The Price of Beauty

WHAT IS THE OBSESSION?! I just don't get it... why are people so obsessed with being perfect that they turn themselves into freakish robot women in this city? I'm sure the root of this relates back to my last post regarding the negative thoughts we learn to believe about ourselves. We have running narratives in our heads about who we are... what our story is. For many people these stories are an endless tape of negativity about all the things they believe are wrong with them. Can't we give ourselves a break before we all end up like Heidi and Micheal Jackson?

Plastic surgery is becoming the latest to join the ranks of the addiction epidemic. Like gambling, drug, alcohol, and sex addictions, plastic surgery is another way for people in pain to "fix" their feelings in maladaptive ways. In plastic surgery addiction, like other addictions, no amount of surgery proves to be satisfying and the obsession remains after procedures are done. Furthermore, the risks of the behavior do not deter from the impulse to "use." Besides the obvious dangers of turning into a freakish looking creature, there are also many tangible threats that this type of excessive behavior presents. The health risks to any surgery are quite frightening despite how common elective surgeries have become. Surgery in America is generally safe, but there are risks and it is surprising that so many people are willing to take the chance and endure the physical pain in order to change the way they look.

This is not a phenomenon that is unique to the US. All over the world women (and men) are paying the price of beauty. Jessica Simpson's show, The Price of Beauty, depicts what women around the world sacrifice for what their culture considers beautiful. In an episode in Thailand, one woman (pictured here) used a cream to make her skin lighter. Instead, her skin was bleached unevenly and permanently. The woman's spirit was broken and her self-esteem shattered. Is all this really worth it?

An imperative change that our community needs to make is to recognize this as an addiction and, therefore, it is essential to have more stringent regulations for doctors, especially plastic surgeons. It is unethical practice to provide such excessive elective plastic surgery that it becomes detrimental to their patients' physical and mental health. It is comparable to doctors who over prescribe drugs for patients who are clearly addicts (i.e. Anna Nicole Smith, Micheal Jackson) Where are the laws to regulate these doctors? What happened to that good old Hippocratic oath?

Almost all types of addiction can be related back to trauma in childhood. Consequently, ethical plastic surgeons will require that patients have a psychological screening before any major plastic surgeries. It's too bad more doctor's don't simply refer their patients for mental health services instead of handing out breast augmentations like candy. If people were able to feel good about themselves on the inside they would not be so critical of their appearance. People trust doctors to make their health a priority and it seems to me that in LA some doctors care more about making a buck than an ethical practice.

The Canyon in Malibu is just one of many substance abuse rehabilitation centers that are beginning to treat this rapidly growing epidemic in LA.

Self Affirmations Work!

"Being happy doesn't mean that everything is perfect. It means that you've decided to look beyond the imperfections."

We could all take a page out of Jessica's book.... Learning to love yourself is hard. We are all our own harshest critics. Somehow society teaches us that it is unacceptable to love ourselves and to shout it from the rooftops like this cute little one. Children always remind me of the way life is supposed to be. Most of us walk around with negative ideas floating around in our heads all day long, clouding our logical thought process. "I'm fat... I'm ugly... I'm not good enough... I'm stupid..." all things that clients, friends, and family have said to me without blinking an eye. Yet for some reason proclaiming how smart, beautiful, funny, or charming we are is as challenging as climbing Mount Everest.

There are plenty of self help books and gimmicks out there that seem silly. However, learning how to positive self-talk is a major part of the widely used practice of Cognitive Behavioral Therapy (CBT). Basically, in layman's terms, CBT argues that the way we think alters the way we feel ... and the way we feel affects the way we behave. Therefore, if we begin to change our thinking about ourselves (even if we don't believe our affirmations at first), eventually we will feel and behave in ways that allign with our thoughts.

Thought stopping is one major way that CBT addresses negative self-talk and intrusive thoughts. Essentially, thought stopping is exactly what it sounds like. When you begin to notice negative thoughts, you give yourself a sudden trigger to stop yourself (including saying "stop" in your head to yourself, clapping your hands, snapping a rubber band on your wrist... anything that works) and then force yourself to replace the negative thought with a happy thought or positive thought about yourself. It seems so simple.... but I've seen this work if it's practiced! Make the choice to replace all the negativity in your life with positivity and see where it leads you...

Here are some positive self-talk phrases that you can look into the mirror and say... just like Jessica did!

- I am beautiful
- I can do anything I put my mind to
- I am lovable
- I am confident in my ability to get through this hard time
- I can focus on the things I like about myself

Be good to yourself and be your own best friend.... after all who else knows you better?

This is my life....

... and I'm getting sick of it!

To report or not to report?

Lately, I have grown tired of my obligation to make child abuse reports. At times, I have felt more like a police officer than a therapist. Reporting suspected child abuse is one of the hardest and most stressful parts of the job, especially because it compromises the relationship and trust between the therapist and client. I surely didn't get into this profession to be a narc. On the other hand, I did get into this profession to protect children who cannot help themselves. And stories like the Jackson brother's remind me why it is such and important part of my job, even though it is never the easiest part.

Stories like these prove the need for mandated reporting laws. This is one of the most horrific child abuse cases I have ever seen in my career. Shockingly, one of these boys reported to their teacher that they were being starved at home, but the boy said that the teacher "did not believe them." Social workers went into this home numerous times and somehow missed the signs of the severe physical abuse and neglect. Apparently at the time of this case, social workers were only legally obligated to investigate the well-being of the foster child that was assigned to them... not assess the safety of the other children in the home. As a result of this case, thankfully the law changed in New Jersey to require social workers to ensure the safety of all children in foster homes, not simply their client.

Adults are supposed to protect children, but somehow in my field it is uncommon for this to occur. I am appaulled that this foster mother, Ms. Jackson, only served a mild sentence of 4 years. In my professional opinion, abuse, especially this severe, is equivalent to murdering a childhood and often ruins chances of having a happy and healthy adult life. These boys are evidence that people do have resilience despite the damaging things that can happen to them... but that doesn't mean they should happen. The sentencing for this type of child abuse should be much more stringent.

How is it possible that not one mandated reporter (teachers, mental health workers, social workers, doctors, nurses) made a suspected child abuse report? When the 19 year old boy was found digging in the trash for food at 3am, a stranger in the neighborhood called 911. He reported to the 911 operator that the child appeared to be under 10 years old. The oldest, at 19, weighed 45 pounds. How could not one teacher throughout his life report this?

I have professionally experienced teachers' resistance to report child abuse quite frequently. I can understand more than anyone how conflicted one feels when having to make a suspected child abuse report on a family that one has a relationship with. However, I also strongly believe in my obligation to do so, not only legally, but morally.

Cultural issues come into play, as well. I have heard teachers say that as white women in an all African American or Latino school, they feel that abuse is part of the culture and it would ruin the relationship with the parents to report. To that I say... SO WHAT?! Whether you believe in child abuse reporting or not, you are obligated by law to report SUSPECTED child abuse. It is not a mandated reporter's job to investigate or decide whether a suspected abuse is worthy of being reported. It is only required that they report it. And by not reporting it you are protecting the abusers... you are perpetuating the secrecy and shame that children carry with them, as a result of the abuse. It shouldn't be about race. A child is a child no matter what color and all should be protected by adults that they trust. If that boy's teacher had made a report, maybe those children would not have suffered as long as they did.

Band aids for Bullet holes: EBPs

LA county has had a long history of putting bandaids over bulletholes. Most recently there has been a budget crisis that has lead to quick fixes like major teacher lay offs. Anyone with common sense would say that LAUSD is already providing such an unacceptable level of education to our children that it seems like a strange choice to reduce the amount of teachers. California has laid off government employees, increased sales tax to almost 10%, cut programs like Healthy Families and CalWORKs, and even released hundreds prisoners early. Again... common sense says these are not solutions. And don't even get me started on how lack of education leads to an increase in the prison population because thats a subject for a whole other post.

The latest solution that affects social work is the budget cuts within the Department of Mental Health (DMH), from which most of the community mental health agencies get their funds. Some other counties are simply cutting entire programs, mostly adult programs. Although I understand why childrens' programs are the most protected, if we "fix" the adults, then the children wouldn't need as much support. LA county has made a smart decision by trying to avoid cutting entire programs because they recognize the chaos that would occur if they stopped providing services for a large population in this crazy city.

However, instead they are forcing Evidence Based Practices (EBPs) on the mental health workers. In order to received funds from DMH, they are requiring the use of therapeutic practices that have been researched and proven to be successful. EBPs, in my opinion, are a double edged sword. On the one hand, I am being trained in effective techniques, such as Trauma- Focused Cognitive Behavioral Therapy and Seeking Safety. These practices have been proven to decrease symptoms in clients who have experienced trauma and there are many great tools that these EBPs provide for clinicians.

On the other hand, clinicians are now chained to the models and unable to use their own discretion about what might be best for their clients. Furthermore, most EBPs are short-term (about 3 months in length). Many of the clients who seek services through community mental health agencies require more intensive and longer term treatment. In particular, Seeking Safety, is more like teaching a course than therapy. There are 25 topics with hand outs and materials that the therapist goes over with the client. Niether of these EBPs emphasize the therapeutic relationship, which I have always felt is the most useful part of treatment. Another troubling obstacle this presents is MORE paperwork. Anyone who has ever done DMH paperwork knows how time consuming and aggravating it is. I spend more time doing paperwork than seeing clients most weeks. This amount of paperwork already seems ineffective. Again... using some common sense one could deduce that if we had less paperwork, we could provide an increased quality and quantity of services.

Do you use EBPs? How are budget cuts effecting your work?