tag:blogger.com,1999:blog-76080614138732316652024-03-19T00:26:37.266-07:00Psych GripeRants and Musings On Our Culture of PsychopathologyVircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.comBlogger37125tag:blogger.com,1999:blog-7608061413873231665.post-86536567262104491982017-02-18T19:04:00.005-08:002017-02-26T18:30:10.489-08:00Portrait of a Personality Disorder, Part 3: Cognitive Distortions in Cluster B PersonalitiesWe all distort things in our heads. If you're honest with yourself, you know you do. We all have distorted memories of relationships and disagreements. We all have distorted ideas about ourselves. We all have distorted ideas about other people and other people's motives.<br />
<br />
But here's the thing . . . Some people distort more frequently and to a greater degree than others. Some people cannot or do not acknowledge their distortions and do not even seem aware they might be distorting. Like all disorders, Cluster B personality disorders are identified, not by unique traits or behaviors, but the frequency, severity and impact of certain traits and behaviors. The cognitive distortions seen in Cluster B personalities have a direct impact on how an individual relates to other people.<br />
<br />
Human relationships are, by and large, reciprocal phenomena. There is give and take. And, there is a feedback loop. I say something nice to you, you say something nice to me, and we both feel good. Or, I say something mean to you, you return the favor, and we both feel bad.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgS_381vJqcC5I2gzgNtkM3FDhW2fbCXFZP9AQBjKMmZQAevwNUogLvROOVEW0DSbEblBKE0aboPX4qs-ZsH1QPy4UzKl87YH00XR_BYQr3Kuz1iL9n-R5SjEHU6z6GNzjFl-WcJpaH5Lgm/s1600/lucylinus.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="275" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgS_381vJqcC5I2gzgNtkM3FDhW2fbCXFZP9AQBjKMmZQAevwNUogLvROOVEW0DSbEblBKE0aboPX4qs-ZsH1QPy4UzKl87YH00XR_BYQr3Kuz1iL9n-R5SjEHU6z6GNzjFl-WcJpaH5Lgm/s400/lucylinus.jpg" width="400" /></a></div>
<br />
With Cluster B personalities, the feedback loop is broken. The short circuit is a defense mechanism in which the individual unconsciously or semi-consciously edits their awareness of their own behavior in such a way to protect their perception of themselves. The result is an individual who sees themselves as always the victim (as in Borderline Personality) or always the better person (as in Narcissistic Personality). Perceptions of other people are not anchored in objective observation but, instead, are wildly changeable based on how the other person makes the personality disordered individual feel at any given time.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjRuB_QWkwovY1oZ2hBOiQ8BSLFAgtA19aHwU4V0HqLYV3VWB9yzoh3XHYOxx7TC6XOxYIeYyn_wFI2Nx5DLzFQiqjB3cAAJrE7oIyf9Z-_nPCO4HZH2R1ZCPAKVXrZ_xavmkJoLc1F4-m/s1600/lucylinus_edited.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="275" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjRuB_QWkwovY1oZ2hBOiQ8BSLFAgtA19aHwU4V0HqLYV3VWB9yzoh3XHYOxx7TC6XOxYIeYyn_wFI2Nx5DLzFQiqjB3cAAJrE7oIyf9Z-_nPCO4HZH2R1ZCPAKVXrZ_xavmkJoLc1F4-m/s400/lucylinus_edited.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Lucy's distorted perception of the same interaction?</td></tr>
</tbody></table>
Lucy of Peanuts provides us a nice illustration of the principle of distortion and the effect it has on relationships. Now, how about we look at a real life example, say, a recent example? Here is an excerpt from Thursday's presidential news conference:<br />
<blockquote class="tr_bq" style="box-sizing: border-box; margin-bottom: 15px; margin-right: 0px;">
<span style="font-size: x-small;">QUESTION: . . . You said that the leaks are real, but the news is fake. I guess I don't understand. It seems that there's a disconnect there. If the information coming from those leaks is real, then how can the stories be fake?</span> </blockquote>
<blockquote class="tr_bq" style="box-sizing: border-box; margin-bottom: 15px; margin-right: 0px;">
<span style="font-size: x-small;">TRUMP: The reporting is fake. Look, look . . .And I'll tell you what else I see. I see tone. You know the word "tone." The tone is such hatred. I'm really not a bad person, by the way. No, but the tone is such -- I do get good ratings, you have to admit that -- the tone is such hatred. . . .But the tone, Jim. If you look -- the hatred. The, I mean, sometimes -- sometimes somebody gets...Well, you look at your show that goes on at 10 o'clock in the evening. You just take a look at that show. That is a constant hit. The panel is almost always exclusive anti-Trump. The good news is he doesn't have good ratings. But the panel is almost exclusive anti-Trump. And the hatred and venom coming from his mouth; the hatred coming from other people on your network. . . I -- I think you would do much better by being different. But you just take a look. Take a look at some of your shows in the morning and the evening. If a guest comes out and says something positive about me, it's -- it's brutal. . . .Tomorrow, they will say, "Donald Trump rants and raves at the press." I'm not ranting and raving. I'm just telling you. You know, you're dishonest people. But -- but I'm not ranting and raving. I love this. I'm having a good time doing it.But tomorrow, the headlines are going to be, "Donald Trump rants and raves." I'm not ranting and raving.Go ahead. . . . </span></blockquote>
<blockquote class="tr_bq" style="box-sizing: border-box; margin-bottom: 15px; margin-right: 0px;">
<span style="font-size: x-small;">QUESTION: Just because of the attack of fake news and attacking our network, I just want to ask you, sir... </span></blockquote>
<blockquote class="tr_bq" style="box-sizing: border-box; margin-bottom: 15px; margin-right: 0px;">
<span style="font-size: x-small;">TRUMP: I'm changing it from fake news, though. </span></blockquote>
<blockquote class="tr_bq" style="box-sizing: border-box; margin-bottom: 15px; margin-right: 0px;">
<span style="font-size: x-small;">QUESTION: Doesn't that under... </span></blockquote>
<blockquote class="tr_bq" style="box-sizing: border-box; margin-bottom: 15px; margin-right: 0px;">
<span style="font-size: x-small;">TRUMP: Very fake news. </span></blockquote>
<blockquote class="tr_bq" style="box-sizing: border-box; margin-bottom: 15px; margin-right: 0px;">
<span style="font-size: x-small;">QUESTION: ... I know, but aren't you...(LAUGHTER) </span></blockquote>
<blockquote class="tr_bq" style="box-sizing: border-box; margin-bottom: 15px; margin-right: 0px;">
<span style="font-size: x-small;">TRUMP: Go ahead. </span></blockquote>
<blockquote class="tr_bq" style="box-sizing: border-box; margin-bottom: 15px; margin-right: 0px;">
<span style="font-size: x-small;">QUESTION: Real news, Mr. President, real news.. . . But aren't you -- aren't you concerned, sir, that you are undermining the people's faith in the First Amendment, freedom of the press, the press in this country, when you call stories you don't like "fake news"? Why not just say it's a story I don't like. </span></blockquote>
<blockquote class="tr_bq" style="box-sizing: border-box; margin-bottom: 15px; margin-right: 0px;">
<span style="font-size: x-small;">TRUMP: I do that. </span></blockquote>
<blockquote class="tr_bq" style="box-sizing: border-box; margin-bottom: 15px; margin-right: 0px;">
<span style="font-size: x-small;">QUESTION: When you call it "fake news," you're undermining confidence in our news media (inaudible) important. </span></blockquote>
<blockquote class="tr_bq" style="box-sizing: border-box; margin-bottom: 15px; margin-right: 0px;">
<span style="font-size: x-small;">TRUMP: No, no. I do that. Here's the thing. OK. I understand what you're -- and you're right about that, except this. See, I know when I should get good and when I should get bad. And sometimes I'll say, "Wow, that's going to be a great story." And I'll get killed.I know what's good and bad. I'd be a pretty good reporter, not as good as you. But I know what's good. I know what's bad. And when they change it and make it really bad, something that should be positive -- sometimes something that should be very positive, they'll make OK. They'll even make it negative.. . . as an example, you're CNN, I mean it's story after story after story is bad. I won. I won.</span></blockquote>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYQ4A24vwv26XAMtU5-h4Uk3XVXPVUs64xYAAsgSRB0hQqwJjquBDt93zFoTYYfX9pP8abzIHfS71e0YOuRm-XQFY7W8VgQg-W5JiGa4nzVonLkzye9yDOdp2l-Vpfqrdpa2smpBWGuJT9/s1600/gty-trump-presser-01-jc-170216_12x5_1600.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="166" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYQ4A24vwv26XAMtU5-h4Uk3XVXPVUs64xYAAsgSRB0hQqwJjquBDt93zFoTYYfX9pP8abzIHfS71e0YOuRm-XQFY7W8VgQg-W5JiGa4nzVonLkzye9yDOdp2l-Vpfqrdpa2smpBWGuJT9/s400/gty-trump-presser-01-jc-170216_12x5_1600.jpg" width="400" /></a></div>
<br />
Here, like Lucy, we have an individual who sees himself as a victim and simultaneously better than, a clear sign of a narcissist (more on that later). And, like Lucy, he is seemingly oblivious to his part in any contentiousness. You can see the distortions all serve to bolster, not just the image of the man, but more specifically, his self-image.<br />
<br />
This is a clear and beautiful example of a neurotic process expressed publicly and recorded by worldwide news outlets. It is less an argument than the man's internal process expressed outwardly, for he is not attempting to convince his audience of his greatness and their badness so much as his argumentation serves to reinforce his internal beliefs. By stating his distortions externally, they become more real for him internally.<br />
<br />
And, this is exactly what is so challenging about relating to and attempting to have a reason-based conversation with someone with a Cluster B personality type. There is no real give and take. The disordered individual is simply having an argument with himself or herself, and, while you may be the target, you cannot meaningfully take part in the manner you are used to if you are expecting a reciprocal give-and-take relationship.<br><br>
<script async src="//pagead2.googlesyndication.com/pagead/js/adsbygoogle.js"></script>
<!-- psychgrip01 -->
<ins class="adsbygoogle"
style="display:block"
data-ad-client="ca-pub-5910952320421723"
data-ad-slot="3638515249"
data-ad-format="auto"></ins>
<script>
(adsbygoogle = window.adsbygoogle || []).push({});
</script>Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com0tag:blogger.com,1999:blog-7608061413873231665.post-37623165589894917632017-02-18T14:02:00.000-08:002017-02-18T17:38:19.675-08:00Portrait of a Personality Disorder, Part 2: What Are Cluster B Personalities?So, we have ten standard personality disorders and they are grouped into three clusters, A, B, and C. Here, we are going to focus on cluster B, arguably the most difficult and controversial of the three clusters, but before we dive in, lets take a quick glance at A and C, and get that out of the way.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCzy3XvW8kVOuFdJztEieuyGqXksCovZUYJb09hwanEquy_4Ep203Ae9zkdMAPMaJUYKedeZZqX1axrXNFYXv7qY98S20SJyUVf2XMpR9xu-4QqtCMlopaWy-kNC3xRW1XhADGu4x8PimZ/s1600/258a2d5a70e3308c27a2b8e0c26868f7.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCzy3XvW8kVOuFdJztEieuyGqXksCovZUYJb09hwanEquy_4Ep203Ae9zkdMAPMaJUYKedeZZqX1axrXNFYXv7qY98S20SJyUVf2XMpR9xu-4QqtCMlopaWy-kNC3xRW1XhADGu4x8PimZ/s320/258a2d5a70e3308c27a2b8e0c26868f7.jpg" width="232" /></a></div>
Cluster A is the "odd duck" cluster of personality types. These are clustered together because they share certain attributes and characteristics. To a layperson, seeing someone with a Cluster A personality on the street, you might assume that person is seriously mentally ill. They might keep to themselves, they might be dirty and unbathed with an unkempt look, they might be wearing a heavy coat in the middle of a warm summer, they might act paranoid. Basically, they look mentally ill. The only thing is, they aren't. There are no delusions, no auditory hallucinations, no manic episodes. This is a person who has separated themselves from society and from normative social standards. They have made themselves social isolates, and there they stay (unless there is a dramatic change to their personality at some point). The specific Cluster A disorders are Paranoid Personality, Schizoid Personality, and Schizotypal Personality Disorders.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYC8oXo_Fp76PwNr10UdAp-4sVsuVEFPzkaPcTdwVSXRNwWV1twDREDMMsMloKDQrBUtkV8Wwd7EF7OhGf1Mx5hIESTHvz08ZDaKA_DyV-q5WmB79lfvO7qMZPcjSApci7-p2JRIr6tOeS/s1600/4803823-123-400x232.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="184" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYC8oXo_Fp76PwNr10UdAp-4sVsuVEFPzkaPcTdwVSXRNwWV1twDREDMMsMloKDQrBUtkV8Wwd7EF7OhGf1Mx5hIESTHvz08ZDaKA_DyV-q5WmB79lfvO7qMZPcjSApci7-p2JRIr6tOeS/s320/4803823-123-400x232.jpg" width="320" /></a></div>
Cluster C is the anxious and fearful cluster of personalities. These are people whose personalities and habits have been shaped by lifelong anxiety and fear, resulting in avoidance, dependence on others, obsessiveness and compulsive behaviors. These are personalities that could be associated with the popularized version of neurosis--bundles of worries with irrational behaviors. The specific disorders are Avoidant Personality, Dependent Personality, and Obsessive-Compulsive Personality Disorders. Please note that Obsessive-Compulsive Personality Disorder is distinct from Obsessive-Compulsive Disorder per se, which was categorized as an anxiety disorder in DSM IV but in the 5th edition was placed in the new category of Obsessive Compulsive and Related Disorders. The very brief explanation of the difference is that OCD per se is more severe and has a higher subjective experience of distress, whereas the personality disorder is characterized by a person who finds comfort in the OCD type behaviors and therefore is not usually motivated to change.<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJT-CwWOxORGZvW3_l0P87Ac2yQvsxlrn3rFJUVKxpNEBjFG-SCGceEM7BqL7Ws7CupYk6n281DjPmxDhnZlF2D6bZ36tdNOEiWP22tc8dEwWtYaRrjFYhx1DKAKeKccq4Stj3780HIzr2/s1600/trump-tower-E_9.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJT-CwWOxORGZvW3_l0P87Ac2yQvsxlrn3rFJUVKxpNEBjFG-SCGceEM7BqL7Ws7CupYk6n281DjPmxDhnZlF2D6bZ36tdNOEiWP22tc8dEwWtYaRrjFYhx1DKAKeKccq4Stj3780HIzr2/s320/trump-tower-E_9.jpg" width="213" /></a></div>
And, now, what we are really here for, Cluster B personalities. These are your worst nightmares, as a therapist. These are people for whom everyone else is wrong. Everyone else is at fault. They are blind to their own role in the making of their misery. Their behaviors are motivated to manipulate and use others while seemingly unaware of what they are doing. They have deep seated defense mechanism and are rarely motivated to change. After all, why should they change when they're never at fault? It's your fault. You made me this way. You change.<br />
<br />
Cluster B personalities are familiar to everyone, but they are notoriously difficult to define and understand. The characteristics that make up these personalities are somewhat disparate, and yet they appear together as a pattern again and again. You will rarely find Cluster B defined or described as a whole, because it is so difficult for people to get a conceptual grip on it. The APA's diagnostic manual, keeping it simple, describes Cluster B thus, "Individuals with these disorders often appear dramatic, emotional, or erratic." That's it. That's what the DSM has to say on the subject. The UK's NHA describes Cluster B thus, "Someone with a cluster B personality disorder struggles to relate to others. As a result, they show patterns of behaviour (sic) most would regard as dramatic, erratic and threatening or disturbing."<br />
<br />
I'm sure I can't expect to do better than the APA or the NHA, but here's my best shot . . . (1) thinking is characterized by cognitive distortions in the form of strongly developed defense mechanisms in which the individual fails to recognize the negative impact to them from their own actions and behaviors (more on this next time), (2) excessive use of out and out dishonesty and subterfuge, (3) actions and interactions frequently tied to secondary gains (i.e., attention seeking behavior), (4) excessive emotional reactions, and (5) apparent lack of substantive empathy (but superficial empathy may be expressed). These personality disorders, besides having some common characteristics, are conceptually tied because there is a fair degree of co-morbidity. In other words, it is not uncommon to find someone, for example, who has a combination of narcissistic and anti-social traits. And this holds true for all four Cluster B disorders.<br />
<br />
In this cluster, we have Anti-Social Personality Disorder. This is very broadly defined disorder that accurately describes just about anyone who has found themselves up against the criminal justice system more than once. It is more widely known by the older term of psychopathic personality. It's characteristics include lack of empathy, lack of stress reaction to violence, dishonesty, disregard for the safety of self and others (but, especially others), lack of remorse, impulsivity, consistent irresponsibility, etc. One point I would like to emphasize is that anti-social types often fail to plan or think ahead. This, of course, is tied to impulsive behaviors, lack of ability to get one's needs met through normative behaviors (e.g., holding a job and budgeting your money to pay rent), and lack of concern about consequences (because cognitively the individual is trapped in the moment, they seem blithely unaware that tomorrow is going to happen).<br />
<br />
Then there is Borderline Personality Disorder. This is the most difficult to understand and relate to, but we see this pattern of behavior quite frequently in the mental health system. With this personality profile, you often see intense emotional reactions, misunderstandings, the individual frequently attributes negative motivations to others, self harm behaviors (e.g., cutting), suicidal gestures, suicide attempts, intense anger (but often masked), and highly unstable relationships. Being in any kind of relationship with such an individual can be very difficult due to the constant manipulation and polar emotional swings between clinging and anger.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigrlB-I4Nypyd6Fzt78YwbZv_ajr-GZv0fs4doqNm510rT5hPB7ty8FH8Tz6p0uKkCipiF2ABAOFQWGNyEgubZhQ0_ARBute8uzrgm6P_PDLWmGLw46l9Qwrx3o6GcATBr5FbdTALwJqG6/s1600/fw_fainting-victorian-lady1.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigrlB-I4Nypyd6Fzt78YwbZv_ajr-GZv0fs4doqNm510rT5hPB7ty8FH8Tz6p0uKkCipiF2ABAOFQWGNyEgubZhQ0_ARBute8uzrgm6P_PDLWmGLw46l9Qwrx3o6GcATBr5FbdTALwJqG6/s1600/fw_fainting-victorian-lady1.jpg" /></a></div>
Histrionic Personality Disorder is the least often diagnosed of this cluster. Many clinicians and researchers have questioned the validity of this diagnosis, but I think it is more accurate to say it is an anachronism in the sense that it is an idiom of emotional distress that was common in the cultural context of the past but is much less common now. To give you a sense of the flavor, criteria include (1) Is uncomfortable in situations in which he or she is not the center of attention, (2) . . . inappropriate sexually seductive or provocative behavior, (4) . . . uses physical appearance to draw attention to self, (6) shows self-dramatization, theatricality, and exaggerated expression of emotion. Et cetera.<br />
<br />
And, lastly, we have Narcissistic Personality Disorder. It's been splashed all over the news, of late. Most people already have a sense of what narcissism is, but that concept is not necessarily the same as the personality disorder. Anyway, I'll save this one for a later, dedicated, blog post.<br />
<br />
In our next installment we'll try to get a grip on those pesky Cluster B cognitive distortions that are so damn crazy making.Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com0tag:blogger.com,1999:blog-7608061413873231665.post-19424888474121423682017-02-18T11:37:00.000-08:002017-02-19T07:37:40.854-08:00Portrait of a Personality Disorder, Part 1: What Is a Personality Disorder?<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiQiNkqS2sLVViBURwhR_eJVwGEGDq_FtAU1qd35O1Gski8z9PzE6yXEdSBoNDfFsJzfBCd8kL6UFDno3In7RERXqbIx9nM9BlAqCs9hGX3ybe-yP2IdFjm86uX5dP8vl7lD1rIlzL9k8m/s1600/women-s-2015-new-european-fashion-novelty-personality-color-block-Weird-letter-print-short-sleeve-cute.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiQiNkqS2sLVViBURwhR_eJVwGEGDq_FtAU1qd35O1Gski8z9PzE6yXEdSBoNDfFsJzfBCd8kL6UFDno3In7RERXqbIx9nM9BlAqCs9hGX3ybe-yP2IdFjm86uX5dP8vl7lD1rIlzL9k8m/s320/women-s-2015-new-european-fashion-novelty-personality-color-block-Weird-letter-print-short-sleeve-cute.jpg" width="294" /></a>Can a personality be an illness?<br />
<br />
Well, not exactly. Everyone has a unique personality. And, some are more likable than others, I suppose, but when and how is it appropriate to slap the "disorder" label on someone's personality?<br />
<br />
In answering this question, it is important to understand that all mental disorders, including severe disorders such as schizophrenia, are defined by behaviors and/or inner states that cause distress or dysfunction for the individual or for people around them. This concept is true of the larger medical field, as well. Take for instance the individual with six digits on each hand. It is an unusual condition, yes, but do we consider it an illness? No, nor should we (unless of course, having six fingers is excessively distressing and dysfunctional or you simply want to say it is so the insurance will pay for surgical "correction," but that's a wholly different blog post, for another day). On the other hand, being born with the inability to produce blood clotting components is considered a disease for the simple fact that it will lead to a quick demise unless treated.<br />
<br />
Biologically, every individual is unique, and the human population presents a vast range of phenotypes. Disease cannot be defined by deviation from the norm, alone, but must be defined by impact, dysfunction, pain and death. This is even more true with mental disorders. We cannot pathologize based on what looks different or anormative, alone. We have to limit our determination of disorder to the impact of behaviors and inner states, i.e., distress and dysfunction. And, this is even more important when discussing the pathology of personalities. Why? Because, it is far too tempting for us to label people we don't like or don't understand as disordered.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjT5ely3I7pbTu0eBW1fT8wxVS-ERjAGsh0dJJY9piqmV1r5p_6w5LOX1lTsNECH1WSyAHV9egETr-TSeNEgL-yMdg8cs-M-JuNo_kJz3Qia7eSjM7C7PYuqIB2bYcRuUdlK3lGWhbYgdAG/s1600/giphy.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjT5ely3I7pbTu0eBW1fT8wxVS-ERjAGsh0dJJY9piqmV1r5p_6w5LOX1lTsNECH1WSyAHV9egETr-TSeNEgL-yMdg8cs-M-JuNo_kJz3Qia7eSjM7C7PYuqIB2bYcRuUdlK3lGWhbYgdAG/s1600/giphy.gif" /></a></div>
<br />
According to the American Psychiatric Association (APA) in the latest diagnostic manual (DSM 5), "A personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, <i><b>and </b>leads to distress or impairment</i>" (emphasis mine).<br />
<br />
This definition attempts to limit the idea of personality disorder within strict parameters, but let's face it, it's still wide open. The DSM 5, like its predecessor, the DSM IV TR, then goes on to list 10 specific personality disorders grouped into three clusters, A, B, and C, and an eleventh, "unspecified" personality disorder for personalities that meet the general definition but do not meet criteria for any one of the 10 specific disorders. Lastly, there is a disorder for personality change due to a medical condition.<br />
<br />
Personality disorders carry some controversy in the field and some clinicians simply refuse to acknowledge them or diagnose them, but this is the minority of clinicians, I think. I too was very skeptical as a new clinician, but over two decades of working with a wide variety of clients, I have come to recognize there really are some distinct patterns of personality dysfunction and pathology, and it does us no good to pretend it does not exist.<br />
<br />
Personality disorders are categorically distinguished from major mental illness. This idea goes back a ways, well before Freud, even. The personality disorder idea is the intellectual descendant of the concept of <i>moral insanity</i>. This was a diagnostic category proposed in 1835 by a certain Dr. Prichard. He defined it as "madness consisting in a morbid perversion of the natural feelings, affections, inclinations, temper, habits, moral dispositions, and natural impulses, without any remarkable disorder or defect of the interest or knowing and reasoning faculties, and particularly without any insane illusion [delusions] or hallucinations." It remains an important distinction that personality disorders are defined by cognitive <i>distortions </i>and aberrant behaviors and emotions as opposed to cognitive <i>impairment </i>or delusions or hallucinations as these are indicative of major mental illness.<br />
<br />
Well, there's a nice little overview. Not too boring I hope. In the next installment, we will take a big bite into Cluster B types and figure out why they leave such a bad taste in your mouth. Then, we'll examine what we mean by cognitive distortions and why it leaves you wondering if you're the crazy one. Finally, we will narrow our focus on narcissists and what you can do when your family member, or your boss, or your president has this personality disorder.Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com0tag:blogger.com,1999:blog-7608061413873231665.post-67206160036047198112014-01-07T06:26:00.001-08:002017-02-10T08:38:24.981-08:00Psychoanalysis Comic, 1955<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlyuG_MmRozYVcFPe-L2mPGu897dGct-sZNxKHQ0rSBmy-byURq6pMh0hJYp5zTXPfDmqpqj9bPE8bsxF1-cqPQGpb9KmhGwXst-xoR66MkLs4-YsWZp6bSneYlxoQ4G2Exu4ystK_zY_0/s1600/PSYCHOANALYSIS_Tiny_Tot_Comics_1955.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlyuG_MmRozYVcFPe-L2mPGu897dGct-sZNxKHQ0rSBmy-byURq6pMh0hJYp5zTXPfDmqpqj9bPE8bsxF1-cqPQGpb9KmhGwXst-xoR66MkLs4-YsWZp6bSneYlxoQ4G2Exu4ystK_zY_0/s640/PSYCHOANALYSIS_Tiny_Tot_Comics_1955.jpg" width="447" /></a></div>
<br />Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com0tag:blogger.com,1999:blog-7608061413873231665.post-42525696991185945682013-11-06T10:56:00.001-08:002013-11-08T07:45:59.584-08:00Making Our Children Conform Using Mental TrickeryHere is an absolutely excellent article by Elizabeth Weil in the New Republic in which she analyzes the increasing use of various therapeutic techniques to get kids to conform to expected classroom behavior. It is a more subtle but insidious form of pathologizing children who are being normal children. Much of it is predicated on the now well known delayed gratification studies of young children. You've heard it before--the test child is told not to eat the marshmallow in order to get two marshmallows in a few minutes.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://www.newrepublic.com/article/114527/self-regulation-american-schools-are-failing-nonconformist-kids?google_editors_picks=true" target="_blank"><img border="0" src="http://designyoutrust.com/wp-content/uploads6/Bildschirmfoto20090916um14.26.28.jpg" height="221" width="400" /></a></div>
<br />
Everyone who has a child with childhood impulses is immediately struck by inner fear. Is my child the one who can't wait? What does this mean for her/his future career?<br />
<br />
Now this is the basis for all kinds of behavior modification schemes used in schools. The problems Weil outlines include that (1) we are telling our children they are mentally sick or wrong, and (2) the empirical evidence does does not support the actual interventions being used.<br />
<br />
It is yet another case of wanting to believe this is the right way to do things because it sounds good.<br />
<br />
<div style="text-align: center;">
<a href="http://www.newrepublic.com/article/114527/self-regulation-american-schools-are-failing-nonconformist-kids?google_editors_picks=true" target="_blank">Self-Regulation: American Schools Are Failing Nonconformist Kids</a></div>
<br />
Please take a look, it is worth the read.Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com2tag:blogger.com,1999:blog-7608061413873231665.post-82564569694162486622013-10-09T15:47:00.003-07:002017-02-18T08:38:50.060-08:00Seeking Safety from TraumaOver the last decade we have seen a deluge of spilled ink and sermons delivered on the topic of Trauma (capital letter intended). Therapists and other clinicians are wont to see Trauma as the cause of all mental/emotional distress and disorder. Payers and regulators want to see Trauma informed care as the standard for all services.<br />
<br />
Please don't misunderstand and think I am about to argue against trauma as a factor of etiology. I am not. Please do not think I am going argue against trauma sensitive care. I am not.<br />
<br />
I do, however, have to take issue with a number of things. One of which, I will briefly introduce here, is an intuitive response to emotional trauma (or the vision of Trauma in the mind's eye of the therapist). I have noticed a tendency among my colleagues to <i>fix </i>Trauma through the exclusive use of invoking Safety (capital letter intended).<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhh4GwqcpfMEQfDzEe6lvBnfE_Ve_UzqkGdOHseKdaoayvp2b5ooUpPWoYPw5-JItQnjv-SlkrZ_AfzCvEA0eazE-ZKoOVidZkougVv7J3sGNh0Pb8Qs0wF4LvvGRr-btX4Q4ArpuH9-H5w/s1600/aplaceimagined-indoor-toddler-playhouse.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhh4GwqcpfMEQfDzEe6lvBnfE_Ve_UzqkGdOHseKdaoayvp2b5ooUpPWoYPw5-JItQnjv-SlkrZ_AfzCvEA0eazE-ZKoOVidZkougVv7J3sGNh0Pb8Qs0wF4LvvGRr-btX4Q4ArpuH9-H5w/s320/aplaceimagined-indoor-toddler-playhouse.jpg" width="239" /></a></div>
What is Safety? It is a mythical destination we point people to who we believe are wounded by emotional trauma. In its simplest and cliched manifestation, it is the "safe place" we tell people to go to inside themselves when they are distressed by Traumas past or current. In its most Utopian manifestation, it is the construction (socially and physically) of a space (or whole communities) designed to remove all sources of trauma and reminders of trauma. A Safe place is a place where people speak to each other exclusively in soft and supportive tones. A Safe place has no rules to remind us we are not in control. In a Safe place no one tells me I am wrong. A Safe place is a place without "no".<br />
<br />
The idea of creating Safety seems to come to some practitioners by intuition and without need for training. For other practitioners (e.g., Sandra Bloom) it is a treatment model that is bottled, trademarked and sold, but more than that it is a morally driven world view. It is true by faith and has to be defended against the unbelieving (read: medical model).<br />
<br />
Why do we need to create Safety? Because Trauma doesn't just hurt in the moment, it continues to harm day after day, year after year. Life's little annoyances and disappointments are more than they are. They are reminders of the Trauma. Triggers and re-triggers. It harms even when the individual has no idea it continues to harm. Why? Because the clinician believes. Sometimes the individual doesn't even know they were Traumatized. In those cases, the true believing therapist has to help the individual remember . . . (we know where that leads).<br />
<br />
That's the reasoning for it. I can't fault the premise (that psychological trauma hurts), but I doubt the conclusions.<br />
<br />
So then, <i>does </i>creating a Safe place help? I feel the need to ask, if only because so many around me seem to take it on faith.<br />
<br />
I haven't come across so much empirical evidence apart from the some apocryphal study about mice and cat hairs. But maybe this Trauma-Safety dilemma has a corollary in Happiness? Seeking Happiness for the Sad seems like a very similar impulse to me. And in that realm I think we do have some evidence that tells us it is a fool's quest. Turning Sadness into Happiness through the power of affirmations, replacing negative self talk with positive self talk, while intuitively sensible, turns out to be the psychological equivalent of trying to catch a rainbow. Every time I tell myself I'm beautiful and smart and wonderful, the opposites of those things echo in the mind and I have to increase my affirmations louder and louder to myself, but in the end, affirmations in a vacuum do not lead to Happiness.<br />
<br />
Could the quest for Safety be a similar fairy tale? A nagging doubt tells me so. The fact that no one questions it, makes me worry all the more.<br />
<ul>
<li>Focusing so exclusively on Safety paradoxically highlights an individual's vulnerability.</li>
<li>Focusing so exclusively on past Trauma reifies victimhood and takes the person out of the here and now.</li>
<li>By focusing on victimhood we take away a person's agency.</li>
<li>By focusing on the past we can't change, we forget the here and now where a person actually <i>does </i>have the power to change things.</li>
<li>By externalizing cause and effect we have taken all control away from the person.</li>
</ul>
<div>
Considering these things, is it any wonder that we see so many people taking part in this therapeutic approach sink deeper and deeper into dysfunction?</div>
Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com4tag:blogger.com,1999:blog-7608061413873231665.post-77945327421320822132013-09-09T10:37:00.000-07:002013-09-09T13:43:36.425-07:00Autism's Tipping Point<div class="separator" style="clear: both; text-align: center;">
<a href="http://peteking.house.gov/sites/king.house.gov/files/featured_image/issues/autism-awareness.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://peteking.house.gov/sites/king.house.gov/files/featured_image/issues/autism-awareness.jpg" height="320" width="173" /></a></div>
Besides being an expert at neuroscience, to the benefit of the greater good neuroskeptic also dabbles in cultural criticism of science and healthcare with an eye toward empirical observation of the ethnocultural processes of those areas. A bit of armchair social science, but well done.<br />
<div>
<br /></div>
<div>
His latest piece on the phenomenal growth of autism:</div>
<div>
<br /></div>
<div>
<a href="http://blogs.discovermagazine.com/neuroskeptic/2013/09/04/are-we-heading-for-peak-autism" target="_blank">Are We Headed For "Peak Autism"?</a></div>
<div>
<br /></div>
<div>
Many have observed the unnatural increase in autism over recent years. In the midst of this apparent epidemic, news stories push "autism awareness" and "promising findings" about the cause(s) of autism.</div>
<div>
<br /></div>
<div>
Among practitioners, among psychiatric naysayers, among the small community of social scientists who make medicine, psychiatry and science their field of study, there has been much conjecture about the sociocultural factors behind the growth. The usual conclusion based on observation and/or conjecture, is that the incidence of the underlying condition has probably not changed dramatically, but instead we are seeing an expanding practical definition of autism as interpreted by clinicians in the field. You can add to this the fact of heightened awareness of the diagnosis resulting in people (clinicians, parents, teachers, etc.) seeing it where they didn't see it before (rightly or wrongly). This, in the context of a loosely defined spectrum disorder that (like all mental health diagnoses) is determined by a check list of behavioral signs and indicators allowing for broad differences of interpretation and understanding.</div>
<div>
<br /></div>
<div>
Sadly the places and people with money to pay for research don't seem particularly interested in putting resources into resolving this question.</div>
<div>
<br /></div>
<div>
Lucky for us we have a guerrilla social science researcher in neuroskeptic who counted the number of research papers (via PubMed) on the subject of autism, relative to several other disorders. He found that autism research has increased eight fold in 12 years, about twice the rate of ADHD (the next highest growth disorder) and maybe 4x (about) the growth of schizophrenia research. It is hugely out of proportion to the 4% growth in science (as a whole) per year.</div>
<div>
<br /></div>
<div>
I might take it a step further and just state what has been clear over the last 150 years or so of psychology and psychiatry--the field, popular and professional, is driven by fads.</div>
Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com3tag:blogger.com,1999:blog-7608061413873231665.post-58817353567162014282013-08-12T15:51:00.000-07:002013-08-12T20:14:47.191-07:00Peers of the Mental Health Realm<div dir="ltr" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The last decade has seen a flood of peer counselors in the public mental health system in the U.S., the basic idea modeled, if loosely, on the the practice of recovered addicts becoming counselors in the alcohol and other drug (AOD) treatment field. In mental health it has the added gain of making public mental health treatment a more humane and understanding place. Psychiatric survivor activists have long called for this move. If services are provided by counselors who have themselves experienced mental health problems and have been on the receiving end of services, then services will inevitably be rendered in a more sensitive and user-friendly manner.</span>
</div>
<br />
<div dir="ltr" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<b id="docs-internal-guid-17163a3e-74b8-cfa2-761d-63c467d4acac" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">These things are true as intended, but I feel the need to point out there is also a dark tangled mass of contradictions, uncertainty, and politics that inhabit the practice of peer counseling like a hidden cyst threatening to break open and poison the entire initiative. As always, I find myself the voice of doom and gloom in the fantasy land of Mental Health where fake positivism, false prophets, and general quackery goes hand in hand with unicorns, pixies, and evidence base practices.</span>
</b><br />
<b style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span></b>
<br />
<div dir="ltr" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<b id="docs-internal-guid-17163a3e-74b8-cfa2-761d-63c467d4acac" style="font-weight: normal;"><span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Peer counselors come to the public mental health field like faerie-activists waving their magic "recovery" wands. They go to the dark places of mental health--think Shutter Island, Sucker Punch, One Who Flew Over the Cuckoo's Nest, and hundred other examples--and these peers turn the dark places into sunlit gardens of recovery with doors broken open to let the sunlight in and to let the inmates out to discover they were never mentally ill to begin with--it was all a lie made up by psychiatry and Big Pharma.</span></b><br />
<b style="line-height: 1.15;"><span style="color: black; font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;"><br /></span></b>
<b id="docs-internal-guid-17163a3e-74b8-cfa2-761d-63c467d4acac" style="line-height: 1.15;"><span style="color: black; font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">The only thing is, it’s just another lie really. Let me give you a smattering.</span></b><br />
<b style="line-height: 1.15;"><span style="color: black; font-family: Arial; font-size: 15px; font-weight: normal; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><br /></span></b>
<b id="docs-internal-guid-17163a3e-74b8-cfa2-761d-63c467d4acac" style="line-height: 1.15;"><span style="color: black; font-family: Arial; font-size: 15px; font-weight: normal; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">1. Peers do not necessarily have special insight into the experience of individual mental health system users.</span></b><br />
<b style="line-height: 1.15;"><span style="color: black; font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;"><br /></span></b>
<b id="docs-internal-guid-17163a3e-74b8-cfa2-761d-63c467d4acac" style="line-height: 1.15;"><span style="color: black; font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">Mental health peers are self defined. It has to be so for simple legal reasons. A prospective employer is not permitted to ask about an applicant’s disability. It is contingent upon the applicant to decide if she or he is or is not a mental health peer.</span></b><br />
<b style="line-height: 1.15;"><span style="color: black; font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;"><br /></span></b>
<b id="docs-internal-guid-17163a3e-74b8-cfa2-761d-63c467d4acac" style="line-height: 1.15;"><span style="color: black; font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">In the AOD field, addiction disorders are a straightforward set of behavioral categories that are bound by a single phenomenon: addiction. Straightforward, relative to mental health anyway. By contrast, mental health disorders cover so vast an array of human behavior patterns so as to be absurd. What does it mean to be a mental health peer? Does someone who experienced adult attention deficit have some kind of special insight into what it’s like to experience schizophrenia? Or vice versa? If that seems like a stretch, it’s because it is.</span></b><br />
<b style="line-height: 1.3082386363636365;"><span style="color: black; font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;"><br /></span></b>
<b id="docs-internal-guid-17163a3e-74b8-cfa2-761d-63c467d4acac" style="line-height: 1.3082386363636365;"><span style="color: black; font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">Imagine, if you will, a world in which medical peers--people who have experienced medical problems and have received medical treatment in their lifetimes--replace nurses in your doctor’s clinic. Will a medical peer who has experienced medical treatment for eczema have some special understanding, gleaned from experience, into the medical needs of a patient with necrotizing fasciitis? Sound preposterous? Why then is the idea of mental health peers any less preposterous?</span></b><br />
<b style="line-height: 1.3082386363636365;"><span style="color: black; font-family: Arial; font-size: 15px; font-weight: normal; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><br /></span></b>
<b id="docs-internal-guid-17163a3e-74b8-cfa2-761d-63c467d4acac" style="line-height: 1.3082386363636365;"><span style="color: black; font-family: Arial; font-size: 15px; font-weight: normal; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">2. In mental health, recovery is a word without meaning</span><span style="color: black; font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">.</span></b><br />
<b style="line-height: 1.3082386363636365;"><span style="color: black; font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;"><br /></span></b>
<b id="docs-internal-guid-17163a3e-74b8-cfa2-761d-63c467d4acac" style="line-height: 1.3082386363636365;"><span style="color: black; font-family: Arial; font-size: 15px; font-weight: normal; vertical-align: baseline; white-space: pre-wrap;">One of the basic rationalizations for peer counselors is that a peer is a living example of recovery, a person with a mental health condition who has persevered, and met their therapeutic goals, and now can work productively as a peer counselor.</span></b><br />
<span style="font-family: Arial; font-size: 15px; line-height: 1.3082386363636365; white-space: pre-wrap;"><br /></span>
<span style="font-family: Arial; font-size: 15px; line-height: 1.3082386363636365; white-space: pre-wrap;">It stands to reason. This rationale works very well in AOD services where peer counselors are the norm. In that field, peer counselors have beat their addiction--they are in recovery--and they can help other addicts on the path to recovery through the wisdom of their experience.</span><br />
<span style="font-family: Arial; font-size: 15px; line-height: 1.3082386363636365; white-space: pre-wrap;"><br /></span>
<span style="font-family: Arial; font-size: 15px; line-height: 1.3082386363636365; white-space: pre-wrap;">Okay, that’s all well and good. But. In the AOD field, recovery is black and white. You are either using, or you aren’t. Recovery is tested and assured by urinalysis.</span></div>
</div>
<div dir="ltr" style="line-height: 1.3082386363636365; margin-bottom: 1pt; margin-top: 3pt;">
<span style="font-family: Arial; font-size: 15px; line-height: 1.3082386363636365; white-space: pre-wrap;"><br /></span>
<span style="font-family: Arial; font-size: 15px; line-height: 1.3082386363636365; white-space: pre-wrap;">If you think mental health has a standard of recovery, you are mistaken. Recovery, like the peer identity itself, is entirely self defined. Anyone, and I mean anyone, can walk through the door and proclaim they are a peer and they are in recovery. There is no testing and such claims are accepted at face value, at least at time of hire. This literally true.</span><br />
<span style="font-family: Arial; font-size: 15px; line-height: 1.3082386363636365; white-space: pre-wrap;"><br /></span>
<span style="font-family: Arial; font-size: 15px; line-height: 1.3082386363636365; white-space: pre-wrap;">Sadly, I have seen peer counselors (and therapists and psychiatrists for that matter) with untreated axis II disorders do great harm.</span><br />
<span style="color: black; font-family: Arial; font-size: 15px; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><br /></span>
<span style="color: black; font-family: Arial; font-size: 15px; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">3. The sudden, poorly thought-out growth in peer services is driven by feel-good politics</span><span style="color: black; font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">.</span><br />
<span style="font-family: Arial; font-size: 15px; line-height: 1.15; white-space: pre-wrap;"><br /></span>
<span style="font-family: Arial; font-size: 15px; line-height: 1.15; white-space: pre-wrap;">This true statement does not discount the possibility of benefit from having peers working in the system, but, it does tell us something about the process that led to the current situation and can illuminate how preventable problems were allowed to fester. The peer counselor initiative may have a grassroots origin in the consumer/survivor movement, but it came to fruition because of state legislatures and state level department heads made the decision that peer delivered services is a good thing and made it so through law and regulation that, if not mandates, at least incentivises the practice in many states.</span><br />
<span style="font-family: Arial; font-size: 15px; line-height: 1.15; white-space: pre-wrap;"><br /></span>
<span style="font-family: Arial; font-size: 15px; line-height: 1.15; white-space: pre-wrap;">System changes driven at the state level are seldom well considered.</span><br />
<span style="font-family: Arial; font-size: 15px; line-height: 1.15; text-decoration: underline; white-space: pre-wrap;"><br /></span>
<span style="font-family: Arial; font-size: 15px; line-height: 1.15; text-decoration: underline; white-space: pre-wrap;">4. And it is powered by cost cutting.</span><br />
<span style="font-family: Arial; font-size: 15px; line-height: 1.15; white-space: pre-wrap;"><br /></span>
<span style="font-family: Arial; font-size: 15px; line-height: 1.15; white-space: pre-wrap;">Medicaid reimbursement for services delivered by a peer counselor is considerably less than reimbursement for services provided by bachelors and masters level clinicians. This impacts state budgets.</span><br />
<span style="font-family: Arial; font-size: 15px; white-space: pre-wrap;"><br /></span>
<span style="font-family: Arial; font-size: 15px; white-space: pre-wrap;">Need I say more?</span></div>
Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com3tag:blogger.com,1999:blog-7608061413873231665.post-177614136366927542013-02-24T11:10:00.001-08:002013-02-24T14:28:33.079-08:00The Folly of DID<div class="separator" style="clear: both; text-align: center;">
<a href="http://upload.wikimedia.org/wikipedia/commons/7/7c/Racton_Monument-Tower-Folly_-_geograph.org.uk_-_145096.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="http://upload.wikimedia.org/wikipedia/commons/7/7c/Racton_Monument-Tower-Folly_-_geograph.org.uk_-_145096.jpg" width="240" /></a></div>
Not that I've been there myself, but I understand if you travel through England you might come across some of these apparent medieval towers or castles in various states of ruin.<br />
<br />
Except that they aren't medieval and they aren't ruins. They were built to look like ruins. Many of them were constructed in the 18th and 19th centuries by persons with excess wealth and imagination. A little bit of deception for someone's amusement. They refer to them with the term <i>folly</i>.<br />
<br />
That brings us to Dissociative Identity Disorder, AKA multiple personalities . . .<br />
<br />
I just came across this good review of the DID controversy by Dr. August Piper:<br />
<br />
<h3 style="background-color: #f9fafb; font-family: arial; font-size: 14px; text-align: center;">
<a href="http://ww1.cpa-apc.org/Publications/Archives/CJP/2004/september/piper.asp" target="_blank">The Persistence of Folly: A Critical Examination of Dissociative Identity Disorder. Part I. The Excesses of an Improbable Concept</a></h3>
<br />
Here is an excerpt:<br />
<br />
<div style="background-color: #f9fafb; font-family: Verdana, arial, sans-serif; font-size: 11px; text-align: left;">
With the recent appearance of several critical articles and books, the concepts of dissociative amnesia and dissociative identity disorder (DID) have suffered some significant wounds (1–5). Between 1993 and 1998, the principal dissociative disorders organization lost nearly one-half of its members (1). In 1998, <i>Dissociation</i>, the journal of the dissociative disorders field, ceased publication. A paper published in 2000 examined the weaknesses in the dissociative amnesia construct (6). Various dissociative disorder units in Canada and the US (for example, in Manitoba, Illinois, Pennsylvania, and Texas) have been closed down. US appellate courts have repeatedly refused to accept dissociative amnesia as a valid entity (6), and several ardent defenders of dissociative disorders faced criminal sanctions, malpractice lawsuits, and other serious legal difficulties.</div>
<div style="background-color: #f9fafb; font-family: Verdana, arial, sans-serif; font-size: 11px; text-align: left;">
<br /></div>
<div style="background-color: #f9fafb; font-family: Verdana, arial, sans-serif; font-size: 11px; text-align: left;">
<b>Nevertheless, despite the significant harm these concepts have wrought in North America, some Canadian and US practitioners continue to support, and practise according to, dissociative disorder concepts </b>(7–9). Further, these North American countries export the concepts. In India, for example, the cinema has influenced the production of dissociative signs (10), and 4 recent papers demonstrate a recurring interest in spreading awareness of DID to other countries (11–14).</div>
<br />
and on it goes.<br />
<br />
Like the follies built by the idle rich of the romantic period, DID is not simply wrong, it is a fantasy people want to believe and proliferate.Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com1tag:blogger.com,1999:blog-7608061413873231665.post-61601514700270236982012-12-29T18:21:00.001-08:002012-12-29T18:21:53.758-08:00Mental Illness and Danger: The DataYet again, Neuroskeptic delivers well vetted empirical data on topic and, as if, on cue. In this case a massive study in Australia exploring the statistical links between crime and mental illness.<br />
<br />
<div style="text-align: center;">
<a href="http://neuroskeptic.blogspot.com/2012/12/mental-illness-and-crime-yet-again.html" target="_blank">Mental Illness and Crime, Yet Again</a></div>
Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com0tag:blogger.com,1999:blog-7608061413873231665.post-28164335301069411202012-12-23T11:16:00.000-08:002017-02-18T08:43:52.395-08:00Mental Health or Gun Control?[accidentally deleted this post, so I'm reposting]<br />
<br />
<span style="background-color: #fff9ee; color: #222222; font-family: "georgia" , "utopia" , "palatino linotype" , "palatino" , serif; font-size: 15px; line-height: 21px;">Public discourse, political, media, whatever, likes to frame things in dichotomies, false or otherwise. No wonder that in the wake of yet another tragedy we seem to hear we have a choice with two options. Limit access to military style weaponry </span><i style="background-color: #fff9ee; color: #222222; font-family: Georgia, Utopia, 'Palatino Linotype', Palatino, serif; font-size: 15px; line-height: 21px;">or</i><span style="background-color: #fff9ee; color: #222222; font-family: "georgia" , "utopia" , "palatino linotype" , "palatino" , serif; font-size: 15px; line-height: 21px;"> provide more mental health services.</span><br />
<br style="background-color: #fff9ee; color: #222222; font-family: Georgia, Utopia, 'Palatino Linotype', Palatino, serif; font-size: 15px; line-height: 21px;" />
<span style="background-color: #fff9ee; color: #222222; font-family: "georgia" , "utopia" , "palatino linotype" , "palatino" , serif; font-size: 15px; line-height: 21px;">I don't like forced choice questions. Usually makes me feel like I'm being railroaded. Usually is the case too.</span><br />
<br style="background-color: #fff9ee; color: #222222; font-family: Georgia, Utopia, 'Palatino Linotype', Palatino, serif; font-size: 15px; line-height: 21px;" />
<span style="background-color: #fff9ee; color: #222222; font-family: "georgia" , "utopia" , "palatino linotype" , "palatino" , serif; font-size: 15px; line-height: 21px;">Just a few thoughts on the mental health side of the equation. People on both, or all, sides of the political spectrum are generally supportive of increased mental health services when something like this happens, but few people are aware of what that means or the issues involved.</span><br />
<br style="background-color: #fff9ee; color: #222222; font-family: Georgia, Utopia, 'Palatino Linotype', Palatino, serif; font-size: 15px; line-height: 21px;" />
<span style="background-color: #fff9ee; color: #222222; font-family: "georgia" , "utopia" , "palatino linotype" , "palatino" , serif; font-size: 15px; line-height: 21px;">Here is just an outline of a few things people should be aware of.</span><br />
<div class="separator" style="background-color: #fff9ee; clear: both; color: #222222; font-family: Georgia, Utopia, 'Palatino Linotype', Palatino, serif; font-size: 15px; line-height: 21px; text-align: center;">
</div>
<ul style="background-color: #fff9ee; color: #222222; font-family: Georgia, Utopia, 'Palatino Linotype', Palatino, serif; font-size: 15px; line-height: 21px; margin: 0.5em 0px; padding: 0px 2.5em;">
<li style="margin: 0px 0px 0.25em; padding: 0px;">Not every mental health problem can be resolved by talk therapy (an understatement)</li>
<li style="margin: 0px 0px 0.25em; padding: 0px;">Not every mental health problem can be resolved by medication (another understatement)</li>
<li style="margin: 0px 0px 0.25em; padding: 0px;">Except under very legally circumscribed circumstances, we, as a society, cannot make people visit and talk to a therapist.</li>
<li style="margin: 0px 0px 0.25em; padding: 0px;">Even where we can legally compel someone to see a therapist, we can't compel individuals to care or to want to change or to benefit from therapy they don't want.</li>
<li style="margin: 0px 0px 0.25em; padding: 0px;">Likewise, we cannot compel most people to take medications even if we think they are very not sane.</li>
<li style="margin: 0px 0px 0.25em; padding: 0px;">When we can compel someone to take medications, it may not actually help much, and may have severe repercussions for the individual (side effects up to and including death, psychological and physical trauma from restraints and forced injections).</li>
<li style="margin: 0px 0px 0.25em; padding: 0px;">Civil commitment laws (or interpretation of them) have drifted toward the individual liberty side of the equation. This is in no small degree a result of historical abuses in the mental health system. It likely also reflects shifts in the overall sociopolitical zeitgeist.</li>
<li style="margin: 0px 0px 0.25em; padding: 0px;">We generally cannot civilly commit, and thus compel treatment and seclusion, unless someone has already engaged violently or they have made credible threats. There are times when individuals with mental health problems plan violent actions and choose <i>not </i>to broadcast their intentions to mental health professionals. In these cases it is very hard to predict and even where we have concerns there is often very little we can do.</li>
</ul>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaUQFpmkclD8ecwkKw2E1asZzedEYbJV-0T5Gpjx4UNPMJqSmkIdIZm728ojf_j0c0wSQDVK0OgCTYz9gANPHaJaxOd6A9Opbb7TPck5bT3aVkecx9xaVxsywGakUwvRuFSpiXlFPCV76p/s1600/forced_injection_image.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="252" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaUQFpmkclD8ecwkKw2E1asZzedEYbJV-0T5Gpjx4UNPMJqSmkIdIZm728ojf_j0c0wSQDVK0OgCTYz9gANPHaJaxOd6A9Opbb7TPck5bT3aVkecx9xaVxsywGakUwvRuFSpiXlFPCV76p/s400/forced_injection_image.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">This continues to be the state of the field when it comes to extreme mental states and available interventions</td></tr>
</tbody></table>
<span style="background-color: #fff9ee; color: #222222; font-family: georgia, utopia, "palatino linotype", palatino, serif; font-size: 15px;">It saddens me deeply every time I talk to some parent who has come to me believing I will be able to intervene with their adult son or daughter with a psychiatric disability and I see the relentless disappointment on their faces as I explain to them the limitations of what we can do to intervene with an adult who does not want help.</span><br />
<br style="background-color: #fff9ee; color: #222222; font-family: Georgia, Utopia, 'Palatino Linotype', Palatino, serif; font-size: 15px; line-height: 21px;" />
<span style="background-color: #fff9ee; color: #222222; font-family: "georgia" , "utopia" , "palatino linotype" , "palatino" , serif; font-size: 15px; line-height: 21px;">Just so everyone knows. Increasing availability of mental health support may be a good thing and it may help, but it will never be a complete solution to protect us and our children from rampages and violence.</span></div>
<div>
<span style="background-color: #fff9ee; color: #222222; font-family: "georgia" , "utopia" , "palatino linotype" , "palatino" , serif; font-size: 15px; line-height: 21px;"><br /></span></div>
<div>
<span style="color: #222222; font-family: "georgia" , "utopia" , "palatino linotype" , "palatino" , serif;"><span style="font-size: 15px; line-height: 21px;">addendum -- Oregon is now looking at increasing civil commitment from six months to two years after a Eugene police officer was gunned down by a woman in a psychotic and paranoid mental state. I happen to think this is the wrong approach. Lengthening commitment would have made no difference to the death of the officer. The real rub is what it takes to place a hold and then commit someone. If the legislators want to make a difference, they will need to look at that issue instead.</span></span></div>
Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com2tag:blogger.com,1999:blog-7608061413873231665.post-30655331112642008732012-08-21T20:17:00.003-07:002013-02-24T11:25:00.804-08:00A Buffet of Childhood Diagnoses<div class="separator" style="clear: both; text-align: center;">
</div>
I just want to promote this very good post on Neuroskeptic on the North American epidemic of diagnosing young children with the adult disorder of Bipolar and the American Psychiatric Association's attempt to fight this problem by writing yet another childhood disorder into the DSM-V.<br />
<br />
<a href="http://neuroskeptic.blogspot.com/2012/08/psychiatrists-does-fire-put-out-fire.html" target="_blank">Psychiatrists: Does Fire Put Out Fire?</a><br />
<br />
What is it about North America that we want to believe all our children are mentally sick?Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com1tag:blogger.com,1999:blog-7608061413873231665.post-47869815623784609552012-08-20T17:15:00.001-07:002012-12-23T19:06:43.069-08:00Dissociation, DID, Culture, and Empirical Evidence<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
Dissociation is some kind of human phenomenon that crosses time and place in the human experience. Most forms of dissociation occur in the context of religious ecstasy. There are many many examples. Umbanda in Brazil. Indigenous Taiwanese healers. Balinese ritual trance (people have been know to go into spontaneous trance states even working in factories in Indonesia). Pentecostal direct experiences with the Holy Spirit. Speaking in tongues.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSI4j3l8gqMiAzBq1qi6Hef5fxEwVyfexqYLaLugFufm0e-6iPcy4bC4d_C3jYOOva2hKx4h8BJxlpJt91Qj31Y2CmYlVF3TKxmLUB_-28cowFC0ZZZqvPUPS2rkfMW1Pc7XuTL1ITiyq0/s1600/umbanda.jpg.crdownload" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="Umbanda trance" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSI4j3l8gqMiAzBq1qi6Hef5fxEwVyfexqYLaLugFufm0e-6iPcy4bC4d_C3jYOOva2hKx4h8BJxlpJt91Qj31Y2CmYlVF3TKxmLUB_-28cowFC0ZZZqvPUPS2rkfMW1Pc7XuTL1ITiyq0/s1600/umbanda.jpg.crdownload" title="Umbanda trance" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
The list goes on. But, we find that dissociation manifests differently in different cultural contexts.</div>
<br />
Dissociation itself is not what is in question, but Dissociative Identity Disorder (DID), previously known as multiple personalities, is.<br />
<br />
In North American culture, dissociation generally manifests, if not in a tent revival, than in the context of hypnosis or with the patients of certain therapists with proclivities for the promotion of DID.<br />
<br />
Does DID occur universally or is it a product of the North American culture of psychopathology? We already know that mental health disorders can be a product of cultural place and time. Hysteria in Victorian Europe and America is one well known example. Neurasthenia in China is another example that has been written on extensively.<br />
<br />
Is DID another disorder that is not universal but tied to the Zeitgeist of a particular place an time? Right now the field of mental health is in an intellectual tug of war on the topic. We have the historical record that gives us some insight. The concept of multiple personalities appeared early on in the development of the field of psychology, but it was an extremely rare diagnosis up to a certain point. That point was the publication of "Sybil" in 1973 and the subsequent film adaptation. This was the story of Shirley Mason, AKA Sybil Dorsett, who claimed to have multiple personalities, (and later said she made the whole thing up to please her therapist, and then changed her mind again). After the popularization of multiple personalities by "Sybil" it became a mainstream diagnosis and has benefited from several waves of popularity since.<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYBH2Cy84l2Uoz7zJADvOdUEi7T7Jjn5kPFH13w1pBPg1ALCalV0lU786N6tvkwWe4sWWSvWCDuH1qncck8mWSTCjrI_JYysyYCh6-TkKt8Co4wj73kRYNGZlmIZp1GgW_f_1q_Xvoqdw_/s1600/Sybil_DVD.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYBH2Cy84l2Uoz7zJADvOdUEi7T7Jjn5kPFH13w1pBPg1ALCalV0lU786N6tvkwWe4sWWSvWCDuH1qncck8mWSTCjrI_JYysyYCh6-TkKt8Co4wj73kRYNGZlmIZp1GgW_f_1q_Xvoqdw_/s200/Sybil_DVD.jpg" width="134" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Sally Field acting</td></tr>
</tbody></table>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJ6-lknA58ylrnxN5-kvLZIyWUJi5Nrv3D6ju38QuMHR-MXTMGNJ4bOe7oQd4errRVB8W_dZZTV4-cHkm4Jyj5_RlnU2qal4XrwCXMVCgnUvsxzOHhfcdyhMh-0ywJBwDgMu_YlGef76WE/s1600/shirley+mason.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJ6-lknA58ylrnxN5-kvLZIyWUJi5Nrv3D6ju38QuMHR-MXTMGNJ4bOe7oQd4errRVB8W_dZZTV4-cHkm4Jyj5_RlnU2qal4XrwCXMVCgnUvsxzOHhfcdyhMh-0ywJBwDgMu_YlGef76WE/s200/shirley+mason.jpg" width="138" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Shirley in youth</td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2Xsk3m1CdqBkbyy3gDA1t26LtHoxTWITMAgvsWDHIQdOdUDIgVZCsZVwx3QevUv0FCbBq4HPosQQFyiF2fJvLSSRir_a2jW0FF6St46aZ2AHpIDORN1tZAuimFtyQvxohkUTa3t8uPDtL/s1600/y_images_Sybil+Isabel+Dorsett_0.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2Xsk3m1CdqBkbyy3gDA1t26LtHoxTWITMAgvsWDHIQdOdUDIgVZCsZVwx3QevUv0FCbBq4HPosQQFyiF2fJvLSSRir_a2jW0FF6St46aZ2AHpIDORN1tZAuimFtyQvxohkUTa3t8uPDtL/s200/y_images_Sybil+Isabel+Dorsett_0.jpg" width="141" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">"Sybil" acting?</td></tr>
</tbody></table>
Dr. Richard J. McNally, et al., has now provided us with an empirical window on the topic. He crafted a controlled study to test a fundamental basis of the DID construct, the amnesic barrier. The amnesic barrier being the concept that as a DID identified individual transitions from personality to personality, the one personality has no direct memory of the other personality or personalities.<br />
<br />
These researchers used a concealed information task that consisted of flashed words on a screen in which subjects were instructed to push "yes" or "no" based on whether or not the word was on a list. What DID identified subjects did not know is that some of the words flashed on the screen were taken from surveys conducted with at least two of each of their personalities. The words were specific to the personalities, such as the name of a friend or a favorite food, for instance.<br />
<br />
The crux of the study was on a microsecond lag in pressing the button related to words autobiographical to the personality. This occurred as expected. Unfortunately for the construct of DID, the same delay occurred for words related to alternate personalities (not currently present/aware personalities), showing that knowledge crosses alternate personalities, undermining if not disproving the amnesic barrier. It also implies, if not deception, at least an attempt on the part of the subjects to conform to the cultural model of DID.<br />
<br />
McNally concludes that "Cultures provide envelopes for people to express suffering or psychological pain and DID is one such cultural trope. . . . I don't think much would be lost if the diagnosis were eliminated from the Diagnostic and Statistical Manual."<br />
<br />
<a href="http://news.harvard.edu/gazette/story/2012/08/a-story-that-doesnt-hold-up/" target="_blank">Source: "A story that doesn't hold up" in the Harvard Gazette</a><br />
<br />
<a href="http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0040580" target="_blank">Original paper is on PloS ONE here</a>Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com0tag:blogger.com,1999:blog-7608061413873231665.post-63643530888185587082012-08-20T15:01:00.001-07:002017-02-26T18:07:02.678-08:00DID in defense of crime: the case of William Bergen Greene and his therapist<div class="separator tr_bq" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg12bVQdbq05c04QLztx1wn-y7PhSanecYHQ2AkZZLI7-7vMoflEn90YlbMl_hvSP5LdI10YdkY23MhPfOVjNXBuh9WyfcpZnJpaEj4RuPhTC_U_CinnDJpltW2ZGCQ5bxHP2gjCOIDb7tB/s1600/1128414.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="mugshot of William Bergen Greene" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg12bVQdbq05c04QLztx1wn-y7PhSanecYHQ2AkZZLI7-7vMoflEn90YlbMl_hvSP5LdI10YdkY23MhPfOVjNXBuh9WyfcpZnJpaEj4RuPhTC_U_CinnDJpltW2ZGCQ5bxHP2gjCOIDb7tB/s1600/1128414.jpg" title="Greene" /></a></div>
William Bergen Greene was a troubled man who started with a troubled childhood. He apparently suffered severe abuse as an early child until he was made a ward of the state at age eight. He suffered further abuse in foster homes and institutions. At age 17 he escaped from his institution and started his adult life of chronic criminality. He was so frequently convicted of sexual offences that he spent the vast majority of his adult life in prison. He remains incarcerated today in Washington State.<br />
<br />
He became a prison sex offender patient after a 1988 conviction. His prison sex offender therapist, known to the public only by the initials M.S. (because she later became another victim of Mr. Greene's many sex offenses), was the first to diagnose him with Dissociative Identity Disorder (DID) otherwise known as multiple personalities.<br />
<br />
Her course of therapy started with hypnosis. With this extremely questionable (if not negligent) technique she proceeded to draw out (or co-develop) some 24 personalities in her patient, not the least of whom were "Auto," a non-human robot personality, and "Smokey" the dragon. Yes, a dragon personality.<br />
<br />
Another therapist at the prison disagreed with M.S.'s diagnosis. Instead he diagnosed Greene with Malingering. Incidentally, malingering is listed and described in the psychiatric diagnostic manual and is designated with code V65.2. V-codes generally indicate a diagnostically important factor or condition that is not itself a disorder. Malingering, of course, is not a disorder that is treatable under Medicaid but is described as "the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives." Typically, external incentives have to do with financial gain, or avoidance of responsibilities or consequences. In this case, Greene was already convicted and incarcerated. The dissenting therapist warned that Greene's malingering was motivated by his life-long pursuit of sexual victims. He warned that Greene was setting his therapist, M.S., up for a future assault. The dissenting therapist's assessment proved to be prophetic, but sadly failed to influence M.S. Not only did she continue her work treating Greene's purported DID, she seemed to become increasingly close to her patient.<br />
<br />
Greene was released from prison in 1992. Within days of his release, M.S. quit her job at the prison and took Greene on as a private patient.<br />
<br />
Was it coincidence that she quit immediately after his release? I can't say, but it is suggestive of a therapist who was severely enmeshed with her patient.<br />
<br />
She met him for therapy on a routine of bi-weekly sessions, but if so, they must have been extremely long sessions, because by the end, when he finally assaulted her in 1994, she had racked up over 2000 hours of therapy with this single patient. By comparison, standard out-patient therapy is generally in the range of 12 to 54 hours of therapy per year. Yet more evidence of enmeshment if not outright obsession on the part of the therapist.<br />
<br />
M.S. received a phone call from a distressed Greene on April 29, 1994. She knew he was under stress from several things and she was worried he might be suicidal, so she went to meet him at his apartment. He was talking very slowly with a childlike voice. He kept referring to himself as "we." I will add here, the "royal we" is a common trait or affectation among DID patients and it seems unlikely it was the first time he used it in M.S.'s presence but later, in court, she would use it as one of the evidences of his personality fragmentation at the time of the crime.<br />
<br />
At some point, as M.S. tried to console the oddly behaving Greene, alone with him in his apartment, she figured out that he was on cocaine. In a moment of good judgment, she chose to leave. Unfortunately for her, he barred her way out. They struggled and M.S. fell. He ripped off her shirt and bra and touched her, ignoring her protestations and clear statements for him to stop. He took her to the bathroom and held her there for two hours. He continued to molest her there, taking breaks only to shoot up a drug, presumably cocaine. Throughout this incident, Greene's behaviors were later described by M.S. as childlike with frequent but brief bouts of crying. Near the end he removed his own pants and touched himself but failed to achieve a result and soon after said she could go, but when she tried, he changed him mind, tackling her and left her bound and gagged as he removed himself from the scene in M.S.'s car.<br />
<br />
Once Greene had fled, M.S. was able to remove her bonds and escaped to a hospital across the street where she called the police. Greene was soon apprehended and charged with kidnapping and indecent liberties.<br />
<br />
Greene plead not guilty by reason of insanity, but in his first trial, Judge Thorpe ruled that DID could not be used in an insanity defense due to lack scientific consensus on the existence of the disorder. The defense attorney, David Koch, was not permitted to even mention DID. Greene himself assisted his defense attorney, telling his attorney that one of his alter personalities was trained in law. Without DID as a defense, the case rested solely on whether or not Greene had committed the deeds. He was quickly found guilty on both counts.<br />
<br />
In 1998, Greene and Koch appealed to the Washington Court of Appeals. Appeals continued back and forth up to the U.S. Ninth Circuit Court and, in the end, he was granted a retrial. <br />
<br />
A pre-trial hearing was held to determine if DID could be used as an insanity defense. The defense team brought in expert Dr. Robert B. Olsen who testified that DID was generally accepted in the field but conceded after interviewing Greene, he could not say who Greene really was much less determine his sanity due to the number of alter personalities. The prosecution brought in their own expert, Gregg J. Gabliardi who failed to challenge DID, stating that he agreed it was generally accepted. His only contribution to the prosecution was to testify that it would be impossible to determine the sanity of each separate personality or determine which personality was responsible for which of the actions Greene had taken.<br />
<br />
This was clearly a low point in the field of psychiatry when two psychiatrists under oath fail to mention any controversy related to this diagnosis. One wonders if Olsen or Gabliardi had in fact believed they could determine guilt and responsibility of one specific personality out of 15, what the criminal justice system would be expected to do with that information? How do you incarcerate one personality out of many?<br />
<br />
With the given experts, it is not surprising in the retrial the defense was allowed to use DID as an insanity defense to claim that Greene was not legally responsible for his actions. He had two new public defenders in the second trial, Teresa Conlan and Marybeth Dingledy. The second trial took place over five days in September 2003 in Snohomish County courthouse.<br />
<br />
In one of the strangest twists in the history of DID being used to avoid truth and consequences, Greene's victim, his former therapist, the now 53-year-old M.S. demanded to testify in his defense. In the retrial she was permitted to do so. She claimed that only she could explain the impact of his terrible disorder, DID, on Greene and its role in causing his behavior on the night of his attack on her. M.S. testified before the court that it was not Greene himself who had attacked her but actually three of his alter personalities: Sam; Tyrone, a three or four year old; and Auto, a robot. She explained to the jury it was not Greene, but Auto the robot who grabbed her and held her down. It was not Greene who molested her for two hours, but Tyrone the child. The personality Sam appeared for only a moment and tried to save her, but was quickly taken over by the other two personalities. M.S. testified her belief that the chronic sex offender Greene was not responsible for the attack because he was not present during the attack and had no awareness of it until he was informed of it later when he was in police custody.<br />
<br />
In an odd about face, the expert witness, Dr. Olsen, who had originally testified for the defense, switched sides and testified for the prosecution in the actual trial itself. He now said he believed Greene was malingering. In the trial, the prosecution also brought in a new expert witness, psychologist Richard Packard who testified that Greene did not have DID at all. Packard diagnosed the chronic sex offender with antisocial (AKA psychopathic) personality disorder and a sexual paraphilia disorder. Packard further stated his doubt about the veracity of DID as a legitimate disorder. Packard firmly believed that Greene had simply been faking DID from the beginning. Greene's cellmate, a certain Eric Fleischmann, testified that he too attempted to fake DID with Greene's coaching but had failed.<br />
<br />
Defense witness, Dr. Marlene Streinberg, then vice president of the International Society for the Study of Dissociation, testified that DID was real and that Greene fit the profile. In spite of Dr. Streinberg's rather weak assertions and in spite of the frantic testimony of an enmeshed and obsessed therapist, Greene lost his second trial and was again found guilty on both counts. The jury deliberated for five hours and were done in time to go home for dinner. Greene was sentenced to life as a three-strike felon<br />
<br />
Now in prison, Greene has since been charged with the 1979 rape and murder of a 25 year old woman by the name of Sylvia Durante in Seattle. Greene's DNA from his sperm was found on Ms. Durante's body. He was convicted of her murder in 2005.<br />
<br />
Not everybody is a believer in DID. No matter how self important and self righteous the tone of its promoters like Streinberg, jurors, and most people with any level of critical thought or common sense, remain unconvinced. Juror, Jim Camp, from Greene's retrial, stated the jury "just didn't believe it."<br />
<br />
Sources:<br />
<blockquote>
Sullivan, Jennifer; Insanity defense fails for attacker; <i>The Seattle Times</i>; Nov. 21 2003; as viewed on web 8/2012. </blockquote>
<blockquote>
Fersch, Ellsworth; <i>Thinking About the Insanity Defense: Answers to Frequently Asked Questions</i>; iUniverse, Lincoln, NE: 2005</blockquote>
<script async src="//pagead2.googlesyndication.com/pagead/js/adsbygoogle.js"></script>
<!-- psychgrip01 -->
<ins class="adsbygoogle"
style="display:block"
data-ad-client="ca-pub-5910952320421723"
data-ad-slot="3638515249"
data-ad-format="auto"></ins>
<script>
(adsbygoogle = window.adsbygoogle || []).push({});
</script>
Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com0tag:blogger.com,1999:blog-7608061413873231665.post-79732100237358121322012-08-13T11:47:00.002-07:002012-08-21T19:57:24.942-07:00Multiple Personalities and ResponsibilityMultiple Personalities, now known as Dissociative Identity Disorder (DID), is the single most controversial diagnosis in the diagnostic manual. Most would agree with that statement I think.<br />
<br />
One of the most bizarre aspects of this diagnosis and its promoters is the wish to have their cake and eat it too. Let me give you a few examples of what I am talking about. These are composite examples that have been slightly altered, not pertaining to any individual patient, but the comments attributed to therapists essentially express comments I have heard at one point or another.<br />
<br />
Patient A signed a legal contract and later wanted to back out. Patient A's therapist states, without any sign of misgiving or embarrassment: "People just don't understand that [Patient A]'s part [alternate personality] signed the contract and [Patient A] can't be held responsible." Why is this having and eating cake simultaneously? Well, let me explain. Both the patient and the therapist believe and strongly advocate for Patient A's right to live and act in the community as a fully fledged adult citizen, and yet, they both want the world hold Patient A free of all agreements and obligations that Patient A has selectively decided some other personality inhabiting her body is responsible for. This sort of undermines the basic social contract doesn't it? Either Patient A is mentally competent to make agreements and sign contracts and be held responsible for her obligations, or if she really cannot competently sign contracts and be held responsible due to her psychiatric condition she should not be allowed to and her her therapist needs to be working to develop a legal guardian who can actually make binding decisions on behalf of Patient A who is apparently not competent to do so on her own.<br />
<br />
Patient B is granted Social Security Disability for a psychiatric condition. His primary diagnosis is DID. He then enters university and goes through to complete a graduate program. Throughout, he continues to receive monthly disability payments intended for individuals who are too disabled to work. Both he and his therapist maintain that Patient B is both entitled to disability and able to legitimately complete a graduate program in the field of economics because his parts switch only when he is at the school and he can temporarily maintain his "host personality." When returning home or out in the community he "switches" to different personalities and is therefore disabled. After receiving his degree in economics, he continues to receive monthly disability payments and his therapist continues to be paid by Medicaid. Patient B is both disabled and yet he is not. It seems to me an ethical and competent therapist would be working with Patient B to utilize his graduate degree in a productive manner to his own personal and financial benefit. Instead, the therapist continues to promote the idea that in spite of earning a graduate degree Patient B is too disabled to work and must continue in therapy indefinitely. It may be no coincidence that if Patient B earns wage income, he will ultimately lose both Social Security Disability and Medicaid and the therapist's cash cow with dry up.<br />
<br />
Patient C commits a felony crime of posing as a property owner (which she is not), collecting deposits and rents from multiple prospective renters and then flees the scene. She spends the money on a car, clothing and a purebred Pomeranian dog for herself. When tracked down by detectives and arrested, Patient C, her therapist and her defense lawyer all maintain that Patient C cannot be held responsible for the crime. None of them dispute that her physical body was present at the time of the crime and in fact committed the crime, but they claim her body was inhabited by a personality who believed it was the property owner, therefore person/body of Patient C (the only legal and biological entity in this case) cannot be held responsible. The "host personality" of Patient C cannot be held responsible because she was dissociated and was not aware of what occurred and had no control over it. Furthermore, the "property owner" personality cannot be held responsible either because he/she/it really believed it was a property owner and did not realize it was committing a crime. What does the therapist and defense attorney request? That Patient C be freed and allowed to continue the same therapy (that failed to prevent her criminal behavior in the first place) because this is what Patient C "needs."<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgb17AQqK_VwfdasQkgcF027UfRm2PiOyEDaj3MF1kcMvkWgWLMtHAxXOgwKH7WdEkaQlE6L6rhFMxZh7dxsDmiyieSR_F3uBsCu17DhbNpW-CkaZHfieTpZ9tnKy7qomD0poPJIIY3tWjx/s1600/jekyll-hyde3.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="Dr. Jekyll and Mr. Hyde" border="0" height="270" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgb17AQqK_VwfdasQkgcF027UfRm2PiOyEDaj3MF1kcMvkWgWLMtHAxXOgwKH7WdEkaQlE6L6rhFMxZh7dxsDmiyieSR_F3uBsCu17DhbNpW-CkaZHfieTpZ9tnKy7qomD0poPJIIY3tWjx/s400/jekyll-hyde3.png" title="Is Jekyll responsible for Hyde's crimes?" width="400" /></a></div>
<br />
DID patients, therapists and promoters seem to have a problem with responsibility. Basically they can disavow responsibility for anything with negative consequences for the patient/client/consumer but otherwise expect the world to treat the DID patient as a completely competent and responsible citizen. Does that sound just a little too convenient? Most jurors find it pretty fishy, that's why it almost never succeeds as a legal defense, but that doesn't stop people from trying.<br />
<br />
Here are some interesting facts about DID and crime. A small study published in 1989 (Putnum, Diagnosis and treatment of multiple personality disorder) found that 35% of female DID patients reported committing crimes including 7% of which were homicides and 47% of men with DID reported committing crimes of which 19% had committed homicide.<br />
<br />
In the end, you can't have your cake and eat it too.Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com0tag:blogger.com,1999:blog-7608061413873231665.post-14107275170116803312012-07-29T11:57:00.004-07:002012-07-30T08:13:10.334-07:00Why Does Norway Want Breivik to Be Insane?Anders Breivik bombed downtown Oslo and went about methodically murdering 77 people and injuring many more. In his recent trial that came to a close last month he calmly described how he did it and discussed with detached curiosity the victims' various reactions or lack of reactions to his attacks. Throughout, he taunted family members, survivors and the world with what can only be described as a psychopathic sneer.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtUjRy4mntfVJhElNTeQgJT0bS2btN8GqpzykrIH3BxVShDYE0hfou_NZZk2Kgg6Asi5Dv0tw3n1iebm5KbpgEPZOwFypgO5ojAvXYS56XIt6fktufATikpZmNIHWcHEB3UaUHCl5i0OVM/s1600/breivik_sociopath.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="sociopathic killer photo from trial" border="0" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtUjRy4mntfVJhElNTeQgJT0bS2btN8GqpzykrIH3BxVShDYE0hfou_NZZk2Kgg6Asi5Dv0tw3n1iebm5KbpgEPZOwFypgO5ojAvXYS56XIt6fktufATikpZmNIHWcHEB3UaUHCl5i0OVM/s400/breivik_sociopath.jpg" title="Anders Breivik's subtle sneer" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A sneer, micro or macro, is the universal expression of contempt</td></tr>
</tbody></table>
<br />
Is he insane? This was the central question the recent trial revolved around. Prosecutors want him to be insane, even though they now admit their doubt on the subject. Prosecutor, Svein Holden, is quoted by the BBC as stating, "We are not convinced or certain that Breivik is insane but we are in doubt." And yet, they continue to argue he should not be imprisoned but should instead be committed to a psychiatric institution.<br />
<br />
Here, insane is more or less defined as psychotic. Is he psychotic (insane) or psychopathic (sane but very very bad)? That is the question. Technically the defense is on a fool's mission to explain his actions as justified, but that is beyond absurd. One wonders if the defense attorneys have undergone cognitive deficiency testing themselves--if not, perhaps they should. While there is little if any evidence of actual psychosis there is a strong desire to place Breivik in that category, or maybe more to the point, to place him outside the categories of normal or sane.<br />
<br />
Other than the fact that Norway has one of the most lenient and forgiving criminal justice systems on the planet, I know too little of that place and culture to fully understand their reasoning. I can only surmise it gives some comfort to hold a belief that a man capable of doing what Breivik did cannot be normal or sane. In a lay sense, what Breivik did makes him, by definition, insane. This creates a safe psychological boundary between him and us.<br />
<br />
It is an understandable sentiment, I'm sure. But what does it say about a criminal justice system where prosecutors are not motivated by truth but by the outcome that makes them the most comfortable?<br />
<br />
Can a man like Breivik be helped by psychiatric care? <i>If he were in fact psychotic,</i> there are drugs that may (or may not) help. Add some cognitive-behavioral whatnot and sometimes we see improvement, even dramatic improvement at times. Conversely, if he is a straight up psychopath (as is likely the case), there is very little help possible if we want to be honest about it.<br />
<br />
The Norwegian prosecutors fail to recognize the collateral impact of their strategy is to add more fear and stigma to the actual insane, the 1% or so of the world's population with a form of psychosis at some point in their lives. Granted there have been plenty of psychotic shooters and killers over the years, and we may very well have experienced another one in Colorado just this month, but the vast majority of people with psychotic experiences, <i>1% of the world's population</i>, are as non-violent as anyone else. Some psychotic individuals can be dangerous, but lets not pin everything too horrific to comprehend on them just to make us feel a little more removed from the human potential for evil.Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com0tag:blogger.com,1999:blog-7608061413873231665.post-51652140036867014932012-07-07T16:54:00.000-07:002012-07-30T08:16:11.886-07:00They Want Us to BelieveThere is a ubiquitous use of tense in mental health treatment, and curiously, it highlights an interesting contrast with the evangelists of multiple personalities. <br />
<br />
In working with people on the more severe end of the spectrum of mental health disease (or "disease" in quotations if you prefer) we usually find that we cannot directly challenge beliefs <i></i><i>we believe</i> are delusive without threatening to lose the relationship, the precious rapport, that is often our only hope of helping, and yet we don't want to reinforce the delusion just in order to maintain rapport as that would also be counterproductive, so we try to ease our way through the dilemma with a little play of tense. The client speaks in the indicative, "I have an implant in my neck that Richard Nixon speaks to me though." It is a solid fact. Meanwhile, we clinicians reflect in the subjunctive, "You believe . . .", "You said . . .", or you might even risk a "I believe you believe . . ." We leave it in an open and conjectural mood to show understanding, and thereby avoiding conflict, but without reinforcing.<br />
<br />
Changes in tense are also important in the strictly professional side of mental health when we take our professionally sanctioned beliefs and apply them in the real world. The ultimate document of professional belief, the Diagnostic and Statistical Manual, <i>The DSM</i>, is written entirely in the indicative tense. Every mental health diagnosis is a fact and every criterion of every diagnosis is a fact. These facts are immutable immobile objects with crisp edges. The DSM is seemingly free from conjecture or uncertainty, much less fantasy and make believe. Here we find ourselves in another dilemma because most clinicians (and researchers too I would guess) do not believe the diagnostic categories handed down from on high are factual at all. Most of us handle these interesting but crude objects with healthy skepticism. They are all works in progress that may or may not hold up long enough for the next edition. The clients we work with are individual people who do not always so easily fit these models. We are well aware they are just that, models. Is Schizophrenia really a single disease entity or several that happen to look similar? No one really knows for the time being. So, we think and talk about these things in the subjunctive manner even though Medicaid forces us to write out our final diagnoses in the indicative.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgie6Qmy0zNwHZt1zz6kP7hDKXRB4LCAEX56CbasjUCQPZV9w4jJK18mBLCBUXmcEQaBFoUFgw0IvRgZ0nuTKNMkruNiQyfDlGzpXRafJMaAEf5O-C4bLuU3LKXb_pj94pHxoai6gaJSETT/s1600/I-Want-to-Believe-A4a2.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="three faces of eve as flying saucer UFO" border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgie6Qmy0zNwHZt1zz6kP7hDKXRB4LCAEX56CbasjUCQPZV9w4jJK18mBLCBUXmcEQaBFoUFgw0IvRgZ0nuTKNMkruNiQyfDlGzpXRafJMaAEf5O-C4bLuU3LKXb_pj94pHxoai6gaJSETT/s400/I-Want-to-Believe-A4a2.jpg" title="I want to believe in multiple personalities" width="282" /></a></div>
It has recently struck me, however, when it comes to therapists who are wont to diagnose and promote Dissociative Identity Disorder (or Multiple Personality Disorder), the above outlined patterns do not hold.<br />
<br />
Firstly, there is no distance between the belief of the clinician and the belief of the client. They become fused in a shared belief. A shared fantasy. A shared dramatic enactment. Between clinician and client, the belief system is spoken of in the indicative. Changes of mood are distinct personages inhabiting a single body. The clinician pronounces it. The client reflects it and gradually comes to act it and be it. The reality that DID becomes depends on the indicative mood. The clinician and client must truly believe and always speak of it in the most confident and unwavering language. Any doubt may cause the mirage to waver and blow away in the wind. The clinician is on stage also, enacting the role of professional therapist, but it is an "as if" that only looks like therapy. In fact, it is therapy in reverse, rather than curing or ameliorating, with this therapy the symptoms of the client strangely increase in strength and definition over time and eventually become cemented facts.<br />
<br />
Secondly, there is no healthy skepticism on the part of the clinician in the professional realm. Always these therapists use the same indicative tense used in the DSM whenever discussing their one cherished true diagnosis of DID. They are believers who want us to believe in it too. To convince themselves and us, they don't use the language of belief, they use the language of hard facts. There are no maybes or uncertainties. The facts of DID are proven and true. Professionals who doubt run the risk of being called closed-minded or ignorant of the facts, or finally when we fail to align we are told we are invalidating toward their clients--spoken as if it is the worst possible insult. It always strikes me that the selfsame therapists who want so hard to believe in the <i>fact</i> of DID are often the most doubtful of just about any other diagnosis in the DSM. I have been told by a straight faced bearded therapist that many cases of Schizophrenia <i>are actually </i>DID. There are many many people out there with mood fluctuations who have DID and don't even know it. Or so I'm told. I suppose the right therapist can skillfully draw out the symptoms and turn annoying mood fluctuations into a disabling condition and Medicaid will reward the therapist for many years to come.<br />
<br />
It may be no coincidence the only other people I have experienced such a hard sell from, miraculously turning uncertainties into facts, are car salesmen and preachers. I can't say that I've ever knowingly been part of a cult, but I imagine cult leaders also are inclined toward an indicative mood.Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com0tag:blogger.com,1999:blog-7608061413873231665.post-41212055360642756172011-05-10T13:35:00.000-07:002011-05-13T10:47:56.351-07:00Bipolar Paradigm Swings<div class="MsoNormal"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWtKMkfRzC0zc6CKLlikH3qjUsOw-W-5Y2Dsjwi7CfOHTmf5z7orVDZ62lmLPV_beeuoksz15C8GMRQyV11k-wZOktJifS8Y7Q1M67ZI4dPKxcwMIEI-kx7j7RZES6tJ8gosdMWrFLFH2a/s1600/hula-hoops.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWtKMkfRzC0zc6CKLlikH3qjUsOw-W-5Y2Dsjwi7CfOHTmf5z7orVDZ62lmLPV_beeuoksz15C8GMRQyV11k-wZOktJifS8Y7Q1M67ZI4dPKxcwMIEI-kx7j7RZES6tJ8gosdMWrFLFH2a/s320/hula-hoops.jpg" width="260" /></a></div><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">But seriously folks, there really is a problem with the trauma fad. Just the other day, I had a therapist tell me, without blinking an eye, that 95% of mental illness is caused by trauma. And, as you might imagine, coming from a therapist, the statement was made with the upmost in self-important tones with flavor highlights of virtuous condescension.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Yes, obviously, she read it off a brochure, or somewhere in all that blather on the web that has taken the place of brochures. But where did this “fact” originate in the first place?</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Looking back to the mid-20<sup>th</sup> century, there were any number of theorists who promoted the idea that schizophrenia was caused by trauma, or at least, early childhood events and social environment. Generally speaking, dating back to this era, we have the idea that a child bonds with a parent (the word “attachment” is quite chic at the moment), the parent psychologically hurts the child’s sense of self—typically through abuse, neglect or ambivalence (this is the basic trauma)—and, the child ultimately develops schizophrenia or just about any other diagnosis you can think of for that matter. Here we have the infamous “schizophrenicgenic” mother who relates to her child in an ambivalent or abusive manner and causes the child to become insane in adulthood. The theoretic underpinning is the (now dated) belief that schizophrenia is a result of a weak ego that disintegrates and is overwhelmed by the id when the subject is faced with the challenges and pressures of adult life.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Essentially, childhood trauma perpetrated by an adult (to who the child is bonded) results in the development of a weak ego. A weak ego results (later in life) in flooding of impulses and internal stimuli emanating from the subconscious. Hence, insanity. Neat little theory and it was quite the rage in the 50’s but slowly declined in subsequent decades and by 1990 had very little following in professional circles.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">You can dig even deeper into the intellectual history of psychology. Freud comes to mind and he had his antecedents in previous beliefs about the causes of insanity going all the way back to Plato and Hippocrates. Hippocrates, as you might imagine, saw insanity as caused by an imbalance of <i>humors</i> in the body, but Plato interpreted it as <i>reason</i> being overwhelmed by <i>emotion</i> (but before you get too excited keep in mind that Plato also advocated that people who were sick and not likely to contribute should simply be killed). This is just to point out the old nature versus nurture or, more correctly, mind (or spirit) versus body debate goes way back to ancient times and has been with us ever since.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Fast forward: Prozac was approved by the FDA in 1987. One of the first atypical antipsychotics, Clozaril, was made available in 1989. The schizophrenicgenic mother idea had been on the decline for a very long time and the biomedical model was on the rise, driven by pharmaceuticals and helped along by National Alliance for the Mentally Ill, an advocacy group whose core mission was to combat the blame-the-parents stigma resultant from the schizophrenicgenic mother hypothesis.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">All this is really to point out the pendulum swing in mental health ideology. The biomedical approach was on a high in the 1990’s, most famously expressed in the NAMI slogan, “Mental Illness Is a <u>No-Fault</u> Brain Disease.” At the height of it, you couldn’t use the word trauma without being jumped on and re-educated on the biological basis of mental illness.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">My, how things change. In 15 years, things have more or less reversed, and clinicians are barraged with trademarked treatment models and consumer activists and mental health reform all aimed at eradicating what we were training people in 15 years ago. </span><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Even key players in the designing of the DSM-III and IV are coming out publicly to denounce the very basis of psychiatric diagnosing. </span><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"> </span><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Now the only word that matters is trauma. Trauma is the cause of mental illness and the only possible cure is to understand and validate the trauma. We seem to have come full circle. Attachment theory again finds the source of all psychopathology to emanate from problems in early attachment and early developmental trauma. We are pretty much back to the schizophrenicgenic mother concept in all but name.*</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">I exaggerate only slightly for emphasis.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">The, I hope obvious, problem with all this is that these bipolar paradigm swings are not based on advances in knowledge so much as fickle swings in popular sentiment.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">We are simply replacing one reductionist model (mental illness is a no-fault brain disease) with another reductionist model (95% of mental illness is caused by trauma). Not that reductionism is all bad. Even Stephen J. Gould pointed out the crucial importance of reductionism in the scientific process. <st1:place w:st="on"><st1:city w:st="on">Newton</st1:city></st1:place> described gravity with a simple but elegant formula. <st1:city w:st="on"><st1:place w:st="on">Darwin</st1:place></st1:city> reduced all that complex biological diversity down to a few core principles of evolution. But, this is not what we are seeing in mental health. Although it wears the cloak of empiricism, it looks a lot more like political ideology or hopeful religious beliefs. It all comes down to wishful thinking. People build treatment models and cherry pick research results, all in order to bolster what they already believe or what they want to believe.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">The mental health field would be a much more healthy and functional endeavor if we all just decided to be honest with ourselves and each other. We want to help people, but we don’t really know what the hell we are doing.</span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">* Of course, as gender beliefs have changed over the years, it is now more likely that we will see the father as the source of trauma/abuse/neglect/ambivalence as opposed to the mother.</span></div>Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com9tag:blogger.com,1999:blog-7608061413873231665.post-8597038457190016012011-04-28T09:22:00.000-07:002011-04-29T17:15:34.540-07:00The Trauma BandwagonGee whiz. Is it just me, or is there a "trauma" jihad going on? I can't open my eyes without seeing the word "trauma" in bold headlines in newspapers and journals and in 4H newsletters. Do I see a new line of Hallmark "Trauma Condolence and Get Well" Cards on the way?<br />
<br />
Don't get me wrong now. I fully support the idea that psychological trauma is bad and can lead to bad things, and supporting people who have experienced trauma is a good thing, but let's try to have some perspective here people. There is a mob mentality going on. Is it a competition? Is that it? That would explain why people seem to think they're going to get a special treat if they use the word "trauma" more often and louder than anyone else. A kind of self-satisfied glow appears on people's faces every time they use the word.<br />
<br />
Maybe I'm just an old stick-in-the-mud Scrooge. Bah-humbug.Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com4tag:blogger.com,1999:blog-7608061413873231665.post-16684155897366649292011-04-11T12:08:00.000-07:002011-04-13T11:00:57.374-07:00Two New Mental Disorders?<div class="MsoNormal"><span style="font-family: Arial;">Researchers are forever trying to link existing mental disorders with some kind, any kind, of brain structure “abnormality.” Even the weakest of links send people into hysterical excitement and soon we see flashy headlines claiming Researchers Find Neurological Cause . . .” for, well, just fill in the blank yourself with your favorite mental disorder.<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgw5jA9LHuYezKox8-atHPDLQ3tiAvZT45vnj3JTBXVBvXUt8s6Us-SxXAKqUdLTjksFVr-Pdau4IAfXjdYgYYALHJBPibIrhW24HVem7msG1CnhzFMsXw950wqHYL-38EZ02Sq6x0evxLS/s1600/simpson-brain+%25281%2529.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgw5jA9LHuYezKox8-atHPDLQ3tiAvZT45vnj3JTBXVBvXUt8s6Us-SxXAKqUdLTjksFVr-Pdau4IAfXjdYgYYALHJBPibIrhW24HVem7msG1CnhzFMsXw950wqHYL-38EZ02Sq6x0evxLS/s1600/simpson-brain+%25281%2529.jpg" /></a></div><div class="MsoNormal"><span style="font-family: Arial;">So, this is just what I was thinking about when I came across this flashy brain structure study, published in Current Biology, which found a significant link between anatomical brain differences and certain identifiable behaviors. It’s a headline grabber for sure.<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Arial;">Of course, any researcher who has an actual college degree and took Statistics 101, would never, never assume that correlation equals causation, but this doesn’t stop people from doing endless correlational studies that grab headlines and are statistically significant but are of no use diagnostically.<o:p></o:p></span></div><div class="Typedtext"><br />
</div><div class="MsoNormal"><span style="font-family: Arial;">If you don’t know what I’m talking about, you can see for yourself. Go to Google and do a search for: “brain structure” +adhd<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Arial;">ADHD happens to be a favorite target for useless correlational brain structure studies that might be interesting but give us no immediately useful knowledge because the differences they find can never be clearly separated out from the background noise of human variation.<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Arial;">But, back to the topic at hand . . . this write-up from Current Biology, found a strong link between brain structure and behavior that gives us a greater neurological understanding of this behavior than we have of many mental disorders. What I don’t understand is why the authors didn’t make that leap and suggest a couple new diagnoses. Does it make any difference that the behavior they looked at was political identification? Honestly, I don’t know why it should make any difference; it seems to me we have two new perfectly good mental illness labels with some statistically significant data to back it all up. All we need to do now is develop some psychopharmacological interventions and some evidence based psychotherapies. Then we’re in business.<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Arial;">Kanai, et al., found that people who say they are liberal (gee, does anyone really do that anymore?) have thicker anterior cingulated cortexes. On the other hand, people who go around using the word conservative in reference to themselves have inflated right (wing) amygdalas. So, the authors interpret this to mean that liberals are able to cope with conflicting information (in other words, they’re spineless elitist smarty-pants who can’t make decisions) while conservatives are more able to recognize threats (which I interpret just a little further as meaning they are neurologically closer to highland gorillas than they are to homo sapiens sapiens).<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Arial;">Well, that’s all very cute, but let’s turn this into a real money maker. It’s simple. All we have to do is turn the glass-half-full language into glass-half-empty language. Like this:<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Arial;"><i><b>Liberalism Not Otherwise Specified</b></i> is linked to smaller than average amygdalas resulting in impaired ability to recognize threats leading to being taken advantage of by freeloaders and traumatized by bullies and obstinate foreign powers.<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Arial;"><i><b>Conservatism With or Without Paranoid Delusions</b></i> is linked to withered anterior cingulates resulting in impaired ability to process complex information leading to reactive, bellicose and sometimes violent behaviors when confronted with multifaceted ideas and situations.<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Arial;">See? That wasn’t so hard, was it now? Is it too late to get them added to the DSM-5?<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><span style="font-family: Arial; font-size: 12pt;">Reference: Ryota Kanai, Tom Feilden, Colin Firth, Geraint Rees. Political Orientations Are Correlated with Brain Structure in Young Adults. Current Biology, 07 April 2011 DOI: 10.1016/j.cub.2011.03.017</span>Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com3tag:blogger.com,1999:blog-7608061413873231665.post-15470037927546477922011-04-06T10:03:00.000-07:002011-04-11T12:31:31.862-07:00There are Psychiatric Diagnoses and Then There is Reality<div class="MsoNormal">Reality is a hard thing to pin down sometimes. Why do the stars spin in a circle overhead? Why are the people born under the constellation of Scorpio always such jerks?</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I suppose the scientific method comes in there somewhere. But let’s face it, our empirically grounded bodies of knowledge have their limits. We can be hopeful that we will continue to expand our horizons of knowledge, but knowing what we really know and how we know it is probably a good thing. I mean, isn’t that part of the whole scientific endeavor?</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Well, I know you agree with me, but can someone help me understand how this message got so mixed up in the field of psychology? In psychology, “scientific findings” and diagnostic labels seem to be thrown around with about as much critical scrutiny as a gibbering glossolalic soliloquy might receive in the midst of a writhing Pentecostal congregation.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Among practitioners, it seems to me, that the diagnostic categories of the DSM are typically taken with several cobblestone-sized grains of salt. Not so among journalists or among the ubiquitous faceless internet-based free-advice-givers with their pop-up ad business models. Doubly not so among purveyors of “evidence-based” therapies who use flashy headlines from the world of scientific research to prove their wares (acupuncture, Blood-Letting<span style="font-family: Symbol;">Ò</span>, Eye Movement Desensitization Reprogramming, etc.).</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">It bothers me, not a little, that DSM labels are thrown around the way they are and it troubles me that so many researchers build their research designs as if these committee-written categories are unquestionable real-world phenomena. Does anyone really believe that there is a discrete Major Depressive Disorder that is a distinct and separate process from Dysthymia? Even that most archetypal of mental disorders, Schizophrenia, is quite fuzzy around the edges, and there continues to be some question as to whether we are dealing with a single disease process or multiple phenomena with similar and overlapping symptoms.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">It is a truism that, in young disciplines, where there is a dearth of causal understanding, we tend to fall back on simple categorization of observable phenomena. That, in fact, accounts for every single mental health diagnosis now in use. These are loose categories based on our sad attempts to group complex human behaviors into digestible and palatable portions that we can pretend to understand and try to get the insurance companies to swallow without puking all over us.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">With the upcoming DSM-V we are going to realign our categories by shifting our bullet-item-symptoms from one list to another and rebranding our labels, but still we will end up with somewhat arbitrary diagnostic descriptions authored by compromising, wordsmithing committees and deeply confounded by cultural assumptions, political correctness and insurance driven language games.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Some day, maybe, we will have our grand synthesis of psychology, neurology and genetics, but we are not there yet people. Please let’s stop playing pretend.</div>Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com0tag:blogger.com,1999:blog-7608061413873231665.post-5665258627409597512011-03-04T12:08:00.000-08:002017-02-22T08:58:55.014-08:00More on Borderlines and Crime<div class="MsoNormal" style="margin-bottom: 6.0pt;">
<span class="Apple-style-span" style="font-family: "arial";"></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><span style="font-family: "arial";">In January I posted on <a href="http://psychgripe.blogspot.com/2011/01/borderline-personality-disorder-crime.html">Borderline Personality Disorder, Crime and Responsibility</a>. More recently, I came across an interesting literature review on the topic of BPD and its association with crime and incarceration. “Borderline Personality and Criminality,” by Randy and Lori Sansone, was published in Psychiatry in 2009.<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><span style="font-family: "arial";">In this paper, the authors review multiple studies that have looked into the rates of Borderline Personality Disorder among the incarcerated and the criminal. They acknowledge that it is not a comprehensive review and they did find a wide discrepancy in findings probably related to differences in methodology as well as peculiarities of different sample populations drawn on from penitentiaries.<o:p></o:p></span></span><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKN6wvuacqlsl7BYrVPXnlS2glsZWbeOj7NhhTGsc0CMhIJmrLO0ryn8VDHxE_8w4wwa5ZQJ0meuX_J7XXK9YRoyO65tDtPp1QetRco1Val6sJvbkxP7DPGxhk7S7Hzo_-okMG2WhcybU7/s1600/images.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKN6wvuacqlsl7BYrVPXnlS2glsZWbeOj7NhhTGsc0CMhIJmrLO0ryn8VDHxE_8w4wwa5ZQJ0meuX_J7XXK9YRoyO65tDtPp1QetRco1Val6sJvbkxP7DPGxhk7S7Hzo_-okMG2WhcybU7/s1600/images.jpg" /></a></div>
<span class="Apple-style-span" style="font-family: "arial";"><br />
</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><span style="font-family: "arial";">Their overall conclusions:<o:p></o:p></span></span></div>
<blockquote>
<span class="Apple-style-span" style="font-family: "arial";"><span style="font-family: "arial";">According to the findings of the majority of studies in this area, compared to rates expected in the community, BPD is over-represented in prison populations. This finding may be particularly evident among female prisoners. Rates vary, depending on the methodology, but generally appear to be in the range of 25-50 percent.</span></span></blockquote>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><span style="font-family: "arial";">This is a considerable difference from the rate in the general population that has been measured at between two and six percent. <o:p></o:p></span></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><br />
</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><span style="font-family: "arial";">They continue:<o:p></o:p></span></span></div>
<blockquote>
<span class="Apple-style-span" style="font-family: "arial";"><span style="font-family: "arial";">Factors that may be associated with the presence of BPD among criminals include being female, having a history of childhood sexual abuse, committing an impulsive and violent crime (e.g., murder), having antisocial personality disorder traits, and perpetrating domestic violence. given this association, clinicians in both mental health and primary care settings need to be aware of the possibilities of such histories in their patients with BPD.</span></span></blockquote>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><span style="font-family: "arial";">Gender:<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><span style="font-family: "arial";">It is well known that BPD has a higher rate among women than men. This holds true in prison populations as well. Rates among incarcerated men range around 5-6%, very similar, but maybe slightly higher than men in general. Now where it gets interesting is with women. Studies varied significantly in their findings. On the low end, one study found 11.5% of incarcerated women to have BPD but another study found as many as 42.9%! This last study was conducted in <st1:country-region w:st="on"><st1:place w:st="on">Germany</st1:place></st1:country-region> using structured interviews. Overall, not only do imprisoned women have a higher rate of BPD than men, but also significantly higher than women in general.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><br />
</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><span style="font-family: "arial";">It has often been speculated that the overall gender imbalance is due to biases in the formulation of the disorder criteria or biases in the act of diagnosing. The authors mention this question in passing but do not offer any speculations. (In my own, non-scientific, observations from the world of practice, I believe that because we expect to see BPD in women it leads to over-diagnosing among women where any kind of Axis II behavioral problems tend to result in a BPD label while, in contrast, BPD traits in men often go unnoted or misinterpreted as anti-social features.)<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><br />
</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><span style="font-family: "arial";">Childhood sexual abuse:<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><span style="font-family: "arial";">As with the general population, incarcerated people with BPD had a higher rate of childhood sexual abuse. Not surprisingly, history of childhood sexual abuse was even higher for incarcerated women who were both sex offenders themselves and met the criteria for BPD.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><br />
</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><span style="font-family: "arial";">Violent offenses:<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><span style="font-family: "arial";">Overall, data supports an association between BPD with higher rates of violence (toward others) when comparing prisoners with and without BPD. One study found that women prisoners who had committed crimes related to major violence were four times more likely to meet criteria for BPD than women who had committed minimally violent crimes. Another study of men in British prisons for murder found 49% of their subjects had BPD traits.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><br />
</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><span style="font-family: "arial";">Some studies looked at violence in association to subtypes of BPD. One study found serial murderers to be associated with a strongly manipulative subtype of BPD. Another study relates rage-based murder with an “over-control” subtype of BPD. The authors conclude that “the majority of current data and impressions indicate an association between BPD and the impulsive, rage-fueled murder."<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><br />
</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><span style="font-family: "arial";">Antisocial personality:<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><span style="font-family: "arial";">Both BPD and Antisocial Personality Disorder are associated with higher rates of violence. Antisocial individuals tend to engage in more property crimes and are more calculating and planned. Borderline individuals tend toward episodes of aggression and violence.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><br />
</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><span style="font-family: "arial";">Where BPD and APD co-occur, there are significantly higher rates of anger, impulsivity and aggression resulting in a higher score of psychopathy. (Personally, I've often felt there is a significant overlap between these two categories but the authors do not give any additional insight on the topic.)<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><br />
</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><span style="font-family: "arial";">Domestic Violence:<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><span style="font-family: "arial";">Multiple studies have found a very solid association between BPD and both male and female batterers. Many batterers have a history of experiencing trauma themselves, and this, in turn, is also associated with development of BPD. One study found that 27% of women arrested for domestic violence met the criteria for BPD.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><br />
</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><span style="font-family: "arial";">Overall it seems there is a very clear link between BPD and both violence and criminality in general. The strength of that link varies quite a bit from study to study, however. The authors offer no causal speculations. Make of it what you will.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><br />
</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial";"><span style="font-family: "arial";">Reference: Sansone, Randy; Sansone, Lori (2009). “Borderline Personality and Criminality.” Psychiatry; 6(10):16-20.<o:p></o:p></span></span></div>
Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com4tag:blogger.com,1999:blog-7608061413873231665.post-23034385612660309372011-03-02T09:45:00.000-08:002011-03-03T14:52:00.812-08:00Drug Money and Scientific Objectivity<div class="MsoNormal"><span style="font-family: Arial;">A study published in the Canadian Medical Association Journal (CMAJ) confirms what we all suspected. Drug money sullies the objectivity of medical journals.<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Arial;">Medical journals run the gambit from purely funded by subscription to those that are funded solely by advertising. Some journals have both kinds of revenue. The ad-supported journals get most of their business from pharmaceutical manufacturers. These drug money supported journals are typically sent free to doctors around the world and have much larger circulation than the subscription supported journals. These free journals are also less likely to be peer reviewed.<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Arial;">The CMAJ study examined 11 medical journals with distributions in <st1:country-region w:st="on"><st1:place w:st="on">Germany</st1:place></st1:country-region> in 2007. In addition they surveyed Canadian general practitioners to find what journals they rely on for up-to-date data. The write-up states, “Our study shows that the tendency to positively recommend the use of a drug depends on the source of a journal’s funding . . . Free journals almost exclusively endorse the use of the selected drugs, whereas journals that rely exclusively on subscription fees for their revenue are more likely to recommend against the use the same drugs. . . . More than half of the doctors surveyed had used free journals as a source of information during the previous months.”<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Arial;">This kind of bias can be critical when adverse reaction to prescription medication is the sixth leading cause of the death, at least in the <st1:country-region w:st="on"><st1:place w:st="on">US</st1:place></st1:country-region> (reported in JAMA several years ago). This study was not specific to psychiatric drugs but it certainly has salience in the psychiatric field where many medicinal treatments have questionable benefit. If the risk-benefit calculation is skewed, then neither doctors nor patients are making truly informed decisions.<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="font-family: Arial;">We now know that people with severe mental illness have life spans that are 20 years shorter than the general population. How much of that is a result of our pharmaceutical treatments?<o:p></o:p></span><br />
<span style="font-family: Arial;"><br />
</span><br />
<span style="font-family: Arial;">Reference: Becker, Anette; et al. Canadian Medical Association Journal (2011, March 1). The influence of advertising on drug recommendations.</span></div>Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com0tag:blogger.com,1999:blog-7608061413873231665.post-35731830210897684272011-02-04T10:53:00.000-08:002011-03-04T15:49:36.764-08:00Crime, stupidity and responsibility among mental health professionals<div class="MsoNormal" style="margin-bottom: 12.0pt;"><span style="font-family: Arial;">I in no way want to promote the <st1:place w:st="on"><st1:placetype w:st="on">Church</st1:placetype> of <st1:placename w:st="on">Scientology</st1:placename></st1:place> nor am I in the fan club of Dr. Thomas Szasz. <o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 12.0pt;"><span style="font-family: Arial;">I don’t have much to say about Scientology other than the fact that it gets pretty annoying to be accused of being a Scientologist simply because I question the validity of a diagnostic category like Attention Deficit Disorder and maybe I’ve suggested that giving amphetamines to young children might not be the best solution to this non-disease.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 12.0pt;"><span style="font-family: Arial;">On the other hand, I could say a lot about Szasz who is something like the father of the anti-psychiatry movement. I certainly think that he has done a lot of good by questioning the assumptions and practices in the mental health field going all the way back to the 1950’s. Unfortunately, his discourse and that of his anti-psychiatry disciples is just as ideological and lacking in factuality as the worst drivel coming out of NAMI and from pharmaceutical marketers and the APA for that matter. But, we’ll save that discussion for a later post.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 12.0pt;"><span style="font-family: Arial;">Today, I just wanted to share about their Psychiatric Crimes Database, a rogues' gallery of badly behaved mental health professionals. It makes for a, maybe not exactly fun, but perhaps amusing at times and otherwise disturbing read. It is part of a website presented to the world by the Citizens’ Commission on Human Rights (CCHR). CCHR is a joint effort by Szasz and the Scientologists dating back to 1969. Its mission is to ”investigate and expose psychiatric violations of human rights and to clean up the field of mental healing.”<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 12.0pt;"><span style="font-family: Arial;">They claim to have aided in increasing prosecutions of mental health professionals of all kinds and to have promoted improved ethical and legal standards in the industry. As to the later of these claims, I cannot vouch for the activities of CCHR itself, but I can say from my experience in mental health that the consistent pressure from the psychiatric survivor and anti-psychiatry movements, which have at least symbolic if not real leadership and impetus from Szasz, have had an actual and positive impact in the industry by increasing awareness and respect for things like informed consent and patient/client choice. Yet, that being said, I do have to question what they seem to want to imply about themselves and the industry with their database.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 12.0pt;"><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyFMP61Sa3p_4vbaDnzWf3k-wNxv8_0fmYYNLtQI-KaBKHP2IOMusO_DIAEdx8-wG8i_UdrUMCX8p97939bl2_B_Iuh7odMbSEKhHkQyvlvZJZsw86u1YiiGAOOebCghjp7OnqxSNBlLai/s1600/carrie-denbow.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyFMP61Sa3p_4vbaDnzWf3k-wNxv8_0fmYYNLtQI-KaBKHP2IOMusO_DIAEdx8-wG8i_UdrUMCX8p97939bl2_B_Iuh7odMbSEKhHkQyvlvZJZsw86u1YiiGAOOebCghjp7OnqxSNBlLai/s200/carrie-denbow.jpg" width="159" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Carrie Denbow, social worker, had her license suspended, according to the CCHR site, due to accusations she had sexual relations with a minor client in a motel room with two other students while drinking and smoking marijuana. The client was an adolescent to whom she was providing counseling. It is further alleged that Ms. Denbow took the client to her office three or four times a week where she performed oral sex followed by intercourse. It is also alleged she broke confidence by seeking relationship advice from her minor client's peers. Ms. Denbow was let go from her job in 2009.</td></tr>
</tbody></table><span class="Apple-style-span" style="font-family: Arial;">The Psychiatirc Crimes Database is, very simply, a list of prosecutions and licensing censures against mental health professionals. It appears to be updated quite frequently; there are eleven items in the database for January of 2011. If CCHR had a role in any of these investigations, it is not evident and seems unlikely. It appears to simply be a list of items gathered from the news and public records. Items span a gambit of crimes and ethical violations. Just in the last couple of months we see everything from a psychologist having his license placed on probation due to DUI to a psychiatrist charged with attempted murder for stabbing a patient twice in the chest with a sword.</span></div><div class="MsoNormal" style="margin-bottom: 12.0pt;"><span style="font-family: Arial;">My non-scientific cursory look at the database leads me to the conclusion that the most common category is the big no-no of sexual relationships between providers and clients, in some cases with minor clients. This appears to be followed by billing and documentational faults leading to charges of fraud. A third category is providing excessive prescriptions of controlled substances, sometimes for a payoff, sometimes without medical examination (as in being handed out in a public park in one case). Otherwise, items are a miscellany of misdemeanors, violations and serious crimes. <o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 12.0pt;"><span style="font-family: Arial;">The website explains its purpose:<o:p></o:p></span></div><blockquote>The following database is being presented as a public interest service to law enforcement agencies, health care fraud investigators, immigration offices, international police agencies, medical and psychological licensing boards, and the general public.</blockquote><div class="MsoNormal" style="margin-bottom: 12.0pt;"><span style="font-family: Arial;">And claims to impact larger issues:<o:p></o:p></span></div><blockquote>Many psychiatrists have an intimate knowledge of criminality-one which has nothing to do with the professions involvement in the expert witness field.</blockquote><ul style="margin-top: 0in;" type="disc"><li class="MsoNormal" style="margin-bottom: 12.0pt; mso-list: l0 level1 lfo1; tab-stops: list .5in;"><blockquote>Between $20 billion and $40 billion is defrauded by the American psychiatric industry in any given year.</blockquote></li>
<li class="MsoNormal" style="margin-bottom: 12.0pt; mso-list: l0 level1 lfo1; tab-stops: list .5in;"><blockquote>At least 10% of psychiatrists admit to sexually abusing their patients: In America, that's at least 4,500 rapes and, internationally, more than 15,000 rapes.</blockquote></li>
<li class="MsoNormal" style="margin-bottom: 12.0pt; mso-list: l0 level1 lfo1; tab-stops: list .5in;"><blockquote>Psychiatrists, psychologists and psychotherapists have the dubious distinction of having laws specifically designed to curtail their tendency to commit sex crimes against those in their charge.</blockquote></li>
<li class="MsoNormal" style="margin-bottom: 12.0pt; mso-list: l0 level1 lfo1; tab-stops: list .5in;"><blockquote>A 1992 study of Medicaid and Medicare insurance fraud in the <st1:place w:st="on"><st1:country-region w:st="on">U.S.</st1:country-region></st1:place> showed psychiatry to have the worst track record of all medical disciplines.</blockquote></li>
</ul><div class="Typedtext" style="margin-bottom: 12.0pt;"><span style="font-family: Arial;">They don’t indicate how they came up with the specific numbers (e.g., 10% of psychiatrists admit to sexually abusing patients), but it is also true that both Szasz and the Scientologists share an overall denouncement of the very concept of mental illness and this database has to be seen as part of their larger pogrom against all things psychiatric. <o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 12.0pt;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5pHZwHIwOEnFi5okRhkp9uMgWCysXj0GddR38kURN0k5ETCxh_KKjXwGb75munBG2cjT5kpjZRA883gyeAvul93KFfN9LWzijv6acPPnr2iYP3VcZiKofaV6DHmDPuuDeY2hGHgTMv_bS/s1600/douglas-rank.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5pHZwHIwOEnFi5okRhkp9uMgWCysXj0GddR38kURN0k5ETCxh_KKjXwGb75munBG2cjT5kpjZRA883gyeAvul93KFfN9LWzijv6acPPnr2iYP3VcZiKofaV6DHmDPuuDeY2hGHgTMv_bS/s1600/douglas-rank.png" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Psychiatrist Douglas Rank who, according to CCHR, was charged with stabbing a woman in the chest twice with a sword in front of his office. The wounds were life-threatening, but she survived after hospitalization. She was apparently both his patient and in a "personal relationship" with him. Rank was sentenced to 15 years after plea bargaining down from attempted murder to first-degree assault. He had previously been investigated for over medicating and having sex with a patient.</td></tr>
</tbody></table><span class="Apple-style-span" style="font-family: Arial;">Speaking to that implied intent, I have to feel that simply listing every kind of crime and stupid behavior of individual mental health providers cannot be taken as a condemnation of the industry as a whole. There is plenty of room to criticize the mental health field and all of its tenuous assumptions and cherished beliefs, but, in my opinion, the fact that a particular California psychologist had his license placed on a probationary status, for instance, according to the CCHR site, because he was found awakening from unconsciousness in a department store after hours with a pocket full of methamphetamine, has no real bearing on the field of mental health other than the fact that it is peopled by human beings who are capable of addictions, errors, criminality and stupidity as humans are in any profession. </span></div><div class="MsoNormal" style="margin-bottom: 12.0pt;"><span style="font-family: Arial;">Furthermore, the fact that professionals are censured, placed on probation, suspended and prosecuted, if anything, indicates that the industry does in fact have good safeguards and oversight by which to protect consumers and the public.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 12.0pt;"><span style="font-family: Arial;">Yet, the database does have an impact on the reader, and if you haven’t yet, I suggest every one take a look at it who has an interest in mental health whether as a provider, consumer, family member or interested bystander. If nothing else, it serves as a reminder that it is always a good idea to be cautious and do a little research before accepting a particular professional as the mechanic of your mind, so to speak.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 12pt; text-align: center;"><span style="font-family: Arial;"><a href="http://www.psychcrime.org/news/">Psychiatric Crimes Database</a><o:p></o:p></span></div>Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com0tag:blogger.com,1999:blog-7608061413873231665.post-57738201205136424022011-01-28T17:46:00.000-08:002017-02-26T18:26:10.051-08:00Borderline Personality Disorder, Crime, and Responsibility<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;">On the topic of mental disorders and responsibility—of late, I’ve been hearing several therapists repeat a couple things that bother me:</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;"><br />
</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;">1) Borderline Personality Disorder is just as serious as Schizophrenia and sufferers of BPD should be given just as much clinical attention and services.</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;"><br />
</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;">I have to say, no, BPD is <u>not</u> the same as schizophrenia and should not in fact be treated the in the same manner. Should medical professionals be told they need to treat sunburn the same way they treat cancer? I think not. Furthermore, I don’t know why we treat so many people whose primary presenting problem is BPD in the public mental health system intended for people with severe disabilities. The bulk of the empirical research seems to show that BPD is best treated in the community with an established and effective therapy such as Dialectical Behavioral Therapy or similar. Placing people with BPD in residential facilities for the severely disabled will only be detrimental for both the client and everyone else who lives or works at the facility.</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;"><br />
</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;">2) People with BPD who behave manipulatively should not be blamed or expected to change because their behavior is avolitional.</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;"><br />
</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;">I will agree that “blaming” the client is in no way helpful, nor will expecting someone with BPD to instantly change result in anything but frustration. However, it is simply false to say that someone with BPD has no ability to modulate mood or behavior. No human behavior short of reflexes or seizures are avolitional. Making false statements of this kind, even in apparent defense of people with serious disorders, only serves to increase the divide in understanding. It also takes away from the agency and empowerment of the client that we are trying to help. Someone with BPD is not helpless to change. Change can happen with trust and support as long as there is a real desire in the person to make a change. Setting clear but respectful limits helps too, because we all know that, like it or not, life has limits. It is not at all helpful to give the BPD patient the message that anything they do is okay just because they have a diagnosis. Such a message can be devastatingly harmful.</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;"><br />
</span></div>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;">It might help to illustrate this issue. Take a look at this excerpt from a recent news article (well, it's news-ish, I guess, it's from The Sun):</span></div>
<blockquote>
<b>A WOMAN has been jailed for cruelly imprisoning three young children in a disgusting room without clothes, food or water</b>.</blockquote>
<blockquote>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMzfkc5HFFnNSwd9EDNLWUc9C5UeCWsQZZy5rL2LT-jdwyifvEWIP9CE1fKdKFxLhnEcBTCaNOJG0Q8YGYhsyKj0NEFPQqjhkxvjEcgFREyqL-lm_KqdiJjYERLYVDVCgl36jJ1CZhrh9y/s1600/sick_daniella_henderson.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMzfkc5HFFnNSwd9EDNLWUc9C5UeCWsQZZy5rL2LT-jdwyifvEWIP9CE1fKdKFxLhnEcBTCaNOJG0Q8YGYhsyKj0NEFPQqjhkxvjEcgFREyqL-lm_KqdiJjYERLYVDVCgl36jJ1CZhrh9y/s320/sick_daniella_henderson.jpg" width="229" /></a></div>
Jan. 25, 2011. Sick Daniella Henderson left the youngsters in the squalid conditions and their ordeal only ended when the kids were seen hanging out of a window desperate for help.</blockquote>
<blockquote>
When police arrived at the house they found the bedroom they had been left in all day stank of urine, had no beds or furniture and had a bucket as a toilet.</blockquote>
<blockquote>
The grandfather of one of the children today slammed sick <st1:place w:st="on"><st1:city w:st="on">Henderson</st1:city></st1:place>'s 15-month jail term as too lenient. . . .</blockquote>
<blockquote>
Penny Moreland, defending, said: "Most people will find this shocking and distressing. This has not borne out of pure malice or badness.</blockquote>
<blockquote>
"She was deteriorating mentally and has a borderline personality disorder [sic]."</blockquote>
<div class="MsoNormal">
<span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;">The defense attorney here is presenting what a certain ilk of therapists are trying to put out there, that someone with BPD cannot be held responsible for their behavior.</span>
<span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;">I would say, yes, it is distressing. The defense states that the behavior was not malice or badness and seems to imply that the behavior cannot be malice or badness as long as the behavior is “explained” by a mental health disorder, in this case BPD. It seems to be an underlying tacit assumption that the categories of malicious behavior and symptomatic behavior are mutually exclusive.<o:p></o:p></span>
<span class="Apple-style-span" style="font-family: "arial" , "helvetica" , sans-serif;">At the risk of blaming people with BPD for their own behaviors, I have to question the validity of this assumed dichotomy. Is it possible that someone’s behavior might be driven by BPD <u>and</u> that person is acting with malice?</span>
</div>
<br>
<script async src="//pagead2.googlesyndication.com/pagead/js/adsbygoogle.js"></script>
<!-- psychgrip01 -->
<ins class="adsbygoogle"
style="display:block"
data-ad-client="ca-pub-5910952320421723"
data-ad-slot="3638515249"
data-ad-format="auto"></ins>
<script>
(adsbygoogle = window.adsbygoogle || []).push({});
</script>
Vircazhm Magazinehttp://www.blogger.com/profile/01087601235530226889noreply@blogger.com1