New Jersey History (NJH - E-Journal)
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Portrait of a Man Imprisoned in an Altered State of Consciousness: The Case of "Sean"
No full textThis case study describes the first 18 months of weekly psychotherapy with a man suffering from a debilitating chronic psychosis that centers around his conviction that a group of four older men that he refers to as the Council of Four (CoF) operate a machine that can monitor his thoughts to determine if he is having disrespectful thoughts toward them. The patient lives in an altered state of consciousness in which the privacy of mind that people generally take for granted has dissolved. Every Monday the CoF sends him a Morse-code-like message conveyed by automobile horns. It is his belief that if he can meet the standards of the CoF they will reward him with a lucrative book deal and movie contract, which will allow him to approach a female movie star of whom he is much enamored. This case study describes a treatment approach that integrates cognitive-behavioral therapy (CBT) and psychodynamic technique, where CBT techniques are used to consider the literal falsity of the CoF idea while a psychodynamic approach is used to examine the figurative truth of the delusion by exploring the meaning of his subjugation to the CoF
Phenomenological, Epistemological, and Integrative Perspectives on the Case of "Sean"
No full text This article presents my response to commentaries on my case of "Sean" (Garrett, 2020) by Louis Sass and Jamie Walkup (2020), and by Paul Wachtel (2020). In my response to the Sass and Walkup commentary, I underscore what I consider their very astute observation that Sean seems to be aware that he himself can place Megan in a mental space where he relates to her, in which case she is an object of his subjectivity closely allied with his imagination, while he does not have the same experience of placing the CoF in an imagined scene because they are expressions of his own subjectivity rather than being objects of his subjectivity. Elsewhere in their commentary Sass and Walkup argue that delusions are not simply mistaken "truth statements" about the world (a view I share), which they believe might not be expected to respond to CBT techniques that examine beliefs. However, I think their emphasis of this point may have led them to a less than fully accurate account of my approach to and use of CBT, which I attempt to correct in my response. I also show why I believe some the Sean’s awareness of his situation was a hard-won result of his treatment rather than a precursor to his psychotherapy. And I respond to their speculation that Sean might more properly be diagnosed as having a delusional disorder, a sentiment I do not share. I also question the validity of the diagnosis of schizophrenia and say why I prefer the more open-ended descriptor "psychosis." Wachtel's commentary reflects the observations of an experienced clinician thinking about psychotherapy process. He understands what I am trying to do, and at times articulates the clinical process with Sean with greater clarity and in a wider context than would occur to me in my own words. His observations allow me to expand upon several points here. Specifically, (a) I acknowledge the lack of more information about Sean’s family as an important limitation in the therapy; (b) I expand my description of the way in which I try to listen to patients and conduct psychotherapy; (c) I underscore Wachtel's observation that the primary conflict that appears in psychotic symptoms may be Oedipal (although this is not always so); (d) I agree with and elaborate Wachtel’s idea that the past is not discovered in psychotherapy like a "woolly mammoth" unearthed in frozen tundra, but rather the past speaks through a living host that shapes its voice; and (e) I describe in more detail how the therapy process allowed me to over time to find a common language in the phrases "guilt loop" and "guilt work" in a way that advanced the therapy.
The Keys to the Prison: Michael Garrett's Integrative Approach to the Treatment of Psychosis
No full textThis discussion of Michael Garrett's (2020) case study, "Portrait of a Man Imprisoned in an Altered State of Consciousness: The Case of 'Sean,'" examines the integrative conceptualization and practice that is evident in the presentation. Among the themes explored are the particular way that Garrett approaches issues often conceived in the psychoanalytic literature as 'Oedipal' and 'preoedipal;' the role of corrective emotional experiences; the boundaries of self and other in subjective experience; the cyclical nature of the dynamics that maintain Sean’s guilt and his problematic life patterns; and the creative tactics through which Garrett integrates psychodynamic and cognitive-behavioral perspectives in his efforts to help Sean escape from the repetitive pattern in which he is caught
Understanding the Role of Inflexibly Enacted Masculinity Norms in Therapy: A Commentary on the Case of "Tommy"
No full textThe case of "Tommy" highlights both an underutilized methodology for increasing the field’s understanding of the therapeutic process in working with men, and the importance of addressing inflexibly enacted masculinity norms. My commentary focuses on detailing how the methodology helps those of us interested in understanding how masculine norms contribute to men’s presenting concerns, help-seeking, and experiences in treatment focusing on the multi-directionality of relational experiences, masculine identity development, and presenting issues. Then I discuss how the concepts of inflexibility has its roots within an Interpersonal Therapy framework (e.g., Kiesler, 1983) and how this inflexibility develops consistently with explanations contained in Precarious Manhood Theory (i.e., Vandello & Bosson, 2013)
Art History, Art Museums, and Power: A Critical Art History Curriculum
No full textEngaging in the recent tradition of disciplinary and instructional self-critique by art historians teaching at the college level, this teaching practice reflection pursues the question of how an art history survey class can benefit from activities grounded in theoretical texts. In the format of scholarly personal narrative (SPN), a personal background and justification for incorporating critical theory-based lessons into the introductory art history curriculum, including narrative descriptions of four curricular areas and an example museum project, are detailed. The article paints a personal picture as well as extols the general benefits, based on the author's perspective and experiences, of incorporating critical theory and critical pedagogical theory into art history courses. As SPN, the article focuses on personal teaching experiences and reflections organized in a scholarly structure, and demonstrates the possibilities of this method of scholarship on teaching and learning in art history
Treating Masculinity: A Commentary on The Hybrid Case Study of "Tommy"
No full textDr. Christopher Dewey (2020) wrote up the hybrid case study of "Tommy," a college student who presents with symptoms of masculine depression and alcohol use problems. The importance of this case study is heightened by the current national conversation about masculinity. Context is provided for the topic of men and depression. Consideration is given to the ways Dewey addresses and works as a clinician with traditional masculinity norms that Tommy endorses. Emphasis is given to the way men are socialized at a young age to conform to traditional masculinity norms, and how to work therapeutically with such men. Strengths and critiques of the case are discussed, organized into the following themes: masculine depression, normative male alexithymia, traditional masculinity ideology, discrepancy strain, questioning masculinity, positive masculinity, making masculinity less salient, dealing with problematic alcohol use, family history, trauma, relationships with women, social media consumption, performance as a college student, treatment goals and the course of treatment, and intersectionality
Assessing Undergraduate Fashion History Research via Content Analysis
No full textUndergraduate art history students are often asked to write research essays on specific artworks, but that research is rarely considered publishable or reliable. This article analyzes undergraduate student essays on fashion history to determine whether the research produced can be considered reliable according to generally accepted art historical standards. It employs content analysis to make those determinations in addition to the instructor's own standards and those governing the Fashion History Timeline, an open-access hub of fashion history research. The article investigates the impact of a multi-stage writing and revision process on student writing outcomes and on student grades. Finally, it addresses the benefits of quantifying student research via content analysis for improving both teaching and student outcomes
Understanding How Perceptions of Power and Identity Influence Student Engagement and Teaching in Undergraduate Art History Survey Courses
No full textStudent engagement in undergraduate art history survey courses has been a concern of art historians for decades. In this article I discuss my dissertation study in which I explored how perceptions of student and teacher identity, acting within classroom power dynamics, influence student engagement and pedagogy in undergraduate art history survey courses. Through concept mapping, interviews, and observations of three instructors and nine students in undergraduate art history survey courses at a public university in southeastern Texas, I explore perceptions of students and instructors regarding self, each other, course content, teaching style, and expectations of one another to understand how identity and power influence student engagement and pedagogy. I explored these perceptions through the theoretical lenses of power and identity. The results may offer insight as to how we address perceptions of declining student engagement in undergraduate art history survey courses
Virtual Realities: On Delusion, Shame, and Intersubjectivity
No full text In our contribution, we note the remarkable nature of Dr. Michael Garrett’s (2020) case study of "Sean" and of the rich therapeutic relationship he so eloquently describes with his client. We then discuss several overlapping topics: the question of diagnosis and functional considerations, the patient’s attitude toward his delusions, and certain issues pertaining to the therapeutic relationship. Regarding diagnosis: we ask about the extent to which the patient "Sean" might or might not qualify as a case of schizophrenia. It is not clear from the report that Sean demonstrates the widespread disturbances of perception, cognition, and affect that would be expected in prototypical cases of schizophrenia. His psychopathology seems largely bound up with his delusions or delusional system, and these latter do not seem distinctively "bizarre." We suggest that "Sean" might better be viewed as a case of delusional disorder (while recognizing the vagueness of the boundaries between these and other conditions). We examine Sean’s attitude toward his delusions in some detail, asking whether this seems in keeping with what is assumed by the standard poor-reality-testing formula that is adopted in mainstream psychiatry, psychoanalysis, and the CBT approach to psychosis. The standard view assumes that a patient’s delusions, though false, are believed by him or her, and that the delusional objects or events are experienced as having the ontological status of something truly real (existing in the objective and intersubjective world). In our view, evidence suggests that Sean did not in fact experience his own delusions in this literalist way, but implicitly recognized their purely subjective or "virtual" nature. In light of this, we question the appropriateness of adopting the standard CBTp approach to this aspect of his psychopathology. The success of the treatment may be more intimately bound up with the relationship-building aspect (e.g., with Dr. Garrett’s skillful use of humor and perspective-taking) than with the empirical or logical refutation of his delusional preoccupations that CBTp theories would seem to emphasize. There are interesting parallels between the treatment of delusions in psychotic patients and the progression of theories in science described by such philosophers as Kuhn and Lakatos. Finally, we consider an additional aspect of the therapeutic encounter: namely, the avoidance of issues (well-advised, in our view) that could provoke or revive a sense of inferiority or humiliation in the patient (that is, of shame concerns). This is one of many demonstrations of this therapist’s remarkable skill, discernment, and capacity for empathy.
Revisiting "Tommy": Further Considerations of Best Practices for Addressing Inflexibly Enacted Traditional Masculinity Norms (IE-TMNs) with Boys and Men in Therapy
No full textIn this article, I respond to the thoughtful commentaries and critiques offered by James Mahalik (2020), Ethan Hoffman and Michael Addis (2020), and Ginelle Wolfe and Ron Levant (2020) on my hybrid case study of "Tommy" (Dewey, 2020), a college freshman exhibiting symptoms of depression, alcohol use concerns, and inflexibly enacted traditional masculinity norms (IE-TMNs) during a time of difficult transitions and loss in his life. These commentaries have reaffirmed many of my beliefs about best practices for working with boys and men in therapy, while also expanding my knowledge of the psychology of men and masculinities (PMM) and introducing me to conceptual frameworks and therapeutic goals not directly explored in my original case study. Additionally, these three commentaries underscored areas of particular importance that I would like to discuss in further detail, including, (a) Hoffman and Addis’s differentiation between reconstructing and deconstructing masculinity as treatment aims when working with boys and men in therapy; (b) the benefits of employing Interpersonal Theory to better conceptualize presenting concerns related to traditional masculinity norms as highlighted by Mahalik; (c) constructive criticism from Wolfe and Levant and from Addis and Hoffman about the need for closer examination of social justice themes that arise when addressing masculinity in treatment; and (d) concerns about the generalizability of the case study raised by all three commentaries.