Tribute & Report from Dr. Norma Clark

"The immersion in the process, the lack of distraction from TV etc enabled me to cleanse my mind too. I had no idea what to expect when I went to visit, but, like some of the other clients there, I had not expected the calm, the sense of inner quiet that I left with and still feel a week later. Nor had I expected the clarity of thought and seeing that I experienced in the Circle." - Dr. Norma Clark

"Perhaps the thing I liked most about Choose Again was the lack of psychiatric language. Anywhere at anytime. There was a certain freedom in that. No one had been given a “diagnosis” by Choose Again staff. There was no talk of neurotransmitters or any psychological disorder or disease process (yet everyone there had been given a diagnosis of sorts by the therapists/psychiatrists they had seen prior to coming to Choose Again) The Diagnostic and Statistical Manual, the DSM, the “Bible” of psychiatry was not in evidence anywhere.  When I contacted the Program Director Diederik Wolsak about visiting during the week of Xmas, I asked if there would be enough clients for me to see how the Program did its work. Diederik responded with “We are all clients.” I appreciated that statement even more after spending a week at Choose Again. With the absence of the accepted diagnostic categories, everyone at Choose Again is unbound and free to look at the core difficulties that we all share: we are deeply attached to our stories; we believe our stories define who we are; we believe our thoughts; we live in an internal world of guilt and shame; we do not know that we can choose again to have different thoughts, different experiences, a different life. The way we manifest our distress (drinking, overeating, restricting food, depression etc), which leads to the “diagnosis”, does not matter. What does matter is looking at our thoughts and choosing again.
I run a very busy solo private psychiatry practice in Houston Texas. I have been in practice for over 18 years… I have worked in inpatient, residential and outpatient settings and with a broad range of the diagnoses that typify psychiatric practice. I practice within the boundaries of psychiatry and I have learned not to criticize that. I prescribe medications if needed, I do what is necessary. But more and more I have come across clients who want a different approach. They want to move away from the medications and the labels of diagnostic categories. They want their lives to be altered in very profound ways. On a more personal level, the more I have been willing to look at my own stories and thought processes (Diederik’s “we are all clients”), the more willing I have been to put into practice some of my reading from Ramana Maharshi, or from Papaji, or from the Course In Miracles, the more my life has changed and the less willing I have become to leave these ideas out of the work I do.  Why would I ignore such powerful ideas with their potential to change lives? Just in case anyone thinks that “spiritual issues” have no place in psychiatry, I would point him/her to Dialectical Behavioral Therapy, now a much researched, much valued mainstream treatment in psychiatry. Its developer, the now world renowned Marsha Linehan PhD, is a practicing Zen Buddhist who has incorporated many Buddhist ideas into the treatment she developed. She did this as part of healing herself from the psychiatric diagnosis she was given in her late teens and early 20’s (yes…we really are all clients).
Choose Again is in Costa Rica, on eleven acres of lush land that sits on the shores of lake Arenal. There are small cottages on the land, where clients share rooms. There is a central meeting area used for Yoga most mornings (except Sunday), and for Circle which is the context in which most of the work takes place. A few steps away is the kitchen/dining/ hang out area where all meals are taken (a huge emphasis on fresh fruit and vegetables) and where at 9:30 each morning, there is a reading and commentary on one of the lessons from A Course In Miracles. There is no radio, no TV, no cable. The focus is totally on the healing process. Costa Rica is a quiet, safe, and friendly place. The extensive land surrounding Choose Again is marked by “roads” maintained by the electric company. The roads run through fields and walking/hiking along them, which is a daily part of the program, provides exercise (the roads are a bit steep in places) and an immersion in the beauty of the landscape. In just one week my legs were stronger from the walking and my balance improved from the yoga.
The core meeting at Choose Again is Circle. This takes place after morning yoga, breakfast and the study of the daily Course in Miracles lesson. Staff and clients (and the occasional visitor) all sit in circle. A reading is chosen from The Course, or from Papaji or a similar work. Everyone reads as the book goes around the circle. Then there is a period of silence for four or five minutes and then once again, the book goes around as each person comments on what the reading has to do with their own thought process and their own story. It is during this commentary process that much of the work at Choose Again is done. Since the core belief here is that we are all attached to our stories and believe our thoughts, then the particulars of the story really don’t matter that much. There are people with severe depression and multiple suicide attempts, addicts of all descriptions(food, drugs, alcohol, sex etc), people with histories of sexual, emotional and physical abuse; couples whose marriages are foundering for all sorts of reasons; curious visitors; all of us sit in circle and look at our beliefs. I guess you could say that this is just another form of group therapy, and in a way it is. But it didn’t feel like it to me. I’ve thought about it for a while, trying to sense why the process did not feel like run of the mill group therapy.
Diederik, Claudette and Dawn are the leaders/way-showers of the group, but they are so open about their own process and their own stories that it is hard to see them as the hierarchical power figures more common in traditional medical models. It is obvious that neither Diederik, Claudette or Dawn are attached to their stories, and it is equally obvious that all three walk their talk. That lends an authenticity and purpose to the meetings, and it enhances the willingness of the group members to open up and participate. There is one other thing that I noticed and that is the lack of judgment in the Circle. We are all the same so who is there to judge? There is a safety there and a genuine caring that all of us in the circle learn to see things differently, let go of the thoughts that bind us and Choose Again. The message is given over and over and over again and those who listen and accept the message tell remarkable stories of healing, even those who came to the program never having engaged in any sort of spiritual work in the past. Medications are discontinued (both psychiatric and those for medical diagnoses), anxiety decreases, suicidal thoughts cease, addictive behaviors wither away. The people I talked to at the program seemed surprised by the process and its effects (in particular the person who discontinued lifelong diabetes and hypertension medications within two weeks of being there…. “I guess it must have been the stress I put myself under that caused the illnesses”. I met him when he had been off the meds for about four weeks with no ill effects). Most have been in traditional mental health treatment processes for years and while many will agree that these processes helped, they came to Choose Again as a “last resort” and received more help than they had expected.
One has to want to participate in this process. I don’t know how it would work for people who were forced to go to treatment. A teenager who was there at the same time clearly expressed that there was  benefit from the stay. The story of an adoption and rejection by biological parents were used to justify much destructive behavior, and the teenager could now see that a story that had been believed did not have to be …. but there was no wish to change, no wish to choose again and the teenager was very clear about that too. I watched as day by day the circle participants worked with calm and yes, love, to talk with the teenager and encourage different ways of seeing. There was no change. Yet outside of the circle, the interactions of the teenager with the other clients was marked by a warmth and caring that I confess I found difficult to understand and for a while I wondered if it was faked, the sort of “bliss ninny” nonsense that can go on in spiritual circles. But it wasn’t. There was genuine love and concern along with an understanding that we all make our own choices, even as teenagers. And who is anyone else to judge?
The immersion in the process, the lack of distraction from TV etc enabled me to cleanse my mind too. I had no idea what to expect when I went to visit, but, like some of the other clients there, I had not expected the calm, the sense of inner quiet that I left with and still feel a week later. Nor had I expected the clarity of thought and seeing that I experienced in the Circle. No doubt being willing to suspend my judgments and totally, fully participate in the process helped. This is what was done by all the clients who told me how beneficial the program had been. This is what helped all of us to be able to Choose Again." - Dr. Norma Clark