Cuban song sung by Silvio Rodriguez.

“Two country people were fishing in a river. As they fished and talked, they saw a child floating down the river dangerously close to the rushing waterfall. Fearing the child would drown, one of them jumped in the river and brought the child safely to the bank. But soon there was another child floating down the river, then another, and another. Soon the river was filled with children all heading toward the whitewater and waterfall.

Both of them rushed to save as many children as they could, but there were too many children, they would never be able to save them all. One of the two jumped out of the river and started running upstream along the bank. The other yelled “hey where are you going? we need to save these children.” The first yelled back “I’m going upstream to stop whomever is throwing them in.”

– Prevention Parable

For three decades the voices of #MeToo have echoed off the walls of my psychotherapy office. What a long overdue and welcome relief to hear them resound at long last, even be believed in the larger world outside. Gratified and hopeful though I am that the issues of exploitation, abuse and sexual injustice are getting wide mass and mainstream attention, I find myself thinking more deeply about its causes and prevention. Policy and punishment appear to be beginning and changing, and much more is needed than that, to interrupt a pandemic that is daily proving to be even more ubiquitous than we may have thought. I am interested in adding to our responses the major categories of education and treatment for perpetrators and all boys and men; and locating sexual health in all of its ramifications as a public health issue for all children and adults in our country. I for one, am old enough to remember the “false memory” movement where victims and their therapists were blamed and villainized for “fabricating” stories and symptoms of sexual trauma, attempting to drive it back into darkness and silence. We must all work hard to keep that from happening again, and prevent this devastating reality from slipping back under its cloak of denial into hiddenness and complicity.

A new perspective is emerging in the larger sexuality field. There is a budding movement to redefine the concept of sexual health from one that is value, moral, culture and pathology laden, toward a more thoughtful and subjective criterion that emphasizes consent, pleasure and self-regulation.

As awareness grows, we see the beginnings of progress toward changing attitudes, policy, and education about gender, power, sexual harassment and abuse. That is heartening. However, while the #MeToo movement shines a much-needed spotlight on gender and power inequality, it is also an aspect of a far more complex web of problems. By looking a little wider, at more of the issues in play, casting a wider net may garner a better shot at success. Awareness of exploitation and abuse of women and children is imperative, as are sanctions and consequences for perpetrators and sexual opportunists of all kinds. I propose that we also guard against solutions that are too simple, or become a contest that further divides men and women. Perhaps this pandemic of out of control sexual behavior, reflects a cultural crisis involving sexual health, that we may have a public health crisis on our hands. As in yet another parable, of the blind men and the elephant, viewing the parts in isolation, does not convey an accurate enough big picture, and will certainly fall far short of our goals. We need to sort and study in depth the various issues, integrate them, and then put the mosaic together. While with certainty for many men who exploit, abuse and intimidate women, sanction and punishment are the only appropriate response, I also see a fundamental imperative to put sexual education and sexual health through the lifespan on the national public health agenda.

Still, however, sexuality in the larger world, and even in the relatively progressive Bay Area, continues to be sensationalized, commodified, pathologized, mystified and globally titillating, with there being a poverty of information. Although it has become routine to see advertising for sex enhancing medications and other products, most people have a limited understanding of what is sexually realistic or “normal.” I am repeatedly dismayed by clients’ reports that the oncologist treating their cancers; the psychiatrists treating their depression; even their couples’ therapists do not educate, inform them, or do not inquire about sexual function and satisfaction. Because their helpers do not initiate the dialog, they conclude either that it is wrong to ask, or that they are simply supposed to know.

My career began in the 1980’s when the Women’s Movement had recently given voice to violence against women and children. My work with sexually traumatized women took me down an unexpectedly winding road. Realizing how difficult a relationship was for my clients, I became a busy couples therapist, then sex therapist. Sexuality was so difficult for so many of these traumatized women, that it became a focus of my attention and my work.

 “Out of Control Sexual Behavior”

The advent and rise of the Internet brought with it what every “new” technology and medium of communication historically had: it became a vehicle and a new commercial avenue for sex. Pornography in every imaginable and unimaginable iteration appeared, and it became a widely discussed and often sensationalized topic in the world and in the field of sex therapy. It certainly began to show up in my office, with partners or spouses wondering or worrying about what it might mean. Is porn use cheating? Is it patholological or damaging? How much is too much? Due to “Accessibility, Affordability and Anonymity” people could spend inordinate amounts of time watching it and many did. A literature and treatment industry soon mushroomed around pornography in both professional and mass public realms, with little agreement or data supporting it. In my office, I witnessed the pain, suffering, shame, humiliation, confusion anger and despair of couples, where one partner, (in my practice usually male) repeatedly hurt and betrayed a spouse he truly loved. Both were baffled and desperately dismayed that he would not or could not stop. Then I began hearing about other activities: affairs, sex for money, anonymous sex with strangers, empty “hook-ups” and all taking place without explicit agreement between the two who sat in front of me.

“Two Minds”/Split Self

The specifics of the sexual behaviors varied, but the consistent element was what came to be described as a kind of split Self. Essentially the sufferer (or perpetrator) was of two minds: there was a part of the Self that did not want to engage in the behaviors in question, were even repelled and ashamed of them; and another part that irresistibly did. I saw this often in my practice, and it is an experience known to most of us where the warring pull of temptation versus a commitment, value system or priority seem to agonizingly tear the individual apart. The battleground of the two parts in this case was the body and sexual behavior in question, be it infidelity, or some other variation on betrayal. I have seen a broad range. The problem was often less the specific behavior per se, than the drive to repetitively do something in spite of its impact, its consequences and against one’s better judgment. Often these individuals were betraying their own deeply cherished values and morals, and rather shocking themselves. For myself, I struggled and searched for an understanding and an approach that would help both clients and their partners make sense out of what seemed incomprehensible, and maybe even find a way to navigate through it together. No small feat, especially as often the impact on the betrayed partner is many faceted and profound.

Sexual Health

2015 brought the seminal work of Doug Braun Harvey, who with his co-author and collaborator Michael Vigorito wrote a groundbreaking book on what they termed Out of Control Sexual Behavior or OCSB. They brought a different lens to the problems of sexual harassment, opportunism, exploitation and abuse, building a coherent and dignified conceptualization, and a treatment approach. The centerpiece of their work is a concise definition of sexual health, which is also its heart and soul.

Sexual health consists of a framework of six essential and non-negotiable principles. Within the frame of those principles, individuals and couples determine for themselves what their sexual activities are to be. For many individuals and couples, these concepts are astonishingly new and they have never thought about them or discussed them. In fact it is remarkable how many couples have barely if at all talked about sex, or their sexual relationship. We live in a world where we are bombarded with sexual stimulation and sexual myth, and information is at a minimum. Doctors and surgeons, prescribing physicians and psychiatrists, teachers and even therapists more often than not fail to speak or educate about sexuality. The majority of clients I have seen over the decades, if they have had any relevant sex education at any time in their early or adult lives, it was pitifully lacking. So I found the six principles to be a surprisingly useful teaching tool.

First and most important of the six principles, is Unambiguous Consent. By unambiguous consent we mean, beyond “No means No!” that unspoken “deals” must be spoken about. If he buys me an expensive dinner, what do I “owe” him? Is it true that revealing attire means “I am available?” Is it “fair” to change my mind? What is the impact of mind altering substances on consent, even if the substance use itself was consensual? And power differentials are a game changer. “What will it cost me if I don’t do what you want?” And “What do I want to do about that?”

Consent is a huge, complex and multidimensional topic, and I view it as a vital component and expression of care and empathy. I teach couples to practice “informed consent” about most anything; as a way that we acknowledge, honor and create equality around differentness. Even something as fundamental as when we discuss any difficult or personal matter, is a point for consensual agreement. In the larger world, consent is complicated by many factors, the most obvious of course, is power.

The other five principles are:

Non-exploitation: This of course means a commitment to being ethical, thoughtful and respectful of the integrity, rights and preferences of all parties to the interaction. It also considers what might be a power inequality between the two parties that could complicate the question of consent. I have also found that as with so many concepts, definitions of what constitutes exploitation, vary widely. Some individuals view pornography and paid sex as categorically exploitative of the sex worker. Others do not. Again, individuals and couples must elaborate and agree on their terms.

Protection from HIV, STI’s and Unwanted Pregnancy: Shared responsibility for safety and equality in all its forms.

Honesty: A commitment to transparency. So often the worst injury in sexual predation and betrayal stems from deceit, of intention, motivation and meaning. I have certainly also seen couples disagree on “lying by omission,” which also needs to be explicitly negotiated.

Shared Values: Sexuality is tied to a vast range of diverse philosophical, moral and religious meaning systems. Gender, exclusivity, sexual frequency, even preferred sexual acts for example, are all personal and subjective, and must be known, negotiated and compatible.

Mutual Pleasure: Not to be forgotten, with the emphasis on mutual.

If the whole world operated on these principles, OCSB as well as the entire #MeToo phenomenon and all its abusers, would pass into grim history.

Beside the Six Principles, the authors detail the problem of “split Self,” of being of two minds, which can result in unwanted sexual behavior, and the emotional and relationship difficulties and disasters that it can bring. Numerous devastating examples of have flooded into my office over the years. Braun Harvey and Vigorito developed an approach consisting of individual, group and couples education and therapy, emphasizing accountability, self regulation and relational integrity. I found their framework to be of great use to me, and many of my struggling and suffering couples.

Self regulation is a concept that is becoming more and more a part of the mental health lexicon as we finally come to better understand the role of the brain and nervous system in human psychology and health. It would seem like a “no brainer” that the brain profoundly shapes the mind, but it has been a long time coming. Self regulation boils down to maintaining balance and control, a fundamental ability that is most noticeable in its absence.

Rules and Regulation

Regulation is the balance between energy and rest, intensity and ease, excitement and calm, sympathetic and parasympathetic: the ability to rev up when appropriate and then settle down. As children we rely on caregivers to oversee or manage these functions. Under the best of circumstances, children are soothed and comforted by parents, their fears and worries are eased, their frustrations and anger tempered or contained by a good parent. As children, we need first to be taught to identify, name and effectively express impulses and feelings. With maturity, we ideally learn to manage our energy, our activation, our impulses, ourselves, to self-regulate. A “regulated” nervous system, is one wherein individuals can control and choose how to behave. Rather than rely on external rules, we ideally become able to trust an internal mechanism of control. Of course none of us do it perfectly. We all have the occasional emotional outburst we regret, the impulse to overspend, the one too many brownies.

The same is true for sexual feelings. Pioneer sexuality educator Betty Dodson teaches that parents’ normalization and acceptance of children’s sexual feelings, and helping them to understand and manage them, are the fundamental building blocks of later sexual health. In the world of sexuality what can feel like a runaway train to an adolescent, becomes manageable to a regulated adult.

In a world where couples rarely talk about sex with each other, let alone their children; and sex education in schools is minimal at best, this is all too rare. However regulation, within a solid sexual health framework, provides a foundation for individuals and couples to thoughtfully, honestly and intentionally evolve and negotiate their arousal and their own erotic palette. That would be a worthy goal.

What Is Wrong With These Men?

Bill Clinton rose out of a matrix of parental alcoholism and violence to become a Rhodes Scholar and Yale Law School graduate. He went on to become the youngest governor in the nation at 32, an age when I was barely emerging from drugs, sex and rock ‘n roll. Elected president in 1992, at just 46, he was arguably the most powerful man in the world, a success story at the pinnacle of success. Why would he risk it all on scandalous, wanton sexual behavior with someone who apparently meant little to him?

Bill Cosby has dominated the sexual predator stage for some years, with one after another of his alleged victims speaking out before his conviction this month on three counts of aggravated indecent assault. But before that downfall, Cosby was also another great American success story. “The Cosby Show” was TV’s biggest hit of the 1980s, earning him the moniker “America’s dad.” He also earned a doctorate in education from the University of Massachusetts, and became a widely followed civil rights activist. Popular, rich and famous; with a beautiful family, he appeared to have it all. Why would someone like this have to drug women to have sex with them? Or why would he want to have sex with unconscious women?

Al Franken, Kevin Spacey, Anthony Weiner, Charlie Rose, Eric Schneiderman, Woody Allen… What is wrong with these men? And how many men, famous or not, powerful or not, “good souls” or “good spouses” or not, are fractured by split selves, and out of control? With the statistic that one in three women are victims of some kind of abuse, harassment, rape and other unwanted sexual attention, it is clear that these men are but a fraction of those who perpetrate.

As a trauma therapist, I have seen the gamut of wildly dysregulated sexuality, from frozenness in seemingly endless sexual impasses, to erotic extremes of every imaginable and unimaginable ilk. I see plenty of “split self” sexuality in the traumatized. Braun Harvey and Vigorito, agree that trauma may be a factor in Out of Control Sexual Behavior some of the time, but certainly not in all cases.

I asked Braun Harvey, “What do you think about this #MeToo phenomenon from an OCSB standpoint?” He replied that sadly, for the most part men do not talk about sexual health, unless they have either been victimized or have themselves already perpetrated. Men’s conversations about sex tend to be limited to what our president referred to as harmless “locker room banter:” competitive, posturing, vapid. Beyond that, even though bombarded with Viagra advertising, most men know very little about what is really “normal” and what other people are doing. Couples commonly don’t talk about sex in any meaningful way. It is time to begin a national discourse about sexual health.

Braun Harvey continued that consent as a concept is largely not broached until it becomes part of a conversation about sexuality, and even then not nearly enough. The broader implications of mutuality, consideration and equality are weak at best in our culture, which was been built largely on the motifs of self-reliance and rugged individualism, not to mention slavery.

Moving Upstream: What More Can We Do?

In 2001 our then Surgeon General, the enlightened David Satcher issued a “Call to Action to Promote Sexual Health and Responsible Sexual Behavior.” Not that different from Braun Harvey’s formulation, it went as far as to place sexual health among both our nation’s values and rights. Education, policy and accessible services must make sexuality as safe, just and dignified, as all other matters of health.

“A major responsibility of the Surgeon General is to provide the best available science based information to the American people to assist in protecting and advancing the health and safety of our Nation,” Satcher’s call proclaimed. “This report represents another effort to meet that responsibility… These challenges can be met but first we must find common ground and reach consensus on some important problems and their possible solutions. It is necessary to appreciate what sexual health is, that it is connected with both physical and mental health, and that it is important throughout the entire lifespan, not just the reproductive years. It is also important to recognize the responsibilities that individuals and communities have in protecting sexual health. The responsibility of well-informed adults as educators and role models for their children cannot be overstated. Issues around sexuality can be difficult to discuss because they are personal and because there is great diversity in how they are perceived and approached. Yet, they greatly impact public health and, thus, it is time to begin that discussion… We need to appreciate the diversity of our culture, engage in mature, thoughtful and respectful discussion, be informed by the science that is available to us, and invest in continued research. This is a call to action. We cannot remain complacent. Doing nothing is unacceptable. Our efforts will not only have an impact on the current health status of our citizens, but will lay a foundation for a healthier society in the future.

Where Did It Go?

Dr. Satcher cited in his 2001 report:

• STDs infect approximately 12 million persons each year
• an estimated 40,000 new HIV infections occur each year
• nearly one-half of pregnancies are unintended
• an estimated 22% of women and 2% of men have been victims of a forced sexual act
• an estimated 104,000 children are victims of sexual abuse each year

A 2007 federal study on abstinence education found that these programs had no impact on the rate of teen sexual abstinence. Rather, teens in states that prescribe abstinence education are actually more likely to become pregnant. 1 in 4 teens in the US receives information about abstinence without receiving any information or instructions about birth control. Among teens aged 18–19, 41% report that they know little or nothing about condoms.

The chilling rates of child sexual exploitation have not changed much. In a 2015 report:

• 37% of American children are reported to Child Protective Services by their 18^th birthday (African American children are reported at 54%)
• 1 in 4 girls and 1 in 6 boys will be sexually abused before they turn 18

Clearly it is time to dust off and revisit Dr. Satcher’s call, and resuscitate sex education that will enable boys and men to make sense out of, and speak about confusing sexual feelings; or desires and impulses they don’t know how to manage before they perpetrate. Girls too, besides learning about consent and equality need to learn about what problematic and out of control sexuality look like. In others and in themselves. Identifying a problem and ready access to help that would not be shaming or stigmatized might prevent a lot of damage to self and others. These discussions might begin in the elementary grades.

None of this is in any way intended to let #MeToo offenders off the hook, or excuse sexual harassment, abuse or violence. Quite the opposite. I believe we must continue to make the policy and legal changes that will stop the Harvey Weinsteins, and Larry Nassars (the Physician who abused generations of young gymnasts entrusted to his care,) and protect and prevent children and adults from any unwanted and/or exploitative sexual attention or activity. Parenting classes might expand to include sexuality and sexual health as important parenting responsibilities. And besides making it safe and effective for children and adults to report their experiences, we need sexuality education that covers both wanted and unwanted sexual activity, and the nature of out of control feeling and behavior. Rather than hide and continue it, those afflicted will be able to recognize it; and know that help is available before they do harm, or more harm. And we need to make sure that help is readily available. This means training health care and mental health professionals including school counselors and other key adults at schools, about diagnosis and treatment that are positive, sex positive and effective.

When the infamous pussy grabbing video burst on the scene in 2015, I thought for sure candidate Trump was finished. As a professional, a woman and a civilized human being, I just could not fathom that a man who did and said such a thing could become the president of the United States, there was simply no way he could continue to advance toward the White House after such an affront.

I was shocked and horrified to see how wrong I had been, and that men still impress and amuse each other with “conquests,” and not only in locker rooms. That furor died down. Other shock and horror has followed. And I am concerned about the real change that needs to take hold. I don’t want our cat-eared pussy hats to migrate to the back of the drawer. I don’t want the cries of #MeToo to fade again into silence without the essential response: a response that will include sanctions and reparations for wrong-doing.

The renowned neuroscientist Antonio Damasio, in his most recent book, tracks human evolution back to the earliest bacteria. He posits that it is feeling, the experience that something is “wrong,” something is out of balance with well-being and preservation of the species, that impels the organism to find the correction that will restore health. That, in conjunction with natural selection, brought us from our forebears – those early bacteria that were even without nuclei – to the conscious, complex-brained, and hopefully self-aware beings that we have become. Damasio seeks to create more respect and value for feeling as being fundamental to the advance of healthful life. We need to teach young children to recognize the feelings associated with “good touch” and “secret touch;” older girls to recognize and understand the feeling of unwanted or exploitative attention; and sufferers of dysregulated arousal and sexuality to identify the feeling that something is awry in their bodies. All of this before injury and shame has calcified in these young, and older bodies. It is my fervent hope that we can use the outrage of the #MeToo movement in that direction. This would include parents, teachers, coaches, employers, managers, employees, chefs, bloggers, celebrities, policy makers and of course all health and mental health professionals, all speaking up for sexual health. I guess that is most of us really.

My book “Working with the Developmental Trauma of Childhood Neglect: Using Psychotherapy and Attachment Theory Techniques in Clinical Practice” was published on August 31st. It provides psychotherapists with a multidimensional view of childhood neglect and a practical roadmap for facilitating survivors’ healing.

For me historically, holidays, anniversaries, birthdays and other marked dates that cycled around every year laden with hopes and expectations, fantasies and even magical prayers were always a terrible trap. Particularly those that were supposed to be occasion for lavish and abundant presents. In our family they of course usually were not. I certainly longed for that special gift on that one special day that would symbolize and communicate that I matter, that I was indeed seen, heard, and even cared for, at least for a minute. The non-Jewish kids thought that because Hanukkah has 8 days, we got 8 presents, one each night. Not so in our family, where it was more or less one. Invariably at least one of us wound up in the bathroom crying every year. 

As I got older, my refuge came in being an impassioned creator of gifts. My little world became a lively whirlwind of craft, the sewing machine buzzing, the floor littered with colorful threads, scraps and wisps of the flighty tissue paper of Simplicity sewing patterns. It was happy little workshop, although it also failed in the quest to feel special, loved, seen, and valued. Nonetheless parts of that set of rituals persist to this day, although the media have rolled over many times. And a variety of craft has become an activity of absolute and unadulterated joy or I won’t do it. In our little cosmos of childhood neglect and trauma, however, the holidays approached with a family tradition of hope and dread. Norman Rockwell was most definitely MIA.

 Although she never spoke of it, our mom must have had some sort of strong feeling about the holidays too, or at least some of them. She always told the story that she and Dad got married on Christmas Day in 1949, so they would “always have something to celebrate that day too.” And I am sure it is from her that I inherited my hopeless case of Christmas tree envy, as she also loved the glittering trees, and of course we could never have one. In my twenties when I lived with my “gentile” partner, every year we got our Christmas tree the day after Thanksgiving. I loved watching the lights twinkle each night. Fire hazard or not, reluctantly we took the tree down on Valentines Day, swept up the little carpet of dry pine needles, and said good bye to the sweet smell for another by now only nine and a half months.

My husband and I emulated my parents just a bit, getting married the day after Thanksgiving, 1991. This year marks our 30th year of marriage, which is for so many reasons unimaginable. Between the trauma-neglect brain’s confusion surrounding time; the surreal blur of the Pandemic years, and the incredulity of not only living this long, but achieving and sustaining a joyful and lasting partnership… Well I never thought it would happen to me. 

The nature of trauma and neglect is a surreality of time. The dorsolateral right prefrontal cortex which understands and regulates a sense of time, is one of the areas highjacked or knocked out by trauma of many kinds. It leaves a person feeling that this will never end. In a trauma ridden family home that is often true until the child gets old enough to get away. If you find it challenging or even impossible to practice affirmations and tell yourself something positive about tomorrow being another day, don’t compound it with self blame and censure. Just know that your poor old bushwhacked brain needs a hand and can get there. The cycling of the seasons, the inevitable approach of the seasonal markers of time getting away can be painful. It may seem to signify more loss: “life is passing me by…” Then the holidays threaten an even greater burden of weight.

 And there can be the additional blight of anniversary reactions, another mysterious bearer of the trauma story. The body, emotional and sensory apparatuses log events in a wordless, impressionistic way such that even just the arrival of a season or time of year can bring a wash of felt experience or mood that may appear to “come from nowhere.” Perhaps the brain is summoning an emissary, like a “Ghost of Christmas Past” to deliver another chapter of the trauma story unknown to ordinary autobiographical memory. “Why do I feel so bad?” That may be why. It is easy to feel guilty or ashamed about not being cheerful and happy around these annual events. It is a ready reflex to sink into self-recrimination and compound the lousy mood with self-blame and self-hatred. That is one reason why I like physiology so much. I never imagined that science would be such a source of comfort! Repeat, “It is not your fault!” 

Ritual

It seems that every culture in the world, throughout time, has created its own repeating ritual traditions. They contribute to identity formation and a sense of continuity and even faith. It is often said that the definition of insanity is to keep doing the same thing and expecting a different result. However to keep doing the same thing and expecting the same result might be very sane indeed, and an adaptive practice. That has certainly been true of my little craft workshop. 

When I got old enough, and blessedly have the resources and the privilege, my husband and I make a ritual of escape from the winter holidays. I despise what I call the “Three C’s” of these holidays: Commercialization, Consumerism and Commotion – at least in the US. The ever-present reminder to buy; what is certainly in the Bay Area off-the-charts traffic, not to mention the pressure to have families and loved ones to celebrate with… I find it all unbearable. We leave town and head for somewhere quiet, out of the way, and warm. One of the ironic perks of the COVID Pandemic, for those of us lucky enough to be healthy, was that all of that holiday uproar was perhaps tempered a bit. We just couldn’t mob the stores. Perhaps people did something parallel in the privacy of their own cyber worlds, but it was not as much “in my face” so to speak. I don’t mean to heartlessly and Scrooge-like disparage the ritual of gifts. I do also love them, when they have heart; are not obligatory or “transactional;” or part of some insidious unspoken “deal.”

I also like the annual reminder of charitable organizations, who toil tirelessly throughout the year, often doing the most difficult of work, and often on an underfunded shoestring budget, needing and requesting support. I feel better about their doing what I either can’t or won’t do myself, by helping as much as I can. I remember how some years ago now, San Francisco Mayor London Breed first got my “vote,” (not the most astute way of making political choices I’ll admit!) She wasn’t even running for anything yet at the time. I heard an interview where she told the story of growing up poor in San Francisco, raised by her grandmother. Without running water in their apartment, of course there was no money for Christmas presents. And then came Toys for Tots. “I got a present! I became that happy little girl who got a Christmas present!” Breed has loved Toys for Tots ever since, and certainly put it on the radar for me. 

Self Reflection

Although I am not religious, I do like the Jewish New Year tradition of self reflection. The Jewish New Year comes in the fall, usually in September so it coincided with what for me was the start of the school year. Nowadays I believe school starts in August which I view as a “crime against nature” as August to me represents high summer and is no time to start school! Anyway, the start of the school year was a laden annual marker in itself, and the injunction to review the past year and think ahead to the next one was a worthy and even somewhat natural practice. Cycles of the year, and known dates and events seemed to provide a welcome jog to my often-addled memory. Where was I last year on this date? And because it is a recognized date it may stand out in some way. Perhaps I can picture how I observed it then, which might open the flow to what my priority was then, what happened then? Where do I want to go in this next orbit around the sun? I used to journal. For some reason I don’t do that anymore although it can be a very useful practice.

IF we can do it without a whip I find self-reflection to be my go-to holiday observance. By whip, however,  I mean self-reflection that is tinged with criticism, harsh regret and aspiration; or that smacks of judgment, even punishment. These are no way to celebrate a holiday! Hopefully I would never treat anyone else with tidings of judgment, blame and pressure to shape up! Why would I treat myself that way? There is even a contorted grandiosity in the expectation of exaggerated achievement or perfection; and there is a blessed humility in the act of heartfelt, realistic self-reflection, and flexible, fluid goal setting that allows for the unanticipated, which is often even better than what we planned. 

Let’s Make a Miracle

Many do not know that the Hanukkah story is the story of a miracle. The “eternal light” is the ceremonial lamp that burns continuously in every Jewish sanctuary, symbolizing the eternal, unfailing presence of God. As the story goes, the Jews were embroiled in war with their then oppressors, and the eternal light in their Temple ran dangerously low on oil. At the key moment, there was only enough oil in the lamp to last one day, with the danger that the light would be extinguished. Miraculously the oil for one day lasted for eight, so the light burned on until the Jews were victorious, and able to replenish it. So besides being another celebration of victory over oppression, this miracle represents unending, uncompromising protection and comforting presence, maybe even hope? Not a bad symbol for our purposes I figure.

Milestones may also be a chronic rhythmic reminder of how painfully long recovery takes. One reason why I have been on an insatiable quest all these years, to learn all the newest and best evidence based treatment approaches for trauma, is that. It incenses me that after a childhood ravaged by overwhelming experiences not of one’s own making, survivors then have to spend years and seemingly endless amounts of money and time, to in effect, climb out of a hole and arrive in life. That is a tragic injustice as far as I am concerned, that I have dedicated my life to at least attempt to rectify. It is also important to know, that the devastating and seemingly endless duration is not your fault! Not your sloth or ineptitude. 

Much of the deepest of injury is in the attachment systems of the brain and date back to developmental stages in infancy. This is not to make the duration appear worse or hopeless, but rather to “normalize” it. And I can honestly say, and this is one of those annoying things that therapists might say, every bit of my own journey which often felt (and even occasionally still does!) feel endless, serves me. As Bruce Hornsby says in his wonderful and timeless song Swan Song “To be sure I don’t regret much, not much at all.”

I believe recovery is a kind of miracle in itself. I do think of mine that way, replete with the many angels who entered my life as healers, teachers and helpers of all sorts. It is a good time to remember that, at least for me. So my wishes for all are Peace, Health, Love, and with luck, even some Joy. And because I can’t help myself, I must add:

Cheese on Earth!

Best wishes of the season!

My book “Working with the Developmental Trauma of Childhood Neglect: Using Psychotherapy and Attachment Theory Techniques in Clinical Practice” was published on August 31st. It provides psychotherapists with a multidimensional view of childhood neglect and a practical roadmap for facilitating survivors’ healing.

People, Place, and Brain

In our apartment building in New York, everyone seemed to have numbers on their arms, sad eyes and thick German accents. My great Aunt Gertrud would take me to the park in my stroller. She called me a “dickopf “ (fathead) because I was such a “terrible eater” right from the start. On Saturdays I often went with my dad on the subway to the orthodox “schul,” our special time together. I would sit next to him in the men’s section, my little legs dangling from the hard wooden bench, and braid the fringes on his “talis.”  Other than that I did not get out that much. Mr. Shall the nice old man who painted portraits of each of us (see the portrait of myself age four); and Mrs. Bodine my piano teacher, were all in the building. So it was easy for me to believe, the whole world was like us.

 It was only when I went to public school kindergarten that I began to get the confusing messages about identity that got more and more confusing as I got older. Fit in, but not too much. I learned the complicated word “assimilate,” which accompanied the complicated messages. My mother’s family, even though they had nothing, still identified with an intellectual elite, my grandmother proudly being one of the first women to graduate from Oxford. She tried desperately to talk my mother out of marrying my father, who never went to high school, (although he “showed” her years later by getting his MA from Stanford.) My dad was simply ferocious about our marrying Jews. So we were in some ways “superior?” certainly and thankfully not like them. And yet fleeing hideous rejection and persecution, many here were ignorant or prejudiced, so we might have to hide or prove ourselves as worthy or equal, or “pass.” Oy vey. And that was even before all the identity challenges of adolescence and then of moving to Indiana!

“He’s Adopted”

In the Colin Kaepernick movie “Colin in Black and White,” is one poignant scene, where the teenaged Colin has reached the long awaited milestone of getting his drivers’ permit and is out practicing with both of his white parents in the car. He is doing nicely, when he is randomly pulled over by a cop, apparently for “driving while black.” His father pipes up quickly saying, “What did he do, Officer?” The cop looks over at Colin’s dad, sitting in the passenger seat, and sternly asks, “Who are you?” His mother jumps in  from the back seat, “We’re his parents.” And quickly adds, “he’s adopted.” It sounds almost apologetic. Variations on that scene repeat in the course of the movie, and one can only imagine how many times it recycled in his life. It reminded me of a time when I had a small crash on a bike trip in Oregon that left me with a whopping shiner. Walking down the small town street with a black eye, I could see people looking at me, looking at my husband, and glancing back and forth between us, trying not to be too obvious. I remember how ashamed I felt. Somehow it matters who others, even strangers think I am.

Colin’s life and identity formation as a person of color in a white world, was far more complicated than I knew as I saw him heroically taking a knee. Obama unfortunately does not address this experience in his recent memoir, which I doggedly trudged all the way through to its final 700^th page.

How Many ACES in One 40 Minute Interview?

This morning in the wee hours I heard another compelling interview, this time a young Pakistani man whose family were immigrants in Northern Ireland. I knew a tiny smattering about the fractured identity of Ireland. I remember when I was traveling in Latin America in 1981, following the news in the Spanish language newspapers of the Irish freedom fighter Bobby Sands as he struggled through an ultimately fatal hunger strike. The young interviewee, arriving in Ireland anxiously discovered that there was nary a brown face anywhere to be seen. Making it even more complicated was that his father was a devout, strict and authoritarian Muslim; and his mother had joyfully discovered and embraced Catholicism. Some of his childhood memories involved his mother secretly sneaking him out to go to be baptized, later to confession and ultimately Confirmation. These little clandestine escapades were exciting and special times with Mom. His father on the other hand, was fierce, harsh and demanding of both his mother and himself. Yet much like myself, his brutal father was also his greatest role model in some ways. I have always said that all of my best qualities are from my father, and he is the one whom you will most often hear me quoting and rhapsodizing. It has taken me years and decades to integrate these seemingly opposing pieces, and I suppose I am still not finished. This man felt quite similarly.   

Caught in a clash of multiple identities, Irish, Pakistani, Muslim, Catholic, father, mother, he was plagued by the question, “who am I?” It was unanswerable. And he had a brewing rage toward his father that was only building, when in his teens, his father was mysteriously and violently murdered. The circumstances and facts of his father’s murder were never resolved, and his massive swirl of emotions and identity questions became a lifetime agony. I thought of my own little conflict, and how it has challenged me, and in comparison with that? Wow! And now I am doing what I always tell everyone not to do! It is pointless to compare or minimize one trauma against another! Don’t do it!

The Default Mode Network

The developmental neuroscience researchers teach us that the sense of Self develops in the Default Mode Network (DMN) of the brain, deep in the brain’s most primitive region. This is like the idle mode of a car, where the car settles when it is not “under task” meaning in drive or park. It is where we drop for self-reflection or relaxation, if we are lucky.  The infant brain develops in resonance with the brain of the caregiver, right hemisphere to right hemisphere. We begin to grow a Self through the consistent presence of a caring other: the gaze, the touch, the song, the loving emotional tone. That is how the little circuits begin to form and fire and wire, long before any of the complexities of life events intervene, distort, and compel.  

So you may ask, why do I feel so bad? Why do I have so much confusion about who I am or what to do, or what is “right” or “good enough” or “real?” The answers may lie deep in the brainstem, long before we had the equipment for autobiographical memory, let alone the words. We needed that consistent other, and when that failed or was insufficient or absent, we lack for the essential tool to make sense out of all the many complications that might come later. For healing we need the consistent others, the touch, the song and the positive emotion.

As the Dalai Lama is known for saying “Be kind whenever possible. It is always possible!” I would emphasize, be kind to yourself!

My book “Working with the Developmental Trauma of Childhood Neglect: Using Psychotherapy and Attachment Theory Techniques in Clinical Practice” was published on August 31st. It provides psychotherapists with a multidimensional view of childhood neglect and a practical roadmap for facilitating survivors’ healing.

Wanting, Longing and the Conundrum of Need

In the attachment literature Berkeley luminary Mary Main eloquently describes the “dilemma without solution.” For this bereft infant the source of safety and the source of terror, reside in the same person, who happens to be the most important person in the world: the primary parent. As every human baby is born into the world in effect a bundle of needs, these infants are born into an impossible bind, a perennial struggle with reaching toward and backing away all at once, in a painful and clumsy vacillation, that culminates ultimately in devastating freeze or collapse; and despair, ultimately devolving into numbing or dissociation. They are met with this destiny at their very arrival.

Dissociation is a confusing term in our vocabulary, because it corresponds to two related but distinct responses. It can mean both an emotionless, dull or numbing absence or failure of presence. And/or it can mean splitting off, i.e., separating or disconnecting into parts of the Self. Both can be the tragic outcome of this primordial neglect.

Modern Myths

 Admittedly I have two gnawing and often unpopular biases. One is what I call the “myth” of unconditional love.  By nature, the human infant remains dependent longer than perhaps any other mammal. We would hope to be received and welcomed as a “bundle of joy,” a worthy hope that nature prepares us for. Nature’s design also is that the responsibility and the task of parents to attend to the unending needs of their infant child. That is why babies are so cute and irresistably charming, and why our systems are particularly laced with oxytocin, the love chemical, at this crucial time. Unconditionality is the birthright of that child, it is the parents’ unending “job” to provide and attend.

The child infant of course, has no words, only a cry. A “good enough,” present parent learns to differentiate which cry indicates which need: which indicates “I’m cold, I’m wet, I’m hungry, I’m lonely, I’m scared…” And again, according to the attachment researchers, the best of the “good enough” parents only get it “right” 30% of the time, the rest being a persistent dance of rupture and repair. In these happy cases, the child learns repair is possible. It is safe to receive or not, to need, to hope and to want, because one way or another, eventually we will return to homeostasis. Eventually Mama will pick me up and hold me, and all will be well. Gradually and with luck, we learn regulation. And this lucky child will also grow up with an ease about fundamental human need.

The child of neglect is not so lucky. Even hoping to receive becomes risky business. By any means possible, the child might try and fail to get attended to; get what they need for a while. They will experiment with various strategies: being cute, funny, inordinately smart, they might protest, attempt to be very good, even taking care of the parent. I am sure I tried all of them. In fact, my mother used to recall how at the age of three, little Ruthie was organizing the “little kids” in play, dancing around a tree. She would smile about it, I was desperately already then earning my keep.

When all else fails the child withdraws into the lonely devastation of numbing. And as placid as it may look from the outside, it is a state of high anxiety. From the inside it may come to feel like “nothing,” and there is no category for feeling. Self- reliance becomes something of an assumption or an identity. Need becomes a mortal enemy.

 I have found that where many clients might reject the neglect designation, “self-reliance” seems to fit for them, and as it is highly regarded in the American culture of “rugged individualism” it may even seem like a compliment. However, the relationship to our fundamental species determined interpersonal need, our humanness, is distorted. Somewhere, deep inside, most likely far outside of awareness, the longing is logged: the missing experience of unconditionality, of being adored with nothing expected of us; of being understood without words, because the other makes it their task and their mandate to understand us; the expectation that our needs make sense to the other and will be gratified. And sadly our chance at interpersonal unconditionality, does not come again.

 In adult life, however, the need might rear up, and center on an intimate partner. This is where my bias comes in: the myths that persist, in the fantasy of the child turned adult, is what I call the “myth” of unconditional love, of having a partner whose mandate it is or “should be,” to “meet my needs.” It is a trap, because (I believe) it will never again be someone else’s “job.” Sadly, by no ones’ “fault” that window has closed. There are schools of thought and even of relationship therapy that teach that these are reasonable hopes or even demands. I am afraid I am not of that school. Some couples argue about it. And it can be a very hard sell.

Needs and Knees

These last few historic years have faced the world with many unsavory truths. Two of them prominently featured human knees: George Floyd was brutally and heartlessly murdered with a heavy, unrelenting knee to his neck for over nine minutes, despite his cries and gasps for breath; and Colin Kaepernick’s heroic defiantly “taking a knee” in unrelenting protest against the unrelenting racism of this country. Both helped to fuel a growing Black Lives Matter movement, which I fervently hope will not get lost in the fickle march of history.

One thing I especially like about the language of Black Lives Matter, is that it forces the question of relevance and the hierarchy of our values. With or without our awareness, it addresses what we do or do not deem important. How much do we in fact care about the needs and dignity of others? There it is again, the often-inconvenient intrusion of human need, our own, the needs of others. How do we rank them? How do we respond to them? Both George Floyd and Colin Kaepernick have become kind of heroes to me, and firm gentle reminders, of what matters.

 I have been doggedly watching for news of Colin over the now maybe five years that he has been black listed (no pun intended!) for his outspokenness about race and prejudice in the NFL and in this country, thus proving and consolidating his point. It has been a great sacrifice on his part. I eagerly looked forward to his recently released Netflix documentary Colin in Black and White. Last weekend I watched it.

Colin was adopted at birth by a kind hearted white couple, and grew up in a white world. The movie gives a closeup of his early years, and the many contradictions of life in a white and unintegrated world. It gives a whole new meaning to the word integration. And all the challenges of identity formation, the main requirement of our developing years, are heightened and further complicated by the unrelenting intrusion of race, and the additional complications of looking so “different” from his family.

     Although the movie was perhaps disappointing to me in that it did not run very deep, there was one thing that struck me, and that harkens back to our theme. Colin was an all-around super star athlete. He excelled at football, baseball and basketball. When the time came, he was offered full ride baseball scholarships to virtually all of the most highly regarded universities in the US. But his dream was to be a quarterback. That was all he really wanted. Colin passed on all the baseball offers, holding out and tirelessly training for the elusive quarterback offer that almost never came. It was amazing to watch him painfully and steadfastly continue to work hard, endure and determinedly wait. When it finally does arrive, the viewer can see what a great sacrifice it has been for him to hold out for what was most wanted and cherished, and then to risk it and in effect lose it for his beliefs.

 It is almost a mystery how dogged he is about his “first love,” being a football QB. Until we get to what for me, was the most poignant line in the whole movie. Describing his adoption story, he recounts, “my parents were all set up to adopt another baby.” He even knows her name, which I do not recall. At the very last moment, they learn that the baby they thought they were adopting, is “not available.” We are not told why, nor the race of the original baby. But they are offered Colin instead. His parents accept Colin, whom they love and thoughtfully care for and raise. But in the most profound and telling line in the film, Colin tells us, “But from the very beginning of life, I have never been anyone’s first choice.” He still languishes on the sidelines.

Meet My Needs

One of the perks of disordered sleep is that I catch some of the most quirky and extraordinary, imaginative programming on Public Radio. In this case, Public Radio Remix in the wee hours on Sunday mornings. The other day I heard a story about “the fadeout,” a particular style of ending songs that was popularized in the music of the 1970’s. I was fascinated, mostly because admittedly, I had never given a moment’s thought to how songs end. I never noticed how all AC/DC songs have the same ending, or the unusual, not always originally intentional endings of some of the most well known songs on the Beatles’ Sargent Pepper album, classic symphonic endings, even folkloric “shave and a haircut” type endings, or the “fadeout.” I simply never really asked the question: How do we end things? How do we determine what matters? Your “needs?” My needs? Football? Baseball? How do we harmonize them, integrate them, cooperate with nature? How do we order them with grace and dignity?

I woke up the other day with a crazy image. I saw two “bundles of needs,” old wrapped handkerchief-tied-on-a-stick type bundles, as from fairytale book illustrations. They have hands outstretched for a handshake. These two bundles of needs are greeting each other with “Pleasure to meet you!” What a great thought!  With that, I fade out for today.

My book “Working with the Developmental Trauma of Childhood Neglect: Using Psychotherapy and Attachment Theory Techniques in Clinical Practice” was published on August 31st. It provides psychotherapists with a multidimensional view of childhood neglect and a practical roadmap for facilitating survivors’ healing.