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I’ve written on this subject before, and others are catching on. John Grohol of PsychCentral writes:
Eight medications for a single child? Heck, I wouldn’t want to see an adult taking that many medications for a psychiatric disorder, much less a child of 10.(1)
Yes, he talked about a report of a child being on 2 antipsychotics, 2 mood stabilizers, 2 stimulants, 1 antidepressant, and another med just for ADHD. You’ve got to be kidding me.
I wish this surprised me. It doesn’t. Dr. Grohol thinks things might be better if the diagnoses were rendered by psychiatrists….maybe…maybe…
…general practitioners and physicians should never be diagnosing a child’s psychiatric condition unless they are a psychiatrist, plain and simple. They might offer a preliminary diagnosis, but then the rule should be that they refer on to a qualified mental health professional (a psychiatrist is fine, but psychologists and other mental health professionals are also well-qualified to properly diagnose and recommend a comprehensive treatment plan).
I’ve evaluated numerous children diagnosed by psychiatrists who were on 4 different classes of medication for ADHD (antipsychotic, mood stablizer, antidepressant, and another med to combat side effects). As Dr. Grohol notes:
Compared to adults, few studies have been done to ensure the safety and efficacy of many of these psychiatric medications (except for childhood concerns like ADHD). Medications for children are sometimes necessary, absolutely. But it should be done only under the oversight of a specialist in mental health concerns (a psychiatrist) and treatment should, ideally, be conducted through a treatment of team of mixed mental health professionals.
I would urge even more caution that Dr. Grohol. A psychiatrist will typically spend 15-30 minutes evaluating the issue. Usually (not always), their only tool is medication. In my practice, if it is at all feasible, I work with the patient in every way I can think of to avoid medication. Occasionally, it’s not possible. But very often it is. If a psychiatrist wants to put your child on meds, ask if it has been approved for use in children. There are not many meds that have been, but they are used all the time.
(1). http://psychcentral.com/blog/archives/2008/12/15/overprescribing-medications-in-children/
Women who deliver vaginally may be more responsive to their newborns in the early postpartum period than those who deliver via cesarean section, new research suggests.1
This has been speculated about for a long time, but new research shows that it is the case. I think it only makes sense. As humans, I think we are automatically more connected with others with whom we have suffered together. But, I think the other point is that this method is more natural (as God intended perhaps). I realize that there are many situations where this is not an option, but I also know that over the years, the decision of vaginal versus cesarean birth has been a matter of convenience. I don’t necessarily mean the woman either. I’ve heard stories about a doctor having to come in on a holiday to deliver a baby, and in order to get it over as soon as possible, opted for cesarean. Or worse, induced the birth and utilized forceps for the most rapid delivery possible. Doctors like their holiday times as much as anyone.
The research also found:
“We found a significant difference in activity in certain cortical and subcortical areas of the brain in this group of mothers who delivered vaginally compared with those who delivered by cesarean section. Broadly speaking, the cortical brain regions are believed to be important for regulating emotions and empathy,” principal investigator James Swain, MD, PhD, FRCPS, told Medscape Psychiatry.
This research is part of a longer term study examining the relationship between bonding at delivery method. The researchers reported that cesarean deliveries have increased from 4.5% in 1965 to 29.1% in 2006. Based on my observations, people who were born via cesarean section are more reactive to sudden changes, scared of surprises, and have more difficulty with life transitions.
I remember one fellow I saw. He was a bartender. Over the years, he joked to all of his friends, “I’ve been a bartender since I was six.” He started out by getting his father a new beer whenever requested (which was often). He didn’t know any different. This was normal family life to him. Then his father was killed in a truck driving accident when he was 8-years-old. His mother became extremely depressed and couldn’t function (couldn’t cook, couldn’t comfort, couldn’t provide parental correction, and so forth). So, he became the perfect boy (independent, high achieving, extremely helpful, protective of those with emotional needs, and so forth).
Unfortunately, he missed out on his childhood. When he became an adult, he dropped out of college, started using drugs, hooked up with women who were bad news, and generally disappointed his mother. She didn’t give him any attention or concern after the death of his father (she couldn’t). He missed his dad horribly. He became a bartender to repeat the early pattern (serving beer and liquor to folks). He also repeated a number of other patterns from his relationship with his father.
These things represent an unconscious wish “for a better outcome.” The person wishes greatly that things had not turned out the way that they had. They keep repeating, in ineffective ways, the early traumatic experience. Unconsciously, they are trying to resolve the early problem–to make things turn out differently. On another level, their symptoms are communicating the problem from their past. When they end up finding a shrink who can understand these things, they are finally able to communicate, verbally, what bothered them so horribly. Unfortunately, with today’s training, there are not many shrinks who can understand this unconscious communication. It’s rare that I don’t see this communication. I see it every single day in my practice. The symptom communicates the problem.
Just as when you have an intense pain in your shoulder communicates that there might be a physical problem with your shoulder. This prompts you to seek medical attention. Life patterns and problems also prompt people to seek psychological help. Too often, this is not recognized in my opinion.
The first thing to consider when you have apparent physiological problems, is that you have a physical problem (a problem with your body). You want to have this checked out by a doctor. Even in cases where many doctors think that the problem is psychological, a significant percentage of case are actually a physiological problem.
Now, there are also a number of cases that have a psychological component. That doesn’t mean that the pain or the symptom is not “real.” Because it certainly is—all symptoms are experienced in the mind. If your finger is cut, it feels like it is in your finger where the pain is, but it is actually ‘felt’ in your mind. Pain signals are sent from the site of the injury to the brain.
It’s been estimated that up to 90% of doctor’s visits are for difficulties that have a psychological component.1 Perhaps that’s a bit misleading, because of the strong link between the mind and the body.
When I first started graduate school, I noticed that every break I had, I got sick! There are different theories as to why this happens. But I found the most important component was my thinking. Now that’s odd isn’t it? Now, during the time of year when people have more of the flu, colds, etc.. (winter), we all notice when others are sniffling, coughing, and blowing their noses. We think, “I hope I don’t get that.” But, we end up getting it anyway, a lot of the time. Oddly, as long as I thought, “I don’t have time to get sick,” and as long as it was actually true, I did not get sick. At times, an illness can perform a function. Such as a severe cold may force you to rest more than you would otherwise. You may have a personality type where you don’t rest enough, but if you are forced to rest, you will.
Now, another notion is that aspects of immune system activity may increase under stress, but then crashes after the stress is gone (I’ve simplified this greatly). This increases our susceptibility to infections of various types. One study found that Olympic athletes are more likely to become ill in the period after the competition is over. Studies have shown that the immune response tends to crash for these individuals after the competition is over. So there is a mind component, but there is also a body component to this. They are intimately linked.
There is a branch of psychology called, Psychoneuroimmunology.2 This is a branch that investigates the relationship between psychological variables, neurological variables, and immunological variables. It’s a fascinating field of study, and there is much to learn about the relationship between the mind and the body. We are only beginning to scratch the surface with our understanding.
1 http://stress.about.com/od/stresshealth/f/psychosomatic.htm
2 http://en.wikipedia.org/wiki/Psychoneuroimmunology
The mind and the body are intimately interconnected. If we’re honest, we don’t understand how this works. Suffice it to say, we only understand some of the results.
One woman I saw was having marital problems. She developed severe hives. She and her husband had an intense argument and she felt the relationship was on the verge of ending. She could not put her feelings about this into words, so I asked her to put it into an image. She rubbed her hand against the bare wall behind her. She said, “This is it. It’s nothing! That’s what I saw for my life. Or stepping off of the edge of the Grand Canyon at night. You can’t see anything. You don’t know how far your falling. It’s just terror.” She showed me her hives when she first came in. I asked her to show me again at the end of the session (they were greatly reduced and she found this remarkable!). This is but a simple example of how emotions can be expressed in the body.
The interesting thing is, with hypnosis, a certain area of the body can be focused on. And while general immune system features may not change (such as circulation of killer T-cells), the immune response changes for the very specific area that is focused on. For example, let’s say a person has a wart on their finger. If in hypnosis, you have them visualize that wart shrinking and healing, there will be a very specific immune system response in that area only! So, how in the world can this happen? Warts are caused by a virus. But the immune system can be unconsciously directed to the very specific area in question by the mind!
I will continue this series in the future.
I work with a lot of folks who have a great deal more ability than they ever utilize. I often find myself scratching my head….”This person is extremely capable, but they’ve gone for years only making minimum wage.” They never ask for a raise. They put up with mistreatment in their dead-end job. They are not assertive in their personal relationships (they make no demands on their friends or spouses or boyfriends or girlfriends).
Sometimes, they had a learning disability, and came to believe that they were incompetent. Sometimes they had a speech problem (problems learning how to talk). Sometimes they had problems in developing motor skills (problems learning how to walk, had medical conditions requiring braces on their legs, had an early high fever resulting in poor motor skills, experienced a lack of oxygen at birth resulting in poor motor skills, and so forth). Sometimes, they were viewed by a parent as being completely incompetent, and told that they would be a failure. The reasons are numerous and very personal to the individual.
But the upshot, is that a person’s self-perception becomes their reality. Be willing to fail. You’ll gain more wisdom from failure than you ever will from success. God didn’t give you the skills and abilities that you have for no reason.
I don’t know if this is just bad reporting or bad science. But, if you believe it, you ought to have your man tested to make sure he is monogamous before you marry him. Although the title of the story states, “Possible Monogamy Gene Found in Humans,” it goes on to say that no such thing was studied.
In the prairie voles and marmosets, receptors for the two systems sit on adjacent cells, so social activity is highly rewarding, leading to monogamy.
It also says,
They found that variation in a section of the gene called RS3 334 was linked to how men bond with their partners. Men can have none, one or two copies of the RS3 334 section, and the higher the number of copies, the worse men scored on a measure of pair bonding.
Not only that, men with two copies of RS3 334 were more likely to be unmarried than men with one or none, and if they were married, they were twice as likely to have a marital crisis.
Okay, cute study. This is the problem with ethology, the study of animal behavior from a biological perspective, and then extending it to human behavior. This is often done in evolutionary psychology, and is junk science in my opinion.
“Sorry honey, I must have multiple copies of that RS3 334 gene.”
Yeah, that would fly. Good luck with that one.
Or how about this,
“Honey, I’d like to have you tested for the RS3 334 gene before we get married, because multiple copies make animals unfaithful.”
Good luck with that too.
Believe it or not, we all have self-defeating expectations at times. What do I mean by this?
“I wish I could meet someone to date…”
“What have you done to try to meet somebody?”
“Well nothing. Nobody would want to date me anyway.”
“Hmmm…”
A self-defeating expectation is different from outright self-sabotage. With self-sabotage, a person approaches a goal only to shoot themselves in the foot by something they do. For example, a person might drop out of college with only a class or two left to complete before achieving a degree. Secretly, they may fear that they will fail in their chosen career path, so it’s short-circuited before it even has a chance to start.
Most often with both patterns, there is an element of anxiety that is often subtly concealed. There can sometimes be a deep-seated belief, “Whatever I do, I am doomed to fail.” This often becomes a self-fulfilling prophecy. A person brings about that which they fear.
Now, believe it or not, sometimes a self-defeating pattern brings about things that are more positive in a person’s life. I remember one lady whose grandmother wanted her to become a nurse. She had a very close relationship with her grandmother. One day, her grandmother was complaining about a pain in her leg. Her grandmother remarked, “Oh, I probably just pulled a muscle.” And she responded, “Yeah, probably so.” Two days later, the grandmother was dead because a blood clot in her leg dislodged and ended up in her heart. This woman felt tremendously guilty—that she had caused her grandmother’s death by not suggesting that she see a doctor. She felt she had to fulfill her grandmother’s dreams for her in becoming a nurse. But she struggled in college. She became more depressed. She kept flunking certain classes. It was not because she lacked intelligence—I tested her IQ level and she should have been able to get all A’s or at least A’s and B’s in every class she took. What we discovered was that she didn’t really want to be a nurse. Once she was able to resolve her feelings of guilt about her grandmother’s death, she was able to see that her grandmother would have wanted her to choose a profession that she wanted to choose. She switched majors and started getting the A’s and B’s that I knew she was capable of.
Sometimes the patterns of self-defeat run a little deeper and keep repeating over and over. Most often, this has to do with a pattern of experiences in childhood that leads the person to have deep doubts about the competence or effectiveness. These patterns take longer to resolve, because the self-defeating beliefs are very strong and resist change. Sometimes, these patterns take several years to resolve. There may be numerous subtle anxieties that keep a person in a repeating pattern of self-defeat. But, if you are truly motivated to overcome these patterns and have a shrink that you connect with, you can overcome these patterns with a lot of hard work. Unfortunately, there is no medication that will help you do this, and there is no quick fix. It is difficult to resolve these patterns outside of a psychotherapeutic relationship, because everyone has their blinders.
Race horses are fitted with blinders. The blinders restrict their field of vision to basically straight ahead of them. This is so they do not become frightened by other things that are going on around them. People have “mental blinders,” defenses that keep them from recognizing those things that frighten them. Psychotherapy can help people remove these blinders and confront their fears and anxieties.
This is a long overdue summary of recent psychology news items that I have found to be of interest.
Estrogen Relieves Psychotic Symptoms in Women With Schizophrenia – In a single double-blind study of the use of estrogen in women with severe schizophrenia, it was found that symptoms were significantly reduced compared to placebo. This study was related to the observation that many women with schizophrenia experience a relapse of psychotic symptoms or increased psychosis during low-estrogen phases of the menstrual cycle. This is interesting in that I have seen at least one patient who experienced psychosis ONLY during this phase.
Experimental Agent Safe, May “Dissolve” Amyloid Plaques in Mild to Moderate AD – If you have a parent, grandparent, or another relative with presumed Alzheimer’s disease, you probably know something about how devastating it can be. One theory of Alzheimer’s disease involves the notion of a build up of beta amyloid plaques in the brain. Apparently, this studied demonstrated the ability of an antibody to attack these plaques. While interesting, the researchers have yet to demonstrate that this actually improves cognition and memory. They hope this has to do with the short duration of the study, which was basically to test the safety of the drug.
Early Study Finds Increased Non-Hodgkin’s Lymphoma in Long-Term Users of Tricyclic Antidepressants – A recently published study showed an association between lymphoma and use of tricyclic antidepressant medication. The authors were careful to point out, that this was just an association, and there was no proof that the medications caused lymphoma. Tricyclic medications are an older generation of medication than the current SSRI medications. They are sometimes used when there is no response to SSRIs, and sometimes can be used as a sleep aid (trazadone specifically). The risk was higher with long-term use.
Sage Oil Supplements May Help Short-Term Memory – Short-term memory is commonly used to what’s referred to as recent memory. A study found that Sage oil supplements helped people have better recall on a word-learning task.
I find that the idea of “Locus of Control” often comes up in treatment. (1)
A person with an Internal locus of control is said to believe that they have control over their own decisions and things that happen in their lives. A person with an external locus of control, believes that their personal decisions and things that happens in life, are determined by external factors (the situation that they find themselves in).
So, very often, in treatment, it is important to establish what things a person has control over, and what things a person does not have control over. I’d say in probably 70 to 80% of the people I see, there are distortions in their notions of control. Sometimes, they feel like they should be able to control everything. Even those situations which we have no control over. Other times, they don’t feel like they have control over anything, including any aspect of themselves.
An exaggerated notion of external locus of control is often associated with depression. An exaggerated notion of internal locus of control is often associated with anxiety and anger. The point is, that there are some things you can control in your life and within yourself, and there are other things that you cannot. As with many things in life, the point is finding the most realistic balance between the two. This is not something that is easily done, and will be a continual balancing act for almost everyone.
I quoted this old proverb previously in On Feeling Defective:
“For want of a nail the shoe was lost.
For want of a shoe the horse was lost.
For want of a horse the rider was lost.
For want of a rider the battle was lost.
For want of a battle the kingdom was lost.
And all for the want of a horseshoe nail.”
This quote has often been used by my mentor. I used this to describe my approach to treatment. But, as I’ve been thinking about this more, it also applies to all of our lives. Sometimes, we get caught up in intellectual arguments. Sometimes, we get caught up in our desires. Sometimes, we get caught up in the everyday details of everyday life.
But, I think what you want to do in a lot of situations, is to find that nail. It may be extremely difficult. And there are times when there is no nail. But, most often the nail is there if you are open, and dig enough. Most often for believers, you might find that nail to be God. Not, that all your problems will be solved. I don’t mean to say that like many televangelists do, but I do think that nail that God provides can often help to win that war in your life. Regardless, I think it is important to focus on “What is the most important thing?” Whether this be your outlook on life, or a difficult situation that you face.
I’ve noted before that the role of psychiatrists is largely focused only the medication that a patient takes. To be fair, there are a few psychiatrists out there who do actual psychotherapy. Recent research shows this to be declining very steadily. (1)
I think the recent research on the decline of psychotherapy in psychiatry underestimates the ‘true’ shift in the field of psychiatry. The research is based on billing codes, and I know a little about that. I do computer consulting with a mental health center on their electronic medical record system. If the session goes over 15 minutes, it is billed as medication review + MD psychotherapy. So, in other words, if the session lasts more than 15 minutes, it is considered psychotherapy. This is whether it is true psychotherapy, or just an extended discussion of medication. There are no psychiatrists within a 50 mile radius of my practice that I would consider that provide true “psychotherapy.” So, the research results from 2004-2005 showing that 29% of psychiatrists provide ‘psychotherapy,’ is quite distorted. It frankly just means that sometimes they run over 15 minutes in the discussion of medication. I’m not saying that there are not any psychiatrists who provide psychotherapy, I’m just saying that it is very rare. That’s why you ought to be very skeptical about psychologists who have prescription privileges, because it is likely that they will go the way of psychiatrists.
(1). http://www.medscape.com/viewarticle/578684?src=mpnews&spon=12&uac=107497SN
Viktor Frankl, author of Man’s Search for Meaning, observed that a person who has a strong enough “why” can cope with any “how.” What he meant by this was that if your reason for enduring something is powerful enough (the why), you can endure whatever you need to for achieving your goal (the how). His observations were based on his experiences in a Nazi concentration camp. He observed that when others in the camp gave up their reasons for being, they died within a few days. So, your meaning in life can actually have a link to and affect your physical health. For some, their driving sense of meaning was their faith, and for others–seeing their families again. The most important thing was that they had this sense of meaning.
Now towards the end of the book, he describes a survey that he conducted. He found that one of the most meaningful experiences a person can have is overcoming great difficulty and then helping others to do the same. I understand this on a very personal level as a Shrink, and it is very true. I recommend the book if you haven’t read it. It can give you a different perspective on life and suffering.
What do I mean by that? The ‘Nonverbal Level.’ What I mean is traumatic experiences that occur before the development of language, or around the time when language is just developing. People who experience these early traumas, often times medical experiences, tend to develop a wide range of difficulties. Most notably, difficulty with self-expression.
I’ve talked a little about early traumatic experiences before. In some ways a person’s emotional development becomes “fixed” or “fixated” at the age at which the trauma occurred. In may other ways they may fully develop (intellectually, physically, etc…).
I met a fellow professional at a conference a few years ago who shared that she had developed an intense aversion to all kinds of fruits and vegetables after an extrended hospital stay at the age of 2. There was no conscious memory of this experience. But her mother told her that she loved fruit and vegetables before going into the hospital, and after being in the hospital would never touch them again. Now, when I met her, she was 40 years old! She had never eaten any fruit or vegetables since that time. And could not do so. She would immediately gag.
She told me a little about her early medical experiences that she learned from her parents. I made a slightly unprofessional comment, “I bet you are extremely ‘gaggy.’” In other words, she has a hypersensitive gag reflex. She said, “Yes, I always have been. I can’t eat any fruit or vegetables without gagging. It’s the texture.” Now, this was related to the fact of being in the hospital for many months, and having tubes down her throat at this very early age.
Now, many people who have very early traumas (traumatic births, early medical traumas in the first couple years of life, etc…) have extreme difficulty in expressing themselves. It may be just talking at all that’s a problem. It may be specific to emotional expression. Regardless, there is almost always a problem in this area.
So, if you have a child who has to be in the hospital at a very young age, the best I can tell you is be there for them as much as you possibly can. Provide a great deal of reassurance and physical comfort (hugs, kisses, touch, etc…). Talk to them. Be soothing. You cannot completely erase the traumatic nature of the experience, but you will reduce it draumatically.
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