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.

When I was barely more than a toddler, living in Manhattan, I learned a very big word: restitution. My parents, both survivors of the Nazi Holocaust, had not lived in this country too long. It was 1959. We lived in a large, old brick apartment building, where all our neighbors seemed to have numbers on their arms. I easily imagined that to be the norm, true of all people. One day, my parents received a letter in the mail. It said we would be receiving a small check each month: restitution. The German government was attempting to compensate Jews for the pillaging of possessions they had suffered. Of course they could not replace the 6 million murdered, but it was a gesture of reconciliation. It was the first I had learned of such a concept, attempting to repair broken trust or damage perpetrated. Although it was small consolation for my profoundly traumatized parents, it was still somehow gratifying and certainly much needed.

It was hard to believe when I heard on the news that it was the anniversary of the brutal murder of George Floyd. How has that time passed already? As an attachment theory-oriented therapist, I am still haunted by his cries for his mother in those last nine minutes of his life. “Mama, Mama…” As a somatic therapist who is regularly teaching clients about breath and a the calming power of intentional breathing, the words “I can’t breathe…” the same words gasped by Eric Garner in a similar police murder in 2014, have gained a whole new traumatic meaning. What have we learned in this ensuing time since Floyd’s tragic death? Does anyone remember Eric Garner? Will anything be significantly different for the poor, disenfranchised and of color in our country and the world, or will this be just one more episode, like a traumatic flashback, that recurs and persists and continues to perpetuate pain and enduring dysregulation and dysfunction?

As a relationship therapist, I am constantly trying to teach clients and often couples the power and magic of apology. Most do not really know how, having never heard a meaningful apology for harm done to themselves, and also living as we do, in a culture of blame. Many even view apology as an admission of defeat, so it is a humiliation to take responsibility for relationship repair. If made at all, apology is tinged with a self-canceling defensiveness, and so have no impact at all. In a memorable episode of the long discontinued television program, Sopranos, when one character, Christopher, while under the influence of heroin, sat on and suffocated his girlfriend’s beloved little dog to death. He shrugged his shoulders dramatically and exclaimed to his devastated girlfriend “Hey! I’m sorry!” Of course this had no meaning to the bereft young woman.

Eve Ensler, now known as “V” published a profound book that appeared in 2019: The Apology. Before that, I had found little literature of use on this crucial subject. For some years I have been gestating a book on the subject, which I still intend to write. But V’s view on the subject was the closest to my own that I have encountered yet. In it, more than 30 years after his death, she writes the letter of apology from her viciously abusive father that she had always hoped and longed to receive from him, but never had. It is written in his imagined voice, and in chilling detail he recounts and owns what he did to her over decades. Without defending it, he also tells the story of is own trauma, which does not excuse the harm he perpetrated, but somehow makes sense of it for her. Oh yes: the intergenerational transmission of trauma. The book affected me so deeply, that I bought dozens of copies to give to friends, in my quest to spread the word.

Again, most of my clients, survivors of trauma and neglect, have never heard an apology for what they endured.  And clients ask me, “Wasn’t she doing terrible wrong? I am so angry! And I feel guilty that I am so angry. Could she just not help it? Was she just doing the best she could?” Both are true. But more importantly, how do we interrupt this insidious legacy? Restitution is a noble symbolic gesture, and certainly moves in the right direction, but it does not go deep enough. Or it is effective but not sufficient. As Janis Spring Abrams, who writes eloquently about the trauma of infidelity, “cheap forgiveness” skips the depth of pain and rage, and fails to restore or create true, reparative intimacy. We need to fully experience the unsavory emotions for the apology/forgiveness to “work,” and have impact.

I believe the way forward, besides transforming dysregulated brains with neurofeedback, and every way we can, is teaching the elusive practice of authentic empathy. A relatively recent concept, empathy only first appeared in the Oxford English Dictionary in the Nineteenth Century. It is still poorly understood. And it stands in contrast to the simpler, more familiar concept of sympathy. Sympathy is feeling compassionate and assumably understanding emotion on the other’s behalf, but still squarely from one’s own point of view. It is drawing on one’s own reservoir of experience to imagine the feeling of the other, attempting to speak from that. One can still remain lodged in one’s own narcissism, and even feel superior. Empathy however, is stepping if momentarily into the other’s world, and working at truly feeling how it is for them. Not to agree or “give them a pass” so to speak, but rather to make sense of how this could have happened. V’s father was the product of a horrific and unprocessed history. That by no means excuses wrong perpetrated! But rather makes sense of what is otherwise incomprehensible and unforgiveable. And forgiveness benefits, more than anyone else, the forgiver. V felt tremendous relief. It did not retrieve lost years, and the protracted storm of agony, or the thousands of helpful and unhelpful therapy dollars, but provided a sea change of direction. Granted, these perpetrators never chose to do their own work, which is part of what makes the questions complex unanswerable.

In cheese-making, the essential first ingredient is the starter culture, an interesting and unintended double entendre. The culture is an organic compound that stimulates or catalyzes the milk to “ripen” changing its chemistry to make it receptive to the agent of transformation, which miraculously transforms the milk from liquid to delicious solid. A certain amount of time is required for this magic to transpire, for the cheese to “mature.” For the cheese-maker, patience is more than a virtue. I believe that empathy and the teaching of empathy, better yet, a culture of empathy, is an essential first step in breaking chains, of both oppression and intergenerational transmission of trauma and neglect. And of course continuing to stir the vat!