Parenting Styles and ADHD Symptoms

 

In my continued effort to beat a dead horse, this post concerns yet another not-so-science-based characteristic of authors of the literature on ADHD: their refusal to consider any alternate interpretations of their data other than that they are studying some sort of brain disease. In this case, they do not consider the possibility that the symptoms of their subjects come as a result of environmental issues, such as a chaotic home environment and/or sleep deprivation.

One well-publicized study (Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD | American Journal of Psychiatry (psychiatryonline.org) purports to show that up to 90% of children who have attention-deficit/hyperactivity disorder (ADHD) may continue to experience residual symptoms of the disorder into young adulthood. Amazingly, the authors add that they may also have periods of remission along the way. In other words, ADHD is a disease with waxing and waning symptoms. Could it not be that other, environmental issues that create their symptoms are what is doing the waxing and waning???

In another publication, Greg Mattingly, MD, of the Midwest Research Group, tells us that, “Instead of resorting to positive parenting, many of them [parents of kids diagnosed with ADHD] have fallen back on what we call negative parenting: scolding, discipline, getting frustrated. As we shift into next year, we need to shift into how we shift into a positive parenting model. I want you to talk to your kids with encouragement about the school year. Share something each day that was something cool they learned in a positive way, and then complement them for sharing that fact back with you."

So the symptoms get better with positive changes in parenting style? The author doesn’t seem to consider the possibility that negative parenting styles were perhaps a big cause of the so-called disease in the first place. 

This reminds me of TARA, a support group for parents of people with BPD (at least those that weren’t physically or sexually abusive, since those relatively common parents-of-kids-with-the-disorder would never join a parent support group —other than perhaps the False Memory Syndrome Foundation). They teach parents how not to invalidate their kids but somehow don’t mention the DBT theory that an invalidating environment is a major cause of the disorder in the first place. In TARA's case, this isn’t a bad thing because if they did that, a lot of these parents wouldn’t attend their seminars. But researchers in the field ignores this issue as well.

My "Groupthink in Science" Book Available in Paperback

Now in paperback on Amazon

 Amazon.com: Groupthink in Science: Greed, Pathological Altruism, Ideology, Competition, and Culture: 9783030368210: Allen, David M., Howell, James W.: Books

When You Can Never Be Content If You’re Contented

 

I could find somebody   new somebody who'd be true

But honey I'm stickin' to you just to torture myself

Say it out loud I'm sick and I'm proud

~ Kacey Jones, “Just to Torture Myself”

Way back in March of 2012, I wrote a post about members of couples who complain about a lack of affection from their long-term partners, and in response quoted advice columnist Amy Dickenson: "In relationships, if you always do what you always did, you'll always get what you always got." I opined that, because these people continue to either put up with or needlessly inflict frustration on their partners, then each member of the couple believes the other member of the couple really wants the relationship to continue in its current form no matter how much they may complain about it.

Each member of the couple discounts their own compulsive behavior as indicating that they, too, want the current parameters of the relationship to continue because they are playing a role in their own family of origin that requires denying that they are playing that role. For a fuller explanation, see this post. In actuality, both members of the couple are highly ambivalent about making any changes. They really do hate the current situation, but this negative feeling dwarfs in comparison to their fear of having a better one, due to anticipated consequences to their respective families-of-origin.

Does this state of affairs also pertain to relationships that are chronically and significantly neglectful or abusive, or to those characterized by repeated infidelity, rather than just to those that are merely chronically frustrating? Absolutely. The ability of people to put up with ongoing pain in these situations is impressive. People who do that often act as if they are too stupid or evil to even know that this is what’s going on, but those appearances are con jobs.

This can easily be seen in two letters recently published in the Ask Annie advice column:

6/4/21. Dear Annie: I have dated a guy for the last six years, always long-distance. I have loved this man with my whole heart. The issue is we have not met each other's families. He has never met my kids and doesn't even want to. He will not acknowledge our relationship on his social media profiles. His parents know nothing of me. We do not spend holidays or birthdays together. We do not go on dates. The last time we saw each other in person was two years ago. He barely even texts me. There is always an excuse as to why he is unavailable. Yet he claims that he loves me. I just don't get it. I want to leave, but I care about him so much. What do I do? -- Mixed Signals

6/5/21. Dear Annie: I met a man about four years ago. We started dating a week after we met, upon his insistence. Well, after we were together a year, I found out that he was messaging with a girl online and had been for several months. She didn't want him. Then, a month after that, I heard he cheated on me with someone from work who was in her early 20s, the same age as his daughter. I confronted him, but he refused to admit he was guilty. However, I've caught him exchanging sexual messages with a couple of other girls online since then. He says he's never actually hooked up with them in person. I guess my question for you is, is it worth trying to keep this man in my life? I love him, and he says he loves me, but part of me is no longer in love with him. If I'm being honest, I've felt this way ever since I heard of his cheating with that young woman. What do you think, Annie: Should I set him on the curb on trash day? My heart is telling me to stay, but my mind is wanting me to tell him to get lost. -- Confused Girlfriend

Of course, in both cases the advice columnist advised breaking off the relationship. In other cases, advice columnists have also recommended psychotherapy if the letter writer couldn’t seem to do that.

I submit that both of these letter writers already knew exactly what the advice columnist would recommend, but are just acting so stupid that they can’t see the obvious. In fact, I would guess that they both will stay in the relationship anyway, giving the partner even more evidence that that is what they really wanted to do all along! I mean, how could they not know what advice they would get. The way they word their letters practically begs for that ever-so-obvious advice.

If I were seeing them in therapy, hearing this would be the perfect opportunity for me to ask the Adlerian question: So what would be the downside of being in a relationship with someone who was actually there for you?

Book Review: Not to People Like Us by Susan Weitzman

"If you think I support domestic abuse-- if you think my not explicitly writing, ad nauseum, "NO TOLERANCE" or "IT'S NOT THE VICTIM'S FAULT" is evidence that I think "sometimes the bitch deserves it "then I can tell you without error that [this year] is going to be way too complicated a year for you to endure, and you are seeing a psychiatrist, and it isn't helping. Stop being you. The world does not have to validate your prejudices." ~ The Last Psychiatrist.

 

Warning: Since I am writing about domestic abuse, I quote the Last Psychiatrist before people start accusing me of “victim blaming” or “excusing the abuser.” Obviously, people who injure other people are committing a crime and deserve to be in jail. But that doesn’t mean the victims have no responsibility for any self destructive behavior (which BTW is NOT a crime) they exhibit – like returning to their abusers again and again and protecting them by keeping the abuse secret. 

As Michael Kerr once said, when it comes to relationships: “It’s all my fault” and “I had nothing to do with it” are both irrational ideas. The sad part about this is that absolving the victim of any and all responsibility for their predicament often has the effect of making them feel more helpless, useless, and resigned to their fate. The people who do this to them are without a doubt harming the very people they claim to be helping.

The book being reviewed here is about upper class, affluent couples in which the men physically and mentally abuse their wives. The author believes the couple dynamics in this population are different than in those in poorer communities. Strangely, most of the women she discusses are highly-educated professionals or have high paying jobs, and some of them even earned more than their husbands.

The most interesting thing about this book for me is the author. As I read it, I kept wondering if she thinks these women are as stupid as they act, although she is clearly questioning that proposition. She spends half the book wondering about how such bright, educated woman can believe their bullcrap excuses for staying in these relationships, and blame themselves for the abuse (although some of them did admit to provoking it, to supposedly make the beatings "more predictable" as if they weren't predicable enough), and the other half buying into their rationalizations.

I find this interesting because, when I first started thinking about psychotherapy paradigms, I myself struggled with this question mightily. I called it the "question of stupidity," and resolving it led me to the concepts of mutual role functions support, the paradox of altruism, and something called dialectical causality.

Still, I wondered why the author didn’t question some of her own assumptions. For instance, she says most of these women she has interviewed did not come from families of origins in which there was significant spousal abuse. Well, maybe, but how can she know she is being told the truth about that? 

These women often lied about the abuse from their husbands to everyone for years, and even to other therapists, before coming clean. Some of them told their mothers about it, and the author admits that their mothers essentially blamed them for the abuse and told them to go back to their husbands. And in her chapter on the children from these relationships, she says, “…they too feel that they must hide the family secret.” If the abuse victim grew up in such a family, wouldn’t that characterization apply to her? So what on earth makes the author believe these women would suddenly become paragons of honesty about their parents when they come to see her?

Some of the women also claimed to think that they would be left penniless if they were to leave their successful husbands, even though many have or had successful careers themselves, and that their husbands will be able to manipulate the courts so they would never get alimony or child support. Well, rich successful men sometimes are able to do that, but in what alternate universe are there no attorneys capable of forcing otherwise reluctant men to fork over the cash? Maybe these cases where the rich men prevail are won partly because their wives hired lawyers who secretly believe that she really did deserve what she got. 

Why are they hiring such terrible lawyers? Weitzman brings up the O.J. Simpson case as an example, but apparently does not know how badly the prosecutors botched the case. (This is brilliantly described in the book Perfect Pitch by Jon Steel).

Then there is the book’s title. These women allegedly hide the abuse because they sort of think it isn’t supposed to be happening in their social circles, and they are ashamed. But if someone is beating the crap out of you, why would you care whether or not it was happening to anyone else? It’s clearly happening to you, and it’s clearly evil. If fact, if you really thought your situation was that unusual, that would highlight how unacceptable it ought to be.

And another implicit premise here seems to be that being embarrassed is worse than having your jaw broken! Really???

The stories the author relates literally reek of gender role conflicts in both the husbands and wives, but gender roles barely rate a mention. Despite the author’s psychodynamic training, the concept of intrapsychic conflict seems foreign to her, let alone her having an understanding of family systems issues and the power of groupthink and kin selection. 

For example, despite being successful career women, many of these women expected, and were expected by their husbands, to do all of the domestic chores and child rearing. One father wouldn’t even get up to feed the baby when mommy was violently ill. A lot of the couples also stopped having sex while the man was off having multiple affairs – the old Victorian whore/Madonna conflict in the flesh.

The author correctly points out that most of these men have narcissistic personality disorder, but she does not understand the family dynamics of it. (As my readers know, my views of that are different than the prevailing wisdom). She does make the accurate point that one of the DSM criteria for this disorder, lack of empathy, is incorrect. These men have very good empathy. The problem is they use it in order to more successfully manipulate other people to get what they want. Not having something is obviously not the same thing as using something one has in the service of bad intentions.

The author does acknowledge that these women did seem to ignore red flags when they first meet their husbands, but seems to downplay the significance of this, and offers no convincing explanations of why they would do this. In fact, as I like to say, there are often more red flags than at a meeting of Chinese communists.

Oh well.

Substance Abuse: Self-Destructive Behavior

 "The surest way to humility is humiliation” ~ commonly heard saying at Catholic 12-Step meetings in Ireland

 

It seems like the debate over whether or not substance abuse is a “disease” is never ending, as described recently by fellow blogger George Dawson. I really don’t want to get into the particulars of that, because the debate is almost always a waste a time due to the multiple definitions of the word disease that get employed and continually conflated in such debates.

 

I’d rather focus on one main issue: How much control do most addicts have over their drug use? My opinion is that the question can best be answered by re-classifying most, though maybe not all, substance addiction behavior as self-destructive behavior. Voluntary. If it were not voluntary, addicts would have next to no control over when and under which circumstances they chose to not indulge, no matter the consequences. Almost no addict is using 24/7 unless they are actively suicidal.

 

Now, some people might argue that substance abuse might be a form of obsessive-compulsive disorder. When people with OCD who have compulsions do not engage in their compulsion, their anxiety level skyrockets. This may be due to clearly abnormal firing of some nuclei in their brain. While they can certainly choose to let their anxiety skyrocket, this choice is indeed very difficult.

 

However, skyrocketing anxiety can have another cause besides the clearly pathological firing of brain nuclei. It can also be caused by panic over anticipated consequences of engaging or not engaging in a particular behavior. If doing so might lead to massive invalidation by everyone a person knows and cares about, then doing so becomes very difficult because of kin selection and tribalism, two subjects I have previously blogged about extensively.

 

Although, due to our current state of knowledge about the brain – literally the most complicated object in the known universe – there is no way of knowing for certain if most substance abusers indulge because of feared consequences of not indulging, or because of abnormal brain firing of some sort. And of course there may be two different types of addicts, so either or even both possibilities may be true depending on which addict one is dealing with.

 

Based on my clinical experience with all sorts of self-destructive and self-defeating behavior in my psychotherapy patients, I’m going to come down on the side of feared consequences for most of them. So am I saying an addict’s family system needs them to continue to be addicts in some way? Well yes, that’s exactly what I am saying.

 

If this is the situation, it does not make sense to ask the question of whether or not the addict wants to be an addict, because in fact they would be ambivalent about it (intrapsychic conflict, the primary concept in psychoanalysis – what a novel idea!). While some substance use in moderation in some contexts is indeed pleasurable, the life of an addict is anything but. They hate what the drug does to them. Many no longer even get high from cocaine after extended use, for example. And if getting high really made them feel so good, then why aren’t addicts the happiest people around instead of some of the most miserable? The problem is that the feeling of existential terror due to kin group invalidation feels even worse. So they indulge. Self-destructively.

 

Now, the family groupthink issue which triggers any given family’s need to have an addict in their mist to remain stable is not always the same, so each family has to be evaluated individually on its own terms. But let me discuss the most common example of such an issue: Puritanism.

 

Puritans on the whole believe, to put it bluntly, that we are nothing but sinful piles of crap in God’s eyes, and that we have to be sinners because, well, all people are sinners who must therefore ask for God’s forgiveness. So, as clearly stated in the 12 steps, which are based on Protestant conversion techniques, our will must be a problem. If we are willful, we simply must come to a bad end. The only way out is to renounce our will and turn it over to a “higher power” - which is actually the group to which we belong. And do what they want us to.

Did someone mention willfulness there?

I’ve heard docs from 12-Step programs give talks at medical meetings during which they would tell the most humiliating stories about their own crazy behavior when they were using – a public version of what they do in meetings. Essentially, these folks are substituting a less harmful form of self-abasement for a more harmful one. Just like the Irish slogan at the top of this post says rather overtly. I suppose that’s the better of the two options, but it’s still self-destructive. But it makes their conflicted parents feel better about not acting on their own forbidden impulses. While having already received vicarious satisfaction of these very impulses watching their children indulge. Heaven forbid anyone might feel good about doing something selfish.

Why Fat Shaming is Counterproductive

 

"If you are overweight and your parents are overweight, the inclination is to blame genetics...did fatness genes get passed on, or was it overeating behavior? After all, fat people tend to have fat pets." ~ Tim Ferriss

As most of my readers probably have noticed, there has been in the media a lot of talk about “acceptance” of obesity and “body positivity.” People who dare to criticize the obese for leading what is clearly a highly unhealthy life style which both shortens their average life expectancy and leaves them more vulnerable to a whole host of rather unpleasant diseases like serious COVID complications are torn apart for being “fat-shaming” monstrous, offensive people who are trying to shame people for how they look. TV talk show hosts Bill Maher and James Cordon got into a public tiff about this.

We now have plus sized Barbie dolls as well as celebrities like Lizzo sing the praises of having a large body. How dare anyone “fat-shame” anyone?

Actually I agree that fat shaming is a waste of time and is in fact counterproductive, but maybe not for the reasons most people think. On the other hand, turning unhealthfulness into a virtue is not exactly a smart thing to do either.

Now of course some people put on weight much more easily than others. Some people have diseases like hypothyroidism which cause obesity, although they are treatable in the majority of cases. But significant obesity (and I am NOT talking about just being somewhat overweight) is due to serious over-eating and avoiding exercise which is, like I will say about substance abuse in an upcoming post, self-destructive behavior.

It is certainly not genetic, as there has been a huge uptick in the number of obese individuals in many countries over the last thirty years or so, and to my knowledge there have been no selective breeding programs for obesity. There were very few kids with weight issues when I was in school in the fifties and sixties – unlike today.

In my model, self-destructive behavior is a form of self debasement designed to keep the person from self-actualizing in a way that might seem to threaten family homeostasis. In this model, obese people do not need to be shamed, because they are already feeling ashamed of themselves. In fact, they are frequently doing what they do in order to generate shame! They are, in a sense, trying to feel bad about themselves. Therefore, if you shame them, you are in fact reinforcing this tendency, and they get worse rather than better. The shaming serves as a “reward” (in the behaviorist sense, although certainly not in the usual sense) for the behavior that leads to the obesity!

Of course, if other people don’t say anything about the problem, the self-destructive behavior still continues. Truly a damned-if-you-do, damned-if-you-don’t situation for anyone who is truly concerned about the health and safety of an obese individual.

The key to solving this issue is understanding of and empathy with the collective forces that have led to this unfortunate behavior, and honestly taking responsibility for one’s own behavior. A tall order for those enmeshed in this kind of groupthink.

Healthy versus Unhealthy Love

It's best to be able to take care of your spouse's needs while still being true to yourself and taking care of your own as well.

 https://www.relationsarea.com/what-is-the-difference-between-healthy-and-unhealthy-love/

Book Review: The Quick Fix by Jesse Singal

 

As someone who has been a critic of many of the excesses and science fiction currently present in clinical psychology, psychiatry, and psychotherapy, I have often been frustrated by how little attention has been paid in these professions to the problems that I bring up. Yeah, I know, awwww, poor me, people won’t listen to me. But aside from my narcissistic injury, a lot of patients are receiving substandard care due to the alignment of the forces described in the masthead of my blog.

This excellent and entertaining book by Singal tackles similar issues that have recently been plaguing experimental and social psychology. For those who don’t know, the field of academic psychology is actually two separate fields: clinical psychology, which deals with psychotherapy and other treatments for people with psychological problems, and experimental psychology, which studies both normal and abnormal psychology from an academic perspective. Interestingly, these two branches of the academic discipline are often very critical of each other, and members often refuse to communicate with one another.

Singal’s focus is on what he clearly shows is an explosion of overly-simplified ideas about how to change widespread social behavior, which have been widely taken up by politicians, corporations and the media and praised in TED talks, but which are often backed by very weak and inconsistent evidence that was obtained by highly suspect means and invalid experimental designs. 

Unfortunately, quick fixes have a strong appeal to human beings who are often averse to complicated formulations that look at the wide variety of different influences on human beings that results in their overall behavioral tendencies.

He tackles such widely-believed ideas as the importance of self esteem, fear of so-called “super-predators,” and the belief that societal forces like sexism and racism can be defeated by victims who act as if they were powerful, have grit, or think positively. He looks at notions of “implicit bias” that corporations have been using to train their employees to make themselves feel better about decreasing racism and sexism in their midst—without actually doing anything about the explicit biases which are really at the heart of the problem. Let’s focus on repairing individuals without any reference to the collective forces with which they are faced! Gee, sounds a lot like my criticism of the current treatment of patients with personality disorders.

He brings up, often in very humorous ways,  frequently ignored issues that are widespread in psychological research such as self-report bias, third variables that aren’t even considered, the fundamental attribution error (familiar to my readers), the file drawer effect (studies which come out negative are not reported so that the number of positive studies is misleading), the questionable use of p values, overgeneralizing by ignoring the context in which a research project was done, range restriction in statistics, the “jangle” fallacy (calling the same phenomenon by different names),  social desirability considerations in subject self-report, hypothesizing after results are known to explain away seemingly contradictory results (“HARKing”), the lack of replication in findings, and “bullet point” bias (oversimplification of complex situations).

Wow! Highly recommended.

Creativity and Self-Actualization

One of the themes of this blog concerns the forces that interfere with the ability of people to self-actualize, or express themselves and their opinions, and act on their own personal desires, even when their kin or social group may not always be supportive. Self-actualized people do not always follow in groupthink patterns during which they will go along to get along, agreeing with the family or ethnic groups ideas and philosophies while remaining willfully blind to any information that contradicts the group mythology.

 

Although she did not put it in those terms exactly, the question of whether the ability to do this is an important contribution to creativity in the arts and sciences was addressed by Nancy C. Andreasen, a well known psychiatry professor at the University of Iowa College of Medicine and the former editor in chief of The American Journal of Psychiatry, in an article entitled Secrets of the Creative Brain in the July/August 2014 issue of the Atlantic magazine. 

 

She describes a study she has been doing with a lot of creative people, many of whom are celebrities. In the article, she first discusses the often purported relationship between genius and madness, and found that there is indeed some truth to the idea that there is some. The incidence of mental illnesses in her subjects and their family members is indeed higher than expected. Although some of it may involve heredity, as evidenced by the incidence of schizophrenia, most of the psychiatric disorders found in her sample were those that primarily involve interpersonal dysfunction: certain mood and anxiety disorders and alcoholism.

 

Why might that be? Her answer speaks to my speculation about the role of self-actualization in creative people:  

 

“One possible contributory factor is a personality style shared by many of my creative subjects. These subjects are adventuresome and exploratory. They take risks. Particularly in science, the best work tends to occur in new frontiers. (As a popular saying among scientists goes: “When you work at the cutting edge, you are likely to bleed.”) They have to confront doubt and rejection. And yet they have to persist in spite of that, because they believe strongly in the value of what they do. This can lead to psychic pain, which may manifest itself as depression or anxiety, or lead people to attempt to reduce their discomfort by turning to pain relievers such as alcohol.”

To be innovative in one’s field involves the ability to persist in letting one’s mind work in the face of scorn and rejection from one’s peers. Even though it does hurt, innovators didn’t let rejection of publications or grant application stop them from continuing. They also had the wherewithal to be proven wrong at times and yet not be discouraged from continuing to search widely for better answers to technical questions.

 

Creative genius also involved the willingness to teach oneself about a wide variety of subjects rather than be spoon fed by teachers only in one’s chosen field of endeavor. Andreasen noted that many of her subjects were what she referred to as autodidacts – basically self-taught. Many had gotten in trouble with their school teachers for pointing out times when the teacher said something that was not true. She also found that many of her subjects were “polymaths” – people who read widely not only in their chosen area of expertise but in many subjects, both in the sciences and the humanities.

This sounds like self-actualization to me.

 

Loose Associations Between Various Clinical Attributes of Patients Sharing a Diagnosis

Doctors are being pressured more and more to make quicker and quicker clinical decisions using information from studies that show correlations between certain symptoms and certain genes and other patient attributes, both psychological and physical. They are at risk of becoming sucked into a Lake Wobegon effect - the fictional town where it was said everyone’s intelligence is above average. Clinicians should still  assess each individual separately in order to avoid conclusions based on the ecological fallacy (thinking all patients with a particular disorder react exactly the same as the average patient with the disorder). In fact, most people with a certain characteristic fall outside of the average value when looking at another characteristic that seems to correlate with it.

Some people object to personality disorder diagnosis for a similar reason: each person with these disorders presents somewhat differently than the “average” person with the disorder.

However, this whole problem does not mean that we should completely avoid making diagnoses or looking for other correlating characteristics which are likely to be found in the average person in a group. This information can provide a clinician with clues as to where to start an investigation. The diagnosis of borderline personality disorder, for instance, correlates strongly with the spoiler role developed in families in which the parents have conflicts over the role of being a parent. This knowledge is useful in telling a physician or therapist what questions to ask the patient when exploration of the relevant factors begins. 

It does not, however, mean that an initial inquiry is guaranteed to be fruitful, only that in many cases it will be, so starting there may save the clinician a lot of time looking at things that will turn out to be irrelevant. For it to be useful, however, the doctor must treat an initial idea as an hypothesis, and be completely open to the possibility that the hypothesis may turn out to be wrong.

Obviously, the strength of any discovered correlation affects how soon one should start looking for it. Much of the personality disorder literature these days is clinically useless because the correlations “discovered” are either too small, too obvious, or too unimportant to mean much of anything in helping the clinician develop some sort of psychotherapeutic strategy. A study by Wildey et. al. in the  August 2020 issue of the Journal of Personality Disorders found correlations between so-called externalizing disorders like antisocial personality disorder or substance abuse and the negative quality of a person’s relationships using multiple assessment methods. Ya think?

Some studies even look for associations between qualities that are actually intrinsic to the definition of a personality disorder and the disorders themselves. A rose is a rose last time I looked. Like people with BPD being very reactive. I kid you not.

Even dumber is looking at so-called “mediating” variables. For example, one study in the Journal of Personality Disorders by Sato et. al, in the April 2020 issue found that “rejection sensitivity” was mediated by attachment anxiety, the need to belong, and self-criticism. You mean if you think negatively about yourself but still want to fit in, that might lead to anxiety? I know academics face the need to publish or perish, but as I am fond of saying, “No Sh*t, Sherlock.”