Corporal Punishment: What Exactly are We Talking About Here?

The intriguing headline Physical Punishment Tied to Aggression, Hyperactivity headed a report by Reuters Health Information dated January 17, 2014.  The report summarized a study done in the African nation of Tanzania, where, it said, “physical punishment is considered normal.” The conclusion of the study was summarized as: “Regardless of the culture a child lives in, corporal punishment may do lasting psychological harm” and “primary school students who were beaten by teachers or family members in the name of discipline tended to show more behavior problems, not fewer.”

The article went on to summarize the findings:

Some people still believe, despite an overwhelming body of evidence, that corporal punishment in some cultures won't result in as many negative effects," George Holden told Reuters Health. "But, as this study shows, it's difficult to find support for that argument," said Holden, a professor of psychology at Southern Methodist University in Dallas, who was not involved in the study. Past research, mainly in industrialized countries, has found that children and teens who experience corporal punishment may "externalize" their negative experiences in the form of bad behavior and emotional problems, Hecker and his colleagues write in the journal Child Abuse & Neglect.

To test whether the same is true in a culture where physical punishment is the norm and the law allows teachers to use it, the researchers interviewed 409 children between grades 2 and 7 at one private school in Tanzania, on the east coast of Africa. Participants averaged 10.5 years old. Ninety-five percent of the boys and girls said they had been physically punished at least once in their lifetime by a teacher. The same percentage reported physical punishment from parents or caregivers.

Nine percent of children had higher-than-normal levels of hyperactivity. About 11 percent of the kids showed less empathetic behavior than peers who had not experienced physical punishment.

Of course, as James Penston argues in his book Stats.con, correlational studies like this can be problematic. Still, as someone who argues that acting out, antisocial behavior, and hyperactivity are primarily responses to environmental family-of-origin issues - not the result of being a kid being born a genetically “bad seed” - I thought this study might be supporting evidence for my opinion.

But something about that story bothered me. "Corporal punishment?" Is that the right term the authors should have used?

I say no, because it is too vague. When the topic of corporal punishment for children comes up, there is a tendency of a lot of people to mix apples and oranges. In fact, in just about any controversial issue about almost anything, there is a generic tendency for a lot of people to fallaciously argue by conflating a variety of different factors, and then acting as if they are all talking about the same thing.  In particular, they ignore important qualitative and quantitative differences such as frequency and severity of certain phenomena. Arguments of this sort are yet another example of the art of misleading others.

Allow me to illustrate with this study. A little further down the article it spelled out what types of corporal punishment were being included in the study:

The majority of children, 82%, had been beaten with sticks, belts or other objects …Nearly a quarter of the kids had experienced punishment so severe that they were injured.

Corporal punishment? Well, yes. But the type of corporal punishment they describe is not exactly comparable to a swat on the rear administered by a parent to a toddler who just darted out dangerously into the street.  What is being described in this article is frank physical child abuse.

And yet I have seen the argument advanced that children should never ever be spanked, because spanking just teaches people to be violent or to use violence as their go-to problem solving skill.  Gee, I know an awful lot of people who had been spanked as children who are about as non-violent as they come.  Maybe I just hang out with wierdos or something.

While there are indeed some people who argue in print that no rod should ever be spared in not spoiling the child, no one I know is arguing the merits of beating the crud out of children. 

Apples and oranges. It’s really not all that hard to tell the difference between a spanking and a beating. 

It may very well be that mild spanking is ineffective as a form of punishment, or that there are better ways to accomplish the same disciplinary goal, or that it should be used only sparingly.  But causing kids to become violent in and by itself?  That’s just plain nonsense.

Whether you are for spanking or against it, equating light spanking with child abuse trivializes the latter. This then has a rather unfortunate side effect: People who read that spanking is included in the definition of child abuse often come to the conclusion that child abuse statistics must therefore be hopelessly inflated, so it cannot be nearly as big a problem as we know it actually is. So they lose interest. Losing the support of these people not only does not help the noble cause of reducing child abuse, it actively undermines it.

Anecdotal Evidence and Inductive Conclusions in Psychiatry: Part I

“Can a valid diagnosis be arrived at if laboratory tests are not available? Of course it can. Total reliance on on lab tests to the exclusion of other factors when seeking validity is not science but scientism” ~ Hannah Decker, Ph.D

In my post of April 1, 2010, Is “Data” the Plural of “Anecdote?” I pointed out that in most hard sciences, stories about a scientist or practitioner’s personal experience can be contrasted with “empirical” data from studies, and that the latter usually has more validity that the former.  

As I also pointed out, however, “…many of the randomized, placebo-controlled, double-blind drug studies can be every bit as biased as the worst anecdotal evidence. We are now living in an age of 'marketing-based medicine,' as opposed to evidence–based medicine" (randomized = the use of chance alone to assign the participants in an experiment or trial to different groups; placebo = inert sugar pill; double-blind = neither the person evaluating the research subject nor the subject knows during the experiment if the subject received the placebo or the active medication).

In psychiatry, the situation is even more complex, since there are almost no objective lab tests and we can't read minds, so we must rely on the experimenter's personal observations, or answers by subjects to psychological tests in which we do not know how honest subjects are being or even if they really understand the questions, or patient self reports. All of these sources of data, while important, are highly subjective and can hardly be considered "empirical" in the same sense as, say, a chemical reaction.

Another big point about anecdotes is that they are not worthless in science. Some of the most important discoveries in all of medicine were based initially on anecdotal evidence. In Part II of this post, I will describe how to determine the validity and generalizability of conclusions generated from a group of “anecdotal” clinical observations. That is, how can we tell if the anecdotes are the typical situation seen with a particular combination of clinical variables and which therefore can lead to a conclusion that will probably apply to most patients with a given disorder? Are the conclusions probably true, or probably false? 

In this post, however, I want to contrast conclusions based on a “clinical anecdote” with inductive reasoning. Remember, the first step in the scientific method is observation.

According to Wikipedia, inductive reasoning (as opposed to deductive reasoning) is reasoning in which the premises seek to supply strong evidence for, but not absolute proof of, the truth of the conclusion. It is usually based on seeing the same phenomena over and over again without any exceptions.

The truth of an inductive argument is supposed to be probable, based upon the evidence given. The same phenomena involving two variables are observed repeatedly, and other variables which correlate with the phenomena are shown to be not necessarily connected it, and a tentative conclusion or assumption is drawn regarding the relationship between the two variables.

Deductive reasoning, whose conclusions are more certain, is the process of reasoning from one or more general statements (premises) to reach a logically certain conclusion. Deductive reasoning links premises with conclusions. If all premises are true, if the terms are clear, and if the rules of deductive logic are followed, then the conclusion reached is necessarily true.

To anyone familiar with formal logic, deductive reasoning takes the form of a syllogism:

All men are mortal

Socrates is a man

Therefore, Socrates in mortal

If the first two statements are true, then the third statement must be true. Deductive reasoning is considered the entire basis of science by some scientifically illiterate individuals. 

The problem is that both premises in the above examples are inductive conclusions! Just because all observed men have turned out to be mortal does not in any way prove that the next man you come across cannot be immortal!

The first thing you should have learned from your Geometry 1 class in high school is that there is absolutely no way to prove that the shortest distance between two points on a flat two-dimensional surface is a straight line. It is just that every time you measure it, it is. You just have to assume it.

I have a pen in my hand which I am holding about three feet off the ground. Every time I have dropped it under controlled conditions, it fell to the ground. I can never prove that the next time I let it go, it will fall. So let’s see. Well, I’ll be darned. It did it again!

In other words, ALL scientific deductions are based on premises which are unprovable inductive conclusions. Therefore, presto change-o, if no inductive conclusions are scientific, then no deductive conclusions are either. Or in other words, science would not really exist.

Syllogistically:

              All scientific conclusions are based on inductive reasoning

              Inductive reasoning never proves anything

      Therefore, no scientific conclusions are proven.

Bullcrap.

Woody Allen, Mia Farrow, Dylan Farrow, and Soon-Yi Previn: Old Controversies about False Abuse Accusations Rekindled

Woody Allen wins the Golden Globe’s Cecil B. Demille Award for his life’s work from the Hollywood Foreign Press Association, and an old family war is rekindled for all the public to see. Mia Farrow, Woody's ex girlfriend, criticized the award because of an old accusation that Woody Allen had molested his then seven year old daughter. Then the now 27 year old woman, Dylan Farrow, publishes her own open letter to the New York Times describing in detail what she alleges happened to her:

http://kristof.blogs.nytimes.com/2014/02/01/an-open-letter-from-dylan-farrow/?_php=true&_type=blogs&_r=0

Dylan Farrow

Her description is quite detailed and very much consistent with a lot of stories from abuse victims that I have heard over the years.  

I would first like to say unequivocally that the biggest problem in this country is not that false accusations of child abuse by those claiming to be incest victims are believed, but that the true ones are not. The best studies indicate that about 95% of such claims by adults turn out to be basically true, despite many specific details being recalled erroneously. It’s easy to confuse a blue shirt with a black one or a morning for an afternoon, for example, but one is not likely to get being raped mixed up with taking a trip to the supermarket.

But what about that other 5%? The false accusations? It used to be that overzealous therapists pressured their more suggestible patients into “admitting” to having been abused under the nonsensical premise than anyone suffering from one psychological disorder or another simply must have been abused. Well, a few malpractice suits later, that phenomenon seems to have abated.

The most common situation in which false accusations are made at present is during hotly-contested, super-nasty divorces with child custody being a bone of contention. Such false accusations are tied in with the phenomenon of parental alienation, in which one parent who maintains primary custody fills a child’s head with vicious lies and half-truths about the other parent. Parents who put their kids in the middle of their messy relationships like that are just as deserving of condemnation as a child abuser, because doing so is indeed a form of psychological child abuse.

Which is what makes the Woody Allen case so interesting. 

Before Miss Farrow had her most recent say, Oscar nominated and Emmy winning film director Robert B. Weide published a story that had some possibly damning information in it about the whole sordid mess.

http://www.thedailybeast.com/articles/2014/01/27/the-woody-allen-allegations-not-so-fast.html

Now, I am not claiming to know the truth in the case. Repeat, I am not claiming to know the truth about what may or may not have happened to Miss Farrow. I can only make some general comments about publically available information, which never tells the whole story. As to Mr. Weide’s article, IF IT IS ALL TRUE AND COMPLETE (I’ll be repeating a version of that phrase several times, since some readers will undoubtedly not catch it the first few times), I can point out that there are an awful lot of the most typical indicators of a false accusation absolutely aglow in this story, at least as reported by the author of the piece.

Still, this does not necessarily mean that the accusations are false, or that Mr. Allen (no relation) is telling the truth about being innocent. Repeat, nothing discussed in this post proves anything one way or the other.

If you want to know how children can be induced to tell adults whatever the adults want to hear, I recommend a movie called Indictment: the McMartin Trial, about a preschool scandal in Southern California in the early 1980’s. The alleged abusers were all eventually exonerated, but not before overzealous social workers elicited highly detailed stories from the children that were believed in spite of there being absolutely no evidence that they ever occurred, and which defied credulity in the first place. Like a story of a class field trip to the set of a pornographic movie.

At the time of the original allegations made by Woody Allen’s girlfriend-at-the-time Mia Farrow, Woody was having an inappropriate affair with Mia’s adopted daughter Soon-Yi Previn. Mia allegedly found out about the affair when she found naked pictures of her daughter taken by Woody. An affair with her own daughter!  (Soon-Yi was at least 19 at the time, and Woody Allen’s extent of “parental” involvement was taking the girl to the occasional basketball game, so it is not true that he was her stepfather. Mia and Woody did not live together, were never married, and Soon-Yi’s adopted father was Andre Previn).

So, as Mr. Weide points out, “It’s understandable that Mia would remain furious with Woody for the rest of her life.”  She would have reason to suspect Woody of the worst possible behavior.  Of course, she herself was an admitted cheater who apparently had more than one affair herself during her life. Maybe Woody was the one who got angry first. Who knows? The point is that there was a lot of anger involved in this break up, which makes this fertile ground for possible parental alienation behavior on Mia’s part.

According to the article by Weide,

On August 4, 1992, almost four months after the revelation about Woody and Soon-Yi’s relationship understandably ignited a firestorm within the Farrow household, Woody was visiting Frog Hollow, the Farrow country home in Bridgewater, Connecticut, where Mia and several of her kids were staying. During an unsupervised moment, Woody allegedly took Dylan into the attic and, shall we say, “touched her inappropriately.” Later in the day, it was alleged that the child was wearing her sundress, but that her underpants were missing. The following day, Mia’s daughter allegedly told her mother what had happened, and Mia put the child’s recounting of the story on videotape as evidence... 

If Mia’s account is true, it means that in the middle of custody and support negotiations, during which Woody needed to be on his best behavior, in a house belonging to his furious ex-girlfriend, and filled with people seething mad at him, Woody, who is a well-known claustrophobic, decided this would be the ideal time and place to take his daughter into an attic and molest her, quickly, before a house full of children and nannies noticed they were both missing...

As for the evidentiary videotape of young Dylan’s claims, it’s been noted that there were several starts and stops in the recording, essentially creating in-camera “edits” to the young girl’s commentary. This raises questions as to what was happening when the tape wasn’t running. Was Mia “coaching” her daughter off-camera, as suggested by the investigators? Mia says no—she merely turned the camera on whenever Dylan starting talking about what Daddy did. Maybe we should take Mia at her word on this. Since I wasn’t there, I think it’s good policy not to presume what took place...

A New York Times article dated March 26, 1993, quotes from Mia’s own testimony, during which she recalled taking the child to a doctor on the same day as the alleged incident. Farrow recalled, “I think (Dylan) said (Allen) touched her, but when asked where, she just looked around and went like this,” at which point Mia patted her shoulders. Farrow recalls she took Dylan to another doctor, four days later. On the stand, Allen’s attorney asked Mia about the second doctor’s findings: “There was no evidence of injury to the anal or vaginal area, is that correct?” Farrow answered, “Yes.”...

Former nanny Monica Thompson (whose salary was paid by Allen, since three of the brood were also his) swore in a deposition to Allen’s attorneys that she was pressured by Farrow to support the molestation charges, and the pressure led her to resign her position. Thompson had this to say about the videotape: ““I know that the tape was made over the course of at least two and perhaps three days. I recall Ms. Farrow saying to Dylan at that time, ‘Dylan, what did daddy do… and what did he do next?’ Dylan appeared not to be interested, and Ms. Farrow would stop taping for a while and then continue.”...

Dr. John Leventhal further swears Dylan’s statements at the hospital contradicted each other as well as the story she told on the videotape. “Those were not minor inconsistencies. She told us initially that she hadn’t been touched in the vaginal area, and she then told us that she had, then she told us that she hadn’t.” He also said the child’s accounts had “a rehearsed quality.” At one point, she told him, “I like to cheat on my stories.”

And then there was this quote from Moses Farrow - Dylan's brother, also adopted, and now a 36-year-old family therapist: "My mother drummed it into me to hate my father for tearing apart the family and sexually molesting my sister," Moses Farrow, 36, told People Magazine. "And I hated him for her for years. I see now that this was a vengeful way to pay him back for falling in love with Soon-Yi." He added, "Pleasing my mother was very powerful motivation [for Dylan] because to be on her wrong side was horrible." 

Dylan called her brother's statement a betrayal.

It’s also interesting that Mia Farrow’s brother, John Charles Villiers-Farrow, has been convicted of multiple counts of child molestation. Mia may have exposed her children to him, so maybe there is a perp that is not Woody.

These observations, if true and complete, raise some serious questions about whether Dylan might be being loyal to her mother by repeating her not-really-true story in the press after her mother brought the subject back to public attention after the Golden Globes.

So, after reading this, anyone who thinks that Dylan’s accusation simply must be true or simply must be false is either highly defensive, blinded by anger, or a simpleton. No offense.

As someone who has studied dysfunctional families for almost 40 years, and who specializes in helping adults who were abused by attachment figures as children successfully confront their abusers, I want to add a few more random random thoughts about the case:    

1.  While reporting ongoing child abuse to the police and prosecuting the perp to the full extent of the law is absolutely essential, airing dirty laundry in public this long after the fact is almost always counterproductive for the victim. Victims may think they would feel a lot better if they get either revenge or just plain old justice for the perpetrator, and they may for a short time. But they are still left with a gaping hole in their soul where their family should be, and they often still have great difficulty self actualizing, or successfully charting their own course in life. As my readers know, I recommend that my patients work with me to discover ways to get past their family member’s formidable defenses and confront the issues involved head on.

2.  There's ALWAYS more to the story that abuse victims and other family members tell people about - even people who know them very well, let alone strangers or the public. Sometimes my patients leave out essentials of their experiences for MONTHS into therapy.

Victims of child abuse are much more likely to hide their parent's behavior than they are to exaggerate it.  

3.  That Dylan Farrow came from a highly dysfunctional background that harmed her seems to be a near certainty, but the details that we know about this case raise a lot more questions than they answer about what actually happened. 

Events in a family can be lied about out of loyalty by one family member to another. I would certainly want to ask about Dylan's relationship with her mother. If Dylan was abused, that means that Mia failed to protect her daughter in this case. Many abuse victims are more angry with the non-protective parent than with the abuser!  Sometimes that anger is covered up. In a reaction formation, the person obsessively loves and/or idolizes the person she's really furious with.  (Not saying it's true, but if Mia coached Dylan and pressured her to make the accusation, this could create a LOT of interesting scenarios).

That some of the Mia's children are angry with her seems likely. As I mentioned earlier, it was reported that Mia found out about Woody's relationship with Soon Yi by finding nude pictures of her around the house, taken by Woody. If this is true, why would Soon Yi, who was an adult at the time, have a sexual relationship with her own mother's boyfriend and then conveniently leave evidence about it lying around the house for Mom to find? (Did she leave it around accidentally? Bullshit). If this is true, then to surmise that Soon Yi is really pissed with her mother is probably a safe bet. Why is she so angry? That would be an interesting story.

I also find it fascinating that Soon Yi seems to get a free pass on her relationship with Woody – she married him and adopted children with him and they are still together - from all the people who are absolutely certain that Woody is a pedophile.

We also know by her own admission and a pregnancy that there was cheating in Mia's past, and families in which infidelity is the norm create a lot of chaos for children. Certainly child sexual abuse could also be present, but it would just as certainly not be required for this "family" to be severely dysfunctional.

Guest Post: Failure to Launch: How Fear in Families Makes for Adult Children Living at Home

Today's guest post is by Elizabeth Reed. This is the sixth post in which a writer recounts his or her own experience in a family with a problematic history, as well as the problem's aftermath. In this post, the author describes how, in an attempt to be completely different from one of her own parents, she may have overcompensated and by doing so interfered with her son's growth and independence.

I am right now in the midst of a situation with my twenty-one year old son which I have created for myself out of fear and ignorance. In my desire to help my son to cope with bad situations in our family life I have actually made it much harder for him to become a man. I am at fault but I am not struggling with guilt; I am not wholly to blame but I am struggling with how to change the current dynamics of my relationship with my son.

It is so very difficult, at least in my mind, to change a relationship that has been forming since he was in the womb. I wonder how other mothers of sons deal with their relationships. The whole mother/son relationship is totally different than the mother/daughter relationship. At least it is in my case. At one point in their lives as toddlers sons often desire to marry their mom out of admiration. I watch in awe at the oversized football player who tells his mom he loves her on national television. And yet they must leave mom and make their way in the world. They can sometimes get so tangled up if the mother is not very careful, and it can end up creating a situation in which the boy does not develop the ability to make his way.

I have two children; the oldest is a girl and is now twenty-eight. I did the exact same things with my daughter that I did with my son. For six years of her life I was single and there were many occasions when it was just her and I, and we spent all our time together with no one else involved. I did the same things for her that I did for my son. Helped with homework, helped with chores, supported them at school, etc. She grew into a wonderfully independent, intelligent young women. 

Yes, she has issues to deal with like father issues and mistakes in parenting that I have made but she is dealing and working through them. She has gone on to get her bachelor’s degree and is working on a master’s degree. She is employed doing something she loves and is thriving in her career. She has a boyfriend that she has had for two years, and she will be the first to admit that she has emotional handicaps but she is seeing a counselor and making a conscious effort to work through them.

The first really huge mistake I made with my son, I think, was in buying him a vehicle at sixteen -  because after all I did the same thing for my daughter. She was scared to death to drive a car so I thought the best thing to do was to get her out there right away. We live in a large metropolitan area and it was important that she learn how to drive to get anywhere. She was a very responsible driver and nothing changed as far as her behavior. 

Not so with my son.When he got a vehicle it was as if I had given him his own apartment. He went totally wild and we struggled with him coming home, not answering his phone, and hanging out with all the wrong people. He began to experiment with drugs, mostly pills and pot, and he began smoking cigarettes. He totally went away from everything we were about as a family.

So let me go back to the beginning and give you some background. When I was pregnant with my son I went into early labor at about six months. It had something to do with a terrible hurricane, flooding, and a lot of stress. The doctor put me on a medication called Brethine which is now strictly taboo for pregnant women because it can cause brain damage, ADHD, autism, and more. When my son was born he acted like a baby who might have had a mother who did drugs. He did not like to be held much and cried at the drop of a hat. When he was laughing it could turn into tears very quickly, which immediately made me even more protective and fearful. 

From Kindergarten the teachers were telling me he had ADHD. He was not mean or aggressive or loud but he could not keep his focus. I took him to have him tested by our local University because they had a wonderful department full of students and professors who were doing studies, and it was in my budget. They checked him for learning disabilities, checked his eyesight, his hearing, and evaluated him for ADHD. All checked out. He was said to be normal with an IQ of bright/average, and they thought he was only “borderline ADHD.” They said he was a bright, delightful child.

He was a happy boy and full of energy. When he did something wrong he smiled and tried to charm us. It was difficult not to laugh at him when he was ornery but I did my best to stand my ground. His dad, however, would laugh at him and was not much of a disciplinarian. His dad was born to privilege and had been mostly raised by a nanny.

His dad had been a drug addict before I met him; we married when he was thirty-one and I was thirty-four. I knew very little about addiction except alcoholism. We had met in church and he had a great job and seemed to have everything on track. I knew he had been in jail for his addiction and had gotten out at twenty-eight, only three years prior to our marriage. I had no idea what I was getting into or how deep his problem went.

I too was emotionally unstable and needed attention because of an unloving relationship I had had with my own father. We were two extremely needy people looking for the other to meet our needs and there was no way that could happen. He simply needed a babysitter to keep him from doing anything wrong and to take care of his needs to be fed and picked up after. I needed a friend, a lover, and someone to laugh with and make me feel loved and special. 

He had absolutely no idea how to do that and in fact did not have a clue what love was because he had been on drugs most of his life. My job was to serve him and basically be a roommate; my emotional well was empty. Because he could not fill it up, it turned into resentment on my part. Our marriage at first was empty but then it turned ugly.

All the while I was doing my best to be the mom my kids needed, to be there for them always and help them to feel loved and to try to keep normalcy in their lives. I went overboard to make them happy. The more I did for my daughter the more she wanted to give back. It was not so with my son. He took and never thought to return. He does express his love verbally and with hugs but does not actually put a lot of action behind his words. He sometimes feels bad that he is not performing up to par but feeling bad is as far as it goes.

His dad did go back on drugs after we were married for eleven years - probably because we were so very unhappy and I had pretty much given up on trying to keep our relationship going. My son was ten at the time and this split further sent me into over-drive in trying to love and protect him. Then we moved away to a new part of town, and since he had so many feelings of rejection and inadequacy, at thirteen he made friends with the kids in his like position and started making poor decisions. We worked through most of this but then when I bought him a car the roof caved in.

We barely got him to stay in high school even though he was completely capable of making good grades. He just simply did not want to be there. So I rescued him and moved him to another school, smaller and with more one-on-one attention. He graduated high school by the skin of his teeth and tried college but could not handle it. Not the work, but the time and sitting. He has been diagnosed with an anxiety disorder and has difficulty staying somewhere he does not want to be. I know that this is a combination of a psychological disorder but also a convenient excuse for when he does not want to do something. This problem is spilling over into his not keeping jobs and now not wanting to even look for one because he is afraid of being rejected or having to be somewhere he does not want to be and then panicking.

He lives with me and his grandmother, which is a sweet deal for him. He wants me in his life but wants to be independent so we are doing this push-me-away, pull-me-in routine almost daily. I have talked to him about how he needs to push himself and take one step at a time. I tell him that he is a man now and has to do things for himself and he agrees. When I stop doing things for him sometimes he does well and other times he gets upset and wonders why I do not love him any longer.

I really wanted for him to realize on his own that he has to do something to change his life. His father and I are divorced now for over five years and separated for eight and his recommendation to me is that I should kick him out and let him learn the hard way. I so want for him to step up to the plate without the rug being completely pulled out from under him. And knowing that I am primarily to blame makes it even more difficult for me because I did not know how to be any other kind of mother and still do not know how to change our dynamic.

Being raised with an angry and sometimes irrational father and a mother who loved to a fault did not help. I did not want to be abusive like my father so I erred on the side of love like my mom who had grown up with an alcoholic father. But it is an enabling love that sometimes does more harm than good. But speaking for myself, I do not know where I would be now without her unconditional love in the midst of total rejection and dismissal by my dad.

I have been learning from my relationship with God my Father that the right kind of love is for the other person’s good and cannot always be the easiest kind of love. It is never too late to change but it is very difficult to sort out emotions and change ways of thinking that you have had for over fifty years. I know, however, that I need to do it for myself and for my son. And I want the pattern to stop being passed down through the generations. Now I understand about the passage of scripture from the Bible that talks about the children suffering from the sins of their parents. Fears, anxieties, guilt, lack of or an overabundance of love because of fear are all detrimental to the family dynamic and for producing healthy children.

From looking at both of my children I have to surmise that much of it is also based on predisposition and bent because my daughter was able to push herself beyond my inadequacies and sometimes over-bearing love. I have no other basis to judge this on except my own children but I think it must have something also to do with the sexes; men being primarily takers and women givers. I am not trying to offend or be anti-men but I have observed this behavior in more and more men especially of late.

I am determined not to give up on myself or my son in changing the dynamics of our relationship and both of us becoming emotionally and mentally well in the process. I see that far too often when it gets too difficult that parents and children give up on each other and stay wounded and hurt for life. I am full of love, sometimes the wrong kind, but I refuse to let go and will persevere in finding a healing avenue for myself and hopefully this will spill over into my son’s life as well. I am not only trusting in my own initiative but I am trusting in God to help us to recover what we have lost.

Author Bio:

Elizabeth Reed is a freelance writer and a resident blogger at Liveinnanny.org. She particularly enjoys writing about parenting, childcare, health and wellness. In addition, she is an expert consultant on issues related to household management and kids.

Pathological Altruism

Pathological Altruism is the first book I have come across (thanks to an anonymous commenter on my blog) that deals broadly with a subject that has been near and dear to my heart. I have been writing about its manifestations in families for almost thirty years.

Pathological altruism is defined as actions designed by someone to help others at one’s own expense that, in the long run, harm not only the giver but the recipient as well. I first thought about it way back in 1985 as I was writing my first book, which was eventually published in 1988.

My ideas stemmed from the writings of family systems therapy pioneer Mara Selvini Palazzoli and her group in the book Paradox and Counterparadox. She described how children are willing to sacrifice their own well being in order to stabilize emotionally dysregulated parents and to preserve family homeostasis - the rules upon which family interactions are regulated and made predictable.

I noted that this sort of self-sacrifice led to a paradox, which I called the altruistic paradox. I got braver later on and re-named it with the moniker I originally had in mind, the Mother Theresa Paradox. Although the altruistic actions of family members would calm things down in the short haul, in the long run they would backfire. This happened for a number of reasons. 

First, such acting out would usually prevent family members from actually discussing mutual dilemmas and intrapsychic conflicts with one another in a way in which problems might be resolved.

Second, in cases in which parents would overly sacrifice themselves for their children in order to follow the homeostatic rules within the family of origin they themselves had grown up in, they would prevent their children from developing skills such as frustration tolerance that would allow their children to eventually function independently. The kids would never seem to grow up. I believe that refusing to grow up eventually becomes their choice and is also, in fact, a major act of self-sacrifice in a culture which values independence.

Third, an imbalance between giving and receiving in which the former is considered a virtue and the latter a vice creates a situation in which group members all become frustrated because no one is willing to receive what the others have to give!

The altruistic behavior within the group is described and explained by evolutionary biologists using the concept of kin selection.

The book Pathological Altruism is an edited collection that includes many different perspectives from a wide range of academics. Although I disagreed with many of the chapter authors, I am certainly delighted that this topic is being tackled, and I was indeed thrilled when the reader told me about the book's existence. As the editors of the book say in their introduction, perhaps pathological altruism has been so little discussed for pathologically altruistic reasons.

As the book illustrates, the concept of pathological altruism certainly can provide powerful answers to such questions as why some people become "co-dependent," why the most difficult patients to treat on a cancer ward are often former cancer ward nurses, and why some people seem to be victimized by criminals far more than the average Joe.

Some of the authors question whether pure altruism even exists – maybe all behavior is performed in order to make one's self feel better, not the other guy. If it does exist, how can we even know that it is pathological?

We can never be certain about the motives behind any human action, as people can be dishonest about that not only with others but with themselves. And maybe they sometimes do not understand their own motives, or they are under the sway of genetically determined processes over which they have no control. As Joseph Miller was quoted as saying, “It is orders of magnitude more difficult to study internal than external stimuli.”

In the book's discussions about making determinations of the motives behind the behavior of another person, one major omission is a pattern that I think is perhaps the most important. While many of the authors wrote about how apparently altruistic behavior can be used to mask covert or hidden selfish intentions, none of them discussed the opposite: how apparently selfish behavior can be used to mask covert or hidden altruistic intentions. For illustrations of how and why this happens, see my posts, The Language of Love from 4/17/10, and my two posts on dysfunctional family roles, Part I and Part II.

I did find much to admire in the writings of many of the authors, but in general I found that a lot of them make the same kinds of errors in thinking that I have brought up in this blog. For instance, they often have very simplistic understanding of what heritability means, or what the differences seen on fMRI scans between various people while doing certain tasks mean. They far overstate genetic influences on behavior.

On a related issue, as author Joachim I. Krueger points out in Chapter 30, there is a tendency of many of the authors to ignore social psychological influences, and think that a lot of the motivation behind pathologically altruistic behavior stems from one’s own internal predispositions rather than from being reactive to environmental contingencies.

These two errors come together in discussions by some of the authors of the "five factor" model for personality. These factors represent behavioral tendencies that may stem mostly from genetic predispositions. Someone may naturally be more agreeable than most others, for instance, and if all environments were the same in regards to the consequences of being agreeable, such a person would be more likely to be agreeable than someone without this genetic predisposition.

Of course, we all operate within many different environments, each of which is constantly subject to change due to the operation of a literally infinite number of variables. People who are agreeable, if they see that such behavior will lead to adverse consequences, will not be so likely to be agreeable than they would be if left purely to their own devices. When an fMRI scan is done, for instance, that is a measure of the brain’s reactivity within only one of a myriad of other contextual possibilities. In other words, context is everything.

Motivated people can easily defy their own natural inclinations when they see that it is in their or their family's interests to do so. In fact, if there's one thing I have learned in doing psychotherapy for close to 40 years, it is that people can construct a very complicated false self, as first discussed by psychoanalysts Jung and Winnecott, in which they completely submerge many of their own strong inclinations. 

In chapter 29 by Marc Hauser, he points out that from an evolutionary standpoint, it may be advantageous for a person to appear tougher, sexier, or more caring than they actually are. Primatologists have long known about the prevalence of and advantages of being able to deceive other members of one's own species. Hauser also talks about what I refer to as the Actor's Paradox: The act of deception is more convincing if the actors can convince themselves that they really are the character they are playing.

Paradoxically, the tendency of humans to use deception in the act of sacrificing oneself for the sake of their kin group may itself have a very powerful genetic component. This genetic tendency is probably far more powerful that any genetic influences on the five factors, if I had to guess.

The logical error of genetic determinism can be illustrated with an article that was cited by chapter 21 author John W. Traphagan (Freeman, J.B. et. al., “Culture shapes a mesolimbic response to signals of dominance and subordination that associates with behavior,” Neuroimage 47 (2009) 351-359). The brains of Japanese and Americans were scanned while the subjects reacted to photographs of people acting in dominant and subordinate ways, with the nationality of the subjects in the photographs being ambiguous. Statistically significant differences on the scans emerged.

It seems to me that it is highly unlikely that the distribution of genes creating each of the five factors of personality would be hugely different in Japanese or Americans, so this study shows that cultural training affects brain function during certain tasks. It probably does not reflect genetic differences to any significant degree. Of course, if this was a study done by psychiatrists, who always declare differences to be abnormalities, being Japanese would be called a disease!

Of course, it could be that the distribution of genes does vary markedly in different populations. But I doubt it. In Chapter 22, Joan Y. Chiao et. al. opine that empathy and altruism differ in different cultures because of such discrepancies in gene distribution. They chart different countries that vary on the balance between individuality versus collectivism within their cultures versus the percentage of different alleles (versions) of a gene that affects serotonin. 

Although a few seemingly highly collectivist cultures had significantly more of one allele than the other, in fact almost all of the countries had a very similar distribution. In fact, the USA and Brazil, rated vastly different on the individualism-collectivism scale (10% versus 70%), had almost exactly the same allele distribution. 

One wonders if perhaps there might be other more collectivist countries that were not included on the graph that would have been outliers in the opposite direction. This reminds me of a famous old study that showed heart attacks were more common in countries in which there was a higher fat intake in the average diet – a study which for some reason completely left out France. The French eat a lot of fat and have a relatively low incidence of heart attacks.

Some of the chapters in the book seemed to me to be overly academic or discuss arguments that seem to boil down to semantics. The book is probably not meant for lay readers. However, despite all of these reservations, the book has enough great stuff in it for me to recommend it to anyone with an interest in this fascinating subject.  

Corruption at Child and Adolescent Psychiatric Hospitals

I have been discussing the huge rise in diagnoses of pediatric bipolar disorder spurred on by Harvard psychiatrist Joseph Biederman and many others (not to mention the huge rise in diagnoses of bipolar disorder in adults), for a long time in this blog. While there are rare children who present with bipolar disorder, they are few and far between, and they are obviously psychotic. Most children getting the diagnosis now don’t even come close.

Not only have the big pharmaceutical companies benefitted from this, but it has also been a big financial boon for the for-profit psychiatric hospitals that have child and adolescent units, and the corrupt child psychiatrists who admit patients into them.

Of course, critics of psychiatry seem to think that it is only psychiatrists who are subject to greed, corruption, and excess. Not people running investment and banking firms, "alternative" medicine websites, auto repair shops, oil companies, or the for-profit prison system prosecuting a racist and phony war on drugs. Not even Congressmen! Just psychiatrists. 

Wolf of Wall Street, anyone? Nope. It's just the Wolf of Roxbury Drive (also known as Couch Canyon in Beverly Hills).

Anyway, the following graphic displays the incredible upsurge in hospital admissions for this alleged disorder between 1997 and 2010.

Unfortunately, fraudulent practices in child and adolescent psychiatric units are nothing new. Only the phony diagnoses have changed. In the 1980’s and 1990’s, adolescents with behavioral disturbances were kept in hospitals run by National Medical Enterprises (NME) (now Tenet), Charter (now Magellan), and some others for months at a time – until their insurance benefits ran out. They were then abruptly discharged.

Then, as now, parents were assured that their parenting, chaotic lifestyles, and/or marital problems had nothing at all to do with the behavior problems their children were having. After all, if the hospitals told the truth, parents might take their children out of the hospital in protest. 

Back then, the hospital said the culprit behind what we used to call juvenile delinquency was obviously heavy metal music!

I’m not kidding.

The hospital chains were eventually prosecuted by the United States Justice Department for billing fraud and abuse, as well as for making false diagnoses and even for false imprisonment. This is why the firms reorganized and changed their names.  

So they needed a new way to make money fraudulently, and the Biedermans of the world were happy to oblige them with false diagnoses of bipolar disorder and of course ADHD - or both.

One of my former trainees, now a colleague, told an interesting personal anecdote about a hospital with an adolescent unit, although this concerned a young adult patient with borderline personality disorder (BPD). The doctor planned a brief hospitalization for the girl in order to stabilize her, and - following the way I trained him - soon told her he was going to discharge her. Hospitalization tends to make patients with BPD worse rather than better if they are kept there longer than just briefly.

The hospital literally went behind his back and spoke with the girls parents. They told them that they were concerned that my colleague’s discharge plan was premature and was going to harm their daughter!

As soon as my colleague found out about this, he resigned from the hospital staff. I trained him well.

Of course, being an ethical psychiatrist can get you into trouble. The child and adolescent psychiatry department at the University of Tennessee Health Sciences Center, when I first came there in 1992, was heavily into "structural" family therapy and not just drugging children. It's leader, David Pruitt, had been trained by the family systems therapy pioneer Salvador Minuchin himself. 

Many years later, the department opened a new psychiatric ward at LeBonheur Children's Hospital. Only trouble was, our department's philosophy was to only hospitalize children who actually needed to be in the hospital. There were not enough patients to make the unit a viable concern, so the hospital closed it. So now, children who actually need inpatient care are completely at the mercy of the private chains.

Here are some news stories about the NME scandal:

 From Answers.com

The trouble began in 1991 when the Texas attorney general sued NME for alleged overbilling practices at its psychiatric facilities in that state. Allegations of wrongdoing were compounded that year, as individual patients began to accuse NME of having held them in psychiatric facilities against their will, only releasing them when their insurance coverage was exhausted. 

Eventually, more than 130 patient suits would be filed. Further, in the summer of 1992, 19 insurance companies, including Metropolitan Life, Aetna, Prudential, and Mutual of Omaha--some of the biggest providers in the country--filed suit accusing NME of an elaborate program of insurance fraud, beginning as early as 1988, whereby NME admitted tens of thousands of patients who did not need inpatient care, paying illegal kickbacks to referring physicians, fabricating trumped-up diagnoses, and charging exorbitant fees to treat them. At its peak, the cost of the fraud was estimated at $750 million.

 In August 1993, 600 FBI and other federal agents raided NME's headquarters and 11 of its psychiatric facilities, seizing hundreds of documents as part of an investigation into possible criminal misconduct. To his credit, Barbakow insisted on full cooperation with the investigations.

The scandals significantly damaged NME's finances as well as its reputation, as operating profits from the psychiatric division fell from $234 million in 1991 to just $3 million in 1993. As for the cost of putting the past behind, by the end of 1993 settlements with only a few of the insurance companies in question had already topped $125 million. Moreover, after spending nearly $65 million in legal fees, NME pled guilty to felony federal charges in 1994 and agreed to pay $379 million to the Justice Department and the Department of Health and Human Services, the largest settlement in history between the U.S. government and a healthcare provider.

From Uow:

In its first incarnation during the 1980s and 1990s the company was called National Medical Enterprises (NME). It was involved in a massive scandal defrauding Medicare by buying patients for up to US $2000 each from anyone who could persuade them to come to hospital. The company had contracts with bounty hunters and even pleaded guilty to kidnapping a patients. It bought patients from Canada.

Vast numbers, many of them children did not need hospital admission. The company lied to them and kept them in hospital for the full duration of their insurance all the time providing them with vast amounts of unneeded treatment. All of this was signed for by doctors. The company eventually pleaded guilty to criminal practices in 1994, was forced to sell its specialty hospitals where the fraud occurred, entered into a variety of integrity and compliance agreements and paid in the region of US $1 billion in settlements and compensation to patients

From Business Week  9/12/93:  

On Aug. 26, 600 FBI and other federal agents swooped down on NME's Santa Monica (Calif.) headquarters and 11 of its psychiatric facilities, seizing hundreds of documents. The government hasn't filed charges against NME, but sources close to the investigation say the FBI raid follows a two-year probe into possible criminal misconduct, including widespread overbilling and fraudulent diagnoses to extend patients' hospital stays.

"GOLDEN RULES." Insurers claimed that NME's top management instructed hospital administrators to adopt "intake" goals designed to lure patients into NME hospitals for lengthy and unnecessary treatments. Although the Justice Dept. isn't elaborating, sources say the government is investigating possible illegal marketing and billing practices that are the crux of lawsuits filed last year against NME by 19 insurers, including Prudential, Aetna, and Travelers.

In one internal NME document called "Intake Focus Golden Rules," which was obtained by insurers, hospital administrators declared: "Intake is our most important system--nothing else matters if we don't do that well." To that end, hospital staffers were urged in the document to admit fully half of all patients who came in for an evaluation. Barbakow, a board member since December, 1990, says the document was put out by lower-level managers. NME says it was later recalled when headquarters learned of its existence.

The FBI has also been interviewing former NME patients who are suing the company for false imprisonment. Robert Andrews, a Fort Worth lawyer who is handling 68 such cases, claims NME guide manuals instructed staffers to "push the pain" by convincing parents that if their kids weren't admitted, they might commit suicide. NME says the manual hasn't been used in years.

Dawn McClary is one plaintiff. McClary, now 20, says she spent 20 months from December, 1987, to July, 1989, at NME's Brookhaven Hospital in Dallas after quarreling with her parents about staying out late. After a three-week evaluation, McClary alleges, she was misdiagnosed with a borderline personality disorder and strapped to a wheelchair or her bed for days at a time. McClary's parents were advised she should stay at Brookhaven for five years. But when her insurance policy refused to continue payments, McClary says she was finally released. Total cost to her insurer: $298,000. NME says it's barred by law from discussing patient treatment.