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Tuesday, July 18, 2017

Book Review: "Behave" by Robert M. Sapolsky




For anyone who wants to understand all of the huge number of factors that influence human behavior, as well as counter overly pat, simple, or downright mythological explanations for it, I cannot recommend a book more highly than this one. Every page – and there are almost 700 of them - is just packed with enlightening information on the role of almost everything you can think of. 

These factors include genes, gene regulation, epigenetics, neurotransmitters, hormones, brain structures, neural networks, unconscious cuing and sensory triggers, stress responses and protective factors, neural plasticity, peers and social acceptance, attachment figures, brain development in childhood and adolescence, socioeconomic and hierarchical status, collectivist vs. individualistic cultures, gender, reactions to “them” vs. “us,” heritibility  vs. inheritance of traits, gene/environmental interactions,  population density, evolution (individual, kin, and group selection), reciprocal and pathological altruism, obedience vs. resistance, cooperation vs. competition, and empathy. And a whole lot more.

Can one book really be that encyclopedic?? Yes! I have no idea how he accomplished writing this. 

If you do not understand some of the scientific concepts that are under discussion, he conveniently includes three appendices in the book to help explain them. Not that the main body of the book is dry and overly technical. It is laced throughout with witty jokes, stories, and ironic observations that kept me thoroughly entertained.

Does he leave anything out? Well, yes, he does not seem to know about the effects of rapid cultural change on families which may create shared intrapsychic conflicts leading to parents giving mixed messages to their children which then trigger and reinforce their repetitive self destructive behavior. But I haven’t yet seen anyone else write about that besides me – at least not in the way I have conceptualized the process - so I wouldn’t expect that. He also doesn’t discuss the effects of chaos theory on the amazingly multi-factorial “causes” of behavior he goes into - a minor quibble.

Sopolsky shoots down behavioral and neuroscientific myths believed by health care professionals, some scientists, and the lay public alike (what mirror neurons actually do, for example) with the abandon of someone armed with an Uzi facing off against people armed with swords. Amazing.

Some of his important points: 

1.       Brains and cultures co-evolve.

2.       We haven’t evolved to be selfish or altruistic, but to behave in particular ways in particular settings. Context is everything.

3.       Genes are not about inevitabilities, but about potentials and vulnerabilities, and they do not determine any behavior on their own.

4.       Evolution has been most consequential when altering regulation of genes, not the genes themselves.

5.       Saying a biological system works well is not a value judgment – it can function equally well for those who do something wonderful or in those who do something horrific.

6.       Nothing seems to cause anything - everything just modulates something else within a specific environmental context. And changing one thing often changes ten other things as a byproduct.

7.       Any causative factor within any specified population of individuals within any specific environmental context has an average effect on behavior that may or may not apply to any given individual. There are always exceptions.

What an accomplishment.

Thursday, July 6, 2017

Themes of This Blog Seen In Newspaper Advice Columns: The Game without End, Gender Role Division




In Amy Dickinson’s advice columns of 5/29, 6/14 and 6/18/17, and in Carolyn Hax’s column of 6/23/17, the Agony aunts published letters which serve as a good, simple and straightforward illustrations of something that family therapists have called the game without end, described in several previous posts.

Whenever one member of a couple or a family makes a good case for changing the rules by which people in the family operate, other members of the family (or the other member of the couple) get suspicious. The person making the request has always followed the old rules. I mean, they say they want things to be different, but do they really?

So the person making the request gets “tested” to see how sincere their request really is. The others make the requested changes, but do so in an obnoxious or annoying manner. My favorite illustration of this is a situation widely created by rapidly evolving changes in gender role functioning, which the letters that are the subject of the current post clearly illustrate.

Both members of a couple work, but somehow everyone - including the females - has always expected the female to do all or most of the housework due to the rules followed by earlier generations of men and women.  The woman often has treated the kitchen, for example, as her own personal fiefdom in which she is the undisputed boss of how things are supposed to be done.

If she suddenly asks her husband or boyfriend to help clean up and do his share of the cooking, he wonders if she really wants that - because of her prior attitude and the accompanying behavior, which had been readily and repeatedly observable up to this point.

So, when it’s his turn to clean the kitchen, he does a half-baked job and puts the dishes and pots and pans in all new places, so that his partner cannot find them when it’s her turn to do, say the cooking. Or he does any of numerous other passive-aggressive things that annoy the heck out of her. So she criticizes him unmercifully for his poor performance.

In a sense, she starts criticizing him for doing the very thing she had asked him to do in the first place.

His conclusion: "See, she really didn’t want me to help out after all." I can never understand why he discounts his own behavior in drawing this conclusion, but that is highly typical.

An effective way to handle a game without end so that the rules really can change is described here.

So for those readers to are skeptical, here are some abbreviated letters from the advice columnists:

5/29/17. Dear Amy: I am really tired of my husband asking: “How can I help you?” “What can I do for you?” or “What do you need?”Here’s why this upsets me: If I am cooking dinner for the both of us and he asks, “What can I do for you?” I think, well, you are eating this dinner too, so why not just ask, “What can I do?” Why is he offering to do something “for me”? I get so frustrated that my response is: “…nothing.” When I suggest that he just pitch in, he tells me that I do these household things so much better than he does. 

He seems to want me to need him. I don’t need him. I just want him to initiate the household work on his own. He watches TV while I run around picking up the house or making dinner, and his only response is, “Am I in your way?”...When he finally does something like putting a load in the washer, he needs to announce it like it’s the second coming. What can I do? - — Frustrated!

A response from a man to the above letter: 6/14/17. Dear Amy: I am a man who has been in the same position as “Frustrated’s” husband, who would ask, “What can I do for you?” instead of just taking responsibility for his half of the household chores. I used to be like this. I just didn’t know how to be helpful and I didn’t want to get in the way. Honestly, my wife basically trained me how to take on more responsibility and now we work together. — Reformed (This guy is still letting her be the boss!)

Dear Reformed: I have received a huge response to this letter, and many men echo your statement — they needed some guidance and when they got it, they stepped up.

6/18/17. Above letter, continued. Dear Amy: I understand a lot of men are responding to the letter from “Frustrated!” about her husband’s lack of initiative regarding household chores. In my case, I jump in and do my best, but my efforts are criticized and belittled. It is hardly inspiring me to do more. — Also Frustrated

6/23/17.  Dear Carolyn: I love my partner. He recently moved in... I’m so tired of people who won’t clean up after themselves and leave it until I do it. I made it very clear to my partner before he moved in that it was important to me...But I’m already tired of asking and I’ve been reading about “the mental load.” Like last night: I was stressed and headed to my second job and he asked what he could do to make me feel better (sweet!) so I said, get wrapping paper and a card and wrap your sister’s wedding present. And when I got home later, he had! But. The box was left out instead of recycled, the couple of dishes I used to feed us before I went to work weren’t done, the living room was a mess ... he just doesn’t see it…— I’m Already Tired




Saturday, June 10, 2017

Themes of This Blog Seen In Newspaper Advice Columns: The Principal of Opposite Behaviors





In Amy Dickinson’s advice column of 4/5/17, she published a letter which serves as a good, simple and straightforward illustration of something I call the principle of opposite behaviors, described in several previous posts, as well as illustrating how seemingly opposite behaviors are actually just two sides of the same ambivalent coin.

The principle states that completely opposite behavior patterns can lead to the exact same result. If you’re afraid of being dependent on others, you can refuse to let anyone help you with anything. Or you can ask for way too much, annoying and eventually driving off people who might want to help you. In either case, you will end up with no help!

This principle comes into play when someone is ambivalent about certain rules of behavior in specific social situations. If this ambivalence is pervasive and frequently seen as a problem, said people who exhibited it were once called neurotics. The psychoanalysts who were the first to describe intrapsychic conflicts as a phenomenon missed the fact that these conflicts were usually shared by all the members of their patients’ entire family. 

In some cases, the conflict is expressed by compulsive or polarized behavior at one end of the spectrum - or at the exact opposite end. Some highly ambivalent people go back and forth between the two extremes, while in other cases, one generation goes to one extreme, the next to the other, and the third back to the first one.

In the letter, the father in the family was ambivalent how involved he should be with his son, and his conflictual behavior became apparent at his son’s little league games. His behavior was polarized and seemingly the exact opposite of that of his fatherAmy’s answer points out that trying not to be like your own parents in some way that you didn’t like can lead to a situation in which you try to do the exact opposite – and get the exact same result. Here, in abbreviated form, is the letter and the relevant response.

Dear Amy:  ...when we go to our son’s Little League games…my husband is the loud one on the sidelines — pacing, swearing and turning red; he micromanages our son, and shouts belittling comments at him and other kids on our team. He argues with the umpires, and complains about the coaches… he has been ejected from games during those seasons. I’ve tried asking him to be calmer...He says that he’s a lot better than his own dad, who never showed up for anything…


Dear Exhausted: Your husband claims that he is “better” than his own father was, but how is getting ejected from a game better than not showing up for the game? Either way, Dad is not at the game!

Sunday, May 21, 2017

Climate Change and Severe Mental Illness Deniers Use a Common Strategy




One topic I discuss on this blog is the tactics used by various advocacy groups to make misleading arguments in their efforts to advance their interests.

There is, of course, a large anti-psychiatry contingent that argues that severe and chronic mental illnesses like schizophrenia and (real) bipolar disorder are not real brain diseases.  They also argue that, since their brains are normal, the abilities of affected individuals to think rationally enough to properly take care of themselves are not highly impaired, so that involuntary commitment and treatment are never indicated under any circumstances. Of course, they seem to make a big exception for people who suffer from the brain disease of Alzheimer’s disease, but that’s another issue.

It recently occurred to me that the argument I have been hearing from those who deny that climate change exists, or that people are contributing to it, is very similar to one that is used by the mental illness deniers. They knowingly set a bar for “proving” the nature of these phenomena that is totally unachievable by science, and then use this ridiculously high bar to assert that, since the science is not "proven," then it is invalid.

In complex phenomena like weather or brain structure and function, the number of involved factors contributing to the final result is enormous, and their interactions unpredictable to a significant degree. Schizophrenia, for instance, is clearly not a disease of the gross pathology of the brain, which is what the deniers insist is necessary for “proof,” but is probably a disease of the interconnections between literally billions of nerve cell synapses that connect one neuron to others. We have no way currently to map out these connections in precise detail, and they change constantly over very short periods of time, so we cannot prove that they are pathological. There is, however, an astronomical amount of indirect evidence that they are.

Similarly, climate change deniers use the fact that the various computer models which predict how the process will unfold differ from one another in their predictions about the exact timing and locations of various expected weather events as evidence that the science is completely flawed. What they completely omit to mention, of course, is that no one is arguing that we have or probably ever will have the ability to predict weather patterns with that degree of precision. They also conveniently forget to mention that all the models point in the same direction, and that the patterns are already happening in ways that are consistent with the more general predictions.

Well, there are a lot of things that science cannot predict with absolute certainty, so we have to go with the preponderance of the evidence. In cases in which the consequences of inaction are enormous, we still have to act without this ridiculously high level of “proof.”

I would argue that allowing the mentally ill to languish in jails or in cardboard boxes on the streets of cities like San Francisco is such an instance. So is climate change that can lead to mass population dislocations with resultant wars, severe pollution, starvation, and the spread of tropical diseases that might kill us all.

I do not know if there is a name for this logical fallacy so glibly employed by science deniers. But there should be!

Friday, April 28, 2017

Measuring the Nature of Parenting Practices in Studies




A "scientific" journal article entitled, “Which dimension of parenting predicts the change of callous unemotional traits in children with disruptive behavior disorder?” By Muratori and others in the August 2016 issue of Comprehensive Psychiatry attempted to determine whether parenting practices influenced the development of so called callous and unemotional (CU) character traits in children. Alternatively, are those traits – which are common in children with disruptive behavior –more genetic in origin? 

In the study, no significant relationship was found between "negative" parenting and CU traits; these two variables were also unrelated when "positive" parenting was considered in the same model. However, using a slightly different model, higher levels of positive parenting predicted lower levels of CU traits.

Although I would like to believe and tend to agree that “positivity” in parent-child relationships helps decrease acting out behavior in children, a huge problem with this type of study is how the hell can you precisely measure the nature of the relationship between parents and children? The biggest problems with that include the fact that these relationships are not constants but vary across time and situational contexts. Parents might be good disciplinarians when it comes to providing children with adequate curfews, for example, but terrible at allowing them to stay up all hours of the night. Furthermore, the disciplinary practices certainly change over time as the children get older.

Second, how does a study even attempt to measure the tone of parenting practices? This study used a measure called The Alabama Parenting Questionnaire (APQ) [40] mother report. This parent report measure has five subscales: parental involvement, positive parenting, poor monitoring/supervision, inconsistent discipline, and corporal punishment. Items are rated on a 5-point Likert scale, ranging from 1 (never) to 5 (always).

They used the mother’s own report of her own disciplinary practices! If a mother were abusive or inconsistent, how likely do these authors think she would admit to it, even if she were very self-aware, which obviously many people are not. There is no way to be sure, of course, but the odds are very good that the amount of “negative” parenting is  higher than their study results would indicate, while the amount of “positive” parenting could be overestimated. 

And which particular types of those parental behaviors listed in the instrument were the most relevant to the question at hand? There is no way to know!

When it comes to assessing the effects of family interactions, details make a huge difference. And as I have maintained over and over again, in order to get these details, you would need a camera on both the parents and the children 24 hours a day over a significant time period. This type of study using absolutely no direct observation of what is purportedly being measured is a complete waste of time.

Wednesday, April 5, 2017

My Second Book Finally Available at a Reasonable Price




My second book, "Deciphering Motivation in Psychotherapy" was reissued a while back after going out of print, but was priced in the stratosphere. It's now available on Amazon for a more reasonable price at https://www.amazon.com/Deciphering-Motivation-Psychotherapy-Critical-Psychiatry/dp/0306437902/ref=mt_hardcover?_encoding=UTF8&me=

The book covers the often covert nature of interpersonal communications within dysfunctional families, and helps both therapists and lay readers learn how to dig out hidden meanings in their verbal interactions. The hidden meanings, in turn, reveal the ulterior motives and underlying internal conflicts of the involved family members. 

The book also clarifies the concept of dialectics in a way that I think is way more accurate that the way the concept is used in Dialectical Behavior Therapy (DBT).

Wednesday, March 29, 2017

Those Big Bad Benzodiazepines





Rare events in the midst of really large numbers of people are still quite common

I often get into debates with Pharma-brainwashed doctors and addiction specialists about the relative dangers and abuse potential of benzodiazepines like Klonopin, Valium, and Ativan. Even the DEA recognizes that they have low abuse potential by classifying them as Schedule IV, which literally means "low abuse potential." Adderall and opiates, in contrast, are Schedule II, which means high abuse potential.
Well, low abuse potential still means that some people will abuse them, but with any drug, risks must be weighed against benefits.
As to the risks, unless you are mixing them with other central nervous system depressants like opiates or alcohol,  the worst thing about being addicted to a benzo is that you are addicted to a benzo. For the vast majority of people, they don't cause any inebriation, and they have almost no side effects. For the few who do get troublesome side effects, the doctor can in those cases discontinue prescribing them. Just like with any other drug!
Benzodiazepines are worth their weight in gold in the treatment of panic disorder with agorophobia. Antidepressants can also help, but often not as much. And they have many more side effects, including destroying a patient's sex life.
At the VA, where benzo's are discouraged, I literally saw veterans who were housebound since Vietnam because of comorbid PTSD and panic disorder (the two conditions are co-morbid in 50-70% of veterans with PTSD according to the only two studies). If antidepressants did not stop their panic attacks, doctors would not prescribe benzo's! If you had choose between having no life and being addicted to a benzo, which would YOU choose? I know what I would do.
For patients with borderline personality disorder who self mutilate - the "cutters" and "burners" for example - benzodiazepines can be combined with SSRI (or MAOI) antidepressants. This combination often results in either complete elimination of or a significant decrease in the frequency of this behavior. Much better and far more quickly than dialectical behavior therapy does, by the way.
There are no clinical trials that support that last statement because the pharmaceutical companies will not do them. Benzo's and antidepressants are generic and cheap, and they'd rather that docs prescribe drugs like antipsychotics that have far more risks. But I've been treating this population for forty years in two states, and in a variety of different clinical settings (private practice, academia, public mental health centers and inpatient units, and the VA), with tremendous results. And other doctors who do this get the same results that I do. So tell me it's anecdotal. So is the belief that parachutes reduce the number of deaths and injuries after falls from airplanes.
A common retort to my position has to do with emergency room admissions caused by misuse of benzodiazepines, as well as the fact that methadone and suboxone clinic patient love to mix those drugs with benzos. On the latter point the solution is simple: be careful prescribing the drugs in that population. And the former?
According to JAMA Psychiatry, there are an estimated 271,000 visits to emergency rooms annually for non-medical uses of benzodiazepines (and how many of these involve simultaneous use of other substances of abuse such as alcohol or opiates is not quantified, but it is probably very highly significant).

That sounds like (and is) quite a few - until you also learn that about 5% of adults between 18 and 80 are taking the medications, which is roughly 12.25 million people. So only about two percent of users end up with severe medical issues per year. Not zero, but a relatively small percentage, and btw, there were also an average of about 78,000 annual ER trips for problems during the same period related to...Tylenol. Maybe we should we ban it.

Wednesday, March 15, 2017

More Cutting Edge (but With an Amazingly Dull Knife) Research




As I did on my posts of November 30, 2011,  October 2, 2012,September 17, 2013June 3, 2014, February 24, 2015, December 15, 2015, and September 13, 2016, it’s time once again to look over the highlights of the latest issue of one of my two favorite psychiatry journals, Duh! and No Sh*t, Sherlock. We'll take a look at the unsurprising findings published in the latest issue of the former. My comments are in bronze.

As I pointed out in those earlier posts, research dollars are very limited and therefore precious. Why waste good money trying to study new, cutting edge or controversial ideas that might turn out to be wrong, when we can study things that that are already known to be true but have yet to be "proven"? Such an approach increases the success rate of studies almost astronomically. And studies with positive results are far more likely to be published than those that come up negative.

Clinical Psychiatric News article, June, 2016Data from a longitudinal study reported at the World Congress on Osteoarthritis show that weight gain in young women is an independent predictor of future low back pain. Well, maybe their backs would do better if they carried around a sack of bricks slung over their shoulders 24 hours a day.

7/21/16. Apparently these researchers don't watch the evening news. Addiction To Prescription Opioids May Be Tied To Creation Of Market For Cheaper, Potent Heroin, Analysis Suggests. The Washington Post (7/20, Humphreys) “Wonkblog” reports that the relationship between restricting access to prescription opioids and increasing heroin use is more complicated than some critics of the Comprehensive Addiction and Recovery Act believe, according to a systemic analysis of the matter that was published in the New England Journal of Medicine. The analysis was led by the National Institute on Drug Abuse’s Wilson Compton who says that restricting access to prescription opioids does not automatically increase heroin use, but that having many people addicted to prescription opioids may be tied to the creation of a market for cheap, potent heroin that appeals to people addicted to prescription opioids, which may explain the increase in heroin use in recent years.


7/21/16.  And these researchers apparently don't get out much. Alcohol Intoxication Increases Aggression While Cannabis Use Reduces Such Feelings, Study Finds. The Washington Post (7/20) reports research published in the journal Psychopharmacology suggest “alcohol intoxication increased subjective aggression” while those who smoke marijuana “became less aggressive when they were high.” Researchers concluded that the “results in the present study support the hypothesis that acute alcohol intoxication increases feelings of aggression and that acute cannabis intoxication reduces feelings of aggression.” The findings are in line with other research.


7/25/16. People exposed to addictive substances found to have higher chance of getting addicted to them. Greater Pain Found to Increase Risk of Opioid Use Disorder. Researchers have long suspected that the level of pain experienced by a patient may increase his or her risk of developing an opioid use disorder. A study in AJP in Advance has for the first time taken a prospective look at this link, revealing a significant association between pain and prescription opioid use disorder at baseline and three years later. The researchers found that people with moderate or severe pain had a 41 percent higher risk of developing prescription opioid use disorders than those without, independent of demographics or other potential contributing factors. Males, younger adults (of either gender), and those with a family history of antisocial personality disorder were also found to be more likely to develop opioid use disorder.
8/2/16. Being sedentary bad for the heart? Who knew? Watching TV longer increases risk of fatal blood clot, study finds. The New York Times (8/1, Bakalar) reports a new study published in the journal Circulation by Japanese researchers analyzing “86,024 generally healthy people who filled out questionnaires with items about health and lifestyle, including time spent watching television,” found that more time watching television increases the risk for a fatal blood clot. Researchers estimated that, after adjusting for other factors, “watching for two and a half to five hours increased the risk for a fatal clot by 70 percent, and watching more than five hours increased the risk by 250 percent,” compared to watching for less than two and half hours each day.

 

8/2/16. Less serious disorders found to have better prognosis. Predictors of outcomes in outpatients with anorexia nervosa: Results from the ANTOP study. Psychiatry Research, 08/01/2016  Clinical Article. Wild B, et al. – Researchers explored the factors that may predict outcomes in outpatients with anorexia nervosa (AN). They concluded that better outcome was achieved in those who had a higher baseline BMI [Body Mass Index] and shorter illness duration.


8/24/16.  Traumatic brain injuries seen in many domestic assault survivors. The AP (8/23, Tanner) reports that, according to the Centers for Disease Control and Prevention, “about one-quarter of U.S. women and 14 percent of men have experienced severe physical assaults by a partner in their lifetime, including hitting, punching, being slammed against something hard or pushed down stairs.” Meanwhile, according to a research review published this year in the journal Family & Community Health, “head and neck injuries are among the most common, and data suggest that domestic assaults may cause traumatic brain injuries in at least 60 percent of survivors.” Being assaulted can lead to head trauma! OH NO!

9/6/16. Taking care of someone who can't tell you what's wrong should be a breeze! Relatives Who Care For Patients With Dementia Often Experience Frustration Due To Poor Communication, Study Suggests. The Washington Post (9/4, Bluth) reported relatives who care for patients with advanced dementia often experience difficulty because they can no longer communicate with their loved ones, according to a study published in the American Journal of Alzheimer’s Disease & Other Dementias. Researchers found that many family caretakers were often frustrated with their relatives with dementia because they could no longer communicate what they needed or when they were in pain.


9/16/16. But what about all those codgers I see running out on the streets? Many older US adults are physically inactive, CDC study finds. The CBS News (9/15, Welch) website reports, “More than a quarter of Americans age 50 and older do not move beyond basic everyday activities,” research indicates. TIME (9/15, Oaklander) reports that according to an “analysis of 2014 surveillance data, 28% of Americans ages 50 and over are inactive – meaning that 31 million adults are moving no more than necessary to perform the most basic functions of daily life.” HealthDay (9/15, Dotinga) reports that such inactivity increases the risk for “heart disease, diabetes, and cancer,” researchers from the CDC’s Physical Activity and Health Branch found. What’s more, “the older Americans get, the less exercise they get,” investigators found. “Thirty-five percent of people aged 75 and older were inactive, as were 27 percent of those between 65 and 74, and 25 percent of those aged 50 to 64,” the study revealed. 

12/13/16. Risk For Opioid Relapse May Be Lower After Voluntary Treatment Than After Compulsory Treatment, Small Study Indicates. Healio (12/12, Oldt) reports patients “with opioid dependence who were treated in compulsory drug detention centers were significantly more likely to relapse after release than those treated with methadone in voluntary drug treatment centers,” researchers found after conducting “a parallel, two-arm, prospective observational study of individuals with opioid dependence treated in Malaysia.” The findings of the study, which included 184 participants, were published online Dec. 7 in The Lancet Global Health. The author of an accompanying editorial observed that the study findings “provide solid evidence in support of an urgent need to expand availability of, and access to, evidence-based voluntary drug-dependence treatment approaches to all individuals affected by drug dependence.” Because motivation for treatment is irrelevant to its success.


12/12/16. Pain is associated with poorer grades, reduced emotional well-being, and attention problems in adolescents The Clinical Journal of Pain, 12/12/2016  Clinical Article  - Voerman JS, et al. – Findings imply that the association between pain and Dutch adolescents grades is intervened by reduced emotional well–being and attention problems. The association between pain and math grades is mediated by emotional problems. The outcomes recommend that an intervention targeted at the pain in adolescents could have a positive effect on their emotional well–being, attention, and school performance. What a shock! Being in pain has effects on your emotional and cognitive functioning.


2/21/16. Impact of somatic severity on long-term mortality in anorexia nervosa 
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 12/21/2016  Clinical Article, Stheneur C, et al. – The present study sought to survey whether time in somatic intensive care unit, justified by a patient’s somatic condition in the course of hospital care, has any association with patient outcome in terms of mortality in the long term. The findings suggest that the clinical seriousness of the somatic condition during hospitalisation for AN is a risk factor for excess mortality in the medium term. In the present study, 195 patients were hospitalised for AN between April 1996 and May 2002, 97 were re-assessed 9 years later on average. Researchers observed that out of 195 patients hospitalised for AN between April 1996 and May 2002, 29 had required transfer to intensive care. Findings revealed that mortality at 9 years was 20 times higher in the group having been transferred to intensive care, irrespective of the duration of follow-up.  You mean, the sickest patients had the worst prognosis? How can that be?

Impaired Social Functioning Appears To Be Most Common In Schizophrenia, Study Indicates.

Healio (1/4, Oldt) reports that among people “with schizophrenia spectrum disorders, major depressive disorder with psychosis and bipolar disorder with psychosis, impaired social functioning was most common in schizophrenia,” researchers found in a study including “individuals with schizophrenia spectrum disorders (n = 269), major depressive disorder with psychosis (n = 77), bipolar disorder with psychosis (n = 139), and a comparison group without psychotic disorders.” Participants were followed for 20 years. The findings were published online Dec. 16 in the American Journal of Psychiatry, a publication of the American Psychiatric Association. Have these people ever even been to a psychiatric ward?

1/11/17. And here we thought booze was a cure all: Using Alcohol To Deal With Unpleasant Memories May Worsen Certain Mental Health Conditions, Mouse Study Indicates. The New York Daily News (1/10, Jagannathan) reports that instead of easing the pain of “distressing memories,” alcohol may “actually make it more difficult to cope with distressing memories,” researchers found.  Medical Daily (1/10, Dovey) reports that using alcohol as a coping mechanism “to deal with unpleasant memories...doesn’t work, and may actually worsen certain mental health conditions, such as” post-traumatic stress disorder (PTSD), researchers found. Working with mice, investigators found that “alcohol consumption did not help to ease fearful emotional memories, and may have strengthened them.”

1/23/17. Because no one ever drinks to forget. Spousal Loss Found to Increase Risk of Alcohol Use Disorder.  Spousal loss due to divorce or death appears to be associated with an enduring risk of alcohol use disorder (AUD), but remarriage may help to reduce this risk, according to a study published today in AJP in Advance. “The pronounced elevation in AUD risk following divorce or widowhood, and the protective effect of both first marriage and remarriage against subsequent AUD, speaks to the profound impact of marriage on problematic alcohol use and the importance of clinical surveillance for AUD among divorced or widowed individuals,” lead author Kenneth Kendler, M.D., of Virginia Commonwealth University and colleagues wrote.  And on a related note: Getting A Divorce May Increase The Risk Of Developing An Alcohol Use Disorder For Both Genders, Study Indicates. Medscape (1/26, Anderson) reports, “Getting a divorce increases the risk of developing an alcohol use disorder (AUD) by more than sevenfold for women and almost sixfold for men,” researchers found after identifying and then following “942,366 individuals born in Sweden between 1960 and 1990 who were married and residing with their spouse in or after 1990 and who had no AUD prior to marriage.” The findings were published online Jan. 20 in the American Journal of Psychiatry, a publication of the American Psychiatric Association.


1/24/17. Stress and anxiety were always thought to be totally unrelated. Stress Of Managing Breast Cancer Care May Provoke Symptoms Of Anxiety In Partners, Caregivers, Study Suggests. HealthDay (1/23, Thompson) reports that research suggests “the stress of managing breast cancer care provokes symptoms of anxiety in more than 42 percent of partners and caregivers.” Investigators found that “this stress-induced anxiety can last years after their loved one’s illness.” Investigators came to these conclusions after surveying “289 partners of patients diagnosed with breast cancer at age 40 or younger.” The findings are scheduled to be presented at a meeting of the American Society for Clinical Oncology. 



A Lancet study reports that deprivation and neglect in early childhood can have a lasting psychological effect into adulthood. Using findings from a study that assessed children adopted from Romanian institutions into families in the United Kingdom, The Lancet reports that deprivation and neglect in early childhood can have a lasting psychological effect into adulthood.

Tuesday, February 28, 2017

Not Taking the Bait in Family Discussions




When adult children complain to their parents about how the parents are repetitively engaging in invalidating, hateful, critical, demanding, and or abusive behavior towards them, the elder family members have almost always developed a number of ways to get them to shut the hell up. Often these ways include dismissing the adult children's complaints by accusing their progeny of being:

A) Little snowflakes (to use the current trendy term) who are overly-sensitive, weak, selfish, unable to take a little good natured teasing, or "high maintenance."

and/or

B) Stupid - reading things into what the parents are saying that are not really there.

and/or

C) Pathological -making things up that did not even happen or twisting the meaning of everything the parents says to unfairly shift the blame for the child's problem onto the poor, put-upon parents.

Unfortunately, in many of today's psychotherapy models, many therapists seems to agree with the parents that the adult child's problems are all in their heads and are not, in fact, due to their having being traumatized or understandably upset by dysfunctional or abusive family relationships.  

And of course, as readers of my blogs know, if parents act as if they expect  their children to act in weak, stupid, or pathological ways, in response the children often do indeed start to act out exactly what they are being accused of doing. When dysfunctional family patterns include that phenomenon in addition to the problematic parental behavior mentioned at the top of the post, the situation is a bit more complicated to talk about and will not be discussed further here.

To solve the problems, the adult children have to find a way to not shut the hell up, but to constructively push the conversation forward in order to put a stop to the problematic patterns. (I'm currently under contract for and working on a self-help book for New Harbinger publishers that discusses in great detail a large number of different strategies for achieving this goal).

This post will discuss one countermove to use when you are being accused of A, B, and/or C above that is often successful in disarming the parents and pushing the conversation onward. Of course, no strategy works with all families, or even all the time within any one family. But this one increases the odds of productive conversations when adult children bring up the complaints mentioned in the first paragraph of the post.

The strategy is based on a premise that was described beautifully and concisely by my colleague Dr. Jim Woods. He said, "You can't be pulled into a game of tug-of-war if you don't pick up the rope."

In this case, the accusations by the parents are bait. They want you to take it. You are being baited into becoming angry or defensive. Once that happens, constructive conversations immediately end in fight, flight, or freeze responses. No problems get solved then. Do not take the bait!

So how to avoid doing so?

Let's say you tell your parents that their demands are getting on your nerves because no matter how much you do, it never seems to be enough for them, and that that they seem to ignore the fact that you have other things to do and cannot just drop everything at a moment's notice to do things for them. Say they respond by telling that you are grossly exaggerating how much they ask of you, and that you ought to be happy to take the time to help them out. They add that you are being ungrateful. Just think of all the sacrifices they had to make for you when you were growing up!

How not to respond:

A) Argue with them about the frequency or reasonableness of their requests, or how much they sacrificed for you as a child.

B) Attack them and tell them they are insensitive, overly-critical clods.

C) Defend yourself by pointing out that your life is busy and of course you cannot always just drop everything to come over and do something for them.

D) Explain in detail your feelings and go on and on about how those feelings are justified.

E). Scold them or lecture them about etiquette and the proper relationship between adult children and their parents.

The basic form of the recommended response:

"Well, maybe so, Dad, but I am finding this situation to be a big problem. Do you think you could help me out by checking with me first about when it would be convenient for me to come over to help you?"

This sort of response is basically a refusal to argue about the merits of your personality characteristics, but trying instead to make a relationship better. In doing this, you are neither agreeing nor disagreeing with their characterization of you. It might be accurate, partially accurate, or complete wrong. Who's to say, really? That isn't the point. The point is how you are reacting to them when they do something, not whether your reactions are justified or not. They should want to know that so that everyone can, to quote Rodney King, just get along.

Surely they'd prefer a pleasant relationships to an unpleasant one. I know that it often looks as if this is not the case, but nonetheless, I advise that you give them the benefit of the doubt.