Dr. Allen Interviewed on a New Podcast about Family Dynamics

A new podcast in which I'm interviewed about my model of family dysfunction on Reclaim Your Reality:

https://www.youtube.com/watch?v=HOwg9RxBXTQ

History of the Groupthink Concept

Conformist Herd Mentality by Brynn Who Likes Editing.  Creative Commons CC0 1.0 Universal Public Domain Dedication

 

One of the things I have written about several times is how both therapists and psychotherapy theorists consistently confuse  things going on entirely in people's minds with conformist, herd mentality, or groupthink.

Groupthink is a term first in introduced by Irvin Janis (May 26, 1918 – November 15, 1990). He was an American research psychologist at Yale University, and coined the term in the 1970s. He mostly focused on business groups trying to come to a consensus, and not so much on the groupthink in politics, religion, and self-destructive behavior. He particularly looked at groups trying to minimize conflict without testing or analysis. This was similar to what was described by Margaret Heffernan. in her book Willful Blindness. 

A group is especially vulnerable to groupthink when its members are similar in background and insulated from outside opinions (as I would say, like any young kid in a family). They promote simplistic and stereotyped thinking, and stifle individual creative and independent thought.

Janis originally developed the concept of groupthink by analyzing major historical foreign-policy fiascos - such  the Vietnam War and the Bay of Pigs invasion, and wondering how intelligent leaders could make disastrously irrational decisions. The term itself was made to be similar to the doublethink idea from the dystopian novel 1984. Janis formally introduced the topic in a published an essay by Stephen J. Gerras in the Yale Alumni Magazine, and in a 1971 article in Psychology Today. Irvin then detailed it further in his 1972 book, Victims of Groupthink. 

It changed the way we think about decision making. People in groups make critical decisions, and fail to consider the full range of alternatives or consult experts who could offer different perspectives. 

He outlined eight symptoms of groupthink — behaviors that show up when decision-makers are more concerned with consensus than clarity.

•        Illusion of invulnerability

•        Collective rationalization

•        Belief in inherent morality

•        Stereotyping outsiders

•        Direct pressure on dissenters

•        Self-censorship

•        Illusion of unanimity

•        Illusion of unanimity

• Mindguards who shield the group from dissenting information

Do Genes Directly Affect Human Behavior?

DNA double helix horizontal.png by Jerome Walker, Public domain

One thing that I have complained about over the years is the tendency of many biological psychiatrists to misread the science to way over-emphasize genetic causative factors of repetitive problematic behavior - susceptible to treatment with drugs - and way under emphasize causative environmental factors - for which psychotherapy would be the preferred treatment.

A recent study  in Translational Psychiatry (Aug 2026) illustrates the problem. It showed that patients with social anxiety disorder shared genetic risk factors with several major psychiatric illnesses, including schizophrenia, bipolar disorder, and depression. The study looked at polygenic risk scores, not just one or two genes. Shared genetic factors were not associated with disease severity or common clinical subtypes.  And the observed effect sizes were generally small.  The article did not specify, but I suspect that, additionally, some of their cases of social anxiety may have not shared many of these genetic risk factors, while control subjects may have.

Social anxiety disorder is hardly the only psychiatric diagnosis that commonly shares genes with other psychiatric illnesses. Almost all of them do! This make it even more ironic that many nurse practitioners and even quite a few psychiatrists seem to add on a new drug as soon as a patient exhibits any new symptoms. Anxiety and mood symptoms are naturally at the top of the list, but subjects often have co-occurring symptoms of several other behavioral disorders like these subjects did: schizophrenia, bipolar disorder, and even anorexia nervosa. 

Any one gene is not necessary or specific in predicting the vast majority of psychiatric disorders.

This is not to say that in some cases an addition of medication to psychotherapy is never required. I remember seeing a study that showed that 40% of subjects diagnosed with borderline personality disorder met full criteria for panic disorder. (It was higher percentage than that in my clinical practice). Patients often did not disclose these symptoms unless specifically asked, and I did. 

Furthermore, a panic attack seemed to occur immediately before the patients engaged in self-mutilation like cutting. If the panic disorder was adequately medicated, the self-injuring behavior often disappeared. MUCH more quickly than with a course of dialectical behavioral therapy.

But what I observed was that patients previously treated by a mental health practitioner were coming to me on a whole medley of different psychoactive med. Sometimes they cancelled each other out. Like I always say, “Uppers and Downers and Bears! Oh my!"

Several companies also offer to look at a client's genetic makeup to predict which antidepressant is most likely to work for them. When I tried these tests, they were for the most part not useful clinically. I did a better job of predicting which antidepressant to start out with than these tests.

Genes do affect human behavior in a variety of ways, but as Robert Sapolsky points out in his book Behave, each of them only makes certain responses a little more or a little less likely. They don't determine it any further than that. And this applies to normal human brains, not just diseased ones.

Therapists' Myopia

Boysmartphone.jpg by Andy Graff. Creative Commons Zero, Public Domain 

A major deficit in the thinking of many mental health professionals and therapists is a myopic understanding of various psychological phenomena. I have frequently written posts about them thinking that everything relevant to therapy occurs completely inside the head of an individual. Since humans are extremely social to the point of being tribalistic groupthinkers, ignoring how the problem behavior affects and is affected by social interactions – especially with kin – is frankly absurd. 

Family systems therapists do look at social interactions, but often go the opposite extreme and ignore what is going on in the minds of individuals. A smart therapists looks at both.

I first thought about this in regards to episodes of child abuse or domestic violence. Therapists want to know what happens, but neglect to ask about what is going on at home when the abuse is not happening – what’s the relationship like most of the time? Do other family members have some influence on events or ignore obvious signs?  What would happen if the patients spoke up? What do the abusers say right before it happens, and right afterwards? Literally dozens of other important questions like those.

Nowadays there’s a lot of talk and information about the problems created if children spend too much time on social media. Any untoward result like poor social skills or attention problems is automatically attributed entirely to the screen time without regard to what parents are doing at the same time as the child is online. While the risks that are spoken of do happen a lot, it is NOT the only factor. A recent study sorta proves me right:

              A recent study published in JAMA Pediatrics, showed parents “spending too much time on a smartphone can lead to slower vocabulary growth in children. ... Much of the research about screen time and developmental delays has focused on children, but parental overuse of devices may play an important role in their children’s growth-both by reducing the frequency of quality social interactions and indirectly reinforcing a non-ideal behavior.” Researchers found that “parental smartphone use accounted for 4.5% of the variance in children’s vocabulary scores.”

In some families the situation is much worse. In the families of some of the children who eventually develop borderline personality disorder, the parents are often on social media at the same time as the child. There is almost no communication between them for long periods, and the parents get annoyed if the child interrupts their own activity. But when the child goes outside, the parent shifts into acting like the proverbial helicopter parent, trying way too hard to make the child’s life as responsibility free as possible. And seems to resent having to do that but won't admit it.

Bad combination.

Book Review: I Hate You Don't Leave Me by Jerold Kreisman and Hal Straus

 

My model of the primary causes of borderline personality disorder (BPD) - parents with a severe psychodynamic conflict over having children and who give mixed messages to their children - has only been written about by a couple of other psychotherapy researchers. I am currently working on a journal article with Dr. Mark Ruffalo about the effect of the double binds these children are faced with on their future relationships - especially ones with anyone who is trying to "fix" them like a narcissistic member of the opposite sex or a therapist.

The above self help book is in its third edition and has been around for years. When I first saw the title I thought it might be the first book in the popular press to refer to the messages sent by a parent to a child (or adult child) that I've been talking about.

When I finally got around to reading it, however, it was more about the message people with BPD send out to other adults including therapists. In my model, the adults with the disorder do indeed do unto others that which is being done to them.

The book does talk about how such a conflict may be passed downs from one generation to another but only briefly. However, it is designed primarily for is both people with the disorder and their families. 

The author does an excellent job of pointing out the pro's and con's of current theories and treatments used by therapists. He illustrates them with case studies. There is a lot of poor research out there, as well as a myriad of different professional opinions about various aspects of the disorder. The book does a pretty good job of separating the wheat from the chaff.

The author also looks at some of the same societal and cultural changes in recent years that I have written about, which likely play a part in the increased incidence of the disorder. "A modern parent, emotionally detached and alienated -  yet at the same time pampering and over indulgent - becomes a likely candidate to mold future borderline personalities" (p 88).

I strongly recommend the book for anyone who has the disorder, or who has been dealing with someone with the disorder.

Ambiguity in Family Conversations

Send Medicine and Arms by A1Cafel, by the Creative Commons Attribution-Share Alike 2.0 Generic 

 

This post will continue on from my posts (2/24, 3/19 and 4/14, and 6/2) summarizing how I incorporated ideas from from fields outside of mental health into my psychotherapy model, as well as how I tried to fit together seemingly contradictory theoretical aspects of several other psychotherapy schools. I've discussed why family members shape their behavior and the the rules by which the family operates in order to to maintain homeostasis. The rules allow family members to be predictable and to maintain their function within the system.

I also discussed how and why people can be highly conflicted about some of the roles they play in their family but cannot and will not admit to this ambivalence. Often they won't even talk about experiences they had in the had that affected them and led to this situation. In my post of 4/1/14 I described a study I did which identified unexplained contradictions in the behavior of parents in  regards to how members should love, work, and play, and what opinions they seem to think are established realities. This phenomenon was seen considerably more frequently in the families of subjects with personality disorders than in those without one.

In this post I'll describe benefits that the academic field of linguistics can provide psychotherapists.

My book Deciphering Motivation in Psychotherapy discusses in detail the following, which is also discusses in two previous blog posts:

Since these parents are conflicted about their parental roles, they constantly give off mixed messages to their children about what is expected from them. Much of what they say about things and how they behave in various contexts is often highly ambiguous, but they will deny it if confronted about it. The yearnings they won't admit to somehow come out indirectly in their behavior and conversations.

The aspects of language that gives this away was described in the previous post: http://davidmallenmd.blogspot.com/2016/07/ambiguous-language-and-recognizing_19.html. Any sentence in any language can always be interpreted in at least two different ways.  Important examples include the use of adjectives with a seemingly wrong connotation ("excuse" vs. "reason"), a misleading tone of voice or body language, and direct contradictions of previous statements. It is also important to remember that the meaning of anything is interpreted with the context and repetitiveness of all previous statements and behavior - over the entire course of a relationship. 

This is also what family and couples therapists need to be aware of when evaluating interpersonal behavior seen in a therapy or research session. Two people who have a history together know important implications in a conversation that an outside listener would not be privy to.

 This leaves the children to try to figure out how to simultaneously meet their parents’ contradictory perceived needs to be, for example, both needed by their children and, simultaneously, for their children to just go away. Believe it or not, there's usually a way to combine them into one pattern of behavior. How they do so is detailed in the blogpost:

http://davidmallenmd.blogspot.com/search?q=actions+speak+louder

Therapists Conflate Performance and Ability

 A few years ago I did a blog post (July 22 2013) about movies that purport to be about someone with borderline personality disorder, and mentioned that the two most accurate portrayals came in the movies Thirteen and Frances.

Recently I came across the clip from the latter movie which dramatically illustrates why clients with this disorder are so unpopular with therapists who don't know how to handle interactions like the one in the clip.

Frances with Jessica Lange came out in 1982. As I wrote in the previous post, it was highly fictionalized but inspired by the true story of a minor movie star named Frances Farmer who ended up in a mental hospital. In the clip, Frances cunningly makes her psychiatrist break into a cold sweat by zeroing in on his insecurities.

Check it out at the link below. Try to imagine how uncomfortable you would be if you were in the therapist's position. 

When I first treated someone with the disorder as a psychiatric trainee, my very first patient had the disorder - and it wasn't even yet in psychiatric diagnostic manual, the DSM. She had been seeing another resident, who had moved on in the residency program. She described this woman as a Goddess - except for the fact that she had abandoned the patient and stuck her with me. She spent the first two or three sessions doing nothing but insulting or attacking me - mostly for my inexperience, of course. Then she went to my supervisor to complain about me, and asked to be transferred to a different therapist. Luckily, he was one of the few therapists at the time that was on to people like her, and  told her she was stuck with me and to give me more time.

"Splitting:" the belief some therapists have that these patients see others as all good or all bad with nothing in between. There is strong evidence that this behavior is more of a strategy for eliciting certain reactions and is part of a "false self: or persona which is meant to stabilize a dysfunctional family of origin. But a lot of therapists don't seem to really understand the difference between innate ability and performance.

At the time, of course, I didn't know anything about any of that. Very few in psychiatrists in those days knew much of anything at all about family systems theory . I began wondering what on earth had made me decide to go into this line of work. But somehow I had managed to stay cool during the ordeal. The patient settled down and stayed with me weekly for the entire academic year.

I still had no real ideas about why she had been so hostile at the beginning, but at the end of treatment she made a confession that really peaked my interest in BPD. She said what she had been thinking at the time she had been attacking me - not in hindsight but at the time. She was secretly telling herself, "This guy is amazing. He's not throwing me out of the office." What she had been doing was literally all an act, and that in fact, she was secretly admiring me. Now why would anyone act like that?

https://www.google.com/search?q=lane+smith+and+jessica+lange+in+Frances&sca_esv=fbc3f32290323a31&sxsrf=ANbL-n4wub5Y-I9FiDbpMECVt3J9s_kFsw%3A1780024592766&ei=EAUZaua7LuOjqtsP5ZyPqQY&biw=1279&bih=758&ved=0ahUKEwjmg6ysxN2UAxXjkWoFHWXOI2UQ4dUDCBA&uact=5&oq=lane+smith+and+jessica+lange+in+Frances&gs_lp=Egxnd3Mtd2l6LXNlcnAiJ2xhbmUgc21pdGggYW5kIGplc3NpY2EgbGFuZ2UgaW4gRnJhbmNlczIFECEYoAEyBRAhGKABMgUQIRigATIFECEYqwJI8XxQsQdY0WFwAngBkAEAmAFioAHQCaoBAjE1uAEDyAEA-AEBmAIPoAKUCcICChAAGLADGNYEGEfCAg4QABiwAxjkAhjWBNgBAcICFxAuGLADGLgGGNgCGMgDGNoGGNwG2AEBwgIFEAAY7wXCAggQABiABBiiBMICCBAAGKIEGIkFwgIKECEYoAEYwwQYCsICBBAhGArCAggQIRigARjDBJgDAIgGAZAGD7oGBggBEAEYCZIHBDE0LjGgB8M2sgcEMTIuMbgHhAnCBwcwLjguNS4yyAc8gAgA&sclient=gws-wiz-serp#fpstate=ive&vld=cid:da6f290f,vid:X701amn7SmU,st:0

 

Self Actualization and Why It may be So Difficult

 

Walking Reflection jpg by Tomascastelazo, creative commons attribution share alike 4.0

This post will continue on from my posts (2/24, 3/19 and 4/14) summarizing how I incorporated ideas from from fields outside of mental health into my psychotherapy model, as well as how I tried to fit together seemingly contradictory theoretical aspects of several other psychotherapy schools, I discussed how families operate by rules mostly set by the prevailing culture, and  how those rules change and how families may not be able to keep up, leading members to share intrapsychic conflicts.

But how does this all manifest itself inside the brains and minds of individuals, and why they do they feel they have to sacrifice aspects of themselves in order to stabilize the family? Why can’t they just go ahead and do whatever they really want to? I mean, if we’d like to believe in free will (and I do), why do they make this choice?

The answer boils down to how the rules of interpersonal engagement are laid down in the brain during  childhood, and how individuals generally feel when they ignore the rules.

Babies come into the universe knowing absolutely nothing about how the universe works and how they can best adjust to their circumstances. They literally do not even know their own body parts can be controlled. We are programmed to learn about our universe through interactions with primary attachment figures. As children spontaneously emit various behaviors (including expressing thoughts that occur to them) that parent find acceptable, the attachment figures  do something called mirroring (first described psychoanalyst Heinz Kohut) - they validate, affirm, and reflect back to the child creating sense of value, grandiosity, and self-worth. That allows a person to build healthy self-esteem and a stable internal identity.

The rate of the creation of synaptic pathways in the brain through this process, particularly in infancy, is phenomenal (less useful pathways are later “pruned” through a process called neural plasticity).

When babies grow older, and throughout much of their lives, they continue to emit new self-generated behavior. When that behavior is grossly at odds with their self image and for which they had not received validation, the evolutionary process that created kin selection kicks in, and they get very uncomfortable. If they are actively invalidated by parents and the rest of the family system when they do or experience something, it creates a sense of existential terror that psychotherapists called groundlessness or anomie. It’s like they don’t know who they are any more. The worse that attachment figures attack ideas and behaviors that don’t jibe with the family homeostasis (as are many efforts at self-actualization), the worse a person’s terror.

People do have the ability to persist in new thought and behavior patterns despite this feeling, and if they stick to them, the feeling of groundlessness eventually dissipates. It’s also often the case that the attachment figures are themselves ambivalent about the behavior in question, but refuse to talk about this for fear of being invalidated by their own attachment figures. They then give children mixed messages about what is expected of them. How I believe children read these contradictory messages will be summarized in the last post in this series.

Book Review: Finding My Way by Malala Yousafzai

 

For those unfamiliar with her story, Malala Yousafzai lived with her family in an area of Pakistan that was overrun by the Taliban for a few years starting when she was 11. Even before the Taliban took over, many girls in the area did not go to school and tended to be married off by their families at a very young age. Malala was way ahead of her own tribe and was actively advocating for schools for females. This led to a member of the Taliban searching her out and then shooting her in the head. Luckily, she survived. Her family began to fear for their own safety and emigrated to England. After she recovered from numerous surgeries, she found that she had become a symbol for gender equality, particularly in education.

 

In this blog I have written extensively about cultural lag, in which the opportunities for individual expression apart from one's tribe (self actualization) has become more prevalent, but for various reasons some families don't keep up with the changes. In this situation, parents may be highly ambivalent about such things as gender roles, but can't admit it, and then give off mixed messages to their kids about what is expected from them. If the child guesses wrong, the parents decompensate in various ways. Because of an evolutionary process called kin selection, the children develop a strong tendency to sacrifice their own needs and opinions to stabilize the system.

 

I have mostly focused on how this process plays out in the Western world, but also wrote about how it plays out when a family from one culture moves to a place with a more individualistic outlook. This leads to the strange situation where the children in the family are somehow expected to play by the old rules while simultaneously serving as the family's ambassador to the new culture.

 

Malala's story is an amazing illustration of this process - as if seen in IMAX, technicolor, and 8 channel Dolby stereo sound. When she starts college at Oxford she tries to adjust to new rules on just about everything. For example, she starts to fall in love with a man but can't afford to be even seen in photo with him and certainly can't invite him over to meet her parents. In their original culture, women were not even allowed to be seen with a unrelated member of the opposite sex, let alone go out on a date. She knew of several examples of "honor killings." In one, a 15 year old girl was literally murdered by her own parents for looking too long at a boy on the street.

 

Malala continued becoming a spokesperson for women's education. She became famous worldwide and went to many conferences in England and overseas. The government provided her with 24 hour security both at home and abroad, because people like the Taliban continued to oppose her agenda and might strike out again.

 

When she talks about her interactions with her own parents over these things, she does not provide a whole lot of details about their reactions. My theory would predict that she had some covert, ambiguous validation for her political positions from them, or she would not have done what she did in Pakistan. If an outsider observed them interacting, however, the parents might seem more partial to their traditional culture than they actually were. They might of had to hide their true opinions because of the social stigma - even from each other. Again, I can't say that for certain based on the book descriptions, but I bet I'm right.

 

In fact, Mom was illiterate and did act traditionally - at least most of the time. She would occasionally say something about wanting to go to a beauty salon, which was extremely uncommon in her native village. She was also described as expressing reservations about her daughter's new behavior- perhaps half heartedly. But interestingly, she never seemed to move to actually try to stop her from doing what she was doing. And this pattern may have gone back more than one generation. Malala had been very close to one of her grandmothers, who appeared to her to be somewhat liberal. Obviously, I again wasn't there to observe this, but Malala's descriptions of her family's reactions to her is highly consistent with double messages being sent out.

 

When she had first come to Britain, she had put up with multiple surgeries, and had to learn how to walk all over again. At first she seemed to have no memory of her shooting. She had waken up from it in a hospital. However, soon she was overcome by images of it, and developed symptoms of PTSD and panic disorder. Of course, this made her transition to more feminist values even more difficult than it might have been otherwise. Psychotherapy was not acceptable to her culture, yet she found a therapist and worked hard. She persisted with her crusade. Her courage is truly amazing.

 

She's also an extremely talented writer. It was hard to put the book down.

Are Your Intrapsychic Conflicts Only in Your Head? Or is Ambivalence Contagious?

 

"Mixed messages at Forthampton" by Philip Pankhurst, Creative Commons Attribution-Share Alike 2.0

Continuing on from my last two posts about how I incorporated ideas into my psychotherapy model from fields outside of mental health, as well as how I tried to fit together seemingly contradictory theoretical aspects of several other psychotherapy schools: 

I previously mentioned how the rules by which families are supposed to function within their own culture have changed as culture has evolved, with more and more freedom allowed to individuals to set their own course – cultural evolution. I also have mentioned that problems with family homeostasis seemed to me to be highly related to the intrapsychic conflict which is one of the hallmarks of psychoanalysis. That is defined as a conflict between one’s natural desires (the “id” ) and one’s conscience or learned rules of interpersonal and work behavior (the “superego”). So what is the exact nature of this relationship?

In today’s world, the newly found freedoms to follow one’s own muse independently can seem highly attractive to people who are stuck with the old, more collectivist rules. The new rules seem to allow, in some instances, for much more satisfying behavior. But engaging in it puts the person at odds with their family system – in this case their own parents and extended family. If a person dares to even talk about these new options, and their desirability - let alone partake of them - their families may come down on them like the proverbial ton of bricks.

For reasons to be discussed in the next entry in this series, they decide that it best to go along with the old rules. But that doesn’t mean that new possibilities are no longer attractive. Such a person becomes highly ambivalent about their own choices. Their surroundings usually provide a constant reminder of what they may be missing.

In other words, they develop an intrapsychic conflict.  But I believe the psychoanalysts missed something important with this concept of theirs: This conflict does not end up residing in just the one person’s mind, but can become shared by their own spouses and children. So how does this happen?

I’ll leave the question about spouses for another time, but let’s look at parent-child relationships in situations like this.

To simplify the process quite a bit, a parent’s ambivalence can result, in various degrees, to their giving off double messages about what they expect from their own children. They may vicariously enjoy their hidden desires somewhat by living through their kids as the kids engage  in them - but won’t ever admit to that being the case because it would expose their own hidden desires. And if the kids are too successful at enjoying them, their parent may get depressed and/or jealous precisely because they really had wanted to do these things themselves. 

Depending on the nature and extent of the underlying ambivalence, this may not create too big of a problem. However, if it’s a real hot-button issue for a person’s family, in response the parent may appear to become highly unstable. And if their kids make the wrong decisions when this occurs? The parents seem to decompensate. They may start drinking more or threaten divorce from one another. Domestic violence may increase.  They may even become suicidal.

Because of the evolutionary forces of kin selection, children in this type of situation are almost always moved to try to stabilize a parent who appears to them to be  unstable. They will then sacrifice their own underlying desires in order to do so. But how?  The parent is such cases is giving out a highly confusing mixed message. For example, a common conflict in today’s Western societies are the new opportunities for women to enter the workforce and not just be wives and mothers, in a situation where their doing so may be highly alarming to their own parents. To their kids, such a mom can seem to resent being saddled with taking care of kids, but guilty if they are not constantly there for their kids. They covertly hope that their kid can be in a career that they had let themselves had forsaken, but then seem to decompensate if that starts to happen. What does the kid do then?!?

To even understand this picture further, we need to further discuss why they just don’t do whatever the hell they really want to do. How does kin selection manifest itself in a modern human’s mind?  In the next post in this series, I will discuss the relevance of ideas from two other therapy schools – mirroring (from Heinz Kohut) and groundlessness (from existential psychotherapy).