When to Stay within Your Scope

There are times when “fake it ’til you make it” is fine. This was not one of those times:

An amateur painter decided to “restore” this 19th-century Spanish fresco and instead created far more damage.

This is what happens when people underestimate the skill needed to produce a job well done. If the original artist, Elias Garcia Martinez, were still alive, can you imagine his frustration, outrage, grief?

I know some of you can in fact imagine it, because you experience it regularly in your profession. I’m thinking of:

• The accountant who tries to make sense of a client’s years of do-it-yourself tax preparation.
• The hair stylist who has to endure the client’s hysterical ranting because the instructions on the box weren’t clear.
• The mechanic who has to tell the customer his engine is blown because he thought oil changes were optional.
• The surgeon who must amputate a child’s foot because the parent “knew” how to tend to a puncture wound.
• The investment adviser who tries to salvage what’s left of a retirement fund after the client learned that flipping houses is actually not such a sure thing.
• The police officer barraged with community hostility after a neighborhood-watch volunteer took justice into his own hands.

And then there’s the counselor who patches clients’ psyches back together after some high-and-mighty know-it-all did a “hoarding cleanout,” or the corporate psychologist who works to undo the damage from a boss who insists AD/HD is just laziness. (Welcome to my world.)

I despair that this message will only resonate with people who are already careful, who already know that their skills have a limit and they should stay within it. The ones I see doing damage appear to be fully encapsulated within their arrogance: They don’t listen to cautions like this, and they don’t look back at the carnage in their wake.

Then again, maybe there is hope for that person who hasn’t yet crossed the line. If that’s you–if you’re thinking you’ve been doing this work long enough to take a chance, or if you’re feeling like only suckers pay someone to do that, or if you’re figuring it looks easy enough on television or Pinterest–please think again. What’s the worst that could happen if you get it wrong?

Seriously. What is it?

Wing it all you want with a recipe, a craft project, a paint color … anything that will only cost you what you can afford to lose. But if your foray outside your boundaries of competence could hurt someone else–even if you don’t see how, even if you know it won’t, even if you’re insulted that I would doubt you–still: You owe it to the world to humble yourself and avoid that risk.

The ruined fresco is a deep loss for its home church, but as unfortunate as it is, human harm is far more tragic. Acknowledge your scope and stay within it. If you’ve overstepped, make amends if possible and do it right next time. Don’t make messes of other people’s frescoes, or finances, or homes, or hearts or minds.

I don’t want to hear your name falling with my clients’ tears. Whether or not you realize it yet, you don’t want that either.

 

Monstrosity TV

Here’s my new name for “reality TV.” After the stunt “Dr. Phil” pulled yesterday, characterizing people with post-traumatic stress disorder as “monsters” and “damaged goods,” it’s time to call this type of media what it is: Monstrosity TV.

First, two definitions:

• Post-traumatic stress disorder (PTSD) is the current official name for a condition caused by one or more overwhelmingly traumatic experiences. It is a common outcome for combat veterans, but it also sometimes results from trauma in civilian life. There is a movement among some healthcare professionals and veterans’ advocates to redefine PTSD not as a mental illness but as a form of brain injury; I find this reframing both logical and destigmatizing.
• Phillip McGraw, or “Dr. Phil,” is, according to Wikipedia, “an American television personality, author, former psychologist, and the host of the television show Dr. Phil, which debuted in 2002. McGraw first gained celebrity status with appearances on The Oprah Winfrey Show in the late 1990s.” Multiple sources report that he is not currently licensed to practice psychology. Dr. Paul G. Mattiuzzi (who is a licensed psychologist) wrote a detailed blog post explaining why McGraw is able to do what he does on TV without a license.

The fact that McGraw is unlicensed is a beef for another day. This post is much simpler: You don’t have to be a licensed mental health professional, or any kind of professional–you don’t even have to be a grown-up–to know it’s harmful to call a person a monster or damaged goods. Poll any kindergarten class:

“Boys and girls, is it nice to call someone a monster?”

{“Noooooooooooooo, Ms. Staaaaaanleeeeey!”}

“Would that hurt your feelings?”

{“Yeeeeeesss, Ms. Staaaaaanleeeeey!”}

“Should you do it, then?”

{“Noooooooooooooo, Ms. Staaaaaanleeeeey!”}

Apparently Dr. Phil and his peers in Monstrosity TV, which I also sometimes call exploitainment, either never read or rejected the lessons of Robert Fulghum’s All I Really Need to Know I Learned in Kindergarten (1988).

Rationalize this all you want, but you’ll never make it OK. Here are some of the arguments I hear in support of this category of media:

• “They appeared on the show of their own free will.” The media definition of “free will” is not the same as the definition followed by healthcare professionals. In my world (i.e. the real world, where people who legally portray themselves as mental health experts are licensed), free will means autonomy, and autonomy entitles the person to informed consent. Informed consent is defined as agreeing to something after you have been given all pertinent information needed to make a non-coerced, non-manipulated, non-deceived choice. Further, informed consent is retractable. You have the right to withdraw your consent before, during, or after the event. In research studies, this means participants have the right to drop out mid-experiment, even if their withdrawal ruins the study. In television, this would require that all depicted parties be allowed to review and approve the final edited version of the show before it is aired, and it would also give them the right to later withdraw their consent and require (by simple request, not legal action) that the show be removed from circulation.
• “We do much more good than harm.” There is no acceptable level of avoidable human harm in this context. None. Not even a few outliers. Zero-point-zero. There are some situations in which the risk of harm could be acceptable, such as a person choosing, with fully informed consent, to undergo an experimental cancer treatment. This is not that.
• “If we didn’t do this, the problem would be unknown and countless people would go without help.” You can’t know that. You can’t prove that. The fact that you have generated demand for this and are now fulfilling that demand doesn’t qualify you as virtuous; if it did, every drug dealer would be in line for sainthood.
• “Doing some harm is inevitable in these situations. It can’t be avoided.” If you believe that, accept that, ignore documented best practices that refute that, ignore codes of ethics that forbid that, and continue to do what you do knowing it will sometimes cause harm, you missed your calling. Go back 70 years and put in an application at Auschwitz.

Yeah, I said that. If the shoe fits, you have two choices:

1. Wear it as you walk the ethical low road and know that, beyond the cameras and the starstruck fans, you have colleagues who have lost respect for you.
2. Wake up, recognize the flawed beliefs you’ve been exercising, tolerate the cognitive dissonance that will come with reversing your direction, and start doing the right thing.

Notice: This blog is not a substitute for individualized healthcare. Links or references to other persons or websites do not indicate endorsement by those entities.

 

Freaky Reality, or, In Defense of the At-Risk Unknown

“Visually unusual beings”: Now there’s a euphemism.

In a history of circus freak shows, the site Monstrous.com notes, “Since Antiquity, visually unusual beings had been exhibited in public spaces. In the 16th century, street performances involving these beings were organized for the enjoyment of the public.” The phenomenon exploded with P. T. Barnum in 1841 and “for more than a hundred years, the sideshow was to become an indispensable appendage of American circus culture.”

Those who were freaks by choice–who were fairly compensated for it and knew exactly what they were doing–managed it fine. Some, like John Merrick, the “Elephant Man,” reportedly had no other employment options, so the work saved their lives; some even became quite wealthy and retired from the circus to enjoy many comfortable years of private life. However, the problem that eventually ended circus sideshows was that most of the “freaks” were vulnerable people coerced or tricked into performing. Once the public caught on to this and either a) expressed their outrage or disdain or b) stopped going because they knew their friends would disapprove, sideshows lost their appeal.

Until now. If ever there was a compelling argument in favor of reincarnation, reality TV is it: It’s got Barnum’s mark all over it. These shows make it possible to watch people smoking crack, scratching at hallucinated meth-bugs, eating non-food items, and protecting the feelings of inanimate objects, and here’s the best part: Nobody has to see you watching it. So much for politically correct peer pressure.

Lots of people have lots of opinions about reality TV, but for me it comes down to two words: informed consent. It’s both a legal and an ethical concept with many facets, but the basic gist of informed consent is that the person:

• has been given accurate and complete information about what s/he’s consenting to,
• has not been pressured or coerced in any way,
• can withdraw that consent at any time, even after completion of the project, and
• is legally and mentally capable of giving that consent.

Is a person with persistent psychosis or advanced dementia mentally capable of giving informed consent? Rarely. Is a 13-year-old legally capable? No. How many minors and apparently mentally incapacitated people have you seen on reality shows? Riiiight.

As I see it, there are four types of people on reality shows. I define these four types based on where they fall in two different dichotomies: Famous or anonymous, and savvy or at-risk. By at-risk, I mean more easily conned, tricked, manipulated, pressured, or exploited due to their mental or “visually unusual” traits or behaviors. Here are the four types:

1. The “Savvy Celeb”: A celebrity who starts or joins on with a reality show strictly as a career move. Take Donald Trump, for example.
2. The “At-Risk Celeb”: A celebrity who is already burdened with personal or professional problems when s/he signs on with a reality show. Whether or not s/he will be exploited depends largely on his or her advisors. Charlie Sheen is a current example.
3. The “Savvy Unknown”: A non-celebrity who recognizes s/he has something of interest to producers, wants to sell it, and makes a fully informed choice in selling it. Example: Octo-Mom.
4. The “At-Risk Unknown”: A non-celebrity hoping to receive help for a problem featured on the show. They’re not doing it solely for money or fame or prizes; they’re doing it out of desperation. The people who appear on shows like Hoarders, Intervention, and Beyond Scared Straight are examples.

When participants give fully informed consent (not just “permission”), fine. When they don’t, the show is exploiting them. I think it’s safe to assume that those who are already celebrities when they appear on these shows have advisors (agents, lawyers) to help them avoid unwanted exploitation, but the Unknowns do not, and not all of them are savvy enough to recognize what they’re agreeing to. Some have never even seen the show, but they bow to their family’s pressure to participate or they believe, incorrectly, that being on the show is a form of therapy.

The best possible outcome: The participant’s life is unharmed and also enhanced in some way by his or her appearance on the show. The worst possible outcome: Participating in the show causes the person harm. When that participant is a Savvy Celeb or Savvy Unknown, the harm is certainly unfortunate, but it was the person’s informed choice to risk it. Even the At-Risk Celeb is making an informed choice about participating in a project that s/he, as a professional entertainer or public figure, understands is intended as entertainment. None of those three scenarios, even with tragic outcomes, presents a compelling argument against reality TV, because the participants knew what they were getting into.

The At-Risk Unknown–the person who is not a professional entertainer or public figure, has no circle of savvy advisors, and has a desperate need for help–is another story. When that person is denied informed consent and exploited or otherwise harmed, the circus should be shut down.