Tuesday, June 21, 2016

For Big Pharma, Charity Begins at Home - and at Taxpayer Expense

Martin Shkreli

According to an article in the British Medical Journal, from 2011 to 2014 drug companies have increased the prices of four of the top 10 drugs sold in the United States by more than 100%, and the prices of the remaining six by more than 50%. 

Most people are familiar with the story of Martin Shkreli, former chief executive of Turing Pharmaceuticals. In August 2015, he purchased a generic drug called Daraprim that treats toxoplasmosis—a life-threatening parasitic infection that many AIDS patients contract—and immediately raised its price by more than 5,000 percent. He has not been alone. The price of many generic as well as brand-named drugs has skyrocketed. In psychiatry, an old antidepressant named Parnate, available since the early 1960's, can cost over $250 per month. It probably ought to be one of those five dollar generics.

What a lot of people may not know is that these price increases are part of what seems to be a scam to bleed tax dollars from Medicare. According to a recent article in Bloomberg News, within days of increasing the cost of Darapin, Turing contacted Patient Services Inc., or PSI - a charity that helps people pay for the insurance copayments on costly drugs. Turing wanted PSI to create a fund for patients who had the AIDS complication that could be treated with Daraprim.

PSI, as it turns out, is one of seven patient-assistance charitable organizations commonly known as a copay charities. There are also many smaller ones. They offer assistance to some of the 40 million Americans covered through the government-funded Medicare Part D drug program.

Having just made Daraprim much more costly, Turing was now seemingly offering to make it more affordable. But that is hardly the whole story. It is also a story about how U.S. taxpayers support a billion-dollar system in which charitable giving is, in effect, a very profitable form of investment for drug companies—one that may also be tax-deductible!

Drug companies know that, all other things being equal, the more expensive they make a drug, the fewer people will purchase it. However, if insurance pays for the drug, then this is is no longer much of an issue. The kicker is that when the Part D Medicare drug law was passed, it included a provision that Medicare, with its leverage on negotiating drug prices created by the size of its insured population, cannot bargain with drug companies for lower prices. If the insurance company uses a "charity" which covers patient co-pays and the so-called donut hole, patients will fill their prescriptions and taxpayers end up paying the huge price increases.

As the Bloomberg article points out, "A million-dollar contribution from a pharmaceutical company to a copay charity can keep hundreds of patients from abandoning a newly pricey drug, enabling the donor to collect many millions from Medicare. The contributions also provide public-relations cover for drug companies when they face criticism for price hikes."

The article added, "Fueled almost entirely by drugmakers’ contributions, the seven biggest copay charities, which cover scores of diseases, had combined contributions of $1.1 billion in 2014. That is more than twice the figure in 2010, mirroring the surge in drug prices. For that $1 billion in aid, drug companies get many billions back.

According to a recent article in USA Today, charity-run funds are now facing new scrutiny by prosecutors in two states and by The Department of Health and Human Services' office of the inspector general. But the focus is only on whether or not co-pay charities favor donor companies' drugs over those sold by other companies. No one is challenging the whole scheme.

Those who are concerned that the government spends too much money and that the national debt is too large should ask themselves why politicians prohibited Medicare from negotiating volume discounts with Pharma companies, thusly creating these lucrative opportunities for them at taxpayer expense.

Tuesday, June 7, 2016

Marketing Methamphetamine Clones for Fun and Profit

From 2010 (when I first started this blog) until 2013, I published several posts about the United States Department of Justice assessing huge fines against several large pharmaceutical company for off-label marketing and false advertising about several different psychiatric drugs. Somehow in September of 2014, I missed  a big one. 

That time, a large fine was assessed against my least favorite of all the drug companies, Shire Pharmaceuticals - the maker of the methamphetamine clones Adderall and Vyvanse. They also make a version of Ritalin called Daytrana.

As far as I'm concerned, this company is nothing but a dope dealer that cares only for profits and not a whit for their victims - er, I mean consumers. The company does its best to convince doctors to dope up kids who have various behavior problems - which in reality are mostly due to problematic parenting and/or chaotic home environments - with highly abuseable and dangerous stimulants. 

I have written several posts on the huge increase in prescriptions for these medications in children over the last twenty years or so. Now, we are seeing a huge increase in prescriptions of these drugs to adults for the adult version of "ADHD." While there may be both adults and children with minimal brain dysfunction who have a real disorder that requires this medication, most people who are given this diagnosis present with symptoms which are caused by other factors. The biggest ones: the effects of bad environments mentioned above which create anxiety and low moods, and amphetamine abuse. The later patients lie to their physicians in order to get the drugs. 

The drugs not only get people high, but are also used as performance-enhancing drugs for mental activities—much like steroids are used to enhance performance for physical activities.

Currently, medications to treat ADHD are one of the most lucrative sectors of the US drug market, totaling more than $10 billion in sales - 83 million prescriptions in 2014, according to data from IMS Health, ”with adults using more of these medications..." The “2013 edition of the Diagnostic and Statistical Manual of Mental Disorders... relaxed the definition for” ADHD in adults."

ADHD symptoms are easily faked. A 2010 study found that 22% of adults tested for ADHD exaggerated their symptoms. And that was probably only those subjects who would admit to it! Such exaggeration has been made much easier by the wide availability of online symptom checklists. 

Getting back to the matter at hand, Shire Pharmaceuticals LLC  paid a $56.5 million fine to resolve civil allegations that it violated the False Claims Act as a result of its marketing and promotion of these drugs. As one can easily see from the above figures, that's actually a very small cost of doing business. Among other things, they marketed Adderall XR based on unsupported claims that Adderall XR would prevent poor academic performance, loss of employment, criminal behavior, traffic accidents and sexually transmitted diseases. 

Shire medical science liaison allegedly told a state formulary board that Vyvanse “provides less abuse liability” than “every other long-acting release mechanism” on the market.  However, the government contended that no study Shire conducted had concluded that Vyvanse was not abuseable, and, as an amphetamine product, the Vyvanse label included an FDA-mandated black box warning for its potential for misuse and abuse. Shire also made allegedly unsupported claims that treatment with Vyvanse would prevent car accidents, divorce, arrests and unemployment. 

Interestingly, the Justice Department was alerted to these marketing practicing by whistleblowers. The allegations arose from a lawsuit filed by Dr. Gerardo Torres, a former Shire executive, and a separate lawsuit filed by Anita Hsieh, Kara Harris and Ian Clark, former Shire sales representatives. The lawsuits were filed under the False Claims Act’s whistleblower provisions, which permit private parties to sue for false claims on behalf of the government and to share in any recovery. 

The marketing of stimulants for "adult ADHD" is as heinous as the marketing to children and teens. According to an article published by Medscape, "... the prevalence of [supposed] ADHD in adults these days is about half that in children. For years, the legitimacy of the adult ADHD was based on the belief that it was a condition that started in childhood and, for some, persisted into adulthood. 

But last year that hypothesis was shaken by the publication of a provocative, long-term study that followed more than 1,000 New Zealand children until age 38. In that study Terrie Moffitt, PhD, a psychologist at Duke University, and her colleagues found that in childhood, 6% of those in the study had ADHD. At age 38, that number had dropped to 3%.

And the biggest surprise was the lack of evidence of significant overlap between the two groups. Only 5% of those with ADHD in childhood still met the criteria at age 38. And only 10% of those who met the definition at age 38 were among those with the supposed condition in childhood.
The Medscape news article concluded from this data that "Studies suggest people diagnosed with ADHD as adults may have a condition that differs from ADHD seen in children." Wow. I would come to a different conclusion. Namely, that most of these patients did not have "ADHD" at all, but something else entirely.
And in yet more marketing-of-dope-to-children news (without a peep out of the pesky National Institute for Drug Abuse or the FDA), there’s a new, candy-flavored amphetamine on the market. Adzenys is chewable and fruity! Dr. Alexander Papp, affiliated with University of California, San Diego, asked, “What’s next? Gummy bears?”

Tuesday, May 24, 2016

Invalidating Therapists Act Like Job's Counselors

Recently I heard a story about a man who made a choice regarding his career that was at odds with family expectations. He was roundly criticized by his father, some of his siblings, as well as an uncle.

Much later, when the man started having financial problems, these relatives told him immediately that this was all his fault. According to them, his financial woes just had to be because of the career decision he had made.

This is an example of what I refer to as clustering - family members ganging up on one of the members for breaking a family rule, and pressuring him or her to tow the party line.

In an analogous fashion, some therapists inadvertently feed into a patient's problems rather than help remedy them, and in the process invalidate their own patients. Before getting to that, however, I wanted to mention that the man in question likened his relatives to "Job's Counselors." I of course had heard the story of Job, but I had never heard about that part.

As most readers will know, the Book of Job in the Bible describes the tale of a pious and righteous man named Job, who had considerable wealth as well as wonderful sons and daughters. In heaven, God asks Satan for his opinion of Job's piety. Satan answers that Job is pious only because God has blessed him; if God were to take away everything that Job had, then he would surely curse God.

God then gives Satan permission to take Job's wealth and kill all of his children and servants. Still, Job continues to praise God. Then, God allows Satan to afflict his body with boils; still he remains pious.

Three of Job's friends became known as "Job's Counselors:"  Eliphaz, Bildad, and Zophar. The friends tell Job that his suffering simply must be a punishment for sin, for God causes no one to suffer innocently. This of course, is the exact opposite of the truth as laid down in the story.

So how does this relate to therapists inadvertently invalidating their patients? Well, many therapists focus on alleged defects in their patients and work on such things as "anger management," "distress tolerance skills," or fixing the patient's defective "mentalization" (the ability to accurately assess the intentions of other people). 

These sorts of interventions presume that if someone is upset, angry, or unhappy with the way the world is treating them, then therefore there must be something wrong with them. Even when they are in fact being abused horribly!

Now, in defense of therapists who received reductionistic training, it is true that patients often act as if there is something wrong with them in these sorts of areas. However, as I have discussed in previous posts, there is a big difference in patients' public performance at a task as opposed to what they are capable of doing.

Often the alleged defects are in reality part of one of the dysfunctional family roles frequently described in this blog. People who are exclusively trained in CBT do not know about —or if they do they do not accept—the concept of a persona or false self. CBT made a name for itself by attacking psychoanalysis, its predecessor as the predominant form of therapy, and rejected all of its concepts regardless of whether they were right or wrong.

Researchers in personality disorders routinely make this same logical error all the time in studies. They look at the subjects' reactions without looking at all at what they are reacting to! It is a bit like watching a movie in which all but one of the characters - both their behavior and their verbalizations - are redacted so that the viewer can only see what one character is doing and saying, apparently in a vacuum. And then asking the viewer to guess why the one remaining character talks and acts the way he does.

An excellent example of precisely this appeared in the February 2016 issue of the Journal of Personality Disorders - a study called "Using Negative Emotions to Trace the Experience of Borderline Personality Pathology" by M. Law and others. Research subjects were asked to record their emotions (especially irritability, anger, shame and guilt) five times a day for two weeks, but not the environmental triggers which seemed to create these feelings. 

The authors came to the shocking conclusion that the subject's BPD symptoms and their negative emotions were intricately related. No sh*t, Sherlock.

Wouldn't it have been just a little more informative to have gotten data that would help us understand what sorts of situations were most likely to trigger both the negative emotions and the symptoms of people with borderline traits? Ya think?

Tuesday, May 10, 2016

Book Review: Prescriptions Without Pills by Susan Heitler

When I first started to develop my integrative psychotherapy paradigm, unified therapy, a central problem I focused on was how patients could fruitfully discuss sensitive family dynamics with their parents without the conversation turning into just another variation on the same exact dysfunctional theme. How could someone confront highly invalidating and/or abusive parents about their interactions, with a goal to stopping them, without the conversation devolving into mutual rage, defensiveness, attacks, and/or emotional cutoffs?

I was amazed at how family members could be such experts at re-framing something meant to be constructive back into something highly destructive. Readers of the comments to my blog posts on Psychology Today know that even today many people think I am the insane one for even thinking it is possible to interrupt this admittedly highly malignant process.

After I first developed and wrote about some good strategies for keeping things constructive, I came across a helpful book by Susan Heitler, Ph.D., called From Conflict to Resolution (W.W. Norton, 1990), which described several strategies for detoxifying toxic interchanges between intimates as well as between patients and therapists. The book helped me to refine and expand upon my repertoire of strategies. Since every family and family member responds differently, the more strategies I have in my bag of tricks, the more different patients I can help.

I later briefly met Dr. Heitler at a meeting of the Society for the Exploration of Psychotherapy Integration, an organization to which we both belong. Its purpose is to look into ways to integrate various ideas from the different "schools" in psychotherapy— primarily the psychoanalytic/psychodynamic therapies and cognitive behavior schools.

(As an aside, I have since become less involved with the organization for two reasons. First, the leaders of the group were afraid that if they succeeded in devising an overarching theory, then they would just become yet another therapy school. I, on the other hand, was tired of exploring and was interested in actually doing. Second, family systems and social psychology were woefully underrepresented in the group. Since humans are among the most social of organisms, that just seemed crazy).

Dr. Heitler has now written a self-help book for lay readers which goes over a lot of the same territory as the Conflict book, Prescriptions Without Pills: For Relief of depression, anger, anxiety and more. The title stems from an opinion we both share: today there has been an explosion of excessive prescribing of anti-depressant and anti-anxiety medication to clients who just have problems in living. While she is not against the use of medication, it is often just plain ineffective for many problems with which people come to mental health professionals. Antidepressants for example, as I have written about many times, are completely useless for chronic unhappiness as opposed to Major Depressive Disorder.

The book is chock filled with very useful suggestions for people who are locked into what were once termed neurotic styles. (See the book of the same title by David Shapiro from way back in 1965). The term neurosis has unfortunately now been practically banned from psychological discourse and psychiatric diagnosis because its role as a "cause" for any psychological problem has not been "proven." 

It refers to problems created for people because of internal conflicts between what they would like to do based on their own preferences and what they think they are supposed to do based on the "rules" they have learned from their ethnic group, religion, and most importantly their families of origin. "Style" refers to such things as ways of thinking and perceiving, modes of subjectively experiencing other people, and repetitive, unthinking types of stereotypical behavioral transactions in various circumstances within one's interpersonal relationships.

People who will benefit most from this book are those who learned these styles growing up and who have gotten into some bad habits which create sadness (the author uses the word depression but seems, at least in this book, to have conflated major depression and dysthymia, the differences between which are elucidated in this post), anxiety, anger, and/or addictive behavior—but who are generally functioning fairly well in some areas of their lives, have minimally cordial relationships with their parents and siblings, and are highly motivated to change. They will find the suggestions in the book quite helpful in getting problematic behaviors and feelings under control. This in turn will help them with their love life and their work life as they interact with others.

I do not believe that people with more severe personality pathology and highly dysfunctional families will be able to successfully avail themselves of these strategies for reasons I will also mention in a bit. So this book will not be as helpful for folks like that.

Dr. Heitler describes the typical habitual ways neurotic people respond to problems, particularly interpersonal ones. The one healthy one is to define and boldly face the problems and to work on solutions to them. The unhealthy ones include folding (leading to discouragement and low moods; fighting (leading to anger and aggression); freezing (leading to chronic anxiety); and fleeing (obsessively burying oneself in a substance or behavior and becoming addicted to it).

A big part of the techniques for changing the bad behavior when it starts to occur is stopping and thinking about what the real nature of the problem is, as well as the reasons behind one's own seemingly overly-strong, over-the-top emotional reactions. The reasons for those are often past experiences with important attachment figures (emphasis on the word past. If those experiences are ongoing, that's a 'hole 'nother level) which bring up strong feelings.

For instance, if when you were growing up your divorced father frequently did not show up for his visitation days when he was supposed to, and in response you started to think that you are basically unlovable, then any time another person disappoints you, you might over-react even if the other person had a very valid reason for not doing what you had expected. 

This is actually a way of conceptualizing what the psychoanalysts call transference. Many cognitive behaviorists claim they don't believe in it, even though they actually do but just call it by another name: mental schemas.

Dr. Heitler recommends visualization techniques one can use to let one's mind recall the important precipitating events from one's past. The techniques can be thought of as another way of employing what the analysts call free association.

She also suggests many useful questions to ask oneself and ways of thinking that one can use to explore one's own psyche, to change perceptions about what other people might really be doing and thinking, and clarifying dilemmas in life. She describes how one can use their own strong feelings as a vehicle for constructive engagement with other people in order to solve mutual problems.

When discussing mutual problems that occur in intimate relationships, certain words and phrases often lead to more conflict than light. The author provides a useful list of words to use and words to avoid in what she calls the Word Patrol.

The reasons these otherwise wise and productive suggestions are likely to fail in people from more disturbed families with ongoing repetitive dysfunction relationship patterns is because they are quickly and easily overcome by powerful family reactions to the patient's new behavior. If your new behavior causes your mother to suddenly stick her head in an oven, metaphorically or literally speaking, or if everybody you know and care about comes down on you like a pack of hungry wolves with the strong message, "You're wrong, change back," most people will wilt and go back to the way they were. This process is particularly vicious in families that produce people with borderline personality disorders, as described in this post.

Instead of responding with less defensiveness and anger, dysfunctional family members can twist around what anyone says no matter what words are used or avoided. They can employ ambiguity and double messages to such a degree that the person who is trying to engage them in problem solving does not know what was actually meant or whether or not any issue was really resolved.

This does not mean that family members in families like these cannot be reached. They most definitely can be. But the process is way more difficult and intricate than the solutions described in this book might seem to imply.

Tuesday, April 26, 2016

Successfully Confronting One's Family of Origin Members: What Comes Next?

A commenter on one of my blogposts posed what I thought were some very good questions. The post itself was about how some other therapists think I'm a horrible therapist because I send my patients who come from highly dysfunctional or abusive families back into the hornet's nest to confront and hopefully change ongoing repetitive dysfunctional interactions with family of origin members.

The anonymous commenter asked: Even if a patient is able to confront or dialogue with their parent to stem the abusive behavior, wouldn't that be just the beginning of the work of patient? Just because Mom and Dad have stopped being the insufferable fools that they are, a) they don't necessarily understand the family dynamics at work and b) their corrected behavior is not going to help the patient with his habitual emotional responses that have hampered his life. Once Mom and Dad have been more or less straightened out, what is the patient's next move?

I realized that, although I covered this in detail in my books for therapists, I had not really addressed the answers to these questions here in the blog. So here goes:

First of all, the dialog with the parents usually does include an empathic discussion of the family dynamics and the reasons for the parents' problematic behavior (metacommunication). The goal is to do this without condoning any of their past or current damaging behavior. That problematic behavior is the most powerful trigger and reinforcer of the patient's dysfunctional role within the family. (Many of these roles have been described in detail in previous posts, and are models for the various personality disorders).

How individuals play the dysfunctional roles in everyday life is based on a model in their heads of how to respond to various social situations with significant others. These models are called role relationship schemas. These schemas and the resultant behavior are performed automatically and subconsciously in response to various pre-determined social cues, and are therefore performed thoughtlessly in most situations.

When the parents stop feeding into and/or triggering someone's schemas, this seems to start to free the person up to experiment with alternate ways of relating to others. While going through this process, however, the individual may often also experience something called post-individuation depression or groundlessness in which they come to the realization do not seem know who they are any more. They have yet to become acquainted with the true self that they had been, before this, invariably suppressing throughout much of their lives. Paradoxically, their role behavior or false self feels real, while their true self feels false!

As a therapist, I explain this feeling to them and reassure them this horrible feeling will soon pass.

Many patients will then spontaneously start to experiment with new ways of relating to others. If not, typical cognitive-behavioral psychotherapy interventions from the therapist - which would have before this point been quickly overpowered by the reactions of family members - suddenly become very effective in moving patients forward.

Finally, the patient is instructed on how to handle the issue of family relapses. It is almost inevitable that they and the parents will at some future point fall back into their old dysfunctional habits. As we all know, long-time habits are indeed quite hard to break. However, once the earlier metacommunication had taken place, it is fairly straightforward to bring the relapse up with the parents and refer back to what had been discussed and decided upon earlier. The patient is instructed to wait until everyone cools down before attempting this maneuver.

Before I terminate therapy with a patient, I praise the patient for taking what we had discussed in therapy and employing that which we had decided to do so effectively. I believe it is important that patients take a realistic view about giving credit where credit is due, so they can have confidence that it was they who had actually accomplished the goals of therapy. This reassures them that they can therefore carry on without the therapist's help - and without the therapist having to pretend that the therapist had nothing to do with it at all, as some family systems therapists recommend.

Tuesday, April 12, 2016

Direct to Consumer Drug Advertising: There's a Sucker Born Every Minute

Have you seen them? TV and print ads advocating the use of a new drug called Rexulti as something that can be used to augment an antidepressant when the antidepressant alone does not completely relieve all of your symptoms. These ads are only slightly different than ads you may have seen in the past for Abilify, which was also touted for the exact same indication.

As it turns out, both of these drugs are manufactured and distributed by the same companies: Otsuka Pharmacuetical Company and its marketing partner Bristol-Myers Squibb. And guess what? Abilify recently went generic (which means its original manufacturer has lost its patent protection and therefore its monopoly on the drug) under its chemical name, aripiprazole. 

Rexulti's chemical name seems oddly similar: brexpiprazole. Coincidence?

Well here are pictures of the chemical structures of the two compounds.

Remarkably similar, no? In fact, these drugs have effects on people that are nearly identical, have only slightly different side effects, and they both have the exact same indications. And of course they are not antidepressants at all as many of you have probably been led to believe, but antipsychotics: meant to treat delusions and hallucinations in schizophrenia, bipolar disorder (the real kind), and major depression with psychotic features.

(BTW, we've always known that any antipsychotic medication can augment an antidepressant in some patients. However, they have potentially very toxic side effects, and there are other, safer drugs which can also augment an antidepressant, such as lithium and a thyroid hormone named T3. I think benzodiazepine drugs such as clonazepam do as well, but drug companies are not about to do studies confirming that, because benzo's are so cheap and free of side effects).

There is one very big difference between Rexulti and Aripriprazole: the price. Generic Aripiprazole will be much, much cheaper. Why on earth would anyone ask for an expensive drug when a cheaper, nearly identical drug with the same effectiveness and nearly the same side effects is available?

Well of course they would not. Which is where the direct to consumer ads come in. The company wants to keep up its profits, so it pushes their new drug without any reference to their old one. And people are suckered into demanding it from their doctors. As someone once said, no one ever went broke underestimating the intelligence of the American people.

Now I can't prove that the company developed Rexulti in anticipation of losing its patient protection on Abilify, but the timing is a bit suspicious, wouldn't you say?

Drug companies have lots of tricks to extend their patent protections aside from just coming up with new conditions for which a drug is indicated, coming up with an extended release version of the same drug, or newly combining the drug with a second drug. 

Some drugs are converted to other drugs in the body which are in fact the compounds that have the desired effects (active metabolites). So after the parent drug goes off patent, they release the active metabolite as a "new" drug. Think Effexor vs. Prestique.

Some drug compounds come in two different versions which have the same chemical formula but different geometry - the two molecules (enantiomers) are mirror images of one another. One of the two versions may be effective for a given symptom while the other may have little effect. So drug companies first issue a mix of both versions (racemic mixtures), and when that drug goes off patent, they release a drug which is  the pure, active enantomier. Voila, new more expensive drug, new patent, and the clock keeping track of how long the company retains exclusive ownership of the drug starts to tick anew. Think: Celexa vs. Lexapro, and Prilosec vs. Nexium.

So if you pay attention to those ads, you will be being taken as sucker.

Tuesday, March 29, 2016

Adult Children Who Cut Off Their Parents: an Interesting Variation on This Theme.

My posts on this blog (May, 27,2014) and on my Psychology Today blog (November 17, 2014), Are Parents Who are Cut Off by Their Adult Children Really That Clueless, generated more comments than almost any of my other post (37 and 163 respectively). Additionally, the post itself on this blog has had more hits than any of the others.

In the posts, I reproduced letters to newspaper advice columnists from parents who had been cut off by their adult children, and who claimed to have no idea why their adult children felt the need to do this. I also printed one letter from the adult child of one of those letter writers telling the other side of the story. Without addressing the issue of who's "fault" it was that the cutoff took place, or who was "wrong" and who was "right," I opined that the apparent cluelessness of the parents was in most instances feigned. They usually knew to a greater or lesser extent exactly why what had happened had taken place.

Well the comments from readers came fast and furiously from family members on both sides of this divide, and they were very predictable. Adult children who had cut off a parent generally wrote about all the bad things their parent had done to them and how the parent would never admit to any of it. Parents came back with a vengeance saying, in so many words, "I didn't do anything wrong," and they accused me of parent bashing.

Here's a typical exchange:

Anonymous: Yes, you are correct. Virtually all of the time, when people cut off parents, or anyone else in their immediate family, you can bet there's a damn good reason. The parents will act like the poor victims. Don't believe them. There's actually a forum on the Internet where they can all get together. At first they maintain their innocent victim stance, but you will soon see their vicious hatred expressed toward their children.

Emelu: Not so. I have done nothing wrong. I've been in counseling. Been open to understand if I did wrong. Been totally honest with myself. And there is nothing I've done wrong.

I always find it interesting that whenever I write posts - particularly on the family dynamics of borderline personality disorder - adult children with the disorder who make comments often seem to accuse me of blaming them, while the parents of such children often accuse me of exactly the opposite: blaming the parents.

In most of these cases, I think the reason for these opposite reactions has to do with selective reading of the posts. This, in turn, is triggered by guilt and defensiveness. Or, occasionally, some of these folks just hate it when I give away their secrets.

In general, both of the positions "It's all my fault" and "I had nothing whatsoever to do with this" are, equally, both irrational and cowardly for any of the involved parties. 

In cutoffs, however, can it sometimes be that the parents really are completely clueless about why their children are avoiding them? That they are absolutely at a loss to understand what has happened? Some commenters said their cut-off children even accused them of things that they know they did not in fact do. Is that always denial?

As everyone was taught in school about true-false tests, beware of any question containing the words "always" or "never." I do think that, in a very limited proportion of these cases, the letter-writing parents are indeed genuinely flabbergasted at their adult children's negative responses to them and the phony accusations. In these cases, IMO the adult children are hiding their real reasons for the cutoff.

So why would a child cut off a parent who was not guilty of any significant abuse, neglect, or invalidation?

One common reason occurs in situations in which the parents feel tremendously overburdened and overwhelmed by the responsibilities of child care, or feel that the child's needs are preventing them from doing other things that they really badly want to do. They feel guilty when they admit this, even to themselves, and they always take care of their children when they are supposed to, and do so appropriately for the most part. They do not usually take their internal frustrations over being exhausted directly out on the children to a major extent, and genuinely love them.

They think that somehow their children are not aware of how tired and frustrated they are, but they are kidding themselves. The attachment theorist John Bowlby theorized that children observe their parents very carefully, without attracting too much attention when they do, and become experts on what their parents are all about and what motivates them by the time the children are just two years old.

In videotapes of family therapy sessions with small children in the room that I have seen, as the therapist speaks with the parents, one may observe the child playing with a toy in the corner. The child seems to be oblivious to the adult conversation. But then, when something concerning them comes up in the conversation, the child suddenly makes a comment about it. Without even looking up. Clearly, they are listening the whole time.

Parents in the situation under discussion in this post do in fact give a lot of clues as to how burdened they feel. They might for instance constantly and compulsively complain to their friends and anyone else who might listen, saying something along the lines of, "I'm always there for my kids! They're my #1 priority. I respond to everything they need, even though I have to work full time. I so wish my boss would understand this better. There's just never enough time. And I'm sooooo tired. I used to have hobbies I really enjoyed, but I've had to put them aside. I sure do miss those days!"

Even after their children reach adulthood, parents like this may have a very hard time trying to not cater to their adult child's every need - or even his or her every whim. While still complaining about it to everyone else.

In such cases, children may get the impression that the parent really wants to be free of them, but just cannot admit it. In response, they sacrifice their own desires for a good relationship and make themselves scarce. They cannot tell their parent the real reason for their doing that, because they know that this will make the parent even more miserable than he or she already seems to be. 

A truthful statement would make the parent feel even guiltier for wanting to be free of any family burdens. The parent would probably deny these feelings anyway, because the parent is under the mistaken impression that admitting this would drive their children even further away.

In order to avoid causing their parent to feel this way, the adult child may in difficult cases volunteer to be the villain in the piece. They may purposely make it look like they are cutting off the parents because they are selfish or narcissistic. If that does not work, they can escalate. They up the ante by making what they know are false accusations about parental misdeeds. That way, the parent can easily maintain the belief that he or she had nothing to do with the cut off. 

As an alternate strategy, or in addition, they may influence their spouse to make it look like the spouse has taken control over them and is domineering and purposely creating trouble with the parent and enforcing the cut off. For more on this, see the post, Your Spouse's Secret Mission.

Anything to help parents avoid looking at their own conflicts!

This is a sad state of affairs because, ironically, if the parents could admit to their ambivalence and negative feelings, any problematic resultant family conflicts can in most of the cases be fairly easily resolved through metacommunication and negotiation. The children's efforts to "help" the parents to deal with their guilt backfires and prevents a solution.

I know that many readers react to these kinds of formulations by thinking I am giving people too much credit, and that most of them do not operate with this level of sophistication. When it comes to fitting in with one's kin, church, or ethnic group, I strongly believe that they not only can, but they do. 

Tuesday, March 15, 2016

Groupthink: A Paradoxical Type

A recurrent theme in this blog is that one cannot understand repetitive self-destructing, self-defeating, or self-subverting behavior without reference to group dynamics. Because of the forces of kin selection, we are all biologically predisposed to sacrifice our own needs/ideas/happiness in order to fit into the various kin and ethnic groups to which we belong - although we can all override this tendency and face the consequences if we so desire. 

Part of the way we fit ourselves into any group is to pretend to subscribe to the validity of the rules and ideas shared by the other members of our group: what is today called groupthink.

I recently came across an idea about a peculiar and almost paradoxical phenomenon which is one interesting manifestation of groupthink. It is known as the Abilene Paradox, first described by Jerry P. Harvey in 1974. It is similar to my idea about what is going on with members of couples embroiled in repetitive dysfunctional relationships. Members of such couples almost always assume that it's the partner, not they, who want and need their relationship to continue in its current miserable form (cross motive reading).

As described by Harvey, the Abilene Paradox is based on a personal experience in which his family all agreed to travel over 50 miles in extreme heat and in a non-air conditioned car in order to eat at a restaurant in Abilene, Texas. In reality, not a single member of the family actually wanted to take this trip when someone suggested it. However, every single one of them mistakenly believed that all the other family members were in favor of going. 

And so they all went, and they all were miserable for the entire trip.

This is sort of the inverse of the situation in which an individual who has reservations about a group decision goes along with a group on some idea or project when the other members all, in fact, do think it's a good idea. The end result in each case is of course exactly the same: everyone goes along with the idea. In many such cases, the altruistic intention backfires and ends up harming everyone.

Going along to get along in a business atmosphere, as mentioned in a previous post, can eventually lead to the demise of an entire business. Harvey also discussed the Watergate scandal as another example of a situation in which everyone went along with an idea that they mostly all knew was a terrible one, because that was what they thought everyone else wanted them to do.

Sometimes, what fools these mortals be.

Tuesday, March 1, 2016

More Baloney about Implanting False Memories

TV show available at

In an otherwise excellent episode of Nova on PBS about recent research into memory - available for viewing in its entirety at the website above - the show takes what is for me a disturbing turn around the 38 minute mark. It starts to discuss the issue of whether false memories can be implanted in people. An academic psychologist named Julia Shaw discussed her experiments which she believes "proved" that you can induce in someone a memory of a crime in the distant past that they did not actually commit.

Dr. Julia Shaw

According to an article in the New Yorker, Shaw modeled her work after that of child abuse apologist and memory pseudo-expert Elizabeth Lofton. Shaw claimed that she was able to induce this kind of false memory in 70% of her subjects. Of course, even if this were true, it means that she was unable to supposedly accomplish this feat in almost one third of her subjects, which leaves us with the question of what distinguishes that portion of the sample from the others.

But leaving that aside, let's look at the experiment she did, as shown with a film of one probably illustrative subject during the experiment. The experimenter brought up a supposed incident that occurred when the subject was 12 years old. Dr. Shaw told the subject that the subject's parents had told her about the false incident. She said, "What happened was you initiated a fight that was so severe that the police called your parents. They said it happened in the fall when you were with Ryan when it happened." She mentioned two facts that were in fact true - a move the family had made around that time, and the name of someone she knew.

The subject's first response was not surprising, and it was quite definitive - if not emphatic. As I relate the dialog in the experiment, I want readers to notice that the subject moves from a quick and clear-cut response at first, denying this happened, to later describing an event that she starts to think may possibly have happened. In the later interview, not only is her language tentative, but she looks puzzled and is intermittently shaking her head no! If you don't believe me, watch the show segment for yourself by clicking on the link under the picture at the top of the post.

The key point the reader should also consider is that the experimenter has now put the subject in the position of calling her parents liars! If they are generally truthful, hearing that they reported something that seems completely alien to her whole personality will at the very least introduce cognitive dissonance and self doubt. I mean, why would her parents make up something like that? This self doubt is clearly manifested in the patient's facial expressions and tone of voice as she says the things she says in the film. 

However, even if the parents were notorious for being fast and loose with the truth or made a habit of blaming the subject for things that were not her fault (a not uncommon feature in dysfunctional families), due to family loyalty the patient might still become motivated to protect her parents' reputation to the experimenter and perhaps also to save herself from an argument with the parents later on. Family loyalty is something Dr. Shaw apparently either knows nothing about and/or has never even considered.

The subject's initial response to the experimenter relating to her what her parents allegedly said had "happened" was this:  "Honestly, I don't remember. I don't know what you're talking about. I don't think I've ever been in a fight." (She laughs). I'm so confused!" While she said this, I observed not the least bit of hesitation.

Dr. Shaw admits during the program that she uses techniques meant to create social pressure to get the subject to come up with the false "memory." Experiments in social psychology have shown that the pressure to conform to a group can cause people to say things that they actually know are not true. In other words, they blatantly lie in order to fit in. The most famous of these experiments were done by Soloman Asch, as described here.

Shaw tells the subject, "Relax, close your eyes, and focus on trying to retrieve this." This instruction implicitly assumes that the event the experimenter concocted actually took place. Then comes a little extra social pressure: "It seems strange, but it does work for most people." She then has the patient picture herself at the time and place under discussion. "Picture yourself at the age of 14 and it's Fall and you were with Ryan when it happened."

A week later, the subject starts talking tentatively, "I remember like a verbal fight." She has an unmistakable puzzled look on her face. "It seems so unlikely." Clearly, she is not really recalling any specific event, but trying to put together bits and pieces in her memory from other things that might have happened to her - again, I strongly suspect, to avoid either saying or believing that her parents have lied about her. 

She continues, "Maybe I pushed or something."

Shaw encourages her to continue. "Good! Ok!"

Subject: "I feel like she pushed [significant pause] me first. 

Feeling like something might be true is hardly the same as actually remembering it.

A week later, the subject embellishes the non-story: "I think the cops showed up." (Translation: I'm not really sure about this). "We were kind of having maybe like a verbal kind of fight and it got into a push." Maybe? Again, does not sound like a specific memory at all. And the coup-de-grace: After saying this, she again shakes her head no.

Dr. Shaw confidently asserts that she has now proven that you can induce false memories in people, when what she actually proved was that under conditions of social pressure, cognitive dissonance, and/or family loyalty issues (and probably in several other contexts), you can induce people to make stuff up. And sometimes even lie to themselves about it.