Category Archives: Advocacy

An Account of Invisible Disability in Graduate Psychology Training

“But you look so healthy, I’m sure you’ll be fine.”

You would never know that I have a disability from just looking at me. To most people, I appear to be healthy and well-adjusted for my age. Enrolled in a doctoral clinical program, doing well in my coursework, taking on extra curricular activities – from an objective viewpoint, it is easy to assume that I lead a similar life to most people my age in my situation. Yet the very fact that things seem normal is one of the most challenging aspects to an invisible disability. Unless I go out of my way to explain it, you would likely never know that I suffer from severe tinnitus and hyperacusis, or constant ringing in the ears and extreme sensitivity to sound.

“Oh I get tinnitus sometimes, too. You should just ignore it like I do.”

Although increasingly common, issues of tinnitus and hyperacusis are not widely understood, nor is there a clear way of measuring what makes someone’s condition severe (Blasing, Goebel, Flotzinger, Berthold, & Kroner-Herwig, 2010). Unlike hearing impairment, in which the limitations of hearing are objectively measured by a hearing test, the methods for measuring tinnitus are far more subjective. Therefore, people tend to measure tinnitus severity by the amount of stress that people who encounter it experience – tinnitus generally falls into the basic categories of bothersome and non-bothersome. For the bothersome type, there are several remedies with an evidence basis, including various audiological interventions that incorporate psychoeducational counseling (Chan, 2009).

Additionally, Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Stress Reduction (MBSR) protocols have all been shown to alleviate tinnitus-related distress to varying degrees (Gans, Cole, & Greenberg, 2015; Hesser, Westin, Hayes, & Andersson, 2009). Yet once all of these have been attempted, and the person experiencing the tinnitus and hyperacusis is still not well, current available interventions have little else to offer. Having founded a support group in Palo Alto that is part of a national network and witnessing the pain and despair tinnitus can cause firsthand, I can personally attest to the widespread need for more effective treatments and interventions.

 “Sorry, but I can’t lower the music volume because the other customers want it turned up loud.”

The challenges I face with tinnitus and hyperacusis have impacted every area of my life. While providing me with a sense of mission to contribute to research and advocacy for individuals with my condition and other invisible disabilities, the path to get there has been thoroughly demanding and challenging. Simple things like riding on public transportation, food shopping, and being in noisy restaurants are all potentially painful situations for me. Urban environments are also dangerous, considering the regularity of emergency vehicle sirens, construction, car horns, loud motorcycles, and other frequent noise. At a more personal level, I have even had to tell people that their voice or laugh is too loud, and ask if they can speak more quietly when I am nearby. Frequently, my conditions become exacerbated if I do not have an opportunity to advocate for myself and explain to people the unusual nature of my sound sensitivity so that it may be accommodated.

“If the class gets too loud for you, you can just leave.”

While I am grateful to be engaged in a course of study that I am passionate about, it is a constant challenge to maintain an effective balance between self-care and productivity. Graduate level training in psychology is thoroughly demanding of a person’s physical and emotional resources, particularly considering clinical placements that may require long commutes on top of endless hours of coursework and research requirements. My condition results in frequent exhaustion and difficulty sleeping, with the symptoms often intensified resulting from stress and demands of graduate school. Excessive fatigue is common when someone experiences a disability (Olkin, 1999); by sheer requirement of rest alone, it takes more time to get the same amount of things done. In my case, many aspects of my training are limited and guided by my condition, starting from choosing a school that has parking access and adequate disability resources. Other aspects of the process are restrictive for me too, as clinical training placements involving families with small children and milieu settings with youth are frequently quite loud and therefore not compatible with my illness. Even socializing can be a challenge, as my condition is worsened from time spent in large groups of people in which many conversations are happening. I must rely on my professors, supervisors, and peers to understand and help when I need accommodations for my disability, and even when I must leave a potentially harmful situation for me.

“Oh come on, this can’t be too loud, we’re just having fun.”

Explaining this is frequently difficult. When it’s people’s lifetime experience that being in social situations is a good thing, and they display the best of intentions by wanting me to be there. It can be very hard to articulate how challenged I am by being in the places where people gather such as restaurants, parties, and bars. As such, I am left out of much social activity that I used to partake in and that used to be a resource for me – having a disability requires constant re-adaptation to life, and often in isolation from others.

Diversity factors among graduate students include all the varied forms in which disability manifests. While mobility issues obviously must be accounted for, greater awareness of other types of disabilities, including less visible, chronic disabilities such as endometriosis, Crohn’s disease, irritable bowel syndrome, brain injury, fibromyalgia, and other common conditions such as tinnitus and hyperacusis still require greater awareness among the general public. In this time when diversity is becoming an ever more present dimension of clinical proficiency, it is essential that training programs incorporate greater awareness of the potential impact of disability on people’s lives.

“Well, at least you don’t have a real disability.”

Despite the challenges my disability has put me through, it has been my experience that people truly want to help – even when they aren’t sure how. Yet sadly, often it is the case that when things become too challenging to attend to, it is a culturally consistent reaction to tend to look away. Many of the needs of people who experience limitations due to their disability may be solved by a very simple method – don’t be afraid to ask what it’s like for them, and how you may be able to help. Even just being recognized for dealing with the challenge of an invisible disability can be a huge relief.

About the Author:

Ben Greenberg is a fourth-year doctoral clinical psychology student at the American School of Professional Psychology at Argosy University, San Francisco. A former professional symphony French horn player, he played in the Colorado Symphony Orchestra, Jerusalem Symphony, Hong Kong Philharmonic, and Cairo Opera Orchestra before leaving his career due to debilitating tinnitus and hyperacusis. He is currently a grant recipient of the American Tinnitus Association for his research in the impact of sound sensitivity in tinnitus, and lives in Oakland, CA.

 

References:

Blasing, L., Goebel, G., Flotzinger, U., Berthold, A., & Kroner-Herwig, B. (2010). Hypersensitivity to sound in tinnitus patients: An analysis of a construct based on questionnaire and audiological data. International Journal of Audiology, 49(7), 518-526. doi: 10.3109/14992021003724996

Chan, Y. (2009). Tinnitus: Etiology, classification, characteristics, and treatment. Discovery Medicine, 8(42), 133-136. Retrieved from: http://www.discoverymedicine.com/Yvonne-Chan

Gans, J., Cole, M., & Greenberg, B. (2015). Sustained Benefit of Mindfulness-Based Tinnitus Stress Reduction (MBTSR) in Adults with Chronic Tinnitus: a Pilot Study. Mindfulness. doi: 10.1007/s12671-015-0403-x

Hesser, H., Westin, V., Hayes, S. C., & Andersson, G. (2009). Clients’ in-session acceptance and cognitive defusion behaviors in acceptance-based treatment of tinnitus distress. Behavior Research and Therapy, 47(6), 523-528. doi: 10.1016/j.brat.2009.02.002

Olkin, R. (1999). What psychotherapists should know about disability. New York: Guilford Press.

Why Policy?

US Capitol Rotunda

U.S. Capitol Rotunda, Source: Flickr, user sidkid

“Why policy?”

I have been asked this simple, two-word question more times than any other question in the past year. Back in September, I began working as a graduate-level policy scholar for the Public Interest Government Relations office at the American Psychological Association. As this opportunity coincided with my fifth year of doctoral studies at Virginia Commonwealth University, I have often had to explain my hectic schedule upon meeting new individuals. Research and academia, most will understand, as those things fit seamlessly into the doctoral studies mold. But then comes the follow-up question: Why policy?

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How Much Do Black Lives Matter to the APA?

protestAs a student member of the APA and a psychologist in training, I’ve been disappointed in the American Psychological Association’s (APA) public response to the deaths of African American’s at the hands of police officers as well as mass shooters. While I’ve appreciated APA’s vigorous response to the Orlando tragedy, I couldn’t help but compare it to the APA’s response to the Charleston shootings. When I looked back to see if the APA offered services to the families of the victims of the Charleston shootings, or any other resources, I couldn’t find anything, not even a public statement condemning the shootings. Granted, the Charleston shooting occurred only a few weeks before the release of the Hoffman Report.  Yet preoccupation with the Hoffman Report does not explain APA’s silence, as it issued four press releases between the day of the Charleston shooting and the release of the Hoffman Report.

Moreover, the APA’s virtual silence in response to the numerous police shootings of unarmed African American men, women, and children is dumbfounding.  In an op-ed in response to Ferguson, written by former APA President Nadine Kaslow and former APA CEO Norman Anderson, the authors fall short of condemning the shooting of an unarmed black teenager and state, “[t]he judicial system will determine exactly what transpired between Michael Brown and the police officer.” Considering the historical treatment of African Americans by the judicial system, and the continued shocking disparities, their faith in the ability of the system to determine what transpired and provide a just outcome was questionable at best.  Perhaps Kaslow and Anderson’s questionable faith is representative of the APA’s position overall, and explains the silence.

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Take the ally challenge!

I am sick of writing posts in the wake of tragedies, and sickened to know that unless something drastically changes, they will continue to happen as they have for so many years. But I also know we can do better; I can do better. Specifically, allies need to do more in the times when there is no system-based tragedy making headlines. Therefore I am taking a 30-day ally challenge and I would love you to join me!

Sometimes trying to be an ally can feel overwhelming because there are so many social justice issues around the world to care about. Sometimes I end up doing nothing because I do not know where to begin, or how to begin. Sometimes I get stuck because I know there are people who dedicate their lives to social justice, whether on a global scale by people like Paul Farmer, or on a local scale, like the founders of the Wisconsin youth organization Proud Theater, and that as much as I would like to be, I am not one of them. It is too easy for daily life to get in the way when there is no crisis to respond to. I realize, of course, that the ability to not engage fully in a topic if it doesn’t fit in my schedule is the result of the many privileged identities I hold, but that does not change the fact that I often end up analyzing data or checking Facebook, rather than really engaging as an ally.

If you are like me, and want to do more to make the world better but are feeling stuck, let’s try this month-long experiment together. I would contend, as others have, that being an ally is a verb rather than an identity label. It is not something someone is, but something someone does, and therefore something we can practice daily in order to improve.

This is my plan of attack to practice becoming a better ally.

Step 1: Choose a topic.

We know that in order to make behavior changes, the goals have to be manageable. There are countless areas of disparity and oppression in the world, but in order to prevent inertia, I will pick one topic to focus on for two weeks – just one! (With the sad exception of responding to crises, like the recent shootings)

Step 2: Pick a time.

Behavior change works best if we can incorporate it into our daily routine. What time works best for you to do your allying? It might take some scheduling trial and error, but I think I’ll try lunchtime…

Step 3: Become an informed ally.

Without knowing about an issue, it is difficult to effectively work for change. Every day I will spend 10 minutes learning about the topic I have chosen. Is this enough time to spend allying? No. It is not even close to enough time to do justice to learning deeply about a topic. However, it is ten minutes more than I am currently spending and therefore a step in the right direction. Specifically, I will seek out perspectives of members of communities affected by the issue, as well as the perspectives of those whose beliefs run counter to my own. It is difficult to create change without dialogue, and difficult to create dialogue without understanding perspectives across the aisle.

Step 4: Take action.

Knowing about the ways in which our system is broken is a start, but allying also requires doing something about it. Each week I will therefore also do some sort of action outside my comfort zone. There are a lot of ways to be an ally in daily life, some of which might not be entirely within my control. For example, it is important to speak up about microaggressions when we see them. We can do things to increase our efficacy speaking up, like learning about how to recognize microaggressions and how to communicate effectively about them. But what if I spend the day doing research in my office and legitimately do not encounter any microaggressions to challenge? The action I take each week has to be something I can initiate that I would not have done otherwise, whether that means attending a solidarity event, volunteering, donating, starting a dialogue, or calling a legislator.

Step 5: Tell your friends.

Behaviors changes are more likely to be maintained when people have social support for making the change. Share what you’re doing and what you’ve learned with your friends and family. Spread the word. Create a network of people practicing allying.

Step 6: Do it again the next month!

In this way at the end of one month I will know more about two topics and have taken four small actions related to them. If I keep it up over a year, that will lead to knowing more about 24 topics with 48 small actions. If I get my friends to join me, who knows how big the ripples may go.

I may not ever be an ally rock star, but I sure can work at becoming a better one than I currently am.  If those of us who hold privileged identities make an effort to be more intentional allies when there is not a national tragedy, not only might that make us better at responding to tragedies when they do happen, but it might also help us start using our power more effectively to prevent them in the first place. We might not be able to solve all broken things all at once, but that shouldn’t stop us from practicing the actions needed to learn about what is broken and be part of the solution. I hope you join me in this allying challenge!

SomosOrlando

#SomosOrlando: Latinx LGBTQ+ being Ignored while Simultaneously Killed

SomosOrlandoThis blog post is a joint collaboration between: James J. García, Chair of the APAGS Committee for the Advancement of Racial and Ethnic Diversity (CARED), Roberto L. Abreu, Co-chair of the National Latina/o Psychological Association Orgullo Latinx: Sexual Orientation and Gender Identity SIG and Division 45 Student Committee Co-liaison, & Laura P. Minero, Student Representative of the National Latina/o Psychological Association

Disclaimer: The opinions in this blog represent the personal opinions of the authors and not necessarily those of APA, APAGS or NLPA.

Across the nation, many of our hearts were broken by the massacre of 49 LGBTQ+ individuals and 50+ wounded during Pride Month and “Latino night” at a nightclub in Orlando. As photographs and names of the victims began to pour in, it was undeniable that most of the LGBTQ+ victims (90%) were Latinx, mostly Puerto Rican and other Latinx backgrounds. We also know that some of the victims came from mixed status families or were undocumented themselves. These challenges add further complexity to the grief and trauma they (and their families) historically have, and will continue to, experience on a daily basis.

As reporters in popular news channels struggled to pronounce the last names of the victims, the racial and ethnic identities of the LGBTQ+ victims were ignored. Many reporters refused to utter the letters “LGBTQ;” comments such as “this is an attack on all of us” were used to generalize this issue to all Americans. Although these statements were meant to show support and solidarity, indeed it concerns all Americans, these messages felt invalidating as this attack was directed at LBGTQ+ people, particularly us the Latinx LGBTQ+ community. This points to a larger systemic and historic problem in the United States: the attempt to sanitize, strip away, and demonize Black, Brown and LGBTQ+ bodies from their identities via a system of oppression, power and privilege sustained by White supremacy, heterosexuality and cisgender identities.

Within the sociopolitical context, we are negatively stereotyped by the media as unsuccessful, a group of criminals, foreign born, and only Spanish-speaking. These stereotypes disregard us as a diverse group of people by ignoring the heterogeneity within our communities. The blatant ethnic gloss against us is not new nor is it the result of recent political rhetoric; rather, there is an extensive history of hostility, which perpetuates a failure to acknowledge our intersections as Latinx LGBTQ+. For those of us who identify as Latinx LGBTQ+, we cannot help but feel that we are being ignored while simultaneously being killed.

There are three points of discourse missing from the current media narrative:

  • First, the sorrow of our Latinx LGBTQ+ community is being used to fuel hatred against the Muslim community and marginalize LGBTQ+ Muslims; however, our plights are similar, as we all live in survival mode to exist in a system that has set us up for disadvantage.
  • Second, there is no mentioning of homophobia and heterosexism within the Latina/o community, which pushed us to create our own spaces where we can temporarily break free of the violence, prejudice and discrimination from our own familias.
  • Lastly, the conversations seem to gloss over racism against LGBTQ+ people of color and those who are biracial/multiracial within the LGBTQ+ community.

Dauntingly, what can we do as psychologists-in-training?

Interpersonal level:

Departmental level:

  • Develop, create, and host healing spaces for LGBTQ+ people of color
  • Advocate for a statement/comment from your Department/University
  • Attend Pride and remembrance events as a Department

Societal level:

Living at the intersection of Black, Brown and LGBTQ+ is to expect that you can be discarded at any time without getting the chance to exist in your own skin. To this end, we, as psychologists-in-training, need to continue having these conversations to effect change together and at different levels of our society.