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Eight years ago, I began working at the Department of Veteran Affairs. My task was to study evidence-based treatments for post-traumatic stress disorder with a team of psychologists and other public health researchers of various stripes.
At that time, we knew a full course of these gold-standard mental health treatments could help people manage PTSD symptoms, but we also knew that many people discontinued treatment before the point that it was useful. We wanted to know why. My primary role was to interview Veterans who discontinued treatment, their therapists, and someone the Veterans counted on in their personal lives in order to better understand what went wrong.
What I heard was heartbreaking. The chasm between how the treatments were implemented and what the Veterans needed from them was enormous. As expected, these interviews had important implications for improving PTSD treatment. What I hadn’t expected was how bearing witness like this would help me articulate what had been missing in my own psychology training. I knew what professors thought about mental health and its treatment. I knew what clinicians thought. I knew what researchers thought, too. But I knew very little about what people who actually experienced these disorders thought. A giant piece of the puzzle was missing.
A number of papers have come out of our work at the VA. One of the most time consuming articles has been the complex, careful comparison of how Veterans and therapists made sense of these unsuccessful treatment experiences at VA hospitals across the United States. We learned where the pairs agreed and where they didn’t and made inferences about what those patterns could tell us about how we in the mental health field can do better. Even though I left the VA six years ago, I’ve continued to contribute to this work, and I’m thrilled to share that our paper, Making sense of poor adherence in PTSD treatment from the perspectives of veterans and their therapists, was published online this month in the peer-reviewed journal Psychological Trauma: Theory, Research, Practice, Policy.

Your Curated Reading List
At times when my attention and heart are frayed, I turn to poetry for restoration. This month Catalog of Unabashed Gratitude by Ross Gay was the attentive, heart-felt read that I needed.
Very Cold People by Sarah Manguso is unlike any other novel I’ve read. Her sparse, staccato writing is deliciously dense.
The characters in this novel are drawn to Mercy Street, which has everything and nothing to do with the abortion clinic there. Jennifer Haigh’s gifted storytelling is on display in Mercy Street: A Novel.

Something Delightful
When something delights me, like really tickles me, I sometimes let out a yip of a laugh. Some might call it a cackle.
If you’ve met me in real life, you know exactly what I’m referring to with that description and that fact embarrasses me. That’s part of why I have such a soft spot for the poet Ross Gay, who once said during a taping of the public radio show On Being with Krista Tippett that my laugh delighted him. Now every time I laugh like that and reflexively cover my mouth, I think of him and let my hand fall. Concealing joy rarely serves anyone. In a way, this section of the newsletter is an homage to him and his essay collection The Book of Delights.
For me, this month was not filled with delighted laughs, yip-esque or otherwise. But I do believe the practice of noticing what sparks delight has value. When I notice delight, I feel more connected to myself and the world around me. I am able to act in ways that are more skillful.
When delight is hard for me to access, my habit is to enlist the help of nature. Every day, things are a little different outside. If you know how to look, there’s always a measure of magic there.
One day on a walk, I noticed snowmelt running under the ice on the sidewalk. I watched it for a long while. I felt calm. I didn’t yip-laugh, but I did feel a thrum of quiet delight.
The experience reminded me of a poem of Gay’s called Thank You. It’s one from his poetry collection Catalogue of Unabashed Gratitude, which I read earlier this month. After I read the poem, I read it again. Two weeks later, when I attended Jean Haley and Kaia Svien’s workshop at Common Ground Meditation Center Living in Liminal Space with Love: An inquiry into and conversations on how to be present with the unknown, Jean read that same poem at the event’s close. I cried, and I wasn’t the only one, so she read it again.
Gay’s poem is clearly a resonant benediction for our times. Sometimes delight doesn’t move through us with the propulsion of a yip-laugh, but it can profoundly move us all the same. Here are Gay’s words, which I hope delight you:
If you find yourself half naked
and barefoot in the frosty grass, hearing,
again, the earth’s great, sonorous moan that says
you are the air of the now and gone, that says
all you love will turn to dust,
and will meet you there, do not
raise your fist. Do not raise
your small voice against it. And do not
take cover. Instead, curl your toes
into the grass, watch the cloud
ascending from your lips. Walk
through the garden’s dormant splendor.
Say only, thank you.
Thank you.
Ross Gay, Catalogue of Unabashed Gratitude

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