Monday, October 27, 2008

On blaming the parents

It's been well over a year since I last posted - this blog got lost in the shuffle of daily life, trying to find a steady job (which I could have, except I'm picky enough to want something I actually enjoy, so I'm still temping), working temp jobs to pay rent, having a social life, having a relationship, finding a house, keeping the one we're still stuck in somewhat decent, not killing housemates for not helping with that last one... I got prodded in a comment to say that I'm actually doing something useful here though, so I'll try and get going again.

As of a few months, I've been doing temp work at a closed mental health facility for 12 to 18-year-olds. It's a fairly new concept in the Netherlands. Up until less than a year ago, you either managed to cope in a somewhat open setting, where you had some freedom to come and go as you pleased, or you went to juvenile prison. Now our juvenile prisons aren't even technically considered prisons, as, unlike in the US, they do focus on rehabilitation, so they do offer some basic amount of treatment - but you're still putting children who are particularly vulnerable in with what you know to be a bad crowd, which is problematic. And there is the message it sends to the kids in question, when you put them in prison for having mental health issues.

One of the things I've been in charge of are the file screenings for new applicants. As a closed setting is a matter of last resort - after all, you don't want to lock children, or anyone, up unless you've tried all other options - these children usually have impressive files by the time they get to us. One thing these files often get me thinking about is parenting. There are a lot of children in our house who have very clearly been dealt a very lousy hand when it comes to parenting, and whose problems clearly stem from problems with parenting. I'm very seriously considering trying to go work for the Dutch equivalent of the Child Protective Services since I've started screening these files, since it makes painfully obvious the effects abuse has on children.

The thing is, when you're blaming parents for their childrens' problems - as the above might imply - you venture into tricky territory. There's a history in psychology of blaming the parents for anything that might be wrong with their children. Autism, for example, used to be explained by claiming a child's mother wasn't sufficiently affectionate towards her child. This has since been found to be nonsense, but before that was determined, it caused a good bit of damage; making parents responsible for their children's disability in that way is a huge burden to place on a parent who already has been dealt a hard hand in dealing with that disability.

I am, in fact, firmly in the camp of Good Enough Parenting; you're never going to be a perfect parent, and you don't have to be to raise a child. Children have a pretty good tolerance for "Mommy's trying to juggle 6 things at once and is short on time now" or bumping their head while you're not looking etc etc. You're highly unlikely to cause autism or ADHD through your parenting style, and as long as you're reasonably committed to being a good parent and making an effort, you probably won't cause any kind of serious behavioral problems.

So what is the difference between what I am saying, and blaming parents for autism?

Basically, you are talking about two fundamentally different types of problems: reactive behavioral problems, and psychiatric problems. The latter refers to concrete disorders, which no one is really to blame for. ADHD, autism, depression, schizophrenia all come forward as results of a complex interplay of genetics and environment where upbringing is going to be a comparatively minor factor. It is, in large part, the luck of the draw that determines whether you, or your child ends up with one of those. Reactive behavioral problems are different; reactive behavioral problems are basically healthy children responding to a crazy world. These are children who are raised in an environment where they were never taught healthy ways of dealing with the world. They have mostly been abused or ignored, or may have encountered traumatic experiences. They have been taught unhealthy ways to view the world, and you'll often find that, if you take on their world view for a moment, their actions make perfect sense. Reactive problems are the kinds of problems I'm thinking of when I want to join CPS.

The thing is, when you're talking about reactive problems, you are talking about extremes of behavior. You might have noticed that I qualified my statement about good enough parenting with "as long as you're reasonably committed to being a good parent and making an effort". Children with reactive behavioral problems are generally the children of parents who are either unwilling or unable to commit to being a good parent (or, in some cases, the children who are unlucky enough to run into the wrong crowd at the wrong time. Reactive problems come into being as a response to the environment, and while we often end up talking about parents when we talk about childrens' environments, they are far from the only influence on their children).

Also, this doesn't mean you don't have any influence as a parent when your child does have a psychiatric disorder. I know a young boy who I strongly suspect of having a minor degree of ADHD. If you give him space, he can be a nightmare; pushes rules to breaking point, permanently tries out how far he can go, restless... I also know that boy as a really nice kid. The difference? Structure. If you create a clear framework for him, and enforce it in recognizable ways, that gives him ways to channel his energy in ways that make him most charming and loveable. Children with autism can similarly benefit from a parent willing to work with their limits and possibilities. But there needs to be a recognition that this puts demands on parents that go beyond those of parenting a 'healthy' child. When a parent is unable to meet these extra demands, that doesn't mean that they're a bad parent, or that they're causing the problems. It means their plate is overfilled.

So where does that leave us? Probably with a point I've made in an earlier post already; at the end of the day, it's not one thing or the other, biology or upbringing, that determines the outcome for a child. But if you have a child that has been biologically unlucky, it's going to take a lot of extra effort to get an outcome where they can cope with life effectively, and if you have a child that's been biologically lucky, you're going to have to make an effort to create a problem in their development. There are, however, no clear lines in this.

Of course, that leaves you with one final question: now what? Even if it's quite clear that parents are somehow to blame, then what? Once children are done with closed treatment, they are going to have to deal with their parents again. Every child needs their parents, even if they might have to find a new place for them in their lives, one which is less, or differently, involved. There's no point in blame; it misses the point. All there is is putting your every effort into finding a way for everyone to interact in the best way they can.

Sunday, July 01, 2007

Bits and pieces

Apparently, this is the first case study of delusions involving computer games. Considering how long computer games have been around, I'm surprised it took this long. If your mind plays tricks on you, it's going to use things that are familiar to you, so your delusions are going to be about things that are familiar to you. I'd've thought that computer games were ubiquitous enough to be the center of delusions for a while already.

I do agree with this observation: "A worrying aspect is that, in many of these games, points are scored for acting violently or even killing. If the game is transposed into the real word by a delusional state, the risk of subsequent violence is high—particularly if violence is not perceived to be illegal or morally wrong." It's a seriously bad thing when we go from people thinking they're secret agents and trying to break codes, or thinking God talks to them and trying to heal the world with the power of their minds, to people trying to score as many game points as possible by running people over.


Your author finally gathered up her courage and registered as a blood donor. This involved a lot of gathering courage - I've been postponing this for years and years because I hate needles. One of the last times I got poked by a needle involved me almost fainting. However, I figure that me being uncomfortable for 10 to 15 minutes to give blood does not outweigh someone else dying from lack of blood.

This did, however, lead to me discussing blood and needle phobias. Blood and needle phobias are actually kind of special. With most phobias, it is actually impossible to faint. Fear makes you tense up, prepare to either fight for all you're worth or run like hell. This means your blood pressure actually goes up, while fainting involves your blood pressure dropping.

Aside from being an interesting tidbit, that actually means you need to treat them differently. For most phobias, part of treatment involves confronting people with their fears, and showing them that nothing bad will happen. It might feel like you're going to faint, but really, you won't. It's not that bad. Try that with a blood and needle phobia, and you just confirmed the person's fears. So treatment for blood and needle phobias, aside from the usual, actually involves training in how to raise your blood pressure.

Tuesday, March 20, 2007

Does that make me crazy?

A friend of mine was recently advised by her GP to go see a psychologist for some problems she'd been having with her family for several years by now, that were causing her a lot of stress. I happened to speak to her boyfriend before I got to talk to her, and he mentioned she was having a bit of a rough time with that advice. So I gave it some time, and gave her a call - it was high time we meet up again anyways. So we chatted for a while, and then got to the advice from her doctor. "I'm still so young," she said "I shouldn't be messed up yet!"

Meanwhile, another close friend is having trouble with his thesis, and running into fear of failure problems, which had already been diagnosed when he was in highschool. About 9 months into what should have been a 4 month project, he asks me whether I can't help him work it out. I'm a psychologist, after all, but since I'm also a friend, he'd feel less crazy asking me for help.

Somehow, there's a big stigma attached to seeing a psychologist. So let me make one thing clear: seeing a psychologist does NOT make you crazy. In a lot of cases, in fact, it might make you a lot more mentally healthy than not going.

The fact of the matter is, sometimes things break under stress, whether that's your mind, your body or your car. Put enough pressure on it, and it'll start having problems. And sometimes things break down in easy-to-fix ways, that you might be able to fix yourself, or have fixed by a friend that happens to be good with cars. Other times, you need a professional - or you might want a professional to have a look before things break down to prevent problems. That doesn't make you crazy. That just means that life is rough sometimes, and that an outsider with knowledge of and experience with how these things work can be more helpful than the friend who might listen well and have good advice, but who, even if they know their way around these things, are too personally involved to be quite objective. Staying away from help when you need it is only making your life needlessly harder.

Sunday, March 11, 2007

Pop that pill

I did my internship at a very ambitious university. This is the kind of school where if you're not getting top grades, you might as well have failed in the eyes of many teachers and co-students. The material was tough, too. This university is renowned internationally for being one of the top schools in its field. My job there was too counsel students, and it was not uncommon for students to just flat-out ask whether they couldn't just take some pill. After all, they were doing a high-profile study, which they needed to excel at. They didn't have time to be unwell. Pop a pill, get back to work.

My mother is in psychology as well, and works with a primary and highschool students, with a focus on problems they're experiencing at school. Of course, the most popular diagnosis in those cases is ADHD, and schools are of course very aware of that diagnosis. So if a kid is being extremely disruptive in class, they're likely to start calling ADHD. And, how convenient, you can pop a pill for that! Mom has had multiple cases where, before a diagnosis was even made, school was calling for the kid to be put on Ritalin. She's had cases where the child was put on Ritalin in spite of her objections. Sometimes, it worked out okay. She's also had crisis calls where a child that was put on Ritalin in spite of her advice to the contrary had to be taken to the hospital by ambulance because they went acutely psychotic as a consequence of completely wrong medication for the child's problems.

I remember being in the US, and being astounded at the fact that there are commercials on TV for prescription medication. There is a reason these medicines are prescription only - it is not safe for non-medically-trained persons to decide about these. So why put doctors in the situation where they have to turn down the request for a certain drug time and time again, for perfectly valid reasons that patients might or might not understand? Why give these people false hope? Why advertise something people can't buy?

Here's the thing about medication for mental health problems: for some people, it's a life-saver. I know people who are able to function by grace of their Prozac (or substitute other brand name) or Ritalin (likewise) or haldol. However, that is true for a limited number of cases, and only if you actually have the chenical imbalance the drug in question corrects. If you don't have that imbalance, that's where problems come in. It is perfectly possible to be a busy child and disruptive in class without having ADHD and the underlying neurochemical problems. Give that child Ritalin, and you might end up with a child that completely loses touch with reality. Give haldol to a person who's not actually psychotic, and you'll introduce a syndrom that very closely mimic Parkinson.

Of course, not every case of mismedication is that dramatic. In 99% of cases, Prozac does actually make people feel a bit happier. However, it does have side effects - including such fun things as sexual dysfunction, gastrointestinal problems, headaches, nightmares, insomnia and seizures. Also, SSRIs, the drug class Prozac belongs to, are a relatively new drug, having been found in the 1980s. There's no way of knowing what the long term effects of taking in over decades might be. Also, the jury is still out on whether Prozac might not actually cause extreme violence or suicide in a small percentage of those who take it. Prozac manufacturer Eli Lily says not. Eli Lily also hid research results that might point to the contrary. Also, the nasty thing about SSRIs is that the symptoms you get from weaning your body off them look a lot like depression, making it hard to stop taking them.

Now as I said, there are people with a chemical imbalance underlying their depression that have little choice in the matter. However, a lot of the time, depression can be caused my circumstances and thought processes. That can be solved by changing circumstances and getting into talk therapy. Talk therapy can be pretty quick and easy. Cognitive behavioral therapy often brings significant improvements in 5-10 45 minute sessions. Weigh that against years, or even just months, of side effects and taking pills - and the knowledge that you learn things that will last even after you quit therapy, whereas when you quit the drugs, the effect is over.

You still sure that the pill is the easy solution?

Sunday, October 29, 2006

How many percents nature is your omelet?

One of the major discussions within the field of psychology is the question of nature versus nurture. If you get or don't get a disorder, or if you become or don't become a juvenile delinquent, is that because you were born that way, or because of the way life treated you? It's an interesting discussion, with often surprising results.

For example, anti-social behavior and delinquency are often thought to be learned behavior. We are all born cute adorable babies who can do no wrong, right? Wrong. When scientists in New Zealand decided to follow every single baby born in a town in a certain year for as long as possible (the children in question are currently about 26, and still being followed, as are their children), they found that most people who wound up showing a lot of anti-social and delinquent behavior as adults were difficult as babies and toddlers already. And while some difficult babies and toddlers turned out fine people, there were virtually no children who had been lovely babies who ended up problem children as adults.

On the other side of the equation, training programs for children of mentally retarded mothers (one of the main risk factors for mental retardation) have been found to lead to IQs that are, at average, about 20 points higher than those children of mothers with retardation who didn't participate in these programs. In many cases, those 20 IQ points were enough to lift the children out of the mentally retarded category into average.

Now this research is all great and fascinating. The problem is, people want numbers. How many percents nature is x disorder, and how many percents nurture? For those people, I have a question, which one of my teachers once asked our class. However, it requires some introduction.

If you're making an omelet, you also have both nature - eggs, some milk, spices, maybe some mushrooms and ham - and nurture - you break the eggs into a bowl, mix them with the milk and spices, cut up your ham and mushrooms, heat some butter in a pan... Now I can change around some of this, and still get a fine omelette. It's no less of an omelet if I decide to leave out the mushrooms because my friend hates them, or use soy milk instead of regular, nor is it less of an omelet if I decide to start with cutting things instead of with breaking the eggs. But if I completely change either the nature, say by leaving out the eggs, I won't get an omelet no matter what I do. If I completely change the nurture, say by deciding I'd rather juggle the eggs or have a food fight, the result won't be an omelet either. So I need both the right nature and the right nurture to end up with the result I want. Now, if I do end up with an omelet... how many percents nature is that omelet?

With special thanks to prof. dr. Orobio de Castro, who, in my first year of studies, gave a lecture that still stands our in my mind 4 years later.

Tuesday, September 26, 2006

I blame biology

I'm a big fan of thrillers. I'm not into gore, but I like scary. This has made all my (ex)boyfriends laugh at me, because while I like them, I go through the roof whenever one of these saw-it-coming-miles-away startle moments come up. And I hide when there's gore. The men can stop laughing now though, because it's not my fault - it's just biology!

Your basic emotions are scared and angry - flight or fight, withdraw or approach. The first is controlled by a hormone called cortisol. If your cortisol levels are high you're stressed and scared, and unlikely to approach things that you don't know for a fact are safe. Anger, on the other hand, is controlled by testosteron. That's right - anger is controlled by what is best known as "the male sex hormone", which men have about 5 to 10 times as much of as women. So that automatically puts men at an advantage when it comes to not being scared - they always have so much angry hormone in them, the scared hormone gets less of a chance.

Now while you mostly hear that the female system runs on progesteron and estrogen, on an emotional level, the hormone with the most influence in the female system is really oxytocin. When you're talking physical functions, it kickstarts labor and breastfeeding. Emotionally, it helps promote bonding (want an excuse for lots of good sex? It's good for your relationship: oxytocin is released after orgasm, making you bond with your partner more strongly) and it helps with social recognition. That is, people with high levels of oxytocin (i.e. women!) are better at recognizing facial expression and other signs of emotion in people around them.

See how my system cheats me? Lower levels of testosteron mean I get scared more easily than my boyfriend anyways, and then the higher levels of oxytocin mean that (assuming the actors are doing their job right!) I'm getting more and stronger "danger!" signals from the people in the movie, so I get more reason to be scared.

So really, there are two ways to twist this: 1) I'm being cheated by my system and it's not my fault scary movies scare the hell out of me or 2) *I* don't have a problem! It's the men that are overly aggressive and blind to other people's emotions! Either way, it clearly isn't my fault.

Sunday, September 17, 2006

Everyone's an expert in psychology

I spent most of yesterday at a masterclass about a new therapy mechanism for children. It was a post grad course, so I shouldn't have been there, but, as they say, it's not what you know but who you know, and I know the right people, it seems. Of course, said people probably feel the same way because they happily abused me for both feedback and doing small jobs like handing things out for them, figuring out the video equipment and running around grabbing the stuff they forgot.

Anyway, the end effect was that I was sitting there, in a room full of social scientists with years of experience, feeling horribly inexperienced and quite ignorant. After all, all these people had been doing this stuff for YEARS, and I've hardly started.

Until, at some point, one of the teachers started about the basic attitude towards children. She'd copied a line from a book, but, she mentioned, she'd added quotation marks. Could anyone tell her why? Most people there looked at her somewhat dumbfounded. I felt a lot smarter all of a sudden.

The line was something like "The therapist 'plays' the ignorant adult". That's not an exact quote, but it comes down to the same thing. The reason the quotation marks are there? It isn't playing. You aren't pretending to be ignorant about what the child, or any client is telling you. As a therapist and human being, you are ignorant about what another person thinks and feels - even if you can make a decent guess that when someone gives you a look that could kill, he's not currently feeling particularly loving towards you.

Here's the thing: psychologists are experts on the processes. We're the ones who learn that "if you put x, y, and z into a human mind, a, b or c is the likely outcome and m, n, and o are approximately what happens in between." And while that information does pretty much apply to the individual, there are a few problems there:

1) notice the "likely" and "approximately" in there? Psychology isn't hard science, and it's very rare to get one-on-one "x input leads to y output" type of connections. When one of my housemates got home drunk and started walking into other people's rooms and setting off fireworks in the house in the middle of the night, some of us got furious with him, others were scared and one housemate decided that it's a party and joined in. Same input, different outputs.

2) the input goes WAY further than just the one event you might be discussing. The way your mom held you or didn't in the first years after you were born? That's part of the input. Whether you have siblings and how you get along with them? Part of the input. Just had a fight with your partner? Part of the input. Slept badly? Part of the input. Won the lottery? Part of the input. All of those things didn't happen? Part of the input as well. Somewhere, there might be a complete model that predicts exactly how The Person (TM) responds to every single event... But it would need to take so much into account that the human mind would't be able to process it.

The end effect is that the only way to really tell the mental end effects of any event is to be inside the mind in question. A psychologist, with all their expertise might be able to help deal with those effects and give insight in how you might have come to those end effects - but they won't know what those end effects ARE until you show or tell them. And that's no different with children than it is with adults. You are the only true expert on you.

Sitting in that room with about 13 experts in social sciences unable to figure that out, I was somewhat scared. Do these people all really think they know the mind of their clients, whatever age they may be? So I want to give out a general warning: if you're seeing a psychologist or a mental health professional of any kind who insists he knows what you think - not who can make a decent guess after having talked with you about the way you think for several sessions, but tells you what you think with such insistence they'd make you doubt your own thoughts - kick them. For yourself, of course, but for me as well. I'm sick of people thinking psychology makes me a mindreader.

Wednesday, August 23, 2006

Not so silly childrens' game

Last weekend has been busy for me - I had a guest over from Norway, who joined me and my boyfriend to a big music festival. Thus, no long entry, but I wanted to comment on a conversation we had.

For some reason, our houseguest - let's call him Sugar just to annoy him - came to the topic of Peek-a-boo. He was essentially commenting that it was the stupidest thing. After all, wouldn't you be majorly freaked out if someone came up to you, hid their face behind their hands and then took their hands away shouting "Peek-a-boo!"? I have to admit, I would be.

The thing is, I'm a bit older than the children I'd play peek-a-boo with. Peek-a-boo is pretty much designed as a training in object permanence, and if you make it to 23 (well, almost) without getting THAT down, you have a problem.

Object permanence refers to the fact that just because you can't see something, that doesn't mean it's not there. That might seem obvious, but it's not when you're brandnew at life. As it turns out, babies younger than 6 months have no clue about it. If you hide their favorite toy under a napkin, they'll think it's just gone. After that they slowly start grasping that, hey, their toy didn't just disappear. You're just an ass who keep hiding it from them and they can take it back! It'll be a bit tenuous for a while - they'll be confused if you hide it somewhere else than they're used to and look in the original hiding spot - but at about 9 months they usually know how it works.

The thing is, that this doesn't just go for their favorite toy. It goes for everything, including people. Mommy hiding her face, and then reappearing, teaches them that mommy, too, will not disappear if she's out of sight for a while.

So, play peek-a-boo with your kids a lot. And enjoy the fact that they like the fact you don't go away. It won't last that long.

Monday, August 14, 2006

Safety in numbers

A few years ago, I got to attend a concert by former Pink Floyd leadsman Roger Waters. I'm a great fan of the work of both the group and the man, so I was thrilled.

One of the absolute musts at a concert of both the current Pink Floyd (in so much as that still exists) is of course "The Wall", so several songs from that album got played. Among others, there was "Run", a song that strongly refers to racist riots. As the mass of people around me got into the song, I could feel the mob mentality rising. Safety in numbers, my ass - this felt like people here would do any stupid thing that'd occur to the man on the stage.

The thing is, there is safety in numbers - safety from having to feel responsible. And that is the thing that happens in riots. Because there are so many people doing something - breaking into stores, throwing rocks at the police, trashing cars, and whatever else you care to come up with - no one person feels responsible anymore. After all, everyone else is doing it, so why should *you* feel responsible? So you go ahead and join in the chaos. After all, it's pretty satisfying to see and hear a window smash under your hands - or so I imagine, anyways, knowing the way I gloat when I hear my mage's fireballs hit in my computer games.

The other side of that medal is when people *don't* do something when they *should* be doing something. Like when people are hurt in a busy street and everyone just passes them by, or when no one intervenes when someone is getting beat up. People take their cues from people around them - if no one else is stopping, why should you? A stranger in the street isn't *your* responsibility, is he?

The way to break this is rather simple. Remind people of their responsibility. If you are the person being passed by, instead of the person passing by, call out, not to people in general, but to one specific person. The lady in the blue coat is far more likely to respond when you call to *her* instead of to the abstract general populace.

And if no one else is stopping, why should she? Because *she* is the one being called to.

Saturday, August 05, 2006

Psychology students' disease... with a twist

Anyone ever hear of medical students' disease? Apparently, doctors in the general area of a medicine faculty can tell what is being taught during that period, because medical students start appearing, claiming to have whatever type of disease they are currently learning about. We all have a great many symptoms of anything when we're looking for them, it seems.

Psychology students, and particularly students of clinical psychology (that is, those of us who like to occupy their time with crazies) get that too, but with a twist. More than thinking we have a disorder ourselves, we start seeing them all around us. The socially awkward statistics professor? Clearly autistic. The housemate who can't decide on one boyfriend and changes her opinion of you at the speed of light? Borderline, obviously. Friend having a rough week? Better make sure she doesn't have a depression!

Maybe if we're really honest, we'll admit we see them in ourselves, too. I've recognized traits of autism in myself, and a fellow intern is fairly convinced she has ADHD. But really, mostly, we see them in others.

The thing is, while most people may not have a disorder that could or should be diagnosed, this recognition isn't necessarily wrong. The thing about mental disorders is that they're not a matter of you either have them or you don't - you have them to some extent. Mental disorders aren't some kind of completely alien state that some people are in and the rest of us aren't. Mental disorders are extremes of normal, healthy behavior.

For some disorders, this is easy to understand. We're all sad sometimes, and seeing depression as an extreme of that isn't that hard. And you can probably point out people in your surroundings who are more stable, and others who are less so, so seeing borderline personality disorder as an extreme of that isn't that far-fetched either.

For other problems, this may seem like a bold statement. After all, what's normal and healthy about hallucinations or having multiple personalities? But I think we've all had moments when you are convinced you see something, or hear someone call your name, and then find that you imagined it. And all of us are a bit of a different person when we're working than when we are with our lovers or friends.

So, if disorder are all extremes of normal behavior, where do you put the line? At what point does normal behavior become a disorder?

The answer to that is both simple and complicated: a disorder is when you're on such an extreme of normal behavior that you can't function anymore. What's complicated about that, you say? The part where different people need to be able to do different things to function, and have different definitions of functioning. If you're a surgeon who becomes afraid of open wounds after an accident, for example, that keeps you from performing your profession, and thus hinders your functioning. If you work at a bank, that same fear won't be so much of a problem, since you don't get in touch with open wounds a whole lot. In the first case, it will be considered a disorder. In the second, it won't. Being afraid of snakes is far more likely to be considered a disorder if you live in, say, the Australian Outback, where you are likely to actually encounter them, than if, like me, you live in north-western Europe, where you won't find any snakes until the greenhouse effect takes a better hold on us.

At the end of the day, though, there's really only one conclusion to be drawn: we're all crazy. Some of us are just more crazy than others.